Cutaneous Infection

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Cutaneous Infection
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Cutaneous Infections

• Bacterial
• Viral
• Fungal
• Mycobacterial
• Protozoan
• Ectoparasitic

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Cutaneous Infections

• Systemically invasive
• Subdermal involvement
• Skin limited
• Stratum Corneum limited

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Impetigo

• Staph aureus or Strep pyogenes
• Bullous variant caused most often by phage 2
  Staph that produces exotoxins
• Highly contagious (day care nightmare)

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Bullous Impetigo
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Bullous impetigo
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Nonbullous Impetigo

• Honey colored crusted plaques
• Seen in children 2-5 years old.
• Rarely develops in intact skin.
• Poststreptococcal glomerulonephritis
• Presents with hematuria and proteinuria
• Red cell casts

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Nonbullous Impetigo
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Nonbullous Impetigo
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Treatment of Impetigo

• Oral Antibiotics coverage of S. areus and
  Streptococcus
• Topical Mupirocin

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Folliculitis

• Infection of the hair follicle
• Most commonly staphylococcal
• Involvement of the deep part of the follicle
  results in a furuncle (boil)
• Differentiate from pseudofolliculitis, acne
  vulgaris and keratosis pilaris

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Folliculits
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Cellulitis and Erysipelas

• Erysipelas involves superficial dermis while
  cellulitis involves the deep dermis and
  subcutaneous tissue.
• Both often associated with fever and chills
• Erysipelas is usually on face or legs
• Recurrence is common (25) in erysipelas because
  of the lymphatic damage

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Erysipelas
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Cellulitis
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Onycholysis due to Pseudomonas
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Ecthyma gangrenosum
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Malignant Otitis Externa

• Seen in immunocompromised, particularly diabetics
• Osteomyelitis of the skull base or temporal bone
• Severe earache, worse at night
• Caused by P. aurginosa

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Malignant Otitis Externa
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Acute Meningococcemia

• Caused by Neisseria meningitidis
• Meningitis is usually seen
• Kills rapidly (within hours)
• Transmitted through respiratory secretions, a
  viral infection may enhance ability to invade
  blood stream
• Petechiae and erythematous macules or papules.
  Later, ecchymoses and skin necrosis

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Meningococcemia
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Meningococcemia
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Mycobacterial infections

• Atypical mycobacteria fish tank granuloma
• Leprosy
• Tuberculosis
• Lupus vulgaris
• Scrofuloderm

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Fish Tank Granuloma
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Herpes

• Erythematous, vesicular rash
• May be systemically ill especially eczema
  herpeticum
• Zoster is reactivation of varicella
• Involvement of V1 should prompt ophtho consult
  not steroids!!!

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Herpes Simplex

• Caused by HSV-1 and HSV-2
• Infections occurs at the primary site,
  transported via neurons to dorsal root ganglion
  where latency is established
• Pain, tenderness or tingling occur often before
  reactivation.
• Grouped vesicles on erythematous base
• Vesicles often umbilicated

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Herpes Simplex VirusEczema Herpeticum
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Herpes Simplex VirusEczema Herpeticum
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Herpes Simplex Virus
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Herpes Simplex Virus
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Herpes Simplex Virus
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Varicella

• Chicken Poxincubation about 14 days
• Prodrome mild in children, more severe in
  adults
• Eruptive Phase rose petal macule, then
  vesicle which becomes cloudy, begins on trunk and
  spreads, centripetal distribution
• Varicella Zoster shingles, reactivation
• Pain may last long after (postherpetic neuralgia)

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Varicella
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Varicella Zoster
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Varicella
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Molluscum Contagiosum

• Double stranded DNA poxvirus
• 2-5 mm discrete umbilicated papules
• Spreads to areas of inflamed skin or injury
• Common and disfiguring in patients with HIV. DDx
  of MC in this pop. includes crypto and other
  fungal infx
• May be an STD in adults suprapubic and genital
  lesions
• Most are self limited, but may last 2-4 years
• Tx includes cryo, curettage, cantharidin, Aldara
  or no treatment.

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Molluscum Contagiosum

• Caused by pox virus
• Characteristic umbillicated papules, molluscum
  bodies on biopsy
• May be an STD in adults suprapubic and genital
  lesions
• Giant molluscum in AIDS pts, ddx in this pop.
  includes crypto and other fungal infx
• Tx includes cryo, curettage, cantharidin, Aldara
  or nothing they will spontaneously resolve

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Molluscum Contagiosum
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Molluscum Contagiosum
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Human Papilloma Viruses

• Verrucae vulgarescommon wart
• Verrucae planaflat warts
• Verrucae plantaresplantar warts
• Condyloma acuminatagenital warts

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Human Papilloma Viruses

• Verrucae vulgares HPV 2,4,29
• Verrucae plana HPV 3,10,28,49
• Verrucae plantares HPV 1
• Condyloma acuminata HPV 6 and 11
• HPV 16, 18, 26, 27, 30, 31, 33-5 and others

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Verruca vulagaris
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Verrucae Plana
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Verrucae Plantares
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Condyloma acuminita
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Condyloma acuminita
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Hand, foot, mouth disease

• Usually coxsackievirus A16 and enterovirus 71
• Oral lesions
• 3-7mm oval vesicles with red border
• Heal within 7 days

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Hand, foot, mouth disease
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Pityriasis Rosea

• Begins with herald patch, then develops eruptive
  plaques 7-14 days later. Lasts about 6 weeks
• About 2/3 of cases have history of preceding
  upper respiratory tract infection
• Most common in fall and winter
• Mean age 23 with most between ages 10 and 35
• Most asymptomatic, but can be pruritic

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Pityriasis Rosea
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Pityriasis Rosea

• 2-10cm round or oval papulosquamous plaques
• Salmon colored with collarette of scale
• Along skin lines Christmas tree pattern

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Pityriasis Rosea Therapy

• Self limited, so therapy often not required
• If pruritic, phototherapy effective
• Topical steroids sometimes helpful

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Exanthems

• Scarlet fever streptococcal erythrogenic toxin
• Rubella
• Erythema infectiosum parvovirus B19
• Roseola infantum human herpes virus 6 and 7
• Kawasaki syndrome

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Scarlet Fever
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Scarlet Fever
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Scarlet Fever
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Roseola infantum
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Erythema Infectiosum
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Erythema Infectiosum
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Kawasaki Disease
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Kawasaki Disease
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Dermatophytes

• Named for area involved tinea capitis, corporis,
  manum, facei, pedis, cruris, etc.
• Incognito refers to tinea mistakenly treated
  with topical steroids
• If there is scale, do KOH exam
• Severe tinea capitis can lead to kerion, may
  result in scarring alopecia
• Topical and systemic antifungals /-
  kearatolytics

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Superficial Fungal Infections

• Caused by dermatophytes Microsporum,
  Trichophyton, Epidermophyton
• Tinea capitis ectothrix or endothrix
• Tinea pedis athletes foot
• Tinea cruris jock itch
• Tinea corporis

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Tinea Pedis

• Interdigital web space type
• Inflammatory vesicular form
• Dry, Scaly moccassin type
• Two feetone hand syndrome usually it is the
  hand used to scratch the feet

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Tinea Pedis
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Tinea Corporis
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Tinea Manum
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Tinea cruris
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Tinea Capitis

• Most often T. tonsurans in U.S.A.
• Four types black dot, seborrheic dermatitis
  type, pustular, and inflammatory (kerion)
• Favus T. schoenleinii, thick crust of hyphae
  and skin debris (scutula)
• Must treat systemically

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Black-dot Tinea Capitis
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Tinea capitis Inflammatory and Noninflammatory
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Kerion
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Black-dot Tinea Capitis
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Favus
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Candidiasis

• Oral Candidiasis
• Balanitis
• Intertrigo
• Angular Cheilitis (perleche)
• Chronic paronychia
• Look for satellite pustules

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Cutaneous candidiasis
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Tinea Versicolor

• Caused by lipophilic yeast M. furfur (or p.
  ovale, depending on who you read)
• Treat with topical or systemic antifungals
• Frequently recurrent
• Appearance variable depending on background skin
  color
• KOH is spaghetti meatballs

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Tinea Versicolor
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Seborrheic Dermatitis

• Infants cradle cap, greasy yellow adherent
  crusts on the scalp vertex
• Young children blepharitis and tinea amiantacea
• Adults Yellow scale erythema on nasolabial
  folds, glabella, scalp hairline, in beard if
  present, post-auricular, concha, central chest,
  body folds
• HIV/AIDS Frequently present and more severe

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Seborrheic Dermatitis Therapy

• Topical Steroids
• Topical Antifungals
• Topical Sulfacetamide
• Frequent Washings with Zinc, Selenium or
  Salicylic acid shampoos

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Seborrheic Dermatitis
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Scabies

• Caused by Sarcoptes scabiei
• Pregnant female mite burrows in the stratum
  corneum, lays eggs about 2-3 per day. Eggs hatch
  after about a week.
• See burrows, papules, vesicles
• In immunocompromised and elderly, can be crusted
  and hyperkeratotic (Norwegian scabies)

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Scabies burrow
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Scabies
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Crusted Scabies
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Pediculosis

• Head lice Pediculosis humanus var. capitis
• Body lice Pediculosis humanus var. corporis
• Pubic lice Pthirus pubis

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Pediculosis humanus
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Pediculosis pubis

• Presents as pruritus
• Up to 30 have a sexually transmitted disease
• Pubic area, medial thighs, abdomen, beards,
  eyelashes in children
• Can see maculae ceruleae which are grayish blue
  macules 1-2 cm in diameter

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Pediculosis pubis
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Tick-borne Diseases Dermacentor
Ixodes
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Rocky Mountain spotted fever

• Can be spotless (Westerman, E.)
• Transmitted by Dermacentor ticks, infected with
  Rickettsia rickettsii
• About 1 week after bite, fever(94),
  headache(88), myalgias(85), vomiting(60)
• Rash is seen in about 85

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Rocky Mountain Spotted Fever

• Erythematous macules begin on ankles and wrists,
  then to palms and soles, then generalized
  (centrifugal distribution)
• Eruption becomes petechial
• Mortality in those untreated is estimated to be
  about 30
• Preferred treatment is doxycycline.

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Rocky Mountain Spotted Fever
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Brown Recluse Spider

• Loxoscelidae reclusus aka fiddle-back spider
• Bites occur when forced into contact with the
  skin.
• Expanding blue gray macule around the puncture
  site which becomes necrotic,
• Pain may become severe, associated with fever,
  chills, nausea, vomiting, myalgias
• Hemolysis, thrompocytopenia, rare DIC more
  commonly seen in children

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Brown Recluse Spider