insect bites, infestation, and bacteria

Pruritis which worsens at night, which is especially interdigital

Scabies until proven otherwise

Combination of products to avoid when treating a fungal infection

Antifungals with steroids

Differential diagnoses of Tinea Cruris

Candidiasis,

Seborrheic dermatitis,

Intertrigo,

Psoriasis,

Erythrasma

Complications of Tinea pedis

Portal of entry for bacterial cellulitis

Treatment of macerated Tinea pedalis

20min aluminum acetate soaks, topical turbinafine

Treatment of dry and scaly Tinea pedis

Local Terbinafine, urea 10% lotion

Diagnosis and treatment of Tinea capitis

Confirm with fungal testing (systemic is necessary)

Oral tervinatine

Exception of Tinea capitis treatment

Microsporum responds better to oral Griseofulvin

Presentation of Tinea unguium

Thickened, discolored, brittle, distorted nails separated from the bed

Important diagnostic/treatment note of Tinea unguium:

Systemic treatment rq, so confirm fungal infection

DDx of Tinea unguium:

Trauma, psoriasis, plenty of other nail dystrophies

First line treatment of cutaneous candidiasis

Topical Nystatin or -azole

What tinea infections require systemic therapy?

tinea capitis, tinea unguium

Types of Pediculosis

Capitis, corporis, and pubisW

Where are lice/nits found in pediculosis corporis

clothing seams

Treatment of Pediculosis

Replace/clean contaminated laundry

Permethrin rinse, repeated at day 9

DDx of Pediculosis

Seborrheic Dermatitis

Intense general pruritis which is often worse at night, with 3mm burrows

Scabies signs &Sx

Common areas of scabies itching/burrows

Interdigital, wrists, palms, axillae, areolae, pubis, and scrotum

Important history to take that may indicate scabies

Whether other residents have had itching

What is the more-contagious subtype of scabies?

Crusted scabies

What is an important note once scabies Dx has been reached?

It’s highly contagious (especially crusted scabies)

What infestation skin disease is a major infection control concern?

Crusted scabies

Scabies treatment

Permethrin 5% cream, or oral ivermectin

Counseling for scabies treatment

Pruritis may persist for a time after treatment ends

Types of tinea

Capitis, Corporis, Cruris, Pedis, Unguium

Pruritis, sharp borders, advancing scaly edge, central clearing, sometimes accompanied by maceration/fissuring

Tinea

What discerns tinea cruris from candidiasis?

Scrotum is spared from Tinea cruris

KOH that reveals hyphae

Tineae

Where to take a KOH scaping from on a possible fungal infection?

Advancing border

Treatment of Tinea corporis, cruris, and pedis

Topical Terbinafine

DDx of tinea

Lupus erythematous,

syphilis,

granuloma annulare,

pityriasis rosea,

annular psoriasis

Bright red rash with satellite papules/pustules, often accompanied by maceration

Candidiasis

Common locations of candidiasis

Inframammary and abdominal folds, groin, axillae, diaper, fingers

KOH that reveals pseudohyphae

Candidiasis

Candidiasis treatment

Topical nystatin or -azole

Hypopigmented macules/patches with a fine scale. Asymptomatic, or mild pruritis

Tinea Versicolor

KOH that reveals short, “spaghetti and meatball” hyphae

Tinea Versicolor

Bright red, raised, sharply-demarcated plaque. Possible fever, chills, and malaise

Erysipelas

Superficial lymphatic infection

Erysipelas

What tests can support a clinical diagnosis of erysipelas?

CBC showing leukocytosis, blood cultures

Deep dermis/subcutaneous infection

Cellulitis

Tender, poorly-demarcated erythematous skin

Cellulitis

Tender, poorly-demarcated erythematous skin with associated lymphangitis and lyphadenopathy

Cellulitis

Cellulitis without drainage, fluctuance, or abcess

Non-purulent (strep)

Cellulitis with drainage, fluctuance, or an abcess

Purulent; Staph

Tender, poorly-demarcated erythematous skin which has fluctuance

Purulent cellulitis

Treatment for bright red skin that is raised and sharply demarcated or tender and poorly demarcated, but has no fluctuance

Oral cephalexin or dicloxacillin

IV cefazolin or nafcillin

Penicillin allergy: clindamycin

Oral treatment for suspected erysipelas or non-purulent cellulitis

Cephalexin or dicloxacillin

IV treatment for suspected erysipelas or non-purulent cellulitis

Cefazolin or nafcillin

Penicillin-allergic treatment for suspected erysipelas or non-purulent cellulitis

Clindamycin

counseling & guidelines for suspected erysipelas or non-purulent cellulitis

Reassess response in 1-2d.

If worsening, change antibiotic.

If purulent, change treatment

Maintain meds for 5d to 2 weeks

Treatment for purulent cellulitis

Drain abcess, then TMP-SMZ, doxy, clinda, or vanco

Rapidly-spreading redness with severe pain, can be accompanied by dusky/purple color, bullae, crepitus, or necrosis

Necrotizing Fasciitis

Treatment for suspected necrotizing fasciitis

URGENT surgical consult, and broad-spectrum IV antibiotics

Superficial blisters with purulent material, leaving “honey-colored” crusts

Impetigo

What is Pilonidial disease?

A hair-related acquired PROCESS of cyst formation

Treatment for Pilonidial disease

Drainage, or Surgical ref for chronic cases

Pathogens of folliculitis (3)

Staph (normal)

Pseudomonas (hot tub)

Malassezia (fungal)

Highly pruritic folliculitis

Malassezia (fungal)

Treatments of folliculitis

Top mupirocin or clinda

Dermatitis that presents with pruritis and vesicles

Allergic contact dermatitis

Dermatitis with burning and dryness

Irritant contact dermatitis

Morbilliform/maculopapular eruption with symmetric presentation

Likely cutaneous drug eruption, measles, contact dermatitis, seborrheic dermatitis, or tinea

How to discern between measles and drug eruption?

Correlate with recent drug exposure