Bacterial infections of Skin

Learning objectives of bacterial infections

of skin

Define Pyoderma and classify it.

List the normal flora of skin.
Define impetigo. List the differentiating features of
bullous and non-bullous impetigo.
Describe the C/F, investigations of impetigo.
Outline the management of impetigo.
Learning objectives of bacterial
infections of skin
Define folliculitis , classify it and describe the
management of it.
Describe the C/F, investigations and management of
ecthyma/ cellulites/ erysipelas/ furuncle/ carbuncle/ SSSS.
List the skin infection produced by B- hemolytic
streptococci.
List the skin infection produced by staphylococci.
 Normal flora of skin
Classification:
1. Resident flora: grow on skin & relatively
stable in no. and composition at particular sites
2. Transient flora: lie on skin surface without
attachment, unable to multiply & disappear
within short time
3. Transient or temporary residents
 Normal Skin Flora
Major bacterial groups

Coryneforms (Gram +ve, pleomorphic rods)

Corynebacterium (Aerobic & lipophilic)

Brevibacterium (Aerobic & non-lipophilic)

Propinobacterium (Anaerobic)

Contd
 - Staphylococci (Gram +ve cocci, aerobs)
S. epidermidis, S. hominis, S.hemolyticus, S. saprophyticus
Minor bacterial groups
Acinetobacter (25%)
Micrococci

Fungal group
Pityriasporum
 Bacterial infection of the skin
(Pyoderma)
Classification of pyodermas
1. Primary
Impetigo
Ecthyma
Folliculitis
Superficial
Deep
* Folliculitis of leg
* Furuncle
* Carbuncle
* Sycosis Barbae
 Cellulitis/ Erysipelas
Pyonychia
SSSS
TSS

2. Secondary
Secondary infection of preexisting dermatoses
eg. Atopic dermatitis, Scabies
 Impetigo (contagious superficial infection)

Non-bullous Bullous
1. Cause
- Streptococcal (Group A) Staph. aureus
- Staph. aureus (Phage Groups II)
2. Pre-school and young school age All ages
3. Very thin walled vesicle on an erythematus base Bullae of 1-2cm
4. Transient Persist for 2-3 day
5. Yellowish-brain crusts (thick) Thin, flat,
brownish crust

Contd
6. Irregular peripheral extension without Central healing with
healing peripheral extension

7. Regional adenitis Rare

8. Constitutional symptoms present Absent
9. Face (around the nose, mouth & limbs) occur anywhere
10. Palms & sole spared May involved
11.MM, very rare May involved
Predisposing factors
Malnutrition
Diabetes
Immuno-compromise status

Complications
Streptococcal infection
PSGN (strep M-type 49)
Scarlet fever
Urticaria
Erythema mutiforme
 Ecthyma
Streptococcal & staph
Common in children
Small bullae or pustules on erythematous base
Formation of adherent dry crusts
Beneath which ulcer present
Indurated base
Heals with scar and pigmentation
Buttocks, thighs and legs, commonly affected
 Folliculitis
Superficial folliculitis
Infection of hair follicles
Commonly caused by staph. aureus
Children
Scalp & limb
Rarely painful
Heals in a week
 Folliculitis
Deep folliculitis of leg
Chronic
Staph. aureus
Hair follicles of leg
Multiple
Atrophic scar
 Furuncle (Boil)
Acute

Staph. aureus

Small, follicular noduler -- Pustule--necrotic-

-discharge pus

Painful

Constitutional symptoms
 Heals with scar
Age: Adult
Site: Neck, Wrist, Waist, Buttocks, Face

Complication
Cavernous Sinus thrombosis, (upper lip & check)
Septicemia (malnutrition)
 Carbuncle

Extensive infection of a group of contagious follicles

Staph. aureus
Middle or old age
Predisposing factors
Diabetes
Malnutrition
Severe generalized dermatoses
During prolonged steroid therapy
 Painful, hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms
 Sycosis barbae
Beard region
Pustules surrounded by erythema
Males
After puberty
After trauma
Upper lip and chin
Staph. aureus
 Cellulitis
Acute/sub-acute/chronic
Inflammation of loose connective tissue
Streptococcal (Group A)
Erythematous, edematous, swelling
Pain/tenderness
Constitutional upset
 Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful
Staphylococcal scalded skin synotrane
(Ritters Disease)
Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph. upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

Staphylococcal scalded skin synotrane
(Ritters Disease)
Denuded skin
Heals 7 - 14 day
Dont grow staph. from blister fluid
Complication 2%
Cellulitis
Pneumonia
Prognosis : Rule
Principles of therapy of pyoderma
Good personal hygiene
Management of predisposing factors
Local
Attend to traumas, Pressure, Sweating, Bites
Treat pre-existing dermatosis
Investigate carrier sites: Nose, Axilla, Perineum
Systemic
Treatment of disease like DM
Nutritional deficiency
Immunodeficiency
Principles of therapy of pyoderma
Local therapy
Cleaning with soap-water and weak KMN04
solution
Removal of crusts with KMN04 soluation
Application of antibacterial cream

Systemic therapy
Antibiotics
Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

D.M.
T/t of staph. carriage elimination

Nasal & perineal care

Rifampicin 600 mg/d 7-10 days
Clindamycin 150 mg/d 3 months
Topical mupirocin
Replacement of microflora with a less pathogenic
stains of S.aurus (strain 502)
 S.aureus produces skin infection
I. Direct infection of skin and adjuscent tissues
a. Impetigo
b. Ecthyma
c. Folliculitis
d. Furunculosis
e. Carbuncle
f. Sycosis
II.Cutaneous disease due to effect of bacterial toxin
a. Staphylococcal scalded skin syndrome
b. Toxic shock syndrome
 -hemolytic streptococcus produces
skin infection
I. Direct infection of skin or subcutaneous
a. Impetigo (non bullous)
b. Ecthyma
c. Erysipelas
d. Cellulitis
e. Vulvovaginitis
f. Blistering distal dactylitis
g. Necrotizing fascitis
II. Secondary infection
Eczema infection
III. Tissue damage from circulating toxin
Scarlet fever

IV. Skin lesion attributed to allergic hypersensitivity

to streptococcal antigens
E.Nodosum
Vasculitis

V. Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)
Guttate psoriasis
Consider the following in relation to bacterial infection of skin

a. Cellulitis is the inflammation of subcutaneous tissue as

well as dermis caused by Streptococcus.
b. Bullous impetigo is caused by streptococci
c. In erysipelas, inflammation is limited to dermis and
upper
part of subcutaneous tissue.
d. Furunculosis is caused by Streptococcus
Thank you