Local and systemic therapy in the treatment of streptoderma in children. Streptoderma in children Streptoderma in children ICD code 10

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

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

Streptococci are quite stable in the external environment. In dust and on household items, they can persist 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 tonsillitis, pneumonia, erysipelas, scarlet fever, and purulent meningitis.

The source of infection with streptoderma can only be a person, both as a bacteriocarrier and suffering from tonsillitis, erysipelas, scarlet fever, and even common cold 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 get on the skin by contact.

Reasons for development

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

• skin injury;
• metabolic disorders;
• skin pH changes;
• decreased immune defense.

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

Metabolic disorders. Hormonal disruptions, as well as metabolic diseases, such as diabetes, adversely affect the quality of the skin. Changes can be of the following nature:

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

These problems greatly simplify the penetration of bacteria into the thickness of the skin, and create the basis for a streptococcal infection.

Skin pH changes. 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 skin pH 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, pathology thyroid gland and etc.
• Abuse cosmetics having an alkaline reaction. Most often, this is ordinary soap, which has a pH around 11.
• Noninfectious 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;
• malnutrition: the abuse of sweets, fatty foods, deficiency of vitamins and microelements;
• circulatory disorders in the skin - diabetes mellitus, heart failure;
• coagulopathy (diseases of the blood coagulation system), cirrhosis of the liver, kidney failure, etc.

By origin, streptoderma can be classified as follows.

• Primary - occurs on apparently healthy skin against the background of injuries.
• Secondary - is a complication of any noncommunicable disease such as atopic eczema.

Symptoms

As with any other infectious diseases, the symptoms of streptoderma can be divided into general and local.
General signs - non-specific symptoms of the presence of an infectious process in the body:

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

The severity of general symptoms is different and depends on the type of disease, the age of the patient, individual characteristics immunity.

Local signs - symptoms of the disease directly on the skin: vesicles 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

By external symptoms skin lesions streptoderma can be divided into the following forms:

• simple;
• bullous;
• slit-like;
• erythema-squamous;
• tourniole;
• 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 staging.

• At the beginning, against the background of a slight reddening, a conflict 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 eschar has passed, the skin remains dark pink for some time.
• The total duration of the development of one vesicle is 5-7 days.

Usually open areas of the skin are affected - the face and limbs. The first conflict, as a rule, bothers the patient a little, so it goes unnoticed. However, the liquid from conflict contains a huge amount of streptococci, which, through scratching, clothes, 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 lesions.

bullous impetigo

A more severe form of streptoderma. The blisters are larger and are called bullae. Their content is purulent. More often violated general state organism. After the bullae are opened, erosions (similar to an ulcer) can form in their place.

Slit-like impetigo or streptococcal congestion

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 single conflicts without a tendency to spread and usually passes quickly without consequences.

Erythematous squamous streptoderma or dry impetigo

With this form of the disease, bubbles do not appear. Red, itchy patches covered with white scales form on the skin. It spreads more slowly and lasts longer than the above forms.

Turniol or superficial panaritium

Usually accompanies simple impetigo. Occurs as a result of the contents of the conflict entering the skin around the nail bed due to scratching. The skin around the nail becomes reddened, swollen, sharply painful, conflicts appear later.

Streptococcal diaper rash

It occurs not only in children, but also in the elderly, as well as sedentary obese people with poor-quality care. The essence of the problem is the infection of ordinary diaper rash with streptococcus. Large folds of skin are affected. Conflicts leave behind cracks that do not heal for a long time. It is difficult and long to be treated, especially in adults.

Streptococcal (vulgar) ecthyma

Severe form of streptococcal pyoderma affecting the entire thickness of the skin and subcutaneous adipose tissue. It is a purulent long non-healing ulcer. It usually affects the legs, but can also occur on the trunk or arms. It usually accompanies diabetes mellitus, 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:

1. Characteristic changes in the skin.
2. General infectious laboratory signs - an increase in leukocytes in the blood, an increase in ESR, the appearance of a large number protein in the urine.
3. Detection of streptococci in the secret of conflict or bull - light microscopy of the secret is used or the pathogen is determined by seeding.

Treatment

Therapy for streptoderma consists of general and local treatment.

General or systemic treatment of streptoderma is the appointment of antibiotics. In mild and moderate cases, antibacterial agents are administered orally. In severe cases, intramuscularly or intravenously.

The main groups of antibiotics are as follows:

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

Local treatment of streptoderma is the treatment of 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.

With streptoderma, bandages are usually not used, however, with unbearable itching, it is possible to cover the foci on the affected skin with gauze bandages to prevent the spread of the disease. It can also be taken orally for itching. antihistamines: loratadine, cetrizine, etc.

Streptoderma is a contagious disease. The patient is isolated at home or in an infectious disease 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.

• Observe 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, contact a specialist immediately.

What is streptococcal infection

If the local immunity of the child is developed, skin are not disturbed, the immune system functions normally, the reproduction 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 babies, 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 with otitis, rhinitis, when discharge from the auricles and nose irritates the skin
• When exposed 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 conditionally pathogenic microbial flora of the body - with sufficiently intense local immunity, integrity of the skin and mucous membranes, normal functioning immune system organism as a whole, the active development and spread of this microorganism is limited, and the disease does not develop.

Classification

Streptococcal pyoderma is classified downstream into 2 forms:

The latter is associated with the constant presence of skin injuries, varicose veins veins, diabetes mellitus and other causes of weakening of local immunity and the general condition of the body. The skin on 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 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 the skin. In such situations, rashes are often localized in the nasal cavity and mouth, on the upper and lower limbs, on the face and other open areas of the skin;
• bullous impetigo - differs in severe flow than the previous form, in particular, large vesicles 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 oral cavity, on the wings of the nose and in the eye area;
• superficial panaritium - is formed against the background of the lack of treatment of streptococcal impetigo;
• streptococcal diaper rash - lesions of the skin are located in the areas of natural folds and in the behind-the-ear zone;
• erythematosquamous streptoderma - characterized by slow spread and much less discomfort compared to other forms;
• ecthyma vulgaris is the most severe type of disease, since the negative effect of streptococcus extends to the deep layers of the skin.

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

• 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 flow, such a pathology is divided into:

• acute - has pronounced symptoms, is quite easy to treat and leads to a quick 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 an illness throughout his life.

Depending on the depth of the skin lesion, streptoderma occurs:

However, depending on the location of the rashes, there are several clinical forms of this disease:

Depending on the causative agent, there are the following clinical forms diseases:

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

Stages of the disease

There are 3 stages of the disease:

1. Bullous (blistering). The initial stage is characterized by a rash of vesicles with pus in the lesion. First, a red spot appears, and after a day a conflict (bubble) is formed. Over time, the number of bubbles increases. The size of the bubbles can be very different.
2. Non-bullous. The skin at this stage is deeply affected, the blisters do not heal well. Ulcers are formed - streptococcal ecthyma. They soon begin to dry out.
3. Chronic stage. It develops with neglected or improper treatment. It is characterized by episodic 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, up to 1 mm bubbles appear - conflicts, collected in groups, inside conflicts there is a cloudy white or yellowish liquid.

After opening the bubbles, the leaked liquid dries up, 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 appear with any common form of the disease and include:

• an increase in body temperature up to 38 ° C and above
• health disorder
• intoxication
• headache
• muscle and joint pain
• nausea, vomiting
• inflammation of the lymph nodes in the area of ​​\u200b\u200bthe foci of infection
• changes in blood tests

The duration of the disease depends on the form 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 encountered form. In this case, the child has 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 hidden period lasts about a week. After its completion, round or oval pink spots appear on the skin of an infected person, covered with small-plate scales, quickly degenerating into purulent-bubble 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 the skin lesion, two forms of the disease are distinguished:

• streptococcal impetigo (in this case, the blisters quickly open and heal, leaving no traces behind);
• ordinary ecthyma (in this case, the growth layer of the skin is damaged and scars remain after the healing of the opened vesicles).

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 rise to subfebrile temperature and enlarged 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 neglecting the rules of personal hygiene, it quickly becomes widespread.

In this case, the disease manifests itself in the form of large lesions with uneven edges and exfoliating epidermis along their periphery. After intentional 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 treat such a disease to carry out diagnostic measures and draw up tactics. The doctor can make a correct diagnosis already during the initial examination, however, other manipulations may be required to establish the form of the disease.

First of all, the clinician should:

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

Laboratory studies are limited to the implementation of:

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

In cases where a 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 by the characteristic appearance of the elements, usually immediately. In doubtful and severe cases, cultures of the discharge from the elements are done on the microflora, usually immediately with the determination of sensitivity to antibiotics, in order to start effective therapy as soon as possible.

In severe cases, be sure to take general analysis blood, which can be found increase in ESR, the number of leukocytes and a change in their formula towards neutrophilia. Sometimes the doctor may prescribe additional studies 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 with diseases such as pityriasis versicolor, urticaria, atopic dermatitis, pyoderma and eczema. The main criteria for diagnosing the disease are:

• stay in the lesion;
• the presence of a characteristic clinical picture.

In addition, in the process of diagnosing, microscopic examination and bacteriological seeding of scraping spots are performed. At the same time, streptococci are found in the material taken during scraping from an infected person.

Treatment

A dermatologist should treat any streptoderma. Doing something on your own is unacceptable, especially with complex forms, such as SSTS or an acute diffuse form.

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

Streptoderma in children photo how it starts

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.

It is possible to treat streptoderma with the additional use of physiotherapy in the form of phototherapy. In difficult cases, surgery is required.

Preventive measures must be taken to prevent re-infection and the spread of infection.

Pathology can be cured using the following conservative methods:

• oral medication;
• application of local medicines- ointments and antiseptics;
• physiotherapy procedures;
• dieting;
• use of traditional medicine recipes.

Treatment of streptoderma in children with medicines includes admission:

• antibacterial substances;
• antihistamines;
• multivitamins;
• immunomodulators.

For local use, the following antiseptics are indicated:

• hydrogen peroxide;
• fucorcin;
• salicylic alcohol;
• boric acid;
• greenery.

A list of what streptoderma is treated in children with ointments:

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

The most effective physiotherapy procedures are:

• UFOK;
• UV and UHF;
• laser therapy.

Treatment at home can be carried out only after the approval of the attending physician and is aimed at 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 serious autoimmune diseases such as rheumatism, glomerulonephritis or endocarditis.

hygiene rules

In some cases, this is enough, in some - they are very surprised when it turns out that a child cannot recover from a seemingly small sore for several weeks, new rashes appear, and other family members become infected.

Mandatory hygiene moments in the treatment of streptoderma in children:

• do not wash, at least 3-4 days, do not moisten the affected areas with water, as it is an excellent carrier of infection in this case;
• gently wipe the unaffected areas of the skin with a damp towel or a cotton swab soaked in water or a decoction of a string / chamomile;
• make sure that the child does not comb 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 should 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 for the period of illness, and wash plastic ones regularly;
• constantly change or iron the child's bedding with a hot iron, especially pillowcases;
• in the presence of minor skin lesions - regularly treat them with an antiseptic.

Local treatment

What to do if your child has this disease? Regardless of the localization of foci of rashes on the skin and their number, if streptoderma is detected, it is necessary to prescribe the treatment of this disease.

Impetigo is a highly contagious bacterial infection and should 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, drugs are prescribed orally, in severe cases - intramuscularly or intravenously.

Streptoderma during pregnancy

Topical treatment may complement antibiotic therapy. Conflicts are treated 2-3 times a day with an alcohol solution of brilliant green or methylene blue.

If the lesion is small and general infectious phenomena are not observed, antibiotics can not be taken orally and limited to the treatment of diseased skin with antibacterial ointments, creams or lotions, most often based on mupirocin or eriromycin.

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

During the entire period of treatment, the child should not visit Kindergarten. It is necessary to follow the rules of personal hygiene, especially the cleanliness of the hands, so that the patient, combing the affected skin, does not carry 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 restorative drugs, broad-spectrum antibiotic ointments, vitamin therapy, therapeutic ultraviolet irradiation on the affected areas of the skin, hemotherapy, and UV blood irradiation.

During the treatment period, patients are instructed to completely exclude any contact with water, and carefully 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 in children's groups. In addition, people who had close contact with them are also being isolated for 10 days.

Pustules and blisters in the lesions are carefully opened with a sterile needle at the base 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 vaseline: 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 seizures on the patient's face, which must be regularly and thoroughly wiped with 2% silver nitrate. With prolonged and sluggish streptoderma, patients are recommended to be treated with antibiotic therapy.

Complications and why the disease is dangerous

With improper and untimely treatment, microbial eczema will follow. A 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 resolves without sequelae. 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).

The reasons

The cause of streptoderma is streptococcus. Streptococci penetrate the skin in the area of ​​microtraumas of the epidermis and cause an inflammatory process of a predominantly superficial nature, however, in the presence of predisposing factors, deep streptoderma may develop.

Other causes of streptoderma may include:

• decreased appetite;
• hypo-, beriberi, dysproteinemia;
• metabolic disorders;
• acute and chronic diseases;
• physical fatigue;
• neuropsychic overwork, vegetative neurosis;
• changes in the reactivity of the body;
• hypothermia and overheating of the body;
• local circulatory disorders and innervation of the skin;
• skin pH changes;
• microtrauma;
• excessive contamination of the skin;
• the presence of skin diseases.

Symptoms

Among the main symptoms, one can single out the formation on the face, buttocks, on the back of a light pink spots various sizes (1-3 cm), which are covered with scales. Usually there is a slight itching and dryness of the skin, sometimes there may be an increase in body temperature, an increase in lymph nodes, an itchy rash appears. Conflicts are also formed - superficial vesicles, 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, diaper dermatitis. After 2-3 days, purulent-bloody crusts form. After rejection of the crusts, a rounded ulcer with steep edges, a juicy, bleeding bottom, covered with a dirty gray coating, is found. Healing occurs slowly - up to 3 weeks and ends with the formation of a pigmented scar.

However, like any other infection, streptoderma can give complications to internal organs, damage to the heart muscle (myocarditis) and kidneys (glomerulonephritis) is especially common.

Classification

Diagnostics

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

Bacteriological research methods (collection of material from the infectious focus with subsequent inoculation in order to isolate etiologically significant microorganisms and determine their sensitivity to antibacterial drugs).

It is necessary to do tests for the presence of fungi in the study of scrapings and conduct additional diagnostics to exclude eczema.

Sources

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

Streptoderma in children - includes a whole group skin diseases having an infectious and allergic nature. Most often, this disease is diagnosed in babies in the age category from 2 to 7 years. The danger lies in the fact that the pathological process is transmitted from person to person.

Based on the name, it becomes clear that the main source of the disease is becoming, which releases specific substances that poison the human body. The second important factor in the formation is any violation of the integrity of the skin. In addition, there are several ways of transmission of a disease-causing agent.

Simple or erythematosquamous streptoderma is characterized by:

• localization on the face, in particular the perioral region, cheeks and chin. Several times less frequently observed foci on the trunk and limbs;
• the appearance of clearly delimited foci having a round or oval shape;
• the acquisition of spots of a pinkish hue;
• peeling of damaged skin.

Symptoms of streptococcal diaper rash are:

• the occurrence of inflammatory elements in the folds of the anterior wall abdominal cavity, on the buttocks, in the armpits, behind auricles and in the inguinal-femoral zone;
• weeping eroded vesicles;
• bright pink color of lesions;
• the location of screenings around the main accumulation of the rash, which can be vesicles, pustules and crusts;
• the appearance of painful cracks and erosions.

Streptoderma in the form of ecthyma vulgaris is expressed in the following signs:

• deep damage to the skin;
• localization of elements on the legs and hips, in the lumbar region and on the buttocks, on the arms and torso;
• the formation of conflicts or pustules filled with serous-bloody or serous-purulent fluid;
• spontaneous opening of the bubbles leads to the fact that the contents dry out and form a crust of a yellowish-brown hue;
• after removal of the crust, a deep ulcer is exposed, causing severe pain;
• the formation of a pigmented scar at the site of the ulcer.

In addition, streptoderma in a child, regardless of type, is accompanied by such clinical manifestations:

• an increase in temperature or fever;
• weakness and lethargy;
• headache;
• sleep disorder;
• loss of appetite or complete aversion to food;
• irritability and tearfulness;
• frequent mood swings;
• an increase in the size of regional lymph nodes painful on palpation.

Diagnostics

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

First of all, the clinician should:

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

Laboratory studies are limited to the implementation of:

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

In cases where a 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:

• staphylococcal;
• newborns;
• or ;
• syphilitic ulcers;
• allergic rash.

Treatment

Pathology can be cured using the following conservative methods:

• oral medication;
• the use of local medicines - ointments and antiseptics;
• physiotherapy procedures;
• dieting;
• use of traditional medicine recipes.

Treatment of streptoderma in children with medications includes taking:

• antibacterial substances;
• antihistamines;
• multivitamins;
• immunomodulators.

For local use, the following antiseptics are indicated:

• hydrogen peroxide;
• fucorcin;
• salicylic alcohol;
• boric acid;
• greenery.

A list of what streptoderma is treated in children with ointments:

The most effective physiotherapy procedures are:

• UFOK;
• UV and UHF;
• laser therapy.

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

• animal fat;
• decoction based on horse sorrel, nettle and yarrow;
• infusion of camel thorn;
• raincoat mushroom;
• decoction of oak bark and sour;
• powders of malachite, hairy hawk and horsetail.

In addition, it is very important to observe such rules of hygiene.

Children are very sensitive to various infectious agents. Streptoderma, characterized by a rash on the body and other negative manifestations, occurs against the background of damage to the body by streptococcal bacteria. The article contains information about what kind of disease it is, how it starts, how to treat it, and how the rash looks in the photo.

Pyoderma, which occurs against the background of damage to the body by streptococci, is also called streptoderma. When a disease occurs on the body of a child or an adult, rashes form in the form of conflicts. Pathology is divided into superficial type (streptococcal impetigo, seizures, felon, dry streptoderma) and deep (chronic ulcerative-vegetative pyoderma, ecthyma vulgaris and others).

Infection occurs through close contact healthy person with a carrier of streptococcal infection. Incubation lasts approximately 6-7 days, depending on the strength of the child's immunity. In a chronic course, ulcers form on the body that do not heal for a long period. ICD-10 pathology code - L08.

What you need to know about infection

Several interesting facts about streptococcal infection:

• More often, streptoderma in children and adults is diagnosed in areas with a tropical and subtropical climate.
• Streptococci are the causative agents of such common diseases as tonsillitis, bronchitis, pneumonia, and others.
• According to medical statistics, every fiftieth child suffers streptoderma.
• More difficult to treat chronic deep form of dermatitis.
• About 40% of all skin diseases are caused by streptococci bacteria.
• Pathology ranks first among all skin diseases that children suffer from (about 60%).

More often, the disease under consideration affects babies under 7 years old, which is associated with an underdeveloped immune defense of the body.

Like other diseases of an infectious nature, streptoderma can cause complications in a child. With a mild course, foci of infection spread locally. If there is no treatment, the bacteria infect the internal organs, provoking inflammatory processes in them.

With the defeat of the nasopharynx occurs sinusitis, sinusitis, tonsillitis. If bacteria enter the ear, otitis media develops. When the lungs are affected, pneumonia is diagnosed. The spread of streptococci in the region of the heart leads to endocarditis. The defeat of the skull is fraught with meningitis, meningoencephalitis. Improper treatment or lack of it often leads to the formation of non-healing ulcers or the development of microbial eczema.

Causes of streptoderma

Skin disease is divided into several forms. Among them are the following:

• Primary - develops when an infectious agent enters directly on the skin. In this case, an inflammatory process occurs.
• Secondary - this is the form in which streptococci join the already existing pathology in the child (eczema, herpes simplex, chicken pox, and others).

The causative agent of the disease is streptococcus. The organism belongs to opportunistic bacteria, which are frequent "inhabitants" of the human body. The bacterium lives on the skin, without penetrating into the body due to the human immune defense. If the natural defense weakens, the likelihood of developing streptoderma increases. In this case, rashes appear on the body in the form of spots of various diameters, which do not heal for a long time with the formation of characteristic crusts.

The skin is the largest human organ that protects against the effects of negative environmental factors. Under the influence of various provoking factors, this protection is weakened, which can cause streptoderma in a child.

The causes of the disease include:

• Mechanical damage to the dermis. Skin injuries, even such as scratches, cuts, abrasions. They are a predisposing factor to the penetration of various pathogens into the body.
• Hormonal disorders in the body. Hormones perform important functions. Thanks to them, metabolic processes and body growth are carried out. Hormonal disorders entail dry skin, the appearance of cracks on it, reddening of the dermis and other negative symptoms. This can contribute to the development of streptoderma.
• Fluctuations in the pH level of the dermis. Normal pH should range from 5.2 to 5.6 units. This provides reliable protection against pathogenic agents. If the pH is disturbed, the risk of various skin pathologies increases.
• the presence of chronic inflammatory processes on the skin.

The risk group includes children with a genetic predisposition to allergic reactions and various dermatitis (urticaria, seborrheic, atopic dermatitis and other diseases).

Immune protection of the child

Human immunity is necessary to protect the body from various disease-causing agents. Decreased immunity often causes many diseases, in particular streptoderma.

Reasons for weakening the immune system:

• Diseases of the digestive system (ulcer, gastritis, duodenitis).
• Pathologies endocrine system(diabetes mellitus, hypothyroidism, hyperthyroidism, adrenal insufficiency).
• Improper nutrition - eating a large amount of sweet, salty, smoked, fatty foods can lead to a decrease in immune defenses.
• Lack of vitamins. Like malnutrition, a deficiency of certain microelements causes a weakening of natural defenses, which often leads to streptoderma.
• Stress, chronic fatigue, taking certain drugs can provoke a deterioration in immunity. medications during the treatment of other diseases.

Poor immunity is also often the result of circulatory disorders in the body, for example, in the formation of blood clots, with hyperemia and other conditions.

How to understand that a child has streptoderma? Infectious pathologies begin with incubation period. The disease in question is no exception. Many children can carry the infection for a long time without spreading it to others. Due to weakened immunity and under the influence of other provocative causes, streptococci enter the active stage. This is the beginning of the incubation period. It usually takes 3 to 10 days. At this time, the child does not have any symptoms.

After the end of incubation, streptoderma goes through three stages:

1. Bubble. At this stage, the surface layers of the dermis are damaged, characterized by the formation of inflammatory areas on the skin with rashes in the form of small bubbles. Bubbles with purulent contents form 24 hours after the appearance of red spots. The number of these bubbles is very different, from a few to dozens. The rash tends to merge. After healing of wounds, no traces remain on the skin.
2. bullous. For this stage, a deeper lesion of the skin of the child is characteristic. In this case, ulcers of rather large sizes occur (streptococcal erythema). The patient's condition is characterized as severe or moderate. After rejection of the crusts, scars remain on the body. Treatment of pathology takes a rather long period.
3. chronic stage. Chronic streptoderma develops with improper treatment or its absence. At the same time, rather extensive and deep lesions appear on the child's body. After wound healing, characteristic dark spots, the dermis peels off for a long time.

The most dangerous is the bullous and chronic form. To prevent possible complications it is necessary to treat the pathology when the first symptoms appear. To do this, parents need to show the baby to a pediatrician or dermatologist. Self-medication is extremely dangerous for the health of the child.

Symptoms of streptoderma depending on the type of disease

Streptococci cause a huge number of types of streptoderma in children. These forms differ from each other according to such signs as the localization of rashes, external manifestations of the disease, the severity of the course, and so on. Consider the common forms of the disease in more detail.

This form of pathology is usually acute and rapid. The symptoms of the disease include the formation on the face, nose, less often on the limbs and buttocks, pink spots with a whitish coating and characteristic peeling. When diagnosing dry streptoderma, it is often confused with allergic dermatitis.

In most cases, children easily tolerate this form of the disease. Itching and other negative manifestations are absent. Rarely, the patient has an increase in body temperature and other complaints in the form of the disease under consideration.

In the absence of proper treatment, dry streptoderma can turn into chronic form. With such a course, other pathogens can join, which causes seizures, angular stomatitis, eczematous processes and other complications.

Streptococcal or contagious impetigo is a skin disease that occurs mainly in childhood, as well as in women with dry and sensitive dermis.

The disease is characterized by the formation of purulent vesicles on the skin. When they are opened, crusts with a yellowish tint remain on the dermis. In a typical course, the localization of rashes is noted mainly on the face. Treatment is with antibiotics and disinfectants.

bullous impetigo

This form of streptoderma is more severe in children. With it, vesicles containing serous fluid appear on the body. With the further development of the disease, it passes into purulent contents. After opening the bula, an ulcer remains on the body, which heals for a rather long time.

Symptoms typical for bullous impetigo:

• increase in body temperature;
• weakness, loss of appetite;
• capriciousness;
• sleep disturbance;
• swollen lymph nodes.

The duration of the disease is about two months. In the absence of treatment, the child has various complications.

The rash in this form of the disease is localized in the corners of the mouth, in the area of ​​​​the eyes and wings of the nose. When the crusts crack, the child experiences pain, the wound bleeds.

In the absence of proper therapy, the pathology turns into chronic course which is quite difficult to deal with.

This form of the disease is caused by streptococcal, less often streptococcal-staphylococcal infection. This type of streptoderma is localized mainly in the buttocks, lower back, less often on the arms, legs, fingers, head, face, abdomen, eyes, and even in the ear. At the onset of the disease, several spots up to 2 cm in diameter appear on the body. The papule is filled with serous-purulent contents. After opening the bubble, a reddish edematous rim appears around it.

In place of the papule, a deep ulcer appears, rather painful, with jagged edges. After 3-4 weeks, the wound scars, leaving a patch of skin with pigmentation in its place. With weakened immunity, new formations appear throughout the month, streptoderma is complicated by lymphadenitis or lymphangitis.

Periungual or superficial panaritium

With this form of streptoderma, development is observed purulent process in the area of ​​the nail plate. Inflammation can affect both the roller and the tissues under the nail plate.

Symptoms of the disease in a child:

• redness and swelling of the skin around the nail;
• general deterioration of well-being;
• chills;
• headache;
• loss of appetite;
• capriciousness;
• enlargement and inflammation of the lymph nodes;
• increase in body temperature.

If these signs are found, contact medical institution should be mandatory. In the absence of proper treatment, complications such as lymphadenitis, phlegmon, and blood poisoning may occur.

Streptococcal stomatitis

Stomatitis is an inflammation of the oral mucosa. One of the forms of the disease is caused precisely by streptococci. Symptoms of pathology include swelling of the mucous membrane, redness. In severe cases, white bubbles appear in the child's mouth - pustules, erosion, bleeding gums.

If stomatitis has developed, it is necessary to record a small patient with a dentist. With improper treatment, the disease can provoke otitis, purulent tonsillitis and other serious complications.

A dermatologist is involved in the diagnosis of childhood streptoderma. A competent doctor can determine the pathology only by visual signs in the patient. The specialist takes into account the presence or absence of such signs as conflict, crusts, cracks, ulcers, erosion.

Diagnosis is confirmed with laboratory tests. In this case, the following procedures can be assigned to the child:

• bacterial culture of discharge from the vesicles;
• skin scraping in the affected area for fungal infections;
• inspection of diseased areas through a Wood's lamp.

Sometimes when making a diagnosis, the doctor may have doubts. In such situations, streptoderma is differentiated with similar skin pathologies. In a chronic relapsing course of pathology, a child may need to undergo an ultrasound scan, fecal analysis for worm eggs, consultation with a gastroenterologist and other specialists.

Differential Diagnosis

Many skin pathologies have a very similar course with streptoderma. To exclude certain diseases, differential diagnosis is carried out. Consider similar clinical picture illness.

Unlike herpes, streptococcal seizures open quickly, which is accompanied by the formation of painful cracks in the corners of the mouth. With herpes, the bubbles persist for a longer period and cracks after them, as a rule, are absent.

Streptoderma often appears on previously injured areas of the body. Herpes occurs on a clean area of ​​​​the dermis. In addition, with pyoderma, there is no itching characteristic of a herpes infection.

allergic rash

For some forms of allergies in children, the appearance of small-diameter bubbles on the skin, as with streptoderma, is characteristic. It is possible to confuse an allergy with an infection provoked by streptococci, as a rule, at the initial stages of the pathology. The main distinguishing feature of allergies is that such a rash turns pale when you press it. With streptoderma, this does not happen.

Any skin disease accompanied by the appearance of rashes of purulent etiology on the body is called pyoderma in medical practice. Streptoderma is just a type of pyoderma. Streptococci, affecting the skin, form a transparent, rather than cloudy pus, which provokes a special appearance rashes. In this regard, streptoderma is a conditionally separate type of pyoderma.

Differential Diagnosis carried out with mixed staphylococcal-streptococcal impetigo. In another way it is called vulgar. At the same time, the beginning of these two forms of pathology is identical. If a streptococcal infection has joined, the papule obsession becomes cloudy.

Rashes with syphilis

The syphilitic rash has many atypical variations. One of them is syphilitic papules in the corners of the mouth. Unlike jamming, the area of ​​​​inflammation with them extends far to the mucous membranes of the mouth. A child can become infected with syphilis through household contact with an infected person.

Chicken pox

In the initial stages of the disease, rashes appear first on the face, then spread to other parts of the body. Characteristic red vesicles appear in children on the pope, chest, legs, arms. Chickenpox can occur both in a newborn child and in an adult. In connection with such a spread of pimples, this disease can be confused with streptoderma, but after an increase in body temperature and the spread of the rash to other parts of the body, the diagnosis leaves no doubt.

Is the disease contagious

Many mothers and fathers are interested in whether this disease is transmitted from child to child. When playing outside, babies often come into close contact with each other, play with shared toys, sneeze, cough. As we have already found out, this type of skin disease is caused by streptococci, and these bacteria are easily spread by household and airborne droplets. Therefore, streptoderma is contagious.

If the child is injured or scratched, this place should be treated with an antiseptic. An adult should also be attentive to damage to the skin, even of a minor nature.

Treatment Methods

Due to the fact that streptoderma is caused by pathogenic microorganisms in the form of streptococcus bacteria, the disease in an infant and older children is treated with antibiotics. In addition, softening ointments, vitamin preparations, local antiseptics and some other means are used.

Ointments are used among children as prescribed by a doctor. Medicines in this form of release provide effective disposal from pathogenic microflora on the skin, which contributes to a speedy recovery.

Names of popular ointments for the treatment of streptoderma:

• Baneocin;
• Fucidin;
• Levomekol;
• Akriderm GK;
• Zinc;
• Acyclovir;
• Tetracycline ointment and others.

To smear the affected areas on the body of a child with streptoderma should be according to the scheme prescribed by the doctor. Usually, the course of treatment with antibacterial agents lasts 7-10 days, but sometimes the treatment has a longer duration, depending on the severity of the course of the disease in a particular patient. When it comes to the treatment of infants, the independent use of any drugs is strictly prohibited. Before starting therapy, it is imperative to show the child to a specialist.

If the rash is located on the lips, on the eyelid, in the corners of the mouth, ointments should be used with extreme caution. It is important to ensure that the medicine does not get on the mucous membranes.

Medicines for internal use

Sometimes it is quite difficult to cure streptoderma using only ointments. This may apply, for example, to situations where the rash is hidden under the hair on the head or the course of the pathology is complicated. In such cases, doctors prescribe therapy with oral antibiotics.

Antibacterial agents for internal use:

• Sumamed;
• Amoxiclav;
• Augmentin;
• Suprax and others.

Any antibacterial drugs should be used according to a strict scheme with clear dosages. Violation of the instructions can provoke a relapse of the disease and poor healing effect. In addition, the misuse of antibiotics often leads to the development of side effects.

Modern pharmacology offers a wide range of disinfecting solutions for the local treatment of rashes in various skin pathologies. Their use is convenient, and most importantly, safe.

Treatment of streptoderma involves opening the blisters with their subsequent treatment with antiseptics and antibacterial ointments. Solutions for local disinfection include:

• Hydrogen peroxide;
• Brilliant green (brilliant green);
• Fukortsin;
• Salicylic alcohol.

These preparations are used exclusively for external application. In this case, it is necessary to capture not only the diseased area, but also a few millimeters of healthy skin. How many times to smear the dermis in the affected areas? Re-treatment is carried out 2-3 times a day.

When applying an antiseptic to the skin, the child may experience pain and burning. After the solution dries, these sensations go away.

At home, the treatment of streptoderma in children can be carried out with the help of some folk recipes.

Let's consider a few of them:

• Garlic juice. It's simple and safe method to get rid of the rash. Garlic has been proven to be an excellent natural antibiotic. For the treatment of bubbles, it is necessary to lubricate the affected areas of the skin with juice 3-4 times during the day.
• A solution of potassium permanganate. To prepare a disinfectant, you need to dissolve several granules of pink powder in boiled water and treat the wounds on the child's body with this remedy. Such a medicine will quickly eliminate pathogenic bacteria.
• Chamomile. The plant has an analgesic, wound healing and disinfecting effect. A decoction of chamomile will help get rid of the sore. To prepare it, you should brew a tablespoon of the plant with a glass of boiling water and let the remedy brew for 1.5-2 hours. Wash the wounds with the received medicine.
• Calendula flowers. Brew a tablespoon of the plant with a glass of boiling water, leave the medicine for several hours. The resulting tool to treat the place of rashes.
• Pomegranate juice with honey helps to eliminate streptoderma in a child. To do this, the products must be mixed in equal proportions, the product should be stored in the refrigerator. Sick areas should be lubricated with this medicine 3-4 times a day.

Streptoderma is a dermatological bacterial disease caused by streptococci. It is characterized by the fact that pinkish scaly rounded spots form on the skin.

It is more correct to call this disease streptoderma, since together with staphyloderma, they form an extensive group of pustular skin diseases (pyoderma). The development of these diseases is based on a purulent inflammatory process, dermal and subcutaneous fat. All pyoderma are divided into clinical forms depending on the pathogen, prevalence and depth. 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 pyoderma caused by streptococci (mainly group A beta-hemolytic streptococci).

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

• the depth of the inflammatory process (superficial or deep streptoderma);
• localization of the inflammatory process;
• the age of the patient, 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 subcutaneous fat fiber) and vulgar ecthyma.

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

Causes of streptoderma

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

Also, they help maintain the natural defense mechanisms of the skin.

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

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

Attention. In the presence of risk factors (decreased immunity, skin trauma, etc.), the level of nonspecific resistance is markedly reduced. Against this background, the inflammatory process can be caused by both pathogenic microorganisms and conditionally pathogenic 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 deficiency sleep, 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 (youthful acne, etc.);
• endocrine diseases (diabetes mellitus, polycystic ovary syndrome, thyroid disease, etc.);
• concomitant diseases of the skin (dermatitis, psoriasis, etc.);
• non-compliance with the rules of personal hygiene;
• improperly selected skin care (overdrying of the skin, the use of too aggressive cleansers, etc.);
• the use of low-quality cosmetics;
• obesity;
• the presence of foci chronic infection(streptococcal tonsillitis).

Attention. Due to lack barrier functions skin, children early age more prone to staphylo- and streptoderma than adults.

What can cause streptoderma

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

Group A beta-hemolytic streptococci are the main cause of all streptoderma. Green and non-hemolytic streptococci affect the skin less often and, as a rule, cause streptoderma in children or debilitated patients.

For reference. The prevalence of streptoderma is due to 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, when 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 the lesion of smooth skin.

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