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Acute pyogenic infections of the skin, caused by hemolytic streptococci and S. aureus, account for the vast majority of bacterial infections of the skin seen in ambulatory practice. In preschool children the principal manifestation is pyoderma, which is usually caused by Group A Streptococcus. In this age group pyoderma regularly responds to systemic penicillin therapy plus adjunctive local care to the lesions. However, in older age groups, the ability to distinguish streptococcal from staphylococcal skin infections on the basis of clinical features alone is poor, and penicillin treatment failures are more common. Safe, effective antibiotics that are effective against both staphylococci and streptococci are readily available. For this reason penicillinase-resistant semisynthtic penicillins and or erythromycin can be used to treat acute pyogenic skin infections in older age groups.

The most common blistering diseases encountered in children are impetigo, burns, acute dermatitis, friction blisters, viral blisters, insect bite reactions, and linear IgA dermatosis. Diagnosis should be based on specific clinical manifestations and, when necessary, results of a Tzanck test or skin biopsy. A search for an intact blister is always warranted when erosions, oozing, or crusts are noted.

Acropustulosis of infancy (Al) is a syndrome consisting of pruritic pustules that are found primarily on the extremities of infants. It is uncommon, but not rare, and persists about two years. In two infants in whom Al began at birth, there was a striking response to sulfones. There was no response to other therapy. Laboratory findings are not diagnostic for Al. Similar histopathologic changes (subcorneal pustules) can be found in other eruptions of infancy.

Bart's syndrome is one among the lesser known presentations of epidermolysis bullosa. It is characterized by congenital localized bullae of skin and mucous membranes sometimes associated with nail deformities, all of which disappear during the neonatal period. Early recognition allows for avoidance of inappropriate systemic or local therapy.

Oriental Sore is the dry cutaneous form of leishmaniasis, a parasitic infection common to man and to certain vertebrates and transmitted by insects: the phlebotomes. This benign tropical disease exists in South East France where it remains very rare, human contamination always being accidental. The lesions, single or multiple, affect the skin only. On the face, the differential diagnosis arises with other much commoner cutaneous lesions (impetigo, etc.). They consist, after 2 to 4 months of incubation, of a rounded erythematous papule, neither pruritic nor painful, which becomes secondarily excavated to produce a crusted ulcer. This lesion, typical at this stage, then persists for many months before an unsightly scar develops. Treatment is local: surgical excision offering the possibility of histological examination and hence a diagnosis. Plastic surgery may be used to correct scars in advanced forms.

Sixteen children with "scalded skin" due to staphylococcal infections are described [six cases of staphylococcal scarlet fever, 6 cases of bullous impetigo and 4 cases of toxic epidermal necrolysis (Lyell's disease--of which Ritter's disease is only the neonatal manifestation)]. The clinical features of each of these conditions are described, the common feature being the severity of the pathological changes. The role of the exfoliating toxin secreted by the pathogenic staphylococci mostly belonging to phagegroup II, phagetype 3A, 3N, 3C, 55 or 71) is emphasized. Treatment should be aimed at reducing secondary infection by strict asepsis and by eradicating staphylococci with appropriate antibiotic therapy. Corticosteroids have no beneficial effect. The outcome is good if these principles are applied strictly.

The condition of a 3-year-old boy with an intermittent, generalized, bullous eruption was initially diagnosed as (and treated as) bullous impetigo. After a relapse, two skin biopsies were performed. Each biopsy specimen showed the changes of eosinophilic spongiosis. A third biopsy specimen was also examined by direct immunofluorescence microscopy. The specimen showed deposition of IgG in the intercellular region of the epidermis. The patient's serum contained intercellular antibodies in a dilution of 1:160, confirming the diagnosis of pemphigus. A biopsy should be performed in the case of a child with a persistent or recurring bullous eruption; immunofluorescence microscopy of the biopsy is essential.

Skin infection occurs in any age-group, sex, and race but is particularly common in children. It is usually minor, but may indicate underlying systemic disease or may lead to systemic infection. Streptococci and staphylococci are common causes. Group A beta-hemolytic streptococci account for the majority of streptococcal infections in man. Infection most often involves the lower extremities and produces spreading erythema and necrosis but little purulence. Staphylococcal infections most commonly involve the face, the hair follicles and eccrine sweat ducts being the initial sites. Lesions appear as bullae and pustules with a narrow rim of erythema. Intense cellulitis surrounding the lesions usually points to a virulent, penicillin-resistant strain of Staphylococcus. Treatment of both types of infection consists of cleansing with antibacterial agents, removal of crusts, application of warm compresses, and use of topical or systemic antibiotics, depending on the severity of the infection and the type of pyoderma involved.

Coagulase-positive staphylococci of phage group II produce an epidermolytic toxin that results in a spectrum of diseases that include localized bullous impetigo, generalized scarlatiniform syndrome without exfoliation, and staphylococcal scalded-skin syndrome (SSSS). The mechanism of action of the toxin occurs at the level of the lower stratum granulosum, resulting in intraepidermal cleavage. Generalized exfoliative dermatitis, or SSSS, is one of the most severe infections characterized by generalized epidermolysis with desquamation. Generalized scarlatiniform syndrome is an erythematous rash without exfoliation. A localized infection that results in a bulla larger than 5 mm in diameter is bullous impetigo.

Impetigo herpetiformis was diagnosed in a primigravida woman on clinical, laboratory, and histopathological grounds. This disease should be considered as a rare and serious variant of generalized pustular psoriasis. After initiating prednisone therapy, antepartum registration of fetal heart rate patterns appears necessary to evaluate fetal well-being. Subsequent pregnancies of the patient were not recommended.

A bullous type of papular urticaria is seen commonly in Iraq. The eruption can be extensive, simulating some of the more serious bullous skin diseases. This paper describes the condition clinically and histologically.

Pregnancy is a period of profound endocrine and metabolic changes which are tolerated by the body for a relatively short time. During gestation both physiologic and pathologic changes can occur in the skin, nails, and hair shafts which should be recognized and appropriately managed by the dermatologist. These changes can conveniently be placed into five broad categories: (1) physiologic changes in skin and appendages caused principally by the hormonal milieu, (2) cutaneous tumors affected by pregnancy, (3) diseases specifically associated with pregnancy, (4) genital infections of perinatal importance, and (5) other dermatologic diseases influenced by pregnancy. A discussion of each of these topics reveals the vast spectrum of dermatologic disease seen in pregnancy and underscores the important role of the dermatologist in the care of pregnant patients.

The growing incidence among newborns of B-streptococcal diseases has been accompanied by the appearance of less common findings, such as Impetigo neonatorum bullosa. The pathological pattern is described. Brief reference is made to literature.

A problem-oriented algorithm is used to categorize skin eruptions in children into 10 morphologic groups, eliminating much of the difficulty and confusion of antiquated terms. This approach results in rapid differential diagnosis of common skin rashes in children.

Impetigo herpetiformis is a rare pustular disorder that primarily affects pregnant women. Clinically and histologically it bears some resemblance to pustular psoriasis. This similarity has led authors to name the disease "the pustular psoriasis of pregnancy." A case is described that demonstrates the characteristic features of impetigo herpetiformis, as compared with pustular psoriasis, and emphasizes the need to preserve it as a separate entity.