Streptococcal impetigo is found everywhere in people with delicate and sensitive skin. This infection is usually a consequence of poor hygiene, which is why it often happens in children, especially in the warm season.
Definition
Streptococcal impetigo (ICD 10 L01) is a highly contagious skin disease caused by a group of streptococci bacteria. It manifests itself as a conflict (a small bubble rash) with swelling and redness. Being located in groups, the bubbles merge and increase, and after the rashes pass, pinkish spots still remain on the skin for some time.
Skin manifestations are updated every five to six days. Infection quickly spreads to healthy areas, and the process begins again. Improper treatment and prevention can cause damage to a large area of the skin. The most common localization: face, hands, shoulders and other exposed areas of the skin.
In dermatology, the following varieties of streptococcal impetigo are distinguished: bullous, annular, slit-like, as well as tournamentol (disease of nail ridges), streptococcal diaper rash and post-erosive syphilide.
Reasons for impetigo
The main causative agents of infection are streptococcus and staphylococcus. The transmission method is contact, through dirty hands, toys, clothes and other household items. The penetration of bacteria through the mucous membranes is possible only if they are damaged, such as cracks or scratches.
Streptococcal impetigo in children occurs against the background of atopic dermatitis, eczema, allergic contact dermatitis, as the immune system is already compromised. Maceration of the skin, hyperhidrosis (sweating), rhinitis or otitis media with copious discharge are also favorable conditions for the onset of the disease. Parents of young children call streptococcal impetigo "ognevka", because in the children's team it is spreading at an amazing speed.
Symptoms of the disease
It all starts with the appearance of small reddish spots on the skin. After a few hours, bubbles appear in their place, but hyperemia does not go anywhere - these are conflicts. At this stage, the bubbles are tense, the liquid that is in them is transparent. But over time, the dome settles them, and the contents become cloudy and turns into pus. From this moment, two possible scenarios are possible: the pus dries, and yellow or brown crusts remain on the skin, or the bubbles spontaneously open, liquid pus flows out, leaving wounds. After everything heals or the peels peel off, lilac spots remain on the skin for a while.
Staphylococcal impetigo lasts without treatment (one cycle is conflict) for seven days. The rash is usually located in open areas of the body: face, arms, stomach and back. Conflicts are located conglomerates and tend to merge. Since the child itches, he spreads the infection throughout his body. If there is adequate treatment, the disease goes away after a month and does not leave behind cosmetic consequences.
Diagnostics
A dermatologist can clinically determine streptococcal impetigo. A photo of the skin (dermatoscopy) and a study of its acidity only confirm the diagnosis. To accurately know the etiology of the disease, the contents of the vesicles are plated on nutrient media, and when a bacterial colony grows, its microscopy is performed.
If the disease often recurs, it makes sense to be examined by an immunologist so as not to miss any serious violations. Bacterial skin diseases are the first bell indicating the magnitude of the problem.
The doctor in the process of collecting information about the disease needs to differentiate it with folliculitis, ostiofolliculitis, vulgar impetigo, epidemic pemphigus, herpes simplex, During dermatitis. Clinically, they all resemble streptococcal impetigo. A photo of damaged skin with a large increase helps to distinguish diseases from each other.
Ring impetigo
This disease begins with the appearance of small flat vesicles that are filled with a cloudy liquid. They quickly grow in breadth, spreading to healthy areas, but at the same time they dry out in the center with the formation of a brown crust. Therefore, by the end of the disease, the conflicts are in the form of rings. In some cases, the pattern of the rashes resembles a garland.
In all other respects, the disease usually resembles streptococcal impetigo. Specialists differentiate this form with herpes zoster, exudative erythema and Dühring's dermatitis.
Bullous impetigo
The causative agent is streptococcus, but in some cases, staphylococcus is also sown in patients. Bacteria enter the body through macerated skin. Most often this happens in the summer. The literature describes entire epidemics of this disease in soldiers.
Signs that distinguish bullous and streptococcal impetigo, this is primarily a type of rash. Large bubbles (up to two centimeters) have a hemispherical shape and are filled with a cloudy liquid with an admixture of blood. The favorite localization of these conflicts is the hands and lower legs. Around the affected areas there is swelling and inflammation of the lymphatic vessels. Local symptoms are accompanied by a general reaction of the body: fever, headache, increased white blood cells and ESR (erythrocyte sedimentation rate) in a general blood test.
Against other skin diseases, bullous impetigo is even more severe.
Streptogenic jam
This is streptococcal impetigo, which develops in the corners of the mouth with the formation of small flat vesicles, filled first with serous fluid and then pus. Due to constant traumatization (during meals, talking), the conflicts are opened, and cracks appear in their place. If the disease is neglected, then these cracks are quite deep and painful. In childhood, seizures often recur. This is due to a low level of hygiene and a lack of B vitamins, as well as the presence of diseases such as diabetes.
Differentiates seizures with a solid chancre, early congenital syphilis, Plummer-Winson syndrome. The first two diseases are characterized by positive serological reactions to syphilis and the presence of other symptoms, and Plummer-Winson syndrome is accompanied by hypochromic anemia, dysphagia, glossitis and stomatitis, which are not present with streptococcal seizures.
Superficial felon (Tournament)
This disease is a type of bullous impetigo and occurs in the periungual ridges. Its occurrence is provoked by injuries, burrs and scratches that become infected with streptococcus and suppurate. The bubbles are arranged in the shape of a horseshoe, surrounding the nail plates on the arms and legs. This can be either an isolated lesion of one finger, or a common one, covering the entire hand.
Bubbles increase in breadth and are filled with serous or purulent contents. If the lid of the bubble is damaged, erosion remains, which crusts over time. If the disease proceeds favorably, then all the sores heal, but in rare cases, the infection penetrates deeper under the nail, up to its rejection. After this, the bacteria spread through the lymphatic and blood vessels.
Superficial panaritium should be distinguished from chancre panaritium, candidiasis of the nail ridges and dermatitis Allopo. Chancre is a manifestation of primary syphilis, so it has characteristic symptoms: a dense red-cyanotic elevation with an ulcer in the center. In addition, the patient has other signs of syphilis. Candidiasis of the nail rollers is a manifestation of a systemic decrease in immunity. Finger tissue edema in this case is absent, the nails are dirty brown in color, and fungi are found in the erosion that is separated.
Posterosive Syphiloid
Or else Severest-Jacques disease. It is most often found in infants with overweight. Due to the presence of a large number of folds, parents are not always able to take good care of them, so patches of maceration and irritation appear on the skin.
The main symptom of the disease is the appearance of a rash on the buttocks, which after opening leaves erosion surrounded by a corolla of desquamated skin cells. In advanced cases, conflict can be located on the back and inner thighs, merge, forming bizarre arcuate figures.
After some time, erosion sites are infiltrated, and papules appear in their place. After resolving the rash, i.e. healing of ulcers, age spots often remain. Due to such an abundance of morphological elements, it is not always possible to diagnose a disease on time.
Differential diagnosis is carried out with papular syphilis and microbial eczema. In the first case, a positive Wasserman reaction is observed , and in the second, there is no redness under the polymorphic elements of the rash. In addition, papules and vesicles with microbial eczema do not merge with each other.
Treatment
There are general principles for the treatment of streptoderma, which will help eliminate streptococcal impetigo. Treatment is with antibacterial drugs and topical disinfectants. If the elements of the rash are single, then they can be treated with aniline dyes: brilliant green or fucorcin. It is also effective to use ointments with antibiotics (Oxycort, Dermazolone, Neomycin, and others). With the spread of conflict to large areas of the skin, streptococcal impetigo can be treated with resorcinol lotions.
Tableted antibiotic therapy is advisable in especially severe cases and with frequent relapses of the disease. In addition, fortifying drugs are additionally prescribed. Streptococcal impetigo in children is not fundamentally different. The treatment remains the same, but before applying the ointment, it is necessary to wait for the spontaneous opening of the vesicles, and also make sure that the child does not comb the skin.
Recommendations and prevention
As preventive measures, a hygiene culture needs to be instilled. Children and adults are advised not to wet the affected areas throughout the treatment process. All the following measures must be observed:
- Avoid contact with other children;
- use separate bath accessories and regularly change bed and underwear;
- give the patient a set of dishes.
If these rules are observed, then the disease will not spread either within the family or within the children's team. In order to prevent infection, do not neglect personal hygiene, always carefully treat abrasions and scratches and try not to comb the skin during rashes. Recurrent streptococcal impetigo is a complication that develops due to a decrease in the body's resistance. Do not forget about it and watch your health.