Skin lesions, solar damage, cancers, skin infections Flashcards
What are the risk factors for cutaneous candida infection?
Broad spectrum antibiotics
Diabetes
General Debility
Immunodeficiency
Obesity
Immobility
What type of skin environment leads to candida infection on the skin?
Usually conditions that make the skin moist or macerated predispose to candida infection
What are 4 treatment steps for this? If drugs are used, please provide dosing.
This is a candida infection
- Keep Skin dry
- Apply a barrier cream like white parafin or zinc oxide
- Topical anti-fungal cream
Clotrimazole 1% cream, applied topically, twice daily until skin is clear
Or miconazole 2% cream same instructions. This is safer for breast candida if breast feeding
- If there is pruritus then you can use a topical steroid such as hydrocortisone 1% cream applied twice daily for 2 weeks
Oral Anti-fungal therapy is not usually needed
What is folliculitis and what are the two main groups of causes ?
It is any inflammation of the hair follicle that presents as a papule or pustule with an erythematous base
Non-infective causes
Infective Causes
What are the infective agents that cause folliculitis?
(Up to 6)
Mostly Staphylococcus Aureus
Sometimes Pseudomonas Aeruginosa (from spas/hot tubs)
Sometimes Malassezia yeasts
Dermophytes
Dermodex mites
Herpes Simplex virus
List non antibiotic management advice for infective folliculitis?
(4)
Warm compressors
Antiseptic wash- benzoyl peroxide or whatever is in Dettol (chloroxylenol)
Clean sharp razors when shaving
Advise patients to avoid triggers
What to do for treatment of folliculitis, thought to be due to Staphylococcus Aureus?
Treat as impetigo
In non endemic settings
For localised lesions
mupirocin 2% ointment or cream topically to crusted areas, 8-hourly for 5 days.
For widespread lesions
Flucloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 days. Stop therapy earlier if infection has resolved.
Dicloxacillin or Cephalexin can be used instead, with the exact same dosing
What is this?
How would you describe it?
This is perioral impetigo
Showing perioral honey coloured crusts
Caused by Staphylococcus Aureus
What are the complications of impetigo?
(7)
Widespread cellulitis
Staphylococcal Scalded Skin syndrome
Scarlet Fever
Post-strephtococcal Glomerulonephritis
Streptococcal Toxic shock syndrome
Post inflammatory pigmentation
Scarring
What is the treatment for Impetigo in ENDEMIC settings?
i.e remote communities in central and northern Australia dosing not required.
benzathine benzylpenicillin intramuscularly as a single dose
FYI
adult: 1.2 million units (2.3 mL)
child less than 10 kg: 0.45 million units (0.9 mL)
child 10 kg to less than 20 kg: 0.6 million units (1.2 mL)
child 20 kg or more: 1.2 million units (2.3 mL)
Or
trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, 12-hourly for 3 days
While the bactrim may be easier to administer, if there is a risk of not following up then give the IM penicillin
Difference between impetigo and bullous impetigo?
non bullous starts with a macule, and might develop a pustule or vesicle, this ruptures usually leaving a honey coloured crust. There is minimal surrounding erythema. Patients are usually well otherwise.
Bullous impetigo have quickly appearing thin walled small or large bullae that spontaneously rupture and ooze a yellow discharge. More likely to cause systemic features. Can affect any part of the body.
What is this?
How do you treat it?
Erythrasma
caused by Corynebacterium minutissimum.
Treat with
fusidate sodium 2% ointment topically, twice daily for 14 days - not actually sure this is available in australia
But can also use
Clarithryomycin 1gram as a single oral dose.
Which virus is responsible for this?
Herpes Simplex virus
Coldsores are commonly caused by _____ _____ ____ and they can be treated with _______________ which is available ____________.
If the outbreak is severe you can use ____________ in an __________.
Children who do not have control over their secretions should be ________ from _______
Herpes Simplex virus
benzydamine 1% gel (adult and child 6 years or older), topically to the lesions, 2- to 3-hourly as necessary.
Over the counter
famciclovir 500 mg orally, 12-hourly for 7 days
adult
excluded, from, school or childcare
What does human papillomavirus cause on the skin?
warty papules or plaques on the skin.