Ministry of Education and Science

of the Kyrgyz Republic

INTERNATIONAL HIGHER SCHOOL OF MEDICINE

Department of infectious diseases and

dermatovenerology
subject dermatovenerology

“Pyoderma”

Educational allowance for foreign students,

medical residents and interns

1
 Ministry of Education and Science
of the Kyrgyz Republic

INTERNATIONAL HIGHER SCHOOL OF MEDICINE

Department of infectious diseases and

dermatovenerology
subject dermatovenerology

“Pyoderma”

Educational allowance for foreign students,

medical residents and interns

Bishkek - 2020

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Published by Еditorial Board decision of International Higher School of Medicine
Members:
C.m.s., Associate Professor Akhunbaev S.M. – Rector of IHSM
D.m.s., Professor Uzakov O.J. – Vice-Rector of IHSM
D.m.s., Professor Alekseev V.P.
D.m.s., Professor Aidaraliev A.A.
C.m.s., Associate Professor Usenova A.A.

The composition of the Bioethical Committee:

Chairman - D.m.s., Professor Uzakov O.J.
Members:
D.m.s., Professor Atykanov A.O.
C.m.s., Associate Professor Usenova А.А.
Ph.D., Associate Professor Dzhusupov K.O.
C.m.s. Davletbaev R.M.
Alymkulova N.N.
Bazhanova A.E.
Rysalieva N.T.
Usubalieva A.A.
Ismanova K.A

Compiled by: assistant of infectious diseases and dermatovenerology

department`s Shakirova A.T.
C.m.s., Associate Professor Akhunbaev S.M.
D.m.s., Professor, medical coordinator of IHSM Umetaliev U.K.
Reviewers
- Vice-Rector, Doctor of medical science, Prof. Uzakov O.J.
- PhD, Associate Professor of the Department of microbiology,
virology and immunology I.K. Akhunbaev KSMA Aldzhambaeva [Link].
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 Infectious dermatoses are very common in all age groups. Patients with
infections of the skin and subcutaneous fat constitute the most significant group
of patients with dermatological profile - 34–36%.
The training manual addresses the issues of etiopathogenesis, clinic, diagnosis,
treatment and prevention of infectious skin diseases - pyoderma. The principles for
the diagnosis and treatment of skin infections comply with the clinical
recommendations for the profile “Dermatovenerology. Are given situational tasks
and test control of knowledge.
A content analysis is carried out taking into account the literature review and the
authors’s long experience in this manual.
Designed for foreign students faculty of medicine.

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INTRODUCTION

Pyoderma (from the Greek “pyon” - Pus, the derma - skin) - pustular skin
disease caused by pyogenic cocci, especially staphylococci, streptococci, sometimes
others (Proteus vulgaris, Pseudomonas aeruginosa, Escherichia coli). The most
common skin diseases among all age groups, occupy one of the first places. There
may be seen, initially on intact of skin under the influence of exogenous and
endogenous factors, and as a complication of other skin diseases accompanied by
itching (eczema, scabies, dermatitis).

Study subject – Pyoderma

The purpose of lessons

To be able to correctly diagnose pyoderma, a differential diagnosis between

different clinical forms and other diseases, to outline a strategy for further
examination and prescribe treatment.

The goals
The student should know:

- Definition of pyoderma;

- Etiology and pathogenesis of pyoderma;

- Classification and clinical manifestations forms of pyoderma;

- Methods of diagnosis;

- Differential-diagnostic signs between the different forms of the disease and other
diseases;

- Means of general and local therapy of these diseases;

- Prevention of pyoderma.

The student should be able to:

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- Describe the elements of an eruption;

- To determine the form and stage of the disease;

- A preliminary diagnosis, outline survey plan;

- Appropriate treatment.

Integrative communication topics with other disciplines

Pyoderma among skin diseases are quite common. It should be noted that these
skin diseases manifest at any age and are a reflection of internal diseases. Therefore,
knowledge of the clinical manifestations of these pathologies are not only
dermatologists, but also other physicians (pediatricians, therapists, cosmetologists,
surgeons).

Information unit

Healthy skin has a natural defense against pathogens. This is accomplished by

continuous peeling, the acid pH of the level, the bactericidal properties of
polyunsaturated fatty acids, the antagonistic properties of normal skin flora.

Pustular skin disease - developed under the influence of the various exogenous
and endogenous factors.

Exogenous factors:

- Skin trauma;

- Contamination of the skin, poor hygiene, excessive leather degreasing;

- Violation of the secretory function of the skin;

- Overcooling and overheating of the skin;

- Ecological environment.

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Endogenous factors:

- Centers of a chronic infection;

- Gastrointestinal disease;

- Metabolic disorders;

- Diseases of the endocrine system;

- Neuroses, trauma, fatigue;

- Chronic intoxication;

- Immune deficiency, HIV infection.

Classification of pyoderma:

Classified according to the etiological basis. According to this classification

distinguish between staphylococcus, streptococcus and mixed.

Streptostaphylococcal lesions of the skin. In each group, according to the depth of

lesions isolated superficial and deep pyoderma that the flow can occur acutely and
chronically.

By superficial pustular skin lesions are nosological forms, that affects the epidermis
and dermis.

With deep pyoderma defect can capture not only the dermis but also the hypodermis.

Staphylococcal pyoderma:

1. Staphylococcal pyoderma in early childhood.

2. Staphylococcal pyoderma children and adults.

3. Staphylococcal pyoderma in adults only.

Staphylococcal pyoderma in early childhood:

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• vesiculopustulosis;

• multiple abscesses in children (pseudofuruncules Finger);

• epidemic pemphigus newborns (pemphigus neonatorum);

• exfoliative dermatitis Ritter von (SSSS syndrome, staphylococcal skin burnt).

Staphylococcal pyoderma of children and adults:

• ostiofolliculitis Bosschaert;

• folliculitis;

• boil;

• carbuncle.

Staphylococcal pyoderma in adults :

• hydradenitis;

• vulgar psychosis (psychosis vulgaris).

Streptococcal pyoderma:

• streptococcal impetigo (impetigo streptogenes);

• streptococcal onychia and paronychia (turniol);

• angular stomatitis (slit impetigo);

• bullous impetigo;

• streptococcal ecthyma (ecthyma vulgaris, ecthyma terebrans, ecthyma

gangrenosum);

• intertriginous streptoderma;

• lichen simplex.

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Mixed pyoderma:

• vulgar impetigo (impetigo streptococcal, staphylococcal);

• pyoderma (Hoffman) (chancre - a painless ulcer, particularly one developing on the

genitals as a result of venereal disease.);

• chronic ulcerative pyoderma.

Clinical and anatomical classification of ulcerative pyoderma:

1. Actually ulcerative pyoderma:

a) chronic ulcerous pyoderma;

b) chronic ulcerative pyoderma vegetans;

c) pyoderma gangrenosum (ulcerative dermatitis);

g) сhanсriform (chancre) pyoderma (Hoffman);

d) ecthyma.

2. Vegetating pyoderma:

a) chronic vegetans pyoderma (Hallopeau);

b) chronic vegetans pyoderma (Azya);

c) chronic vegetative pyostomatitis (McCarthy);

g) serpengium chronic pyoderma.

3. Pustular-fistulous pyoderma (Pyodermia fistulans sinifica)

a) tuberculous - cutis colliquativa pyoderma (scrofuloderma);

b) fistulous pyoderma area adrectal fiber, natural skin folds, sacrum and coccyx;

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c) fistula complicated by pyoderma, developing on the background of conglomerate
(large, mass) and phlegmonous acne, lightning acne, chronic folliculitis,
perifolliculitis abscesses.

I. Staphylococcal pyoderma

Staphylococcal pyoderma in early childhood

Vesiculopustulosis occurs in early childhood. Acute purulent lesion mouth of

apocrine sweat glands. There is often premature, weak, low birth weight, as well as in
children with high sweating. For the disease characterized by the appearance of
pustules with a microcephaly. The most frequent localization - the scalp, body, skin
folds.

Multiple abscesses in children - inflammation throughout the apocrine sweat

gland. Localization mainly on the scalp, back, hips, in the natural folds of the skin.
There are multiple large nodule hyperemia. A sharp pain on palpation. Then there is
yellowish green pus and Necrotic core is formed. Complications of the disease:
cellulitis and sepsis.

Epidemic pemphigus of newborns – after 5 - 10 days from the moment of

birth. Acute contagious superficial staphylodermis arising due to breach of aseptic
and antiseptic. Entre the umbilical wound, subsequently occur generalization of
infection. On the skin of the trunk, scalp, skin folds appear in bubbles of various sizes
of 0.5-1.5 cm with a thin flabby tire, inflammatory margins at the periphery. Then the
bubble burst, forming erosive surface. The child is not calm, refuses food, disorders
of the gastro - intestinal tract with increasing temperature. Complications, such as
otitis media, pneumonia, sepsis is rare.

Exfoliative dermatitis of Ritter - severe staphylococcal disease in children. First,

in natural holes with bubbles appear blisters, opened, forming erosive surface, with
the detachment of the epidermis. Symptom of Nikolsky +. Staphylococcal scalded
skin syndrome caused by the exfoliative toxin of Staphylococcus aureus.

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Subsequently, the entire surface is affected child's skin for several days. The
epidermis peels off the layers of skin which resembles the surface after a burn injury.
The child's condition is serious, may develop complications (pneumonia, sepsis).

The differential diagnosis is carried out with a syphilitic pemphigus, epidermolysis

bullosa, ichthyosis:

- When syphilitic pemphigus occurs, it often seen on the palms and soles, calves,
rarely seen on the thighs with infiltration, with no known disorders. The diagnosis is
the serological testing of the mother's blood and the baby confirms it.

- Epidermolysis bullosa, the manifestations of which are already visible at birth of the
baby, in which blisters appear with a minor trauma.

- Epidermolytic ichthyosis. Newborn skin is bright red, there are vast areas of
delamination of the epidermis with formation of erosions and blisters of various sizes
with a sluggish skin and positive Nikolsky symptom. In the 3-4 year life warty
growths.

Staphylococcal pyoderma of children and adults.

Osteofolliculitis (staphylococcal impetigo Bockhart) is characterized by small

follicular superficial pustules hemispherical shape with a diameter of 1-2 mm with
purulent head at the base of the hair follicle with a margin of hyperemia. There are
single and multiple, not prone to the merger. Often localized on the face, sometimes
the trunk, extremities. After 3-4 days, the contents of pustules shrinks in the crust,
which disappear without leaving a trace.

Folliculitis - an acute purulent inflammation of the hair follicle. Pustules larger

size (0.5-1.5 cm in diameter), has a conical shape, is penetrated by hair. Usually there
is soreness, depending on the depth of destruction of the hair follicle. Pustule opens
with the release of pus or shrinking in the crust.

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 Furuncle - occurs in the propagation of pathogenic staphylococci in depth,
characterized by necrotic inflammation of the hair follicle, sebaceous glands and
surrounding tissue. At the beginning of the disease it is limited infiltration, bright red
in color, with marked tenderness. Then appears in the center of the pustule
infiltration, infiltration softening, pustule opens with pus, as we see the necrotic core.
Later necrotic core is expelled with the formation of ulcers, and then forms a scar.

Staphylococcal pyoderma of adults.

Vulgar sycosis - chronic suppurative process characterized by inflammation of

the hair follicles of the beard and mustache, less often than other areas (pubic area,
etc.) for affected people the main cause is - non-compliance with hygiene regulations
when shaving. The causative agent of the disease is the association of S. aureus or
different strains of staphylococci. The disease is characterized by the appearance of
foci with marked infiltration of the skin bluish-brown color, on which there are
blisters, erosion, serous-purulent crusts.

The differential diagnosis is carried out with the parasitic sycosis. Parasitic sycosis -
acute course, characterized by the formation of dense and deeper nodes, the tendency
to self-healing and finding in the laboratory study of the fungus mycelium.

Hydradenitis. Purulent inflammation of apocrine glands. hydradenitis localizes

often in the armpit, around the nipples, navel, genitals and anus. The thicker the skin
produces small infiltrates the size of a pea, which gradually increase, are joined to
each other and with the surrounding tissues, forming a continuous painful
inflammatory infiltrate bluish-purple color. After 4-5 days there is fluctuation, units
opened with the formation of fistulas, with purulent discharge. For the disease
characterized by a chronic relapsing course torpid (mentally or physically inactive;
lethargic).

The differential diagnosis is carried out with strumoderma. The disease occurs in
childhood and adolescence. Clinically - ulcer surface, soft, bridge with scars.

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Favourite localization - submandibular region, neck, supraclavicular and subclavian
area. Laboratory - Mycobacterium tuberculosis.

Streptococcal pyoderma:

• streptococcal impetigo (impetigo streptogenes);

• streptococcal onychia and paronychia (turniol);

• angular stomatitis (slit impetigo);

• bullous impetigo;

• streptococcal ecthyma (ecthyma vulgaris, ecthyma terebrans,

ecthyma gangrenosum);

• intertriginous streptoderma;

• lichen simplex.

Streptociccal impetigo. The disease is characterized by contagious, especially

among the children. It transmitted by contact-household. In the background appears
hyperemic vial filled with serous at first, then purulent contents (flycten), opened
with the formation of erosions, weeping. Erosion covered by loose, straw-yellow
crusts. After falling off crusts, redness, scars and atrophy of the left side. Favourite
localization - the skin of the upper and lower extremities.

Streptococcal onychia and paronychia. The manifestation is the nail in children

and adults. The skin gets reddish, swollen, painful. Formed a vesicle with a
transparent, then contents gets turbid. Vesicle turns into a pustule, sometimes covers
the nail on three sides like a horseshoe with hyperemia. Sometimes the process goes
into chronic: color is purple, cyanotic, edematous, the edges of the nail ridges and
peeling of the epidermis. deformed nail plate is present. The differential diagnosis is
carried out with candidiasis of nails and nail ridges. Finding the fungal elements in
the material selection and its culture, nail dystrophy and onycholysis with
depigmentation of the nail plate.
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 Angular stomatitis congested, edematous skin formed slit-like erosion,
maceration, cracks are covered with purulent crusts. It can affect the skin in the
corners of the eyes, at the base of the nose wings. The disease tends to chronicity.
Differential diagnosis with Candida bridou. Candida defeat corner of the mouth -
occur in adults, combined with vulvovaginal lesions of the mucous membranes and
skin, microscopy - Candida albicans.

Bullous impetigo. Clinical variety of streptococcal impetigo. More often

develops on the hands, feet, legs. Clinically characterized by the appearance of large
bubbles with a diameter of 1 cm or more from the hard cover.

Streptococcal ecthyma. The disease is more common in patients suffering from

alcoholism in the elderly. The most frequent localization of the lower limbs. Deep
Tissue injury with ulceration in a limited area. The causative agent is Streptococcus
pyogenes. Development of the disease begins with the appearance of flyctens with
purulent contents, for several days in a shrinking crust. Under the crust is revealed a
deep ulcer with swollen edges and bottom. The bottom is covered with necrotic,
purulent and mucoid plaque. Within 2-4 weeks develops ulcer scar. Increasing the
nearby lymph nodes. In patients with possible fever, weakness. The clinical course is
divided into ordinary ecthyma (ecthyma vulgaris) and gangrenous ecthyma (ecthyma
terebrans et gangrenosum).

The differential diagnosis is carried out with a syphilitic ecthyma, varicose ulcers of
the lower leg. Syphilitic ecthyma - pustules of varying depth, 1-6 cm in diameter,
covered with a tightly fitting crusts, dirty - mud-colored ulcers with granulation,
subjective - no pain. The most common manifestation of adverse malignant course of
syphilis.

Intertriginous streptoderma (intertriginous area is where two skin areas may

touch or rub together. Examples of intertriginous areas are the axilla of the arm, the
anogenital region, skin folds of the breasts, and between digits localized on the
contact surfaces of the large folds: groin, armpits, neck, buttocks, behind auricles. It
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is characterized by the presence of irritation, quickly opened to form a moist erosions
with sharp scalloped borders and pyococcus. Screenings are at the periphery. This
form of streptococcal common in children with overweight, diabetes, excessive
sweating. Streptococcal intertrigo is differentiated from intertriginous candidiasis -
erythema with clear boundaries, exudation, sub corneal pustule, satellite papular-
pustular lesions.

Lichen simplex. The disease occurs on exposed skin, rarely limb, trunk. The skin
lesions appear clearly limited, whitish color with fine defurfuration
(the shedding of the epidermis in the form of fine scales). After recourse depigmented
spot. Differential diagnosis is carried out with vitiligo. With clearly limited areas of
vitiligo depigmentation milky white, without peeling, prone to peripheral fusion,
sometimes up to a total deformation, hair discolored in the centers.

Mixed pyoderma:

• vulgar impetigo (impetigo streptococcal, staphylococcal);

• chancriform pyoderma (Hoffman);

• chronic ulcerative pyoderma.

Clinical and anatomical classification of ulcerative pyoderma

1. Actually ulcerative pyoderma:

a) chronic ulcerous pyoderma;

b) chronic ulcerative pyoderma vegetans (Chernogubov);

c) pyoderma gangrenosum (ulcerative dermatitis);

g) chancriform pyoderma (Hoffman);

d) ecthyma

2. vegetating pyoderma:

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a) chronic vegetans pyoderma (Hallopeau);

b) chronic vegetans pyoderma (Azya);

c) chronic vegetative piostomatit (McCarthy);

d) chronic pyoderma serpenginous

3. fistulous pyoderma (Pyoderma fistulans sinifica)

a) tuberculous-colliquative pyoderma;

b) fistulous pyoderma area adrectal fiber, natural skin folds, sacrum and coccyx;

c) fistula complicated by pyoderma, developing with conglomerate background and

phlegmonous acne, lightning acne, chronic folliculitis, perifolliculitis abscesses.

Vulgar impetigo. Contagious diseases, especially in children. In adults, it occurs

as a distinct disease, and as a complication of scabies and other pruritic dermatoses.
Localized mainly on the face, hands and can spread to other skin areas. On congested
skin appear purulent phlyctenas prone shrivel in the thick yellowish green crust,
beneath which revealed erosive wet surface. After rejection crusts form slightly scaly
patches disappear in the future. The differential diagnosis is carried out with
microbial eczema, pemphigus, candidiasis lesions of skin folds and nail ridges.

Chackriform pyoderma. Localization - the genital area, red border of the upper
and lower lips, less mucous membranes of the mouth and cheeks, tongue, mouth
corners, chin, bridge of the nose, eyelids and eyebrows. The disease begins with the
appearance of the vesicle and the formation of erosion or ulceration. Ulcerative defect
has a rounded shape and sealing of the bottom. However, unlike the dense infiltration
chancre, underlying the ulcer beyond the ulcer. Healing occurs without scar or scar
the surface is formed.

Histopathology. Perivascular and diffuse infiltration - polymorphonuclear

neutrophils, eosinophils, lymphoid cells and histiocytes. Acanthosis, edema,
expansion of blood vessels and lymph.
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Differential diagnosis of syphilis (chancre). Distinguish shankriform pyoderma from
chancre to help research and pale serology reactive treponema syphilis.

Chronic ulcerative and ulcerative pyoderma vegetans (pyodermitis chronica

exulcerans et vegetans). The disease is characterized by a long and persistent course,
in the pathogenesis, the main role belongs to the disruption of the immune system.
suffer most of the adults, at least the older children. Localization - the upper and
lower limbs, may affect other areas of the skin. Ulcers have jagged edges, sluggish
granulating, coated with serous purulent dense bloom (ulcerative form) or overly
abundant projecting vegetations (ulcerative vegetans form), with the base of the
unpleasant-smelling serous purulent discharge. The skin around the ulcer surface is
inflamed, it can be seen in the follicular and non-follicular superficial pustules,
sometimes coalescing into a solid field of defeat, are covered with purulent crusts,
from under which separates serous purulent exudate. The process spreads, capturing
all the new areas of the skin, accompanied by tenderness, limited limb movement.
Healing takes rough scarring.

Histopathology - changes in the epidermis and dermis in chronic inflammation with

foci of granulomatous structure, necrosis, abscess formation. Lymphocytes,
histiocytes, fibroblasts with an admixture of neutrophils, eosinophils and plasma
cells. Necrosis, abscesses.

The differential diagnosis spend with colliquative and warty skin tuberculosis, deep
fungal infections:

- colliquative lupus is characterized by dense painless nodules that grow in size and
become cyanotic node adherent to the underlying tissues. Later assembly opened with
the release of pus. On-site assembly is formed ulcer with soft-edged, yellowish
coating and granulation at the bottom. After healing there are "torn" scars of irregular
shape, covered papillate skin outgrowths. The preferential localization - the neck,
limbs less. Tuberculin positive reactions.

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- Lupus is characterized by warty nodules painless red with a bluish tint, which merge
into infiltrative elements on the surface appear warty growths, covered horn masses,
peripheral zone free of growths and has the form of a reddish rim. The rash often
located on the fingers, the back and the palm of the hands, soles. Tuberculin positive
reactions.

- Pyoderma gangrenosum. The disease is common in adults, rare in children.

Gangrenous pyoderma develops against the background of systemic or internal
disease (ulcerative colitis, Crohn's disease, malignant diseases of the internal organs).
Characterized by the appearance of pustules, furunculous rash that opened, ulcers are
formed with peripheral rapid growth, lipid-pink color with jagged edges, overhanging
fragments of the epidermis. The bottom of the ulcer has granulation, purulent and
hemorrhagic discharge from the putrid odor. Favourite localization skin of the lower
limbs, at least the upper body limbs, face. Chronic recurrent disease.

Histopathology. Swelling of the vessel walls, vessel thrombosis in the upper dermis,
skin necrosis in the subcutaneous tissue and the depth. Granulomatous infiltrates
consisting of lymphocytes, neutrophils, plasma cells, and fibroblasts.

- Chronic vegetans pyoderma. At the beginning of the disease there are multiple
grouped pustules, after opening formed warty vegetation with purulent contents
cover. Then foci coalesce into larger, with erythematous halo and clear contours.
Favourite localization - the scalp, forehead, lips, mucous membrane of the cheeks,
nose, armpits, genitals.

Histopathology. Intraepidermal eosinophilic abscesses and pseudo epiteliomatous

hyperplasia with papillomatosis, chronic granulomatous inflammation in the dermis.
Cells - lymphocytes, histiocytes, eosinophils and neutrophils.

Differential diagnosis with vegetating pemphigus, warty tuberculosis, secondary

syphilis, mycosis.

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- Pemphigus vegetans - a kind of vulgar pemphigus differs predominance of
vegetative cells and benign course. Vesicles are located on the oral mucosa, in skin
folds and around the orifices. With the opening of bubbles at the surface erosions
formed succulent vegetation pink-red color, soft texture, covered with gray bloom
with purulent discharge, fetid odor. later, the vegetating erosion merge into large
pockets, the surface becomes dry, hyperkeratotic, covered with cracks. Subjectively,
there is soreness and itching of the skin. Nikolsky symptom positive.

Vegetating pyoderma. Local proliferation of abundant vegetation, with the formation

of crusts. Localization - upper, lower limbs. Lesions are localized on the mucous
membrane of the mouth, papular and pustular elements, vegetation, erosion. In the
history of patients the disease gastro-intestinal tract.

Fistulous pyoderma: pyoderma similar colliquative tuberculosis. The disease is

characterized by the appearance of subcutaneous nodules purple, components soften
in the center, formed fluctuations, fistulas, ulcers with necrotic content. Formation of
bridge shaped scars. The patient complains of pain in the lesion.

The differential diagnosis is carried out with colliquative tuberculosis.

Fistula pyoderma area adrectal fiber, natural skin folds, sacrum and coccyx.
Subcutaneous nodules, fistulas with pus. Usually there is: pain, itching, skin
moisture.

Acne keloid found only in men. It is characterized by eruptions of small, dense,

painful papules coalescing into plaques bluish-red color. Hair within the
inflammatory lesions are located on the 10-15 tassels of hair from the same follicle.

The process is localized on the scalp in the back of the head with the transition to the
back of the neck. The disease is characterized by a prolonged course and ends with
sclerotherapy affected areas.

Histopathology. The epidermis - slight hyperkeratosis, parakeratosis, acanthosis. The

thicker dermis focal infiltrates consisting of neutrophils, plasma large cells,
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histiocytes, eosinophils. In the central part of the accumulation of white blood cells
(abscess).

The differential diagnosis is carried out with colliquative and warty tuberculosis,
deep fungal infections.

Folliculitis scarring is characterized by inflammation of the hair follicle, with

subsequent destruction and persistent alopecia. It is noted that the appearance on the
scalp, sometimes in the armpits foci of scar alopecia of different size and shape. The
disease is characterized by a long sluggish flow with periods of exacerbation.

Histopathology. In the early pustular stage - abscesses at the top of the follicle with
infiltrate. Perifollicular infiltration - neutrophils, histiocytes, lymphoid and plasma
cells. Granulomatous tissue - lymphoid and plasma cells, fibroblasts.

The differential diagnosis is carried out with lupus erythematosus, scleroderma,

lichen planus head.

Folliculitis and perifolliculitis head abscessed undermining Hoffmann

characterized by the appearance on the scalp in the parietal and occipital areas
tubercles yellowish or bluish-red color with a soft consistency with a stretched,
thinned, hairless skin. Outbreaks merge in winding strands, pus from fistulas.

The differential diagnosis is carried out with strumoderma (scrofuloderma), deep

mycoses, tertiary syphilides.

DIAGNOSTICS

• Clinical analysis of blood and urine tests, a complex of serological tests for syphilis.

• Biochemical blood test (total protein, total bilirubin, cholesterol and its fractions,
glucose, urea, creatinine, phosphatase, ALT, AST).

• Immunological study (study of immune status)

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• Microbiological examination and identification of the pathogen with the definition
of the sensitivity of microorganisms to antibiotics.

• Histological examination of skin biopsies may be needed.

• Ultrasound examination of internal organs.

• Consultation of experts (the therapist, the immunologist, oncologist, surgeon,

endocrinologist).

TREATMENT

Drug therapy.

Outdoor therapy:

Antiseptic external preparations:

• brilliant green solution.

• fukortsin.

• methylene blue aqueous solution.

• potassium permanganate aqueous solution.

• Hydrogen peroxide solution.

• chlorhexidine.

Antibacterial drugs for external use:

• neomycin sulfate + zinc bacitracin, powder, ointment, topically.

• gentamicin sulfate, ointment or cream.

• fusidic acid cream or ointment topically.

• mupirocin 2% ointment.

• erythromycin ointment.
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• lincomycin hydrochloride.

• silver sulfathiazole.

Topical glucocorticosteroid agent, combined with antibacterial agents administered in

the event of an acute inflammatory process, accompanied by erythema, swelling,
itching, and often in the presence of pruritic dermatoses complicated by secondary
pyoderma.

• tetracycline hydrochloride + triamcinolone acetonide, aerosol.

• oxytetracycline + hydrocortisone acetate hydrochloride.

• fusidic acid + betamethasone cream.

• fusidic acid + hydrocortisone cream.

• betamethasone valerate + gentamicin sulfate.

• betamethasone dipropionate + gentamicin sulfate.

Systemic therapy:

Antibiotic therapy, taking into account the selected microflora and its sensitivity to
antibiotics. In acute forms of antibiotics should be prescribed a course for at least 5-7
days, chronic - 7-10 days.

Antibiotics penicillin:

• Amoxicillin, Amoxicillin + clavulanic acid, Ampicillin + oxacillin 500 mg Intra

muscularly.

Antibiotics of cephalosporin group:

• Cefalexin, Cefazolin, Cefixime, Cefotaxime, Ceftriaxone (rotatsef), Cefepime

dichloride monohydrate.

Antibiotics tetracycline:

22
• Tetracycline are inside of 0.25 g 4 times a day, Metacycline, Doxycycline.

Antibiotics - macrolides:

• Erythromycin, Azithromycin, Clarithromycin.

Antibiotics aminoglycoside:

• Gentamicin.

Antibacterials lincosamides group:

• Clindamycin.

Glucocorticosteroid medications for regular use (in peptic ulcer, ulcerative vegetating
pyoderma):

• prednisolone, dexamethasone injection, betamethasone disodium phosphate,

betamethasone dipropionate.

Systemic retinoids: isotretinoin.

Immunobiological means:

• the purified liquid staphylococcal toxoid + staphylococcal toxoid.

• staphylococcal therapeutic liquid vaccine (antifagin staphylococcal).

• antistaphylococcal human immunoglobulin liquid.

In the treatment of diseases of staphylococcal etiology, accompanied by bacteremia

and sepsis are used:

• antistaphylococcal human immunoglobulin for intravenous injection.

• Human normal immunoglobulin.

Non-pharmacological therapy.

• UHF – therapy.

23
 Surgery

Surgical treatment is only necessary when the chronic inflammatory process

proceeds with the formation of malignant large areas of tissue necrosis (necrosis).
The most common surgical treatment is necessary in such cases stafilodermy as
furuncle, carbuncle, hydradenitis.

PREVENTION

Fighting pustular disease is a set of preventive measures. Hygienic common mode,

full and regular meals, physical education and sports. The treatment of common
diseases. Compliance with the rules of personal hygiene. Isolating children with
streptococcal impetigo and vulgar, of diseases. Early treatment of initial
manifestations.

Primary prevention of pyoderma is timely processing of micro traumas antiseptic,

wound surfaces. Conduct treatment identified concomitant diseases, against which
may develop pyoderma (diseases of the digestive tract, upper respiratory tract, etc.).

Secondary prevention of pyoderma include periodic medical examinations of

children's institutions and decreed groups, accounting and analysis of morbidity,
clinical examination of patients, carrying out preventive treatment (staphylococcal
toxoid, vitamins, general ultraviolet irradiation, reorganization focal infections).

• SELF-CONTROL TESTS
1. Hydradenitis is inflammation of?
A. apocrine sweat glands
B. smooth skin
C. the mouth of the hair follicles
D. perifollicular tissue
E. hair follicles
2. External therapy of furuncle is done by
A. 3% oxolinic ointment
24
 B. 20% benzyl benzoate emulsion
C. lassar paste
D. 5% sulfur-salicylic ointment
E. pure ichthyol
3. Exogenous factors contributing to the development of pyoderma:
A. skin injury
B. acromegaly
C. hypothermia
D. cardiopathy
E. overheating
4. Staphylodermas include:
A. tourniol
B. furuncle
C. chancriforme papillae
D. vulgar sycosis
E. angulus
5. Primary morphological elements in streptoderma:
A. conflict
B. impetigo
C. acne
D. papule
E. ecthyma
6. Elements at Staphyloderma:
A. node
B. tubercle
C. ecthyma
D. rupeea
E. impetigo
7. The streptoderma include:
A. erysipelas
B. hydradenitis
C. boil
D. angular stomatitis
E. ostiofolliculitis
8. Clinical symptoms of vulgar sycosis:
A. hair loss
B. damage to the beard and mustache area
25
 C. regional lymphadenitis
D. the appearance of scars
E. polyadenitis
9. Strepto-staphyloderma include:
A. chancriform pyoderma
B. intertriginous streptoderma
C. vulgar impetigo
D. angular stomatitis
10. In case of chancriform pyoderma, regional lymph nodes are:
A. not increased
B. increased
C. soft
D. tight elastic
E. fluctuate
11. Which kind of pyoderma is caused by a lesion of the eccrine sweat glands?
A. multiple abscesses in children
B. staphylococcal sycosis
C. vesiculopustosis
D. vulgar impetigo
12. Morbidity with chancriform pyoderma is:
A. absent
B. moderate
C. strong
D. very strong
E. insignificant
13. Streptoderma affects:
A. smooth skin
B. hair follicles
C. sebaceous glands
D. sweat glands

Task № 1
A 32-year-old patient approached with appearance of inflammatory nodes with
pustular elements in the center with durations of three months. He was engaged in
self-treatment: he applied bandages with ichthyic ointment on the nodes. Nodes were
opened with the release of pus, but new elements continued to appear in new places.
Inspecting the skin of the shoulders-and hips, there were up to 10 nodes ranging
26
from 1.0 x 1.0 to 1.5 x 1.5 cm. The skin is bright red in color, swollen, and pustules
are visible in the center of the nodes. The skin over the other elements is bluish-red,
in the center - small ulcerations are visible from which pus is secreted. In addition,
there are fresh scars of size 0.5 x 0.5 cm bluish-red.
The task:
o make a preliminary diagnosis;
o assign examination and treatment.
Task № 2
A 42-year-old man came to the reception with complaints about the presence of an
ulcer in the area of the glans penis, accompanied by a slight pain. Ill for about three
days declines Extraneous sexual relations . Wife is examined and totally healthy.
When viewed in the area of the glans penis, there is an ulcer 1.0 x 1.0 cm in size with
regular rounded outlines, with a raised edge, infiltrated with a bottom of meat-red
color covered with purulent bloom. The inguinal lymph nodes are enlarged to 1.5 x 1,
5 cm, slightly painful, not soldered to each other and to the surrounding tissues.
The task:
o make a preliminary diagnosis;
o assign examination;
o conduct differential diagnostics;
o prescribe treatment.
Task № 3
A mother with a five-year-old girl came to a dermatologist with a complaint of minor
itching and a rash in the chin area. The child is sick for 5 days. Initially, redness
appeares on the chin, then a flabby bubble with purulent contents, which after some
time turned into an uneven crust of straw-yellow color. The mother used ointment
deperzolon on the affected area, but new rashes continued to appear, in connection
with which she went to the doctor. The child attends kindergarten. From a survey of
the mother, it was found out that two children in the group have similar rashes on the
skin. Objectively: On the skin of the chin on erythema there are layered crusts of
honey-yellow color, sometimes hemorrhagic in nature. On the periphery of the main
focus, single small conflicts are noted. On the skin of the right nasal passage there is
peel yellow in color.
The task:
o make a preliminary diagnosis;
o assign examination and treatment.
o to recommend therapeutic and preventive measures.

27
Task № 4
A 23-year-old student, a student, complained of a rash in the nasolabial triangle and
in the chin area, sometimes accompanied by a burning sensation, slight itching or
tingling. Ill for 2 years. Initially, separated bubbles appears on the skin above the
upper lip with purulent contents, penetrated by hair in the center. Pustules are
quickly dried up, forming crusts, then new rashes appeared at the same place.
Gradually, the lesion expanded, taking up the entire nasolabial triangle. A month ago,
the same rash began to appear on the chin. Appealed to the doctor at the place of
residence, were appointed with disinfectant solutions and ointments, but the treatment
was ineffective. notes chronic rhinitis, cholecystitis. Objectively: The patient is
irritable, mentally depressed. nasolabial area, skin infiltrated on chin, there is
hyperemia, a large number of pustules penetrated by hair, dirty yellow crusts.
The task:
o make a preliminary diagnosis;
o assign examination and treatment.
Task № 5
A 52-year-old patient, a worker, complains on pain, burning sensations and , ulcers
on the right leg, insomnia, and general weakness. Considers himself ill for 5 months.
Following after the trauma of the middle third of the right leg, a furuncle appeared,
after an autopsy, of which the ulcer was formed. On the background of antibiotic
treatment (orally), vitamins and external agents, the ulcer gradually deepened and
increased in size, taking up the entire front-side surface of the tibia. Of all diseases
notes focal pulmonary tuberculosis, thrombophlebitis of the veins of the lower
extremities. Objectively. On the anterior-lateral surface of the right tibia, with a
transition to the rear of the right foot, there is an ulcer with scalloped outlines,
compacted infiltrated edges, an uneven, loose bottom with sluggish gray granulations
and a significant amount of sero-purulent discharge.
The task:
o make a preliminary diagnosis;
o assign examination and treatment.

28
List of literature:
Summary:
- Dermatology: for universities / EV Sokolovsky [et al.]; Ed. [Link]. - M
.: Academy, 2005. - 521, [1] p.: silt. - (Higher professional [Link])
- Diseases of the mucous membrane of the mouth and lips / EV Borovsky, AL
Mashkilleyson, TF Vinogradov and others -. M .: MEDpress, 2001. - 318 p.
- Skin and venereal diseases: Universities / OL Ivanov [et al.]; Ed. [Link]. - M
Chicot, 2002. - 477, [1] p .: silt. - (Textbooks for medical students). - App .: s.371-
377,397-399.
- JK Skripkin Skin and venereal diseases: [Link] [Link] /YU.K.
Skripkin. - M.: Triada-Pharm, 2001. - 656s.
Additional:
- Diseases of the skin and sexually transmitted infections by: Reference / YK
Skripkin [et al.]. - M .: Medical inform. Agency, 2006. - 542s.
- Vladimirov Skin and venereal diseases: Atlas / VV Vladimirov, BI Zudin. - M .:
Medicine, 1982. - 288 p.
- Dermatology and Venereology: Ref. / Ed .: [Link] etc. -. 3rd ed. - M .:
Astra Farm Service, 2005. - 590s.
- Novikov AI, Loginova EA Diseases of the skin infectious and parasitic origin: A
Guide for Physicians / AI Novikov, EA Loginova. - M .: [Link]; Nizhni
Novgorod: Publishing house NSMA. -2001.-281 p.
- Romanenko IM Treatment of skin and venereal diseases: A Guide for Physicians: In
2 t. / I. M. Romanenko, VV Kulaga, SL Afonin. - M .: Medical inform. Agency,
2006. - 903s.

29
folliculitis

30
hydradenitis furuncle in thigh.

31
vesicular pustules streptococcal impetigo

sycosis. ulcerative pyoderma vegetans

32
vulgar impetigo strept. impetigo

ecthyma pyoderma granulosum

33
osteofolliculitis acne keloid

follicles and perifolliculitis Hoffman acne keloid

34
 chronic carbuncle vegetans pyoderma Allopo

pseudofurunculosis strep impetigo

35
streptococcal onychia paronychia

angular stomatitis chancriform pyoderma

36
 vulgar impetigo erysipelas

vulgar impetigo chronic ulcerative pyoderma

37
surface strepodermia acute hydradenitis

furuncle strep impetigo

38
39