Herpes Zoster, Scabies, Paronychia, Pediculosis, Tinea Flashcards
Herpes Zoster: What is it?
- AKA shingles
- a viral infection resulting from reactivation of varicella zoster or an acute infection with the virus
Herpes Zoster: Risk Factors
- older adults
- immunocompromised
- stress
Herpes Zoster: Assessment Findings
- 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
Herpes Zoster: Diagnostic Studies
- usually clinical diagnosis
- consider HIV testing
- consider screening for diabetes
Herpes Zoster: Prevention
- 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
Herpes Zoster: Pharmacologic Management
- 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
Herpes Zoster: Antivirals
- 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
Herpes Zoster: Complications
- 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
Herpes Zoster: Postherpetic Neuralgia
- a possible complication of shingles
- very difficult to treat
- neuropathic pain that occurs due to damage to a peripheral nerve
Herpes Zoster: Postherpetic Neuralgia Treatment
- gabapentin
- lidocaine patches
- tricyclic antidepressants (amitriptyline)
- capsaicin cream
Paronychia: What is it?
- an acute infection of the nail folds and periungual tissues
Paronychia: Cause
- usually staph aureus
Paronychia: Risk Factors
- women
- DM
- trauma to nailbed, finger, or toe
- ingrown nails
- frequently wet hands and feet
- compromised immune system
Paronychia: Assessment Findings
- pain around the skin of the nail plate
- erythema, tenderness
- may have pus coming from site
Paronychia: Diagnostic Studies
- usually none
- can do a gram stain or C&S
Paronychia: Prevention
- avoid prolonged contact with water or moisture
- wear gloves if needed
- make sure tetanus is up to date
Paronychia: Non-Pharmacologic Treatment
- warm compresses and soaks TID
- I&D
- removal of ingrown nail
Paronychia: Pharmacologic Treatment
- 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
Pediculosis: What is it?
- 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
Pediculus capitis
Head lice
Pediculus corporis
Body lice
Pediculus pubis
Pubic lice
Pediculosis: Risk Factors
- more common in women and girls
- poor hygiene
- crowded conditions
- sexual transmission
- sharing of hats and combs
** Unusual in African Americans
Pediculosis: Assessment Findings
- pruritis
- excoriations