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Clin Med1 1 > L2 Fungus Acne Bugs > Flashcards

L2 Fungus Acne Bugs Flashcards

0
Q

Tinia Capitis : Gray Patch

A

scaly demarkated patch that spreads centrifugally;
hairs break off 2.3 mm above skin and becomes silver
endemic form, due to pets

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1
Q

Dermatophyte: Tinea capitis

A
  • Trichophyton sp. (T. Tonsurans (USA))
  • Microsporum sp. (M. Canis (EUrope))
    Epidem: 3-14 yo, AA, bad hygiene, overcrowding, low soc.econ, asym. carriers
    3 types: Gray patch, blac dot*, Flavus
    Fomite transmission
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2
Q

Black Dot Tinea Capitis

A

hair breaks off at the skin so the black dot is hair under skin
most common in US

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3
Q

Flavus Tinea Capitis

A

rare

hairy follicular inflammation causing crusting

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4
Q

Tinia Capitis Dx eval

A
  • KOH prep (scraping from affected scalp, add KOH and look under mscope)
  • Wood’s light (gray fluoresces a greenish culture; flavus blue; black dot not fluorescent)
  • culture (4-6 wks)
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5
Q

Tinea Capitis DDx

A 
Seborrheic Dermatitis
Contact dermatisis
pustular/plaque psoriasis
Atopic dermatits
alopecia areata
trichotillomania
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6
Q

Tinea Capitis Tx

A

Griseofulvin 6-12 wks (tx for microsporum)
Terbinafine 2-4 wks (tx if TRICHOPHYTON (USA))
Itraconazole (4-6 wks) and fluconazole (3-6 wks) or pulse therapy(8-12)
[Cant use ketocanazole with above]
Pets; carriers don’t need oral AF, can tx with blue selsum shampoo
Need extended f/u

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7
Q

Tinea Corporis

A

Etiology: T. Rubrum* (see slide)
Epi: occlusive clothing, humidity exacerbate (wrestlers); fomites/person to person
- pruritic (itchy), annular (round), erythematous plaque with central clearing and advancing border (border usually raised)
women shaving legs - worse with steroid topicals

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8
Q

Dx Eval and DDx

A

KOH prep
Culture
DDx: Erythema annulare centrifugum, nummular eczema, psoriasis, tinea versicolor

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9
Q

Tinea corporis (ring worm) Tx:

A
  • Topical angifungals (-azole)
  • systemic tx in special cases (terbinafine, fluconazole, itraconazole) [no ketocanazole]
  • sports restrictions (for 10-15 days after tx)
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10
Q

Tinea cruris (groin genital area)

A
  • T. Rubum* and E.floccosum*
  • 2nd most common dermatophytosis
    m>f, adults, direct contact, fomites or auto-inoculation
    occlusive clothing, humidity
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11
Q

Tinea Cruris

A

Spares the scrotum; helps distinguish TC from a yeast infection or Candida in same area

  • well-marginated, annular PLAQUE with scaly raised border
  • from inguinal fold to inner thigh
  • pruritis and pain
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12
Q

Tinia Cruris Dx eval and DDx and Tx

A
  • KOH prep
  • culture
    DDx:
    erythrasma, cutaneous candidiasis, intertrigo, contact derm, psoriasis, seborrheic derm, Lichen simplex chronicus, folliculitis
    Tx: topical antifungals, resistant cases: oral griseofulvin (AF), tx concomitant tinea pedis and/or onychomycosis, daily talcum powder;
    avoid hot baths and wear loose clothes
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13
Q

Tinea Pedis

A

T. rubrum *
Epi: MOST COMMON dermatophytosis, 10%, Risk: occlusive shoes, communal baths/pools
4 types: interdigital * (athlete’s foot) - at risk for 2ndary bact infection
Chronic Hyperkeratotic (Moccasin) - chronic
Vesiculolullous - hard vessicles
Acute Ulcerative - severe where you have bacterial inf and possible septic infection

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14
Q

Tinea Pedia Dx Eval, DDx, and Tx

A

Dx: KOH
DDx: Eczema, psoriasis, BACTERIAL COINFECTION (always look for with TP), interdigital erythrasma, dyshidrosis, contact derm
Tx: topical AF cream x 4 wks
chronic disease (oral tx for moccasin TP)
Burow’s wet dressings for vesiculation or maceration, 20 min BID-TID
Tx 2ndary infections
Foot powder, tx of shoes, proper shoes

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15
Q

Yeast Infections: Tinea VERSICOLOR

A

Malassezia sp. (M. Furfur, M. Globosa)
Epid: hot humid weather, 2-8% in US, no age, sex, race, more visible in dark skin,
Risk: excess sweat, hyperhidrosis, OCP, sys steroids, Cushings disease, immunodepression, malnourished
Clin: hypo/hyper-pigmented, salmon or erythematous macules

16
Q

Tinea Versicolor Dx, DDx and Tx

A

Dx: KOH (potassium hydroxide)
Wood’s Lamp: yellow to yellow-green fluorescence in 1/3
DDx: Pityriasis alba/rosea, seborrheic derm, dermatophyte inf’s, erythrasma, vitiligo, psoriasis, 2ndary syphilis
Tx: 1) Topical - Azole AF’s (ketocanazole topical ok) x 2 wks
- Selenium sulfide (lot,shamp,foam) x 1 wk
2) Systemic - Oral azole AFs
- Oral terbinafine and griseofulvin NOT effective
Recurrence is common - can go on maint tx - use oral or topical 1/mo

17
Q

Acne Vulgaris

A

most common in US, teens (10-20% adults)
Risk: friction/trauma, comedogenic topicals, meds (glucocorticoids, OCP, lithium, INH, phenytoin, phenobarbital), genetic, PCOS (polycystic ovarian syndrome)

18
Q

Acne vulgaris definition

A

chronic inflam disease of the pilosebaceous unit, self-limited

  1. increased sebum prod’n by seb glands
  2. hyperkeratinization of the follicle
  3. colonization of the follicle (Propionibacterium acnes)
  4. Inflammatory rxn
19
Q

Acne Vulgaris types

A

Comedones (closed: plugged with sebum and keratin; open at top: blackhead)

Papules, pustules (inflammation surrounds follicles), nodules (inflammation in and around papules?) [All three have redness]

20
Q

Acne V DDx and Dx

A

DDx: Sebaceous hyperplasia
acne rosacea
perioral derm
folliculitis

Dx: mild - less than 1/2 face, usu comodones in T zone, no nodules, poss inflammation
moderate - more than 1/2 face and poss back, maybe some nodules
severe - severe nodules, lots of scarring

21
Q

Acne V Tx

A

try tx for min of 8 weeks
Topical retinoids: Trerinoin (Retian-A) (C), Adapalene (Differin)(C), Tazarotene (Tazorac):Category X pregnancy
Prevent formation and reduce comedone, anti-inf
Indications - monotherapy for non-inflamm acne (open/closed comedones)
- combo therapy with ABs for inflamm acne

Topical ABs: Clindamycin, Erythromycin
Indications: mild-moderate inflamm or mixed acne
Use in combo with benzoyl peroxide to prevent resistance (?)
More effective when in combo with retinoids

22
Q

Acne V Tx other topicals and oral ABs

A

Other topicals:
Alelaic acid (mix antimicrobial and anticomedonal; mild-moderate inflam or mixed acne)
Dapsone (AB but MOA? mode of action? is inhibiting inflammation)
Benzoyl peroxide (bactericidal: mild-moderate mixed acne, as combo)
Salicylic acid (anticomedonal)

Oral ABs (8 wks): Doxycycline, Minocyline, Erythromycin, Tetracycline
Moderate-severe; add benzoyl peroxide; once contolled, maintain with topical retinoids
23
Q

Acne V Tx other

A
  • OCP (oral contraceptives): Ortho Tri-Cyclen, Yaz, Estrostep
    2nd line, inf and non-inf; (estrogen has anti androgen properties)
  • Spironolactone (Aldactone):
    androgen receptor antagonist; 2nd/3rd line or alternative to isotretinoin
  • Oral isotretinoin (acutane): for severe recalcitrant (uncooperative) or less severe treatment resistant
    40% long term remission, 40% need topicals or ABs, 20% re-tx
    Monitor: CBC, Lipids, Liver enzymes (acute hepatitis risk)
    Side-eff: depression, suicide, HA, dry skin and MM? multiple myoloma, GI upset
    iPLEDGE program to prevent pregnancy - strict tests
  • Other: clean BID, h2o based skin products, picking
24
Q

4 signs of skin

A

Distribution
Shape
Border
Pigmenation

25
Q

Acne Rosacea general

A

More in whites, f>m, in 30+ yo
Immune disfx, inflam rxn to cutaneous organisms, UV, Vascular
Definition: Erythema of central face, persisting for months of more
Distribution: nose, cheeks, chin, forehead
Subtypes: Erythematotelangiectatic, papulopustular, phymatous, ocular
Clin: - flushing, papules, pustules, telangiectasias
-facial burning, edema, plaques, dry appearance, phyma, peripheral flushing, ocular manifestation
-flares of exacerbation and inactivity
-Triggers: temp, sun, wind, hot drinks, excercise, spices, ETOH, menapausal flushing, meds - flushing, cosmetics, emotions

26
Q

Rosacea DDx

A 
Acne V
SLE (lupus)
Polymyositis
Sarcoidosis
Photoderamtitis
Drug eruptions
Perioral derm
27
Q

Rosacea Tx

A

Dx’d by inspection
Topicals: 1st line for mild papulopustular rosacea
- Metrogel (Metronidazole) FDA *
- Azelaic Acid (Azelex) FDA *
- Sulfacetamide / sulfur cream
-benzoyl peroxide/clindamycin or benz per/erythromycin (not as effect)
- topical brimonidine (vasoconstrictive alpha-2 adrenergic rec agonist)*
(FDA for persistent facial erythema of rosacea, 2013)

28
Q

Pediculosis Capitis

A

Head Lice
4-6 wk incubation
often asymptomatic
pruritis - itching is allergic rxn to salive
Eggs hatch after 10 days - some tx lice some kills eggs, some kill both
Dx: Visual inspection
Nits fluoresce pale blue with Wood’s light

29
Q

Pediculosis Capitis DDx and Tx

A

Head lice
DDx: hair casts, seborrheic derm, exzema, psoriasis, hair spray residue, delusions of parasitosis
Tx:Topical pediculicies! (Perythroids, malathion, spinosad, top ivermectin)
!! DON”T use LINDANE!!
Wet combing
Oral: ivermectin, TMP-SMX (combo with Permethrin)

30
Q

Scabies

A

host-specific mite (Sarcoptes scabeie)
live 3-days away from host
female mite excavates a burrow in the stratum corneum in which she lays 2-3/day for 30 days
Eggs hatch in 10 days - !!!Do re-tx in 10 days!!!

All age/race/gender
Transmission?

31
Q

Scabies clin and dx

A

initial lesion
BURROW IS PATHOGENIC (and diagnostic of scabies)
Back and head often spared
Pruritis, and some urticaria

dx: visualization of burrow
microscopic ID of mite, eggs or fecal pellets

32
Q

Scabies DDx

A 
Atopic derm
Dyshidrotic eczema
Contact derm
Insect bite rxn
Derm herpertiformis
Psoriasis
Delusions of parasitosis
33
Q

Scabies Tx

A

1) Scabicide: initial tx +2nd application 1 wk later
- PERMETHRIN 5% cream
-Lindane
-Ivermectin orally
2) Fomite control
3) Tx household contacts
POSTSCABETIC Itch - itch for wks after tx
Oral antihistamines and emollients/cleaning

34
Q

Bee sting management

A

generalized systemic rxin in .4-3% (not anaphylaxis)
Mngt: cleanse, ice, anesthetic injection
- oral or parenteral diphenhydramine for urticaria/pruritis
- epinephrine for anaphilaxis

Clin Med1 1 (8 decks)

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