PYOGENIC SKIN INFECTIONS

Dr. Zaryab Ghauri (House Officer)

Skin Highly effective barrier

Normal Skin Flora Biological Shield

Staphylococcus aureus Anterior Nares 35% Perineum 20% Axilla 5-10% Toe webs 5-10% Infant 72% Streptococcus pyogenes Throat 10% Transient Skin Carriage 0.5-1%

Staphylococcus Aureus Techoic acid Protien-A Coagulase + TSST-1 Exfoliative Toxin MRSA- PVL (Panton Valentine Leucocidin)

Streptococcus Pyogene M Protein Exotoxin A Streptolysin O

Pyogenic Skin Infections Pyoderma A skin infection with formation

of pus

Impetigo Ecthyma Erysipelas Cellulitis Inflammatory Diseases Of Hair Follicle Superficial Folliculitis Pseudofolliculitis Fruncle Carbuncle Sycosis

IMPETIGO

Non Bullous Impetigo GABHs Techoic Acid Face, Nose, Perioral, Limbs

Bullous Impetigo Staphylococcus Aureus Techoic Acid Exotoxin A Face, Neck, Axillary and

Crural folds, Diaper area

Non Bullous Impetigo Bullous Impetigo

Complications Of Impetigo Poststreptococcal Glomerulonephritis Staphylococcal Scalded Skin Syndrome

Other rare Scarlet fever Urticaria Erythema multiform Ecthyma

ECTHYMA

Pustule that erodes and form an ulcer with an adherent crust Dermal necrosis and Inflammation

Ulcerative Staphylococcal or Streptococcal Pyoderma

Shins or Dorsal feet

MANAGEMENT OF ECTHYMA AND IMPETIGO Gram stain and Culture of Pus Patient education Antibacterial washes Chlorhexidine or Sodium Hypochlorite Topical Antibiotics- Fusidic acid, Mupirocin and Retapamulin

Oral Antibiotics Penicillin 1st Generation Cephalosporin

MRSA Recurrent Mupirocin Rifampacin 600mg 4x daily with Cloxacillin 500mg daily 4x for 10 days or Climdamycin 150mg daily for 3 months

ERYSIPELAS VSCELLULITIS

Cellulitis Erysipelas

Chronic recurrent Erysipelas, Chronic Lymphangitis

Local Persistant lymphedema Permanent Hypertrophic Fibrosis Elephantiasis Nostra

Complications

Helicobacter Cellulitis

Pnemococcal Cellulitis Hemophilus Influenza Cellulitis

MANAGEMENT OF CELLULITIS AND ERYSIPELAS Culture or cutaneous aspirations Dicloxacillin, Cephalexin Clindamycin, Erythromycin Vancomycin+ Piperacillin Tazobactam or Imipenem/ Meropenem Recuurent Cellulitis Penicillin G or Amoxicillin Erythromycin

Oral Penicillin or Erythromycin BD for 4-52 weeks

or IM Benzathine Penicillin 2.4mIU every 2 weeks

INFLAMMATORY DISEASES OF. HAIR FOLLICLE

SUPERFICIAL PUSTULAR FOLLICULITIS Thin walled pustules at follicle orifices caused by Staph aureus Extremities, Perioral, Scalp Fragile, white domed pustules in crops

Pseudofolliculitis Hot Tub Folliculitis Fungal Folliculitis Acne Keloidalis Nuchae

FRUNCULOSIS

Fruncle or Boil Round, tender, circumscribed, perifollicular abscess Nape, Axilla, Buttocks Malnutrition, Diabetes, Atopic dermatitis, AIDS, Alcoholism

Hospital Frunculosis Marked resistance to antibiotics

CARBUNCLE

Group of contagious follicles Malnutrition, Diabetes, Drug Addiction, Prolonged steroid Therapy Back, Shoulder , Buttock

SYCOSIS

SYCOSIS VULGARIS Sycosis Barbae(Barber’s Itch) Perifollicular, chronic, pustules

Beard Recurrent Begin with erythema and itching, in a day or two one or more pin head sized pustules, pierced by hairs

SYCOSIS LUPOIDES Peripheral extension and central scar formation with hairless atro-phic area bordered by pustules and crusts

MANAGEMENT OF INFLAMMATORY DISEASES OF HAIR FOLLICLE Gram stain and Culture of Pus Patient education Antibacterial washes Chlorhexidine or Sodium Hypochlorite Topical Antibiotics- Fusidic acid, Mupirocin and Retapamulin

Incision and Drainage Recurrent Mupirocin Chronic Frunculosis Rifampacin 600mg 4x daily with Cloxacillin 500mg 4x daily for 10 days or Clindamycin 150mg daily for 3 months

MANAGEMENT OFSKIN AND SOFT TISSUE INFECTIONS

MANAGEMENT OF SSTI

MANAGEMENT OF SSTI

THANK YOU

References:Andrew’s Diseases of SkinRooks Textbook of DermatologyMedscapehttp://cid.oxfordjournals.org/content/early/2014/06/14/cid.ciu296.full.pdf+html