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Clinical Methods > Derm Infections > Flashcards

Derm Infections Flashcards

1
Q

What is folliculitis?

What is the most common organism?

A

Inflamed hair follicle which can affect any hair bearing area - presents with a tender red spot with pustule

Usually bacterial - Staph Aureus

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2
Q

List 2 factors which worsen folliculitis

How do we manage it?

A

Things that cause regrowing hairs: shaving, waxing, electrolysis

Management: stop exacerbating factors, hygiene, swabs may be useful to treat infection

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3
Q

What is cellulitis and how does it present?

A

Infection of the lower dermis and subcutaneous tissue

Presents as red, painful, swollen skin with fairly well-defined margins and systemic symptoms

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4
Q

If a patient presents with cellulitis what should we ask them to do in terms of monitoring?

What is the clinical relevance of this?

A

Always ask patient to draw a line around the area to monitor the cellulitis and see if it spreads over time

If it does, patient may need to switch from oral antibiotic to IV antibiotics

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5
Q

List 4 risk factors for Cellulitis

A
  1. Trauma
  2. Previous episodes; re-infection in same area
  3. Venous disease; blood pooling in the area
  4. Chronic diseases - DM, immunosuppression
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6
Q

In what population is cellulitis most common?

A

Elderly

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7
Q

Most common causitive organism in cellulitis

A
  • Strep pyogenes (2/3)
  • S. aureus (1/3)
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8
Q

How is Cellulitis diagnosed and treated?

A

Diagnosis:

  • Clinical
  • Bloods: Incl WCC and CRP (normally ↑)
  • Blood cultures (only if IV antibiotics are required)

Treatment:

  • Uncomplicated - Oral Flucloxacillin/ Co-fluampicil, Analgesia and treatment of co-morbidites
  • Systemic upset: Hospital admission, IVI/ IV Abx, O2
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9
Q

What is Erysipelas?

A

Similar to cellulitis BUT more superficial; affects upper dermis

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10
Q

Where and How does Erysipelas present?

A

Usually presents on lower legs but can affect face

Presents as:

  • Sharp raised border
  • Bright red, firm and swollen (cellulitis is firmer)
  • Blistering may be present
  • Painful and warm
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11
Q

In what population is Erysipelas most common?

A

Infants and elderly

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12
Q

What is the most common causitive organism in Erysipelas

A

Strep pyogenes and S. aureus

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13
Q

How is Erysipelas disagnosed and treated?

A

Diagnosed: Bloods (Incl WCC and CRP) and cultures

Management:

  • RICE; Rest, Ice, Elevation and Compression
  • Abx (Flucloxacillin first line)
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14
Q

Compare 2 differences between Cellulitis and Erysipelas

A
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15
Q

Syphilis is a STI causes by which organism?

What are the 4 stages of disease?

A

Treponema pallidum

Stages: primary, secondary, latent, tertiary

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16
Q

Presentation during each stage of syphilis

A

Painless ulceration at infection site - genitals/ anus/ oral mucosa of mouth (1o) followed by a widespread macular rash with secondary symptoms (2o)

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17
Q

Investigations for Syphilis

A
  1. blood test-MHA-TP
  2. Serology
  3. Dark ground microscopy
  4. PCR of swab samples
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18
Q

Management of Syphilis

A

Penicillin injection

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19
Q

What are the 2 types of Herpes and how does each present?

A

HSV-1: Oral Herpes

HSV-2: Genital Herpes

Present with characteristic fluid filled vesicles that burst to produce ulcers

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20
Q

How do we diagnose and treat Herpes

A

Diagnosis: NAAT or PCR testing of swab from ulcer or vesicle fluid

Management:

  • ORAL Acyclovir 200mg 5x a day for 5 days
  • Analgesia
  • Salt bathing
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21
Q

What is Eczema Herpeticum and how does it present?

A

Rare and serious skin infection caused by one of the herpes viruses (NOT an STI)

Presents with clusters of itchy and painbul blisters

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22
Q

How do we diagnose and treat Eczema herpeticum?

A

Diagnosis: Swab for PCR but not realy helpful… need to treat ASAP anyway

Treatment:

  • Conservative; no treatment if mild
  • Topical antivirals; ZOVIRAX
  • Oral antivirals +/- Abx for 2o bacterial infection ie. S. aureus infection
  • ACICLOVIR; 200 mg 5 times daily for 5 days
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23
Q

What is Chicken Pox?

How does it present?

A

Highly contagious viral infection caused by the Varicella- zoster virus which mainly affects children

Presents with:

  • ACUTE fever
  • blistered, itchy, erythematous rash
  • progresses to vesicles on the stomach, back and face, which then spreads to other parts of the body
24
Q

List 4 associated symptoms of chickenpox

A
  1. Fever
  2. Headache
  3. Nausea, vomiting
  4. Chickenpox pneumonitis (in severe cases, potentially fatal; check for respiratory symptoms; RED FLAGS)
25
Q

Chickenpox most commonly affects children, what is meant by the prodrome phase when it affects adults?

A

Prodromal phase upto 48 hours before the rash

Symptoms incl: fever, malaise, headache, loss of appetite and abdominal pain

Chickenpox is usually more severe in adults and can be life-threatening in complicated cases

26
Q

What is Molluscum Contagiosum?

A

Skin infection caused by a poxvirus molluscum contagiosum that occurs in childhood. Causes localised clusters of epidermal papules called mollusca

Also seen in immunosuppressed adults

27
Q

List 2 ways in which Molluscum Contagiosum spreads

A
  1. Direct and indirect contact
  2. Koebnerises; i.e. SPREADS WITH TRAUMA
28
Q

What is the Koebner Phenomenon?

A

Appearance of new skin lesions of a pre-existing dermatosis on areas of cutaneous injury in otherwise healthy skin

Seen in MC

29
Q

Describe the appearance of the skin lesions seen in Molluscum Contagiosum

A
  • Clusters of small round UMBILICATED papules with an axy shiny look
  • Do not coaslesce together but can group up together
  • Umbilication= cratering in the middle
  • Favours creases; moist warm areas
30
Q

Treatment of Molluscum Contagiosum

A

Clears within 2 years; self-limiting for 1-2 years therefore no treatment available on NHS

Can cause ↑parental anxiety, so can also use:

  • Salicylic acid
  • Molludab; OTC prep, KOH 5%; helps clear within 2-3 days

Reccomended to leave alone as the risk of scarring ↑ with treatment but give Abx if needed for a 2o bacterial infection

31
Q

What are Shingles and how does it present?

A

Localised, blistering and painful rash caused by reactivation of varicella-zoster virus (VZV)

ie from chicken pox-> can later erupt as shingles

32
Q

Describe the characteristic distribution of shingles

A

Dermatomal distribution

33
Q

Describe the course of shingles

A
  1. Eruption is preceded by pain on that patch of skin or feeling unwell-
  2. Blistering rash then starts
  3. Prodrome; unwell, painful skin with no rash

Lasts 7-10 days

34
Q

What is the most common complication of shingles?

Incl 2 signs/symptoms of this

A

Postherpetic neuralgia - allodynia and hyperalgesia

35
Q

What is another complication of shingles which is a potential medical emergency?

What investigations must we do for this?

A

OPHTHALMIC SHINGLES: risk of viral corneal infection which can affect sight

Do fluorescein staining in eyes to check for dendritic ulcers for viral infection

Check ear canal for blisters

36
Q

Management of acute Herpes Zoster

A
  1. Antiviral treatment - ↓ pain and duration of symptoms if started within 1-3 days of onset
  2. Rest and analgesia
  3. Protective ointment for rash ie. petroleum jelly.
  4. Oral Abx for 2o infection
37
Q

Management of Postherpetic neuralgia

A

PHN may be difficult to treat successfully, may respond to any of the following

  1. Early use of antiviral medication
  2. Local anaesthetic applications ie. Emler anaesthetic cream
  3. Topical capsaicin
  4. TCA’s eg. Amitriptyline
  5. Anti-epileptics ie. gabapentin and pregabalin
  6. Transcutaneous electrical nerve stimulation (TENS) or acupuncture
  7. Botulinum toxin ( Botox) into the affected area
38
Q

What is Pityriasis Versicolor and how does it present?

A

A common fungal infection that causes small patches of skin to become scaly and discoloured

Can present with different colours; brown/ paler/pink patches but is ALWAYS symetrical!

39
Q

What Fungi causes pityriasis versicolor?

What other condition is also cause by this organism?

A

Malassezia infection

Also causes seborrheic dermatitis

40
Q

Diagnosis and treatment of Pityriasis versicolor?

A

Diagnosis: Clinical features alone (yellow-green wood lamp tinge, scrapings)

Treatment:

  • Topical antifungals - Ketoconazole/Terbinafine
  • Oral antifungals; if disease does not resolve eg. oral Fluconazole/ Ketoconazole
41
Q

Impt DDx for Pityriasis Versicolor

A

Vitiligo

42
Q

How does oral candidiasis present?

How would you treat?

A

Presents with painful white plaques on tongue, inner cheeks, gums, tonsils or throat. Lesions can be painful and may bleed slightly when scraped

Treatment: Oral Nystatin and Miconazole

43
Q

How does vulvovaginal candidiasis present?

A
  1. Profuse, white, curd-like discharge
  2. Vaginal itch, discomfort and erythema
  3. Inflammation can lead to dysuria and dyspareunia
44
Q

How would you diagnose and treat vulvovaginal candidiasis

A

Diagnose: high vaginal swab for microscopy and culture

Treatment:

  • Oral fluconazole (anti-fungal) OR
  • Intravaginal antifungal cream or pessary - econazole
45
Q

List 4 other candidal infections

A
  1. Balanitis - Swollen head of penis, pink/red rash, swelling, sore, discharge
  2. Intertrigo - inflammation in folds of the skin eg. breasts, elbow creases etc..
  3. Napkin dermatitis
  4. Nail infections
46
Q

What are Dermatophytosis (tinea) infections?

How do we classify the different types?

A

Fungal infections caused by dermatophytes - group of fungi that invade and grow in dead keratin

Named depending on which part of the body is affected eg. Tinea pedis - foot (Athlete’s foot)

47
Q

Management of Dermatophyte Infections

A
  1. Treat underlying cause; DM, Immunosuppression, Eczema, Venous disease
  2. TOPICALS: all below +/- Hydrocortisone
  • Clotrimazole
  • Terbinafine
  • Miconazole
  • Amorolfine nail lacquer
  1. ORAL ANTIFUNGALS: Itraconazole
  • For treatment resistant disease
  • If disease is widespread/ extensive
  • Affecting hair bearing areas
48
Q

What are scabies and how does it present?

A

Very itchy rash caused by a parasitic mite (Sarcoptes scabiei) that burrows in the skin surface esp in wed spaces of fingers; visible after some time

49
Q

List 3 risk factors for scabies

A
  1. Poverty/ Overcrowding
  2. Institutions ; care homes. Orphanages
  3. Poor hygiene

Spread by direct contact

50
Q

What sign can be seen under dermoscopy indicating Scabies

A

Chevron Sign; wing-shaped/ paraglider sign

51
Q

Medical treatment of scabies?

A
  1. Topical Permethrin 5% (LOTION), leave on for 8-10 hrs - Repeat after 8 days
  2. Oral Ivermectin; if patient is unable to apply cream, poor absorption, in care homes
52
Q

What MUST we do if an individual is diagnosed with scabies?

A

CONTACT TRACING

53
Q

In additon to medical treatments, list 2 other things we should advise patients

A
  1. Bed linen, towels and clothing should be laundered after treatment
  2. Non-washable items should be sealed in a plastic bag and stored for one week
  3. Rooms should be thoroughly cleaned with normal household products; fumigation or specialised cleaning is not required.
  4. Carpeted floors and upholstered furniture should be vacuumed.
54
Q

What is meant by Pediculosis capitis vs Pediculosis corporis?

A

HEAD LICE; Pediculosis capitis

BODY LICE; Pediculosis corporis

55
Q

Treatment of lice?

A
  1. Combing
  2. Suffocating agent; 4% Dimeticone (hedrin)
  3. Insecticide- Permethrin

Clinical Methods (21 decks)

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