PENYAKIT KULIT YANG

DISEBABKAN OLEH BAKTERI

Infeksi bakteri pd kulit dibagi menjadi 4:
Infeksi primer
Infeksi sekunder
Manifestasi kulit akibat infeksi bakteri
pd organ dalam
Kondisi reaktif kulit akibat infeksi
bakteri
Patogenesis umum infeksi bakteri pd kulit :

The portal of entry

The host defenses and inflammatory
response to microbial invasion
Pathogenic properties of the organism
 PYODERMA
Infeksi pada kulit, yang disebabkan oleh
bakteri yg membentuk nanah atau piogenik
dan mudah menular
Etiologi :
Staphylococcus S.aureus
Streptococcus Streptococcus grup A
Kedua-duanya
 Faktor predisposisi :

Daya tahan tubuh rendah

Higiene individu kurang
Higiene lingkungan kurang
Telah ada penyakit kulit sebelumnya
 Klasifikasi pyoderma :

PRIMER SEKUNDER

Impetigo Impetigenisata
Folikulitis
Furunkel
Karbunkel
Paronikia
Ektima
 IMPETIGO

Pioderma superfisialis (terbatas pada

epidermis)
Etiology : Streptococcus B hemolyticus
S.aureus
Ada 2 bentuk:
a. Bulosa
b. Non-bulosa / krustosa
 a. IMPETIGO BULOSA
Impetigo vesiko-bulosa, cacar monyet
Etiology : phage group II S.aureus (strain 77
& 55) exfoliatin toxin type A and B
Clinical :
newborn and older infants
Vesicle flaccid bullae (rapid progression)
Nikolsky sign (-)
Bullae : clear yellow fluid dark yellow & turbid
Margin : sharply demarcated w/o erythematous
halo
w/i a day or two bullae rupture & collapse
IMPETIGO BULOSA
 IMPETIGO BULOSA

Lab :
Gram stain
Culture
histoPA
DD/ :
Contact dermatitis
Insect bite
Bullous drug eruption
 IMPETIGO BULOSA

Complication :
Cellulitis
Lymphangitis
Bacteremia
Osteomyelitis
Septic arthritis
Pneumonitis
Septicemia
SSSS
IMPETIGO NON BULOSA/KRUSTOSA

Impetigo kontagiosa, impetigo vulgaris,

impetigo Tillbury Fox
70% of cases of this form of pyoderma
Etiology :
Streptococcus group A pre-school aged
children (<2 y.o)
S.aureus Children of all ages and adults
IMPETIGO NON BULOSA/KRUSTOSA

Clinical finding:
Pruritus; soreness; burning ; painless
Commonly on the skin of the face (around the
nares) or extremities after trauma
Transient pustule or vesicle honey-colored
crusted plaque (2cm) w/i surrounding
erythema
No constitutional symptoms
Regional lymphadenopathy (90%)
IMPETIGO NON BULOSA/KRUSTOSA
IMPETIGO NON BULOSA/KRUSTOSA

Lab :
Gram stain
Culture
DD/ :
Atopic dermatitis
Allergic contact dermatitis
Varicella
Dermatophyte infection
IMPETIGO NON BULOSA/KRUSTOSA

Complication :
Untreated process may persist and new
lesions over the course and for several weeks
Resolve spontaneusly except there is some
underlying cutaneous disease
Erysipelas
Cellulitis
Bacteremia
Major serious sequela acute post-
streptococcal glomerulonephritis
 MANAGEMENT OF IMPETIGO
Washing (removal of dirt, crusts and debris
by soaking with soap & water)
Good hygiene
Pharmacology: topical and systemic
Topical : mupirocin; fusidic acid
Systemic :
Penicillin DOC
Dicloxacillin; amoxicillin and clavulanic acid
Azythromycin
Clindamycin
Erythromycin
 FOLIKULITIS

Def : a pyoderma that begins within the hair

follicles
Classified :
Depth of invasion : superficial and deep
Microbial etiology : bacterial, fungal, viral and
parasite infestation
 FOLIKULITIS SUPERFISIAL

Impetigo Bockhart;
follicular impetigo
Etiology : S.aureus
Clinical finding:
Location : scalp (children);
beard area, axillae,
extremities, buttocks
(adults)
A small, fragile, dome-
shaped pustule
infudibulum of a hair
follicle
DD/ : - gram-negative folliculitis
Pityrosporum
folliculitis
Herpes simplex
Deep folliculitis
sycosis barbae
 FURUNKEL
Boil
Deep-seated inflammatory nodule that develops
around a hair follicle, usually from a preceding,
more superficial folliculitis and often evolving into
an abcess
Etiology: S.aureus
Clinical finding :
Pain surrounding the lesion
Nodule (hard, tender, red folliculocentric) enlarge
fluctuant abcess formation rupture
Single/multiple
Furunkel / Furunkulosis ?
 FURUNKEL
Lab: Complication
Leukocytosis Not common
Gram stain of pus Recurrent furunculosis
Culture
 KARBUNKEL
Larger, more serious
inflammatory lesion with
a deeper base
Extremely painful
Fever, malaise
Location : nape of the
neck, the back or thighs
Efl : red, indurated,
multiple pustules
confluent
 MANAGEMENT OF FURUNCLE &
CARBUNCLE
Washing and hygiene
Localized local application of moist heat
Systemic systemic antibiotic
Incision and draining the lesions
 EKTIMA
A cutaneous pyoderma
characterized by thick crusted
erosions or ulceration
Etiology: S.aureus &/ group A
Streptococcus
Clinical finding:
Poor hygiene & neglect
Location : lower extremities
(children, DM, elderly)
Efl: ulcer punched-out,
indurated, raised, violaceous,
granulating base
slow to heal need several
weeks of antibiotic treatments
 ERISIPELAS

Soft tissue infection erysipelas & cellulitis

Usually present at an antecedent lesion or
site
Local pain, variable degrees of erythema,
systemic symptoms
 ERISIPELAS
Distinct type of superficial
cutaneous cellulitis with
marked dermal lymphatic
vessel involvement
Etiology : group A -
hemolytic Streptococcus
(>>) ; S.aureus (<<)
Clinical finding :
Face, lower extremities
Pain, superficial erythema
and plaque-like edema with Recurrent lymphedema
sharply defined margin to
normal tissue
 SELULITIS
Extends deeper into the dermis and subcutaneous
tissue
Etiology : S.aureus and group A Streptococcus
(>>)
Clinical finding :
Erythema, tenderness, pain
Lack of distinctive margins between affected and normal
skin
Deeper, firmer form of tender induration
Crepitus on palpation
Bulla and necrosis
Regional lymphadenopathy
SELULITIS
 ERITRASMA
Common superficial bacterial infection of the skin
characterized by well-defined but irregular reddish
brown patches, occuring in intertrigonous areas, or
by fissuring and white maceration in the toe clefts
Etiology : Corynebacterium minutissimum
Clinical finding:
Men > women
Asymptomatic pruritus
Location : genitocrural, web spaces of the feet, axillary,
inframammary regions
Efl: well demarcated, reddish brown, superficial, finely
scaly and finely wrinkled patches; hyperkeratotic white
macerated plaque
 ERITRASMA
Lab : Management :
Woods lamp coral Topical
red Benzoyl peroxide wash
Gram stain BPO 5% gel
Clindamycin 2% sol
DD/
Systemic
Tinea cruris
Erythromycin PO
Pitiriasis versikolor Clarythromycin 1g SD
Psoriasis inversa
 Perlu diketahui :

Paronikia
Staphylococcal scalded skin syndrome