Cutaneous infection & infestation (2) Flashcards
1
Q
Management of genital warts
A
- topical podophyllum or cryotherapy are commonly used as first-line treatments depending on the location and type of lesion. Multiple, non-keratinised warts are generally best treated with topical agents whereas solitary, keratinised warts respond better to cryotherapy
- imiquimod is a topical cream which is generally used second line
- genital warts are often resistant to treatment and recurrence is common although the majority of anogenital infections with HPV clear without intervention within 1-2 years
2
Q
Management of warts (in general)
A
- generally not treated
- may resolve in 2 years
- difficult to treat
*if very severe case → laser treatments (plastic surgeon)
3
Q
Spot diagnosis
A
Molluscum Contagiosum
4
Q
Molluscum contagiosum
- pathophysiology
- transmission
- epidemiology
A
Molluscum contagiosum
- a common skin infection
- caused by molluscum contagiosum virus (MCV), a member of the Poxviridae family
- transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels
- the majority of cases occur in children (often in children with atopic eczema), with the maximum incidence in preschool children aged 1-4 years
5
Q
Features of molluscum contagiosum
A
- characteristic pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter
- lesions appear in clusters in areas anywhere on the body (except the palms of the hands and the soles of the feet)
- in children, lesions are commonly seen on the trunk and in flexures, but anogenital lesions may also occur
- in adults, sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen
- Rarely, lesions can occur on the oral mucosa and on the eyelids
6
Q
Self-care advice in molluscum contagiosum
A
Self care advice:
- molluscum contagiosum is a self-limiting condition
- Spontaneous resolution usually occurs within 18 months
- lesions are contagious, and it is sensible to avoid sharing towels, clothing, and baths with uninfected people (e.g. siblings)
- encourage people not to scratch the lesions. If it is problematic, consider treatment to alleviate the itch
- exclusion from school, gym, or swimming is not necessary
7
Q
Management of molluscum contagiosum
A
Treatment is not usually recommended.
If lesions are troublesome or considered unsightly, use simple trauma or cryotherapy, depending on the parents’ wishes and the child’s age:
- Squeezing (with fingernails) or piercing (orange stick) lesions may be tried, following a bath. Treatment should be limited to a few lesions at one time
- Cryotherapy may be used in older children or adults, if the healthcare professional is experienced in the procedure
- Eczema or inflammation can develop around lesions prior to resolution. Treatment may be required if:
- → Itching is problematic; prescribe an emollient and a mild topical corticosteroid (e.g. hydrocortisone 1%)
- → The skin looks infected (e.g. oedema, crusting); prescribe a topical antibiotic (e.g. fusidic acid 2%)
8
Q
Referral in molluscum contagiosum
A
Referral may be necessary in some circumstances:
- For people who are HIV-positive with extensive lesions urgent referral to a HIV specialist
- For people with eyelid-margin or ocular lesions and associated red eye urgent referral to an ophthalmologist
- Adults with anogenital lesions should be referred to genito-urinary medicine, for screening for other sexually transmitted infections
9
Q
Spot diagnosis
A
Ringworm → tinea corporis
10
Q
Tinea Corporis
- cause
- description
- treatment
A
- causes include Trichophyton rubrum and Trichophyton verrucosum (e.g. from contact with cattle)
- well-defined annular, erythematous lesions with pustules and papules
- may be treated with oral fluconazole
11
Q
(3) main types of infection with dermatophyte
A
Tinea is a term given to dermatophyte fungal infections
Three main types of infection are described depending on what part of the body is infected
- tinea capitis - scalp
- tinea corporis - trunk, legs or arms
- tinea pedis - feet
12
Q
Tinea capitis
- cause
- management
A
Tinea capitis (scalp ringworm)
- a cause of scarring alopecia mainly seen in children
- if untreated a raised, pustular, spongy/boggy mass called a kerion may form
- most common cause is Trichophyton tonsurans in the UK and the USA
- may also be caused by Microsporum canis acquired from cats or dogs
- diagnosis: lesions due to Microsporum canis green fluorescence under Wood’s lamp*. However the most useful investigation is scalp scrapings
- management: oral antifungals: terbinafine for Trichophyton tonsurans infections and griseofulvin for Microsporum infections. Topical ketoconazole shampoo should be given for the first two weeks to reduce transmission
13
Q
What’s that?
A
Tinea pedis (athlete’s foot)
- characterised by itchy, peeling skin between the toes
- common in adolescence
14
Q
Management of tinea pedis
A
- General measures should be first-line, including meticulous drying of feet, especially between the toes, avoidance of occlusive footwear, and the use of barrier protection (sandals) in communal facilities.
- Topical antifungal therapy once or twice daily is usually sufficient. These include azoles, allylamines, butenafine, ciclopirox, and tolnaftate. A typical course is 2 to 4 weeks, but single dose regimes can be successful for mild infection
- For those who do not respond to topical therapy, an oral antifungal agent may be needed for a few weeks. These include:
- Terbinafine
- Itraconazole
- Fluconazole
- Griseofulvin
15
Q
If we suspect fungal infection what are we going to do?
A
Skin scrappings → send to microbiology
17
Q
Potential causes (infective agents) of fungal nail infections
A
Onychomycosis is fungal infection of the nails. This may be caused by:
- dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases
- yeasts - such as Candida
- non-dermatophyte moulds
21
Q
Management of nail fungal infections
A
- do not need to be treated if it is asymptomatic and the patient is not bothered by the appearance
- diagnosis should be confirmed by microbiology before starting treatment
- dermatophyte infection:
- oral terbinafine is currently recommended first-line with oral itraconazole as an alternative
- 6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be treated for 3 - 6 months
- treatment is successful in around 50-80% of people
-
Candida infection:
- mild disease should be treated with topical antifungals (e.g. Amorolfine) whilst more severe infections should be treated with oral itraconazole for a period of 12 weeks
- if topical treatment is given treatment should be continued for 6 months for fingernails and 9-12 months for toenails
23
Q
Features of scabies
A
- widespread pruritus
- linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
- in infants, the face and scalp may also be affected
- secondary features are seen due to scratching: excoriation, infection
26
Q
- Diagnosis
- Management
A
Crusted (Norwegian) scabies
- Crusted scabies is seen in patients with suppressed immunity, especially HIV
- The crusted skin will be teeming with hundreds of thousands of organisms
Ivermectin is the treatment of choice and isolation is essential
