Ch 3 MDT Flashcards
Inflammation of a hair follicle that can occur anywhere on the body where hair is found
Folliculitis
Most common infectious etiology of bacterial Folliculitis
Staph aureus
Most common etiologies of non-infectious Folliculitis
Pseudo-folliculitis barbae (PFB)
Mechanical Folliculitis (Skinny Jean Syndrome)
Folliculitis Risk Factors
Hair removal (shaving, plucking, waxing, epilating agents)
Other pruritic skin conditions: eczema, scabies
Occlusive dressing or clothing
Personal carrier or contact with MRSA-infected persons
Diabetes
Immunosuppression
Use of hot tubs or saunas
Chronic antibiotic use
Tattoos
Poor Hygiene
Abrupt onset of follicular erythematous papules or pustules, with pruritus and pain in hairy areas
Rash occurs on hair-bearing skin, especially the face (beard, proximal limbs, scalp, and pubis
Folliculitis
Pseudomonal folliculitis appears as a widespread rash, located mainly at:
Trunk and limbs
Clinical hallmark of folliculitis
Hair emanating from the center of the pustule
General treatment and prevention of Folliculitis
Antiseptic and supportive care is usually enough
MRSA drugs
Bactrim
Clindamycin
Doxycycline
Complications of Folliculitis
Recurrent Folliculitis (PRIMARY)
Progression to furunculosis or abscesses
Cellulitis
Condition caused by ingrowing hairs, mostly in the beard area
Affects people with curly hair or those with hair follicles oriented at an oblique angle to the skin surface
Pseudofolliculitis Barbae
PFB
What is often a problem in affected skin, especially in African-American people?
Keloid formation
What may result from PFB?
Scarring and hyperpigmentation
PFB affects ____% of black people
and ___% of white people
50-75%
3-5%
Treatment for mild to moderate PFB
Medical treatment with grooming modifications
Treatment for moderate to severe PFB
Laser hair reduction with grooming modifications
PFB Laser Treatment
A series of at least ____ treatments is usually needed, with ____ days in between
Three
30-45 days
A contagious, superficial, intra-epidermal infection occurring prominently on exposed areas of the face and extremities
Impetigo
A deeper, ulcerated impetigo infection often with lymphadenitis
Ecthyma
Most common form of impetigo.
Formation of vesiculopustular that rupture, leading to crusting with a characteristic golden appearance
Local lymphadenopathy may occur
Nonbullous impetigo
Staphylococcal impetigo that progresses from small to large flaccid bullae
Ruptured bullae leaves brown crust
Less lymphadenopathy
Trunk more affected
Bullous impetigo
Impetigo risk factors
Warm, humid environment
Tropical or subtropical climate
Summer or fall season
Minor trauma, insect bites, breaches in skin
Poor hygiene, poverty, crowding, epidemics, wartime
Familial spread
Complication of pediculosis, scabies, chickenpox, eczema /atopic dermatitis
Contact Dermatitis
Burns
Contact sports
Children in daycare
Carriage of group A streptococcus and Staph aureus
Cutaneous pyoderma characterized by thickly crusted erosions or ulcerations.
Usually a consequence of neglected impetigo and classically evolves in impetigo occluded by footwear and clothing
Ecthyma
What is the key to avoid infection of impetigo?
Avoidance of spreading
HAND WASHING
Treatment for impetigo
Mupirocin ointment
Remove crusts clean with gentle washing 2-3 times daily; clean with antibacterial soap, chlorhexidine, or betadine
Severe impetigo treatment may require:
Nafcillin or Cefazolin IV antibiotics
Complications of Impetigo
Ecthyma
Cellulitis
Resistance to treatment
Lymphangitis
Furunculosis
An acute bacterial infection of the dermis and subcutaneous tissue
Typically caused by bacterial penetration through a break in the skin
Cellulitis
Most common etiologies of cellulitis
Hemolytic streptococci
Staph aureus
Gram-negative aerobic bacilli
Cellulitis is present with what four classic signs of inflammation?
Erythema
Edema
Tenderness
Elevated skin temperature
Most common portal of entry for lower leg cellulitis
Toe web intertrigo with fissuring
Secondary to interdigital tinea pedis
History
- Previous trauma, surgery, animal/human bites, dermatitis, and fungal infection are portals of entry for bacterial pathogens
- Pain, itching, and/or burning
- Fever, chills, and malaise
Cellulitis
Physical Exam
- Localized pain and tenderness with erythema, induration, swelling, and warmth
- Regional lymphadenopathy
- Purulent drainage from abscesses
Cellulitis
Labs considered for cellulitis when:
Signs of systemic disease (Fever, HR >100, SBP <90 mm Hg)
What needs to be ruled out in a patient with cellulitis?
DVT
Cellulitis treatment
Mark borders with a permanent marker
Immobilize and elevate limb
Pain relief
Compression for edema
Antibiotics
Antibiotics of choice for Human and Animal bites
Amoxicillin & clavulanic acid (Augmentin)
Complications of Cellulitis
Local abscess or bacteremia, sepsis
Superinfection with gram-negative organisms
Lymphangitis
Gangrene
Medical Emergency
Rare and rapidly progressing infection involving any layer of soft tissue including skin, subcutaneous fat, fascia, and/or muscle
Extensive tissue destruction, systemic toxicity, limb loss and are potentially fatal
Necrotizing Fasciitis
Risk factors for necrotizing fasciitis
Major penetrating trauma
Minor laceration or blunt trauma
Skin breach
Recent surgery
Mucosal breach
Immunosuppression
Malignancy
Obesity
Alcoholism
Most frequently occurs in the extremities and may mimic DVT
Pain, erythema, edema, cellulitis and high fever
Pain is out of proportion to the severity of the physical findings
Necrotizing Fasciitis
Labs for Necrotizing Fasciitis
MRI: Edema along the fascial plane
X-ray, CT or US are useful in demonstrating the air bubble in soft tissues
Cultures: Group A strep and mixed aerobic and anaerobic bacteria
Treatment for Necrotizing Fasciitis
Prompt and wide surgical debridement is the cornerstone
Broad-spectrum antibiotics
MEDEVAC
Complications of Necrotizing Fasciitis
Toxic shock syndrome
Amputation
Septic Shock
Death
A well-circumscribed, painful, inflammatory nodule at any site that contains hair follicles. May extend into the dermis and subcutaneous tissues
Furuncle
A collection of pus within the dermis and deeper skin tissues. Manifests as painful, tender, fluctuant, and erythematous nodules
Typically do not present with systemic symptoms
Abscess
A coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles
Typically presents with systemic symptoms and fever
Carbuncle
Risk factors of abscesses (furuncle, abscess, carbuncle)
Carriage of pathogenic staphylococcus sp. in nares, skin, axilla, and perineum
Diabetes mellitus, malnutrition, alcoholism, obesity, atopic dermatitis
Deep subcutaneous erythematous papules enlarge to deep-seated nodules that can be stable or become fluctuant within several days
Multiple Hair Follicles. Most commonly occurs on the back of the neck, upper back and lateral thighs
Tender, perifollicular swelling, terminating in discharge of pus and necrotic plug
Malaise, chills, and fever may precede or occur during the height of inflammation
Carbuncle
Mainstay treatment for an abscess, furuncle, or carbuncle
Incision and Drainage
Carbuncles should be handled by dermatology or general surgery in all situations unless patient is:
Unable to be transferred
Most common benign cutaneous cysts
Sebaceous Cyst (epidermal)
The cyst wall consists of normal stratified squamous epithelium derived from:
Follicular infundibulum
Firm or fluctuant flesh-to-yellow colored solitary nodule (0.5-5 cm) which often connects with the surface by keratin-filled pores
Grow slowly over time and may remain stable for months to years
Commonly located on face, neck, upper back, chest; if due to trauma, on buttocks, palms, or plantar side of feet
Stable epidermal cyst
Warm, red and boggy and tender on palpation
Sterile, purulent material and keratin debris often point towards and drain to the surface
These lesions mimic and present very similarly to abscesses
Inflamed/Ruptured Epidermal Cyst
Biopsy of a cyst shows:
Encapsulated keratinocytes and cellular debris
Indications for removal of cysts
Inflamed/ruptured or infected epidermal cyst
Produces functional deficit
Cosmetic
Pain secondary to location and duties
Cysts
What must be removed to prevent further infection?
Capsule
The most common benign mesenchymal neoplasm in adults and are composed of mature white adipocytes
Lipoma
Lipomas can occur on any part of the body and usually develop superficially in the ______ tissue
Subcutaneous
Soft, painless subcutaneous nodule ranging in size from 1->10 cm
Occur most frequently on the trunk and upper extremities and can be round, oval, or multilobulated
Frequently patients have more than one
Lipoma
Transition of a preexisting lipoma to an atypical lipomatous tumor represents an exceeding rare phenomenon at ___%
<0.1%
Lipomas may be excised by dermatology for what reasons?
Cosmetic
Pain
Impedance of duties
Intramuscular lipoma recurrence rate is up to ___%
20%
Acute inflammatory process, with or without abscess formation, that involves the proximal and lateral nail folds and that has been present for less than 6 weeks
Paronychia
Paronychia is commonly caused by:
Manicuring, nail biting, thumb sucking, and picking at a hangnail
Acute paronychia of the toes is associated with:
Ingrown toenails
Most common infection of the hand, representing 35% of all hand infections in the U.S.
Paronychia
Paronychia treatment
Warm compresses or soaks
Drainage using a scalpel blade inserted between the nail and nail fold
Antibiotics if warranted
What is unnecessary in the treatment of paronychia?
Skin incision
Complications of paronychia
Further extension of infection with deeper involvement
Nail distortion in chronic infections
Abscess of the distal phalanx fat pad
Staph aureus is the most common pathogen
Painful and swollen distal pulp space
Felon
The digital pulp, the fleshy mass at the fingertips, is divided into multiple compartments by _____ _____ that provide structural support
Fibrous septae
Pyogenic infection of the distal digital pulp space, with pus collecting in the spaces formed by the vertical septa anchoring the pad to the distal phalanx
Nearly always follows minor finger injury (splinter or needle prick)
Felon
Felon treatment
Incision and drainage by a Dermatologist
Antibiotics
Labs/Studies/Imaging for a Felon
Imaging to evaluate for retained foreign body and to rule out involvement of the distal phalanx
Complications of a Felon
Osteitis & osteomyelitis
Ulcerative and tissue necrosis
Flexor tenosynovitis
Septic Arthritis
Grows best in warm, moist environments so infection is often confined to mucous membranes and intertriginous areas
Opportunistic pathogen when allowed to overgrow and predisposing conditions permit
Candida (fungal)
What layers of the epithelium does yeast infect?
Outer Layers only
Fungal infection Risk Factors
Hormonal alterations
-Pregnancy, oral contraceptives, diabetes
Elimination of competing microorganisms
-Antibiotics
Physical environment changes
-Skin maceration, increased humidity/temperature
Direct/Indirect Immunosuppression
-Corticosteroid therapy, immunosuppression
Candidiasis occurs most commonly in what type of areas?
Intertriginous areas (axillae, groin, digital web spaces, glans penis, beneath breasts, vulvovaginal)
Red, glistening surface with a long, cigarette paper-like, scaling and advancing border
Candidiasis
Treatment for Candidiasis
Skin kept dry and exposed to air as much as possible
Antifungals
What is not recommended in the treatment for Candidiasis?
Topical Steroids
Diagnosis for Candidiasis is based on:
Clinical Appearance
Location of Infection
Presence of predisposing factors
Candidiasis
Positive culture alone is usually meaningless because Candida is:
Omnipresent
Superficial fungal infections of the skin/scalp; various forms of dermatophytosis
Tinea
Infection of the crural fold and gluteal cleft
Tinea Cruris
Infection involving the face, trunk, and /or extremities often presents with ring-shaped lesions, hence the misnomer ringworm
Tinea corporis
Infection of the scalp and hair; affected areas of the scalp can show characteristic black dots resulting from broken hairs
Tinea capitis
Can subsist on protein, namely keratin and can cause disease in keratin-rich structures such as skin, nails, and hair
Dermatophytes
Infections acquired from animals
Zoophilic
Infections acquired from personal contact
Anthropophilic
Scaling, round or oval pruritic plaques characterized by a sharply defined annular pattern with peripheral activity and central clearing
Papules and occasionally pustules/vesicles present at border and, less commonly in center
Tinea Corporis
Treatment for Tinea Corporis
Antifungal creams for at least 2 weeks
Continue treatment 1 week after resolution of infection
Tinea corporis treatment that requires oral therapy
Extensive lesions or those with red papules
Tinea corporis
What medication may be considered for highly inflamed lesions to minimize scarring?
Short course of prednisone
Labs/studies/imaging for Tinea Corporis
KOH Prep
Woods lamp
Complications of Tinea Corporis
Extension of diease down to the hair follicles
Well-marginated, erythematous, halfmoon-shaped plaques in crural folds that spread to medial thighs; advancing border is well defined, often with fine scaling and sometimes vesicular eruptions
Lesions are usually bilateral and do not include scrotum/penis (unlike candida infections)
Tinea Cruris
First line treatment for Tinea Cruris
Topical antifungal cream
Absorbent powders
Treatment for refractory, inflammatory or widespread tinea cruris infections
Oral antifungals
Resume topical antifungals/powders once resolved
Complications of Tinea Cruris
Secondary Bacteria infections
Superficial infection in the interdigital web and soles of the feet caused by dermatophytes
Most common Dermatophyte infection
Tinea Pedis
Itching, burning, and stinging of interdigital webs and plantar surfaces
Pain may indicate secondary infection
Most present with asymptomatic scaling
Woods lamp exam with not fluoresce
Tinea Pedis
Treatment for Tinea Pedis
Open-toed shoes
Shower shoes
Dry between toes after showering & frequent sock changing
Cotten socks (absorbent, non-synthetic)
Antifungal powders
Wide shoes
Caused by Pityrosporum orbiculare
Organism is nourished by sebum
Very common in excess heat and humidity
-Prevalence can reach 50% in tropical areas
Not a dermatophyte infection
Tinea versicolor
Velvety tan, pink or white macules that do not tan
Fine scales that are not visible but are seen by scraping the lesion
Central upper back, chest, and proximal areas (highest concentration of sebum)
Asymptomatic; Appearance is often the patient’s main concern
Tinea Versicolor
Labs/Studies for Tinea Versicolor
Woods lamp will show hypo-pigmented areas of infections
-Faint yellow-green fluorescence
Complications of Tinea Versicolor
Relapses without any complications
Treatment for Tinea Versicolor
Selenium sulfide from neck to waist
Ketoconazole shampoo to chest and back
Oral treatment for Tinea Versicolor is reserved for patients with:
Extensive disease who do not response to topical treatment
Acquired through direct contact of the nail with dermatophytes, yeast, or non-dermatophyte molds in the environment or through spread of fungal infection from affected skin
Onychomycosis
Predisposing factors for onychomycosis
Tinea pedis, psoriasis, hyperhidrosis, obesity, advancing age, contact with infected household members
Trauma, poor nail grooming, sports and fitness activities, occlusive shoes
Most common onychomycosis presentation
Distal subungual onychomycosis
-Begins with white/yellow/brown discoloration of distal corner of the nail that gradually spreads moving proximally
Treatment for Onychomycosis
Confirm with KOH & fungal culture for potential liver toxicity
LFT
Oral antifungal (Gold Standard)
Required labs for onychomycosis
KOH and Fungal Culture to begin treatment
Disposition for onychomycosis
Consult to dermatology and/or podiatry
A contagious parasitic infection of the skin caused by the mite Sarcoptes scabiei
Scabies
Scabies is transmitted by:
Prolonged human to human direct skin contact
Scabies rash appears __ weeks after exposure
2-6 weeks