Pyoderma is an infectious dermatological disease requiring long-term treatment (depending on the depth of skin lesion). If there is no therapeutic effect on the foci of the disease, the pathology is able to pass into the chronic stage of development, fraught with disability.
Often the causative agents of the disease are streptococci or staphylococci. But more often the latter become the cause of the development of pyoderma. But the habitat of streptococci are, in the main, mucous membranes.
Staphylococci are present on the skin of every person, but not always they cause the appearance of a pathological process. Often this happens under the influence of a weakening of immunity, temperature drops, prolonged depressions.
In addition, other pathogens, such as pseudodiphtheria bacillus, yeast fungi, and others, inhabit the skin integument of humans. When creating favorable conditions for their reproduction, they are also capable of causing purulent skin lesions.
Causes of pyoderma
A lot of microorganisms live on the skin of a person. Some of them do not pose a threat to health, as they are part of the normal microflora, but there are also those whose abnormal activity can cause the development of pyoderma. Throughout their life, these bacteria secrete enzymes, exo- and endotoxins, which cause an aggressive reaction of the body. As a consequence, the development of the disease occurs.
Of great importance are working conditions, and human compliance with the rules of hygiene. In addition, age and the state of human immunity play an important role. If the immune system is weakened, while hygiene rules are neglected, the risk of pyoderma development is significantly increased. The disease can be caused by external factors, for example, micro-trauma, stress, hypothermia or overheating. In addition, people with diabetes, GI diseases, malfunctions in the process of hematopoiesis and others fall into the risk group. All these diseases depress the immune system, making a person vulnerable to attack by pathogens.
Oily skin is an excellent habitat for piococci, as changing the chemical composition of subcutaneous fat significantly reduces the sterilization properties of the skin. The fluctuations in the level of hormones and the prolonged use of glucocorticoids lead to the development of diseases predisposing to the development of pyoderma.
Clinical manifestations of pyoderma depend on the cause of its development and its type. According to the generally accepted classification, pyoderma are:
- Staphylococcal. With this type of disease, only the superficial layers of the dermis are affected. A variety of this form of pyoderma include ostiofolliculitis, folliculitis, vulgar vulgar and impetigo, furunculosis, carbuncle, abscesses in newborns, etc.
- Streptococcal. Streptoderma - a kind of superficial pyoderma, which is characterized by the appearance of deprivation on the face and impetigo. If the infection affects the deep layers of the dermis, the patient may experience ecstema or erysipelas.
- Mixed. This form causes the development of streptofrostococcal impetigo and ecthyma. Chronic pyoderma is divided into ulcerative, vegetative and shan-formiform forms. If there is a serious lesion with an infection of the legs, a gangrenous form develops. Against the backdrop of weak immunity, such a disease can, in the end, lead to the need for amputation of the diseased limb.
Each of the groups is divided into 2 subgroups, which are determined depending on how deep is the lesion of the dermis (superficial and deep forms).
All varieties of pyoderma have similar symptoms, which, however, in each situation may differ in different intensity. So, the disease can manifest itself:
- hyperemia of the skin in the affected area, its swelling and soreness;
- the formation of a foci of inflammation with serous-purulent contents inside;
- violation of skin pigmentation;
- sensation of itching, burning, tingling;
- increased and painful lymph nodes.
With multiple rashes and deep lesions, symptoms of general intoxication manifest themselves: fever, nausea, loss of working capacity, etc. Heavy varieties of pyoderma (carbuncle, gangrenous forms, etc.) cause a more serious clinical picture. Patients may suffer from vomiting, delusions, confusion, hallucinations.
It is important to consider that in young children the symptomatology is more severe, because the immune system of the child not yet fully formed, and therefore unable to fully combat the pathological process. In addition, due to the small body weight, there is a more intense poisoning of the child's body by poisons, formed during the process of dying of infected tissues.
Specific signs in different types of pyoderma:
|Ostiophalliculitis||Small pustules (pustules) with reddening at the base. Localize on the neck, face, legs, shoulders. After maturation, atrophy, leaving no scarring|
|Folliculitis||Foci of inflammation are larger, slightly painful, with a thick wall, pustules with dense greenish or whitish-yellow pus surrounded by reddened swelling of the skin. With a deep form of soreness increased, bubbles with pus reach 15 mm, the zone of hyperemia increased. If a lot of pustules are formed, the process is accompanied by deterioration of the condition, blood indices.|
|Epidemic pemphigus of newborns||Bubbles with a dull whitish exudate capture the entire surface of the skin in the first week of life. When merging blisters develop erosion. Massive spread of pemphigus can lead to the death of the baby.|
|Sycosis vulgaris||Shallow inflammation of hair bulbs in the zone of the lips, nose, chin, temples, pubic area. Frequent fusion of abscesses, redness, itching.|
|Furuncle||Very painful, cone-shaped crimson knot up to 50 mm in diameter, deeply penetrating into the thickness of the skin, filled with pus and a rod of dying tissues. When the abscess is opened up to 10 days, the syphilis exudes with pus and the necrotic stem expels. Heals up to 14 - 20 days with scarring.|
|Hydradenite||An acute-painful dense purulent node in the thickness of the cellulose up to 40 - 70 mm, formed from several abscesses in the zone of the sweat glands of the armpits. Characteristic: thick pus, cyanotic-purple color, strong puffiness. Maturation of the purulent conglomerate and the release of pus from the open holes are accompanied by severe pain, fever, nausea. Lasts up to 10 - 15 days. Tightening of the wound after cleansing 10 - 12 days.|
|Carbuncle||Formed during the confluence of 2 - 3 furuncles as a very large, almost black in color, a dense abscess in the thickness of the dermis. Characteristic: intense pulling pain, plentiful suppuration, several central rods of dead tissue, fistula formation. After expulsion from the dermis of the rods, a deep ulcer appears, healing slowly with the formation of a coarse rumen. The course is severe with fever, chills, vomiting, high risk of sepsis.|
|Intertriginous||Flat phlyctenes (serous blisters) that burst, revealing red, wet wound zones that merge into foci, surrounded by exfoliating fragments of the skin. Allocations dry up, forming brown crusts, under which the skin changes color.|
|Papulo-erosive||Small, combining bubbles with a watery-bloody exudate. They burst, leaving the inflamed, wet erosions. The disease quickly flows into a chronic form, with difficulty responding to therapy.|
|Erythemato-squamous (dry lichen)||Rounded red-pink areas with small, flour-like scaly scales are formed. Sometimes there is itching. Can be combined with a creviceal impetigo, intertriginous pyoderma.|
|Streptococcal impetigo||Flat bubbles (fliken) 5 - 10 mm with a watery (or purulent) exudate on the face (lips, gums, inside the cheeks). The dried discharge from fliken forms dry crusts of honey-yellow color. After their removal on the skin, long, not passing red spots are visible.|
|Ecthyma vulgaris||Blister 10 - 20 mm with purulent, watery, sucronic contents. Dry brownish-brown crusts, the tissue is inflamed, has a bluish-purple color. Under the crust, a deep ulcer forms, healing long and leaving a scar and a changed color of the skin along the edges.|
|Erys||A sharp reddening for 5 - 8 hours is transformed into a bright red swelling and a dense inflammatory focus, transferring to cellulose. Skin hot, painful, stretched. The rise in temperature is up to 39 - 40 C.|
|Diffusive (diffuse) streptoderma||Large flicken or small bubbles merge into large foci on the hyperemia edematous skin. Under the burst bubbles, ulceration with uneven contours opens. Abundant discharge, while drying out, form greenish-yellow crusts. The hearth grows quickly, capturing healthy skin. The course is long, gives relapses.|
|Shankrupformaya||Single, painless, rounded ulcer 10 - 20 mm, covered with a bloody crust. Around the dense edema. Outwardly similar to syphilitic hard chancre. Sometimes there are several ulcers. Lymph nodes swell. Heals after 30 to 60 days.|
|Chronic ulcerative vegetative||Inflammation, swelling and hyperemia. Ulcers and soft flat plaques of cyanotic red color are covered with ulcers and are surrounded by a pink corolla. Foci from fused pustules, plaques and ulcers secrete serous-purulent fluid. After removal of loose crusts, epithelial growths in the form of papillae and thick pus are revealed. Soreness. Aggressive spread with the capture of healthy areas.|
Pyoderma - photos
The initial stage of pyoderma development and the type of pathological eruptions can be seen on the photos below:
Pyoderma in children
The child's organism is the most favorable environment for the habitat and reproduction of pathogenic microflora. Skin covers of the child are too thin, so through the sweat glands pathogenic microorganisms easily penetrate into the underlying layers of the dermis. Often the cause is infection with coccal bacteria, but sometimes the pathological process may be a consequence of abnormal activity of Pseudomonas aeruginosa or Escherichia coli. Diseases and newborn babies are affected, and the umbilical wound slowly heals.
Pyoderma in children begins with a slight reddening on the surface of the skin, which soon turns into a vial filled with pus. After opening rashes in their place, crusts are formed, which then themselves fall away. If the situation is started, the abscesses can develop into boils, and this is fraught with the development of an abscess or phlegmon. The child develops a fever, serious complications arise. Because of the frequent need for combing itchy wounds, the infectious process in children spreads quite quickly. To treat the disease, small patients are prescribed antimicrobials.
To prevent the development of the disease in the child, parents should monitor the hygiene of his body. When skin is cleaned, skin particles, feces, urine, which are a very favorable environment for the microflora that provokes pyoderma, remain on them. Along with hygienic procedures, the child must ensure a balanced diet, and protect him from hypothermia or overheating.
To wipe the skin of children, use a weak solution of potassium permanganate or a 1-2% solution of salicylic acid. Treating the skin of a child with antiseptics, oils or balms should be at least 3 times a day.
First of all, visual inspection and questioning of the patient for complaints are carried out. But this is not enough. To distinguish pyoderma from other types of dermatoses, accompanied by similar signs, it is necessary to perform a number of diagnostic (laboratory and instrumental) procedures:
- Clinical investigation of the contents of ulcers, ulcers, wounds, pustules present on the patient's skin.
- Microscopy of the pathological contents of the rash and adjacent tissues.
- Histological analysis for the detection of cancer changes in affected tissues.
- Blood test for hemoglobin.
- PCR analysis of blood and contents of ulcers for the early detection of the type of pathogen.
- Test PRP on syphilis.
To identify specific diseases that caused pyoderma, it is necessary to consult other specialized medical specialists. For this you need:
- to pass or take place kaprogrammu and an immunogram;
- to pass the analysis on revealing a dysbacteriosis;
- to pass analyzes on hormones;
- to undergo cancer research;
- Do ultrasound diagnosis of the abdominal cavity.
Than to treat pyoderma?
Complex treatment is prescribed only by a dermatologist. Therapy may be etiological, pathogenetic and symptomatic. With mixed forms of pyoderma, treatment can be outpatient or stationary, which is determined individually, based on the severity of the clinical manifestations peculiar to each particular case.
- In the affected area, the hair is neatly trimmed, but not shaved to prevent the spread of pathogenic microflora to healthy areas of the skin. In case of extensive damage to the skin, the patient is not allowed to conduct water procedures: contact with water, if the disease is acute, is highly undesirable. The epidermis around the affected area is treated with alcohol solutions of aniline dyes and disinfectants. A good effect is caused by solutions of salicylic acid and potassium permanganate.
- Although contact with water should be minimized, washing hands daily is extremely necessary. After this, treat the nail plates with 2% iodine solution to prevent the spread of the infection. Several times a day, it is necessary to thoroughly wipe the healthy skin with a moist sponge.
- Of great importance is nutrition. Throughout the course of treatment, it is necessary to comply with the dairy and vegetable diet, giving up simple carbohydrates, alcohol and extractives.
- In the presence of concomitant diseases, symptoms of intoxication or exhaustion, or in protracted course, which threatens to pass into a chronic form, antibiotic therapy is performed. Prior to the appointment of specific drugs performs bakposev and antibioticogram. In this case, the antimicrobial agents of the penicillin series are practically not used. Instead, patients are prescribed macrolides or tetracyclines. But Erythromycin and Tetracycline are not used in the treatment of children and pregnant women.
- When several pathogens are detected, combined antimicrobials and cephalosporins are prescribed. They have a wide spectrum of action and are resistant to any changes in bacterial microflora in the patient's body. The course of therapy, as a rule, is 7 days. Dosage is prescribed by the doctor for each patient individually. Sulfanilamide drugs are considered ineffective in pyoderma, but if the patient has intolerance to other antibiotic drugs, Sulfamethoxazole can be used in combination with Trimethoprim, or Sulfonomethoxime in the required dosage.
- Specific immunotherapy in combination with antibiotic treatment gives positive results for flaccid or chronic course.
- Inpatient treatment, the patient is injected with anatoxins, specific antigens or staphyloprotectins. Manipulation is carried out twice a week. The method of administration is subcutaneous.
- To stimulate the nonspecific human immune system, autohemotransfusion, transfusion of individual blood components, ultraviolet irradiation of blood is carried out. It is also advisable to use methyluracil and alcohol extracts of magnolia vine or eleutherococcus. They also improve the functioning of immunity.
- In the presence of immune failures, immunostimulating drugs from the thymus group, gamma globulin, stimulants of interferon production are prescribed. Vitaminotherapy is provided for all types of pyoderma.
The operation is performed only if there is extensive tissue necrosis caused by pyoderma. Often, surgical intervention is indicated in carbuncle, furuncle, hydradenitis. The essence of this method of treatment consists in piercing the wall of the bladder with a thin scalpel and further draining it. Anesthetic preparations are used before manipulation.
It is impossible to remove the purulent-necrotic stem independently - this can lead to very serious consequences!
Absence of treatment and deep infection by the infectious process of the lower layers of the dermis can lead to:
- inflammation of the blood vessels and lymph nodes;
- spread of infection in the tissues of internal organs and bones;
- suppurative abscesses of different localization;
- purulent mediastinitis;
- the development of the phlegm of the orbit;
- the formation of thrombi in the vessels of the brain;
- sepsis with severe consequences.
Prevention of pyoderma development is facilitated by:
- adherence to hygiene rules;
- the timely treatment of chronic diseases;
- observance of sanitary norms at work at the enterprises;
- urgent treatment of wounds and other skin injuries with antiseptics;
- regular passage of preventive medical examinations.
Often, treatment of pyoderma, taking place in mild and moderate severity, is carried out at home. But ignore the symptoms of the disease in no case it is impossible - when they manifest, you must always seek help from a dermatologist. Only the doctor will be able to prescribe adequate treatment and prescribe the necessary dosages of medications.
At home, the patient will only need to follow the rules of personal hygiene, follow the doctor's instructions with regard to pharmacotherapy and in time to handle any damage that has arisen on the surface of the skin.
Timely detection of the disease makes it possible to begin treatment urgently. This, in turn, will help to avoid adverse complications.
- Accurate compliance with all the recommendations of the doctor, especially in terms of diagnosis and treatment, makes predictions for recovery is very favorable.
- Self-medication, or an attempt to squeeze out abscesses leads to the spread of infection and aggravation of the disease. This approach causes serious complications, which make the prognosis for recovery very unfavorable.
Proceeding from all the above, it is possible to draw an unequivocal conclusion: it is impossible to engage in self-medication with pyoderma - this increases the risk of unpleasant complications.
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