BACTERIAL SKIN INFECTION

KUSHAL KUMAR
 BACTERIAL INFECTION OF SKIN
The Skin
Definition

Skin is largest organ of body. It protects

underlying tissues and organs, protects body
from mechanical injury, and ultraviolet rays of
sun.
SKIN INFECTIONS

• The skin always has some amount of bacteria, fungus

and viruses living on it.

• Occur when there are breaks in the skin and the

organisms have uncontrolled growth
 Staph. Aureus Infection

1. Direct infection of skin : impetigo, ecthyma, folliculitis,

furunculosis, carbuncle, sycosis.

2. Secondary infection: eczema, infestations, ulcers, …etc.

3. Effect of bacterial toxin: staph.-associated scalded skin

syndrome (SSSS), toxic shock syndrome.
 Strepto. Infection
(gp A streptococci)

 Direct inf. of skin or subcut. tissue: Impetigo, ecthyma,

cellulitis, vulvovaginitis, perianal inf., ulcers, blistering,
necrotizing fasciitis.
 2ry inf.: eczema, infestations, ulcers, …etc.
 Tissue damage from circulating toxin: scarlet fever, toxic
shock-like syndrome.
 Skin lesions attributed to allergic hyper-sensitivity to
strepto. antigens: erythema nodosum, vasculitis.
 Skin dis. provoked or influenced by strepto. inf.: psoriasis
IMPETIGO
• Acute contagious skin infection caused
mostly by staph. Aureus and strept.
• Affects children mainly, esp. in summer
times.
CLINICAL TYPES

• 1- Non-bullous impetigo:
• Caused by staph., strept. or both organisms.

• 2- Bullous impetigo:
• Caused by staph aureus.
NON-BULLOUS IMPETIGO

• Staph. aureus or gp A stretp. or both “mixed infections”.

• May arise as 1ry inf. or as 2ry inf. of pre-existing dermatoses, e.g.
pediculosis, scabies & eczemas.
• An intact st. corneum is probably the most important defense against
invasion of pathogenic bacteria.
• A thin-walled vesicle on
erythematous base, that soon
ruptures & the exuding serum
dries to form yellowish-brown
(honey-color) crusts that dry &
separate leaving erythema
which fades without scarring.

• Regional adenitis with fever

may occur in severe cases.
 Sites: Exposed parts eg. face &
extremities. Scalp .Any part
could be affected except palms
& soles.
 Complications: Post-
streptococcal acute glomerulo-
nephritis “AGN” especially in
cases due to strepto. pyogenes
VARITIES:

• Circinate impetigo: with

peripheral extension of
lesion & healing in the
center.
• Crusted impetigo:
• on the scalp complicating
pediculosis. Occipital &
cervical Lymph nodes are
usually enlarged & tender.
• Ecthyma (ulcerative
impetigo): adherent crusts,
beneath which purulent
irregular ulcers occur. Healing
occurs after few weeks, with
scarring.
• Site: more on distal extremities
(thighs & legs).
BULLOUS IMPETIGO

• Age: all ages, but commoner in

childhood & newborn (impetigo
neonatorum).
• Site: face is often affected, but
the lesions may occur anywhere,
including palms & soles.
• The bullae are less rapidly
ruptured (persist for 2-3 days) &
become much larger. The
contents are at first clear, later
cloudy. After rupture, thin,
brownish crusts are formed.
BULLOUS IMPETIGO

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BULLOUS IMPETIGO

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BULLOUS IMPETIGO

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TREATMENT OF IMPETIGO:

 Treatment of predisposing causes: e.g. pediculosis & scabies.

 Remove the crusts: by olive oil or hydrogen peroxide.
 Topical antibiotic: e.g. tetracycline, gentamycin,
FOLLICULITIS
• inflammatory disease of the hair follicles, which may be

infectious or non-infectious.
SUPERFICIAL FOLLICULITIS
(BOCKHART’S IMPETIGO)
• a dome-shaped pustule at the
orifice of a hair follicle that heals
within 7-10 days.
• Caused by staph aureus
and affects mainly
extremities and scalp.
• Topical steroids are a
common predisposing
factor.
SYCHOSIS VULGARIS
• Recurrent red follicular papules

or pustules centered on a hair,

usually remain discrete over the

beard or upper lip, but may

coalesce to produce raised

plaques studded with pustules.

SYCOSIS VULGARIS

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PSEUDOFOLLICULITIS
• from penetration into the
skin of sharp tips of shaved
hairs.
FRUNCULOSIS (BOILS)
• It is a staphylococcal infection , but
deeper than folliculitis & invades
the deep parts of the hair
folliculitis.
• Occasionally several closely
grouped boils will combine to form
a carbuncle. The carbuncle usually
occurs in diabetic cases. The site
of election is the back of the neck.
FURUNCLE

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FURUNCLE / CARBUNCLE

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CELLULITIS & ERYSIPELAS
• Cellulitis is an infection of subcutaneous tissues.
• Ersipelas: It’s due to infection of the dermis & upper
subcutaneous tissue by gp A streptococci. The organism
reaches the dermis through a wound or small abrasion. It
is regarded as a superficial “dermal” form of cellulitis.
 Erythema, heat, swelling
and pain or tenderness.
 Fever and malaise which
is more severe in
erysipelas.
 In erysipelas: blistering
and hemorrhage.
 Lymphadenopathy are
frequent.
• Edge of the lesion: well
demarcated and raised in
erysipelas and diffuse in
cellulitis.
CELLULITIS

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CELLULITIS

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COMPLICATIONS

• Recurrences may lead to lymphedema.

• Subcutaneous abscess.

• Septicemia.

• Nephritis.
TREATMENT

• Systemic antibiotics, especially penicillin, e.g. benzyl

penicillin (600-1200 mg IV/6 hrs)

• Rest, analgesics.
ERYSIPELAS

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SKIN DISEASES RELATED TO
CORYNEFORM BACTERIA

ERYTHRASMA
• It is mild, chronic, localized
superficial infection of skin by
Coryn. Minutissimum.
• Clinically: sharply-defined but
irregular brown, scaly patches
• usually localized to groins,
axillae, toe clefts or may cover
extensive areas of trunk &
limbs. Obesity & DM may
coexist.
• Coral red fluorescence under
wood’s light.
TREATMENT

• Topical treatment with azole antifungal agents for 2 weeks

or topical fucidin.

• Erythromycin orally.