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COMMON SKIN INFECTIONS

COMMON SKIN INFECTIONS. Presented By Shalina Shaik PGY 2 Emory Family Medicine. Skin Infections. The skin always has some amount of bacteria, fungus and viruses living on it. Occur when there are breaks in the skin and the organisms have uncontrolled growth. Causative Organisms.

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COMMON SKIN INFECTIONS

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  1. COMMON SKIN INFECTIONS Presented By ShalinaShaik PGY 2 EmoryFamily Medicine

  2. Skin Infections The skin always has some amount of bacteria, fungus and viruses living on it. Occur when there are breaks in the skin and the organisms have uncontrolled growth

  3. Causative Organisms Bacterial Fungal Viral Parasitic

  4. Bacterial Skin Infections Very common Range from annoying to deadly infections Mostly caused by Staph aureus and Strep

  5. Bacterial Skin Infections • Folliculitis • Infection of hair follicle • Usually heals without scarring • Caused by Staph aureus • Tx: Warm saline compresses. If does not resolve spontaneously in 1- 2 weeks, topical mupirocin. Oral dicloxacillin ( very rare)

  6. Young male presenting with pruriticerythematousmacules that progressed to papules and pustules. 3 days ago he has been to a whirl pool. Hot tub folliculitis

  7. Hot tub Folliculits • Caused by Pseudomonas aeruginosa, commonly found in contaminated waterpools, hot tubs, water slides or physiotherapy pools • Rash can erupt anywhere on the body that has been in contact with contaminated water • Most cases resolve on their own, tx : silvadene cream, cipro (for widespread cases) • Prevention: frequent changing of water, continous water filtration, monitoring of disinfectant levels( chlorination) in pools. • Showering after contact does not prevent infection

  8. Furuncle Carbuncle

  9. Staph Skin Infections • Furuncle/Boil • Infection of pilosebaceous unit(hair follicle and surrounding tissue) • Usually must drain before they heal – takes less than 2 wks • Complicated boils – over middle of face/ spine or with fever • Carbuncle • Several furuncles that are densly packed together • common in diabetics • Tx : severe cases, first I&D • Oral abx (dicloxacillin or cephalexin) if fever

  10. Acute Paronychia

  11. Acute Paronychia • Infection of lateral and posterior nail fold • Most common pathogen Staph aureus • Results from nail biting, finger sucking, excessive manicuring or penetrating trauma • Conservative tx: Warm soaks/ oral antibiotics ( clindamycin, augmentin) • If abscess or fluctuance is present, spontaneous drainage / incision and drainage. • I & D: blade is directed away from the nail plate

  12. Impetigo contagiosa (Non bullous form)

  13. Impetigo (Bullous form)

  14. Impetigo • Nonbullous (MC form) – principal pathogen is Staph aureus. Group A beta hemolytic strep minority of cases. • Bullous form is nearly caused by Staph aureus ( common in infants and children <2yrs) • Honey crusted lesions/large vesicles • Tx: topical mupirocin as effective as oral abx • Oral abx for nonlocalized cases - dicloxacillin, 1st gen cephalosporin, augmentin. Macrolides not adequate given increasing resistance. • Complication: Strep glomerulonephritis • Nasal carriage, source for recc, tx w/ topical mupirocin x 5 d • Very contagious, appropriate hygiene for prevention

  15. Cellulitis

  16. Cellulitis • Painful erythematous infection of dermis and subcut tissue • MCC is beta hemolytic strep , may be combined with staph ( MRSA on the rise) Commonly occurs near skin breaks, such as trauma, surgical wounds, tinea infections( in diabetics) • Tx: 1st gen cephalosporins, augmentin • Limited dis w/ oral, extensive dis requires parenteraltx • Outpttx with rocephininj provides 24 hr coverage( option in few pts), pt shud be reassesed the following day. Marking the erythema margins w/ ink is helpful in following the progression or regression of cellulitis. • I&D if fluctuant • May turn into necrotizing fascitis – medical emergency

  17. MRSA Infections – on the rise • Community associated – MRSA • in children in daycare • Athletes • Military recruits • Healthcare associated –MRSA • Resistant to multiple abx, send for C&S • Tx : CA- MRSA :Clindamycin, Doxycycline, Bactrim, Vancomycin HA-MRSA : Vanc, Linezolid • Recurrence very common • Prevention: personal hygiene is the key • Wash hands !! • Do not share personal items • Cover all open wounds

  18. Coral pink florescence Erythrasma

  19. Erythrasma Results in pink patches to brown scales, may be pruritic. Lichenification and hyperpigmentation common Caused by Corynebacteriumminutissimum Commonly found in intertriginous areas/ toe webs Prevalent among diabetics, obese, and in warm climates, worsened by wearing occlusive clothing DDx: tinea, acanthosis Dx: KOH neg, Wood’s lamp : coral pink fluorescence Tx: oral erythromycin 1-2 weeks Abx soap to prevent recc

  20. Fungal Skin infections

  21. Tineacapitis Tinea corporis

  22. Tinea unguim Tinea pedis

  23. Tinea infections T. corporis – Ringworm of the body T. capitis scalp T. cruris groin T. pedis foot T. unguim nail Tinea/ dermatophyte infections caused by Trichophyton, Epidermophyton and Microsporum

  24. Tinea cont.. T. corporis :Itchy, annular patch, well defined edge, scaling more obvious at the edges( central clearing) T.pedis / Athlete’s foot T. unguim : onycholysis, subungual hyperkeratosis, dystrophy/pigmentary changes T.capitis

  25. Tinea tx Topical terbinafine/ azole x nearly 4 wks Oral tx for T. capitis, Onychomycosis – need at least 6 – 12 wks tx Topical nystatin not effective against Tinea. It works for Candida. Griseofulvin – is cheap, but has more side effects and needs longer duration of tx

  26. Kerion

  27. Kerion Severe case of scalp ringworm Appears as inflammed, thickened pus filled area, sometimes accompanied with fever Zoophilicdermatophytes is the usual cause 2/2 exaggerated response of immune system or an allergic reaction to fungus Tx : oral antifungals, oral steroids (for severe inflammation)

  28. hypopigmented Pityriasisversicolor

  29. Pityriasisversicolor • Ppted by heat, sweat, steroids • Asymptomatic scaly macules on chest, back and face • Caused by a yeast – Malasseziafurfur • Tx: topical azoles / terbinafine/ selenium sulfide • Recurrence is common. Tx with oral antifungals for 1-3 days prevents recurrence for several months.

  30. CutaneousCandidiasis

  31. Diaper Candidiasis

  32. Cutaneouscandidiasis • Candida sp- commensal of GIT • Precipitating Factors • Endocrinopathy • Immunosuppression • Fe/Zn deficiency • Oral antibiotic Rx Candidalintertrigo-breasts, groin, web spaces • Erythematous patch with satellite lesions • Vaginitis/balanitis • Oropharyngealcandidiasis is marker for AIDS • Tx : topical Nystatin / Azoles. For widespread disease oral azoles. • Rx underlying disorder • Reduce moisture- • Wt loss, cotton underwear • Absorbent/antifungal powder Nystatin

  33. Chronic Paronychia

  34. Chronic paronychia Swollen, tender boggy nail folds Caused by Candida albicans ( 95%) Wet alkaline work Excess manicuring/Dishwashers/Bartenders/Housekeepers Damage to cuticle Swelling of nail fold (bolstering) Nail dystrophy Keep hands dry /Wear gloves Long term Rx Oral Azoles Antifungal solution-(high alcohol content) +/-Broad spectrum antibiotics-cover staph/GNB

  35. Common Viral Skin Infections

  36. Commonwart Plantar wart

  37. Viral warts/Condylomas/Squamous cell papillomas/ Verrucae • Small, rough tumor w/ cauliflower surface or solid blister • Hands, feet, genital areas • Caused by HPV – 6 & 11 serotypes • Tx : topical irritants • Salicylic acid, podophyllin, cantharidin,trichloroacetic acid • Destructive methods: cryo, electro, laser excision/curretage • Prevention: Gardasil vaccine

  38. Herpes labialis Herpetic gingivostomatitis

  39. Herpetic whitlow

  40. Herpes simplex infections Mucocutaneous: prodrome followed by grouped tensed vesicles over an erythematous base Herpetic gingivostomatitis in children H.labialis/cold sores/Whitlow – caused by HSV 1 Genital herpes : usually caused by HSV2 Dx: clinical, if atypical lesion: Tzanck , PCR, Culture, serology Tx: acyclovir, valacyclovir: reduce viral shedding and duration of sx during primary infection Recc infection: tx with beginning of the first symptom Frequent eruptions( >6/yr) should receive daily supressivetx Herpetic whitlow, no I & D ( risk of bactsuperinfection or systemic spread.

  41. Molluscumcontagiosum

  42. Molluscumcontagiousm Caused by pox virus, MCV Flesh colored, dome shaped,pearly w/ typical central umbilication Common in children Autoinoculation spreads to neighboring areas Tx: self resolving sometimes or cryotherapy( using liquid nitrogen)

  43. Hand Foot And Mouth Disease

  44. Hand foot and mouth disease Caused by Coxsackie A16, member of enterovirus family Rash w/ small tender blisters, fever, sore throat, ulcers in throat, loss of appetite ,HA Children under 10 yrs of age Spread by person to person Outbreaks in summer and early fall Symptomatic tx: tylenol, prevent dehydration

  45. Common Parasitic Skin Infestations

  46. Scabies

  47. Scabies Caused by human itch mite( Sarcoptesscabievarhominis) Mite burrows into upper layers of skin, where it lives and lays its eggs Finger webs, ulnar border of forearm, axilla Intense itching, esp at night and pimple like skin rash Crowded conditions, contagious Tx: 5% permethrin cream, whole family should be treated , calamine / oral antihistamine for itching Complications: secondary infection leading to impetigo Prevention: avoid contact w/ infected persons

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