Pyoderma and its types: how to resist the aggression of abscesses. Pustular infection

Section 2. PRIVATE DERMATOLOGY. Chapter 7

Definition. Pustular skin diseases (pyoderma) are infectious skin diseases that develop as a result of the introduction of pathogens into it - pathogenic pyococci, the most common of which are staphylococci and streptococci.

Etiology and pathogenesis. Piococci are very common in our environment: in the air (in the form of aerosols), in the dust of rooms, in clothes, in underwear; they are also found on the surface of the body of a healthy person. There are three types of human skin microflora:

1) resident flora(microorganisms that constantly colonize the skin);

2) temporary resident flora(microorganisms that infect the skin and multiply on it, but persist for a certain period of time);

3) transient (air) flora(bacteria that infect the skin, but rarely multiply on it and gradually disappear).

Gram-positive microorganisms belong to the first and second groups: Propionibacterium acnes, Propionibacterium gra-nulosum, Corynebacterium minutissimum, Corynebacterium tenuis, Staphylococcus epidermidis and Gram-negative bacteria: Esheri-hia coli, Proteus, Enterobacter, Pseudomonas, Acinetobacter. The transient flora includes mainly staphylococci and streptococci. They then in most cases are the causative agents of pyoderma. However, due to the fact that the skin has protective properties in relation to infectious agents, predisposing causes are necessary for the development of pyoderma. Under conditions of a healthy body, normal fat and sweating, the resident microflora prevents the reproduction of transient microflora, gradually replacing

it from the microbial population. The causes predisposing to the development of pyoderma are both exogenous and endogenous factors.

1. Factors that reduce or neutralize the bactericidal properties of sebum and sweat: skin contamination, especially lubricating oils, flammable liquids, coarse dust particles; local circulatory disorders (acrocyanosis, varicose veins, chills); local hypothermia and overheating.

2. Factors that violate the permeability of the skin and create an "entrance gate" of infection. These include microtrauma (abrasions, cuts, injections, bites, scratches, abrasions, splinters); maceration of the stratum corneum of the epidermis (hyperhidrosis, prolonged exogenous exposure to water); hypovitaminosis (A, C).

3. Factors that suppress immune reactivity and reduce nonspecific resistance of the organism. These include factors that initiate the development of secondary immunodeficiencies, causing the development of immune tolerance and sensitization to pyococci: foci of chronic infection (chronic tonsillitis, dental granuloma, chronic sinusitis and sinusitis, chronic cholecystitis); general hypothermia and overheating; metabolic disorders, especially carbohydrate (diabetes mellitus); lack of nutrition; anemia; intestinal intoxication; physical fatigue; stress and nervous strain; endocrine disorders; hypovitaminosis (A, B, C, E); previous treatment of intercurrent diseases with the use of glucocorticosteroid or immunosuppressive therapy.

4. Factors that suppress the resident flora and reduce the microbiological protection of the skin. This is excessively frequent washing, especially with the use of antibacterial agents, leading to skin dysbacteriosis and allowing transient pathogenic microflora to “fix” on it (abuse of perfumery and cosmetic products containing triclosan and other antiseptics).

According to the etiological basis, pyoderma is divided into staphylococcal (staphyloderma) and streptococcal (streptoderma). The causative agents of staphyloderma are Staphylococcus aureus, and in some cases - epidermal and even saprophytic. The causative agents of streptoderma are most often β-hemolytic streptococci of serogroup A. In addition, there are atypical pyoderma, pathogens

which can be various microorganisms. Infection of the skin with pyococci occurs not only due to contact with a patient with pyoderma, but may be due to the transmission of microorganisms by airborne droplets, for example, from patients or carriers of the infection containing bacteria in the nasopharynx. It is known that up to 40% of adolescents are carriers of group A streptococcus in the nasopharynx, and carriers of nasopharyngeal staphylococci often cannot get rid of them due to the pronounced resistance of these nasopharyngeal pyococci to antibiotics.

Getting on the skin, staphylococci penetrate into its natural openings, and therefore affect mainly the appendages (hair follicles, sebaceous and sweat glands). They cause a purulent-exudative inflammatory reaction. Depending on the depth of penetration of staphylococci into the skin and the severity of this reaction, staphyloderma begins with an abscess, nodule or node. The exceptions are epidemic pemphigoid and staphylococcal scalded skin syndrome, the causative agent of which is coagulase-positive Staphylococcus aureus of phage group II, 71 phage type. This type of pathogen has the ability to secrete a special exotoxin - exfoliatin (epidermolysin), which causes diffuse skin lesions with the formation of a bubble in the epidermis.

Streptococci affect the epidermis diffusely, without penetrating into the appendages of the skin, and cause a serous-exudative inflammatory reaction with the formation of one primary element of a skin rash - a flabby bladder (conflicts).

To staphylococcal pyoderma include: ostiofol-liculitis, sycosis, folliculitis, furuncle, carbuncle, hidradenitis, as well as staphyloderma of newborns, infancy and early childhood - ostioporitis (periporitis, vesiculo-pustules), multiple skin abscesses, epidemic pemphigoid (pemphigus of the newborn), staphylococcal scalded skin syndrome (exfoliative dermatitis of newborns by Ritter von Rittershain).

To streptococcal pyoderma include: impetigo, intertriginous and chronic diffuse streptoderma, ecthyma.

Atypical pyoderma manifest themselves mainly in chronic ulcerative, vegetative and abscessing forms, very reminiscent of focal tuberculosis of the skin and some mycoses (deep, candidal, moldy).

7.1. STAPHILODERMA

Ostiofolliculitis

Definition. Ostiofolliculitis (folliculitis superficial, osteofolliculitis)- acute purulent inflammation of the mouth of the hair follicle (Fig. 5).

Etiology and pathogenesis. The causative agent of the disease is coagulase-positive Staphylococcus aureus. The main predisposing cause of the development of the disease is excessive contamination of the skin, especially in conditions of excessive sweating, damp clothing and skin maceration.

clinical picture. Characterized by formation at the mouth (ostium) hair follicle pustules the size of a pinhead, permeated with hair and fringed with a halo of hyperemia. After 2-4 days, the pustule shrinks into a crust, which disappears without leaving a trace. Some pustules may grow peripherally, increasing in size to the size of a large pea (Bockhard's staphylococcal impetigo). Ostiofolliculitis can be either single or multiple. Rashes of pustules can be observed on any part of the skin covered with hair, but their most common localization is the skin of the face, neck and extremities. Sometimes the disease can take on a relapsing character.

Diagnostics ostiofolliculitis is based on a characteristic clinical picture: small, short-lived follicular pustules with mild inflammation around them, located on different parts of the skin.

differential diagnosis. Ostiofolliculitis should be differentiated with vulgar sycosis, pustular form of acne vulgaris, bromine and iodine acne, acne syphilide.

Treatment.General therapy not required. It is carried out in exceptional cases, when the disease is persistent chronically relapsing. Incentives are given

Rice. 5. Ostiofolliculitis. The arrow indicates the route of penetration of staphylococci

agents (autohemotherapy, methyluracil, aloe extract).

Physiotherapy. With a widespread process, UVI is prescribed - total suberythemal doses.

External Therapy limited to the treatment of pustules with a 1% solution of brilliant green or 2% tincture of iodine. Other disinfectants in the form of an ointment or powder are also used. The skin around the lesions is treated with a 2% alcohol solution of salicylic or boric acid.

Sycosis

Definition. Sycosis (perifolliculitis of the beard, sycosis staphylogenes)- chronic recurrent purulent-inflammatory folliculitis of a limited area of ​​the skin, mainly the area of ​​the beard and mustache (Fig. 6).

Etiology and pathogenesis. The causes of the development of the disease lie mainly in skin sensitization to staphylococci and suppression of the sterilizing properties of sebum due to neuroendocrine disorders. Patients often suffer from hypofunction of the gonads.

clinical picture. The disease occurs almost exclusively in men. It is localized in the area of ​​growth of the beard, mustache, eyebrows, sometimes on the pubis, scalp, in the armpits. The lesion begins with the appearance of follicular pustules, similar to ostiofolliculitis, which continuously recur in a limited area of ​​\u200b\u200bthe skin. Gradually, reactive inflammation develops around the affected follicles with the formation of a diffuse dermal infiltrate. Purulent crusts form on its surface. Pulled out hairs are surrounded by a vitreous muff at the root. The disease proceeds torpidno.

Diagnostics sycosis is based on a characteristic clinical picture: many constantly recurring follicular pustules in a limited area of ​​\u200b\u200bthe skin (more often

Rice. 6. Sycosis. The arrow indicates the route of penetration of staphylococci

area of ​​the beard and mustache), accompanied by the development of a chronic inflammatory reaction.

Treatment.General therapy includes the appointment of antibiotics (oxacillin, cephalexin, rifampicin, augmentin) and stimulants (autohemotherapy, pyrogenal, immunonal, taktivin), if necessary, correction of hormonal disorders.

Physiotherapy - UVI erythemal doses.

Outdoor therapy. In the acute period, pustules are treated with an alcohol solution of aniline dyes, pastes or creams with anti-inflammatory, disinfectant and resolving agents (boron-tar, sulfur-tar), creams or ointments containing glucocorticosteroid and antibacterial drugs ("oxycort" are applied to the infiltrate). , "celestoderm-B with garamycin", "fucicort", etc.). To prevent recurrence, careful skin care is necessary (rubbing with a 2% alcohol solution of salicylic or boric acid).

Folliculitis

Definition. Folliculitis (deep folliculitis, folliculitis)- acute purulent inflammation of the middle and lower segments of the hair follicle (Fig. 7).

Etiology and pathogenesis. The causative agents of folliculitis are various types of staphylococci, among which the most common is coagulase-positive staphylococcus aureus. Microorganisms, having penetrated into the mouth of the hair follicle, sequentially penetrate into the middle and lower parts of the follicular epithelium, causing purulent fusion of the latter. The process is limited to perifollicular tissue.

Rice. 7. Folliculitis. The arrow indicates the route of penetration of staphylococci

clinical picture. Folliculitis differs from osteofolliculitis by a deeper location of the inflammatory process in the hair follicle. It is a pink papule the size of a pea. In the center of it, a pustule, penetrated by hair, often develops. After a few days, the papule either resolves or, suppurating, opens with the formation of a pinpoint ulcer, which subsequently heals and leaves a scar. Predisposing causes for the development of folliculitis are most often exogenous factors.

Diagnostics folliculitis is based on a characteristic clinical picture, manifested by rashes of inflammatory lenticular nodules that open with the release of creamy pus, or spontaneously resolve.

differential diagnosis. Folliculitis should be differentiated with the papular form of acne vulgaris, bromine and iodine acne, acne syphilis.

Treatment similar to the treatment of ostiofolliculitis.

Furuncle

Definition. Furuncle (furunculus)- acute purulent-necrotic inflammation of the hair follicle and its surrounding tissues (Fig. 8) (see color inc., Fig. 1).

Etiology and pathogenesis. The causative agent of the disease is coa-gulase-positive Staphylococcus aureus. Due to the high pathogenicity of the pathogen, which ensures the release of a significant amount of enzymes (esterases, proteinases, collagenases, etc.), the initial infectious process (folliculitis) turns into perifolliculitis, causing extensive necrosis of surrounding tissues. Infection often occurs by airborne droplets from nasopharyngeal carriers, as well as due to microtraumatism and wearing contaminated clothing.

clinical picture. Furuncle develops as a result of acute purulent necro-

Rice. eight. Furuncle. The arrows indicate the routes of penetration of staphylococci.

tic inflammation of the hair follicle and surrounding tissues. The initial manifestations of a furuncle look like ostiofolliculitis or folliculitis, but they are painful. After 1-2 days, an inflammatory node is formed, rapidly increasing to the size of a hazelnut or walnut, while pain intensifies. After a few days, the node is opened with the release of pus. At the same time, dead tissue of a greenish color is found - a "necrotic rod". After its demarcation and rejection, an ulcer remains with pus, which quickly heals by scarring.

In some cases, purulent fusion of almost the entire infiltrate occurs along with a necrotic rod and an abscess (abscessing boil) is formed. In other cases, on the contrary, suppuration is expressed very slightly - this is the so-called dry boil.

Sometimes there are different furuncle complications. Due to the penetration of staphylococci into the lymphatic vessels, lymphangitis and regional lymphadenitis develop. The spread of infection to neighboring tissues leads to the development of phlegmon, osteomyelitis. The close connection of the skin of the chin with the periosteum (due to dense connective tissue strands) contributes to the development of osteomyelitis of the lower jaw. In debilitated patients, a furuncle on the lower leg can transform into chronic ulcerative pyoderma. The entry of staphylococci into the blood causes the formation of metastatic abscesses in the bones, muscles, perirenal tissue, kidneys and other organs. This may be predisposed by an injury to the corresponding organ with hemorrhage (even a small one), which creates favorable conditions for the sedimentation of microorganisms. Finally, the course of the boil can become malignant: the infiltrate increases in size, the edema increases, due to which the tissues become tense and dense, thrombophlebitis develops around the boil, as well as lymphangitis and regional lymphadenitis, pain increases sharply, body temperature rises (up to 40 ° C) , the number of leukocytes in the peripheral blood increases, the ESR rises, a headache appears, consciousness is darkened. The result of such development of a boil can be sepsis or septicopyemia with the formation of multiple abscesses in the internal organs, which leads to death. Most dangerous carbuncle, developing on the face and, in particular, in the region of the nasolabial triangle, nose and lips

(especially on the top). In these cases, the presence of a dense and very superficially located venous network creates favorable conditions for the penetration of infection into the vessels and the development of purulent meningitis. Dissemination is facilitated by the high mobility of mimic muscles, squeezing out the initial elements of the boil, cutting them off during shaving, and irrational local treatment.

Furunculosis. Under furunculosis understand multiple rash of boils or constant recurrence of single boils. Furunculosis can be localized (for example, on the back of the neck, in the lumbar region) or general - with dissemination of boils throughout the skin.

Localized furunculosis, like solitary boils, is due to the influence of exogenous predisposing causes, general furunculosis is due to the influence of predominantly endogenous causes. With short-term exposure to predisposing factors, acute furunculosis develops, with prolonged exposure - chronic. Recurrent boils, which are related to chronic furunculosis, are associated mainly with skin sensitization to staphylococci. Furunculosis, especially acute, is often accompanied by general malaise, fever. Sometimes these phenomena are observed with a single boil.

Diagnostics furuncle and furunculosis is carried out on the basis of a characteristic clinical picture: painful inflammatory nodes, forming necrotic rods in the central part, which are rejected with the formation of purulent crater-like ulcers.

differential diagnosis. Furuncles should be differentiated from deep folliculitis, carbuncle, hydradenitis, scrofuloderma.

Treatment.General therapy in the treatment of a single uncomplicated boil, located outside the face, is not required. General treatment is used for the localization of a boil on the face (with mandatory bed rest), complicated boils of any localization, as well as furunculosis. In these cases, antibiotics are required. Semi-synthetic preparations of penicillin, cephalosporins, rifamycins, augmentin are effective. In chronic furunculosis, immunostimulating therapy should be used (prepa-

thymus, interferon, immunal, pyrogenal) and general strengthening (vitamins A, B 1, B 2, C, E, P) therapy.

Physiotherapy used in the stage of developing infiltrate, when it is advisable to use dry heat (UHF therapy, Sollux).

Outdoor therapy. Before starting treatment, the hair around the boil should be cut (but not shaved!). In the initial stage, characterized by the development of an inflammatory infiltrate, pure ichthyol is used, which is applied 1-2 times a day to the lesion in the form of cakes covered with cotton wool. In this case, bandages or stickers are not required, since ichthyol adheres well to the skin. During dressings, previously applied ichthyol is removed with warm water. The surrounding healthy skin is wiped with a 2% alcohol solution of boric or salicylic acid in the direction from the periphery to the center. Washing in a bath, bath or shower is prohibited. After opening the boil, ichthyol is contraindicated and can only be applied to the marginal zone of the infiltrate. A gauze napkin is applied to the central part of the opened boil or a turunda is introduced with a hypertonic solution of sodium chloride. The napkin is attached with adhesive tape or glue, circular bandages are not used, as they can cause autoinoculation and spread of infection. Dressings are carried out at least 2 times a day. Such local therapy is carried out up to the complete rejection of necrotic masses. After rejection of the necrotic rod, ointments containing antibacterial agents (streptocid, tetracycline, erythromycin, lincomycin, "baneocin", etc.) are used. When a boil is localized on the face, ichthyol is not used, maximum rest of the facial muscles is created, and therefore the patient is forbidden to talk and is transferred to liquid food. Abscessing boils are treated surgically: an abscess is opened.

Carbuncle

Definition. Carbuncle (carbunculus)- extensive acute purulent-necrotic inflammation of the dermis and subcutaneous fatty tissue, involving several nearby hair follicles in the inflammatory process (Fig. 9).

Etiology and pathogenesis. The causative agent of the disease is coagulase-positive Staphylococcus aureus, sometimes in combination with streptococci. The development of the carbuncle is due to

Rice. 9. Carbuncle. The arrows indicate the routes of penetration of staphylococci.

but, on the one hand, high virulent and pathogenic properties of staphylococci, on the other hand, a pronounced influence of endogenous predisposing causes. The combination of these two factors leads to extensive purulent-necrotic inflammation with the development of deep phlegmon, reaching the fascia and muscles. clinical picture. The development of a carbuncle begins in the same way as a furuncle, however, staphylococci in this case quickly penetrate from the hair follicle into the lymphatic vessels of the deep sections of the dermis and subcutaneous tissue, which leads to the spread of a purulent-necrotic inflammatory process and an increase in the initially formed infiltrate to large sizes. Severe edema develops around the infiltrate. The patient is worried about a sharp pain.

Carbuncles are usually solitary. However, they are usually accompanied by fever, chills, headache. The further course of the carbuncle is characterized by the formation of several perforations on its surface, from which thick pus is released mixed with blood. Soon, the entire skin covering the carbuncle melts, and then a deep ulcer (sometimes reaching the fascia and even muscles) is exposed, the bottom of which is a continuous necrotic mass of a dirty green color. After demarcation and rejection of the latter, the ulcer is filled with granulations and heals with the formation of a rough scar. In some cases, the course of the carbuncle is complicated in the same way as the course of the boil.

Diagnostics carbuncle is based on a characteristic clinical picture, manifested by the development of a large, suppurating and turning into an abscess inflammatory node, located in the deep sections of the skin, accompanied by a general intoxication syndrome and opening in the form of several holes, united by a common cavity containing thick creamy pus.

differential diagnosis. Carbuncle is differentiated from furuncle, hydradenitis, scrofuloderma.

Treatment is carried out according to the same principles as the treatment of a complicated boil with the mandatory prescription of antibiotics and stimulants. A feature of external therapy is the preliminary surgical opening of the abscess.

Hydradenitis

Definition. Hydradenitis (hidradenitis)- acute purulent inflammation of the apocrine sweat gland (Fig. 10).

Etiology and pathogenesis. Hidradenitis is caused by coagulase-positive Staphylococcus aureus, sometimes in combination with other gram-negative bacteria such as Proteus, Klebsiela, E. coli. The predisposing causes for the development of staphylococcal lesions of the apocrine sweat glands are mainly increased sweating, skin contamination, friction with clothing, shaving damage to the armpits, and dysfunction of the gonads.

clinical picture. In the armpit, less often - on the labia majora or on other areas of the skin containing apocrine glands (in the anus, navel, pubis, nipple field, in the inguinal region), a node appears, often reaching the size of a chicken egg. The skin over it is purplish red. The node is painful. Sometimes the body temperature rises. Soon it softens and opens with the release of a large amount of pus. Healing occurs with the formation of a scar. In some cases, hydradenitis is resolved without purulent fusion of the infiltrate and does not leave a scar. Hidradenitis differs from a furuncle in a hemispherical shape and the absence of a necrotic rod. With the defeat of several glands, a group of nodes develops, which, turning into abscesses, can merge with each other. The course of the disease sometimes acquires a chronic, relapsing character.

Diagnostics disease is carried out on the basis of the clinical picture - pus-

Rice. ten. Hydradenitis. The arrows indicate the routes of penetration of staphylococci.

but-inflammatory node located in the anatomical areas of the skin containing apocrine sweat glands, and opened with the release of a significant amount of pus without the formation of a necrotic core.

differential diagnosis. Hidradenitis is differentiated with scrofuloderma, deep folliculitis, furuncle, carbuncle.

Treatment hidradenitis is similar to the treatment of a boil. In case of recurrent hydradenitis, general strengthening and immunocorrective agents are additionally prescribed (see "Treatment of furunculosis"). Often used surgical methods of treatment (opening nodes).

7.2. STAPHILODERMAIA OF NEWBORN,

INFANT AND EARLY CHILDHOOD

Ostioporitis

Definition. Ostioporitis (periporitis, vesiculopustulosis) is an acute purulent inflammation of the mouths of the sweat glands in newborns.

Etiology and pathogenesis. Staphylococcal lesion of the mouths of the sweat glands develops in the first days of a child's life against the background of predisposing factors, which include, first of all, skin maceration due to excessive sweating in violation of the rules for swaddling children. Common predisposing factors include premature birth, artificial feeding of the child.

clinical picture. In the area of ​​the inguinal and axillary folds, the skin of the trunk and the scalp, numerous pustules ranging in size from millet grain to a pea pour out. Pustules are surrounded by a hyperemic corolla, they quickly shrink into crusts, which subsequently fall off, leaving no traces of the disease. In asthenic, weakened children, the process covers vast areas and tends to merge.

Diagnostics vesiculopustulosis is carried out on the basis of anamnesis data (violation of the rules for caring for a child) and a characteristic clinical picture - a rash of multiple pustules in areas of increased sweating.

Differential Diagnosis carried out with osteofollicitis and scabies.

Treatment consists in lubricating the affected areas of the skin with 1-2% alcohol or aqueous solutions of aniline dyes. The surrounding healthy skin is treated with 2% salicylic or boric alcohol. It is not recommended to bathe the child during the treatment period.

Multiple skin abscesses

Definition. Multiple skin abscesses (Finger's pseudofurunculosis) is an acute purulent inflammation of the eccrine sweat glands in newborns, infants and young children.

Etiology and pathogenesis. The causative agent of the disease is Staphylococcus aureus, sometimes in combination with streptococci and other microorganisms. The main cause of the disease is skin maceration caused by excessive sweating of the child against the background of its untidy content (violation of the rules of swaddling and skin care). Concomitant predisposing factors are past childhood infections, rickets, diseases of the gastrointestinal tract, reduced nutrition, artificial feeding.

clinical picture. The disease begins with the appearance in the back, back of the neck, thighs and buttocks of numerous dense nodes the size of a large pea, the skin over which becomes a bluish-red hue. The nodes slowly increase, reaching the size of a cherry and gradually turning into abscesses, then a fluctuation appears and they open, releasing bloody pus. Above some of the nodes, superficial pustules may be observed at the mouths of the ducts of the eccrine sweat glands (ostioporitis).

Diagnostics the disease is carried out on the basis of anamnesis data (violation of the rules for swaddling a child) and a characteristic clinical picture - a rash of multiple compacted inflammatory nodes that form purulent abscesses and are often combined with manifestations of vesiculopustulosis.

Differential Diagnosis should be carried out with folliculitis and furunculosis.

Treatment.General therapy includes the appointment of broad-spectrum antibiotics and stimulants (maternal blood injections, gamma globulin).

External Therapy consists in imposing ichthyol cakes on developing nodes and piercing developed abscesses in combination with lubricating them with alcohol solutions of aniline dyes. Healthy skin of the trunk and extremities is wiped with colorless disinfectant solutions (2% alcohol solution of salicylic or boric acid).

epidemic pemphigoid

Definition. Epidemic pemphigoid (epidemic pemphigus of the newborn, pyococcal pemphigoid, pemphigus neonatorum)- acute highly contagious staphylococcal disease of newborns, characterized by diffuse skin lesions with the formation of blisters in the epidermis.

Etiology and pathogenesis. The causative agent of the disease is Staphylococcus aureus phage type 71, which secretes an exfoliative exotoxin (epidermolysin), which causes acantholysis of the epidermis under its stratum corneum with the formation of superficial blisters. The source of infection is the medical staff of maternity hospitals and mothers of newborns, including bacteria carriers of nasopharyngeal staphylococci. The high contagiousness of the pathogen causes outbreaks and the development of epidemics in medical institutions. The occurrence of the disease is promoted by premature birth and toxicosis of pregnant women.

clinical picture. The disease begins, as a rule, at 2-3 weeks of a child's life. It is characterized by rashes in the area of ​​the trunk, neck, head, limbs on unchanged or slightly hyperemic skin of small (pea-sized) blisters filled with serous contents. The blisters gradually increase in size, their contents become cloudy, then they open up, forming moist, brightly inflammatory erosions. There is no infiltrate at the base of the erosions, and they quickly epithelialize. The disease proceeds paroxysmal with repeated outbreaks of fresh rashes, in premature or debilitated children it may be accompanied by general phenomena - fever, increased ESR, leukocytosis, eosinophilia.

Diagnostics pyococcal pemphigoid is based on a characteristic clinical picture (flash-like development of small blisters with rapidly cloudy contents) and data

nyh anamnesis (the appearance of the first rashes 1-2 weeks after the birth of the child).

differential diagnosis. Epidemic pemphigoid should be differentiated from syphilitic pemphigus of newborns (examination of the cystic fluid for the presence of pale treponema, and blood for serological reactions), chicken pox, epidermolysis bullosa.

Treatment.General therapy is carried out in severe cases, accompanied by a syndrome of general intoxication, and includes the appointment of broad-spectrum antibiotics, vitamins, parenteral administration of maternal blood.

External Therapy consists in removing the covers of the blisters and prescribing warm baths with a solution of potassium permanganate. After the cessation of weeping - creams with anti-inflammatory and disinfectants.

Staphylococcal scalded skin syndrome

Definition. Staphylococcal scalded skin syndrome (exfoliative dermatitis of newborns by Ritter von Rittershein, Lyell's staphylococcal syndrome) is an acute severe staphylococcal disease characterized by diffuse skin lesions with the formation of large flabby blisters, clinically resembling second-degree burns.

Etiology and pathogenesis. The causative agent of the disease is Staphylococcus aureus of phage group II, phage type 71, which secretes a special exotoxin (exfoliatin, epidermolysin), which causes extensive subcorneal acantholysis of the epidermis with the formation of large surface blisters. The infectious process develops in children in the first 3 months of life, most often in maternity hospitals, where the sources of infection are medical staff or puerperas. Older children or even immunosuppressed adults may develop the disease, which is most common in patients on long-term immunosuppressive therapy (for example, for a kidney transplant).

clinical picture. The disease begins with a bright acute inflammatory periorificial erythema, reminiscent of exanthema in scarlet fever. Starting around the mouth, navel, anus, genitals, erythema spreads rapidly, and large blisters appear on it within 1-2 days, quickly opening and exposing extensive weeping erosions.

Nikolsky's symptom is positive. Bubbles and erosions undergo peripheral growth, merging, they can capture almost the entire skin of the child. At this stage, the lesion may be accompanied by fever, elevated ESR, leukocytosis, eosinophilia, and anemia. With the appointment of adequate therapy against the background of a decrease in the intensity of hyperemia and swelling of the skin, re-epithelialization of erosions occurs within one week.

Diagnostics exfoliative dermatitis of newborns is based on a characteristic clinical picture - multiple blisters increasing in size, demonstrating extensive acantholysis of the epidermis (positive Nikolsky symptom) and often accompanied by a syndrome of general intoxication.

Differential Diagnosis carried out with thermal burns, syphilitic pemphigus of newborns, bullous epidermolysis. In adults, staphylococcal scalded skin syndrome is differentiated from toxic epidermal necrolysis.

Treatment.General therapy includes the appointment of penicillinase-resistant antibiotics (amoxiclav) or other broad-spectrum antibiotics.

External Therapy begins with the appointment of warm baths with a solution of potassium permanganate on the area of ​​weeping erosion. Ointments with disinfectants are applied to the crusts.

7.3. STREPTODERMIAImpetigo

Definition. Impetigo (impetigo streptogenes)- acute diffuse serous inflammation of the skin with the formation of subcorneal or intraepidermal blisters.

Etiology and pathogenesis. The causative agent of the disease is group A β-hemolytic streptococcus. In rare cases (bullous impetigo), coagulase-positive staphylococci of phage type 71, causing intraepidermal acantholysis, are involved in the pathogenesis of the development of intraepidermal blisters. The leading predisposing cause for the development of impetigo is microtrauma (shaving, scratching, insect bites).

clinical picture. Streptococcal impetigo is characterized by a sudden onset, expressed in the formation

against the background of hyperemia of subcorneal blisters, which turn within a few hours into layered or bumpy crusts of honey-yellow color, upon removal of which erosions are exposed, bordered by a narrow collar of the stratum corneum. The primary element is a superficial (under the stratum corneum) flabby bladder up to 1 cm in size with transparent serous contents - conflict. It shrinks so quickly into a crust that, as a rule, it is visible. As a result of the addition of a staphylococcal infection, the crusts acquire a greenish-yellow color (streptostaphylococcal, or vulgar impetigo). The disease is accompanied by itching, so the crusts can be hemorrhagic. Impetiginous elements tend to grow peripherally and merge. Often regional lymphadenitis develops. Children are more often affected. Favorite localization - face, for men - the area of ​​​​growth of the beard and mustache, for women - the scalp. Sometimes, especially in children, the mucous membranes of the mouth, nose, and eyes are involved in the process: conflicts arise that quickly open with the formation of painful erosions.

In some patients, after the resolution of impetigo, for a long time, flour-like or scaly scaly hyperemic spots remain on the faces. Similar elements may occur primarily, predominantly in children before puberty, as well as in adults working outdoors. In summer, under the influence of sunlight, the spots may disappear, but the skin in their place tans to a lesser extent and becomes lighter than healthy. Such a lesion of the skin of the face is considered as an erased, dry form of impetigo and is called simple, or white, deprive faces.

In some cases, the growing conflict shrinks into a crust (lamellar) only in the central part, and a cystic roller remains along the periphery (annular impetigo). In other cases, conflict persists, located in the deeper layers of the epidermis. It, without opening and shrinking into a crust, increases in volume and reaches the size of a large bubble. (bullous impetigo). Often, bullous impetigo develops in the area of ​​​​the nail ridges (usually in the presence of burrs), horseshoe-shaped surrounding the nail plate (superficial panaritium).

In persons who have a habit of licking their lips, as well as in those who sleep with their mouths open, from which saliva flows, excessive moistening of the corners of the mouth occurs, which contributes to

orgy slit-like impetigo ("jam"). The latter is an erosion surrounded by a collar of the stratum corneum left from the lid of the conflict; a crack forms in the depths of the mouth, and honey-yellow crusts appear on the skin around it. The course of the jam is very stubborn. Candidiasis of the corners of the mouth (it does not form crusts) and papular syphilis of the corresponding localization, which is characterized by infiltration at the base of erosion, have a picture similar to slit-like impetigo.

Papulo-erosive syphilis resembles another impetigo observed in infants. Conflicts appear on the buttocks and back of the thighs, which quickly open up, leaving behind erosion. A papular infiltrate soon develops at the base of the erosions. This form of streptoderma is called syphilitic posterosive papular impetigo. The predisposing cause of its development is maceration and skin irritation with feces with insufficient care for the child (hence the other name - diaper dermatitis). This explains the originality of the clinical picture: moisture prevents the formation of crusts, "washes away" the collar of the stratum corneum around erosions (remnants of the tire conflict); irritation causes reactive infiltrative inflammation at their base.

Diagnostics impetigo is based on anamnesis data (microtraumatism, skin contamination) and a characteristic clinical picture (flash-like appearance of rapidly cloudy and drying superficial blisters).

differential diagnosis. Impetigo should be differentiated from arteficial and allergic dermatitis. Slit-like impetigo is differentiated from seizures with yeast lesions. Differential diagnosis of diaper dermatitis is carried out with papular infiltration in congenital syphilis. The diagnosis of syphiloid-like posterosive papular impetigo should be confirmed by negative results of the study of discharge erosions for pale treponema and negative results of serological tests for syphilis.

Treatment.General therapy carried out with the widespread nature of the process and the presence of complications in the form of lymphangitis and lymphadenitis. In these cases, antibiotics are prescribed (semi-synthetic penicillins, rifamycins, cephalosporins).

External Therapy carried out depending on the clinical form of impetigo. The skin around the lesions 3-4 times a day is wiped with disinfectants (2% alcohol solution of salicylic, boric, boric-levomycetin-salicylic acid). Bubbles are opened with the removal of tires. In the stage of weeping erosion, lotions or wet-drying dressings are used with solutions of 0.25% silver nitrate, 1-2% resorcinol, 1-2% boric acid, Alibur liquid. After the cessation of weeping or the presence of dry crusts, ointments with disinfectants are applied. With severe inflammation along the periphery of the lesions, it is possible for a short time (within 1-2 days) to use ointments and creams containing glucocorticosteroids and antibacterial agents ("belogent", "diprogent", "fucikort", "lorinden- FROM".)

Intertriginous streptoderma

Definition. Intertriginous streptoderma (streptococcal diaper rash, streptococcal intertrigo) is a diffuse serous-purulent inflammation of the skin with the formation of blisters that develops in the inguinal-femoral and intergluteal folds, in the armpits, in the folds of the abdomen and neck in obese subjects, less often in the interdigital folds of the feet, sometimes - brushes.

Etiology and pathogenesis. The causative agent of the disease is group A β-hemolytic streptococcus. The process is a streptococcal skin lesion, the predisposing causes of which are increased sweating and sebum secretion, leucorrhea, urinary incontinence, discharge from fistulas, hemorrhoids, warming compresses, insufficient drying of skin folds after bathing, etc. Sometimes the cause is the excretion of sugar with sweat in diabetic patients.

clinical picture. Clinically, streptococcal intertrigo is a wet erosive surface formed as a result of the opening of the conflict, bordered by the collar of the stratum corneum. Its boundaries are clear, large-scalloped. In the depth of the fold, superficial, non-bleeding cracks are longitudinally located. Lesions have peripheral growth that occurs by detachment of the stratum corneum. Outside the contact areas of the skin, the clinical picture takes the form of impetigo. Subjective sensations are expressed in the form of itching (pain, burning are less often noted).

Diagnostics the disease is carried out on the basis of a characteristic clinical picture (large scalloped wet erosions located in large folds of the skin). In difficult cases, laboratory diagnostics (microscopic or cultural methods) is used.

differential diagnosis. Streptococcal diaper rash should be differentiated from intertriginous candidiasis (yeast diaper rash).

Treatment.General therapy is carried out in the presence of complications (lymphangitis, lymphadenitis) or chronically recurrent course of the disease and includes the appointment of antibiotics and stimulants.

Physiotherapy is prescribed after the removal of acute inflammatory phenomena and the cessation of weeping in the form of UV radiation with erythemal doses on the affected skin.

Outdoor therapy. When wetting - lotions and wet-drying dressings from disinfectants and anti-inflammatory drugs (2% alcohol solution of boric acid, 2% resorcinol solution, Alibur liquid, etc.). After cessation of weeping and removal of acute inflammation, pastes with disinfectants and anti-inflammatory agents are used (2% gentian violet, ethacridine-boron-naftalan, 2% methylene), it is possible to use creams containing glucocorticosteroids and disinfectants ("polcortolone-TS", "oxycort", "celestoderm-B with garamycin", "fucicort", etc.). In stubborn cases, characterized by the development of chronic inflammation, ointments with resolving and disinfecting agents are used - 5-10% sulfur-tar, Wilkinson's ointment, 10% ichthyol. Since intertriginous streptoderma is not always possible to differentiate from intertriginous candidiasis, drugs that act on both streptococci and yeast-like fungi should be used.

Chronic diffuse streptoderma

Definition. Chronic diffuse streptoderma is an extensive chronic focus of serous or serous-purulent inflammation that diffusely affects the skin of the lower leg, less often the scalp.

Etiology and pathogenesis. The disease is a streptococcal or strepto-staphylococcal disease

skin, the originality of the clinical picture and the chronic course of which are due to persistent local circulatory disorders that cause hypoxia of skin tissues. Most often they are associated with constant hypothermia of the legs or head, varicose veins, daily long stay on the legs, etc.

Clinical picture characterized by hyperemia, often congestive, slight infiltration, clear large-scalloped borders formed by the collar of the stratum corneum. The surface of the focus is covered with large lamellar serous-purulent and serous-hemorrhagic crusts, between them - erosion. Upon removal of the crusts, a continuous weeping surface is exposed. The lesion is gradually "spreading" along the periphery. Around it, it is possible to detect primary elements - large conflicts. The disease is characterized by torpidity, proceeds for a long time, the inflammatory process either worsens or subsides. In the latter case, wetting stops, and the crusts are replaced by large scales. The long course of the disease contributes to its transformation into microbial eczema, which is expressed in the appearance of microerosions on an erythematous background that separate drops of serous fluid.

Diagnostics chronic diffuse streptoderma is based on the features of the clinical picture (large wet erosion, sometimes covered with purulent-hemorrhagic crusts and large-lamellar scales, which is located most often in the area of ​​\u200b\u200bthe legs and often in patients with impaired trophism of the lower extremities).

Differential Diagnosis carried out with microbial eczema.

Treatment.General therapy. From the means of general treatment, intramuscular injections of a 10% solution of calcium gluconate, 10 ml daily or every other day, antihistamines, vitamins (B 1, B 6, C, P, PP), immunostimulating therapy (autohemotherapy, pyrogenal, methyluracil, taktivin, reaferon ), as well as broad-spectrum antibiotics (ampicillin, azlocillin, amoxiclav).

Physiotherapy carried out in the same way as with intertriginous streptoderma.

Outdoor therapy. When wetting, it is recommended to use lotions and wet-drying dressings from solutions with disinfectants and astringents (0.25% silver nitrate solution, 2% alcohol solution of resorcinol, boric

acids, Alibur liquid). On crusts - ointments with disinfectants. After the removal of acute inflammatory phenomena and the cessation of weeping, pastes with disinfectants and anti-inflammatory drugs are used (etacridine-boron-naftalan, 2% methylene, 3-5% ichthyol), it is possible to use creams containing glucocorticosteroids and disinfectants ("white -gent", "diprogent", "lorinden-S", "fucicort", "celesto-derm-B with garamycin"). In the stage of chronic inflammation, torpid flow, ointments with resolving and disinfecting agents are shown - sulfur-tar-naftalan, tar and naftalan in equal parts.

Ectima

Definition. Ecthyma is an acute serous-purulent-necrotic inflammation of the skin that develops as a result of microorganisms entering the depth of the skin (under the epidermis) and causing necrosis of the dermis with the formation of ulceration (see color inc., Fig. 2).

Etiology and pathogenesis. Ecthyma can be not only streptococcal, but also strepto-staphylococcal, staphylococcal, and in exceptional cases - gonococcal. The penetration of the infection into the depths of the skin is caused by microtraumas and, mainly, by scratching due to lice, scabies and other itchy dermatoses. The disease often develops against the background of a decrease in immune reactivity due to hypovitaminosis, stress, chronic intercurrent diseases.

clinical picture. Due to the peculiarities of the etiopathogenesis, the disease begins with the formation of not a conflict, but a deep, against the background of an inflammatory infiltrate, a bubble or an epidermal-dermal pustule the size of a large pea or more. A bubble or pustule quickly shrinks into a serous-hemorrhagic or purulent-hemorrhagic crust, immersed in the thickness of the skin and bordered by a zone of soft hyperemia. Upon removal of the crust, an ulcer with sheer edges is found, which fills with granulations over time. Ecthymas are usually multiple, often linear (in the course of scratching); favorite localization - lower limbs and buttocks. In unscrupulous people, in the presence of congestion in the legs, in weakened patients, the disease without treatment can become chronic.

Diagnostics ecthyma is carried out on the basis of a characteristic clinical picture (purulent hemorrhagic crusts inlaid into the skin, as well as superficial rounded ulcers located in the lower extremities).

differential diagnosis. Ecthyma vulgaris should be differentiated from chronic pyococcal ulcer, acute necrotizing type of cutaneous leishmaniasis, indurative erythema, and syphilitic gumma.

Treatment.General therapy. Of the general treatment, vitamins are prescribed (A, B 1, B 6, C, P) and stimulating therapy (autohemotherapy, methyluracil, pyrogenal, thymalin). With a common process, a complicated course, broad-spectrum antibiotics are used.

Physiotherapy carried out similarly to the treatment of streptococcal diaper rash and chronic diffuse streptoderma.

Outdoor therapy. The skin around the affected areas is wiped with disinfectant alcohols or treated with aniline dyes. The conflict tires are removed, and ointments with disinfectants are applied to the crusts. After removing the covers of the bubbles or the discharge of the crusts, lotions or wet-drying dressings with disinfectants and anti-inflammatory agents are used (1% silver nitrate solution, 2% boric acid solution, 1% resorcinol solution). The same ointments with disinfectants are applied to the dried ulcer. With a weak tendency to healing, Mikulich ointment, iruksol, levosin, 10% methyluracil ointment are used.

7.4. ATYPICAL PYODERMAS

Definition. Atypical pyoderma is a chronic sluggish ulcerative, vegetative and abscessed form of pyoderma, difficult to treat and very reminiscent of focal skin tuberculosis and deep mycoses.

Etiology and pathogenesis. The nature of the clinical manifestations of these pyodermas does not depend on the type of pathogen, which, in addition to staphylococci and streptococci, can be a wide variety of microorganisms and their combinations in the form of mixed infections. The main role in the development of clinical pictures belongs to the state of the macroorganism, which, for various reasons, changes its reactivity. Examination of patients reveals a variety of

immune disorders and a decrease in nonspecific resistance, characteristic of various types of immunodeficiencies (primary, secondary (infectious) and primary-secondary).

Chronic ulcerative pyoderma

clinical picture. Chronic ulcerative pyoderma (chronic pyogenic ulcer) is localized mainly on the shins (see color inc., Fig. 3). Most often it is preceded by a boil or ecthyma. In debilitated patients, the ulcers that form in these diseases lose their tendency to heal and acquire a long, torpid course. Their bottom is covered with flaccid granulations, the edges are slightly infiltrated, congestively hyperemic, palpation is painful. In some cases, chronic pyogenic ulcers increase in size and merge with one another. The lesion gradually grows in one direction or another, while scarring in the central part (serpiginous-ulcerative pyoderma). Sometimes a pyogenic ulcer, localized on the genitals, the red border of the lips, eyelids, is so reminiscent of a hard chancre (chancriform pyoderma) that it is possible to exclude the diagnosis of primary syphilis only after repeated laboratory examination of the patient.

Diagnostics disease is carried out on the basis of the characteristics of the clinical picture (torpid flowing chronic pyogenic ulcers, tending to deepen and peripheral growth).

Differential Diagnosis carried out with vulgar ecthyma, indurative erythema, acutely necrotizing type of cutaneous leishmaniasis and syphilitic gumma.

Chronic vegetative pyoderma

Clinical picture chronic vegetative pyoderma is a soft bluish-red plaque covered with purulent crusts, upon removal of which a juicy papillomatous (vegetative) surface of the infiltrate is exposed. When squeezing the plaque, large drops of thick green pus are released. Deep pustules are found around it. Vegetative pyoderma is localized mainly on the back surface of the hands and feet, in the ankles. The lesions have a tendency to peripheral

mu growth, heal with the formation of a scar, in which there are interspersed areas of normal skin.

Diagnostics disease is based on data from microbiological and histological studies, as well as on the features of the clinical picture (torpidly flowing papillomatous plaques, covered with purulent crusts and located in the region of the distal extremities).

Differential Diagnosis should be carried out with warty tuberculosis of the skin and deep mycoses (chromomycosis, blastomycosis, sporotrichosis).

Chronic abscess pyoderma

Clinical picture characterized by the formation of an inflammatory node, the skin over which acquires a bluish-red color. Gradually, the node softens and turns into an abscess. Over time, the abscess opens, forming one or more holes, from which liquid pus is released, often with an admixture of blood. In those cases when several nodes develop, abscesses are connected to each other by fistulous passages, and the lesion becomes very similar to colliquitative tuberculosis (scrofuloderma). This impression is intensified after the formation of uneven ("torn", "shaggy") scars. Hence the name of such a variety of abscessed pyoderma is collicative, or scrofuloderma-like, pyoderma. The most common localization of abscessed pyoderma is the buttocks, perineum, armpits, back of the neck, face.

Diagnostics chronic abscessing pyoderma is carried out on the basis of data from microbiological studies and a characteristic clinical picture (torpid flowing purulent abscesses in the deep sections of the skin, tending to slow peripheral growth, breaking through several holes and connecting with each other).

Differential Diagnosis carried out with scrofuloderma and actinomycosis.

Treatment of chronic atypical pyoderma

General therapy. Treatment is carried out in courses. At the first stage, immunotherapy is recommended to correct immune disorders caused by secondary infectious immunity.

nodeficiency. For this purpose, thymus preparations (tactivin, thymalin), interferon (reaferon), levamisole are prescribed, with the help of which the number of total T-lymphocytes and T-helpers in the blood increases, the ratio of T-helpers and cytotoxic T-cells normalizes, and antibodyogenesis increases. , phagocytosis is activated, and in the foci of infection, the antibiotic resistance of the pathogen decreases. Next, antibiotics are prescribed (taking into account changes in the sensitivity of microorganisms to them) in combination with stimulants of humoral immunity and nonspecific resistance (pyrogenal, prodigiosan, vaccines, immunal, methyluracil, pentoxyl, diucifon, vitamins A, C, E). Such treatment is carried out until remission is achieved, during which (under the guise of antibiotic therapy) surgical treatment of the affected skin is used.

Physiotherapy. Of the physiotherapeutic agents, UVI is used locally, electrophoresis or phonophoresis of lidase and antibiotics.

External Therapy depends on the form of atypical pyoderma. With ulcerative pyoderma - washing the foci with disinfectant solutions, followed by the use of ointments with antibacterial agents. With vegetative pyoderma, after the cessation of pus release, antibiotic ointments are applied. Treatment of abscessed pyoderma consists in washing the fistulous passages with antibiotics and ends with the excision of nodes and abscesses within healthy tissue. Fresh unopened nodes are treated with a 40% dimexide solution containing antibiotics.

7.5. PIOALLERGIDES

Definition. Pyoallergides are secondary rashes that develop in patients with pyoderma in conditions of skin sensitization to the corresponding pyococci.

Etiology and pathogenesis. The development of sensitization to pio-cocci usually occurs in chronic pyoderma, often streptococcal etiology, which is usually associated with irrational, irritating local treatment, leading to the absorption of pio-cocci or their decay products into the blood.

clinical picture. Suddenly, a widespread, symmetrical, monomorphic rash appears on the trunk, limbs, face, consisting of roseola, scaly in the center, or follicular papules, papulo-vesicular or papules.

lo-pustular elements. With the defeat of the palms and soles, pioallergid is manifested by dyshidrosis or blistering rashes. In some cases, the development of pioallergid is accompanied by an increase in body temperature.

Diagnostics pioallergides is based on a characteristic clinical picture (development of symmetrical monomorphic rashes on various parts of the body in patients with foci of pyogenic bacterial skin infection).

Treatment. First of all, it is necessary to cancel the previous treatment of the primary pyococcal focus. General treatment is carried out - desensitizing therapy, including calcium preparations and antihistamines (diphenhydramine, diazolin, "Kestin", "Erius", etc.), with an increase in body temperature - antibiotics; locally - corticosteroid ointments, creams "elo-com", "advantan", etc.).

7.6. PREVENTION OF PYODERMA

Preventive measures aimed at reducing the incidence of pustular skin diseases should be carried out systematically, taking into account a thorough analysis of the causes of their occurrence, living conditions, life, physical and mental stress of various contingents of the population. Therefore, the prevention of pyoderma includes a whole range of activities.

Accounting and analysis of morbidity. Accurate and systematic accounting of pustular diseases is of great importance, as it allows you to establish the true and specific causes of their occurrence and spread.

Sanitary and hygienic measures should be aimed at maintaining the cleanliness of the skin, especially among workers in various industries and agriculture, whose work is directly related to the constant excessive contamination of the skin. The most important is the creation of conditions for personal hygiene. Washbasins and showers with hot and cold water should be installed in enterprises, and employees should be regularly provided with soap and clean towels. To remove poorly washed contaminants (fuels and lubricants, paints and varnishes), special cleaning agents should be used. Of great importance is the provision of overalls, its regular change and washing, as

contaminated and worn-out overalls cause great harm. To prevent hypothermia of persons working outdoors in cold weather, it is necessary to provide warm clothing. It is also of great importance to maintain cleanliness in working and residential premises, compliance with the temperature regime and normal humidity in them.

Sanitary measures. In addition to the generally accepted methods for improving the sanitary condition in workshops, workshops, garages, etc., much attention should be paid to the prevention of microtraumatism and the provision of assistance with it. Persons who are constantly exposed to the risk of microtraumatism should be trained in self-help and mutual assistance skills. First-aid kits should be constantly equipped with means of protection against infection of microtraumas: Novikov liquid (tannin 1.0, brilliant green 0.2; alcohol 0.2; castor oil 0.5; collodion 20.0), 2% alcohol solution of iodine and other disinfectants.

Strengthening the physical condition of people. To improve health, it is necessary to pay attention to improving living conditions and nutrition, hardening the body through propaganda and methodically correct organization of physical exercises, sports, and water procedures. It is necessary to achieve an even distribution of the workload and the organization of good rest, preventing the development of the "chronic fatigue syndrome" and contributing to the strengthening of physical development, reducing morbidity and labor losses.

Therapeutic and preventive measures include early detection of initial forms of pyoderma, timely, correct and complete treatment, prevention of recurrence of diseases, identification and sanitation of sources and chronic carriers of infection. Irrational therapy causes the spread of infection, and in addition to complications of a purulent nature (lymphadenitis, lymphangitis), it can lead to sensitization to pyococci (primarily streptococci), which contributes to the development of complications such as pyoallergides, microbial eczema, erythema nodosum and acute glomerulonephritis. In this regard, it is of great importance to train medical workers (especially middle managers) in the correct methods of external treatment and rehabilitation of those who have been ill. Knowledge of the principles of external therapy of pustular skin diseases helps to prevent dissemination of the process.

sa, prevent recurrence of infection and reduce the likelihood of complications. In the external treatment of patients, the following main principles must be observed:

1) treatment of the focus of skin infection is carried out with the help of disinfectants, which allows you to effectively act directly on the pathogen;

2) to prevent dissemination of infection, it is necessary to prohibit washing in the bath, as well as treat healthy skin surrounding the affected areas with disinfectants;

Pustular skin diseases (pyodermatitis). Pustular diseases occupy one of the first places in the general morbidity of the population, and among skin diseases they are the most common.

Pustular skin diseases - pyodermatitis (from the Greek word "peony" - pus, "derma" - skin), are caused by pyogenic microbes - staphylococci and streptococci.

Staphylococci and streptococci are in the air along with the smallest dust particles invisible to the eye and are deposited on surrounding objects, on hands, hairdressing underwear, and on non-disinfected hairdressing tools.

Common chemical agents for the destruction of microbes (5% carbolic acid solution, 0.1% sublimate solution, 3% formaldehyde solution) kill them within 15-30 minutes.

The most common cause of pustular diseases are minor injuries, minor damage to the skin. Very often they do not make themselves felt until purulent inflammation of the skin develops. Healthy intact skin is a reliable defense against the penetration of pyogenic microbes into it.

Pollution of the skin disrupts its functions, weakens the protective reactions of the skin.

A variety of chemicals (acids, alkalis, etc.) can cause superficial burns, cracks, which also contributes to the development of pyodermatitis.

One of the causes of pustular diseases may be increased skin moisture (due to heavy sweating or the action of moisture on the skin during work). It is known that the stratum corneum of the skin is durable, but it does not withstand prolonged exposure to moisture and becomes permeable to microbes.

Staphylococci most often affect the hair follicles, less often the sweat glands. They tend to penetrate deeper parts of the skin. Streptococci mainly affect the epidermis, and the process spreads over the surface of the skin.

There are also mixed forms of pustular skin disease caused by staphylococci and streptococci. According to the depth of the location of the abscess in the skin, superficial and deep pyodermatitis are distinguished.

Staphylococcal diseases. These diseases always affect either the hair follicles or the sweat glands.

Staphylococci cause the following diseases: folliculitis, staphylococcal sycosis, furuncle, carbuncle, hidradenitis.

Superficial staphylococcal skin diseases include folliculitis and sycosis.

Folliculitis is a purulent inflammation of the hair follicle (hair follicle). Folliculitis is superficial or deep (Fig. 7).

With superficial folliculitis, a small greenish-yellow abscess appears, with a millet or hemp grain. It is located at the mouth of the hair follicle, from the center of which a hair protrudes, more often a vellus. The abscess is surrounded by a narrow belt of reddening of the skin. The appearance of an abscess is not accompanied by a sensation of pain. There may be mild itching. Superficial folliculitis lasts 5-6 days, after which the contents of the pustules shrink into a crust. After the crust falls off, a bluish spot remains, which subsequently disappears without a trace.

Less often, instead of an abscess, there is an insignificant red nodule, which subsequently disappears without suppuration.

With deep folliculitis, the onset of the disease is the same as with superficial, but then there are signs of the spread of purulent inflammation in depth, which captures part of the follicle or even the entire follicle. First, a small red nodule appears on the skin in the area of ​​​​the mouth of the follicle, then an abscess, around which redness increases, pain appears. When palpated, a seal is felt in the circumference of the follicle. After a few days, the pus shrinks into a crust, or the abscess opens, releasing pus.

Under favorable conditions, the disease resolves without treatment within 5-6 days. If the lesion captures the entire follicle, then small scars may remain after healing.

Folliculitis, especially superficial, is a mild disease. However, it must be remembered that contaminated linen, nails, staphylococci from this abscess can be transferred to other areas of the skin and cause new folliculitis or other more serious diseases there. Very often in sick people you can see whole "families" of folliculitis - this means that the skin has been inseminated with staphylococci from the primary source located here. This happens when a water warming compress is placed on the boil. On moistened skin, staphylococci multiply rapidly and spread, affecting numerous hair follicles.

Folliculitis can occur anywhere on the skin. Especially often they are found on the folds of the arms and legs, where there is a lot of vellus hair. This disease is more often observed in men, since their sebaceous-hair apparatus is more developed than in women.

Staphylococcal sycosis, a chronic pustular skin disease, occurs infrequently, mainly in men and less often in women.

Sycosis begins with the formation of small pustules (folliculitis) permeated with hair at the mouths of the hair follicles. Pustules are initially solitary, then merge and form continuous lesions with inflammation in the surrounding tissues. It is characteristic that with sycosis, the follicles dissolve, but new ones appear to replace the disappeared ones. Their number gradually increases, the lesion expands. Due to the continuous rash of pustules, the skin at the site of the process coarsens, takes on a red-purple color, becomes covered with crusts, and somewhat thickens. Over time, crusts gradually accumulate on the area of ​​​​skin affected by sycosis, after falling off of which small abrasions and sores remain. A purulent liquid oozes out of them, which shrinks into new crusts.

Most often, sycosis affects areas of the skin on the face in the area of ​​​​the beard, eyebrows, and in the armpits.

Shaving in violation of sanitary rules can lead to the development of sycosis. The development of sycosis is also facilitated by the skin of the face contaminated for a long time.

It must be said that sycosis often begins with skin lesions of the upper lip in people suffering from chronic rhinitis. Discharge from the nose irritates the skin and surrounding areas, contributing to the rash of new pustules.

With sycosis, patients sometimes complain of a feeling of tension in the pustules, slight itching and burning, and soreness.

To prevent the occurrence of sycosis in hairdressing salons, it is necessary to strictly follow sanitary rules during shaving.

Deep staphylococcal diseases include furuncle, carbuncle, hydradenitis.

Furuncle (boil) - a disease of the hair follicles, sebaceous glands and surrounding tissue with a tendency to necrosis.

The disease begins with the appearance of a small abscess at the mouth of the hair follicle, i.e. from superficial folliculitis. The inflammatory process is rapidly intensifying. A painful knot the size of a walnut is formed. The skin over it becomes purple-red, swollen. The purulent crust formed at the top of the boil soon disappears, and thick pus begins to stand out from the boil. The process of maturation of the boil lasts several days. After removal of pus, a deep ulcer is formed, at the bottom of which you can see the core of the boil - a thick greenish mass, which is the dead tissue of the follicle. After the rod is rejected, the ulcer begins to heal. A scar usually remains in place of the boil. The duration of the disease is 10-14 days.

The whole process of development of a boil is accompanied by burning, soreness, chilling, sometimes an increase in body temperature, which subside after rejection of the rod.

Boils are located on any part of the skin, but more often on places of friction with clothes: on the neck, lower back, buttocks, thighs, as well as on the forearms and hands. Furuncles on the face, lips and forehead are accompanied by severe swelling of the skin.

It is impossible to squeeze out purulent contents from a beginning or developing boil, since the inside of the rod contains, like in a chamber, staphylococci that are very dangerous for human health. They are removed from the body only when the rod is rejected. Until this moment, it is necessary to protect the boil from pressure, friction, from any injuries. The rod must not be squeezed out, it must not be removed, otherwise the rod will break and staphylococci will penetrate into the surrounding tissues or directly into the blood, which can lead to general blood poisoning (sepsis).

A boil is especially dangerous when it is located on the face, on the upper lip. It can be accompanied here by a large inflammatory edema, even tissue thickening. In these places, large blood vessels are close, in particular the vessels of the brain, where staphylococci can get. Such a boil must be especially protected from injuries and bruises.

Furunculosis - multiple boils scattered throughout the body, appearing either repeatedly after healing, or continuously one after another for weeks, months, years, or with more or less long breaks. Very often, a patient can see several boils on the skin at the same time, which are in different stages of development: scars that have just appeared, have reached full development, and remain in place of former boils.

Furuncles with furunculosis have a normal appearance, but their development proceeds more slowly, with less pain.

A carbuncle is a collection of many boils. In this case, the symptoms of the disease are more pronounced. Staphylococci penetrate deep into the skin and cause necrosis of not only the skin, but also the subcutaneous tissue over a large area. On the affected area, when individual abscesses have not yet merged, several holes are noted. In this area, the skin first becomes bright red, then bluish-purple. Extensive painful swelling develops. Soon the swelling softens and breaks through several holes, from which pus is released. An extensive ulcer is formed, in the depths of which a shapeless dead tissue of a greenish color is visible - a “necrotic core”. Gradually, the rod separates and is pushed out along with a large amount of pus. After the dead tissue falls off, the ulcer gradually (within 5-6 weeks) heals. In its place remains a rough scar.

The process of carbuncle formation is accompanied by swelling, severe pain and very high temperature.

Most often, carbuncles are located on the neck, lower back. With carbuncles of the face, blockage of the cerebral vessels, blood poisoning (sepsis) can develop. Foci of purulent lesions sometimes appear in the internal organs, as a result of which the death of the patient may occur.

Everything that has been said about the careful handling of the boil applies even more so to the carbuncle.

Hidradenitis is a purulent inflammation of the sweat glands in the armpits. The disease begins with the formation of a small, dense, painful nodule, the size of a cherry seed. Within a few days, the nodule increases in volume. The skin on the affected areas turns red, swelling is planned. Soon an abscess is formed, which is opened.

Hydradenitis is more common in women.

The process of development and healing of hidradenitis lasts 2-3 weeks. Bilateral hydradenitis is especially long-lasting. Increased sweating, various kinds of injuries, violation of the hygienic content of the skin contribute to the occurrence of hydradenitis.

Streptococcal diseases. In contrast to staphylococcal lesions, they are not associated with hair follicles, sebaceous and sweat glands, the initial manifestation in them is not an abscess, but a flaccid bladder filled with a clear, rapidly cloudy liquid. Streptococcal impetigo is a superficial pustular disease that most often occurs in children. Impetigo usually affects open parts of the body - the skin of the face, behind the ears, around the openings of the mouth and nose, on the hands. One or more small flat bubbles the size of a pea appear. Very quickly, the clear liquid of the bubble becomes cloudy. After 1-2 days, the bubble bursts, its contents dry up, forming a thin crust. At first thin, it then thickens, but remains loose, fragile. The color of the crust is straw-yellow, and in the case of an admixture of blood - brownish. On closer examination, along with crusts, one or two flat, inconspicuous bubbles can be seen, which also quickly turn into crusts.

After 5-7 days, the crust disappears, a pinkish spot remains in its place, which soon disappears without a trace.

The suddenness, speed of the appearance of a pustular rash is one of the important signs of impetigo.

Impetigo is easily passed on to other children. Therefore, children with this disease should not be allowed in nurseries, schools and other public places.

Zayeda is a streptococcal disease of the skin at the corners of the mouth. The emerging bubble quickly turns into an abscess, the thin cover of which quickly bursts. In the future, a thin, tender crust is formed. When opening the mouth while eating, talking, bubbles and crusts constantly break with the formation of new ones. Experiencing pain when opening the mouth, the patient involuntarily and often licks the affected corner of the mouth, repeating this every time it dries up.

If the disease is not treated, then after a while a superficial crack may form in the affected corner of the mouth, which, due to constant irritation of the skin by saliva, passing food, may not heal for a long time.

Zayeda is a highly contagious disease, easily transmitted through kissing, through common objects (plates, spoons, a common towel, etc.).

Superficial panaritium occurs exclusively in adults. The disease develops with finger injuries, burrs, when conditions appear for penetration into the thickness of the skin of streptococci. For example, carrying out a manicure without observing sanitary rules. First, flat blisters form, horseshoe-shaped, capturing the skin surrounding the nail. The blisters contain a light-colored liquid, which subsequently becomes purulent. Swelling and a feeling of soreness, redness are noted. After the opening of the bubbles, weeping foci are formed, covering the nail ridges, and sometimes the nail bed. Affected areas bleed. Inflammation can spread around the circumference and capture the phalanx, and even the entire finger. When the nail bed is damaged, the nail plate falls off.

With modern methods of treatment, superficial streptococcal panaritium is cured within 12-15 days.

Subcutaneous panaritium is a deep inflammatory purulent process of the fingers, capturing the subcutaneous tissue. The disease is caused by streptococci, which enter the depths of the skin through some kind of damage - with a splinter, with cuts, injections, etc.

An abscess forms in the depths of the skin, the finger increases significantly in volume, severe pain appears.

Erysipelatous inflammation of the skin (erysipelas) is a disease caused by a special type of streptococcus. Streptococcus penetrates the skin in violation of its integrity. Most often, erysipelas of the skin occurs on the face, arms or legs.

Initially, a sharply demarcated reddening of the skin appears, which quickly spreads over its surface. In the affected areas, the skin is edematous, tense, painful when pressed, bubbles may appear. This disease is accompanied by a significant increase in temperature, general malaise, as well as itching, burning and a feeling of tension in diseased areas of the skin.

Strepto-, staphylococcal diseases. When strepto-, staphylococci enter the skin, mixed strepto-, staphylococcal diseases can occur. There are several types of this disease.

Strepto-, staphylococcal impetigo - the disease is very contagious, more common in children. First, a bubble appears, which, due to the addition of staphylococci, turns into an abscess in a few hours; the contents of the abscess dries up and thick, yellowish-honey-colored crusts form, which fall off after 6-8 days. Strepto-, staphylococcal impetigo often occurs on the face, behind the ears. The duration of the disease is 8-15 days, after which pigmentation remains; in the future, the skin acquires a normal appearance.

An abscess is formed due to the ingress of pyogenic microbes during trauma or contamination of the wound. At the same time, the skin itself and subcutaneous fat are involved in the process. At the site of the lesion, redness, swelling, painful induration with further softening of the tissue are noted. As a complication of the disease, blood poisoning (sepsis) can occur. Most often, an abscess is noted in miners, diggers, fisheries workers, that is, in people of those professions in which there is severe skin contamination and the possibility of injury.

Phlegmon is a disease caused by pyogenic microbes. Compared with a phlegmon abscess, the lesion is more extensive. With it, purulent inflammation of the subcutaneous fat occurs, followed by gangrene (necrosis). First, a dense, very painful elevation is formed on the skin - a knot, followed by maturation of the knot, purulent fusion of deep tissues. In patients, the temperature rises and the general condition worsens. Phlegmon can be accompanied by bleeding, and if urgent measures are not taken, the disease can end in death.

Prevention of pustular diseases at work and at home. Given that pustular diseases are quite common, it is very important to be able to prevent them. The main causes of pustular diseases are: microtraumatism, skin contamination, etc.

Prevention for microtraumas is to provide first aid on the spot: it is necessary to treat the microtrauma as soon as possible. For the treatment of microtraumas, it is recommended to use BF-2 glue. It is applied to the damaged area of ​​the skin. After 1-2 minutes, the adhesive dries and forms an elastic film that lasts 4-5 days. After the film has formed, hands can be washed with soap and hot water; the film is not washed off.

Of great importance in the prevention of pustular diseases is personal hygiene. During the working day, the exposed parts of the body of barbershop workers are contaminated with dust, particles of cut hair, nails, and skin flakes. All this is mixed with the secretion of the sebaceous and sweat glands and leads to their blockage. Therefore, the most important point in the prevention of pustular skin diseases is the systematic washing of the body. Hairdressing salons should be equipped with a shower that workers can take at the end of the shift.

Hairdressers should pay special attention to hand care. This requirement stems from the specifics of the profession of a hairdresser who constantly touches the visitor's hair or face. If he does not follow elementary hygiene rules, he can get sick, not only himself, but also transfer pathogenic microbes from one client to another. Therefore, the most important requirement for the work of a hairdresser is the mandatory washing of hands before serving each visitor.

Tuberculous diseases of the skin. These diseases are caused by a tubercle bacillus.

Tuberculosis of the skin does not develop in all patients with tuberculosis. Infection can occur either as a result of the tuberculosis pathogen entering the skin from the affected organ through the blood vessels, or as a result of the spread of the tuberculosis process from the diseased organ to the adjacent skin.

Patients with skin tuberculosis do not pose a danger to others if they do not have an active process in the lungs. However, such patients are not allowed to work.

Tuberculosis of the skin is very diverse. The most common are lupus and scrofuloderma.

Lupus is the most severe form of skin tuberculosis. More common in women and children. In almost 1/4 of cases, lupus affects the face. The tip and wings of the nose are predominantly affected. From here, the disease can spread to the lips, chin, eyelids. Lupus is characterized by small soft bumps in the depths of the skin the size of a rust-colored pinhead. They usually come out in groups. Tubercles are prone to decay. In these cases, small superficial sores appear, healing with the formation of scars, on which fresh tubercles may reappear.

Lupus is a chronic disease. If the patient does not go to the doctor and is not treated, then the disease lasts for decades. As a result, the patient's face is disfigured - the wings of the nose are destroyed, the tip of the nose, the resulting scars can cause eversion of the eyelids, a significant narrowing of the mouth.

Scrofuloderma is the most common form of skin tuberculosis after lupus. It is observed more often in children and adolescents. The lesions are usually located on the neck, in the armpits, in the upper part of the sternum. The disease begins in the subcutaneous tissue in the form of small nodules that do not disturb the patient and are easily mobile. Gradually, the nodules increase and protrude above the surface of the skin. Subsequently, the nodules are soldered to the skin, which acquires a bluish-purple color, becomes thinner and opens with one or more holes, releasing purulent-bloody contents. Ulcers heal with uneven scarring.

Anthrax. The disease caused by anthrax bacteria is called anthrax. Human infection occurs from sick animals: horses, sheep, pigs, cattle. In addition, the disease can occur in people who process raw materials: workers in slaughterhouses skinning; workers engaged in the manufacture of brushes and brushes; workers in tanneries, etc. The disease can be transmitted through soil, feed, if the latter are contaminated with anthrax bacteria.

The disease manifests itself as swelling of the skin with a vesicle or bladder containing bloody fluid. This vesicle appears 1-3 days after infection and is most often located on the face or hands. After the bubble bursts, deep necrosis of the tissue is visible, and new bubbles develop around the skin. The disease is accompanied by high fever, severe headache and other severe symptoms. The sick are taken to the hospital for isolation and treatment. Animals diagnosed with anthrax are immediately slaughtered, and their corpses are buried to a depth of at least 2 m. Eating the meat of animals with anthrax is strictly prohibited.

Those working on dairy farms, slaughterhouses, tanneries, bristle and hair factories are required to carefully carry out all personal prevention measures: immediate disinfection of abrasions, scratches, wearing overalls and changing them regularly.

In hairdressing salons, to prevent the transmission of anthrax, it is forbidden to use shaving brushes without prior disinfection, and not only brushes that were in use, but also new ones are subject to disinfection (for more details, see the section "Disinfection of tools").

Pustular skin diseases (pyoderma) are infectious skin lesions that are caused by the introduction of staphylococci or streptococci.

Less commonly, the cause of pyoderma can be other pathogens - Pseudomonas aeruginosa, Proteus vulgaris, Escherichia coli, pneumococci. Pyodermas are very common diseases.

Etiology. The causative agents of pyoderma are most often staphylococci and streptococci, which belong to the gram-positive microbial flora. The most pathogenic of all types of staphylococci are such species as Staphylococcus aureus (the most pathogenic), epidermal and saprophytic staphylococcus (residents of the normal skin flora).

Staphylococci are facultative anaerobes and colonize the upper layers of the epidermis, more in the region of the mouths of hair follicles, sebaceous and sweat glands, i.e. most often affect the skin appendages.

Streptococci (saprophytic and epidermal) are present on the surface of smooth human skin without connection with skin appendages, more often on the face and in the area of ​​natural folds.

Under conditions of normal homeostasis of the human body, normal sweating and sebum secretion with a slightly acidic pH of the environment, the resident microflora of the skin surface is a constantly acting “biological brake”, which, due to microbial antagonism, prevents the reproduction of pathogenic microflora, displacing it from the microbial population. Systemic immune and endocrine disorders of the macroorganism, changing the chemistry of skin sweat and sebum, can lead to biological changes in the resident flora and the transition of pathogenic strains of staphylococci and streptococci into pathogenic ones, which can also be associated with gram-negative flora.

Pathogenesis. There are exogenous and endogenous factors that contribute to the penetration of pyococci into the skin and the development of pyodermatitis.

Exogenous factors include microtrauma and macrotrauma (scratches, abrasions, cuts, insect bites); maceration of the stratum corneum as a result of excessive sweating, exposure to moisture; skin contamination, both domestic (violation of hygiene standards) and professional (lubricating oils, flammable liquids, coarse dust particles of coal, cement, earth, lime); general and local hypothermia and overheating.

All of these exogenous factors violate the protective barrier function of the skin and contribute to the penetration of microflora.

Endogenous factors include:

1) the presence in the body of foci of chronic infection (ENT pathology, odontogenic, urogenital chronic pathology);

2) endocrine diseases (diabetes mellitus, hypercortisolism, hyperandrogenism);

3) chronic intoxication (alcoholism, drug addiction);

4) malnutrition (hypovitaminosis, protein deficiency);

5) immunodeficiency states (treatment with glucocorticoid drugs, immunosuppressants, HIV infection, radiation therapy).

Both endogenous and exogenous factors ultimately lead to a decrease in humoral and cellular immunity, resulting in a decrease in the protective function of the skin. This leads to a change in the amount and composition of the microbial flora on the surface of the skin towards the predominance of pathogenic species and strains of cocci.

Classification. Pyoderma is classified according to the etiological principle. According to this classification, staphylococcal, streptococcal and mixed (streptostaphylococcal) skin lesions are distinguished. In each group, superficial and deep pyodermas are distinguished, which can occur acutely and chronically.

Superficial pustular skin lesions include those nosological forms in which the epidermis and the upper layer of the dermis are affected.

With deep pyoderma, the lesion can capture not only the dermis, but also the hypodermis.

Staphylococcal pyoderma

Staphylococcal pyoderma, occurring acutely:

1) superficial (ostiofolliculitis, superficial folliculitis, staphylococcal bullous impetigo (in children), staphylococcal pemphigoid of newborns);

2) deep (deep folliculitis, furuncle, acute furunculosis, carbuncle, hydradenitis, multiple abscesses of infants).

Staphylococcal pyoderma, occurring chronically:

1) superficial (sycosis vulgaris);

2) deep (chronic furunculosis (localized and general), decalving folliculitis).

Streptococcal pyoderma

Streptococcal pyoderma, occurring acutely:

1) superficial (streptococcal impetigo, diaper rash);

2) deep (streptococcal ecthyma, erysipelas).

Streptococcal pyoderma, occurring chronically - chronic diffuse streptoderma.

Streptostaphylococcal pyoderma

Streptostaphylococcal pyoderma, occurring acutely:

1) superficial (impetigo vulgaris);

2) deep (ecthyma vulgaris).

Streptostaphylococcal pyoderma, occurring chronically (chronic atypical pyoderma):

1) ulcerative chronic pyoderma and its varieties (chancriform pyoderma);

2) ulcerative-vegetative pyoderma;

3) abscessing chronic pyoderma and its varieties (inverse conglobate acne).

Various pyodermas can occur primarily on previously unaltered skin, as well as secondarily against the background of existing skin lesions. Most often, these are itchy dermatoses (scabies, lice, atopic dermatitis, eczema), predisposing to the development of pustular pathology.

Clinic. Skin rashes with pyoderma are polymorphic. The type of primary elements of the rash depends on the type of pathogen and the depth of the skin lesion.

Staphylococcal skin lesions are usually associated with sebaceous hair follicles and sweat glands (apocrine and eccrine), and the inflammatory reaction they cause is purulent or purulent-necrotic in nature.

Different nosological forms of pustular skin lesions can manifest themselves with the same element of the rash. For example, ostiofolliculitis, superficial folliculitis and vulgar sycosis are manifested by a follicular abscess, and an inflammatory follicular nodule occurs with folliculitis (superficial and deep), decalving folliculitis, sometimes with a small boil.

The inflammatory node is found at the debut of a furuncle, carbuncle, multiple abscesses of infants (pseudofurunculosis).

Streptococcal skin lesions, unlike staphyloderma, do not affect the sebaceous hair follicle and sweat glands. They are characterized by a predominantly superficial inflammatory lesion of smooth skin with the release of serous exudate.

The main primary eruptive element in superficial streptoderma is the superficial bladder. In those localizations of the skin, where the stratum corneum is relatively thin, the streptococcal bladder looks sluggish, flabby, it is called conflict. In those areas where there is hyperkeratosis (palms, soles, periungual zones), streptococcal blisters may have a tense appearance, a fairly dense cover, serous or cloudy contents.

With deep streptococcal skin lesions, the primary eruptive element may be a deep epidermal pustule with limited necrosis of the underlying dermis (ecthyma) or edematous erythema with clear, rapidly increasing borders (erysipelas).

Ostiofolliculitis

This is an inflammation of the mouth of the hair follicle. It appears as a small (up to 2–3 mm in diameter) cone-shaped or hemispherical abscess containing whitish or yellowish cloudy pus. The pustule is located at the mouth of the hair follicle, penetrated by hair in the center and surrounded by a narrow halo of hyperemia. Ostiofolliculitis often occurs in open areas of the body that are subjected to friction, shaving, combing, exposure to lubricating oils (face, neck, extensor surfaces of the limbs, scalp). The process is superficial, resolution is observed after 2-3 days. The pustule dries up to a yellowish-brown crust, the corolla of hyperemia disappears, after the rejection of the crust, slight hyperpigmentation may remain.

In unfavorable situations (friction, maceration), ostiofolliculitis can deepen (turn into folliculitis and even furuncle), or individual ostiofolliculitis can increase in area and form the so-called staphylococcal impetigo.

Folliculitis

This is a purulent inflammation of the hair follicle with a lesion of its upper part or the entire hair follicle. Depending on the depth of the lesion, there are superficial and deep folliculitis.

In most cases, superficial folliculitis begins, like ostiofolliculitis, with a small abscess at the mouth of the follicle. The process quickly spreads deep into the follicle, which is clinically manifested by an increase in the zone of hyperemia, the appearance of a painful dense inflammatory papule at the base of the abscess with a diameter of more than 5-7 mm. In cases where superficial folliculitis develops without previous ostiofolliculitis, a follicularly located inflammatory papule with a diameter of about 5 mm is immediately formed. It has a conical or hemispherical shape, in the center it is permeated with hair. After 2-3 days, a follicular tense pustule forms around the hair. After 4-7 days, the pustule dries up to a yellowish crust, after which there may be congestive hyperemia and pigmentation.

Deep folliculitis is characterized by a total lesion of the entire hair follicle, accompanied by severe pain, hyperemia, swelling, tissue infiltration around the follicle, i.e., an inflammatory node is formed that clinically resembles a boil. It is distinguished from the latter by the absence of a necrotic rod in the center of the infiltrate.

Impetigo staphylococcus

This form of the disease occurs mainly in newborns with their unhygienic content. Pathogenic staphylococci that have penetrated the skin secrete a powerful exotoxin - exfoliatin, which destroys the desmosomes of epidermal cells at the level of the granular layer. This leads to the formation of separate blisters filled with yellow pus. Such a lesion is called epidemic staphylococcal pemphigus of the newborn, or staphylococcal pemphigoid. The disease proceeds severely with an increase in body temperature, the development of intoxication syndrome up to septicemia. Babies suck badly at the breast, lose weight, and septic complications are possible.

Staphylococcal pemphigoid usually occurs 3 to 5 days after the baby is born, but it can develop during the first month of life. Superficial flaccid bubbles (conflicts) appear in size from a pea to a hazelnut. Their contents are first serous, then serous-purulent. The blisters are surrounded by a mild inflammatory corolla and are located on normal skin.

After the rupture of the bubble, weeping erosion remains, surrounded on the periphery by the remnants of the tire. Unlike ordinary impetigo, a crust does not form. Rashes are most often located on the chest, back, in skin folds. Rashes almost never occur on the skin of the palms and soles.

The malignant course of staphylococcal pemphigoid leads to a universal skin lesion. This condition is called exfoliative dermatitis of Ritter von Rittershain, or staphylococcal "burned" skin syndrome. The clinical picture of this syndrome is characterized by an acute onset, high body temperature and intoxication, an increase in diffuse skin erythema, first around the navel and mouth, then in the skin folds. There is a superficial detachment of the epidermis at the level of the granular layer, fragments of the stratum corneum hang from the affected skin. The clinical picture may resemble toxic epidermal necrolysis (Lyell's syndrome), in which epidermal detachment occurs at the basement membrane level.

Without adequate antibacterial and detoxifying treatment, newborns can die.

Sycosis staphylococcal, or vulgar

This is a chronic superficial skin lesion, manifested by numerous recurrent ostiofolliculitis and superficial folliculitis, followed by infiltration of the surrounding skin.

The disease, as a rule, is observed in adult men and is localized on the face (the area of ​​growth of the mustache and beard), much less often spreads to the pubis, the edges of the eyelids, eyebrows, scalp, axillary zones. In the pathogenesis of vulgar sycosis on the face, chronic foci of infection in the head area and re-traumatization of the skin during wet shaving are important.

The disease begins with small follicular pustules, which repeatedly recur many times in the same place. Gradually, the process expands due to the involvement of more and more new follicles and the formation of new follicular pustules along the periphery of the focus. The skin in the affected area becomes cyanotic and diffusely infiltrated. After the opening of the pustules, accumulations of purulent crusts of different thickness are formed, in the places of their discharge - diffuse weeping. Hair removal in the affected area is painless and easy. In the root zones of epilated hair, a vitreous clutch is clearly visible.

Vulgar sycosis proceeds for a long time, recurring for many years. Subjective sensations are insignificant, patients may feel slight itching, burning, tightening of the skin in the lesion.

In a natural course, the process resolves itself within 2-3 months, leaving cicatricial alopecia in its place.

Folliculitis decalvans, or sycosis lupoid

This is a rare form of staphylococcal lesions of the hair follicle, in which chronic folliculitis without severe pustulation and ulceration leads to skin atrophy and persistent baldness. The etiology and pathogenesis are not well understood. The causative agent is Staphylococcus aureus, additional colonization in the hair cells of gram-negative microbial flora is also possible. This can be caused by altered immunological reactivity of the body against the background of seborrheic status, chronic focal infection, diabetes mellitus. The microbial factor, apparently, is only one of the pathogenetic links in the development of this disease.

Men of average and advanced age are ill more often. The pathological process can be located in the area of ​​the beard and mustache, in the temporal and parietal areas of the scalp.

The disease is characterized by a chronic course. Against the background of congestive erythema, grouped follicular nodules and pustules appear, as well as follicularly located light yellow crusts and grayish scales, which are easily removed by scraping. These elements merge and form a clearly demarcated round or oval infiltrated plaque 2–3 cm in diameter, wine-red, with a flat, painless infiltrate at the base. Gradually, in its central part, the skin turns pale, thinner, becomes smooth, devoid of hair and slightly sinks - a characteristic central atrophy of the skin develops. Within its limits, new follicles do not arise and single hairs or tufts of hair may still be preserved. The peripheral zone of the focus, about 1 cm wide, is slightly elevated, more hyperemic, moderately infiltrated. In this zone are numerous follicular papules with rare pustules in the center. The focus slowly progressively increases in area due to the appearance of new folliculitis along the periphery. Sometimes the growth of the focus prevails at one of its poles, which leads to the formation of an irregular, asymmetric lesion. With diascopy of the edge of the focus, the symptom of apple jelly is not determined.

The course of the process is chronic, lasting for many months and years with periods of incomplete remission and spontaneous exacerbations. The general condition of patients is not disturbed, subjective sensations are usually absent. When the lesions are located on the scalp, patients may experience pain, which, apparently, is due to the anatomical features of the skin in this area (the proximity of the aponeurosis).

Furuncle

This is an acute purulent-necrotic inflammation of the hair follicle and perifollicular connective tissue. Furuncle refers to the deep form of staphyloderma. The primary eruptive element of the boil is an inflammatory node that forms around the hair follicle infected with staphylococci.

The onset of the disease is associated with the formation of an inflammatory purulent infiltrate around the hair follicle, which in the early stages can be small in size (like folliculitis), however, the process quickly captures the entire depth of the hair follicle, the surrounding connective tissue and the adjacent sebaceous gland and is an inflammatory stagnant-hyperemic node , conically rising above the surface of the skin. Soreness increases, jerking, throbbing pains are possible.

With the localization of the boil in the face, especially on the upper lip, there is extensive swelling around the infiltrate. After 3-4 days, fluctuation begins to be determined in the center of the infiltrate, a purulent fistula is formed around the hair, upon opening of which a small amount of thick pus is released, a small ulcer is formed. At the bottom of this ulcer, a necrotic core of a greenish color is revealed. After another 2 - 3 days, the necrotic rod is rejected with a small amount of blood and pus, after which pain and inflammation are significantly reduced. In place of the rejected necrotic rod, a deep crater-like ulcer is formed, which, after being cleansed of pus and remnants of necrotic masses, is filled with granulations, a retracted scar is gradually formed, the size and depth of which depends on the size of necrosis in the center of the boil.

A furuncle can occur in any part of the skin where there are hair follicles. Single boils are usually localized on the forearms, face, back of the neck, lower back, buttocks, thighs.

Usually, single boils are not accompanied by a violation of general well-being and an increase in body temperature. The exception is the furuncle of the face.

Particular attention should be paid to patients in whom the furuncle is located in the area of ​​the lips, on the nose, in the nasolabial triangle and in the area of ​​the external auditory canal. Mimic movements of the face, traumatization of boils during shaving or an attempt to squeeze them out can lead to serious complications (thrombophlebitis of the veins of the face).

The process is accompanied by the appearance of diffuse hyperemia of facial tissues, their tension and soreness.

Pain and signs of general intoxication increase: body temperature can reach 40 ° C, patients complain of chills, weakness, headache. There may be confusion. The hemogram changes: leukocytosis, accelerated ESR, shift of the leukocyte formula to the left.

The anatomical features of the venous outflow on the face, the presence of anastomoses with the cavernous sinus of the brain can lead to more severe complications - the spread of staphylococcal infection and the development of meningitis, meningoencephalitis, septicopyemia and sepsis with the formation of multiple abscesses in various organs and tissues. Thus, with untimely and irrational treatment of a facial boil, the process can proceed malignantly and lead to death.

Furuncles of the extremities, especially those located near the joints and easily injured, can be complicated by regional lymphadenitis and lymphangitis. Sometimes acute glomerulonephritis develops.

Furunculosis

This is the presence of multiple boils on the skin or sequential recurrence of boils. There are acute furunculosis, in which many boils are present on the skin at the same time, and chronic furunculosis, when boils (single or multiple) recur sequentially at short intervals for months and even years. According to the prevalence, localized (limited) furunculosis and widespread (disseminated) are distinguished.

Acute furunculosis develops, as a rule, with short-term exposure to exogenous and less often endogenous predisposing factors, while chronic furunculosis develops with the long-term presence of endogenous predisposing factors. These include the presence of foci of chronic infection, diabetes mellitus, unbalanced nutrition, hypovitaminosis, chronic intoxication, hypercortisolism, immunodeficiency states.

Localized furunculosis (acute and chronic) develops as a result of the introduction of staphylococci into several adjacent follicles. This is facilitated by a number of factors: pronounced staphylococcus virulence, traumatization, skin contamination with lubricating oils, local hypothermia of the skin.

Carbuncle, or charcoal

This is a very severe and deep form of staphyloderma, which is a purulent-necrotic inflammation of the deep layers of the dermis and hypodermis with the involvement of many hair follicles in the process. It is most often caused by the most pathogenic Staphylococcus aureus. In the pathogenesis of carbuncle development, the weakening of the body's defenses, diabetes mellitus, and immunosuppressive states are of great importance.

More often, the carbuncle is solitary and develops in places that are most susceptible to friction of clothing (this is the back of the neck, lower back, buttocks, upper and lower limbs).

The disease begins with the formation of an extensive inflammatory node in the deep layers of the dermis and hypodermis. A dense, painful inflammatory node is not clearly defined, rapidly increases in depth and width, and can reach a fairly large size. Within a few days, the infiltrate acquires a purple-red color and protrudes significantly above the surface of the skin. Growing perifocal edema and throbbing pain in the node area.

The general condition of the patient is sharply disturbed: there is a high temperature, chills, headache. After 5-7 days, a fluctuation appears in the center of the infiltrate, indicating purulent fusion. The skin in the center of the infiltrate acquires a black color due to necrosis. The cavity opens to the surface with multiple fistulous openings corresponding to the mouths of the hair follicles, from which thick yellow-greenish pus is released with an admixture of blood. In the holes formed, deep-lying necrotic masses of a greenish color are visible.

Melting of the edges of individual fistulous passages leads to the formation of a single extensive ulcer with uneven edges and a necrotic bottom.

In the natural course of the process, necrotic masses can persist for a long time, up to 2-3 weeks, gradually being rejected. This is accompanied by a gradual improvement in the general condition of the patient, a decrease in body temperature to normal, a significant decrease in local swelling and pain. After rejection, a deep ulcer is formed, sometimes up to the fascia and muscles, with undermined edges, the bottom of which is gradually filled with granulations, and the defect is scarred within 2-3 weeks. A rough scar of irregular shape remains.

The most malignant course has an anthrax of the facial zone, since it can be complicated by thrombophlebitis of the facial veins, thrombosis of the sinuses of the brain, embolism, septicemia, and sepsis.

Hydradenitis

This is a purulent inflammation of the apocrine sweat glands. The disease is inherent in mature people who have actively functioning apocrine sweat glands. The most common form of localization is hydradenitis in the axillary zone. But hydradenitis can also occur in all anatomical locations where apocrine sweat glands are located: the area around the nipples, perianally, on the skin of the scrotum, labia majora, around the navel.

Factors contributing to the introduction of pathogenic staphylococci into the mouths of the hair follicles and excretory ducts of the glands are skin trauma, the irrational use of antiperspirant deodorants, as well as all pathogenetic factors leading to immunosuppression.

The disease begins with the appearance of a dense node or several nodes in the deep layers of the skin, which are initially determined only by palpation. Gradually, their size increases, the skin over them turns red. As the inflammatory reaction increases, the nodes become soldered to the skin, it acquires a bluish-red color, pain intensifies.

In cases where several nodes are located side by side, a continuous tuberous infiltrate may form, consisting of hemispherical nodes. The process can be two-way. Within a few days, the nodes undergo central softening due to the development of an abscess and gradually open with purulent fistulas with the release of thick yellow-green pus. Gradually, the cavity of abscesses is emptied, the severity of inflammation subsides, and the process of scarring begins. In place of hidradenitis, an inverted scar or scars are formed (depending on the number of fistulous passages).

In the case of timely treatment at the stage of infiltration, the process may not abscess, but gradually dissolve without a trace.

Streptococcal impetigo

This common superficial form of streptoderma predominantly affects children and young women. Skin lesions usually affect open areas: face (around the nose and mouth), parotid areas, extremities.

The disease becomes more frequent in the warm season. In conditions of close bodily contact, streptococcal infection is easily transmitted from a sick person to a healthy one. Epidemic outbreaks are possible in children's groups.

In the occurrence of streptococcal impetigo, micro- and macrotrauma of the skin, maceration are of great importance.

Pathogenic streptococci that secrete proteolytic enzymes, having penetrated into the skin lesions, lyse the intercellular bonds of the surface layers of the epidermis, leading to the formation of a primary eruptive element - conflicts, which dries up with the formation of a grayish-yellowish crust. Around conflicts and crusts, a small corolla of hyperemia is noticeable. Conflicts and crusts rapidly increase in size and may merge. The serous exudate of the revealed conflicts infects the surrounding skin, and the process spreads rapidly.

Under favorable conditions, erosion epithelialize, the crusts fall off, in their place there is a slight hyperemia, then light pigmentation. There are no permanent marks. The average duration of the development of conflicts in the crust and the completion of epithelialization does not exceed a week. However, with constant dissemination and the emergence of new and fresh conflicts, the process can be delayed. With single rashes of a small area, subjective sensations are insignificant (slight itching). With extensive areas of damage, patients may complain of burning, itching.

Complications of streptococcal impetigo can be lymphangitis and regional lymphadenitis, eczematization (especially in people prone to atopy), in children - the development of infectious-toxic glomerulonephritis.

There are several varieties of impetigo: slit-like, annular, vesicular (bullous) and its variety - periungual impetigo.

Infection with streptococcus of the skin of the wings of the nose and under the nose can lead to the development of superficial impetiginous rhinitis, which is manifested by superficial inflammation of the skin of the wings of the nose and the formation of conflicts there, drying out with confluent crusts.

Angular impetigo, or streptococcal zaeda, affects the corners of the mouth on one or both sides. The primary eruptive element is the superficial conflict, which opens very quickly and forms a slit-like erosion surrounded by a narrow corolla of the macerated stratum corneum of the epidermis. Periodically in the morning after sleep, erosion can be covered with a loose yellowish crust, which is quickly rejected, again exposing a weeping slit-like erosion. Palpation of the base of erosion does not reveal a significant infiltrate.

Impetigo vulgaris or contagious

The disease is caused by pathogenic streptococci, which cause the primary eruptive element - subcorneal conflict. However, the staphylococcal flora joins very quickly, leading to pronounced suppuration and the formation of purulent cavity elements that dry out with honey-yellow or greenish crusts.

Like streptococcal, impetigo vulgaris is most common in children in open areas of the body. With close bodily contact, especially in children's groups, mass outbreaks of impetigo vulgaris are possible.

Streptococcal diaper rash

Streptococcal lesion, accompanied by inflammation of the contacting surfaces in the skin folds and characterized by a long course with frequent relapses.

The development of this lesion is initially based on intertriginous dermatitis (diaper rash), which develops as a result of friction of the skin surfaces in the fold, maceration of the stratum corneum due to intense sweating, discharge from natural openings and other causes, in the absence of proper hygienic skin care (fermentation and decomposition occurs sebum and sweat). These factors lead to the development of an inflammatory reaction of the skin folds and the addition of streptococcal flora, often in association with yeast-like fungi.

A number of diseases predispose to the development of diaper rash: obesity, type 2 diabetes, gout, severe forms of seborrheic dermatitis, hypercortisolism.

Manifestations of streptococcal diaper rash are quite typical: the contacting skin surfaces in the folds (especially in obese people) are hyperemic, edematous, maceration of the stratum corneum and its erosion are noted. Due to the constant exposure to friction, the resulting streptococcal conflicts instantly open up, leaving behind confluent surface erosions with a border of a macerated stratum corneum exfoliated along the edge. The eroded zones become wet, cracks are determined in the depth of the fold. The edges of the foci are scalloped. Subjectively, patients complain of burning, itching, and if cracks occur, pain. With regression of diaper rash, persistent pigmentation may remain.

Streptoderma diffuse chronic

This is a chronic diffuse inflammation of the skin of the lower extremities as a result of vascular disorders, prolonged repeated hypothermia or maceration of the skin.

The skin of the legs is usually affected. The first spill element is multiple conflicts, which quickly dry out to crusts, under which surface erosions remain on a stagnant-hyperemic base. The lesion is asymmetric, the contours are clear, the outlines are large-scalloped. The surface of the focus is covered with lamellar and stratified crusts or cortical scales of a yellowish-greenish color, when removed, an erosive surface with serous-purulent exudate is revealed.

Due to the peripheral growth of the foci, their area gradually increases, fresh conflicts can be found along the edges, which merge with the main focus, dry out in crusts and create scalloped contours of the affected area. The process can be complicated by lymphangitis and lymphadenitis, eczematization may develop. Without adequate treatment, this form of pyoderma is chronic and can recur. In some cases, chronic diffuse streptoderma develops around infected wounds, purulent fistulas, and trophic ulcers. In such cases, it is commonly called paratraumatic streptoderma.

Ecthyma vulgaris, or streptococcal ulcer

This is a deep form of streptoderma.

In addition to streptococci, staphylococci and gram-negative flora (Proteus vulgaris, Escherichia and Pseudomonas aeruginosa) can participate in the development of ecthyma. The development of the disease is promoted by skin injuries, insufficient skin hygiene, circulatory disorders of the lower extremities, immunodeficiency states, and chronic intoxication.

Ecthyma is most often localized on the skin of the legs, but can occur on the skin of the thighs, buttocks, lower back. The disease begins with the appearance of a large conflict with cloudy (sometimes hemorrhagic) contents or a deep epidermal-dermal pustule. On the periphery of these elements there is a bright hyperemic border. Rapidly developing necrosis leads to the formation of a deep ulcer covered with a brown crust. The elements are large, with a diameter of 2 cm or more. The crust is deeply immersed in the skin tissue, a soft infiltrate gradually forms around.

If the crust is removed, a deep, rounded ulcer with sheer or undermined edges and an uneven necrotic bottom is exposed. Independent regression of ecthyma is slow. Within 2-4 weeks, it gradually scars, leaving behind an atrophic scar with surrounding hyperpigmentation. Ecthymes can be multiple, but they are always located separately. If there are no complications, the general health of patients remains satisfactory.

Ecthyma can be complicated by regional lymphadenitis, lymphangitis, and sometimes phlebitis. Perhaps the development of glomerulonephritis. With prolonged existence of ecthyma on the legs, transformation into chronic ulcerative pyoderma is possible.

Erysipelas

It is an acute deep streptococcal inflammation of the skin, accompanied by fever and intoxication.

The source of infection can be both bacteria carriers and patients with tonsillitis, chronic rhinitis, tonsillitis, streptoderma, i.e. those diseases that are caused by streptococci.

The cause of the disease is group A hemolytic streptococcus, which penetrates through damaged skin and affects the lymphatic vessels of the skin, leading to acute inflammation. Chronic traumatization of the skin, the presence of cracks, scratching can lead to recurrence of erysipelas and persistence of infection in the lymph nodes. Repeated inflammatory processes lead to cicatricial changes in the tissues around the lymphocapillaries, their obliteration and the development of elephantiasis of the limb.

The incubation period of infection ranges from several hours to several days. The disease begins acutely, in some patients prodromal phenomena are observed in the form of malaise, chilling, headache. At the site of penetration of the pathogen into the skin, a red edematous spot appears, which quickly increases in size, acquiring a scalloped character. The boundaries are clear, the skin in the focus is edematous, tense, shiny, hot to the touch.

At the site of the lesion, patients are concerned about pain (especially in the marginal zones of the focus), burning sensations, and fullness. This is accompanied by a sharp rise in temperature and other symptoms of intoxication (chills, headache, severe weakness, in the most severe cases, confusion).

According to the severity of intoxication, mild, moderate and severe forms of erysipelas are distinguished. According to the clinical manifestations in the focus, there are the usual form (erythema and edema), bullous-hemorrhagic (against the background of erythema, blisters with serous-hemorrhagic contents form), phlegmonous form (suppuration of subcutaneous fatty tissue) and the most severe - gangrenous form (necrotizing fasciitis), flowing with gangrene of subcutaneous tissue, fascia and underlying muscles.

Erysipelatous inflammation of the face can be complicated by dire consequences up to thrombosis of the sinuses of the brain and the development of sepsis. In all forms of the disease, regional lymph nodes are enlarged and painful.

The main complications of erysipelas include the development of persistent lymphostasis (elephantiasis), the formation of abscesses, phlegmon, phlebitis, gangrene. Sensitization to streptococcal toxins can provoke the formation of glomerulonephritis, myocarditis, rheumatism, dermatomyositis.

Due to the high contagiousness of the disease and the possibility of developing severe complications, patients should be hospitalized in a purulent or infectious department in order to maximize isolation from other patients.

A special group of rare chronic (atypical) pyoderma has been isolated from purulent skin diseases. It included ulcerative atypical pyoderma (chronic pyococcal ulcer) and its variety - chancriform pyoderma; chronic abscessed pyoderma and its variety - inverse conglobate acne.

All these rare nosological forms of atypical pyoderma have different etiology and pathogenesis. Monocultures or associations of microorganisms (staphylococci, streptococci, enterococci, Escherichia coli and Pseudomonas aeruginosa, Proteus vulgaris) can be sown from the lesions.

There is no connection between the type of pathogen and the form of pyoderma. The development of these forms of chronic pyoderma is due not so much to an infectious factor as to an unusual, altered reactivity of the macroorganism, the type and severity of immunodeficiency.

In all patients with chronic atypical pyoderma, a variety of immune disorders are detected, as well as a decrease in nonspecific resistance of the body.

In some cases, patients with chronic atypical pyoderma are diagnosed with ulcerative colitis, Crohn's disease, chronic myeloid leukemia, lymphoma, diabetes mellitus, alcoholism and other severe concomitant diseases leading to immunodeficiency.

All forms of chronic atypical pyoderma have common features:

1) the presence of immunodeficiency;

2) chronic course;

3) granulomatous structure of the infiltrate in the dermis and hypodermis;

4) resistance to treatment with antibacterial drugs while maintaining the sensitivity of the microbial flora isolated from the foci to these antibacterial agents;

5) high sensitivity of the skin to various irritants.

Chronic atypical pyoderma may begin with ordinary pyoderma or with skin injuries secondary to pyococcal infection. Gradually, they turn into an ulcerative and ulcerative-vegetative atypical form of pyoderma, clinically resembling skin tuberculosis or deep mycoses.

Diagnosis is based on the clinical picture and the results of microbiological, histological and immunological studies.

There are no standard schemes that could quickly provide a positive clinical effect. Treatment of patients with chronic atypical pyoderma is a difficult task, which often cannot be solved during the first standard treatment.

If immune disorders are detected, they are corrected, after which it is advisable to carry out a combined antibacterial therapy of the patient, taking into account the sensitivity of the microbial flora.

However, it should be noted that antibiotic therapy alone does not give a significant effect. It should be combined with short courses of glucocorticosteroids, anti-inflammatory drugs, sometimes with cytostatics, immune replacement therapy.

With abscessing inverse acne, in addition to antibiotics, isotretinoin treatment is prescribed at a dose of 0.5–1 mg per 1 kg of body weight per day for 12–16 weeks. Such treatment has a positive effect, as well as in severe acne. Patients suffering from chronic pyoderma, it is necessary to conduct repeated courses of reasonable, individually selected therapy.

Principles of therapy for pyoderma. In the treatment of pyoderma, the main principles must be observed.

1. Influence the cause of pyoderma, i.e., carry out etiotropic (antimicrobial) treatment.

2. Eliminate predisposing factors (pathogenetic therapy): carry out correction of carbohydrate metabolism, elimination of vitamin deficiency, sanitation of foci of chronic infection, immunostimulating therapy.

3. Prevent the spread of infection to undamaged areas of the skin (temporary prohibition of washing and visiting pools, prohibition of compresses, skin massage in the pyoderma area, treatment of unaffected skin around pyoderma foci with antiseptics).

Etiotropic therapy of pyoderma is aimed at suppressing the vital activity of the pyococcal flora that caused a purulent disease of the human skin. This therapy can be general (systemic) or external, local (topical).

Indications for general antibiotic therapy:

1) multiple pyoderma, their rapid spread over the skin, lack of effect from external therapy;

2) the appearance of lymphangitis, enlarged and painful lymph nodes;

3) the presence of a general reaction of the body to purulent inflammation: fever, chills, malaise, weakness;

4) deep uncomplicated and especially complicated pyoderma of the face (the threat of lymphogenous and hematogenous dissemination of infection up to thrombosis of the venous sinuses of the brain and the development of purulent meningitis).

A relative indication (the issue is decided in each case based on the totality of clinical data) is the presence of even mild forms of pyoderma in debilitated patients on the background of immunosuppressive, radiation therapy, HIV-infected patients, patients with exocrine or hematological pathology.

Systemic antibiotic therapy can be carried out with antibiotics or sulfonamides. The choice of these agents is desirable to be carried out in accordance with the results of a microbiological study of purulent discharge from the foci of pyoderma (inoculation, isolation of a pure culture of the pathogen and determination of its sensitivity to antibiotics).

Preparations of the penicillin group have the greatest sensitizing activity, more often than other antibiotics cause toxicoderma. It is undesirable to prescribe them to patients with purulent complications of eczematous rashes, suffering from atopy, since penicillins exacerbate the course of the underlying disease (it is better to replace them with macrolides, fluoroquinolones). In patients with psoriasis, penicillin therapy can lead to an exacerbation of the skin process, the development of psoriatic arthritis.

The volume of external therapy for pyoderma is determined by the depth and severity of skin lesions. So, in acute superficial pyoderma, accompanied by the formation of superficial pustules on the skin, they should be opened, followed by immediate treatment with external antiseptics.

With deep pyoderma in the stage of infiltration, a resolving therapy should be prescribed, aimed at increasing hyperemia in the focus and thereby contributing to either the rapid self-resolution of the infiltrate, or rapid abscess formation. For this, ichthyol applications are used on the emerging infiltrate, physiotherapeutic effects: UHF, low-energy laser radiation, dry thermal procedures . Of particular note is the undesirability of compresses, applications of paraffin or ozocerite, since these procedures are accompanied by skin maceration and can cause aggravation of the purulent process.

If there are signs of an abscess of deep pyoderma, they should be surgically opened, followed by drainage of the purulent cavity with the help of turundas moistened with hypertonic sodium chloride solution, antiseptic solutions.

After the appearance of active granulations, it is advisable to apply dressings with ointments containing antiseptics and biostimulants.

When pyoderma occurs subacutely or chronically, the surface of the foci is covered with purulent crusts, they must be removed by softening with antiseptic ointment, followed by mechanical action with swabs moistened with a 3% aqueous solution of hydrogen peroxide. After removal of purulent crusts, the focus is treated with an aqueous or alcoholic solution of an antiseptic.

Pustular skin diseases (pyoderma) are a group of infectious diseases caused by streptococci and staphylococci. On a healthy body, these microorganisms exist in limited quantities, without manifesting themselves in any way. But with any "entrance gate" - skin damage caused by microtraumas, dermatosis with skin itching, contaminated skin, reduced immunity, chronic ailments, changes in the composition of sweat and increased sweating - begin to develop actively.

Sometimes pyoderma can be triggered by other infections - Pseudomonas aeruginosa and Escherichia coli, Proteus vulgaris, pneumococci. Pustular skin problems are fairly common diseases.

Causes and conditions of skin diseases

Pustular skin diseases are caused by streptococci and staphylococci

Among the causative agents of pyoderma, staphylococci and streptococci are in the first place. Staphylococci often inhabit the upper layers of the skin: the mouth of the follicle, sweat and sebaceous glands.

Streptococci colonize the epidermis: the face, areas of natural folds.

With normal homeostasis, moderate sweating, microorganisms that live on the skin serve as a kind of “brake” that displaces pathogenic microflora. Endocrine and immune disorders change the chemical composition of sweat and sebum, provoking the activity of foreign microflora.

The mechanism of development of skin diseases

There are external (exogenous) and internal (endogenous) causes that affect the activity of pyococci and the occurrence of pyodermatitis. The first group includes:

• Skin injuries of a different nature (cuts, irritations, mosquito bites, scratching).
• Maceration (waterlogging) of the skin with increased sweating or the constant presence of moisture on the stratum corneum.
• Skin pollution: at the household level (ignoring hygiene standards) or professional (constant skin irritation with fuels and lubricants, coal dust particles, etc.).
• General or local overheating or cooling.

Internal factors:

• Chronic infections (pathologies of the genitourinary system, the consequences of untreated caries, ENT diseases).
• Endocrine problems associated with diabetes mellitus, hyperandrogenism, hypercortisolism.
• Chronic alcohol or drug poisoning.
• Unbalanced diet (protein deficiency, beriberi).
• Immune disorders provoked by the use of glucocorticoid drugs and immunosuppressants in HIV and after exposure.

Both those and other reasons reduce all types of immunity and skin capabilities. Gradually, the composition of the microflora deteriorates.

Classification of pyoderma

Types of diseases depend on the cause that causes them, therefore they are divided into staphylococcal, streptococcal and mixed pathologies. Each type of disease can be superficial and deep, occurring acutely and chronically. With a superficial form, the infection affects the epidermis and dermis, with a deep one, the dermis and hypodermis.

Staphylococcal varieties

Among pyodermas with an acute course of the disease, there are:

• Superficial form: ostiofolliculitis, folliculitis, impetigo bullous (in children), pemphigoid of infants.
• A deep variety found in boils, folliculitis, carbuncles, hydradenitis.

The chronic stage of staphylococcal skin diseases is:

• Superficial, as in sycosis vulgaris.
• Deep - with furunculosis, decalving folliculitis.

Pyoderma is a fairly common disease.

streptococcal infections

The acute form is characteristic:

• For superficial types of impetigo and diaper rash.
• With deep erysipelas and ecthyma.

The chronic stage occurs with diffuse streptoderma.

mixed type

Streptostaphylococcal pyoderma in acute form are:

• Superficial, like impetigo vulgaris.
• Deep - vulgar ecthyma.

Of the chronic forms of mixed pyoderma, there are:

• Ulcerative pustular disease.
• Ulcerative vegetative pyoderma.
• Abscessing pyoderma.

Pustular skin diseases occur on absolutely clean skin or on the basis of previous skin problems - scabies, eczema, pediculosis, dermatitis.

Clinical Features

The rash in pustular infections is polymorphic. The type of primary rash will depend on the degree of tissue damage.

Staphylococcal pathogens multiply on the hair follicles and sweat glands and provoke inflammation.

Rashes with pyoderma are polyphoric

Different types of skin lesions may look the same, for example, follicular pustules occur with ostiofolliculitis, folliculitis and sycosis, and an inflammatory nodule may be a sign of folliculitis or just a boil. Streptococcal infections prefer smooth skin.

The main external symptom of superficial streptoderma is a bubble. With a thin stratum corneum, it has a flabby appearance (conflict), with hyperkeratosis (on the palms, feet), the superficial blisters are more solid, filled with serous fluid.

If the infection is deep, the rash will be in the form of ecthyma - an epidermal pustule with local necrosis of edematous erythema with a growing focus of inflammation (for example, erysipelas).

Staphylococcal skin infections

1. Ostiofolliculitis is an inflammation of the follicle. It has the appearance of a small (Ǿ 2-3 cm) abscess in the form of a hemisphere or cone with a cream-colored pus, surrounded by a halo of hyperemia. An infection develops on the open part of the body (on the face, neck, head, folds of the arms and legs). These areas are often under the influence of mechanical and chemical irritants (friction, shaving, household and industrial chemicals). After 2-3 days, the redness disappears, the brown crust dries up. After its rejection, the color of the skin changes slightly. With friction or maceration, the disease can progress, become more severe.
2. Folliculitis is a purulent inflammation that affects the hair follicle. The surface process begins, like the previous pyoderma, with a small abscess deepening into the mouth. The surrounding skin turns red and thickens, the abscess increases to 5-7 mm in diameter. If the infection is primary, the papule is in the form of a cone or hemisphere up to 5 mm in diameter. After 2-3 days, a dense pustule appears, disappearing after a week. After peeling off the dried crust, congestive redness is observed. With a deep form, the entire hair follicle is affected. The painful process is accompanied by redness, swelling, infiltration
3. Impetigo develops in a child already in the hospital (in violation of hygienic standards of care). Staphylococci that have invaded the dermis produce exfoliatin, which destroys the epidermis. Yellow purulent blisters form. Pathology is called pemphigus of infants. In children, the disease develops in the first week or month of life. On examination, you can see blisters the size of a hazelnut with a purulent filler. They appear on clean skin surrounded by an inflamed halo. When the bubble opens, wet erosion remains with the remnants of the upper layer without a crust. The rash can be seen on the chest, back, in the folds of the limbs. The malignant form affects the entire body of the child. The disease begins with fever, increased erythema at the navel, around the mouth, in the folds. The skin exfoliates, hanging like petals on the damaged areas. Without timely treatment of impetigo in children, a fatal outcome is possible.
4. Sycosis vulgaris is a chronic form of the disease. The main signs: periodically manifesting ostiofolliculitis and superficial folliculitis with infiltration of the problem area. Adult men are more often ill, rashes can be observed near the mustache and beard, on the pubis, under the armpits, eyebrows, eyelids and head. Prerequisites for pustular diseases of the scalp can be frequent shaving and chronic infections of the scalp. Inflammation begins with individual pustules, constantly recurring in one area. Gradually, new follicles are involved, and the focus grows. The skin in the problem area turns blue, infiltrated. When opening pustules, accumulations of crusts are observed, after their exfoliation, a wet spot remains. Hair is removed painlessly, in their place you can see a vitreous clutch. The disease proceeds for a long time, with periodic relapses. Discomfort is insignificant: itching and burning. If left untreated, the condition returns to normal spontaneously after 2-3 months.
5. Sycosis lupoid is a rare type of pathology, when the skin atrophies, baldness is observed even without abscesses. The causative agent is Staphylococcus aureus, possibly the presence of other microflora. The prerequisites are a drop in immunity in diabetics and chronic infections. It affects men over 40 years of age. Colonies are settled around the mustache and beard, on the temples and crown. With erythema with easily detachable crusts and gray scales, nodes and pustules develop in groups, forming a dark red plaque Ǿ 2-3 cm. Over time, it turns pale in the center, becomes thin and smooth and, as it were, is drawn inward. All signs of its atrophy are observed, new follicles no longer appear, individual hairs remain. The radius of the focus of inflammation (up to 1 cm) is filled with follicular papules, gradually its size increases, the spot acquires an asymmetric shape, there is no apple jelly syndrome during diascopy. The process stretches over several years. Discomfort occurs only on the head due to the proximity of the aponeurosis.
6. A furuncle is a deep inflammation of the follicle and tissues. The node develops around the affected follicle, where pus accumulates. Gradually, the disease covers the tissues and the sebaceous gland, turning into a painful knot. Edema is visible on the face. After 3-4 days, a fistula is formed, after opening it, an ulcer is obtained with a green necrotic core at the base. After 2-3 days, it is rejected with spotting. Pulsation and pain are reduced. In place of the ulcer there will be a retracted scar. Furuncle settles anywhere with hair follicles. On the face, they are the most traumatic and, if irritated, can provoke facial thrombophlebitis with edema, high fever, and confusion. Injured boils of the extremities are dangerous complication in the form of acute glomerulonephritis.
7. Furunculosis is boils with periodic repetitions in the acute form and single manifestations in the chronic form. It is local and widespread. The acute form is provoked by exogenous factors, the chronic stage - diabetes mellitus, infections, beriberi, nutritional errors, poisoning, decreased immunity.
8. Carbuncle is a severe pyoderma that involves deep skin layers and many follicles. In pathogenesis, diabetes mellitus and an immunosuppressive state are of particular importance. Localized on the lower back, neck, arms and legs. The formation of the node is accompanied by headache, fever, blackening of the inflammation zone. The carbuncle opens in 5-7 days. The ulcer gradually heals, the condition returns to normal. Without medical assistance, the process is delayed for 2-3 weeks. Carbuncle on the face can give complications in the form of thrombophlebitis of the veins, embolism, sepsis, cerebral thrombosis.
9. Hidradenitis - inflammation of the apocrine glands in adulthood as a result of skin trauma or illiterate use of deodorants. It is localized under the armpits, but it is possible to damage the nipples, genitals, and navel. At first, the node under the skin can only be determined by touch. Gradually, the place turns red and blue, pain appears. Fistulas are opened, yellow-green exudate is allocated. The scar at the site of the fistula is retracted. If treated promptly, an abscess can be avoided.

Streptococcal and mixed pyoderma

1. Streptococcal impetigo often affects children and women, especially in summer. The rash is localized near the ears, nose, mouth, arms and legs. The infection is transmitted through contact, trauma, maceration. Surrounded by a red border, yellow-green crusts gradually grow. After opening, conflict infection progresses rapidly. With a positive course, erosion epithelializes without stable traces. Complications are possible in the form of lymphangitis and imfadenitis, eczematization, in children - glomerulonephritis. Vulgar impetigo is provoked by pathogenic streptococci, staphylococci gradually join, causing suppuration and drying yellow-green crusts. Most often, children get sick with it, outbreaks of an epidemic are possible.
2. Streptococcal diaper rash is a prolonged, often recurring inflammation of contact tissues. With poor hygiene, the contact surface in the folds is irritated, sweat secretions decompose. Inflammation is often complemented by yeast fungi. Diaper rash contributes to type 2 diabetes, obesity, gout, seborrheic dermatitis. In edematous folds, the skin becomes wet, erosion and cracks appear. Complaints of pain and itching. With regression, pigmentation is preserved.
3. Diffuse streptoderma is a chronic skin disease of the skin of the legs after hypothermia, maceration, problems with blood vessels. The shins are most often affected, especially in the presence of wounds and fistulas. Ulcers dry up, erosions with serous pus remain under the crusts. With the growth of the focus, complications are possible: lymphangitis and lymphadenitis. Without timely treatment, the disease becomes chronic.
4. Ecthyma vulgaris is a deep type of streptoderma that develops against the background of injuries, pollution, impaired blood flow in the legs, and intoxication. In addition to the shins, hips, buttocks, and the lumbar region may be affected. Starts with a large bubble with hazy filler and a red border. After necrosis, an ulcer with a brown crust is formed. It heals on its own within a month, leaving a hyperpigmented scar. Possible complications in the form of phlebitis, lymphangitis, lymphadenitis.
5. Erysipelas is a deep skin lesion, with symptoms of intoxication and fever. Sources of infection - any patients with streptococci (tonsillitis, rhinitis, tonsillitis, streptoderma). Frequent injuries, cracks, scratching provoke relapses, leading to cicatricial changes and the formation of elephantine legs. The onset of inflammation is acute: there is swelling with hot skin. Complaints of pain, burning, distension, temperature rises. Allocate the usual form (with erythema and edema), bullous-hemorrhagic, phlegmous (with suppuration) and gangrenous (with gangrene). Complications are severe: elephantiasis, phlegmon, abscesses, gangrene. On the face, sepsis, thrombosis of the sinuses of the brain is possible. Patients with erysipelas are desirable to be hospitalized.

Diagnosis and principles of treatment of pustular diseases

For the treatment and prevention of complications of pustular skin diseases, Ilon K, produced by the well-known German pharmaceutical company Cesra Arzneimittel GmbH & Co, has proven itself well.

Ilon is produced in the form of an ointment, which is based on turpentine substances - larch oil and extract, which have a healing, antibacterial and tonic effect. As an adjunct, Ilon K is widely used to treat mild, localized pustular skin lesions of various etiologies, such as folliculitis, boils, abscesses, panaritiums and inflammation of the sweat glands. Depending on the degree of suppuration, apply the ointment to the affected area of ​​the skin once or twice a day, apply a sterile bandage or plaster on top.

Ointment Ilon K is not an antibiotic, and therefore has practically no contraindications. The natural composition of the ointment allows you to use it not only in the treatment, but also to prevent the appearance of purulent inflammation on the skin.

Now, widely known in many countries of Europe, the CIS and the Baltic states, Ilon K ointment can also be bought in Russian pharmacies. Be sure to purchase it, and it will become a permanent "resident" of your home first aid kit.

Pustular skin diseases are treated by a dermatologist, mycologist, surgeon

In order to influence the cause of the disease, it is necessary to carry out antimicrobial therapy, block provoking factors, adjust carbohydrate metabolism, prescribe a vitamin complex, and eliminate chronic infectious pathologies.

Etiotropic treatment should suppress the pyococcal flora. Practice both local and general treatment. Systemic therapy is carried out with:

• Multiple pyoderma and the rapid spread of infection.
• Enlarged and painful lymph nodes.
• Fever, chills, malaise and other reactions of the body.
• Complicated and deep pyoderma of the face with the threat of complications.

In debilitated patients (after irradiation, with HIV syndrome, hematological pathologies), treatment should be based on all clinical data. General therapy involves the appointment of antibiotics, sulfonamides. The choice of drugs is based on the analysis of purulent exudate (sowing, isolation of the pathogen, checking its sensitivity to drugs).

Medicines of the penicillin group can cause toxicoderma, so they are not prescribed to patients with purulent eczema. Exacerbations are also possible with psoriasis.

External treatment depends on the degree of damage and the form of the disease. In acute cases, the pustules are opened, treating the wounds with an antiseptic. For deep wounds, a resolving therapy is indicated that accelerates the self-resolution of the infiltrate: dressings with ichthyol ointment, UHF, dry heat. Compresses, ozocerite, paraffin baths are contraindicated.

Treatment is selected based on the analysis of purulent exudate

With deep abscesses, they are opened by surgical methods, organizing drainage with turundas soaked in an antiseptic solution.

In the chronic stage, purulent crusts from the surface must be removed mechanically using swabs soaked in hydrogen peroxide. They are preliminarily softened with an antiseptic ointment. After removing the crust, the wound is washed with an antiseptic.

From nonspecific methods, autohemotherapy, the introduction of protein blood substitutes, pyrogenal, prodigiosan, methyluracil and splenin are used. To strengthen the immune system in children and adults, herbalists recommend echinacea, ginseng, Chinese magnolia vine.

Prevention of pyoderma

Prevention of pustular skin diseases involves a temporary ban on water procedures, compresses, local massage, the use of antiseptics for problem skin that contribute to the spread of infection. If the scalp is affected, do not wash your hair. They are cut in the problem area, but not shaved. Healthy skin along the edges of the focus of inflammation is treated with a 1-2% solution of salicylic acid or potassium permanganate.

Nails should be cut short, treated with 2% iodine solution before procedures. You can't squeeze out the pustules!

Pyoderma can provoke epidemics in children's institutions, so it is so important to observe the sanitary regime, isolate patients in a timely manner and identify potential carriers of the infection.

Particular attention is paid to microtraumas: they are treated with a solution of aniline dyes, iodine, Lifusol film aerosol.

It is important to timely identify and treat diseases that worsen the protective properties of the skin.

The skin of children is easily contaminated while playing or working on the site, in the garden, orchard. Dust, dirt and the microorganisms contained in them - staphylococci and streptococci - are introduced into the skin grooves, depressions and irregularities. Dirt irritates the skin, causes itching and scratching, through which, as well as through scratches, abrasions and wounds, pyogenic microorganisms penetrate deep into the skin, often causing pustular diseases. The less the skin is damaged and contaminated, the less often pustular diseases occur on it. The weaker the child, the lower the resistance of his body, the more susceptible his skin to the harmful effects of microorganisms. Therefore, pustular diseases especially often occur during or after various diseases. Exudative diathesis, diabetes, anemia, gastrointestinal diseases, as well as heat, hypothermia, tight, uncomfortable and especially dirty clothes contribute to the occurrence of pustular skin lesions. A drop of pus from the patient's abscess on the skin of a healthy child can cause a similar disease in him. Among various skin diseases in children, pyoderma accounts for about 40%. Pustular diseases most often occur in the form of streptoderma and staphyloderma.

Streptoderma is pustular skin lesions caused by streptococci; characterized by a superficial lesion of smooth skin and its folds (impetigo, seizure, paronychia).

Impetigo(from lat. impetus - sudden) is highly contagious and is characterized by a rash of vesicles on a reddened background. At the site of penetration of a pyogenic microorganism, more often on open parts of the body; the corners of the mouth (zaeda), behind the ears, the nail roller (paronychia) - first a red spot or swelling is formed, and then a bubble the size of a pinhead to ten kopeck coins. Soon the bubble turns into an abscess, which, when dried, is covered with a thin yellow-orange crust (“honey crust”). New bubbles and crusts form nearby. The disease easily passes not only from one place of the skin to another, but also from one child to another, so the patient must be separated from other children. Towels, dishes, napkins of the patient are stored separately. Toys and things that he used should be washed with hot water and soap, or even better, boiled. Treatment of the patient is carried out only according to the doctor's prescription.

Staphyloderma - pustular diseases caused by staphylococci; characterized by lesions of the skin appendages (hair follicles, sweat and sebaceous glands).

Folliculitis- inflammation of the hair follicle. The disease is characterized by the appearance of small, 1-2 mm pustules, penetrated in the center by hair and surrounded by a narrow pink border. With a favorable course, after 3-4 days, the contents of the pustules dry out, yellowish crusts form, after which there are no traces on the skin (Fig. 27, a).

Furuncle (boil)- acute inflammation of the hair follicle, sebaceous gland and subcutaneous fat. For 3-5 days, the boil increases, reaching the size of a hazelnut and more. The skin in the area of ​​​​the boil turns red and thins. After opening, dead tissue and an ulcer are visible in the center, after healing of which a scar remains. If the necessary measures are taken in the early stages of the development of the boil (application of a clean ichthyol bandage, physiotherapy, etc.), it can resolve, and then the scar does not form (Fig. 27, b).

Carbuncle- suppuration of several follicles located nearby. Large areas of subcutaneous adipose tissue become inflamed. There are malaise, headaches, body temperature rises. The disease sometimes lasts more than a month. It is especially dangerous if the carbuncle is formed on the face, since the purulent process can penetrate into the membranes of the brain (Fig. 27, c).

Prevention. In case of pustular diseases, compresses should not be used, since, by softening the skin, they contribute to the spread of purulent lesions; for the same reasons, you can not take baths and showers. Intact skin should be wiped daily with alcohol in half with water or vodka; cut nails short; lubricate the subungual spaces with antiseptic solutions. All this protects healthy parts of the body from infection with a pustular infection. With pustular diseases, it is not recommended to give children chocolate, honey, jam, sweets, spicy foods and smoked meats. To prevent pustular diseases, it is necessary to increase the overall resistance of the body, provide good nutrition with enough vitamins, the right regimen, and follow the hygienic rules for skin care and clothing.

Hydradenitis- purulent inflammation of the apocrine sweat glands, which does not occur in children.