Skin infections [completed] Flashcards
What does ASMETHOD stand for?
Age
Self/someone else
Medication
Extra medicines (What person has already tried for presenting complaint)
Time persisting
History
Other symptoms
Danger symptoms
Why may a request for a skin condition be more difficult?
Skin colour and shading - resources often use white skin
Different presentations based on age and skin tone
- e.g chicken pox in children is on whole body and in adults is mostly head and neck.
May not be able to see affected skin
What additional question should be asked for a kin complaint?
- What does it feel like? soft/ hard raised/flat
- Does it itch?
- Does it bleed?
- Recent lifestyle changes?
- Is there pain?
- Allergies?
How should you finish off a consultation for a skin complaint?
How will a patient know if it is getting better or worse? changes in look/feel/other symptoms?
What should they do if it doesn’t go away?
What if it comes back again? If infection, certain treatments may suppress it for a while but can be reinfected
What is cellulitis?
- Deep tissue infection of the dermis/ subcutaneous layer
What are some symptoms of cellulitis?
- Commonly occurs in lower limb
Red
Hot
Very painful - burning sensation
Oedema
Tightness
Rash will grow in size
May get a fever
How can a patient track the size of a rash in cellulitis?
Use a pen to draw a line around the border to see if it grows
What should be done if a person with cellulitis also presents with chills and joint pain?
Refer - could be septicaemia as infection has spread through body could lead to blistering and necrosis
What are the common causes of cellulitis?
Staph aureus and Strep pyogenes - naturally flora
Key questions to ask in suspected cellulitis?
How long have they had symptoms?
Trauma to area? skin break, bite or ongoing condition
Additional symptoms (FEVER AND CHILLS)
Who are some vulnerable groups for cellulitis?
Elderly
Anyone with abrasion or skin trauma (e.g. athletes foot)
Anyone who has had an insect bite
Overweight
Poor venous flow to extremities
Ulceration
Diabetes
Immunocompromised
How is cellulitis diagnosed?
Visual diagnosis and question is usually sufficient but IN CLINICAL SETTING could aspirate fluid and look for organisms with microscopy
What is uncomplicated cellulitis?
No systemic toxicity or uncontrolled comorbidities
What antibiotics may be given to treat cellulitis if flucloxacillin is inappropriate:
Doxycycline 200mg on day 1 then 100mg ONCE A DAY for a total of 5-7 days.
Clarithromycin 500mg TWICE A DAY for 5-7 days (PENICILLIN ALLERGY)
What should be done straightaway if a person with cellulitis has just returned from abroad?
Test using swab or aspiration
What is some non drug advice that could be given to patients with cellulitis?
Raise the affected limb and drink plenty of fluids
Rest the effected limb and elevate it with a pillow or stool to relieve oedema
When should patients refer back in cellulitis?
- issues with medication , worsening of symptoms or systemic symptoms
How long should it take for a patient to see an improvement with cellulitis after treatment?
7 days (review after 2 days)
What are the classes of cellulitis?
Class I - no signs of systemic toxicity or uncontrolled comorbidities (uncomplicated)
Class II - person may be systemically well/unwell BUT has a comorbidity that could complicate or delay resolution.
Class III - significant systemic upset such as confusion, hypotension or tachycardia OR they have unstable comorbidities or a lim-threatening infection due to vascular compromise
Class IV - sepsis or life-threatening infection such as necrotising fasciitis
What is impetigo?
An superficial infection of the epidermis caused by staph aureus or strep pyogenes penetrating through a breach in the skin.
Who is impetigo common in?
Pre school children
People who live in hot areas
Young adults
elderly
How doe BULLOUS impetigo present?
Bullae - fluid filled lesions over 1-2cm in diameter
Blister rupture leaving a thin flat yellow/brown crust
Redness
How does NON BULLOUS impetigo present?
Thin walled vesicles or pustules that break easily so may not even be sene on clinical examination. Exudate released forms a golden brown crust
Where on the body is impetigo common?
Face and other exposed skin
What other symptoms may a person with impetigo experience?
Itching and pain
How does impetigo spread?
Through skin to skin contact. Spreads rapidly.
Can spread to other people or other areas of a person’s body
What advice is given for the treatment/prevention of spread of uncomplicated impetigo?
Clean and remove crusts
Wash affected areas with soap and water
Washes hands regularly especially after touching affected areas
Dont scratch
Dont share towels, face cloths, person care products
Thoroughly clean contaminated toys
How long should a person who has impetigo stay away from school or work?
Stay away from school or work until lesion are healed, dried and crusted
OR 48 hours after antibiotics/hydrogen peroxide treatment is initiated
What MUST food handlers who have impetigo do?
REQUIRED BY LAW TO INFORM EMPLOYER IMMEDIATELY
What is the drug treatment for localised non-bullous impetigo?
If person is systemically unwell/ at high risk of complications:
Hydrogen peroxide 1% cream to be used TWO OR THREE TIMES A DAY for FIVE DAYS
Fusidic acid 2% to be used THREE TIMES A DAY for FIVE DAYS
or
Mupirocin 2% to be used THREE TIMES A DAY for FIVE DAYS
Special nasal products if in nose or around margin of nose.
What is the drug treatment for widespread non-bulous impetigo?
If person is NOT systemically unwell and has no other conditions:
Fusidic acid 2% to be used THREE TIMES A DAY for FIVE DAYS
or
Mupirocin 2% to be used THREE TIMES A DAY for FIVE DAYS
Special nasal products if in nose or around margin of nose.
OR
Oral flucloxacillin 500mg FOUR TIMES A DAY for 5 DAYS
(If penicillin allergy - clarithromycin 250mg TWICE A DAY FOR 5 DAYS)
What can be given to provide symptomatic relief of itching in impetigo?
Oral antihistamine such as chlorphenamine (piriton)
What is dandruff?
A common skin condition caused by increased skin production and turnover. It may also be caused due to an overgrowth of malassezia yeast on the scalp.
What can make dandruff worse?
Stress
Overwashing
Use of certain gels, serums etc
What can be seen in a patient with dandruff?
Dry white and grey flakes on the hair and clothes
How can dandruff be treated?
Anti-dandruff shampoos:
- T gel
- Alpecin
- Head and Shoulders
What is sebborhoeic dermatitis?
A condition of the scalp possibly caused by an overreaction of malassezia years which leads to chronic inflammation - may also be in other areas. It is more severe than dandruff.
What symptoms may a person with seborrhoea dermatitis present with?
Thick YELLOW flakes (not white like dandruff)
Oily appearance
Redness of skin - scalp, hairline, foreheads, cheeks etc
What is sebborhoeic dermatitis in children called?
Cradle cap - resolves by 8-12 months old
What is seborrhoea dermatitis like in adults?
Chronic and may fluctuate
How is sebborhoiec dermatitis of the scalp or beard treated?
- antidandruff shampoos (e.g. head and shoulders)
- Antifungal shampoos such as ketoconazole 2% (nizoral), selenium sulphide (Selsun) and coal tar (Polytar)
Treatment must be continued in the long term.
If a person with seborrhoeic dermatitis is referred what can be prescribed for them?
Corticosteroids - betamethasone valerate 0.1%
What treatment is given for seborrhoea dermatitis of the body?
Ketoconazole 2% CREAM
Topical imidazole (clotrimazole)
Ketoconazole shampoo such as nizoral to use as body wash
Hydrocortisone 1% cream for FLARES
What is tinea corporis? How does this present?
Fungal infection of the body also known as ringworm.
Ring shaped with red scaly ri, and clear on inside. Starts small and grows. Demarcated border.
What is tinea cruris? How does this present?
Also known as jock itch or dhobi itch.
Occurs at the top of the thigh/inner thigh as this is a warm and most area due to sweating.
Who is at risk of tinea cruris?
Overweight patients
Men who wear close fitting underwear
Lack of air to groin area
People with tinea pedis (athletes foot) - if foot touches underwear can spread to groin.
What is tinea unguium?
Fungal nail infection.
Thick yellowing nails. nail can become brittle and life away from nail bed or if it spreads to the skin the nail breaks off taking skin with it which is very painful.
Who is tinea unguium common in?
Older people or young people who use communal showers
What is tinea capitis?
fungal infection.
Ringworm of the scalp
What are the drug treatments for tinea (NOT ON NAIL) infections?
FUNGICIDALS
- Terbinafine 1% cream or spray bought OTC and used ONCE OR TWICE A DAY FOR & DAYS
FUNGISTATICS
- miconazole, clotrimazole, ketoconazoles (can be combined with hydrocortisone if there is inflammation) used 2-3 times a day and continued after infection is gone.
-tolnaftate
- undecenoates
What drug treatment is given in tinea unguium?
Amorolfine 5% nail lacquer applied once a week - file nail infected area before use
Needs to be used for 6-12 months or more
What is some non drug advice that can be given for tinea infections?
Hygiene daily washing and dry throughly
Do not share towels and sheets - wash often
Avoid tight clothing, underwear, uncomfortable shoes
Change socks daily
allow skin to breathe
Use an antifungal powder for prevention
Do not scratch
Look after skin - clean and moisturised to keep skin integrity
What can tinea be easily confused with?
Intertrigo which is caused by Candida albicans. However, intertrigo is not round it sits in the fold and is completely red (no clear centre) and there is also no scaling.
What is the treatment for intertrigo?
Same as tinea infections
Fungicidal terbinafine
Ketoconazole, miconazole, econazole - with hydrocortisone if necessary
What is hand, foot and mouth disease?
A viral infection that is seen commonly in young children. It is acute and self-limiting unless it leads to secondary infection. The causative organism is Coxsackie 16 virus.
What are the symptoms of hand, foot and mouth disease?
Vesicles (blisters) in the mouth, feet and hands
Prodrimal symptoms of fever, malaise, myalgia, abdominal pain, sore mouth, cough, eating less
How soon do symptoms arise after infection with Coxsackie 16 virus and how soon do they resolve?
3-7 days incubation
prodromal symptoms
1-2 days later lesion appear
Take 7-10 days to heal
Some may start to feel unwelll but may take 4-8 weeks for symptoms to appear
How can hand, foot and mouth disease be transmitted?
Secretions from infected person - fluid from blister
Faeco-oral route (not washing hands thoroughly)
What are the drug treatments for hand foot and mouth disease?
Paracetamol and ibuprofen
What is the non-drug advice for hand, foot and mouth disease?
Soft food diet if vesicles in mouth are painful
Adequate fluid intake (may hurt to drink) - signs of dehydration are reduced urine, lethargy, cold peripheries, and reduce skin turgor
Antibiotics not needed as viral infection
Washing and drying hands thoroughly before eating and after going to the toilet
Covering mouth and nose when sneezing or coughing.
Wipe nose and mouth with disposable tissues
Care when handling used tissues and nappies (virus carried in faecal matter)
Hot cycle wash for soiled clothing bedding and towels.
Do not share cups, towels, clothes or eating utensils
DO NOT deliberately pierce blisters
AVOID contact with pregnant women
