Basic SKIN INFECTIONS

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Basic SKIN INFECTIONS Presented By Shalina Shaik PGY 2 Emory Family Medicine

Skin Infections The skin dependably has some measure of microorganisms, organism and infections living on it. Happen when there are breaks in the skin and the living beings have uncontrolled development

Causative Organisms Bacterial Fungal Viral Parasitic

Bacterial Skin Infections Very normal Range from irritating to savage diseases Mostly brought about by Staph aureus and Strep

Bacterial Skin Infections Folliculitis Infection of hair follicle Usually recuperates without scarring Caused by Staph aureus Tx : Warm saline packs. In the event that does not resolve suddenly in 1-2 weeks, topical mupirocin . Oral dicloxacillin ( exceptionally uncommon)

Young male giving pruritic erythematous macules that advanced to papules and pustules. 3 days back he has been to a spin pool. Hot tub folliculitis

Hot tub Folliculits Caused by Pseudomonas aeruginosa , regularly found in defiled waterpools , hot tubs, water slides or physiotherapy pools Rash can eject anyplace on the body that has been in contact with tainted water Most cases resolve all alone, tx : silvadene cream, cipro (for broad cases) Prevention: visit changing of water, continous water filtration, observing of disinfectant levels( chlorination) in pools. Giving after contact does not counteract disease

Furuncle Carbuncle

Staph Skin Infections Furuncle/Boil Infection of pilosebaceous unit(hair follicle and encompassing tissue) Usually should deplete before they recuperate – takes under 2 wks Complicated bubbles – over center of face/spine or fever Carbuncle Several furuncles that are densly stuffed together basic in diabetics Tx : serious cases, first I&D Oral abx ( dicloxacillin or cephalexin ) if fever

Acute Paronychia

Acute Paronychia Infection of horizontal and back nail overlap Most normal pathogen Staph aureus Results from nail gnawing, finger sucking, exorbitant manicuring or infiltrating injury Conservative tx : Warm douses/oral anti-microbials ( clindamycin , augmentin ) If sore or fluctuance is available, unconstrained waste/cut and seepage. I & D: sharp edge is coordinated far from the nail plate

Impetigo contagiosa (Non bullous shape)

Impetigo ( Bullous frame)

Impetigo Nonbullous (MC shape) – main pathogen is Staph aureus . Assemble A beta hemolytic strep minority of cases. Bullous shape is almost brought on by Staph aureus ( regular in babies and youngsters <2yrs) Honey crusted injuries/huge vesicles Tx : topical mupirocin as powerful as oral abx Oral abx for nonlocalized cases - dicloxacillin , 1 st gen cephalosporin, augmentin . Macrolides not satisfactory given expanding resistance. Confusion: Strep glomerulonephritis Nasal carriage, hotspot for recc , tx w/topical mupirocin x 5 d Very infectious, suitable cleanliness for anticipation

Cellulitis

Cellulitis Painful erythematous contamination of dermis and subcut tissue MCC is beta hemolytic strep , might be consolidated with staph ( MRSA on the ascent) Commonly happens close skin breaks, for example, injury, surgical injuries, tinea diseases( in diabetics) Tx : 1 st gen cephalosporins , augmentin Limited dis w/oral, broad dis requires parenteral tx Outpt tx with rocephin inj gives 24 hr scope( choice in couple of pts), pt shud be reassesed the next day. Denoting the erythema edges w/ink is useful in taking after the movement or relapse of cellulitis . I&D if fluctuant May transform into necrotizing fascitis – medicinal crisis

MRSA Infections – on the ascent Community related – MRSA in youngsters in childcare Athletes Military enlisted people Healthcare related –MRSA Resistant to numerous abx , send for C&S Tx : CA-MRSA : Clindamycin , Doxycycline , Bactrim , Vancomycin HA-MRSA : Vanc , Linezolid Recurrence extremely basic Prevention: individual cleanliness is the key Wash hands !! Try not to share individual things Cover every open injury

Coral pink brilliance Erythrasma

Erythrasma Results in pink patches to cocoa scales, might be pruritic . Lichenification and hyperpigmentation normal Caused by Corynebacterium minutissimum Commonly found in intertriginous territories/toe networks Prevalent among diabetics, corpulent, and in warm atmospheres, declined by wearing occlusive attire DDx : tinea , acanthosis Dx : KOH neg , Wood's light : coral pink fluorescence Tx : oral erythromycin 1-2 weeks Abx cleanser to anticipate recc

Fungal Skin contaminations

Tinea capitis Tinea corporis

Tinea unguim Tinea pedis

Tinea diseases T. corporis – Ringworm of the body T. capitis scalp T. cruris crotch T. pedis foot T. unguim nail Tinea/dermatophyte diseases created by Trichophyton , Epidermophyton and Microsporum

Tinea cont.. T. corporis :Itchy, annular fix, very much characterized edge, scaling more evident at the edges( focal clearing) T.pedis/Athlete's foot T. unguim : onycholysis , subungual hyperkeratosis, dystrophy/pigmentary changes T.capitis

Tinea tx Topical terbinafine/azole x about 4 wks Oral tx for T. capitis , Onychomycosis – require no less than 6 – 12 wks tx Topical nystatin not compelling against Tinea . It works for Candida. Griseofulvin – is shabby, yet has more symptoms and needs longer span of tx

Kerion

Kerion Severe instance of scalp ringworm Appears as inflammed , thickened discharge filled range, at times went with fever Zoophilic dermatophytes is the typical cause 2/2 misrepresented reaction of invulnerable framework or a hypersensitive response to growth Tx : oral antifungals , oral steroids (for serious irritation)

hypopigmented Pityr iasis versicolor

Pityriasis versicolor Ppted by warmth, sweat, steroids Asymptomatic layered macules on trunk, back and confront Caused by a yeast – Malassezia furfur Tx : topical azoles/terbinafine/selenium sulfide Recurrence is normal. Tx with oral antifungals for 1-3 days averts repeat for a while.

Cutaneous Candidiasis

Diaper Candidiasis

Cutaneous candidiasis Candida sp-commensal of GIT Precipitating Factors Endocrinopathy Immunosuppression Fe/Zn inadequacy Oral anti-microbial Rx Candidal intertrigo - bosoms, crotch, web spaces Erythematous fix with satellite injuries Vaginitis/balanitis Oropharyngeal candidiasis is marker for AIDS Tx : topical Nystatin/Azoles. For across the board illness oral azoles. Rx basic issue Reduce dampness Wt misfortune, cotton clothing Absorbent/antifungal powder Nystatin

Chronic Paronychia

Chronic paronychia Swollen, delicate boggy nail folds Caused by Candida albicans ( 95%) Wet soluble work Excess manicuring/Dishwashers/Bartenders/Housekeepers Damage to fingernail skin Swelling of nail overlay (reinforcing) Nail dystrophy Keep hands dry/Wear gloves Long term Rx Oral Azoles Antifungal arrangement (high liquor content) +/ - Broad range anti-infection agents cover staph/GNB

Common Viral Skin Infections

Common wart Plantar wart

Viral warts/Condylomas/Squamous cell papillomas/Verrucae Small, harsh tumor w/cauliflower surface or strong rankle Hands, feet, genital territories Caused by HPV – 6 & 11 serotypes Tx : topical aggravations Salicylic corrosive, podophyllin , cantharidin,trichloroacetic corrosive Destructive strategies: cryo , electro, laser extraction/curretage Prevention: Gardasil immunization

Herpes labialis Herpetic gingivostomatitis

Herpetic whitlow

Herpes simplex diseases Mucocutaneous : prodrome took after by assembled strained vesicles over an erythematous base Herpetic gingivostomatitis in kids H.labialis/mouth blisters/Whitlow – brought about by HSV 1 Genital herpes : normally created by HSV2 Dx : clinical, if atypical injury: Tzanck , PCR, Culture, serology Tx : acyclovir, valacyclovir : decrease viral shedding and span of sx amid essential contamination Recc disease: tx with start of the main indication Frequent emissions( >6/yr) ought to get day by day supressive tx Herpetic whitlow, no I & D ( danger of bact superinfection or systemic spread.

Molluscum contagiosum

Molluscum contagiousm Caused by pox infection, MCV Flesh shaded, vault shaped,pearly w/run of the mill focal umbilication Common in youngsters Autoinoculation spreads to neighboring ranges Tx : self settling now and again or cryotherapy ( utilizing fluid nitrogen)

Hand Foot And Mouth Disease

Hand foot and mouth malady Caused by Coxsackie A16, individual from enterovirus family Rash w/little delicate rankles, fever, sore throat, ulcers in throat, loss of hunger ,HA Children under 10 yrs of age Spread by individual to individual Outbreaks in summer and early fall Symptomatic tx : tylenol , avoid lack of hydration

Common Parasitic Skin Infestations

Scabies

Scabies Caused by human tingle vermin( Sarcoptes scabie var hominis ) Mite tunnels into upper layers of skin, where it lives and lays its eggs Finger networks, ulnar fringe of lower arm, axilla Intense tingling, esp around evening time and pimple like skin rash Crowded conditions, infectious Tx : 5% permethrin cream, entire family ought to be dealt with , calamine/oral antihistamine for tingling Complications: auxiliary contamination prompting to