PYODERMA

Creator:
Rini Ardianti Alwi
Ida Samban
Buyung Sugianto

Advisor:
dr. Mutmainnah

Supervisior:
dr. Sri Vitayani, Sp.KK
 Introduction
Pyoderma:
Skin infection caused by Staphylococcus
aureus or Streptococcus hemolyticus
Classification:
Impetigo, folliculitis, furuncle, carbuncle,
echtyma, paronikia, erysipelas, cellulitis
& Staphylococcal scalded skin syndrome
IMPETIGO
Definition:
Superficial infection localized in the subcorneal of the
epidermis
Epidemiology:
Bullous impetigo any age
Crustosa impetigo children
Etiology:
Bullous impetigo Staphylococcus aureus
Crustosa impetigo Streptococcus hemolyticus
 Portals of entry of infection
Primary impetigo arises at minor
breaks in the skin.
Secondary impetigo (impetiginization)
underlying dermatoses & traumatic
breaks in the integrity of the epidermis.
 Physical examination
Bullous impetigo:
Erythema, vesicles,
bullae
Distribution:
intertriginous sites,
face, chest & the back
Crustosa impetigo:

Vesicles or pustules
rupture, erosions, crust.
(Golden-yellow crusts)

Distribution:
On the face
 Management
1. Topical treatment :
Mupirocin ointment

2. Systemic antimicrobiol treatment

1. Organism : Group A Streptococcus.
Drug of choice / dose :
Penicillin VK
Benzathine penicilin
Alternative drugs :
Erythromycin
Cephalexin
 2. Organism : Staphylococcus aureus.
Drug of choice / dose :
Dicloxacillin
Alternative drugs :
Cephalexin
Amoxicillin plus clavulanic acid
(-lactamase inhibitor)
DD:
Bullous impetigo dermatofitosis
Crustosa impetigo echtyma
FOLLICULITIS
Definition:
A bacterial infection that involve the ostium of
a hair follicle
Epidemiology:
Any age, most common in adult
Etiology :
Most common Staphylococcus aureus
Classified :
Superficial folliculitis.
Deep folliculitis.
Local treatment :
Local antibiotics (mupirocin).
Warm saline compresses.
DD:
Tinea barbe
Akne vulgaris
FURUNCEL
 Deep seated inflammatory nodule hair
follicle.
Usually from a preceding superficial
folliculitis elvolving into an abscess.
The neck, face, axillae & buttock.
Complicate preexisting lesions.
 Start as a hard, tender, red folliculo centric
nodule in hair-bearing skin enlarges
painful & fluctuant rupture occurs pus &
necrotic material pain surrounding the lesion
subsides redness & edema diminish several
days to weeks.
Solitary lesions or multiple lesions in sites the
buttocks.
CARBUNCLE
 Larger, more serious inflammatory with a
deeper base.
Fever, malaise patient appear quite ill.

Involved area is red & indurated, multiple

pustules on the surface yellow-gray
irregular crater at the center heal slowly
by granulating.
Furuncle & carbuncle bacteremic spread of
infection & recurrence individuals perspire
excessively or poor skin hygiene.
Treatment of furuncles & carbuncles :
- Drainage.
- Systemic antibiotic:
* Dicloxacillin
* Clindamycin
* Erythromycin
DD:
Sporatrikosis
ECHTYMA
Definition:
A deep necrotic infection of the skin
(eidermis & dermis)
Epidemiology:
Any age. More common in children
Etiology:
Staphylococcus aureus or Streptococcus
hemolyticus
 CLINICAL MANIFESTATION
Vesicle or vesicopustule
with an erythematous base
erodes through epidermis
into dermis form a
crusted ulcer with elevated
margins
Distribution:
Extremitas inferior
 Therapy
Systemic:
Dicloxacillin

Cephalexin

Clindamycin

Ciprofloxacin

Topical:
* Local wound care
* Mupirocin apply twice daily
* Bacitracin apply twice daily
DD:
Impetigo krustosa

folikulitis
PARONIKIA
Definition:
Inflamation of crease of the nail
Epidemiology:
Any age, especially laundryman
Etiology:
Staphylococcus aureus
 CLINICAL MANIFESTATION

Edema
Abses

Painful

Distribution:
Nail
Therapy:
Topical insisi & drainase
Sistemik Ab (Kloksasilin)
DD:
Pianikia
ERYSIPELAS
Superficial cutaneous
cellulitis with marked
dermal lymphatic vessel
involvement painful,
bright-red, raised,
edematous, sharply
marginated from the
surrounding normal skin
Caused :
Group A -hemolytic streptococcus.
Staphylococcus aureus (rarely).
Group B streptococcus in the
newborn.
Predilection : face, lower legs, areas of
preexisting lymphedema, umbilical
stumps.
Age of onset : any age.
Cellulitis
 Clinical manifestations

Erythema
Warmth

Swelling

Local pain

Tenderness
* Tissue feels hard on palpation & painful.
* Age of onset : any age.
Caused :
* Staphylococcus aureus.
* Group A -hemolytic streptococcus.

Management
* Rest, immobilization.
* Drain abscess, debride necrotic tissue.
* Antimicrobial therapy
Staphylococcal scalded skin
syndrome
Definition:
Severe skin inflamation disease with
epydermolysis
Epidemiology:
Most common: in children (<5 years)
Etiology:
Staphylococcus aureus (faga 52, 55 or 71)
CLINICAL MANIFESTATION
Fever
Erytheme

Bula

Epidermolysis

Predilection:
universal
Treatment:
Ab (Kloksasilin)

Klindamisin

DD:
Nekrosis Epidermal Toksik (N.E.T.)
Any question ?