Verified 06/24/2022 by PasseportSanté
Dermatomyositis (DHD), formerly called erysipelas, corresponds to an infection of the deeper layers of the skin (dermis and hypodermis).
It is secondary to a wound that served as an entry point for microbes. In general, antibiotics can overcome it. We are evaluating.
What is seborrheic dermatitis (DHD)?
Dermatomyositis (DHD) also called “non-necrotizing bacterial dermatitis” (DHBNN) and formerly “erysipelas” is a dermatitis of the dermis and parenchyma.
As a reminder, the skin consists of three layers:
- epidermis (on the surface);
- Weft (located in the depth).
Inflammation is most often caused by infection with group A hemolytic streptococci (Streptococcus pyogenes).
The main risk factors identified were venous insufficiency, lymphedema, peripheral vascular disease, diabetes, immunosuppression, and obesity.
Local causes are athlete’s foot, ulcers, trauma and insect bites. During these various lesions, the germ enters the body and develops in the deeper layers of the skin.
The incidence of DHD is estimated to be 9 cases per 100,000 per year1. The disease usually appears in adults after 40 years, regardless of gender. It is rare in children.
Treatment includes oral antibiotics (often an anti-streptococcal), analgesics, elevation of the affected limb, and rest.
Frequency of complications (abscess, additional infection, generalized infection, necrotizing fasciitis, cellulitis, sepsis, etc.) is feared in DHD, representing a medical emergency.
Atrophic bacterial dermatitis: what are its symptoms?
Any area of the body can be affected, but the extremities (legs, rarely arms), extremities (feet and hands), and the face are most often affected:
- The skin is red, hot, painful and swollen. If left untreated, these symptoms may spread.
- The patient may develop fever, chills and feeling unwell.
- loss of appetite and a change in the general condition that are often associated;
- bullae and/or purpura (small red dots) may appear on the affected skin;
- Peripheral swelling (which may be butterfly shaped) may surround DHD when it affects the face.
- Lymph nodes near the affected area are enlarged and sometimes palpable. The lymphatic pathway can also be noticeable in the form of red streaks.
As soon as these signs appear, medical advice is necessary. It consists of giving antibiotic treatment and searching for the “entry point” of bacteria
What are the causes of seborrheic dermatitis (DHD)?
Seborrheic dermatitis (DHD) occurs on already damaged skin. A wound, even in its most minimal form, presents an opportunity for pathogens to penetrate into the deeper layers of the skin such as the dermis and hypodermis, triggering an inflammatory reaction.
Damaged skin as a gateway
Seborrheic dermatitis (DHD) is a complication of a skin wound. It can be any type of pest:
- Skin fungal infections.
- Accidental or surgical wound
- insect sting;
- button ;
- Venous or lymphatic edema.
- signs of a chronic skin disease (eczema, psoriasis, etc.);
- Dermatological effects of radiation.
DHD is secondary to a bacterial infection, and is often associated with streptococcus (in 85% of cases). They are mainly from group A beta-hemolytic streptococcus and sometimes groups B, C or G.
The bacteria penetrate into the deeper layers of the skin. Then the microbes multiply inside the tissues. The causative MRSA is rarely identified by blood culture.
In hospital situations, fine needle aspiration may be used to identify the causative bacteria. Other bacterial agents are sometimes present: Staphylococcus aureus, Gram-negative bacilli, etc.
Who is at risk of developing DHD seborrheic dermatitis?
Some people are more likely to develop DHD:
- patients over 40 years old;
- Immunocompromised patients.
- people who have been exposed for long periods of time to non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids;
- drug addicts;
- People with venous and arterial insufficiency in the legs.
- people with cancer or malignant blood diseases;
- People in a precarious situation (whose hygiene is not enough).
A clinical examination by a physician or dermatologist is usually sufficient to diagnose DHD. Supplementary examinations (intervention via needle aspiration) may be performed in order to identify the bacteria involved.
Biological examinations using a blood sample eventually confirm the diagnosis with an elevated C-reactive protein level and an increase in the number of leukocytes (leukocytosis) that testify to an inflammatory syndrome.
The entry point for microbes and contributing factors is systematically searched for.
Finally, the plate should be marked with a red flag and photographed in order to monitor its development. If it increases in size after 48 hours and despite antibiotic treatment, this is a sign of antibiotic resistance. So the treatment needs to be reconsidered.
What is the treatment for seborrheic dermatitis (DHD)?
In the absence of co-morbidity or signs of danger, DHD is treated with oral antibiotics for 7 days.
In the first intention, the doctor prescribes amoxicillin, whether in adults, children, or pregnant or breastfeeding women. Other treatments are offered in case of penicillin allergy (pristinamycin, clindamycin, sulfamethoxazole – trimethoprim, etc.).
After initiation of antibiotic therapy, the development of DHD should be adequate within 48 hours, otherwise hospitalization should be considered.
In addition, measures to improve response to antibiotic therapy are associated with:
- Resting the affected area
- Treatment of ‘point of entry’ lesion and contributing risk factors;
- venous pressure as soon as the pain improves;
- The height of the affected limb.
- Giving analgesics in case of pain. It is not recommended to take other treatments such as anti-inflammatories or blood thinners. Healing is effective within one to two weeks.
The patient must be admitted to the hospital in certain cases:
- Resistance to antibiotic therapy is observed at 48 hours;
- concomitant diseases (diabetes, immunosuppression, renal failure, etc.);
- long-term treatment with anti-inflammatories (NSAIDs, corticosteroids);
- Signs of complications: abscess, malignant staphylococcal disease of the face, necrotizing fasciitis, cellulitis (gas gangrene), marked deterioration in the general condition, etc.
DHD is a medical-surgical emergency, in rare cases:
- Symptoms of sepsis.
- nervous or respiratory signs (hypoesthesia, crackles, etc.);
- Shock state with signs of visceral insufficiency, etc.
In these cases, surgical exploration is performed. Antibiotic treatment may be given.
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