PyodermaL08.00

Acute or chronic infection of the epidermis (impetigo contagiosa) and possibly also of the various skin appendages (infection of the hair follicles = folliculitis; infection of the nail organs = paronychia; infection of the sweat glands = hidradenitis). This leads to pus rashes and overlapping scaling and crust formation.

A distinction is made between diseases which are called "pyoderm" and have a pyodermic appearance, but which are based on a different etiopathogenesis (e.g. Pyoderma gangraenosum).

• Non-follicularly bound pyoderma:
  • contagious impetigo
    • blistered impetigo
      • Impetigo contagiosa, small vesicles
      • Impetigo contagiosa, large-bubble
    • Non-vesicular impetigo
  • Panaritium
    • bulla repens
    • Paronychia (acute and chronic)
  • Phlegmons
  • Vegetative pyoderma (Pyoderma vegetans)
  • Perianal strep dermatitis.
• Follicularly bound pyodermias:
  • Superficial folliculitis (folliculitis in common parlance)
  • Round folliculitis
    • Boils (special case: furunculosis)
    • Carbuncle
• Pyoderma bound to sweat glands:
  • suppurative hidradenitis
  • Infant periporitis.

Blister fluid or fresh, weeping crusts are suitable for examination. The smear material is heat-fixed and stained for methylene blue or Gram. In the Gram stain, the gram-positive cocci can be detected in cluster or grape form. Pathogen culture is usually performed on blood agar. The result can be read after 24-48h. A further differentiation can be made by means of the colored series (Api-Staph system, Api-20-Strep system).

• Benzylpenicillin is the agent of choice for infections with β-haemolytic streptococci. Alternatively, erythromycin, tetracyclines, clindamycin or cephalosporins can be used.
• For staphylococcal infections: cephalosporins or flucloxacillin (e.g. Staphylex Kps.) 3 times/day 1 g in 3 doses. Alternatively: Vancomycin, Teicoplanin, Dicloxacillin, Clindamycin, Fosfomycin.

Cave! Smear infections caused by lesions or bandages. Disinfection of utensils!

Bacterial superinfected dermatoses are to be separated. The term impetiginization is reserved for this. However, this differentiation is not always clear.

1. Abeck D et al (2001) Pyodermias - An interdisciplinary problem. Dtsch Ärztebl 98: 2950-2960
2. Hartman-Adams H et l. (2014) Impetigo: diagnosis and treatment. On Fam Physician 90:229-35.