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Flashcards in Skin Infections Deck (69)
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1

Complications of untreated skin and soft tissue infections (SSTI)

Sepsis
Underlying bone infection

2

Primary SSTI

Previously healthy skin, usually single pathogen

3

Secondary SSTI

Previously damaged skin, usually polymicrobial

4

Complicated SSTI

Deeper layers (muscle, fascia), usually require surgical intervention OR immunocompromised pts

5

Tinea unguinum

Nails

6

Tinea manuum

Hands

7

Predisposing factors to fungal infections

Diabetes
Impaired circulation
Immunosuppressive drugs
Poor nutrition and hygiene
Skin occlusion
Warm and humid climates

8

Tinea pedis

Men > women
Whites > blacks
Adults > children
Athletes > non-athletes
Shoes > sandals

9

Presentation of tinea pedis

Soggy, malodorous, thickened skin
Acute vesicular rash
Fine scaling of the affected area with varying degrees of inflammation
Cracks and fissures may also be present
Typically involves lateral toe webs
-Between 4th and 5th or 3rd and 4th toes
Can spread to sole or instep
-Rarely to the dorsum

10

Presentation of tinea corporis

Smooth and bare skin
-Begin as small, circular, red, scaly areas
Spread peripherally and borders may contain vesicles or pustules

11

Tx goals for fungal infections

Provide symptomatic relief
Eradicate infection
Prevent future infection

12

Nonprescription tx for fungal infections

Appropriate for tinea pedis, corporis, cruris
Capitis and unguium require prescription tx

13

Clotrimazole 1% and miconazole nitrate 2%

Inhibit biosynthesis of sterols and damage the fungal cell wall, altering permeability resulting in loss of essential intracellular elements
Apply BID for up to 4 wks
Nonprescription
Mild skin irritation can occur at application site
No drug-drug interactions with nl topical use

14

Terbinafine 1% topical

Inhibits squalene epoxidase resulting in accumulation of squalene within fungal cell causing cell death
Apply BID for up to 4 wks
-Some trials showed resolution of tinea pedis after 7 days of tx

15

Product selection of fungal infection tx

Ointments, creams, powders, and aerosols
Creams are the most efficient and effective
Sprays and powders are good adjuncts for prevention

16

Terbinafine oral

First line for fungal nail infections
-250 mg daily for 6 wks-fingernails
-250 mg daily for 12 weeks- toenails
CBC and ALT/AST levels at baseline and every 4-6 wks during tx- rare but serious hepatic failure...don't use with chronic or acute liver disease

17

Psoriasis dx

Nail pitting, rash elsewhere on body, FHx of psoriasis

18

Lichen planus dx

Nail atrophy, scarring at proximal aspect of nail

19

Yellow nail syndrome dx

Multiple nails turn yellow, grow slowly, increased longitudinal and transverse curvature, intermittent pain and shedding, associated with chronic sinusitis, bronchiectasis, lymphedema

20

Trauma of nails

Single nail affected, homogeneous alteration of nail color and altered shape of nail

21

Folliculitis

Inflammation of hair follicle (stye)

22

Furuncles

Infections of hair follicle that extends beyond follicle into subcutaneous skin layers

23

Carbuncle

Group of furuncles forming a single area

24

Abscess

Collections of pus within dermis or deeper tissues

25

Pathogen for folliculitis, furuncles, carbuncles, and abscesses

Typically S. aureus
Underchlorinated pools and hot tubs have resulted in some Pseudomonas infections

26

Tx for folliculitis, furuncles, carbuncles, and abscesses

Warm, moist compresses for follicultiis and small furuncles
I & D should be performed if inflamed cysts, carbuncles, abscesses, and large furuncles
Usually do not require systemic abx unless extensive area affected or systemic signs of infection
T: >38 degrees C or < 36 degrees C
Tachypnea >20 breaths/min or PaCO2 <32 mm Hg
Tachycardia > 90 bpm
WBC > 12,000 or <4,000

27

Mild bacterial SSTI (folliculitis, etc.)

Purulent infection with no systemic signs of infection

28

Moderate bacterial SSTI (folliculitis, etc.)

Purulent infection with systemic signs of infection

29

Severe bacterial SSTI (folliculitis, etc.)

Pt has failed I & D and oral abx
IC pts
Systemic signs of infection + HYPOTENSION

30

Primary tx for folliculitis, furuncles, carbuncles, and abscesses

I & D (this may be adequate alone) PLUS
TMP-SMX
Doxycycline
If no response after 2-3 days, look for complications and consider Vancomycin
For moderately ill pt with acute bacterial skin and skin structure infection requiring parenteral therapy but who can be managed as an outpt:
-Dalbavancin
-Oritavancin