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Clin Med III: Dermatology > infectious dermatology > Flashcards

infectious dermatology Flashcards

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1
Q

impetigo - what pathogen is responsible for MSSA and MRSA

A

S aureus

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2
Q

what pathogen causes bullous impetigo

A

Epidermolytic toxin A – producing S. aureus causes scalded skin syndrome

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3
Q

impetigo: Beta – hemolytic strep is what group?

A

group A

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4
Q

impetigo is MC in who

A

children but any age

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5
Q

impetigo MC occurs where?

A
  1. Minor breaks in the skin
  2. Around the nose
  3. Atopic dermatitis
  4. Traumatic wounds
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6
Q

Bullous stains of S. aureus = exfoliative toxin A leads to?

Bullous Impetigo

A

leads to loss of cell adhesion in the superficial epidermis

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7
Q

Bullous stains of S. aureus is MC in what age?

Bullous Impetigo

A

newborn and older infants

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8
Q

Often asx
Can be painful and tender
Erosions with crusts
1 – 3 cm lesions
Central healing often after several weeks
Regional lymphadenopathy

A

Impetigo Non-bullous

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9
Q

arrangement of Impetigo Non-bullous

A

Scattered, discrete lesions
w/o tx confluent
Satellite lesions occur from autoinoculation

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10
Q

impetigo vesicles can progress quickly to ?

A

bullae

  • No erythema noted
  • filled with serous fluid
  • Yellow –> dark brown
  • (-) Nikolsky sign
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11
Q

? days = collapse and leave erosions with crusts

Impetigo Bullous

A

1-2

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12
Q

nikolsky sign?

A

a skin finding in which the top layers of the skin slip away from the lower layers when rubbed

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13
Q

dx impetigo

A

Gram stain and culture often necessary for bullous type

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14
Q

impetigo tx

A
  1. Warm water soaks x 15-20 min BID
  2. mupirocin x 5 d.
  3. For widespread infection = 7 d ABX
    - Cephalexin
    - Erythromycin
  4. MRSA = Doxy
  5. Critically ill patients with MRSA/MRSA = vanc/linezolid
  6. Bullous or severe = PO ABX
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15
Q

pt ed for impetigo

A
  1. Good Hygiene
    - Nails, proper soap, frequent washing
  2. Underlying condition tx
  3. Mupirocin in other areas where skin barrier has been broken
  4. Wounds covered
  5. Avoid contact with others (>24hrs post ABX initiation)
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16
Q

prevention impetigo

A
  • BPO wash
  • Check family members for signs
  • Ethanol or isopropyl gel for hands
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17
Q
  • Infection of the hair follicle with +/- pus in the ostium of the follicle
  • Non tender /slightly tender
  • Pruritic
A

Folliculitis

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18
Q

causes of Folliculitis (pathogens)

A
  • Bacteria (S.aureus)
  • Fungi
  • Mites
  • Virus
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19
Q

prediposing factors for folliculitis

A
  • Shaving hair bearing areas
  • Occlusion of hair bearing areas
  • Hot tub usage
  • Topical CS
  • Systemic ABX (G- can proliferate)
  • Diabetes
  • Immunosuppression
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20
Q

Folliculitis - Can progress and become ?

A

an abscess or furuncle formation

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21
Q

What causes folliculitis to progress it into an abscess or furuncle formation?

pathogens

A
  • S. aureus
  • Pseudomonas (hot tub) - MC trunk
  • Viral (herpetic and molluscum)
  • Fungal (candida, malassezia)
  • Other: Syphilitic
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22
Q

G- to acne pt who worsens on systemic ABX w/ small follicular pustules = ?

A

gram neg folliculitis

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23
Q

dx folliculitis

A

clinical
gram stain
C&S
KOH (fungal)

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24
Q

mild tc folliculitis

A
  • Warm compresses
  • Wash with BPO or antibacterial soap (dial)
  • ABX if spontaneous resolution does not occur within 2-3 weeks or if symptoms worsen
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25
Q

tx moderate folliculitis

A
  1. Clindamycin BID x 10 days
  2. Mupirocin TID x 10 days
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26
Q

tx severe folliculitis

MSSA/MRSA

A
  1. Oral – MSSA - Cephalexin (Keflex)
  2. Oral – MRSA
    - Doxycycline 100mg BID x 10 days
    - Bactrim
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27
Q

prevention folliculitis

A

BPO body wash
Chlorhexidine body wash

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28
Q
  • Collection of pus accumulated in a tissue = inflammatory response to an infectious process of foreign body
  • Acute or chronic localized inflammation
  • Arises in any organ or tissue
A

Abscess

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29
Q

Arises in any organ or tissue - Skin & dermis, subcutaneous fat, muscle, or a variety

  • Tender
  • Red
  • Hot
  • Indurated nodule
  • +/- fever + constitutional sx
  • Days / weeks = pus formation (within a central space)
A

Abscess

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30
Q

dx abscess

A

Gram Stain and C&S of exudate
Typically MSSA or MRSA

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31
Q

tx abscess

A
  • I&D
  • ABX Therapy.
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32
Q

indications for abx for abscess

A
  • Single abscess ≥2 cm
  • Multiple lesions
  • Extensive surrounding cellulitis
  • Immunosuppression or other comorbidities
  • S/S toxicity ( fever >100.5°F, hypotension, or sustained tachycardia)
  • Inadequate clinical response to I&D alone
  • Indwelling medical device (prosthetic joint, vascular graft, or pacemaker)
  • High risk for transmission of S. aureus to others (athletes, group home)
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33
Q

oral vs IV Abx for abscess

A
  1. Toxic? - Fever, Hypotension, Tachycardia
  2. Rapid progression after 48hr of PO ABX?
  3. Inability to tolerate orals?
  4. Close to indwelling device? - Prosthetics, graft, catheter
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34
Q

abscess - For large lesions consider ?

A

surgery with general surgeon or plastics
Difficult areas
* Palms
* Soles
* Nasolabial areas
* Genitalia

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35
Q

prevention abscess

A
  • Antibacterial soap or BPO wash
  • Avoid heat and friction
  • Educate patients to Avoid squeezing (PATIENTS LOVE TO DO THIS)
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36
Q
  • Acute, deep seated, red, hot, tender nodule or abscess
  • Abscess = boil
  • 1-2 cm
  • Fluctuant - Nodule with cavitation after drainage
  • Any hair bearing region
  • from a staphylococcal folliculitis
A

Furuncle

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37
Q

furuncle management

A
  1. Warm compresses 10 min daily; Erythema = ABX probably necessary
  2. Bactrim, Clindamycin, Doxycycline
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38
Q
  • Deeper infection composed of interconnecting abscesses usually arising in several contiguous hair follicles
  • Patient is typically ill appearing
  • Fever + along with constitutional sx
  • Painful/tender
A

Carbuncle

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39
Q

MC locations for Carbuncle

A

nape of neck, back, and thighs

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40
Q

dx carbuncle

A

Clinical gram stain is helpful with C&S

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41
Q

tx for carbuncle

A
  • uncomplicated - Bactrim, Clindamycin, Doxycycline
  • COMPLICATED = ADMISSION FOR IV ABX
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42
Q

admission for Carbuncle if? tx?

A
  • Toxic appearing
  • Rapid progression
  • No improvement after 24-48 hours of PO ABX

Vancomycin 1-2 g IV daily DOC

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43
Q

Rapid progression of infection with extensive necrosis of soft tissues and overlying skin
AKA: Flesh eating disease

A

Necrotizing Fasciitis

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44
Q

etiology Necrotizing Fasciitis

A

polymicrobial

  • Beta-hemolytic GAS
  • Pseudomonas aeruginosa
  • Clostridium
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45
Q

pathophys of Necrotizing Fasciitis

A

Bacteria release enzymes/gases that degrade fascia resulting in rapid proliferation, local thrombosis, ischemia and necrosis

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46
Q

Necrotizing Fasciitis may be began as?

A

May begin deep at site of nonpenetrating minor trauma

  • bruise, muscle, or strain
  • Minor trauma
  • Laceration
  • Needle puncture
  • Surgical incision
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47
Q

Necrotizing Fasciitis is MC in what age?

A

Middle age (mid 30 - mid 40’s)

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48
Q

RF Necrotizing Fasciitis

A
  1. DM
  2. ETOH abuse
  3. liver dz
  4. CKD
  5. malnutrition
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49
Q

Necrotizing Fasciitis - If skin necrosis is not obvious suspect if there are signs of sepsis and/or some of the following local symptoms:

A
  1. Severe pain
  2. Indurated swelling
  3. Bullae
  4. Cyanosis
  5. Skin pallor
  6. Skin hypesthesia
  7. Crepitation
  8. Muscle weakness
  9. Foul smelling exudates
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50
Q

Necrotizing Fasciitis - 4 signs to identify

A
  1. Local redness
  2. Edema
  3. Warmth
  4. Pain
  • Appears 36 – 72 hours after onset
  • Involves soft tissue becomes blue in color
  • Vesicles and bullae appear - spread along fascial plane
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51
Q

Necrotizing Fasciitis progression

A

Extensive cutaneous soft tissue necrosis develops

  • Black eschar with surrounding irregular border of erythema
  • Fever and other constitutional symptoms
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52
Q

ddx Necrotizing Fasciitis

A
  1. Pyoderma gangrenosum
  2. Calciphylaxis
  3. Purpura fulminans
  4. Warfarin necrosis
  5. Pressure ulcer
  6. Brown recluse spider bite
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53
Q

Key clinical red flags of Necrotizing Fasciitis:

A
  • Severe, constant pain out of proportion to physical exam, or anesthesia
  • Erythema evolving into a dusky gray color
  • Malodorous, watery “dirty dishwater” discharge
  • Gas (crepitus, or crackling sounds) in the soft tissues
  • Edema extending beyond areas of erythema
  • Rapid progression despite antibiotic therapy
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54
Q

tx Necrotizing Fasciitis

A
  1. Surgical debridement
    - CBC, CMP, CK, ABG, UA, serum/deep tissue culture
    - CT, MRI, Plain film - GAS?
  2. broad spectrum ABX
    - Carbepenem
    - Ampicillin/sulbactam
    - Clindamycin
    - MRSA - Vancomycin

all dependent on gram stain / C&S

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55
Q

Acute superficial infection (dermis and dermal lymphatic vessels)

A

Erysipelas

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56
Q

MCC Erysipelas

A

group A 𝛃-hemolytic streptococcus

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57
Q

Erysipelas is MC in what age

A

young children and older adults

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58
Q

s/s erysipelas

A
  1. Prodrome - fever, chills, anorexia, malaise
  2. General - +/- signs of sepsis
  3. Lesion
    - painful/tender/hot
    - bright red, raised, edematous, indurated plaque
    - sharp borders
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59
Q

Acute infection of the dermis and subcutaneous tissue

A

Cellulitis

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60
Q

etiology Cellulitis

A
  • S. aureus (MC) and Group A β-hemolytic streptococcus
  • Cat/Dog trauma: Pasteurella multocida
  • Freshwater wound: Aeromonas
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61
Q

Epidemiology Cellulitis

A

MC middle age adults

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62
Q

cellulitis - A focused history should determine ?

A
  • immune status
  • comorbid conditions
  • possible sites and causes of skin barrier disruption
  • prior h/o cellulitis, and methicillin-resistant S. aureus (MRSA) risk factors
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63
Q

s/s cellulitis

A
  1. (Similar to erysipelas)
  2. Prodrome - fever, chills, anorexia, malaise
  3. General - +/- signs of sepsis
  4. Lesion
    - painful/tender/hot
    - bright red, edematous, (+/- induration)
    - indistinct borders (not raised)
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64
Q

RF cellulitis

A
  1. Minor skin trauma
  2. Body piercing
  3. Intravenous drug use
  4. Tinea pedis infection
  5. Animal bites
  6. Peripheral vascular disease
  7. Immune suppression (chronic systemic steroid use, neutropenia, immunosuppressive medications, alcohol use disorder)
  8. Lymphatic damage (lymph node dissection, radiation therapy, vein harvest for coronary artery bypass surgery, and damage that occurs following multiple prior episodes of cellulitis)
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65
Q

RF Erysipelas & Cellulitis

A
  1. Compromised skin integrity - atopic dermatitis, insect bite, surgery, trauma, IV drug use
  2. Compromised immune system - AIDS, DM, ESRD, CA, immunosuppressive therapy, drug/ETOH abuse
66
Q

ddx Erysipelas & Cellulitis

A
  1. DVT
  2. stasis dermatitis
  3. contact dermatitis,
  4. urticaria
  5. insect bite
  6. fixed drug eruption
  7. erythema nodosum
  8. acute gout
  9. erythema migrans (Lyme)
  10. pre-vesicular herpes zoster
67
Q

dx w/u for Erysipelas & Cellulitis

A
  1. **Clinical dx **
  2. Labs only if systemic symptoms are present
    - CBC, CMP, ESR, blood cx
  3. Imaging - US or MRI if needed
68
Q

indications for imaging for Erysipelas & Cellulitis

A

ruling out abscess, necrotizing fasciitis, pyomyositis, and gas forming anaerobic bacterial infection

69
Q

complications from Erysipelas & Cellulitis

A

Abscess formation, bacteremia, endocarditis, osteomyelitis, metastatic infection, sepsis, toxic shock syndrome

70
Q

indications for Erysipelas & Cellulitis for IV abx

A
  1. Systemic presentation: Fever > 100.5, hypotension, sustained tachycardia
  2. Rapidly spreading lesion
  3. Progression of clinical features after 48 h of oral abx
  4. Unable to tolerate oral therapy
  5. Comorbidities: immunosuppression, neutropenia, asplenia, cirrhosis, heart/renal failure

can be switched to PO once systemic s/s resolve

71
Q

IV tx for Erysipelas & Cellulitis (MRSA & MSSA)

A
  1. MRSA coverage
    - vancomycin (1st line)
    - daptomycin (2nd line)
  2. MSSA coverage
    - cefazolin
    - clindamycin
    - nafcillin
72
Q

oral therapy for Erysipelas & Cellulitis

MRSA& MSSA

A
  1. MRSA coverage
    - clindamycin (first line)
    - amoxicillin + TMP-SMX/doxycycline
  2. MSSA coverage
    - cephalexin
    - nafcillin
    - clindamycin
73
Q

Special considerations in treatment for Erysipelas & Cellulitis

A
  1. Dog/cat bite: Augmentin - Pasteurella multocida
  2. Human bite: Augmentin - Eikenella, Group A Streptococcus; Broad spectrum ABX
  3. Exposure to fresh water: cipro - Aeromonas
  4. Exposure to salt water: doxy - Vibrio vulnificus
74
Q

Acute inflammatory process involving the subcutaneous lymphatic channels

A

Lymphangitis

75
Q

causes of acute & chronic Lymphangitis

A
  1. GAS, S. aureus, Herpes simplex virus
  2. Chronic - Mycobacterium marinum
76
Q

portals of Lymphangitis

A
  1. Break in skin
  2. Wound
  3. Paronychia
  4. Primary herpes simplex
77
Q
  • Pain +/- erythema proximal to break in skin
  • Red linear streaks and palpable lymphatic cord
A

Lymphangitis

78
Q

ddx Lymphangitis

A
  • Phyto-allergic contact dermatitis
  • Superficial thrombophlebitis
  • Mycobacterium marinum
  • N. brasiliensis
  • S. schenckii
79
Q

dx Lymphangitis

A
  1. Clinical dx
    - Resolves with correct diagnosis and treatment
    - cx if open and actively weeping
  2. Labs only if systemic sx
    - CBC, CMP, blood cultures
80
Q

tx Lymphangitis

A
  1. Oral ABX dependent on sensitivity
    - Dicloxacillin or 1st generation cephalosporin
    - MRSA Clinda or Bactrim
  2. F/u 24-48 hours
    - ABX indications: toxic appearing or no improvement after 24-48 hours
81
Q

Superficial fungal infection of the skin

A

Cutaneous Candidiasis

82
Q

MC pathogen causing Cutaneous Candidiasis

A

Candida albicans

83
Q

MC ages for Cutaneous Candidiasis

A

neonates and adults >65 years old

84
Q

MC areas involved for Cutaneous Candidiasis

A

Genitocrural, gluteal, interdigital, inframammary, axilla, under pannus

85
Q

Cutaneous Candidiasis RF

A
  1. Obesity
  2. DM
  3. local occlusion/moisture
  4. steroid/abx use
  5. hyperhidrosis
  6. incontinence
86
Q
  • Pruritic
  • Tender/painful
  • Macerated
  • Erythematous
  • Satellite lesions typically present; beefy red
A

Cutaneous Candidiasis

87
Q

dx Cutaneous Candidiasis

A

KOH prep

88
Q

ddx Cutaneous Candidiasis

A
  1. Tinea
  2. Psoriasis
  3. Dermatitis
  4. AD
  5. Secondary syphilis
89
Q

tx Mild to moderate
Cutaneous Candidiasis

A

Topical antifungals 2-3 wks - Continue x 2 weeks after clearance

  • Ketoconazole
  • Econazole
  • Clotrimazole
  • Miconazole
90
Q

tx for severe cutaneous candidiasis

A

Oral antifungals
Fluconazole (Diflucan) 100mg PO daily x 2-3 weeks

91
Q

prevention of Cutaneous Candidiasis

A

Keep areas dry

  1. Powders (Zeasorb AF)
  2. Hair dryer
  3. Avoid occlusive clothing
92
Q
  • Inflammation of the glans penis, can be triggered by numerous factors.
  • Affects uncircumcised men with poor hygiene.
A

Balanitis

93
Q

common infectious triggers for Balanitis

A

candida, Trichomonas vaginalis, gonorrhoeae, streptococcus

94
Q

hx components for balanitis

A

DM, culture, KOH, Tzank smear, RPR-Syphilis, patch test

95
Q

tx balanitis

A

Improved personal hygiene, use of low to medium potency topical steroid until improved

96
Q

Unique group of fungi capable of infecting nonviable keratinized cutaneous structures

A

Dermatophyte

97
Q

Dermatophyte can infect what parts of the body?

A
  1. Stratum corneum
  2. Nails
  3. Hair
98
Q

Arthrospores can survive in human scales for ?

A

12 months

99
Q

3 genera of dermatopytes

A
  1. Trichophyton (MC) - Hair and nail
  2. Microsporum
  3. Epidermophyton
100
Q

Dermatophytes - Scalp MC in who

A

Children

101
Q

Dermatophytes transmission

A
  • Person to person (MC)
  • Animals
  • Soil (least common)
102
Q

pathophys Dermatophytes

A

dermatophytes produce enzymes (keratinases) that break down keratin allowing fungi to invade epidermis, nail and hair shaft

103
Q

tinea pedis

A

feet

104
Q

tinea cruris

A

groin

105
Q

tinea corporis

A

trunk/extremities

106
Q

tinea manuum

A

hands

107
Q

tinea facialis

A

face

108
Q

tinea capitis

A

hair

109
Q

tinea barbae

A

facial hair

110
Q

onychomycosis

A

nails

111
Q

classifications of Dermatophytes

A
  • Person to person = anthropophilic
  • Animal to human = zoophilic
  • Environmental = geophilic
112
Q

predisposing factors for Dermatophytes

A
  1. atopy, ichthyosis
  2. collagen vascular disease - RA, SLE, temporal arteritis, scleroderma
  3. steroid use (oral/topical)
  4. sweating, local occlusion
  5. occupational exposure
113
Q

dx options for Dermatophytes

A

Dx testing direct microscopy

  1. Skin & Nail for KOH
    - Skin - use a blade to scrape skin cells from area
    - Nail - use a dull scalpel to remove excess keratin from nail
    - Hair - remove hair at root
  2. Woods lamp - “black light”
    - Blue green fluorescence = Microsporum
  3. fungal cx
  4. Dermatopathology via skin biopsy
114
Q

how to perform KOH

A
  1. 2 drops of 10% KOH to glass slide - sit for 15 min
  2. Inspect under low and high power
    - hyphae and spores will be present
115
Q

Dermatophytes how to collect for fungal cx

A
  1. skin: specimen obtained with brush (tooth or cervical brush)
  2. hair: specimen remove 5-10 hairs with forcep/hemostat at one time, use brush to obtain scales, use brush to inoculate fungal medium.
  3. nail: use fingernail clipper or sharp curette to obtain keratinous debris from under nail

place specimen inside a fungi culture medium

116
Q

pros and cons of fungal cx for dermatophytes

A
  • Limitations - requires days-wks to return definitive diagnosis
  • Benefits - differentiates between fungal spp.
117
Q

pros and con for skin bx for dermatophytes

A
  1. Benefits - most sensitive form of diagnosis
  2. Limitations
    - skin biopsy sample required
    - more invasive testing
118
Q

topical antifungals for dermatophytes

A

Imidazoles

  • Clotrimazole (Lotrimin)
  • Miconazole (Micatin)
  • Ketoconazole (Nizoral)

Allylamines

  • Naftfine (Naftin)
  • Terbinafine (Lamisil)
119
Q

Systemic Treatment for Dermatophytes

A

(CBC, Cr, LFT’s)
Systemic PO agents

  1. Imidazole
    - Itraconazole
    - Ketoconazole
    - Fluconazole
  2. Allyamine
    - Terbinafine ***
120
Q

tinea capitis is MC in who

A

MC in children
MC in AA

121
Q

presentation of Ectothrix occurring outside the hair shaft

Tinea Capitis

A

“grey patch” = scaly
Circular = hairs broken off = very brittle

122
Q

Three presentations of Endothrix = occurs within the hair shaft

Tinea Capitis

A
  • “Black dot”
  • Kerion
  • Favus
123
Q

noninflammatory tinea capitis

A
  • Scaling
  • Pruritus
  • Alopecia
  • Adenopathy
124
Q

flammatory tinea capitis

A

Pain
Tenderness
Alopecia

125
Q

what are the “black dots” in tinea capitis

A

Broken off hairs near the scalp = swollen hair shafts

  1. Dots occur because broken hairs at the scalp
  2. Diffuse and poorly circumscribed
    - Caused by: T. tonsurans, T. violaceum
126
Q

what is Kerion in tinea capitis

A
  1. Inflammatory mass in which remaining hairs are loose
  2. Boggy, purulent, inflamed nodules, and plaques
  3. Painful = drains pus from multiple openings
  4. Hairs do not break off but fall out or pulled without pain
  5. Crusting and matting of surrounding hairs
  6. Caused by: T. verrucosum; T. mentagrophytes
    - Heals with scaring alopecia
127
Q

Latin for honeycomb
Perifollicular erythema and matting of hair
Thick/yellow crusts
Odor
Doesn’t clear spontaneously
Results in scarring alopecia

A

Favus - Tinea Capitis

128
Q

dx Tinea Capitis

A
  1. Woods Lamp - T. tonsurans does not fluoresce
  2. Direct microscopy
  3. Fungal cx - growth seen in 10-14 d
  4. Bacterial cx - r/o bacterial with staph
129
Q

Tinea Capitis w/o tx can lead to ?

A

permanent hair loss

130
Q

tx tinea capitis

A

PO antifungals:
Terbinafine 250mg QD x 4-6 weeks
Griseofulvin 20-25mg/kg/day x 4-6 weeks

Antifungal shampoos - Ketoconazole 2% shampoo QD

131
Q

prevention tinea capitis

A
  1. Wash clothing, bedding, and towels
  2. Wash furniture if in contact
  3. Avoid used pillow cases
  4. Avoid head to head contact
  5. Disinfect combs and other hair products
132
Q

“Jock Itch”
Inguinal folds = thighs
Subacute or chronic dermatophytosis of the upper thigh and adjacent inguinal and pubic regions

A

Tinea Cruris

133
Q

Tinea Cruris MC in who?

A

MC in males
Co-exists with Tinea Pedis typically

134
Q

Large scaling, well demarcated dull red/tan/brown plaques
Central clearing
Papules and pustules @ margins

A

Tinea Cruris

135
Q

dx tinea crusis

A

clinical

136
Q

tx tinea cruris

A
  1. Topical antifungal x +/- 3 weeks
    - Ketoconazole
    - Econazole
    — Zeasorb AF powder
  2. PO Antifungals if failure of topicals
    - Griseofulvin 375-500 mg daily x 2-4 weeks
136
Q

management/prevention tinea cruris

A
  1. Wear shower shoes while bathing
  2. Put on socks before pants
  3. Antifungal/drying powders
  4. Benzoyl peroxide wash
  5. Alcohol based sanitizer gels
  6. Avoid tight fitted clothing/use cotton underwear
137
Q

Fungal/dermatophyte infection involving anywhere on the body
**wrestlers infection

A

Tinea Corporis
aka ring worm

138
Q

dx tinea corporis

A

clinical
bx if unsure

139
Q

Can be asx
Pruritus depending on area
Sharply marginated plaques
Vesicles and papules
Central clearing

A

Tinea Corporis

140
Q

tx Tinea Corporis

A
  1. Topical antifungals
  2. Oral antifungals (large surface area)
    - Terbinafine 250 QD x 4 weeks
    — CBC, Cr, LFT’s
141
Q

Erythema
Scaling
Maceration
+/- bullae formation
MC dermatophyte infection athlete’s foot

A

Tinea Pedis

142
Q

if tinea cruris is dx, what other body part do you need to check?

A

feet - Tinea Pedis

143
Q

Tinea Pedis MC in what age group?

A

20-50y

144
Q

RF Tinea Pedis

A

hot, humid climate, occlusive footwear, hyperhidrosis

145
Q

4 subtypes of tinea pedis

A
  1. Interdigital
  2. Moccasin
  3. Inflammatory
  4. Ulcerative
146
Q

Dry scaling
Maceration
Fissuring
Hyperhidrosis is common
MC site = between 4th and 5th toe

which type of Tinea Pedis

A

Interdigital Type

146
Q

Well demarcated
Scaling with erythema
Papules at margin
Fine white scale
Hyperkeratosis
MC on soles or lateral border of feet
MC bilateral

which type of tinea pedis

A

Moccasin Type

147
Q

Vesicles or bullae with clear fluid
Pus usually indicates secondary bacterial infection
After rupture erosions with ragged ringlike border
ID reaction can occur
MC on sole, instep, and web spaces

which type of tinea pedis

A

inflammatory

148
Q

Extension of interdigital tinea pedis onto the plantar and lateral foot
May have secondary bacterial infection S. aureus

which type of tinea pedis

A

ulcerative

149
Q

tx tinea pedis

A
  1. Topical antifungal
    - BID x 2-4 weeks
    - Ketoconazole & Econazole BID
  2. Oral antifungal - Best for hyperkeratotic
    - Terbinafine 250 mg QD x 2-6 weeks
    - ALL SYSTEMICS = BLOOD WORK (Cr, LFT’s, CBC)
150
Q

prevention tinea pedis

A
  1. Wash with BPO daily
  2. Use antifungal powder (Zeasorb AF)
  3. Shower shoes in communal showers
  4. Alcohol based sanitizers
151
Q

T/F: Pityriasis Versicolor is part of the group cause dby deramtophyte

Tinea Versicolor

A

F, it is not

152
Q

Tinea Versicolor MC in who

A

adolescents

153
Q

Tinea Versicolor is an overgrowth of?

A

Malassezia furfur
Seen often in patients with oily skin (thrives in this environment)

154
Q

RF tinea versicolor

A
  • Climate
  • Sweating
  • Immunodeficiency
  • Products
  • Steroid use
  • Oily skin
155
Q

is tinea versicolor contagious?

A

no

156
Q

s/s tinea versicolor

A

clinically asx

  1. Patient can experience some itching possibly psychological
  2. Patient usually complains about the appearance
    - Macules +/- scale
    - Patches +/- scale
    - Plaques +/- scale
    — Hypo/hyperpigmentation
    — Erythema
157
Q

dx tinea versicolor

A
  • KOH shows hyphae and budding yeast (spaghetti and meatballs)
  • Woods light
158
Q

tx tinea versicolor

A
  1. Selenium sulfide or zinc pyrithion
  2. Topical antifungals ketoconazole
    - PO therapy not recommended unless failure of topicals

Clin Med III: Dermatology (13 decks)

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