Dry streptoderma ICD 10. Streptoderma in children. Tourniole or superficial panaritium

Definition

Streptoderma is a skin lesion caused by streptococci. The disease is caused by various strains of streptococci (most often group D).

Reasons

The cause of streptoderma is streptococcus. Streptococci penetrate the skin in the area of microtrauma of the epidermis and cause an inflammatory process of a predominantly superficial nature, however, in the presence of predisposing factors, the development of deep streptodermia is possible.

Other causes of streptoderma may include:

decreased appetite;
hypo-, avitaminosis, dysproteinemia;
metabolic disorders;
acute and chronic diseases;
physical fatigue;
neuropsychic fatigue, vegetative neurosis;
changes in the body's reactivity;
hypothermia and overheating of the body;
local disorders of blood supply and innervation of the skin;
changes in skin pH;
microtraumas;
excessive skin contamination;
presence of skin diseases.

Symptoms

Among the main symptoms can be identified the formation on the face, buttocks, and back of light pink spots of various sizes (1-3 cm), which are covered with scales. Usually there is a slight itching and dry skin, sometimes there may be an increase in body temperature, enlargement of the lymph nodes, and an itchy rash. Phlyctenas are also formed - superficial blisters, the serous contents of which quickly become cloudy, and the phlyctenas themselves quickly open, forming erosion, or becoming covered with a crust.

Streptococcal diaper rash, characteristic cracks, and diaper dermatitis also sometimes appear in the area of the folds. After 2–3 days, purulent-bloody crusts form. After the crusts are rejected, a round ulcer with steep edges, a juicy, bleeding bottom, covered with a dirty gray coating, is discovered. Healing occurs slowly - up to 3 weeks and ends with the formation of a pigmented scar.

However, like any other infectious disease, streptoderma can cause complications on internal organs, especially damage to the heart muscle (myocarditis) and kidneys (glomerulonephritis).

Classification

Classification of streptoderma

superficial
	pityriasis alba (lichen simplex)
	superficial panaritium (tourniole)

	syphiloid-like papular impetigo of children
	acute and chronic diffuse superficial streptoderma
deep streptoderma	ecthyma: vulgar, penetrating
deep streptoderma	Prevention In order not to provoke the recurrence of the disease, you should avoid getting water or moisture on the affected areas. Streptoderma must be eliminated by drying to form a crust. Alcohol tinctures and salicylic alcohol can be used as a remedy. Once the infection is localized, the wound will heal and the crust will disappear. If the disease actively progresses, it must be treated with disinfectants. They remove harmful microorganisms, germs, eliminate unpleasant odors and prevent the spread of new ones. If the disease develops seriously, you should consult a specialist. Streptoderma should be treated with medications. Hormonal ointments and antibiotics are used to relieve especially painful and difficult cases. After an illness, repeated outbreaks often occur. To prevent relapses, it is necessary to eliminate predisposing factors: cracks in the skin; injuries, scratches; suppurative processes, etc.

Streptoderma is caused by an opportunistic bacterium - streptococcus, which is a normal symbiont of the human body. Streptococci can live on the mucous membrane of the nose, oral cavity and pharynx, in the vagina, as well as in the large intestine, but their main habitat is the surface of the skin.

Normally, human skin has a lot of barrier mechanisms that do not allow various bacteria to harm the body, but under certain conditions streptococci can penetrate into the thickness of the skin, causing purulent inflammation in it, which is called streptoderma.

Streptococci are quite stable in the external environment. They can persist in dust and on household objects for months, losing their pathogenicity. The bacteria can withstand heating up to 56 degrees for 30 minutes and boiling up to 15.

The bacteria that cause pyoderma are also the causative agents of such common diseases as sore throat, pneumonia, erysipelas, scarlet fever, and purulent meningitis.

The source of streptoderma infection can only be a person, both a carrier of the bacteria and someone suffering from sore throat, erysipelas, scarlet fever, and even a common runny nose or acute bronchitis. Infection from animals is impossible, since streptococcus is a symbiont exclusively of humans.

The route of transmission of streptococci is mainly airborne, but in the vast majority of cases they reach the skin through contact.

Reasons for development

Streptococci can penetrate the thickness of the skin and cause inflammation there due to the following factors:

skin injuries;
metabolic disorders;
changes in skin pH;
decreased immune defense.

Skin injuries. The skin is reliable armor against any microorganisms, however, even minor damage, such as scratches, scratches, bites, cuts, abrasions, etc., can become an entry point for infections. Having penetrated into small wounds, bacteria bypass the protective barriers of the skin, which is the cause of streptoderma.

Metabolic disorders. Hormonal imbalances, as well as metabolic diseases, such as diabetes, negatively affect the quality of the skin. Changes may be of the following nature:

dryness, redness, peeling;
chronic itching;
disruption of healing processes;
disturbance in the processes of sebum production.

These problems make it much easier for bacteria to penetrate into the thickness of the skin, and create the ground for streptococcal infection.

Changes in skin pH. Normally, the acidity of the skin is in the range of 4–5.7. Such conditions are unfavorable for the life of most pathogenic microbes, including streptococci, however, when the pH of the skin shifts above 6, the latter begin to actively multiply on it, which can lead to the development of streptoderma.

The reasons for the pH shift are as follows.

Endocrine diseases – diabetes mellitus, thyroid pathology, etc.
Abuse of cosmetics that have an alkaline reaction. Most often this is ordinary soap, which has a pH of around 11.
Non-infectious dermatitis.

Decreased immune defense. A decrease in the immune status of the skin can occur for the following reasons:

chronic diseases of the digestive system: gastritis, duodenitis, etc.;
chronic stress;
unhealthy diet: abuse of sweet, fatty foods, deficiency of vitamins and microelements;
poor circulation in the skin - diabetes, heart failure;
coagulopathies (diseases of the blood coagulation system), liver cirrhosis, renal failure, etc.

Streptoderma can be classified according to its origin as follows.

Primary – occurs on apparently healthy skin against the background of trauma.
Secondary - is a complication of a non-infectious disease, for example, atopic eczema.

Symptoms

Like any other infectious diseases, the symptoms of streptoderma can be divided into general and local.
General signs are nonspecific symptoms of the presence of an infectious process in the body:

increased body temperature;
weakness, weakness, lack of appetite, headache;
enlarged lymph nodes in the affected area.

The severity of general symptoms varies and depends on the type of disease, the age of the patient, and the individual characteristics of the immune system.

Local signs are symptoms of the disease directly on the skin: blisters of various sizes filled with transparent, cloudy or purulent contents, redness and swelling of the affected areas, peeling and yellowish crusts.

Classification by skin manifestations

Based on the external symptoms of skin damage, streptoderma can be divided into the following forms:

simple;
bullous;
slit-like;
erythemo-squamous;
tourniol;
streptococcal diaper rash;
streptococcal ecthyma.

Simple form or streptococcal impetigo

The main group of patients are children under 12 years of age.

The disease goes through a certain stage.

At the beginning, against the background of slight redness, phlyctena appears - a tense bubble 1-3 mm in diameter, filled with liquid.
Then the liquid becomes cloudy. The blisters open spontaneously or as a result of scratching, quickly becoming covered with yellowish scabs.
After the scab comes off, the skin remains dark pink for some time.
The total development time of one vesicle is 5-7 days.

Usually exposed areas of the skin are affected - the face and limbs. The first conflict, as a rule, worries the patient little and therefore goes unnoticed. However, the fluid from phlyctena contains a huge amount of streptococci, which, through scratching, clothing, bedding, etc., begin to infect new areas of the skin if treatment is not started on time. General symptoms appear infrequently, usually with streptoderma in children or with large areas of skin damage.

Bullous impetigo

A more severe form of streptoderma. The bubbles are larger in size and are called bullae. Their contents are purulent in nature. Much more often the general condition of the body is disturbed. After opening the bullae, erosions (analogous to ulcers) may form in their place.

Slit-like impetigo or streptococcal seizure

It occurs in the corners of the mouth, less often in the area of the wings of the nose or the folds of the corners of the eyes. It manifests itself as isolated conflicts without a tendency to spread and usually passes quickly without consequences.

Erythemosquamous streptoderma or dry impetigo

With this form of the disease, no blisters appear. Red itchy spots covered with white scales form on the skin. It spreads more slowly and lasts longer than the forms described above.

Tourniole or superficial panaritium

Usually accompanied by simple impetigo. It occurs as a result of the contents of phlyctene getting into the skin around the nail bed due to scratching. The skin around the nail becomes red, swollen, sharply painful, and later conflicts appear.

Streptococcal diaper rash

It occurs not only in children, but also in older people, as well as sedentary obese people with poor quality care. The essence of the problem is infection of common diaper rash with streptococcus. Large folds of skin are affected. Conflicts leave behind long-lasting cracks. Treatment is difficult and long, especially in adults.

Streptococcal (vulgar) ecthyma

A severe form of streptococcal pyoderma, affecting the entire thickness of the skin and subcutaneous fat. It is a purulent, non-healing ulcer. It usually affects the legs, but can also occur on the torso or arms. Usually accompanies diabetes, heart failure and other problems that reduce the body's immunoreactivity.

Diagnostics

The diagnosis of streptoderma is based on the following groups of diagnostic criteria:

Characteristic changes on the skin.
General infectious laboratory signs are an increase in leukocytes in the blood, an increase in ESR, and the appearance of a small amount of protein in the urine.
Detection of streptococci in the secretion of lycten or bullae - light microscopy of the secretion or determination of the pathogen by culture is used.

Treatment

Therapy for streptoderma consists of general and local treatment.

General or systemic treatment of streptoderma consists of prescribing antibiotics. In mild and moderate cases, antibacterial agents are administered orally. In severe cases, intramuscular or intravenous.

The main groups of antibiotics are as follows:

Penicillins: augmentin, amoxiclav.
Cephalosporins: cephalexin, cefuroxime, cefazolin.
Macrolides: clarithromycin, azithromycin, erythromycin.

Local treatment of streptoderma involves treating the affected areas of the skin with a 2% alcohol solution of brilliant green 2-3 times a day.

In mild cases, in the presence of single rashes and the absence of general infectious symptoms, only local treatment of streptoderma is possible. For this purpose, antibacterial ointments and creams based on erythromycin, tetracycline, bacitracin, mupirocin, neomycin, etc. are used.

For streptoderma, bandages are usually not used, but if the itching is unbearable, you can cover the lesions on the affected skin with gauze bandages to prevent the spread of the disease. Also, for itching, it is possible to use antihistamines internally: loratadine, cetrizine, etc.

Streptoderma is a contagious disease. The patient is isolated at home or in an infectious diseases hospital for the entire duration of treatment. Quarantine is imposed on preschool institutions.

Prevention

You can avoid infection with streptoderma by following a few simple rules.

Follow the rules of personal hygiene, wash your hands often with soap.
Children's toys also need to be washed periodically.
Any, even the most minor, wounds and abrasions should be treated properly.
At the first symptoms of streptoderma, immediately contact a specialist.

What is streptococcal infection

If the child’s local immunity is developed, the skin is not damaged, the immune system functions normally, the proliferation of streptococcus is suppressed by the body. A more severe and persistent course of streptoderma, relapses of the disease occur in children with the following predisposing factors:

When a child’s immunological reactivity is impaired: premature infants, with hypotrophy in children, anemia, with helminthiasis (see worms in children, worms in humans), with general infections.
In children with chronic skin diseases: scabies (symptoms), pediculosis (lice in children), allergic manifestations, atopic dermatitis
And also for otitis, rhinitis, when discharge from the ears and nose irritates the skin
When exposed to external factors - high and low temperatures - burns and frostbite
Poor personal hygiene, poor child care
Prolonged or constant contact of damaged skin with water, lack of treatment.

Causes of streptoderma

The causative agents of the disease, microorganisms of the streptococcus family, are typical representatives of the opportunistic microbial flora of the body - with sufficiently intense local immunity, integrity of the skin and mucous membranes, and normal functioning of the body's immune system as a whole, the active development and spread of this microorganism is limited, and the disease does not develop.

Classification

Streptococcal pyoderma is classified according to its course into 2 forms:

The latter is associated with the constant presence of skin injuries, varicose veins, diabetes mellitus and other reasons for the weakening of local immunity and the general condition of the body. The skin at the site of the former conflicts is dry and flaky.

As mentioned above, such a disease is considered a collective term - this means that it includes a whole group of pathological conditions. Thus, streptoderma in children exists in the following forms:

Streptococcal impetigo is the most common type of pathology and is characterized by the fact that it affects only the top layer of skin. In such situations, rashes are often localized in the nasal cavity and mouth, on the upper and lower extremities, on the face and other open areas of the skin;
bullous impetigo - characterized by a more severe course than the previous form, in particular, large bubbles or bullae filled with liquid are formed. This type of disease requires careful and long-term treatment;
slit-like impetigo - expressed in the fact that it is localized in places where cracks form, for example, in the corners of the mouth, on the wings of the nose and in the eye area;
superficial felon – formed due to the lack of treatment for streptococcal impetigo;
streptococcal diaper rash - lesions of the skin are located in the areas of natural folds and in the behind-the-ear area;
erythematosquamous streptoderma - characterized by slow spread and causes significantly less discomfort compared to other forms;
Ecthyma vulgaris is the most severe type of disease, since the negative effect of streptococcus spreads to the deep layers of the skin.

During diagnosis, clinicians also rely on the nature of the rash, which is why there are:

dry streptoderma - the basis of the symptoms is the appearance of spots and peeling of the skin;
exudative streptoderma - is such if the formation of bubbles of various sizes filled with liquid occurs. When they are opened, weeping, swelling and redness of the surrounding skin are observed.

According to the method of occurrence, this pathology is divided into:

acute – has pronounced symptoms, is quite easy to treat and leads to a rapid recovery of the patient;
chronic - proceeds sluggishly, diagnosis is possible only in the phase of exacerbation of clinical signs and requires long-term treatment. Often leads to complications. Sometimes a child may suffer from the disease throughout his life.

Depending on the depth of damage to the skin, streptoderma occurs:

However, depending on the location of the rash, several clinical forms of this disease are distinguished:

Depending on the pathogen, the following clinical forms of the disease are distinguished:

streptococcal impetigo (streptoderma);
staphylococcal impetigo;
vulgar impetigo - caused by mixed flora, that is, streptococci and staphylococci at the same time.

Stages of the disease

There are 3 stages of the disease:

Bullous (vesical). The initial stage is characterized by the eruption of blisters with pus in the lesion. First, a red spot appears, and within a day a phlyctena (bubble) forms. Over time, the number of bubbles increases. The size of the bubbles can be very different.
Non-bullous. The skin at this stage is deeply affected, the blisters do not heal well. Ulcers form - streptococcal ecthyma. Soon they begin to dry out.
Chronic stage. Develops with neglected or improper treatment. Characterized by occasional weeping rashes.

Symptoms and signs of streptoderma

The main manifestations of the disease are:

Most often, impetigo affects the face and hands. On slightly reddened skin, small bubbles up to 1 mm appear - phlyctenas, collected in groups; inside the phlyctenas there is a cloudy white or yellowish liquid.

After the bubbles open, the leaked liquid dries, forming yellowish crusts or scales on the skin. After the crusts fall off, redness of the skin persists for some time.

Streptoderma

After recovery, hyperpigmentation may remain at the site of redness for several months.

Symptoms and forms of the disease

Common symptoms can occur with any common form of the disease and include:

increase in body temperature to 38 °C and above
poor health
intoxication
headache
pain in muscles and joints
nausea, vomiting
inflammation of the lymph nodes in the area of infection
changes in blood tests

The duration of the disease depends on the shape and severity of the lesion and ranges from 3 to 14 days. Depending on the location and depth of the lesion in children, several of the most common forms of streptoderma are distinguished.

Streptococcal impetigo

The classic, most common and frequently occurring form. In this case, the child develops single small rashes of a characteristic appearance on the skin of the face, hands, feet and other open areas of the body. Streptoderma in the nose usually also occurs in the form of classic impetigo.

The latent period lasts about a week. After its completion, round or oval pink spots appear on the skin of an infected person, covered with fine-plate scales, quickly degenerating into purulent-vesicular elements.

The diameter of these spots can reach 5 cm, while the favorite places for their localization are the face, buttocks, limbs of the patient and his back.

Streptoderma code according to ICD 10: L01

Depending on the depth of skin damage, two forms of the disease are distinguished:

streptococcal impetigo (in this case, the blisters quickly open and heal without leaving any traces behind);
ordinary ecthyma (in this case, the germ layer of the skin is damaged and after healing of the opened blisters, scars remain).

Subjective sensations with streptoderma are usually absent: in some cases, patients complain of dryness of the affected skin and slight itching. With extensive lesions of streptococcal infection, the patient may have a low-grade fever and enlarge regional lymph nodes.

Initially, streptoderma is strictly localized, but in the absence of adequate and timely treatment, with frequent contact with water, as well as with neglect of personal hygiene rules, it quickly spreads.

In this case, the disease manifests itself in the form of large lesions with uneven edges and exfoliating epidermis along their periphery. After deliberate or careless opening of purulent blisters, yellowish-brown crusts form on the surface of the patient’s body.

When these crusts are removed, an erosive, bright pink surface is exposed.

Diagnostics

Either a pediatrician or a pediatric dermatologist knows how to carry out diagnostic measures and formulate tactics on how to treat such a disease. The doctor can make the correct diagnosis during the initial examination, but other manipulations may be required to establish the form of the disease.

First and foremost, the clinician should:

study the patient’s medical history to identify the underlying disease in secondary streptoderma;
collect and analyze life history to establish the route of infection;
carefully examine the affected areas of the skin;
interview the parents of the young patient in detail to determine the severity of the symptoms and the severity of the disease.

Laboratory research is limited to:

bacterial culture separated from blisters;
microscopic examination of scrapings from damaged skin;
general clinical analysis and blood biochemistry;
tuberculin tests;
coprograms.

In cases where the doctor suspects a severe course of streptoderma with damage to internal organs, general instrumental procedures will be required, including ultrasound, radiography, CT and MRI.

It is necessary to differentiate such a disease from:

The diagnosis is made by an experienced pediatric dermatologist or pediatrician based on the characteristic appearance of the elements, usually immediately. In doubtful and severe cases, cultures of the discharge from the elements are done for microflora, usually immediately with determination of sensitivity to antibiotics, in order to begin effective therapy as early as possible.

In severe cases, a general blood test must be taken, in which an increase in ESR, the number of leukocytes and a change in their formula towards neutrophilia can be detected. Sometimes the doctor may prescribe additional tests to identify or exclude concomitant diseases:

The diagnosis of impetigo consists of the following criteria:

In the process of making a diagnosis, the disease is differentiated from diseases such as pityriasis versicolor, urticaria, atopic dermatitis, pyoderma and eczema. The main criteria for diagnosing the disease are:

stay in the affected area;
presence of a characteristic clinical picture.

In addition, during the diagnostic process, microscopic examination and bacteriological culture of stain scrapings are performed. In this case, streptococci are found in the material taken from scraping from an infected person.

Treatment

Any streptoderma should be treated by a dermatologist. Doing something on your own is unacceptable, especially in complex forms, for example, SSTS or acute diffuse form.

The table describes the treatment methods used for streptococcal suppuration of the skin.

Type of treatmentMethods and drugs

Local drug treatment	for a small area of rash, treat blisters and crusts, as well as the skin around them, topically with alcohol solutions of aniline dyes (muchsine, brilliant green) or a saturated solution of potassium permanganate; Wipe the skin around the rash with boric or salicylic alcohol; for opened peels, use aqueous solutions of aniline dyes; when wet, make lotions and bandages with anti-inflammatory and disinfectants; after drying and for ecthyma - ointments with an antibiotic or disinfectant component; after removing inflammatory foci during diaper rash, wipe with salicylic or boric alcohol and apply powder.
Systemic drugs	vitamin therapy; immunostimulating drugs; for large areas of damage - systemic antibiotics (cephalosporins, macrolides); antihistamines to relieve itching; intravenous administration of immunoglobulins for toxic shock syndrome.
Diet	exclude fatty, sweet, highly salted foods, as well as various seasonings from the diet; Proteins should predominate in the diet.
Skin care	the affected areas should not be washed, only treated with disinfectant solutions or decoctions; Wash clean skin with antibacterial soap.
Traditional methods	can be used as an adjuvant therapy with the approval of the attending physician; powder made from crushed oak bark and horsetail - for healing ulcers; compresses made from St. John's wort oil; lotions from decoctions of oak bark; lotions of black pepper and garlic juice, taken in equal parts; chamomile decoction lotions.

Streptoderma in children: photo of how it begins

Sometimes the treatment of streptoderma is supplemented with homeopathy. It is also necessary to eliminate the indirect causes of the disease, for example, to achieve remission of atopic dermatitis, the treatment of which is described not only by dermatology and immunology, but also by psychosomatics.

Streptoderma can also be treated with the additional use of physiotherapy in the form of light therapy. In difficult cases, surgical intervention is required.

To prevent re-infection and the spread of infection, preventive measures must be followed.

The pathology can be cured using the following conservative methods:

oral medication;
the use of local medicines - ointments and antiseptics;
physiotherapeutic procedures;
diet;
use of traditional medicine recipes.

Treatment of streptoderma in children with medications includes:

antibacterial substances;
antihistamines;
multivitamins;
immunomodulators.

The following antiseptics are indicated for local use:

hydrogen peroxide;
fucorcin;
salicylic alcohol;
boric acid;
brilliant green.

A list of how streptoderma is treated in children using ointments:

"Mupirocin";
"Tetracycline ointment";
"Altargo";
"Levomekol";
"Baneotsin";
"Levomitil";
"Ichthyol ointment";
"Gentamicin ointment";
"Lincomycin ointment."

The most effective physiotherapeutic procedures are:

UFOK;
UFO and UHF;
laser therapy.

Treatment at home can only be carried out after the approval of the attending physician and is intended for use as lotions:

Any form of streptoderma, even local, requires mandatory treatment, as it tends to spread, is contagious and, in addition, streptococcus can provoke such serious autoimmune diseases as rheumatism, glomerulonephritis or endocarditis.

Hygiene rules

In some cases, this turns out to be enough, in others, they are very surprised when it turns out that the child cannot recover from a seemingly minor illness for several weeks, new rashes appear, and other family members become infected.

Mandatory hygiene aspects when treating streptoderma in children:

do not wash for at least 3-4 days, do not wet the affected areas with water, as it is an excellent carrier of infection in this case;
Gently wipe unaffected areas of the skin with a damp towel or a cotton swab dipped in water or a decoction of string/chamomile;
ensure that the child does not scratch the affected areas; in addition to purely mechanical restrictions, antihistamines, which are prescribed by a doctor, also help to reduce itching of the skin;
the child must have an individual towel hanging separately from the towels of other family members;
individual dishes and cutlery, which must be carefully processed after a sick child has used them;
It is better to remove soft toys during the period of illness, and wash plastic ones regularly;
constantly change or iron the child’s bed linen, especially pillowcases, with a hot iron;
If there are minor skin lesions, treat them regularly with an antiseptic.

Local treatment

What to do if your child has this disease? Regardless of the location of the lesions on the skin and their number, when streptoderma is detected, treatment for this disease is mandatory.

Impetigo is a highly contagious bacterial infection and must be treated with antibiotics, especially in children.

The drugs of choice in this case are “protected” penicillins (Augmentin, amoxiclav), as well as 1-2 generation cephalosporins (cephalexin, cefotaxime). In mild cases, medications are prescribed orally, in severe cases - intramuscularly or intravenously.

Streptoderma during pregnancy

Local treatment can complement antibacterial therapy. Phlyctenes are treated 2-3 times a day with an alcohol solution of brilliant green or methylene blue.

If the lesion is small and no general infectious phenomena are observed, you can not take antibiotics orally and limit yourself to treating the diseased skin with antibacterial ointments, creams or lotions, most often based on mupirocin or eryromycin.

Also, only local treatment can be used in adults, especially if impetigo is secondary.

During the entire treatment period, the child should not attend kindergarten. It is necessary to ensure compliance with the rules of personal hygiene, especially the cleanliness of hands, so that the patient, when scratching the affected skin, does not spread bacteria to healthy areas.

In cases where the foci of streptoderma on the patient's skin are single and the patient's general condition does not suffer, only local treatment of the disease is carried out.

In all other cases, in addition to local remedies, patients are prescribed general tonic drugs, ointments with a broad-spectrum antibiotic, vitamin therapy, therapeutic ultraviolet irradiation of the affected areas of the skin, hemotherapy, and UV irradiation of the blood.

During the treatment period, patients are instructed to completely avoid any contact with water, and to thoroughly wipe healthy areas of the skin with a cotton swab soaked in a decoction of chamomile flowers or other antiseptic medications.

Children with streptoderma are not allowed into children's groups. In addition, those who have close contact with them are also isolated for 10 days.

Pustules and blisters in the lesions are carefully opened at the base with a sterile needle and treated twice a day with brilliant green, methylene blue or other aniline dyes.

After treatment, dry aseptic dressings with disinfectant solutions and ointments are applied to the lesions. The crusts formed during streptoderma are carefully lubricated with salicylic petroleum jelly: this allows you to painlessly remove them after 20–25 hours.

The development of the disease is often accompanied by the appearance of non-healing marks on the patient’s face, which must be regularly and thoroughly wiped with 2% silver nitrate. For long-term and indolent streptoderma, patients are recommended to be treated with antibacterial therapy.

Complications and how dangerous the disease is

If treated incorrectly and untimely, microbial eczema will follow. The complication can be diagnosed by drops of serous fluid, which is released against a reddened background of microerosions.

In the vast majority of cases, impetigo goes away without consequences. However, there are situations when this disease can cause irreparable harm to the body.

Streptococcal impetigo, like any other streptococcal infection (erysipelas, scarlet fever, tonsillitis, etc.) can cause a malfunction in the immune system due to which the kidneys (nephritis) or heart (myocarditis, rheumatism) can suffer.

Definition

Streptoderma is a skin lesion caused by streptococci. The disease is caused by various strains of streptococci (most often group D).

Reasons

Other causes of streptoderma may include:

decreased appetite;
hypo-, avitaminosis, dysproteinemia;
metabolic disorders;
acute and chronic diseases;
physical fatigue;
neuropsychic fatigue, vegetative neurosis;
changes in the body's reactivity;
hypothermia and overheating of the body;
local disorders of blood supply and innervation of the skin;
changes in skin pH;
microtraumas;
excessive skin contamination;
presence of skin diseases.

Symptoms

Among the main symptoms can be identified the formation on the face, buttocks, and back of light pink spots of various sizes (1-3 cm), which are covered with scales. Usually there is a slight itching and dry skin, sometimes there may be an increase in body temperature, enlarged lymph nodes, and an itchy rash. Phlyctens are also formed - superficial blisters, the serous contents of which quickly become cloudy, and the conflicts themselves quickly open, forming erosion, or becoming covered with a crust.

Also sometimes streptococcal diaper rash, characteristic cracks, and diaper dermatitis appear in the area of the folds. After 2–3 days, purulent-bloody crusts form. After the crusts are rejected, a round ulcer with steep edges, a juicy, bleeding bottom, covered with a dirty gray coating, is discovered. Healing occurs slowly - up to 3 weeks and ends with the formation of a pigmented scar.

However, like any other infectious disease, streptoderma can cause complications on internal organs, especially damage to the heart muscle (myocarditis) and kidneys (glomerulonephritis).

Classification

Diagnostics

Diagnosis is made on the basis of anamnesis and clinical picture.

Bacteriological research methods (sampling of material from an infectious focus followed by culture in order to isolate etiologically significant microorganisms and determine their sensitivity to antibacterial drugs).

Tests should be done for the presence of fungi when examining scrapings and additional diagnostics should be carried out to rule out eczema.

Sources

https://liqmed.ru/disease/streptodermiya/
http://badacne.ru/streptodermiya/streptodermiya-mkb-10.html
http://med36.com/ill/951

Treatment of streptoderma in children is not a long process. Despite this, it must be comprehensive, even if the disease is mild. The disease involves the skin and is characterized by a variety of symptoms.

According to the International Classification of Diseases, 10th revision (ICD-10), streptoderma is assigned the code L08. This section includes pyoderma with code L08.1 and specified infectious lesions - L08.8.

The cause of streptoderma in children is the entry into the body and the conduct of life in this environment by a pathogenic microorganism - streptococcus.

Such a one can attach to the skin, getting there from the following sources:

household items: toys, towels, dishes, etc.;
from a sick person or from a healthy person who is a carrier of infection;
from a person suffering from such pathologies as: sore throat, pharyngitis, scarlet fever, .

The disease is epidemic in nature. Children attending kindergartens, schools, and sections can get sick by catching an infection from another child. The duration of the incubation period is from 2 to 10 days.

Based on the source of transmission of the infection, the modes of transmission of the disease are distinguished:

contact: during direct contact of the skin of a sick person with the epidermis of a healthy person (during games, kissing, etc.);
contact-household: during the transfer of any object from a sick person to a healthy person - toys, towels, dishes, etc.;
airborne: during sneezing or coughing, when infected saliva gets on the damaged skin of a healthy person.

Reasons for relapse

In the normal state of the immune system (both local and general), and the absence of a violation of the integrity of the epidermis, streptococcal infection has no chance of survival in the body; it is simply suppressed.

Relapses, as well as the progressive course of the disease, occur in the following cases:

in case of impaired immunological reactivity, which is observed in premature infants, in children with anemia, malnutrition;
with the concomitant development of another infectious pathology;
with the concomitant development of a chronic skin disease (scabies, lice, etc.);
for allergic symptoms;
with the concomitant development of otitis, rhinitis (due to the release of exudate from the nose, which irritates the skin).

The development of the disease is also influenced by external factors: high or low temperature (burn, frostbite of the skin, through which streptococci can enter the body).

If personal hygiene is not observed when caring for a child, this also increases the risk of pathology.

What forms can the disease take?

What streptoderma looks like can be said based on the form of the disease. In medicine, there is a division of pathology into the following types.

Streptococcal impetigo

It is difficult to say for sure how streptoderma of this form begins. In some children, the initial stage of development of the pathology is a slight redness of the skin, while in others characteristic blisters immediately appear.

At first, a clear exudate is localized in the vesicles, which over time turns into pus mixed with blood. Bubbles can merge with each other into one large spot. To the question Is streptoderma contagious in children, we can say with certainty - yes. The contents of the elements that have burst contain a large volume of streptococci, which, when they come into contact with the skin of a healthy person, cause streptoderma. After the bubbles have dried, crusts remain in their place, and after the latter dry out, blue spots remain.

Bullous and slit-like impetigo

Streptoderma in children appears in the form of large blisters, larger in size than the elements of streptococcal impetigo. After the blisters burst, a crust forms in their place, and after it dries out, erosion occurs with progressive development.

A slit-like appearance on a child’s face is in the form of a nick that appears in the corners of the mouth. An oblong-shaped element quickly bursts, and a crack appears in its place.

Ringworm simplex

Dry streptoderma in children is characterized by the appearance on the skin of rounded elements that have a pinkish or whitish tint. The rash may be slightly itchy.

Impetigo of nails

An inflammatory process occurs around the nails, and the nail plate can completely peel off. The disease develops after injury to a finger or with chronic hangnails. The general condition may worsen.

Intertrigo

Symptoms of streptoderma in children occur in skin folds. The rash quickly merges into one large spot, forming a bright red, weeping erosion. With a long course of the disease, a fungal or staphylococcal infection may occur with the appearance of other characteristic symptoms.

Ecthyma vulgaris

At the initial stage, the pathology has the same symptoms as with the classic form of streptoderma, but with blisters that are more dense. After opening them, ulcers appear containing rough edges and dirty plaque. After the ulcer heals, a scar and pigmentation appear.

Diagnosis of the disease and features of therapy

A dermatologist is involved in the diagnosis and treatment of streptoderma on the hands, streptoderma on the legs and other areas of the body. He will be able to determine the form of the disease and its stage by the appearance of the rash.

To confirm the diagnosis, prescribe additional diagnostic measures:

microscopy of epidermal scraping (for fungus);
bacteriological culture of the secreted exudate;
examination of the skin under a Wood's lamp;
RPR test and tuberculin test (to exclude syphilitic ulcers and skin tuberculosis).

Differential analysis of streptoderma on the child’s head and in other areas of the body is carried out with such skin pathologies as herpes simplex, chickenpox, pyoderma, pemphigus, candidiasis, eczema.

How to cure streptoderma is decided by a specialist after examining the patient. Streptoderma in children should be treated as early as possible to avoid negative consequences. The treatment is complex.

Hygiene

Using the right ointment is the first step in the treatment of streptoderma

First of all, it is necessary to maintain personal hygiene. Even if the mother adheres to all other prescriptions of the attending physician, uses prescribed medications, but does not maintain hygiene, the chances of a quick recovery are reduced.

For streptoderma, it is important to follow the following recommendations:

in the first 3-4 days after the bubbles begin to appear It is prohibited to carry out water treatments(water is a conductor of infection);
those areas of the skin where there are no pathological elements are wiped with a cotton swab dipped in warm water or a decoction of medicinal herbs (chamomile, string);
you need to prevent scratching the blisters;
The child must have individual household items: a towel, dishes, which are carefully treated after use;
plastic toys are washed every day, and soft ones are put away on the far shelf;
Bedding is changed daily or ironed.

If there is any, even minor, damage to the skin, it is treated with an antiseptic solution three times a day.

Local therapy

How to treat streptoderma in children, what medications are prescribed and what manipulations are performed? Treatment can be carried out at home, but only in accordance with the prescription of the attending physician.

The blisters are carefully opened using an injection needle pre-treated with an antiseptic.. Next, the surface is treated with a solution of aniline dyes, and a dry antiseptic bandage is applied.

To remove crusts, use salicylic petroleum jelly, which is first applied to areas with crusts, leaving for 2-3 hours. The following ointments can also be used in the treatment of streptoderma in children at home.

	Dosage, method of application	Contraindications	Side effects	Average price, rub.
STREPTOCIDE, ointment	Apply a thin layer, securing with a bandage on top. The frequency of use is determined by the doctor	Hypersensitivity, acute porphyria, acute renal pathologies, infants, pregnancy, lactation	Allergic reactions	60-80
TETRACYCLINE, ointment	Apply a thin layer under the bandage 2 times a day	Hypersensitivity, children under 11 years of age	Allergic reactions	20-30
GENTAXAN, ointment	Apply a thin layer to problem areas 2 times a day, securing with a tight bandage on top	Hypersensitivity	Pruritus syndrome, dermatitis, urticaria	1300
BANEOTSIN, ointment	For streptoderma in children, apply Baneocin twice a day, securing with a bandage on top	Hypersensitivity, severe skin damage	Hives, increased dry skin	300
BACTROBAN, ointment	Apply with a cotton swab 2-3 times a day, spreading over problem skin, secure with a bandage on top	Hypersensitivity	Urticaria, erythema, hyperemia	400

Streptocide ointment has a pronounced antimicrobial effect and helps suppress infection. The only one disadvantage of the drug - the addiction of pathogenic microorganisms to the substances included in the composition, which becomes the reason for the ineffectiveness of the ointment.
Tetracycline ointment has an antiseptic effect, helping to quickly eliminate pathogens. The drug contains an antibacterial substance from the tetracycline group - tetracycline hydrochloride.
Gentaxan ointment has a powerful antimicrobial effect due to the gentamicin sulfate contained in the composition. Despite the high effectiveness of the drug, ointment often causes side effects in the form of a skin allergic reaction.
Baneocin ointment also refers to antibacterial drugs used in the treatment of gram-positive pathogenic microorganisms. The drug is prescribed to both children and adults.
Bactroban ointment includes the antibacterial component mupirocin. The drug helps stop the growth and activity of pathogenic microorganisms and has a bactericidal effect. The drug is used both in monotherapy and in complex treatment of streptoderma.
Ointments for streptoderma are prescribed by the attending physician, based on the form of the disease. If local therapy does not help get rid of the pathology, drugs in the form of tablets are used.

Antiseptics

You can disinfect the surface of the skin where the rash is localized using any antiseptic solution.

Name of the drug, release form	Dosage, method of application	Contraindications	Side effects	Average price, rub.
DIAMOND GREEN, liquid	Treat affected areas 2-3 times a day	Hypersensitivity, weeping skin wounds, bleeding		36
HYDROGEN PEROXIDE, liquid	Treat the affected areas several times a day with a swab	Hypersensitivity	Allergic skin reaction	6
BORONAL ALCOHOL, liquid	Treat affected areas 2 times a day	Hypersensitivity	Allergic skin reaction	16

The Brilliant Green solution has an antiseptic effect and is used not only for streptoderma, but also for many other skin diseases. Side effects are rare and allows the drug to be used in the treatment of pathology in young children.
Hydrogen peroxide is a product that is used to disinfect damaged areas of the skin (which is necessary for streptoderma), as well as to stop minor bleeding and in dental practice. Due to the natural composition of the drug, there are practically no side effects.
Boric alcohol has an antiseptic effect and rarely causes irritation skin. It is used not only for streptoderma, but also for other skin pathologies in children (for example, diaper rash).

Systemic antibiotic therapy

In severe cases, antibiotics are prescribed. These could be penicillins - drugs that are most effective in treatment. Macrolides are considered no less effective.

The dosage, duration of therapy, and type of antibiotic are determined by the attending physician. Self-medication with antibiotics is prohibited; they often cause side symptoms.

Name of the drug, release form	Dosage, method of application	Contraindications	Side effects	Average price, rub.
AMOXILAV, tablets	Children under 2 years old - 2.5 mg, after 2 years old - 5 mg once	Diseases of the heart, blood, respiratory system, liver, kidneys, periods of pregnancy and lactation, hypersensitivity to components	Nausea and vomiting syndrome, flatulence, allergic reactions, dyspepsia, convulsions	300-400
ERYTHROMYCIN, tablets	20-40 mg per 1 kg of weight, 3 times a day	Similar	Similar	18-102
FLEMOXIN, tablets	30-60 mg per 1 kg of weight, 2-3 times a day	Similar	Similar	250

Amoxiclav belongs to the penicillin group and rarely causes side symptoms due to its good tolerance by the body. If tablets with this name are prescribed for adults, then for children it is advisable to use a suspension.
Erythromycin belongs to the macrolide group and is better tolerated by the body than penicillins. The effect of the drug is identical to penicillins. Long-term use of Erythromycin may cause pathogen resistance to its substances.
Flemoxin belongs to the group of semisynthetic ampicillins. The advantage of the drug is its fairly rapid absorption. The drug belongs to the combination of drugs and is used not only for skin diseases, but also for gastrointestinal tract, respiratory system (including children).

Folk remedies

Tinctures, decoctions or compresses from medicinal plants are effective assistants in the treatment of the disease

How to quickly cure streptoderma at home, are there any folk remedies that are approved for use by both adults and children?

Chamomile, oak bark (infusion of these has a drying effect): pour 1 tbsp. l. raw materials 200 ml of boiling water, leave for an hour, strain, apply a compress to the affected area 2 times a day;
elderberry bark (a decoction of the bark helps soften the crusts): 1 tbsp. l. raw materials, pour 200 ml of milk, boil for 15 minutes, cool, apply lotions to the affected area three times a day;
grated garlic, ground pepper (to eliminate weeping plaques): mix the ingredients in equal volume, apply on a piece of gauze, then on the affected area, leave for 15 minutes (make a compress twice a day).

You can increase the body's protective function, thereby speeding up recovery, by taking an infusion of hazel bark and leaves: 1 tbsp. l. raw materials pour 200 ml of boiling water, leave for an hour, strain, take 1-2 tbsp orally before meals. l.

How to brew a series for bathing a newborn - read. What should be the temperature of the water for swimming?

Differential analysis and duration of treatment

For example, a herpetic rash is present along with a pain syndrome, while with streptoderma it is absent. Chickenpox is characterized by the simultaneous presence of both fresh pimples and already dried blisters.

Streptoderma does not occur with catarrhal symptoms: there is no cough or runny nose. At the initial stage of bubble formation, they have transparent contents, whereas with other skin diseases it may immediately become cloudy.

Streptococcal seizures differ from herpes ones in that they open quickly, forming cracks behind them. After opening the herpes element, no cracks remain.

The ongoing disease can be accurately determined based on the results of the diagnostic measures performed.

The duration of treatment for streptoderma in children on the face and other areas of the body is influenced by the following factors:

the age of the patient (children recover faster due to a strong immune system than adults);
severity of the ongoing disease;
the presence of concomitant pathologies.

If you start therapy for streptoderma at the initial stage of development, you can recover within 7-10 days. When the pathology is advanced, therapy lasts for months.

Features of treatment in infants

When treating newborns, it is important to follow all doctor’s instructions. There is no need to interrupt therapy, even if positive changes in the general condition are visible.

If there is an elevated temperature, the baby is prescribed bed rest and taking appropriate medications (antipyretics: Nurofen or others). Water procedures are contraindicated for this period.

It is necessary to keep your baby's hands clean and his nails trimmed (find out in a separate article). This is necessary because even if the child touches the rash, the risk of secondary infection will be minimized.

The living space where the newborn is constantly located is ventilated and wet cleaned daily. If the baby is breastfed, the nursing mother should eat a healthy diet. Artificial animals are transferred to hypoallergenic mixtures. How to choose the right mixture, what criteria to use to do this is described.

Features of the disease in adults and during pregnancy

The course of streptococcal infection in adults is milder than in children. Complications are rare.

If you ignore the therapy prescribed by your doctor, the rash can spread to large areas of the body.

Treatment of the disease in adults is no different from that carried out for children. The exception is the period of pregnancy, during which many drugs are prohibited for use. Systemic therapy is rarely performed. More often they use local drugs that are not harmful to the fetus.

Complications

Streptoderma can be accompanied by complications, especially with untimely and inadequate treatment. Among them:

chronicity of the inflammatory process;
rough scars that require cosmetic procedures;
development of microbial eczema;
fungal infections requiring other specific therapy;
dermal atrophy.

Preventive measures

Observe the rules of personal hygiene yourself and teach your children from a very young age. It is better to prevent the occurrence of a disease than to end up persistently pursuing treatment.

We found out how to treat streptoderma in a child on the face or in another area.

It is necessary to take care of the prevention of the disease, how to deal with it and its negative consequences.

Preventive measures include:

timely treatment of wounds on the skin using appropriate medications;
avoiding scratching the skin if a skin disease develops, an insect bite, or other injuries;
maintaining personal hygiene (very important);
maintaining a healthy lifestyle;
maintaining proper nutrition;
avoiding contact with sick people.

Conclusions

Streptoderma is not a dangerous disease, but the first symptoms should not be missed. Give the necessary treatment immediately. If you start therapy in a timely manner and carry it out correctly, you can hope for a complete recovery and no relapses.

Streptoderma is a dermatological bacterial disease caused by streptococci. It is characterized by the formation of pinkish, flaky, round spots on the skin.

It is more correct to call this disease streptoderma, since together with staphyloderma, they form a large group of pustular skin diseases (pyoderma). The development of these diseases is based on a purulent inflammatory process that affects the skin and subcutaneous fat. All pyoderma are divided into clinical forms depending on the pathogen, the prevalence and depth of the inflammatory process.

Pyoderma code (staphyloderma and streptoderma) ICD 10 – L08.0. Streptococcal impetigo is classified as L01. Erysipelas (caused by group A beta-hemolytic streptococci) is classified as A46.

For reference. Streptoderma is a pyoderma caused by streptococci (mainly group A beta-hemolytic streptococci).

Symptoms of the disease are quite diverse and largely depend on:

depth of the inflammatory process (superficial or deep streptoderma);
localization of the inflammatory process;
the patient’s age, the state of his immunity, the presence of concomitant diseases, etc.

Streptoderma - classification

Depending on the depth of the inflammatory process, streptoderma is usually divided into superficial and deep.

Superficial forms of streptoderma are presented:

streptococcal impetigo;
crevice impetigo;
papulo-erosive streptoderma;
intertriginous streptoderma;
erysipelas;
streptococcal toxic shock syndrome;
acute diffuse streptoderma.

Deep forms of streptoderma include cellulite (phlegmon of subcutaneous fat) and vulgar ecthyma.

For reference. In some cases, the inflammatory process can be caused by mixed flora (staphylostreptoderma), in which case superficial vulgar impetigo most often develops.

Causes of streptoderma

Normally, human skin is colonized by a large number of opportunistic microorganisms. They constitute its natural microflora and do not cause an inflammatory process.

They also help maintain the skin's natural defense mechanisms.

With a sufficient level of immunity, intact skin has nonspecific resistance (relative innate resistance to some pathogenic microorganisms). Nonspecific resistance is the first protective barrier that prevents infectious agents from entering the body.

Fatty acids secreted by the skin have a pronounced bactericidal effect (destroying) on group A beta-hemolytic streptococci.

Attention. In the presence of risk factors (decreased immunity, skin trauma, etc.), the level of nonspecific resistance is noticeably reduced. Against this background, the inflammatory process can be caused by both pathogenic microorganisms and opportunistic microorganisms that are constantly present on the skin.

Risk factors contributing to the development of inflammatory processes in the skin and subcutaneous fat are:

immunodeficiency states;
stress, chronic sleep deficiency, overwork;
constant hypothermia;
work in hot, stuffy rooms;
living in regions with a humid climate;
work in conditions of high humidity (greenhouses, etc.);
violations of the integrity of the skin;
deficiency of vitamins A, B, C, E, as well as zinc, magnesium or sulfur;
unbalanced diet;
hormonal changes (adolescent acne, etc.);
endocrine diseases (diabetes mellitus, polycystic ovary syndrome, thyroid disease, etc.);
concomitant skin diseases (dermatitis, psoriasis, etc.);
failure to comply with personal hygiene rules;
improperly selected skin care (overdrying the skin, using too aggressive cleansers, etc.);
use of low-quality cosmetics;
obesity;
the presence of foci of chronic infection (streptococcal tonsillitis).

Attention. Due to the lack of barrier functions of the skin, young children are more predisposed to staphylo- and streptoderma than adults.

What can cause streptoderma

The most pathogenic streptococci for humans, often causing streptoderma, are hemolytic, viridans and non-hemolytic streptococci.

The main cause of all streptococci are beta-hemolytic streptococci of group A. Viridans and non-hemolytic streptococci affect the skin less frequently and, as a rule, cause streptoderma in children or weakened patients.

For reference. The prevalence of streptoderma is determined by the fact that about 45% of schoolchildren (in older patients this percentage is higher) are chronic carriers of group A beta-hemolytic streptococci in the nasopharynx.

Streptococci are transmitted by airborne droplets, coughing, talking or sneezing.

In the presence of streptococcal inflammatory processes on the skin (erysipelas, impetigo, etc.), the infection can be transmitted by contact (personal items, sheets).

For reference. The main difference between streptoderma and staphyloderma is damage to smooth skin.

With streptoderma, the skin around the mouth, the skin of the legs, armpits, over the mammary glands, in the groin and buttock folds, etc. are affected. There is also a peripheral spread of the inflammatory process (from the center to the periphery).

Reading time: 2 min.

The term “streptoderma” unites a whole group of dermatological diseases, the causative agent of which is the pyogenic bacteria streptococci. Penetrating into the subcutaneous space, they lead to the development of a purulent-inflammatory process, which, if left untreated, can cause serious complications.

Streptoderma in children is much more common than in adults, since their immune system is underdeveloped and cannot resist infection. In addition, abrasions, scratches and other damage are easier to form on a child’s thin and delicate skin, through which pathogenic microorganisms can penetrate.

On the skin of every person there is always a large number of microorganisms, including opportunistic ones, which include streptococci. As long as the skin sufficiently performs barrier functions, streptococci are in a latent (dormant) state, causing no harm.

A decrease in protective forces may occur due to the following factors:

past viral infections;
helminthic infestations;
hypothermia or overheating of the body;
hypovitaminosis;
nervous tension;
presence of chronic diseases.

Skin damage and various dermatological diseases contribute to the penetration of streptococci into the subcutaneous tissue. Lack of personal hygiene plays a significant role in the occurrence of streptoderma.

Routes of infection

All forms of streptoderma are infectious diseases that are easily transmitted from a sick person to a healthy person. You can become infected in the following ways:

in close communication through shaking hands, kissing, hugging;
through door handles, handrails in transport, store counters, personal items;
through airborne droplets when a person coughs or sneezes.

In children's groups, streptoderma disease can lead to an epidemiological outbreak. Therefore, when the first signs are detected, the sick child must be isolated, and a quarantine is declared in the kindergarten or nursery for the entire incubation period (10-12 days).

Types of streptoderma

To simplify the system of statistical recording of the reasons for the population's visits to medical institutions, as well as to implement a general methodological approach to various diseases, the International Classification of Diseases (ICD) was created.

Every decade, the list of diseases included in the ICD is reviewed and clarified by the competent commission. Currently, the tenth revision of the International Classification ICD-10, adopted in 1989, is in effect.

According to this classifier, streptoderma is included in the section “Other local infections of the skin and subcutaneous tissue” and is assigned code L08. In addition, the most commonly diagnosed form of streptoderma, impetigo, is separated into a separate subsection with code L01.

The main forms of streptoderma and their main symptoms are presented in the following table: