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BACTERIAL SKIN INFECTIONS NORMAL FLORA OF SKIN Gm + COCCI  STAPHYLOCOCCUS  MICROCOCCUS Gm + RODS  PROPIONIBACTIRIUM  CORYNEBACTIRIUM Gm –VE RODS.

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Presentation on theme: "BACTERIAL SKIN INFECTIONS NORMAL FLORA OF SKIN Gm + COCCI  STAPHYLOCOCCUS  MICROCOCCUS Gm + RODS  PROPIONIBACTIRIUM  CORYNEBACTIRIUM Gm –VE RODS."— Presentation transcript:

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2 BACTERIAL SKIN INFECTIONS

3 NORMAL FLORA OF SKIN Gm + COCCI  STAPHYLOCOCCUS  MICROCOCCUS Gm + RODS  PROPIONIBACTIRIUM  CORYNEBACTIRIUM Gm –VE RODS  ACINETOBACTER

4 ROLE OF NORMAL FLORA  DEFENCE AGAINST BACTERIAL INFECTION THROUGH BACTERIAL INTERFERENCE  PRODUCTION OF FREE FATTY ACIDS(FFA) FROM SKIN LIPIDS

5 STAPHYLOCOCCUS AUREUS  ANTERIOR NARES 35 %  PERIANAL SKIN 20 %  AXILLARY SKIN 5-10 %  TOE WEBS 5-10 %

6 REDUCTION OF CARRIAGE  MUPIROCINE OINTMENT INTRANASALLY FOR 5 DAYS  ORAL RIFAMPICIN 600mg 7-10 DAYS  CLINDAMYCIN 150mg/day FOR 3 MONTHS

7 STAPHYLOCOCCUS DISEASES  Impetigo  Ecthyma  Scalded skin syndrome  Furunculosis  Folliculitis  Carbuncle  Sycosis

8 STREPTOCOCCUS DISEASES  Impetigo  Ecthyma  Erysipelas  Cellulitis  Scarlet fever  Intertrigo

9 IMPETIGO  CONTAGIOUS SUPERFICIAL INFECTION OF THE SKIN  ORGANISIMS: STAPHYLOCOCCUS AUREUS, STREPTOCOCCUS  PEAK SEASON: LATE SUMMER  AGE: PRESCHOOL & YOUNG SCHOOL AGE  EXISTING SKIN DISEASE: SCABIES, PEDICULOSIS

10 CLINICAL FEATURES  VESICLE ON ERYTHEMATOUS BASE  RUPTURES - SERUM EXUDES  YELLOWISH BROWN CRUST  PERIPHERAL EXTENSION  HEALS WITHOUT SCARRING

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15 TREATMENT TOPICAL ANTIBIOTICS  NEOMYCIN  BACITRACIN  FUCIDIC ACID  MUPIROCIN SYSTEMIC ANTIBIOTICS  IF WIDESPREAD OR SEVERE

16 ECTHYMA PYOGENIC INFECTION OF THE SKIN CHERACTERISED BY FORMATION OF CRUST BENEATH WHICH ULCERATION OCCURS

17 AETIOLOGY  STAPH. AUREUS, STREPTOCOCCUS  POOR HYGIENE  MALNUTRITION  OTHER PREDISPOSING FACTORS

18 CLINICAL FEATURES  BULLAE OR PUSTULE  HARD CRUST  PURULENT IRREGULAR ULCER  HEALS WITH SCARRING  BUTTOCKS, THIGHS AND LEGS

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20 TREATMENT  SAME AS FOR IMPETIGO

21 INFECTIONS INVOLVING HAIR FOLLICLES  FOLLICULITIS  FURUNCLE  CARBUNCLE

22 FOLLICULITIS INFLAMMATORY CONDITION OF THE HAIR FOLLICLE WITH CHANGES CONFINED TO OSTIUM

23 AETIOLOGY  BACTERIAL: STAPHYLOCOCCAL  FUNGAL: TRICHOPHYTON RUBRUM  CHEMICAL: TAR  DRUGS: STEROIDS

24 CLINICAL FEATURES  SMALL FOLLICULAR PAPULE OR PUSTULE  RARELY PAINFUL  HEALS WITHOUT SCAR

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28 TREATMENT  REMOVE UNDERLYING CAUSE  TOPICAL ANTISEPTICS  TOPICAL ANTIBIOTICS  SYSTEMIC ANTIBIOTICS

29 FURUNCLE ACUTE USUALLY NECROTIC AND DEEP SEATED INFECTION OF HAIR FOLLICLE

30 AETIOLOGY  STAPH. AUREUS  SEBORRHOEIC / ATOPIC INDIVIDUALS  DIABETICS  SCABIES  HIV  MALNUTRITION

31 CLINICAL FEATURES  SMALL FOLLICULAR NODULE  TENDER  LOCALIZED NECROSIS  HEALS WITH SCARRING  FEVER & MILD CONSTITUTIONAL SYMPTOMS  CAVERNOUS SINUS THROMBOSIS

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36 TREATMENT  GENERAL MEASURES  SYSTEMIC ANTIBIOTICS  TOPICAL ANTIBIOTICS  ANALGESICS

37 CARBUNCLE DEEP SEATED INFECTION OF A GROUP OF CONTIGUOUS HAIR FOLLICLES

38 AETIOLOGY  STAPH. AUREUS  MIDDLE AGED MEN  DIABETES, MALNUTRITION  CARDIAC FAILURE  DRUG ADDICTS  PROLONGED STEROIDS  ERYTHRODERMA

39 CLINICAL FEATURES  HARD RED PAINFUL NODULE  MULTIPLE DISCHARGING FOLLICULAR SINUSES  NECROSIS OF INTERVENING SKIN  DEEP ULCER WITH PURULENT FLOOR  BACK OF NECK, SHOULDERS, HIPS, THIGH  FEVER  SEPTICAEMIA

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41 TREATMENT  SYSTEMIC ANTIBIOTICS  TOPICAL ANTIBIOTICS  ANTIPYRETICS/ ANALGESICS  SURGICAL INTERVENTION WHEN INDICATED  REMOVAL OF UNDERLYING CAUSE

42 CELLULITIS ACUTE, SUBACUTE OR CHRONIC INFECTION OF LOOSE CONNECTIVE TISSUE PERTICULARLY SUBCUTIS

43 AETIOLOGY  STREPTOCOCCI  H. INFLUENZA  STAPH. AUREUS  PSEUDOMONAS

44 CLINICAL FEATURES  ERYTHEMA  SWELLING  HOT & TENDER  ILL-DEFINED MARGINS  CONSTITUTIONAL SYMPTOMS

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48 COMPLICATIONS  FASCIITIS  MYOSITIS  GANGRENE  SUBCUTANEOUS ABSCESSES  SEPTICAEMIA

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50 TREATMENT  APPROPRIATE ANTIBIOTICS  ANALGESICS  REST  TREATMENT OF COMPLICATIONS

51 ERYSIPELAS  EDGES WELL DEMARCATED, RAISED  BLISTERING COMMON  MORE SUPERFICIAL INVOLVEMENT  FACE COMMON SITE  RESPONSE TO TREATMENT RAPID

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54  Common skin condition affecting the skin folds such as under the arms, in the groin and between the toes.  Erythrasma does not usually cause any symptoms.  It presents as a slowly enlarging patches of pink or brown dry skin.  Caused by  Corynebacterium minutissimum.

55  Diagnosis confirmed by Wood’s lamp examintation which turns erythrasma to fluoresce a coral-pink colour.  Erythrasma can be treated with antiseptic and topical antibiotic such as: fusidic acid cream Clindamycin solution. Erythromycin lotion.

56 VIRAL INFECTIONS OF SKIN

57 VIRAL WARTS  HUMAN PAPILLOMA VIRUS  DNA – VIRUS 50-55nm  77 DIFFERENT TYPES

58 CONT’D  INFECT SQUAMOUS EPITHELIA  CAUSE CELL PROLIFERATION -- PAPILLOMA  DYSPLASIA / NEOPLASIA

59 TYPES  Common warts  Plane warts  Filiform warts  Plantar warts  Acuminate warts

60 COMMON WARTS  HPV - 2  FIRM PAPULES / PLAQUES  ROUGH HORNY SURFACE  SYMPTOMLESS  SITES - BACK OF HANDS, FINGERS, ANYWHERE ON SKIN  65% DISAPPEAR IN 2 Yrs

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67 PLANE WARTS  HPV 3, 10  SMOOTH, FLAT OR SLIGHTLY ELEVATED  1- 5 mm ROUND OR POLYGONAL  FACE AND BACK OF HANDS

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70 FILIFORM WARTS  FINGER-LIKE PROJECTIONS  FACE, NECK AND SCALP  COMMONLY IN MALES

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72 PLANTAR WARTS  HPV 1, 2, 4, 57  SMALL SHINING SAGO GRAIN LIKE PAPULE  USUALLY PAINFUL HYPERKERATOTIC  PRESSURE AREAS OF SOLE, PALMS  MOSAIC PATTERN

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76 ACUMINATE WARTS  HPV- 6, 11, 16 ; VENERIALLY ACQUIRED  MUCO-CUTANEOUS JUNCTIONS AND INTERTRIGINOUS AREAS  SOFT, PINK, MOIST SURFACE  PEDUNCULATED OR CAULIFLOWER LIKE  MACERATION - INFECTION, MALODOUR

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78 DIAGNOSIS  HISTOLOGY  ELECTRON MICROSCOPY  IMMUNOHISTOCHEMISTRY (TYPE SPECIFIC ANTIBODIES)  PCR

79  SPONTANEOUS RESOLUTION  GENERAL MEASURES TREATMENT  AVOIDANCE OF SHARED TOWELS AND SHOES  AVOID BITING NAILS  ADEQUATE PLASTIC STRAPPING AT SWIMMING POOL

80 DESTRUCTIVE MODALITIES  Electrocautery  Cryotherapy  Salicylic acid  Podophyllin  Surgical methods  CO2 Laser

81 Other modalities  Cimetidine  Retinoids  Interferon  Imiquimod  Antiviral therapy (cidofovir)  Intralesional bleomycin

82 MOLLUSCUM CONTAGIOSUM  Caused by MCV-1, MCV-2  Mainly in children  Direct contact  Discrete shiny, pearly white, rounded papules  Umbilicated centers

83 TREATMENT  General measures  Topical Retinoids  Puncture with wooden probe dipped in tincture iodine  Cryotherapy  Electrocautery  CO2 Laser

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85 HERPES SIMPLEX  Herpes virus hominis  Type 1, 2  Persist in sensory nerve ganglia  Spread: Direct contact, droplets

86 CLINICAL FEATURES  Sub-clinical  Age 1-5 years  Incubation period 5 days  Fever, malaise, dribbling of saliva  Gums - swollen, inflamed Primary infection

87 Cont’d  Vesicles, ulcers  Tongue, pharynx, palate, buccal mucosa  Regional lymph nodes – enlarged & tender  Recovery in 2 weeks

88 Cont’d  Herpes genitalis  Kerato-cunjunctivitis  Inoculation herpes simplex

89 Recurrent infection  50% type 1, 95% type 2  Smaller vesicles  Close grouping  No constitutional symptoms  Buccal mucosa not affected

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93 TRIGGERING FACTORS  Minor trauma  Febrile illnesses  UV radiation  Dental surgery  Pre-menstrual period  Emotional stress

94 COMPLICATIONS  Cranial Nerve palsies e.g. Bell's palsy  Eczema herpeticum  Erythema multiforme  Encephalitis

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96 TREATMENT  Mild, uncomplicated : no treatment or topical antiseptic  Severe primary infection : antiviral therapy (Acyclovir 200mg 5 times/day)  Recurrent : topical antiviral

97 CHICKEN POX  HERPES VIRUS VARICELLAE  DROPLET INFECTION  2 -10 YEARS  INCUBATION PERIOD : 14-17 DAYS

98 CLINICAL FEATURES  FEVER, MALAISE, RASH  MORBILIFORM ERYTHEMA  PAPULES, VESICLES  PUSTULES WITH RED AREOLA  DRY CRUST, PINK DEPRESSION  HEALS WITHOUT SCARRING

99 Sign (dewdrop on a rose petal)

100 Papules & vesicles

101 Polymorphic lesions

102 Chickenpox & bullous impetigo

103 Large pustules & umbilicated lesions

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105 COMPLICATIONS  SECONDRY INFECTION  ENCEPHALITIS  HEPATITIS  PNEUMONIA  ARTHRITIS  SEPTICAEMIA  STEVENS - JOHNSON SYNDROME

106 TREATMENT  REST  ANALGESICS  SOOTHING ANTISEPTICS  DAILY BATHING  ANTIBIOTICS FOR SECONDARY BACTERIAL INFECTION  ANTIVIRAL THERAPY

107 HERPES ZOSTER(SHINGLES)  HERPES VIRUS VARICELLAE  INCIDENCE INCREASES WITH AGE  PATIENTS ARE INFECTIOUS

108 CLINICAL FEATURES  FIRST MENIFESTATION – SEVERE PAIN  HEADACHE, MALAISE, LOCALISED TENDERNESS  GROUPED RED PAPULES IN DERMATOMAL PATTERN  VESICLES, PUSTULES

109 Cont’d  MUCOUS MEMBRANE INVOLVEMENT  LYMPHADENOPATHY  RECOVERY 2-4 WEEKS  OCCASIONALLY PAIN NOT FOLLOWED BY ERUPTION

110 Cont’d  THORACIC - 53%  CERVICAL - 20%  TRIGEMINAL - 15%  LUMBOSACRAL - 11%

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113 Disseminated lesions

114 COMPLICATIONS  FACIAL PALSY  SENSORY LOSS  MENINGOENCEPHALITIS  POST HERPETIC NEURALGIA (PHN)

115 TREATMENT  BED REST  ANALGESICS  LOCAL ANTISEPTICS  TOPICAL ANTIBIOTICS  ANTIVIRAL THERAPY  TREATMENT OF PHN

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