Pyoderma is an infectious dermatological disease that requires prolonged treatment (depending on the depth of the skin lesion). In the absence of a therapeutic effect on the foci of the disease, the pathology is capable of turning into a chronic stage of development, fraught with disability.
Often the causative agents of the disease are streptococci or staphylococcus. But more often the latter cause the development of pyoderma. But the habitat of streptococci are mainly mucous membranes.
Staphylococci are present on the skin of each person, but they do not always cause the appearance of a pathological process. Often this happens under the influence of weakened immunity, temperature changes, prolonged depressions.
In addition, other pathogens live on human skin - pseudo-diphtheria bacillus, yeast fungi, etc. When creating conditions favorable for their reproduction, they can also cause purulent skin lesions.
Causes of Pyoderma
On the skin of humans inhabited by many microorganisms. Some of them do not pose a threat to health, since they are part of normal microflora, but there are also those whose abnormal activity can cause the development of pyoderma. During the period of their vital activity, these bacteria secrete enzymes, exo- and endotoxins, which cause an aggressive reaction of the body. As a result, the development of the disease occurs.
Of great importance are the working conditions, and human compliance with the rules of hygiene. In addition, the important role played by the age and state of human immunity. If the immune system is weak, while the rules of hygiene are neglected, the risk of pyoderma increases significantly. The disease can also be caused by external factors, for example, microtraumas, stresses, hypothermia, or overheating. In addition, people with diabetes mellitus, gastrointestinal diseases, malfunctions in the blood formation process, etc. are at risk. All these diseases inhibit the immune system, making a person vulnerable to the attack of pathogens.
Oily skin is an excellent habitat for the Pococci, since a change in the chemical composition of subcutaneous fat significantly reduces the sterilization properties of the skin. Fluctuations in hormone levels and long-term use of glucocorticoids leads to the development of diseases that predispose 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. This type of disease affects only the superficial layers of the dermis. A variety of this form of pyodermatitis include ostiofollikulit, folliculitis, vicosis vulgaris and impetigo, furunculosis, carbuncle, abscesses in newborns, etc.
- Streptococcal. Streptoderma is a type of superficial pyodermatitis characterized by the appearance of lichen on the face and impetigo. If the infection affects the deep layers of the dermis, the patient may have ecthyma or erysipelas.
- Mixed. This form causes the development of streptostaphylococcal impetigo and ecthyma. Chronic pyoderma is divided into ulcerative, vegetative and shankriformnuyu form. If there is a severe infection of the legs, a gangrenous form develops. Against the background of weak immunity, such a disease may eventually lead to the need for amputation of a sore limb.
Each group is divided into 2 subgroups, which are determined depending on how deep the lesion of the dermis is (surface and deep forms).
All types 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 tenderness;
- formation of inflammation with sero-purulent contents inside;
- violation of skin pigmentation;
- sensation of itching, burning, stinging;
- enlargement and tenderness of the lymph nodes.
In case of multiple rashes and deep lesions, symptoms of general intoxication appear: fever, nausea, loss of performance, etc. Severe types of pyoderma (carbuncle, gangrenous forms, etc.) cause a more serious clinical picture. Patients may suffer from vomiting, delusional states, confusion, hallucinations.
It is important to bear in mind that in young children the symptoms are more severe, since the child’s immune system is not yet fully formed, and therefore is unable to fully deal with the pathological process. In addition, due to the low body mass, a more intense poisoning of the child’s body occurs with poisons formed during the process of dying off of the infected tissues.
Specific signs of different types of pyoderma:
|Ostiofolliculitis||Small pustules (pustules) with redness at the base. Localized on the neck, face, legs, shoulders. After maturation, they atrophy, leaving no scars.|
|Folliculitis||The foci of inflammation are larger, weakly painful, with a thick wall, pustules with dense greenish or whitish-yellow pus surrounded by reddened swollen skin. In deep form, pain is increased, blisters with pus reach 15 mm, the area of hyperemia is increased. If many pustules are formed, the process is accompanied by a deterioration of the condition, blood counts.|
|Epidemic pemphigus of newborns||Bubbles with dull-whitish exudate capture the entire surface of the skin in the first week of life. When blistering, erosion develops. Massive spread of pemphigus can lead to the death of the infant.|
|Sycosis vulgar||Shallow inflammation of the hair follicles in the area of the lips, nose, chin, temples, pubis. Frequent fusion of pustules, 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 core of dying tissue. At the opening of the abscess up to 10 days there is an outflow of ichor with pus and the ejection of a necrotic rod. Heals up to 14 - 20 days with scarring.|
|Hydradenitis||Acute-painful dense purulent node in the thickness of the fiber up to 40 - 70 mm, formed from several ulcers in the area of the sweat glands of the armpits. Characterized by: thick pus, bluish-purple color, strong swelling. The maturation of purulent conglomerate and the release of pus from the openings is accompanied by severe pain, fever, nausea. Lasts up to 10 - 15 days. Tightening the wound after cleansing 10 - 12 days.|
|Carbuncle||Formed during the confluence of 2 - 3 boils as a very large, almost black in color dense abscess in the thickness of the dermis. Characterized by: intense, jerking pain, profuse suppuration, several central rods of dead tissue, the formation of fistulas. After the rods are pushed out of the dermis, a deep ulcer appears, which heals slowly with the formation of a rough scar. For heavy with fever, chills, vomiting, high risk of sepsis.|
|Intertriginous||Flat flikteni (serous bubbles), which burst, opening red weeping wound zones, which merge into foci surrounded by exfoliating skin fragments. The excretions dry up, forming brown crusts under which the skin changes color.|
|Papulo-erosive||The small, uniting bubbles with water-blood exudate. Burst, leaving inflamed, wet erosion. The disease quickly flows into a chronic form that hardly responds to therapy.|
|Erythemato squamous (dry lichen)||Rounded red-pink patches are formed with small, flour-like, flaky scales. Sometimes itchy. It can be combined with slit impetigo, intertriginous pyoderma.|
|Strep impetigo||Flat bubbles (conflict) 5 - 10 mm with watery (or purulent) exudate on the face (lips, gums, inside the cheeks). Dried precipitates from flichen form dry honey-yellow crusts. After their removal on the skin, red spots that have not been seen for a long time are visible.|
|Ethtima vulgaris||Blister 10 - 20 mm with purulent, watery, blood-like contents. Dry brown-brown crusts, inflamed tissue, has a bluish-purple color. A deep ulcer is formed under the crust, which heals for a long time and leaves a scar and a changed skin color along the edges.|
|Erysipelas||A sharp reddening in 5 - 8 hours transforming into a bright red edematous and dense inflammatory focus, turning into fiber. The skin is hot, painful, stretched. The temperature rise to 39 - 40 C.|
|Diffuse (diffuse) streptoderma||Large flicenes or small bubbles merge into large foci of hyperemic edematous skin. Under bursting blisters opens ulceration with uneven contours. Abundant discharge, drying out, form greenish-yellow crusts. The hearth is growing rapidly, capturing healthy skin. For a long, gives relapses.|
|Shankriformnaya||A single, painless, rounded ulcer 10 - 20 mm, covered with a bloody crust. Around tight swelling. Externally similar to syphilitic chancroid. Sometimes several ulcers form. Lymph nodes swell. Heals after 30 - 60 days.|
|Chronic ulcerative vegetative||Inflammation, swelling and hyperemia. Ulcers and soft flat plaques of a bluish-red color are covered with ulcers and are surrounded by a pink corolla. Foci of fused pustules, plaques and ulcers secrete a purulent serous fluid. After removing loose crusts, epithelial growths in the form of papillae and thick pus are exposed. Soreness Aggressive spread with the capture of healthy areas.|
Pyoderma - photo
The initial stage of development of pyoderma and the type of pathological rash can be seen in the photo below:
Pyoderma in children
The children's organism is the most favorable environment for habitat and reproduction of pathogenic microflora. The skin of the child is too thin, so the pathogens easily penetrate through the sweat glands into the underlying dermis. Often the cause is infection with cocci bacteria, but sometimes the pathological process can be the result of anomalous activity of pseudomonas or Escherichia coli. Newborn babies, in which the umbilical wound is slowly healing, are susceptible to illness.
Pyoderma in children begins with a slight redness on the surface of the skin, which soon turns into a vial filled with pus. After opening the eruptions, crusts form in their place, which then disappear themselves. If the situation is run, ulcers can develop into boils, and this is fraught with the development of an abscess or phlegmon. The child develops fever, there are serious complications. Due to the frequent need to scratch itchy wounds, the infectious process in children spreads rather quickly. Antimicrobial agents are prescribed for the treatment of the disease in small patients.
To prevent the development of the disease in a child, parents should monitor the hygiene of his body. In the case of an inexhaustible cleansing of the skin, there remain on them particles of food, feces, urine, which is a very favorable medium for microflora, provoking pyoderma. Along with hygienic procedures, the child must provide a balanced diet, and protect it from overcooling or overheating.
To wipe the skin of children need to use a weak solution of potassium permanganate or 1-2% solution of salicylic acid. Treat the skin of the child with antiseptics, oils or balms should be at least 3 times a day.
First of all, a visual inspection and questioning of the patient for complaints is carried out. But this is not enough. To distinguish pyoderma from other types of dermatosis, accompanied by similar symptoms, it is necessary to conduct a number of diagnostic (laboratory and instrumental) procedures:
- Clinical study of the contents of ulcers, ulcers, wounds, pustules present on the patient's skin.
- Microscopy of the pathological contents of the rash and surrounding tissues.
- Histological analysis for oncological changes in the affected tissues.
- Blood test for hemoglobin.
- PCR analysis of blood and the contents of the abscesses for the early detection of the type of pathogen.
- PRP test for syphilis.
In order to identify specific diseases that caused pyoderma, it is necessary to consult other specialized medical specialists. For this you need:
- undergo caprogram and immunogram;
- be tested for the detection of dysbiosis;
- be tested for hormones;
- get cancer research;
- make ultrasound diagnosis of abdominal organs.
How to treat pyoderma?
Comprehensive treatment prescribed only by a dermatologist. Therapy may be etiological, pathogenetic and symptomatic. When mixed forms of pyoderma treatment can be outpatient or inpatient, which is determined individually, based on the severity characteristic of each case of clinical manifestations.
- In the affected area, the hair is neatly clipped, but not shaved, in order to prevent the spread of pathogenic microflora to healthy skin. In case of extensive skin lesions, the patient is prohibited from carrying out 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. Solutions of salicylic acid and potassium permanganate have a good effect.
- Although contact with water should be minimized, washing hands daily is imperative. After that, nail plates should be treated with 2% iodine solution to prevent the spread of infection. Several times a day, you need to thoroughly wipe healthy skin with a damp sponge.
- Great nutrition. Throughout the course of treatment, it is necessary to follow a milk-vegetable diet, abandoning simple carbohydrates, alcohol and extractive substances.
- In the presence of concomitant diseases, symptoms of intoxication or exhaustion, or with a protracted course that threatens to become chronic, antibiotic therapy is carried out. Before the appointment of specific drugs performs bacposiv and antibiogram. In this case, antimicrobial agents of the penicillin series are practically not used. Instead, patients are prescribed macrolides or tetracyclines. But erythromycin and tetracycline is not used in the treatment of children and pregnant women.
- If several pathogens are detected at the same time, 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 is usually 7 days.The dosage is prescribed by the doctor for each patient individually. Sulfanilamide drugs are considered ineffective for pyoderma, but if the patient is intolerant of other antibiotic drugs, Sulfamethoxazole can be used in combination with Trimethoprim, or Sulfonemethoxime in the required dosage.
- Specific immunotherapy combined with antibiotic treatment gives positive results for sluggish or chronic course.
- In inpatient treatment, anatoxins, specific antigens or staphylocoproteins are administered to the patient. Manipulations are carried out twice a week. The route of administration is subcutaneous.
- In order to stimulate the nonspecific immune system of a person, autohemotransfusion, transfusion of individual blood components, and ultraviolet blood irradiation are carried out. It is also advisable to use methyluracil and alcoholic extracts of Schizandra or Eleutherococcus. They also improve the functioning of the immune system.
- In the presence of immune disruptions, immunostimulatory drugs from the thymus group, gamma globulins, and interferon stimulants are prescribed. Vitamin therapy is performed 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 the carbuncle, furuncle, hydradenitis. The essence of this method of treatment is to pierce the bladder wall with a thin scalpel and further drain it. Before manipulation using painkillers.
It is impossible to remove the purulent-necrotic rod independently - this can lead to very serious consequences!
Lack 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;
- the spread of infection in the tissues of internal organs and bones;
- purulent abscesses of various localization;
- purulent mediastinitis;
- development of cellulitis of the orbit;
- the formation of blood clots in the vessels of the brain;
- sepsis with severe consequences.
To prevent the development of pyoderma contributes to:
- timely treatment of chronic diseases;
- compliance with sanitary standards when working in enterprises;
- emergency treatment of wounds and other injuries of the skin with antiseptics;
- regular preventive medical examinations.
Often, treatment of pyoderma, occurring in mild and moderate severity, is carried out at home. But in no case it is impossible to ignore the symptoms of the disease - in case of their manifestation it is necessary to seek help from a dermatologist. Only a doctor will be able to prescribe adequate treatment and prescribe the necessary dosages of drugs.
At home, the patient will only need to follow the rules of personal hygiene, follow the doctor's instructions regarding pharmacotherapy and promptly treat any damage that has occurred on the skin's surface.
Early detection of the disease makes it possible to immediately begin treatment. This, in turn, will help avoid adverse complications.
- Exact compliance with all the recommendations of the doctor, especially in terms of diagnosis and treatment, makes predictions of recovery very favorable.
- Doing self-medication, or an attempt to squeeze the ulcers leads to the spread of infection and aggravate the course of the disease. This approach causes serious complications that make the prognosis for recovery very unfavorable.
Based on the foregoing, one can make an unequivocal conclusion: it is impossible to self-medicate with pyoderma - this increases the risk of unpleasant complications.