There are many saprophytes and a small number of pathogenic microorganisms that normally live on human skin without causing disease. These bacteria form the skin flora. Skin flora is of two types: permanent and variable flora. Bacterial density is higher in open areas than in other areas. Staph in these areas. aureus is found at higher rates than other regions. Gram-negative coliform bacteria are more common in closed and folded areas such as the armpit and groin. There are some principles in the diagnosis and treatment of bacterial skin infections. It is important to distinguish the type of bacteria in the lesion; It is necessary to take an appropriate sample from the lesion, evaluate the gram stain well, and select the appropriate medium for culture.
Pyodermas caused by staphylococci: impetigo, furuncle, carbuncle, sycosis simplex, hordeolum, acne keloid, hydrosis adenitis, scalded skin syndrome (ritter's disease), Systemic infections caused by staphylococci, toxic shock syndrome.
Pyodermis caused by streptococci: impetigo, ecthyma, erysipelas, cellulitis, lymphangitis, systemic infections caused by streptococci and scarlet fever.
Impetigo< br /> It is a superficial, contagious, common superficial pyoderma of the skin. There are two clinical forms; non-bullous impetigo (streptococcus) (impetigo contagiosum, dry, 70%), bullous impetigo (staphylococcus). It is usually seen in children. An erythema appears after a minor trauma. Then it rapidly turns into a vesicle, pustule, and sometimes a bulla. It is thought that the types that present with pustules are more likely to be streptococcal, while those that present with blisters are thought to be staphylococcal. These elements open quickly. Its serous or purulent content flows out, then the erosion remaining in its place is covered with kurut. Honey-colored crusts make diagnosis easier. Lesions heal spontaneously within 7-10 days and leave no scars. Post-inflammatory hyper- or hypopigmentation may develop. If the pustules are picked and played with, the condition may last longer in the presence of eczema, scabies and atopic dermatitis. It is mostly located on the face. It can occur anywhere in children. Lesions, which are highly contagious, can be transmitted within the family or through direct contact in the nursery. There is usually regional adenopathy. The only serious complication is poststreptococcal glomerulonephritis (18-21 days) (scarlet fever, urticaria, erythema multiforme). Clinic and huh Diagnosis is not difficult due to its rapid spread. Subcorneal pustular dermatosis, syphilis pustules, bullous type juvenile pemphigoid, Duhring's disease (dermatitis herpetiformis) may be considered in the differential diagnosis.
Sicosis Simplex
It is a bacterial folliculitis and perifolliculitis of the beard area. (papule and pustule developing in the hair follicle). It is seen in men; upper lip, areas where the mandible opens. The causative agent is Staphylococcus aureus (nasal carrier). Any trauma can initiate auto- or hetero-inoculation disease. It starts as a simple single folliculitis and spreads rapidly. Itching and shaving facilitate the spread. Folliculitis may deepen. In very severe cases, vegetative or granulomatous reactions may occur. Hairs generally do not fall out and scars are sparse. Tinea barbae and lupus vulgaris should be considered in the differential diagnosis. Antiseptic dressing, antibiotic ointment and systemic antibiotics are used in the treatment. Nasal nasal carriage is investigated in chronic cases and antibiotic ointments and creams are used.
Hydrozadenitis
Hidradenitis suppurativa, dog udders. It is a chronic suppurative and cicatricial disease of the apocrine sweat glands. It is common in the ages between puberty and menopause. Obesity and seborrheic background are facilitating factors. It is usually an infection with S.aureus. The condition, which is most common in the axilla, is also seen less frequently in other areas where apocrine glands are located, such as the inguinal and genital areas. First, a painful erythematous nodule appears. There may be several. It may remain like this for weeks or become a pustule. When the pustule opens, a thick pus comes out. There is no necrotic plug here. Scars remain in their place, and overlapping scars may cause dysfunction. Fistulas are seen as complications in the anogenital region. Clinical appearance is sufficient for diagnosis. Scrofuloderma in the axilla and inguinal ulceration should be considered in the differential diagnosis. Systemic antibiotics should be used for a long time in treatment. Cosmetics and antiperspirants should be banned. Fluctuating lesions are opened with an incision. Antiseptic solutions and antibiotic ointments are useful. Retinoids are used. In very stubborn cases, the glands are surgically removed.
Ecthyma
Generally group A b eta is due to hemolytic streptococci; most commonly streptococus pyogenes. It is the deep and ulcerative type of pyoderma. It is located in the lower extremities and gluteal areas. It is most common in children in developed countries, and at all ages in developing countries due to malnutrition and poor hygiene conditions. It begins with superficial vesico-pustular elements on an erythematous base following a picure or minor trauma. It rapidly deepens and ulcerates. It has a hard and thick crust attached to it. When the kurut is removed, a 2-3 mm deep, purulent ulcer with steep edges and a bleeding base appears in its place. Generally, the number of lesions is low. It heals in a few weeks, leaving scars. There is no difficulty in diagnosis. It helps distinguish depth from impetigo. In the treatment, the dryness is removed. Dressings and antibiotic ointments are applied. Antibiotics are given systemically. It is important to improve hygiene and nutritional conditions and to treat other diseases that may predispose.
Erysipelas
The causative agent is group A streptococci (less commonly G, B, C, D). It is a superficial acute bacterial skin infection of the skin and subcutaneous tissue. The agent may enter through a minor abrasion or erosion. Initially, it is a small shiny erythematous plaque. It spreads rapidly. It may manifest itself with symptoms such as sudden fever and chills. The mature lesion is hard, edematous, warm, shiny and erythematous and can reach 10-15 centimeters in diameter. Most of the time it is single. It is slightly raised from the intact skin and separated by a sharp border. The lesion is quite painful. In very severe infections, vesicles and bullae develop, petechiae, ecchymosis and even gangrene may occur. As the lesion regresses, desquamation may regress with post-inflammatory hyperpigmentation. Systemic symptoms such as high fever, chills and fatigue accompany the disease. There is leukocytosis around 15,000-20,000, ASO is high. Diagnosis is made by clinical features. In differential diagnosis; facial angioneurotic edema, contact dermatitis, DLE, PLE, SLE should be considered. Penicillin is the best drug for treatment or 2.4 mu of benzathine penicillin is given. If there is allergy, erythromycin or azithromycin macrolide group can be given. High dose should be applied for at least 10 days. Bed rest and symptomatic measures relieve the patient; cold dressings and leg elevation can be performed. In severe patients, infants and the elderly, immunosuppressed IV pen G 600000-2mu 4×1 can be given. Staf fall Presumed resistant to dicloxacillin, nafcillin, penicillinase. In more resistant treatments, clindamycin and methylmycin are given 2 weeks ago and 3 weeks of treatment if there is a history of recurrence. In cases such as lymphedema, oral pen G 1gr/day or erythromycin can be given. Foot elevation and wet dressing should be done.
Cellulitis
Staphylococcus aureus causes this infection alone or together with streptococci. Up to 2 years of age, Haemophilus influenzae type B is the cause of facial cellulite. Erythema, edema, temperature increase, blisters and necrosis may occur in severe cases. In recurrent cases, lymphedema occurs as a result of chronic damage. Treatment is the same as erysipelas.
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