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Skin - Derm/Plastics > Skin infection > Flashcards

Skin infection Flashcards

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1
Q

What is this?

A

Folliculitis

  • Red papules (bumps) or pustles in hair follicles –> inflammation of hair follicles
  • Can be caused by staph aureus or sterile
    • sterile = caused by physical (epilation) or chemical injury

Usually self-limiting

Ix: skin swab

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2
Q

What is the Rx for folliculitis?

A

Rx:

  • none (usually self limiting)
  • topical mupiricin,
  • fuscidic acid,
  • oral abx
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3
Q

What is this?

A
  • A furuncle (boil)
  • a fluctuant tender warm red nodule
  • it is a deep infection of hair follicle
  • comomonly on back of neck
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4
Q

What is the Ix for boil/furuncle?

A

Ix =

  • skin swab
  • & microbiology
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5
Q

What is the Rx for boil (furuncle)?

A
  • Flucloxacillin
  • +/- incision and drainage
      • it is a thick capsulated structure
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6
Q

What is this?

seen in young child, redness and golden crusting

A
  • Impetigo
  • a common superficial infection of the epidermis
    • VERY INFECTIOUS FROM PUBLIC HEALTH PERSEPCTIVE
      • keep home from daycare etc until CRUST is GONE
  • by staph aureus or strep pyogenes
    *
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7
Q

What Ix do you do for impetigo?

A
  • bacterial swabs
  • & nasal swabs
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8
Q

What is the Rx for impetigo?

A
  • topical antibiotics
  • mupirocin
  • or fusidic acid
  • or flucloxacillin
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9
Q

What is this?

What is the causative agent?

Who does it affect?

A

Staphylococcal scalded skin syndrome

it is caused by staph aureus -> it disrupts the keratinocyte adhesion so the stratum corneum comes away completely giving these erosions

  • specifically the epidermolytic staph aureas infection toxin
    • ​= cleavage of desmoglein 1 complex (desmosomes)

it affects the children, elderly & immunosupressed + adults with renal impairment

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10
Q

What are the ssx of staphylococal scalded skin syndrome?

A

over 1-2 days develop:

  • Fever
  • tender erythema
  • flaccid blisters & bullae
  • superficial erosions

lesions are painful

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11
Q

what Ix do you do for staphylococcal scalded skin syndrome?

A

bacterial swabs

  • nasopharynx
  • perineal
  • skin
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12
Q

What is the Rx for staphylococal scalded skin syndrome?

A
  • ADMIT
  • analgesics
  • emollients
  • IV flucloxacillin
  • supportive therapy

recovery is within 5-7 days

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13
Q

What is this?

Causative agents?

A

cellulitis!

red leg

infection of deep dermis and subcutis

caused by strep pyogenes and staph aureus usually

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14
Q

What are the RF for cellulitis?

A
  • immunosupression
  • wounds
  • leg ulcers
  • minor skin injury
    • (inc athletes foots cracks - make sure heal them)
    • toe web intertrigo (skin rubbing)
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15
Q

What is the Ix for cellulitis?

A
  • bloods, blood cultures,
  • skin swab,
  • check temperature,
  • mark affected area –> importnant to see how redness develops or goes down
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16
Q

What is the Rx for cellulitis?

A

Rx:

  • elevation of affected limb, abx

–> oral pen V & flucloxacillin or IV flucloxacillin (local guidelines), microbiology advice

in pregnancy:

  • Clarithromycin or erythromycin

if penicillin allergic:

  • doxycycline
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17
Q

What is this?

Causitive agent?

A

Erysipelas

(St Antony’s fire)

  • = acute infection of the dermis
  • is caused by group A strep
  • unless DM patient then = staph aureus (~cos skin breaks)
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18
Q

How do you distinguish erysipelas from cellulitis?

A

erysipelas (St Antony’s fire) has a well defined raised red boarder

cellultis = red leg [infection is deep dermis and subcutis vs just dermis in erysipelas]

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19
Q

What are the symptoms of erysipelas?

A
  • pts feel unwell
  • hot, painful, erythematous, odematous area
  • NB: if in face there is risk of invasion into sinuses
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20
Q

What are the risk factors for erysipelas?

A
  • tinea pedis
  • lymphoedema
  • DM
  • previous cellulitis
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21
Q

What are the Ix and Rx for erysipelas?

A

Ix: Swabs, bloods, cultures if febrile

Rx: mark boarder, abx, elevate, fluids

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22
Q

What is this?

purpura (larger BV bleeding), blistering and purple-black

A

Necrotising fasciitis

purple-black = necrosis

infection of the dermis, subcutis and muscle

it spreads along fascial planes so its hard to diagnose early on

EMERGENCY

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23
Q

What are the signs and syx of necrotising fasciitis?

A

Pt is unwell

pain from the lesion out of proportion to size (as inf in fascia)

swelling, poorly defined erythema

purpura, blistering and necrosis

24
Q

What are the RFs for necrotising fasciitis?

A
  • surgery
  • minor trauma
  • immunosupression
25
Q

What Ix should be done for necrotising fasciitis?

A
  • bloods, cultures,
  • skin swab & aspirate blister fluid,
  • XRs (gas in subcutaneous fascia),
  • MRI (surgical planning),
  • deep incisional skin biopsy
26
Q

What is the Rx for necrotising fasciitis?

A
  • analgesia, ICU
  • IV access –> fluid resus, high dose broad spectrum abx,
  • surgical debridement ,
27
Q

What is the difference between HPV warts and common warts?

A

HPV = infection of keratinocytes in the basal cell layer

common warts are hyperkeratotic papules/nodules (raised and under or over 1cm respectively)

28
Q

What do HPV 6&11 cause?

A

genital warts

29
Q

What do HPV 16 & 18 cause?

A

cervical and anogenital SCC

30
Q

How does HPV spread?

A

transmission via direct contact

(the HPV virus is in the basal layer of epidermis)

31
Q

What does this describe?

Bleeding or thrombosed capillaries on plantar side of foot

A

verrucae / plantar warts

32
Q

what does this describe?

skin coloured, flat topped papules

A

plane warts

33
Q

How can anogenital warts be gotten?

A

Sexual or autoinoculation

34
Q

What are the treatments available for warts?

A
  1. Salicylic acid preperations (fungicide & aspirin manufacture)
  2. Cryotherapy
  3. Pulsed dye laser
  4. Anti-mitotic
  5. Immunological – imiquimod cream
35
Q

What types of HSV ulcer infection are there?

and its Rx?

A

HSV1 = skin

HSV2= genital

the virus persists in sensory ganglia of infected patients

lesions recur at the same time

Rx = oral aciclovir

36
Q

What is the herpes (HSV) related complication of eczema?

A

eczema herpeticum!

where the vesicles and/or vesico-pustules form and turn to punched out haemorrhage erosions and can be clustered –> ulcers

they are painful and itchy

37
Q

How do you Ix eczema herpeticum?

A

viral swabs

PCR

& micro

38
Q

How do you Rx ezcema herpeticum?

A

oral / IV acyclovir

avoid steroids

heals over 2-6 weeks

39
Q

What is this?

what ssx & syx?

A

VZV - chickenpox!

Clinical dx

red macules –> vesicles (also in mouth) –> pustules –> crusted (may be haemorrhagic)

lesions are painful or itchy,

heal with no scarring

NB: kids also get fever, headache, myalgia and malaise

transmission is via droplet and direct contact

40
Q

What Ix can do you do chickenpox? (vzv)

A

clinical dx

  • but can swab vesicle base:
  • for direct immunofluorescence
  • & viral swabs,
  • PCR,
  • bacterial swabs
41
Q

What Rx can you give for chickenpox?

A
  • supportive
  • or can give IV aciclovir if immunocompromised
  • oral aciclovir decreases duration of illness IF given w/i 1st 24 hours
42
Q

What does this describe?

  • Localised pain
  • 1 - 3 days before appearance of skin manifestations …
  • Group(s) of red papules which evolve –> vesicles & become confluent
  • Dermatomal distribution
  • Elderly/ immunocompromised

What Ix do you do?

A

Shingles!

Reactivation of varicella zoster (from chickenpox) in the peripheral sensory nerves

  • viral swab vesicle,
  • PCR, +/- bacterial swabs
43
Q

What is the treatment plan for shingles?

A
  • Aciclovir for 5 days within first 72h
  • analgesia
  • +/- antibiotics

Give IV aciclovir if:

  • immunocompromised
  • opthalmic zoster (sc corneal sensation, bacterial infection, scarring)
    • & opthaml referral
44
Q

What use does amitryptyline or gabapentin have in shingles?

A

treating post herpetic neuralgia!

^ is difficult to manage

45
Q

What does this describe/pic show?

  • pearly, pink coloured papules that are umbilicated (dip in middle)
  • can be up to 5mm in diameter

when they resolve they can become inflammed & crusty

BUT NB: lesions can persist for months - years (rarely)

A

Molluscum contagiosum

(poxvirus infection)

–> transmitted by direct contact

common in young children ESP IF

  • Atopic eczema
  • immunosupressed
46
Q

What is the Rx of molluscum contagiosum?

A
  • none or cryotherapy,
  • topical 0.15% podophyllotoxin cream
47
Q

What are dermatophytes?

& how do they transmit?

A

Fungi which cause skin infections e.g.

  • tinea aka ringworm

they transmit indirectly via skin scaled or shed hair

NB: dermatophytes and yeast are superficial fungi where deep fungal infections inc. chromomycosis or sporotrichosis

classic fungi description = asymmetrical, scaly, erythematous, well demarcated expanding margin with central clearing

48
Q

What is this?

& describe it

A

erythema

scaly edge lesion

central clearing

49
Q

what does this describe?

  • rash over left foot
  • scaly & red

& Rx it?

A

tinea pedis - athletes foot

Rx = anti-fungal e.g. topical terbinafine

50
Q

What is tinea cruris?

Ix and Rx?

A

groin rash

Ix = skin scrapings!

Rx = topical or systemic antifungal

51
Q

What is tinea capitis Rx and what else do you need to do?

A

treat with oral & shampoo antifungals

–> or risk ending up with scarring and allopecic patches

= caused by trichophyton tonsurans = HIGHLY INFECTIVE –> Screen FAMILY MEMBERS

52
Q

What is tinea barbae?

Ix & Rx?

A

dermatophyte infection of beard area

Infection of coarse facial hair =

  • inflamed,
  • red,
  • crusty,
  • nodules/pustules,
  • furuncle (boil)

Ix: skin scrapings & hair

Rx: oral antifungals

53
Q

What is it called when tinea is treated using topical steroids (not antifungals) and then the appearance changes - the rash then gets worse when steroids stopped.

It is less scaly, the margin less raised and more pustular and extensive…

A

Tinea incognito

54
Q

What does this describe?

  • intense pruritis
  • itching in web space of fingers
  • crusting
  • tracts
  • spread by skin to skin contact
A
  • Scabies!
  • sarcoptes scabei = the mite

very contageous! esp crusting

tracts are where mites go - the burrows are pathognomonic

the female mite burrows into the epidermis & lays eggs

= allergy to mite eggs

55
Q

What is permethrin or malathion the treatment for?

A

Scabies (sarcoptes scabei)

56
Q

What are >3 painless bites together indicative of?

A

bed bugs!

the common bedbug = cimex lectularius

nocturnal blood sucking ectoparasites

Skin - Derm/Plastics (5 decks)

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