PYODERMA (pyodermia; grech, pyon pus + derma skin; synonym pustulous diseases of skin) — the group of the acute and chronic, superficial and deep inflammations of the skin caused by pyogenic cocci (stafilokokka and streptococci) are more rare Xing purulent and intestinal sticks and other microorganisms.
The standard classification of P. does not exist. On etiol, to a sign P. divide all into staphylococcal, streptococcal and mixed (streptostafilokokkovy). On depth of defeat select superficial and deep Items. Staphylococcal P. (a synonym of a staphyloderma) include superficial forms — staphylococcal impetigo (see), a folliculitis ordinary (see. Folliculitis ), a sycosis ordinary (see. Sycosis ), epidemic pemphigus of newborns, Rittera dermatitis exfoliative (cm.), vezikulopustulez, eels vulgar (see. Eels ) and deep forms — deep folliculitis (see), furuncle (see), anthrax (see), hydradenitis (see), multiple abscesses of skin at children (see. Staphylococcal infection ). Carry superficial forms to streptococcal P. (a synonym of a streptoderma) — streptococcal impetigo (see), streptococcal defeat of big skin folds (see. Intertrigo ) and deep forms — vulgar ecthyma (see), an erysipelatous inflammation (see. Ugly face ). The mixed streptostafilokokkovy P. include a superficial form — streptostafilokokkovy, or vulgar, impetigo, and also a number of options hron, deep the Item. On duration of a current allocate acute and chronic P., also mixed options are possible. Items can be primary or develop for the second time, complicating other skin diseases, for example itch, eczema.
Items — the most widespread disease of skin both at adults, and at children, to-rye can ache at any age since the period of a neonatality. At children superficial streptococcal P. is more often observed, adults have various forms staphylococcal the Item. Among other diseases of skin of P., according to a number of researchers, makes 17,5 — 43,9%. The item has big ud. weight among diseases with disability. The disease occurs at workers of coal and metallurgical industry, at workers of agriculture.
As a result of big scheduled maintenance P.'s incidence steadily decreases.
In the conditions of hot climate at most it falls P.'s incidence on the aestivo-autumnal period, in a frigid climate — for the winter period.
Stafilokokki and quite often streptococci live on skin of healthy people, without causing a disease. The reason of development of P., in most cases and to a lesser extent streptococcal, transformation of pyococci, saprofitiro-vavshy on skin, into pathogenic forms is staphylococcal that is promoted by the lowered body resistance, and also lack of the correct care of skin, its pollution (especially production), the Traumatization and maceration of skin leading to disturbance of an integrity of a corneous layer. Overheating and overcooling of an organism, the increased perspiration, being followed by change of pH of skin in the alkaline party and reduction of its self-sterilizing properties, can promote emergence of the Item.
Disturbances of functions of internals, nervous and endocrine systems can cause sensitization of skin or decrease in its resilience to the pyococci gaining at the same time pathogenic properties. Depending on the sensibilizing properties of the pyococci which caused process and degree of body resistance, in particular skin, the state raised or a hyposensitivity to the corresponding pyococci can develop, a cut comes to light by means of skin tests with a vaccine of pyococci. The sensitization to pyococci can lead to development of secondary allergic rashes — pioallergid. The pyoderma does not leave durable immunity.
In staphylococcal P.' ozbuditel the most part are golden and white staphylococcus, streptococcal P. — a piogenic streptococcus.
In an experiment it was proved that upon transition of a nonpathogenic form of staphylococcus to pathogenic the apatogenous white strain of staphylococcus gains hemolitic, fermentative, fibrin lytic properties, and also a factor of permeability, i.e. line of pathogenic staphylococcus. These properties are changeable or at all disappear that is explained by the changing living conditions of microorganisms.
Patogistologiya The item depends on a type of the activator and sharpness of a current patol, process. Suppuration, education in skin of the focal cellular infiltrate consisting preferential of segmentoyaderny leukocytes is characteristic of staphylococcal P. For streptococcal P. typically serous inflammation without suppuration, developing of the expressed hypostasis with formation of the cavity filled with serous exudate. In the mixed streptostafilokokko-vy P. it is inherent polymorphocellular hron, inflammatory infiltration, at separate forms with a granulematozny structure (ulcer vegetans and gangrenous P.).
The forms P. which are not described in volumes by independent articles are given in article.
Epidemic pemphigus of newborns (pemphigus neonatorum; synonym: a pemphigus of newborns, piokokkovy pemphigoid) — acute staphylococcal damage of skin with high contageousness. It is characterized by development of the large bubbles surrounded with an inflammatory nimbus, which are quickly increasing by peripheral growth; during the opening of bubbles the becoming wet bright pink erosion are formed. Skin of a stomach (especially around a navel) and extremities is surprised. Process can accept widespread character with involvement of mucous membranes of an oral cavity, nose, and also genitalias and development of the general phenomena (fervescence, concern, vomiting, a frequent chair). Complications, napr, otitis, pneumonia, sepsis are possible. Especially severe form of a disease is represented by so-called exfoliative dermatitis of Ritter.
Vezikulopustulez (vesiculopustulosis; the synonym staphylococcal ostioporit) — staphylococcal defeat of mouths of channels of ekkrinny sweat glands. At a vezikulopustuleza newborns in the first days of life on the sites of skin which are exposed to maceration owing to the increased perspiration (a pilar part of the head, axillary poles, inguinal folds, a trunk) have usually numerous pustules size about a pin head surrounded with the inflammatory roller.
Chronic deep pyodermas
carry the abscessing and undermining folliculitis and a perifolliculitis of the head, a sycosis To them lupoid (see. Sycosis ), dekalviruyushchy folliculitis of Kenko, hron, deep ulcer and vegetans P., hron, piokokkovy ulcer, hron, vegetans pyoderma Allopo, shankriformny P., gangrenous P., spherical and keloid eels (see), etc.
The abscessing and undermining folliculitis and perifolliculitis of the head (folliculitis et perifolliculitis abscedens et suffodiens capitis; the synonym multiple abscesses of the head with destructive cellulitis of Pyyuzi) arises on a pilar part of the head — the multiple deep, rather quickly softened inflammatory nodes after which spontaneous opening there are deep fistulose courses merging in the depth of skin are formed. Gradually on sites of defeat keloid cicatrixes are formed wide linear, sometimes, and on the neighboring sites new nodes appear. Quite often at the same time on skin of a trunk there are spherical and keloid eels that causes the assumption that this form P. — one of kinds of spherical eels, a wedge which features are connected with localization.
Dekalviruyushchy folliculitis of Kenko (folliculitis decalvans Quinquaud). On a pilar part of the head, less often on other places arise it is long the existing low-painful inflammatory folliculites which are leaving behind the flat hems reminding an atrophy of skin at to a pseudopelade (see). Quite often process serpiginirut (cicatrizes on one party and at the same time extends to another).
Chronic deep ulcer and vegetans pyoderma (pyodermia chronica profunda, ulcerosa et vegetans) described in 1925 H. A. Chernogubov who established that pyococci can cause a granulematozny inflammation in skin and the phenomena of proliferation in epidermis. Adult men are ill more often. The disease can be shown by unsharply limited dense follicular bluish-red and more pale small knots of different size, sometimes with a pustule in the center; the soft infiltrirovanny plaques of bluish-red color covered rykhlo with the sitting crusts under which there are papillary growths and the fistulopodobny ulcerations which are reported among themselves; deep skrofulodermopodobny fluctuating nodes, sometimes with fistular openings, at the same time process can be localized around an anus — the so-called abscessing fistulose dermatitis around an anus (dermatitis perianalis fistulosa); «shaggy» hems like hems of a kollikva-tivny tuberculosis cutis. The disease can be limited (quite often localization on the back of brushes) and extended with disturbance of the general condition of patients; damage of bones (a piogenic osteopathy) is possible, is more often in the form of a periostitis of shins.
For hron, deep ulcer and vegetans P. high degree of a sensitization of an organism to the activator with the advent of secondary allergic rashes is characteristic. The disease proceeds is mostly long, especially heavy current is noted when process is followed by an anergy (see. Reactivity of an organism ).
Chronic piokokkovy ulcer (ulcus chronicum pyococcicum; synonym: the chronic ulcer pyoderma, pyodermia chronica ulcerosa) is formed more often on site than an injury (a paratraumatic pyoderma). Hron, a piokokkovy ulcer can arise also on site a vulgar ecthyma, a furuncle or ostrovoznikayushchy inflammatory infiltrate, quickly, in several days, nekrotiziruyushchegosya. The ulceration gradually increases and can reach 10 — 15 cm in the diameter. A form of an ulcer round or oval, sometimes wrong, edges more often steep, plotnovaty, the bottom is covered with necrotic masses, then there is a clarification of a bottom and scarring. Duration of progressing of process is various — from 2 weeks to 2 months and more, duration of a stage of scarring depends on the sizes of an ulcer, localization, the general condition of an organism, etc.
Chronic vegetans pyoderma of Allopo (pyodermia chronica vegetans Hallopeau) represents a rare form P. at which the pustule which is not connected with a follicle after opening begins to vegetirovat. Process can be widespread and take a pilar part of the head, a face, skin folds, etc. Sometimes there are deep infiltrates; the mucous membrane of an oral cavity is surprised.
Shankriformny pyoderma (pyodermia schancrifor-mis) is localized on generative organs, a red border of lips, on centuries. The disease begins with formation of a bubble after which opening the erosion is bared or the ulcer of a round or oval form, myasokrasny color, sometimes with a gangrenous plaque, low-painful, often considerably condensed in the basis, reminding clinically hard ulcer is more often (see. Syphilis ). Multiple ulcers, regional lymphadenitis are possible.
Gangrenous pyoderma (pyodermia gangraenosa), or extensive ulcer P. of fulminant type, is caused by golden staphylococcus, various types of a streptococcus, sometimes diphtheroid sticks; it is observed at the weakened patients suffering hron, ulcer colitis, polyarthritis, and also the diseases which are followed krio-or a paraproteinemia. At the same time on various sites of skin there are furunkulopodobny infiltrates, to-rye quickly break up with formation of the ulcers extending on the periphery with purulent separated and a vegetans surface. Edges of ulcers are edematous, purple-red color, a podryta; ulcers heal scarring. Giperergichesky allergic vascular reaction is the cornerstone of gangrenous P.'s development. Current heavy; the lethal outcome is possible.
Quite often at one patient it is possible to observe various wedge, forms hron, deep P. — a politipny pyoderma of Kogoya (pyodermia poly-typica Kogoj).
At P. arise allergic rashes (a synonym of a pioallergida), is more often after the irritating local therapy of primary centers of P. (impetigo, a furuncle, a hydradenitis, hron, deep P., etc.) or after administration of immune drugs (a vaccine, staphylococcal anatoxin, etc.). Pioallergida can be shown by lichenoid, pustular, erythematic, eritematoskvamozny, eczematic, polymorphic rashes. They appear suddenly, sometimes being followed by an indisposition, a headache, fervescence and other general phenomena. Specific allergic skin reactions (see. Skin tests ) in the presence of pio-allergids are sharply positive.
Pyococci from blood are not sowed and mostly are not found also in pioallergida. In the immunnobiologichesky relation of a pioallergida are contrast of so-called piyemid, or piyemichesky dermatosis, to-rye represent the rashes arising in the hematogenous way at the staphylococcal or streptococcal sepsis which is followed usually by an anergy. To Pia-midy, especially staphylococcal, are characterized by true polymorphic rashes with a pustular component (spots, small knots, bubbles, superficial and deep pustules, flat infiltrates, etc.); from blood sow pyococci. Piyemida confirm the heavy course of piokokkovy process.
P.'s Diagnosis establish on the basis a wedge, the picture confirmed in doubtful cases mikrobiol. a research separated ulcers, pustules, and also purulent crusts. Differential diagnosis is carried out between some forms hron, deep P. and deep mycoses (see), manifestations of tertiary syphilis (see) and a tuberculosis cutis (see. Tuberculosis extra pulmonary, tuberculosis cutis ).
P.'s Treatment includes specific and nonspecific methods. From specific methods of treatment use an immunotherapy (a piovak-tsina, staphylococcal anatoxin, a filtrate, a phage, antiphagin), antibiotics with preliminary definition of sensitivity to them of the microorganisms which caused the Item. From nonspecific methods of treatment use more often autohemotherapy (see), a dietotherapy (restriction of carbohydrates, an electrolyte-deficient diet, etc.), hormones, vitamins A, groups B, SI appoint other fortifying means.
In the presence of dysfunctions of internals, a nervous system, hemadens, a metabolism carry out their possible correction.
Topical treatment depends from a wedge, pictures P. On not opened nodes impose pure Ichthyolum, on ulcer surfaces — ointments with antibiotics, bandages with antiseptic liquids, Shostakovsky's balm both another epithelizing and desinfectants. At vegetans defeats apply a scraping an acute spoon of Folkmann or destruction of vegetations diathermocoagulation (see). In certain cases, especially at extensive fluctuating defeats, an operative measure is shown. At hron, a piokokkovy ulcer impose cherepitseobrazny grids from a sticky plaster or zhelatinotsinkovy bandages. At all forms P. it is possible to make UF-radiation by suberythema doses. In order to avoid transmission of infection on healthy sites of skin sick P. are not recommended to wash affected areas, healthy skin around them should be rubbed off disinfecting liquid, napr, camphoric, salicyl alcohol; nails need to be cut shortly and once a day to grease the ends of fingers of hands of 1 — 2% with spirit solution of iodine, any aniline dye, boric or salicylic acids. To avoid planting, on piodermichesky rashes it is not necessary to impose the warming compresses. The bandages applied only in case of need (the continuous friction of sites of defeat leading to maceration of skin), it is necessary to change often.
the Majority of forms P. at rational treatment and elimination of the factors contributing to its development is allowed completely or with formation of cicatricial changes of skin (a furuncle, an anthrax, hron, deep ulcer and vegetans P.). In some cases, napr, at an epidekhmichesky pemphigus of newborns, exfoliative dermatitis of Ritter, P. can become complicated sepsis (see) that can lead to a lethal outcome.
P.'s Prevention consists in the maintenance of skin in purity (frequent washing and change of linen). Also protection of skin from traumatization and maceration (at disturbance of an integrity of a skin surface it is necessary to process immediately the respective site a desinfectant), fight against the increased perspiration is of great importance (see. Hyperhidrosis ), protection of an organism from overcooling.
For P.'s prevention preservation of bactericidal, eamosterilizuyushchy properties of skin matters that interferes with activation of cocci, sapro-fitiruyushchy on it, at emergence of the contributing conditions (traumatizations, maceration of skin, etc.). Strengthening of an organism is promoted by sports activities, physical culture, stay in the fresh air, a sufficient dream, healthy nutrition, etc. The system of preventive actions joins treatment available hron, diseases, first of all a diabetes mellitus and other diseases of a metabolism, went. - kish. frustration, focal infection, etc.
In order to avoid P.'s infection, children are especially inclined to Krom, it is necessary to exclude close contact of children with P. Sleduyet's patients to perform systematic inspections of employees of child care facilities; persons with P. are not allowed to work with children before full treatment.
P.'s prevention in conditions of production consists from all-sanitary and a dignity. - tekhn, actions, including individual protection and personal hygiene of the worker, and also a dignity. - a gleam. work. Main objective of a complex dignity. - tekhn, measures fight against microtraumatism by mechanization of production, keeping in order of a workplace and tools, etc. is. The small injuries got in operating time need to be processed preventively directly in workshops desinfectants: glue liquid of Novikov (5 parts of a tannin, 1 part of tetraethyl-diamino-triphenyl-carbohydride sulfate, 1 part of alcohol, 2,5 parts of castor oil and 100 parts of a collodion); BF-6 glue or aniline dyes. During the work with cooling oils and emulsions it is necessary to clear them of small metal shavings, sand and to aim to reduce contact of skin with these substances. Paramount value in P.'s prevention have creation good an all-gigabyte. field conditions of work, the correct organization of cleaning of skin of workers in time and after work, existence of good ventilation, wash basins, shower installations, hot water, soap, and also special clothes, footwear.
P.'s prevention in conditions of production happens especially successful when specialized actions are developed for various industries and workers of agriculture since depending on kind of work P.'s prevention has the features. So, e.g., in P.'s pathogeny at workers of mechanical and metallurgical industry the leading role is played by microtraumatism and irritation of skin oils, workers of oil industry have a hit on skin of oil and formation of oil eels, and also pollution of skin dust, workers of the peat industry have a microtraumatism, a xeroderma, its impurity, etc.
In the peat industry the preventive method of Paykin was widely adopted: use of a shower after work, rinsing of brushes within 5 min. warm 0,5% solution of spirit of ammonia, legs — 0,75% solution of spirit of ammonia within 7 — 8 min. Then on the dried-up skin apply a thin film of vaseline which is better for keeping on skin till the morning. For cleaning of skin of hands after work use also soap and lanolin paste, synthetic detergents (DNS-AK), etc. Apply protective pastes and ointments (HIOT-6 paste, Selissky's ointment) to P.'s prevention, to-rye before work apply with a thin coat on skin of hands; the film which is formed at the same time is impenetrable for oils, emulsions, kerosene and other organic solvents.
Bibliography: Ashmarin Yu. Ya. and Kreynin V. M. Furunkulez, M., 1974; B and z y to and A. P. and Savitsky JI. H. Reaction of agglomeration of leukocytes as an indicator of humoral immunity at patients with a pyoderma, Vestn, dermas, and veins., No. 11, page 45, 1979; JI e with - N and c to and y A. I. Reactions of cellular immunity at patients with staphylodermas, in the same place, JVq 3, page 12, 1981; Mashkilleyson JI. H. Infectious and parasitic diseases of skin, M., 1960; Sobolev P. S., etc. Materials to a pathogeny of a pyoderma, Vestn, dermas, and veins., JSfc 3, page 11, 1977; Troitsk A. D. Piodermita, JI., 1958, bibliogr.; G e of t-1 e r W. Systematische Dermatologie und Grenzgebiete, Bd 2, S. 1180, Lpz., 1972, Bibliogr.
L. H. Mashkilleyson, O. K. Shaposhnikov.