Non-bullous impetigo is a superficial bacterial skin infection that causes clusters of vesicles or pustules that rupture, forming honey-colored crusts. Bullous impetigo causes larger bullae that rupture, leaving larger crusts. Ecthyma is a deeper skin infection than impetigo that can cause scarring. Folliculitis causes pustules in hair follicles while furuncles are deeper infected follicles and carbuncles involve connected furuncles. Erysipelas presents as shiny, raised plaques caused mainly by streptococci bacteria. Treatment focuses on good hygiene, treating predisposing factors, cleaning and antibiotics.

1. SUPERFICIAL BACTERIAL
INFECTIONS

2. STAPHYLOCOCCAL

3. STREPTOCOCCAL

5. Impetigo
Non-bullous
1. Cause
Streptococcal (Group A)
Staph. aureus (Phage Groups II)
2. Pre-school / Children
3. Very thin walled vesicle
on an erythematous base
4. Transient
5. Thick yellowish crusts
Bullous
Staph. aureus
All ages
Bullae of 1-2cm
Persist for 2-3 day
Thin, flat, brownish crust

6. 6. Irregular peripheral extension
Without healing
Central extension with healing
7. Regional LAN
Rare
8. Constitutional symptoms present
Absent
9. Face (around the nose, mouth & limbs)
10. Palms & sole spared
occur anywhere
May be involved

7. Impetigo (Non-Bullous)
Non-bullous impetigo is a
superficial skin infection that
manifests as clusters of
vesicles or pustules that
rupture and develop a honeycolored crust.
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.

12. Ecthyma
• Strep / Staph
• Common in children
• Small bullae or pustules on erythematous base
• Formation of adherent dry crusts
• Ulcer present beneath
• Indurated base
• Heals with scar and pigmentation
• Buttocks, thighs and legs commonly affected

13. Ecthyma is a skin infection
similar to impetigo, but more
deeply invasive. Usually caused
by a streptococcus infection,
ecthyma goes through the outer
layer (epidermis) to the deeper
layer (dermis) of skin, possibly
causing scars.
Ecthyma gangrenosum is a
bacterial skin infection (caused
by Pseudomonas aeruginosa)
that usually occurs in people
with a compromised immune
system.

16. Folliculitis
• Superficial folliculitis (= Bockhardt’s Impetigo)
• Dome-shaped pustule at Follicular Ostium at
Infundibulum
• Commonly caused by Staph. Aureus
• Children
• Scalp & limbs
• Rarely painful
• Heals in a week

19. Furuncle
• Friction / Occlusion / Perspiration
• Staph. aureus
• Small, hard, tender, folliculocentric nodule
 Fluctuant  Ruptures
• Painful
• Constitutional symptoms

20. • Heals with scar
• Site: Neck, Wrist, Waist, Buttocks, Face

22. Carbuncle
• Extensive infection of a group of contagious follicles
that develop subcutaneous connections
• Staph. aureus
• Middle or old age
• Nape of Neck / Buttocks
• Painful, hard lump

23. • Suppuration begins after 5-7 days
• Pus discharge from multiple follicular orificies
• Necrosis of intervening skin
• Large deep ulcer with yellowish granulation tissue
• Constitutional symptoms

24. Carbuncles

25. 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 GAS and occurs most
frequently on the legs and face. Also by S aureus.
• It is commonly accompanied by high fever, chills, and
malaise. Erysipelas may be recurrent and may result in
chronic lymphedema.

26. Erysipelas is characterized by shiny, raised, indurated,
and tender plaque-like lesions with distinct margins. It is
most often caused by β-hemolytic streptococci and
occurs most frequently on the legs and face.

27. 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, Umblical, Perineum
Systemic
• Treatment of disease like DM
• Nutritional deficiency
• Immunodeficiency

28. Principles of therapy of pyoderma
• Local therapy
– Cleaning with soap-water and weak KMN04
solution to remove crusts
– Application of antibacterial cream
• Systemic therapy
– Antibiotics

29. Staphylococcal Pyoderma :
Specific Treatment

30. Specific Treatment :
Streptococcal Pyoderma

31. Staphylococcal Carrier Elimination
• Nasal / Umblical / Perianal Care (4-point)
• Rifampicin 600 mg/d x 7-10 days
• Clindamycin 150 mg/d x 3 months
• Topical mupirocin 2% for nasal
decolonization

32. THANK YOU