Types of pyoderma: treatment, symptoms, photos, classification

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Pyoderma is a dermatological pathology with the appearance of suppuration, various inflammatory and ulcerative dermatological changes that occur due to the introduction of pyogenic( pyogenic) organisms into the dermis. We will talk about it today.

What is such a pathology?

Pyoderma is a medical name that unites dermatological pathologies, with the characteristic appearance of suppuration, inflammatory-ulcerative skin changes that occur due to the introduction into the dermis of pyogenic( pyogenic) organisms - pyococci. Piococci is a term that combines staphylococci and streptococci.

Pyoderma can be primary, that is, arise as a lesion of healthy skin, and secondary, when pyoderma becomes either one of the signs of an internal disease, or acts as its complication.

Can I get pyoderma? Many species have a high degree of contagiousness( infectiousness) in contact, transmitted from the diseased or carrier. Sometimes, when the concentration of bacteria in the air when sneezing, coughing a person with purulent foci in the nasopharynx, pyococci can enter the healthy body by airborne droplets.

What is pyoderma, the video below will tell you:

Pyoderma classification by species

The main pathogens of pyoderma, capable of causing pathological manifestations in the epidermis themselves( gram-positive Staphylococcus), including golden, epidermal, hemolytic, and streptococci( independently of other diseases)Streptococcus). There are 2 basic types of pyoderma in accordance with the identified pathogen:

• staphyloderma, when the main aggressor is staphylococcus;
• streptoderma if pathology develops with the introduction of streptococcus.

In addition, it is often diagnosed as streptofrostoderma - a mixed lesion of the dermis of both species of cocci.

In addition to these, in combination with other pathogens, the disease is caused by anaerobic bacteria( vulgar proteus), enterobacteria( E. coli) and highly resistant to antibiotics Pseudomonas aeruginosa( Pseudomonas aeruginosa), which interact with other anaerobic microbes and fungi and among themselves.

With any pathogen, pyoderma can be acutely, even lightning-fast, wearing a sluggish character with periodic exacerbations. Its manifestations can be limited to a certain area of ​​development of abscesses, and if the skin rash occurs all over the body or over a large area, the disease is considered diffuse( widespread).

Pyoderma on the face of an adult( photo)

Staphylodermia

Pain manifestations are concentrated in the area of ​​hair bulbs( follicles), sebaceous and sweat ducts and glands. Inflammatory changes occur with the release of pus and the formation of areas with a destroyed tissue( necrosis), which is due to the action of enzymes and toxins produced by the microbe.

Surface

To surface types are:

1. Ostiophalliculitis. Inflammation is concentrated in the upper segment of the follicle or sebaceous duct.
2. Folliculitis. Suppuration occurs throughout the follicle with inflammation of the adjacent tissue.
3. Sick is vulgar. Pustular lesions on the skin( usually in men) in hair growth areas( mustache, beard, sometimes - on the pubic skin).
4. Epidemic pemphigus( pemphigus, pyococcus pemphigoid). Spreading a multitude of abscesses all over the body( except for the palms and soles) in infants, usually in the first days after birth. Very contagious. With a massive lesion, the death of a child is possible. Staphylococcal periportitis( vesiculopustulosis). Inflammation in the zone of the mouths of sweat ducts in infants with localization on the head, in wrinkles, on the skin of the trunk.
5. Acne disease. Long-term current pathology caused by suppuration of the sebaceous gland ducts in young children and young people on the face, chest, shoulders. Passes to acne and keloid acne.

Deep forms of

Deep forms of staphylodermia:

1. Furuncle. Deep purulent and painful formation with inflammation of adjacent tissue on the cheeks, nose, buttocks, back of the neck, hips.
2. Hydradenite. Severely leaking purulent process with necrosis, affecting the ducts and sweat glands in the zone of the armpits, anal passage, groin.
3. Carbuncle. Deep extensive suppuration with tissue necrosis, affecting several hair bulbs.
4. Multiple abscesses ( another term - Finger pseudofurunculosis) is a form of common staphylococcal dermis of newborn babies, in which a lot of purulent cavities are formed in the thickness of the skin on the back, buttocks, neck.

Streptodermia

Streptococcus damages mainly the upper epidermis, forming at the insertion sites inclined to growth fictenes( flat soft blisters) containing light yellow serous exudate, secreted by inflamed tissue. The streptokinase enzyme produced by Streptococcus disrupts the blood viscosity at the site of inflammation, destroys the DNA of the cells, stimulates the rapid expansion of the abnormal process.

Superficial species:

1. Dry streptodermia( lichen). Acute, infectious type of streptococcal lesion, more often diagnosed in childhood-adolescence. Pink scaly spots form in typical cases on the cheeks, around the mouth, behind the ears, on the skin of the folds of the hands and feet.
2. Papulo-erosive. Diaper dermatitis or streptococcal diaper often develops on the buttocks, in the perineum, on the skin of the thighs only in infants, often suffering from digestive disorders, rickets, which are long in diapers.
3. Simple( white), Bubble lichen of the face( erythematosquamous streptoderma).Acutely manifested in adolescence in the form of epidemics.
4. Streptococcal impetigo, including such subtypes as bullous, slit, tourneyol( inflammation of tissues around the nail plates).
5. Intertriginous streptoderma. Diagnosed in young patients in the groin, underarms, buttocks, behind the ears( usually with obesity, excessive sweating).

Deep lesions:

1. Ecthyma vulgaris. Refers to ulcerative streptoderma, which is characterized by long-term course and relapses. Most often occurs on the skin of the knees, buttocks. Complicated by the introduction of the ulcer of staphylococcus, inflammation of the lymph nodes.
2. of erysipelas. Inflammation of the dermis and lymphatic tissue with severe manifestations of general intoxication. More often diagnose after 45 - 50 years.
3. Diffusive( diffused) streptoderma. Pathology of chronic course with the formation of edema, inflamed, purulent and long non-healing ulcerous erosions.

The pyoderma classification is described in detail in the video below:

Streptostafilodermia( mixed species)

Most typical for mixed coccoid form:

1. Shankriform ulcerative streptostafilodermia. Rarely occurring inflammation of the dermis with the formation of ulcers in the neck, lips, reproductive organs.
2. Gangrenous. Severe, long-term progressive pathology with focal gangrene development and local tissue necrosis. Refers to emergency conditions, leads to disability.
3. Ulcerative vegetative. Expressed in the long-term current and increasing process of tissue destruction with the formation of purulent, wet ulcers.
4. Panaritium. The formation of purulent painful blisters around the nail on the swollen inflamed skin, accompanied by temperature.
5. Acne fastens. Severely leaking and difficult to respond to treatment type of acne with a sharp onset, more often diagnosed in young boys and boys.

Pyoderma in the child

Causes of the

Staphyloderma
Ostiophalliculitis	Small pustules( pustules) with reddening at the base. Localize on the neck, face, legs, shoulders. After maturing, atrophy without leaving scars
Folliculitis	Foci of inflammation are larger, slightly painful, with a thick wall, pustules with dense greenish or whitish-yellow pus surrounded by reddened, swollen skin. With a deep form of soreness increased, bubbles with pus reach 15 mm, the zone of hyperemia increased. If a lot of pustules are formed, the process is accompanied by deterioration of the condition, blood indices.
Epidemic pemphigus of newborns	Bubbles with cloudy whitish exudate capture the entire surface of the skin in the first week of life. When merging blisters develop erosion. Massive spread of pemphigus can lead to the death of the baby.
Sickose vulgar	Shallow inflammation of hair bulbs in the zone of the lips, nose, chin, temples, pubis. Frequent fusion of abscesses, redness, itching.
Furuncle	Very painful, cone-shaped crimson knot up to 50 mm in diameter, deeply embedded in the thickness of the skin, filled with pus and a rod of dying tissues. When the abscess is opened up to 10 days, the syphilis exudes with pus and the necrotic stem expels. Heals up to 14 - 20 days with scarring.
Hydradenitis	An acute painful, purulent nodule in the thickness of the cellulose up to 40 - 70 mm, formed from several ulcers in the zone of the sweat glands of the armpits. Characteristic: thick pus, cyanotic-purple color, strong puffiness. Maturation of the purulent conglomerate and the release of pus from the open holes are accompanied by severe pain, fever, nausea. Lasts up to 10 - 15 days. Tightening of the wound after cleansing 10 - 12 days.
Carbuncle	Formed during the fusion of 2 - 3 boils as a very large, almost black in color, a dense abscess in the thickness of the dermis. Characteristic: intense pulling pain, plentiful suppuration, several central rods of dead tissue, fistula formation. After expulsion from the dermis of the rods, a deep ulcer appears, healing slowly with the formation of a coarse rumen. The course is severe with fever, chills, vomiting, high risk of sepsis.
Streptodermia
Intertriginous	Flat flicthenians( serous blisters) that burst, revealing red, wet wound areas that merge into foci, surrounded by flaking skin fragments. Allocations dry up, forming brown crusts, under which the skin changes color.
Papular-erosive	Small, combining blisters with a watery-bloody exudate. They burst, leaving the inflamed, wet erosions. The disease quickly flows into a chronic form, with difficulty responding to therapy.
Erythemato-squamous( dry lichen)	Rounded red-pink patches are formed, with small flakes similar to flour, scaly. Sometimes there is itching. Can be combined with a creviceal impetigo, intertriginous pyoderma.
Streptococcal impetigo	Flat bubbles( fliken) 5 - 10 mm with a watery( or purulent) exudate on the face( lips, gums, inside the cheeks).The dried discharge from fliken forms dry crusts of honey-yellow color. After their removal on the skin, long, not passing red spots are visible.
Ecthyma vulgar	Blister 10 - 20 mm with purulent, watery, sucronic contents. Dry brownish-brown crusts, the tissue is inflamed, has a bluish-purple color. Under the crust, a deep ulcer forms, healing long and leaving a scar and a changed skin color along the edges.
erysipelas	A sharp reddening for 5 - 8 hours transforming into a bright red swelling and dense inflammatory focus, passing on the cellulose. Skin hot, painful, stretched. Temperature rise to 39 - 40 C.
Diffusive( diffuse) streptodermia	Large flicks or small blisters merge into large foci on the hyperemia edematous skin. Under the burst bubbles, ulceration with uneven contours opens. Abundant discharge, while drying out, form greenish-yellow crusts. The hearth grows quickly, capturing healthy skin. The course is long, gives relapses.
Mixed staphylosterepiddermia
Shanriciform pyoderma	Single, painless, rounded ulcer 10-20 mm, covered with bloody crust. Around the dense edema. Outwardly similar to syphilitic hard chancre. Sometimes there are several ulcers. Lymph nodes swell. Heals after 30 to 60 days.
Chronic ulcerative vegetative	Inflammation, swelling and hyperemia. Ulcers and soft flat plaques of cyanotic red color are covered with ulcers and are surrounded by a pink corolla. Foci from fused pustules, plaques and ulcers secrete serous-purulent fluid. After removing loose crusts, epithelial growths in the form of papillae and thick pus are revealed. Soreness. Aggressive spread with the capture of healthy areas.
Acne vulgaris	Bubble rashes with thick purulent contents on the back, neck, chest, shoulders, excluding the face; rapid development of the ulcerative process; temperature is above 38C; severe pain in muscles, bones, abdomen; weight loss, anemia; worsening picture of blood with a high content of leukocytes, increased ESR. The healing of foci occurs with the formation of scars.
Kind of pyoderma	Basic symptomatology

The leading cause causing pyoderma is the penetration of coccal microbes into the tissues of the hair follicles, sweat and sebaceous glands with ducts, damage. However, the causes of secondary forms of pyoderma, including ulcerative, gangrenous species, are still being studied, since in such cases seeding with gnatogenic agents of skin sites is secondary, that is, it occurs after the development of a certain pathology.

Key factors-provocators:

• skin lesions( wounds, injections, abrasions, bites, combs, burns);
• acute or long-term decline in general and local immunity;
• skin pathologies, including allergic-dependent dermatitis, tick-borne lesions;
• heredity;
• shifts in the functioning of endocrine organs( "thyroid gland", hypothalamus, pituitary gland, adrenal glands, sex glands), hormonal failures;
• diabetes;
• vascular diseases, varicose veins, thrombophlebitis, hematopoiesis disorders, gastrointestinal diseases;
• focal infections with an inflammatory process in a particular organ or tissue, including the stomach, intestines, nasopharynx and ear area, reproductive organs;
• drift of pyogenic flora during surgical manipulations;
• hypersensitivity to allergens and reaction to piococci;
• disorders of a neurological nature and thermoregulation system
• non-compliance with personal hygiene;
• periodic skin trauma in certain areas;
• increased humidity, absorption capacity, alkaline skin reaction;
• intolerance to certain medications;
• frequent overcooling or overheating;
• long-term experiences and strong physical fatigue;
• depletion, any long-term disease;
• obesity, a breakdown in the metabolism of fats and carbohydrates;
• contamination of the epidermis with paints, kerosene, solvents, oils, varnish, coal dust, gasoline, cement.

Symptoms of

General

Common symptoms characteristic of any kind of pyoderma are similar and expressed in the following manifestations( of varying severity):

• hyperemia( redness), swelling, pain;
• formation of a purulent-serous focus;
• skin pigmentation disorder, its structure;
• itching, burning, tingling;
• increase, tenderness of lymph nodes;
• with massive rashes, deep suppuration - general deterioration associated with intoxication, fever, nausea, disability;
• severe pyoderma, including carbuncle, hydradenitis, gangrenous forms, give serious symptoms of general intoxication with the neurological component: vomiting, delirium, hallucinations.

It should be noted that all external and internal signs of pyoderma in infants, children, are more intense due to undeveloped immune system, immaturity of the dermis, vessels, organs. The small body weight of a young patient is a factor that aggravates the poisoning( intoxication) of the child's organism with poisons that are formed when the necrotic( dead) in the places of suppuration is decomposed. And the younger the child, the stronger this factor is expressed.

Specific signs for different kinds of pyoderma

Diagnosis

Diagnosis is established after an analysis of abnormal manifestations on the patient's skin and general signs of development in the body of inflammation.

To clarify the diagnosis and distinguish pyoderma from other dermatoses with similar symptoms, instrumental and laboratory methods are used, among them:

• study of exudate taken from pustules, vesicles, ulcers, for the presence of specific species of pyogenic organisms( sowing);
• microscopy of detachable and tissue fragments( study under a microscope);
• histological analysis for detecting oncological changes in tissues;
• blood sampling for hemoglobin;
• PCR analysis of blood and exudate for the early detection of a specific pathogen species;
• test-RPR for syphilis.

To identify the existing diseases that are capable of provoking the development of pyoderma, they are examined by specialized doctors.

It is necessary: ​​

• to make a kaprogram, immunogram;
• to conduct research on dysbiosis;
• to make blood biochemistry analysis and highly specialized analyzes for hormonal status, development of cancer process and other as directed by a narrow specialist;
• do ultrasound of the abdominal organs.

Treatment

Treatment scheme, the choice of specific physiotherapy procedures, medicines are associated with the type of pyoderma, the severity of the process, the severity of the manifestations, age, internal diseases. The patient is maintained by a dermatologist, a surgeon with the addition of other specialists, if necessary.

Therapeutic method

Shown:

• ultraviolet irradiation to improve the local protective properties of the dermis, strictly in dosages that are not capable of causing flushing( redness);
• dry heat, UHF( only by doctor's prescription, since it is allowed for all forms of pyoderma);

• vitamin therapy with special emphasis on group B, vitamin A, C, E;
• means for strengthening the immune system: tincture of eleutherococcus, aralia, pantocrin, mummy;
• diet with restriction of salt, carbohydrates, preservatives, alcohol, spices;
• method of blood transfusion( blood transfusion) in severe forms.

By medicamentous method

Selection of ointments, glucocorticosteroids, antibiotics is carried out only taking into account the species pyogenic pyococcus, otherwise the medicine will be useless.

External means

Used for washing and applications with superficial pyoderma: alcohol solutions, antimicrobial, antiseptic ointments, gels, aerosols, depressing growth and activity of piococci, simultaneously relieving pain and inflammation.

Among the most common:

1. Synthomycin ointment, erythromycin, zelenka, Fukortsin, Chlorhexidine, Betadine, Levosin, Gentamicin, Levomecol, Stellanin, Gentaksan, Bactroban, Piolizin.
2. Combined corticosteroid agents combining anti-inflammatory and antibacterial action: Gyoxysone, Triamcinolone, Fucicort, Belogent, Lorinden C, Triderm.

Also:

• For extensive ulcers and wounds, hydrocolloid sealed dressings are used.
• Before the use of external pharmaceutical means must uncover abscesses, clean them from dead tissues and pus( only in a medical institution), treat the wound areas.
• For gangrenous pyoderma, surgical sanitation and alcohol are prohibited in order not to injure the wounds and cause them to increase. They use "soft sanitation", applying moist compresses with salt, Burov's liquid, furacilin, a slightly pink solution of "manganese".

Antibiotic medicines

Before prescribing antibiotics or already using them, an antibioticogram is made to determine the degree of sensitivity of the detected pyococcus to different types of antibiotics. On the basis of the obtained result, the most effective antimicrobial preparation is selected.

Antibiotic drugs use:

• with ineffectiveness of local remedies;
• as an obligatory part of treatment in a widespread or deep painful process with obvious signs of poisoning, fever;
• with rapidly progressing pyoderma, complicated by concomitant pathologies;
• Always with the therapy of furuncle, carbuncle, hydradenitis.

If pyoderma flows easily or with moderate severity, medications are taken orally. In severe forms, antibacterial drugs are injected into a vein or muscle by a course of at least 6 to 10 days.

• Traditionally used drugs: Amoxicillin, Ampiox, Cephalexin, Cefazolin, Cefotaxime, Ceftriaxone, Doxycycline, Gentamicin, Tobramycin, Clarithromycin, Amikacin, Erythromycin.
• In the therapy of pyelenic pyoderma use Cefuroxime, Thalidomide, Dapsone, Clofazimine.

Hormones

Assign with severe pyoderma, including gangrenous form. As a rule, in large doses( up to 80 mg per day) prescribe prednisolone, a short course.

Immunotherapy

This method involves the connection to antibiotics of drugs that neutralize the action of pyococci, their poisons, enhance resistance to microbial agents. Recommended for long-term ongoing processes with relapse at least once in 12 weeks. Prior to the application of pharmaceuticals, the baseline parameters of the immune system are examined using an immunogram.

Apply: leukinferon, staphylococcal and streptococcal toxoid, dry bacteriophage vaccine, antistaphylococcal immunoglobulin.

Operation

Surgical intervention is necessary in case of severe pyoderma with aggressive purulent-inflammatory process deepened into the dermis, and formation of large amounts of pus and necrotic tissue fragments that must be removed.

Always used in carbuncle, hydradenitis, furuncle, accompanied by concurrent administration of antibiotics. The operation is conducted under local( or general) anesthesia. Step by step open the abscesses, remove pus and necrotic tissues, drain the wound, make bandages with NaCl solution( 10%), enzymes( Trypsin, Himopsin, Chymotrypsin).

Prevention of disease

Preventive measures against pyoderma of various types are simple and easy to perform. These include:

• mandatory and early antimicrobial treatment of small wounds, abrasions on the skin;
• maintenance of skin cleanness and taking measures against its excessive pollution during labor activity, including home homesteads;
• treatment of any foci of inflammation and chronic infection, including nasopharynx and foci of caries;
• early referral to the doctor at the first sign of skin changes and timely diagnosis.

Complications of

Without the treatment and with a deep process in the thickness of the subcutaneous tissues are possible:

• inflammation of the lymph nodes and vessels;
• penetration of infection into the organs and bone tissue;
• development of multiple abscesses, purulent mediastinitis, phlegmon of the orbit;
• of meningitis, thrombosis of cerebral vessels;
• blood infection with a very unfavorable outcome.

Forecast

Carrying out diagnostic examinations with the appearance of initial symptoms of pyoderma will allow you to quickly select the tactics of treatment and prevent complications or the transition of the disease into a prolonged form.

• Accurate compliance with the prescribed dosage of drugs, constant consultation and examination by specialists will help even in the most difficult processes.
• The consequence of self-treatment or removal of ulcers is the deepening of the process, its spread to healthy skin, scars, severe complications.

Pyoderma treatment is described in the video below: