Folliculitis, Furnculosis, Carbunculosis, Hidradenitis Suppurativa, Insect Bites, Warts Flashcards
Folliculitis: What is it?
- an inflammatory process involving any part of the hair follicle
- most commonly secondary to infection, usually staph aureus
Folliculitis: Risk Factors
- DM
- immunosuppression
- poor hygiene
- shaving
- tight jeans
- occlusive steroid therapy
- exposure to contaminated water in hot tubs or swimming pools
Folliculitis: Assessment Findings
- itching and burning in hairy areas
- superficial pustule with mild erythema
- less than 5 mm in size surrounding a hair follicle
Folliculitis: Diagnostic Tests
- gram stain and culture
** Important to differentiate bacterial from non-bacterial folliculitis
Folliculitis: Possible Complications
Abscess formation
Folliculitis: Prevention
- good hygiene
- avoiding heat/friction
- frequent handwashing
- changing towels and sheets daily
- treating hot tubs and pools properly
- controlling blood glucose in diabetics
Folliculitis: Non-Pharmacologic Treatment
- intermittent application of warm, moist compresses
- allow spontaneous drainage
- frequent hand washing
- hydrate skin and apply moisturizing shaving gel before shaving
Folliculitis: Treatment for generalized folliculitis
Anhydrous ethyl alcohol containing 6.25% aluminum chloride applied 3-7 times per week to lesions
Folliculitis: Pseudomonas Folliculitis Treatment
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
Folliculitis: Bacterial Folliculitis Treatment
MRSA - vancomycin
MSSA - cefazolin
** Both for 4-8 weeks if scalp, axilla, beard, or groin
Folliculitis: Gram negative Folliculitis Treatment in acne
Isotretinoin
Folliculitis: Eosinophilic Folliculitis Treatment
Combination of potent topical corticosteroids and oral antihistamines
Folliculitis: Malassezia Folliculitis Treatment
Topical sulfacetamide lotion BID alone or in combination with itraconazole or fluconazole
Folliculitis: Demodex Folliculitis Treatment
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
Furuncle: What is it?
- 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
Furuncle: Risk Factors
- DM
- Injection drug use
- HIV/immunosuppression
- Athletic teams
- Prisons
- Military
- Hospitalization
- Homelessness
Furuncle: Assessment Findings
- 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
Furuncle: Diagnostic Tests
- slight leukocytosis
- C&S of wound drainage
Furuncle: Prevention
- 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
Furuncle: Non-Pharmacologic Management
- intermittent application of warm, moist compresses for pain and to promote spontaneous drainage
- good hygiene
- I&D
Furuncle: Pharmacological Management
- 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
Carbuncle: What is it?
Can simply be defined as multiple furuncles grouped together
Carbuncle: Risk Factors
- males
- chronic disease states
- older adults
- alcoholics
Carbuncle: Assessment Findings
A cluster of furuncles that develop slowly, often accompanied by fever, sloughing, drainage, and pain
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
Hidradenitis Suppurativa: Risk Factors
- obesity
- DM
- female gender
- cigarette smoker
- family history
- black race
- hyperandrogenism
Hidradenitis Suppurativa: Assessment Findings
- cyst like abscessess
- painful
- tunneling
- erythematous
- odorous
- lots of discharge
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
Hidradenitis Suppurativa: Prevention
- avoid constrictive clothing
- weight loss if obese
- good hygiene
- smoking cessation
Hidradenitis Suppurativa: Pharmacologic Management of disease with inflammatory lesions without skin tunneling or scarring
- 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
Hidradenitis Suppurativa: Pharmacologic Management of disease with inflammatory lesions with skin tunneling or scarring
- 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.
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)
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
Spider/Insect Bites and Stings: Systemic Allergic Reactions
- Prominent flushing and hypotension
- Epi pen
- Referral to allergist
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
Black Widow Bite: Treatment (Mild)
- gently clean with soap and water
- oral ibuprofen/acetaminophen
- tetanus if needed
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
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
Brown Recluse Spider Bite: Treatment
- Local effects
- clean with soap and water
- apply cold packs
- pain meds (NSAIDs or opioids)
- tetanus prophylaxis if needed
- Systemic toxicity
- labs to assess for hemolytic anemia, rhabdomyolysis, or kidney injury
- if any of these are indicated or DIC, admit to hospital
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
Warts: Risk Factors
- skin trauma
- contact with wart exudate
- working with poultry, fish, and meat
- immunocompromise
Common Wart
verruca vulgaris
Plantar Wart
verruca plantaris
Warts: Assessment Findings
- elevated, flesh colored papules with a rough surface
- more common on hands and feet
Warts: Diagnostic Studies
clinical exam
Warts: Prevention
- wear shoes in public showers
- do not use nail files, pumice stones, etc. that have been used on other people
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.
Warts: Refractory Wart Treatment
- Topical immunotherapy with contact allergens
- intralesional bleomycin
- fluorouracil
** Initiated by specialist
Warts: Alternative Treatments
- imiquimod
- trichloroacetic acid
- duct tape
- pulsed dye laser
- intralesional immunotherapy
- surgery
- oral cimetidine
** Initiated by specialist
