BACTERIAL SKIN INFECTIONS

NORMAL FLORA OF SKIN

• Gm + COCCI STAPHYLOCOCCUS MICROCOCCUS

• Gm + RODS PROPIONIBACTIRIUM CORYNEBACTIRIUM

• Gm –VE RODS ACINETOBACTER

ROLE OF NORMAL FLORA

DEFENCE AGAINST BACTERIAL INFECTION

THROUGH BACTERIAL INTERFERENCE

PRODUCTION OF FREE FATTY ACIDS(FFA) FROM

SKIN LIPIDS

STAPHYLOCOCCUS AUREUS

ANTERIOR NARES 35 %

PERIANAL SKIN 20 %

AXILLARY SKIN 5-10 %

TOE WEBS 5-10 %

REDUCTION OF CARRIAGE

MUPIROCINE OINTMENT INTRANASALLY FOR 5 DAYS

ORAL RIFAMPICIN 600mg 7-10 DAYS

CLINDAMYCIN 150mg/day FOR 3 MONTHS

STAPHYLOCOCCUS DISEASES

ImpetigoEcthymaScalded skin syndromeFurunculosisFolliculitisCarbuncleSycosis

STREPTOCOCCUS DISEASES

ImpetigoEcthymaErysipelasCellulitisScarlet feverIntertrigo

IMPETIGO

CONTAGIOUS SUPERFICIAL INFECTION OF THE SKIN

ORGANISIMS: STAPHYLOCOCCUS AUREUS,

STREPTOCOCCUS

PEAK SEASON: LATE SUMMER

AGE: PRESCHOOL & YOUNG SCHOOL AGE

EXISTING SKIN DISEASE: SCABIES, PEDICULOSIS

CLINICAL FEATURES

VESICLE ON ERYTHEMATOUS BASE

RUPTURES - SERUM EXUDES

YELLOWISH BROWN CRUST

PERIPHERAL EXTENSION

HEALS WITHOUT SCARRING

TREATMENT

TOPICAL ANTIBIOTICS

NEOMYCIN

BACITRACIN

FUCIDIC ACID

MUPIROCIN

SYSTEMIC ANTIBIOTICS

IF WIDESPREAD OR SEVERE

ECTHYMA

PYOGENIC INFECTION OF THE SKIN CHERACTERISED BY FORMATION OFCRUST BENEATH WHICH ULCERATIONOCCURS

AETIOLOGY

STAPH. AUREUS, STREPTOCOCCUS

POOR HYGIENE

MALNUTRITION

OTHER PREDISPOSING FACTORS

CLINICAL FEATURES

BULLAE OR PUSTULE

HARD CRUST

PURULENT IRREGULAR ULCER

HEALS WITH SCARRING

BUTTOCKS, THIGHS AND LEGS

TREATMENT

SAME AS FOR IMPETIGO

INFECTIONS INVOLVING HAIR FOLLICLES

FOLLICULITIS

FURUNCLE

CARBUNCLE

FOLLICULITIS

INFLAMMATORY CONDITION OF THE HAIR FOLLICLE WITH CHANGES CONFINED TO OSTIUM

AETIOLOGY

BACTERIAL: STAPHYLOCOCCAL

FUNGAL: TRICHOPHYTON RUBRUM

CHEMICAL: TAR

DRUGS: STEROIDS

CLINICAL FEATURES

SMALL FOLLICULAR PAPULE OR PUSTULE

RARELY PAINFUL

HEALS WITHOUT SCAR

TREATMENT

REMOVE UNDERLYING CAUSE

TOPICAL ANTISEPTICS

TOPICAL ANTIBIOTICS

SYSTEMIC ANTIBIOTICS

FURUNCLE

ACUTE USUALLY NECROTIC AND DEEP SEATED INFECTION OF HAIR FOLLICLE

AETIOLOGY

STAPH. AUREUS

SEBORRHOEIC / ATOPIC INDIVIDUALS

DIABETICS

SCABIES

HIV

MALNUTRITION

CLINICAL FEATURES

SMALL FOLLICULAR NODULE

TENDER

LOCALIZED NECROSIS

HEALS WITH SCARRING

FEVER & MILD CONSTITUTIONAL SYMPTOMS

CAVERNOUS SINUS THROMBOSIS

TREATMENT

GENERAL MEASURES

SYSTEMIC ANTIBIOTICS

TOPICAL ANTIBIOTICS

ANALGESICS

CARBUNCLE

DEEP SEATED INFECTION OF A GROUP OF CONTIGUOUS HAIR FOLLICLES

AETIOLOGY

STAPH. AUREUS

MIDDLE AGED MEN

DIABETES, MALNUTRITION

CARDIAC FAILURE

DRUG ADDICTS

PROLONGED STEROIDS

ERYTHRODERMA

CLINICAL FEATURES

HARD RED PAINFUL NODULE

MULTIPLE DISCHARGING FOLLICULAR SINUSES

NECROSIS OF INTERVENING SKIN

DEEP ULCER WITH PURULENT FLOOR

BACK OF NECK, SHOULDERS, HIPS, THIGH

FEVER

SEPTICAEMIA

TREATMENT

SYSTEMIC ANTIBIOTICS

TOPICAL ANTIBIOTICS

ANTIPYRETICS/ ANALGESICS

SURGICAL INTERVENTION WHEN INDICATED

REMOVAL OF UNDERLYING CAUSE

CELLULITIS

ACUTE, SUBACUTE OR CHRONIC INFECTION OF LOOSE CONNECTIVE TISSUE PERTICULARLY SUBCUTIS

AETIOLOGY

STREPTOCOCCI

H. INFLUENZA

STAPH. AUREUS

PSEUDOMONAS

CLINICAL FEATURES

ERYTHEMA

SWELLING

HOT & TENDER

ILL-DEFINED MARGINS

CONSTITUTIONAL SYMPTOMS

COMPLICATIONS

FASCIITIS

MYOSITIS

GANGRENE

SUBCUTANEOUS ABSCESSES

SEPTICAEMIA

TREATMENT

APPROPRIATE ANTIBIOTICS

ANALGESICS

REST

TREATMENT OF COMPLICATIONS

ERYSIPELAS

EDGES WELL DEMARCATED, RAISED

BLISTERING COMMON

MORE SUPERFICIAL INVOLVEMENT

FACE COMMON SITE

RESPONSE TO TREATMENT RAPID

Common skin condition affecting the skin folds such as under the arms, in the groin and between the toes.

Erythrasma does not usually cause any symptoms.

It presents as a slowly enlarging patches of pink or brown dry skin.

Caused by Corynebacterium minutissimum.

Diagnosis confirmed by Wood’s lamp examintation which turns erythrasma to fluoresce a coral-pink colour.

Erythrasma can be treated with antiseptic and topical antibiotic such as: • fusidic acid cream • Clindamycin solution.•Erythromycin lotion.

VIRAL INFECTIONS OF SKIN

VIRAL WARTS

HUMAN PAPILLOMA VIRUS

DNA – VIRUS 50-55nm

77 DIFFERENT TYPES

CONT’D

INFECT SQUAMOUS EPITHELIA

CAUSE CELL PROLIFERATION -- PAPILLOMA

DYSPLASIA / NEOPLASIA

TYPES

Common warts

Plane warts

Filiform warts

Plantar warts

Acuminate warts

COMMON WARTS HPV - 2

FIRM PAPULES / PLAQUES

ROUGH HORNY SURFACE

SYMPTOMLESS

SITES - BACK OF HANDS, FINGERS,

ANYWHERE ON SKIN

65% DISAPPEAR IN 2 Yrs

PLANE WARTS

HPV 3, 10

SMOOTH, FLAT OR SLIGHTLY ELEVATED

1- 5 mm ROUND OR POLYGONAL

FACE AND BACK OF HANDS

FILIFORM WARTS

FINGER-LIKE PROJECTIONS

FACE, NECK AND SCALP

COMMONLY IN MALES

PLANTAR WARTS

HPV 1, 2, 4, 57

SMALL SHINING SAGO GRAIN LIKE PAPULE

USUALLY PAINFUL HYPERKERATOTIC

PRESSURE AREAS OF SOLE, PALMS

MOSAIC PATTERN

ACUMINATE WARTS

HPV- 6, 11, 16 ; VENERIALLY ACQUIRED

MUCO-CUTANEOUS JUNCTIONS AND INTERTRIGINOUS

AREAS

SOFT, PINK , MOIST SURFACE

PEDUNCULATED OR CAULIFLOWER LIKE

MACERATION - INFECTION, MALODOUR

DIAGNOSIS

HISTOLOGY

ELECTRON MICROSCOPY

IMMUNOHISTOCHEMISTRY (TYPE

SPECIFIC ANTIBODIES)

PCR

SPONTANEOUS RESOLUTION

GENERAL MEASURES

TREATMENT

AVOIDANCE OF SHARED TOWELS AND SHOES

AVOID BITING NAILS

ADEQUATE PLASTIC STRAPPING AT SWIMMING POOL

DESTRUCTIVE MODALITIES

Electrocautery

Cryotherapy

Salicylic acid

Podophyllin

Surgical methods

CO2 Laser

Other modalities

Cimetidine

Retinoids

Interferon

Imiquimod

Antiviral therapy (cidofovir)

Intralesional bleomycin

MOLLUSCUM CONTAGIOSUM

Caused by MCV-1, MCV-2

Mainly in children

Direct contact

Discrete shiny, pearly white, rounded papules

Umbilicated centers

TREATMENT

General measures

Topical Retinoids

Puncture with wooden probe dipped in tincture

iodine

Cryotherapy

Electrocautery

CO2 Laser

HERPES SIMPLEX

Herpes virus hominis

Type 1, 2

Persist in sensory nerve ganglia

Spread: Direct contact, droplets

CLINICAL FEATURES

Sub-clinical

Age 1-5 years

Incubation period 5 days

Fever, malaise, dribbling of saliva

Gums - swollen, inflamed

Primary infection

Cont’d

Vesicles, ulcers

Tongue, pharynx, palate, buccal mucosa

Regional lymph nodes – enlarged & tender

Recovery in 2 weeks

Cont’d

Herpes genitalis

Kerato-cunjunctivitis

Inoculation herpes simplex

Recurrent infection

50% type 1, 95% type 2

Smaller vesicles

Close grouping

No constitutional symptoms

Buccal mucosa not affected

TRIGGERING FACTORS

Minor trauma

Febrile illnesses

UV radiation

Dental surgery

Pre-menstrual period

Emotional stress

COMPLICATIONS

Cranial Nerve palsies e.g. Bell's palsy

Eczema herpeticum

Erythema multiforme

Encephalitis

TREATMENT

Mild, uncomplicated : no treatment or topical

antiseptic

Severe primary infection : antiviral therapy

(Acyclovir 200mg 5 times/day)

Recurrent : topical antiviral

CHICKEN POX

HERPES VIRUS VARICELLAE

DROPLET INFECTION

2 -10 YEARS

INCUBATION PERIOD : 14-17 DAYS

CLINICAL FEATURES

FEVER, MALAISE, RASH

MORBILIFORM ERYTHEMA

PAPULES, VESICLES

PUSTULES WITH RED AREOLA

DRY CRUST, PINK DEPRESSION

HEALS WITHOUT SCARRING

Sign (dewdrop on a rose petal)

Papules & vesicles

Polymorphic lesions

Chickenpox & bullous impetigo

Large pustules & umbilicated lesions

COMPLICATIONS

SECONDRY INFECTION

ENCEPHALITIS

HEPATITIS

PNEUMONIA

ARTHRITIS

SEPTICAEMIA

STEVENS - JOHNSON SYNDROME

TREATMENT

REST

ANALGESICS

SOOTHING ANTISEPTICS

DAILY BATHING

ANTIBIOTICS FOR SECONDARY BACTERIAL

INFECTION

ANTIVIRAL THERAPY

HERPES ZOSTER(SHINGLES)

HERPES VIRUS VARICELLAE

INCIDENCE INCREASES WITH AGE

PATIENTS ARE INFECTIOUS

CLINICAL FEATURES

FIRST MENIFESTATION – SEVERE PAIN

HEADACHE, MALAISE, LOCALISED

TENDERNESS

GROUPED RED PAPULES IN DERMATOMAL

PATTERN

VESICLES, PUSTULES

Cont’d

MUCOUS MEMBRANE INVOLVEMENT

LYMPHADENOPATHY

RECOVERY 2-4 WEEKS

OCCASIONALLY PAIN NOT FOLLOWED BY ERUPTION

Cont’d

THORACIC - 53%

CERVICAL - 20%

TRIGEMINAL - 15%

LUMBOSACRAL - 11%

Disseminated lesions

COMPLICATIONS

FACIAL PALSY

SENSORY LOSS

MENINGOENCEPHALITIS

POST HERPETIC NEURALGIA (PHN)

TREATMENT

BED REST

ANALGESICS

LOCAL ANTISEPTICS

TOPICAL ANTIBIOTICS

ANTIVIRAL THERAPY

TREATMENT OF PHN