IMPETIGO (Latin. impetigo) — contagious disease of skin of a streptococcal and staphylococcal etiology; one of common forms pyodermas (see). In the Middle Ages of impetigo called all skin defeats covered with purulent crusts. In 18 century R. Willan and Beytmen (Th. Bateman) specified the term impetigo which began to be applied to designation of the diseases which are characterized by the superficial pustules which are quickly drying up in yellow friable crusts. Fox (W. T. Fox) clinically confirmed a kongagioznost And. also suggested to call it impetigo contagiosa.
The etiology and a pathogeny
On skin of the person streptococci and staphylococcus are found as a part of saprofitiruyushchy microflora. In cases when under the influence of any ekzo-or internal causes tension of immunity decreases and barrier function of skin is weakened, cocci turn into pathogenic forms: there are hemolitic and dermonekrotiziruyushchy forms which at adverse, provoking emergence And. conditions (pollution and injuries of skin, overheating, cooling) cause a disease. Among numerous internal causes the main role belongs to weakening of immune mechanisms of protection when a low caption of a complement, antitoxin, decrease in phagocytosis, weak activity of a lysozyme and anti-hyaluronidase in a human body are combined with strengthening of influence of the proteolytic enzymes produced by stafilokokka and streptococci (hyaluronidases, plazmokoagulaza, collagenases, proteinases, etc.). In a pathogeny disbolism (a hypoproteinemia, especially low content of gamma-globulins, a hyperglycemia, hypocalcemias), insufficient activity of gipofizarnonadpochechnikovy system, a thyroid gland and gonads are important.
The adults who had quinsy quite often are carriers of cocci and a source of infection of skin of children. Flashes are observed And. in a family, and also in child care facilities. And. quite often develops at children against the background of a pruritic dermatosis (neurodermatitis, eczema) as a result of infection of skin at raschesa.
Allocate several wedge, types I. (on etiol, to a sign):
1. And. streptococcal, or streptogenny (synonym: Fox's impetigo, Yadasson's impetigo, a superficial streptoderma), including seven a wedge, versions: ring-shaped And., violent And., slit-like And., And. vegetans, And. mucous membranes, sifilopodobny post-erosive papular And. and idle time deprive of the person (a synonym of pityriasis alba).
2. And. staphylococcal, or stafilogenny (synonym: Bokhart's impetigo, follicular And., superficial staphylococcal folliculitis).
3. And. streptostafilokokkovy, or streptostafilogenny (synonym vulgar And.).
The allocated earlier pemfigoidny form streptococcal And. — the so-called pemphigus of newborns — is carried to diseases of the staphylococcal nature (see. Pyoderma ).
Both at streptococcal, and at staphylococcal versions And. a basic element is the pustule, edges develops directly under a corneous layer. Pustule (see) contains fibrin, neutrophilic leukocytes and a nek-swarm quantity of lymphocytes. In a pustule it is possible to find the groups of cocci which are located vnekletochno or in neutrophils. In an aculeiform layer under a pustule it is noted spongiosas (see), there are a lot of migrating neutrophils. In an upper part of a derma — the insignificant inflammatory infiltrate consisting of neutrophils and lymphocytes.
Impetigo staphylococcal — a superficial purulent inflammation of hair follicles — see. Folliculitis .
Impetigo streptococcal it is more often observed at children, teenagers, young women. It is characterized by a rash of the superficial (subhorn) slightly towering bubbles — phlyctenas (see) dia. 0,5 — 1,0 cm with transparent or slightly muddy contents surrounded with an inflammatory nimbus (tsvetn. fig. 1). Phlyctenas are located absent-mindedly or is grouped, can merge, covering in the started cases extensive sites of skin, hl. obr. on a face (And. masklike), is more rare on shins, feet, brushes (tsvetn. fig. 2). Contents of phlyctenas shrink with formation of yellowish thin crusts which in 5 — 7 days disappear, leaving on a nek-swarm time pinkish spots with a narrow border of the exfoliating corneous layer. Distinguish the following a wedge. versions.
1. And. ring-shaped differs in formation of large flat bubbles (phlyctenas) which central part dries up with formation of a yellowish-brown crust while process extends on the periphery therefore phlyctenas get a ring-shaped form, and also a form of garlands, sickles, etc.
2. And. violent is characterized by emergence of a small amount of phlyctenas in the form of the large intense hemispherical bubbles with muddy contents which are quickly increasing in a size (to the size of hazelnut); after opening of bubbles the erosive surfaces which are also increasing on the periphery are formed; on their border scraps of a tire of bubbles are visible. Favourite localization — the back of brushes, feet, shins. Quite often the bubble is formed in a zone of the nail roller and podkovoobrazno surrounds a nail plate — a so-called superficial periungual felon (turniol) which can arise owing to agnails, an injury at manicure, a prick a needle, etc.; at the same time as a result of disturbance of food of a matrix on a nail plate cross furrows with slightly raised edges — the BO so-called lines can be formed.
3. And. slit-like — a disease of skin in corners of a mouth — see. Perleche .
4. And. mucous membranes the century and an eyeglobe is characterized by small flat bubbles or aphthous rashes on a mucous membrane of a mouth, a nose, a conjunctiva, is more rare — on a cornea. It is usually combined with damage of skin.
5. And. vegetans — erosive surfaces usual And. turn into the vegetans centers which are becoming covered by purulent crusts, surrounded with the horn cover subdug by exudate.
6. Sifilopodobny post-erosive papular And. it is observed more often at children of chest age; it is characterized by emergence on buttocks, a back surface of hips of the phlyctenas which are opened with formation of erosion in which basis papular infiltrate in this connection rashes remind erosive syphilitic papules (see develops. Psevdosifilis papular ).
7. Idle time deprive of the person — an abortal version And., it is observed usually at children. On face skin pink spots of various size with small scales on a surface appear, under the influence of sunshine there is an uneven xanthopathy, edges temporarily remains (whitish spots on the sunbathed skin).
Impetigo streptostafilokokkovy — the most often found form of a pyoderma, appears at children on face skin. At the same time initial bubbles of a streptococcal origin as a result of quickly joining staphylococcal infection turn into the bubbles with contents of yellow and honey color which are becoming covered then thick komkovaty crusts of ocherous-yellow color (tsvetn. fig. 3). Usually there is a lot of rashes, they merge and quickly extend. The disease can develop on a pilar part of the head, especially at pediculosis, can complicate mange (see); at the same time on an extensor surface of an elbow (Hardy's sign), on skin of a penis, buttocks and an inner surface of hips the purulent large isolated crusts are formed. Quite often streptostafilokokkovy And. develops at children against the background of rhinitis, otitis, a blepharitis in the form of recurrent rashes near a nose, auricles, on centuries (impetigo scrofulosa).
The course of impetigo can be long, recurrent. In most cases skin defeats are not followed by sharply expressed general phenomena. But in cases of acute emergence And., widespread process, formation of erosive surfaces, papular infiltrate the subfebrile temperature, a headache, the general weakness are observed; children badly eat, a dream uneasy. In hard cases, especially at weakened and babies, the phenomena of considerable intoxication of an organism are observed, there can be focal erythrosis (see), followed by the expressed fever, limfangiity (see), lymphadenitis (see), abscesses and damage of kidneys — acute glomerulonephritis (see).
the Diagnosis is based on a wedge, a picture, is confirmed by a laboratory research: the activator is found at crops separated from pustules on mediums. Differential diagnosis of separate forms I. carry out with other kinds of a pyoderma, syphilis, fungus diseases (Candidiasis, a trichophytosis). Often happens the general inspection of the patient on identification of the internal pathogenic causes provoking and supporting a disease, and also identification of possible complications is necessary.
the Patient with widespread rashes and the general phenomena of intoxication is appointed by antibiotics of a broad spectrum of activity (Oletetrinum, Albomycinum, Rondomycinum, etc. are especially effective). Phlyctenas (bubbles) open, erosion process 1 — 2% solution of aniline paints (diamond greens, a methylrosanilinum chloride or 5 — 10% solution of anthocyan). Apply 5% of kolimitsinovy, dibiomitsinovy, 0,5 — 1,5% of erythromycin or 5% to removal of purulent crusts and antiinflammatory action polimiksinovy ointments, 2 — 3% white mercury ointment, and also the creams and ointments containing corticosteroid hormones together with antibiotics: Oxycortum, Geocortonum, locacortenum, Dermosolonum.
Duration of use of antibiotics depends on a form I. and its currents. Streptocides are used less often. Appoint Etazolum, Norsulfazolum and means of long action — Sulfapyridazinum and sulfadimethoxine (Madribonum). At a long current the specific and nonspecific immunotherapy is widely used: staphylococcal anatoxin, staphylococcal antiphagin, stafilofiltrat, staphylococcal bacteriophage, strepto-and stafilovaktsina, streptofibroantigen, gamma-globulin, native plasma, autohemotherapy and hemotransfusions. From fortifying means apply iron, phytin, Rutinum, ascorbic to - that, vitamins A, V. Pishcha of patients shall contain the increased amount of proteins, vitamins; carbohydrates are limited, salty products are excluded; it is necessary to include preferential milk and vegetable products in a diet.
Forecast in uncomplicated cases, as a rule, favorable, at the correct treatment and careful care of the child of a complication are observed seldom. Timely begun treatment of complications also leads to recovery.
is important sanitation of skin and oral cavity, administration of vitamins. In day nursery and kindergartens the systematic dignity is necessary. - epid, supervision, a hardening of children; careful control of a condition of skin at the teenagers undergoing inservice training is very important. At manufacturing enterprises carrying out a dignity is necessary. - a gigabyte. actions: protection of skin against pollution and damages, timely processing of microtraumas, correct care of skin.
Bibliography: White G. B. Piodermita, page 64, M., 1958; Borzov M. V. Pustulous diseases of skin, Chisinau, 1953; Golosovker S. Ya. A pyoderma at children, page 49, 54, M., 1960; Brown G*. R. Systemic therapy of impetigo, Clin. Med., v. 80, p. 36, 1973; David V. L’impetigo et son treatment, Rev. Med. (Paris), t. 11, p. 1635, 1970; E1 of Zawahry M., Abdel Aziz A. S o 1 i m a n M. The etiology of impetigo contagiosa, Brit. J. Derm., v. 87, p. 420, 1972.
Yu. K. Skripkin.