5. pioderma
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Transcript of 5. pioderma
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PYODERMACreator:Rini Ardianti AlwiIda SambanBuyung Sugianto
Advisor:dr. Mutmainnah
Supervisior:dr. Sri Vitayani, Sp.KK
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IntroductionPyoderma: Skin infection caused by Staphylococcus aureus or Streptococcus hemolyticus Classification: Impetigo, folliculitis, furuncle, carbuncle, echtyma, paronikia, erysipelas, cellulitis & Staphylococcal scalded skin syndrome
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IMPETIGO
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Definition:Superficial infection localized in the subcorneal of the epidermisEpidemiology: Bullous impetigo any ageCrustosa impetigo childrenEtiology:Bullous impetigo Staphylococcus aureus Crustosa impetigo Streptococcus hemolyticus
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Portals of entry of infectionPrimary impetigo arises at minor breaks in the skin.Secondary impetigo (impetiginization) underlying dermatoses & traumatic breaks in the integrity of the epidermis.
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Physical examinationBullous impetigo:Erythema, vesicles, bullaeDistribution: intertriginous sites, face, chest & the back
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Crustosa impetigo:
Vesicles or pustules rupture, erosions, crust.(Golden-yellow crusts)
Distribution: On the face
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Topical treatment :Mupirocin ointment ManagementSystemic antimicrobiol treatmentOrganism : Group A Streptococcus.Drug of choice / dose :Penicillin VKBenzathine penicilin
Alternative drugs :Erythromycin Cephalexin
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Organism : Staphylococcus aureus.Drug of choice / dose :DicloxacillinAlternative drugs :Cephalexin Amoxicillin plus clavulanic acid (-lactamase inhibitor)DD:Bullous impetigo dermatofitosisCrustosa impetigo echtyma
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FOLLICULITIS
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Definition: A bacterial infection that involve the ostium of a hair follicleEpidemiology:Any age, most common in adultEtiology : Most common Staphylococcus aureusClassified :Superficial folliculitis.Deep folliculitis.
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Local treatment :Local antibiotics (mupirocin).Warm saline compresses.DD:Tinea barbeAkne vulgaris
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FURUNCEL
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Deep seated inflammatory nodule hair follicle.Usually from a preceding superficial folliculitis elvolving into an abscess.The neck, face, axillae & buttock.Complicate preexisting lesions.
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Start as a hard, tender, red folliculo centric nodule in hair-bearing skin enlarges painful & fluctuant rupture occurs pus & necrotic material pain surrounding the lesion subsides redness & edema diminish several days to weeks.Solitary lesions or multiple lesions in sites the buttocks.
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CARBUNCLE
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Larger, more serious inflammatory with a deeper base.Fever, malaise patient appear quite ill.Involved area is red & indurated, multiple pustules on the surface yellow-gray irregular crater at the center heal slowly by granulating.
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Furuncle & carbuncle bacteremic spread of infection & recurrence individuals perspire excessively or poor skin hygiene.Treatment of furuncles & carbuncles :- Drainage.- Systemic antibiotic:* Dicloxacillin * Clindamycin * Erythromycin
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DD:Sporatrikosis
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ECHTYMA
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Definition: A deep necrotic infection of the skin (eidermis & dermis)Epidemiology:Any age. More common in childrenEtiology: Staphylococcus aureus or Streptococcus hemolyticus
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CLINICAL MANIFESTATION Vesicle or vesicopustule with an erythematous base erodes through epidermis into dermis form a crusted ulcer with elevated margins Distribution:Extremitas inferior
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Therapy
Systemic:Dicloxacillin Cephalexin Clindamycin CiprofloxacinTopical:* Local wound care* Mupirocin apply twice daily* Bacitracin apply twice daily
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DD:Impetigo krustosa folikulitis
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PARONIKIA
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Definition:Inflamation of crease of the nailEpidemiology:Any age, especially laundrymanEtiology:Staphylococcus aureus
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CLINICAL MANIFESTATIONEdemaAbsesPainful
Distribution: Nail
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Therapy:Topical insisi & drainaseSistemik Ab (Kloksasilin)DD:Pianikia
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ERYSIPELAS
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Superficial cutaneous cellulitis with marked dermal lymphatic vessel involvement painful, bright-red, raised, edematous, sharply marginated from the surrounding normal skin
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Caused :Group A -hemolytic streptococcus.Staphylococcus aureus (rarely).Group B streptococcus in the newborn.Predilection : face, lower legs, areas of preexisting lymphedema, umbilical stumps.Age of onset : any age.
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Cellulitis
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Clinical manifestationsErythemaWarmthSwellingLocal painTenderness
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* Tissue feels hard on palpation & painful.* Age of onset : any age.Caused :* Staphylococcus aureus.* Group A -hemolytic streptococcus.Management* Rest, immobilization.* Drain abscess, debride necrotic tissue.* Antimicrobial therapy
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Staphylococcal scalded skin syndrome
- Definition:Severe skin inflamation disease with epydermolysisEpidemiology:Most common: in children (
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CLINICAL MANIFESTATIONFeverErythemeBulaEpidermolysis
Predilection:universal
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Treatment:Ab (Kloksasilin)KlindamisinDD:Nekrosis Epidermal Toksik (N.E.T.)
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Any question ?