Skin Rashes and Dermatology Flashcards

Question

Describe the management of CLASSICAL SCABIES.

Answer 1

NON-PHARMACOLOGICAL MANAGEMENT ✔️ all sheets, towels and clothing to be washed in > 50°C ✔️ all lounges, couches, beds etc. to be covered and stored away for 1 week ✔️ all floors to be mopped / vacuumed ✔️ keep children home from school / day care ✔️ keep adults home from work ✔️ avoid itching and scratching of lesions due to risk of secondary bacterial infection ✔️ clip nails prior to applying cream ✔️ re-apply cream if hands are washed within 8 hours of applying ✔️ put mittens on children to avoid scratching PHARMACOLOGICAL MANAGEMENT 1. Permethrin 5% cream --> apply to entire body from the neck day and leave for 8 hours (overnight); reapply in 7 to 10 days if symptoms have not subsided (NOT suitable for children < 6 months of age or pregnant women). 2. Benzyl benzonate 25% cream --> apply to entire body and leave for 24 hours. 3. Ivermectin --> oral tablet; repeat in 7 to 10 days. Note that the itch may take up to 4 weeks to subside.

Answer 2

✔️ secondary bacterial infection (e.g. impetigo, cellulitis) ✔️ RHD ✔️ PSGN ✔️ recurrence and incomplete eradication

Answer 3

Staph. aureus

Answer 4

``` ✔️ school-aged children ✔️ ATIS children ✔️ immunocompromised ✔️ overcrowding ✔️ poor hygiene / sanitation ✔️ poor health literacy ✔️ sibling / close contact with confirmed disease ```

Answer 5

There are three ways in which impetigo can present: 1. non-bullous 2. bullous 3. ecthyma NON-BULLOUS - Begins as small papule on the hands and face --> develops into pustule with crusted top - Erythematous base - Golden crust - Most commonly located on the hands and face - Highly contagious - Heals without scarring - Most commonly caused by S. aureus BULLOUS - Begins as a small vesicle --> develops into a flaccid bulli over a couple of days - Burst - Heal without scarring - Most commonly caused by S. pyogenes ECTHYMA - Begins as non-bullous impetigo - Develops into large, punched-out ulcers - Heals WITH scarring

Answer 6

NON-PHARMACOLOGICAL ✔️ keep children home from school/ day care until sores have completely healed ✔️ cover sores with a waterproof dressing to avoid contamination ✔️ avoid scratching ✔️ encourage use of individual towels and linen by all household members ✔️ practice appropriate hygiene and sanitation PHARMACOLOGICAL ✔️ 2% muprocin cream, applied TDS for 7 to 10 days ✔️ oral antibiotics if initial treatment fails

Answer 7

LIFESTYLE MODIFICATIONS ✔️ avoid known triggers ✔️ encourage bathing in lukewarm bath; pat dry ✔️ encourage use of cotton clothing; nil synthetic fabrics ✔️ avoid scratching lesions as this can cause secondary bacterial infection ✔️ avoid soaps and shampoos with fragrances ✔️ avoid surfaces that may damage skin TOPICAL EMOLLIENTS ✔️ apply a fragrance-free emollient (e.g.Sorbolene, QV cream) TWICE per day --> increase to four times per day during an acute eczema flare ✔️ apply occlusive dressings ANTIBIOTICS ✔️ use topical antibiotics sparingly, only if secondary bacterial infection is suspected ✔️ flucloxacillin or ceftatexin TOPICAL CORTICOSTEROIDS ✔️ 1% hydrocortisone for face ✔️ 0.05% bethamethasone diproprionate for trunks and limbs

Answer 8

✔️ acute onset rash, unilateral, usually in lower limb ✔️ very, very painful ✔️ rapidly spreading ✔️ "dusky" purple appearace ✔️ crepitus beneath skin (if caused by Clostridium)

Answer 9

✔️ immediate surgical referral ✔️ surgical debridement of necrotic tissue ✔️ immediate IV antibiotics (penicillin, clindamycin, metronidazole, cephalosporins, carbapenems, vancomycin, and linezolid) ✔️ IV fluids and oxygen ✔️ consider hyperbaric therapy if anaerobic organism is cultured

Answer 10

AETIOLOGY Develops after GAS infection (pharyngitis / tonsillitis or impetigo). ``` RISK FACTORS ✔️ overcrowding ✔️ poor sanitation and hygiene ✔️ low SES ✔️ immunocompromised ✔️ known contact with GAS infection ✔️ age < 2 years or > 10 years ``` CLINICAL PRESENTATION ✔️ rash develops 12 to 48 hours after fever ✔️ bright red blotches that become widespread ✔️ rash located below the neck, armpits etc. ✔️ "sandpaper" skin ✔️ resolves within 7 days (without antibiotics) or within 24 hours (with antibiotics) MANAGEMENT 1. Oral penicillin for 10 days or a single dose of IM penicillin. 2. Encourage hydration and oral intake. 3. Paracetamol for headache, fever and joint pain. 4. Oral antihistamines if rash is itchy. ``` COMPLICATIONS ✔️ ARF ✔️ RHD ✔️ PSGN ✔️ Septicemia ✔️ Pneumonia ✔️ Acute otitis media ✔️ Osteomyelitis ```

Answer 11

``` AETIOLOGY HSV1 virus (most commonly); occasionally HSV2 virus. ``` Transmission is through direct contact with someone with active lesions. RISK FACTORS ✔️ immunocompromised ✔️ young age ✔️ poor hygiene / sanitation ``` CLINICAL PRESENTATION ✔️ multiple erythematous-based ulcers located in the mouth and oral area ✔️ extremely painful ✔️ drooling ✔️ refusal to eat or drink ✔️ symptoms last 10 to 14 days ``` MANAGEMENT 1. Fluid replacement (NGT or IV) 2. Topical analgesia (e.g. lidnogaine gel)

Answer 12

AETIOLOGY ✔️ Coxsackie Virus ✔️ Echovirus ✔️ Enterovirus ``` RISK FACTORS ✔️ child < 10 years ✔️ attends day care ✔️ known contacts ✔️ immunocompromised ``` CLINICAL PRESENTATION ✔️ non-specific, viral prodrome ✔️ blisters on palmar surface of hands, dorsum of feet and mucosal surface of mouth ✔️ reduced oral intake, leading to dehydration ``` MANAGEMENT ✔️ do NOT burst the blisters ✔️ cover blisters to avoid contact with others ✔️ keep home from school / day care ✔️ paracetamol for fever ✔️ antiseptic mouth wash ✔️ maintain hydration ``` COMPLICATIONS ✔️ dehydration ✔️ meningitis (rare)

Answer 13

AETIOLOGY ✔️ Human Herpes Virus 6 or 7 CLINICAL PRESENTATION ✔️ macules / papules that blanch ✔️ some macules / papules may be surrounded by a lighter halo ✔️ begins on trunk and spreads to face, limbs etc. ✔️ high fever (as high as 40°C) ✔️ lethargy, irritability, reduced feeding MANAGEMENT 1. Encourage oral intake 2. Paracetamol for fever 3. Self-limiting infection

Skin Rashes and Dermatology Flashcards

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