Deep piodermiya – group of the pyoinflammatory damages of skin (mainly its deep layers – terms) caused by infection of fabrics of a stafilokokkama, streptococci or the mixed microflora. Symptoms of a disease differ depending on expressiveness of an inflammation and character of the activator, but surely include hypostasis, morbidity, reddening and formation of pus. Diagnostics of a deep piodermiya is based on external skin manifestations and microbiological researches for identification of the activator. In treatment surgical methods for ensuring outflow of pus, local and general antibiotics, antimicrobic and antiseptics are widely used.
Deep piodermiya – a purulent disease of integuments which feature is defeat terms, hypodermic cellulose, deeply located hair follicles, sweat and sebaceous glands. This state is one of the most widespread pathologies in dermatology – according to different data, it is the share of it to from 30 to 40% of all dermatological diseases. Practically each person a minimum several times in life suffered from manifestations of various forms of a deep piodermiya. It is explained by high prevalence of activators (stafilokokk and streptococci), their virulence, a huge variety of strains. In most cases the deep piodermiya does not threaten human life and even recovers independently without special therapy, but it can sometimes be the cause of intoxication, a source of the metastatic purulent centers and even the reason of sepsis.
Reasons of a deep piodermiya
In the wide plan, a deep piodermiya – the damage of skin caused by gnoyerodny microflora to which carry stafilokokk, streptococci, a sinegnoyny stick and some other microorganisms. However more than 95% of cases are caused by kokkovy flora as it is widespread in the environment and is partly presented even on the surface of skin of the healthy person. At penetration into skin tissues through microcracks, injuries of epidermis, along hair cores and on channels of skin glands microorganisms begin to breed violently. The enzymes and various toxins emitted by them in the course of activity cause destruction of cells of skin. As a result of these processes primary center located in a term is formed – symptoms of a deep piodermiya at this stage are not observed.
Microorganisms and the enzymes emitted by them have strong immunogene properties therefore practically right after formation of primary center there is an immediate reaction of immune system. Traditionally the first fabric macrophages react to infection, then by a hemotaksis neutrophils, and then and other immunocompetent cages get to future center of a deep piodermiya. Biologically active agents emitted by them lead to local hypostasis, reddening, emergence of painful feelings. Clinically it corresponds to the first stage of a deep piodermiya – to formation of the inflammatory center which can tend to expansion.
At a certain stage immunity manages to localize an inflammation, and its distribution in fabrics stops. Neutrophils attack pathogenic microorganisms and partly own fabrics (secondary alteration) in the center with pus formation – the substance consisting of "splinters" of activators, the destroyed own cages and the died neutrophils. Development of a deep piodermiya is facilitated under a number of circumstances – the lowered immunity, diabetes, exhaustion, hypovitaminoses and other states weakening an organism. An important role is played by neglect rules of personal hygiene, excess production of skin fat, local overcooling of skin. With the lowered immunity the deep piodermiya is dangerous to persons that it is capable to cause strong damages, to become the reason of various complications some of which can threaten human life directly.
Symptoms of a deep piodermiya
There are several clinical kinds of a deep piodermiya which it is characterized by different activators, expressiveness of symptoms and type of the struck fabrics. All forms of this disease on character of the microflora which caused an inflammation divide into stafilodermiya, streptodermiya and the mixed versions which sometimes call streptostafilodermiya. Carry furuncles, an anthrax, gidradenita to the deep piodermiya caused by stafilokokka and deep follikulit. Deep streptodermiya are presented vulgar ektimy, and inflammations because of the mixed microflora – chronic ulcer by a piodermiya.
Furuncle – a kind of a deep piodermiya which feature is defeat of a hair follicle it is purulent - necrotic character with transition to surrounding fabrics. The superficial purulent inflammation can precede its development (follikulit), however also primary development of deep process is possible. On the site of the skin surrounding a hair the center of crimson color from several millimeters to 1-2 centimeters in size, painful and dense is formed at first, its temperature is much higher than surrounding integuments. Then the deep piodermiya of this kind is followed by emergence of pus in which center there will be a core from nekrotizirovanny fabric. It is purulent - necrotic contents are torn away in 3-10 days, on the place of damage of skin the small ulcer which quickly cicatrizes is formed.
Anthrax – heavier kind of a deep piodermiya caused by staphylococcal flora and which is characterized by defeat of deep layers terms and hypodermic fatty cellulose. In the depth of skin there is a dense infiltrate, integuments over it get a cyanotic-crimson shade, become hot and painful. In several days in the center of a deep piodermiya pustula begin to be formed, there is a release of pus and necrotic cores, on the place of defeat the ulcer is formed. All this is followed by the expressed general symptoms – intoxication, fever, pains of the shooting character in the place of an anthrax. Regionarny lymphadenitis is noted and limfangit. After permission of this form of a deep piodermiya on the place of defeat there is a noticeable hem.
Gidradenit – a form of a deep piodermiya at which apokrinovy sweat glands with development of a purulent inflammation are surprised. Because of it characteristic localization of the pathological centers – axillary hollows, okolososkovy and anogenitalny areas. Gidradenit begins with development of painful knot of cyanotic color which for several days considerably increases in sizes and are spontaneously opened with allocation of plentiful amount of pus. Then there is a gradual healing, hems are formed in extremely exceptional cases. At this form of a deep piodermiya regionarny lymphadenitis is also noted and limfangit, but the general symptoms are expressed poorly. Gidradenita, especially in the field of axillary hollows, are inclined to a frequent recurrence.
Deep follikulit – one of the easiest forms of a deep piodermiya which differs from a usual follikulit in more expressed defeat of hair bulbs. The symptomatology in general is similar to a furuncle, however the manifestations which were less expressed, the general symptoms practically are never observed. The main diagnostic criterion allowing the dermatologist to distinguish a furuncle from a deep follikulit – absence is purulent - a necrotic inflammation as the characteristic necrotic core is not formed.
Vulgar ektima – the form of a deep piodermiya caused by streptococcal microflora. Most often affects shin skin at the weakened patients, in extremely exceptional cases arises at healthy people. Ektima begins with education on a surface of integuments of a pustula with muddy contents serous, sometimes hemorrhagic character. Then the pustula disappears and on its place the typical center of a deep piodermiya – a painful ulcer with the expressed inflammatory rim is formed around, the bottom of education is covered with a pus layer. In 2-3 weeks after emergence of an ulcer its gradual scarring with development of a noticeable scar begins.
Chronic ulcer the piodermiya – a skin disease which causative agents is the mixed microflora, the greatest role in development of pathology plays golden staphylococcus and streptococci of group A. The deep piodermiya of this kind most often develops at the weakened patients – the exhausted persons having alcoholism, elderly people. It is characterized by education on the lower extremities of the erosion of irregular shape with torn edges surrounded with the inflamed skin. The bottom of ulcer educations is covered with pus, often there are allocations with an unpleasant fetid smell. Erosion a long time do not heal and are inclined to a frequent recurrence or defeat of other sites of integuments.
Metastatic purulent damages of regionarny lymph nodes and the remote bodies can be complications of any kind of a deep piodermiya. The deep follikulita and furuncles arising within a nasolabial triangle are especially dangerous in this regard – the anastomoza of blood vessels which are available there promote an infection drift in a brain and its covers. The weakened patients against the background of a deep piodermiya can have phlegmons and sepsis which are zhizneugrozhayushchy states. Development of toxic shock is in rare instances possible.
Diagnostics of a deep piodermiya
Diagnostics of various forms of a deep piodermiya is performed by means of survey of the dermatologist (consultation of the surgeon can sometimes be required). From additional methods of a research most often apply crops of pus to definition of character of the activator and to clarification of its sensitivity to antibacterial means. At development of the general symptoms also in some cases performing the general blood test, in the most hard cases – is necessary for blood for diagnosis of sepsis. Results of survey depend on a form of a deep piodermiya and a stage of its development – it can be just inflammatory center created an abscess, a wound or an ulcer with purulent separated. At crops are defined staphylococcus or streptococci, the mixed microflora can be found. Microbiological researches of crops can define a look and a strain of the activator, and also its sensitivity to antibiotics.
If there is a temperature increase, a headache, weakness that performing the general blood test is necessary. Usually at a deep piodermiya little nonspecific signs of an inflammation – increase in speed of subsidence of erythrocytes, small are defined. In more hard cases already expressed changes are observed – the significant growth in SOE expressed changes in distribution of neutrophils come to light. In blood there is a set of young forms of this fraction of leukocytes that the name of neytrofilny shift carries to the left. If there are suspicions that the deep piodermiya became the sepsis reason, make crops of blood on nutrient mediums – normal blood of the person is absolutely sterile, growth of cultures speaks about existence of the activator in blood. For diagnostics of such complications as the metastatic purulent centers can be applied ultrasonic, radiological and other methods of clinical trials.
Treatment of a deep piodermiya
At purulent defeats, insignificant on expressiveness, without the general displays of intoxication it is recommended to wait for spontaneous permission of a deep piodermiya. Medical actions come down to prevention of complications. In the presence of hair around their purulent center it is necessary to shear accurately – use of the razor can lead to spread of an infection. It is not recommended to wash the site with the center of a deep piodermiya, it is only admissible to wipe skin around it with disinfecting solutions (hlorgeksidiny, solution of salicylic acid). It is strictly forbidden to open independently without participation of the dermatologist or the surgeon an abscess or in any way to accelerate office of pus – it can lead to an activator dissemination.
If the deep piodermiya is characterized by development of the large centers with the advent of the general symptoms (fever, weakness, headaches), then purpose of antibacterial means, such as erythromycin, is necessary, lincomycin – it is previously desirable to make bacterial crops and to define medicine to which this microorganism is most sensitive. At a deep piodermiya apply also antimicrobic means from group of sulfanylamides – for example, + trimetopry. In recent years in hard cases of purulent damages of skin use also immunological medicines – staphylococcal , anti-staphylococcal hyperimmune plasma and some other.
At a deep arrangement of the center of a piodermiya, considerable by the sizes, resort to surgical opening of a cavity of an abscess for formation of a drainage and outflow of pus. Besides, it allows to deliver antiseptic and antibacterial medicines directly to the area of defeat that accelerates treatment. Opening of the center of a deep piodermiya has to happen in the sterile room and be carried out by the qualified purulent surgeon.
Forecast and prevention of a deep piodermiya
In most cases the forecast at development of various forms of a deep piodermiya favorable – after office of pus happens healing of the center, is quite frequent with formation of hems. However at the weakened patients with the low level of immunity development of complications some of which can threaten life is possible and demand treatment in the conditions of a hospital. For prevention of development of a deep piodermiya it is necessary to follow the rules of personal hygiene, in due time to process skin damages (grazes, cuts) by antiseptics. Besides, it is important to eliminate possible sources of an infection in an organism – carious teeth, chronic infections of ENT organs.