Pyoderma
Description:
Pyoderma (from Greek pýon - pus and Greek dérma - skin) - the purulent damage of skin resulting from implementation in it pyogenic cocci. One of the most widespread skin diseases.
Pyoderma symptoms:
Staphylodermas. Distinguish the following kinds of staphylodermas: osteofolliculitis, folliculitis, sycosis, epidemic pemphigus of newborns (superficial staphylodermas), furuncle, anthrax and hydradenitis (deep staphylodermas).
Osteofolliculitis - the small pustule located in the mouth of a hair follicle with a dense tire which of center the hair will stand; on the periphery the pustule is bordered with a narrow rim of a hyperemia. At spread of suppuration to depth of a follicle the osteofolliculitis is transformed to a folliculitis which clinically differs from the first in availability of infiltrate in the form of the inflammatory small knot located around a hair. Ostiofollikulita and folliculites can be single and multiple. They are localized on any site of an integument where there are long or well developed vellus hair. At involution the purulent crust after which falling away the cyanotic-pink spot over time disappearing is found is formed.
Staphylococcal sycosis - multiple, closely located on cyanotic-red and infiltrirovanny skin usually of a chin and an upper lip of an ostmofollikulita and the folliculites which are at various stages of evolution and inclined to long, sometimes to a long-term, recurrent current.
Epidemic pemphigus of newborns - the high-contagious acute disease affecting newborns in the first 7-10 days of life. It is characterized by numerous bubbles of various size with transparent or muddy contents and a thin flabby tire. All integument, except for palms and soles is surprised. Bubbles a part dry up with formation of thin crusts or, continuing to increase in sizes, merge with each other and are opened, leading to formation of the erosive surfaces sometimes taking all skin (exfoliative dermatitis of Ritter). Involvement in process of mucous membranes is possible. The general phenomena, sometimes heavy, leading to a lethal outcome can join.
Furuncle - it is purulent - a necrotic inflammation of a hair follicle and the fabrics surrounding it; clinically represents an ostrovospalitelny node with a pustule on a top. When opening the necrotic core after which rejection the ulcer healing a hem is formed is bared. Subjectively - pain. Furuncles can be single and multiple, their current - acute and chronic. Sometimes lymphadenites and limfangita, fever join. At localization on a face, especially in a nasolabial triangle, meningeal complications are possible.
Anthrax - the dense deep infiltrate of purple-red color with the phenomena of sharply expressed perifocal hypostasis resulting necrotic - a purulent inflammation of skin and a hypodermic fatty tissue. Through the formed openings the dense pus mixed with blood is emitted. After sloughing the deep ulcer healing a rough hem is formed. Subjectively - painful pains. The general state is, as a rule, broken. An anthrax arises at the weakened and exhausted faces on a nape, a back and a waist. An anthrax of the person is extremely dangerous.
Hydradenitis - a purulent inflammation of apocrine sweat glands. In skin (usually axillary hollows) the ostrovospalitelny node when which opening pus is emitted forms. Afterwards process is exposed to scarring. Morbidity is noted. The general disturbances are possible, especially at the multiple hydradenites forming massive conglomerates. The hydradenitis meets at the stout women suffering from perspiration more often.
Streptodermas. The basic morphological element of streptodermas is the phlyctena - the cavity in epidermis with a thin and flabby tire filled with serous and purulent or purulent contents, located on smooth skin and not tied with a grease and hair follicle. Distinguish streptococcal impetigo, violent impetigo and a vulgar ecthyma.
Streptococcal impetigo - the contagious disease affecting children and young women. It is characterized by a rash of the phlyctenas bordered with a hyperemia rim. Quite often the tire of phlyctenas is broken off with formation of the superficial erosion of rose-red color separating plentiful exudate. Exudate, as well as contents of phlyctenas, quickly dries up with formation of honey-yellow crusts after which falling away pink spots, soon disappearing are found. When progressing a phlyctena become multiple, can merge in the extensive centers covered with massive crusts. The moderate itch or easy burning is noted. The general state usually is not broken. Process is localized on any site of skin, a thicket on a face, in particular in mouth corners in the form of a crack (perleche); sometimes the phlyctena podkovoobrazno covers a nail (periungual impetigo). At accession of a staphylococcal infection the amber-yellow pustules which are quickly drying up in thick friable serous and purulent crusts, sometimes with blood impurity are formed - there is vulgar impetigo differing in big contageousness, defeat of extensive sites of skin, accession of folliculites, furuncles and lymphadenites.
Violent impetigo - the heaviest option of streptococcal impetigo; develops usually at adults on feet, shins and brushes. Differs in the large intense bubbles having serous or serous and bloody exudate and a thick tire. Skin around them is inflamed. Limfangita, lymphadenites, the general disturbances, changes in gemogramma can join.
Vulgar ecthyma - the only deep form of a streptoderma; develops more often at adults on shins, buttocks, hips and a trunk. There is a large deeply located phlyctena with purulent or is purulent - the hemorrhagic contents which are drying up in a thick crust under which the ulcer is found. Healing by superficial, more rare the involved hem. The quantity of ecthymas varies from single to multiple. They get a long current from the weakened faces.
Prognozdlya of treatment at acute forms, as a rule, favorable, at chronic, especially proceeding against the background of a serious general illness, can be bad.
Pyoderma reasons:
Activators of pyodermas - staphylococcus and streptococci. By the etiological principle distinguish staphylodermas and streptodermas which are in turn subdivided on superficial and deep.
The pathogeny of pyodermas is difficult. In a pathogeny an important role is played by endogenous disturbances (a diabetes mellitus, diseases of blood, a deviation in vitamin exchange, gastrointestinal frustration, obesity, diseases of a liver, a neuropathy, etc.), exogenous influences (microtraumas, attritions, cooling, overheating, pollution of skin, defective food, etc.) and prolonged treatment by corticosteroids and cytostatics.
Treatment of the Pyoderma:
Treatment of pyodermas etiological, pathogenetic, symptomatic; begin with the choice of antibiotics on the basis of data of a bacteriological research and the sensitivity test to them, if necessary against the background of therapy of associated diseases. Antibiotics of the first generation or highly effective semi-synthetic penicillin and cephalosporins of 3 generations at the same nosological forms apply depending on a type of sensitivity and the activator.
At the acute course of a disease it is necessary to appoint antibiotics not less than 5-7 days, at chronic – 7-14 days.
In treatment of pyodermas use tetracyclines (tetracycline, doxycycline, metacycline), aminoglycosides, macroleads, lincomycin, rifampicin, Fusidinum, etc.
In treatment of patients with a chronic pyoderma, especially heavy (ulcer and vegetans, gangrenous forms), it is impossible to do without drugs influencing microblood circulation. As vasoprotectives use Actovegin on 5 ml intravenously daily, trental, Teonicolum, никотинат sodium more often. From gepatoprotektor it is reasonable to appoint Siliborum, solizy, to a nigedaz on 1 tablet 3 times a day during 3 weeks, Essentiale forte, etc.
Vitamins of group B (B6, B12), polyvitamins and polyvitaminic drugs with microelements are shown.
At treatment of chronic pyodermas, especially deep (chronic ulcer, ulcer and vegetans, gangrenous forms), corticosteroid drugs and cytostatics appoint. Corticosteroids (Prednisolonum) appoint in a dose 15-20 mg/days within 15-20 days with the subsequent dose decline each 3-5 days before full cancellation. At a gangrenous pyoderma of a dose of corticosteroids is much higher – 40-60 mg/days. From tsitostatik preference is given to a methotrexate which is entered on 50 mg once a week intramusculary (2-3 injections on a course).
Means of a specific immunotherapy: the vaccine is a staphylococcal medical, acellular dry staphylococcal vaccine.
Immunocorrective means after an antibioticotherapia are appointed that patient at whom remission is shorter than 3 months, it is desirable after definition of indicators of immunity and sensitivity to the immunomodulatory drugs in vitro.
Repeated courses of immunoproofreaders are conducted taking into account indicators of an immunogramma or a gemogramma if the research of quantity of populations and subpopulations of lymphocytes is impossible.
Immunomodulators are appointed if lymphocytes less than 1000 in 1 мкл blood (less than 19%) and eosinophils are absent.
In complex treatment of patients with a chronic pyoderma use a wide range of immunocorrective drugs (тактивин, тимоген, тимоптин, Thymalinum, миелопид, ликопид, to ruza).
Perhaps transdermal radiation of blood helium - the neon laser with use of the device ULF-01 (wavelength of 0,632 MICRONS). The light guide is imposed on area of a projection of a kubitalny vein. Power at the exit of the light guide of 17 MW, exposure of 20-30 min. Procedures are appointed daily, to a course of 15 procedures.
Outside treatment of pyodermas. At ulcer defects delete crusts, necrotic sites of fabric, pus, wash out suppurative focuses aseptic solutions (% Furacilin 1:5000, 1 solution of boric acid, 1% solution of a tannin), then use an aerosol of a gelevin, 1% solution of a dioxidin, 2% solution of a hlorgeksidin of a biglyukonat. At inflammatory infiltration in the centers on furuncles, an anthrax, hydradenites impose Ichthyolum with Dimexidum (1:1), trypsin, chemical opsin, chymotrypsin for rejection of necrotic sites of fabric and pus. 2-3 times a day apply the bandage impregnated tomitsidy or paste from 5% of the specified funds the struck centers.
At pyodermas good nutrition with restriction of carbohydrates is recommended.
