Venereology / / April 30, 2016
Streptococcal skin lesions
Synonym - impetigo Fox
The skin is mainly the body exposed areas - face (often in holes - near the nostrils, mouth), hands, legs and feet, especially in children, there are different size flat phlyctenas,light-filled first, then gradually mutneyuschim content.On the circumference there is a small phlyctenas reactive redness, subjective phenomena are almost absent.After opening the contents phlyctenas quickly dries to a light yellow crust, which after some time disappears, leaving depigmented spot.If you remove the peel force, which is not always easy to do, it is detected erosive wet surface;debridement in this case is much slower than after spontaneous falling away of crust.
When you join a staph infection develops so-called contagious or vulgar impetigo, in which there is more pronounced purulent contents of the conflict, and formed after opening the cover different honey yellow color;in rare cases, such "honey" crusts cover the entire face.It begins impetiginozny proce
Like strep, and mixed streptostafilokokkovoe impetigo is acute, and rational treatment process is completed in 1-2 weeks.In some cases, especially in debilitated and malnourished children, the disease can take several protracted;more often it concerns some specific locations impetiginoznogo process.
The varieties of streptococcal impetigo include the following forms, the clinical picture of which depends in part on the localization process.
Simple rosea person or "dry pyoderma», occurs mainly in children of school age, it is characterized by a barely perceptible redness and pronounced fine desquamation;Patients with this feeling in the affected areas of skin contraction.The disease is sometimes just have a whole group of students.
Zayed, angular stomatitis, or "rotten corner» develops in the corners of the mouth-sided or symmetrical.First, there exists a short and quickly opened a small conflict with a light content, and the next step is detected erosive surface on the adjoining sections of the corners of the mouth, at times formed a crust, and in the central part of the lesion - a small crack.During sometimes long, in some cases, there relapse within a few months and years.Often at the same time the patient has another form of streptococcal.
cystic impetigo occurs more frequently in the lower extremities.Bubbles are usually large quantities, intense, with serous-purulent, and sometimes with bloody contents.This species streptoderma more common in adults, for in some cases prolonged.
One subspecies cystic impetigo is pemphigus newborns, which is an epidemic disease that develops in the first days of life as a result of inadequate care for his skin.There is a more or less considerable number of tense or flaccid blisters of various sizes on the head, neck, trunk and limbs, often in skin folds;Reactive redness is expressed by a circle of smaller bubbles.Bubbles usually soon opened and in their place open red erosive surface, tending to epithelialization.All the course of the disease is about 2-3 weeks, and almost always end successfully.In some cases, pemphigus newborn accompanied by more or less severe common phenomena, in particular gastro-intestinal disorders, fever, and others.
Sometimes bubbles have a larger size and are distributed over almost the entire surface of the skin, there is a disease known as exfoliative dermatitis Ritter.
Another much easier and more localized subspecies cystic impetigo is okolonogtevogo conflict or turniol , affects almost exclusively children, who in place of burrs or scratches from fingernails, sometimes the legs (walking barefoot) having an arcuate, the envelope of the nail, flat form bubbles with light, and then serous-purulent and sometimes bloody contents.
The varieties of streptococcal impetigo are also ring-shaped, tortuous, and serpiginous impetigo, which in the absence of proper treatment can be spread over large parts of the skin.
All forms of streptococcus and mixed impetigo contagious, especially for delicate, more easily traumatized skin of children, adolescents and young women.The allocated with different pathogenic streptococci properties.These forms of pyoderma, as already mentioned, usually develop as a result of infection from patients with streptococcal directly or through objects (things, linen, etc..), The relevant contaminated secretions.Often, a patient may be seen at the same time various clinical streptococcal species, as well as all of pyoderma.
Sometimes strep impetigo takes more or less diffuse.It is possible to distinguish two forms: acute and chronic.
Acute diffuse streptoderma occurs almost exclusively in adults.Process for a few days spread over large areas of the skin, localized predominantly on the face, neck, scalp and extremities, accompanied by fever and malaise significant.Common events held prior to the return of skin phenomena.This form is rare.In some patients the appearance of a diffuse process precedes any infectious focus on the skin (diaper rash, microbial eczema, etc..).
so-called strep epidermitis is a kind of chronic streptococcal impetigo.Ill mostly adults.The disease is localized mainly in the legs, around the nipple of the breast and under the breast, behind auricles;process often develops at the site of injury (in the broadest sense of the word).Asymmetry, sharp defeat boundaries typical strep phlyctenas on its surface, and sometimes near the hearth, thick greenish-yellow crusts and erosive wet surfaces, flaking epidermal inwards whisk, a tendency to peripheral growth - all this characterizes this form streptoderma.Subjective effects are usually minor.The current sluggish, long, often complicated eczematization.
Histologically for strep impetigo is characterized by superficial bladder location - directly under the horny layer (granular layer in this case is the bottom of the bladder), or in the stratum corneum;bubble contains polymorphonuclear leukocytes, serous fluid and microorganisms.At the top of the skin itself has relatively little inflammatory reaction - vasodilatation and small leukocyte infiltration.
In typical cases of streptococcal and staphylococcal-mixed streptococcal impetigo diagnosed difficulty is not.You should only keep in mind that often impetiginozny process is secondary to the main layering skin disease nepiodermicheskogo nature.Therefore, in such cases it is necessary to be careful for the final diagnosis, which can sometimes be elucidated only after impetiginizatsii phenomenon will be eliminated.
Simple rosea person or "dry pyoderma", should be able to distinguish from seborrhea and seborrheic dermatitis ( "seboreidov").For the latter characteristic yellow color eruptions, large inflammation, often feeling the itch;usually while the patient can detect the phenomenon of seborrhea on the scalp."Dry pyoderma" is almost exclusively in children.
Zayed difficult to mix with any other disease, but it must be borne in mind that the same clinical picture perleches may be due to both Streptococci and yeasts and giporiboflavinozom and, naturally, various combinations of thesefactors.From syphilitic mucous plaques, sometimes localized in the corners of the mouth, Zayed different initial fliktenoy, soreness, lack opalovidnoy painting and inflammatory halo around the periphery;moreover, there are no other signs of secondary syphilis period;in cases of doubt, should produce a study on Treponema pallidum.
neonatal pemphigus often have to be differentiated from syphilitic pemphigus, from which it differs: the absence of blisters on the palms and soles (localization, very characteristic of syphilitic pemphigus), the absence of any other signs of congenital syphilis, often by the presence of more or less severe general phenomenaand etc.;in cases of doubt, you can resort to the study of the contents of bubbles on Treponema pallidum, and the importance may be appropriate careful examination of the mother and serology.It should also be borne in mind that pemphigus newborns in maternity wards is sometimes epidemic.
serpiginous form of strep impetigo, in some cases, especially in the localization on the trunk and limbs can be confused with dermatitis herpetiformis Duhring, in which sometimes also have rashes serpiginous character.The absence of lesions typical of dermatitis herpetiformis, the limited nature of the lesion (cases limited dermatitis Duhring is very rare), the absence of common phenomena, and blood eosinophilia allow to reject the diagnosis of dermatitis herpetiformis.
- Sycosis ordinary
- Multiple abscesses in children (psevdofurunkulez Finger)
child sick impetigo, whether it is at home or in child care, must be isolated from healthy children have a separate linen, towels, and clothing;when washing linen should be boiled with soda.Persons working in institutions that have emerged pyoderma, you must not allow the work to cure.
in maternity newborn source of infection and the development of their pemphigus often is the staff, particularly midwives, nurse, ill pyoderma (even covered parts of the body), at least the mother, sick pyoderma.It must be borne in mind that persons who recover pyoderma, can be carriers of Staphylococcus aureus in 2-3 months.When the first cases of pemphigus newborns in the maternity hospital is necessary in order to prevent the outbreak immediately to inspect all medical personnel with dismissal from work of persons who have discovered the phenomenon of pyoderma.It is necessary to isolate all affected children with their mothers and to allocate dedicated staff for their service.In addition, there should be a complete disinfection in the maternity ward, where cases of the disease have been observed, or in all the maternity hospital.In pemphigus newborn prevention is crucial adherence to aseptic and antiseptic rules in the nursing home, as well as the reception of births to mothers with symptoms of pyoderma in prison with a special service personnel;the children of these mothers before discharge should be in prison.