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1A Dermatology > Skin Infections and Infestations > Flashcards

Skin Infections and Infestations Flashcards

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Dermatology Board Prep flashcards
1
Q

Skin Infections: types

A

Bacterial
Fungal
Viral

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2
Q

What lives on our skin

A 
Aerobic cocci
Staphylococcus epidermidis (1)++
Staphylococcus aureus* (2)+
Other aerobic and anaerobic bacteria
Corynebacterium
Propionbacterium
Yeasts
Malassezia furfur
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3
Q

signs of an infection:

A 
Erythema
Hot
Tender
Pus
Exudate
Fever
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4
Q

Signs its not an infection:

A
  • No systemic symptoms
  • Rash is not hot, tender and there is no exudate
  • Atopic eczema

Other clues:
* Patient was apyrexial, no rigors *
** Long history of a relapsing rash **
* No growth of pathogens on skin swab *
Not everything which is purulent is an infection

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5
Q

Skin infection Investigations - Bacterial

A

Skin swab for Microscopy, culture and sensitivities (M,C&S)

If clinically indicated:
Full blood count, ESR
U&Es, LFTs, Calcium, CRP
Skin biopsy

Swab – Staphylococcus aureus
blue - cocci (diplo)

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6
Q

Most Common Bacterial Skin infection:

A

Impetigo

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7
Q

Impetigo

A

Impetigo – superficial skin infection

It is the most common bacterial skin infection in children

Scabs around face/mouth

Can be bullous

Staphylococcus aureus, Streptococcus pyogenes

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8
Q

Impetigo Causative Agents

A

Staphylococcus aureus, Streptococcus pyogenes

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9
Q

Impetigo - treatment

IF LOCALISED

A

Always check local formulary
If localised:
Fusidic acid 2% cream 3-4 times daily for 5 days
Mupirocin 2% cream up to 3 times daily for 5 days (if MRSA)

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10
Q

Impetigo - treatment

IF WIDESPREAD, SEVERE, BULLOUS

A

If widespread, severe, bullous:
Flucloxacillin 500mg oral four times daily for 7 days
Erythromycin 500mg oral four times daily for 7 days

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11
Q

Cellulitis/Erysipelas BOTH PRESENT AS:

A

ERYTHEMA

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12
Q

Cellulitis/Erysipelas Causative organisms

A

Cellulitis/Erysipelas
Likely organism
Streptococcus pyogenes,
Staphylococcus aureus

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13
Q

Cellulitis/Erysipelas Treatment - 1st Choice

A

1st choice antibiotic (if severe)
Flucloxacillin 1g IV every 6 hours
plus Benzylpenicillin 1.8g IV every 6 hours

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14
Q

Differential diagnosis

Erythema/Bullae

A

Deep vein thrombosis

Venous eczema

Allergic contact dermatitis

Necrotising fasciitis

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15
Q

Bacterial Infection Management

A 
Take swab
Start antibiotics
Review after ~48hrs
check skin swab result
switch according to sensitivities
If not better in a week:	
consider alternative diagnosis
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16
Q

Tense Bullae, Blisters and Swelling - non-infective cause:

A

Oedema blisters

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17
Q

Oedema blisters:

A

Acute exacerbation of oedema
Dorsum of feet
Often erythematous
Can feel hot

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18
Q

Non-infective venous disease often misdiagnosed as cellulitis

A

Lipodermatosclerosis

19
Q

Lipodermatosclerosis

A 
If acute can be hot and tender
look for signs of venous disease
bilateral (often misdiagnosed as cellulitis)
treatment:
treat underlying venous disease
topical steroids
20
Q

Fungal infections

A

Tinea
Infection by a Dermatophyte
Candidiasis
ROUND - RED RINGS

21
Q

Tinea

A 
Name depends on site affected
Ringworm or Tinea corporis if on body
Tinea capitis if on head
Tinea pedis (Athlete’s foot)
Tinea cruris affects the groin
Onychomycosis affects the nails
22
Q

Tinea capitis

A

head

23
Q

Ringworm or Tinea corporis

A

Body

24
Q

Tinea pedis

A

Feet (Athlete’s foot)

25
Q

Tinea cruris

A

groin

26
Q

Onychomycosis

A

Tinea of nails

27
Q

Fungi Skin Investigations

A

Skin scrapings

Specimens should be inoculated onto primary isolation media, like dextrose agar and incubated at 26-28C for 4 weeks

28
Q

Tinea - treatment

A

Tinea infection of feet, body, hands or groin usually responds to topical treatment:
- Terbinafine or clotrimazole cream

Tinea infection of scalp or nails requires oral antifungals

Check and treat other family members

29
Q

Eczema versus Tinea

A

History
Distribution
Skin scrapings
Eczema is extremely common, Tinea corporis or ringworm very rare

30
Q

Yeasts

A

Candida albicans

can be Infertigo

31
Q

Yeasts - Candida

Treatment:

A

Nystatin, Miconazole, Ketoconazole cream

32
Q

Yeasts- Intertrigo Treatment

A

Intertrigo:
Most cases are secondary to friction and irritating effect of sweat
Can be due to infection or skin condition
Emollient can often help

33
Q

Viral infections

A

Hand/finger warts

Human papilloma virus

34
Q

Viral infections - warts: Advice

A

Warts are contagious but the risk of transmission is low
Children with warts should NOT be excluded from physical activities, but should take care to minimise transmission
Cover the wart with a waterproof plaster when swimming

35
Q

Viral infections - warts:

Treatment

A

Normally not necessary:
Give patient a leaflet on viral warts
Treatments are not very effective
Wart paints and cryotherapy can stimulate immune system
Warts will go away when patient develops immunity against wart virus

36
Q

Viral infections - Molluscum Contagiosum

A

DNA pox virus
Umbilicated papules
May become secondarily infected
Will resolve when patient develops immunity

37
Q

Viral infections - Molluscum Contagiosum:

Treatment

A

5% Potassium Hydroxide

38
Q

Viral Infections - Herpes Simplex Virus (HSV)

A

Herpes simplex 1 and 2
Cold sore
Eczema herpeticum
Treat with aciclovir

39
Q

Viral Infections - Herpes Simplex Virus (HSV)

Treatment

A

Treat with aciclovir

40
Q

Viral Infections - Herpes Zoster Virus

A

Chicken Pox

41
Q

Scabies

A

Scabies
Sarcoptes scabei
Needle scrabing - suction - microscopy - look for mites or burrowing chech hands and genitalia
Also get crusted Norwegain Scabies

42
Q

Crusted Norwegain Scabies

A

Thousands of mites Neurological disease or immunosuppession
Thick white crusts anywhere Need multiple treatments

43
Q

Scabies Treatment

A

Permethrin cream top to toe for 8 hours
Two applications ~ 30g 1 week apart
Oral ivermectin can be used
Not licensed in UK
Treat all in household and close contacts
Explain itch may take 1-4 weeks to settle
treat symptomatically with steroid

44
Q

Key points to remember for Skin Infections

A 
Skin infections are common, but
Pus doesn’t mean infection
Positive swab doesn’t mean infection
Diagnosis is made by history and clinical findings 
Supported by microbiology
Treat empirically then adjust
Ask for advice if required

1A Dermatology (9 decks)

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