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Management of patients with

Bacterial skin disorders

1 BY Bekele T.(BSc,MSc)
Bacterial Infections

Impetigo
superficial infection of the skin consisting of
vesicle that soon rupture to form honey
yellow crust.
Is caused by either staphylococci or
streptococci.
The diseases is much common in children
It has sudden onset and short course
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Nonbullous Impetigo

70 percent of cases of impetigo


Affects both children and adults
Caused by Group A Streptococcus, S. aureus
or both.
Spread occurs from nasal carriers to skin or
from skin to skin

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Nonbullous Impetigo

The face (especially around the nares)


commonly affected.
Constitutional symptoms are absent
The initial lesion is a transient vesicle or pustule
that quickly evolves into a honey-colored
crusted plaque.
Surrounding erythema may be present.
Regional lymphadenopathy is present in
patients with prolonged untreated infection.
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Nonbullous Impetigo Rx

Treatment is removal of the crusts and


application of topical antibiotics like
Tetracycline, Bacroban, or Foban twice a day
for 3 to 5 days
Systemic antibiotics to prevent infection.
Most cases will respond to treatment and heal
with out scaring.

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Bullous Impetigo

Less common form of impetigo


Mainly affects newborns and infants
Caused by S. aureus
Exfoliative toxins types A and B are responsible
for the clinical pictures.
Rapidly progressing flaccid bullae, usually arising
from grossly normal skin and initially contain clear
yellow fluid that subsequently becomes dark
20 yellow and turbid. BY Bekele T.(BSc,MSc)
Bullous Impetigo

Light brown to golden-yellow crusts is formed


later.
Gram stain may help in diagnosis
Local treatment with mupirocin ointment and
removal of crusts and maintenance of
cleanliness is sufficient to cure mild cases
Systemic agents for severe cases.

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Bullous Impetigo

Cellulitis, lymphangitis, and bacteremia with


resultant osteomyelitis, septic arthritis,
pneumonitis, and septicemia may follow
untreated cases

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Because the blisters are
so superficial, they
rapidly break to give
honey-coloured
crusts

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ECTHYMA

Ecthyma, like impetigo is caused by S.


aureus and/or group A streptococcus.
The upper dermis & epidermis both are
affected.
Poor hygiene and neglect are key elements
in pathogenesis
Most commonly occur on the lower
extremities
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ECTHYMA

Children, neglected elderly patients or


individuals with diabetes mellitus are
specially predisposed.
Start by vesicle/pustule then to blister
breakdown to form ulcer.
The ulcer has a punched out appearance
with dirty grayish-yellow crust, indurated red
margin
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Adult with ecthyma before Immediately crust removed
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crust BY Bekele T.(BSc,MSc)
One month later Two months later
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ECTHYMA

Systemic antibiotics covering the etiologic


agents with local wound care and correction
of underlying conditions is the treatment
The lesions heal slowly with scaring.
Serious complications may occur

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FOLLICULITIS

Inflammation beginning within the hair follicle


Could be superficial and Deep, Infectious or
Non-infectious.
Infectious causes include Baceria (S. aureus,
Ps. aueroginosa, gram negatives),
Fungi (Dermatophytes, Pitrosporum,Candida
spp.),
Viruses (Herpes Simplex, Mulluscum
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FOLLICULITIS

Noninfectious
folliculitis are
common in black people:
Pseudofolliculitis barbae
Folliculitis keloidalis,
Perifolliculitis capitis

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FOLLICULITIS

Superficial folliculitis (also been termed



follicular or Bockhart's impetigo)
presents as small fragile dome-shaped
pustule.
occurs at the infundibulum of a hair
follicle, often on the scalps of children
and
in the beard area, axillae, extremities,
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FOLLICULITIS

Sycosis barbae is a deep folliculitis


with perifollicular inflammation
occurring in the bearded areas of
the face and upper lip.

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FOLLICULITIS

A furuncle or boil is a deep-seated


inflammatory nodule that develops about a
hair follicle,
Usually from a preceding, more superficial
folliculitis and often evolving into an abscess

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FOLLICULITIS

A carbuncle is a more extensive, deeper,


communicating, infiltrated lesion that
develops when suppuration occurs in thick
inelastic skin.
Fever and malaise are often present
Both furuncle and carbuncle are caused by
S. aureus.

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Folliculitis Infection at the
mouth of a hair follicle.
See a pustule with a hair
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FOLLICULITIS

Simple furunculosis may be treated by local


application of moist heat and topical
antibiotics
Presence of systemic symptoms is an
indication to give penicillinase resistant
antibiotics.
Drainage of abscess may also be needed.

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CELLULITIS

Inflammation of subcutaneous tissue


S. aureus and group A streptococci are
by far the most common etiologic agents
Disruption of the barrier function together
with the bacterial and host factors are
responsible in progression of the disease

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CELLULITIS

In many cases there is a history of an


antecedent lesion
Patients experience erythema, local pain, and
tenderness and variable degrees of systemic
symptoms
Indurated, tender and hot, vaguely
demarcated lesion with swelling of the affected
limb is evident.
Regional lymph nodes may be involved.
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