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PENYAKIT KULIT YANG

DISEBABKAN OLEH BAKTERI

Yunita Hapsari
Bagian Ilmu Kesehatan Kulit dan
Kelamin
Fakultas Kedokteran Universitas
Mataram

PYODERMA
Infeksi pada kulit, yang disebabkan
oleh bakteri yg membentuk nanah
atau piogenik dan mudah menular
Etiologi :
Staphylococcus S.aureus
Streptococcus Streptococcus grup A
Kedua-duanya

Faktor predisposisi :
Daya tahan tubuh rendah
Higiene individu kurang
Higiene lingkungan kurang
Telah ada penyakit kulit sebelumnya

Klasifikasi pyoderma :
PRIMER

Impetigo
Folikulitis
Furunkel
Karbunkel
Paronikia
Ektima

SEKUNDER
Impetigenisata
Hidradenitis
supurativa
Intertrigo
Ulkus

IMPETIGO
Pyoderma superfisial
Etiology : Streptococcus grup A
S.aureus
2 bentuk :
Bulosa
Non-bulosa / krustosa

IMPETIGO BULOSA
Impetigo vesiko-bulosa, cacar monyet
Etiology : phage group II S.aureus (strain
77 & 55) exfoliatin toxin type A and B
Clinical :

newborn and older infants


Vesicle flaccid bullae (rapid progression)
Nikolsky sign (-)
Bullae : clear yellow fluid dark yellow &
turbid
Margin : sharply demarcated w/o erythematous
halo
w/i a day or two bullae rupture & collapse

IMPETIGO BULOSA

IMPETIGO BULOSA
Lab :
Pengecatan Gram
Kultur
histoPA

DD/ :
Dermatitis kontak
Insect bite
Erupsi obat tipe bulosa

IMPETIGO BULOSA
Complication :

Cellulitis
Lymphangitis
Bacteremia
Osteomyelitis
Septic arthritis
Pneumonitis
Septicemia
SSSS

IMPETIGO NON BULOSA/KRUSTOSA


Impetigo kontagiosa, impetigo vulgaris,
impetigo Tillbury Fox
70% of cases of this form of pyoderma
Etiology :
Streptococcus group A pre-school aged
children (<2 y.o)
S.aureus Children of all ages and adults

IMPETIGO NON BULOSA/KRUSTOSA


Clinical finding:
Pruritus; soreness; burning ; painless
Commonly on the skin of the face (around
the nares) or extremities after trauma
Transient pustule or vesicle honeycolored crusted plaque (2cm) w/i
surrounding erythema
No constitutional symptoms
Regional lymphadenopathy (90%)

IMPETIGO NON BULOSA/KRUSTOSA

IMPETIGO NON BULOSA/KRUSTOSA


Lab :
Gram stain
Culture

DD/ :

Atopic dermatitis
Allergic contact dermatitis
Varicella
Dermatophyte infection

IMPETIGO NON BULOSA/KRUSTOSA


Complication :
Untreated process may persist and new
lesions over the course and for several
weeks
Resolve spontaneusly except there is some
underlying cutaneous disease
Erysipelas
Cellulitis
Bacteremia
Major serious sequela acute poststreptococcal glomerulonephritis

MANAGEMENT OF IMPETIGO
Washing (removal of dirt, crusts and
debris by soaking with soap & water)
Good hygiene
Pharmacology: topical and systemic
Topical & Systemic Antibiotic

FOLIKULITIS
Def : a pyoderma that begins within
the hair follicles
Classified :
Depth of invasion : superficial and deep
Microbial etiology : bacterial, fungal, viral
and parasite infestation

FOLIKULITIS SUPERFISIAL
Impetigo Bockhart;
follicular impetigo
Etiology : S.aureus
Clinical finding:

Location : scalp
(children); beard area,
axillae, extremities,
buttocks (adults)
A small, fragile, domeshaped pustule
infudibulum of a hair
follicle

DD/ : -

gram-negative
folliculitis
Pityrosporum
folliculitis
Herpes simplex

Deep folliculitis
sycosis barbae

FURUNKEL
Boil / bisul
Deep-seated inflammatory nodule that
develops around a hair follicle, usually from a
preceding, more superficial folliculitis and
often evolving into an abcess
Etiology: S.aureus
Clinical finding :
Pain surrounding the lesion
Nodule (hard, tender, red folliculocentric)
enlarge fluctuant abcess formation rupture
Single/multiple

Furunkel / Furunkulosis ?

FURUNKEL
Lab:
Leukocytosis
Gram stain of pus
Culture

Complication
Not common
Recurrent
furunculosis

KARBUNKEL
Larger, more serious
inflammatory lesion
with a deeper base
Extremely painful
Fever, malaise
Location : nape of the
neck, the back or
thighs
Efl : red, indurated,
multiple pustules
confluent

MANAGEMENT OF FURUNCLE &


CARBUNCLE

Washing and hygiene


Localized local application of moist
heat
Systemic systemic antibiotic
Incision and draining the lesions

EKTIMA
A cutaneous pyoderma
characterized by thick
crusted erosions or
ulceration
Etiology: S.aureus &/ group A
Streptococcus
Clinical finding:
Poor hygiene & neglect
Location : lower extremities
(children, DM, elderly)
Efl: ulcer punched-out,
indurated, raised, violaceous,
granulating base
slow to heal need several
weeks of antibiotic treatments

ERISIPELAS
Soft tissue infection erysipelas &
cellulitis
Usually present at an antecedent
lesion or site
Local pain, variable degrees of
erythema, systemic symptoms

ERISIPELAS
Distinct type of
superficial cutaneous
cellulitis with marked
dermal lymphatic vessel
involvement
Etiology : group A hemolytic Streptococcus
(>>) ; S.aureus (<<)
Clinical finding :
Face, lower extremities
Pain, superficial erythema
and plaque-like edema
with sharply defined
margin to normal tissue

Recurrent lymphedema

SELULITIS
Extends deeper into the dermis and
subcutaneous tissue
Etiology : S.aureus and group A
Streptococcus (>>)
Clinical finding :
Erythema, tenderness, pain
Lack of distinctive margins between affected and
normal skin
Deeper, firmer form of tender induration
Crepitus on palpation
Bulla and necrosis
Regional lymphadenopathy

SELULITIS

PENATALAKSANAAN
Istirahat tirah baring & elevasi tungkai
Sistemik antibiotic
Topikal : kompres dingin dengan normal
saline steril
Intervensi bedah