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BACTERIAL SKIN
INFECTIONS
NORMAL FLORA OF SKIN
• Gm + COCCI
 STAPHYLOCOCCUS
 MICROCOCCUS
• Gm + RODS
 PROPIONIBACTIRIUM
 CORYNEBACTIRIUM
• Gm –VE RODS
 ACINETOBACTER
ROLE OF NORMAL FLORA
DEFENCE AGAINST BACTERIAL INFECTION
THROUGH BACTERIAL INTERFERENCE
PRODUCTION OF FREE FATTY ACIDS(FFA) FROM
SKIN LIPIDS
STAPHYLOCOCCUS AUREUS
ANTERIOR NARES 35 %
PERIANAL SKIN 20 %
AXILLARY SKIN 5-10 %
TOE WEBS 5-10 %
REDUCTION OF CARRIAGE
MUPIROCINE OINTMENT INTRANASALLY FOR 5 DAYS
ORAL RIFAMPICIN 600mg 7-10 DAYS
CLINDAMYCIN 150mg/day FOR 3 MONTHS
STAPHYLOCOCCUS DISEASES
Impetigo
Ecthyma
Scalded skin syndrome
Furunculosis
Folliculitis
Carbuncle
Sycosis
STREPTOCOCCUS DISEASES
Impetigo
Ecthyma
Erysipelas
Cellulitis
Scarlet fever
Intertrigo
IMPETIGO
 CONTAGIOUS SUPERFICIAL INFECTION OF THE SKIN
 ORGANISIMS: STAPHYLOCOCCUS AUREUS,
STREPTOCOCCUS
 PEAK SEASON: LATE SUMMER
 AGE: PRESCHOOL & YOUNG SCHOOL AGE
 EXISTING SKIN DISEASE: SCABIES, PEDICULOSIS
CLINICAL FEATURES
 VESICLE ON ERYTHEMATOUS BASE
 RUPTURES - SERUM EXUDES
 YELLOWISH BROWN CRUST
 PERIPHERAL EXTENSION
 HEALS WITHOUT SCARRING
TREATMENT
TOPICAL ANTIBIOTICS

NEOMYCIN
 BACITRACIN
 FUCIDIC ACID
 MUPIROCIN
SYSTEMIC ANTIBIOTICS

IF WIDESPREAD OR SEVERE
ECTHYMA
PYOGENIC INFECTION OF THE SKIN
CHERACTERISED BY FORMATION OF
CRUST BENEATH WHICH ULCERATION
OCCURS
AETIOLOGY
 STAPH. AUREUS, STREPTOCOCCUS
 POOR HYGIENE
 MALNUTRITION
 OTHER PREDISPOSING FACTORS
CLINICAL FEATURES
 BULLAE OR PUSTULE
 HARD CRUST
 PURULENT IRREGULAR ULCER
 HEALS WITH SCARRING
 BUTTOCKS, THIGHS AND LEGS
TREATMENT
 SAME AS FOR IMPETIGO
INFECTIONS INVOLVING
HAIR FOLLICLES
FOLLICULITIS
FURUNCLE
CARBUNCLE
FOLLICULITIS
INFLAMMATORY CONDITION OF THE HAIR
FOLLICLE WITH CHANGES CONFINED TO
OSTIUM
AETIOLOGY
BACTERIAL: STAPHYLOCOCCAL
FUNGAL: TRICHOPHYTON RUBRUM
CHEMICAL: TAR
DRUGS: STEROIDS
CLINICAL FEATURES
SMALL FOLLICULAR PAPULE OR PUSTULE
RARELY PAINFUL
HEALS WITHOUT SCAR
TREATMENT
REMOVE UNDERLYING CAUSE
TOPICAL ANTISEPTICS
TOPICAL ANTIBIOTICS
SYSTEMIC ANTIBIOTICS
FURUNCLE
ACUTE USUALLY NECROTIC AND DEEP
SEATED INFECTION OF HAIR FOLLICLE
AETIOLOGY
 STAPH. AUREUS
 SEBORRHOEIC / ATOPIC INDIVIDUALS
 DIABETICS
 SCABIES
 HIV
 MALNUTRITION
CLINICAL FEATURES
 SMALL FOLLICULAR NODULE
 TENDER
 LOCALIZED NECROSIS
 HEALS WITH SCARRING
 FEVER & MILD CONSTITUTIONAL SYMPTOMS
 CAVERNOUS SINUS THROMBOSIS
TREATMENT
GENERAL MEASURES
SYSTEMIC ANTIBIOTICS
TOPICAL ANTIBIOTICS
ANALGESICS
CARBUNCLE
DEEP SEATED INFECTION OF A GROUP OF
CONTIGUOUS HAIR FOLLICLES
AETIOLOGY
 STAPH. AUREUS
 MIDDLE AGED MEN
 DIABETES, MALNUTRITION
 CARDIAC FAILURE
 DRUG ADDICTS
 PROLONGED STEROIDS
 ERYTHRODERMA
CLINICAL FEATURES
 HARD RED PAINFUL NODULE
 MULTIPLE DISCHARGING FOLLICULAR SINUSES
 NECROSIS OF INTERVENING SKIN
 DEEP ULCER WITH PURULENT FLOOR
 BACK OF NECK, SHOULDERS, HIPS, THIGH
 FEVER
 SEPTICAEMIA
TREATMENT
 SYSTEMIC ANTIBIOTICS
 TOPICAL ANTIBIOTICS
 ANTIPYRETICS/ ANALGESICS
 SURGICAL INTERVENTION WHEN INDICATED
 REMOVAL OF UNDERLYING CAUSE
CELLULITIS
ACUTE, SUBACUTE OR CHRONIC INFECTION
OF LOOSE CONNECTIVE TISSUE
PERTICULARLY SUBCUTIS
AETIOLOGY
 STREPTOCOCCI
 H. INFLUENZA
 STAPH. AUREUS
 PSEUDOMONAS
CLINICAL FEATURES
 ERYTHEMA
 SWELLING
 HOT & TENDER
 ILL-DEFINED MARGINS
 CONSTITUTIONAL SYMPTOMS
COMPLICATIONS
 FASCIITIS
 MYOSITIS
 GANGRENE
 SUBCUTANEOUS ABSCESSES
 SEPTICAEMIA
TREATMENT
 APPROPRIATE ANTIBIOTICS
 ANALGESICS
 REST
 TREATMENT OF COMPLICATIONS
ERYSIPELAS
 EDGES WELL DEMARCATED, RAISED
 BLISTERING COMMON
 MORE SUPERFICIAL INVOLVEMENT
 FACE COMMON SITE
 RESPONSE TO TREATMENT RAPID
 Common skin condition affecting the skin folds
such as under the arms, in the groin and between
the toes.
 Erythrasma does not usually cause any symptoms.
 It presents as a slowly enlarging patches of pink or
brown dry skin.
Caused by  Corynebacterium minutissimum.
Diagnosis confirmed by Wood’s lamp examintation
which turns erythrasma to fluoresce a coral-pink colour.
Erythrasma can be treated with
antiseptic and topical antibiotic
such as:
• fusidic acid cream
• Clindamycin solution.
•Erythromycin lotion.
VIRAL INFECTIONS
OF SKIN
VIRAL WARTS
 HUMAN PAPILLOMA VIRUS
 DNA – VIRUS 50-55nm
 77 DIFFERENT TYPES
CONT’D
INFECT SQUAMOUS EPITHELIA
CAUSE CELL PROLIFERATION -- PAPILLOMA
DYSPLASIA / NEOPLASIA
TYPES
Common warts
Plane warts
Filiform warts
Plantar warts
Acuminate warts
COMMON WARTS
 HPV - 2
 FIRM PAPULES / PLAQUES
 ROUGH HORNY SURFACE
 SYMPTOMLESS
 SITES - BACK OF HANDS, FINGERS,
ANYWHERE ON SKIN
 65% DISAPPEAR IN 2 Yrs
PLANE WARTS
HPV 3, 10
SMOOTH, FLAT OR SLIGHTLY ELEVATED
1- 5 mm ROUND OR POLYGONAL
FACE AND BACK OF HANDS
FILIFORM WARTS
FINGER-LIKE PROJECTIONS
FACE, NECK AND SCALP
COMMONLY IN MALES
PLANTAR WARTS
HPV 1, 2, 4, 57
SMALL SHINING SAGO GRAIN LIKE PAPULE
USUALLY PAINFUL HYPERKERATOTIC
PRESSURE AREAS OF SOLE, PALMS
MOSAIC PATTERN
ACUMINATE WARTS
 HPV- 6, 11, 16 ; VENERIALLY ACQUIRED
 MUCO-CUTANEOUS JUNCTIONS AND INTERTRIGINOUS
AREAS
 SOFT, PINK , MOIST SURFACE
 PEDUNCULATED OR CAULIFLOWER LIKE
 MACERATION - INFECTION, MALODOUR
DIAGNOSIS
HISTOLOGY
ELECTRON MICROSCOPY
IMMUNOHISTOCHEMISTRY
SPECIFIC ANTIBODIES)
PCR
(TYPE
TREATMENT
 SPONTANEOUS RESOLUTION
 GENERAL MEASURES
 AVOIDANCE OF SHARED TOWELS AND SHOES
 AVOID BITING NAILS
 ADEQUATE PLASTIC STRAPPING AT SWIMMING POOL
DESTRUCTIVE MODALITIES
Electrocautery
Cryotherapy
Salicylic acid
Podophyllin
Surgical methods
CO2 Laser
Other modalities
Cimetidine
Retinoids
Interferon
Imiquimod
Antiviral therapy (cidofovir)
Intralesional bleomycin
MOLLUSCUM CONTAGIOSUM
 Caused by MCV-1, MCV-2
 Mainly in children
 Direct contact
 Discrete shiny, pearly white, rounded papules
 Umbilicated centers
TREATMENT
General measures
Topical Retinoids
Puncture with wooden probe dipped in tincture
iodine
Cryotherapy
Electrocautery
CO2 Laser
HERPES SIMPLEX
Herpes virus hominis
Type 1, 2
Persist in sensory nerve ganglia
Spread: Direct contact, droplets
CLINICAL FEATURES
Primary infection
 Sub-clinical
 Age 1-5 years
 Incubation period 5 days
 Fever, malaise, dribbling of saliva
 Gums - swollen, inflamed
Cont’d
 Vesicles, ulcers
 Tongue, pharynx, palate, buccal mucosa
 Regional lymph nodes – enlarged & tender
 Recovery in 2 weeks
Cont’d
Herpes genitalis
Kerato-cunjunctivitis
Inoculation herpes simplex
Recurrent infection
50% type 1, 95% type 2
Smaller vesicles
Close grouping
No constitutional symptoms
Buccal mucosa not affected
TRIGGERING FACTORS
 Minor trauma
 Febrile illnesses
 UV radiation
 Dental surgery
 Pre-menstrual period
 Emotional stress
COMPLICATIONS
 Cranial Nerve palsies e.g. Bell's palsy
 Eczema herpeticum
 Erythema multiforme
 Encephalitis
TREATMENT
Mild, uncomplicated : no treatment or topical
antiseptic
Severe primary infection : antiviral therapy
(Acyclovir 200mg 5 times/day)
Recurrent : topical antiviral
CHICKEN POX
HERPES VIRUS VARICELLAE
DROPLET INFECTION
2 -10 YEARS
INCUBATION PERIOD : 14-17 DAYS
CLINICAL FEATURES
 FEVER, MALAISE, RASH
 MORBILIFORM ERYTHEMA
 PAPULES, VESICLES
 PUSTULES WITH RED AREOLA
 DRY CRUST, PINK DEPRESSION
 HEALS WITHOUT SCARRING
Sign (dewdrop on a rose petal)
Papules & vesicles
Polymorphic lesions
Chickenpox & bullous impetigo
Large pustules & umbilicated lesions
COMPLICATIONS
 SECONDRY INFECTION
 ENCEPHALITIS
 HEPATITIS
 PNEUMONIA
 ARTHRITIS
 SEPTICAEMIA
 STEVENS - JOHNSON SYNDROME
TREATMENT
 REST
 ANALGESICS
 SOOTHING ANTISEPTICS
 DAILY BATHING
 ANTIBIOTICS FOR SECONDARY BACTERIAL
INFECTION
 ANTIVIRAL THERAPY
HERPES ZOSTER(SHINGLES)
HERPES VIRUS VARICELLAE
INCIDENCE INCREASES WITH AGE
PATIENTS ARE INFECTIOUS
CLINICAL FEATURES
 FIRST MENIFESTATION – SEVERE PAIN
 HEADACHE, MALAISE, LOCALISED
TENDERNESS
 GROUPED RED PAPULES IN DERMATOMAL
PATTERN
 VESICLES, PUSTULES
Cont’d
 MUCOUS MEMBRANE INVOLVEMENT
 LYMPHADENOPATHY
 RECOVERY 2-4 WEEKS
 OCCASIONALLY PAIN NOT FOLLOWED BY ERUPTION
Cont’d
THORACIC - 53%
CERVICAL - 20%
TRIGEMINAL - 15%
LUMBOSACRAL - 11%
Disseminated lesions
COMPLICATIONS
FACIAL PALSY
SENSORY LOSS
MENINGOENCEPHALITIS
POST HERPETIC NEURALGIA (PHN)
TREATMENT
 BED REST
 ANALGESICS
 LOCAL ANTISEPTICS
 TOPICAL ANTIBIOTICS
 ANTIVIRAL THERAPY
 TREATMENT OF PHN