PYODERMAS

Dr. Asih Budiastuti, SpKK

Department of Dermato-venereology
Medical Faculty of Diponegoro University
Semarang

Definition
Skin infection
Caused by pyogenic bacteria
Easily transmitted

Etiology
Staphylococcus ( S. aureus, S. albus )
Streptococcus haemoliticus

Corynebacterium minutissimum

Prediposition factors:
o Low stamina, malnutrition,
gravis anemia, diabetes mellitus

o Low hygiene individual

o Low hygiene area

o Pre-existing skin diseases

Classification
1. Primary pyodermas
-

infection on the normal skin without

other skin diseass
Caused by: one type microorganisme
Staphylococcus and Streptococcus
Characteristic skin manifestation

Primary pyodermas (examples)

a)

b)
c)
d)

e)
f)
g)

h)
i)
j)

Impetigo
Folliculitis
Furuncles
Carbuncles
Ecthyma
Erythrasma
Erysipelas
Cellulitis
Paronychia
Staphylococcal scalded skin syndrome

2.Secondary pyoderma
Complicating preexisting skin lesions, such
as scabies, eczema, varicella, thus clinical
manifestations are not characteristic.
Examples:
- Hidradenitis supurativa
- Intertrigo
- Ulcers
- Infectious eczematous dermatitis

PYODERMAS TREATMENT
1. General treatments:
- Medical; personal & environmental
hygiene advices
- Immunological factor
- Antibiotics

Systemic Antibiotics:
a) Penicillin: ampicillin, amoxicillin,

b)
c)
d)

e)

penicillin resistant strain:

amoxicillin+clavulanate acid (3x125mg,
250-500mg), cloxacillin.
Erythromycin 30-40 mg/kg/day 3 doses
Cefalexin: 50 mg/kg/day 2 doses
Lincomycin: 30 mg/kg/day 3-4 doses
Ciprofloxacin 2 x 500-750 mg

Topical Antibiotic
Mupirocin
Gentamycin
Erythromycin
Fucidic acid

Tetracycline 3%
Chlorampenicol
Neomycin+basitracin

Secondary pyodermas : treatment of the

preexisting diseases
Chronic cases: culture & resistance test

2.Specific treatments:

PRIMARY PYODERMAS
4 types of primary pyoderma considered from
the etiology:
1. Staphylococcus
- impetigo contagiosa bullosa
- folliculitis, furuncles & carbuncles
- sycosis barbae
- Staphylococcal Scalded Skin Syndrome

PRIMARY PYODERMAS (etiology)

2. Streptococcus:
q Impetigo contagiosa crustosa
q Ecthyma
q Erysipelas
3. Staphylococcus & Streptococcus:
v Cellulitis
4. Corynebacterium minutissimum:
- Erythrasma

IMPETIGO
A bacterial infection that attacks
superficial epidermal between stratum
corneum and stratum granulosum, very
infectious.
2 types of impetigo:
1. Impetigo contagiosa bullosa
2. Impetigo contagiosa crustosa

1.

Impetigo contagiosa bullosa

= Impetigo neonatorum

Neonatal 10-14 days: on the palm of

hand, face, mucous membrane, along
with constitution manifestations
Pre-school children neck, arm
Flaccid Bullae (hipopion), erosions
scalded-by-fire-like appearance

2. Impetigo contagiosa
crustosa
Manifestation: erythematous eritema, vesicle
and bullae pustule thick crust.
Predilection: face, extremities

Streptococcus group A serotype 2.

Complicationsacute glomerulonephritis
The most serious complication!

IMPETIGO
Hipopion

Impetigo contagiosa crustosa

Impetigo contagiosa bullosa

FOLLICULITIS
A hair follicle infection.
Course & clinical manifestations:
1. Superficial folliculitis
There are small fragile domeshaped
pustules occur at the infundibulum of hair
follicles, erythematous surrounding
2. Deep folliculitis
Deep microabces + crust abces collar
button

Deep folliculitis (Examples):

i. Sycosis barbae occuring in the bearded
areas of the face and upper lip.
ii. Hordeolum (stye): a deep folliculitis of the
cilia of the eyelid margin.
Nodule is covered by pustule swelling of
perifollicular tissue when dried becomes
crust at the edge of palpebra.
Treatment

: warm compress

Complication: blepharitis & eye refraction

disorder

FOLLICULITIS

SYCOSIS BARBAE

FURUNCLES
An infection in hair follicles & surrounding tissue
(perifoliculer)
Course & clinical manifestations:
Acute pain, nodules with sharply defined
margins, erythema 5 days: central
suppuration, blind boil.
Predilection: nape, axilla, buttocks.
Predisposition factors:
- Diabetes mellitus
-Malnutrition
- Seborrheic dermatitis
Th/Specific: if there is abscess incision

FURUNCLE

CARBUNCLES

the worst form of a furuncle, with coalescence of

furuncles and marked inflammation, there are

multiple pustules.
Course & clinical manifestations:
1. Superficial carbuncles:
Red nodules, multiple perforation : without
leaving deep ulcers.
2. Deep carbuncles:
The nodules appear like carsinoma, multiple
perforations, leaving deep ulcer. Carbuncles
ulcer

Carbuncle (treatment)
Treatment:
Systemic: general pyodermas treatment
Local: - upper nodule : warm compress
- abscess
: incision

CARBUNCLE

ECTHYMA
A pyogenic infection, characterized by sticky
crustae. There are ulcers if crusts are
debrided
Course & clinical manifestations:
Predilection:
legs,
buttocks

vesiculopustulae thick crust the ulcer

has a punch out appearance, the margin of
the ulcer is indurated, raised and violaceous.
DD/ Impetigo

ECTHYMA

ERYTHRASMA
A skin disease caused by gram-positive
bacterial infection, superficial lesions with
sharply defined margins.
Etiology: Corynebacterium minutissimum
Symptoms & signs:
The body folds, axilla, genitocrural, toe web
macula (brownish redness) or plaque, fine
scaly.
Woods lamp: a coral red fluorescence.
Predisposing factors: heat, humidity, obesity.
Treatment: erythromycin 4 x 250 mg/ day.

ERYTHRASMA

ERYSIPELAS
(superficial cellulitis)
An acute infection disorder caused by
Streptococcus betahaemoliticus with cardinal
signs of sharply circumscribed erythematous
skin, fever and chills
Predilections:
face and head extremities & genital
Predisposition factor: cachexia, diabetes
mellitus, systemic diseases, and bad hygiene

ERYSIPELAS (course & clinical

manifestation)
Beginning from ulcer, wound, pustule.
Quick progress pain, fever, weakness
Spreading erythema to the periphery,
sharply circumscribed, oedema, palpation:
warm & pain. Vesicles & bullae on the
erythematous skin.
Exacerbation in the same place causes
permanent changes: swelling, oedema can
be caused by blockage of the venous and
lymphatic vessels on the lips, lower legs
and feet. Elephantiasis nostras

ERYSIPELAS
Predilections:
face and head extremities
& genital
Treatments:
v Bed rest
v General pyoderma treatment:
systemic antibiotic
Cold compress
Complication: ELEPHANTIASIS NOSTRAS

ELEPHANTIASIS NOSTRAS
VERUCOSUS
It is caused by recurrent erysipelas
Location: lower legs
Feet: very thick and big (2-3 x normal)
Verrucous lesions are made up of
crowded wart-like growths with
papilomas among them.
Caused by lymphatic vessels blockage

CELLULITIS
acute infection, where the inflammation
involves more of soft tissue, extending
deeper into the dermis and subcutaneous
tissues,
primary sign: skin erythematic without sharply

defined margins.

Etiology:
Group A Streptococcus &Staphylococcus
aureus; Group B Streptococcus neonatus

Course & clinical manifestations:

vBeginning from insect bite, small wound, ulcers
(porte dentre). Erythema and severe pain, fever
and chills, palpation: pain and heat.

vVesicles local abscess necrotic.

vCelullitis can occur on the head, perianal
cellulitis,
vBecoming march celullitis, gangrene gas,
necrotizing fasciitis if the infections have extended
into the fascia and caused blood vessels
thrombosis gangrene.
vInitially is edematous, warm, red, extended, raising
vesicles or bullaes crepitation sign

Cellulitis treatment:
Bed rest better general conditions
Systemic:
antibiotic

general

pyoderma

treatment:

Topically: acute cold compress

Abscess/ gangrene incision, debridement of
necrotic tissues

PARONYCHIA
an infection of the nail fold surrounding the nail
plate.
E/: Staphylococcus or fungal: Candida albicans
Course & clinical manifestations:
Beginning from nail folds expanding into nail
matrix & nail plate : characterized by the
swelling of the lateral nail fold adjacent to the
side of the nail, a drop of pus may sometimes
be expressed from them.
Chronic paronychia is favored by ingrown nail,
prolonged immersion in water and simple
injuries. There is latitude line on the nail fold.

PARONYCHIA
Treatments:
o Systemic: acute antibiotic/ penicillin
o Topical:
Acute rivanol 1 %, after drying antibiotic
ointment
Chronic/ recurrence nail extraction
Candida albicans:
Antibiotic+ Anticandida nystatin
Prognosis: generally good.

STAPHYLOCOCCAL SCALDEDSKIN SYNDROME (SSSS)

A skin infection, caused by typical exotoxin of
Staphylococcus aureus with a characteristic sign
of epidermolysis.
Etiology & pathogenesis:
v Group 11 phage (type 52,55 and 71)
Staphylococcus aureus.
v The exotoxins produce epidermolysis on all over
the body into the epidermis.
v There is no bacteria found on the skin.
v Focal infections are eye, nose, throat & ear
infection.

SSSS (Course& clinical manifestations)

High fever, accompanied by upper respiratory
tract infections
Erythem on the face, neck, axilla, groin all
over the body in 24 hours.
Characteristic tissue-papers like wrinkling of
epidermis is followed by appearance of large
flaccid bullae (Nicolsky sign +) like combustion
Complication: cellulitis, pneumonia, septicemia
DD: Toxic epidermal necrolysis.

SSSS (Treatments)
Systemic: cloxacillin adult 3x250mg/day

Neonatus 3x50mg/day orally

Topical: wide lesions sofratulle/
antibiotic cream
Intravenous electrolyte and liquid wide
epidermolysis produces electrolyte and
liquid imbalance

SSSS

SECONDARY PYODERMA
Examples:
- Hidradenitis supurativa
- Intertrigo
- Ulcers

HIDRADENITIS SUPPURATIVA
A chronic &recurrent suppurativa infection in
apocrine sweat glands.
Affecting apocrine sweat gland, in adult men
& women
E/:Staphylococcus aureus & Proteus Sp
Course & clinical manifestations:
Preceded by injuries, axilla hair cutting,
deodorant using.
Predilection: the axilla, perianal & genital.

HIDRADENITIS SUPPURATIVA
DD/:Scrofuloderma
Treatments:
Usually very difficult, considering the multiple
lesions and the deep location on the
profundal layer
Abscess incision
Chronic and cicatrix apocrine gland
excision
PROGNOSIS: poor -- recurrence

HIDRADENITIS SUPURATIVA

INTERTRIGO
An inflammation in the redundant skin
folds, erosion, red-colored
Predilection:
The favorite sites are the groin, axillae,
between the toes, the intergluteal cleft,
under the pendulous breast where the
skin meets

INTERTRIGO (Course & clinical

manifestations)

Initially the skin is red, maceration, hyperemia,

erosions & fissure. e.g: diaper rash
Influencing factors:
Obesity
Hot temperature & high moisture, sweat
retention, maceration, irritation on the skin.
Bacterial populations, flora decompositions
produces an offensive odor.
Bacterial populations causing inflammation
increased moisture more macerations
DD: Dermatomycosis

INTERTRIGO (Treatment)
1.

2.
3.

4.
5.
6.

Milid intertrigo: thorough cleansing & dyring of

area 2x/d. All soap should be rinsed off
Liberal use of baby powder
Using uplifting brassieres preventing hanging
breasts
Using cotton underwear it can absorb the
sweat; looser underpants
Using electric fans/ ac a cool environment
Medications:
a. systemic: antibiotic orally
b topical: mild cases corticosteroid creams
moderate cases antibiotic creams

INTERTRIGO

ULCERS

1.
2.
3.
4.
5.
6.

a skin disorder caused by tissue necrotic

occurring in the epidermis, dermis and
subcutan expanding into bone tissue.
Ulcers caused by bacteria:
Pyogenicum ulcer
Carbuncles ulcers
Tuberculosis ulcers
Tropicum ulcers
Durum ulcers
Molle ulcers

Consider these when describing

an ulcer:
-

Shape:
round on the pyogenic ulcer
oval on the tropicum ulcer
irregular on the traumatic ulcer
Border:
raised on mycosis fungoides
Verrucosa on carcinoma ulcer
Undermined on tuberculosis ulcer

Consider these when describing

an ulcer
Base:
- dirty on carbuncles ulcer
- Clean on durum ulcer
Surrounding skin:
- red on carbuncles ulcer
- Livide on tuberculosis ulcer

PYOGENICUM ULCER
Round-shaped, 0.5-1 cm in diameter,
red border, covered by pus,
often on the foot,
E/: Streptococcus/ Staphylococcus.

CARBUNCLES ULCERS
Furuncles convalesce, necrotic,
Predilection: on the back and nape,
In diabetes mellitus patient.

TUBERCULOSIS ULCERS
A. Orificialis tuberculosis ulcer
It is on the oral & anal orifice edge. Livide
on the surrounding skin, undermined
border, pale granulation tissue and
hemorrhage easily on the base.
B. Tuberculosis limphadenitis on the neck
and axilla, becomes abscess, fistula &
ulcers.
E/: tuberculosis bacterial toxin

DURUM ULCERS
Initially it appears as asmall erosion,
expanding to the periphery. The base is
verrucous, red, covering serum
sometimes dried. Palpation feels like
cartilage and there is no pain, inguinal
lymph gland enlargement.
E/ Treponema pallidum.

THANK YOU
AK