COMMON SKIN INFECTIONS

1
COMMON SKIN INFECTIONS
Presented By Shalina Shaik PGY 2 Emory Family
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 pruritic erythematous
macules 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 ID
• 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 lt2yrs)
• 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
  parenteral tx
• Outpt tx with rocephin inj 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.
• ID 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 CS
• 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 Corynebacterium minutissimum
• 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, Woods lamp coral pink
  fluorescence
• Tx oral erythromycin 1-2 weeks
• Abx soap to prevent recc

20
(No Transcript)
21
Fungal Skin infections
22
Tinea capitis
Tinea corporis
23
Tinea unguim
Tinea pedis
24
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

25
Tinea cont..

• T. corporis Itchy, annular patch, well defined
  edge, scaling more obvious at the edges( central
  clearing)
• T.pedis / Athletes foot
• T. unguim onycholysis, subungual
  hyperkeratosis, dystrophy/pigmentary changes
• T.capitis

26
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

27
Kerion
28
Kerion

• Severe case of scalp ringworm
• Appears as inflammed, thickened pus filled area,
  sometimes accompanied with fever
• Zoophilic dermatophytes 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)

29
hypopigmented
Pityriasis versicolor
30
Pityriasis versicolor

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

31
Cutaneous Candidiasis
32
Diaper Candidiasis
33
Cutaneous candidiasis

• Candida sp- commensal of GIT
• Precipitating Factors
• Endocrinopathy
• Immunosuppression
• Fe/Zn deficiency
• Oral antibiotic Rx
• Candidal intertrigo-breasts, groin, web spaces
• Erythematous patch with satellite lesions
• Vaginitis/balanitis
• Oropharyngeal candidiasis 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

34
Chronic Paronychia
35
Chronic paronychia

• Swollen, tender boggy nail folds
• Caused by Candida albicans ( 95)
• Wet alkaline work Excess manicuring/Dishwashers/Ba
  rtenders/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

36
(No Transcript)
37
Common Viral Skin Infections
38
Common wart
Plantar wart
39
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,trichloro
  acetic acid
• Destructive methods cryo, electro, laser
  excision/curretage
• Prevention Gardasil vaccine

40
Herpes labialis
Herpetic gingivostomatitis
41
Herpetic whitlow
42
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( gt6/yr) should receive daily
  supressive tx
• Herpetic whitlow, no I D ( risk of bact
  superinfection or systemic spread.

43
Molluscum contagiosum
44
Molluscum contagiousm

• 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)

45
Hand Foot And Mouth Disease
46
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

47
(No Transcript)
48
Common Parasitic Skin Infestations
49
Scabies
50
Scabies

• Caused by human itch mite( Sarcoptes scabie var
  hominis)
• 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

51
Chiggers
52
Chiggers

• Caused by larval form of harvest mite/ red bug
• Prevalent in hot and humid climate
• Common in spring and summer
• Live in berry patches, tall grass and weeds , and
  woodland edges
• Severe itchy red bumps over waist, ankles,
  armits, neck
• Tx for itching calamine, oral benadryl,
  topical steroid cream
• Prevention protective clothing, insect
  repellant( DEET)

53
(No Transcript)