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Dermatology > Lecture 3: Infections > Flashcards

Lecture 3: Infections Flashcards

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1
Q

MCC of bullous impetigo

A

Staph Aureus & GAS

Both MSSA and MRSA (GAS and as)

Results in scalded skin syndrome

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2
Q

MC demographic for bullous impetigo

A

Newborn and older infants

bullies and babies

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3
Q

MC demographic for non-bullous impetigo

A

All ages

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4
Q

Presentation of non-bullous impetigo

A
  • Painful and tender
  • Erosions with crusts
  • 1-3 cm lesions
  • Central healing
  • Regional LAN
  • Scattered, discrete lesions
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5
Q

What is autoinoculating?

A

Kid scratches vesicle, spreads to a different area.

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6
Q

Presentation of bullous impetigo

A
  • No erythema
  • Vesicles => bullae
  • Yellow => dark brown
  • negative Nikolsky sign

Collapse of bullae in 1-2d

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7
Q

How is bullous impetigo dx?

A

Clinically, BUT often use Gram stain & culture

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8
Q

Tx of impetigo

A
  • Warm water soaks followed by topical mupirocin
  • 7d abx for widespread (keflex or erythromycin)
  • MRSA = doxy
  • Critically ill with MRSA = vanco or linezolid
  • Bullous or severe = PO
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9
Q

Patient education for impetigo

A
  • Good hygiene
  • Mupirocin in any skin breaks
  • Avoid contact with others in first 24h of abx use
  • BPO wash
  • Ethanol or isopropyl gel for hands

BPO = benzoyl peroxide

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10
Q

How soon should you f/u for impetigo?

A

1 week

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11
Q

First line systemic tx for impetigo

A
  • Systemic: dicloxacillin/augmentin/cephalexin
  • If PCN allergic: macrolides

dicey IM

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12
Q

Define folliculitis

A

Infection of hair follicle +/- pus in the ostium of the follicle

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13
Q

What does folliculitis become if it progresses? Most common organisms?

A
  • Becomes abscesses or furuncles
  • Staph, Pseudomonas hot tub, Viral , fungal, syphilis
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14
Q

How is folliculitis dx?

A
  • Clinical, but it can be confirmed with
  • Gram stain
  • C&S
  • KOH if fungal suspected
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15
Q

Tx of folliculitis

A
  • Mild: warm compresses, BPO wash
  • Moderate: topical abx = clinda or mupirocin
  • Severe MSSA: Keflex
  • Severe MRSA: Doxy or bactrim x10d

almost all superficial MRSA seems to be doxy

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16
Q

What are the typical causative organisms for an abscess related to folliculitis?

A

MSSA or MRSA

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17
Q

When is abx therapy indicated for an abscessed folliculitis?

A
  • Single >= 2cm
  • Multiple
  • Surrounding cellulitis
  • Immunosuppression and other comorbidities
  • S/S toxicity
  • Inadequate response
  • Indwelling medical device
  • High risk of transmission
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18
Q

When is surgery considered for I&D?

A
  • Very large
  • Located on palms (nerves?)
  • Soles (nerves?)
  • Nasolabial areas
  • Genitalia
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19
Q

What is a furuncle?

A

Acute, deep seated, red, hot, tender nodule or abscess

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20
Q

Presentation of a furuncle

A
  • Nodule with cavitation after drainage
  • Staphylococcal folliculitis
  • Any hair bearing region
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21
Q

Management of a furuncle

A
  • Warm compresses
  • Erythema = need abx
  • Bactrim
  • Clinda
  • Doxy

7d take the car of uncles to BCD

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22
Q

What is a carbuncle?

A

Deeper connection of interconnected furuncles

A car of furuncles

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23
Q

MC location for carbuncles

A
  • Nape of neck
  • Back
  • Thighs

trunk of the car

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24
Q

Management of uncomplicated carbuncle

A
  • Bactrim
  • Clinda
  • Doxy

7d take the car of uncles to BCD

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25
When to admit for carbuncle and DOC?
* Toxic * Rapid progression * No improvement after 24-48h of PO ABX * **DOC: Vanco 1-2g IV daily** | Deep = vanco
26
What is necrotizing fasciitis?
* Flesh eating disease * **Rapid progression of infection with extensive necrosis of soft tissues and overlying skin**
27
MCC of necrotizing fasciitis?
* GABHS * Pseudomonas * Clostridium | Polymicrobial
28
MC demographic and risk factors for necrotizing fasciitis?
* **Middle aged 30-40s** * DM, ETOH abuse, Liver dz, CKD, malnutrition | Often begins with **non-penetrating** minor trauma
29
Presentation of necrotizing fasciitis
* Severe pain out of proportion * Skin hyperthesia * Cyanosis * Skin pallor * Muscle weakness * **Foul smelling exudate**
30
As necrotizing fasciitis develops, what does it appear as?
* Cyanotic * Vesicle and bullae appearance * **Black eschar with surrounding irregular border** * Fever and systemic symptoms
31
Clinical red flags for necrotizing fasciitis?
* Severe, constant **pain out of proportion** to PE * Erythema turning into **dusky gray** * **Malodorous, dirty dishwater discharge** * Gas in the soft tissues * Edema beyond erythema * **Rapid progression**
32
Tx of necrotizing fasciitis
* **Debridement** * Broad spectrum ABX: carbapenem, unasyn, clinda, vanco for MRSA, **all depends on gram stain and C&S**
33
What is erysipelas?
Acute, superficial infection of the dermis and **dermal lymphatic vessels**
34
MC demographic and etiology of erysipelas?
* GABHS * MC in **young children or older adults**
35
How does erysipelas present?
1. **Prodrome** of fever, chills, anorexia, malaise 2. General signs of sepsis potentially 3. Lesions that are painful/tender/hot, bright, red, edematous plaques with **sharp borders**
36
What is cellulitis?
Acute infection of the dermis and **subcutaneous tissue**
37
Etiology of cellulitis and MC demographic
* Staph and GABHS * Cat/dog: **Pasteurella multocida** * Freshwater: aeromonas * MC: **middle aged adults**
38
Presentation of cellulitis
* **Prodrome** * General signs of sepsis potentially * Painful/red/hot/tender * bright red * **Indistinct/irregular borders** | Erysipelas has sharp borders and is superficial
39
RFs for cellulitis
* **Minor skin trauma** * Body piercing * **IVDU** * Tinea pedis infection * **Animal bites** * PVD * **Immunosuppressed** * Lymphatic damage
40
Dx of cellulitis
Clinical | Workup of labs and imaging mainly for systemic or r/o abscess
41
Indications for admission for cellulitis
* Systemic presentation * Rapidly spreading * Progression after **48h of abx** * **Unable to tolerate PO** * Comorbidities of **immunosuppression/liver/heart/renal failure**
42
IV management for cellulitis/erysipelas
* **MRSA: vanco** 1st, dapto 2nd * MSSA: cefazolin, clinda, nafcillin | Extra deep
43
**Oral** management for cellulitis/erysipelas
* **MRSA: clinda** 1st, amox + bactrim or doxy * MSSA: keflex, nafcillin, clinda
44
Bite or water exposure requires different management in regards to erysipelas & cellulitis. What are the ABX?
* Dog/cat bite: augmentin (animal are augmented) * Human bite: Eikenella = broad spectrum (augmentin) * Freshwater = cipro for aeromonas (fresh cod) * Saltwater = doxy for vibrio (salty duck) | If Eik bites, you need broad coverage
45
Etiologies for lymphangitis
* Acute: GAS, staph, **HSV** * Chronic: mycobacterium marinum | marinating
46
Tx of lymphangitis
* **Dicloxacillin** or 1st gen cephalo (keflex) * **MRSA: clinda** or bactrim | Dependent on sensitivity
47
Followup for lymphangitis
**24-48h after**, checking for improvement
48
MCC of cutaneous candidiasis and MC demographic
* MCC: **candida albicans** * MC in **neonates and seniors**
49
RFs for cutaneous candidiasis
* Obesity * DM * Local occlusion/moisture * Steroid/abx use * Hyperhidrosis * Incontinence
50
Presentation of cutaneous candidiasis
* **Pruritic** * Tender/painful * Macerated * Erythematous * **Satellite lesions**
51
How is cutaneous candidiasis dx?
KOH prep | fungus need KOH
52
Tx of mild-mod cutaneous candidiasis?
Topical antifungals: keto, eco, **clotri**, miconazole
53
Tx of severe cutaneous candidiasis?
Oral antifungals: **fluconazole x 2-3 wk**
54
What is balanitis?
* Inflammation of the Glans penis * MC in **uncircumcised men** with poor hygiene
55
What is a dermatophyte?
Unique group of fungi capable of infecting non-viable keratinized cutaneous structures (stratum corneum, nails, hair)
56
3 genera of dermatophytes
* Trichophyton (MC) in hair and fails * Microsporum * Epidermophyton
57
Where are dermatophytes MC in? Transmission methods?
* **MC in the scalp or children or intertriginous areas** of young/older adults * Transmission: * **Person to person is MC** * Animals * Soil is least common
58
What are the tinea locations?
* Tinea pedis: feet * Tinea cruris: groin * Tinea corporis: trunk/extremities * Tinea manuum: hands * Tinea facialis: face * Tinea capitis: hair * Tinea barbae: facial hair * Onychomycosis: nails
59
What are the 3 classifications of dermatophyte transmission?
* Person to person = anthropophilic * Animal to human = zoophilic * Environmental = geophilic
60
How are dermatophytes tested?
* **KOH prep showing hyphae and spores** * Woods lamp with **black light will show microsporum** * Fungal cultures (more definitive but takes days-weeks) * Dermatopathology skin biopsy (**more sensitive** but need an entire skin biopsy)
61
Tx of tineas
* Topical Imidazoles: **clotrim, mico, keto** * Topical Allylamines: naftifine, terbinafine
62
Systemic tx of dermatophytes
* Imidazoles PO: Itra, keto, **flucon** * Allylamines: **Terbinafine**
63
Who is tinea capitis MC in?
AA children
64
What is ectothrix?
* A grey patch with a scaly appearance * Hair shafts are broken off and brittle * **An infection OUTSIDE of the hair shaft**
65
What is endothrix?
* **Black dot appearance** * Infection within the hair shaft
66
How does non-inflammatory tinea capitis appear?
* Scaling * Pruiritis * Alopecia * Adenopathy
67
How does inflammatory tinea capitis present?
* **Painful** * **Tender** * Alopecia
68
How do the black dots appear in tinea capitis?
* Broken off hairs => swollen shafts * Diffuse and poorly circumscribed * MCC: T tonsurans or violaceum | **TV**s in the house (endothrix is inside)
69
What is kerion?
* Inflammatory mass in which remaining hairs are loose * Boggy, purulent, inflamed nodules, and plaques * Crusting and matting * MCC: T. verrucosum and mengatophytes (heals with scars) | very mangy kerion
70
What is favus?
* Latin for honeycomb * Perifollicular erythema and matting of hair * Malodorous and scarring
71
Which tinea does not fluoresce?
T tonsurans | not light cause it weighs a **ton**
72
Tx of tinea capitis
* PO antifungals: terbinafine or **griseofulvin (take with greasy meal)** * Antifungal ketoconazole shampoo
73
What is tinea cruris/jock itch commonly seen with?
Tinea pedis | Athletes and jocks
74
How does tinea cruris present?
* Large scaling, well-demarcated plaques * Central clearing * Papules/pustules at margins
75
Tx of tinea cruris
* Topical keto or econazole * Griseofulvin if above fails
76
What is tinea corporis?
* RING WORM * **Wrestler's infection**
77
Presentation of tinea corporis
* **sharply marginated** plaques * Vesicles and papules * Central clearing
78
Tx of tinea corporis
* Topical antifungals * Oral antifungals (if big): terbinafine x 4 wks
79
How does tinea pedis/athlete's foot present?
* Erythema * Scaling * Maceration * +/- bullae formation **diagnosed tinea**
80
4 subtypes of tinea pedis
* Interdigital * Moccasin * Inflammatory * Ulcerative
81
How does interdigital tinea pedis present?
* Dry scaling * Maceration * Fissuring, esp with hyperhidrosis * **MC between 4th and 5th toe**
82
How does moccasin tinea pedis present?
* Well demarcated * Scaling with erythema * Papules at margins * Fine white scaling * Hyperkeratosis, which is MC on soles/lateral borders of feet and occurs **bilaterally**
83
How does inflammatory tinea pedis present?
* **Vesicles or bullae with clear fluid** * Presence of pus = **secondary bacterial infection** * Ruptures will leave erosions with ringlike border **ID reaction can occur** * MC on the sole, instep, and webspaces
84
How does ulcerative tinea pedis present?
**Extension of interdigital tinea pedis** onto plantar and lateral foot, presenting with a **secondary bacterial infection**
85
Tx of tinea pedis
* Topical: ketoconazole & econazole BID x 2-4wk * **Oral best for hyperkeratosis:** **terbinafine**
86
What is tinea versicolor?
* AKA pityriasis versicolor * **Not a dermatophyte infection** * MC in adolescents, due to an overgrowth of malassezia furfur | **NOT CONTAGIOUS**
87
How does tinea versicolor typically present?
* Macules w/ w/o scale * Patches w/ w/o scale * Plaques w/ w/o scale * Hypo/hyperpigmentation * Erythema
88
What does KOH prep show for tinea versicolor?
Hyphae and budding yeast **spaghetti and meatballs** | very colored
89
Tx for tinea versicolor
* Selenium sulfide or zinc pyrithion * Topical antifungals: ketoconazole | PO only if topicals fail

Dermatology (12 decks)

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