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Dermatology Primer . Selected Skin Diseases and Treatment Tailored for the Athletic Trainer Prepared by Dr. Garth Russo 6.December.2002. Dermatology: Common Pathology. Infectious Bacterial Viral Fungal Parasitic Immunologic Inflammatory Allergic Acne.

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Dermatology primer

Dermatology Primer

Selected Skin Diseases and Treatment

Tailored for the Athletic Trainer

Prepared by Dr. Garth Russo 6.December.2002


Dermatology common pathology
Dermatology: Common Pathology

  • Infectious

    • Bacterial

    • Viral

    • Fungal

    • Parasitic

  • Immunologic

    • Inflammatory

    • Allergic

    • Acne


Bacterial infections
Bacterial Infections

  • Staphylococcus aureus and Streptococcus pyogenes account for the vast majority of skin infections

  • Staph and strep have historical and contemporary significance

  • Both are part of the normal flora of our skin

  • A wide variety of bacteria are associated with unique circumstances (e.g.. meningitis, tetanus, anthrax, syphilis)

  • Bacterial infections are generally opportunistic and locally tissue destructive stimulating inflammation and pus formation

  • Antibiotic resistance issues are significant

  • Folliculitis

  • Cellulitis

  • Impetigo

  • Boil/Furuncle/Abscess/Carbuncle


  • Folliculitis common
    Folliculitis: Common

    • Small pustules located at the base of hairs within the follicle structure. Generally a staph infection.

    • Symptoms are generally mild and the course can be self limited. The condition can be recurrent and frustrating regardless of treatment.

    • Warm moist skin (bathing suits)and irritation of skin (shaving, chafing, drying) are risk factors

    • Treatment consists of oral or topical antibiotics, general skin care, support.

    • The benefit of antibacterial soaps is suspect and potentially harmful



    Folliculitis special circumstances
    Folliculitis: Special Circumstances

    • Hot tub Folliculitis

      • Caused by Pseudomonas aeruginosa found in hot tubs that are poorly cleaned, especially wooden.

      • Appears much like common folliculitis 1-2 days after exposure, lesions become larger and more varied in size

      • Can be most evident where bathing suits rub

      • Very superficial and self limited

      • May occasionally be treated with oral antibiotics, ciprofloxacin or Augmentin



    Folliculitis special circumstances1
    Folliculitis: Special Circumstances

    • Pseudofolliculitis barbae (razor bumps)

      • Tightly curled hairs embed into skin and irritate it generating raised, reddened papule or pustule

      • Treated by allowing hair to grow out, using hair growth inhibitors.

    • Acne keliodalis

      • Inflammation from a folliculitis at base of neck, generally in back, or a pseudofolliculitis makes a keloid, or hypertrophic scar.

      • Treated with primary prevention, antibiotics, or local steroid injections.




    Cellulitis
    Cellulitis

    • A superficial infection of the skin by a bacteria, usually strep or staph

    • Appears as a reddened, raised, tender or painful area with sharply defined margins. May generate fever, flu symptoms

    • Often associated with skin trauma

    • Generally not associated with drainage but can weep

    • Will progress, if not treated, to a deeper infection

    • Necrotizing fasciitis (“flesh eating bacteria”)

    • Treated with antibiotics, generally cephalexin, erythromycin, dicloxicillin, Augmentin



    Impetigo
    Impetigo

    • The most common skin infection in children

    • Characterized by various forms; bullous, vesicular, or pustular. Very superficial

    • Caused by staph or strep bacteria, and form is often a function of which bacteria is present

    • Bullous form is usually staph

    • Vesicular form begins small and ruptures to form a characteristic “honey” crust

    • Can be quite contagious and patients will often auto-infect themselves by scratching

    • Treated with anti-staph/strep antibiotics. Topical mupiricin (Bactroban) effective



    Boil furuncle abscess carbuncle
    Boil, Furuncle, Abscess, Carbuncle

    • Deeper skin infection with staph or strep bacteria.

    • Hallmark is tissue destruction, marked inflammatory response, central necrosis and pus accumulation

    • Carbuncle is generally a term used for interconnected abscesses, furuncle if abscessed follicles

    • Hidradenitis suppurativa is a carbuncle of apocrine sweat glands, usually in the axilla

    • The hallmark of treatment is surgical, I&D. Anti-staph/strep antibiotics are also useful






    Viral infections
    Viral Infections

    • Herpes Simplex I

    • Herpes Simplex II

    • Cutaneous Herpes

    • Varicella (Chicken Pox)

    • Vaccinia (Small Pox)

    • Papiloma Virus (Warts)

    • Molluscum Contageosum

    • Viral Exanthems


    Herpes simplex
    Herpes Simplex

    • HSV I

      • Oral Herpes, fever blister

    • HSV II

      • Genital herpes

    • Cutaneous Herpes

      • Herpes Gladiatorum

    • Treatment: Antiviral drugs; reverse transcriptase inhibitors (RTI’s); acyclovir (Zovirax), famcyclovir (Famvir) valcyclovir (Valtrex). Topical acyclovir, penciclovir (Denavir), docosanol (Abreva)

    • Response is varied and timing is important for all


    Herpes virus behavior
    Herpes VirusBehavior




    Cutaneous herpes herpes gladiatorum
    Cutaneous Herpes: Herpes Gladiatorum


    Varicella virus
    Varicella Virus

    • Chicken Pox

    • Shingles

      • The Varicella virus is in the Herpes Virus family

      • Most attained immunity by active infection in past, now vaccine

      • Varicella is very dangerous to fetus if pregnant mom gets infected, or to immunocompromised

      • Shingles is a consequence of primary infection, dermatomal distribution

      • Prevention: Varicella vaccine: Children, single dose; Adult, two separated by 4-6 months

      • Shingles associated with post herpetic neuralgia

      • Treatment with RTI’s, skin care, anti itch or anti-pain meds, colloid (oatmeal baths)

      • In both cases patients are infectious until lesions crust


    Chicken pox
    Chicken Pox

    Chicken pox are characterized by vesicles on a red base of varying shapes and levels of development. There may be mild fever and flu like symptoms but generally patients are not too sick. Complications, however include pneumonia, meningitis, encephalitis, and overwhelming sepsis.

    Resolution generally occurs by 7 to 10 days.



    Variola smallpox
    Variola: Smallpox

    • Smallpox

      • Eradicated from the US 1949, world (Somalia) in 1977

      • Two clinical forms; Variola minor and major

      • Potential weapon of mass destruction


    Warts
    Warts

    • Common wart

    • Plantar Wart

    • Genital Wart

      • There are many many species of wart virus

      • Can be located anywhere, and different species like different sites.

      • Treatment is generally similar:

        • Tissue destruction by freezing, burning, excision, acids, laser

        • Chemotherapy; podophyllin

        • Immunotherapy; imiquimod, bleomycin, interferon

        • Mechanical; smothering/tape

      • Can be self limited. 66% of warts resolve within a year

      • Some strains are associated with cervical cancer





    Molluscum contagiosum
    Molluscum Contagiosum

    • Very contagious pox virus infection, sexually transmittable with reports of transmission through shared towels and gym equipment. Generally self limited, made worse by shaving. Can last for months and treatment is usually by tissue destruction, freezing, acid, needle curettage.



    Fungal infections
    Fungal Infections

    • Fungal infections are generally opportunistic, less communicable (except T. Capitis), more superficial

    • Prefer warm, moist, or thickly keratinized skin

    • Causes are trichophyton and microsporum species referred to as dermatophytes. Occasionally yeast or candida

    • Generic lesions are inflammatory and appear eczematous, flaky, red, itchy

  • Tinea Corporis (on the body)

  • Tinea Pedis (on the foot)

  • Tinea Cruris (in the groin area)

  • Tinea Capitis (on the head)


  • Fungal infections treatment
    Fungal Infections:Treatment

    • Topical antifungal creams are the mainstay of therapy

      • Lamisil, Lotrimin, Mycelex, etc. All OTC

      • Often topical steroids will be used to lessen inflammatory response. Mycolog, Lotrisone

      • Tinea versicolor: use of Selsun shampoo, selenium sulfide common, also oral antifungal in a single dose; ketoconazole 400mg po once.

    • Oral therapies needed for nail infections, advanced athlete’s foot, scalp infections.

      • Lamisil, Sporonox, Nizoral (ketoconazole), Griseofulvin, Diflucan all have a place and unique dosing regimens based on location and type of fungus








    Parasites scabies
    Parasites:Scabies


    Scabies treatment
    Scabies: Treatment

    • Lindane (Kwell)

    • Crotamiton (Eurax)

    • Permethrin 5% (Elimite)

      • Itch is often out of proportion to rash

      • Incubation period is about 1 month

      • Treatment may have to be repeated in a week

      • Clothing and bedding should be washed with hot water

      • Intimate contacts should be considered for treatment

      • Secondary infection of lesions is common


    Immunologic processes
    Immunologic Processes

    • Inflammatory Conditions

    • Allergic Responses

    • Acne


    Inflammatory conditions
    Inflammatory Conditions

    • Inflammatory Conditions

      • Eczema

      • Psoriasis

      • Contact Dermatitis

      • Pityriasis Rosea

        • Essentially all of these conditions respond to topical and/or oral steroids

        • General principles include skin protection and moisturizers

        • Therapy for psoriasis can include immune modulating drugs like methotrexate, and/or UV therapies, and can be both toxic and complex





    Contact dermatitis
    Contact Dermatitis

    • Rhus Dermatitis (poison ivy)

    • Tape Adhesive Dermatitis

    • Latex Sensitivity

      • This class of different conditions accounts for the majority of occupational skin disease in the US

      • A patient can develop sensitivity at any time

      • Avoidance is cornerstone of therapy





    Allergic reactions
    Allergic Reactions

    • Urticaria (hives)

      • Urticaria are classically associated with histamine release generating the “wheal and flare” response typical of a hive

      • Cause is typically a drug, food, sting or bite but can be mechanical, stress related, viral or autoimmune

      • Can be acute or chronic

      • May represent part of more systemic allergic and life threatening process

      • Treatment includes epinephrine, oral antihistamines, steroids, cool compresses and avoidance



    Acne

    • Acne Vulgaris

    • Other Acne

    • Rosacea

      • Acne is a mixture of mechanical and inflammatory processes

      • Treatment involves:

        • topical products that dry, irritate, or promote more rapid skin turnover

        • Removal of any external causes (occupational, mechanical, steroids)

        • Oral or topical antibiotics that suppress proprionobacterium acnes growth

        • Oral retinoids (Accutane)that alter sebum production more permanently


    Acne vulgaris
    Acne Vulgaris

    • Closed Comedone (whitehead)

    • Open Comedone (blackhead)

    • Pustular Acne

    • Nodulocystic Acne




    Other acne
    Other Acne

    • Steriod Acne

    • Neonatal Acne

    • Occupational Acne

    • Acne Mechanica

    • Acne Cosmetica

    • Excoriated Acne





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