Dermatology Flashcards
What is Cellulitis
- Infection of the deep dermis and subcutaneous tissue
How does Cellulitis occur and what are the most common causative organisms
- Develops when micro-organisms gain entry to the dermal and subcutaneous tissues via disruptions in the cutaneous barrier (eg. minor skin injury)
- Most common causative bacteria are Streptococcus pyogenes** (catalase -ve)andStaphylococcus aureus** (catalse +ve)
What are the risk factors for Cellulitis
diabetes, venous insufficiency, eczema, oedema, obesity
What are the clinical features of Cellulitis
- Acute onset of red, painful, hot, swollen skin
- Poorly defined (not well demarcated) lesions
- Most commonly occurs on the legs (shins)
- Systemic Symptoms → fever, chills, nausea, headache
(Look at Obs ⇒ consider sepsis). Septic Signs → high HR, high RR, low BP, confusion (low GCS).
What are the investigations for Cellulitis
- Clinical Diagnosis → only request further tests if signs of systemic illness or septicaemia
- High WCC and CRP
- Skin Swab MCS → can identify pathogen and antibiotics susceptibility
- If patient admitted and septicaemia suspected → blood cultures and sensitivities
Hospital admission if there is significant systemic upset and/or co-morbidities.
What is the management of Cellulitis
- Class I (no systemic systems or co-morbidities) → managed in primary care with oral antibiotics: Flucloxacillin
- Class II (systemically unwell or systemically well with co-morbidity) → short term hospitalization
- Class III (significant systemic upset) or IV (sepsis or nec fasc) → urgent hospital admission: IV co-amoxiclav, cefuroxime, clindamycin or ceftriaxone
What is Eczema
Inflammatory skin condition characterised by dry, pruritic skin with a chronic relapsing course
What are the risk factors for Eczema
Risk Factors → allergic rhinitis (hayfever), age <5 years, family history of eczema, PMH/FH of atopy (food allergies, asthma)
What is Contact Dermatitis
type of eczema occuring following exposure to a causative agent (hx may say patient has new occupation).
What are the clinical features of Eczema
- Pruritus → may have excorations (scratch marks)
- Dry Skin
- Acute Flares → erythema, scaling, vesicles, papules
- Lichenification (thick leathery skin due to constant scratching) and Hyperpigmentation → if chronic
What are the sites of skin involvement for both infants and children?
- Sites of Skin Involvement → infants typically show involvement of the cheeks, forehead, scalp and extensor surfaces.
Children typically have involvement of the flexures, particularly the wrists, ankles, and antecubital and popliteal fossa
What are the investigations for Eczema
- Clinical Diagnosis
- Elevated IgE Levels
What is the Management for Eczema
- Emollients → improve skin barrier function by rehydrating the skin
- Topical Corticosteroids → hydrocortisone
- Severe Cases ⇒ systemic immunosuppressive agents (Oral Ciclosporin)
What are the risk factors for Pressure Sores
Risk Factors → immobility, recent surgery or intensive care stay, diabetes, malnutrition
What is the system used to screen for patients who are at risk of developing pressure ulcers.
Waterlow Score
