Yuni Eka Anggraini

A. General Characteristics
1. Skin is relatively resistant to infection.
2. Microflora inhibits harmful organism.
3. Skin infections occur when protective
mechanism fall.

Entry :
1) Skin (pores, hair follicles).
2) Wounds (scratches, cuts, burns).
3) Insect & animal bites.
 Broken skin allows Bacteria to enter
Pyoderma
• Pyoderma is a group name for pyococcal dermatoses which
are generally purulent.

• In tropical countries, pyoderma is a common problem,

particularly in the summer and the monsoon.

• The two important pyogenic organisms are the Staphylococcus

aureus and the Streptococcus pyogenes.

• Follicular infections are mainly due to staphylococci; while

erysipelas and cellulitis are caused by streptococci.

• Besides these, other organisms which occasionally come

across in pyodermas are Proteus, Pseudomonas and Coliform
bacilli.
 Bacterial Infection of Skin
Lab. Diagnosis
Suspected organisms
 Impetigo: Group A Streptococcus, Staphylococcus
aureus
 Folliculitis: Staphylococcus aureus, Pseudomonas
aeruginosa
 Furuncles: Staphylococcus aureus
 carbuncles: Staphylococcus aureus
 Cellulitis: Group A Streptococcus, Staphylococcus aureus,
Haemophilus influenzae
 Erysipelas: Group A Streptococcus
 Necrotizing fasciitis: Group A Streptococcus, Clostridium perfringens and
other species, Bacteroides fragilis, ther anaerobes, Enterobacteriaceae,
seudomonas aeruginosa
 S. aureus produces skin
infection
I. Direct infection of skin and adjacent tissues
a. Impetigo
b. Ecthyma
c. Folliculitis
d. Furunculosis
e. Carbuncle
f. Sycosis barbae
II. Cutaneous disease due to effect of bacterial toxin
a. Staphylococcal scalded skin syndrome
b. Toxic shock syndrome
ß-hemolytic streptococcus
produces skin infection
I. Direct infection of skin or subcutaneous
a. Impetigo (non bullous)
b. Ecthyma
c. Erysipelas
d. Cellulitis
e. Necrotizing fascitis

II. Secondary infection

Eczema infection
Pyodermas
1. Impetigo: Infection of the epidermis

portal of entry: primary and secondary

infection
age of onset: children (primary)
duration : days to week
Contageous and can be spread
through puss from an infected person
touching the skin
 Impetigo (Non-Bullous)
superficial skin infection that
manifests as small erosions
with golden-yellow crust /a
honey-colored crust. (crusted
erosions)
Impetigo (Bullous)
Bullous impetigo is a superficial
skin infection that manifests as
clusters of vesicles or pustules that
enlarge rapidly to form bullae. The
bullae burst and expose larger
bases, which become covered with
honey-colored varnish or crust.
 2. Ecthyma: Begin as vesicles that rupture, creating
circular erythematous lesions with adherent crusts.

similar to impetigo, but more deeply

invasive. Usually caused by a
streptococcus infection  ulceration
with a thick adherent crust, possibly
causing scars.
Ecthyma gangrenosum is a bacterial skin
infection (caused by Pseudomonas
aeruginosa) that usually occurs in people
with a compromised immune system.
3. Folliculitis: Inflammation at the opening of the hair follicle that
causes erythematous papules and pustules surrounding
individual hairs.

usually caused by S. aureus but occasionally P. aeruginosa (hot-tub folliculitis)

or other organisms.

Effect:
• Can result in hair loss or scarring
• Two types: superficial folliculitis and deep folliculitis
Symptoms of superficial folliculitis

• Clusters of small red bumps

• Pus-filled blisters
• Itchy and tenderness
Types:
• Staphylococcal folliculitis
• Pseudomonas folliculitis (hot tub folliculitis).
• Tinea barbae
• Pseudofolliculitis barbae
• Pityrosporum folliculitis
• Herpetic folliculitis
Symptoms of Deep folliculitis

• Large swollen bumps

• Pus-filled blisters
• Lots of pain
• Possbile scars

Types:
Gram-negative folliculitis
Boils and carbuncles
Eosinophilic folliculitis
Furuncles (boils) are tender nodules or pustules caused
by staphylococcal infection. Carbuncles are clusters of
furuncles that are subcutaneously connected.
Risk factors

• Medical conditions that reduce immune system to

infection
• Trauma to your skin from surgery
• Long-term antibiotic therapy for acne
• Topical corticosteroid therapy
• Obesity
• Living in a warm, humid climate
• Poor hygiene
• Diabetes melitus
4. Cutaneous Abscess

• A cutaneous abscess is a localized collection of pus in the skin

and may occur on any skin surface.
5. Hidradenitis suppurativa
• Hidradenitis suppurativa is a chronic, scarring
inflammation of apocrine glands of the axillae, groin, and
around the nipples and anus.
6. Erysipelas
• Erysipelas is a type of superficial cellulitis
with dermal lymphatic involvement.
• Erysipelas is characterized clinically by shiny,
raised, indurated, and tender plaque-like
lesions with distinct margins.
• Erysipelas is most often caused by group A
(or rarely group C or G) β-hemolytic
streptococci and occurs most frequently on
the legs and face.
• Other causes - Staphylococcus aureus
(including methicillin-resistant S. aureus
[MRSA]), Klebsiella pneumoniae,
Haemophilus influenzae, Escherichia coli.
• It is commonly accompanied by high fever,
chills, and malaise. Erysipelas may be
recurrent and may result in chronic
lymphedema.
 7. Cellulitis

affects the deeper dermis and

subcutaneous fat
The affected area
• Warmth
• Erythema
• Edema
• Tenderness
The proximal to the area
• Ascending lymphangitis
• lymphadenopathy
Predisposing factors include disruption to
the skin barrier as a result of trauma,
inflammation, preexisting skin infection (ie
tinea pedis), and edema
 8. Necrotizing Subcutaneous Infection

(Necrotizing Fasciitis)

• Typically caused by a mixture of aerobic and anaerobic

organisms that cause necrosis of subcutaneous tissue, usually
including the fascia.

• This infection most commonly affects the extremities and

perineum. Affected tissues become red, hot, and swollen,
resembling severe cellulitis.

• Without timely treatment, the area becomes gangrenous. Patients

are acutely ill. Diagnosis is by history and examination and is
supported by evidence of overwhelming infection.

• Treatment involves antibiotics and surgical debridement.

Prognosis is poor without early, aggressive treatment.
9. Staphylococcal scalded-skin syndrome
(SSSS)

• caused by exfoliative toxins of S. Aureus in the

epidermis.
• most frequently in infants and children up to age
6.
• A fever and reddening around the mouth or eyes
first appear, followed by painful exfoliation,
erosion and blistering.
• Nikolsky’s sign is positive.
• Systemic management and care, and
administration of antibiotics are the main
treatments.
Bacterial Infection of Skin
Lab. Diagnosis

Specimen collection.
1. Skin biopsy
2. Skin swab
3. Pus swab
4. Nasal / skin swab
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 antiseptic solution
• Removal of crusts with antiseptic sol (eg. KMN04 solution)
• Application of antibacterial cream

• Systemic therapy
• Antibiotics