CUTANEOUS INFECTIONS AND INFESTATIONS DR. MOHAMMED ALSHAHWAN MD
BACTERIA MYCOBACTERIA VIRUS FUNGUS PARASITEWorm Arthropod Protozoa STD (SEXUALLY TRANSMITTED DISEASE)
BACTERIAL I. Impetigo Superficial non-follicular infection due to staphylococcus and streptococcus Children not sick pustule (honey-colored crust ) Face and Acral areas Primary or secondary
II. Erysipelas deep cutaneous infection (Dermal) due to streptococcus after penetrating trauma ( CHRONIC LYMPHEDEMA) sick Face and Acral areas Unilateral sharply demarcated edematous red plaque
III. Cellulitis deep cutaneous infection (up to SC FAT) due to streptococcus after penetrating trauma ( CHRONIC LYMPHEDEMA) sick Face and Acral areas Unilateral Diffuse (NOT well demarcated) edematous red plaque Blood Culture in immuocompramized pts.
IV. Erythrasma Corynebacterium minutissimum (not contagious) Asymptomatic Flexures well demarcated scaly reddish-brown patch with advancing edge. Coral-red fluorescence
MYCOBACTERIAL I.TUBERCULOSIS Exogenous tuberculosis chancre Direct extension scrofuloderma Hematogenous spread lupus vulgaris
Lupus vulgaris Most common type of Cutaneous TB Children Female Head and neck only Red-brown nodules and plaques (apple-jelly nodules) when it ulcerate it heal with unhealthy scar
II. LEPROSY M.leprae faceoral transmition Close contact in endemic area (India) Delay in presentation ( 20 years)
Classification of leprosy Indeterminate stage ill-defined hypopigmented anesthatic hairless dry patch Tubercaloid leprosy Few ( < 3) well demarcated scaly red anesthatic hairless dry annular plaques with central clearing Adjacent nerve swelling
Lepromatous leprosy Multiple diffuse symmetrical skin-colored to red-brown plaques and nodules Leonine face blindness Peripheral neuropathy Borderline leprosy
VIRAL INFECTION WART Human papilloma virus (HPV) Direct contact Asymptomatic transmition Delay in presentation Oncogenic potential (HPV 16 and 18) High recurrence rate
CUTANOUS ( HPV 1 and 3 ) common wart flat wart planter wart GENITAL (HPV 16 and 18) classic condyloma acuminata
GENITAL WART *STD *Oncogenic HPVs ( Cervical cancer) *Usually more persistent and difficult to treat .
TREATMENT * Tissue destructive modalities Keratolytic (salicylic acid and podophyllin) Cryotherapy ( Liquid nitrogen) CO2 laser * Pulse-dye laser * Immunotherapy
MOLLUSCUM CONTAGIOSUM POX virus Direct contact Asymptomatic transmition Children Genital type is STD
Multiple UMBLICATED skin colored or reddish papule affecting the face and extremities. CURETTAGE is the treatment of choice for few lesions KOH is the treatment of choice for multiple lesions.
ORF POX virus Contact with infected cattle or sheep After 2 weeks of incubation a solitary expanding red papule with vesicle at the center which become necrotic at the end. Patient develop IMMUNITY afterward
HERPES SIMPLEX Human Herpes virus I and II Direct contact Asymptomatic transmition Latency High recurrence rate
CUTANEOUS ( HSV I ) orolibialis Initial Herpatic whitlow Recurrence herpes ophtalmicus GENITAL ( HSV II ) Initial Recurrence
Incubation period : 7- 10 days. After 24-48 hours of burning and tingling sensation the patient develop grouped vesicles on erythematous base which ulcerate within 24 hours. The whole illness is around 7-10 days.
Tzank smear Direct fluorescent antibody test Viral culture Blood serology
VARICELLAE ZOSTER VIRUS (VZV) FACEORAL CHICKENPOX ( Children) HERPES ZOSTER (Adult) is due to reactivation of VZV which was dorminant in nerve root ganglion
CHICKENPOX Incubation period : 2 weeks Prodrom of respiratory coryza followed by disseminated red macules with central vesicles. The whole illness : 3 weeks The patient contagious 5 days before and 5 days after skin eruption
HERPES ZOSTER After 24-48 hours of burning and tingling sensation the patient develop grouped vesicles on erythematous base which ulcerate within 24 hours. The whole illness is around 7-10 days. Post-herpetic neuralgia (PHN) which usually persist for around 4 weeks.
It is almost always DERMATOMAL SPINAL (Thoracic ) CRANIAL ( Trigeminal) SERIOUS involvement 1.Ophthalmic division of trigeminal nerve. 2. Geniculate ganglia (Ramsey-hunt syndrome) 3.Sacral ganglia.
Treatment HERPES SIMPLEX Acyclovir 200 mg five time a day for a week HERPES ZOSTER Acyclovir 800 mg five time a day for a week
FUNGAL DERMATOPHYTE Tinea Pedis (most common) 1.Erosive interdigitalis 2. Hyperkeratotic type(T. rubrum) 3. Inflammatory type(T.mentagrophyte)
Tinea corporis / Tinea cruris 1.Hyperkeratotic type (T. rubrum) well-demarcated annular red hyperkeratotic plaque with central clearing (Ring worm) 2.Inflammatory type (T.mentagrophyte) well-demarcated edematous red plaque with superimposed pustules
Tinea Capitis 1.Hyperkeratotic (black dot) usually due to T. tonsurans 2. Inflammatory (Kerion) usually due to M. canis complex 3. Favus * Due to T. schoenleinii * it characterized by the presence of Scutulae .