Stafilodermiya – group of the piodermiya of a bacterial etiology caused by microorganisms from group of staphylococcus. Symptoms of this state and their expressiveness differ depending on a form of skin defeat, like reactivity of an organism, existence of the accompanying violations (decrease of the activity of immunity, injuries of skin). Diagnostics of various forms of a stafilodermiya is performed on the basis of results of dermatological survey, microbiological researches of skin and pus. All-clinical blood tests and urine can play a supporting role. Treatment of a stafilodermiya is made by the various local and system antibacterial means supporting by medicines, physical therapy.
Stafilodermiya (staphylococcal piodermiya) – set of the pyoinflammatory damages of skin caused by stafilokokka. Is very widespread dermatological state – practically each person during life has purulent inflammations of skin of varying severity caused by these bacteria. So frequent occurrence is caused by the fact that staphylococcus are quite widely presented in the environment – they can long be airborne also on household items, be a part of microflora of integuments and mucous membranes of the person. Besides, the stafilodermiya is sometimes provoked by a drift of pathogenic bacteria from other purulent centers in an organism. Defeat can arise at any age, but at children the stafilodermiya proceeds differently, than at adults (an epidemic puzyrchatka of newborns) owing to certain anatomic features of a structure of skin. Because of the bacterial nature of a disease and stability of stafilokokk in the external environment similar states have the expressed contageousness, are capable to be transmitted at a touch or through the general objects (towels, bed linen, basts) that needs to be considered at treatment of pathology.
Penetration of stafilokokk (as a rule, golden or white) in skin tissue through microcracks, channels grease and sweat glands or open wounds (grazes and cuts) is the reason of development of all forms of a stafilodermiya. The hematogenic or limfogenny metastatic drift of the activator from other centers of a purulent infection (carious teeth, abscesses of internals, lymphadenites) is less often observed. At the same time from depth of penetration of stafilokokk, their activity (especially in respect of release of proteolytic enzymes and ekzotoksin) and like reactivity of an organism the stafilodermiya form depends.
After hit of bacteria in skin tissue in the absence of operation of local factors of immunological protection rough reproduction of microorganisms with allocation of a huge amount of enzymes and immunogene toxins begins. It characterizes the first stage of development of any purulent process including stafilodermiya. Then in the center of defeat immunocompetent cages (neutrophils, macrophages, lymphocytes) which stimulate an inflammation by means of release of biologically active agents begin to migrate. There is an expansion of blood vessels, hypostasis of fabrics, formation of "an inflammatory shaft" around the center of bacteria – these processes and make a clinical picture of a stafilodermiya. At the subsequent stages of development the fibroblasta forming the capsule around the pathological center are activated, and mix together with the broken-up fabrics forms pus of the died neutrophils and stafilokokk.
If the purulent inflammation has extensive character, a significant amount of toxins gets into blood that leads to development of the general symptoms – weaknesses, temperature increase, a headache. In most cases stafilodermiya sooner or later by a natural way the drainage for pus outflow (break of abscess) is formed, inflammatory manifestations gradually die away. If pathological process affected a basal membrane of epidermis, on the place of the pathological center more or less noticeable hem is formed. At superficial forms of a stafilodermiya the basal membrane remains intact that promotes full healing and restoration of a normal integument.
Classification and symptoms of a stafilodermiya
Many distinctions in the clinical current have the different forms of a stafilodermiya that allows the dermatologist to determine its type by only one symptomatology of a disease. On these distinctions classification of this pyoinflammatory state is constructed. Stafilodermiya can be superficial, deep and children's. Carry various kinds of follikulit (ostiofollikulit, superficial and deep follikulit) to superficial forms, and also vulgar . Deep types of a stafilodermiya unite in themselves furuncles, an anthrax and staphylococcal gidradenita. The children's form of this damage of skin is presented by an epidemic puzyrchatka of newborns who patomorfologichesk belongs to superficial types, but has a number of the features caused by a structure of integuments of small children.
Ostiofollikulit (staphylococcal impetigo of Bokhart) – rather easy kind of a superficial stafilodermiya. Most often it strikes men, arises on a face in a zone of growth of moustaches and beards, the area around a hair core always strikes, can have multiple or single character. The beginning of pathological process is characterized by emergence of a pustula of red color with a diameter about 1 millimeter on which place the semi-spherical yellowish abscess is formed over time. In 2-3 days it is transformed to a lurid crust with a diameter of 2-3 millimeters. In 2-3 days the crust disappears, on its place about a week the pink speck which then completely disappears can remain.
Superficial follikulit it is conditionally possible to call the complicated form of the previous option of a stafilodermiya as it is characterized by deeper defeat of hair follicles. The clinical picture reminds ostiofollikulit, but at the same time is more expressed – the size of papular elements has 2-3 millimeters a diameter, and full healing can take up to 2-3 weeks. Around the centers of defeat the inflammatory roller and reddening of skin is, as a rule, observed, local morbidity is quite often noted, but the general symptoms (weakness, temperature increase) at a superficial follikulit are not observed.
Deep follikulit – the expressed form of a superficial stafilodermiya at which pyoinflammatory process covers all thickness of a hair follicle. It is shown by single or multiple gnoynichka with a diameter up to 10-15 millimeters of various localization. The damage of skin, considerable on the area, caused by multiple follikulita that can demonstrate existence of an immunodeficiency, diabetes and other general diseases is in certain cases observed. At this option of a stafilodermiya moderate morbidity of skin is noted, at extensive defeats the general symptoms can be registered: weakness, headache, temperature increase.
Vulgar is the chronic kind of a stafilodermiya most often having recidivous character of a current. Mainly strikes men, arises on a face and a neck, sometimes in the field of a pubis or on a back. In development of a vulgar sikoz it is possible to allocate several stages. Originally on skin single superficial follikulita, spontaneously disappearing in several days are formed. After that there are deeper purulent defeats of a diskovidny form which merge among themselves, forming extensive chartreuse crusts. At their office on skin painful erosive surfaces decide on the long period of healing.
Furuncle – option of a deep stafilodermiya which feature is it is purulent - necrotic character of an inflammation. Most often it is formed on a face, a neck, shoulders, emergence of furuncles on a back and buttocks is sometimes possible. Duration of development of this form of a stafilodermiya makes about 14 days, process includes three stages. At first there is an expressed inflammatory infiltrate which is followed by reddening, morbidity, consolidation of skin in the field of defeat. Then formation of an abscess with a necrotic core in the middle begins, the size of abscess can reach 5 centimeters, temperature increase of a body and deterioration in the general condition of an organism is observed. The third stage of this form of a stafilodermiya (healing) is characterized by development of granulations and scarring. In certain cases multiple formation of furuncles which carries the name can take place – usually this process comes to light at the general weakening of an organism.
Anthrax – the kind of a stafilodermiya reminding a furuncle, but differing from it in defeat at once of several close located follicles with involvement of extensive volume of tissues of skin. Process is characterized by more expressed symptoms – infiltration can have a diameter of 10-20 centimeters, the size of abscesses makes 2-6 centimeters. After formation of the inflammatory center and abscess there is its softening to allocation of a large amount of pus and several necrotic cores. This form of a stafilodermiya is always followed by considerable deterioration in the general state (the increased temperature, a fever) and regionarny lymphadenitis.
Epidemic puzyrchatka of newborns – the stafilodermiya form striking only children in the first weeks of their life. Can be a consequence of a drift of stafilokokk from a genital tract of mother, an intrahospital infection, sometimes – primary immunodeficiency. A symptom of a puzyrchatka of newborns is development on a body of numerous papules with transparent contents. Quite often papules merge among themselves and can take almost all surface of a body of the child. After destruction of papules there is strongly erozirovanny surface of integuments.
Diagnostics and treatment of a stafilodermiya
In dermatology for definition of a stafilodermiya use methods of dermatological survey and a bacteriological research of pus, the supporting role is played by the general blood test. At survey the doctor can determine depth and the nature of pyoinflammatory defeat, and also its stage on the basis of what makes the decision on the nature of further treatment. The bacteriological research is based on crops purulent separated and further identification of the activator – first of all needs it for an exception of streptococcal piodermiya. Also within this research sensitivity of the activator of a stafilodermiya to antibiotics for further therapy can be defined. The general analyses can characterize weight of inflammatory process – in blood sharp increase in speed of subsidence of erythrocytes is found neytrofilny .
Treatment of the majority of forms of a superficial stafilodermiya, as a rule, local, is based on use of ointments with antibiotics, antiseptics and other antimicrobic means. At chronic types of a disease, such as vulgar , also apply ultra-violet radiation and other physiotherapeutic techniques. At deep forms of a stafilodermiya practically always appoint system antibiotics from group of macroleads or tetratsiklin – it becomes not only for the speedy recovery of the patient, but also for prevention of complications (metastatic spread of an infection or sepsis). When the stafilodermiya is caused by the general diseases (an immunodeficiency, diabetes), their therapy also makes the contribution to the speedy recovery.
Forecast and prevention of a stafilodermiya
The forecast of a stafilodermiya, especially its superficial forms, most often favorable – after permission of the pyoinflammatory center on skin does not remain traces. At deep forms of a disease formation of granulations, more or less noticeable hems is possible and it is long the existing infiltrates. Potentially any type of a stafilodermiya can lead to heavy complications, such as sepsis, purulent lymphadenitis, abscesses of internals that creates threat of human life. Extremely seldom at extensive defeats there is toxic shock caused by waste products of stafilokokk and disintegration of fabrics. Only in due time begun antibacterial therapy will help to avoid such manifestations. For prevention of a stafilodermiya it is necessary to maintain immunity up to standard, to keep purity of integuments, to process skin damages by antiseptics, to avoid use of someone else's razors, towels, basts.