Intertriginous Streptoderma (Intertrigo Streptogenes)

The disease occurs on contiguous skin surfaces (under the breasts, in the folds on the abdomen in obese persons, behind the ears, in the inguino-femoral and interglutteal folds, in the axillae, etc.). Very many phlyctenae erupt, coalesce, and burst rapidly leaving continuous erosive weeping bright-rose surfaces with scalloped boundaries and a border of peeling epidermis on the periphery. Sittings of separately arranged pustular lesions in various stages of development are seen next to the main foci of affection. Painful fissures are often found deep in the folds. The disease follows a protracted course with marked subjective disorders. In intertriginous lesions of yeast origin the contents of the bullae and the crusts do not have a yellow hue and elements of yeast-like fungi are discovered in the scraps of epidermis on the periphery of the main foci or in the sittings.

Posterosive Syphiloid, or Papular Syphiloid Impetigo (Syphiloides Posterosives, Impetigo Papulata Syphiloides)

The disease prevails among infants. The favoured localization is the skin on the buttocks, the genitals, and the thighs. Phlyctenae form and rupture rapidly with the formation of erosions, which have an infiltrated base because of which these lesions resemble papulo-erosive syphilid. The acute inflammatory reaction, however, is characteristic neither of pemphigus syphiliticus nor of erosive papular syphilids of infants. Examination for Treponema pallidum and serological blood tests provide the final answer. Improper hygienic care is a conducive factor (the disease is also called diaper dermatitis).

Treatment consists in the use of external agents, as a rule, namely disinfectant solutions and ointments; 1 per cent alcohol or aqueous solutions of aniline dyes (gentian violet, brilliant green or methylene blue) are prescribed when there are only a few small foci with no abundant discharge and no crusts. In cases with crusts, dressings with 5 per cent boric acid-naphthalan ointment are applied. Ointments containing antibiotics, e.g. I per cent erythromycin, Oxycort, Locacorten with neomycin, Lorinden C, Dermosolone, Celestoderm with garamicin ointments have a beneficial effect. Antibiotics are prescribed in impetigo of the nail folds and surgery is undertaken if pain is severe. The ointment is applied once or twice a day. The tops of large bullae are removed with a pair of scissors, the exudate is removed with a sterile cotton tampon, and then one of the ointments listed above is applied.

In impetigo following a torpid course and in frequent recurrences, general therapy is indicated with antibiotics (after the results of an antibioticogram) and vitamins, especially vitamins A, C, and those of the B complex (in cheilitis, perleche, impetigo circinate). Treatment of perleche calls for removal of the cause of the disease (alveolar pyorrhea, inflammation of the oral mucosa, etc.) and the conducive factors (nocturnal salivation) and application of a complex of therapeutic measures, large doses of riboflavin (0.01 g given two or three times a day) among others.

Prevention consists in the observance of hygienic principles, frequent change of underwear and bed-clothes, treatment of minor skin injuries with disinfectant solutions, isolation of children suffering from impetigo, and temporary removal of adults with streptoderma from work in children's establishments. The distal phalanges of the fingers of sick children are painted with 2 per cent alcohol iodine solution and the skin around the lesions is rubbed with 1-2 per cent salicylic alcohol (70° for adults and 40° for children).

The prognosis is always favourable in impetigo.

Ecthyma Vulgaris

The lesion in ecthyma vulgaris is a deep dermal pustule with no involvement of the follicles.

Etiology and pathogenesis. Streptococci are the causative agents although there are reports on the formation of staphylococcal and mixed streptococcal-staphylococcal infections. Factors contributing to the development of ecthyma are erosions and scratches, reduction of general body resistance, metabolic disorders, chronic alcoholism, localized disturbance in lymph and blood circulation, and hypovitaminosis.

Clinical picture and course. The disease sets in with the formation of a bulla with a serous or seropurulent content, which dries rapidly to a soft, golden yellow bulging crust. In most cases, the crust consists of several layers and after it drops off or is removed a round or oval ulcer remains. The floor of the ulcer is covered with a dirty-grey film and bleeds, while its edges are soft, edematous and with congestive hyperemia. The ulcer heals slowly in two or three weeks leaving a superficial scar around which a zone of pigmentation forms. The most common localization is the leg, though ecthyma may also occur on the skin of the thighs, buttocks and the loins (the number of lesions ranging from one or two to several dozens). The subjective symptoms are mild (moderate tenderness of the ulcerations).

The diagnosis is based on the presence of pustules, layered crusts, and ulcerations mainly on the legs, and on the torpid character of the process. In impetigo there are no ulcerations or scars. A furuncle is characterized by a necrotic core and pain. In syphilitic ecthyma the infiltration of the base and edges of the ulcer is harder and serological blood tests yield positive results.

Treatment. The lesions are treated as those of impetigo.

General treatment consists of antibiotics, vitamins and stimulation therapy (autohemotherapy and pyrogens) and high-calorie diet.

Prognosis. With a favourable general condition the disease lasts a few weeks. The process continues for a much longer period if treatment is irrational or not applied at all.

MIXED STREPTO-STAPHYLOCOCCAL PYODERMAS

This is a group of pyodermas in which staphylococci and streptococci act together as the etiological factor. A superficial form (impetigo vulgaris, or strepto-staphylogenes) and atypical varieties of deep pyodermas (chronic ulcero-vegetative pyoderma, pyoderma chancriforme) are distinguished.