Sycosis is a pustular skin disease caused by Staphylococcus aureus. The development is based on neuro-endocrine disorders that change the sensitivity of follicles. Sycosis affects the growth area of the beard and mustache on the face. The disease begins with the clinic of superficial folliculitis, which spread to healthy areas of the skin, recur and are protracted. Disease can be diagnosed on the basis of a characteristic clinical picture. However, for successful treatment, it is necessary to establish the etiology of the disease (mycotic, staphylococcal, lupoid).
Since sycosis belongs to the pyoderma group, microtrauma and cuts during shaving can provoke its occurrence. Chronic rhinitis can also provoke sycosis, as the skin over the upper lip loosens, and during blowing your nose, mucus is rubbed, which contains a large amount of staphylococcal flora. Chronic conjunctivitis often precedes sycosis of the eyelid skin. Removal of nasal hair with tweezers leads to sycosis on the inner surface of the wings of the nose and on the nasal septum.
Sycosis occurs on the hairy part of the face, the area of the mustache and beard is affected. In women, sycosis is diagnosed less often, and it is localized on the inner surface of the wings of the nose, on the eyebrows and along the edge of the eyelids. On the skin of the armpits, on the pubis and on the skin covered with long hair, sycosis occurs in isolated cases.
Disease begins with the formation of superficial folliculites, which are arranged in groups in the form of disks. As the folliculites grow, neighboring areas of the skin are involved in the process, and as a result, most of the skin is affected by sycosis. The primary manifestations of sycosis in the form of shallow folliculitis begin suddenly and pass just as suddenly. But after a short time, the folliculitis returns, its course becomes protracted, deep lesions of the follicles appear and clinically a typical picture can be observed.
The skin affected by sycosis is sharply inflamed, hyperemic and swollen. Soreness increases when touched and hypersensitivity of the affected area. With sycosis, the skin is covered with a large number of pustules that are very close to each other, their base is compacted and has a bright red color.
Purulent pustules quickly dry out, which is why the entire surface is filled with their contents. As a result, the skin affected by sycosis is covered with dirty yellow or greenish crusts. Over time, the crusts disappear, but due to the constant purulent process they reappear. After removing the crusts, the wet inflamed surface is exposed. Often, with sycosis, redness and swelling goes beyond the main focus.
On the periphery of the zone affected there are scattered isolated elements of impetigo, which merge with it as the peripheral growth of the main focus. Since follicular pustules occur one after another in sycosis, the inflammatory infiltrate increases without adequate therapy.
The area affected by sycosis is painful only when touched, otherwise patients rarely complain of itching and burning. Disease completely disfigures a person’s face, and therefore, in addition to the main purulent process, people experience depression, they become withdrawn and cannot lead an active lifestyle. The general condition of patients with sycosis does not suffer, the temperature rises extremely rarely, regional lymph nodes are normal.
Parasitic form differs from ordinary sycosis by a less pronounced infiltration zone, the absence of high-standing single purulent papules and proceeds acutely, without relapses, since with parasitic sycosis immunity develops and self-healing often occurs.
Lupoid sycosis is a rare form of staphylococcal lesion of hair follicles, has a sluggish wave-like chronic course. With lupoid sycosis, pustulation is weakly expressed, but after healing, atrophied skin areas and persistent baldness remain.
Despite the fact that the cause of lupoid form is still the same Staphylococcus aureus, the etiology and mechanism of development have not been fully clarified, since the microbial factor is only one of the links in pathogenesis. With lupoid sycosis, additional colonization of the follicular apparatus by another gram-negative microflora is possible. Lupoid form often develops against the background of seborrheic status, diabetes mellitus and chronic focal infection.
Lupoid sycosis is more often diagnosed in middle-aged and elderly men, the beard and mustache area, temporal and parietal areas of the scalp are affected. Lupoid sycosis has a chronic course and begins with congestive erythema. Grouped follicular nodules, pustules and light yellow crusts appear on its background. Grayish scales are localized near the affected follicles and are easily removed by scraping.
Over time, the pustules and crusts merge, forming a rounded plaque with a diameter of up to 3 cm clearly delimited from healthy skin. Due to infiltration, it has a wine-red color and is located on a flat, painless, compacted base. In the future, the plaque begins to pale from the center to the periphery, the skin above it becomes thinner, becomes smooth and hairless, and the characteristic sinking of the element characteristic of lupoid sycosis develops with the development of skin atrophy in the center. No new pustules are formed within such a plaque, which is an important difference between lupoid sycosis and vulgar. Sometimes single tufts of hair are preserved in the plaque area.
The zone of peripheral infiltration is insignificant – about 1 cm, the skin is slightly elevated, hyperemic, moderate infiltration is noted. In this area, you can see numerous follicular papules with rare pustules in the center. The lesion of sycosis is slowly increasing due to peripheral growth and due to the appearance of new inflamed follicles. In most cases, the affected area has regular rounded shapes, but sometimes the growth of the focus prevails along one of the poles of the sycosis zone, then the shape of the affected area becomes asymmetric and takes uneven outlines.
Lupoid sycosis has been going on for many years, sometimes with long periods of incomplete remission, it worsens spontaneously without any objective reasons. The general condition of patients with sycosis does not suffer, painful or unpleasant sensations are practically absent, except in cases when lupoid sycosis affects the scalp. The soreness is explained by the anatomical features of the scalp and the proximity of aponeurosis.
Vivid clinical manifestations make it possible to accurately diagnose, but it is necessary to differentiate vulgar, parasitic and lupoid sycosis. The basis of parasitic sycosis is a fungal infection and later the staphylococcal microflora joins. With lupoid form, the clinical picture is somewhat different.
Microscopy results exclude or confirm mycotic flora. Sowing and cultural examination of purulent discharge and crusts are carried out before the appointment of antibiotic therapy, since otherwise it is much more difficult to isolate the pathogen. Together with the isolation of the type of pathogen, an examination is carried out for its sensitivity to antimicrobial drugs.
Therapy of sycosis is usually long-term. It is carried out by a dermatologist or mycologist and consists in the topical application of antimicrobial ointments and in taking antibiotics orally. During periods of exacerbation, disinfectant lotions with potassium permanganate and boric acid are used, which prevent repeated contamination and soften purulent crusts. After the rejection of the crusts, gentamicin and syntomycin ointments are applied alternately.
As soon as the process of pus formation subsides, the foci affected by sycosis are lubricated with solutions of aniline dyes – diamond green or methylene blue. The area around is treated with iodine solutions. Tetracycline antibiotics – oxytetracycline, tetracycline and chlortetracycline, taken orally or as intramuscular injections, have a bacteriostatic effect on staphylococci. Laser treatment and UVI therapy are successfully applied.
All patients are shown to take vitamins, iron preparations that stop nervous disorders. With extensive lesions of sycosis, staphylococcal vaccine and autohemotransfusion are used. The prognosis is favorable if the treatment is followed, but it should be borne in mind that interruptions during antibiotic therapy and not following a diet that excludes alcohol and spicy dishes leads to the formation of antibiotic-resistant strains of staphylococci.
Prevention of sycosis is hygiene, accuracy during shaving and antiseptic treatment of minor injuries to prevent their infection.