Bacterial and Viral Skin Infections

Question 1

Cellulitis Physical Exam

Answer 1

Warmth, erythema, edema, and tenderness of the affected area
The margin of cellulitis will not be palpable.
Cellulitis characterized by violaceous color and bullae suggests infection with Streptococcus pneumoniae (pneumococcus)

Question 2

Cellulitis Treatment

Answer 2

Mild:
Bactrim, Clinda, Doxy – Cover MRSA
Cephalexin (Keflex)
Dicloxacillin (Dynapen)
Complicated:
Hospitalization for IV antibiotics (Cover MRSA PLUS)
Ancef (Cephalexin)
Ceftriaxone (Rocephin)
Ampicillin-Sulbactam

Question 3

Erysipelas Treatment

Answer 3

Penicillin G... to cover Group A Beta hemolytic strep
Penicillin VK
Dicloxacillin (Dynapen)
Keflex (Cephalexin)
Clindamycin
Erythromycin
May need analgesics for pain

Question 4

Human Bites Treatment

Answer 4

Amoxicillin-Clavulante (Augmentin) 
Moxifloxin (Avelox) (not under 18)
Clindamycin
DON’T FORGET A TETANUS SHOT (should give in opposite extremity) 
Patient must follow-up in 1-2 days

Question 5

Hidradenitis suppurativa

Answer 5

Chronic, suppurative disease of apocrine gland-bearing skin.
Onset from puberty to climacteric
Predisposing factors:
Obesity, genetic disposition to acne, apocrine duct obstruction
Common sites:
Axilla
Anogenital region

Question 6

Hidradenitis suppurativa Treatment

Answer 6

Combination of:
Intralesional glucocoticoids (Triamsinolone)
PO steroids (Predisone)
Surgery: I & D abscess LAST RESORT!!
Oral antibiotics:
Erythomycin
Tetracycline
minocycline

Question 7

Varicella (Chicken Pox)

Answer 7

Highly contagious:
Two days before onset of rash Until all lesions have crusted
Appear on face and scalp, spread inferiorly to truck (centripetal)
Vesicles appear as “dew drops on a rose pedal”
pruritic
Becomes pustules and crusts over

Question 8

Genital Warts Treatment

Answer 8

Imiquimod (Aldara): Immune response modifier, apply 3 days per week for up to 16 weeks.
Podophyllum , 20% in tincture of benzoin varies in effectiveness
Treat small areas:
Notify pathologist if sending biopsy previously treated
Trichloroacetic acid 25 - 50% (particularly helpful for vaginal)

Question 9

Molluscum Contagiosum

Answer 9

Pox virus
Discrete, 2 - 5 mm, umbilicated, domed-shaped papules
Spread by autoinoculation, scratching, or touching a lesion
Common on face, trunk, extremities in children
Common in genital and pubic areas in adults