‫ميحرلا نمحرلا هللا‬ ‫بسم‬

Bacterial Skin Infections

1- Resident flora :
- Skin is never sterile.
- Skin is colonized by harmless non – pathogenic commensals
on the surface and within the hair follicles e.g staph albus,
propioni bacterium acnes.

2- Transient flora :
Some bacteria can exceptionally colonize the skin for short period,
these include pathogenic and non – pathogenic pacteria which
normally do not live on the skin.

Defence Mechanism of the skin :

1. Dryness of the skin prevents bacterial colonization while
moisture enhances colonization.
2. Skin acts as continous mechanical barrier.
A breasions and ulcerations help bacterial invasion.
3. Disqumation of skin.
4. Unsaturated fatty acids in skin surface lipid have bacteridal
effect.
5. Skin flora : Secret, antibiotis against pathogenic bacteria.

Imgetigo Contagiosum :
Definition : Contagious superficial pyogenic infection of the skin.
Etiology : Streptococci, Staphyllocci or both.

Predisoposing factors :
1. Poor hygine.
2. Septic focus.
3. Malanutrition and anaemia.
 4. Prurtic skin diseases e.g : Scabies.
Age : Infants and ehildren.
- Any age may be affected.

Clinical picture :
Site :
- Exposed parts : faces, Ear, Neck, Hands.
- Scalp.
- Around orifices.
- Any site can be involved.

Morphology :
- Erythematous → macule → Vesicle → Pustule → Oozing
serum → golden yellow crusation.
- The Lesion enlarges with time and Surrounded by erytematous
halo.
- On removal of the Crust, Superfecial erosions appear.
- Haelling occurs with noral skin (No scars).

Types of Impetigo :
1. Classical types.
2. Circinate impetigo.
3. Bullous impetigo.
4. Backhart imperigo(Follicular Imperigo).
5. Ulcerative impeligo (Ecthyma).
6. Impetigo neonatorum (pemphigus – neonatrum).
7. Secondary impetigo :
- Impetigo on top of skin disease : e.g.
- Scabies, Pedicalosis, Eczema.

1/ Circinate impetigo :
Due to spread of lesions on the periphery and healing in the center.

2/ Bullous impetigo :
 - Caused by staph aureus.
- Commonly in infants.
- Lessions are mainly bulae.

3/ Impetigo neonatorum (Pemphigus: Neontorum) :

- Avarity of bullous impetio.
- Occurring few days after birth.
- Could by complicated by diarrhea, pneumonia or meningitis.
- Should by defferntiated from :
 Congenital syphilis.
 Epidermolysis bullosa.

4/ Bockhart Impetig (Follicular Impetigo) :

- It is Superfecual Folliwlitis and Prefolliculitis.
- It takes the form of superficial pustules.
5/ Ecthyma (Uleerative umpetigo) .

Defination :
It is a form of uleerative impetigo involving epidemis and demis.
Age : Young aduts.

Predisposing factors :
- Repeated minor trauma.
- Anemia and Cachexia.
- Poor hypine.
- Scobies.

Site :
- Anterior aspect of legs (skin overlying tibia) why ?
- Site of trauma.
- No subcutaneous tissue.
- Skin is stretched.
- Poor Vasculature and poor healing.
Morphology :
- Vesicle or Pustule on erythemotous bose ⇒ rapidly formed
hard crustation of dried exudates ⇒ under which superficial
ulcer is formed ⇒ healing with scar tissue.
- The process usually recurs.

Complications of impetigo :
1. Lymphangitis and lymphadenitis.
2. Eczematization.
3. Glomerunephritis.
4. Scalet fever.
5. Toximia and bacteraemia.
6. Absces, Cellulitis and eryseplas.

Diagnosis :
- Age, Site, Morphology.
- Stained Smear, Bacterial Culture.

Deferential Diagnosis :
- Chicken pox.
- Herpes simplex.
- Herpes Zoster.
- Burn.
- Eczema.
- Tenia Circinatio.

Treatment of Impetigo :
A) Local :
1. Compresses by : Potassim permingenate 1/8000 for 10 – 15
minutes 2 Times per day to remove the crusts.
2. Dryness of the lesions by :
- Gemtion violet 0.5 – 1 % .
 - Mercurochrome.
3. Local antibacterial agent :
- Neomycine.
- Chloramphenacol.
- Fusidic ocid.

B) General :
1. Systemic antibiotics :
- Penicillin.
- Eryrthromycin.
- Cloxacillin.
2. Cloxacillin is given in bullous impetigo as it is anti – staph.

Sycosis Vulgaris
It is a pyogenic infection of the whole hair folicles.
- Caustive organism : Staph, aureus.
- Sex and age : Males and puberty.
- Site : beard and moustache.

Morphology :
- Diserete erythematous follicular papules or pustules from
which hair emerge.
- Prefollicalar edema.
Course : Chronic with remission and relapse.

Diffferemtial Diagnosis :
1. Tinea barbe.
2. Psuedo – folliculitis.
3. Herpes siplex.
4. Impetigo.

Treatment :
A- Local.
 B- General.

Treatment :
A) Local :
1. Local compresses.
2. Local antibiotics on the beard and the nose.

B) General :
Cloxacillin (anti - stph).

(N.B.) :
1. T. barbae : It is superficial fungal infection of the beard.
Usually in the form of inflammatory papules and nodules
(kerion).
2. Pseudo – folliculitis : It is inflammatory papules and pustule
resulting from penetration of Curved hair into skin few days
after shaving.

Fruncle (Boil)
Definition :
Acute inflammatory rounded tender circumseibed, perifollicular
staph infection which ends into central suppuration (Abscess).
N.B : Carbuncle : Coulesced boils, near by each other, with multiple
openings and skin in between them shows necroses.

Etiology :
A) Caustive organism : Staph, aureus.
B) Predisposing Factors :
1. Pressure, friction of skin in exposed areas and extensor
surfaces.
2. Bad hygiene.
 3. Diseases : D.M, alcoholism, anemia chronic nephritis and
elecrease gammaglobuline.
4. Some cases no underlying causes recorded especially in
athletic individuals.

Clinical Picture :
Morphology :
Prifollicular, tender, hot nodules with erythematous surface, within
few days, central suppuration occurs then it is transformed
intonecrotic core which is remenant of hair follicle.

Localization :
Affect area containg hair follicles :
Face, neck, back, axilla, arms and anorectal region.

Symptoms :
1- The lesion is usually painful and there is throbbing pain.
2- Fever, mild constitional symptoms.

Differntial Diagnosis :
1. Acne vulgaris:
Characterized by black heads around the age of puberty.
2. Bockhart impetigo:
Super fecial pustules around the opening of hair follicles.
3. Herps simplex.
4. Sweat rash.

Treatment :
1- Local meansures :
- Hot compressing.
- Piecing the pointed surface to discharge pus.
 - Cleaning of the area by local antibiotics.
- Avoid occlusive dressings.
2- General :
- Antibiotics as penicillin and Fluxacillin.

Erythrasma
Definition :
Superfecial mild chronic infections of the skin.

Etoiology :
Coryne bacterium minutissmun .

Predispiosing factors :
1- Obesity.
2- Diabetes melliltus.
3- Aneamias.
4- Hyperhydrosis.
5- Increased humidity.

Clinical picture :
Subjective symptoms :
- Non – itchy disfigurement.
- Mild irritation in the groin.

Morphology :
- Dry, slightly scaly yellowish brown patches with sharply
defined irregular border.
- The border is not active.

Location : Flexures :
- Axillae, inner aspect of the tigh, umbilicus, anal claft,
submmary area .
- Bilateral.
Differntial diagnosis :
1- Intertrigo :
Dermatitis due to friction between two opposing skin surfaces
characterized by erythema, erosion, oozing buring itching with
ill-defined border.
2- Pityriasis versicolor.
3- Taenia cruris : erythematous scaly patch with active border.
4- Seborrheic dermatitis.
5- Psoriasis.
6- Candidal dermatitis :
- Area of erythema with macerated white epidermis surrounded
by satellites, pustules and vesicles.

Treatment :
General :
Erythromycin : 1gm daily for two weeks.

Local :
- Local antifungal e-g.
- Tolnaftate twice daily for 2-3 weeks.
- Imidazole derivative cream twice for 2-3 weeks.

Cellulitis and Erysipelas

Cellulitis :
Acute, subacute or chronic inflammation of loose connective tissue
(Subcutaneous).

Erysipelas :
Bacterial infection of the dermis and upper subcutaneous tissue
(superficial).
 Erysopelas Cellulitis
Organism Strep Strep,stoph,Haemophylus –
influnzae.
Tissue offected Superfecia (dermis and upper Deep
sub-cutaneous tissue) (Subcutaneous tissue)
Clinical Picture - Acute, severe systemic – Fever and malaise may be
symptoms(Fever matiase present .
shivering)
Morphology - Erythemetous lesion with well - Erythematous lesion with
defined border . ill-defined border.
Bllue are common. - Necrosis may be present.

Predisposing Factors :
- Malnutrition, Anemia, Alcoholism, Oedaem, D-M. Chronic
debilitating disease.

Site :
- Lower limbs, Face, Extremities Gpmetalia.

Complications :
- Septicemia, Nephritis, Subcutaneous abscessces, lymphdema
and fasciitis.

Treatment :
- Complete Rest.
- Lead subacetate compresses.
- Local antibiotics.
- Systemic antibiotic e-g.
- Penicillin
- Eryrthromyncin For 10 – 14 days
- Cephalosporin
-For recurrent cases long term penicillin.