Pyoderma combine purulent-inflammatory skin diseases, the cause of which is a purulent microflora – pyococci, staphylococci and streptococci. About a third of all skin diseases are various pyoderma; primary form occur when healthy skin is affected, and secondary are a complication of diseases in which skin damage due to itching is possible. Disease is complicated by scabies, eczema, as well as diabetes mellitus and chronic renal failure. If disease occurs with the involvement of deep layers of the skin, then persistent scarring and pigmentation changes remain after it.
A large number of microorganisms are constantly present on the human skin, some of them are normal microflora of the skin, some are saprophytic and transient microflora, which, with a decrease in the protective functions of the skin, can cause pyoderma. As a result of vital activity, microorganisms secrete enzymes, endo- and exotoxins, which causes a local reaction in the form of pyoderma.
In the pathogenesis of pyoderma, an important place is occupied by working conditions and features of human skin, age and the state of the immune system; a decrease in human immunological reactivity and non-compliance with personal hygiene increases the likelihood of pyoderma. In most cases, disease is caused by saprophytic microflora, and therefore patients do not pose a danger to others.
Microtrauma, stressful situations, overheating or hypothermia are factors that reduce the protective functions of the skin and increase the likelihood of pyoderma; people suffering from diabetes mellitus, pathologies of the digestive system, disorders of hematopoiesis and vitamin balance, obesity and exhaustion also depress local immunity fall into the risk group.
The skin, prone to the production of excessive amounts of sebum, which happens in central nervous system disorders, is most vulnerable to pyococci, since a change in the chemical composition of sebum reduces the sterilization properties of the skin. Changes in the hormonal background or taking corticosteroids lead to common diseases that are predisposing to pyoderma.
Disease is classified depending on the depth and severity of the lesion, as well as depending on the pathogen. Superficial form manifested by ostiofolliculitis, skin sycosis are most often staphyloderma. Superficial streptodermia and mixed pyoderma are clinically manifested in the form of impetigo vulgar.
Deep staphyloderma are manifested in the form of deep folliculitis, hydradenitis, furunculosis and carbunculosis. Deep inflammation of the skin with streptococcal infection ends with ulcerative lesions of the skin, proceeding according to the type of ecthyma vulgar. Ulcerative-vegetative chronic forms of deep pyoderma are most often caused by mixed microflora.
A dermatologist treats pyoderma. With this disease, the hair in the focus of infection and around it is cut off, but not shaved, in order to prevent the contamination of pathogenic microflora areas of healthy skin; if pyoderma is generalized, then water procedures, including washing, are prohibited. Contact with water is highly undesirable, especially in the acute phase of the disease.
The skin around the affected area is treated with alcohol solutions of aniline dyes and disinfectants, salicylic acid and a solution of potassium permanganate have a good effect. Despite the fact that contact with water is prohibited, you need to wash your hands thoroughly every day and treat your nails with a 2% iodine solution to prevent the spread of infection, as well as wipe healthy skin with a damp sponge.
Nutrition during the treatment period should be balanced, it is better to switch to a dairy-vegetable diet, completely exclude extractive substances and alcohol from the menu, limit the use of salt and simple carbohydrates. If the patient is weakened, has concomitant diseases or pyoderma takes a prolonged or chronic course, with the addition of symptoms of intoxication, it is advisable to carry out drug treatment of pyoderma with antibacterial drugs. Before prescribing an antibiotic, the discharge or scraping is carried out, the pathogen and its sensitivity to drugs are determined. Penicillin antibiotics are practically not prescribed due to their low effectiveness, macrolides and tetracyclines give a good therapeutic effect, but erythromycin and tetracycline are undesirable to use for the treatment of children and pregnant women.
Treatment with combined antibacterial drugs and cephalosporins (cefotaxime, etc.) is prescribed for infection with mixed microflora, since these drugs have a wide spectrum of action and are resistant to bacterial variability. The course and dosage of drugs are prescribed individually, based on the severity of the course of pyoderma, usually taking antibiotics should not be less than a week. Sulfonamide preparations are less effective in pyoderma, but if the patient is intolerant to antibiotics, then sulfamethoxazole + trimethoprim, sulfomomethoxine are prescribed in the right dosages.
Active specific immunotherapy in combination with antibiotic therapy and local treatment gives good results, especially in chronic and sluggish processes. Subcutaneous injection of anatoxins, specific antigens, staphyloprotectins is carried out twice a week in a polyclinic or in a hospital if the patient is undergoing hospital treatment.
To stimulate nonspecific immunity, autohemotransfusion, transfusion of blood components, ultraviolet irradiation of blood (UVI) are resorted to; drugs such as methyluracil, lemongrass tincture and eleutherococcus extract also stimulate the immune system. If there are immune disorders, it is advisable to treat pyoderma with the appointment of immunostimulants of the thymus group of drugs; gamma globulin preparations and interferon production stimulators. Vitamin therapy is indicated for all types of pyoderma.
Prevention both for people who have no history of pustular diseases, and for people with a history of recurrent pyoderma, consists in observing the rules of personal hygiene, in organizing preventive measures at home and at work. Compliance with sanitary and hygienic standards at work significantly reduces the incidence of pyoderma in a single institution. In addition, timely treatment of injuries and microtraumas makes it possible to exclude further infection of wounds and the development of pyoderma.
Regular preventive medical examinations to identify chronic diseases of the digestive system, ENT organs allow you to prescribe treatment and prevent the development of secondary pyoderma. For patients with diabetes mellitus, prevention of pyoderma consists in more thorough skin care, in timely moisturizing it to prevent maceration and the formation of microtrauma, since in diabetes mellitus, even a small scratch often causes extensive and deep pyoderma.