Streptoderma: causes, treatment, prevention, diagnosis

A group of diseases caused by streptococci with infectious lesions of the skin is called streptoderma. Purulent inflammatory processes begin to develop in different layers of the skin, caused by pyogenic bacteria. Without timely treatment, the patient may develop serious complications that pose a serious threat to health.

Children are most often exposed to streptococcal skin diseases. At an early age, the body’s immunity is still weak and not as well developed as in adult patients. A minor abrasion or scratch will be enough for bacteria to enter the child’s delicate skin.

Classification of streptoderma

The disease is usually divided into several types, depending on the depth of the inflammatory process.

The surface type includes:

paronychia;
inflammation of an erysipelas nature;
toxic shock caused by streptococcal syndrome;
papulo-erosive and intertriginous streptoderma;
crevice impetigo;
acute diffuse disease.

With a deep form of development of pathology, cellulite and vulgar ecthyma are distinguished. Clinical forms are divided into several types, depending on the type of pathogen.

There are three main stages in total:

Initial
. Characterized by small rashes with pus. Within 24 hours, red spots turn into small blisters with a purulent center.
Non-bullous.
The next stage occurs after severe damage to the skin; after the blisters burst, the formation of streptococcal ecthyma begins. Small ulcers appear at the site of acne, and after a few days they dry out completely.
Chronic.
The last form of the disease is often observed with improper therapy. When the body's protective properties decrease, regular rashes occur, causing discomfort and acute pain.

If you suspect the development of streptoderma, an urgent visit to a dermatologist is required. A timely examination helps to prescribe an effective course of treatment and minimize the possibility of subsequent complications or progression of the disease to the next stage.

Complications of pyoderma

Superficial forms of pyoderma can be complicated by transition to deep ones or become a gateway for the addition of another infection. In adults, their course is usually more favorable and there are fewer complications than with deep forms. The exception is erysipelas. Erysipelas can quickly develop into cellulite, subcutaneous abscesses with suppuration of fatty tissue and gangrene.

In children, with regard to superficial forms, the situation is somewhat worse. Due to an underdeveloped immune system, diseases such as exfoliative dermatitis or vesiculopustulosis can lead to pathogens entering the bloodstream (sepsis). With the blood flow, bacteria spread to literally every “corner” of the body, affecting vital organs: the brain, lungs, heart, kidneys. Caused secondary severe pneumonia and meningitis in children are associated with a very high risk of death.

Deep forms are often complicated in adults. The most severe complications are associated with the entry of pathogens and their waste products into the blood. For example, deep folliculitis or a boil in the area of the nasolabial triangle can provoke purulent meningitis and thrombophlebitis due to the entry of staphylococcus into the system of venous sinuses of the skull from the facial veins.

Causes of streptoderma

The skin of any person is always covered with a large number of opportunistic bacteria that do not pose a threat to health. This position, on the contrary, strengthens the skin’s ability to fight pathogens, which include streptococci.

As long as the immune system is not weakened, the skin acts as a reliable barrier and bacteria are not capable of causing harm. But when the protective properties of the body are weakened, there is a threat of the formation of streptoderma.

Decreased immunity may occur for the following reasons:

the presence of other chronic pathologies;
regular stress, poor sleep, excessive physical activity;
sudden hypothermia or, conversely, overheating of the body;
helminthiasis;
previously suffered viral diseases.

Failure to maintain personal hygiene or mechanical damage to the skin can also cause the formation of an infectious disease.

Risk factors are:

poor working conditions, such as being too hot, humid or stuffy;
changes in hormonal levels;
being overweight;
poor nutrition;
diabetes and other endocrine diseases.

Sometimes the causative agent can be low-quality personal care products or cosmetics. Streptoderma can contribute to the development of other scratching diseases due to severe skin itching.

Causes of pyoderma

Frequent causes of pyoderma are hypothermia and overheating of the body under production conditions.

When the body cools, blood circulation is disrupted, swelling of the skin occurs, sebum secretion and sweating decrease, as a result, the skin becomes dry and flaky, making it easily susceptible to injury and infection.

Overheating of the body leads to loss of water and chlorides (mineral salts), the latter affecting the vascular system and the functions of the kidneys and skin.

The possibility of pyogenic infection can be increased by additional irritants like oils and other contaminants.

The skin is able to destroy microorganisms that fall on its surface due to the acidity of the skin (pH), the so-called “acid protective coat of the skin.” Bacterial infection occurs faster in those areas of the skin where the pH is higher - these are the armpits, interdigital folds of the feet, and inguinal folds. Therefore, pathological changes occur more often in these places.

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Ways of infection of streptoderma

Regardless of the form in which the disease occurs, its infectious nature implies rapid transmission.

Infection can occur in one of the following ways:

close contact with an infected patient, such as shaking hands, kissing or hugging;
received injury to the skin in the form of an insect bite, burn or cut;
contact with a surface on which there is a trace of contact with a sick patient, this could be door handles in public places, handrails in transport, cutlery or bath accessories;
by airborne droplets from sneezing or coughing.

When a patient is in a large group, an outbreak of the disease can very quickly lead to a quarantine regime. Therefore, when primary signs of suspected streptoderma appear, the person must immediately be isolated from others. The incubation period can last up to two weeks. At the same time, people who were in direct contact with the sick patient are being monitored.

Prognosis and prevention

The prognosis depends on the form of pyoderma, existing concomitant diseases and the timeliness of assistance provided. With localized superficial forms, the prognosis is most often favorable. Deep and widespread superficial forms also respond well to treatment with adequate therapy and correction of concomitant conditions (diabetes mellitus, immunodeficiency, endocrinopathy).

The most unfavorable prognosis are erysipelas, furunculosis and severe pyoderma of newborns (for example, exfoliative dermatitis, multiple abscesses). These diseases are characterized by a high rate of progression and a high chance of generalization of infection. In addition to the above, the listed infections often occur against the background of diabetes mellitus, immunodeficiencies, malignant blood diseases and other conditions that are themselves difficult to treat.

Chronic infections, such as sycosis vulgaris, although not dangerous, greatly reduce the patient’s quality of life.

Prevention of pyoderma

Primary preventive measures against pyoderma come down to the following principles:

Compliance with safety precautions at work with a high risk of skin injury.
Timely treatment of skin injuries with disinfectants.
Treatment of common diseases that are risk factors for the development of pyoderma (diabetes mellitus, diseases of the ENT organs, digestive tract, etc.).
Therapy of other dermatological pathologies (atopic dermatitis, scabies, eczema, etc.), against which secondary pyoderma occurs.
Compliance with hygiene standards and rules, especially when caring for infants.

How to properly treat injured skin?

When treating abrasions, scratches and cuts, you can follow the following algorithm:

The affected area is washed with clean boiled or bottled water. You can first add a little liquid soap to a container of water.
If the wound bleeds heavily, the affected area must be pressed with a cloth. It is better if it is a sterile bandage. Apply pressure to the wound for at least 5 minutes, without periodically removing the tissue to see if blood flows.
After washing and stopping the bleeding, the wound must be treated with a disinfectant.
If you only have alcohol solutions on hand (solutions of iodine, brilliant green), then you only need to treat them with the edges of the affected area. By no means the wound itself!
Disinfectants such as chlorhexidine, miramistin, povidone-iodine can be used to treat both the edges and the wound itself.
Next, depending on the size, you can stick a bactericidal adhesive plaster on the affected area or apply a gauze bandage, securing it with strips of rolled plaster.

Secondary prevention involves regular medical examinations, medical examinations, and anti-relapse therapy (special skin care, sanitation of foci of chronic infections, UV irradiation, prophylactic intake of vitamins).

Symptoms of streptoderma

The disease does not appear immediately. In the first seven days, characteristic symptoms may be absent, and the first signs appear only in the second week:

rashes appear that form in groups;
oval-shaped spots with a reddish tint, covered with small scales, appear on the skin;
in place of the spots, small pimples very quickly appear, similar to bubbles, filled with a cloudy white or yellow liquid;
within 24 hours, pimples burst, and in their place a dried crust forms;
after some time, the crusts peel off, and red skin becomes visible underneath;
The affected areas of the skin return to normal over time.

Purulent lesions of an infectious nature are most often localized on the face and arms, less often on the legs, back and buttocks. Symptoms may vary, depending on the stage of the disease and its form. An important role is played by the patient’s immunity and the presence of other chronic pathologies that contribute to the weakening of the body’s protective properties.

General weakness and drowsiness may be added to the listed symptoms. Often the rashes are accompanied by nausea and aching pain in the muscles. The temperature may rise slightly and unbearable itching may appear in the areas where acne is located.

What is pyoderma?

Pyoderma is a disease of purulent skin lesions, most often caused by pyogenic (pyogenic) cocci - streptococci and staphylococci, which are constantly found on the skin and mucous membranes. In addition to these pathogens, there are other microorganisms on human skin, such as pseudodiphtheria bacillus, yeast-like fungi, etc., which can also cause disease under certain conditions. The name of the disease comes from the Greek py'on - pus and de'rma - skin). This is one of the most common skin diseases.

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Diagnosis of streptoderma

If characteristic signs of a skin disease appear, an immediate visit to our Your Health clinic in Moscow is required.

At an appointment with a dermatologist, an initial examination will be carried out followed by the appointment of the necessary diagnostic measures, the purpose of which is to confirm the preliminary diagnosis:

taking an anamnesis, during which the doctor will ask leading questions about the onset of symptoms, bad habits and other chronic pathologies;
a survey will be conducted about the place of work and social and living conditions will be clarified;
at the next stage, an examination of the affected areas of the skin is carried out, with an assessment of the localization, degree of prevalence and type of rash;
referral for bacteriological culture to collect the contents of papules and ulcers;
The test reveals the sensitivity of bacteria to various types of medications, which facilitates the correct selection of antibiotics for therapy.

Depending on the results of the study, additional tests may be prescribed in the form of biochemical blood sampling, determining the presence of syphilis and thyroid hormones. General analysis of urine and feces for worms.

Risk factors

Risk factors include all of the predisposing conditions listed above, but special attention should be paid to the following:

The presence of immunodeficiency. With a suppressed immune response, the slightest damage to the skin can cause a pustular infection. Under these conditions, they are also less treatable and are fraught with complications.
Endocrinopathies. Hormonal imbalances can affect the composition of sebum, which can lead to excessive proliferation of staphylococci in the hair follicles and provoke pyoderma.
Poor blood supply, especially in the extremities. This factor significantly increases the likelihood of severe acute and chronic streptostaphyloderma, coupled with chronic alcohol intoxication and/or hypothermia.
Violation of sanitary and hygienic regime. An important factor, the prevention of which is available to everyone, nevertheless still remains relevant.

Is pyoderma contagious?

Some forms of pyoderma are highly contagious diseases. This especially applies to all types of streptococcal lesions. In this regard, it is advisable to avoid contact with patients, which is especially important for young children. Often, patients with pyoderma in the hospital are isolated from other patients.

Streptoderma in children

According to statistics, children are much more likely to develop streptoderma than adult patients. This is due to more delicate skin and not fully strengthened immunity.

The disease in young patients occurs with some distinctive features:

body temperature rises;
most often papulo-erosive streptoderma and streptococcal impetigo are determined by type;
lymph nodes increase in size;
general intoxication of the body begins;
The localization of rashes is most often observed on the thighs, scrotum and buttocks.

The presence of blue-red pimples with a liquid center indicates papulo-erosive streptoderma. The skin around the rash becomes very inflamed and red. When the bubbles burst, weeping crusts form.

Streptococcal impetigo is one of the most contagious skin infections. If one of the children in a kindergarten or school class gets sick, all the other children who are in contact with the sick child will most likely become infected.

Purulent rashes appear on the wings of the nose, mouth and face. The disease may be accompanied by a complication in the form of inflammation of the lymph nodes.

Pathology in children is determined by microscopy of smears taken from infected areas of the skin and subsequent bacteriological analysis. Based on the results obtained, therapy is prescribed. The selection of medications is done very carefully; the doctor in our clinic takes into account the general condition and individual characteristics of the child.

If a child has an infectious skin lesion, parents should follow the recommendations given by the dermatologist:

limit contact with water, which contributes to the development of infection;
explain to the child that wounds should not be scratched;
exclude flour dishes and sweets from the diet;
use underwear made from natural fabrics and change it every day.

Until complete recovery, the child is prohibited from being allowed into the children's group. If you follow all the doctor’s instructions, the course of treatment will go quickly and without serious complications.

Kinds

Superficial staphyloderma

The most common are folliculitis, sycosis vulgaris, ostiofolliculitis, and epidemic pemphigus of newborns. Ostiofolliculitis is an abscess surrounded by a zone of mild hyperemia, penetrated by hair. With folliculitis, the abscess is located against the background of a painful bluish-pink nodule. Vulgar sycosis is called multiple, recurrent ostiofolliculitis and folliculitis against the background of thickened bluish-pink skin, often in the mustache and beard area. Epidemic pemphigus of newborns is a severe, contagious disease of the first days of life. In addition to the palms and soles, the child’s skin becomes covered with large blisters, which later form crusts and extensive erosions.

Deep staphyloderma

The most famous are boils, carbuncles, and hidradenitis. The boil develops from ostiofolliculitis or folliculitis. First, a painful node appears in the thickness of the skin, which enlarges; a large pustule is formed in its center, which opens with the subsequent separation of the purulent-necrotic core. After which, the resulting ulcer gradually scars.

A carbuncle is several boils located in one place, closely adjacent to each other, against the background of a general dense, edematous infiltrate of a bluish-purple color. The deep ulcer formed after opening the carbuncle heals with a rough scar. Hidradenitis is a purulent inflammation of the apocrine sweat glands, often recurrent. In the armpits, anogenital area, and around the nipples of the mammary glands, deep, painful nodes appear, over which the skin is colored bluish-pink. The nodes are opened with the release of liquid pus.

Superficial streptoderma

The most common is streptococcal impetigo . This disease occurs more often on the face in children and young women. Against the background of slightly hyperemic skin, phlyctens (bubbles with opalescent contents) appear, shrinking into yellowish crusts or eroding. When staphylococci are attached, the crusts become greenish-yellow or sometimes hemorrhagic ( impetigo vulgaris ). Without treatment, the disease can affect large areas of the skin. Lichen simplex , more often in children, is an abortive form of streptococcal impetigo. It is expressed by the appearance of whitish or light pink, slightly flaky spots.

Deep streptoderma

Vulgar ecthyma . With this disease, deep pustules appear, shrinking into purulent-bloody crusts, under which ulcers are found. After 2-3 weeks, the ulcers heal.

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Calling a dermatologist to your home to treat streptoderma

Our clinic Your Health in Moscow offers all patients the paid service of calling a dermatologist to your home. To do this, you need to call the specified phone number specifying the reason for the request. The doctor will arrive at your place of residence on the day of your visit. An appointment in a comfortable home environment will allow you to receive qualified assistance with significant savings in free time.

Other advantages of calling a dermatologist at home include:

the opportunity to take most of the required tests without leaving home;
arrival of the dermatologist at the pre-agreed time without delay;
absence of distractions that arise during a personal visit to the clinic;
a preliminary diagnosis is made already at the first visit;
no risk of infecting others through airborne droplets.

The service will be most relevant for people with a lack of time, parents of small children, elderly patients who have difficulty moving and patients with limited physical capabilities.

Sources

Skin and venereal diseases: textbook / ed. O.Yu. Olisova. - M.: Practical Medicine, 2015. - 288 p.: ill.
Golub T.N. Pyoderma: informational and methodological letter for dermatovenerologists and general practitioners.
Kukharik O. S. Modern features of the course of pyoderma // DVKS. 2011.
Plieva Lina Rostislavovna On the treatment of superficial pyoderma // Russian Journal of Skin and Venereal Diseases. 2015. No. 1.
Zverkova F.A. Pyoderma in young children // Regular issues of “RMZh” No. 11, 1997.

Complications of streptoderma

The disease can cause serious harm to the health of patients suffering from immunodeficiency and people prone to frequent allergies. If, when the characteristic symptoms of streptoderma appear, the patient does not seek help in time, then the risk of developing complications increases significantly, which include:

when an infection enters the bloodstream, sepsis may form or blood poisoning may begin;
the appearance of deep wounds from non-healing ulcers;
damage to internal organs by staphylococci, rheumatism and nephritis may develop;
dangerous increase in body temperature;
intestinal dysbiosis;
damage to the fetus during childbirth if the mother has infectious rashes on her body;
the appearance of thrombophlebitis.

Quite often, after severe stages of skin damage, scars form that remain forever. A cosmetic defect subsequently requires additional expensive procedures to smooth out the outer layer of the skin.

Why should you contact our clinic?

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Can it be treated at home?

First of all, it is necessary to establish the nature of pyoderma. In other words, identify the causative agent of the disease and determine its sensitivity to antibiotics. After a course of antibacterial therapy (local use of antibacterial drugs in most cases is ineffective) against the background of normal multivitamin-mineral support (taking vitamins), such diseases usually go away. But pyoderma, as a rule, develops against the background of reduced immunological resistance or is provoked by diseases of the internal organs: stomach, intestines, liver, pancreas. Therefore, an in-depth examination is necessary.

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Prevention of streptoderma

A person at any age can be affected by an infectious skin disease. There is no guaranteed protection against this pathology, but there are a number of preventive measures, the observance of which helps reduce the risk of infection:

rejection of bad habits;
healthy lifestyle;
correct rest regime;
compliance with all generally accepted hygiene standards and sanitary rules;
good nutrition;
daily water treatments with shower;
use of tar or resorcinol soap;
timely change of underwear.

Exercising and frequent exposure to fresh air helps strengthen the immune system. In case of accidental damage to the skin, it is recommended to immediately treat the wound with iodine or hydrogen peroxide. You should try not to trigger chronic diseases if they are present and monitor the current state of the body, preventing possible exacerbations.

Prevention

In order to prevent the occurrence of streptoderma, you should adhere to the rules of prevention. They are very effective and do not present any difficulties.

To maintain health, doctors recommend:

keep your nails in good condition by doing timely manicures;
treat any, even minor, skin damage with antiseptic drugs;
wash your hands after returning from the street;
wash your face after returning from public places;
observe all rules of personal hygiene;
carry out timely treatment of skin irritations;
adhere to a balanced diet;
Take daily walks in the fresh air for at least 30 minutes.

The appearance of signs of streptoderma on the face is a bad signal. It is necessary to immediately contact a dermatologist and find out the nature of the formations. The sooner treatment is started, the higher the chance of recovery. An advanced disease can cause serious complications, including death. Therefore, it is better not to let the situation take its course and treat the disease.

Types of streptoderma

The disease can occur in acute and chronic form. The first is distinguished by aggressive symptoms and clear manifestations in the form of rashes. The chronic form is characterized by regular exacerbations during a period of decreased immunity.

Streptoderma is divided into several types:

intertriginous, when a rash forms in the skin folds and is accompanied by severe itching with a desire to scratch the affected areas, often observed in infants;
dry, with the appearance of white or pink spots up to 5 centimeters in diameter, localized on the neck, arms and legs, after healing, scars often remain;
the most common form of rash on the face, accompanied by rashes in the form of small blisters, the contents of which quickly flow out and a yellowish crust forms in their place.

The manifestation of characteristic symptoms, accompanied by rashes of various locations, indicates an infectious skin lesion. In such situations, an urgent visit to a dermatologist is required. If treatment is not started promptly, the disease can become chronic.

Pyoderma (purulent skin infections) - symptoms and treatment

Pyoderma codes according to the International Classification of Diseases (ICD-10): L00–08, L39.4, L46, L66, L73, L74.8, L88, L98.4, R02.

There are three main groups of pyoderma:

staphyloderma - caused by staphylococci;
streptoderma - occurs when infected with streptococci;
atypical pyoderma - can develop due to exposure to various microbes.

For the first time, the German dermatologist J. Jadasson drew attention to the connection between the form of rashes and various pathogens in 1927. He found that with staphyloderma, pustules are more often formed, and with streptoderma, phlyctenas are more often formed [3].

Staphyloderma

Staphyloderma includes ostiofolliculitis, folliculitis, sycosis vulgaris, cicatricial folliculitis of the head, keloid acne, furuncle, furunculosis, hidradenitis, pseudofurunculosis, carbuncle, pyococcal pemphigoid of newborns, exfoliative dermatitis of Ritter.

Ostiofolliculitis is located at the mouth of the hair follicle and is surrounded by a halo of redness. As the process subsides, it dries into a honey crust, when it falls off the skin heals without a trace.

Folliculitis and deep folliculitis differ from each other in the depth of skin damage. Drying, the pustule becomes covered with a honey crust, then the lesion resolves and a spot or area of pigmentation forms in its place.

Vulgar sycosis develops with chronic skin lesions in the area of the beard and mustache, in the area where bristly hair grows, as well as on the skin of the genitals. The disease occurs almost exclusively in men. Multiple painful superficial and deep pustules cluster and form small plaques. The unkempt appearance of patients leads to additional worries and complicates the picture of the disease with a neurotic syndrome.

Cicatricial scalp folliculitis is a purulent-necrotic inflammation of the hair follicle. It is usually preceded by purulent inflammation in other organs, such as purulent arthritis and osteomyelitis. With folliculitis, a small ulcer forms, and when it heals, a scar appears. Long-term folliculitis leads to small focal baldness.

Keloid acne is a scarring inflammation of the hair follicles on the back of the head and neck. First, deep pustules form along the neck fold, after opening them an irregularly shaped scar remains.

A furuncle is a purulent-necrotic inflammation of the hair follicle and surrounding tissues. Most often it occurs on the back of the neck, face, lower back and buttocks. With single boils, general symptoms do not appear. Boils on the skin of the face and scalp are dangerous: they can be complicated by septic phlebitis, meningitis, sepsis, abscesses in organs and bones.

There is also a special form - malignant boil . Such a node enlarges, loses its outline due to increasing swelling, and causes severe pain. Thrombophlebitis occurs around the boil, and the lymph nodes and vessels become inflamed (lymphadenitis and lymphangitis). The body temperature rises to 40 °C, the head hurts and the consciousness becomes foggy. The number of leukocytes in the blood increases, and the erythrocyte sedimentation rate (ESR) increases. The duration of development of a boil mainly depends on its location, on average it is 1–2 weeks.

Furunculosis is a multiple rash or recurrent appearance of single boils. It is considered recurrent if it lasts more than two months.

Furunculosis can be of several types:

acute or chronic;
localized (for example, on the back of the neck, in the lumbar region) or general (boils spread throughout the body).

With general furunculosis, chills may appear, the temperature may rise, the state of health may worsen, and regional lymphadenitis and lymphangitis may develop.

In a chronic recurrent course, the boil usually develops in 10–13 days. In diabetes mellitus, furunculosis is difficult to treat and often leads to complications. In this case, the node grows in width, persistent redness of the skin occurs, and the purulent process spreads to the subcutaneous tissue (an abscess is formed) [4][7].

Hidradenitis is a purulent inflammation of the apocrine sweat gland, which occurs in the armpit, less often in the pubis, in the genital area and perineum. Hidradenitis most often develops in the summer in obese people. The disease lasts about two weeks, but inflammation often occurs again and lasts up to several months, especially with bilateral damage. The node grows to the size of a walnut or larger, and it hurts a lot. Over time, it opens, releasing creamy pus. Later, a retracted scar forms at the site of the node.

Multiple abscesses of newborns (pseudofurunculosis) are acute purulent inflammation of the eccrine sweat glands. The disease develops in weakened, premature babies with anemia, low weight and poor care. More often it occurs in the first month of life, less often before the age of six months.

With pseudofurunculosis, pustules the size of a pinhead appear on the child’s scalp, torso, arms and legs. They quickly open, their contents dry into a honey-yellow crust. At the same time, numerous painful nodes appear, ranging in size from a pea to an egg, with a purplish-bluish color and a dense consistency. They soften and open, releasing liquid yellow-green pus. With pseudofurunculosis, multiple ulcers form in the form of fistulas. After healing, scars remain.

Some nodes do not open on their own, continuing to bother the child. With the appearance of new nodes, health worsens, body temperature rises to 38–39 ° C, anemia increases, appetite worsens and weight decreases, the liver and spleen enlarge. The disease can be complicated by phlegmon, sepsis, pneumonia, purulent meningitis and osteomyelitis. Pseudofurunculosis is especially severe in newborns with intracranial birth trauma.

Carbuncle is an extensive purulent-necrotic process that occurs due to infection with highly pathogenic strains of staphylococcus [5][8]. Spreading to surrounding tissues, the infection forms a lesion. Carbuncles most often develop in older people on the back of the neck and lower back. Typically, carbuncles are single and often occur with fever, chills, headache, and sometimes impaired consciousness.

A recurrent carbuncle can be a symptom of severe diabetes mellitus, myeloid leukemia, or act as a paraneoplastic syndrome, i.e., be a manifestation of a malignant tumor. Carbuncles are often complicated by sepsis.

Pyococcal pemphigoid of newborns (bullous staphyloderma of newborns) is a superficial purulent inflammation of the skin that appears on the 3–5th day of a child’s life, less often on the 8–15th day. Develops in skin folds on the abdomen, arms, legs and back. The disease lasts from several days to 2–3 weeks. In most cases, the level of leukocytes and neutrophils increases, the leukocyte formula shifts to the left, the ESR accelerates, and sometimes septicopyemia occurs - a form of sepsis in which, along with general intoxication, metastatic abscesses occur in various tissues and organs. At the same time, complications of the umbilical wound (omphalitis, fungus), candidiasis, otitis media, purulent conjunctivitis and pneumonia appear, which indicates a weakened immune system of the child.

Ritter's exfoliative dermatitis is the most severe form of neonatal staphyloderma caused by highly toxigenic strains of staphylococcus. The necrotic process covers the upper layers of the epidermis and can spread to the entire body within a day.

Ritter's dermatitis begins with redness, cracking, and peeling of the superficial layers of the epidermis around the mouth or near the navel. Further symptoms resembling a 2nd degree burn develop. In some cases, the onset of the disease is similar to the first manifestations of pnococcal pemphigoid: blisters appear on apparently healthy skin, which quickly increase, merge with each other and, when opened, reveal extensive erosions. At the height of the disease, the general condition is severe, body temperature reaches 40–41 °C. The level of protein in the blood decreases, the normal ratio between its various fractions is disrupted (hypoproteinemia and disproteinemia), hypochromic anemia occurs, the leukocyte formula shifts to the left, and the ESR accelerates. The process is often complicated by pneumonia, otitis, phlegmon, abscesses and pyelonephritis.

Streptoderma

Streptoderma is an acute inflammatory lesion of the skin with the release of exudate (fluid flowing from small blood vessels during inflammation). The disease is caused by streptococci.

In classic cases, streptoderma occurs superficially. The lesions are usually located in areas of least oxygen supply, such as folds. The exception is children, in whom streptoderma more often affects the facial skin [27].

Streptoderma includes impetigo, ecthyma, streptococcal diaper rash and diffuse streptoderma.

Streptococcal impetigo is the most common form of pyoderma. It is characterized by the formation of blisters on the face, less often on the arms and legs, sometimes the rash is accompanied by mild itching. In some cases, more often in children, the mucous membranes of the mouth, nose and eyes are involved in the process - conflicts arise, which quickly open, and painful erosions form in their place.

In HIV-infected patients, thick crusts appear on the affected skin. The phlyctenes, which occur mainly in the beard and neck area, dry out and closely spaced bright yellow crusts (“blooming impetigo”) form.

There are several clinical types of streptococcal impetigo: ring-shaped, bullous and syphilide-like post-erosive impetigo, superficial panaritium, lichen simplex and seizures.

With ring-shaped impetigo, large flat blisters appear, drying out in the center and expanding at the edges. As a result, figures in the form of rings and garlands are formed.

Bullous impetigo is an exudative inflammation of the deep layers of the epidermis caused by streptococci and staphylococci. When the disease occurs, large hemispherical blisters the size of a pea to a hazelnut form on the skin. They are located mainly on the hands, feet and legs, and do not tend to open. Sometimes swelling occurs around the bladder, lymphangitis, lymphadenitis develops, and the general condition is disturbed. The disease occurs more often in summer.

Superficial panaritium is a superficial streptococcal inflammatory-purulent process. When the disease occurs, phlyctens are formed, surrounding the nail in a horseshoe shape. The disease mainly occurs due to skin injuries and hangnails. May be complicated by osteomyelitis.

Lichen simplex of the face is an incomplete form of streptococcal impetigo, in which blisters form but do not develop into phlyctene. After impetigo resolves, mealy or pityriasis-like scaly red spots remain. Similar elements may arise primarily, mainly in children, less often in adults working outdoors. Under the influence of sunlight, the spots may disappear, but the skin in their place remains unpigmented.

Seizures are exudative inflammation of the skin with a deep defect in the epidermis. Flat conflicts in the corners of the mouth quickly open up, and in their place erosions and linear cracks form, which can spread to the buccal mucosa and deepen. In children the process occurs subacutely, in adults it is chronic with relapses.

Syphilic post-erosive papular impetigo is exudative-infiltrative lesions in the epidermis and upper layers of the dermis. When the disease occurs in children, phlyctens form on the buttocks and thighs, which turn into erosive papules with compaction at the base. The symptoms resemble rashes of erosive lenticular syphilide, so discharge from the surface of the erosion is additionally examined for treponema pallidum.

Ecthyma simple is an ulcerative-necrotic process caused by streptococcus penetrating deep into the skin, under the epidermis. The introduction of bacteria into the skin is caused by microtraumas, most often scratching for lice, scabies and itchy dermatoses. Ecthymas are usually multiple, most often located on the legs and buttocks. Rashes of streptococcal ecthyma in HIV-infected people are small in size, brightly colored and numerous. The disease lasts up to several weeks, longer if the legs are affected.

Streptococcal diaper rash is an erythematous-erosive epidermodermatitis of large folds (erythema is redness of the skin, erosion is a defect in the upper layer of the skin). It develops in the inguinal-femoral and intergluteal folds, armpits, under the mammary glands, behind the ears, in the folds of the abdomen and neck in obese people, less often in the interdigital folds of the feet, and sometimes in the hands. The rash may spread to the skin around the folds and be accompanied by itching. Without treatment, the disease can take up to several weeks to develop.

Chronic diffuse streptoderma is chronic streptococcal epidermodermatitis of the legs, forearms, and less commonly of the scalp. The disease lasts a long time, often worsens over several years, and subsides only after treatment.

Atypical pyoderma

Atypical pyoderma is a purulent nonspecific skin lesion, i.e., it can be caused by various microorganisms [3].

Simple abscess pyoderma is a focal purulent-inflammatory lesion of the deep layers of the skin with the formation of abscesses and ulcers. Rashes often appear on the skin of the face, buttocks, perineum, inguinal-femoral and axillary folds. The disease is accompanied by body temperature up to 38–39 °C and malaise. In HIV-infected children under three years of age, the rash spreads throughout the body.

Scrofuloderma -like pyoderma is a focal purulent-inflammatory lesion of the superficial and deep layers of the skin. Most often, staphylococcus, Escherichia coli and non-pathogenic actinomycetes are detected in the lesions. During the disease, abscesses and ulcers form, then in their place a scar forms, rising above the skin level. The lesions cover large areas, most often the skin of the perineum, neck, scrotum and axillary folds. The disease develops slowly and is sluggish, without exacerbations for many years.

Facial pyoderma is a focal purulent-inflammatory lesion of the subcutaneous fat layer, in which abscesses and ulcers form and pus is abundantly released. The disease begins suddenly and progresses rapidly. Relapses occur in winter and autumn under the influence of hypothermia, mental trauma, and before menstruation. Adolescents are more likely to suffer from facial pyoderma.

Abscessing and undermining folliculitis and perifolliculitis of the head of Hoffman are purulent-inflammatory lesions of hair follicles in the deep layers of the skin. In place of resolved lesions, comedonal scars of irregular shape develop. The disease most often occurs at the age of 24–35 years.

Ulcerative atypical pyoderma. Ulcerative atypical forms include chronic pyococcal ulcer and its variety - chancriform pyoderma.

Chronic pyococcal ulcer is a common purulent-necrotic inflammation of the dermis with many foci. Mostly on the skin of the arms, legs and chest, sharply defined, superficial, round or oval ulcers are formed, which, merging with each other, form lesions with uneven edges. Under favorable conditions, individual ulcers heal spontaneously and smooth, regular-shaped scars form. During an exacerbation, the skin near the rash becomes very sensitive to injury, and new lesions may appear. Chronic pyococcal ulcer disease may be accompanied by anemia, chronic myeloid leukemia and chronic hepatitis. Given the similarity with the symptoms of secondary syphilis, sporotrichosis and blastomycosis, tests are carried out for syphilis and mycoses.

Chancriform pyoderma is a type of chronic pyococcal ulcer whose symptoms resemble primary syphilis. The rash appears in the prepuce area, on the labia majora (especially in children), the back of the hands, on the lips, eyelids, nose, and temples. Chancriform pyoderma is common in HIV-infected people. The rashes are usually isolated and rarely occur again in the same place. To exclude primary syphilis, the ulcer discharge is examined for Treponema pallidum and a blood test is performed using the immunofluorescence method.

Vegetating atypical pyoderma is a multifocal purulent-necrotic lesion of the skin. Large warty, purulent plaques form on the arms, legs and torso, emitting a sweetish smell of pus. The main forms of pyoderma vegetans are chronic ulcerative-vegetative pyoderma, Hallopeau pyoderma vegetans and blastomycosis-like pyoderma.

Chronic ulcerative-vegetative pyoderma is a purulent inflammation of the skin in which pustules appear, and then in their place - ulcerated plaques. The plaques are soft, bluish-red, with defined edges, noticeably raised above the skin and surrounded by a rim of congestive hyperemia. Their surface is completely or partially ulcerated, covered with moist growths with lumpy layers of crusts. When plaques are squeezed from the edges, purulent or bloody-purulent exudate is released from the interpapillary fissures. As healing occurs, scars form. Vegetating pyoderma lasts for months and even years, periodically exacerbating and fading.

Allopo's pyoderma vegetans is an infiltrative-inflammatory skin lesion with a pronounced exudative component. The rashes are located in the perineum, armpits, face and scalp. After opening the pustules, warty growths gradually form at the bottom of the ulcers, the purulent discharge from which shrinks into crusts. The process is often complicated by lymphadenitis. The disease can occur due to deterioration of immunity due to oncology, so it is important to exclude it during examination.

Blastomycosis-like pyoderma is a focal infiltrative-inflammatory lesion of the skin. It begins with the appearance of pustules and nodes, which soon merge into plaques, then bluish-red ulcers with undermined and infiltrated edges form. The lesions are mainly located on the arms and legs and are similar to lesions associated with blastomycosis. Blastomycosis-like pyoderma should be distinguished from tertiary syphilis, indurated erythema of Bazin, deep mycoses, leishmaniasis and squamous cell carcinoma of the skin [5][7].

Streptoderma in pregnant women

In the process of bearing a child, a woman undergoes a significant restructuring of her hormonal levels and a decrease in immunity. The body uses all resources for the development of the fetus. It is at this moment that the expectant mother is most vulnerable to the possibility of streptoderma.

The disease does not harm the health of the unborn baby; infection can only occur when streptococcus enters the bloodstream. Infection can get on the baby's skin during childbirth if there are infectious rashes on the woman's body. In this case, the disease can cause serious complications and threaten the child’s health.

Timely treatment will reduce all risks of infection during childbirth. Doctors will select the most gentle therapeutic course. All prescribed medications will not be dangerous for the baby. Most often, special creams and ointments are prescribed.

Treatment of streptoderma

The course of therapy involves the complex use of antiseptics, antibiotics, the choice of which depends on the type of pathogen, and special ointments. In some cases, additional medications may be prescribed in the form of tablets and injections. Skin itching is relieved with suprastin and telfast. To strengthen the immune system, take vitamins A, B and C.

Depending on the stage of development of the disease, opening of purulent rashes may be required. All related manipulations are carried out in a sterile operating room; operations at home are allowed. After successful opening of the abscesses, the resulting wounds are treated with aniline dyes twice a day. This will help prevent infection.

To speed up the healing process, you need to follow your doctor's recommendations:

provide your own cutlery and dishes, exclude contact with household members;
stop taking baths and showers;
try to change bed linen more often and then wash thoroughly;
Avoid visiting crowded places; it is advisable not to leave home at all until complete recovery.

It is allowed to use folk remedies, which include tinctures of Eleutheroccus, Echinacea and Leuzea. Admission should be carried out only after prior agreement with the attending physician. The effectiveness of treatment will depend on the individual characteristics of the body, age and current condition of the patient.

Elimination of skin lesions

If the disease has not become severe, treatment of streptoderma is carried out on an outpatient basis. If there are severe symptoms - deep erosion and necrotization of tissue, inflammation of the lymph nodes, etc. - the patient is admitted to a dermatological hospital. Therapy consists of:

proper skin care, excluding washing with soap and water, to avoid spreading the disease to other areas;
external treatment of affected areas with aniline dyes, application of ointments with antibiotics and keratolytic compounds;
taking antibiotics in case of lymphangitis and severe intoxication;
specific immunotherapy aimed at combating staphylococcal infection.

In addition, complex vitamins may be additionally prescribed, and at the end of the course of antibiotics, probiotic preparations may be prescribed to restore the intestinal microflora.

Prevention of streptoderma involves frequently washing the skin with soap and water. Research shows that soap solution destroys up to 95% of streptococci on the surface of the skin. Compliance with hygiene rules is especially important after contact with a person suffering from a pustular rash.

Diet for streptoderma

During the acute form of the disease, in addition to treatment with antiseptic agents and antibacterial treatment, it is required to adhere to a diet. The following foods should be included in your daily diet:

legumes and nuts;
lean meat, fish, eggs and a small amount of fresh cottage cheese;
porridge;
soups cooked in low-fat broth;
fruits and vegetables;
unsweetened compotes, decoctions and other drinks with low sugar content.

There are no strict restrictions on foods for patients with streptoderma, but doctors advise to refrain from eating fried foods, sausages, butter and hot seasonings. It is advisable to temporarily exclude from the daily diet all products that contain dyes and flavor enhancers.

Nutrition during an exacerbation

Nutrition plays an important role in the treatment of various forms of pyoderma. The basic principles of diet during an exacerbation of the disease can be described as follows:

Meals should be regular.
Complete in composition of proteins, fats, carbohydrates and vitamins.
The amount of salt in food is sharply limited (up to 5 g).
The amount of carbohydrates is reduced.
Alcohol is completely excluded.
Any products that can provoke allergies are excluded (for this, an allergy history is carefully collected).
The drinking regime is controlled; it is necessary to consume at least 1.5 liters of liquid.

The diet includes low-fat fermented milk products; fresh vegetables, herbs; lean boiled meat and fish; durum wheat pasta; boiled eggs; olive and linseed oils; buckwheat grain; bran.

Streptoderma and similar diseases

Based on external manifestations and test results, not only a diagnosis of streptoderma, but other pathologies of the skin can be established.

In terms of external signs, the diseases are similar to each other, but the treatment regimen is completely different:

allergic dermatitis, characterized by severe itching not only in areas of the rash;
lichen and herpes, viral manifestations with rashes localized in the waist and abdomen, accompanied by elevated body temperature;
eczema, appears upon direct contact with an allergen or as a complication of chronic streptoderma;
staphylococcal pyoderma, destroys the sebaceous glands, and in severe form can cause furunculosis;
chickenpox, a viral pathology accompanied by rashes on various parts of the body;
pityriasis versicolor, characterized by the appearance of brown or reddish spots, the skin in the affected areas begins to peel off.

To accurately establish the disease, it is necessary to undergo a detailed examination and pass the necessary tests. Based on the results, the pathogen will be identified and an accurate diagnosis will be made.

Treatment

Treatment in children
Treatment of omphalitis is carried out only by a doctor. In the initial stage, local use of medications is possible: washing the wound with a solution of hydrogen peroxide, treatment with brilliant green, iodine solution, methylene blue solution and various local antimicrobial drugs. Treatment of pyoderma in children involves the use of broad-spectrum antibiotics, infusion therapy, and immunomodulators. In the initial stages of pyoderma, it is possible to treat pyoderma with local means - solutions of boric and salicylic acids, sanguiritin, eucalymin, tomicide, cyminal and others in the form of solutions, lotions, under a bandage. See also our specialist’s answer to the user’s question: Pyoderma in children, how to cure it?
Treatment in adults
In adults, pyoderma is also treated by a doctor. For mild pyoderma, local medications are used (see above); for moderate severity, broad-spectrum antibiotics and sulfonamides are added to local treatment.
To increase the body's resistance in the treatment of pyoderma, the immunomodulatory drug Thymogen is used. These are Thymogen cream, which is applied to the affected areas, and Thymogen solution for injection.

to the begining

Prognosis for streptoderma

The disease responds well to treatment and if the patient follows the doctor’s recommendations, the therapy will be successful and without complications. The main thing is not to try to get rid of rashes on your own, this can only cause harm.

Modern medications are highly effective and fight streptococcal infections well, which in turn allows you to quickly relieve the inflammatory process and overcome the disease.

If you do not take any measures and ignore the characteristic symptoms, the disease can develop into a chronic form, which carries with it serious complications, infection of internal organs and even blood poisoning, which is especially susceptible to patients with weakened immune systems. Timely treatment eliminates all symptoms of streptoderma within a week.

Publication date: 2020-06-30

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

What drugs help against streptoderma?

Treatment of streptoderma in adults or older adolescents is relatively painless. This is due to the fact that they can be prescribed medications of all types, including antibiotics in the form of ointments and tablets. Typically, basic complex therapy is used, which includes oral, topical medications, and antibiotics.

Before choosing a medication, you need to determine the type of streptoderma; there are seizures, paronychia and impetigo.

Oral medications relieve discomfort and restore immunity. Local preparations, that is, ointments or gels, accelerate the effect of antibiotics, capsules and tablets.

They also eliminate the unpleasant-looking crusts that accompany the disease at all its stages. As for antibiotics, their main effect is to fight infection. But it is important that the medicine is chosen correctly, that is, it takes into account the characteristics of the microorganism that provoked the disease. Therefore, you should listen to the advice of your doctor.

Doctors often choose drugs that control the proliferation of streptococci, gonococci, and meningococci.

You can also take hormonal ointments and buy pharmaceutical products to relieve itching. But the former are used only in extremely severe cases, and the latter are prescribed exclusively as part of symptomatic treatment. Sometimes drug therapy is supported by additional procedures.

For example, ultraviolet radiation is prescribed. And adherents of traditional medicine make baths and wash stains with special herbal solutions. But you shouldn’t rely solely on procedures: they only have an auxiliary effect.