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Year 4 - Special Senses > Dermatology - Skin Infection > Flashcards

Dermatology - Skin Infection Flashcards

1
Q

What is tinea capitis?

A

Infection of scalp hair follicles and the surrounding skin, caused by dermatophyte fungi.

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2
Q

Presentation of tinea capitis.

A

Prepubertal children:
- patchy hair loss
- scaling
- erythema
- regional lymphadenopathy

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3
Q

Examining tinea capitis.

A
  • Wood’s lamp
  • clinical pattern
  • dermoscopy
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4
Q

Investigating tinea capitis.

A

Laboratory investigations advised to isolate the causative organism and direct management:
- scalp scrapings
- plucked hairs

Process for microscopy and culture.

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5
Q

Medical management of tinea capitis.

A

Oral antifungal treatment guided by microscopy and culture.

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6
Q

Social management of tinea capitis.

A
  • children CAN attend school
  • family screening and treatment of those +ve
  • cleansing of hairbrushes / combs
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7
Q

What is tinea pedis?

A

Foot infection due to dermatophyte fungus.

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8
Q

Risk factors for tinea pedis.

A
  • male
  • young adult
  • excessive sweating
  • occlusive footwear
  • systemic corticosteroids
  • walking barefoot in public
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9
Q

Presentation of tinea pedis.

A
  • itchy erosions between the toes
  • scales covering the sole of feet
  • blisters on inner foot
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10
Q

Management of tinea pedis.

A

Topical antifungal therapy daily.

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11
Q

How can recurrence of tinea pedis be prevented?

A
  • dry feet after bathing
  • avoid occlusive footwear
  • dry shoes and boots
  • clean the shower and bathroom floors with bleach
  • treat shoes with antifungal powder
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12
Q

What is the causative organism or vulvovaginal candidiasis?

A

Candida albicans

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13
Q

Risk factors for vulvovaginal candidiasis.

A
  • menstruation
  • pregnancy
  • COCP
  • empirical abx
  • obesity
  • diabetes mellitus
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14
Q

Presentation of vulvovaginal candidiasis.

A
  • itching / soreness
  • dysuria
  • vulval oedema
  • cottage-cheese discharge
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15
Q

Investigating vulvovaginal candidiasis.

A
  • pH derangement
  • vaginal swab
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16
Q

Treatment of vulvovaginal candidiasis.

A

Topical antifungal pessaries, tablets or cream.

Oral antifungals if severe or recurrent infection.

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17
Q

Conservative measures to manage vulvovaginal candidiasis.

A
  • loose fitting clothing
  • soak in salt bath
  • antifungal creams before menstruation
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18
Q

The following measures have not been shown to help with vulvovaginal candidiasis.

A
  • Treatment of sexual partner
  • Special low-sugar, low-yeast or high-yoghurt diets
  • Putting yoghurt into the vagina
  • Probiotics (oral or intravaginal lactobacillus species)
  • Natural remedies and supplements (except boric acid)
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19
Q

Risk factors for oral candidiasis.

A
  • infancy / old age
  • immunosuppression
  • dentures
  • smoking
  • broad spectrum abx
  • inhaled corticosteroids
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20
Q

Presentation of oral candidiasis.

A
  • white patches in mouth
  • angular cheilitis
  • geographic tongue

NB: severe infections may extend to the oesophagus causing difficulty with swallowing.

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21
Q

Conservative measures to treat oral candidiasis.

A
  • good oral hygiene (brish teeth regularly, warm saline water mouth wash)
  • clean dentures
  • remove dentures overnight
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22
Q

Medical management of oral candidiasis.

A

First line: Topical antifungal products (e.g. oral nystatin)

Systemic antifungal treatment may be considered in severe infection.

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23
Q

Causative organism of impetigo.

A

Staphylococcus aureus - causes honey-yellow crusting.

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24
Q

Risk factors for impetigo.

A
  • skin trauma
  • skin conditions (e.g. dermatitis, scabies)
  • immunosuppression
  • warm climate
  • poor hygiene
  • crowded environment
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25
Q

Clinical features of non-bullous impetigo.

A
  • honey-coloured crusts
  • rapid spreading
  • itching
  • regional lymphadenopathy

NB: usually systemically well.

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26
Q

Clinical features of bullous impetigo.

A

Quickly appearing:
- bullae
- spontaneous rupture
- systemic symptoms (e.g. fever, malaise)

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27
Q

Complications of impetigo.

A
  • staphylococcal scaled skin syndrome
  • ecthyma
  • cellulitis
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28
Q

Investigating impetigo.

A

Usually a clinical diagnosis, unless it is severe or recurrent.

If severe / recurrent, consider skin swab.

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29
Q

General management of impetigo.

A
  • regular gentle cleansing to remove honey-coloured crusts
  • practice good hand hygiene
  • cover affected areas with watertight dressing to prevent spread
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30
Q

Medical management of non-bullous impetigo.

A

Topical antiseptic (e.g. hydrogen peroxide 1% cream).

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31
Q

Medical management of bullous impetigo.

A

First line: Flucloxacillin

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32
Q

Preventative measures of impetigo.

A
  • avoid touching affected areas
  • good hand hygiene
  • clean cloth when drying
  • do not share towels
  • clothing and bedding changed daily
  • avoid close contact with others
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33
Q

How long to stay off school with impetigo.

A

Treatment for 24 hours or until lesions crust over.

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34
Q

What is folliculitis?

A

An inflammed hair follice, causing a tender red spot with a surface pustule.

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35
Q

Causes of folliculitis.

A
  • infection
  • blockage
  • irritation
  • skin diseases
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36
Q

Infective causes of folliculitis.

A

Bacterial - Staphylococcus aureus

Fungi - tinea capitis

Parasitic infection - scabies

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37
Q

How to prevent folliculitis from regrowing hairs.

A
  • electric razor
  • apply shaving gel if using a blade shaver
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38
Q

How to avoid folliculitis due to occlusion.

A

Choose oil free moisturisers, as less likely to cause occlusion.

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39
Q

What is cellulitis.

A

A bacterial skin infection resulting in a local area of red, painful and swollen skin.

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40
Q

Risk factors for cellulitis.

A
  • venous disease
  • injury
  • immunodeficiency
  • CKD
  • CLD
  • obesity
  • pregnancy
  • alcoholism
41
Q

Most common causes of cellulitis.

A
  1. Streptococcus pyogenes
  2. Staphylococcus aureus
42
Q

Presentation of cellulitis.

A

Unilateral skin changes:
- painful
- red
- swollen

Systemic symptoms (e.g. fever, rigor) also present.

43
Q

Complications of cellulitis.

A
  • necrotising fasciitis
  • gas gangrene
  • severe sepsis
  • endocarditis
44
Q

Investigations for cellulitis.

A

Bloods:
- FBC (raised WCC)
- CRP (raised)
- blood culture
- D-dimer

Imaging may be performed:
- doppler ultrasound (exclude DVT)

45
Q

Treatment of uncomplicated cellulitis.

A

Oral antibiotics at home, plus:
- analgesia
- adequate water/fluid intake

46
Q

Treatment of cellulitis with systemic illness.

A

Admit to hospital:
- fluids
- IV antibiotics (penicillin based)
- oxygen

Can switch to oral antibiotics once fever has settled, cellulitis has regressed and CRP is reducing.

47
Q

Associations of herpes simplex virus:

a) HSV-1

b) HSV-2

A

a) cold sores

b) genital herpes (STI)

48
Q

Presentation of genital herpes.

A
  • ulcers or blistering lesions
  • neuropathic pain
  • flu-like symptoms
  • dysuria
  • inguinal lymphadenopathy
49
Q

Diagnosis of genital herpes.

A

Clinical diagnosis based upon history and examination.

Viral PCR from a lesion to confirm the diagnosis.

50
Q

Management of genital herpes.

A

Referral to GYM specialist.

First line: aciclovir.

51
Q

Conservative measures in genital herpes.

A
  • paracetamol
  • topical lidocaine
  • cleaning with warm salt water
  • additional oral fluids
  • wear loose clothing
  • avoid intercourse with symptoms
52
Q

Aetiology of chickenpox.

A

Varicella-Zoster virus (VZV)

53
Q

Transmission of chickenpox.

A

Highly contagious - spread by:
- droplet transmission
- direct contact with fluid

54
Q

Clinical features of chickenpox.

A

Itchy red papules progressing to vesicles on the stomach, back and face.

Systemic features include fever, headache, coryzal symptoms.

55
Q

Diagnosis of chickenpox.

A

Clinical diagnosis - often history elicits exposure to infected contact within the last 3 weeks.

Laboratory tests include:
- skin swab for viral PCR
- serology in pregnant women

56
Q

Complications of chickenpox.

A
  • secondary bacterial infection
  • dehydration (N+V)
  • exacerbation of asthma
  • viral pneumonia
  • thrombocytopenia
  • shingles
  • scarring
57
Q

Treatment of chickenpox in children.

A

Symptomatic therapy:
- trim fingernails to minimise scratching
- warm bath and moisturising cream
- paracetamol for fever and pain
- calamine lotion

58
Q

Prevention of the spread of chickenpox.

A

Children should stay away from school until the blisters have formed scabs (up to 10 days).

Pregnant women should avoid visiting friends or family when there is a known case of chickenpox.

59
Q

Complications of chickenpox during pregnancy.

A

Maternal complications:
- pneumonia
- hepatitis
- encaphalitis
- death

Fetal complications:
- congenital abnormality
- severe infection after birth

60
Q

Management of chickenpox exposure in pregnancy:

a) immune to chickenpox

b) not immune to chickenpox

A

a) no management; return if chickenpox rash

b) Varicella-Zoster immunoglobulin (VZIG) within 10 days of contact

61
Q

Treatment of chickenpox in pregnancy.

A

Oral aciclovir.

NB: VZIG not useful after chickenpox rash appears.

62
Q

What is shingles?

A

After primary VZV infection (ie. chickenpox), the virus remains dormat in the dorsal root ganglia of a spinal nerve.

It can reactivate and migrate down sensory nerves, causing shingles.

63
Q

Triggers for shingles.

A
  • pressure on nerve roots
  • radiotherapy
  • spinal surgery
  • infection
  • injury
64
Q

Presentation of shingles.

A

Single dermatome:
- neuropathic pain
- red papules / pustules

65
Q

Complications of shingles.

A
  • eye complications
  • scarring
  • Ramsay Hunt syndrome
  • systemic infection
66
Q

What is post-herpetic neuralgia?

A

Persistence of recurrence of pain in the same dermatomal distribution of shingles.

It causes extreme sensitivity to the skin and itchiness.

67
Q

Treatment of shingles.

A

Conservative measures:
- rest and pain relief
- protective ointment to the rash

Medical management:
- antiviral treatment (e.g. aciclovir)

68
Q

When is immunisation against shingles recommended in the UK?

A

National shingles vaccination programme vaccinates those aged 70-79, due to high risk of complications.

69
Q

Management of post-herpetic neuralgia.

A
  • early use of antiviral medication
  • amitriptyline
  • local anaesthetic applications

NB: NSAIDs and opioids are generally unhelpful.

70
Q

Aetiology of cutaneous warts.

A

Human papilloma virus

71
Q

Risk factors for viral warts.

A
  • school-aged children
  • dermatitis (defective skin barrier)
  • immunosuppression
72
Q

Features of warts.

A

Hard, keratinous surface.

Small red or black dot in the wart (papillary capillaries)

73
Q

Complications of cutaneous viral warts.

A
  • psychosocial effect
  • nail dystrophy / destruction
  • squamous cell carcinoma
74
Q

Examining viral warts.

A

Usually a clinical diagnosis +/- dermoscopy.

May use excisional biopsy if considering SCC.

75
Q

When is active treatment recommended for viral warts?

A
  • immunosuppression
  • presence of complications
  • patient preference
76
Q

Active treatment of warts.

A
  • topic treatment (e.g. salicylic acid)
  • cryotherapy
  • electrosurgery
77
Q

What causes molluscum contagiosum?

A

Poxvirus - there are at least 4 viral subtypes.

78
Q

Transmission of molluscum contagiosum.

A
  • direct skin-to-skin contact
  • direct contact (e.g. shared towels)
  • auto-inoculation by scratching or shaving
  • sexual transmission
79
Q

Presentation of molluscum contagiosum.

A

Skin infection of childhood:
- clusters of papules
- arise in warm, moist places (e.g. armpit, groin)

80
Q

Complications of molluscum contagiosum.

A
  • secondary bacterial infection
  • conjunctivitis
  • disseminated secondary eczema
  • scarring
81
Q

How is molluscum contagiousum diagnosed?

A

Recognised by characteristic clinical appearance or on dermatoscopy.

82
Q

What is the treatment of molluscum contagiosum?

A

Unable to kill the virus:
- topical antiseptics
- wart paints (e.g. salicylic acid)

Physical treatments (e.g. cryotherapy, laser ablation) can cause scarring and are avoided where possible.

83
Q

Prevention of molluscum contagiosum.

A
  • keep hands clean
  • avoid scratching / shaving
  • cover visible lesions with clothing
  • do not share towels or clothing
  • practice safe sex / abstain
84
Q

Prognosis of molluscum contagiosum.

A

Usually harmless - but can take up to 2 years to clear.

85
Q

Risk factors for scabies.

A
  • crowded conditions
  • poor hygiene
  • poverty
  • malnutrition
  • homelessness
  • immunodeficiency
86
Q

Transmission of scabies.

A

Scabies infection is usually transmitted through close bodily skin-to-skin contact.

Spread via fomites (e.g. towels, clothing) is uncommon as the mite perishes within hours of leaving the host.

87
Q

Scabies cycle.

A

1) Male mite fertilises the female on the surface of skin, then dies.

2) Female mite burrows into the stratum corneum, laying eggs.

3) Eggs hatch into larvae after approximately 5 days.

4) Hatched larvae mature into adult mites, and migrate to the skin surface.

88
Q

Signs of scabies.

A
  • generalised itch
  • erythematous rash
  • crusting
  • burrows (web spaces, palms, soles)
  • nodules
89
Q

What is crusted scabies?

A

An altered host immune response results in uncontrolled proliferation of mites (thousands of mites, compared to 10-15 in classical scabies).

90
Q

How is scabies diagnosed?

A

Clinical diagnosis with dermoscopy confirmation.

91
Q

Medical management of scabies.

A

Topical 5% permethrin cream or lotion at night-time.

Repeat after 7-10 days.

92
Q

Practical advice to patients regarding scabies.

A

Close contacts should complete eradication therapy, regardless of symptoms.

Air sheets, towels, clothes, duvets, blankets for 72 hours.

93
Q

A patient applies topical 5% permethrin as eradication therapy for scabies. Their itching continues for several weeks.

Has the therapy worked?

A

Yes - post-scabetic itch is common and may persist for weeks. This does not represent persistent infection or treatment failure.

Antihistamines, emollients and soap avoidance should be advised.

94
Q

Risk factors for headlice infestation.

A
  • female sex
  • children in family
  • sharing beds
  • sharing hair brushes
95
Q

Features of head lice.

A

Scalp:
- visibly see nits
- itch
- irritation
- red-brown spots (excreted digested blood)
- crusting
- scaling

96
Q

Complications of headlice.

A
  • dermatitis
  • impetigo
  • lymphadenopathy
97
Q

How are head lice diagnosed?

A

Identify the nits to make a diagnosis.

Can use dermoscopy of the scalp and hair.

98
Q

Management of head lice.

A
  • wet combing
  • physical insecticide (topical dimeticone)
99
Q

General advise on head lice.

A
  • can attend school
  • no need to treat clothing or bedding
  • cannot prevent
  • BAD leaflet on head lice

Year 4 - Special Senses (17 decks)

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