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