Streptodermatitis. Pyoderma (pustular diseases) of the skin Conversation plan prevention of pustular diseases

Pustular diseases mostly affect patients who violate the rules of personal hygiene, often they are ill with untidy people who poorly monitor the cleanliness of their body, clothing, home and workplace.

On the skin of a person who does not wash regularly enough, billions of pyogenic cocci accumulate, which can cause boils, folliculitis, hydradenitis, ecthyma, etc. It is necessary to take a bath or visit a bathhouse 1-2 times a week and change clothes. This is especially true for those people whose skin is easily contaminated by the nature of their work (cooling and lubricating oils, dust, etc.). Some professions require daily showering.

A person who has received a microtrauma should immediately sanitize the wound by lubricating with iodine tincture or brilliant green.

It is necessary to widely use protective pastes and ointments. When working with coal tars, mineral oils, solvents and varnishes, you can use Hiot-6 paste. After work, the paste should be washed off the skin first with cold and then with warm water and soap. When in contact with oil products, workers must wear kerosene and oil-resistant overalls and gloves.

After the treatment of boils, hydrodenitis, if there is still an infiltrate at the base of the elements, it is necessary to continue therapeutic efforts. Otherwise, the boil may recur again. A poorly treated first boil is the beginning of the second. Overcrowding, untidy maintenance of housing, accumulation of dust in rooms and on objects, furniture, poor ventilation of apartments, lack of sunlight, dampness, clutter with unnecessary items, dirt are the causes of pyoderma. The general condition of the body is also important, a decrease in resistance, recent infections, anemia, malnutrition, hypo- and beriberi, stress, diabetes, aggravated heredity. Methods of hardening the body should also take the main place in the prevention of pustular diseases: water procedures, gymnastics, hiking, sports, skiing, walking in the forest, air and sunbathing. Sun and ultraviolet rays, sea baths, radon and other mineral baths may be allowed only after consultation with a doctor.

For the prevention of pustular diseases, antimicrobial underwear containing chemically bound hexachlorophene has recently begun to be used. Experience has shown that in those enterprises where workers used this linen, the incidence decreased by 30%. In addition, antimicrobial underwear prevents the emergence of new recurrences of staphyloderma. Such underwear is also used in maternity hospitals by women in labor to prevent mastitis and furunculosis.

The use of antimicrobial linen, as shown by the experience of Soviet authors, is completely harmless, does not cause any negative phenomena.

A few words about the diet for pyodermatitis. She occupies an important place. In the prevention of such forms of pyoderma as chronic furunculosis, hidradenitis, sycosis, it is necessary to exclude honey, chocolate, cakes, jam from the diet, limit the consumption of sugar, potatoes. Recommended carrot juice, liquid yeast, a tablespoon 3 times a day with meals, purified sulfur on the tip of a knife 2-3 times a day, zinc sulfide 0.05 g 3 times a day before meals, vitamins A, C, B1.

Pustular skin diseases (pyoderma) - a group of common skin diseases caused by pyogenic microbes - staphylococci and streptococci. Pyogenic microbes are widely distributed in nature. On the surface of the skin of healthy people, you can almost always find staphylococci and streptococci, which have the ability (if a person gets into adverse conditions) to move from non-pathogenic (harmless) forms to pathogenic forms that cause disease. The development of pustular skin diseases is predisposed to constant contamination of the skin, which may be associated with working conditions (dust, lubricating oils, kerosene, gasoline, etc.) cuts, injections, insect bites, scratching, hypothermia and overheating of the body, sweating, overwork, lack of food vitamins A, C, metabolic disorders, especially carbohydrate (for example, in diabetes mellitus), debilitating chronic diseases, non-compliance with personal hygiene.

Pustular skin diseases manifest themselves in a variety of ways: either small suppurating nodules pierced by hair appear on the skin, or large painful cone-shaped nodes with purulent fusion of tissue and the so-called core, blisters with purulent contents can appear, shrinking into purulent crusts - the so-called ipetigo, which most often children get sick. Pustular skin diseases can occur in the form of long-term non-healing ulcers with undermined edges and an uneven bottom covered with a purulent compartment, etc.

Skin damage can be limited, without disturbing the general condition of the patient, but it can also be widespread, accompanied by an increase in body temperature, an increase in nearby lymph nodes, and a change in the blood. In severe cases, a general infection of the body - sepsis can break out.

Pustular skin diseases are especially dangerous for infants, in which the skin and the body as a whole are very sensitive to staphylococcal and streptococcal infections. Pustular skin diseases in children can cause severe complications of kidney disease (nephritis), pneumonia, inflammation of the meninges (meningitis), etc.

Pustular skin diseases can disappear in a few days or weeks, or last for months, and even years, subsiding and resuming (chronic relapsing course of the disease.). The chronic course of pyoderma is more often a consequence of a weakening of the body's defenses in case of metabolic disorders, the function of the endocrine glands, and alcohol abuse.

To prevent pyoderma, personal hygiene, proper skin care, and elimination of sweating are of particular importance. When working in conditions of increased pollution, it is necessary to protect the skin from injury, using overalls, work gloves, etc., even with minor injuries, it is necessary to treat the injury site with some kind of antiseptic agent - a green solution, an alcoholic solution of iodine or apply a bactericidal adhesive plaster. Combs from insect bites, household injuries (for example, a cut with a knife, a prick of a fish bone, etc.) should also be treated with the indicated remedy.

In the chronic course of pyoderma, it is recommended to limit sweet, salty, spicy foods, exclude honey, canned food, fruits, raw vegetables and other foods rich in vitamins should be included in the diet. For the prevention of pustular skin diseases, social events are carried out, which include sanitary and technical measures to eliminate harmful factors in industrial enterprises and agriculture. It is important to strengthen the physical condition, hardening the body, walking in the fresh air, air and sunbathing, bathing, good nutrition. In living quarters, it is necessary to maintain an air temperature that excludes overheating of the body, especially in children, often ventilate the room, etc.

It is very important to avoid close contact of adults suffering from pustular skin diseases with children, especially infants. For the prevention of pustular skin diseases in newborns, proper skin care of the newborn, keeping children clean, protection from overheating and prickly heat is of great importance. A child with pyoderma should be isolated from adult children, have separate linen, a towel. At the first signs of pustular skin diseases in a child, you should consult a pediatrician or dermatologist.

The degree of distribution of pustular is directly dependent on the material well-being and sanitary and cultural literacy of the population.

The lower they are, the more patients with pyoderma. The fight against it is a matter of great national importance, since pyoderma occupies one of the first places among other skin diseases and is often accompanied by temporary disability.

Preventive measures, along with personal protection (personal hygiene), include general sanitary, sanitary and technical measures, as well as sanitary and educational work.

In the implementation of a set of preventive measures to combat pyoderma, the public and administrative and technical personnel should take an active part along with medical personnel.

The main tasks in this work are strict observance of cleanliness at the workplace and at home, the introduction of mechanization and automation of labor-intensive production processes, and the fight against injuries. By common efforts, sanitary and technical norms and rules should be developed and implemented, the most favorable conditions should be created not only at workplaces, but throughout the premises (proper lighting, good ventilation, organization of systematic cleaning, etc.).

All factors contributing to the development of pyoderma should be eliminated. Proper organization of handwashing is of great importance; it is forbidden to use sand, sawdust, kerosene, gasoline, acetone. Young workers need to be taught personal and public hygiene skills.

Individual preventive measures include keeping the skin neat, washing regularly with soap and changing clothes. In production conditions, along with overalls, gloves or mittens, overalls, aprons, etc. are used to protect against pollution.

In factories, factories, collective and state farms to combat pyoderma and other diseases, sanitary posts must be created and constantly functioning under the guidance of medical workers. Their functions include monitoring the cleanliness of workplaces, participating in the organization of shower facilities, washing, repairing overalls, and regularly changing them.

They must pay the main attention to the fight against microtraumatism, which is of primary importance in the development of pyoderma. Microtrauma, scratches, erosion, etc. should be lubricated with a disinfectant 1 - 2% solution of aniline paints or 2 - 5% iodine tincture. Systematically it is necessary to deal with sweating, maceration of the skin, to avoid hypothermia of the body.

Of great importance in the prevention of pyoderma are general strengthening measures aimed at increasing the protective functions of the body (hardening, physical education, sports, regular exposure to fresh air, good sleep, proper daily routine and nutrition).

To prevent infection of children, especially those prone to pyoderma, it is necessary to avoid close contact of patients with healthy ones, systematically conduct preventive examinations of all employees of child care facilities, isolate patients with pyoderma from children's groups (kindergarten, school, boarding school, etc.).

Patients with epidemic pemphigus are immediately isolated from healthy newborns. Personnel are subjected to a thorough examination and, in the presence of staphylococcal disease, appropriate treatment is carried out.

With pseudofurunculosis, prevention consists in hygienic care, cleanliness, frequent bathing, and changing clothes, and rational nutrition. Overwrapping should be avoided. General strengthening treatment is prescribed, baths from a weak solution of potassium permanganate. Children with pseudofurunculosis are subject to dispensary observation.

A child with pyoderma should have separate underwear, a towel, and clothes. The linen used by the patient is disinfected by boiling with soda. Children return to the team only after full recovery. An important role in the fight against pyoderma is played by sanitary propaganda: lectures and talks, posters, brochures, etc.

Preventive measures have their own characteristics depending on the industry and agricultural production. At enterprises where cooling oils and emulsions are used, measures are taken to eliminate or reduce the possibility of skin contact working with these substances.

Among those working in peat, logging and other industries, as well as agricultural workers, whose working conditions contribute to dry skin, pollution, the formation of microtraumas, calluses, etc., the Paikin method is widely used, which consists in the following.

At the end of the working day, workers take a shower; at home, they rinse the brushes with a solution of ammonia for 5 minutes (add 10 ml of ammonia to 2 liters of warm water). The skin is dried by applying a towel (do not rub to avoid injury), and smeared with petroleum jelly. Proper skin care during and after work is of great importance.

In the engineering and metallurgical industries, preventive measures should be aimed primarily at improving sanitary conditions, since microtraumatism and skin irritation with oils are of paramount importance in the occurrence of pyoderma in workers.

Proper cleaning of the skin from industrial pollution is very important. The use of detergent pastes greatly facilitates cleaning.

"Skin and venereal diseases",
A.A. Studnitsin, B.G. Stoyanov

Pioallergides

With long-term pyococcal skin lesions, peculiar secondary skin lesions, pioallergides, may occur. Most often they are observed in chronic streptococcal skin diseases (chronic diffuse streptoderma, long-term impetigo, intertriginous streptoderma), much less often in staphylococcal, in particular atypical, forms of pyoderma.

Pioallergides occur suddenly, symmetrically on the skin of the trunk and extremities. They have the appearance of bright pink spots of various sizes and shapes, covered in the center with small-plate scales, or small follicular papules or papulovesicles, papulopustules. On palms and soles the disseminated eruption of bubbles and bubbles, dense to the touch, is quite often noted. It is accompanied by itching and often an increase in body temperature up to 38 ° C. In such cases, the general condition of the patient is disturbed (headache, fatigue, weakness). As the skin rash worsens over several days, it can become widespread. After holding on for 7-10 days, the disease begins to regress.

Pioallergides develop as a result of the hematogenous spread of microbes or their decay products coming from the main pyogenic focus, in the presence of a pronounced allergic condition. The immediate cause for the appearance of pioallergides is often irritating external preparations applied to the main lesions, the introduction of immunobiological preparations, intercurrent diseases (influenza, etc.).

Treatment. At high temperature and general malaise, antibiotics are indicated, in the absence of general phenomena, intravenous injections of calcium chloride or intramuscular injections of calcium gluconate. Outwardly - indifferent talker and powder.

Significant incidence of pyodermatitis among the population and the resulting disability dictate the need for extensive preventive measures.

The occurrence of pustular diseases is determined not only by the special properties of their pathogens, but also by the influence of adverse external factors, as well as violations of the general condition of the body. Therefore, the prevention of pyodermatitis consists of various measures. The main ones are:

1) accurate accounting and analysis of the incidence of pyodermatitis, making it possible to establish its true causes;

2) sanitary and hygienic measures aimed at maintaining the cleanliness of the skin and eliminating its excessive contamination in everyday life and at work;

3) sanitary and technical measures, the purpose of which, by improving and improving the sanitary and technical conditions of production, is to eliminate the harmful factors in the process of work that contribute to the occurrence of pustular diseases;

4) measures aimed at strengthening the physical condition of people, increasing their resistance to infection;

5) sanitary and educational work.

The widest possibilities for carrying out all these measures are available for the organized part of the population, in particular workers in various branches of industry and agriculture, as well as military personnel. Among the activities of a sanitary and hygienic nature, the creation of conditions for maintaining personal hygiene is of particular importance.

In factories, workers should be provided with wash basins with hot and cold water, enough soap and towels to be able to clean contaminated skin during work breaks and at the end of the working day. For complete cleaning of the skin from industrial pollution (lubricating oils, emulsions, kerosene, etc.), in addition to liquid or dry soap, it is recommended to use special cleansers.

To protect the skin from contamination and irritating effects of chemicals that fall on it during work, it is of great importance to provide workers with clothing that meets the specifics of production. Regular washing is necessary, since soiled overalls, aprons, mittens, shoes, etc., sometimes do more harm than their absence. It is also important to maintain the sanitary condition of residential (hostels, barracks) and workers (workshop, workshop, machine park, etc.) premises and, if possible, ensure a normal temperature regime in them. If it is impossible to comply with the latter (hot workshop, field work in the summer, especially in the southern regions), it is necessary to create conditions for washing in the shower after work.

An equally important role as a predisposing factor contributing to the occurrence of pustular diseases (especially furunculosis) is played by systematic hypothermia of the body, and therefore it is important to provide people working outdoors in cold weather with warm clothes.

Sanitary-technical measures include: monitoring the correct content of production tools, cleaning workplaces from production waste (metal shavings, sawdust, nails, etc.), which helps to reduce microtraumatism; technical measures aimed at preventing contamination of workers' skin with chemicals; proper organization of first aid for microtraumas. In working premises, workshops, workshops, garages, field camps there should be first-aid kits with 1-2% alcohol solution of brilliant green or other dye, 2% alcohol solution of iodine, sterile dressings. For the treatment of microtraumas, Novikov's liquid is recommended (Tannini 1.0, Viridus nitentis 0.2, Spiritus aethylici 96% 0.2 ml, ol. Ricini 0.5 ml, Collodii 20.0), bactericidal adhesive plaster, furaplast, 5% iodine solution in ethyl cellosolve.

In the course of sanitary and educational work, as well as with special instruction, workers should be taught self-help and mutual assistance.

Of great importance are the medical examination of workers, concern for improving living conditions, monitoring public catering, etc. There is a need for widespread promotion of physical methods of strengthening health: physical exercises and sports, daily wiping the skin with cool water, and in the summer taking sun and air baths, bathing, etc. In the general complex of preventive measures, sanitary and educational work is of great importance: familiarizing workers with the pathogenesis of diseases, the necessary preventive measures.

Among the preventive measures should also include the early detection of the initial forms of pustular diseases and their timely treatment.

Depending on the specifics of industry, individual workshops, the characteristics of the activities of state farms, etc., working and living conditions, as well as climatic factors, specific plans for preventive measures based on an analysis of the incidence of pyodermatitis should be developed locally and strictly implemented.

FUNGAL DISEASES (DERMATOPHITIES)

Fungal diseases of the skin develop as a result of the introduction of pathogenic microfungi into it. When living outside the human or animal body, fungi can maintain their viability and virulence for several years. This explains the possibility of infection by indirect contact - through various objects contaminated with scales falling from the skin of patients or hair fragments containing elements of the fungus.

There is no single and generally accepted classification of fungal diseases. More often they use the classification developed in the Department of Mycology of the Central Research Institute of Skin and Venereal Diseases of the Ministry of Health of the USSR. In accordance with this classification, 4 groups of mycoses are distinguished.

1. Keratomycosis: versicolor versicolor, etc. Traditionally, along with versicolor versicolor, a similar disease of erythrasma was considered, which is caused, as has been proven recently, not by fungi, but by corynebacteria and belongs to pseudomycoses (see "Inguinal epidermophytosis").

2. Dermatophytosis: epidermophytosis inguinal (true); mycosis caused by interdigital trichophyton (epidermophytosis of the feet); mycosis caused by red trichophyton (rubromycosis); trichophytosis; microsporia; favus.

3. Candidiasis.

4. Deep mycoses: chromomycosis, etc. Together with deep mycoses, the textbook discusses actinomycosis, a bacterial disease currently classified as pseudomycosis.

In the diagnosis of most mycoses, microscopic examination of scales, lids of vesicles, nail plates, and hair plays an important role. The causative agent of a fungal disease can be detected after enlightenment of the horny substance in a hot solution of caustic alkali.

Treatment. For the treatment of mycoses, antifungal drugs are used. Inside appoint griseofulvin. It is assumed that this antibiotic does not have a fungicidal, but only a fungistatic effect. Coming from the intestines into the blood, it is adsorbed by the cells of the epidermis and accumulates in the stratum corneum and appendages of the skin, as a result of which they become inaccessible for the introduction of the fungus. This is proved by the fact that after about 2-3 weeks from the start of treatment in patients in the proximal part of the hair (or nail), a healthy zone free from fungi appears, while elements of the fungus remain in the distal part. In the process of further application of griseofulvin, the affected part of the hair (or nail) is gradually “pushed out” by the growing part. That is why it is recommended to shave off growing hair every 7-10 days during treatment with grisefulvin.

Griseofulvin is taken in tablets (0.125 each) with meals and washed down with 1 teaspoon of sunflower oil or fish oil. The first control study for fungi is carried out after 12-14 days from the start of treatment, subsequent - every 3-4 days until negative results, then every 5-7 days. The criteria for cure are clinical recovery and triple negative tests. The daily and course doses of griseofulvin depend on the body weight and age of the patient.

In some patients, during treatment with griseofulvin, headache, abdominal pain, diarrhea, vomiting are observed, in the blood - slight eosinophilia, as a very rare occurrence - morbilliform or scarlet fever-like toxidermia, urticaria. Sometimes disorientation develops, so it is not recommended to prescribe griseofulvin on an outpatient basis to drivers of all types of transport.

Contraindications: diseases of the liver, kidneys, blood, malignant neoplasms, cerebrovascular accidents, stroke, porphyria (griseofulvin can enhance photosensitivity), pregnancy, breastfeeding. Griseofulvin can be replaced with drugs of the imidazole group (ketoconazole, etc.).

Anticandida antibiotics include amphoglucamine, prescribed 200,000 IU (2 tablets), then 500,000 IU 2 times a day after meals; mycoheptin - 250,000 IU (5 tablets or capsules) 2 times a day; levorin - 500,000 IU (1 tablet) 2-3 times a day; nystatin - 2000000-3000000 IU (4-6 tablets) per day. The sodium salts of nystatin and levorin dissolve better in the gastrointestinal tract. The duration of the course of treatment with anticandidal antibiotics is 10-14 days. Locally, for mycosis, 2-5% alcohol solutions of iodine, nitrofungin, Castellani liquid, as well as ointments - 5-15% sulfuric and tar, Wilkinson's ointment (Picis liquidae, Sulfuris depurati aa 15.0; Calcii carbonatis praecipitati 10.0; Saponis viridis, naphthalani aa 30.0; Aq. destill 4 ml), 5% amicazole, 0.5-1% decamine, 1% esulan, zincundan, undecin, mycoseptin, canesten, etc. Mycohepgin antibiotics also have a selective anticandidal effect , nystatin and levorin, used in the form of ointments and solutions, amphotericin and decamin ointment. In case of acute inflammatory processes, ointments containing corticosteroids and antifungal agents are recommended: dermosolone, mycosolone, lorinden C. For better penetration of fungicidal preparations into the affected skin, their solutions in dimexide (DMSO) are used.