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Adult Health > Herpes Zoster, Scabies, Paronychia, Pediculosis, Tinea > Flashcards

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
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2
Q

Herpes Zoster: Risk Factors

A
  • older adults
  • immunocompromised
  • stress
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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
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4
Q

Herpes Zoster: Diagnostic Studies

A
  • usually clinical diagnosis
  • consider HIV testing
  • consider screening for diabetes
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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
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6
Q

Herpes Zoster: Pharmacologic Management

A
  1. Antivirals
  2. Analgesic/Antipyretics (tylenol)
  3. 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
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7
Q

Herpes Zoster: Antivirals

A
  1. Valacyclovir 1 g PO TID x 7 days, for uncomplicated disease
  2. Famciclovir 500 mg PO TID x 7 days, should be started within the first 72 hours of the onset of the lesions
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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
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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
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10
Q

Herpes Zoster: Postherpetic Neuralgia Treatment

A
  • gabapentin
  • lidocaine patches
  • tricyclic antidepressants (amitriptyline)
  • capsaicin cream
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11
Q

Paronychia: What is it?

A
  • an acute infection of the nail folds and periungual tissues
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12
Q

Paronychia: Cause

A
  • usually staph aureus
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13
Q

Paronychia: Risk Factors

A
  • women
  • DM
  • trauma to nailbed, finger, or toe
  • ingrown nails
  • frequently wet hands and feet
  • compromised immune system
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14
Q

Paronychia: Assessment Findings

A
  • pain around the skin of the nail plate
  • erythema, tenderness
  • may have pus coming from site
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15
Q

Paronychia: Diagnostic Studies

A
  • usually none
  • can do a gram stain or C&S
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16
Q

Paronychia: Prevention

A
  • avoid prolonged contact with water or moisture
  • wear gloves if needed
  • make sure tetanus is up to date
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17
Q

Paronychia: Non-Pharmacologic Treatment

A
  • warm compresses and soaks TID
  • I&D
  • removal of ingrown nail
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18
Q

Paronychia: Pharmacologic Treatment

A
  1. Mupirocin ointment BID/QID
    OR
  2. Triple antibiotic ointment daily/TID
    OR
  3. Gentamicin ointment TID/QID
    ** If topical antibiotics do not work, may need oral antibiotics
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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
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20
Q

Pediculus capitis

A

Head lice

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21
Q

Pediculus corporis

A

Body lice

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22
Q

Pediculus pubis

A

Pubic lice

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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
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24
Q

Pediculosis: Assessment Findings

A
  • pruritis
  • excoriations
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25
Q

Pediculosis: Pediculus capitis Treatment

A
  1. permethrin 1% cream rinse
  2. 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
  1. Permethrin 1% rinse for 10 minutes
    OR
  2. 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
  1. Permethrin 5% cream (apply from neck down and leave on for 8-12 hours, rinse; repeat in 1 week)
  2. 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
  1. Tinea versicolor - depigments the area
  2. Tinea capitis - head
  3. Tinea corporis - body
  4. Tinea pedis - feet
  5. Tinea cruris - genital area
  6. 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
  1. Topical selenium sulfide lotion
    OR
  2. Ketoconazole shampoo
    OR
  3. 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
  1. Topical terbinafine or butenafine
  2. 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
  1. 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
  1. Terbinafine cream once daily for 7 days
48
Q

Tinea Cruris: Systemic Management

A
  1. 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
  1. Aluminum subacetate solution soaks for 20 minutes BID
  2. 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
  1. Broad-spectrum antifungal cream (clotrimazole, miconazole, ketoconazole)
  2. 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
  1. Itraconazole 200 mg PO daily for 2 weeks or 400 mg PO QD for 1 week
    OR
  2. 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
  1. Trim dead skin
  2. Topical antifungals
  3. Oral antifungals
59
Q

Tinea Unguium: Topical Antifungals

A
  1. 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)
  2. Efinaconazole, apply to affected toenail once daily for 48 weeks (adults only)
  3. Tavaborole, apply to affected toenail once daily for 48 weeks (adults and kids 6 and older)
60
Q

Tinea Unguium: Oral Antifungals

A
  1. Terbinafine
  2. Griseofulvin
  3. 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.

Adult Health (11 decks)

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