Prof Md Shahidullah

MBBS,DDV,MCPS,FCPS,FRCP
Head of the Department
Dermatology and venereology
Shaheed Monsur Ali Medical College
 Superficial pustular folliculitis
 Sycosis vulgaris
 Folliculitis
 Furunculosis
 Carbuncle
 Impetigo contagiosa
 Bullous impetigo
 Staphylococcal Scalded Skin Syndrome
(SSSS)
 Toxic shock syndrome (TSS)
 Ecthyma
 Scarlet fever
 Erysepelas
 Cellulitis
 Necrotizing fasciitis
 Peri anal dermatitis
 Erythema marginatum
 Erythrasma
 Pitted keratolysis
 Intertrigo
 Ecthyma gangrenosum
 Green nail syndrome
 Gram negative toe web infection
 Gram negative folliculitis
 Caused by Staph. Aureus
 Characterised by thin walled pustule at the
follicular orifices
 Involve extrimities, scalp and also on the face
(periorally)
 Appear in crops
 Heals in a few days
Superficial pustular folliculitis
 Chronic perifollicular, pustular staph. Infection of
bearded region
 Involve upper lip (near nose)
 Starts with erythema,
 Associated with burning and itching
 Pin head pustule develop in a days,pierced by hair
 Tendency to recur
 Superficial, involving just the ostium of the hair
follicle
 Often caused by staph. aureus
 Usually involves eye lashes, axillae, pubis and thigh
Treatment
 Incision and drainage
 Topical- chlorhexidine wash/ mupirocin oint.
 Systemic- 1st generation cephalosporin/
dicloxacillin/Trimethoprim-Sulphamethoxazole ( if I
& D and topical therapy fails)
 Deeper, involving the hair follicle.
 Any body site can be affected but often it is neck
buttocks and anogenital area and axilla.
 Culprit strain of staph. aureus in the nares or

perineum.
 Starts as a tender perifollicular inflammatory
nodule become pustular and ends in a central
suppurtion.
 Two or more Furuncles coalesce to form a
carbuncle with separate heads.
 Multiple drainage sinuses
 Maintenance of personal hygiene
 Warm compression/ Incision and drainage
 Daily use of chlorhexidine wash ,specially
axilla, groin and perianal region
 Topical mupirocin oint.
 Systemic antibiotics
 Contagious pyogenic superficial skin infection
marked by discrete thin wall vesicles that become
pustular, rupture and form golden yellow crust.

 Caused by Staph. aureus or strepto. Pyogens or by

both.

 Commonly affects children.

 Occur fruquently in the exposed part of the body (

face, neck and extrimities).

 Repeated Group A streptococcal skin infection

sometimes followed by AGN
Treatment
General: To maintain personal hygiene

Topical: Mupirocin or fusidic acid preparation is effective

(soak off the crust before applying ointment)

Systemic:
A. Streptococcus-
Penicillin G 250mg 6 hrly for 10 days
Erythromycin 500mg 6 hrly for 10 days
Cephalexin 500mg 6 hrly for 10 days
B. Staphylococcus aureus-
Dicloxacillin 500mg 6 hrly for 10 days
Erythromycin 500mg 6 hrly for 10 days
Cephalexin 500mg 6 hrly for10 days
Clidamycin 300mg 6 hrly for 10days
Amoxicillin with clavulenic acid (375/625 mg) tds
for10 days
Recurrent cases
 Topical- mupirocin ointment, applied twice daily in
anterior nares for 10 days

 Systemic-
Rifampicin 600mg/day or dicloxacillin
500mg 6 hrly for 10 days.
 Caused by staphylococci in children and infants turn
into large pustules which burst to form crusted lesions.
 Neonatal type is highly contagious
 Threat in nurseries
 Moderate to severe constitutional symptom
 Complication- frequently occurs diarrhoea with green
stool
 Bacteremia, pneumonia or meningitis may develop
which are rapidly fatal

 Gram’s stain Gram positive cocci

 Adults may have bullous impetigo in warm climate
 Involve axillae, groin and extremities
 Appears as large bulla, may become pustular and
rupture to form crust
Bullous impetigo After treatment
 Severe staphylococcal infection of skin or a toxin
mediated epidermolytic manifestation.

 Exfoliative exotoxin type A & type B elaborated from

staphylococcus

 Commonly neonates and young children are affected

 Skin appears scalded, red, tender, discolored and

denuded with widespread detachment of superficial
layers of epidermis
 Mucous membrane uninvolved
 Rapidly becomes febrile evolving generalized
skin exfoliation at granular layer
 Usually staphylococcus present in distant site
such as pharynx, nose, ear, conjunctiva.
 D/D a) Toxic Epidermal Necrolysis b) Eczema
herpeticum c) Toxic shock syndrome.
 Hospitalization for neonates and young children
 Baths or compresses for debridement of necrotic
superficial epidermis
 In severe case water and electrolyte loss to be
corrected by i/v infusion
 Topical mupirocin in impetigo lesions
 Systemic antibiotic should be given in proper
dose
[dicloxacillin/cepalosporin]
 Purulentskin infection either streptococcal or
staphylococcal characterized by ulceration
under an exudative crust

 Common in shin and dorsal feet

 Lesion may be tender, indurated

 Removal of crust and proper dressing

 Topical antibiotic- mupirocin or bacitracin.

 Systemic- 1st generation cephalosporin /
dicloxacillin
 A localized collection
of pus in a cavity more
than 1 cm

 Perianal abscess

 Fluctuation present

 Confirmed by
aspiration
 Suppurative inflammation, usually of subcutaneous
tissue
 Most common organism group A streptococcus & s.
aureus
 Usually but not always this follows discernible
wound,
 Mild local erythema, tender, malaise, chill and fever
may be present at onset.
 The erythema rapidly become intense and spreading
in nature.
 Areas become infiltrated and often pits on pressure
 Usually legs are affected
 Sometimes central part that ruptures
and discharge pus and necrotic material
 Gangrene, metastatic abscess and grave
sepsis may follow
 Initial empiric therapy intravenous first
generation cephalosporin
Treatment

 Incision & Drainage

 Systemic Antibiotic
 Followed by dressing
 Acute beta heamolytic group A strepococcal
infection of skin involving the superficial dermal
lymphatics.
 Eruption begins as an erythematous patches and
spreads by peripheral extension.
 Transient hyperemia followed by slight
desquamation to intense inflammation with
vesicle or bulla.
 Affected skin is red, hot, swollen and indurated.
 Usually affects face or legs.
 Constitutional symptoms are usually present.
 Raised WBC count
 Systemic penicillin is rapidly effective.
 Erythromycin is also effective
 Starts with erythema and painful indurations of
underlying soft tissues.
 May follow surgery or trauma.
 Anesthesia of involved skin is very characteristic
 Rapid development of black eschar which
transforms into liquidified malodorous necrotic
mass.
 Differ from other variants because of significant
tissue necrosis.
 Lack of response to antimicrobial alone and need
surgical debridement of devitalized tissues.
Bacteremia
 Bacteria presence in the blood

Septicemia
 Blood poisoning, systemic disease
associated with the presence and
persistence of pathogenic microorganism
or the toxins in the blood
 Chronic Bacterial skin infection caused by
corynebacterium minutissimum, gram
positive,non-spore forming rod which is part of
the normal skin flora.
 Asymptomatic or mildly itchy eruption between
the toes ,groins, axillae mimic dermatophyte
infection
 More frequent in warm and humid climate
 Well defined reddish brown patches with some
scales
 Associated with obesity, hyperhidrosis,DM and
other debilitating disease
Investigation
 Wood’s light shows coral red fluorescence
 Bacterial culture reveals growth of corynebactrium
 KOH exam from scale showes no fungus element
Treatment
 Topical erythromycin solution or clindamycin
solution bid for 7 days is effective
 Topical micanozole , econazole also effective
 Systemic erythromycin 250 mg 6 hrly for 1-2 weeks
 Advice to keep the area dry


 Bacterialinfection of plantar stratum corneum
 Asymptomatic, well defined, irregular or discrete
round pits on the soles.
 Commonly associated with plantar hyperhidrosis
 Organism : Kytococcus sedentarius
 Hyperhidrosis to be controlled by
aluminum chloride preparation
Topical erythromycin solution,
clindamycin solution and benzoil
peroxide gel preparations are
effective
Miconazole, clotrimazole and
whitfield ointment are also effective
 Non specific inflammation of opposed skin occurs in
submammary region, axillae, groins and finger or toe-
webs.
 Becomes erythematous, macerated due to friction, heat
and moisture.
 Secondarily infected
 Occurs in hot humid weather
 Obesity is a predisposing factor
 Bacteria streptococcus beta hemolyticus,
corynebacterium minutissimum, pseudomonas
aeruginosa
 Candida and dermatophytes to be excluded.
Treatment
 Moistdressing
 Topical antibiotic/topical fungicidal
 Systemic antibiotic
 Low potent topical steroid/ tacrolimus helpful to
reduce inflammation