Pyoderma

Piodermia (purulent diseases of the skin) is a large group of diseases of the skin caused by the introduction of outside pyogenic kokkov (pyococcal) - Staphylococcus and Streptococcus spp. Frequency pyoderma ranks first among skin diseases, because of the extreme prevalence their agents, especially staphylococci. Staphylococci are almost always on the human skin. Streptococci are found less frequently, mainly in skin folds. In the emergence of some form of pyoderma, in addition to pathogenic kokkov, play a role and a variety of external and internal factors that can reduce the protective properties of the skin and predisposing to the development of pyoderma. These factors include: 1) excessive contamination of the skin, in particular professional pollution - lubricating oils, gasoline, kerosene, coal, cement and other; 2) micro-injuries (cuts, injections, burns, insect bites); 3) hypothermia and hyperthermia skin; 4) low power and lack of vitamins (a, C & others); 5) acute and chronic debilitating diseases, intestinal intoxication, metabolic disorders (especially the carbohydrate - diabetes); 6) long-term physical fatigue and nervous stress.
Natural immunity against pyococcal infection no; in patients with pyoderma may occur hypersensitivity (Allergy).
Staphylococcal pyoderma characterized by lesions mostly appendages of the skin (hair follicles, sebaceous and sweat glands) and purulent or purulent-necrotic nature of the inflammatory response. Much less staphylococci cause surface damage to the skin in the form of bubbles.
Distinguish the following types of staphylococcal pyodermia: hydradenitis (see), anthrax (see), sycosis (see), folliculitis (see), furunkoulez (see).
Strep gangrenosum is characterized by mostly superficial skin lesions, the initial element of which is flaccid bladder (conflicts), tend to peripheral growth. There are the following clinical forms of streptococcal infections of the skin:
impetigo, a strep rash, chronic diffuse strepto-DELMIA, aktima (see).
There are a number of chronic forms of pyococcal disease, etiology and pathogenesis of which (possible combined strepto-staphylococcal infection) has not yet been determined. Most of them are often found the following.
Chronic ulcerative-vegetative gangrenosum is characterized by the formation of limited inflammatory infiltrates in the form of plaques bluish-red colour with papillomatosis surface, covered bloody-purulent crusts. Plaques have different size and increase by peripheral growth. While squeezing them from minisoccer cracks and small pustulezny holes are allocated drops of pus. In the study with a blunt probe deep infiltration is detected connecting purulent cavities. The disease is chronic and can last many months or even years. The lesions are usually localized to the back of the hand and foot in the field ankle, usually at the site of injury.
Treatment: in the presence of extensive pus - compresses from the solution of etakrydina (of rivanol) 1 : 1000, liquid Alibori (Zincum sulfuricum - 4,0: Cuprum sulfuricum - 1,0; Aq. destillata - 1000,0) and others In the quiet period - antibacterial ointment (5% syntomycin, 2% Genzianella and others) and consistently allow (tar) ointment. At the same time spend a stimulating therapy (autohemotherapy). Antibiotics ineffective.
In particularly resistant cases apply scraping of lesions sharp spoon.
Chronic ulcerative pyoderma is characterized by the formation of one ulcers, less often multiple, on the skin of the lower leg arising sharply, but in the future the receiving chronic, sluggish pace. The beginning ulcerative lesions can be vulgar aktima, boil or quickly nekrotizirutee inflammatory infiltrate. The plague has a considerable size, rounded, less scalloped shape. The bottom of the ulcer is covered sluggish granulations grayish-red color, the edges of her slightly infiltrated and cyanotic. Around the ulcer occurs congestive hyperemia. Apparently, the main importance in causing the disease has poor circulation because of a prolonged cooling of the extremities, especially in combination with moisture, while the violation of resistance of blood vessels as the result of hypovitaminosis. In peacetime, the disease is rare, in time of war the number of patients increases. In the differential diagnosis of respect, it should be borne in mind varicose ulcers, which are characterized by the presence of varicose veins. The restorative treatment, vitamins C, B1, rutin; local - in the initial period apply antibacterial ointment, for long-existing ulcers impose zinc-gelatin or plaster bandages, alternate 4-5 days.
Pillersee - secondary rash that can occur on the background of the long-flowing pyococcal (usually streptococcal) skin lesions due to irrational drug treatment of primary lesion or mechanical his irritation (for example, dressings). They appear suddenly, located symmetrically on the skin of the trunk and limbs in the form of pink spots with peeling in the centre or in the form of follicular papules, papules-vesicles, papulopustules (see Primary elements), often accompanied by fever and General malaise. After 5-7 days, the rash gradually regressing.

pyoderma
Fig. 1. Pyodermia chancriforinis. Fig. 2. Pyodermia chronica profunda. Fig. 3. Pyodermia chronica ulcerosa. Fig. 4. Pyodermia chronica vegetans Hallopcau.
pyoderma
Fig. 1 and 2. Ulerythema sycosiforme. Fig. 3. Folliculitis et perifolliculitis abscedens et suffodiens. Fig. 4. Folliculitis decalvans.


Piodermia (pyodermia; from the Greek. pyon - pus and derma - skin) - a group of inflammatory skin lesions caused by the introduction into it from the outside pyogenic kokkov (Staphylococcus and Streptococcus) and much less other microorganisms (Pseudomonas aeruginosa, Escherichia coli, and others). In addition to the so-called pustular diseases of the skin (the epidermis, dermis and appendages), the group of pyodermia decided to include some of defeat pyogenic coccus subcutaneous fat (abscess, phlegmon and others) - the so-called surgical P.
P. widespread among different population groups (the first place among skin diseases), being a common cause of temporary disability. Especially widespread gains., in time of war as in the troops and among the civilian population.
The etiology and pathogenesis. The frequency of pyodermia due to the huge prevalence in the nature of its agents (especially staphylococci) and the wide possibilities of adding them to the skin of the external environment, as well as significant biological variability of pathogens with possible under certain conditions the transition of non-pathogenic forms in pathogenic on the surface of the skin. Staphylococci and to a lesser extent streptococci constantly saprophyticus on healthy skin, without causing infection, because of the inherent skin protective properties (see the Skin). That is why in the development of some form of P. plays the role of not only the presence of pyococcal and their pathogenic properties, but also a variety of exogenous and endogenous predisposing factors. Among the most frequent exogenous predisposing factors include the lack of proper skin care and excessive pollution, in particular production (oil, flammable liquids, coarse dust particles - coal, cement, lime and other), micro-injuries (cuts, injections, scratches, burns, insect bites, etc.,), hypothermia and hyperthermia skin, and maceration her and excessive sweating. Often piodermii occur secondarily as a complication of other skin diseases (eg, itching, eczema and other).
Among the various endogenous predisposing factors should be borne in mind reduced power and, in particular, hypovitaminosis (a, C), acute and chronic debilitating diseases, intestinal intoxication, metabolic disorders (especially carbohydrate), long-term physical
fatigue, as well as violations on the part of the nervous system (nervous stress, vegetative neurosis) and peripheral blood circulation (acrocyanosis, varicose veins, and so on).
Natural immunity against pyococcal infection does not exist, but in the process of development stafilo - and streptococcal skin lesions, as well as under the influence of the introduction of Immunopreparat see the development and growth of both cellular and humoral immunity, bearing antimicrobial and antitoxic character. However immunity against pyococcal is not long and stressful; it varies widely. Along with immunity for pyococcal infection is often a heightened state (sensitization) or, on the contrary, decreased (negative anergy) sensitivity that can be installed intradermal tests vaccine.
Single accepted classification of pyodermia not. The most rational is the etiological classification, according to which all Petrograd divided into staphylococcal and streptococcal. However, this classification requires allocation of the third group, which includes P. caused mixed, strepto-staphylococcal infection, and a number of chronic (atypical forms of P., etiology (a microbial pathogen) and the pathogenesis of which just is not yet established.
Staphylococcal pyoderma. Pathogen - Golden and white staphylococci. The main feature of staphylococcal pyoderma is defeated primarily subordinate formations of the skin (hair follicles, sebaceous and sweat glands) and purulent or purulent-necrotic nature of the inflammatory response. Much less staphylococci cause the development of superficial skin lesions that are not related to the subordinate formations characterized vsapaniem bubbles (disease of newborns, some forms of bullous impetigo). To staphylococcal the pyodermia include: folliculitis, or impetigo Jakarta, separatorny sycosis (see), furuncle (see), anthrax (see), hydradenitis (see), pseudoforces finger (or multiple abscesses children).
Streptococcus pyodermia. Pathogen - hemolytic Streptococcus causes mainly superficial lesions, the initial element of which is flaccid bladder - conflicts. There are the following clinical forms of streptococcal P.: various forms of impetigo-(see), vulgar actimo (see), streptococcal defeat large folds (see diaper Rash), chronic diffuse streptoderma.
Chronic (atypical) forms of pyoderma. Chronic deep ulcers and vegetative pyoderma. The most likely pathogen Staphylococcus aureus, possibly in Association with a Streptococcus. Histologically, along with purulent inflammation of the pockets of the type granulomatous infiltrate. Characterized by the formation of a single (more often) or multiple (less) infiltrated plaques cyanotic-red, covered with loose pusy crusts. For their removal find papillary expansion. While squeezing the plaques from minisoccer cracks and small pustulezny holes stand out thick drops of pus. In the study probe find deep, connected purulent cavities and pustulezny moves. Plaques have different size and increase by peripheral growth (printing. Fig. 2). In the circumference of the hearth often see deep pustules.
The disease progresses slowly and delayed for many months and years. For the healing of scars remain resembling scrofuloderma. Most often, the disease is localized to the rear of brushes, often against the background of injury. Significantly less likely to have the formation of multiple lesions on the skin of the trunk and limbs. When localization on the back of the hand or foot may develop purulent inflammation of the joints. When intradermal staphylococcal vaccine revealed giperergicakie reaction in the form of necrosis. The diagnosis should be borne in mind warty tuberculosis (see Tuberculosis skin) and blastomycosis (see Candidiasis).
Chronic ulcerative pyoderma (pyodeimia chronica ulcerosa, printing. Fig. 3). The causative agent is not precisely set. More often find hemolytic Streptococcus and Staphylococcus or polymicrobial flora. Crucial poor circulation because of prolonged exposure to cold factors (long stay in the humidity, frequent moistening legs and so on), while the violation of resistance of blood vessels in gipovitaminozov condition or infection. Chronic ulcerative pyoderma in peacetime is rare. In war time the number of patients increases significantly.
Localized almost exclusively on the skin of the lower legs. Often occurs at the site of injury. The beginning ulcerative lesions is often acutely emerging and rapidly nekrotizirutee inflammatory infiltrate, less vulgar aktima or a boil. Ulcers are different (often significant) the amount, rounded or oval, less often wrong, with scalloped edges of the form. The bottom of the ulcer is first covered with necrotic masses, further sluggish granulations. The edges of the ulcer somewhat raised, slightly infiltrated, painted in blue-red color. Sores around there is a significant area of congestive hyperemia. Palpation painful. A long, from several weeks to several months. Ulcers often single, less often multiple. Histologically at the base of the ulcer find powerful inflammatory infiltrate of lymphocytes, plasma cells, and in a smaller number of neutrophils, histiocytes and fibroblasts. Blood vessels are narrowed and sclerotic (fibrous).
Sankaritarina piodermia (pyodermia chancriformis, Fig. 1). Extremely rare skin lesion. Localized primarily on the sex organs, the red border of the lips, eyelids. Characterized by the formation sharply limited surface saucer-like ulcers, round or oval form with reinforced base. Often there is considerable purulent discharge. Palpation ulcers little painful. Regional lymph nodes are enlarged, sealed, slightly painful. The clinical picture is so reminiscent of chancre (see Syphilis)that for diagnosis have to resort to a re-examination on the pale Treponema and serological study of blood.
Dissecting undermining folliculitis and cellulitis head (folliculitis et perifolliculitis abscedens et suffodiens capitis). Rare disease observed exclusively in men. Histologically - purulent foci melting of the dermis, surrounded by infiltration type granuloma. Begins with the appearance on the scalp acne pustules, and nodules. Last increased gradually turn into large, towering above the skin hemispherical nodes or valikoobraznye education, places connected (printing. Fig. 3).
The skin above them is the color of ivory or congestive-cyanotic. First, they are dense, then gradually softened and opened a small pustulezne holes, with its blood-purulent fluid. The formed cavity made sluggish by granulations. The hair on the affected areas fall. Large characteristic blackheads. The disease is chronic and may gradually to occupy the entire scalp. After healing formed rough, often keloid scars.
Calvaruso folliculitis Cinco (folliculitis decalvans V. Quinquaud). Characterized by the appearance mainly on the scalp (rarely on other hairy parts of the skin) long-existing follicles heal with the formation of flat atrophic scars, reminiscent of scar atrophy when pseudoplane (see). Observed in adults of both sexes (printing. Fig. 4).
Lupoid sycosis Brock [sycosis lupoides L. Brocq; synonym: seksitarina cicatrizing erythema Uns (ulerythema sycosiforme P. Unna)]. There is almost exclusively men. The causative agent of the disease is aureus. The pathogenesis is unclear. Histologically detected a dense infiltrate composed mainly of plasma cells. It is very likely that lupoid sycosis and calvaruso folliculitis are variations of a single disease. Located most often on the cheeks in the field of growth of beard (usually asymmetrically), less often on the scalp (printing. Fig. 1 and 2). The lesion appears as the surface of the scar, surrounded by inflammatory roller, covered with small follicular pustules. The defeat of the proceeds long-term (in years) and, by increasing peripheral growth may reach values of palms and more. Should differentiate from lupus erythematosus and pseudobinary.
Chronic vegetative pyoderma, Galloppa (pyodermia chronica vegetans N. Hallopeau, printing. Fig. 4). A rare form of the disease of the skin that looks very much like the vegetative the bladderwort (see). Histologically - acanthosis, papillomatosis, the formation of small intraepithelial cavities made by eosinophils, neutrophils and degenerated epithelial cells; in the dermis - inflammatory infiltrate with a large number of eosinophils. The opinion of some dermatologists that vegetative pyoderma is benign option vegetative water, cannot be considered proven. Characterized vsapaniem on the surface, not related to the follicles pustules on the bottom of which after opening the form of vegetation covered with a grayish tinge. Increasing by peripheral growth and merging, they can form extensive lesions localized on the scalp, face, chest, limbs, large folds. Perhaps mucous membranes. For long. The forecast is favorable.
Pyoderma gangrenosum (pyodermia gangrenosa). The etiology and pathogenesis is not clear. When crops is determined polymicrobial flora (Staphylococcus, Streptococcus, E. coli, diphtheroids, and others). It is suggested that pyoderma gangrenosum is developing the mechanism of the phenomenon of Canarelli - Shvartsman (see Shvartsman's phenomenon). It is often stated gipogammaglobulinemia. Histologically in the upper dermis detect acute inflammatory infiltrate and necrotic foci. In medium and deep parts of the dermis infiltration takes on the character of granulomas. Skin lesion begins with education furunculosis infiltrate, which quickly decays with the formation of ulcers, consistently increasing by peripheral growth and often reaching a significant amount. The bottom is covered with sores easy bleeding granulations with small areas of necrosis. The edges of the ulcer swollen, towering in the form of a roller bluish-red colour, saped from under them pus. Healing begins from the center, resulting sores consistently take the ring character. After healing often have recurring. Skin lesion is often combined with chronic ulcerative colitis, rarely with chronic bronchitis, infectious arthritis. For long. The prognosis is poor.
Pillersee (L. N. Mashkilleyson and D. A. Trutnev) - secondary rashes that occur in patients of any primary chronic pyococcal skin involvement (often streptococcal, rarely staphylococcal), as a result of irritation (medical, mechanical) primary lesion or the introduction of biological products (vaccines, toxoid, and others). Pathogenesis just not installed. Some authors secondary rash considered as an allergic reaction to incoming hematogenous decay products of microbes (or tissues of the skin), others - as serverelement process. There acute in the form of common papules-vezikuleznaya, erythematous, eritematosnaya, pustular rash. Sometimes accompanied by General reaction (malaise, fever, headache). After several days to 1-2 weeks, the rash goes away.