5. pioderma

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  • PYODERMACreator:Rini Ardianti AlwiIda SambanBuyung Sugianto

    Advisor:dr. Mutmainnah

    Supervisior:dr. Sri Vitayani, Sp.KK

  • IntroductionPyoderma: Skin infection caused by Staphylococcus aureus or Streptococcus hemolyticus Classification: Impetigo, folliculitis, furuncle, carbuncle, echtyma, paronikia, erysipelas, cellulitis & Staphylococcal scalded skin syndrome

  • IMPETIGO

  • Definition:Superficial infection localized in the subcorneal of the epidermisEpidemiology: Bullous impetigo any ageCrustosa impetigo childrenEtiology:Bullous impetigo Staphylococcus aureus Crustosa impetigo Streptococcus hemolyticus

  • Portals of entry of infectionPrimary impetigo arises at minor breaks in the skin.Secondary impetigo (impetiginization) underlying dermatoses & traumatic breaks in the integrity of the epidermis.

  • Physical examinationBullous impetigo:Erythema, vesicles, bullaeDistribution: intertriginous sites, face, chest & the back

  • Crustosa impetigo:

    Vesicles or pustules rupture, erosions, crust.(Golden-yellow crusts)

    Distribution: On the face

  • Topical treatment :Mupirocin ointment ManagementSystemic antimicrobiol treatmentOrganism : Group A Streptococcus.Drug of choice / dose :Penicillin VKBenzathine penicilin

    Alternative drugs :Erythromycin Cephalexin

  • Organism : Staphylococcus aureus.Drug of choice / dose :DicloxacillinAlternative drugs :Cephalexin Amoxicillin plus clavulanic acid (-lactamase inhibitor)DD:Bullous impetigo dermatofitosisCrustosa impetigo echtyma

  • FOLLICULITIS

  • Definition: A bacterial infection that involve the ostium of a hair follicleEpidemiology:Any age, most common in adultEtiology : Most common Staphylococcus aureusClassified :Superficial folliculitis.Deep folliculitis.

  • Local treatment :Local antibiotics (mupirocin).Warm saline compresses.DD:Tinea barbeAkne vulgaris

  • FURUNCEL

  • Deep seated inflammatory nodule hair follicle.Usually from a preceding superficial folliculitis elvolving into an abscess.The neck, face, axillae & buttock.Complicate preexisting lesions.

  • Start as a hard, tender, red folliculo centric nodule in hair-bearing skin enlarges painful & fluctuant rupture occurs pus & necrotic material pain surrounding the lesion subsides redness & edema diminish several days to weeks.Solitary lesions or multiple lesions in sites the buttocks.

  • CARBUNCLE

  • Larger, more serious inflammatory with a deeper base.Fever, malaise patient appear quite ill.Involved area is red & indurated, multiple pustules on the surface yellow-gray irregular crater at the center heal slowly by granulating.

  • Furuncle & carbuncle bacteremic spread of infection & recurrence individuals perspire excessively or poor skin hygiene.Treatment of furuncles & carbuncles :- Drainage.- Systemic antibiotic:* Dicloxacillin * Clindamycin * Erythromycin

  • DD:Sporatrikosis

  • ECHTYMA

  • Definition: A deep necrotic infection of the skin (eidermis & dermis)Epidemiology:Any age. More common in childrenEtiology: Staphylococcus aureus or Streptococcus hemolyticus

  • CLINICAL MANIFESTATION Vesicle or vesicopustule with an erythematous base erodes through epidermis into dermis form a crusted ulcer with elevated margins Distribution:Extremitas inferior

  • Therapy

    Systemic:Dicloxacillin Cephalexin Clindamycin CiprofloxacinTopical:* Local wound care* Mupirocin apply twice daily* Bacitracin apply twice daily

  • DD:Impetigo krustosa folikulitis

  • PARONIKIA

  • Definition:Inflamation of crease of the nailEpidemiology:Any age, especially laundrymanEtiology:Staphylococcus aureus

  • CLINICAL MANIFESTATIONEdemaAbsesPainful

    Distribution: Nail

  • Therapy:Topical insisi & drainaseSistemik Ab (Kloksasilin)DD:Pianikia

  • ERYSIPELAS

  • Superficial cutaneous cellulitis with marked dermal lymphatic vessel involvement painful, bright-red, raised, edematous, sharply marginated from the surrounding normal skin

  • Caused :Group A -hemolytic streptococcus.Staphylococcus aureus (rarely).Group B streptococcus in the newborn.Predilection : face, lower legs, areas of preexisting lymphedema, umbilical stumps.Age of onset : any age.

  • Cellulitis

  • Clinical manifestationsErythemaWarmthSwellingLocal painTenderness

  • * Tissue feels hard on palpation & painful.* Age of onset : any age.Caused :* Staphylococcus aureus.* Group A -hemolytic streptococcus.Management* Rest, immobilization.* Drain abscess, debride necrotic tissue.* Antimicrobial therapy

  • Staphylococcal scalded skin syndrome

  • Definition:Severe skin inflamation disease with epydermolysisEpidemiology:Most common: in children (
  • CLINICAL MANIFESTATIONFeverErythemeBulaEpidermolysis

    Predilection:universal

  • Treatment:Ab (Kloksasilin)KlindamisinDD:Nekrosis Epidermal Toksik (N.E.T.)

  • Any question ?