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Adult Health > Folliculitis, Furnculosis, Carbunculosis, Hidradenitis Suppurativa, Insect Bites, Warts > Flashcards

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
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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
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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
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4
Q

Folliculitis: Diagnostic Tests

A
  • gram stain and culture
    ** Important to differentiate bacterial from non-bacterial folliculitis
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5
Q

Folliculitis: Possible Complications

A

Abscess formation

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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
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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
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8
Q

Folliculitis: Treatment for generalized folliculitis

A

Anhydrous ethyl alcohol containing 6.25% aluminum chloride applied 3-7 times per week to lesions

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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

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10
Q

Folliculitis: Bacterial Folliculitis Treatment

A

MRSA - vancomycin
MSSA - cefazolin
** Both for 4-8 weeks if scalp, axilla, beard, or groin

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11
Q

Folliculitis: Gram negative Folliculitis Treatment in acne

A

Isotretinoin

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12
Q

Folliculitis: Eosinophilic Folliculitis Treatment

A

Combination of potent topical corticosteroids and oral antihistamines

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13
Q

Folliculitis: Malassezia Folliculitis Treatment

A

Topical sulfacetamide lotion BID alone or in combination with itraconazole or fluconazole

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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

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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
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16
Q

Furuncle: Risk Factors

A
  • DM
  • Injection drug use
  • HIV/immunosuppression
  • Athletic teams
  • Prisons
  • Military
  • Hospitalization
  • Homelessness
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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
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18
Q

Furuncle: Diagnostic Tests

A
  • slight leukocytosis
  • C&S of wound drainage
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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
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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
Q

Hidradenitis Suppurativa: What is it?

A
  • 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
Q

Hidradenitis Suppurativa: Risk Factors

A
  • obesity
  • DM
  • female gender
  • cigarette smoker
  • family history
  • black race
  • hyperandrogenism
27
Q

Hidradenitis Suppurativa: Assessment Findings

A
  • cyst like abscessess
  • painful
  • tunneling
  • erythematous
  • odorous
  • lots of discharge
28
Q

Hidradenitis Suppurativa: Diagnostic Studies

A
  • 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
Q

Hidradenitis Suppurativa: Prevention

A
  • avoid constrictive clothing
  • weight loss if obese
  • good hygiene
  • smoking cessation
30
Q

Hidradenitis Suppurativa: Pharmacologic Management of disease with inflammatory lesions without skin tunneling or scarring

A
  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
Q

Hidradenitis Suppurativa: Pharmacologic Management of disease with inflammatory lesions with skin tunneling or scarring

A
  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
Q

Spider/Insect Bites and Stings: Local Reaction Treatment

A
  • wash with soap and water
  • apply ice or cold pack
  • calamine lotion
  • non sedating oral antihistamines (Zyrtec, Allegra, Claritin)
33
Q

Spider/Insect Bites and Stings: Papular Urticaria

A
  • Recurrent, sometimes chronic, pruritic papules
  • limited use of non sedating antihistamines
  • mid potency corticosteroids applied topically to individual lesions
34
Q

Spider/Insect Bites and Stings: Systemic Allergic Reactions

A
  • Prominent flushing and hypotension
  • Epi pen
  • Referral to allergist
35
Q

Black Widow Bites

A
  • 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
Q

Black Widow Bite: Treatment (Mild)

A
  • gently clean with soap and water
  • oral ibuprofen/acetaminophen
  • tetanus if needed
37
Q

Black Widow Bite: Treatment (Moderate to Severe)

A
  • local wound care
  • tetanus prophylaxis if needed
  • IV morphine (for pain)
  • IV lorazepam (reduce muscle spasms)
  • IV zofran for N/V
38
Q

Brown Recluse Bite

A
  • 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
Q

Brown Recluse Spider Bite: Treatment

A
  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
Q

Warts

A
  • 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
Q

Warts: Risk Factors

A
  • skin trauma
  • contact with wart exudate
  • working with poultry, fish, and meat
  • immunocompromise
42
Q

Common Wart

A

verruca vulgaris

43
Q

Plantar Wart

A

verruca plantaris

44
Q

Warts: Assessment Findings

A
  • elevated, flesh colored papules with a rough surface
  • more common on hands and feet
45
Q

Warts: Diagnostic Studies

A

clinical exam

46
Q

Warts: Prevention

A
  • wear shoes in public showers
  • do not use nail files, pumice stones, etc. that have been used on other people
47
Q

Warts: First Line Therapy

A

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
Q

Warts: Refractory Wart Treatment

A
  • Topical immunotherapy with contact allergens
  • intralesional bleomycin
  • fluorouracil
    ** Initiated by specialist
49
Q

Warts: Alternative Treatments

A
  • imiquimod
  • trichloroacetic acid
  • duct tape
  • pulsed dye laser
  • intralesional immunotherapy
  • surgery
  • oral cimetidine
    ** Initiated by specialist

Adult Health (11 decks)

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