Herpes Zoster, Scabies, Paronychia, Pediculosis, Tinea Flashcards
1
Q
Herpes Zoster: What is it?
A
- AKA shingles
- a viral infection resulting from reactivation of varicella zoster or an acute infection with the virus
2
Q
Herpes Zoster: Risk Factors
A
- older adults
- immunocompromised
- stress
3
Q
Herpes Zoster: Assessment Findings
A
- tingling and pain initially, followed by vescles in a dermatomal distribution, evolving to pustules and then crusting
- the lesions are usually noted unilaterally around the side and back along the dermatome
- they can also be along the trigeminal nerve around the eye and face
- herpes zoster ophthalmicus may cause blindness if not treated promptly
4
Q
Herpes Zoster: Diagnostic Studies
A
- usually clinical diagnosis
- consider HIV testing
- consider screening for diabetes
5
Q
Herpes Zoster: Prevention
A
- Shingrix vaccine x 2 doses at least 2 months apart if 50 or older
- avoid people with known shingles until lesions have crusted over
- avoid the older live vaccine if immunocompromised
6
Q
Herpes Zoster: Pharmacologic Management
A
- Antivirals
- Analgesic/Antipyretics (tylenol)
- Antihistamines/Antipruritics (antihistamines, calamine lotion, and colloidal oatmeal baths)
** Corticosteroids may also be helpful for immunocompromised patients (start with 60 mg/day and taper over 2-3 weeks)
** It usually takes 2-6 weeks to completely get over shingles
7
Q
Herpes Zoster: Antivirals
A
- Valacyclovir 1 g PO TID x 7 days, for uncomplicated disease
- Famciclovir 500 mg PO TID x 7 days, should be started within the first 72 hours of the onset of the lesions
8
Q
Herpes Zoster: Complications
A
- postherpetic neuralgia is a complication of shingles and occurs in approximately 60-70% of patients who are older than 60.
- Risk factors for this include advanced age, female sex, the presence of a prodrome, and severity of a rash or pain
- Antivirals and corticosteroids do not prevent postherpetic neuralgia
9
Q
Herpes Zoster: Postherpetic Neuralgia
A
- a possible complication of shingles
- very difficult to treat
- neuropathic pain that occurs due to damage to a peripheral nerve
10
Q
Herpes Zoster: Postherpetic Neuralgia Treatment
A
- gabapentin
- lidocaine patches
- tricyclic antidepressants (amitriptyline)
- capsaicin cream
11
Q
Paronychia: What is it?
A
- an acute infection of the nail folds and periungual tissues
12
Q
Paronychia: Cause
A
- usually staph aureus
13
Q
Paronychia: Risk Factors
A
- women
- DM
- trauma to nailbed, finger, or toe
- ingrown nails
- frequently wet hands and feet
- compromised immune system
14
Q
Paronychia: Assessment Findings
A
- pain around the skin of the nail plate
- erythema, tenderness
- may have pus coming from site
15
Q
Paronychia: Diagnostic Studies
A
- usually none
- can do a gram stain or C&S
16
Q
Paronychia: Prevention
A
- avoid prolonged contact with water or moisture
- wear gloves if needed
- make sure tetanus is up to date
17
Q
Paronychia: Non-Pharmacologic Treatment
A
- warm compresses and soaks TID
- I&D
- removal of ingrown nail
18
Q
Paronychia: Pharmacologic Treatment
A
- Mupirocin ointment BID/QID
OR - Triple antibiotic ointment daily/TID
OR - Gentamicin ointment TID/QID
** If topical antibiotics do not work, may need oral antibiotics
19
Q
Pediculosis: What is it?
A
- a parasitic infestation of the body, head, or pubic area by lice
- lice eggs can survive up to 3 weeks after removal from a human host
- incubation for lice is about 1 month
20
Q
Pediculus capitis
A
Head lice
21
Q
Pediculus corporis
A
Body lice
22
Q
Pediculus pubis
A
Pubic lice
23
Q
Pediculosis: Risk Factors
A
- more common in women and girls
- poor hygiene
- crowded conditions
- sexual transmission
- sharing of hats and combs
** Unusual in African Americans
24
Q
Pediculosis: Assessment Findings
A
- pruritis
- excoriations
25
Q
Pediculosis: Pediculus capitis Treatment
A
- permethrin 1% cream rinse
- Topical ivermectin is another option
** Oral meds may also be needed in combination with topical meds and they include oral ivermectin 200 mcg/kg for children older than 5 years and more than 15 kg x 7days and oral TMP-SMZ 10 mg TMP/kg/day and 50 mg SMZ/kg/day bid for 10 days
26
Q
Pediculosis: Pediculus corporis Treatment
A
- dispose of infested clothing
- address social situation
27
Q
Pediculosis: Pediculus pubis Treatment
A
- Permethrin 1% rinse for 10 minutes
OR - Permethrin cream 5% for 8 hours
28
Q
Scabies: What is it?
A
- an intensely pruritic skin infestation caused by sarcoptes scabiei
- usually infects those in close living quarters or those who are immunocompromised
29
Q
Scabies: Assessment Findings
A
- itching that is more intense at night
- small, itching blisters that appear in linear form, especially in the interdigital spaces of the hands and feet, wrists, umbilicus, around the axillae
- erythema
- vesicles and papules
30
Q
Scabies: Diagnostic Studies
A
- Burrow ink test
- Adhesive tape (microscopic examination)
31
Q
Scabies: Prevention
A
- treat all intimate contacts
- maintain good hygiene
- wash hands and launder clothes (high heat) or bag bedding and clothing in a plastic bag and set aside for 14 days
32
Q
Scabies: Treatment
A
- Permethrin 5% cream (apply from neck down and leave on for 8-12 hours, rinse; repeat in 1 week)
- Ivermectin
- 200 mcg/kg PO x 1 dose, can give another dose 2 weeks after first dose
- for immunosuppressed patients, ivermectin every 2 weeks for 2-3 doses PLUS topical permethrin every 3 days to once weekly
** Avoid treating pregnant contacts unless diagnosed themselves
** Patients can continue to itch for several weeks following treatment, triamcinolone 0.1% cream can be used
33
Q
Tinea Infections
A
- Tinea versicolor - depigments the area
- Tinea capitis - head
- Tinea corporis - body
- Tinea pedis - feet
- Tinea cruris - genital area
- Onychomycosis - nails
34
Q
Tinea Versicolor
A
- a mild superficial Malssezia fungal infection of the skin that can occur at any age
- usually asymptomatic
- has a high recurrence rate
35
Q
Tinea Versicolor: Diagnostics
A
- KOH prep to rule out other diseases such as vitiligo (causes total, not partial depigmentation) or seborrheic dermatitis
36
Q
Tinea Versicolor: Assessment Findings
A
- presents as velvety, tan, pink, or white macules or thin papules, usually on the upper trunk
37
Q
Tinea Versicolor: Treatment
A
- Topical selenium sulfide lotion
OR - Ketoconazole shampoo
OR - Two doses of fluconazole 300 mg 14 days apart
** Maintenance therapy with selenium sulfide lotion or ketoconazole shampoo is needed to prevent recurrence
38
Q
Tinea Capitis: Risk Factors
A
- daycare attendance
- poor hygiene
- DM
- sharing combs, brushes, hats
39
Q
Tinea Capitis: Diagnostic Studies
A
KOH scraping
40
Q
Tinea Capitis: Management
A
- topical meds are not usually effective
- Oral griseofulvin is BEST 375 mg PO QD or divided doses TID
** Take with high fat meals
** Avoid exposure to sunlight
** Could potentially cause a reaction in those allergic to PCN
** IN pediatric patients older than 2 years, give 10-15 mg/kg/day for 6-8 weeks or until fungal culture is clear
41
Q
Tinea Corporis: What is it?
A
- ringworm of the body
- erythematous rings that have an advancing scaly border and central clearing
- pruritis is common
42
Q
Tinea Corporis: Diagnostic Tests
A
KOH preparation or culture
43
Q
Tinea Corporis: Management
A
- Topical terbinafine or butenafine
- Oral itraconazole 200 mg PO QD x 1 week
** Treatment should be continued for 1-2 weeks after clinical clearing
** Treatment usually takes about 4 weeks
44
Q
Tinea Cruris: What is it and what does it look like?
A
- AKA jock itch
- usually confined to the groin and gluteal cleft
- sharp margins
- clear centers
- spreading scaly peripheries
45
Q
Tinea Cruris: Diagnostic Tests
A
- KOH prep
- skin biopsy or culture
46
Q
Tinea Cruris: General Management
A
- Miconazole nitrate (is a drying powder that can be used in the skin folds, but is better used as a preventative measure)
47
Q
Tinea Cruris: Local Management
A
- Terbinafine cream once daily for 7 days
48
Q
Tinea Cruris: Systemic Management
A
- Itraconazole 200 mg daily OR terbinafine 250 mg PO daily for 1 week
49
Q
Tinea Pedis: What is it and what does it look like?
A
- AKA athlete’s foot
- typically caused by the Trichophyton species
- causes itching, stinging, burning of feet
- maceration in toe webs
- scaling or blistering on soles of feet
** pain may indicate a secondary infection with cellulitis
50
Q
Tinea Pedis: Diagnostic Tests
A
KOH and culture are not always positive for fungi
51
Q
Tinea Pedis: Prevention
A
- wear open toed sandals
- personal hygiene
- use sandals in public showers
- dry between toes after showering
- change socks frequently
- apply dusting or drying powder as necessary
52
Q
Tinea Pedis: Management - Local Macerated Stage
A
- Aluminum subacetate solution soaks for 20 minutes BID
- Broad-spectrum antifungal cream (clotrimazole, miconazole, ketoconazole)
** If these fail, try 1 week of once daily topical terbinafine or butenafine
53
Q
Tinea Pedis: Management - Local Dry and Scaly Stage
A
- Broad-spectrum antifungal cream (clotrimazole, miconazole, ketoconazole)
- Urea 10-20% lotion or cream may increase the efficacy of topical treatments in the thick tinea of the soles
54
Q
Tinea Pedis: Management - Systemic
A
- Itraconazole 200 mg PO daily for 2 weeks or 400 mg PO QD for 1 week
OR - Terbinafine 250 mg PO daily for 2-4 weeks
55
Q
Tinea Unguium: What is it and what does it look like?
A
- AKA onychomycosis
- fungal infection of the nail
- nails are lusterless, brittle, hypertrophic, friable
- crumbly, thickened nails
- 80% of cases occur on toes, with first digit most commonly involved
56
Q
Tinea Unguium: Diagnostic Tests
A
KOH scraping
57
Q
Tinea Unguium: Prevention
A
- good hygiene
- dry between toes after showering
- wear open toed shoes if possible
58
Q
Tinea Unguium: Management
A
- Trim dead skin
- Topical antifungals
- Oral antifungals
59
Q
Tinea Unguium: Topical Antifungals
A
- Ciclopirox as cream, gel, or suspension - apply to adjacent skin and affected nails once daily and remove with alcohol every 7 days for 48 weeks (for adults and kids 12 and older)
- Efinaconazole, apply to affected toenail once daily for 48 weeks (adults only)
- Tavaborole, apply to affected toenail once daily for 48 weeks (adults and kids 6 and older)
60
Q
Tinea Unguium: Oral Antifungals
A
- Terbinafine
- Griseofulvin
- Itraconazole
61
Q
KOH Preparation
A
- microscopic examintion for fungus
1. Scrape the border of the lesion with a sterile scalpel blade moistened with tap water or pluck 2-3 hairs using a hemostat.
2. Transfer specimen to slide with 1 drop of water
3. Add 1 – 2 drops KOH, put on a coverslip, and warm slide for 15-30 seconds
4. Examine under low power with minimum illumination
5. Identify hyphae - thin, often branching strands.
6. Switch to high dry objective to confirm the finding
7. A positive test confirms diagnosis; however, a negative test does not rule out the disease
62
Q
Woods Lamp
A
- Transmits UV light
- Perform in a darkened room
- Useful in certain superficial fungal infections of the scalp.
- Most tinea do not fluoresce
- Macules of tinea versicolor have a golden fluorescence under the Wood lamp.
