Superficial pyoderma is a group of contagious dermatoses, mainly of coccoid origin, affecting the epidermis and upper layers of the dermis. It is clinically manifested by polymorphic rashes of pustules, nodules, bullae, flicken. The shape of the primary element depends on the type of surface pyoderma. Bubbles quickly open, form erosions, become crusted and regress without a trace. Surface pyoderma is diagnosed on the basis of clinical manifestations, dermatoscopy, seeding of the separated bull on media, blood sugar analysis, immunograms. Antibiotics, immunomodulators, vitamins are used in the treatment. Externally, aniline paints and antiseptics are used.
Superficial pyoderma is a purulent lesion of the superficial layers of the skin of bacterial origin, which is often found in dermatology. It accounts for at least a quarter of all skin diseases and more than half of all pyoderma. Superficial pyoderma occurs against the background of non-compliance with the rules of personal hygiene and living in unsanitary conditions. The pyodermic process is professional for workers in the fields of production and agriculture, whose work is associated with unsanitary conditions. Children suffer from superficial pyoderma more often than adults, the incidence rate reaches 30-60% of the total number of children’s dermatoses. The ways of infection are airborne and contact.
The probability of developing the disease depends on the amount and composition of the flora, as well as on the level of resistance of the organism. The main causative agents of superficial pyoderma are representatives of the coccal flora, each of which has its own characteristics. Streptococci cause a pathological process endemic to regions with tropical and subtropical climates. The peak of seasonal microbial activity occurs in the summer months, so in June-August there is an increase in the incidence of superficial pyoderma. The peculiarity of this infection is the manifestation of clinical manifestations and the inability to latent carrier. Staphylococci, on the contrary, are non-endemic, possibly latent carrier, which requires preventive treatment of all those who have come into contact with the patient with superficial pyoderma. The relevance is determined by the prevalence and contagiousness of pathology.
Pathogens of pathology are cocci, widespread in the environment and having a high invasive activity, which allows them to overcome the barrier properties of the skin, fix themselves in the surface layers of the epidermis and dermis, and then multiply. Exogenous and endogenous factors provoke superficial pyoderma. The first include injuries, temperature changes, exposure to chemicals. To the second – fatigue, intoxication, foci of perifocal infection, hypovitaminosis, somatic diseases. The probability of the occurrence of superficial pyoderma increases with violation of the rules of personal hygiene, the presence of unsanitary working and living conditions.
The development of the inflammatory process on the skin depends on the amount of pathogenic flora, reactivity and resistance of the body. Coccal flora, damaging skin cells, stimulates the production of biologically active substances, activates T-lymphocytes with the development of inflammation. The predominance of exudation contributes to the formation of fluid-filled cavities in the epidermis, that is, the appearance of bullae on the skin. Proliferation leads to the appearance of nodules. Inflammation is accompanied by the release of histamine, itching occurs, scratching appears, secondary pyococcal flora joins, superficial pyoderma develops.
Classification and symptoms
Currently, dermatologists divide superficial pyoderma on an etiological basis into streptococcal, staphylococcal and mixed, according to the severity of the process – into acute and chronic. Clinically, all varieties of superficial pyoderma are united by a primary element – a flicken of different sizes and localization.
Acute streptococcal superficial pyoderma include:
- Streptococcal diaper rash (intertrigo), characterized by maceration and swelling of the skin folds. Against this background, flickens appear, which are quickly opened with the formation of erosions that tend to merge. Due to constant friction, the irregular-shaped drain hearth is surrounded by a frill of the epidermis along the periphery – the remnants of the flickten tire. The process is accompanied by itching, burning, excoriation and the addition of a secondary infection.
- Streptococcal impetigo is a contagious dermatosis, which manifests itself as a small bullous rash on the background of hyperemia. The rash is localized on the face, limbs and trunk. The bulls are eroded, covered with crusts that do not leave a trace. The high contagiousness of dermatosis requires isolation of the patient until complete clinical recovery.
- Streptococcal congestion – pustules in the corner of the mouth, not dangerous to the patient’s health, but causing pain. Children or patients with endocrine disorders usually suffer from congestion (cheilitis).
- Streptococcal dry streptodermia, characterized by the appearance of flaky pustules with a tendency to merge and form foci with scalloped edges up to 10 cm in diameter. Children get sick more often. Pathology is localized in the nasolabial folds, behind the ears, on the cheeks.
- Streptococcal panaritium is a pustular inflammation on the palmar surface of the fingers with swelling, hyperemia and soreness.
Among acute staphylococcal superficial pyoderma , there are:
- Ostiofolliculitis is an inflammation of the hair follicle or sebaceous gland with the formation of pustules, from which pus is released when pressed.
- Superficial folliculitis is a pustular inflammation of the hair sac, resolved without traces.
- Bullous impetigo in children is the most dangerous type of superficial pyoderma with purulent hemorrhagic bulls, erosions and multilayer crusts. Nails are affected, somatic diseases worsen, the general well-being of patients is significantly disturbed.
- Pemphigoid of newborns – characterized by the appearance of flicken around the navel and in the folds of the skin. Mucous membranes may be involved in the process.
- Exfoliative (leaf-like) dermatitis of newborns Ritter – resembles the pemphigus of newborns, rashes in the form of bulls are localized around the mouth, navel and anus, on the genitals. The disease has three degrees of severity, is accompanied by a violation of the general condition, can transform into erythroderma. The older the child, the milder the dermatitis.
Mixed superficial pyoderma is represented by an acutely current vulgar impetigo – a contagious skin disease with the formation of flicten around natural openings and the involvement of skin appendages in the process.
Chronic forms of superficial pyoderma include:
Chronic diffuse streptoderma with recurrent rashes of pustules on the lower extremities, resolved with the formation of erosions, crusts. Rashes are accompanied by non-intense itching.
Staphylococcal vulgar sycosis with the formation of folliculitis in the area of the mustache and beard, has a recurrent course.
Mixed chronic atypical abscessing pyoderma with the appearance of flicten of any localization against the background of immunodeficiency and inverse conglobate acne – a type of absceding recurrent pyoderma with the formation of flicten in the armpits, genitals and buttocks after acne.
Diagnosis and treatment
The clinical diagnosis is made on the basis of anamnesis and typical symptoms using dermatoscopy and inoculation of the contents of flikten on nutrient media in order to determine the type of pathogen and its sensitivity to antibiotics. Taking into account the background pathology, blood is taken for sugar, with a severe course of superficial pyoderma, the main characteristics of the immune system are examined using an immunogram. Differentiate superficial pyoderma with acne-like syphilis, pink acne, drug-induced toxicoderma, eosinophilic folliculitis of HIV-infected, hydradenitis, lichen planus, dermatomycosis, epidermolysis bullosa, eczema, candidiasis, bromoderma.
Treatment is aimed at sanitizing the lesion in order to prevent the spread of superficial pyoderma. With localized forms, local therapy is carried out. Flickens are opened, disinfected, antiseptic solutions, aniline paints, pastes with antibiotics, keratoplastic drying patches are prescribed. In case of resistance to external therapy, vitamins and antibiotics are used orally. In severe cases, hormones, immunomodulators, cytostatics, autohemotherapy are indicated. With staphylococcal superficial pyoderma, anti-staphylococcal immunoglobulin, plasma, toxoid, bacteriophage are used. In addition, with superficial pyoderma, UV, UHF, electrophoresis with medications, and a helium-neon laser are effective. Boils are treated surgically.
Prevention of superficial pyoderma consists in observing the rules of personal hygiene and sanitary standards, sanitation of foci of chronic infection. It is forbidden to wash the lesion, squeeze out flickens, apply compresses. It is necessary to treat the affected area around the perimeter with alcohol solutions. The prognosis, subject to hygienic standards, timely diagnosis and treatment, is favorable, the outcome is a complete recovery.