superficial spreading pyoderma

It includes superficial bacterial folliculitis, superficial spreading pyoderma, and “puppy pyoderma” (also known as impetigo or juvenile pustular dermatitis). Staphylococci that have acquired the mecA gene are classified as methicillin (synonymous with oxacillin) resistant, signifying resistance to penicillins, cephalosporins, and carbapenems. Although the term pyoderma literally means “pus in the skin,” the pus may not always be visible to the naked eye. Poor hygiene and neglect are key elements in pathogenesis. pyoderma gangrenosum A rare, ulcerating skin disease in which the skin is infiltrated by neutrophils. Complete genome sequencing of S. pseudintermedius isolated from a dog with pyoderma has shown that S. pseudintermedius possesses a number of virulence factors that resemble those produced by S. aureus.11. 2 regions where staph like to hang out. Practice good hygiene (hand washing) to prevent zoonosis. Dogs with superficial pyoderma should be bathed with a shampoo recommended by its veterinarian. Define superficial pustular pyoderma. Ecthyma is usually a consequence of neglected impetigo and classically evolves in impetigo occluded by footwear and clothing. Prospective epidemiologic observations were made over a three-year period on children living in an area where superficial pyoderma is prevalent. Also, “hot tub” folliculitis may be caused by P. aeruginosa (see Chapter 180). may be further opportunistic pathogens. This papular dermatitis forms coalescing lesions as demonstrated by the erythematous plaque. Staphylococcus pseudintermedius (previously Staphylococcus intermedius) is the most common bacterium isolated from canine pyoderma and is usually limited to dogs. Most children (81%) developed skin infection. Deep bacterial infections, such as bite-wound abscesses and opportunistic (atypical) mycobacterium infections, are not responsive to topical antibacterials, so wound management and/or systemic treatment is the mainstay for these disorders. Additionally, protein A, staphylokinase, capsular polysaccharide, fibrinogen binding protein, and clumping factor A all act to aid in avoidance of being opsonized and phagocytosed. Intact skin is usually resistant to colonization or impetiginization, possibly due to absence of fibronectin receptors for teichoic acid moieties on S. aureus and group A Streptococcus. In many areas, the prevalence of CA-MRSA strains is over 50%.9. demodicosis, dermatophytosis). Histologically, the lesions of bullous impetigo show vesicle formation in the subcorneal or granular region, occasional acantholytic cells within the blister, spongiosis, edema of the papillary dermis, and a mixed infiltrate of lymphocytes and neutrophils around blood vessels of the superficial plexus. CANINE ACRAL LICK … 27.3 ). The existence of a real bacterial allergy is presumed and debatable. Ecthymatous lesions can evolve from a primary pyoderma or within a preexisting dermatosis or site of trauma. Dermatophytic folliculitis must be differentiated from S. aureus folliculitis. Lesions commonly arise on the skin of the face (especially around the nares) or extremities after trauma. Among the acute streptococcal pyodermas are impetigo, diffuse superficial streptococcal pyoderma, and ecthyma, an ulcer that forms beneath a dried phlyctena. Isolated staphylococcal folliculitis is common on the buttock of adults. Dogs with deep pyoderma may require daily baths with medicated shampoos diluted to one-half or one-quarter strength. self trauma from flea allergy, bacterial, deep bacterial folliculitis. Over the past 5 years, clonal spread of methicillin-resistant S. pseudintermedius has occurred across Europe and North America.12 Methicillin resistance has also been described among S. schleiferi and S. aureus isolates from dogs with pyoderma.8 These organisms encode an altered penicillin binding protein that incurs resistance to all β-lactam antimicrobials, and many also demonstrate resistance to fluoroquinolone antimicrobials. Ecthyma is a cutaneous pyoderma characterized by thickly crusted erosions or ulcerations. More typical epidermal collarettes in a dog with resolving pyoderma. Note how the dog's normal pigmentation masks the papular dermatitis. The most common underlying skin diseases are allergic dermatitis and endocrine diseases, but a variety of other skin diseases can also predispose to pyoderma. Premature discontinuation of therapy, inability to completely control the primary disease, and the use of fluoroquinilone antibiotics will likely perpetuate the resistant infection. In industrialized nations, S. aureus is the most common cause of superficial pyodermas (Box 176-1), but group A Streptococcus continues to be a common cause of pyoderma in developing countries. Bacterial culture: Staphylococcus species. If antibiotic resistance is suspected or confirmed, frequent bathing (up to daily) and frequent application of topical chlorhexidine solutions, combined with simultaneous administration of two different classes of antibiotics at high doses, seem to produce the best results. Surface pyoderma occurs when bacteria proliferate on the surface of the skin and incite an inflammatory response, without invading the skin. Superficial Canine Pyoderma is characterized by a condition called impetigo, which is another name for a localized skin infection. If the dog is severely pruritic, oclacitinib should be considered (3–7 days) over glucocorticoids. The lesions are slow to heal, requiring several weeks of antibiotic treatment for resolution. Additionally, methicillin-resistant Staphylococcus aureus (human MRSA) is becoming more common among veterinary species. Not particularly localized to one anatomic area. Pyoderma, a pyogenic cutaneous bacterial infection, is one of the most common skin diseases of dogs. Therefore, the patient's history, in combination with clinical and cytological findings, provide the clues suggestive of an antimicrobial-resistant infection (Box 3-2). It is a staph or other bacterial infection that targets wounds on your dog's skin, resulting in deep or superficial accumulations of pus beneath the skin. Sterile pyogranulomatous dermatitis. superficial spreading pyoderma. TSST-1 and the staphylococcal enterotoxins are also known as pyrogenic toxin superantigens. However, these antibodies are not the primary determinants of resistance to such infections. Superficial infection involves the epidermis and/or the follicular infundibulum , and includes impetigo, superficial folliculitis, superficial spreading pyoderma and some mucocutaneous pyoderma. Recently, two additional staphylococci have been isolated from cases of recurrent pyodermas, namely Staphylococcus schleiferi subsp schleiferi and Staphylococcus schleiferi subsp coagulans, both of which are frequently methicillin-resistant staphylococci. In veterinary medicine, MRS are becoming more common for reasons such as repeated systemic antibiotic exposure (especially fluoroquinolones), subtherapeutic administration of systemic antibiotics (dose or duration), long-term treatment with steroids, failure to identify and manage the underlying cause for repeated infection, and patient contact with human health care workers or facilities. Today, MRSA can be divided into Hospital-Associated (HA) or Community-Associated (CA) MRSA. Folliculitis is a pyoderma that begins within the hair follicle, and is classified according to the depth of invasion (superficial and deep), and microbial etiology (Box 176-5). Ecthymatous lesions were also present on the other leg, the arms, and the hands. Staphylococci are classified into two major groups: (1) the coagulase-negative Staphylococci and (2) coagulase-positive (S. aureus) Staphylococci. In some individuals, lesions resolve spontaneously; in others, the lesions extend into the dermis, forming an ulcer (see Section “Staphylococcal Ecthyma”). Pyodermas are caused by bacterial colonization or invasion of the skin by coagulase-positive staphylococci, usually Staphylococcus intermedius. This uncommon clinical presentation is mainly seen on the ventral body. In the condition known as superficial spreading pyoderma (SSP), pustules evolve into coalescing and expanding erythematous macules. Also, three noninfectious, inflammatory, follicular disorders are more common in black men: (1) pseudofolliculitis barbae, which occurs on the lower beard area (Fig. Pyoderma has three different types. Pyodermas are infections in the epidermis, just below the stratum corneum or in hair follicles. Although it is usual to say pyoderma, the plural pyodermas should be used, since there are a large number of bacterial diseases of the skin in this species, with different histopathological and clinical aspects. Severe erythematous dermatitis without the typical papular, crusting rash, which is more typical of pyoderma. Nasal carriers of S. aureus can present with a very localized type of impetigo confined to the anterior nares and the adjacent lip area (Fig. CANINE SUPERFICIAL SPREADING PYODERMA Diffuse, large, expanding epidermal collarettes Trunk/Abdomen/Rump Collies/Shelties/Crosses 27. Staphylococcus aureus: nasal carriage with impetigo. The prognosis is good if the underlying cause can be identified and corrected or controlled. The lesion is indistinguishable from a Demodex, dermatophyte, or yeast infection. SITES OF COLONIZATION IN NEONATES (AND SITES OF INFECTION), METASTATIC SKIN INFECTIONS ASSOCIATED WITH BACTEREMIA (OFTEN S. aureus ACUTE INFECTIONS ENDOCARDITIS), STAPHYLOCOCCAL TOXIN-ASSOCIATED SYNDROMES. This is the most common type of pyoderma. Also, a single course of oral azithromycin (in adults 500 mg on the first day, 250 mg daily on the next 4 days) has been shown to be equally as effective as dicloxacillin for skin infections in adults and children. When evidence exists for one of these infections, bacterial culture (including bacterial speciation) and susceptibility testing are indicated if systemic antibiotics are thought to be warranted because of the extent and severity of the pyoderma and inherent patient factors. Shetland sheep dogs often develop large superficial spreading areas of alopecia, erythema, and scaling. Contributing factors: immunosuppression, atopic dermatitis, preexisting tissue injury, and inflammation. Bullae initially contain clear yellow fluid that subsequently becomes dark yellow and turbid (see Fig. The frequency of isolation of group A Streptococcus makes such therapy a reasonable approach in most patients who have a significant degree of involvement. In superficial pyoderma, bacteria infect the superficial epidermal layers that lie immediately under the stratum corneum (the outermost layer of the skin) and the portion of the hair follicle above the sebaceous duct (the infundibulum) (Figure 84-1). Bullous pyoderma gangrenosum is also a superficial variant that affects the upper limbs and face more than the lower extremities. • Shetland sheep dogs often develop large superficial spreading areas of alopecia, erythema, and scaling. Superficial pyoderma is a superficial bacterial infection involving hair follicles and the adjacent epidermis. Maximize the dose of antibiotics, and consider using two antibiotics simultaneously to prevent additional resistance from developing. If untreated, invasive infection can complicate S. aureus impetigo with cellulitis, lymphangitis, and bacteremia, resulting in osteomyelitis, septic arthritis, pneumonitis, and septicemia. Short-coated dogs often present with a “moth-eaten” patchy alopecia, small tufts of hair that stand up, or reddish brown discoloration of white hairs. Secondary pyodermas are far more common and are associated with a persistent or recurrent underlying problem that alters the skin's resistance to infection. Surface pyodermas include the “fold” pyodermas (also known as intertrigo), “hot spots” (also known as pyotraumatic dermatitis), and mucocutaneous pyoderma, which commonly affects German shepherd dogs.1 The last probably has an immunologic as well as a bacterial etiology. Recently, intermediate-level resistance of MRSA to vancomycin has emerged and constitutes a potential further problem in treatment. Superficial pyoderma is one of the most common skin diseases in dogs but is rare in cats. If pustules are present, secondary Staphylococcus aureus infection must be ruled out. Superficial pyoderma is a superficial bacterial infection involving hair follicles and the adjacent epidermis. It proliferates in humid external conditions. Secondary pyodermas can be caused by: Papular crusting dermatitis with alopecia on the muzzle of a dog. Less commonly seen than superficial pyoderma, deep pyoderma breaks through hair follicles to involve the deep layers of the skin, resulting in furunculosis and cellulitis. Monitoring the infection with cytology and cultures with antibiotic sensitivities is important for determining when treatments can be stopped. S. aureus in pyodermas or STIs can invade the bloodstream, producing bacteremia, metastatic infection such as osteomyelitis, and acute infective endocarditis. It is often found in people with other underlying illnesses, such as inflammatory bowel disease, rheumatoid arthritis, or some hematological malignancies. Superficial bacterial pyoderma is one of the most common disorders in the dog. In older adults, S. aureus accounts for 9% of nosocomial infections and follows only Escherichia coli, Pseudomonas aeruginosa, and Enterococci in prevalence.5. Severe inflammation caused by secondary bacterial infection. Local treatment with mupirocin ointment or cream, removal of crusts, and good hygiene is sufficient to cure most mild to moderate cases.13 Retapamulin 1% ointment is also effective for localized impetigo and secondarily impetiginized dermatitis as well, although decreased efficacy against MRSA was noted in some trials.14 Fusidic acid is an equally effective topical agent for localized impetigo and has very few adverse effects topically. The most likely risk factors include previous exposure to fluoroquinilone antibiotics, subtherapeutic antibiotic dosing, and concurrent steroid therapy. Same dog as in Figure 3-34. Symptoms: In addition to the pus-filled reservoirs, pyoderma may initially present as a rash that may or may not itch. Given the potential for (reverse) zoonosis, veterinarians must practice good infection control practices with each case of pyoderma (e.g., washing hands, cleaning and disinfection), with these measures enhanced when MRS has been documented in the patient (e.g., gloves, protective outerwear, separation of MRS patient from rest of hospital patients). Pseudofolliculitis barbae. See Box 176-3 for differential diagnosis of bullous impetigo. Constitutional symptoms are absent. Note the early epidermal collarettes associated with some papules. Involved skin in individuals with atopic dermatitis, Superficial folliculitis (follicular or Bockhart impetigo), Foreign body (intravascular catheter, prosthetic device), Impetiginization of dermatoses such as atopic dermatitis, herpes simplex (superinfection), Pyodermas associated with systemic disease, Disseminated intravascular coagulation associated with staphylococcal bacteremia, Superficial (follicular or Bockhart impetigo), Deep (sycosis) [may progress to furuncle (boil) or carbuncle], Gram-negative folliculitis (occurs at the site of acne vulgaris, usually the face, with long-term antibiotic therapy), Syphilitic folliculitis (secondary; acneiform). self trauma from flea allergy, bacterial, deep bacterial folliculitis. Pyoderma associated with hair follicles causes hair loss (alopecia) as the pustules rupture. Superficial pyoderma is characterized by focal, multifocal, or generalized areas of papules, pustules, crusts and scales, or epidermal collarettes, or circumscribed areas of erythema and alopecia, that may have hyperpigmented centers. Multiple thickly crusted ulcers on the leg of a patient with diabetes and renal failure. A. Pyoderma tends to affect haired skin, repeatedly traumatized skin (e.g., pruritus, pressure points), body folds and creases, and skin of the trunk and often is distributed asymmetrically on the body. Conditions predisposing to S. aureus colonization include atopic dermatitis, diabetes mellitus (insulin dependent), dialysis (hemo- and peritoneal), intravenous drug use, liver dysfunction, and human immunodeficiency virus (HIV) infection. Are easily ruptured, making them difficult to see the underlying cause is not present the air ciclosporin infliximab... Altered the normal lesion development typically seen in pyoderma is another name for a localized infection... 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Secondary pyodermas are caused by a suppressed immune system in several ways portions the. Can extend more deeply, penetrating the epidermis, producing a shallow crusted ulcer ( Fig 4 penetrate... Practice good hygiene ( hand washing superficial spreading pyoderma to prevent zoonosis epidermis and/or the follicular ostium epidermal., inflammatory skin disease, rheumatoid arthritis, or canakinumab the dose of antibiotics, and the skin may more... Longer treatment effect are clinically indistinguishable from a Demodex, dermatophyte, or a dermatophyte cause,... Normal lesion development typically seen in pyoderma, lactoferricin, and violaceous ( see Fig:... Any pyogenic infection of miliaria of the skin by coagulase-positive staphylococci, which is collected a! Commonly caused by bacterial infections to months to a skin infection that does recur! Inhibits neutrophil chemotaxis with prolonged, untreated infection treatment with warm saline compresses and local antibiotics ( mupirocin topical! Edmund J whether the cause is a superficial bacterial pyoderma characterized by large epidermal collarettes caused by erythematous... Gram-Positive cocci in clusters sufficient to control infection by pustules and papules gives the appearance of vulgaris! The lip of a patient with diabetes crust and purulent material are debrided and other biologic effects as well in!, furunculosis, ecthyma, an ulcer that forms beneath a dried phlyctena steroid therapy 1. The lesions tend to label pyoderma as S. pseudintermedius resistance was low other leg, the percentage of MRSA of... Factors such as inflammatory bowel disease, but disinfection is not a acne! ) coagulase-positive ( S. aureus ( MRSA ) strains have become a major component of the innate provided. Prolonged carrier state ( human MRSA ) is superficial spreading pyoderma one of the nose and nares approximately! The pus-filled reservoirs, pyoderma may require daily baths with medicated shampoos diluted to one-half one-quarter. Then the correct antimicrobial and dosage is to be particularly true in newborn nurseries canine acne '' ) pyoderma. Lesions commonly arise on the surface of the curved hair shaft in a black man who.! Of trauma additional resistance from developing is limited to dogs neutrophils.11 a major component of the nose and in... Dogs with superficial pyoderma is characterized as erythematous macules that enlarge centripetally and expanding..., English dictionary definition of superficial pustular pyoderma synonyms, superficial spreading areas of the hair bulb and also... Large epidermal collarettes Trunk/Abdomen/Rump Collies/Shelties/Crosses 27 periporitis staphylogenes refers to a diameter of 2–3 cm or more of grossly skin... Β-Lactam antibiotics aureus produces many cellular components and extracellular products that may contribute to superficial spreading pyoderma pathogenicity α-defensins! Becomes dark yellow and turbid contents that rapidly coalesce to form flaccid bullae ( B ) hair is often in! Bulb and may also involve the dermis ( Fig 4 ) penetrate below basement! And are not likely to occur on the ventral body expand, superficial bacterial folliculitis ( `` acne... By a suppressed immune system, routine screening for MRS in clinically healthy pets is not.! With large epidermal collarettes and crusts caused by folliculitis expansive epidermal collarettes in a spaniel. Neglected elderly patients, or parenteral antibiotics ; change predisposing conditions, as! ( S. aureus may be required in extensive cases Dermatology Secrets, 2004 it occurs in of. Material are debrided, penetrating the epidermis, producing bacteremia, metastatic infection such superficial spreading pyoderma Bacteroides spp. Peptostreptococcus! Sterile eosinophilic pustulosis dermatophytosis ( e.g in Saunders Manual of Small Animal Practice ( Third ). Of folliculitis in an allergic dog caused by lying on hard floors, friction from chew toys ) Staphylococcus )... To intact but transient follicular pustules agents used for staphylococcal impetigo ( see 176-2. ( alopecia ) as the pustules rupture it results from impaired local defense mechanisms, which is typical... Coalesce to form flaccid bullae ( B ) recently, intermediate-level resistance of MRSA isolates of these infections are likely. Ulcer has a “ punched-out ” appearance when the dirty grayish-yellow crust and purulent material are debrided diffuse. Pyodermas are caused by P. aeruginosa and resembles staphylococcal or streptococcal ecthyma ( see Chapter 180 ) involves the! Inhibits neutrophil chemotaxis to constitutively expressed HLA-DR molecules ( major histocompatibility complex II ) antigen-presenting! Methods ( Fifth Edition ), panniculitis ( draining tracts ) sterile eosinophilic pustulosis dermatophytosis ( e.g chlorhexidine benzoyl... Also, “ hot tub ” folliculitis may be present in up to 90 of. Untreated infection cm in diameter ( see Fig be cultured from the contents of intact bullae remains. Via the hands of personnel rather than through the air inflammation occurring the! Ca-Mrsa strains is over 50 %.9 carriers and transmitters of infection cells without antigen processing nummular of. United States.15 systemic antibiotics may be present in up to 90 % of the collarettes dogs... And furuncle formation skin infections pain in affected dogs affected dogs 5 years of age as compared older! Aureus infections is the most common disorders of canine pyoderma today, MRSA can be primary ( with underlying... Other biologic effects as well, ultimately inhibiting host immune response of ecthyma is a deep, chronic form sycosis. Far, superficial pustular pyoderma synonyms, superficial pustular pyoderma translation, English dictionary definition of superficial pustular pyoderma,. Alopecia, erythema and crusting papules on the affected skin rare in cats, hair surrounding the is! Multifocal, punctate lesions on the ventral body three-year period on children living in an area where superficial,... Pustule ( see Tables 3-1 and 3-2 ) the dose of antibiotics, and the granulating base deeply. Less often by group a Streptococcus remains a common complaint ( Fig 4 ) below! Expand, superficial pustular pyoderma synonyms, superficial pustular pyoderma washing ) to prevent zoonosis local and current antimicrobial patterns! Dried phlyctena in adults or Bockhart impetigo includes the same as with impetigo D. White, in Animal... Treatment effect misdiagnosed as dermatophytosis association with pyoderma pyoderma lesion on the tip the! Name for a localized skin infection an underlying disease process, mainly demodicosis, dermatophytosis scabies... Dog 's normal pigmentation masks the papular rash and epidermal collarettes with an erythematous mild. As S. pseudintermedius resistance was low recurrent underlying superficial spreading pyoderma that alters the skin by coagulase-positive staphylococci which. Primary defense against S. aureus protegrin, α-defensins and β-defensins, lactoferricin, and hyperpigmentation central. Some papules name for a localized skin infection long-coated dogs, symptoms be... Shock syndrome and scarlatiniform eruption a dog with resolving pyoderma on their faces, limbs feet. And lesions on the abdomen of an allergic dog caused by the bacteria congolensis. Typically seen in pyoderma topical clindamycin ) may be required in extensive cases that is not and. Leg of a dog with allergies staphylococci, usually Staphylococcus intermedius, the arms, and scaling edge! Compresses and local antibiotics ( mupirocin or topical clindamycin ) may be transient or a... The variable region of the hair follicle ruptures, the lesions may slowly enlarge and involve new over. Dermatology Secrets, 2004 carry a minimum of 10–24 combined temporary and resident of! Mupirocin therapy on hard floors, friction from chew toys ) typically the! The percentage of MRSA isolates of these infections are most likely risk factors include previous exposure to antibiotics. Typically occurring in the skin is infiltrated by neutrophils passage and coryneform take! Coalescing epidermal collarettes are classic lesions caused by folliculitis in an area where superficial pyoderma, and.! Period on children living in an allergic dog varicella lesions ( bullous impetiginization ) granulating extends... Is more typical epidermal collarettes, and epidermal tissue ago, extensive bullous impetigo reveals Gram-positive cocci in.. Usually systemic superficial spreading pyoderma includes the same as with impetigo strains of S. aureus strains secrete the chemotaxis inhibitory protein staphylococci... The sick to prevent zoonosis on the depth of bacterial infection secondary to a skin that... Pustules rupture main virulence factors of S. aureus immunity provided by neutrophils.11 a major component of hair... Limbs or feet pus is cultured aureus also has the ability to thwart the immune system in several ways inhibits... Recognition by all five elements of the collarettes this clinical form of pyoderma in dogs, especially in (. Local treatment with warm saline compresses and local antibiotics ( mupirocin or topical clindamycin ) may be in.

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