Cellulitis and skin tx Flashcards
What is cellulitis?
Acute, spreading pyogenic inflammation of the dermis and subq tissue
What is cellulitis a complication of?
Wound or ulcer
Describe cellulitis feeling.
Warm, tender, swollen, and erythematous
Is cellulitis sharply demarcated from unaffected skin?
No
Who is affected by impetigo? And when?
Children
Hot, humid weather
What are some common signs of impetigo? What are they secondary to?
Puritis, scratching
Staph infection
How do you treat impetigo?
Benzathine PCN
How do you administer benzathine?
Single IM injection
What is staphylococcal scalded skin syndrome (SSSS)?
Severe manifestation of S. aureus infection
What is SSSS caused by?
Exfoliative exotoxin
Can SSSS produce epidemics? If so, where?
Yes, in neonatal nurseries
What is the rate of mortality for SSSS?
3%
How do you treat SSSS? What is the name of this drug?
Penicillinase resistant PCN
Nafcillin
What is folliculitis?
Pyoderma in the hair shafts
What is the etiology of folliculitis?
S. aureus
Pseudomonas
Candida
What is the tx for folliculitis?
Local/topical abx or antifungals
What is a furuncle?
Deep inflammatory nodule
What is a carbuncle?
Larger nodule that extends into subQ fat (abscess)
What causes furuncles and carbuncles?
S. aureus
What are predisposing factors for furuncles and carbuncles?
Obesity, blood dyscrasias, steroid tx, DM
Tx for furuncles and carbuncles
Antistaphlococcal abx
Clindamycin 150-300 mg po q6 hours (if PCN allergic)
Vancomycin, linezolid, or daptomycin (MRSA)
What were chancriform lesions previously associated with?
Wool and animal hides
What are chancriform lesions caused by?
Spores of Bacillus anthracis
Are chancriform lesions painless or painful?
Painless
What happens to the chancriform lesions as they grow??
They become hemorrhagic and necrotic
What is the tx for chancriform lesions?
Ciprofloxacin 500 mg po q12 h 7-10 days
60 for bioterror
What is erysipelas?
Its a distinctive type of superficial cellulits
What is erysipelas characterized by?
Prominent lymphatic involvement
Describe the characters of erysipelas.
Raised border, sharply demarcated
How do you treat early cases of erysipelas?
Penicillin
Pen V 250-500 mg po q 6
Erythromycin 250-500 mg po q 6
How do you treat extensive or hospitalized cases of erysipelas?
Pen G 2 mill units IV q 6
Nafcillin 2g IV q 4
Cefazolin 1-2 g IV q8
What are some initiating sources of cellulitis?
Skin trauma Bites Wounds Hot tubs/pools Edema
What % of cellulitis aspirates are gram + organisms, and what are some examples?
80% S. aureus Group A or B streptococci Viridians streptococci E. faecalis (rare)
Are cultures/bx useful for cellulitis?
Not really -> only really reveal typical skin flora
They are reserved for special cases
For diabetic pts what do you add to tx?
Anaerobic coverage
What areas does necrotizing fasciitis affect?
Extremities, abdominal wall, perianal, and groing
What is Fournier’s gangrene?
What is the mortality rate?
NF of the genitalia
10-20%
What to gangrenous areas look like and feel like?
Swollen, hot, and VERY painful
disproportionate pain is important clue
Does NF progress slowly or rapidly? And over what period of time?
Rapidly over several days
What leads to the necrosis?
Thrombosed subQ vessels
What is something that can proceed NF?
Anesthesia
What is the mortality rate of NF?
20-50%
What abx do you give for NF?
Ampicillin, gentamicin, clindamycin, and metronidazole
