Pyoderma (pyodermiae; Greek pyon pus + derma skin; synonym: pustular skin diseases, pyodermatosis, pyodermatitis, pyosis) is a group of skin diseases caused by staphylococci, streptococci, rarely Pseudomonas aeruginosa, Escherichia coli and other microorganisms.

An important role in the development of pyoderma is played by the presence of the entrance gate of infection and the decrease in the body’s defenses. The source of pathogenic microorganisms can be the bacterial flora of the skin, upper respiratory tract, as well as the environment. On the skin, staphylococci are more often found in the mouths of hair follicles and ducts of the sebaceous glands. In the upper respiratory tract, including in the oral cavity, pathogenic staphylococci are found in almost half of healthy people. Pathogenic streptococci are detected mainly in the nasal and oral cavity in about 10% of healthy people, in children in groups (kindergartens, nurseries, hospitals) – up to 70%. Staphylococci and streptococci penetrate the skin in places of microtrauma. The leading role in the occurrence of pyoderma belongs to the suppression of cellular and humoral immunity. Diabetes mellitus contributes to the development (an increase in the sugar content in the skin creates a good nutrient medium for pathogens). Predisposing factors also include hypothermia and overheating of the body, malnutrition, overwork, chronic intoxication (for example, alcoholism), diseases of the gastrointestinal tract, liver, etc.

Depending on the pathogen, staphylococcal, streptococcal and mixed pyoderma are isolated. According to the depth of skin lesions, superficial and deep pyoderma are distinguished. Along the course, pyoderma can be acute and chronic. The same patient is likely to have a combination of superficial and deep pyoderma, while at some stages the disease may have an acute course, at others – a chronic relapsing one. Pyoderma may be a secondary process that complicates other skin diseases, especially accompanied by pruritus.

The clinical picture of pyoderma is varied; depends on the nature of the pathogen, the individual properties of the organism, its reactivity (primarily on the state of the immune system), the influence of predisposing environmental factors, the severity and localization of the pathological process, and also on the duration of the disease.

Atstaphylococcal pyoderma , the process develops mainly in the area of ​​​​hair follicles, in the sebaceous and sweat glands. Forming pustules have a conical or hemispherical shape, their walls are thick, tense, the center of the abscess is often penetrated by hair, the pus that stands out is thick, yellow-green in color. In babies, for example, with epidemic pemphigus of the newborn, there may be superficial blisters that are not associated with hair follicles, sebaceous and sweat glands.

Streptococcal pyoderma is more common in women and babies. The primary morphological element is conflict – a bubble with a sluggish thin cover and serous contents, which quickly becomes serous-purulent, then purulent. The conflict is located within the epidermis, it is characterized by peripheral growth, and if its bottom does not necrotic, as happens when it is transformed into ecthyma, then the erosion formed in its place quickly epithelializes; in the future, short-term hyperpigmentation remains.

In superficial forms, blisters are located within the epidermis; after resolution, they do not leave a lasting trace. With deep pyoderma, blisters are found in the epidermis, dermis, and often in the subcutaneous tissue; after their healing, scars and cicatricial atrophy are formed. With a long course of deep pyoderma, pyoallergides may appear – secondary allergic lesions in the form of various rashes (for example, lichenoid, erythematous, erythematosquamous, eczematous rash).

Staphylococcal pyoderma, or staphyloderma, includes the following skin lesions: sycosis vulgaris, folliculitis, furuncle, hydradenitis, multiple abscesses of newborns, epidemic pemphigus of newborns, Ritter’s exfoliative dermatitis.

Multiple abscesses of newborns, or Finger’s pseudofurunculosis, develop in infants as a result of damage to the excretory ducts and glomeruli of the eccrine sweat glands. The disease is promoted by improper care of children, overheating, high sweating leading to skin maceration, malnutrition, also enteritis, infectious diseases, etc. On the skin of the trunk, more often the back, buttocks, and thighs, numerous dense red-bluish nodes are found, which can increase to hazelnut size. The nodes quickly soften in the center, open, and semi-liquid pus is released from them. The process ends with scarring. In weakened babies, complications in the form of phlegmon and even sepsis are possible. Treatment is carried out by a pediatrician in a children’s hospital. Prescribe antibiotics, restorative agents, perform surgical opening of abscesses.

Streptococcal pyoderma, or streptoderma, is impetigo, streptococcal congestion, simple lichen of the face, chronic diffuse streptoderma, erysipelas, ecthyma vulgaris.

Simple lichen of the facereferred to as an atypical form of streptococcal impetigo. It is more often observed in babies, traditionally in spring or autumn. In children’s groups, the disease can take on an epidemic character. Its appearance is facilitated by non-compliance with the rules of hygienic skin care, insufficient drying of the skin after washing. On the skin of the cheeks, chin, nose, which is not often the trunk, sometimes slightly reddened, round or oval areas of white scaly peeling appear. In some cases, they merge, forming large scalloped foci. It is not often that new foci are noted next to those that resolve. There may be mild itching. Under the influence of sunlight, the disease can pass; the skin on the affected areas tans weaker, which causes secondary leukoderma. The treatment is carried out by a dermatologist on an outpatient basis. Antibiotic ointments are prescribed.

Chronic diffuse streptoderma, or streptococcal epidermitis, is localized mainly on the skin of the extremities, in women within the nipples and under the mammary glands. Characterized by one-sidedness of the lesion, sharp boundaries of the focus, typical streptococcal conflicts on its plane and near the focus, thick greenish-yellow crusts and erosive wet planes that form after opening conflicts, with an epidermal exfoliating corolla, a tendency to peripheral growth. The disease proceeds for a long time. Severe itching is often noted. Not often, as a result of irrational treatment of the primary focus, eczematization occurs with transformation into microbial eczema. The treatment is carried out by a dermatologist. Prescribe antibiotics, local disinfectants (aniline dyes, antibiotic ointments).

Mixed forms include impetigo vulgaris, chronic deep ulcerative and vegetative pyoderma, chronic pyococcal ulcer, chancriform pyoderma.

Chronic deep ulcerative pyoderma is localized more often on the lower extremities. It begins traditionally with a conflict surrounded by a hyperemic rim. In the future, the conflict is opened, and a rapidly growing ulcer appears, along the edge of which there is an infiltrated roller up to 5 mm wide. Due to this roller, an increase in the size of the ulcer occurs. Several ulcers may appear at the same time. Superficial scars remain in their place.

Vegetative pyoderma is localized mainly in large folds of the skin, on the scalp, oral mucosa. The process begins with the formation of pustules that are not associated with follicles. After opening the pustules, the surface of the erosions vegetates. Sometimes granulations develop before the opening of the pustules. As a result of the merger of the rashes, large lesions with scalloped outlines are formed, their surface becomes wet, in some cases crusts form on it. With the resolution of rashes, pigmentation remains in their place.

Chronic pyococcal ulcer is traditionally localized on the lower extremities. The process begins with painful hyperemia, slight swelling; then there is a conflict or abscess, which quickly ulcerate. The resulting painful ulcer is surrounded by an inflammatory edematous rim, due to which it increases, reaching in some cases the size of a palm or more. The ulcer may be round or irregular in shape; as a result of necrosis of its central part, it quickly deepens. In the future, necrotic masses are separated, the bottom of the ulcer becomes clean, smooth, bluish-violet in color; discharge liquid, purulent. Crusts do not form. The scarring of the ulcer continues for a long time. The process traditionally starts from the center. There may be several ulcers at the same time.

Chancriform pyoderma is characterized by the appearance mainly on the external genitalia, face, red border of the lips, oral mucosa, tongue of the vesicle, after the opening of which an erosion or ulcer with a diameter of 2 cm appears, round or oval in shape with a seal at the base, which makes it similar to a hard chancre (see Syphilis). Detachable non-cordinal, often shrinking into a crust. Streptococci and staphylococci are traditionally found in it. Regional lymph nodes are enlarged. After resolution of the vesicle, which is usually solitary, a superficial scar may remain.

Treatment of mixed forms of pyoderma is carried out by a dermatologist on an outpatient basis or in a dermatological hospital, depending on the severity of clinical manifestations. It includes the use of antibacterial agents, vitamins, specific and non-specific immunotherapy, physiotherapy, local disinfectant products are recommended.

Prevention of pyoderma : keeping the skin clean (regular washing and changing clothes), protecting it from trauma and maceration. Microtrauma should be immediately treated with disinfectants. Of paramount importance are measures aimed at increasing the body’s resistance. In order to avoid infection, to which children are especially prone, it will be necessary to beware of their close contact with patients with pyoderma. It is necessary to systematically conduct examinations of the personnel of children’s institutions and remove from work even those with minimal manifestations of the disease. Prevention of pyoderma in a production environment consists of general sanitary, sanitary and technical measures, including individual protection, personal hygiene of the worker and hygienic education.

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