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DE-SP/0411/02
BACTERIAL SKIN INFECTIONS
DE-SP/0411/02
DE-SP/0411/02
■ Bacterial skin infections (Pyodermas)
Classification
Non – follicular pyodermas: Impetigo, ecthyma, erysip...
DE-SP/0411/02
BACTERIAL SKIN INFECTIONS
OR PYODERMAS
DE-SP/0411/02
PYODERMA: Types
PYODERMAPYODERMA
SECONDARY
(to underlying
disease)
PRIMARY
ScabiesScabies
Miliaria/Prickly h...
DE-SP/0411/02
PYODERMA:
Classification
5
DiffuseDiffuse
LocalisedLocalised
SuperficialSuperficial
PerifolliculitisPerifoll...
DE-SP/0411/02
PYODERMAS:
NON FOLLICULAR
DE-SP/0411/02
Impetigo
Risk factors3
■ Gram-positive bacterial infection of superficial epidermal layers1
■ Highly contagi...
DE-SP/0411/02
Non Bullous or
Impetigo contagiosa
Accounts for 70% cases of impetigo
Caused by S.aureus & S.pyogenes
Clinic...
DE-SP/0411/02
Bullous Impetigo
Caused by S.aureus
Clinical presentation
■ Commonly seen in infants
■ Appearance: Bullae wi...
DE-SP/0411/02
Ecthyma
Deeper variant of impetigo
Caused by S.aureus & S.pyogenes or
both
Diagnosis:
■ Predominant site: lo...
DE-SP/0411/02
Erysipelas
 Superficial streptococcal infection extending into cutaneous
lymphatics
CLINICAL PRESENTATION:
...
DE-SP/0411/02
Erysipelas12
Image courtesy: CDC/Dr. Thomas F. Sellers/Emory
University. Accessed from:
http://www.wrongdiag...
DE-SP/0411/02
Cellulitis
■ Deeper variant of erysipelas
involving the deeper
subcutaneous tissue.1
■ Predisposing factor: ...
DE-SP/0411/02
PYODERMAS - FOLLICULAR
DE-SP/0411/02
Superficial Folliculitis
■ Superficial bacterial infection
involving terminal part of hair follicle
■ Causes...
DE-SP/0411/02
Deep Folliculitis1,2
■ Deeper variant of folliculitis involving whole depth of hair follicle
■ Causative org...
DE-SP/0411/02
Furunculosis1,2
■ Deep seated follicular & perifollicular
infection culminating into necrosis
■ Causative or...
DE-SP/0411/02
Carbuncle1,2
■ Deep infection of contiguous hair
follicles
■ Causative organism: S.aureus.
Clinical presenta...
DE-SP/0411/02
TREATMENT OF BACTERIAL
SKIN INFECTIONS
DE-SP/0411/02
Bacterial skin
infections: Treatment1
■ Identification & elimination of predisposing factors like
immunosupp...
DE-SP/0411/02
Bacterial skin
infections: Treatment
■ Topical or oral antibiotic therapy is the treatment of choice
■ Local...
DE-SP/0411/02
Drug MOA Dose 1
Mupirocin Inhibits bacterial protein & RNA
synthesis, by inhibition of isoleucyl-
transfer R...
DE-SP/0411/02
Summary
■ Bacterial infections of the skin could occur de novo or may
secondarily infect pre-existing dermat...
DE-SP/0411/02
“Disclaimer
This educational initiative supported by GlaxoSmithKline Pharmaceuticals
Limited & prepared by R...
DE-SP/0411/02
Abbreviated prescribing
information – T Bact ointment
■ T-bact Ointment (Mupirocin)
Composition: Mupirocin 2...
DE-SP/0411/02
GlaxoSmithKline Pharmaceuticals Ltd Dr Annie Besant Road, Worli, Mumbai-30
For the use only of a Registered ...
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Superficial bacterial infection

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Superficial bacterial infection

  1. 1. DE-SP/0411/02 BACTERIAL SKIN INFECTIONS DE-SP/0411/02
  2. 2. DE-SP/0411/02 ■ Bacterial skin infections (Pyodermas) Classification Non – follicular pyodermas: Impetigo, ecthyma, erysipelas, cellulitis Follicular pyodermas: Folliculitis, furunculosis, carbuncle Treatment ■ Superficial Fungal skin infections Predisposing factors Dermatophytosis Anti-fungal drugs Pityriasis versicolor Cutaneous candidiasis 2 Overview
  3. 3. DE-SP/0411/02 BACTERIAL SKIN INFECTIONS OR PYODERMAS
  4. 4. DE-SP/0411/02 PYODERMA: Types PYODERMAPYODERMA SECONDARY (to underlying disease) PRIMARY ScabiesScabies Miliaria/Prickly heatMiliaria/Prickly heat Eczema/DermatitisEczema/Dermatitis Fungal infectionFungal infection PediculosisPediculosis 4 Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229.
  5. 5. DE-SP/0411/02 PYODERMA: Classification 5 DiffuseDiffuse LocalisedLocalised SuperficialSuperficial PerifolliculitisPerifolliculitis SuperficialSuperficial DeepDeep PYODERMAPYODERMA Non- FOLLICULAR FOLLICULAR Impetigo contagiosa Bullous Impetigo Ecthyma Erysipelas DeepDeep Cellulitis SuperficialSuperficial DeepDeep FolliculitisFolliculitis FuruncleFuruncle CarbuncleCarbuncle Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229.
  6. 6. DE-SP/0411/02 PYODERMAS: NON FOLLICULAR
  7. 7. DE-SP/0411/02 Impetigo Risk factors3 ■ Gram-positive bacterial infection of superficial epidermal layers1 ■ Highly contagious - Organisms often pass from one individual to another by direct hand contact 2 ■ Accounts for 10% of skin diseases treated in pediatric clinics in US2 Classification ■ Nonbullous impetigo (Impetigo contagiosa) ■ Bullous impetigo 7 hot, humid weather crowded living conditions poor hygiene immunosuppression  Nasal carriage of S. aureus: important factor in recurrent infections 1. Singh G.Bacterial Infections. In: Valia RG editor. IADVL Textbook and Atlas of Dermatology.3rd ed. India:Bhalani Publishing House;1994.p.223-251. 2. Available at http://emedicine.medscape.com/article/1052709-overview#a0199. Accessed on 21/04/11 3. Popovich D. Accurately Diagnosing Commonly Misdiagnosed Circular Rashes. Pediatr Nurs. 2007;33(4):315-320.
  8. 8. DE-SP/0411/02 Non Bullous or Impetigo contagiosa Accounts for 70% cases of impetigo Caused by S.aureus & S.pyogenes Clinical presentation ■ Commonly seen in children aged 2 to 5 years ■ Appearance: Multiple honey colored crusted lesions with a ring of erythema. ■ Site: Predominantly face (especially around mouth & nose) ■ Constitutional symptoms: fever, regional lymphadenopathy. Complications ■ Post streptococcal glomerulonephritis in patients infected with nephritogenic strains 8 Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229.
  9. 9. DE-SP/0411/02 Bullous Impetigo Caused by S.aureus Clinical presentation ■ Commonly seen in infants ■ Appearance: Bullae with turbid collection of fluid without a erythematous ring rupture to form thin crusts. Heal in centre to form annular lesions. ■ Predominant site - face but any part of body including mucous membranes may be involved. ■ Constitutional symptoms & lymphadenopathy : Rare Complications ■ Rare 9 Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229.
  10. 10. DE-SP/0411/02 Ecthyma Deeper variant of impetigo Caused by S.aureus & S.pyogenes or both Diagnosis: ■ Predominant site: lower limb, buttocks, legs, thighs ■ Appearance: small bulla or pustule on erythematous base  a crusted (often heaped up), indurated, tender plaque with erythematous ring, removal of adherent crust  irregular ulcer Heals with scarring 10 Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229.
  11. 11. DE-SP/0411/02 Erysipelas  Superficial streptococcal infection extending into cutaneous lymphatics CLINICAL PRESENTATION: ■ Predisposing factors: Recent streptococcal infection, HIV infection, diabetes, alcohol abuse, nephrotic syndrome, or preexisting lymphedema ■ Appearance: small erythematous, warm patch  indurated tense,shiny plaque with sharply demarcated margins, superficial vesiculation may occur. Rapidly spreads through lymphatics  skin "streaking," regional lymph node swelling, tenderness COMPLICATIONS ■ Recurrent infections may cause disfiguring & disabling healing reactions 11 Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229.
  12. 12. DE-SP/0411/02 Erysipelas12 Image courtesy: CDC/Dr. Thomas F. Sellers/Emory University. Accessed from: http://www.wrongdiagnosis.com/phil/html/erysipela s/2874.html
  13. 13. DE-SP/0411/02 Cellulitis ■ Deeper variant of erysipelas involving the deeper subcutaneous tissue.1 ■ Predisposing factor: occult diabetes2 ■ Lesions: are ill-defined with indistinct borders 13 1. Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229. 2.Singh G.Bacterial Infections. In: Valia RG editor. IADVL Textbook and Atlas of Dermatology.3rd ed. India:Bhalani Publishing House;1994.p.223-251.
  14. 14. DE-SP/0411/02 PYODERMAS - FOLLICULAR
  15. 15. DE-SP/0411/02 Superficial Folliculitis ■ Superficial bacterial infection involving terminal part of hair follicle ■ Causes: Infectious - S. aureus; Chemical - mineral, vegetable oils petrolatum (cosmetic or occupational exposure); Mechanical - post waxing, pseudo folliculitis in beard region. ■ Predominant sites: lower limb, post waxing on thighs or deltoid region, pseudofolliculitis -in beard area ■ Appearance: Dome shaped follicular pustules 15 Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229.
  16. 16. DE-SP/0411/02 Deep Folliculitis1,2 ■ Deeper variant of folliculitis involving whole depth of hair follicle ■ Causative organism: S.aureus Clinical presentation ■ Occurs commonly in males 20-40 years of age ■ Predominant sites: beard area (sycosis barbae) especially on upper lip & below angles of mouth, scalp & nape of neck (sycosis nuchae) ■ Appearance: Deep seated erythematous perifollicular papules & pustules. Lesion heals with scarring 16 1. Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229. 2.Singh G.Bacterial Infections. In: Valia RG editor. IADVL Textbook and Atlas of Dermatology.3rd ed. India:Bhalani Publishing House;1994.p.223-251.
  17. 17. DE-SP/0411/02 Furunculosis1,2 ■ Deep seated follicular & perifollicular infection culminating into necrosis ■ Causative organism: S.aureus. Clinical presentation: ■ Occurs in healthy adolescents or adults ■ Predisposing factors: diabetes, steroids ■ Predominant sites: face, axillae, buttocks, perineal region ■ Appearance : 1-2 tender, firm painful red follicular nodules  become necrotic discharge central core. Heal with barely perceptible scarring. ■ Constitutional symptoms: fever, lymphadenopathy 17 1. Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229. 2.Singh G.Bacterial Infections. In: Valia RG editor. IADVL Textbook and Atlas of Dermatology.3rd ed. India:Bhalani Publishing House;1994.p.223-251.
  18. 18. DE-SP/0411/02 Carbuncle1,2 ■ Deep infection of contiguous hair follicles ■ Causative organism: S.aureus. Clinical presentation: ■ Occurs mostly in adults with diabetes or on steroid therapy ■ Predominant site: back ■ Appearance : Tender, indurated, lobulated, intensely erythematous plaque discharging pus from many openings. ■ Constitutional symptoms: fever, invariable. ■ Diagnosis: pus culture sensitivity 18 1. Khanna N. Infections. In: Khanna N editor. Illustrated synopsis of dermatology & sexually transmitted diseases. 1st edition. Peepee publications, Delhi;2006.p.188-229. 2.Singh G.Bacterial Infections. In: Valia RG editor. IADVL Textbook and Atlas of Dermatology.3rd ed. India:Bhalani Publishing House;1994.p.223-251.
  19. 19. DE-SP/0411/02 TREATMENT OF BACTERIAL SKIN INFECTIONS
  20. 20. DE-SP/0411/02 Bacterial skin infections: Treatment1 ■ Identification & elimination of predisposing factors like immunosuppresion, malnutrition, diabetes ■ Local hygiene is important & should be maintained Encourage hand washing2 ■ Supportive measures Removal of crusts Hot fomentation Incision & drainage Rest & limb elevation Concomitant use of oral or topical anti inflammatory creams to relieve pain & inflammation 20 1. Singh G.Bacterial Infections. In: Valia RG editor. IADVL Textbook and Atlas of Dermatology.3rd ed. India:Bhalani Publishing House;1994.p.223-251. 2. . Popovich D. Accurately Diagnosing Commonly Misdiagnosed Circular Rashes. Pediatr Nurs. 2007;33(4):315-320.
  21. 21. DE-SP/0411/02 Bacterial skin infections: Treatment ■ Topical or oral antibiotic therapy is the treatment of choice ■ Localized areas are treated with antibacterial applications having a gram positive spectrum such as: 2% Mupirocin cream or ointment, applied 2-3 times a day 2% Sodium fusidate or fusidic acid cream /ointment, 3-4 times a day 1% Nadifloxacin cream ■ Role of oral antibiotics When widespread or deep infection is present or If localized lesions do not improve with topical medication Penicillinase-stable penicillins like cloxacillin, dicloxacillin are effective including erythromycin, azithromycin, cephalosporins 21 Popovich D. Accurately Diagnosing Commonly Misdiagnosed Circular Rashes. Pediatr Nurs. 2007;33(4):315-320.
  22. 22. DE-SP/0411/02 Drug MOA Dose 1 Mupirocin Inhibits bacterial protein & RNA synthesis, by inhibition of isoleucyl- transfer RNA synthetase2 Primary: apply 2% ointment topically 3 times a day for 3-5 days Secondary: 3 times for 10days Fusidic acid Interferes with amino acid transfer (translocase enzyme) inhibiting bacterial protein synthesis3 Apply 3-4 times daily to the affected part of the skin for a period of 7 days 4 Nadifloxacin (fluroquinolo ne) Inhibits DNA gyrase (required for DNA synthesis & replication), thus inhibits bacterial multiplication5 Apply 1% cream twice daily for one to two weeks Topical Antibacterial Antibiotics 22 1. Micromedex, Drugdex Evaluations, {Mupirocin (November 12, 2010), Nadifloxacin (February 09, 2007), Accessed on April 15, 2011. 2. Ward, Alan et al.Mupirocin: A Review of Its Antibacterial Activity, Pharmacokinetic Properties & Therapeutic Use. Drugs. 1986;32(5):425-444 3. Verbist L. The antimicrobial activity of fusidic acid. J Antimicrob Chemother. 1990 Feb;25 Suppl B:1-5. 4. Fusidin cream Prescribing information. Available at http://www.mims.com. Accessed on April 15,2011. 5. David CH. Mechanisms of Action & Resistance of Older & Newer Fluoroquinolones. Clinical Infectious Diseases 2000;31(Suppl 2):S24–8.
  23. 23. DE-SP/0411/02 Summary ■ Bacterial infections of the skin could occur de novo or may secondarily infect pre-existing dermatoses ■ Commonly seen in pediatric population and adolescents but can affect all age groups ■ Common pathogens implicated are gram positive cocci (staphylococcus aureus & streptococci) ■ Clinical presentation varies with the site & depth of involvement ■ Treatment is with topical antibacterial agents; systemic antibiotics added for extensive infections, deep seated infections & for infections not improving with topical antibacterial agents 23
  24. 24. DE-SP/0411/02 “Disclaimer This educational initiative supported by GlaxoSmithKline Pharmaceuticals Limited & prepared by Rayz Healthcare Consultancy (lead consultant - Dr. Gulrez Tyebkhan) is meant strictly & solely for presentations amongst Registered Medical Practitioners in India. Although great care has been taken in compiling & checking the information, the sponsor GlaxoSmithKline Pharmaceuticals Limited shall not be held responsible or liable for errors, omissions or inaccuracies in this Slide Deck, whether arising from negligence or otherwise, nor for consequences arising therefrom.” 24
  25. 25. DE-SP/0411/02 Abbreviated prescribing information – T Bact ointment ■ T-bact Ointment (Mupirocin) Composition: Mupirocin 2% w/w in a white, translucent water soluble polyethylene glycol base. Indications: For the topical treatment of primary skin infections such as impetigo, folliculitis, furunculosis and ecthyma and secondary bacterial skin infections such as infected dermatosis (e.g., infected eczema), infected traumatic lesions (e.g., abrasions, insect bites, minor wounds and minor burns). For prophylaxis: May be used to avoid bacterial contamination of small wounds, incisions and other clean lesions, and to prevent infection of abrasions and small cuts and wounds. Dosage and administration: Adults, children, elderly and hepatic impairment: 2-3 times a day for up to 10 days, depending on the response. Contraindications: Known hypersensitivity to any of its constituents. Warnings and precautions: Avoid contact with eyes, or use in conjunction with cannulae. If contaminated, the eyes should be thoroughly irrigated with water until the ointment residues have been removed. Do not use intranasally. Do not use in conditions where absorption of large quantities of polyethylene glycol is possible, especially if there is evidence of moderate or severe renal impairment. Interactions: No drug interactions have been reported. Pregnancy and lactation: Adequate human data on use during pregnancy and lactation are not available. However, animal studies have not identified any risk to pregnancy or embryo-foetal development. If a cracked nipple is to be treated, it should be thoroughly washed prior to breast feeding. Use in pregnancy or nursing mothers only when potential benefits outweigh potential risks. Undesirable effects: Burning, itching, erythema, stinging and dryness localised to the area of application, cutaneous sensitisation reactions and very rarely systemic allergic reactions. Version: TBTO/API/IN/2004/006AOC v01 dated 26-Nov- 08. Adapted from Indian Prescribing Information Version 006 / IND 04. 25
  26. 26. DE-SP/0411/02 GlaxoSmithKline Pharmaceuticals Ltd Dr Annie Besant Road, Worli, Mumbai-30 For the use only of a Registered Medical Practitioner DE-SP/0411/02

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