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Skin infection Flashcards

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
What Ix should be done for necrotising fasciitis?
* bloods, cultures, * skin swab & aspirate blister fluid, * XRs (gas in subcutaneous fascia), * MRI (surgical planning), * deep incisional skin biopsy
26
What is the Rx for necrotising fasciitis?
* analgesia, ICU * IV access --\> fluid resus, high dose broad spectrum abx, * surgical debridement ,
27
What is the difference between HPV warts and common warts?
HPV = infection of keratinocytes in the basal cell layer common warts are hyperkeratotic papules/nodules (raised and under or over 1cm respectively)
28
What do HPV 6&11 cause?
genital warts
29
What do HPV 16 & 18 cause?
cervical and anogenital SCC
30
How does HPV spread?
transmission via direct contact (the HPV virus is in the basal layer of epidermis)
31
What does this describe? Bleeding or thrombosed capillaries on plantar side of foot
verrucae / plantar warts
32
what does this describe? skin coloured, flat topped papules
plane warts
33
How can anogenital warts be gotten?
Sexual or autoinoculation
34
What are the treatments available for warts?
1. Salicylic acid preperations (fungicide & aspirin manufacture) 2. Cryotherapy 3. Pulsed dye laser 4. Anti-mitotic 5. Immunological -- imiquimod cream
35
What types of HSV ulcer infection are there? and its Rx?
HSV1 = skin HSV2= genital the virus persists in sensory ganglia of infected patients lesions recur at the same time Rx = oral aciclovir
36
What is the herpes (HSV) related complication of eczema?
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
How do you Ix eczema herpeticum?
viral swabs PCR & micro
38
How do you Rx ezcema herpeticum?
_oral / IV acyclovir_ avoid steroids heals over 2-6 weeks
39
What is this? what ssx & syx?
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
What Ix can do you do chickenpox? (vzv)
clinical dx * but can swab vesicle base: * for direct immunofluorescence * & viral swabs, * PCR, * bacterial swabs
41
What Rx can you give for chickenpox?
* **supportive** * or can give _IV aciclovir_ _if immunocompromised_ * oral aciclovir decreases duration of illness *IF given w/i 1st 24 hours*
42
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?
Shingles! Reactivation of varicella zoster (from chickenpox) in the peripheral sensory nerves * viral swab vesicle, * PCR, +/- bacterial swabs
43
What is the treatment plan for shingles?
* 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
What use does amitryptyline or gabapentin have in shingles?
treating post herpetic neuralgia! ^ is difficult to manage
45
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)
**_Molluscum contagiosum_** **_(poxvirus infection)_** --\> transmitted by *direct contact* common in _young children_ ESP IF * Atopic eczema * immunosupressed
46
What is the Rx of molluscum contagiosum?
* none or cryotherapy, * topical 0.15% podophyllotoxin cream
47
What are dermatophytes? & how do they transmit?
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
What is this? & describe it
erythema scaly edge lesion central clearing
49
what does this describe? * rash over left foot * scaly & red & Rx it?
tinea pedis - athletes foot Rx = anti-fungal e.g. topical terbinafine
50
What is tinea cruris? Ix and Rx?
groin rash Ix = skin scrapings! Rx = topical or systemic antifungal
51
What is tinea capitis Rx and what else do you need to do?
treat with oral & shampoo antifungals --\> or risk ending up with scarring and allopecic patches = caused by trichophyton tonsurans = HIGHLY INFECTIVE --\> Screen FAMILY MEMBERS
52
What is tinea barbae? Ix & Rx?
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
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...
Tinea incognito
54
What does this describe? * intense pruritis * itching in web space of fingers * crusting * tracts * spread by skin to skin contact
* 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
What is permethrin or malathion the treatment for?
Scabies (sarcoptes scabei)
56
What are \>3 painless bites together indicative of?
bed bugs! the common bedbug = **cimex lectularius** nocturnal blood sucking ectoparasites

Skin - Derm/Plastics (5 decks)

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