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Pustular lesions

Clinical methods & Therapeutics

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Pustular lesions

  1. 1. Pustular lesion By Dr. Laraib Jameel Rph Find me on slideshare.net https://www.slideshare.net/
  2. 2. Carbuncles • Definition: A carbuncle is a cluster of boils that have multiple pus “heads.” They’re tender and painful, and cause a severe infection which could leave a scar. • A carbuncle is also called a staph skin infection. • Boils: A boil, also called a furuncle, begins as a painful infection of a single hair follicle. Boils can grow to be larger than a golf ball. • So carbuncle is multiple fruncle.
  3. 3. Carbuncles
  4. 4. • A hair follicle is a part of the skin, which grows a hair by packing old cells together. Attached inside the top of the follicle are sebaceous glands, which are tiny sebum- producing glands in almost all skin except on the palms, lips and soles of the feet. The thicker the hair, the more the number of sebaceous glands there are.
  5. 5. • Causes: A carbuncle usually develops when Staphylococcus aureus bacteria enter your hair follicles. These bacteria are also referred to as “staph.” • Entrance/Portal site: Scrapes, an insect bite and other broken skin make it easy for bacteria to enter your body and cause an infection. This can result in boils or carbuncles (a cluster of boils) filled with fluid and pus. • Location: Carbuncles are usually found on the back of the neck, shoulders, or thigh. They can also appear on your face, armpits, or buttocks; or any area you sweat or experience friction. • Favourite environment of staphs: The moist parts of your body are particularly susceptible to this infection because bacteria thrive in these areas where you sweat or experience friction. • Synonym/ Alternative names: Staph skin infection, Carbunculosis
  6. 6. • Risk factors: Being in close contact with someone who has a carbuncle increases your chances of developing one. (Because the infection can spread when people share space, materials, or devices, such as clothing and whirlpool footbaths.) • The following factors also increase the risk of developing a carbuncle: • poor hygiene • Diabetes (High levels of blood sugar, or glucose, can reduce the immune system's ability to respond to infection.) • a weak immune system • Skin conditions: Psoriasis, eczema, and acne increase susceptibility. • kidney disease (renal carbuncle)- metastasis • Medications: Some medications weaken the immune system. (organ transplant rejection) • shaving and other activities that break the skin • Men get carbuncles more often than women. (Overcrowded ,unhygienic living conditions, scraps on face during shave)
  7. 7. • Symptoms: • Symptoms of boils: Boils can occur anywhere on your skin, but hair-bearing areas where you're most likely to sweat or experience friction. So it appear mainly on the face, back of the neck, armpits, thighs and buttocks. • So sign & symptoms of boils include: • A painful, red bump that starts out small and can enlarge to more than 2 inches (5 centimeters) • Red, swollen skin around the bump • An increase in the size of the bump over a few days as it fills with pus • Development of a yellow-white tip that eventually ruptures and allows the pus to drain out.
  8. 8. • Symptoms of carbuncles: • A carbuncle is a swollen lump or mass under the skin. • It may be the size of a pea or as large as a golf ball. • Color: the carbuncle may be red and irritated and might hurt when you touch it. • A carbuncle usually: • Develops over several days • Have a white or yellow center (contains pus) • Weep, ooze, or crust • Spread to other skin areas • Sometimes, other symptoms may occur. • These may include: • Fatigue • Fever • General discomfort or sick feeling • Skin itching before the carbuncle develops
  9. 9. • Exams and Tests • The health care provider will look at your skin. The diagnosis is based on what the skin looks like. • If u don’t get better from standard treatment, A sample of the pus may be sent to a lab to determine the bacteria causing the infection (bacterial culture). The test result helps your provider determine the appropriate treatment. • Treatment: • Antibiotics. Sometimes your doctor may prescribe antibiotics to help heal severe or recurrent infections. • For larger boils and carbuncles, treatment may include: • Incision and drainage. Your doctor may drain a large boil or carbuncle by making an incision in it. Deep infections that can't be completely drained may be packed with sterile gauze to help soak up and remove additional pus.
  10. 10. • Lifestyle and home remedies • For small boils, these measures may help the infection heal more quickly and prevent it from spreading: • Warm compresses. Apply a warm washcloth or compress to the affected area several times a day, for about 10 minutes each time. This helps the boil rupture and drain more quickly. • Never squeeze or lance a boil yourself. This can spread the infection. • Prevent contamination. Wash your hands thoroughly after treating a boil. Also, launder clothing, towels or compresses that have touched the infected area, especially if you have recurrent infections.
  11. 11. • Complications • Rarely, bacteria from a boil or carbuncle can enter your bloodstream and travel to other parts of your body. The spreading infection, commonly known as blood poisoning (sepsis), can lead to infections deep within your body, such as your heart (endocarditis) and bone (osteomyelitis). • Preventions: • Wash your hands regularly with mild soap. Or use an alcohol-based hand rub often. Careful hand-washing is your best defense against germs. • Keep wounds covered. Keep cuts and abrasions clean and covered with sterile, dry bandages until they heal. • Avoid sharing personal items. Don't share towels, sheets, razors, clothing, athletic equipment and other personal items because Staph infections can spread via objects, as well as from person to person. If you have a cut or sore, wash your towels and linens using detergent and hot water with added bleach, and dry them in a hot dryer.
  12. 12. Furuncle/Boils • Definition: furuncle, begins as a painful infection of a single hair follicle. • Furuncles/Boils can grow to be larger than a golf ball, and they commonly occur on the buttocks, face, neck, armpits and groin.
  13. 13. Comparison b/w carbuncle & furuncle. Furuncle • begins as a painful infection of a single hair follicle. • Also known as boil • Not as deeper as carbuncles. • Furuncles, or boils, are skin abscesses that result from staphylococcal infection. They affect a hair follicle and surrounding tissue. • Symptoms: Furuncles develop rapidly as pink or red bumps. They are often painful. The surrounding skin is typically red, inflamed and tender. • Its infection is not so deeper. • Not so • Not so as Furuncles may go away without any intervention. Sometimes they burst and heal without a scar within 2 days to 3 weeks. Carbuncle • It involves a group of infected hair follicles in one skin location. • Also known as cluster of boils. • is a deeper skin infection because it involves a group of infected hair follicles in one skin location. • Carbuncles are groups of furuncles that join together under the skin. They affect the deeper layers, and they can lead to scarring. • Symptoms: A carbuncle is less common than a furuncle, or boil. It is a collection of boils on one site. It is larger than a single boil, measuring up to 4 inches across. A carbuncle usually has one or more openings that drain pus onto the skin. • Carbuncle infections tend to be deeper and more severe than those caused by furuncle • The infection may lead to generalized body symptoms, including a fever of 100.4 degrees Fahrenheit or higher, and a general feeling of being unwell, weak, and exhausted. • The risk of scarring is higher, and they take longer to develop and to resolve than furuncles.
  14. 14. Similarities between carbuncles & furuncles • starts as a red lump. • The most common cause of a carbuncle & furuncle is a bacterium known as Staphylococcus aureus (S. aureus). • Furuncles and carbuncles typically affect the thighs, armpits, buttocks, face, and neck. • risk of developing furuncles and carbuncle are same (diabetes, poor immune system etc). • They affect males more frequently than females, and especially older men with poor health or a weakened immune system. • Both condition shares same treatment, some times furuncles go away on its own without any intervention. Initial appearance Cause Location Risk factors Susceptibility Home remedies & Treatment
  15. 15. Cancrum/Phagedena • Definition: is a rapidly spreading gangrenous stomatitis which occurs chiefly in debilitated (weakness) or malnourished children, destroying the soft and hard tissue structures. • Or it is gangrenous infection of the mouth and face. • By WHO: it is categorized by the World Health Organization (WHO) as a necrotizing ulcerative stomatitis. • Synonyms: Cancrum oris or noma or fusospirochetal gangrene. • Gangrene is a condition that occurs when body tissue dies. It is caused by a loss of blood supply due to an underlying illness, injury, and/or infection. • Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration
  16. 16. Noma/ cancrum oris
  17. 17. • Anatomicaly it is a severe disfiguring gangrene of the mouth and face that begins as a gingival ulcer and spreads rapidly through the tissues of the mouth and face. Then disrupts anatomic barriers and spreads through muscle and bone. • The resulting gangrene may involve the maxilla, the mandible, and extend to the nose and infraorbital margins • The maxilla is the bone that forms your upper jaw. • The mandible, lower jaw or jawbone is the largest, strongest and lowest bone in the human face. It forms the lower jaw and holds the lower teeth in place. • The infraorbital margin is the lower margin of the eye socket
  18. 18. • NOMA IS…. • is a severe and aggressive gangrenous process (a condition wherein body tissues die due to infection or lack of blood supply) that affects the mouth, nose, and lips. This fatal disease is particularly prevalent among children in sub-Saharan Africa, with an estimated frequency of 1 to 7 cases per 1,000 individuals. Noma usually begins as an ulcer on the mucus membrane at the alveolar margin of the mouth and rapidly spreads into other parts of the mouth, including teeth, jawbone, cheek, tongue, lips, and nose. This eventually results in extensive necrosis and destruction of soft tissues and bones.
  19. 19. • Cause: • a combination of malnutrition, bacterial infection, and compromised immunity is considered to be the main reason behind the onset and progression of this devastating disease. • A type of malnutrition called Kwashiorkor • Kwashiorkor: a form of malnutrition, found in children, caused by dietry insufficiency of protein in combination with carbohydrate. • Pathogenesis: • The exact pathophysiology of noma is not completely understood. The disease mostly affects malnourished children living in underdeveloped tropical countries who have had systemic diseases, such as malaria, measles, primary herpes simplex, scarlet fever, tuberculosis, cancer, or enteritis.
  20. 20. • Bacterial species that are frequently associated with noma include • Fusobacterium necrophorum and Prevotella intermedia. • In neonates, the disease is mainly caused by Pseudomonas aeruginosa. • It is known from scientific findings that acute necrotizing gingivitis and oral herpetic ulcers are the most vital precursor lesions that gradually develop into noma due to infection caused by Fusobacterium necrophorum and Prevotella intermedia. • MECHANISM: Precisely, Fusobacterium necrophorum facilitates the gangrenous process by producing endotoxins, dermonecrotic toxins, and cytoplasmic toxins. • In addition, this Gram-negative anaerobic bacillus also triggers the growth of Prevotella intermedia by producing necessary growth-stimulating factors. • Endotoxin is one of the most important bacterial components of gram (-) outer cell wall & it contributes to the inflammatory process. • cytoplasmic toxin is more sensitive to degradation than is the toxin in the complex cell wall
  21. 21. • Risk factors: • Several risk factors are associated with the pathogenesis of noma. The most vital factor is severe malnutrition, especially protein-calorie malnutrition. • Other factors that significantly contribute to the pathogenesis of noma include: • Living in underdeveloped countries • Poor environmental sanitation • Poor oral hygiene • Frequent exposure to human/animal feces • Prior history of viral or bacterial infection • The risk of developing noma is also increased by diseases that cause immunodeficiency, such as HIV infection. An impaired or compromised immune system (due to infection or other factors) is considered as the hallmark for developing noma.
  22. 22. • Signs and Symptoms • The typical signs and symptoms of noma include • swollen gums, swollen cheek lining, and ulcer formation. • These ulcers spread rapidly and destroy oral and para-oral soft tissues and bones, causing deformity of the face and loss of teeth. • The color of the oral cavity may also change into a greyish color. • In addition, the ulcer rapidly turns into edema with foul- smelling drainage, causing bad breath and skin odor. This also causes excessive saliva secretion from the mouth.
  23. 23. • Diagnosis • A physical examination is done initially to check for inflamed mucus membranes, oral cavity ulcers, and skin ulcers. This is followed by taking a detailed medical history of the patient. • X-ray, MRI, or CT scans of the jaw, head, and neck can also be done to check the extent and severity of the damage. • Bacterial culture analysis using oral swabs can be done to detect the causative species. In some special cases, biopsy of the oral tissue is also performed. • Blood tests are recommended to determine the immune system functioning.
  24. 24. • Treatment • The conditions associated with noma are often life-threatening, if not treated appropriately on time. Administration of systemic antibiotics along with proper nutrition is considered to be the golden standard for managing noma. Supplementation with folic acid, iron, vitamin B complex, and ascorbic acid is also recommended in some cases. In addition, measures should be taken to avoid dehydration and maintain proper electrolyte balance. • Plastic surgery is necessary to reform facial bones and regain the function of mouth and jaw, in addition to removing damaged tissues. • Complications mainly include face deformity, discomfort, difficulty eating, drinking, and even speaking, and social isolation.
  25. 25. Guinea Worm Disease • Guinea worm disease (GWD), is an infection caused by the parasite Dracunculus medinensis. • Synonym: (Dracunculiasis) • A parasite is an organism that feeds off another organism to survive. GWD is spread by drinking water containing Guinea worm larvae • Larvae are immature forms of the worm. GWD affects poor communities in remote parts of Africa that do not have safe water to drink. • GWD can occur at any time of the year but occurs most commonly during peak transmission season, which varies from country to country. In dry regions, people generally get infected during the rainy season, when stagnant surface water is available. In wet regions, people generally get infected during the dry season, when surface water is drying up and becoming stagnant. • GWD is primarily a human disease. However, in recent years infections in animals, particularly in dogs, have been reported. As a result of research into the cause of Guinea worm infections in animals, it is now believed that GWD might also be spread to both animals and humans by eating certain aquatic animals that might carry Guinea worm larvae, like fish or frogs, but do not themselves suffer the effects of transmission
  26. 26. Dracunculus medinensis.
  27. 27. • Spread of disease: • People become infected with Guinea worm by drinking water from ponds and other stagnant water containing tiny “water fleas” that carry the Guinea worm larvae. The larvae are eaten by the water fleas that live in these water sources. • Once drunk, the larvae are released & in the stomach and penetrate the digestive track, passing into the body cavity. During the next 10–14 months, the female larvae grow into full-size adults. These adults are 60–100 centimeters (2–3 feet) long and as wide as a cooked spaghetti noodle. • When the adult female worm is ready to come out, it creates a blister on the skin anywhere on the body, but usually on the legs and feet. This blister causes a very painful burning feeling and it bursts within 24–72 hours. Immersing the affected body part into water helps relieve the pain. It also causes the Guinea worm to come out of the wound and release a milky white liquid into the water that contains millions of immature larvae. This contaminates the water supply and starts the cycle over again. For several days, the female worm can release more larvae whenever it comes in contact with water.
  28. 28. • Sign & Symptoms: • People do not usually have symptoms until about one year after they become infected. • A few days to hours before the worm comes out of the skin, the person may develop a fever, swelling, and pain in the area. • Way to come out: More than 90% of the worms come out of the legs and feet, but worms can appear on other body parts too. • Symptoms can include: • Slight fever • Itchy rash • Nausea • Vomiting • Diarrhea • Dizziness
  29. 29. • People in remote rural communities who have Guinea worm disease often do not have access to health care. • When the adult female worm comes out of the skin, it can be very painful, slow, and disabling. • Often, the wound caused by the worm develops a secondary bacterial infection. This makes the pain worse and can increase the time an infected person is unable to function to weeks or even months. • Sometimes, permanent damage occurs if a person’s joints are infected and become locked.
  30. 30. • Diagnosis: • Diagnosis of GWD is by clinical history and observation of lesions • or the presence of an emerging female worm.
  31. 31. • Treatment: • There is no drug to treat Guinea worm disease and no vaccine to prevent infection. • Once part of the worm begins to come out of the wound, the rest of the worm can only be pulled out a few centimeters each day by winding it around a piece of gauze or a small stick. • Sometimes the whole worm can be pulled out within a few days, but this process usually takes weeks. • As the worm is slowly and carefully removed, the lesion in the skin should be kept cleaned and treated with topical antibiotics if it becomes infected.
  32. 32. • Medicine, • such as aspirin or ibuprofen, can help reduce pain and swelling. • Antibiotic ointment can help prevent secondary bacterial infections. • The worm can also be surgically removed by a trained doctor in a medical facility before a blister forms. • Complications: • Complications of Guinea worm disease include secondary bacterial infections and/or systemic problems like sepsis, joint destruction, and cellulitis.
  33. 33. • Who is at risk of infection: • Anyone who drinks from a pond or other stagnant water source contaminated with Guinea worm larvae is at risk for infection. Larvae are immature forms of the Guinea worm. People who live in countries where GWD is occurring (such as Chad, Ethiopia, Mali, and South Sudan) and consume raw or undercooked aquatic animals (such as small whole fish that have not been gutted, other fish, and frogs) may also be at risk for GWD. People who live in villages where there has been a case of GWD in a human or animal in the recent past are at greatest risk.
  34. 34. Blister/Bullae • Definition: Blisters are small pockets of fluid that usually form in the upper layers of skin or between epidermis & dermis, after it's been damaged. Blisters can develop anywhere on the body but are most common on the hands and feet. • Why blisters are filled with fluid? • Fluid collects under the damaged skin, cushioning (support) the tissue underneath. This protects the tissue from further damage and allows it to heal. • Fluid: Most blisters are filled with a clear fluid (serum), but may be filled with blood (blood blisters) or pus if they become inflamed or infected. • The clear, watery liquid inside a blister is called serum. It leaks in from neighboring tissues as a reaction to injured skin. If the blister remains unopened, serum can provide natural protection for the skin beneath it. • Small blisters are called vesicles. • Bullae: Those larger than half an inch are called bullae.
  35. 35. Lets ask interesting questions
  36. 36. Questions • QNo1- Should you pop or break a blister? • QNo2- in which cases Doctor drain the fluid from blister? • QNo3- Are you prone to getting blisters? • QNo4- Can blisters scar?
  37. 37. • Ans1- Blisters should never be unroofed as this is your body’s way of forming a bandage, • Ans2- But for certain people at risk for infection, a doctor may choose to use a sterile needle to allow fluid to drain. This is especially the case for people with compromised immune systems (people with HIV, diabetes, or those who take medications that suppress the immune system). • Ans3- Some preexisting skin disease can put you at risk for blisters. (eczema, psoriasis) secondly Or the cause could be as simple as walking around with wet or damp feet (whether from sweat or from being in water). In either case, you’re more prone to blisters because the skin barrier is compromised
  38. 38. • Ans4- The depth of the blister determines whether or not it will scar. “The deeper the injury (particularly when it comes to a chemical or heat burn), the more likely it is for a scar to form. Typically, friction blisters do not scar as they tend to be more superficial.
  39. 39. • Causes: • Blisters can be caused by: • friction to the skin • heat for example, from sunburn or a scald • contact with chemicals, such as detergent • medical conditions, such as chickenpox, herpes, Pemphigus, Epidermolysis bullosa, eczema, psoriasis and impetigo
  40. 40. Types of blisters • The main types of blisters are: • friction blisters • blood blisters • heat blisters • Other types of blister are named after the medical condition they are linked to, such as chickenpox and atopic eczema blisters.
  41. 41. Types of Blisters Friction blister • Any repetitive friction or rubbing can cause blisters. • These blisters will usually appear on the hands or feet, as these are the areas that most often encounter repetitive abrasion, whether walking, running or playing the drums. • Areas of skin with a thick horny layer, attached tightly to underlying structures (such as palms of hands and soles of feet) are more likely to generate blisters. • Blisters occur more readily if the conditions are warm, for example, inside a shoe. (in damp areas, skin is compromised) They also form more easily in damp conditions, compared with wet or dry environments.
  42. 42. Heat/Temperature blisters • The timing of burn helps categorize the formation of blister. Second-degree burns will blister immediately, but first-degree burns blister a couple of days after the incident. • Burn: A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals or radiation. • Scald: Burn due to hot liquid • Second degree burn: This type of burn affects both the epidermis and the second layer of skin (dermis). So second-degree burns are more serious because the damage extends beyond the top layer of skin. • Sign: This type burn causes the skin to blister and become • extremely red and sore(pain). • Some blisters pop open, giving the burn a wet or weeping appearance. Over time, thick, soft, scab-like tissue called fibrinous exudate may develop over the wound. • At the opposite end of the spectrum, frostbite also produces blisters. • In both cases, the blister is a defense mechanism deployed to protect lower levels of skin from temperature-related damage.
  43. 43. • Frostbite: Frostbite is an injury caused by freezing of the skin and underlying tissues. Frostbite is most common on the fingers, toes, nose, ears, cheeks and chin. • Exposed skin in cold, windy weather is most vulnerable to frostbite. • Signs and symptoms of frostbite include: • At first, a prickling feeling • Numbness • Red, white, bluish-white skin • Hard or waxy-looking skin • Clumsiness due to joint & muscle stiffness • Blistering after rewarming, in severe cases
  44. 44. Blood blisters • Crushing and pinching • If a small blood vessel near the surface of the skin is ruptured, blood can leak into the gap between the layers of skin causing a blood blister to form. This is a blister filled with blood.
  45. 45. Blister due to Chemical exposure • Chemical exposure • Skin can occasionally blister because of certain chemicals. This is known as contact dermatitis. • It can affect some individuals on contact with the following: • cosmetics • detergents • solvents • nickel sulfate, used in electroplating • balsam of Peru, a flavoring • insect bites and stings • chemical warfare agents, including mustard gas • Eczema: Eczema is the name for a group of conditions that cause the skin to become red, itchy and inflamed. Blisters may sometimes occur. • There are two types of contact dermatitis: A. Irritant contact dermatitis can result from repeated exposure to a substance that irritates the skin, such as: • acids and alkalis B. Allergic contact dermatitis • Allergic contact dermatitis occurs when a person's immune system reacts to a particular substance, known as an allergen.
  46. 46. Blisters due to Medical conditions • A number of medical conditions can cause blisters. • These include: • Chickenpox: • Chickenpox is a very contagious infection caused by the varicella-zoster virus. It mainly affects kids, but adults can get it, too. The telltale sign of chickenpox is a super-itchy skin rash with red blisters. Over the course of several days, the blisters pop and start to leak. Then they crust and scab over before finally healing.
  47. 47. • Herpes: The cold sores produced by the herpes simplex virus are clusters of blisters. • Cold sore: an inflamed blister in or near the mouth, caused by infection with the herpes simplex virus. • Synonym: fever blisters — are a common viral infection. They are tiny, fluid-filled blisters on and around your lips. • These blisters are often grouped together in patches. After the blisters break, a crust forms over the resulting sore. Cold sores usually heal in two to four weeks without leaving a scar.
  48. 48. • Bullous impetigo: (bullous+ impetigo) Mostly seen in children under 2 years, blisters can form on the arms, legs, or trunk. • Impetigo is a common and contagious skin infection. Bacteria like Staphylococcus aureus or Streptococcus pyogenes infect the outer layers of skin, called the epidermis. The face, arms, and legs are most often affected. • The infection often begins in minor cuts, insect bites, or a rash such as eczema, any place where the skin is broken. But it can also occur on healthy skin. • It’s called primary impetigo • when it infects healthy skin and • secondary impetigo when it occurs in broken skin. It isn’t always easy or necessary to make this distinction.
  49. 49. • Dyshidrosis: (Dys-bad hidrosis-sweat) is a skin condition that causes small, fluid-filled blisters to form on the palms of the hands and sides of the fingers. Sometimes the bottoms of the feet are affected too. • The blisters that occur in dyshidrosis generally last around three weeks and cause intense itching. • Symptoms • The blisters are usually small about the width of a standard pencil lead and grouped in clusters • Causes The exact cause of dishidrosis isn't known. It can be associated with a similar skin disorder called atopic dermatitis (eczema), as well as with allergic conditions, such as hay fever.
  50. 50. • Bullous pemphigoid: An autoimmune disease that affects the skin and causes blisters, this is most common in older patients. • Bullous pemphigoid is a rare skin condition that causes large, fluid-filled blisters. They develop on areas of skin that often flex such as the lower abdomen, upper thighs or armpits. Bullous pemphigoid occurs when your immune system attacks a thin layer of tissue below your outer layer of skin. The reason for this abnormal immune response is unknown, although it sometimes can be triggered by taking certain medications.
  51. 51. • Pemphigus: A rare group of autoimmune diseases, this affects the skin and mucous membranes. The immune system attacks an important adhesive molecule in the skin, detaching the epidermis from the rest of the layers of skin. • The signs and symptoms of two common types of pemphigus are as follows: • Pemphigus causes blisters on your skin and mucous membranes. The blisters rupture easily, leaving open sores, which may ooze and become infected. • Pemphigus vulgaris. This type usually begins with blisters in your mouth and then on your skin or genital mucous membranes. The blisters typically are painful but don't itch. Blisters in your mouth or throat may make it hard to swallow and eat. • Pemphigus foliaceus. This type causes • blisters on the chest, back and shoulders. • The blisters tend to be more itchy than • painful. Pemphigus foliaceus doesn't cause mouth blisters.
  52. 52. • Epidermolysis bullosa: This is a genetic disease of the connective tissue that causes blistering of the skin and mucous membranes. • The blisters may appear in response to minor injury, even from heat, rubbing, scratching or adhesive tape. In severe cases, the blisters may occur inside the body, such as the lining of the mouth or the stomach. • Causes • Epidermolysis bullosa is usually inherited. The disease gene may be passed on from one parent who has the disease (autosomal dominant inheritance). Or it may be passed on from both parents (autosomal recessive inheritance) or arise as a new mutation in the affected person that can be passed on
  53. 53. Epidermolysis bullosa
  54. 54. Mechanism of blister formation • The most common type of blister for most individuals is the friction blister. In their most basic form, they occur due to increased shear stress between the surface of the skin and the rest of the body. • The layer of the skin most susceptible to shear forces is the stratum spinosum. As this layer tears away from the tissues below, a plasma-like fluid leaks from the cells and begins to fill the gap that is created. This fluid encourages new growth and regeneration. • Roughly 6 hours after the blister appears, cells at the base of the blister start to take up amino acids and nucleosides. These are the building blocks of protein and DNA. • At 24 hours, cell division is markedly increased. New skin layers above the stratum spinosum are steadily formed. • At 48 hours, a new layer of skin can be seen • As these new cells develop, the fluid is reabsorbed and the swelling subsides.
  55. 55. • Why blisters on feet/ palm causes more pain?? • Painful blisters on the palm of the hands or soles of the feet are often caused by tissue shearing in deeper layers of the skin. These layers lie next to nerve endings, thereby producing more pain.
  56. 56. • Treatment • Most blisters will heal without medical intervention. As the new skin grows beneath the blister, the fluid will slowly disappear and the skin will naturally dry and peel off. • Blisters are best left intact to prevent infection of the affected area. • Popping blisters is not recommended, because the bubble is a protective layer that fends off infection. • Once the barrier is removed, the wound is open to potential invasion by bacteria and can become infected. • Covering the blister with a band-aid or gauze can help protect it from additional trauma while it heals. • Allow the fluid to drain away naturally and carefully wash it with mild soapy water. • Cover the blister and the surrounding area with a sterile, dry dressing. • Some medications, such as hydrocolloid dressings, can help prevent further discomfort and encourage the healing process. • Similarly, with blood blisters, allow them to heal under in their own time. They can be more painful than standard blisters and an ice pack can offer some relief. Place a towel over the affected area, ensuring that the ice pack does not come into contact with the skin directly.
  57. 57. Hydro-colloid dressing
  58. 58. • Prevention • Friction blisters are best prevented by removing the cause of the friction. This can be achieved in a number of ways. • Avoiding blisters on the feet • Wear well-fitted, comfortable footwear and clean socks. Badly fitted or stiff shoes, such as high heels, carry a higher risk of blistering. Moist skin blisters more easily, so socks that manage moisture or frequent sock changes can be helpful. • During exercise and sports, specially designed sports socks can reduce the amount of available foot sweat. • Avoiding blisters on the hands • When using tools, carrying out manual work or playing a sport where holding a bat is necessary, wearing gloves will prevent the majority of blisters. • In some sports, such as gymnastics, weightlifting or rowing, taping up the hands is good practice. Additionally, talcum powder acts to reduce friction and can be used in combination with gloves and tape, or as a stand-alone option. But, because talcum powder absorbs moisture, it will not work well for long durations of activity.
  59. 59. • First aid for blister: • If a blister isn't too painful, try to keep it intact. • Don’t break skin over a blister may provide a natural barrier to bacteria and decreases the risk of infection. • Cover it with an adhesive bandage or moleskin. Cut a piece of moleskin into a doughnut shape and place the pad so that it encircles and protects the blister.
  60. 60. • How to drain a blister • To relieve blister-related pain, drain the fluid while leaving the overlying skin intact. Here's how: • Wash your hands and the blister with soap and warm water. • Swab the blister with iodine. • Sterilize a clean, sharp needle by wiping it with rubbing alcohol. • Use the needle to puncture the blister. Aim for several spots near the blister's edge. Let the fluid drain, but leave the overlying skin in place. • Apply an ointment such as petroleum jelly to the blister and cover it with a nonstick gauze bandage. If a rash appears, stop using the ointment. • Follow-up care.
  61. 61. Abscess • Definition: An abscess is a cavity filled with pus (pyoderma or sepsis). It contains white blood cells, dead tissue and bacteria. • Pyoderma: Infection of skin by pyogenic bacteria
  62. 62. • Abscesses can develop anywhere in the body. • skin abscesses – which develop under the skin • internal abscesses – which develop inside the body, in an organ or in the spaces between organs • Incisional abscess • An incisional abscess is one that develops as a complication secondary to a surgical incision. • It presents as redness and warmth at the margins of the incision with purulent drainage from it. • If the diagnosis is uncertain, the wound should be aspirated with a needle, with aspiration of pus confirming the diagnosis and availing for Gram stain and bacterial
  63. 63. Types of abscess Other types of abscess • There are many other types of abscess, including: • Anorectal abscess – a build-up of pus in the rectum and anus • Bartholin's abscess – a build-up of pus inside one of the Bartholin's glands, which are found on each side of the opening of the vagina( vaginal orifice) • brain abscess – a rare but potentially life-threatening build-up of pus inside the skull • Dental abscess – a build-up of pus under a tooth or in the supporting gum and bone • quinsy (peritonsillar abscess) – a build-up of pus between one of your tonsils and the wall of your throat (as complication of tonsilitis+ bacterial infection) • pilonidal abscess – a build-up of pus in the skin of the cleft of the buttocks (where the buttocks separate) • spinal cord abscess – a build-up of pus around the spinal cord
  64. 64. • Causes of abscesses • Most abscesses are caused by a bacterial infection, parasites, or foreign substances, but bacteria is most common cause. • When bacteria enter your body, your immune system sends infection-fighting white blood cells to the affected area. • As the white blood cells attack the bacteria, some nearby tissue dies, creating a hole which then fills with pus to form an abscess. The pus contains a mixture of dead tissue, white blood cells and bacteria. • Internal abscesses often develop as a complication of an existing condition, such as an infection elsewhere in your body. For example, if your appendix bursts as a result of appendicitis, bacteria can spread inside your tummy (abdomen) and cause an abscess to form. • The most common bacterial organism responsible for the development of skin abscesses is Staphylococcus aureus, although various other organisms can also lead to abscess formation. With the emergence of methicillin- resistant Staphylococcus aureus (MRSA), health care providers must now consider this organism as the possible cause when a skin abscess is encountered.
  65. 65. • Pathophysiology: • An abscess is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body. • The organisms or foreign materials kill the local cells, resulting in the release of cytokines. The cytokines trigger an inflammatory response, which draws large numbers of white blood cells to the area and increases the regional blood flow. • 2- The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.
  66. 66. • Symptoms of an abscess • A skin abscess often appears as a swollen, pus-filled lump under the surface of the skin. • You may also have other symptoms of an infection, such as a high temperature (fever) and chills. • warmth and redness in the affected area • A boil is a common example of a skin abscess.
  67. 67. • Some common Symptoms of internal abscesses • The symptoms of an internal abscess can also vary depending on exactly where in the body the abscess develops. For example, a liver abscess may cause jaundice, whereas an abscess in or near the lungs may cause a cough or shortness of breath. • General symptoms of an internal abscess can include: • discomfort in the area of the abscess • fever • increased sweating • feeling sick • vomiting • chills • pain or swelling in your tummy (abdomen) • loss of appetite and weight loss • extreme tiredness (fatigue) • diarrhoea or constipation
  68. 68. • Risk factors: • You’re at increased risk for this bacterial infection if you have: • close contact with an individual who has a staph infection, which is why these infections are more common in hospitals • a chronic skin disease, like acne or eczema • diabetes • a weakened immune system, which can be caused by infections such as HIV • poor hygiene habits • Infected hair follicles • Infected hair follicles, or folliculitis, may cause abscesses to form in the follicle. Follicles can become infected if the hair within the follicle is trapped and unable to break through the skin, as can happen after shaving. • Trapped hair follicles are commonly known as ingrown hairs. Ingrown hairs can set the stage for an infection. Abscesses that are on or in a hair follicle will often contain this ingrown hair. • Folliculitis may also occur after spending time in an inadequately chlorinated pool or hot tub.
  69. 69. • Exams and Tests • The doctor will take a medical history and may ask you: • How long the abscess has been present • If you recall any injury to that area • What medicines you may be taking • If you have any allergies • If you have had a fever at home • The doctor will examine the abscess and surrounding areas. If it is near your anus, the doctor will perform a rectal exam. If an arm or leg is involved, the doctor will feel for a lymph gland either in your groin or under your arm. • Your doctor may also take a culture or a small amount of fluid from the abscess to test for the presence of bacteria. No other testing methods are necessary to diagnose an abscess. • However, if you’ve had reoccurring skin abscesses and your doctor feels that an underlying medical condition may be the cause, they may take a blood or urine sample.
  70. 70. Difference between cyst and abscess CYST • cyst is a sac enclosed by distinct abnormal cells • Symptoms: a cyst grows slowly and isn’t usually painful, unless it becomes enlarged. • When an already-formed cyst becomes infected, it becomes an abscess. • Not infected. ABSCESS • an abscess is a pus-filled infection in your body caused by, for example, bacteria or fungi. • Symptoms: an abscess is painful, irritated, often red, and swollen, and the infection can cause symptoms elsewhere in the body. • But an abscess doesn’t have to begin as a cyst. It can form on its own. • an abscess is infected
  71. 71. • Treatment: A small skin abscess may drain naturally, or simply shrink, dry up and disappear without any treatment. • Abscesses can be treated in a number of different ways, depending on the type of abscess and how large it is. • The main treatment options include: • antibiotics • a drainage procedure • surgery • Skin abscesses • Some small skin abscesses may drain naturally and get better without the need for treatment. Applying heat in the form of a warm compress, such as a warm flannel, may help reduce any swelling and speed up healing. • However, the flannel should be thoroughly washed afterwards and not used by other people, to avoid spreading the infection. • For larger or persistent skin abscesses, your GP may prescribe a course of antibiotics to help clear the infection and prevent it from spreading.
  72. 72. • Skin abscesses • Some small skin abscesses may drain naturally and get better without the need for treatment. Applying heat in the form of a warm compress, such as a warm flannel, may help reduce any swelling and speed up healing. • However, the flannel should be thoroughly washed afterwards and not used by other people, to avoid spreading the infection. • For larger or persistent skin abscesses, your GP may prescribe a course of antibiotics to help clear the infection and prevent it from spreading. • Sometimes, especially with recurrent infections, you may need to wash off all the bacteria from your body to prevent re-infection (decolonisation). This can be done using antiseptic soap for most of your body and an antibiotic cream for the inside of your nose.
  73. 73. • Surgery (Incision and drainage) • If your skin abscess needs draining, you'll probably have a small operation carried out under anesthetic– usually a local anesthetic where you remain awake and the area around the abscess is numbed. • During the procedure, the surgeon makes a cut (incision) in the abscess, to allow the pus to drain out. They may also take a sample of pus for testing. • Once all of the pus has been removed, the surgeon will clean the hole that is left by the abscess using sterile saline (a salt solution). • The abscess will be left open but covered with a wound dressing, so if any more pus is produced it can drain away easily. If the abscess is deep, an antiseptic dressing (gauze wick) may be placed inside the wound to keep it open. • The procedure may leave a small scar.
  74. 74. • Internal abscesses • The pus usually needs to be drained from an internal abscess, either by using a needle inserted through the skin (percutaneous abscess drainage) or with surgery. • The method used will depend on the size of your abscess and where it is in your body. • Antibiotics will usually be given at the same time, to help kill the infection and prevent it spreading. These may be given as tablets or directly into a vein (intravenously).
  75. 75. • Percutaneous drainage • If the internal abscess is small, your surgeon may be able to drain it using a fine needle. Depending on the location of the abscess, this may be carried out using either a local or general anaesthetic. • The surgeon may use ultrasound scans or computerised tomography (CT) scans to help guide the needle into the right place. • Once the abscess has been located, the surgeon drains the pus using the needle. They may make a small incision in your skin over the abscess, then insert a thin plastic tube called a drainage catheter into it. • The catheter allows the pus to drain out into a bag and may have to be left in place for up to a week. • This procedure may be carried out as a day case procedure, which means you'll be able to go home the same day, although some people will need to stay in hospital for a few days.
  76. 76. • Surgery • You may need to undergo surgery if: • your internal abscess is too large to be drained with a needle • a needle can't get to the abscess safely • needle drainage hasn't been effective in removing all of the pus • The type of surgery you have will depend on the type of internal abscess you have and where it is in your body. Generally, it involves making a larger incision in your skin to allow the pus to be washed out.
  77. 77. • Can Abscesses Be Prevented? • Good hygiene is the best way to avoid infection. Keep cuts and wounds clean, dry, and covered to protect them from germs. • Also, don't share clothing, towels, razors, or bed linens with anyone else. When these items get dirty, wash them separately in very hot water. • Wash your hands well and often using plain soap and water for at least 20 seconds each time. It's OK to use alcohol-based instant hand sanitizers or wipes (the kind that you can pick up at a drugstore) if you're not near any soap and water.
  78. 78. Endemic ulcer BURULI ULCER • Definition: is a chronic, debilitating, necrotizing disease of the skin, soft tissue and sometime bone caused by Mycobacterium ulcerans. • Mycobacterium ulcerans: The organism belongs to the family of bacteria that causes tuberculosis and leprosy. • HOSTORY: Buruli ulcer was first described by Sir Albert Cook in patients from Buruli County in Uganda, • Synonym: Bairnsdale ulcer • Buruli ulcer was first diagnosed in the Bairnsdale area in the 1930s. • Endemic: a disease regularly found among particular people or in a certain area. • Although it has been reported in over 33 countries around the world, the greatest burden of disease is in the tropical regions of West and Central Africa, Australia, and Japan
  79. 79. Buruli ulcer
  80. 80. • Causative organism • Mycobacterium ulcerans is a slow-growing mycobacterium that classically infects the skin and subcutaneous tissues, giving rise to (nodules, plaques) and ulcerated lesions. • After tuberculosis and leprosy, Buruli ulcer is the third most common mycobacteriosis of humans. M. ulcerans grows optimally on routine mycobacteriologic media at 33 °C . • Buruli ulcers generally begin as a painless dermal papule or subcutaneous edematous nodule, which, over a period of weeks to months, breaks down to form an extensive necrotic ulcer with undermined edges. • PAPULE- PIMPLE LIKE • NODULE- SMALL COLLECTION OF TISSUES THAT CAN PALPABLE • EDEMATOUS- SWELLING WITH EXCESSIVE ACCUMULATION OF FLUID
  81. 81. • Pathogenesis: M ulcerans are slow-growing mycobacteria that produce a soluble polyketide exotoxin called mycolactone, which can diffuse extensively in the subcutaneous tissue. • properties mycolactone has both immunosuppressive properties + cytotoxic properties, dramatic tissue destruction occurs without inducing inflammation or systemic symptoms, such as fever, malaise, or adenopathy. • Progression: The toxins made by the bacteria destroy skin cells, small blood vessels and the fat under the skin, which leads to ulceration and skin loss. • Molecular targets • Mycolactone targets proteins, which controls actin dynamics and leads to a loss of cellular detachments and cell death. • (actin protein- present in all eukaryotes & functions as muscle contraction, cell motility, cell division, cytokines) • Mycolactone also inhibits the function of the Sec61 translocation, which is responsible for protein translocation into the endoplasmic reticulum. This affects 30-50% of mammalian proteins, including circulating inflammatory mediators and proteins involved in lipid metabolism, coagulation, and tissue remodeling. Therefore, patients with M ulcerans infections have global and chronic defects in protein metabolism.
  82. 82. • Molecular targets • 1- Mycolactone targets proteins, which controls actin dynamics and leads to a loss of cellular detachments and cell death. • (actin protein- present in all eukaryotes & functions as muscle contraction, cell motility, cell division, cytokines) • 2- Mycolactone also inhibits the function of the Sec61 translocation, which is responsible for protein translocation into the endoplasmic reticulum. This affects 30-50% of mammalian proteins, including circulating inflammatory mediators and proteins involved in lipid metabolism, coagulation, and tissue remodeling. • Therefore, patients with M ulcerans infections have global and chronic defects in protein metabolism.
  83. 83. • Signs and symptoms • Buruli ulcer often starts as a painless swelling (nodule). It can also initially present as a large painless area of induration (plaque) or a diffuse painless swelling of the legs, arms or face (oedema). Local immunosuppressive properties of the mycolactone toxin enable the disease to progress with no pain and fever. Without treatment or sometimes during antibiotics treatment, the nodule, plaque or oedema will ulcerate within 4 weeks with the classical, undermined borders. Occasionally, bone is affected causing gross deformities. • The progression of symptoms can include: • A spot that looks like a mosquito or spider bite forms on the skin (most commonly on the limbs). • The spot grows bigger over days or weeks. • The spot may form a crusty, non-healing scab. • The scab then disintegrates into an ulcer. • The ulcer continues to enlarge. • Unlike other ulcers, this ulcer is usually painless and there is generally no fever or other signs of infection.
  84. 84. • Transmission: • It is not known how humans become infected, although it is thought that mosquitoes may have a role in transmitting the infection. Buruli ulcer is not thought to be transmitted person- to-person. • Recent evidence suggests insects may be involved in the transmission of the infection. These insects are aquatic bugs
  85. 85. • Diagnosis of Buruli ulcer • Buruli ulcer is usually diagnosed by a doctor, based on: • medical history • travel history – if you have travelled to an area associated with Buruli ulcer • physical examination – to identify a slowly enlarging, painless ulcer • swabs or biopsy taken from the ulcer, which are tested in a laboratory. • Laboratory test: • Four standard laboratory methods can be used to confirm Buruli ulcer; • polymerase chain reaction (PCR), direct microscopy, histopathology and culture.
  86. 86. • Treatment: • If treated early, antibiotics for eight weeks are effective in 80% of people. This often includes the medications rifampicin and streptomycin. Clarithromycin or moxifloxacin are sometimes used instead of streptomycin. • Surgery: Treatment may also include cutting out the ulcer. This may be a minor operation and very successful if undertaken early. Advanced disease may require prolonged treatment with extensive skin grafting. Surgical practice can be dangerous in the developing countries where the disease is common.
  87. 87. • Prevention of Buruli ulcer • Although the exact cause of infection in humans is not known, it makes sense to protect yourself from potential sources of infection such as soil and insect bites. Suggestions to reduce the risk of infection include: • Wear gardening gloves, long-sleeved shirts and trousers when working outdoors. • Avoid insect bites by using suitable insect repellents. • Protect cuts or abrasions with sticking plasters. • Promptly wash and cover any scratches or cuts you receive while working outdoors. • visit your doctor if you have a slow-healing skin lesion.

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