May8 M3-Derm-Infections-Lecture Flashcards
impetigo description of diff looks
- yellow crust lesions with erythematous base. very itchy. contagious
- bullae and vesicles, that can be ruptured too
most common cause of nonbullous impetigo and tx
staph aureus (and less commonly GAS) tx=topical or oral Abx
most common cause of bullous impetigo
staph aureus ONLY
tx=topical or oral Abx
bacterial folliculitis description
superficial infection of hair follicles. pustules in perifollicular area with erythematous base
bacterial folliculitis pathogen and tx
staph aureus
tx=antibacterial wash, Abx cream, oral Abx if widespread
furuncle description
pustule. white in middle. red base
carbuncle description
many furuncles that coalesce and make a bigger and deeper inflammation. white bump. red base
abscess description
carbuncle that evolved to painful fully red and very big lesion
organism causing furuncle, carbuncle and abscess
staph aureus
tx of furuncle, carbuncle and abscess
- furuncle (simple furuncle) = warm compresses + topical Abx
- carbuncle (fluctuant furuncle) = incision and drainage
- abscess = incision and drainage
when to give oral Abx for furuncle, carbuncle or abscess
- near midface
- near auditory canal
- recurrent or recalcitrant (persisting)
- very large
ecthyma description
- eroded punched out ulcer
- greyish, yellowish in central area
- surrounding erythema
- a deeper form of nonbullous impetigo*
ecthyma organisms and tx
- GAS AND staph aureus
- oral Abx
erysipelas description
- very red and very well defined infiltrating lesion on nose, cheek and upper lip
- painful
- fever and malaise
- is a superficial cellulitis*
erysipelas organism and tx
GAS
tx=oral Abx
cellulitis description
- swollen limb
- extreme erythema
- well or ill defined
- fever and malaise
- infection of deep dermis and subcutaneous tissues*
cellulitis organisms and tx
- GAS (2/3) and staph aureus (1/3)
- prompt oral or IV Abx
necrotizing fasciitis description
- necrotic sloughering of the skin (initially red and painful, slightly infiltrated with B symptoms)
- deep infection
necrotizing fasciitis organism and tx
GAS or mixed infection
tx=extensive surgical debridement (high mortality rate)
perianal streptococcal disease description
painful, red, infiltrating plaque around anus + fissures + scaling
perianal streptococcal disease organism, dx and tx
GAS
dx=BOTH throat and perianal culture
tx=oral Abx
erythrasma description
brown macular ill-defined patch, in moist parts of the body (occluded intertriginous areas) like axilla. fluorescence under Wood’s lamp (bc of the bacteria)
erythrasma organism and tx
corynebacterial infection
tx=topical Abx
green nail syndrome description
- nail lesion of greenish discolouration, yellow distally and onycholysis (lifting of nail)
- folliculitis with pustules and papules on hairy (follicular) areas and mostly on the trunk
green nail syndrome organism and tx
pseudomonas (makes a greeny pigment)
tx=trim nail, acetic acid soaks, topical Abx
hot tub folliculitis description
lesions and folliculitis with pustules and papules on follicular areas of body that came in contact with hot tub water
hot tub folliculitis organism and tx
pseudomonas
no tx necessary
acute meningococcemia description
petechial lesions, that were previously small papules, and associated necrosis. ill patient. acute and potentially life threatening infection of blood vessels
medical emergency
acute meningococcemia organism and tx
Neisseria meningitidis
tx=high dose IV Abx
scarlet fever
- previously sore throat and fever
- now rash of small erythematous papules like sandpaper. papillae on tongue too. strawberry tongue
- palor around nose and perioral areas
- linear petechiae in skin folds
- children*
scarlet fever organism and tx
- diffuse exanthem (rash usually in children caused my microorganisms, drugs, toxin, autoimmune phenomenon) caused BY GAS pharyngitis
- tx=oral Abx
primary herpetic gingivostomatitis description (primary infection is on mouth)
extreme pain, fever, problems eating, tiny vesicles became pustules and necrotic, eroded, painful. tongue involvement and perioral area. small red papules on lips and tongue
primary genital herpes description
vesicles, then pustules, then shallow ulcers, then become necrotic. end up with ulcers. extensive primary infection. urethritis.
recurrent herpetic infection on mouth and genital area names
mouth: herpes labialis
genital: genital herpes
herpes labialis and genital herpes description
- less extensive than primary lesion
- vesicles, pustules, erosion, shallow ulcers
eczema herpeticum description
- in children with ectopic dermatitis (type of eczema)
- monomorphous lesions. red papules
- can’t control infection
- medical emergency*
herpetic whitlow description
painful lesion on finger tip. red papules. came in contact with patient with herpes
herpes gladiatorum description
- people who do sports like wrestling
- an HSV primary infection
- non mucosal site typically face, neck or arms. papule or plaque that is greyish, white with erythematous base
main diagnostic method for HHV1 and HHV2 infection
morphology
also have PCR or direct fluorescent Ab (DFA)
treatment of primary herpes (primary herpetic gingivostomatitis and primary genital herpes)
- oral or IV antivirals
- pain control
recurrent herpes (herpes labialis, genital herpes) tx
- oral or IV antivirals
- suppressive treatment (if >6 episodes per year)
treatment of eczema herpeticum
IV antivirals
treatment of herpetic whitlow and herpes gladiatorum
oral antivirals
VZV (chickenpox) infection description
- upper extremities, face, trunk, lower extremities
- tiny erythamous vesicles with faint base. become larger. erode. some necrotic ulcers
- very itchy and contagious
- differs from eczema herpeticum bc now have lesions at diff stages of evolution
VZV (chickenpox) tx in children
resolves by itself in 1-3 weeks and may leave scars
VZV (chickenpox) tx in patients other than children
-more risk of complications (pneumonia, meningitis) in adults and imunocompromised pts
give oral or IV antivirals
(vaccine for prevention)
Zoster description
monomorphous lesion following a dermatome. vesicles and pustules. end up with ulcerations
Zoster cause
- initial varicella infection virus lied dormant in spinal dorsal root ganglion and reactivated = herpes zoster (is VZV)
- triggered by stressful event
tx of Zoster and prevention
tx = oral antivirals prevention = vaccine
complications of zoster
- post-herpetic neuralgia (electric-shock like pain for months)
- scarring
- secondary bacterial infection
- meningoencephalitis
- Ramsay-Hunt syndrome (ear problems and facial paralysis + vesicles)
- ocular blindness (nose tip lesions and virus travels up to opthalmic nerve that feeds nose)
HPV effect on fingertips and name
periungal warts
-stiffening and fissuring
HPV effect on skin and name
common warts
- group of papules, kerotic on their top
- skin color (pink) and diff sizes
HPV effect on sole of the feet and name
plantar warts
-endophytic lesions (going inside), shallow erosions, ulcers. yellow
HPV effect near the mouth and name
flat warts
-small papules on face, barely keratotic, brown or skin color
HPV effect on genital area and name
conyloma acuminata
- less keratotic lesions
- more exophytic
- tiny papules, filiform lesiosn, brown color
HPV effect on skin (non mucosal areas) (solitary, non grouped, so not common warts) and name
filiform warts
- solitary filiform lesion
- exophytic, skin color, keratotic
2 types of dividing HPV infections
- nongenital vs genital
- low risk (HPV 6 and 11) vs high risk, malignant transformation risk (HPV 16, 18)
prevention of HPV
vaccine, Gardasil
tx of HPV skin manifestations (common, filiform, plantar, flat and periungal warts + condyloma acuminata)
- liquid nitrogen (cryotherapy)
- salicylic acid
molluscum contagiosum
- primary infection = papules of skin colour, shiny pinkish. then spread to whole body if use towel for ex.
- in children with eczema or ectopic dermatitis = in skin fold
how molluscum contagiosum transmitted in children vs adults
children: school, daycare
adults: sexually transmitted
molluscum contagiosum organism and treatment
poxvirus
- usually self-limited
- tx = liquid nitrogen. curettage.
yeast causing skin infections
- malassezia
- candida
dermatophytes causing skin infections
- microsporum
- trichophyton
- epidermophyton
pytiriasis versicolor description
- macules with scaling on lipid rich areas of the body
- neck, torso, back, groin
- brown or grey or hypopigmented patches. many colors on same pt
pytiriasis versicolor organism, dx and tx
malassezia furfur (part of normal cutaneous flora)
- dx=microscopy with KOH
- tx=topical antifungal
candidiasis description (candidal intertrigo and diaper candidasis if it appears in diaper region in a baby)
in intertriginous areas, erythematous patch. around it, small satellite lesions, some pustules. itchy or tender.
organism causing candidal intertrigo = candidiasis appearing as erythematous patch with satellite red papules on skin of anyone
candida albicans
treatment of candidal intetrigo and diaper candidiasis (caused by candida albicans)
topical antifungal
dermatophytes def and 3 genera
fungi with capability of invading keratinized tissue
- microsporum
- trichophyton
- epidermophyton
tinea corporis (ringworm) description
unique lesions, solitary or multiple. plaque with central area clearing and slight erythema. typical border that is more papular, thicker, higher and keratotic.
tinea corporis organisms and transmission
- trichophyton if had tinea pedis and touched toes and transmitted
- microsporum if from infected cat or dog
tinea corporis dx
scraping and culture and microscopy
tx of tinea corporis
topical antifungal
tinea barbae (tinea sycosis) description
erythematous plaques in beard region. bogginess, yellowish, crusting, pus, yellowish liquid draining
organism of tinea barbae (sycosis) and tx
trichophyton verrucosum
-tx=oral antifungal
tinea capitis 3 possible presentations
- dry dandruff like scaling on the scalp (keratotic dry, hair loss)
- black dots (tiny dots + hair loss)
- kerion (inflammatory boggy mass called kerion + pus and exudate and hair loss)
tinea capitis def
FUNGAL infection of the scalp + HAIR LOSS** (must have it in tinea capitis)
tinea capitis organism and dx
- trichophyton tonsurans, microsporum
- microscopy and cultur + fluorescence on Wood’s light (helps). fluorescence=microsporum
tinea capitis tx
oral antifungal + antifungal lotion and shampoo + antifungal shampoo for all family
tinea pedis description
- athlete’s foot
- small areas of maceration between toes and dry scaly skin. no itch. (mildest form) TO (worse) rest of foot, inflam, papules and plaque. tinea corporis-like advancing edge
tinea pedis organism and tx
- trichophyton or epidermophyton
- tx = topical antifungal + keep feet dry
tinea cruris description
erythematous scaly plaque starting on skin fold and extending on scrotum, edge elevated, thick scaly
(might have been transmitted to scrotum after touching tinea pedis)
tinea cruris organism and tx
- trichophyton or epidermophyton
- tx = topical antifungal
onychomycosis (tinea unguium) description
- yellowish organish discoloration of nail + onycholysis
- starts on toenail IMPORTANT
(IMPORTANT) where onychomycosis starts
on big toenail first, then spreads to others
onychomycosis organism and tx
- trichophyton
- tx = oral antifungal (less commonly oral)
other name for onychomycosis
tinea unguium
scabies (infestation) description
- itchy
- between fingers, webs spaces hands and toes, wrists, under arm, umbilical
- indurated papules, swollen and red. tunnel lesions like insect dig under skin and advanced
- very contagious
scabies dx
scraping and oil microscopy
scabies tx
topical scabicide and tx everyone in house at same time
crusted, Norwegian scabies description
- not itchy
- thick crusts in areas like traditional scabies but may cover whole body
- in immuno problems pts, diabetes, homeless, alcohol abuse
- very contagious
- millions of mites*** whereas traditional scabies = 10-12 mites
tx of crusted, Norwegian scabies
topical scabicide
head lice name of disease
pediculosis capitis
pediculosis capitis descrption
- head lice on hair, move downwards, lay 5-10 eggs a day
- reach scalp to feed on blood
- ITCHY bc of that
- contagious
diseases that head lice carry (pediculosis capitis)
NO DISEASES CARRIED WITH IT
tx of head lice
topical insecticide + remove physically
pediculosis corporis description (body lice)
-live on clothing, jump on patient and back on clothing
(IMPORTANT) pediculosis corporis infections that they transmit
- epidemic typhus
- trench fever
- relapsing fever
tx of pediculosis corporis
hot washing clothes and bed linens
pediculosis pubis (pubic lice) description
- go on pubic hair, deposit eggs, bite patient, feed on blood, then ITCHY
- prefer coarser hair (plus rugueux)
tx of pediculosis pubis
topical insecticide on all hairy areas of the body
