Types of streptoderma: symptoms and peculiarities of various forms of the disease

Streptoderma is a collective concept by which physicians designate the variety of types and forms of skin pathology caused by streptococcal infection. Different types of streptoderma have their own characteristic symptoms, features, and conditions of development. And since streptoderma is considered a skin disease, but representatives of different genders have their own skin characteristics, gender differences should also be taken into account in considering the predisposition to the occurrence of certain types of streptococcal disease. Although, of course, the decisive role still remains with the human immunity.

Diseases combined by the general concept of " streptoderma " may differ by the presence or absence of an exudative surface, the characteristics of individual elements of the rash, the size of the pathological foci and the speed of their spread, the duration of treatment, the presence or absence of factors complicating the course of the disease, etc. For this reason, in the classification of streptoderma can be considered several groups that combine certain types and forms of streptococcal pathology.

The presence of exudate

Considering the different types of streptoderma and their manifestations, medical scientists have come to the conclusion that streptococcal infection on the surface of the skin can behave differently. In most cases, this concept hid the defeat of the skin with a characteristic appearance on the surface of the skin of bubbles with a turbid yellowish liquid - flikten, around which there is a red rim of inflammation.

This type of disease was called weeping streptoderma. The disease is more common in people with tender skin, i.e. For children and women, as well as representatives of the stronger sex with skin not coarse in the sun and wind.

Inflammatory elements formed by the accumulation of bacteria and their metabolic products, with wet streptoderma can be located on different parts of the body, including the nail ridges, the corners of the lips, perineum and genitals, oral cavity.

Such streptoderma is named soaking because of the appearance of bubbles on the body filled with liquid, which subsequently burst to form soak. Subsequently, in place of bursting bubbles, dense crusts of yellow color are formed.

In people with dense and coarse skin (most often in men), streptoderma may occur differently, by analogy with white lichen. With this type of disease, whitish or slightly pinkish lesions of regular or irregular rounded shape, up to 5 cm in size, covered with flaking epidermis appear on the skin. This is dry streptoderma.

Dry it is named due to the absence of a wet surface. In addition to the grayish-white or grayish-yellow flaking films on the skin, there are no other manifestations of streptococcal infection. In other words, it is streptoderma without bubbles and coarse yellow crusts.

Infections with dry streptoderma are localized mainly in the face and behind the ears, so the disease is sometimes called facial lichen. But do not confuse it with white (vitiligo) or pityriasis versicolor, the causative agents of which are not streptococcus bacteria, but fungi. With some similarity of manifestations, the symptoms of the disease have a certain difference (itching is not characteristic of white and scaly depriving of the fungal nature, besides, the localization of the latter rarely affects the face or head). The causative agent of the disease can be easily determined by making a scraping analysis.

The medical name for the dry variety of streptococcal skin disease is erythematous-squamous streptoderma. This type of pathology is referred to as a mild form of the disease, since it is mainly the superficial layers of the epidermis that are affected, which is more likely if the skin is rough and thick.

However, statistics show that a faceless zoster is often diagnosed in children, if the child’s immunity is able to inhibit the penetration of the infection into the deeper layers of the epidermis or the disease has been provoked by a small number of bacteria.

The development of the disease is promoted by the overwhelming or drying of the skin of the face, in which microcracks may appear, insufficient hygiene, insufficient removal of moisture after washing, especially before going outside. Through microdamages, bacteria penetrate the upper layers of the epidermis, where the pathological process develops.

The variety of types of weeping streptoderma

Considering the statistics of streptoderma, it can be seen that the vast majority of patients with this diagnosis are children. The number of registered cases of streptococcal pyoderma in children under 15 years of age is estimated at 111 million. [1]Children's skin has its own structural features, so it is more delicate and thin. All kinds of damages easily appear on it, plus, moreover, bacteria have the ability to multiply not only in the surface layers. It is not surprising that, in childhood, the usually becoming wet forms of the disease are diagnosed.

In adults, streptococcal infection on the skin is less frequently diagnosed, but it is believed that the same weeping form of the disease is more characteristic for women, and for men with coarser skin, it is dry.

Weeping streptoderma, which is also the weeping streptococcal impetigo, is the most common type of streptoderma in people with tender, sensitive skin. This category includes children and women, although sometimes this form of the disease can be diagnosed in men in the area of nails, mucous membranes and areas with less rough skin.

The disease manifests itself by the formation on the skin of individual small specks of bright pink or red color, which in a matter of hours turn into conflict with the inflammatory rim. Inside the bubbles, at first, a transparent exudate is visible, while the conflicts themselves remain strained for some time. It seems that at any moment they may burst, but in reality, after a while, the bubbles become softer, and the liquid inside them becomes duller and becomes yellowish.[2], [3]

Then there are two options for resolving the problem. Bubbles either dry up with the formation of crusts, or spontaneously open (in their place erosions with purulent contents are visible). Erosion also subsequently tightened, covered with a crust, which eventually exfoliates, leaving behind a pink stain. After some time, the stain disappears without a trace.

Weeping streptoderma, as the most common type of streptococcal disease affecting the skin, depending on the localization of pathological foci with flictenes and the nature of the course of the disease can be divided into several subspecies.

Consider various types of weeping streptoderma in terms of their symptoms, localization and features of the disease:

Slit impetigo

This is a type of streptoderma with localization in the area of the corners of the mouth (other names: zaeda, angular stomatitis). The disease develops, like any other variant of streptococcal impetigo. First, redness and irritation can be seen in the corners of the mouth, then small oval vesicles form, after opening which painful cracks remain on the skin.

Slit impetigo usually develops in patients who are accustomed to sleeping with their mouths open, as a result of which the corners of their lips are constantly wetted with saliva, as well as those who have a bad habit of often licking their lips. As a result, the structure of the epidermis is disturbed, it becomes looser, microdamages easily appear on it, through which the infection penetrates.

The disease is difficult to treat due to the fact that when the lips move, the crusts burst, leaving behind them long healing deep cracks. [4]

Impetigo slit can also be localized at the base of the wings of the nose or in the corners of the eyes. Near the nose, the disease usually develops against the background of rhinitis (catarrhal or allergic), in the corners of the eyes inflammatory elements may appear in people with a tendency to tearing.

Streptoderma with ring-shaped erythema

This type of streptoderma is different in the behavior of fliktem. Usually the resolution of these formations on the skin is manifested by their drying, after which the growth of the bubble stops completely. When the annular form of pathology after resolution of the inner part of the bladder, it continues to grow around the perimeter. A rather large rounded inflamed hearth is formed with a dry crust in the middle and small bubbles along the contour.[5]

The disease has an incomprehensible mechanism of development, a long relapsing course (foci may disappear, and after a while appear again) and usually develops against the background of reduced immunity and endocrine disorders.

Continuing inflammation is most likely the response of the immune system to the invasion of alien microorganisms, that is, it is an allergic reaction, in which streptoderma gets a slightly different development with large ring-shaped lesions, in the stage of falling crusts somewhat resembling lichen planus.

As for allergies, in itself it does not cause streptoderma, but its skin manifestations in the form of rash and peeling are a predisposing factor that opens the gate of infection deep into the skin. Streptoderma is an infectious disease, therefore, without the presence of an infectious agent in the wound (in this case, active streptococcus bacteria), purulent inflammation does not develop.

Bullous streptoderma

This type of streptoderma is considered one of the most severe and dangerous. The fact is that any kind of streptoderma is contagious, but with its bullous form, the risk of infection is especially great, because the pus elements are quite large. Cases of toxic shock are described.[6], [7]

While individual small blisters with classical impetigo do not particularly bother patients, then with bullous streptoderma elements can reach 1-3 cm. Upon careful examination inside the flick (more precisely bull), you can see not only yellow pus, but also red blood patches. Bulls have a tendency to increase in size and spontaneous dissection with the release of purulent-bloody contents. In their place are quite large erosion, which are covered with brown crusts, while their growth does not stop, which unites this form with ring impetigo.

When bullous streptoderma inflammatory elements appear mainly on the limbs: the hands are usually affected in the hand, legs - on the feet and skin of the leg.

With this form of the disease with large open foci of damaged skin, there is a great risk of joining also a staphylococcal infection, which complicates the treatment of the disease by forming pus wounds. [8]

Streptococcal impetigo nail rollers (tournamentol)

It is characterized by an infection of the skin around the nail plate. Most often diagnosed on the skin of the fingers, but can also occur on the feet, especially with their constant moisture (sweating feet, working in rubber boots or conditions of high humidity), as well as with the appearance and injury of burrs.

With this type of streptoderma, redness of the skin in the area of the nail ridge and noticeable pain with pressure are first observed. Later on, at the site of reddening, a dense blister with purulent-serous contents is formed, the sizes of which may vary. After opening the bladder and removing pus from it, a cavity remains, having an arcuate or horseshoe-shaped cavity. In the future, the cavity is tightened, leaving behind a scaly area, which also subsequently disappears without a trace.[9]

Itching during the tournament usually does not occur, and the pain can be quite noticeable until the bubble opens.

Intertriginous streptoderma

This variant of weeping streptococcal infection is characterized by the formation of rash elements at the site of diaper rash. Most often diagnosed in young children, but can also affect obese adults, so overweight can be considered among the risk factors for this type of streptoderma. Such a form of streptoderma is not excluded in bedridden patients who suffer from diaper rash due to their forced condition. [10]

The foci of the disease have a well-defined localization - it is the skin folds in the arms and legs, on the abdomen, under the mammary glands, under the buttocks, in the armpits, in the groin. In the place of contact of skin areas usually increased sweating and prickly heat develop. Under the influence of moisture, the skin becomes more loose (maceration). Increased humidity and temperature against the background of the high permeability of the above-mentioned skin areas can play a cruel joke.[11]

On the surface of such areas, irritation and hyperemia appears, the formation of small bubbles that, when rubbed, burst and turn into painful, difficult to heal erosion.

Papulo-erosive streptoderma 

Another name: syphil-like impetigo. It has a certain similarity with the intertriginous form of streptoderma, but is mainly diagnosed in infants.

There is a disease on the background of diaper dermatitis (diaper rash), the cause of which is considered to be improper use of diapers and waterproof diapers. A child can stay out of diapers for days at a time, with the fact that some parents change them irregularly in order to save money. It is convenient for the parents themselves, eliminating laundry and unnecessary worries, and the child can be seriously harmed.[12]

With waterproof diapers, the situation is somewhat different. Between them and the skin of the child, it is desirable to lay an additional layer of breathable tissue, and such diapers should be changed after every urination act, and not when there is no dry place on it.

Diapers and waterproof diapers interfere with the evaporation of fluid from the surface of the skin, making it more loose and sensitive to stimuli. And irritants can be sweat and natural stool (urine and feces of the child, especially liquid). At the same time, irritation arises in equal measure both in babies who are breastfed and in "artificiality".

Sometimes diaper dermatitis can occur even with fabric diapers, if they were badly washed with synthetic detergents. The irritation in this case will be provoked by an allergic reaction to household chemicals.

It is worth noting that in children with exudative diathesis (inadequate reaction of the child’s body to the slightest stimuli, and sometimes even to ordinary influences), diaper rash can occur even when washed with sparing children's means. Predisposition to allergic reactions and skin manifestations with the formation of erosive foci at the site of rash impose such children at risk of papulo-erosive streptoderma, because streptococcus does not sleep and is always ready to infiltrate into areas of delicate skin with weakened immune protection.[13]

Papulo-erosive streptoderma is often called sifilobodnoy. The reason for this is the appearance on the skin in the area of the buttocks, the inner and back of the thighs, in the perineum or scrotum in boys, separate seals having a bluish-red tint and size, sometimes reaching the size of a small pea. Around the papules visible clearly defined inflammatory halo of red. Such formations, hard to touch, resemble hard chancre formed in syphilis.

Subsequently, bubbles appear on the surface of papules with purulent-serous contents. The conflict in the short term spontaneously opened and in their place remain painful erosion, covering with crusts. In the process of drying crusts can burst with the formation of cracks. Around the drying elements visible rim of the chilled epidermis.

Rapid dissection of the flaktem and the presence of permissible peripheral elements of desquamation distinguishes streptoderma from syphilis. Moreover, such rashes do not appear on the mucous membranes, as is typical of syphilitic infection.

Vulgar streptoderma

This is a type of skin infection that is characterized by mixed infection, i.e. This is a combination of streptococcal and staphylococcal impetigo.[14]

The disease may initially be triggered by a mixed infection, since on our skin, streptococci and staphylococci get along well together, being representatives of opportunistic microflora. But in some cases, a staph infection can join already later, if the wound after opening is kept in antiseptic conditions.

In this case, the disease first develops as a classic streptococcal inpetigo, but subsequently pus appears on the site exposed by the flicts (especially characteristic of Staphylococcus aureus, therefore such streptoderma is called purulent), which also accumulates under the formed crusts, making the erosion more profound. Purulent streptoderma can leave behind quite large patches of modified skin with indentations, which only after a certain time become equal to the rest of the skin.[15]

Vulgar streptoderma can be considered as a complicated version of an infection in which both skin and hair follicles are affected. Staphylococcus usually penetrates into the nidus of streptococcal infection when scratching the affected area, if the patient experiences itching (most often children pimples comb it, not realizing the consequences of their actions). The accession of a secondary infection may be accompanied by increased itching and severe painfulness of erosion that is formed, an increased risk of spreading the infection, both along the skin and inside the body with an increase in lymph nodes.[16]

What determines the severity of the disease?

Streptoderma is a disease that can occur in mild, moderate or severe form. It is important to consider not only the forms of streptoderma, but also the characteristics of the patient. The weaker a person’s immunity, the more severe the course of the disease and the greater the likelihood of relapse.

Some types of streptoderma usually occur in a mild form. This refers to the simple form of streptococcal impetigo and its slit species, rarely accompanied by general malaise. But the bullous and purulent forms of streptococcal infection tend to be severe with the appearance of new elements of the rash for several weeks or even months.

The situation is worsened by the predisposition to allergic reactions, in which the hyperemic foci of infection can be quite large and be accompanied by additional allergic rashes.

In some cases, there is a neighborhood of different forms of the disease. For example, a dry form of streptoderma is diagnosed on the face, and weeping on the back, chest or arms.

Squamous (dry) streptoderma and the aforementioned variants of weeping streptococcal infections are manifestations of simple streptoderma, which subsequently does not leave behind visible defects of the skin. Sooner or later, the wounds are tightened and compared with healthy skin.

Another thing is deep streptoderma, which is otherwise called streptococcal iktima. Typically, a lesion of streptococcus affects only the upper layers of the epidermis, but in the deep form of the disease, its lower layers are also affected (basal and spinous, the so-called germ layer, due to cell division of which the regeneration of the skin occurs).

External manifestations of the disease do not differ much from classical impetigo, except for the fact that small elements merge into larger bubbles, which, after opening, leave behind large and deep erosion, covered with purulent-serous yellow crusts with flaking along the periphery. After healing of such erosion, the skin is not fully restored, so the disease leaves an unsightly mark in the form of scars.

Streptoderma

Like most diseases, a streptococcal skin infection can occur in two forms: acute and chronic. Streptoderma is a disease of an infectious nature, in the treatment of which systemic antimicrobial therapy comes to the fore. If, in parallel with antibiotic therapy, you do not take measures to strengthen the immunity or treat the disease lightly (maybe it will go away by itself), there is a likelihood that acute streptoderma, the duration of treatment of which usually takes from 3 to 14 days, will turn into chronic.

Chronic streptoderma has a relapsing course. Inactive bacteria continue their hidden existence in the stratum corneum of the skin and on its surface, but with the slightest decrease in the body's defenses, they are reactivated again with the formation of new lesions (sometimes in place of old ones, sometimes nearby).

Depending on the number of pathogens on the skin and the state of immune protection, focal and diffuse streptoderma can be considered. Focal type of the disease is more characteristic of the acute course. At the same time, separate elements or their groups appear on the body.

Diffuse streptoderma is a type of chronic infection, the triggering factors of which are vascular diseases of the legs (thrombophlebitis, varicose veins). A characteristic feature of this type of streptoderma is the presence of infiltration in the tissues and systemic damage to large areas of skin. The mechanism of development of diffuse streptoderma is associated with prolonged trophic disorders (circulatory disturbance in the skin, hypoxia of the dermis, metabolic disorders and innervation of the skin) caused by chronic vascular and endocrine diseases, hypothermia, after erysipelas, etc.[17]

The disease begins with the appearance of individual elements of the rash on the surface of the hyperemic skin, which subsequently merge into larger foci. The skin around them does not remain reddened and edematous with unhealthy shine. After blistering, painful erosion of various sizes with purulent crusts appears on the surface of the edematous skin.

The first elements that have appeared disappear within 10-12 days, but new ones appear in their place, so the acute stage can be quite long.

The disease has a relapsing course, so the rash and infiltration of separate, rather large areas of the body can either disappear or reappear. This affects mainly the lower extremities in the lower legs and lower thighs.

Whatever the forms and types of streptoderma, streptococcal infection is the culprit. And the way the disease will proceed depends on the state of the immune system and the medical measures taken, among which must be antimicrobial therapy and the use of immunostimulants that increase the functionality of the immune system, and therefore the body's defenses.