1. Pyoderma. Scabies.
Lector: Shkilna M.

2. Content 1. Scabies 2. Norwegian scabies 3. Pthirus pubis 4. Pioderma
Epidemiology
Clinical manifestations
Diagnosis
Complications
2. Norwegian scabies
3. Pthirus pubis
Treatment
4. Pioderma
Folliculitis
Impetigo
Furunculosis ( boil )
Carbuncle
Ecthyma
Erythrasma

3. SCABIES
Scabies is an intensely pruritic, highly contagious infestation of the skin
arachnid mite Sarcoptes scabiei, variety hominis.
Originally, scabies was a term used by the Romans to denote any pruritic skin disease.
In the 17th century, Giovanni Cosimo Bonomo identified the mite as one cause of scabies.

4. Pathophysiology After mating, the male mite dies.
The female mite burrows into the epidermis of the host using her jaws and front legs, where she lays up to 3 eggs per day for the duration of her day lifetime.
An affected host harbors approximately 11 adult female mites during a typical infestation. The eggs hatch in 3-4 days.
The larvae leave the burrow to mature on the skin. Fewer than 10% of the eggs laid result in mature mites.

5. Diagnosis
Definitive diagnosis of scabies is made by direct visualization of the mite, eggs, or feces.
Mineral oil should be placed on the end of a burrow, preferably where a black dot is visible.
The area should then be scraped with a number 5 scalpel blade and the scrapings shed onto a slide.

6. Physical Exam Primary and secondary lesions
The classic rash of scabies includes primary and secondary lesions.
The primary lesions include burrows, papules, vesicles, and pustules.
The secondary lesions occur from scratching and include excoriated papules and crusted areas.

7. Norwegian scabies Severe variant.
Institutionalized persons, down syndrome, and AIDS patients.
Hyperkeratotic crusted nodules.
Secondary bacterial infections, septicemia and death.

8. Exams and Tests Skin Scraping - Place a drop of oil or saline on top
of one of the lesions
- Using a
the area is scraped
- Material collected is placed on a
slide
- Examine under a
to observe the presence of mites or
its eggs

9. Scabies Treatment - start treatment immediately
- treated at the same time to prevent re-infestation with scabies from other persons who might be infected but do not have any symptoms yet
infected persons clothing and bedding needs to be washed in hot water and ironed so as to kill the mite and all of its eggs.

10. The best treatment for scabies is Dermisil

11. Follow Up After treatment, the itching can last for up to 4 weeks
Repeat examination by a doctor in 1-2 weeks is recommended

12. Preventions
Wash all clothing, towels, and bed linens in hot water. Do not allow air drying. You should use the dryer.
- Use the medication as prescribed and instructed. Do not use it more than instructed because you risk causing chemical irritation of your skin.

13. Pthirus pubis Crab louse. Could be found other than genital region.
2mm in length, powerful legs, hair attachment, moves slowly.
Incomplete metamorphosis, eggs, nymph and adult.
Eggs operculated, shiny, stick to hair (nits)

14. Clinical manifestations
Pruritis.
Maculopapular rash.
Excoriation.
Eye lashes scaling.
Skin thickening, macular swellings, hyperpigmentations, Subcutaneous hemorrages (Vagabond’s disease).

15. Predisposing factors:
Pyoderma = bacterial infection in the epidermis, dermis, subcutis or in hair follicles . Etiology: Staphylococcus aureus, streptococcus pyogenus.
Predisposing factors:
Exogenic:
Coetaneous overhydration, maceration;
Poor personal hygiene;
Industrial and life traumas;
Long treatment by cytostatic, corticosteroid drugs.
Endogenic:
Diabetes mellitus.
Chronic infections.
Diminished of immunity.
Hypovitaminosis, disability alimentation.

16. According to etiology:
Pyoderma
Types of pyoderma:
Primary (appeared on the normal skin)
Secondary (as complication of itching dermatoses).
According to etiology:
Staphyloderma.
Streptoderma.
Streptostaphyloderma.
Atypical forms.

17. Impetigo highly contagious, confined to the epidermis
most common in infants and preschool children
more frequently in patients with preexisting skin conditions (e.g., eczema, atopic dermatitis, varicella, angular cheilitis, scabies).
usually in areas of skin breakdown
warm and humid weather, crowded living, and poor hygiene contribute
dominant pathogen is S. aureus, less common S. pyogenes
Bullous or a nonbullous form of the disease:
Bullous: numerous blisters or bullas that rapidly become pustules -> rupture within 1 to 2 days -> thick, honey-colored, crusted plaque remains for days to weeks.
Nonbullous: erythema and tiny, less prominent vesicles -> crusted erosions in the skin. skin lesions are intensely pruritic, local spread as a result of scratching and release of infected fluid; associated regional lymphadenopathy is common.

18. Impetigo
A thin-walled vesicle on erythematous base, that soon ruptures & the exuding serum dries to form yellowish-brown (honey-color) crusts that dry & separate leaving erythema which fades without scarring.
Regional adenitis with fever may occur in severe cases.

19. Impetigo on the scalp

20. Impetigo ( spread streptopyoderma)

21. Impetigo ( spread streptopyoderma)

22. Age: all ages, but commoner in childhood & newborn (impetigo neonatorum).
Site: face is often affected, but the lesions may occur anywhere, including palms & soles. 22

23. Bullous impetigo

24. Crusted impetigo 24

25. Diagnosis of Impetigo Clinical Culture of blister fluid or erosion
The diagnosis of impetigo is most frequently made clinically. If there is doubt, exudate from beneath the crust or blister fluid may be cultured. In streptococcal impetigo anti-DNase B antibodies may be elevated. Leukocytosis is only present in about half the cases. Culture would be done most often in order to determine the sensitivity of the organism, particularly is it MRSA.
Streptococci
Staphylococci 25

26. Treatment of impetigo:
Treatment of predisposing causes: e.g. pediculosis & scabies.
Remove the crusts: by olive oil or hydrogen peroxide.
Topical antibiotic: e.g. tetracycline, bacitracin, gentamycin, mupiracin (Bactroban®), Fusidic acid (Fucidin®). 26

27. Folliculitis Skin lesions
Primary - little inflammatory papules, folliculocentric erythematous pustules, placed in the follicular orifice, with hair in the centre.
Secondary - erosions, which appeared after pustules breakdown, crusts, after falling which –hypopigmentatiоn or hyperpigmentation.
Superficial (inflammation of the follicle orifice) - follicular impetigo
Localization a) Superficial staphylococcal folliculitis:
Face.
Scalp.
Neck.
Trunk, axillae (after shaving).
Buttocks, staphylococcal folliculitis of patients with diabetes mellitus.

28. Staphylococcal folliculitis

29. (inflammation of the whole follicle) - sycosis.
Deep folliculatis
(inflammation of the whole follicle) - sycosis.
Its complication-furuncle, carbuncle.
Localization Chin.
Beard area (zone around the mouth and lips).

30. Furuncle ( boil )
Furuncle (or boil) is an infection of the hair follicle in which purulent extends through the dermis into the subcutaneous tissue, where a small abscess forms. Furuncles can occur anywhere on hairy skin and usually follow an episode of folliculities
Etiology: Staphylococcus aureus.
Localization:
Neck.
Face (chin, upper lip).
Buttocks.
Perinea region.

31. Furuncle

32. Carbuncle
Carbuncle - is a big conglomeration of boils, the inflammation spreading from one follicle to another under the epidermis. The intervening corium is destroyed, and pus is discharged through multiply holes.
Localization:
Hear bearing sites: face, axillae, buttocks, perinea region.
Highly associated with nasal Staph. carriage

33. Carbuncle

34. Ecthyma
Ecthyma is a skin infection similar to impetigo, but more deeply invasive. Usually caused by a streptococcus infection, ecthyma goes through the outer layer (epidermis) to the deeper layer (dermis) of skin, possibly causing scars.
Ecthyma gangrenosum is a bacterial skin infection (caused by Pseudomonas aeruginosa) that usually occurs in people with a compromised immune system. 34

35. Ecthyma
Localization:
Buttocks.
Thighs.
Legs.

36. Skin diseases related to coryneform bacteria
Erythrasma is mild, chronic, localized superficial infection of skin by
Coryn. Minutissimum.
Clinically: sharply-defined but irregular brown, scaly patches 36

37. Sharply-defined but irregular brown, scaly patches
Erythrasma
Sharply-defined but irregular brown, scaly patches
Coral red fluorescence under wood’s light.

38. Erythrasma

39. Topical treatment with azole antifungal agents for 2 weeks or topical fucidin.
Erythromycin orally. 39

40. Laboratory diagnosis
Test material may be obtained from pus of wounds, inflammatory exudates, mucous membrane discharge, blood and faeces.
The material is examined for the presence of pathogenic staphylococci and streptococci.
Tests include microscopy of pus smears, inoculation of test material onto blood agar plates, isolation of the pure culture and its identification.

41. Treatment
Antibiotics (penicillin, phenoxymethyl penicillin, tetracycline, etc.), sulphonamides (norsulphazol, sulphazol, etc.), and antistaphylococcal gamma-globulin.
Semi synthetic preparations of penicillin and tetracycline (Staphylococci produce strains resistant to sulphonamides, antibiotics, and bacteriophage).
To relieve intoxication and improve the immunological defence forces of the body (infusion of glucose, plasma, blood transfusion, injection of cardiac stimulants).
In cases of chronic lesions specific therapy is recommended: auto vaccines, staphylococcal anatoxin, antitoxic serum.