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most skin pathologies occur in what layer of the skin?
epidermis
folliculitis
inflammation of the hair follicles
what are the 2 types of folliculitis?
pathogenic or inflammatory
name 3 pathogens that cause pathogenic folliculitis
Staphylococcus or MRSA
Pseudomonas ("Hot Tub" folliculitis)
Pityrosporum yeast
how does pathogenic folliculitis present and how do you differentiate what pathogen is the cause?
crops of red papules/pustules; bacterial culture
inflammatory folliculitis
common in athletes in high sweet or fritiction areas
your patient has a small patch of pathogenic folliculitis from bacteria, what are you prescribing?
mupirocin or clindamycin
your patient has a large patch of pathogenic folliculitis from Staphylococcus bacteria, what are you prescribing?
cephalexin
your patient has a large patch of pathogenic folliculitis from MRSA, what are you prescribing?
trimethoprim-suldamethoazole
a patient comes in red papules/pustules and says she was just recently in a hot tube. what are you prescribing her?
ciprofloxacin (diagnosis: pathogenic folliculitis from pseudomonas bacteria)
your patient has pathogenic folliculitis from pityrosporum. what treatment would you prescribe?
Topical antifungal (Ketoconazole, econazole, terbinafine (OTC- athletes foot))
Oral antifungal (Fluconazole, terbinafine)
what could you prescribe for irritant/inflammatory folliculitis?
Topical corticosteroid (hydrocortisone, triamcinolone, betamethasone)
Oral corticosteroid (prednisone)
Pseudobarbae Folliculitis
bread area
Acne keloidalis nuchae
Occipital scalp
what patient education should you give relating to folliculitis?
Shaving techniques (with the grain, electric razors)
Avoid waxing
Prevention: reduce irritants, drain hot tub water
furuncle
boil; involves 1 hair follicle
carbuncle
several coalescing furuncles developing in the adjacent hair follicles
risk factors for furncles/carbuncles
Bacterial colonization (staph aureus, MRSA)
History of folliculitis
what do furuncles/carbuncles look that?
tender, red, purulent nodule(s)
how to you diagnosis furuncles/carbuncles?
clinical, bacterial culture
whats the treatment for furuncles/carbuncles?
incision and draining (I and D)
antibiotics- cephalexin or TMP-SMX for MRSA
whats the most common pathogen to cause impetigo?
S. Aureus
whats the hallmark for impetigo?
honey colored crusting
how do you diagnosis impetigo?
clinical, bacterial culture
what are you prescribing for your patient with impetigo?
cephalosporin or TMP-SMX for MRSA
herpes simplex virus is never cured t/f
true
1 multiple choice option
what pathogen causes cold sores?
HSV-1
oral HSV may reoccur _________
episodically
symptoms of oral HSV
Local: burning/pain, itching
Prodromal itching or tingling
Constitutional: Fever, malaise (more common on 1st episode)
Gingivostomatitis/pharyngitis (lesions inside mouth)
signs of oral HSV
Small grouped vesicles which rupture leaving ulcers
how do you diagnosis oral HSV?
clinical, Tzanck smear: look for multi- nucleated giant cells
Viral culture
whats the gold standard/best way to diagnosis oral HSV?
viral culture
your patient comes in with recurring, painful cold sores. what are you prescribing?
acyclovir or valacyclovir
what pathogen causes genital herpes?
HSV 2
what are the symptoms of genital herpes?
Recurrent episodes
Small grouped vesicles on an erythematous base
Tender erosions
Vaginal discharge
Prodromal tingling or burning
whats the best way to diagnosis genital herpes?
viral culture
what are the two most common medications for genital herpes?
Acyclovir and Valacyclovir
herpetic whitlow
Vesicles/erosions at the distal finger/junction of the nail bed and skin
how to diagnose herpetic whitlow?
clinical, viral and bacterial cultures
what do you treat herpetic whitlow with?
acyclovir/valacyclovir
herpes zoster
shingles
what pathogen causes herpes zoster?
Varicella zoster virus (VZV)
what are the symptoms/appearance of herpes zoster?
Pain (extreme!) along one nerve route and dermatome (does NOT cross midline)
Pain frequently precedes rash
Grouped vesicles on erythematous base
Unilateral dermatome distribution
a patient comes in with an extremely painful rash, painful eruption of the ear canal and TM, and ipsilateral facial paralysis. whats the diagnosis and what causes it?
Ramsey Hunt Syndrome -
Infection involving the sensory branch of the facial nerve (CN VII)
zoster ophthalmicus/corneal lesions are from the infection of what nerve and what are 2 signs of this diagnosis?
V1 of trigeminal nerve; Dendritic lesion
Hutchinson sign (V2 involvement (nose))
whats the treatment for herpes zoster?
Acyclovir/valacyclovir x 1 week
what is a serious complication of herpes zoster?
Postherpetic Neuralgia
how can herpes zoster be prevented?
Shingrix recombinant vaccine
an immunocompromised patient comes in with red/purple cutaneous papules, plaques, and nodules. what are you doing to diagnosis this patient and how are you treating it?
biopsy; prescribe acyclovir, valacyclovir (diagnosis: Kaposi's sarcoma)
Kaposi's sarcoma is the reactivation of what?
HHV-8
decubitus ulcers
bed sores
prolonged pressure and vascular insufficiency at weight bearing sites in non ambulating patients leads to ischemia and cutaneous necrosis
where do 70% of decubitus ulcers occur?
hip/buttock
how would you grade a decubitus ulcers that extends to subcutaneous fat?
stage 3 (stage :1 skin is unbroken stage 2: skin is broke to epidermis or dermis stage 4: extends to muscle or bone)
what are some risk factors decubitus ulcers?
Immobility
Decreased sensory perception (won't feel pain/discomfort)
Moisture (adult diapers)
Poor nutritional status
Friction
what are the most common pathogens to cause decubitus ulcers?
Gram positives: Staph, strep
Gram negative rods
what are the most effective ways to treat a decubitus ulcer?
debride, relieve pressure, antibiotics
whats the best way to stop decubitus ulcers from happening?
Prevention!!!!!
Reduce pressure
Timely position changes
Stasis ulcers
Patients with lower extremity edema have skin breakdown secondary to venous insufficiency
typical or textbook location of stasis ulcers
medial aspect of ankle
symptoms/signs of stasis ulcers
Mild erythema
Scaling
Erosion with well-demarcated borders
+/- pruritus
what is the treatment for stasis ulcers?
Decrease edema by
(Compression stockings
Elevate limb)
Diuretics
Debride if indicated
Biopsy atypical lesions
Wound care
why do diabetics get ulcers and not know they have them?
Peripheral neuropathy
what are the main 2 pathogens for diabetic ulcers?
Staph
Gram negative rods
treatment of diabetic ulcers
Educate, educate, educate
Prevention
Bed rest, topical antiseptics
Systemic antibiotics
Debridement
Hospitalization with ID consult
If untreated or treatment unsuccessful: surgery
erysipelas
infection of the upper dermis and lymphatics
where are erysipelas typically seen?
on the face or lower legs
what pathogens cause erysipelas?
Group A strep, Streptococcus pyogenes
you suspect a patient has erysipleas. whats signs and symptoms would you expect them to have?
Bright red, hot raised with sharply demarcated edges
Tense, pitting edema
Vesicles or bullae may develop
Progresses rapidly and painfully
Systemic symptoms
May have red streaking
whats the most common way erysipelas is diagnosed?
clinical
what are you prescribing for your patient with erysipleas?
Antibiotic-Penicillin, cephalosporin, macrolide, or clindamycin
cellulitis
breaks in the skin allow infection to develop in the deeper dermis
where does cellulitis typically occur?
lower extremity, almost always unilateral
signs/symptoms of cellulitis
Pain/swelling
Hot
Fever
Erythema +/- streaking (borders non-demarcated)
Regional adenopathy
Malaise
whats normally the pathogens for cellulitis?
Group A Strep, Staphylococcus aureus, or MRSA
your patient comes in with a hot, painful, erythema rash with streaking. they said they were recently bitten by an animal. what pathogen to you think could of caused this?
Pasteurella
how is cellulitis dianosed?
clinical
Blood cultures
+/- Wound bacterial culture
what are you prescribing for your patient with cellulitis?
Penicillin, cephalosporin, clindamycin
If MRSA: Vancomycin
what pathogen causes tinea?
Dermatophytes- Trichophyton rubrum
where are tineas normally located, generically?
superficial
Tinea versicolor
Noninflammatory dermatophyte infection
what pathogen causes tinea versicolor?
Malassezia yeast
where/what is tinea versicolor more common in?
hot climates, athletes
what does tinea versicolor look like and where is it located?
Pink/brown or hypopigmented diffuse macules with fine scale (flat discolorations)
Located on trunk, proximal limbs, neck
whats the pathogen for tinea corporis?
T. rubrum
in what populations is tinea corporis common in?
children and athletes
explain how tinea corporis presents
Erythematous, scaly, annular plaque
Expands in size with central clearing
Raised "active" border
whats the main pathogen for tinea cruris?
T. rubrum
in what population is tinea cruris more common in?
males
describe how tinea cruris presents
Erythema/scaly plaque with expanding active border
Begins in groin crease, spreads to thigh/abdomen
Pruritus/burning
what pathogen causes tinea capitis?
Trichophyton tonsurans
who is the most likely to get tinea capitis?
children and darker ethnicities (black skin)
describe how tinea capitis presents
Erythematous plaque surrounding hair shaft
Gradually enlarges in annular pattern
Hair shafts frequently break/hair loss
kerion
deep severely inflamed form of T.Capitis
what pathogen causes tinea pedis?
T. rubrum
interdigital tinea pedis
scaling/maceration in toe web spaces
moccasin tinea pedis
scaling/erythema on lateral foot surfaces
whats the pathogen for tinea unguium?
T. rubrum
describe how tinea unguium presents
Yellow, thickened nails with onycholysis
Superficial white discoloration
how could you diagnosis tinea?
Fungal Culture
KOH of fine scale
name some topical and oral antifungals that could be used to treat tinea
Topical
-Clotrimazole (OTC)
-Terbinafine (Lamisil) (OTC)
-Tolnaftate (Tinactin) (OTC)
-Naftifine (Lotrimin) (OTC)
E-conazole (Spectazole)
-Ketoconazole (Nizoral)
-Ciclopirox (Loprox, Penlac)
Oral
-Fluconazole
-Terbinafine
-Griseofulvin
-Itraconazole