Pediatrician about streptoderma in children. How to identify (9 main symptoms) and how to treat a disease in a child?

General signs of streptoderma in children

Streptoderma is a skin infection caused by streptococcal bacteria. It most often occurs in children 2-6 years old. The disease usually begins when bacteria enter a defect in the skin, such as a cut, scratch, or insect bite. The infection manifests itself in the form of vesicles of different sizes.

Reddish patches on the skin, often clustered around the nose and lips, are the first sign of the most common type of streptoderma.

The sores quickly degenerate into vesicles, swell and burst. Then a yellowish crust forms on their surface. Clusters (clusters) of blisters may enlarge, covering larger areas of baby's skin.

After the crusting phase, the sores leave red marks that disappear without leaving scars.

Babies often have a less common type of streptoderma, with larger blisters in the diaper area or skin folds. These bubbles, filled with liquid, burst, leaving a scaly border.

Causes and mechanism of development

Streptoderma is a bacterial infection. The causative agent of streptoderma is streptococcus.

The surface of the skin and the inside of the nose are home to many "friendly" bacteria (commensal) that help protect against harmful bacteria.

Commensal bacteria work to control the population of pathogenic bacteria by producing substances that are toxic to pathogens, depriving disease-causing bacteria of nutrients.

But streptococcus strains can use blemishes in the skin (cuts, scrapes, insect bites, or rashes) to invade and colonize, thereby causing streptoderma.

For about 10 days after bacterial colonization, streptoderma bubbles appear. The mechanism of development of the disease is that the bacteria Streptococcus produce toxins that tear apart the upper layers of the skin, causing the formation of bubbles.

Different strains of streptococci behave differently. Studies have shown that certain strains of Streptococcus bacteria cause throat infections while others cause skin infections.

Streptococcus belongs to the category of conditionally pathogenic flora, that is, it can be on the skin without causing disease.

It is a gram-positive anaerobic bacterium and can survive even without oxygen. There are five main classes of streptococci (A, B, C, D, G), of which β-hemolytic group A streptococcus is the main culprit of streptoderma.

Streptoderma can occur as a primary or secondary disease.

In primary streptoderma, the pathogen enters the body through the injured areas of the upper layer of the skin. This is how the inflammatory process develops. When a child is playing and gets cut, scrapes, or insect bites that allow strep to migrate from the surface of the skin to the wound, it often leads to infection.

With secondary streptoderma, streptococcal infection joins the existing disease affecting the skin (chickenpox, eczema, herpes simplex).

Bacteria can also colonize and cause infection on healthy skin.

Why do some children with streptococcus not develop streptoderma? It is believed that some children are more able to fight off infection due to their skin chemistry and good overall health.

How is streptoderma transmitted in children?

Open sores are itchy and sometimes very painful. They are highly contagious. Scratching the sores can spread the infection from one place on a baby's skin to another or to another person. The infection can also spread from anything an infected person touches.

Because streptoderma spreads so easily, it is also called a "school illness." It can spread rapidly from child to child in a classroom or group where children are in close contact. Therefore, it also spreads easily in families.

Streptoderma is a global disease that has remained at the same incidence rates over the past 45 years. According to statistics, 162 million children in the world develop streptoderma every day.

The bacteria thrive in hot, humid conditions. Thus, streptoderma tends to be seasonal, peaking in summer and declining in colder climates. But in warm and humid climates, it can flare up all year round.

Streptoderma is most common in developing countries and in poor areas of industrial states.

Risk factors

There are certain risk factors associated with susceptibility to streptoderma.

These include:

age 2-6 years;
skin irritation due to another painful condition;
warm and humid climate conditions;
poor hygiene;
regular attendance at a day hospital or school;
the presence of dermatitis;
a weakened immune system;
attending sections such as wrestling and football, which involve physical contact with other children;
the presence of diabetes;
being in a crowded place that allows bacteria to spread easily;
insect bites;
superficial skin injury;
poison ivy burn or allergy rash.

If you find these risk factors in your child, you need to try to get rid of those that can be controlled to minimize infection.

Forms of streptoderma

Streptococcal impetigo

Extremely contagious and the most common of all forms of streptoderma. Small red blisters appear around the mouth and nose, sometimes on the limbs. They soon burst, and liquid or pus flows out of the vesicles, after which thick yellowish-brownish golden crusts remain.

As the crusts dry, a red mark forms, which usually heals without scarring.

Although the sores are not painful, they can itch a lot. It is important to prevent your child from touching or scratching them so as not to stimulate the spread of the infection to other areas of the skin and to other people.

In rare cases, symptoms can be more severe, with fever and swollen lymph nodes in the jaw and neck. This is how the body's defense mechanism fights infection.

Bullous impetigo

This condition is characterized by the formation on the surface of the skin of large bubbles filled with liquid. The disease affects both adults and children, but it usually occurs in children 2-5 years old. In bullous impetigo, the bacteria produce a specific type of toxin. These toxins reduce the adhesion between cells, causing them to separate from each other between the outer skin layer (epidermis) and the skin layer just below (dermis).

Symptoms:

large vesicles. Large blisters develop on children's skin. They can occur on different parts of the skin surface. However, they are more common on the arms, trunk, and legs. Bullous impetigo can also be found on the buttocks;
pus. Blisters are usually swollen and filled with clear, yellow pus. They are painless and easily injured, tearing apart. With bullous impetigo, pain is rare;
red, itchy skin. When the blisters burst, releasing the fluid contained within them, the area of skin surrounding the primary blisters becomes itchy and red;
dark crust. Initially, the bubbles are covered with a yellow crust. In the final stages, a dark crust forms over the vesicles, which eventually goes away as they heal.

Streptococcal jam

With this form of streptoderma, swollen red spots appear in the outer corners of the child's lips.

This can happen on one or both sides of the mouth. The inflammatory condition can last for several days or be a chronic problem.

Strep seizure almost always appears in the corners of the mouth. Symptoms can range from only mild redness to open bleeding.

Minor symptoms:

lump in one or both corners of the mouth;
slight peeling in the corners of the mouth;
slight discomfort when opening the mouth.

Moderate symptoms:

noticeable discomfort in one or both corners of the mouth when eating or opening the mouth;
dry / flaky skin in one or two corners of the mouth;
slight redness and / or swelling in the corner of the mouth.

Serious symptoms:

noticeable discomfort when eating, talking, opening and closing the mouth;
noticeable blisters / wounds in one or both corners of the mouth;
damage to the corners around the edges of the mouth that won't heal

Stepcoccal seizure mainly affects children who are often sick, under constant stress, or lack nutrients, since infections can enter the body more easily if the immune system is weak.

This condition also often develops in children who salivate while sleeping or eating, or in children who use pacifiers, as saliva build-up at the corners of the mouth can lead to cracks and a bacterial infection. Those who bite their nails or frequently keep their thumb in their mouth out of habit are also more prone to this infection.

In addition, children are susceptible to this condition because they are highly sensitive to extreme temperature changes. Dry and cold weather leads to chapped lips, eventually favoring the entry of disease causing bacteria.

Streptococcal diaper rash

A form characterized by skin irritation anywhere on the body where there are folds of skin that rub against each other. These folds create warm pockets where sweat is trapped, creating a fertile breeding ground for bacteria. Because babies are chubby and have short necks, they have more of these folds of skin, making them more prone to this condition.

Symptoms:

a red or reddish brown rash;
moist, itchy skin;
bad smell;
skin that is cracked or crusty.

Diaper rash can appear in the following places:

between the fingers and toes;
in the armpits;
in the inner side of the thigh;
in the groin area;
in the cervical fold;
between the buttocks.

Strep diaper rash appears in any folds of skin that rub against each other and retain moisture. In babies, strep diaper rash often appears in the diaper area. If the child has any manifestations of diaper rash, be sure to consult a specialist. The doctor will check for an infection.

Tourniole

It is an infection of the skin around the nail plates of the hands and feet. The infection can become a serious nuisance and even lead to partial or complete nail loss if left untreated.

Streptococcal tournament almost always occurs around the fingernails and develops rapidly.

This condition begins with swelling and redness around the nail. The skin is most often very sore or tender to the touch, and can sometimes be green-yellow in color, indicating a collection of pus that has formed under the skin.

The most common symptoms are:

redness;
swelling;
sensitivity and pain when touched;
accumulation of pus.

It is necessary to see a doctor when this redness begins to show through the skin around the nail or go to the finger pad. This indicates that the infection may develop into a serious problem in the deeper tissues of the fingertip.

Ektima

It is a skin infection characterized by crusted wounds under which ulcers form. This is a deep form of streptoderma. Ecthyma is characterized by damage to the deep layers of the skin (dermis).

Children of any age and gender are susceptible, but babies with weakened immunity (for example, with diabetes, neutropenia, when taking immunosuppressants, in the presence of a malignant tumor, HIV infection) are at a special risk group.

Other factors that increase the risk of ecthyma:

poor hygiene;
high temperature and humidity, such as living in tropical locations;
presence of minor injuries or other skin conditions such as scratches, insect bites, or dermatitis;
advanced streptoderma.

Ecthyma most commonly affects the buttocks, thighs, calves, ankles, and feet.

Symptoms:

the lesion usually begins to manifest itself as a small blister or pustule on the inflamed area of the skin;
soon the bubble is covered with a hard crust. A hardened ulcer forms under this crust, which is red, swollen, and pus flowing out;
lesions can remain both fixed in size, and can gradually increase to an ulcer with a diameter of 0.5-3 cm;
lesions heal slowly, leaving a scar;
sometimes local lymph nodes become swollen and painful.

Diagnostics

When a child has signs characteristic of streptoderma - spots or blisters - the only correct solution is to contact a specialist who will tell you in detail how to treat streptoderma and prescribe the necessary medications. To clarify the diagnosis, the specialist will prescribe to do a sowing of scrapings from the affected skin areas or the contents of the blisters

Also, the doctor may prescribe:

general blood analysis;
blood test for HIV;
an analysis to assess the levels of thyroid hormones;
stool analysis.

What can be confused with streptoderma?

Sometimes streptoderma is very similar to other conditions.

Atopic dermatitis. The hallmarks are chronic or recurrent itchy lesions and abnormally dry skin; in children, it often affects the face and in places where the limbs are bent.
Candidiasis. It is characterized by erythematous papules or red moist plaques; lesions are usually limited to mucous membranes or fold areas.
Herpes simplex. This disease is characterized by clustered blisters on an inflamed base that rupture, causing crusty erosion; preceding symptoms are possible.
Dermatophytosis. Lesions may be scaly and red with a slightly raised "mobile border" or classic ringworm; blisters are possible, especially on the legs.
Discoid lupus erythematosus. Well-identifiable plaques with tight-fitting scales penetrating the hair follicles; peeled scales look like carpet fibers.
Insect bites. Papules are usually visible at the site of the bite and may be painful; associated urticaria is possible.
Scabies. Lesions consist of abscesses and small discrete (isolated) blisters, often in the bridges of the fingers, characterized by nighttime itching.
Sweet's syndrome. The sudden appearance of painful plaques or nodules with occasional blisters or pustules.
Chickenpox. With it, blisters are common throughout the body at different stages of development. The oral mucosa may be affected.

Complications of streptoderma

Streptoderma usually responds well to good hygiene and topical or oral antibiotics. Rarely, streptoderma leads to serious complications.

Cellulite. If the infection penetrates deep into the skin, it leads to cellulite - purulent fusion of subcutaneous fat. The skin condition is characterized by redness, inflammation, causing fever and pain. Cellulite treatments include pain relievers and antibiotics.
Guttate psoriasis. With teardrop psoriasis, scaly, inflamed, red patches develop on the skin. Spots appear all over the body. It develops very rarely after streptoderma and is not contagious.
Sepsis.Deep streptoderma can lead to sepsis, a bacterial infection of the blood. This life-threatening infection causes fever, rapid breathing, confusion, vomiting, and dizziness. Requires immediate hospitalization.
Post-streptococcal glomerulonephritis. The kidneys have small blood vessels. Post-streptococcal glomerulonephritis develops when these blood vessels become infected. This leads to high blood pressure and dark colored urine, which can be life threatening and requires hospitalization.
Streptococcal toxic shock syndrome. It develops when streptococci release toxins that damage the skin. This syndrome causes pain, fever, and redness throughout the body. This is a rather serious condition in which large portions of the skin simply flake off from the body. The child needs urgent hospitalization and intravenous antibiotics.

How to treat streptoderma in a child?

Treatment goals include relieving discomfort and improving cosmetic appearance, preventing the child from spreading the infection further and preventing it from recurring.

Treatment should ideally be effective, inexpensive, and have minimal side effects.

Treatment for streptoderma usually includes local early therapy as well as antibiotic therapy. Antibiotics for streptoderma in children are used as a local agent or as a combination of systemic and local forms.

Local treatment

Antiseptics. Gentle cleansing, removing honey-yellow crusts for non-bullous impetigo using antibacterial soap and a soft sponge, and frequent application of wet dressings to the affected area is recommended. Good hygiene with antiseptics such as Chlorhexidine, sodium hypochlorite, Gencinviolet will help prevent streptoderma transmission and recurrence, but this treatment has not been proven to be effective.
Local antibacterial agents. Topical antibiotic therapy is considered preferable for children with uncomplicated localized streptoderma. Topical therapy destroys the isolated lesion and limits spread. A local agent is applied after the infected crusts have been removed with an antiseptic and water. Topical antibiotics in the form of ointments have the advantage of being used only where needed. This minimizes antibiotic resistance and prevents gastrointestinal and other systemic side effects. The disadvantages of topical treatment are that it cannot eradicate microorganisms from the respiratory tract, and the use of topical drugs for large lesions is difficult.
Mupirocin. Mupirocin is an antibiotic used topically (on the skin) to treat streptoderma. Unlike most other antibiotics, which act on either bacterial DNA or bacterial walls, Mupirocin blocks the activity of an enzyme called isoleucyl-tRNA synthetase inside bacteria. This enzyme is essential for bacteria to make proteins. Without the ability to make proteins, bacteria die. Due to its unique mechanism of action, there is little chance that bacteria will become resistant to Mupirocin due to exposure to other antibiotics. To treat steptoderma, a small amount of ointment is applied to the affected skin, usually three times a day (every 8 hours). The area may be covered with a sterile gauze cloth. If there is no improvement within 3-5 days, a doctor should be contacted to review the treatment.
Retapamulin. A topical antibiotic used to treat stertoderma. It stops the growth of streptococcus on the skin. Use this medication only on the skin. Wash your hands after use unless you are treating the area on your hands. Clean and dry the affected area first. Then apply some ointment to the affected area. Usually this should be done twice a day for 5 days. You can cover the treated area with a bandage / gauze. This will prevent accidental contact with the child's eyes, nose, or mouth. For maximum benefit, this medication must be used daily. Keep applying it for the prescribed time. Stopping the application too early will allow bacteria to continue to grow, causing the infection to return. You should see some improvement (healed / dry sores, reduced redness) after 3-4 days.
Gentamicin. This remedy is used to treat minor streptoderma and other skin conditions. Gentamicin stops the growth of bacteria. It belongs to the category of aminoglycoside antibiotics. This cream formulation is for the skin only. Wash your hands before use. Clean and dry the affected area and remove dry, hard skin to increase contact between the antibiotic and the infected area. Then, gently apply a small amount of the medication in a thin layer, usually 3-4 times per knocking. The dosage and duration of treatment depend on the state of health and response to treatment. Use this remedy regularly and at the same time. Do not use large amounts of this medicine, do not use it more often, or for longer than prescribed. The child's condition will not improve faster from this, and the risk of adverse reactions may increase. Continue to use this medication for full treatment even when symptoms disappear after a few days.
Baneocin. This ointment for streptoderma in children contains two active ingredients: neomycin and bacitracin, which are antibiotics. These antibiotics are used to get rid of streptoderma by killing bacteria and preventing their growth.

Thanks to the combination of two antibiotics, a wide spectrum of action and a greater effect of the drug are achieved.

Baneocin for streptoderma in children is applied thinly to the affected areas 2-3 times a day.

Systemic antibiotic treatment

Systemic antibiotic therapy can be used for severe streptoderma or when topical therapy fails. Systemic therapy is also recommended when multiple cases of streptoderma occur in educational settings and families.

Treatment for seven days is usually sufficient, but it can be extended if the clinical response is insufficient and antibacterial susceptibility is confirmed.

There is no clear evidence based on preference among the various classes of oral antibiotics. Comparative studies also show no significant difference in cure rates between topical and oral antibiotics.

Before prescribing an antibiotic, the doctor should test the skin samples for resistance. Antibiotics that are most effective include penicillin derivatives (amoxicillin-clavulanic acid (Augmentin)) and the cephalosporin group.

Erythromycin and Clindamycin are alternatives in patients with penicillin hypersensitivity. However, Erythromycin was found to be less effective.

Home remedies

Streptoderma in children causes many symptoms: itching, pain and discomfort in general. You can relieve some of these symptoms by using certain home remedies. In fact, many home remedies also help strengthen the immune system so that the baby's body can better fight infection.

You can use certain remedies at home in conjunction with your doctor's orders.

Fresh juices. Help your child's immune system fight infection by nudging it slightly. These can be vegetable and fruit juices that are rich in vitamin C. You can make fresh juices by grinding spinach, strawberries, or papaya to boost your baby's immune system.
Unprocessed grains, fruits and vegetables. Look for foods high in antioxidants to help your body fight infection faster. Berries, prunes, nectarines, peaches, bananas, bell peppers, tomatoes, broccoli, lentils, beans, and flaxseeds are antioxidant-rich foods to add to your child's diet.
Myrrh essential oil. Myrrh has anti-inflammatory and wound healing properties. Apply myrrh essential oil to the ulcers to relieve and soothe the pain and discomfort the child is experiencing. The oil accelerates the healing of lesions and ulcers.
Zinc. Talk to your doctor about using zinc. Zinc boosts immunity and can be a lifesaver if an infant develops streptoderma in the diaper area. Topical application of zinc can soothe the skin, while oral zinc can help the child's body fight infectious bacteria. Talk to your doctor about the correct dosage and find out if it is right to combine zinc with antibiotics. If you don't want to give your child a zinc supplement, include zinc-rich foods such as unprocessed grains, beans, and nuts in your diet.
Tea tree oil. Tea tree oil has antiseptic properties. It is traditionally used to treat infections of fungal etiology, but it can be used topically to treat almost all types of infections, including streptoderma. It promotes wound healing and helps in stopping the spread of infection.
Olive oil. Scales and crusting on your baby's skin can cause discomfort. You can use olive oil, which is a great natural moisturizer, to soothe your skin and make it easier to remove scabs and crusts. This will allow the topical antibiotic to penetrate deep into the skin to speed up healing. The olive oil will also reduce redness around the blisters.
Turmeric. In many oriental cultures, turmeric has been used as an antibacterial and anti-inflammatory agent since time immemorial. You can apply turmeric paste to wounds and blisters to ensure quick healing. The curcumin substance in turmeric works wonders and helps a child get rid of the infection faster.
Colloidal silver. You will also find that the child is always touching and combing sores and blisters. This is due to the fact that streptoderma is an itchy infection. If the child is not prevented from touching the sores, the infection will spread to other parts of the trunk. Colloidal silver relieves itching and soothes your baby's skin and dries up the rash.
Grapefruit seed extract. Grapefruit Seed Extract is made from grapefruit seeds and cellulose. Many alternative medicine practitioners use the extract to treat steptoderma. You can use it topically by diluting with water and applying it to blisters and sores. This will help not only to heal wounds, but also to relieve inflammation and redness. If your child is experiencing severe discomfort, mix grapefruit seed extract with some aloe vera juice. This will cool the skin and significantly reduce itching.

Hygiene and prevention

Since streptoderma is an infectious bacterial disease, the best way to keep your baby from getting infected is to keep the skin clean. Don't ignore insect bites, cuts, scrapes, and other superficial wounds. Rinse the affected area with warm water and apply disinfectant immediately.

Even if the child nevertheless developed streptoderma after that, it is necessary to keep the rest of the family safe.

After visiting your doctor, take the following measures to prevent the spread of the infection.

Wash infected areas with warm water and soap.
Cover the affected area with a non-stick bandage to prevent your child from scratching wounds and sores with their nails.
Wash your baby's clothes, towel, and bedding every day and separately from the rest of your wash.
Make sure that your child does not share his bedding, towels, and clothing with other family members, especially smaller siblings.
Trim your child's nails to prevent scratches and secondary infections
Wear latex gloves when applying topical antibiotic and always wash your hands thoroughly with soap and running water.
The child must stay at home and not attend educational institutions so that other children do not become infected. The doctor will tell you when the child is no longer contagious before you decide to send him back to school.

Thus, stertoderma in children can be a painful and uncomfortable infection. Since it is highly contagious, if you suspect streptoderma, take your child to a specialist. Early diagnosis and treatment shortens the cycle of infection and also prevents its spread.

Use the medicines prescribed by your doctor and follow the instructions carefully. If your child is prescribed systemic antibiotics, make sure they complete the course even when symptoms have subsided.

Timely and proper treatment prevents complications.