1. Common
Bacterial Infection of
Skin
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

2. The Skin
Skin is largest organ of body.
Maintains homeostasis, protects
underlying tissues and organs,
protects body from mechanical
injury, damaging substances, and
ultraviolet rays of sun.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

3. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

4. Broken skin allows Bacteria to enter
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

5. Unbroken skin prevents entrance of bacteria.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

6. Normal Skin Flora
Major bacterial groups
Coryneforms (Gram +ve)
Staphylococci (Gram +ve cocci, aerobs)
Minor bacterial groups
Acinetobacter (25%) Gram –ve Bacilli
Micrococcus
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

7. Bacterial Infection of Skin:
1. Folliculitis
Folliculitis is a localized infection of one hair
follicle.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

8. Bacterial folliculitis
•Local antiseptics
•Cloxacilline 500 mg
4x/d for 10 days
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

9. folliculitis
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

10. Folliculits
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

11. Management of folliculitis
Avoid greasy applications on the
skin.
Antibiotic: topically can be used.
Systemic antibiotics: - Cloxacillin
or erythromycin (Cefadox) is
choices of treatment.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

12. Folliculitis
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

13. Superficial folliculitis
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

14. Deep folliculitis
Chronic
Staph. Aureus
Hair follicles of leg: Common
Multiple
Atrophic scar
May become chronic especially
in beard area (sycosis barbae)
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

15. 2. Furuncle/Boils
A furuncle is an infection deep within the hair
follicle.
A furuncle or boil is an acute round,
tender, circumscribed, perifollicular
staphylococcal inflammation, which
generally tends to suppurate.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

16. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

17. Boils/ Furuncle
Boils (also called furuncles) are a deep infection of hair follicles.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

18. Furuncle (Boil)
Acute
Staph. Aureus
Small, follicular nodular-Pustule-necrotic-
discharge pus
Heal with scar formation
Neck, Wrist, Waist, Buttocks, Face
Painful
Complication
Thrombosis
Septicemia (esp. on malnutrition patients)
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

19. Treatment: General measures
Preventive measures are very important especially
to prevent recurrence of infection from nasal foci,
autoinoculation, from peri-anal areas.
Avoid squeezing, irritation and trauma to the lesions.
Treatment of the colonized areas and the primary focus
as in nostrils.
Topical antibacterial cream such as Muperacin cream
which when applied twice daily in the nostril for one
week will eradicate colonized micro-organism for 6
months.
Using a suitable anti septic soap may have some good
effect.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

20. 3. Carbuncle
A carbuncle is an infection involving
subcutaneous tissue around several hair
follicles.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

21. Carbuncle
Extensive infection of a group of
contagious follicles
Staph. Aureus
Middle or old age
Predisposing factors
Diabetes
Malnutuition
Severe generalized dermatoses
During prolonged steroid therapy
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

22. Carbuncle
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

23. Carbuncle
Painful
Suppuration begins after 5-7 days
Pus discharge from multiple follicular
orificies
Necrosis of intervening skin
Large deep ulcer
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

24. 4. Impetigo:
Superficial skin infection
.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

25. Impetigo is a bacterial skin infection.
It is often called school sores
because, it most often affects
children.
It is quite contagious.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

26. Impetigo Vesiculopustular skin
infection.
Bacterial:
staphylococcus or
streptococcus
Spread w/ direct contact
w/ lesions
Thick, yellow crust
(commonly on the face)
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

27. Impetigo
S/S
- one or more pimple-like
lesions surrounded by
reddened skin
- lesions fill w/ pus and
later form a thick crust
- itching
Inv. : Swab for C/S
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

28. Impetigo
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

29. Mx:
Remove crust
Localized:Topical Antibiotic
Severe: Systemic antibiotics:
Semisynthetic Penicillin : 7-10 d
Erythromycine (sensitive)
Augmentin (face)
Cephalosporin
Great care with personal hygiene and possible
isolation.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

30. Impetigo
•Local antiseptics
•Cloxacilline 500 mg
4x/d for 10 days
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

31. 4.1. Non-bullous impetigo
Superficial (intraepidermal)
Initially vesicular, then becomes
crusted
S. pyogenes (90%); also S. aureus
Mainly children; highly
communicable
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

32. Nonbullous impetigo
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

33. 4.2. Bullous impetigo
Mainly newborn and younger
children
About 10% of all cases of impetigo
Caused by S. aureus of phage
group II
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

34. Bullous impetigo
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

35. Predisposing factors
Malnutrition
Diabetes
Immuno-compromise status
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

36. Impetigo: Management
Local management for small lesions: -
Wash with betadine solution or saline.
Potassium permanganate 1 in 1000
solution soaking twice a day until the pus
exudates dry up.
Gentian violet (GV) paint 0.5% apply BID.
Topical antibiotics can be used, such as
2% mupirocin, Gentamycine, Fucidic acid
can be used but costly.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

37. Oral amoxacyllin or Ampicillin can also be
used.
For Bullous impetigo: - cloxacillin 500 mg po
QID for 7 to 10 days. In cases, with an allergy
to penicillin, erythromycin can be given.
The underlining skin conditions such as
eczemas, scabies, fungal infection, or
pediculosis should be treated.
When impetigo is neglected it becomes
ecthyma, a superficial infection which involves
the upper dermis which may heal forming a
scar.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

38. 5. Periporitis
Miliary papules and papulovesicles with
staphylococcic infection.
Pustular lesions.
The commonest sites involved are the buttocks,
upper part of the trunk and the scalp.
The lesion affects mainly malnourished infants and
young children.
Skin lesions may progress to sweat gland
abscesses.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

39. Rx
Treatment is directed towards improving the
nutrition and general condition.
Preventing sweat retention by aeration.
Appropriate topical antibiotic may be enough
to control periporitis.
Oral antibiotics may be needed, especially
when there are multiple abscesses.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

40. 6. Ecthyma
Formation of adherent dry crusts,
beneath which ulcer present
Strptococcal & staph
Common in children
Small bullae or pustules
Butocks, thighs and legs, commonly
affected
Heals with scar and pigementation
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

41. Ecthyma
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

42. 7. Sycosis Barbae
Pustules surrounded by erythema
in Beard region
Common in Males
After puberty
After traumas
Upper lip and chin
Staph. auraus common
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

43. Sycosis barbae
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

44. 8. Cellulitis
Acute / Sub-acute / Chronic
inflammation of loose connective tissue
Streptococcal (Group A), Staphylococci
and rarely clostridia.
Erythematous & oedematous swelling
Pain/tenderness
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

45. Cellulitis
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

46. Cellulitis
An acute spreading infection
involving the dermis
Spread: tissue damage,
lowered body defenses, or
virulence of invading organism.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

47. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

48. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

49. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

50. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

51. Cellulitis
Red, painful, hot, swollen skin area with ill-
defined borders.
Deeper involvement of the Subcutaneous
Raised, hot, tender, erythematous
Source: Cut , abrasion or ulcer
Palpable, tender LN
Fever, leucocytosis
Differential Diagnosis: DVT
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

52. DR. Ram Sharan Mehta, MSND,
CON, BPKIHS

53. Mx
Cold application: to relief local discomfort
Analgesic to relief pain
Treat the fever and pain and elevate the
affected part.
Crystalline penicillin or procaine penicillin is
the first line therapy and oral Ampicillin or
Amoxicillin may be used for mild infection
and after the acute phase resolves.
Appropriate Antibiotic, according to culture:
Erythromycin, Augmentin.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

54. 9. ERYSIPELAS
Superficial Cellulitis caused by group A β-hemolytic
streptococcus.
Usually begins on the face or a lower extremity
Having pain, superficial erythema, and plaque-like
edema with a sharply defined margin to normal
tissue
Fever may precede local signs
Boarder easily palpable
Early Stage of Cellulitis?
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

55. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

56. Erysipelas is a type of
cellulites involving mainly the
dermis; other forms of
cellulites extend to the
subcutaneous tissues.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

57. Erysipelas
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

58. Erysipelas
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

59. 10. Pyonychia
Acute Erythmatous swelling of
proximal and lateral nail fold
Painful
Rx: Drain Pus,
Antibiotic,
Analgesic
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

60. Pyonychia
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

61. Pyonychia
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

62. 11. Staphylococcal scalded skin syndrome
(Ritter’s disease)
A severe reaction to S. aureus strains
producing toxins
Large, flaccid bullae rupture, causing
same effect as a third-degree burn
Scald – tender red skin
Denuded skin (necked skin)
Heals 7-14 day
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

63. DR. Ram Sharan Mehta, MSND, CON, BPKIHS

64. Staphylococcal scalded-skin syndrome
DR. Ram Sharan Mehta, MSND, CON,
BPKIHS

65. Complication 2%
Cellulitis
Pneumonia
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

66. 12. Erysipeloid
It is bacterial infection seen in people who handle
raw meat (especially pork) and Fish.
Organism get entry through breaks in the skin.
Common on fingers, hand or forearms.
No systemic symptoms
The main symptom is warmth, tenderness, and
redness on the skin.
Rx: Penicilline-V or Oxytetracycline 500 mg QID
7-10 days
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

67. 13. Principles of therapy of
pyoderma
Good personla hygiene
Local therapy
Cleaning with soap-water and weak
KMN04 solution
Removal of crusts with KMN04 solution
Application of antibacterial cream
Systemic therapy
Antibiotics
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

68. Management of predisposing factors
Local
Attend to traumas, pressure
Treat pre-existing dermatosis
Investigate carrier sites
Systemic
Treatment of disease like DM,
Nutritional deficiency and
immunodeficiency
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

69. 14. Common Diagnostic Tests
for Integumentary Disorders
Biopsy.
Patch Testing: Allergy test
Tzanck smear: detect type of cells in Chicken Pox,
H. simplex, H. Zoster, Bullous diseases
Skin scrapings.
Culture and sensitivity.
Diascopy: visualization by special microscope
Wood’s light examination: Use of U.V. rays
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

70. 15
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

71. 16. Prevention and control of
Bacterial skin diseases
Personal hygiene is the most effective
methods for prevention and control of
bacterial infections.
The following points illustrate the possible
preventive methods for bacterial skin infections:
Washing of hands with warm water and soap
before touching broken skin.
Washing the body with warm water and soap
preferably everyday to remove dust and dirt.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

72. Prevention and control of Bacterial skin
diseases…………………
Wearing the right size and type of clothes to
suit local weather conditions.
After washing clothes, if possible, iron it
before wearing
Regular exposure of the skin to air and
sunlight is beneficial.
It is also important to clear the bacteria
colonizing the nostrils and under the
fingernails with either antibiotic ointment or
petroleum jelly several times daily for one
week of eachMSND, CON, BPKIHS
DR. Ram Sharan Mehta,
month.

73. Methods of Preventing Long
Term Skin Damage
Avoid sun
Avoid midday sun
Use photo-protective clothing,
hats etc
Use sunblocks
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

74. 17. Practice in BPKIHS: Derma OPD
COMMON BACTERIAL INFECTIONS
ARE:
Periporitis
Impetigo (Non-bullous common)
Absces
Cellulitis
Folliculitis
STIs
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

75. Rx Prescribe:
1. Antibiotics:
a. Topical: Mupirocin, Fucidic acid
b. Oral: Cefadox, Cloxacyline
2. Personal hygiene teaching
3. Symptomatic management
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

76. Summary: Common Bacterial Infections
1. Folliculitis: Localized infection of one hair follicles.
2. Furnicle/Boil: Deep hair follicle infection.
3. Carbuncle: Several hair follicle infection.
4. Impetigo: superficial skin infection.
5. Periporitis: Millary and papulovesicles infection.
6. Ecthyma: Formation of adherent dry crusts.
7. Sycosis Barbae: Pustules in beard region.
8. Cellulitis: Loose connective tissue infection.
9. Erysipelas: Superficial cutaneous cellulitis.
10. Pyonochia: Swelling of nail fold.
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

77. 11. Staphylococcal Scalded Skin Syndrome:
RT exfoliative toxins.
12. Erysipeloid : Bacterial infection among
meat handlers.
13. Principles of therapy of pyoderma.
14. Common diagnostic tests for derma
disorders.
15. Common antibiotic used in skin disorders
16.Prevention and control of Bacterial skin
infection.
17. Practices in BPKIHS derma OPD
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

78. Thank you
DR. Ram Sharan Mehta, MSND, CON, BPKIHS

79. MACROSCOPIC TERMS
Macule: Circumscribed lesion of up to 5 mm in diameter characterized by
flatness and usually discolored (often red)
Patch: Circumscribed lesion of more than 5 mm in diameter characterized by
flatness and usually discolored (often red)
Papule: Elevated dome-shaped or flat-topped lesion 5 mm or less across.
Nodule: Elevated lesion with spherical contour greater than 5 mm across.
Plaque: Elevated flat-topped lesion, usually greater than 5 mm across (may be
caused by coalescent papules).
Vesicle: Fluid-filled raised lesion 5 mm or less across.
Bulla: Fluid-filled raised lesion greater than 5 mm across.
Blister: Common term used for vesicle or bulla.
Pustule: Discrete, pus-filled, raised lesion.
Wheal: Itchy, transient, elevated lesion with variable blanching and erythema
formed as the result of dermal edema.
Scale: Dry, horny, platelike excrescence; usually the result of imperfect
cornification (i.e., keratinization).
Lichenification: Thickened and rough skin characterized by prominent skin
markings; usually the result of repeated rubbing in susceptible persons.
Excoriation: Traumatic lesion characterized by breakage of the epidermis,
causing DR. Ramlinear Mehta, MSND,a deep scratch)
a raw Sharan area (i.e., CON, BPKIHS
Onycholysis: Separation of nail plate from nail bed.

80. MICROSCOPIC TERMS (histologic)
Hyperkeratosis: Thickening of the stratum corneum, often associated with a qualitative
abnormality of the keratin.
Parakeratosis: Modes of keratinization characterized by the retention of the nuclei in
the stratum corneum. On mucous membranes, parakeratosis is normal.
Hypergranulosis: Hyperplasia of the stratum granulosum, often due to intense rubbing.
Acanthosis: Diffuse epidermal hyperplasia.
Papillomatosis: Surface elevation caused by hyperplasia and enlargement of
contiguous dermal papillae.
Dyskeratosis: Abnormal keratinization occurring prematurely within individual cells or
groups of cells below the stratum granulosum. Generally the same as DYSPLASIA.
Acantholysis: Loss of intercellular connections resulting in loss of cohesion between
keratinocytes.
Spongiosis: Intercellular edema of the epidermis.
Hydropic swelling (ballooning): Intracellular edema of keratinocytes.
Exocytosis: Infiltration of the epidermis by inflammatory or circulating blood cells.
Erosion: Discontinuity of the skin exhibiting incomplete loss of the epidermis.
Ulceration: Discontinuity of the skin exhibiting complete loss of the epidermis and often
of portions of the dermis and even subcutaneous fat.
Vacuolization: Formation of vacuoles within or adjacent to cells; often refers to basal
cell-basement membrane zone area.
Lentiginous: Referring to a linear pattern of melanocyte proliferation within the
epidermal basal cell layer. Lentiginous melanocytic hyperplasia can occur as a reactive
change or as part of a neoplasm ofCON, BPKIHS
DR. Ram Sharan Mehta, MSND,
melanocytes.