1.1.1. bacterial infection of skin [compatibility mode]

1. Common
Bacterial Infection of
Skin
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

2. The Skin Skin is largest organ of body.
Maintains homeostasis, protects
underlying tissues and organs, underlying tissues and organs, protects body from mechanical
injury, damaging substances, and
ultraviolet rays of sun.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

3. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

4.
Broken skin allows Bacteria to enter DR. Ram Sharan Mehta, MSND, CON, BPKIHS

5. Unbroken skin prevents entrance of bacteria.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

6. Normal Skin Flora

Major bacterial groups
Coryneforms (Gram +ve)

Staphylococci (Gram +ve cocci, aerobs)

Minor bacterial groups
Acinetobacter (25%) Gram –ve Bacilli

Micrococcus
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

7. Bacterial Infection of Skin: 1. Folliculitis
Folliculitis is a localized infection of one hair
follicle.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

8. Bacterial folliculitis
•Local antiseptics
•Cloxacilline 500 mg
4x/d for 10 days
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

9. folliculitis
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

10. Folliculits
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

11. Management of folliculitis

Avoid greasy applications on the
skin.

Antibiotic:
topically can be used.

Systemic antibiotics: -Cloxacillin
or erythromycin
(Cefadox)
is
choices of treatment.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

12. Folliculitis
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

13. Superficial folliculitis
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

14. Deep folliculitis

Chronic

Staph. Aureus

Hair follicles of leg: Common

Hair follicles of leg: Common

Multiple

Atrophic scar

May become chronic especially
in beard area (sycosis barbae)
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

15. 2. Furuncle/Boils

A furuncle is an infection deep within the hair
follicle.

A furuncle or boil is an acute round, tender, circumscribed, perifollicular tender, circumscribed, perifollicular staphylococcal inflammation, which
generally tends to suppurate.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

16. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

17. Boils/ Furuncle
Boils (also called furuncles) are a deep infection of hair follicles.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

18. Furuncle (Boil)
Acute
Staph. Aureus

Small,
follicular nodular
-Pustule-necrotic-
discharge pus

Heal with scar formation Neck, Wrist, Waist, Buttocks, Face

Neck, Wrist, Waist, Buttocks, Face

Painful
Complication
Thrombosis

Septicemia (esp. on malnutrition patients)
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

19. Treatment: General measures Preventive measures are very important especially
to prevent recurrence of infection from nasal foci,
autoinoculation, from peri-anal areas.

Avoid squeezing, irritation and trauma to the lesio ns.

Treatment of the colonized areas and the primary fo cus
as in nostrils.

Topical antibacterial cream such as Muperacin cream

Topical antibacterial cream such as Muperacin cream which when applied twice daily in the nostril for o ne
week will eradicate colonized micro-organism for 6
months.

Using a suitable anti septic soap may have some good
effect.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

20. 3. Carbuncle

A carbuncle is an infection involving
subcutaneous tissue around several hair
follicles.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

21. Carbuncle
Extensive infection of a group of
contagious follicles

Staph. Aureus

Middle or old age

Middle or old age

Predisposing factors

Diabetes

Malnutuition

Severe generalized dermatoses

During prolonged steroid therapy
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

22. Carbuncle
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

23. Carbuncle
Painful

Suppuration begins after 5-7 days

Pus discharge from multiple follicular
orificies
Necrosis of intervening skin

Necrosis of intervening skin

Large deep ulcer
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

24.  
. 
4. Impetigo:
Superficial skin infection
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

25. Impetigo is a
bacterial
skin infection.
It is often called school sores
because, it most often affects because, it most often affects children.
It is quite contagious.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

26. Impetigo

Vesiculopustular skin
infection.

Bacterial:
staphylococcus or
streptococcus

Spread w/ direct contact
w/ lesions

Thick, yellow crust
(commonly on the face)
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

27. Impetigo

S/S -one or more pimple-like
lesions surrounded by
reddened skin reddened skin -lesions fill w/ pus and
later form a thick crust
-itching
Inv.
: Swab for C/S DR. Ram Sharan Mehta, MSND, CON, BPKIHS

28. Impetigo
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

29. Mx: Remove crust
Localized:Topical Antibiotic
Severe: Systemic antibiotics:
Semisynthetic Penicillin : 7
-
10 d
Semisynthetic Penicillin : 7
-
10 d
Erythromycine (sensitive)
Augmentin (face)
Cephalosporin
Great care with personal hygiene and possible
isolation.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

30. Impetigo
•Local antiseptics
•Cloxacilline 500 mg
4x/d for 10 days
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

31. 4.1. Non-bullous impetigo

Superficial (intraepidermal)

Initially vesicular, then becomes
crusted
S. pyogenes
(90%); also
S. aureus

S. pyogenes
(90%); also
S. aureus

Mainly children; highly
communicable
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

32. Nonbullous impetigo
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

33. 4.2. Bullous impetigo

Mainly newborn and younger
children

About 10% of all cases of impetigo

Caused by
S. aureus
of phage

Caused by
S. aureus
of phage
group II
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

34. Bullous impetigo
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

35. Predisposing factors

Malnutrition

Diabetes

Immuno-compromise status
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

36. Impetigo: Management

Local management for small lesions: -
Wash with betadine solution or saline.

Potassium permanganate 1 in 1000
solution soaking twice a day until the pus
exudates dry up. exudates dry up.

Gentian violet (GV) paint 0.5% apply BID.

Topical antibiotics can be used, such as
2% mupirocin, Gentamycine, Fucidic acid
can be used but costly
.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

37.
Oral amoxacyllin or Ampicillin can also be
used.

For Bullous impetigo: -cloxacillin 500 mg po
QID for 7 to 10 days. In cases, with an allergy
to penicillin, erythromycin can be given.

The underlining skin conditions such as eczemas, scabies, fungal infection, or eczemas, scabies, fungal infection, or pediculosis should be treated.

When impetigo is neglected it becomes
ecthyma, a superficial infection which involves
the upper dermis which may heal forming a
scar.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

38. 5. Periporitis

Miliary papules and papulovesicles with
staphylococcic infection.

Pustular lesions.

The commonest sites involved are the buttocks, upper part of the trunk and the scalp.

The lesion affects mainly malnourished infants and
young children.

Skin lesions may progress to sweat gland
abscesses.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

39. Rx

Treatment is directed towards improving the
nutrition and general condition.

Preventing sweat retention by aeration.

Appropriate topical antibiotic may be enough

Appropriate topical antibiotic may be enough to control periporitis.

Oral antibiotics may be needed, especially
when there are multiple abscesses.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

40. 6. Ecthyma

Formation of adherent dry crusts,
beneath which ulcer present

Strptococcal & staph

Common in children

Common in children

Small bullae or pustules

Butocks, thighs and legs, commonly
affected

Heals with scar and pigementation DR. Ram Sharan Mehta, MSND, CON, BPKIHS

41. Ecthyma
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

42. 7. Sycosis Barbae

Pustules surrounded by erythema
in Beard region

Common in Males

After puberty

After traumas

Upper lip and chin

Staph. auraus common
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

43. Sycosis barbae
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

44. 8. Cellulitis

Acute / Sub-acute / Chronic
inflammation of loose connective tissue

Streptococcal (Group A), Staphylococci

Streptococcal (Group A), Staphylococci and rarely clostridia.

Erythematous & oedematous swelling

Pain/tenderness
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

45. Cellulitis
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

46. Cellulitis

An acute spreading infection
involving the dermis

Spread: tissue damage,
lowered body defenses, or
virulence of invading organism.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

47. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

48. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

49. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

50. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

51. Cellulitis

Red, painful, hot, swollen skin area with ill-
defined borders.

Deeper involvement of the Subcutaneous

Raised, hot, tender, erythematous

Raised, hot, tender, erythematous

Source: Cut , abrasion or ulcer

Palpable, tender LN

Fever, leucocytosis

Differential Diagnosis: DVT
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

52. DR. Ram Sharan Mehta, MSND,
CON, BPKIHS

53. Mx
Cold application: to relief local discomfort

Analgesic to relief pain

Treat the fever and pain and elevate the
affected part.

Crystalline penicillin or procaine penicillin is

Crystalline penicillin or procaine penicillin is the first line therapy and oral Ampicillin or
Amoxicillin may be used for mild infection
and after the acute phase resolves.

Appropriate Antibiotic, according to culture:
Erythromycin, Augmentin.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

54. 9. ERYSIPELAS
β
Superficial Cellulitis caused by group A β-hemolytic
streptococcus.
β
Usually begins on the face or a lower extremity
β
Having pain, superficial erythema, and plaque-like edema with a sharply defined margin to normal edema with a sharply defined margin to normal tissue
β
Fever may precede local signs
β
Boarder easily palpable
β
Early Stage of Cellulitis?
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

55. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

56.
Erysipelas is a type of
cellulites involving mainly the
dermis; other forms of
cellulites extend to the cellulites extend to the subcutaneous tissues.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

57. Erysipelas
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

58. Erysipelas
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

59. 10. Pyonychia
Acute Erythmatous swelling of
proximal and lateral nail fold

Painful

Rx: Drain Pus,
Antibiotic,
Analgesic
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

60. Pyonychia
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

61. Pyonychia
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

62. 11. Staphylococcal scalded skin syndrome
(Ritter’s disease)

A severe reaction to S. aureus strains
producing toxins

Large, flaccid bullae rupture, causing same effect as a third
-
degree burn
same effect as a third
-
degree burn

Scald –tender red skin

Denuded skin (necked skin)

Heals 7-14 day
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

63. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

64. Staphylococcal scalded-skin syndrome
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

65.
Complication 2%
Cellulitis

Pneumonia
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

66. 12. Erysipeloid

It is bacterial infection seen in people who handle
raw meat (especially pork) and Fish.

Organism get entry through breaks in the skin.

Common on fingers, hand or forearms.

Common on fingers, hand or forearms.

No systemic symptoms

The main symptom is warmth, tenderness, and
redness on the skin.

Rx: Penicilline-V or Oxytetracycline 500 mg QID
7-10 days
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

67. 13. Principles of therapy of
pyoderma

Good personla hygiene

Local therapy
Cleaning with soap-water and weak
KMN04 solution
Removal of crusts with KMN04 solution

Removal of crusts with KMN04 solution

Application of antibacterial cream

Systemic therapy
Antibiotics DR. Ram Sharan Mehta, MSND, CON, BPKIHS

68. Management of predisposing factors

Local
Attend to traumas, pressure

Treat pre-existing dermatosis

Investigate carrier sites

Systemic
Treatment of disease like DM,
Nutritional deficiency and
immunodeficiency
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

69. 14. Common Diagnostic Tests
for Integumentary Disorders

Biopsy.

Patch Testing: Allergy test

Tzanck smear: detect type of cells in Chicken Pox,
H. simplex, H. Zoster, Bullous diseases

Skin scrapings.

Culture and sensitivity.

Diascopy: visualization by special microscope

Wood’s light examination: Use of U.V. rays
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

70. 15
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

71. 16. Prevention and control of
Bacterial skin diseases
Personal hygiene is the most effective
methods for prevention and control of
bacterial infections.
The following points illustrate the possible The following points illustrate the possible preventive methods for bacterial skin infections:

Washing of hands with warm water and soap
before touching broken skin.
Washing the body with warm water and soap
preferably everyday to remove dust and dirt.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

72. Prevention and control of Bacterial skin
diseases…………………

Wearing the right size and type of clothes to
suit local weather conditions.

After washing clothes, if possible, iron it
before wearing

Regular exposure of the skin to air and

Regular exposure of the skin to air and sunlight is beneficial.

It is also important to clear the bacteria
colonizing the nostrils and under the
fingernails with either antibiotic ointment or
petroleum jelly several times daily for one
week of each month.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

73. Methods of Preventing Long
Term Skin Damage

Avoid sun

Avoid midday sun

Use photo-protective clothing,
hats etc

Use sunblocks DR. Ram Sharan Mehta, MSND, CON, BPKIHS

74. 17. Practice in BPKIHS: Derma OPD
COMMON BACTERIAL INFECTIONS
ARE:

Periporitis

Impetigo (Non
-
bullous common)

Impetigo (Non
-
bullous common)

Absces

Cellulitis

Folliculitis

STIs
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

75. Rx Prescribe: 1. Antibiotics:
a. Topical:
Mupirocin, Fucidic acid
b. Oral:
Cefadox, Cloxacyline
2
. Personal hygiene teaching
2
. Personal hygiene teaching
3. Symptomatic management DR. Ram Sharan Mehta, MSND, CON, BPKIHS

76. Summary:
Common Bacterial Infections
1.
Folliculitis: Localized infection of one hair follicles.
2.
Furnicle/Boil: Deep hair follicle infection.
3.
Carbuncle: Several hair follicle infection.
4.
Impetigo: superficial skin infection.
5.
Periporitis:
Millary and papulovesicles infection.
5.
Periporitis:
Millary and papulovesicles infection.
6.
Ecthyma: Formation of adherent dry crusts.
7.
Sycosis Barbae: Pustules in beard region.
8.
Cellulitis: Loose connective tissue infection.
9.
Erysipelas: Superficial cutaneous cellulitis.
10.
Pyonochia:Swelling of nail fold.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

77. 11. Staphylococcal Scalded Skin Syndrome:
RT exfoliative toxins.
12. Erysipeloid : Bacterial infection among
meat handlers.
13. Principles of therapy of pyoderma.
14. Common diagnostic tests for derma 14. Common diagnostic tests for derma
disorders.
15. Common antibiotic used in skin disorders
16.Prevention and control of Bacterial skin
infection.
17. Practices in BPKIHS derma OPD
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

78. Thank you
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

79. MACRO
SCOPICTERMS
Macule
: Circumscribed lesion of up to 5 mm in diameter char acterized by
flatness and usually discolored (often red)
Patch
: Circumscribed lesion of more than 5 mm in diamete r characterized by
flatness and usually discolored (often red)
Papule
: Elevated dome-shaped or flat-topped lesion 5 mm or less across.
Nodule
: Elevated lesion with spherical contour greater than 5 mm across.
Plaque
: Elevated flat-topped lesion, usually greater than 5 mm across (may be
caused by coalescent papules).
Vesicle
: Fluid-filled raised lesion 5 mm or less across.
Bulla
:
Fluid
-
filled raised lesion greater than
5
mm across.
Bulla
:
Fluid
-
filled raised lesion greater than
5
mm across.
Blister
: Common term used for vesicle or bulla.
Pustule
: Discrete, pus-filled, raised lesion.
Wheal
: Itchy, transient, elevated lesion with variable bla nching and erythema
formed as the result of dermal edema.
Scale
: Dry, horny, platelike excrescence; usually the resu lt of imperfect
cornification (i.e., keratinization).
Lichenification
: Thickened and rough skin characterized by prominent skin
markings; usually the result of repeated rubbing in susceptible persons.
Excoriation
: Traumatic lesion characterized by breakage of the e pidermis,
causing a raw linear area (i.e., a deep scratch)
Onycholysis
: Separation of nail plate from nail bed.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

80. MICRO
SCOPIC TERMS
(histologic)
Hyperkeratosis
: Thickening of the stratum corneum, often associated with a qualitative
abnormality of the keratin.
Parakeratosis
: Modes of keratinization characterized by the retention of the nuclei in
the stratum corneum. On mucous membranes, parakeratosis is normal.
Hypergranulosis
: Hyperplasia of the stratum granulosum, often due to in tense rubbing.
Acanthosis
: Diffuse epidermal hyperplasia.
Papillomatosis
: Surface elevation caused by hyperplasia and enlargement of
contiguous dermal papillae.
Dyskeratosis
: Abnormal keratinization occurring prematurely within in dividual cells or
groups of cells below the stratum granulosum. Generally the same as DYSPLASIA.
Acantholysis
: Loss of intercellular connections resulting in loss of cohesio n between
keratinocytes. keratinocytes. Spongiosis
: Intercellular edema of the epidermis.
Hydropic swelling (ballooning)
: Intracellular edema of keratinocytes.
Exocytosis
: Infiltration of the epidermis by inflammatory or circu lating blood cells.
Erosion
: Discontinuity of the skin exhibiting incomplete loss of th e epidermis.
Ulceration
: Discontinuity of the skin exhibiting complete loss of the epidermis and often
of portions of the dermis and even subcutaneous fat.
Vacuolization
: Formation of vacuoles within or adjacent to cells; often refers to basal
cell-basement membrane zone area.
Lentiginous
: Referring to a linear pattern of melanocyte prolifer ation within the
epidermal basal cell layer. Lentiginous melanocytic hype rplasia can occur as a reactive
change or as part of a neoplasm of melanocytes.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS