infectious dermatology Flashcards
(160 cards)
1
Q
impetigo - what pathogen is responsible for MSSA and MRSA
A
S aureus
2
Q
what pathogen causes bullous impetigo
A
Epidermolytic toxin A – producing S. aureus causes scalded skin syndrome
3
Q
impetigo: Beta – hemolytic strep is what group?
A
group A
4
Q
impetigo is MC in who
A
children but any age
5
Q
impetigo MC occurs where?
A
- Minor breaks in the skin
- Around the nose
- Atopic dermatitis
- Traumatic wounds
6
Q
Bullous stains of S. aureus = exfoliative toxin A leads to?
Bullous Impetigo
A
leads to loss of cell adhesion in the superficial epidermis
7
Q
Bullous stains of S. aureus is MC in what age?
Bullous Impetigo
A
newborn and older infants
8
Q
Often asx
Can be painful and tender
Erosions with crusts
1 – 3 cm lesions
Central healing often after several weeks
Regional lymphadenopathy
A
Impetigo Non-bullous
9
Q
arrangement of Impetigo Non-bullous
A
Scattered, discrete lesions
w/o tx confluent
Satellite lesions occur from autoinoculation
10
Q
impetigo vesicles can progress quickly to ?
A
bullae
- No erythema noted
- filled with serous fluid
- Yellow –> dark brown
- (-) Nikolsky sign
11
Q
? days = collapse and leave erosions with crusts
Impetigo Bullous
A
1-2
12
Q
nikolsky sign?
A
a skin finding in which the top layers of the skin slip away from the lower layers when rubbed
13
Q
dx impetigo
A
Gram stain and culture often necessary for bullous type
14
Q
impetigo tx
A
- Warm water soaks x 15-20 min BID
- mupirocin x 5 d.
- For widespread infection = 7 d ABX
- Cephalexin
- Erythromycin - MRSA = Doxy
- Critically ill patients with MRSA/MRSA = vanc/linezolid
- Bullous or severe = PO ABX
15
Q
pt ed for impetigo
A
- Good Hygiene
- Nails, proper soap, frequent washing - Underlying condition tx
- Mupirocin in other areas where skin barrier has been broken
- Wounds covered
- Avoid contact with others (>24hrs post ABX initiation)
16
Q
prevention impetigo
A
- BPO wash
- Check family members for signs
- Ethanol or isopropyl gel for hands
17
Q
- Infection of the hair follicle with +/- pus in the ostium of the follicle
- Non tender /slightly tender
- Pruritic
A
Folliculitis
18
Q
causes of Folliculitis (pathogens)
A
- Bacteria (S.aureus)
- Fungi
- Mites
- Virus
19
Q
prediposing factors for folliculitis
A
- Shaving hair bearing areas
- Occlusion of hair bearing areas
- Hot tub usage
- Topical CS
- Systemic ABX (G- can proliferate)
- Diabetes
- Immunosuppression
20
Q
Folliculitis - Can progress and become ?
A
an abscess or furuncle formation
21
Q
What causes folliculitis to progress it into an abscess or furuncle formation?
pathogens
A
- S. aureus
- Pseudomonas (hot tub) - MC trunk
- Viral (herpetic and molluscum)
- Fungal (candida, malassezia)
- Other: Syphilitic
22
Q
G- to acne pt who worsens on systemic ABX w/ small follicular pustules = ?
A
gram neg folliculitis
23
Q
dx folliculitis
A
clinical
gram stain
C&S
KOH (fungal)
24
Q
mild tc folliculitis
A
- Warm compresses
- Wash with BPO or antibacterial soap (dial)
- ABX if spontaneous resolution does not occur within 2-3 weeks or if symptoms worsen
25
tx moderate folliculitis
1. Clindamycin BID x 10 days
1. Mupirocin TID x 10 days
26
tx severe folliculitis
| MSSA/MRSA
1. Oral – MSSA - Cephalexin (Keflex)
1. Oral – MRSA
- Doxycycline 100mg BID x 10 days
- Bactrim
27
prevention folliculitis
BPO body wash
Chlorhexidine body wash
28
* Collection of pus accumulated in a tissue = inflammatory response to an infectious process of foreign body
* Acute or chronic localized inflammation
* Arises in any organ or tissue
Abscess
29
Arises in any organ or tissue - Skin & dermis, subcutaneous fat, muscle, or a variety
* Tender
* Red
* Hot
* Indurated nodule
* +/- fever + constitutional sx
* Days / weeks = pus formation (within a central space)
Abscess
30
dx abscess
Gram Stain and C&S of exudate
Typically MSSA or MRSA
31
tx abscess
* I&D
* ABX Therapy.
32
indications for abx for abscess
* Single abscess ≥2 cm
* Multiple lesions
* Extensive surrounding cellulitis
* Immunosuppression or other comorbidities
* S/S toxicity ( fever >100.5°F, hypotension, or sustained tachycardia)
* Inadequate clinical response to I&D alone
* Indwelling medical device (prosthetic joint, vascular graft, or pacemaker)
* High risk for transmission of S. aureus to others (athletes, group home)
33
oral vs IV Abx for abscess
1. Toxic? - Fever, Hypotension, Tachycardia
1. Rapid progression after 48hr of PO ABX?
1. Inability to tolerate orals?
1. Close to indwelling device? - Prosthetics, graft, catheter
34
abscess - For large lesions consider ?
surgery with general surgeon or plastics
Difficult areas
* Palms
* Soles
* Nasolabial areas
* Genitalia
35
prevention abscess
* Antibacterial soap or BPO wash
* Avoid heat and friction
* Educate patients to Avoid squeezing (PATIENTS LOVE TO DO THIS)
36
* Acute, deep seated, red, hot, tender nodule or abscess
* Abscess = boil
* 1-2 cm
* Fluctuant - Nodule with cavitation after drainage
* Any hair bearing region
* from a staphylococcal folliculitis
Furuncle
37
furuncle management
1. Warm compresses 10 min daily; Erythema = ABX probably necessary
1. Bactrim, Clindamycin, Doxycycline
38
* Deeper infection composed of interconnecting abscesses usually arising in several contiguous hair follicles
* Patient is typically ill appearing
* Fever + along with constitutional sx
* Painful/tender
Carbuncle
39
MC locations for Carbuncle
nape of neck, back, and thighs
40
dx carbuncle
Clinical gram stain is helpful with C&S
41
tx for carbuncle
* uncomplicated - Bactrim, Clindamycin, Doxycycline
* COMPLICATED = ADMISSION FOR IV ABX
42
admission for Carbuncle if? tx?
* Toxic appearing
* Rapid progression
* No improvement after 24-48 hours of PO ABX
**Vancomycin** 1-2 g IV daily DOC
43
Rapid progression of infection with extensive necrosis of soft tissues and overlying skin
AKA: Flesh eating disease
Necrotizing Fasciitis
44
etiology Necrotizing Fasciitis
polymicrobial
* Beta-hemolytic GAS
* Pseudomonas aeruginosa
* Clostridium
45
pathophys of Necrotizing Fasciitis
Bacteria release enzymes/gases that degrade fascia resulting in rapid proliferation, local thrombosis, ischemia and necrosis
46
Necrotizing Fasciitis may be began as?
May begin deep at site of nonpenetrating minor trauma
* bruise, muscle, or strain
* Minor trauma
* Laceration
* Needle puncture
* Surgical incision
47
Necrotizing Fasciitis is MC in what age?
Middle age (mid 30 - mid 40’s)
48
RF Necrotizing Fasciitis
1. DM
1. ETOH abuse
1. liver dz
1. CKD
1. malnutrition
49
Necrotizing Fasciitis - If skin necrosis is not obvious suspect if there are signs of sepsis and/or some of the following local symptoms:
1. Severe pain
1. Indurated swelling
1. Bullae
1. Cyanosis
1. Skin pallor
1. Skin hypesthesia
1. Crepitation
1. Muscle weakness
1. Foul smelling exudates
50
Necrotizing Fasciitis - 4 signs to identify
1. Local redness
1. Edema
1. Warmth
1. Pain
* Appears 36 – 72 hours after onset
* Involves soft tissue becomes blue in color
* Vesicles and bullae appear - spread along fascial plane
51
Necrotizing Fasciitis progression
Extensive cutaneous soft tissue necrosis develops
* Black eschar with surrounding irregular border of erythema
* Fever and other constitutional symptoms
52
ddx Necrotizing Fasciitis
1. Pyoderma gangrenosum
1. Calciphylaxis
1. Purpura fulminans
1. Warfarin necrosis
1. Pressure ulcer
1. Brown recluse spider bite
53
Key clinical red flags of Necrotizing Fasciitis:
* Severe, constant pain out of proportion to physical exam, or anesthesia
* Erythema evolving into a dusky gray color
* Malodorous, watery "dirty dishwater" discharge
* Gas (crepitus, or crackling sounds) in the soft tissues
* Edema extending beyond areas of erythema
* Rapid progression despite antibiotic therapy
54
tx Necrotizing Fasciitis
1. Surgical debridement
- CBC, CMP, CK, ABG, UA, serum/deep tissue culture
- CT, MRI, Plain film - GAS?
2. broad spectrum ABX
- Carbepenem
- Ampicillin/sulbactam
- Clindamycin
- MRSA - Vancomycin
**all dependent on gram stain / C&S**
55
Acute superficial infection (dermis and dermal lymphatic vessels)
Erysipelas
56
MCC Erysipelas
group A 𝛃-hemolytic streptococcus
57
Erysipelas is MC in what age
young children and older adults
58
s/s erysipelas
1. Prodrome - fever, chills, anorexia, malaise
1. General - +/- signs of sepsis
1. Lesion
- painful/tender/hot
- bright red, raised, edematous, indurated plaque
- sharp borders
59
Acute infection of the dermis and subcutaneous tissue
Cellulitis
60
etiology Cellulitis
* S. aureus (MC) and Group A β-hemolytic streptococcus
* Cat/Dog trauma: Pasteurella multocida
* Freshwater wound: Aeromonas
61
Epidemiology Cellulitis
MC middle age adults
62
cellulitis - A focused history should determine ?
* immune status
* comorbid conditions
* possible sites and causes of skin barrier disruption
* prior h/o cellulitis, and methicillin-resistant S. aureus (MRSA) risk factors
63
s/s cellulitis
1. (Similar to erysipelas)
1. Prodrome - fever, chills, anorexia, malaise
1. General - +/- signs of sepsis
1. Lesion
- painful/tender/hot
- bright red, edematous, (+/- induration)
- **indistinct** borders (not raised)
64
RF cellulitis
1. Minor skin trauma
1. Body piercing
1. Intravenous drug use
1. Tinea pedis infection
1. Animal bites
1. Peripheral vascular disease
1. Immune suppression (chronic systemic steroid use, neutropenia, immunosuppressive medications, alcohol use disorder)
1. Lymphatic damage (lymph node dissection, radiation therapy, vein harvest for coronary artery bypass surgery, and damage that occurs following multiple prior episodes of cellulitis)
65
RF Erysipelas & Cellulitis
1. Compromised skin integrity - atopic dermatitis, insect bite, surgery, trauma, IV drug use
1. Compromised immune system - AIDS, DM, ESRD, CA, immunosuppressive therapy, drug/ETOH abuse
66
ddx Erysipelas & Cellulitis
1. DVT
1. stasis dermatitis
1. contact dermatitis,
1. urticaria
1. insect bite
1. fixed drug eruption
1. erythema nodosum
1. acute gout
1. erythema migrans (Lyme)
1. pre-vesicular herpes zoster
67
dx w/u for Erysipelas & Cellulitis
1. **Clinical dx **
1. Labs only if systemic symptoms are present
- CBC, CMP, ESR, blood cx
1. Imaging - US or MRI if needed
68
indications for imaging for Erysipelas & Cellulitis
ruling out abscess, necrotizing fasciitis, pyomyositis, and gas forming anaerobic bacterial infection
69
complications from Erysipelas & Cellulitis
Abscess formation, bacteremia, endocarditis, osteomyelitis, metastatic infection, sepsis, toxic shock syndrome
70
indications for Erysipelas & Cellulitis for IV abx
1. Systemic presentation: Fever > 100.5, hypotension, sustained tachycardia
1. Rapidly spreading lesion
1. Progression of clinical features after 48 h of oral abx
1. Unable to tolerate oral therapy
1. Comorbidities: immunosuppression, neutropenia, asplenia, cirrhosis, heart/renal failure
*can be switched to PO once systemic s/s resolve*
71
IV tx for Erysipelas & Cellulitis (MRSA & MSSA)
1. MRSA coverage
- vancomycin (1st line)
- daptomycin (2nd line)
2. MSSA coverage
- cefazolin
- clindamycin
- nafcillin
72
oral therapy for Erysipelas & Cellulitis
| MRSA& MSSA
1. MRSA coverage
- **clindamycin (first line)**
- amoxicillin + TMP-SMX/doxycycline
2. MSSA coverage
- cephalexin
- nafcillin
- clindamycin
73
Special considerations in treatment for Erysipelas & Cellulitis
1. Dog/cat bite: Augmentin - Pasteurella multocida
1. Human bite: Augmentin - Eikenella, Group A Streptococcus; Broad spectrum ABX
1. Exposure to fresh water: cipro - Aeromonas
1. Exposure to salt water: doxy - Vibrio vulnificus
74
Acute inflammatory process involving the subcutaneous lymphatic channels
Lymphangitis
75
causes of acute & chronic Lymphangitis
1. GAS, S. aureus, Herpes simplex virus
2. Chronic - Mycobacterium marinum
76
portals of Lymphangitis
1. Break in skin
1. Wound
1. Paronychia
1. Primary herpes simplex
77
* Pain +/- erythema proximal to break in skin
* Red linear streaks and palpable lymphatic cord
Lymphangitis
78
ddx Lymphangitis
* Phyto-allergic contact dermatitis
* Superficial thrombophlebitis
* Mycobacterium marinum
* N. brasiliensis
* S. schenckii
79
dx Lymphangitis
1. **Clinical dx**
- Resolves with correct diagnosis and treatment
- cx if open and actively weeping
2. Labs only if systemic sx
- CBC, CMP, blood cultures
80
tx Lymphangitis
1. Oral ABX dependent on sensitivity
- Dicloxacillin or 1st generation cephalosporin
- MRSA Clinda or Bactrim
2. F/u 24-48 hours
- ABX indications: toxic appearing or no improvement after 24-48 hours
81
Superficial fungal infection of the skin
Cutaneous Candidiasis
82
MC pathogen causing Cutaneous Candidiasis
Candida albicans
83
MC ages for Cutaneous Candidiasis
neonates and adults >65 years old
84
MC areas involved for Cutaneous Candidiasis
Genitocrural, gluteal, interdigital, inframammary, axilla, under pannus
85
Cutaneous Candidiasis RF
1. Obesity
1. DM
1. local occlusion/moisture
1. steroid/abx use
1. hyperhidrosis
1. incontinence
86
* Pruritic
* Tender/painful
* Macerated
* Erythematous
* Satellite lesions typically present; beefy red
Cutaneous Candidiasis
87
dx Cutaneous Candidiasis
KOH prep
88
ddx Cutaneous Candidiasis
1. Tinea
1. Psoriasis
1. Dermatitis
1. AD
1. Secondary syphilis
89
tx Mild to moderate
Cutaneous Candidiasis
Topical antifungals 2-3 wks - Continue x 2 weeks after clearance
- Ketoconazole
- Econazole
- Clotrimazole
- Miconazole
90
tx for severe cutaneous candidiasis
Oral antifungals
**Fluconazole** (Diflucan) 100mg PO daily x 2-3 weeks
91
prevention of Cutaneous Candidiasis
**Keep areas dry**
1. Powders (Zeasorb AF)
1. Hair dryer
1. Avoid occlusive clothing
92
* Inflammation of the glans penis, can be triggered by numerous factors.
* Affects uncircumcised men with poor hygiene.
Balanitis
93
common infectious triggers for Balanitis
candida, Trichomonas vaginalis, gonorrhoeae, streptococcus
94
hx components for balanitis
DM, culture, KOH, Tzank smear, RPR-Syphilis, patch test
95
tx balanitis
Improved personal hygiene, use of low to medium potency topical steroid until improved
96
Unique group of fungi capable of infecting nonviable keratinized cutaneous structures
Dermatophyte
97
Dermatophyte can infect what parts of the body?
1. Stratum corneum
1. Nails
1. Hair
98
Arthrospores can survive in human scales for ?
12 months
99
3 genera of dermatopytes
1. **Trichophyton (MC)** - Hair and nail
1. Microsporum
1. Epidermophyton
100
Dermatophytes - Scalp MC in who
Children
101
Dermatophytes transmission
* Person to person (MC)
* Animals
* Soil (least common)
102
pathophys Dermatophytes
dermatophytes produce enzymes (keratinases) that break down keratin allowing fungi to invade epidermis, nail and hair shaft
103
tinea pedis
feet
104
tinea cruris
groin
105
tinea corporis
trunk/extremities
106
tinea manuum
hands
107
tinea facialis
face
108
tinea capitis
hair
109
tinea barbae
facial hair
110
onychomycosis
nails
111
classifications of Dermatophytes
* Person to person = anthropophilic
* Animal to human = zoophilic
* Environmental = geophilic
112
predisposing factors for Dermatophytes
1. atopy, ichthyosis
1. collagen vascular disease - RA, SLE, temporal arteritis, scleroderma
1. steroid use (oral/topical)
1. sweating, local occlusion
1. occupational exposure
113
dx options for Dermatophytes
**Dx testing direct microscopy**
1. _Skin & Nail for KOH_
- Skin - use a blade to scrape skin cells from area
- Nail - use a dull scalpel to remove excess keratin from nail
- Hair - remove hair at root
2. _Woods lamp - “black light”_
- Blue green fluorescence = Microsporum
3. _fungal cx_
4. _Dermatopathology via skin biopsy_
114
how to perform KOH
1. 2 drops of 10% KOH to glass slide - sit for 15 min
1. Inspect under low and high power
- hyphae and spores will be present
115
Dermatophytes how to collect for fungal cx
1. **skin**: specimen obtained with brush (tooth or cervical brush)
1. **hair**: specimen remove 5-10 hairs with forcep/hemostat at one time, use brush to obtain scales, use brush to inoculate fungal medium.
1. **nail**: use fingernail clipper or sharp curette to obtain keratinous debris from under nail
place specimen inside a fungi culture medium
116
pros and cons of fungal cx for dermatophytes
* Limitations - requires days-wks to return definitive diagnosis
* Benefits - differentiates between fungal spp.
117
pros and con for skin bx for dermatophytes
1. Benefits - most sensitive form of diagnosis
1. Limitations
- skin biopsy sample required
- more invasive testing
118
topical antifungals for dermatophytes
Imidazoles
* Clotrimazole (Lotrimin)
* Miconazole (Micatin)
* Ketoconazole (Nizoral)
Allylamines
* Naftfine (Naftin)
* Terbinafine (Lamisil)
119
Systemic Treatment for Dermatophytes
(CBC, Cr, LFT’s)
Systemic PO agents
1. Imidazole
- Itraconazole
- Ketoconazole
- Fluconazole
2. Allyamine
- **Terbinafine** ***
120
tinea capitis is MC in who
MC in children
MC in AA
121
presentation of Ectothrix occurring outside the hair shaft
| Tinea Capitis
“grey patch” = scaly
Circular = hairs broken off = very brittle
122
Three presentations of Endothrix = occurs within the hair shaft
| Tinea Capitis
* “Black dot”
* Kerion
* Favus
123
noninflammatory tinea capitis
* Scaling
* Pruritus
* Alopecia
* Adenopathy
124
flammatory tinea capitis
Pain
Tenderness
Alopecia
125
what are the "black dots" in tinea capitis
Broken off hairs near the scalp = swollen hair shafts
1. Dots occur because broken hairs at the scalp
1. Diffuse and poorly circumscribed
- Caused by: T. tonsurans, T. violaceum
126
what is Kerion in tinea capitis
1. Inflammatory mass in which remaining hairs are loose
1. Boggy, purulent, inflamed nodules, and plaques
1. Painful = drains pus from multiple openings
1. Hairs do not break off but fall out or pulled without pain
1. Crusting and matting of surrounding hairs
1. Caused by: T. verrucosum; T. mentagrophytes
- Heals with scaring alopecia
127
Latin for honeycomb
Perifollicular erythema and matting of hair
Thick/yellow crusts
Odor
Doesn’t clear spontaneously
Results in scarring alopecia
Favus - Tinea Capitis
128
dx Tinea Capitis
1. Woods Lamp - **T. tonsurans does not fluoresce**
1. Direct microscopy
1. Fungal cx - growth seen in 10-14 d
1. Bacterial cx - r/o bacterial with staph
129
Tinea Capitis w/o tx can lead to ?
permanent hair loss
130
tx tinea capitis
PO antifungals:
Terbinafine 250mg QD x 4-6 weeks
Griseofulvin 20-25mg/kg/day x 4-6 weeks
Antifungal shampoos - Ketoconazole 2% shampoo QD
131
prevention tinea capitis
1. Wash clothing, bedding, and towels
1. Wash furniture if in contact
1. Avoid used pillow cases
1. Avoid head to head contact
1. Disinfect combs and other hair products
132
“Jock Itch”
Inguinal folds = thighs
Subacute or chronic dermatophytosis of the upper thigh and adjacent inguinal and pubic regions
Tinea Cruris
133
Tinea Cruris MC in who?
MC in males
Co-exists with Tinea Pedis typically
134
Large scaling, well demarcated dull red/tan/brown plaques
Central clearing
Papules and pustules @ margins
Tinea Cruris
135
dx tinea crusis
clinical
136
tx tinea cruris
1. Topical antifungal x +/- 3 weeks
- Ketoconazole
- Econazole
--- Zeasorb AF powder
2. PO Antifungals if failure of topicals
- Griseofulvin 375-500 mg daily x 2-4 weeks
136
management/prevention tinea cruris
1. Wear shower shoes while bathing
1. Put on socks before pants
1. Antifungal/drying powders
1. Benzoyl peroxide wash
1. Alcohol based sanitizer gels
1. Avoid tight fitted clothing/use cotton underwear
137
Fungal/dermatophyte infection involving anywhere on the body
**wrestlers infection
Tinea Corporis
aka ring worm
138
dx tinea corporis
**clinical**
bx if unsure
139
Can be asx
Pruritus depending on area
Sharply marginated plaques
Vesicles and papules
Central clearing
Tinea Corporis
140
tx Tinea Corporis
1. Topical antifungals
2. Oral antifungals (large surface area)
- Terbinafine 250 QD x 4 weeks
--- CBC, Cr, LFT’s
141
Erythema
Scaling
Maceration
+/- bullae formation
MC dermatophyte infection athlete's foot
Tinea Pedis
142
if tinea cruris is dx, what other body part do you need to check?
feet - Tinea Pedis
143
Tinea Pedis MC in what age group?
20-50y
144
RF Tinea Pedis
hot, humid climate, occlusive footwear, hyperhidrosis
145
4 subtypes of tinea pedis
1. Interdigital
1. Moccasin
1. Inflammatory
1. Ulcerative
146
Dry scaling
Maceration
Fissuring
Hyperhidrosis is common
MC site = between 4th and 5th toe
which type of Tinea Pedis
Interdigital Type
146
Well demarcated
Scaling with erythema
Papules at margin
Fine white scale
Hyperkeratosis
**MC on soles or lateral border of feet**
MC bilateral
which type of tinea pedis
Moccasin Type
147
Vesicles or bullae with clear fluid
Pus usually indicates secondary bacterial infection
After rupture erosions with ragged ringlike border
**ID reaction can occur**
MC on sole, instep, and web spaces
which type of tinea pedis
inflammatory
148
Extension of interdigital tinea pedis onto the plantar and lateral foot
May have secondary bacterial infection S. aureus
which type of tinea pedis
ulcerative
149
tx tinea pedis
1. Topical antifungal
- BID x 2-4 weeks
- Ketoconazole & Econazole BID
2. Oral antifungal - Best for hyperkeratotic
- Terbinafine 250 mg QD x 2-6 weeks
- **ALL SYSTEMICS = BLOOD WORK (Cr, LFT’s, CBC)**
150
prevention tinea pedis
1. Wash with BPO daily
1. Use antifungal powder (Zeasorb AF)
1. Shower shoes in communal showers
1. Alcohol based sanitizers
151
T/F: Pityriasis Versicolor is part of the group cause dby deramtophyte
| Tinea Versicolor
F, it is not
152
Tinea Versicolor MC in who
adolescents
153
Tinea Versicolor is an overgrowth of?
**Malassezia furfur**
Seen often in patients with oily skin (thrives in this environment)
154
RF tinea versicolor
* Climate
* Sweating
* Immunodeficiency
* Products
* Steroid use
* Oily skin
155
is tinea versicolor contagious?
no
156
s/s tinea versicolor
clinically asx
1. Patient can experience some itching possibly psychological
2. Patient usually complains about the appearance
- Macules +/- scale
- Patches +/- scale
- Plaques +/- scale
--- Hypo/hyperpigmentation
--- Erythema
157
dx tinea versicolor
* KOH shows hyphae and budding yeast (**spaghetti and meatballs**)
* Woods light
158
tx tinea versicolor
1. Selenium sulfide or zinc pyrithion
1. Topical antifungals ketoconazole
- PO therapy not recommended unless failure of topicals
