Chronic diffuse streptodermia is a recurrent diffuse inflammation of the skin of coccoid etiology. The primary elements are flat bulls that appear against the background of edematous erythema, merging, forming large foci with uneven edges. Serous-purulent blisters are eroded, covered with crusts, new ones appear nearby. The skin is diffusely infiltrated. The disease is diagnosed on the basis of the clinic, microscopy of scrapings and bacteriology of smears from the lesion. Treatment involves improving trophic, sanitation of foci of infection. Bulls are opened, wet-drying antiseptic dressings are applied, vitamin therapy and means that improve peripheral blood circulation are used.
Chronic diffuse streptodermia is a chronic superficial coccal infection of the skin with diffuse infiltration of the skin. A feature of the pathology is its favorite localization around non-healing ulcers or in places of permanent traumatization of the skin. The disease has no age, gender and seasonal framework, it is not endemic. There are no exact data on the structure of the incidence of chronic diffuse streptodermia, since this pathology in some cases is regarded as eczema or a consequence of trophic disorders.
The cause of the disease is streptococcal or strepto-staphylococcal skin intervention. The provoking factors of chronic diffuse streptodermia are varicose veins, thrombophlebitis, irrational irritant therapy.
The mechanism of occurrence of chronic diffuse streptodermia is caused by trophic disorders. In the first variant of development, the main role is played by a long-term violation of local blood circulation. Due to the formation of an erosive and ulcerative area of infected skin, dermal ischemia occurs, caused by vascular spasm as a result of the pathogenic action of microbes on their wall and the development of inflammation. Damaged arteries are thrombosed, which creates additional obstacles to local blood flow. Inflamed tissues around the focus of chronic diffuse streptodermia compress nearby vessels, and the resulting collaterals contribute to the redistribution of blood, which exacerbates the ischemia of the affected area, disrupts the trophism of the skin.
The second variant of the development of chronic diffuse streptodermia is associated with hypoxia of dermal tissues. Oxygen starvation is a consequence of ischemia, but not only. Dermal hypoxia develops as a result of infectious damage to intracellular mitochondrial enzymes. As a result, the cells lose their ability to absorb oxygen.
The third variant of the occurrence of chronic diffuse streptodermia is the occurrence of metabolic disorders. In this case, inflammation in the dermis develops due to the activation of T-lymphocytes of the immune system, which leads to increased cell proliferation in order to restore the integrity of the skin. For this, first of all, protein is required – the main building material of the dermis. Therefore, the delivery of proteins, fats and carbohydrates to the skin, which ensure normal cellular metabolism, changes its proportions in favor of the protein component. The exchange balance is disrupted, and after it, the trophic tissues.
Hypothermia of the skin can slow down the metabolism. In addition, the trophism of the dermis in chronic diffuse streptodermia changes as a result of a violation of the innervation of the skin. Most often this happens when numerous nerve endings located in the skin are pinched by scars that form at the site of ulcers.
The disease begins with a rash of serous-purulent bullae of small size against the background of edematous and hyperemic skin in response to the action of streptococcal and strepto-staphylococcal flora. At the same time, the protective barrier functions of the skin are violated, which allows microbes to gain a foothold on the surface of the epidermis or penetrate deep into the dermis. The strength of the body’s response depends on the state of the patient’s immune system, the virulence of cocci, and their number.
The resulting bulls are opened, expose the erosive surface, covered with serous or serous-purulent crusts, begin to peel off. In chronic diffuse streptodermia, the primary elements tend to merge, therefore, in places of typical localization of the pathological process (on the lower extremities), large foci with indistinct contours appear quite quickly, surrounded by a peeling epidermis along the perimeter.
Rashes are accompanied by prodroma and non-intense itching. The cycle of existence of primary elements is 10-12 days. Next to the involuting formations, fresh ones appear, wetness joins. The course of chronic diffuse streptodermia becomes recurrent, the skin is diffusely infiltrated. Hair follicles and the glandular apparatus of the dermis are involved in the process, ostiofolliculitis develops.
Over time, the foci grow along the periphery, regional lymph nodes increase. In some areas of the skin, the process begins to subside, large-plate peeling appears, small-point erosions with serous filling appear in neighboring foci against the background of bright erythema, which indicates skin sensitization and the beginning of the transformation of chronic diffuse streptodermia into eczema.
Pathology is diagnosed by a dermatologist based on anamnesis and clinical symptoms. To clarify the diagnosis and conduct differential diagnosis , perform:
- microscopy of scraping from the lesion;
- bacteriological seeding of the separated from the epicenter of inflammation to determine sensitivity to antibiotics.
Pathohistology states the absence of a horny and granular layer of the epidermis, alternating with the phenomena of parakeratosis, lymphocytic infiltration. Chronic diffuse streptoderma is differentiated with eczema, atopic dermatitis, pyoderma.
The treatment consists in opening the bulls and disinfecting them. Bandages are carried out. Locally, resorbing sulfur ointments are used, with their ineffectiveness, X-ray therapy is sometimes used. The UVI is shown. Vitamins, vasodilators, drugs that improve trophism are prescribed inside. It is recommended to consult a vascular surgeon.
Prognosis and prevention
The prognosis of chronic diffuse streptodermia is relatively favorable. Prevention consists in observing the rules of personal hygiene and regular skin care.