Cutaneus Bacterial Infection

 PYODERMA  NON-PYODERMA
a. Staphylococcus aureus a. Corynebacterium spp.
- (+) coagulase !! - C. minuttisimun !
- phage II ! - C. tenuis
- phage II type 71 !!! b. Mycobacterium spp.
b. Streptococcus pyogenes  - M. leprae !!
beta haemolytic Strept. - M. tuberculosis !
- Group A Strept. !! - Atypical Mycobact.
- Group B Sterpt. c. Other bacteria
Gram (-): Ps. aeruginosa etc.
Gram (+): E’thrix insidiosa
Bacillus anthracis
 PYODERMA

 Purulent Skin Diseases

 Bacterial Infections on the skin
 Etiology: Pyogenes-cocci
 Yi.: - Staphylococcus aureus &
- Streptococcus beta haemolyticus
 Skin lesions :
Primary Skin Infections
Seccondary Skin Infections
(f.e.: insect bites + scratchs → pus formation)
 PYODERMA
a.Staphylococcus b.Streptococcus
aureus β hemolyticus
 Impetigo bulosa  Impetigo crustosa
(= Impetigo vesico-bulosa) (= I. contagiosa; Tillbury
 Impetigo neonatorum Fox Disease )
 Staph. Scalded Skin Syndr.  Ecthyma
(=Lyell’s Disease)
(=Ulcerative Impetigo)
 Folliculitis: Spf. & Prof.
 Erysipelas
( I. Bockhart & Sycosis barbae)
 Cellulitis
 Furuncles & carbuncle
 Phlegmon
 Paronychia
 Scarlet Fever
 Multiple Absceses of sweats
glands
 Hydradenitis suppurativa
 Impetigo & Ecthyma
 Superficial Skin Infections
 Etiology: Staphylococcus aureus
Streptococcus pyogenes ->
group A & B streptococcus beta hemolyticus.
 Process in epidermis: Impetigo
Process go in dermis: Ecthyma
 Lesions: erosion crust or ulcerasion crust
Impetigo & Ecthyma
 Clinical Classification :

1. Impetigo Crustosa
(Impetigo vulgaris; Impetigo contagiosa; Tillbury
Fox Disease; Impetigo krustosa)
2. Impetigo (Vesico-) Bulosa
3. Impetigo Neonatorum
4. Impetigo Bockhart
(Superficial Folliculitis)
5. Impetigo Ulcerativa
(Ecthyma; Ektima)
 Impetigo
(= Cacar Monyet )
 Contagious pyoderma
 High incidens in young Children ( balita )
 Predilection in d’face, especially surrounding
d’nose & mouth area ( Why ? )
 Initial lesions  small vesicles can easilly broken
 erythematous perifer  pustular + broken 
seropurulen exudate  yellow thick crust.
(Golden Yellow Crust)
Initial Infections  port d’ entrée in d’skin.
Primary infection on minor lesion of d’skin
Seccondary infection on d’affected skin
Pre Existing Dermatoses =
Process  Impetiginization
(= Impetiginisata )
Exp.: Scabies Impetiginisata
Dermatitis atopik
 Ecthyma (Ektima)
Sin: - Ulcerative Impetigo
 Pyoderma ulcerative
 Et./: Group A Streptococcus β haemolyticus
( GAS.)
 Predilection : Lower extrimitas  expose area
(Tungkai bawah )
 Predominant : regio os. Tibia & dorsum pedis
 Heal with several form of scars formation
Ecthyma
Ulcerative Impetigo
 CRUSTED IMPETIGO & ECTHYMA
Synonim
 Impetigo Vulgaris; Impetigo contagiosa;

Contagious Impetigo; Tillbury Fox

 Impetigo Ulserativa; Ulcerative Impetigo

Etiology
 Group A β haemolyticus Streptococcus
pyogenes (GAS)
 Group B Streptococcus β haemolyticus (GBS)
Clinical Manifestation
 Incidence commonly in children, no symptom
(as fever; malaise etc), often after Common
cold ( pilek)
 Patients look healthy → after insects bite,
Pedikulosis capitis & minor trauma etc.
 Initialy with skin lesions f.e.:
Dermatitis/eczema or Scabies →
seccondary infection (Impetiginized)
 Initial lesion macula erythematosus →
blister (vesikel/ bula) + yellow pus →
rupture  crust
Crusted Impetigo
Ecthyma
 Drying purulent exudates = Golden
Yellow Crust (=Honey Bee Crust)
 Crust form in d’ perifer of broken bula
with central healing: Polycyclic &
Circinate
 Erosion → Impetigo Crustosa

 Ulceration → Impetigo Ulserativa

(= Ecthyma)

Crusted Impetigo
Ecthyma
Crusted Impetigo
 Diferensiasi Impetigo Krustosa Ecthyma
Durasi Lesi hari – minggu minggu – bulan
Gejala Tak ada s/d pruritus sakit – lembut
Lesi Kulit
- Type Vesikel – pustula pecah + Ulcerasi + krusta tebal
- Warna erosi erat
- Ukuran & Golden Yellow Crusts Krusta hemorrhagik
bentuk Kecil, bulat/ oval Lebar, bulat/ oval
- Palpasi Nyeri ringan- kasar Tender & indurated
- Susunan Scattered (menyebar jauh) Soliter/ multipel
Discrete (menyebar dekat)
Confluent (lingkaran jadi 1)
Lesi satelit (khas pada
Distribusi
- candida)

Crusted Impetigo
Ecthyma
Distribusi Muka Pergelangan kaki, dorsal
Peri-oral/ nasal kaki, paha, gluteus, “daerah
mudah trauma”

D.D Perioral/ Dermatitis Ekskoriasi gigitan serangga

seborrheic Neurotic excoriation
Dermatitis kontak alergi Ulkus kaki kronik
Herpes Simplex Labialis

Crusted Impetigo
Ecthyma
Ektima EE
Krusta pd kulit luka
 IMPETIGO BULLOSA
Synonim
 Impetigo vesiko-bulosa, cacar monyet

 Impetigo Neonatorum ( in Neonatus )

Etiology
 Staphylococcus aureus (utama)
Clinical Manifestations
 Vesicles & bula + yellow exudate ( jernih –

keruh)
 Appear in normal skin  erytema +/-

 Bula tens/firm  flaccid+pus : Bula hipopion !

 Broken bula → gray-brownish crust or

hemorrhagic crusts: Collarete !

 Erytematous – Erosion - crust

 Predilection: face, upper/lower extrimitas,

intertrigenous site (lipatan kulit)

Impetigo Bullosa
 Impetigo Bulosa  generalized +
desquamation
 In neonatus or infant (=bayi)
 Impetigo Neonatorum
 Pre-school children (=balita) + infection of
Staph. aureus phage 2 type 71  Exfoliatin
(=exotoxin)
 Staphyloccocal Scalded Skin Syndrome
( S.S.S.S. = 4 S. )
Diagnosa
 Clinical finding

 Gram stain or culture M.O.

Differential Diagnosis
 Dermatitis kontak alergi

 Herpes simplex or Herpes Zoster

 Foliculitis bacterialis

 Combustio (luka bakar)

 Pemphigoid bullosa

 Dermatitis herpetiformis
Impetigo Bullosa
Manajemen
 Prevention:

Benzoyl peroxide wash (soap bar)

Kristal permanganas kalicus  + in d’
luke water for bathing (beri dosis
secukupnya, jangan mewarnai kulit)
 Th/ topical: cream/ointment mupirocin
efective  Staph.aureus, GAS & MRSA.

Impetigo Bullosa
 Th/ Sistemik:
 Erithromycin 250-500 mg q.i.d (10 D.s)
40 mg/kgBW/hari q.i.d (10 D.s)
 Cephalexin 250-500 mg q.i.d (10 D.)
40-50 mg/kgBW/D q.i.d (10 D.)
 Minocyclin 100 mg b.i.d (10 D.)
 Ciprofloxacin 500 mg b.i.d (7 D.)
 Tx/. safe for pregnant women: Penicillin
 With out injection: Ampicillin/ Amoxycillin
 If alergy to penicillin, Tx. eritromycin  p.c.
Contra-indication: Gastritis/Maag
Impetigo Bullosa
 FOLLICULITIS
Definition
 Pyoderma in hair folicles

 Characteristic with folicular papule,

pustul, erosion or crust in follicular
infundibulum (epidermis)
 Involved whole follicle structure (Dermis
& Subcutis)
 Etiology: Staphylococcus aureus
 Predisposing factors:
 Hair extraction (menarik & menggosok)
 Occlusion dressing (baju ketat) ►
clothing, adhesive plaster, body position etc.
 Shaving: beard/mustact, axilla & legs hair
 Intertriginous area ► axilla, infra mammary,
inguinal, anogenital etc
 Topical corticosteroid  skin immunity <<
 DM & immunosuppresion state (leukemia,
HIV)

Folliculitis
 Classifications :

1. Folliculitis superficialis :
Impetigo Bockhart

2. Folliculitis profunda :
Sycosis Barbae
Folliculitis
 Folliculitis Superficialis
(Impetigo Bockhart)

 Clinical feature :
Many papul erytematous superfisialis &
small pustul in hair follicles pore
Predilection: face, gluteus & limb)
Chronic condition can occur by frequent
shawing

Folliculitis
 Folliculitis Profunda
(Deep Folliculitis/ Sycosis)
 Clinical feature :
Confluent follicular pustules
Forming tender
Thick erythematous plaque in upper lip &
beard area ► Sycosis barbae (bilateral)
 DD/: Tinea barbae  unilateral + KOH 

Folliculitis
Sycosis barbae
 Management
Avoid & treat predisposing factor
Drainage pus & necrotic tissue
Antibiotic topical & systemic.

Folliculitis
 FURUNCLE & CARBUNCLE
 Definition :
= bisulan =
An acute, deep-seated, red, hot, tender
inflammatory nodule or absces of hair
follicle cause by Staph. aureus infection
Furunculosis : more than 1 furuncle.
Carbuncle : a group furuncles
 Predisposition factors
Chronic Staphylococcus carrier in
external orificium of nose, axilla or
anus (sekitar lubang Alam)
Diabetes, obesitas & poor hygiene

Furunkel & Karbunkel

 Clinical feature :
Red Nodule (merah) + tender
Diameter > 1-2 cm + central necrotic plug
Nodule  fluctuant + absces formation

central pustula
Ruptures absces  drainage pus & necrotic/
debris tissue
Multiple & confluent furuncles (Big Nodule) 
carbuncle  multiple follicular orifices 
drainage pus

Furunkel & Karbunkel

Furunculosis & Carbuncle
 Management
Use anti-bacterial soaps
Tx. Cream/ointment mupirocin
Closed compress (hot)  drainage
spontan (awal)
Incision abses & drainage pus.

Furunkel & Karbunkel

Systemic Antibiotic
 Dixcloxacillin 4 d.d 250-500 mg (10 D.)
 Amox-clav 20 mg/kg BW/d t.i.d (10 D)
 Cephalexin 40-50 mg/kgBW/D.
 Erythromisin 40 mg/kgBW/D q.i.d (10 D)
 Clarythromycin 250-500 mg b.i.d (10 D.)
 Azithromycin 250 mg q.i.d 5-7 D.
 Clindamycin 150-300 mg q.i.d (10 D.)

Furunkel & Karbunkel

 PARONYCHIA (PIONYCHIA)
 Definition:
Acute lateral-posterior nail fold
commonly due to Staphylococcal
infections and others
 Etiology:
Staphylococcus aureus
Streptococcus pyogenes
Pseudomonas aeruginosa
 Clinical Manifestations
Initially minor lesion or skin damage as
port d’entrée
Acute onset & painfull condition in d’nail
fold + pus
Oedema + erythema + pain surrounding
nail fold
Infection spread beneath d’nail bed 
sub-ungual abcess nail plate affected
 loose and distorted

Paronychia
 Management
Local compress with antiseptic solution
10-15 minutes
Drainage pus & clean debris + topical
antibiotic
Systemic antibiotic  7 D.s
Sub-ungual abscess  nail extraction

Paronychia
 ERYSIPELAS, CELLULITIS & PHLEGMON
 Definisi
Acute infection of d’skin with spreading
to dermis and subcutis.
Charakteristic: erythematous tender and
hot surrounding lesions, in d’side of
bacterial infection. (port de’ entre)
Main etiology: Streptococcus pyogenes &
others M.O. that’s can spread
systemically.
ERYSIPELAS
 Dermis & subcutan  upper layer

 Well demarcated border + lymphangitis

CELLULITIS
 Involved whole subcutaneus tissue + diffuse

 Infiltrate with raised + swollen area

PHLEGMON
 Cellulitis with suppuratif process & broken
swollen skin + oozing/pus
Erysipelas, Cellulitis,
Phlegmon
 Etiologi
Erysipelas:
Streptococcus β haemolyticus grup A
( GAS )
 Cellulitis:

Streptococcus pyogenes
(group B Streptococci – GBS),
S.aureus, H.influenzae  anak

Erysipelas, Cellulitis,
Phlegmon
Erysipelas
 Erysipelas, Cellulitis,
Phlegmon
 Pre-existing Dermatosis (1)
Trauma:
 Abrasion, laceration, prick/injection

 Bites: insects, animal/human

 Combustio.

Parasits Infestasion: scabies,

pediculosis capitis, phthriasis pubis
Pyoderma superfisial: impetigo,
folliculitis,furunculosis, ecthyma
 Erysipelas, Cellulitis,
Phlegmon

 Pre-existing Dermatosis (2)

Dermatophytosis: tinea pedis, tinea
corporis, tinea barbae.
Viral infection: herpes simplex,
varicella, herpes zoster.
Inflamatory dermatosis: dermatitis
atopik, dermatitis kontak, psoriasis,
dermatitis stasis.
Ulkus: pressure, venous insuficiency
chronic.
 Erysipelas, Cellulitis,
Phlegmon
 Clinical Manifestations
Pacient look ill + high fever, riggid,
vomite, apathis sometimes delirium
Erythema unilateral in d’infected area
(muka atau kaki)
Erythematous area spreading and warm,
oedematous plaque, in any size with well
demarcated border.
Oedema sometimes develop  bula and
erosion
Complication: nephritis dan septicaemia.
 Management
Patients with complications ►
MRS/Hospitalization.
Rest  lift d’leg if lesions on d’foot.
Locak compress + antiseptic solution (Rivanol +
Betadine)
Systemic antibiotic: deriv. penicillin (i.v) dan
erythromycin
Take care every skin lesions (port de’entre of
M.O.) with asepsis and antiseptic.

Erysipelas, Cellulitis,
Phlegmon
 ABSES MULTIPEL KELENJAR KERINGAT
 Definition
Infections of Eccrin sweat glans due to

Staphylococcus
Characterize with multiple abscess in

predilections area
 Etiology: Staphylococcus aureus
 Incidence: Common in infant/ young children
 Predilection  trunk, occipital & gluteus
 Erythematous deep seated infiltrated nodule 
small size pea-walnut
 Dome shape kuning di tengah (pusat nekrotik/

sumbatan)
 Always multiple, in group, soft → abcses 
pus kuning
 Follow with scarr formation, reccurent in

new area of d’skin

 Indolent – subcutaneus nodule (Hallmark);

khas

Abses Multipel
Kelenjar Keringat
Multiple Abcses of Sweat Glands
 DD/: Furunculosis
 Therapy
 Antibiotikc: topical & systemic

 Tx. Predisposing factors

 Take bath with luke water (Mandi dgn

air yg suhunya sama dgn suhu tubuh)

Abses Multipel
Kelenjar Keringat
 HIDRADENITIS SUPURATIVA
 Sinonim: apocrinitis, hidradenitis axillaris
 Definisi:
 Chronik, suppurative, + scars formation

in d’Apocrin sweats glands infections

in axilla, anogenital region & very rare
in head area.
 Epidemiology
 Ras: most common in black people

 Age: in puberty  young adult or

climacteric
 Sex: male in anogenital area & female in
axilla
 Herediter: Family history with severe
acne  nodulocytik &
hidradenitis suppurativa

Hidradenitis Supurativa
 Etiology
 Unknown, from lesions  main micro-

organisme patogen: Staphyloccus.

 Staph. aureus !!! & Strept. pyogenes

 E.coli, Proteus mirabilis, P.aeruginosa

 Predisposing factors
 Obesitas, hyperhidrosis, bad hygiene.

 Deodorant & hair depilitator

 Recurrent folliculitis  !?

Hidradenitis Supurativa
 Clinical Manifestations
 Intermitent fever + tender/painfull
nodules  abcseses
 Inflamation nodules + erythema  absces

 heal + fistel/ sinus  drainage 

purulen/ seropurulen
 Fibrosis, “bridge” scars, hypertropic scar
& keloidal formation.
 Black double open comedones !!!

Hidradenitis Supurativa
 DD/:
 Furuncle/ carbuncle.

 Lymphadenitis

 Scrophuloderma

 Lympho-granuloma venereum

 Actinomycosis

Hidradenitis Supurativa
 Therapy:
 Same as in Tx. multiple absces of
eccrin sweat glands.
 Systemic:

 Prednison/ Prednisolon oral

( commonly + antibiotic)
 Triamcinolon intra lesi

 Operative: Chronic & recidive cases.

Hidradenitis Supurativa
Chantal met Opa & Oma.
 NON-PYODERMA
 a. Corynebacterium
1. ERYTHRASMA: et/ Corynebact. Minutissimum
2. Tichomycosis axillaris/ pubes : et/ C. tenuis
3. Pitted keratolysis: et/ Corynebact spp.
Kytoccus sedentarius

 b. Mycobacterium
1. LEPRA (=Morbus Hansen): et/ M. leprae
2. Tuberculosis cutis: et/ M. tuberculosis
( Scrofuloderma; TBC cutis verrucosa dll.)
3. Atypical Mycobacterium Infection:
et/ M. marinum  Fish-tank/Swimming pool granuloma
M.scrofulaceum, M. fortuitum, M. chelonei, dll.

 c. Gram (+)/(-) bacteria

1. Erysipeloid: et/ Erysipelothrix rhusiopathiae
2. ANTHRAX: et/ Bacillus anthracis
3. Pseudomonas folliculitis: et/ Pseudomonas aeruginosa
4. Gram negatif folliculitis et/ Klebsiela, Enterobachter, Proteus.
 NON PYODERMA

ERYTHRASMA

 Definisi
 Chronic Bacterial Infections due to m.o.
Corynebacterium minitussismum
 Predilection: intertriginous area in web finger

of foot, regio inguinal & axilla, submammary.

 Lesion Macula erythematous (= Red Spot )
 Erythrasma

 Etiology
o Corynebacterium minitussismum

o Gram  bacillus (diphtheroid); flora

normal
o Produce coproporphyrin + Wood’s light
 coral-pink/Coral-red fluorescence
 Predisposing factors
o Obesity, hyperhidrosis, Diabetes

o Hot & humid climate

o Oclusive & thight dressing

o Maserasion
Eritrasma
 Clinical Manifestation
Asymptomatic or mild itchy

Well defined, brown discoloration

patch + fine, squamous, in d’
intertriginous area such as inguinal fold
, axilla & infra mamary fold (old
woman), sometimes spread to d’trunk
& extremity.
Toe/finger web of d’foot  scaling,

fissure & maserasion

Erythrasma
 Lab. Examinations
 Wood Lamp:  coral-red fluorescence
 Direct Microscopy:
* Prep. KOH  fungal form (-)
* Prep. Gram or Giemsa  fine bacterial
filaments
 Bacterial Culture
* Heavy growth Corynebacterium.
* Rules out Staph. Aureus, GAS & GBS, Candida
* Pseudomonas aeruginosa ( +/ - )
 Management
Prevention:
- Wash with Benzoyl Peroxide (bar)
Local & topical
o Imidazoles or sodium fucidate

o Benzoyl peroxide 2,5% gel 7 d’s.

o Erythromycin sol b.i.d 7 d’s

o Clindamycin sol b.i.d. 7 D’s

Systemic:
+ Erythromycin 250 mg q.i.d p.o 7 d’s.
+ Tetracyclin
Erythrasma
TRICHOMYCOSIS AXILLARIS/PUBES

 Definition
 Corynebacterium infection in axilla or

pubic hair. No fungus

 Etiology: Corynebacterium spp.

 gram (+) diphteroid
For-example: C.tenuis
 Trichomycosis Axillaris

 Clinical Manifestations
 Commonly found with out symptoms,
in young man with bad hygiene.
 We can find yellow materials attached
in d’hair axilla/pubes.
 Management
 Cut d’whole involved hairs

 Tx. Sol. 1% aqueous formalin or

Benzoat Acid compound
 Prevent form reccurency, wash affected
area every day with antiseptic soap.

Trichomycosis Axillaris
 PITTED KERATOLYSIS
 Definition
Defects in stratum corneum, which
thickly keratinzed skin in plantar pedis
with eroded PITS of variable depht,
especially in pedal hyperhydrosis.
Penyakit Kutu Air ( JKT )
Etiology: - Corynebacterium spp.
- Kytococcus sedentarius
KUTU AIR
 Pitted Keratolysis

Clinical Manifestations
Commonly asymtomatic, mild itchy,
sometimes burning & tenderness.
Pitteds  1-8 mm in str. corneum

Pitting lesions khas, confluent  erosion

area (sometimes wide; PRT)
White color in moist stratum corneum
Fully Hydrated
Distributions: in d’toe/fingger web of
d’foot & heel.
 Manajemen
 Wash with benzoyl peroxide soap (bar)

 Reduced sweats with powder 

Aluminium chlorida (Zeasorb)
Topikal - Prep.Benzoyl Peroxide gel
- Cream Erythromycin
 Intradermal botulinum toxin injection

 reduce hyperhydrosis

Pitted Keratolysis
Dank Uw well, oom en tante.