Bacterial infections of Skin

Learning objectives of bacterial infections

of skin
Define Pyoderma and classify it.
List the normal flora of skin.
Define impetigo. List the differentiating features of
bullous and non-bullous impetigo.
Describe the C/F, investigations of impetigo.
Outline the management of impetigo.

Learning objectives of bacterial

infections of skin

Define folliculitis , classify it and describe the

management of it.
Describe the C/F, investigations and management of
ecthyma/ cellulites/ erysipelas/ furuncle/ carbuncle/ SSSS.

List the skin infection produced by B- hemolytic

streptococci.

List the skin infection produced by staphylococci.

Normal flora of skin

Classification:
1. Resident flora: grow on skin & relatively
stable in no. and composition at particular sites
2. Transient flora: lie on skin surface without
attachment, unable to multiply & disappear
within short time
3. Transient or temporary residents

Normal Skin Flora

Major bacterial groups
Coryneforms (Gram +ve, pleomorphic rods)
Corynebacterium (Aerobic & lipophilic)
Brevibacterium (Aerobic & non-lipophilic)
Propinobacterium (Anaerobic)

Contd

- Staphylococci (Gram +ve cocci, aerobs)

S. epidermidis, S. hominis, S.hemolyticus, S. saprophyticus

Minor bacterial groups

Acinetobacter (25%)
Micrococci

Fungal group
Pityriasporum

Bacterial infection of the skin

(Pyoderma)
Classification of pyodermas
1. Primary
Impetigo
Ecthyma
Folliculitis
Superficial
Deep
*
*
*
*

Folliculitis of leg
Furuncle
Carbuncle
Sycosis Barbae

2.

Cellulitis/ Erysipelas
Pyonychia
SSSS
TSS
Secondary
Secondary infection of preexisting dermatoses
eg. Atopic dermatitis, Scabies

Impetigo (contagious superficial infection)

Non-bullous

Bullous

1. Cause
- Streptococcal (Group A)
- Staph. aureus (Phage Groups II)
2. Pre-school and young school age
3. Very thin walled vesicle on an erythematus base
4. Transient
5. Yellowish-brain crusts (thick)

Staph. aureus
All ages
Bullae of 1-2cm
Persist for 2-3 day
Thin, flat,
brownish crust

Contd

6. Irregular peripheral extension without

healing

Central healing with

peripheral extension

7. Regional adenitis
8. Constitutional symptoms present
9. Face (around the nose, mouth & limbs)
10. Palms & sole spared
11.MM, very rare

Rare
Absent
occur anywhere
May involved
May involved

Predisposing factors
Malnutrition
Diabetes
Immuno-compromise status

Complications

Streptococcal infection
PSGN (strep M-type 49)
Scarlet fever
Urticaria
Erythema mutiforme

Ecthyma
Streptococcal & staph
Common in children
Small bullae or pustules on erythematous base
Formation of adherent dry crusts
Beneath which ulcer present
Indurated base
Heals with scar and pigmentation
Buttocks, thighs and legs, commonly affected

Folliculitis
Superficial folliculitis
Infection of hair follicles
Commonly caused by staph. aureus
Children
Scalp & limb
Rarely painful
Heals in a week

Folliculitis
Deep folliculitis of leg
Chronic
Staph. aureus
Hair follicles of leg
Multiple
Atrophic scar

Furuncle (Boil)
Acute
Staph. aureus
Small, follicular noduler -- Pustule-necrotic--discharge pus
Painful
Constitutional symptoms

 Heals with scar

Age: Adult
Site: Neck, Wrist, Waist, Buttocks, Face

Complication
Cavernous Sinus thrombosis, (upper lip & check)
Septicemia (malnutrition)

Carbuncle
Extensive infection of a group of contagious follicles
Staph. aureus
Middle or old age
Predisposing factors
Diabetes
Malnutrition
Severe generalized dermatoses
During prolonged steroid therapy

 Painful, hard lump

Suppuration begins after 5-7 days
Pus discharge from multiple follicular orificies
Necrosis of intervening skin
Large deep ulcer
Constitutional symptoms

Sycosis barbae
Beard region
Pustules surrounded by erythema
Males
After puberty
After trauma
Upper lip and chin
Staph. aureus

Cellulitis
Acute/sub-acute/chronic
Inflammation of loose connective tissue
Streptococcal (Group A)
Erythematous, edematous, swelling
Pain/tenderness
Constitutional upset

Pyonychia
Acute
Erythematous swelling of proximal and lateral
nail fold
Painful

Staphylococcal scalded skin synotrane

(Ritters Disease)
Exotoxin of staph (Phage Group II)
Acantholysis
Occult staph. upper respiratory tract infection or
purulent conjunctivitis
Infants and children
Tender red skin

Staphylococcal scalded skin synotrane

(Ritters Disease)
Denuded skin
Heals 7 - 14 day
Dont grow staph. from blister fluid
Complication 2%
Cellulitis
Pneumonia

Prognosis : Rule

Principles of therapy of pyoderma

Good personal hygiene
Management of predisposing factors
Local
Attend to traumas, Pressure, Sweating, Bites
Treat pre-existing dermatosis
Investigate carrier sites: Nose, Axilla, Perineum

Systemic
Treatment of disease like DM
Nutritional deficiency
Immunodeficiency

Principles of therapy of pyoderma

Local therapy
Cleaning with soap-water and weak KMN04
solution
Removal of crusts with KMN04 soluation
Application of antibacterial cream

Systemic therapy
Antibiotics

Recurrent staphylococcal infection

Persistent nasal carriage
Abnormal neutrophitic chumotaxis
Deficient intracellular killing
Immunodeficient status
D.M.

T/t of staph. carriage elimination

Nasal & perineal care
Rifampicin 600 mg/d 7-10 days
Clindamycin 150 mg/d 3 months
Topical mupirocin
Replacement of microflora with a less pathogenic
stains of S.aurus (strain 502)

S.aureus produces skin infection

I. Direct infection of skin and adjuscent tissues
a.
b.
c.
d.
e.
f.

Impetigo
Ecthyma
Folliculitis
Furunculosis
Carbuncle
Sycosis

II.Cutaneous disease due to effect of bacterial toxin

a.
b.

Staphylococcal scalded skin syndrome

Toxic shock syndrome

-hemolytic streptococcus produces

skin infection
I. Direct infection of skin or subcutaneous
a.
b.
c.
d.
e.
f.
g.

Impetigo (non bullous)

Ecthyma
Erysipelas
Cellulitis
Vulvovaginitis
Blistering distal dactylitis
Necrotizing fascitis

II. Secondary infection

Eczema infection

III. Tissue damage from circulating toxin

Scarlet fever

IV. Skin lesion attributed to allergic hypersensitivity

to streptococcal antigens
E.Nodosum
Vasculitis

V. Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)
Guttate psoriasis

Consider the following in relation to bacterial infection of skin

a.

Cellulitis is the inflammation of subcutaneous tissue as

well as dermis caused by Streptococcus.

b. Bullous impetigo is caused by streptococci

c.
In erysipelas, inflammation is limited to dermis and
upper

part of subcutaneous tissue.

d.

Furunculosis is caused by Streptococcus

Thank you