PYODERMA

Oleh
Dr. Made Sastiningsih, SpKK
 PYODERMA

Definition
 Skin infection
 Caused by pyogenic bacteria
 Easily transmitted

Etiology
 Staphylococcus ( S. aures, S. albus )
 Streptococcus β haemoliticus
 Corynebacterium minutissimum
Prediposition factors:
 Low stamina, malnutrition, gravis anemia, diabetes mellitus
 Low hygiene individual
 Low hygiene area
 Pre-existing skin diseases

Classification
1. Primary pyoderma
 Infection on the normal skin without other skin diseases
 Caused by : one type microorganisme
Staphylococcus and streptococcus
 Characteristic skin manifestation
Primary pyoderma (examples)
a. Impetigo f. Erythrasma
b. Folliculitis g. Erysipelas
c. Furuncles h. Cellulitis
d. Carbuncles i. Paronychia
e. Ecthyma j. Staphylococcal scalded skin syndrome

2. Secondary pyoderma
 Complicating preexisting skin lesions, such as scabies, eczema, varicella, thus
clinical manifestation are not characteristic.
 Example:
- Hidradenitis supurativa
- Intertrigo
- Ulcers
- Secondary infection
PYODERMA TREATMENT
1. General treatments:
 Medical; personal & environmental hygiene advices
 Immunological factor
 Antibiotics

Systemic Antibiotics:
 Penicillin: ampicillin, amoxicillin,
penicillin resistant strain: → amoxicillin+clavulanate acid (3x125mg,
250-500mg), cloxacillin.
 Erythromycin 30-40 mg/kg/day → 3 doses
 Cefalexin: 50 mg/kg/day → 2 doses
 Lincomycin: 30 mg/kg/day → 3-4 doses
 Ciprofloxacin 2x 500-750 mg
Topical Antibiotic
 Mupirocin
 Gentamycin
 Erythromycin
 Fucidic acid
 Tetracycline 3%
 Chlorampenicol
 Neomycin+basitracin

 Secondary pyodermas: treatment of the preexisting diseases

 Chronic cases : culture & resistance test

2. Specific treatments:
PRIMARY PYODERMA
4 types of primary pyoderma considered from the etiology:
1. Staphylococcus
 Impetigo contagiosa bullosa
 Folliculitis, furuncles, & carbuncles
 Sycosis barbae
 Staphylococcal scalded skin syndrome
2. Streptococcus:
 Impetigo contagiosa crustosa
 Ecthyma
 Erysipelas
3. Staphylococcus & Streptococcus
 Cellulitis
4. Corynebacterium minutissimum:
 Erythrasma
IMPETIGO
 A bacterial infection that attack superficial epidermal between stratum
comeum and stratum granulosum, very infectious.
 2 types of impetigo:
1. Impetigo contagiosa bullosa
2. Impetigo contagiosa crustosa
FOLLICULITIS
1. Superficial folliculitis
2. Deep folliculitis
FURUNCLES
An infection in hair follicles & surrounding tissue (perifoliculer)
CARBUNCLES
 The worst form of a furuncle, with coalescence of furuncles and marked
inflammation, there are multiple pustules.
HIDRADENITIS SUPPURATIVA
 A chronic & recurrent suppurativa infection in apocrine sweat glands.
 Affecting apocrine sweat gland, in adult men & women
 E/: Staphylococcus aerus & proteus Sp
SKROFULODERMA
 Kelanjutan perjalanan limfatis tbc tulang, sendi.
 Limfadenitis leher (colliquativa), aksila, supraklavikula, inguinal skrofulosa →
skrofuloderma
 UKK :
 Nodul, merah,biru → ulserasi – banyak fistel – jembatan kulit
 Sembuh – skar - khas
Diagnosis
 Diagnosis pasti dengan menemukan kuman penyebab :
- kultur
- hewan coba marmut
 Terindikasi :
- Tbc tempat lain
- Riwayat penyakit & UKK
- BTA (+)
- PA
- Tuberkulin tes
- Efek OAT
Pengobatan
 OAT (Oabt Anti Tuberkulosis)
-R : rifampisin 10 mg/kgBB
-H : isoniasid (INH) 10 mg/kgBB
-Z : pirazinamid 20-35 mg/kgBB
-E : ethambutol 25/15 mg/kgBB
-S : streptomisin 25 mg/kgBB

Pengobatan
 Rekomendasi utama : 2RHZ / 4RH
 Variasi : - 2RHZ / 4R3H3
- 2RHZ / 4R2H2
 Diawasi : - 2R3H3E3Z3 / 4R3H3
- 2R3H3S3Z3 / 4R3H3
 Resisten : - 2RHZE / 4RH
- 2RHZS / 4RH
Prognosa : - responsif terhadap OAT
Profilaksis : - BCG
ERYSIPELAS
(superficical cellulitis)
 An acute infection disorder caused by streptococcus betahaemoliticus with
cardinal sign of sharply circumscribed erythematous skin, fever and chills
 Predilections :
face and head → extremities & genital
CELLULITIS
 Acute infection, where the inflammation involves more of soft tissue,
extending deeper into the dermis and subcutaneous tissues,
 Primary sign: skin erythematic without sharply defined margins.
Etiology
Group A Streptococcus & Staphylocococus aerus; Group B
Streptocococus → neonatus