Term
| What are examples of bacterial infections/pyodermas? |
|
Definition
-impetigo
-ecthyma
-abscess
-cellulitis
-folliculitis |
|
|
Term
| What are common pathogens of bacterial skin infections? |
|
Definition
-Staphylococcus Aureus Coagulase Positive
-Group A Beta-Hemolytic Streptococcus (GAS) |
|
|
Term
| What factors promote colonization by staph and gas? |
|
Definition
Environmental
-warm weather
-high humidity
-crowded, unsanitary living
Patient
-poor hygiene
-antibiotics
-systemic d/o: DM, immune deficiency
-health care workers
-dialysis
-drug user
Dermatologic
-atopic dermatitis
-trauma: insect bite, abrasions
-rhinorrhea |
|
|
Term
| What are risk factors for Community Acquired MRSA? |
|
Definition
-young age
-participation in contact sport
-sharing towels or athletic equipment
-weakened immune system
-crowded or unsanitary living conditions
-association with health workers |
|
|
Term
| What is clinical presentation of impetigo? |
|
Definition
-commonly on face, buttocks
-regional lymphadenopathy |
|
|
Term
| What are the types and characteristics of impetigo? |
|
Definition
Bullous
-staph
-flaccid bullae
-moist red surface after rupture
Non-bullous
-strep or mixed
-small vesicles
-honey colored crust after rupture |
|
|
Term
| What are diagnostic tests for impetigo? |
|
Definition
|
|
Term
| What is the differential diagnosis for impetigo? |
|
Definition
-herpes simplex, herpes zoster
-contact dermatitis |
|
|
Term
| What is the management for impetigo? |
|
Definition
Education
-etiology
-contagiousness
-treatment
Localized
-Mupirocin 2% cream (Bactroban) TID x3 days
Oral abx
-cephalexin (Keflex) 40-50 mg/kg/day divided TID x10 days
-amoxicillin plus clavulanic acid (Augmentin) 20-40 mg/kg/day BID x10 days
-dicloxacillin 50 mg/kg/day, 250 mg QID x10 days
Recurrences
-nasal mupirocin 2% BID x5 days repeated monthly for months |
|
|
Term
| What is the clinical presentation of abscess? |
|
Definition
-pus-filled nodule in dermis/subcutaneous fat/muscle
-firm red tender nodule, more fluctuant and painful with time
- +/- overlying skin changes consistent with cellulitis |
|
|
Term
| What is the management of abscesses? |
|
Definition
-incision and drainage (I&D)
-culture drainage for sensitivity
-Xray if trauma or foreign body suspected
-warm soaks
-antibiotics
---clindamycin 20-40 mg/kg/day x10 days
---Bactrim DS 1 tab BID x100
---doxycycline 100 mg BID x10 days
---Augmentin 40 mg/kg/day x10 days
-close follow up |
|
|
Term
| What is the etiology of cellulitis? |
|
Definition
-infection of deep dermis and subcutaneous tissue
-strep or staph
- +/- preceding injury |
|
|
Term
| What is the clinical presentation of cellulitis? |
|
Definition
-acute onset of a tender warm, erythematous, edematous firm plaque with indefinite borders
-systemic symptoms
-lymphadenitis |
|
|
Term
| What are diagnostic tests for cellulitis? |
|
Definition
-CBC: possible mild-moderate elevation of WBC
-ESR: elevated
-blood culture: usually negative
-Xray: trauma, foreign body |
|
|
Term
| What is the management of cellulitis? |
|
Definition
-hospitalization or prolonged ER stay for IV abx
-close follow-up for outpatient abx
---clindamycin 20-40 mg/kg/day x10 days
---Bactrim DS 1 tab BID x100
---doxycycline 100 mg BID x10 days
---Augmentin 40 mg/kg/day x10 days
-warm soaks
-elevation
-rest |
|
|
Term
| What are characteristics of periorbital and orbital cellulitis? |
|
Definition
-young children
-eyelid swelling
-illness s/s
-serious sequelae |
|
|
Term
| What are characteristics of streptococcal perianal cellulitis? |
|
Definition
-young children
-perianal redness
-pain with defecation
-afebrile and otherwise well
-culture
-abx |
|
|
Term
| What is the etiology of folliculitis? |
|
Definition
-usually staph aureus
-gram negative folliculitis from hot tub |
|
|
Term
| What is the clinical presentation of folliculitis? |
|
Definition
-small pustule at base of hair shaft
-multiple lesions
-adolescents and young adults |
|
|
Term
| What is the management of folliculitis? |
|
Definition
-antiseptic cleaners
-topical abx, oral if extensive |
|
|
Term
| What is the relationship between folliculitis, furuncle, and carbuncle? |
|
Definition
-furuncle (boil) evolves from superficial folliculitis
-carbuncle: interconnected aggregate of infected furuncles |
|
|
Term
| What is the etiology of paronychia? |
|
Definition
-infection around nailbed, usually of big toe
-secondary to in-grown toenail after improper cutting |
|
|
Term
| What is the management for paronychia? |
|
Definition
-soaks
-oral and topical abx
-nail resection |
|
|
Term
| What are examples of fungal skin infections? |
|
Definition
-tinea capitis: head
-tiena corporis: body, "ringworm"
-tinea cruxis: groin, "jock itch"
-tinea pedis: feet, "athlete's foot"
-tinea unguium: nails
-tinea versicolor |
|
|
Term
| What are factors of transmission for fungal skin infections? |
|
Definition
-often trichophyton tonsurans
-mildly contagious
-inanimate object, animal transmission
-warmth, moisture, recurrent trauma |
|
|
Term
| What are diagnostic tests for fungal skin infections? |
|
Definition
-Woods lamp
-KOH prep
-culture |
|
|
Term
| What are sources of transmission for tinea capitis? |
|
Definition
-combs, brushes, hats
-animal to man |
|
|
Term
| Who is most often affected by tinea capitis? |
|
Definition
-school age children
-African American |
|
|
Term
| What are diagnostic tests for tinea capitis? |
|
Definition
-Woods lamp
-KOH or culture with broken off hair |
|
|
Term
| What are clinical manifestations of tinea capitis? |
|
Definition
-hair loss
-inflammation: scaling, redness
-black dot pattern: broken off hairs, alopecia, no scaliness
-kerion: inflamed, boggy, tender area of alopecia
-pustular type: scattered pustules without scaliness or alopecia
-seborrheic type: diffuse or patchy adherent scale |
|
|
Term
| What is the differential diagnosis for tinea capitis? |
|
Definition
-alopecia areata
-traction alopecia
-trichotillomania
-seborrheic dermatitis
-bacterial infection |
|
|
Term
| What is the management for tinea capitis? |
|
Definition
-oral antifungal taken with a fatty meal, Griseofulvin 10-25 mg/kg/day x6-8 weeks
-selenium sulfide 1% shampoo (Selsun) 2x/week |
|
|
Term
| What are the clinical manifestations of tinea corporis? |
|
Definition
-gradually expanding red ring
-red raised active margin usually scaly or papular
-annular, with central clearing
-mildly pruritic |
|
|
Term
| What are diagnostic tests for tinea corporis? |
|
Definition
-usually not used
-Woods lamp
-KOH: scrape edge of lesion |
|
|
Term
| What is the differential diagnosis for tinea corporis? |
|
Definition
-erythema migrans (Lyme)
-pityriasis rosea (Herald Patch)
-granuloma annulare
-nummular eczema
-psoriasis |
|
|
Term
| What is the management of tinea corporis? |
|
Definition
Education
Topicals BID x6 weeks
-clotrimazole (Lotrimin)
-miconazole (Monistat-Derm)
-ketoconazole (Nizoral)
Systemic
-itraconazole
-terbinafine
-fluconazole |
|
|
Term
| What is the etiology of tinea cruxis? |
|
Definition
| dermatophyte infection of the groin and upper thighs |
|
|
Term
| What is the clinical presentation of tinea cruxis? |
|
Definition
-bilateral crescent-shaped
-reddish, scaly lesions
-sharply defined raised borders
-inner thighs, intertriginal folds
-spares the scrotum
-itching
-may occur simultaneously with tinea pedis (check feet) |
|
|
Term
| What is management of tinea cruxis? |
|
Definition
-education
-keep area clean and dry
-avoid tight fitting undergarments, jock straps; use 100% cotton
-prevention: tinactin powder, especially in hot weather
-medications
---clotrimazole (Lotrimin)
---miconazole (Monistat-Derm)
---ketoconazole (Nizoral)
---itraconazole
---terbinafine
---fluconazole |
|
|
Term
| What is the incidence of tinea pedis? |
|
Definition
-increases with age after puberty
-males > females
-shoes, locker rooms, communal baths
-with other tinea infections |
|
|
Term
| What is the differential diagnosis for tinea pedis? |
|
Definition
-eczema
-psoriasis
-contact dermatitis
-dry skin
-hyperhidrosis
-dyshidrotic eczema |
|
|
Term
| What is the management for tinea pedis? |
|
Definition
Acute
-clotrimazole (Lotrimin)
-miconazole (Monistat-Derm)
-ketoconazole (Nizoral)
-spectazole
-Burrow's wet dressings x30 min daily
Recurrent/Chronic
-heavy cotton socks, changed frequently
-sandals or barefoot when possible
-wider shoes
-powders on foot that absorb moisture (Zeasorb) |
|
|
Term
| What is the incidence of tinea unguium? |
|
Definition
-rare before puberty
-with other fungal infections |
|
|
Term
| What is the clinical presentation of tinea unguium? |
|
Definition
-subungal debris with separation from the nail bed
-yellow, white discoloration
-looks "eaten away" distally
-dry, soft, powdery surface |
|
|
Term
| What is the differential diagnosis for tinea unguium? |
|
Definition
-psoriasis: nail pitting
-leukonychia: trauma-induced white spots
-oncycholysis: separation of nail plate from finger, common in women with long nails |
|
|
Term
| What is the management for tinea unguium? |
|
Definition
-long-term oral antifungals with monitoring of LFTs and CBC
---terbinafine (Lamisil) 250 mg/day
---itraconazole (Sporanox)
-topical creams |
|
|
Term
| What is the etiology of tinea versicolor? |
|
Definition
| -superficial yeast infection by normal skin inhabitant, pityrosporum |
|
|
Term
| What is the incidence of tinea versicolor? |
|
Definition
-adolescents and young adults (years of higher sebaceous activity)
-increased in heat and humidity, tropics |
|
|
Term
| What is the clinical presentation of tinea versicolor? |
|
Definition
-multiple round or oval shaped finely scaling patches
-several colors, uniform in each person: white (hypopigmented), pink, tan (hyperpigmented)
-skin fails to tan
-non-pruritic
-upper trunk and arms |
|
|
Term
| What are diagnostic tests for tinea versicolor? |
|
Definition
-Woods lamp: lesions fluoresce
-KOH: "spaghetti and meatballs" pattern |
|
|
Term
| What is the differential diagnosis for tinea versicolor? |
|
Definition
-vitiligo: depigmented lesions don't scale
-post-inflammatory hypopigmentation
-pityriasis rosea
-guttate psoriasis |
|
|
Term
| What is the management for tinea versicolor? |
|
Definition
Shampoos
-selenium sulfide or ketoconazole (Nizoral) applied to skin, left on for 5-10 min or overnight
-repeated after 1 week, then monthly |
|
|
Term
| What are the 3 forms of lice? |
|
Definition
-egg (nit)
-nymph (young)
-adult |
|
|
Term
| What are the risk factors for head lice? |
|
Definition
-caucasian
-females
-school age
-low income
-direct or indirect contact |
|
|
Term
| What is the clinical presentation of head lice? |
|
Definition
-prominent itching
-nits adhering to hair shaft
-"bite marks", erythematous papules
-adenopathy
-lice- nymph, black dot; adult- larger |
|
|
Term
| What are diagnostic tests for lice? |
|
Definition
-examine nit/lice under magnification
-nits fluoresce under Woods lamp |
|
|
Term
| What is the differential diagnosis for head lice? |
|
Definition
-seborrheic dermatitis
-hair contamination
-dandruff
-contact dermatitis
-insect bites |
|
|
Term
| What is the management for head lice? |
|
Definition
Medications
-permethrin rinse 1% (Nix cream rinse)
-permethrin based shampoo (RID)
-permethrin 5% cream (Elimite)
-malathin lotion 0.5% (Ovide)
-Vaseline
-Ivermectin- single dose
-Bactrim |
|
|
Term
| What are features of pubic lice? |
|
Definition
-crab body structure
-sexual transmission
-eyelashes, eyebrows, beard
-prominent itching |
|
|
Term
| What is the management of pubic lice? |
|
Definition
-same medications as head lice
-eyelashes- Vaseline BID x8 days
-treat sexual contacts
-suspect abuse in young children
-assess for STIs |
|
|
Term
| What is the etiology of scabies? |
|
Definition
-microscopic mite that invades the skin
-specific to humans |
|
|
Term
| What are features of scabies transmission? |
|
Definition
-prolonged contact needed
-rarely by fomites |
|
|
Term
| What is the clinical presentation of scabies? |
|
Definition
-itching: severe, worse at night
-lesions: papules, vesicles, wheals, linear burrows, excoriation, infection
-location: older children- interdigital space, wrist, elbows, ankles, buttocks, umbilicus, groin, axilla; infants- palms, soles, face, scalp |
|
|
Term
| What is a diagnostic test for scabies? |
|
Definition
| microscopic exam of lesions, scrapings |
|
|
Term
| What is the differential diagnosis for scabies? |
|
Definition
-varicella
-herpes
-hand-foot-mouth
-contact dermatitis |
|
|
Term
| What is the management for scabies? |
|
Definition
Medications
-permethrin (Elimite): pts and contacts, wash off after 8-12 hours, repeat in 1 week
-atarax/benadryl
-topical hydrocortisone
Wash all clothes, sheets
Return to school |
|
|
Term
| What types of warts does HPV cause? |
|
Definition
-common
-plantar
-flat
-venereal |
|
|
Term
| What skin condition does the pox virus cause? |
|
Definition
|
|
Term
| What is the incidence of verrucae? |
|
Definition
-7-10% of population
-10-19 year olds |
|
|
Term
| What is the clinical presentation of verrucae vulgaris (common warts)? |
|
Definition
-round, discrete, flesh colored single papule --> larger, darker (yellow brown), roughened, multiple surfaces
-black dots on surface
-common sites: hands, periungual area, elbows, knees |
|
|
Term
| What is the management for verrucae? |
|
Definition
-salicylic acid 15-40% applied daily x8-12 weeks (Mediplast for plantar, Duofilm for common)
-Imiquimod 5% cream (Aldara) for molluscum, common, flat
-duct tape x6 days, soak, debride
-refer to dermatology for liquid nitrogen, surgery, cauterization |
|
|
Term
| What is the clinical presentation of molluscum contagiosum? |
|
Definition
-prepubertal: face, axilla, proximal extremities; postpubertal: genital
-lesions: white-flesh colored, 1-6 mm discrete papules, central umbilication, extrude keratinous contents |
|
|
Term
| What is the management for molluscum contagiosum? |
|
Definition
-wait
-curettage to remove central core |
|
|
Term
| What is the clinical presentation of herpes simplex? |
|
Definition
-grouped vesicles on an erythematous base
-crust formation |
|
|
Term
| What are diagnostic tests for herpes simplex? |
|
Definition
-24 hour culture
-Tzank smear
-fluorescent antibody testing |
|
|
Term
| What is the management of herpes simplex? |
|
Definition
-acyclovir (Zovirax) 400 mg 5x/day x7 days
-valacyclovir (Valtrex) 1000 mg BID x10 days |
|
|
Term
| What is the clinical presentation of atopic dermatitis (eczema)? |
|
Definition
-begins in childhood
-pruritic, erythematous, papovesicular eruption
-progresses to scaling, lichenified, changes of the skin |
|
|
Term
| What is the incidence of atopic dermatitis? |
|
Definition
-3-15% of children
-60% develop by 1 year of age, 90% by 5 years |
|
|
Term
| What is the etiology of eczema? |
|
Definition
-unknown
-associated with allergies, family history, immunologic alteration |
|
|
Term
| What is the relationship between eczema and other atopic conditions? |
|
Definition
| 60% of children with eczema will develop asthma, allergic rhinitis, or other atopic conditions |
|
|
Term
| What is the relationship between eczema and family history? |
|
Definition
| 70% of eczema have a family history of one or more principal allergic d/o |
|
|
Term
| What skin conditions can arise as a complication of eczema? |
|
Definition
-warts
-tinea
-eczema herpeticum: severe, diffuse herpes infection |
|
|
Term
| What are clinical presentations of eczema? |
|
Definition
-itching: prevalent, paroxysms, nighttime
-rash: variable appearance, intensity, location
-appearance: variable; erythematous, scaly, vesicular, oozing, crusting, lichenification
-chronic: exacerbation, remission; 75% resolve, 25% continue into adulthood |
|
|
Term
| What are exacerbating factors of eczema? |
|
Definition
-temperature change: increased warmth, decreased humidity
-excessive bathing
-contact with irritating substances
-emotional stress |
|
|
Term
| What is the management of eczema? |
|
Definition
-bathing: tepid water, moisturizing soap, oil afterward
-moisturizing: 1-3x/day with creams or ointments (Eucerin, Aquaphor, Vaseline)
-hydrocortisone cream: potency according to age, severity, location; sparingly, not to face, 1-2x/day, not under occlusion, not >2wks
-antihistamines: to decrease itching, Benadryl 5 mg/kg/day, Atarax, Zyrtec |
|
|
Term
| What is management of skin complications of eczema? |
|
Definition
-staph infection: cephalexin 25-50 mg/kg/day TID-QID x10 days
-herpes infection: acyclovir 20 mg/kg/day x5 days
-augmentin 20-40 mg/kg/day BID x10 days |
|
|
Term
| What are the 2 types of contact dermatitis? |
|
Definition
Allergic
-delayed hypersensitivity reaction
-poison ivy, metal (nickel), rubber additives (shoes), additives in skin products (sunscreens, cosmetics)
Irritant
-exposure to irritants (detergents, paints) |
|
|
Term
| What is the clinical presentation of contact dermatitis? |
|
Definition
-timing: a few to 48-72 hours after exposure
-itching
-location: based on area of exposure
-appearance: varying degrees of erythema, vesicles, papules, scaling, edema
-resolution: 1-2 weeks |
|
|
Term
| What is the management of contact dermatitis? |
|
Definition
-remove offending agent
-topical and possibly oral steriods
---triamcinalone 1% cream BID x2 weeks
---prednisone (Orapred, Prednisone) 1-2 mg/kg/day
-anti-itching
---oral Benadryl
---Atarax
---Zyrtec
---Claritin
---Aveeno bath
-drying preparations
---Burrows solution
---Calamine lotion
-referral to allergist |
|
|
Term
| What is the etiology of urticaria? |
|
Definition
-ingestants: foods, additives, drugs (abx)
-inhalants: dust, pollen
-injectants: stings (bees), bites, drugs
-infections: strep throat, infectious mono, hepatitis
-internal dz: systemic lupus, thyroid |
|
|
Term
| What are the key points of the history of urticaria? |
|
Definition
-new exposure
-medications
-foods
-bee stings
-symptoms of or exposure to illness |
|
|
Term
| What are key points of the PE for urticaria? |
|
Definition
-hives
-swelling of lips, mucosa (uvula), eyelids
-wheezing
-joint swelling
-VS for shock
-fever for illness |
|
|
Term
| What is the management of urticaria? |
|
Definition
Emergency treatment
-epinephrine SQ
-benadryl IM
-oxygen
-transport to ED
Outpatient
-antihistamine: Benadryl, Atarax, Zyrtec
-no topical cortisone
-Aveeno baths
Education
-avoiding offender
Referral to allergist
-persists after 2 weeks
-bee sting allergy immunotherapy
Epi-Pen |
|
|
Term
| What is the etiology of pityriasis rosea? |
|
Definition
|
|
Term
| What is the incidence of pityriasis rosea? |
|
Definition
| -peak in adolescents and young adults (10-35 years) |
|
|
Term
| What is the clinical presentation of pityriasis rosea? |
|
Definition
Prodrome (uncommon)
-low grade fever
-malaise
-HA
-arthralgia
-pharyngitis
Herald patch
-single round/oval lesion
-sharply defined with a thin, scaling border and paler center
-2-5 cm
-typically on trunk
Generalized rash
-follows herald patch usually 1-2 wks, or 1-30 days
-oval/round < 1 cm
-slightly raised
-pink-brown, covered in fine scales
-follow cleavage lines in skin, Christmas tree pattern on back
-pruritis
-resolves 4-12 weeks without scarring
- |
|
|
Term
| What is the differential diagnosis for pityriasis rosea? |
|
Definition
Herald patch
-tinea corporis (KOH)
Diffuse rash
-secondary syphilis (RPR)
-tinea versicolor (KOH)
-drug eruption |
|
|
Term
| What is the management for pityriasis rosea? |
|
Definition
Education
-no way to enhance resolution
-unknown cause
-may return to normal activities
Treatments
-oral antihistamines PRN pruritis
-sunlight
Skin care
-protect from irritation (wool clothing, excessive bathing)
-mentholated lotions or sprays (Eucerin Anti-Itch)
-moisturizing cream |
|
|
Term
| What is the etiology of acne? |
|
Definition
-androgens stimulate sebaceous glands which produce excessive sebum
-abnormal keratinization in follicular duct
-bacteria (P. acnes) increase with sebum production
-obstruction of duct
---primary lesions: comedones
---secondary lesions: inflammatory papules, pustules, nodules |
|
|
Term
| What are risk factors for acne? |
|
Definition
-adolescence
-male
-family history
-medications: corticosteroids, INH, dilantin, lithium
-costmetic creams: esp. oil based
-menses: 1 week before period
-stress
-NOT diet |
|
|
Term
| What are the 2 types of acne? |
|
Definition
Non-inflammatory lesions
-open (whitehead)
-closed (blackhead)
Inflammatory
-inflammatory papules (pimples)
-cysts
-nodules |
|
|
Term
| What are topical options for management of acne? |
|
Definition
tretinoin
-different strengths of creams and gels
-Retin-A, Avita, Renova
Benzoyl peroxide
-various strengths and preparations
Topical antibiotics
-clindamycin
-combinations
Salicylic acid
Azelaid acid (Finaca cream)
Tazarotene (Tazarac) |
|
|
Term
| What are oral medication options for management of acne? |
|
Definition
-tetracycline 500 mg BID-QID
-doxycycline 100 mg BID
-erythromycin 1 g/day BID-QID
3-12 mos, then decrease dose but increase with flares
sun sensitivity, secondary yeast infection |
|
|
Term
| What are management options for nodular and cystic acne? |
|
Definition
-isotretinoin (Accutane)
-steroid injection into cysts
-oral prednisone
-OCPs: ortho tri-cyclen, Yasmin, Alesse
-spironolactone: for women unable to take OCPs |
|
|
