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year 4 derm > Skin infection and infestation > Flashcards

Skin infection and infestation Flashcards

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1
Q

What normally protects the skin from infection?

A

The normal skin microflora and antimicrobial peptides protect skin from infection

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2
Q

Why does skin damage lead to infection?

A

Micro-organisms can penetrate the skin causing infection

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3
Q

What are the 3 main types of skin infection ?

A
  1. Bacterial
    - Staphylococcal / Streptococci
  2. Viral
    - human papilloma virus / herpes simplex virus
  3. Fungal
    - Dermatophytes (Tinea / ringworm)
    - Yeasts ( candida)
    - Mould (aspergillus)
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4
Q

What are some examples of infestations?

A

Scabies
Lice
Cutaneous leishmaniasis

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5
Q

What are Erysipelas and cellulitis?
How are they different?

A

A spreading bacterial infection of the skin

Cellulitis = deep subcutaneous tissue

Erysipelas = an acute superficial form of cellulitis involving dermis and upper subcutaneous tissue

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6
Q

What causes Erysipelas and cellulitis ?

A

Streptococcus pyogenes
Staphylococcus aureus

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7
Q

What are risk factors for Erysipelas and cellulitis?

A

immunosuppression
wounds
leg ulcers
toeweb intertrigo (rash in toewebb)
minor skin injury

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8
Q

How does Erysipelas and Cellulitis present?

A

Look :
signs of inflammation - swelling (tumor), erythema (rubor), warmth (calor), pain (dolor) - may be lymphangitis

Systemic: fever, malaise, rigors (especially erysipeals)

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9
Q

How do you distinguished Erysipelas from cellulitis ?

A

Erysipelas - well defined, red, raised border

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10
Q

What is the management of Erysipelas and Cellulitis?

A

Non-pharm:
Supportive - rest, leg elevation, sterile dressings

Pharm:
analgesia
Antibiotics (e.g. flucloxacillin or benzylpenicillin)

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11
Q

What are complications of erysipelas and cellulitis>

A

Local necrosis
abscess
sepsis

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12
Q

Diagnosis
Describe

A

Erysipelas
unilateral oedema and erythema with well defined red border.

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13
Q

What is this?

A

Staphylococcal scalded skin syndrome

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14
Q

Who tends to get Staphylococcal scalded skin syndrome?

A

Common in infancy and early childhood?

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15
Q

What causes Staphylococcal scalded skin syndrome?

A

Production of a circulating epidermolytic toxin from phage group II, benzylpenicillin-resistant (coagulase positive) staphylococci

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16
Q

How does Staphylococcal scalded skin syndrome present ?

TIMING, WHERE, APPEARANCE

A

TIMING:
Few hours - days

WHERE:
worse over face, neck, axillae, groin

APPEARANCE:
Scald - like skin followed by large flaccid bulla
Perioral crusting (typical)
Intraepidermal blistering
painful lesions
eruptions can be localised

17
Q

How long is recovery for Staphylococcal scalded skin syndrome?

A

usually 5-7 days

18
Q

What is the management for Staphylococcal scalded skin syndrome?

A

Analgesia

Antibiotics (e.g. a systemic penicillinase-resistant penicillin, flucloxacillin, erythromycin or appropriate cephalosporin)

19
Q

What does this show?

A

Scabies

20
Q

How would you describe the lesion of scabies?

A

Linear burrows - may be tortuous
or
rubbery nodules

21
Q

What are some associated features with scabies?

A

Secondary eczema and impetigo
due to scratching- excoriation, infection

22
Q

What are common sites for scabies?

A

Sides of fingers, finger webs, wrists, elbows, ankle, feel, nipples, genitals

23
Q

What is common to get in the history a pt with scabies?

A

Hx of contact with symptomatic individuals

Pruritus is intense and worse at night

24
Q

What are some investigations you could do for scabies?

A

Skin scrape
extraction of mite and view under telescope

25
Q

What is the management of scabies ?

A

permethrin 5% is first-line
malathion 0.5% is second-line
Guidance on how to use
pruritus persists for up to 4-6 weeks post eradication

26
Q

What should you tell your pt with scabies about how to use insecticide ?

A

apply to all area (including face and scalp)

apply to cool, dry skin

close attention to areas between fingers and toes, under nails, armpit and creases of skin e.g. knee / elbow

Allow to dry and leave for 8-12 hrs for Permethrin and 24 for malathion before washing

Reapply if removed e.g.. hand washing

REPEAT treatment 7 days later

27
Q

What is the pathophysiology of scabies?

A

Caused by the mite Sarcoptes scabiei and spread by prolonged skin contact.

The scabies mite burrows into the skin, laying its eggs in the stratum corneum. The intense pruritus associated with scabies is due to a delayed-type IV hypersensitivity reaction to mites/eggs which occurs about 30 days after the initial infection.

year 4 derm (17 decks)

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