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Transient vesicles Exuding lesions with yellow crusts Erythema

Affects mainly face and limbs, commonly in children

Erythema and bullae which rupture leaving superficial crusts Affects mainly face and limbs in children and adults


Persistent scratching Topical steroids

Toxic reaction between organisms and epidermis resulting in superficial epidermal split in bullous lesions


Staphylococcus aureus Streptococcus pyogenes

Staphylococcus aureus Streptococcus pyogenes in some outbreaks

Staphylococcus aureus


(1) Weaker topical steroids (for the eczema) with topical antibiotics

(2) Systemic antibiotics if necessary

(3) Soaks "with potassium permanganate

Topical antibiotics Systemic antibiotics against both streptococcal and staphylococcal infection

Topical and systemic antibiotics


Avoid prolonged use of topical antibiotics

Return to using weaker steroid It is wise to send a specimen for bacteriology: when infection has healed

Even without clinical evidence of infection most lesions of atopic eczema are colonised by Staphylococcus aureus

Staphylococcal infection can cause generalised superficial shedding of the epidermis—"scalded skin syndrome" (Lyell's disease)

It is wise to send specimens for culture in an outbreak to identify presence of Group A streptococci potentially implicated in glomerulonephritis

Inflammatory nodule affecting the hair follicles develops into a pustule Tender induration with severe inflammation, followed by necrosis Heals with scarring Affects all ages Several boils may coalesce to form a carbuncle

Various forms:

Children—"Follicular impetigo" Adults—

(a) Keloidal folliculitis Back of neck

(b) Acne necrotica Forehead/hairline

(2) Face—"Sycosis barbae"

(3) Legs—Chronic folliculitis

Small bullae may be present initially An adherent crust is followed by a purulent ulcerated lesion with surrounding erythema and induration, which slowly heals Usually on legs

Well defined areas of erythema—very tender, not oedematous Vesicles may form Common sites—abdominal wall in infants; in adults the lower leg and face An area of broken skin, forming a portal of entry, may be found

Underlying disease— (1)

for example, atopy Mechanical damage from (2)

clothing, occlusion

Underlying disease— for example, eczema Infection may be by mechanical precipitated injury, greasy emollients, and occlusive dressings

Hot climate, occlusion More common in debilitated individuals May follow secondary infection of chicken pox

Lymphoedema and severe inflammation due to bacterial toxins

Staphylococcus aureus, usually of same strain as in nose and perineum

Staphylococcus aureus Propionibacterium acnes Malassezia spp. Pseudomonas spp. and other Gram negative organisms

Both Streptococci and Staph. aureus

Staphylococcus aureus Klebsiella pneumoniae Haemophilus influenzae

(1) Antibiotic (penicillinase resistant) systemically

(2) Cleaning of skin with weak chlorhexedine solution or a similar preparation

Topical and long term systemic antibiotics— for example, erythromycin Topical antifungal for Malassezia infection

Improve nutrition Use antibiotic effective against both staphylococci and streptococci

Penicillin or erythromycin

Nasal and perineal swabs '

should be taken to identify carriers

Remember unusual causes— a bricklayer presented with ' a boil on the arm with necrosis due to anthrax (malignant pustule) acquired from the packing straw used for the bricks

Gram negative folliculitis occurs on the face—a complication of long term treatment for acne Gram negative folliculitis on the body is associated with exposure to contaminated baths or whirlpools

Check for debilitating diseases, reticuloses, diabetes

Cellulitis affects the deeper tissues and has more diverse causes, being essentially inflammation of the connective tissue

Streptococcus, Staphylococcus, Haemophilus, and other organisms may be found One of the complications of erysipelas of the face is thrombosis of the cavernous sinus

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