BACTERIAL AND VIRAL INFECTION IN DERMATOLOGY

1. BACTERIAL AND VIRAL INFECTION IN DERMATOLOGY Awali Febriana DERMATO-VENEREOLOGY DEPARTMENT FACULTY OF MEDICINE UNIVERSITAS GADJAH MADA/ SARDJITO HOSPITAL YOGYAKARTA

2. BACTERIAL SKIN INFECTION (PYODERMAS)

3. INFECTION IN DERMATOLOGY Objectives : Comprehend the epidemiology, clinical manifestation, diagnosis and management of bacterial and viral infection diseases in dermatology

4. BACTERIAL INFECTION CAN DIVIDED IN FOUR MAJOR CATEGORIES: • 1. primary skin infection • 2. secondary infection of a primary skin disease (e.g. infected atopic dermatitis) • 3. skin lesions as manifestations of primary infection in some other organ system, usually the blood • 4. reactive skin conditions resulting from bacterial infection (e.g., erythema nodosum due to streptococcal pharyngitis)

5. 1. PRIMARY SKIN INFECTION • Impetigo • Superficial pustules Folliculitis • Pustules Folliculitis • Furuncle • Carbuncle • Erysipelas • Celullitis • Ecthyma • Hydradenitis Suppurativa • Abscess

6. IMPETIGO • Crust on the face • Yellow Color • Self limited disease • Very contagiuos Contagious Impetigo

7. BULLOUS IMPETIGO VESICLE/BULLAE HYPOPION, WITH ERYTHEMATOUS BASED

8. FOLIKULITIS PUSTULOSA PREDILECTION: HAIRY AREA CLINICAL SIGN : PUSTULE , ABCESS. RECCURENT ETIOLOGI : S. AUREUS.

9. FURUNCLE PERYFOLLICULAIR ABSCESS, Clin. Exam.: well define induration with erythematous. Predil.: neck, axilla, buttock Predisposition : poor higyene, DM Etiology: S.aureus FURUNCLE (SINGLE)

10. CARBUNCLE CARBUNCLE (CONFLUENCE FROM FURUNCLE)

11. Celullitis Erysipelas

12. Hidradenitis suppurativa • Hidradenitis suppurativa is a chronic condition of the sweat glands (apocrine). • The sweat glands become clogged due to a variety of reasons, leading to enlargement (dilatation) of the ducts behind them. • Starts soon after puberty and continues into adult life. • more common in women • Hair removal (shaving or using depilatories), deodorants, and irritation from anything rubbing

13. Predilection The groin and armpits Clinical manifestations: noduls, firm tender, red bumps with extensive scar and sinus tracking under the surface of the skin.

14. Management • topical antibiotic solution for mild areas • oral antibiotics to treat more severe areas • injection of steroids into the deep, painful lesions • hormonal therapy • Oral tretinoin • Surgical removal (excision)

15. Abscess An infection characterized by a collection of pus underneath a portion of the skin. Etiology: Staphylococcus aureus and Streptococcus. Predispose factors : ｷAny untreated skin infection ｷDiabetes ｷObesity ｷIntravenous drug abuse ｷWeakened immune system ( illness or medication)

16. Signs and Symptoms • A worsening red, tender swelling that arises over a period of 1–2 weeks. • The pus underneath the skin • a fever or a general sense of not feeling well.

17. Management 1. Drain the pus and fluid collection by making a small incision in the skin after it has been numbed. 2. Oral antibiotics aimed at treating the most common bacteria that cause abscesses.

18. 2. Secondary infection of a primary skin disease (e.g. infected atopic dermatitis)

19. 3. Skin lesions as manifestations of primary infection in some other organ system (Staphylococcal Scaled Skin Syndrome /SSSS) • Etiology: Staphylococcus • Immun reaction for exotoxin (exfoliatin) • Clinical sign: Exfoliative in whole of the body • Management: Hospitalization, Antibiotica (dikloksasilin)

20. Staphylococcal scaled skin syndrome (S4)

21. 4. reactive skin conditions resulting from bacterial infection • Erythema nodosum : nodular, acute erythematous eruption Predilection: extensor aspects of the lower legs Delayed hypersensitivity reaction Caused by streptococcal infection Women more often than men, male-to-female ratio of 1:4. aged 18-34 years The eruptive phase : flulike symptoms of fever, generalized aching. Arthralgia.

22. erythema nodosum nodular red swellings over the shins. MANAGEMENT • cool wet compresses, elevation, and bed rest. • symptomatic relief using NSAIDs • Corticosteroids .evaluation of the underlying cause

23. VIRAL INFECTION

24. VIRAL INFECTION • Herpes virus: • 1. Herpes labialis • 2. Herpes genitalis • 3. Varicella • 4. Herpes zoster • Pox virus : • 1. Variola • 2. Moluscum contagiosum • Human papilloma virus: • 1. Verucca vulgaris • 2. Condyllomata accuminata

25. Pox virus : • 1. Variola Varicella (chiken pox) Smallpox was globally eradicated in the 1970s. Any case of smallpox means a bioterrorism event. Blisters (vesicles) develop all at the same stage, in contrast to chickenpox, where lesions are in different forms at the same time.

26. Human papilloma virus (HPV): • 1. Verucca vulgaris (common wart) • 2. Condylomata acuminata (genital wart) Common warts (verruca vulgaris): Growths on the skin, caused by human papillomavirus (HPV). Clinical manifest: circular raised flesh-colored growths , roughened, irregular surface. Predilection: fingers, backs of the hands, face, knees, and elbows. They are usually not painful and are harmless Genital warts (condyloma acuminata) Caused by more than 30 types (strains) of human papillomavirus (HPV). Transmission: skin-to-skin contact during sexual activity (not need to be vaginal or anal penetration) Some of the virus types may cause cervical cancer.

27. Signs and Symptoms Singly or in multiples and often have multiple small black "dots" at the surface from tiny blood vessels. Common warts are rough, thick, and either skin-colored, pink, or white bumps (1 mm to over 10 mm). Filiform warts are long and narrow, like tufts of thread, and usually small at the base (1–3 mm). Thank you

28. Thank you Signs and Symptoms Singly or in multiples and often have multiple small black "dots" at the surface Common warts are rough, thick, and either skin-colored, pink, or white bumps (1 mm to over 10 mm). Filiform warts are long and narrow, like tufts of thread, and usually small at the base (1–3 mm).

29. Thank you

30. Signs and Symptoms Genital warts • Small 1–2 mm smooth bumps or larger warty, cauliflower-like lesions. • White, gray, or skin-colored. • Predilection: labia, vagina, penis, scrotum, anus, skin around the anus, and groin folds. • They do not cause any symptoms. Thank you

31. Genital warts (condyloma), can appear anywhere in the genital region. Thank you

32. TREATMENT • Destruction with freezing (cryosurgery); burning (electrocautery); laser • Injection of chemotherapy drugs • Application of imiquimod, an immunotherapy agent, • Chemicals to destroy the wart such as podophyllin solution, Caution: • Partner should be checked for infection. • For women, a Pap smear is done to look for any signs of abnormal cervical cells, which can be the first sign of cervical cancer. • For men, the genital area is visually inspected. • Even if that check is normal, may still get warts or cervical cancer in the future. • Genital warts cannot be cured, lesions can recur frequently. • Wait to have sex for at least 2 weeks, after the areas are well healed and you can see no warts. • Consult if patient will be pregnant. Thank you

33. REFERRENCES Elston DM.,2009, Infectious Diseases of the Skin, 1st ed., manson Publishing Ltd. London UK http://www.visualdxhealth.com JawetzMelnick JL. Adelberg EA, Brokks GF, Butel JS and Ornston LN 2004 Medical Microbiology, 20 th ed. Simon and Schuster Asia Pte Ltd, Singapore Odom,.R., James,W., Berger,T., 2000. Andrews’ Diseases of the skin, 9 th ed., WB Saunders Company Tyring SK, Lupi O.,Hengge UR. 2006, Tropical dermatology, 1 st ed. Elsevier Churchill, Livingstone Thank you