Folliculitis, Furnculosis, Carbunculosis, Hidradenitis Suppurativa, Insect Bites, Warts Flashcards
1
Q
Folliculitis: What is it?
A
- an inflammatory process involving any part of the hair follicle
- most commonly secondary to infection, usually staph aureus
2
Q
Folliculitis: Risk Factors
A
- DM
- immunosuppression
- poor hygiene
- shaving
- tight jeans
- occlusive steroid therapy
- exposure to contaminated water in hot tubs or swimming pools
3
Q
Folliculitis: Assessment Findings
A
- itching and burning in hairy areas
- superficial pustule with mild erythema
- less than 5 mm in size surrounding a hair follicle
4
Q
Folliculitis: Diagnostic Tests
A
- gram stain and culture
** Important to differentiate bacterial from non-bacterial folliculitis
5
Q
Folliculitis: Possible Complications
A
Abscess formation
6
Q
Folliculitis: Prevention
A
- good hygiene
- avoiding heat/friction
- frequent handwashing
- changing towels and sheets daily
- treating hot tubs and pools properly
- controlling blood glucose in diabetics
7
Q
Folliculitis: Non-Pharmacologic Treatment
A
- intermittent application of warm, moist compresses
- allow spontaneous drainage
- frequent hand washing
- hydrate skin and apply moisturizing shaving gel before shaving
8
Q
Folliculitis: Treatment for generalized folliculitis
A
Anhydrous ethyl alcohol containing 6.25% aluminum chloride applied 3-7 times per week to lesions
9
Q
Folliculitis: Pseudomonas Folliculitis Treatment
A
Will usually clear spontaneously if not immunosuppressed if lesions are superficial, but also may be treated with ciprofloxacin 500 mg PO BID for 5 days
10
Q
Folliculitis: Bacterial Folliculitis Treatment
A
MRSA - vancomycin
MSSA - cefazolin
** Both for 4-8 weeks if scalp, axilla, beard, or groin
11
Q
Folliculitis: Gram negative Folliculitis Treatment in acne
A
Isotretinoin
12
Q
Folliculitis: Eosinophilic Folliculitis Treatment
A
Combination of potent topical corticosteroids and oral antihistamines
13
Q
Folliculitis: Malassezia Folliculitis Treatment
A
Topical sulfacetamide lotion BID alone or in combination with itraconazole or fluconazole
14
Q
Folliculitis: Demodex Folliculitis Treatment
A
Topical 5% permethrin every other night until clear; ivermectin 200 mcg/kg once weekly; oral metronidazole 500 mg once daily or a combination of the two
15
Q
Furuncle: What is it?
A
- a deep seated infection involving the entire hair follicle and adjacent subcutaneous tissue
- caused by staph
- very contagious
- most common sites: hairy parts exposed to irritation and friction, pressure, or moisture
16
Q
Furuncle: Risk Factors
A
- DM
- Injection drug use
- HIV/immunosuppression
- Athletic teams
- Prisons
- Military
- Hospitalization
- Homelessness
17
Q
Furuncle: Assessment Findings
A
- pain and tenderness
- round or conical abscess
- gradually enlarges, softens, and opens in a few days to 1-2 weeks and discharges necrotic tissue and pus
18
Q
Furuncle: Diagnostic Tests
A
- slight leukocytosis
- C&S of wound drainage
19
Q
Furuncle: Prevention
A
- good hygiene
- avoiding heat/friction
- frequent handwashing
- changing towels and sheets daily
- treating hot tubs and pools properly
- controlling blood glucose in diabetics
- clean meticulously with bleach
20
Q
Furuncle: Non-Pharmacologic Management
A
- intermittent application of warm, moist compresses for pain and to promote spontaneous drainage
- good hygiene
- I&D
21
Q
Furuncle: Pharmacological Management
A
- Begin oral TMP-SMZ 160/800 or 320/1600 PO BID x 10 days or 7 days, respectively at the time of drainage or clindamycin 300 mg PO TID x 10 days
- For suspected MRSA, doxycycline 100 mg PO BID, TMP-SMZ double-strength PO BID, clindamycin 150-300 mg PO BID or linezolid 400 mg PO BID for 7-10 days
22
Q
Carbuncle: What is it?
A
Can simply be defined as multiple furuncles grouped together
23
Q
Carbuncle: Risk Factors
A
- males
- chronic disease states
- older adults
- alcoholics
24
Q
Carbuncle: Assessment Findings
A
A cluster of furuncles that develop slowly, often accompanied by fever, sloughing, drainage, and pain
25
Hidradenitis Suppurativa: What is it?
- AKA acne inversa
- an inflammation of the apocrine (sweat) glands that produces tender, cyst-like abscesses
- insidious onset
- tends to recur
- common sites are the axilla, groin, trunk, scalp, and perianal, perineal, and genital areas
- exacerbations may occur during menses
26
Hidradenitis Suppurativa: Risk Factors
- obesity
- DM
- female gender
- cigarette smoker
- family history
- black race
- hyperandrogenism
27
Hidradenitis Suppurativa: Assessment Findings
- cyst like abscessess
- painful
- tunneling
- erythematous
- odorous
- lots of discharge
28
Hidradenitis Suppurativa: Diagnostic Studies
- clinical exam
- C&S (will need to be a deep culture to isolate the organism)
** Only need a C&S if unsure of diagnosis or not responding to usual treatment
29
Hidradenitis Suppurativa: Prevention
- avoid constrictive clothing
- weight loss if obese
- good hygiene
- smoking cessation
30
Hidradenitis Suppurativa: Pharmacologic Management of disease with inflammatory lesions without skin tunneling or scarring
1. Doxycycline with or without an oral antiandrogenic agent (Spironolactone, OCPs), or metformin
THEN...
- reassess after 3 months
- if satisfactory response, stop doxycycline and continue antiandrogenic agent or metformin and follow for recurrence
- if some improvement but not enough, continue regimen and reassess after another 2-3 months
- if unsatisfactory response, stop doxycycline, and start one of the following: antiandrogenic agent or metformin (if not already taking), oral clindamycin and rifampin, acetretin (if no childbearing potential), or oral dapsone
31
Hidradenitis Suppurativa: Pharmacologic Management of disease with inflammatory lesions with skin tunneling or scarring
1. Doxycycline or clindamycin with or without oral antiandrogenic or metformin
THEN...
- reassess after 3 months
- If satisfactory response, stop the antibiotic and continue the antiandrogenic agent or metformin (if taking) and reassess in 2-3 months.
- if some improvement but not enough, continue regimen and reassess after another 2-3 months
- If unsatisfactory response to initial therapies, stop antibiotic, start biologic (preferably adalimumab), assess need for surgical unroofing of skin tunnels and recurrent nodules, and assess response to biologic therapy in 12-16 weeks.
- If response is satisfactory at this point, continue current therapy and add an antiandrogenic agent or metformin if not already taking. If the response is not satisfactory, switch biologic agents.
32
Spider/Insect Bites and Stings: Local Reaction Treatment
- wash with soap and water
- apply ice or cold pack
- calamine lotion
- non sedating oral antihistamines (Zyrtec, Allegra, Claritin)
33
Spider/Insect Bites and Stings: Papular Urticaria
* Recurrent, sometimes chronic, pruritic papules
- limited use of non sedating antihistamines
- mid potency corticosteroids applied topically to individual lesions
34
Spider/Insect Bites and Stings: Systemic Allergic Reactions
* Prominent flushing and hypotension
- Epi pen
- Referral to allergist
35
Black Widow Bites
- most bites are on extremities, specifically the lower extremities
- vital signs are normal in 70% of patients
- intermittent muscle rigidity or tenderness, especially of the abdomen, chest, or back in 60% of cases
- the typical bite consists of a blanched circular patch with a surrounding red perimeter and central punctum
36
Black Widow Bite: Treatment (Mild)
- gently clean with soap and water
- oral ibuprofen/acetaminophen
- tetanus if needed
37
Black Widow Bite: Treatment (Moderate to Severe)
- local wound care
- tetanus prophylaxis if needed
- IV morphine (for pain)
- IV lorazepam (reduce muscle spasms)
- IV zofran for N/V
38
Brown Recluse Bite
- initially painless, but may become severely painful over next few days
- bites are usually red plaques or papules that develop central pallor, with some bites becoming nectrotic over the next 24-48 hours
- usually occurs indoors from clothing or shoes that have been in a closet and not worn in a while
39
Brown Recluse Spider Bite: Treatment
1. Local effects
- clean with soap and water
- apply cold packs
- pain meds (NSAIDs or opioids)
- tetanus prophylaxis if needed
2. Systemic toxicity
- labs to assess for hemolytic anemia, rhabdomyolysis, or kidney injury
- if any of these are indicated or DIC, admit to hospital
40
Warts
- painless, benign skin growths that infect the top layer of skin and can be transmitted by touch, usually viral
- HPV
- more common in children and young adults
41
Warts: Risk Factors
- skin trauma
- contact with wart exudate
- working with poultry, fish, and meat
- immunocompromise
42
Common Wart
verruca vulgaris
43
Plantar Wart
verruca plantaris
44
Warts: Assessment Findings
- elevated, flesh colored papules with a rough surface
- more common on hands and feet
45
Warts: Diagnostic Studies
clinical exam
46
Warts: Prevention
- wear shoes in public showers
- do not use nail files, pumice stones, etc. that have been used on other people
47
Warts: First Line Therapy
Topical salicylic acid and cryotherapy
** Topical salicylic acid should be applied daily to the wart for up to 12 weeks. Soak and remove the debris every few days. Make sure site is dry before applying.
** Cryotherapy can be used alone or in combination with topical salicylic acid. ** Cryotherapy is done by a clinician repeated every 2-3 weeks until resolved. Two freeze-thaw cycles should be done with each application. If not resolved after 6 treatments, use alternative therapy.
48
Warts: Refractory Wart Treatment
- Topical immunotherapy with contact allergens
- intralesional bleomycin
- fluorouracil
** Initiated by specialist
49
Warts: Alternative Treatments
- imiquimod
- trichloroacetic acid
- duct tape
- pulsed dye laser
- intralesional immunotherapy
- surgery
- oral cimetidine
** Initiated by specialist
