DOCSLIB.ORG

Folliculitis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Folliculitis Folliculitis Common Cutaneous • Inflammation of hair follicle(s) Bacterial Infections • Symptoms: Often pruritic (itchy) Pseudomonas folliculitis Eosinophilic Folliculitis (HIV) Folliculitis: Causes • Bacteria: – Gram positives (Staph): most common – Gram negatives: Pseudomonas – “hot tub” folliculitis • Fungal: Pityrosporum aka Malassezia • HIV: eosinophilic folliculitis (not bacterial) • Renal Failure: perforating folliculitis (not bacterial) Treatment of Folliculitis 21 year old female with controlled Crohn’s disease and history of • Bacterial hidradenitis suppuritiva presents stating – culture pustule she has recurrent flares of her HS – topical clindamycin or oral cephalexin / doxycycline – shower and change shirt after exercise – keep skin dry; loose clothing • Fungal: topical antifungals (e.g., ketoconazole) • Eosinophilic folliculitis – Phototherapy – Treat the HIV MRSA MRSA Eradication • Swab nares mupirocin ointment bid x 5 days • GI noted Crohn’s was controlled but increased – Swab axillae, perineum, pharynx infliximab intensity, but that was not controlling • Chlorhexidine 4% bodywash qd x 1 week recurrent “flares” • Chlorhexidine mouthwash qd x 1 week; soak toothbrush (or disposable) •I & D MRSA on three occasions • Bleach bath: 1/3 cup to tub, soak x 10 min tiw x 1 week, then prn (perhaps weekly) • THIS WAS INFLIXIMAB-RELATED • Oral antibiotics x 14 days: Bactrim, Doxycycline, depends FURUNCULOSIS FROM MRSA COLONIZATION on sensitivities – D/C infliximab • Swab partners – Anti-MRSA regimen • Hand sanitizer frequently – Patient is better • Bleach wipes to surfaces (doorknobs, faucet handles) • Towels use once then wash; paper towels when possible Pointing abscess (furuncle) --pointing requires I & D-- Acute Paronychia Furuncle Treatment Impetigo • Incise & Drain (I & D) Culture pus • Warm soaks • Antibiotics – e.g., cephalexin orally AND mupirocin topically • If recurrent, suspect nasal carriage of Staph aureus swab culture and mupirocin to nares b.i.d. x 5 days q month Bullous ***Impetigo*** impetigo • Superficial skin infection • Contagious • Bullous and non-bullous forms • Causes: Staphylococcus aureus, streptococci (often colonize nose) Note collarettes • Superinfects any defect in skin (eczema, arthropod of scale from bite, etc.) unroofed bullae • Appearance: honey-colored crust • Treatment: mupirocin = best; tid!!!; may require oral antibiotics • Sequelae: post-streptococcal glomerulonephritis; rheumatic fever Impetiginized eczema Staphylococcal In kids, generalized Scalded Skin eczema often doesn’t clear until the Syndrome: impetigo is cleared exofoliative toxin cleaves Dsg 1 SSSS Staphylococcal Scalded Skin Syndrome SSSS SSSS • Infants (3% mortality) and adults with chronic renal insufficiency (50-100% mortality) • Exfoliative toxin ET-A and ET-B • Fever, skin tenderness, peri-oral furrows, exfoliation at flexures • Pan-culture • Therapy: I.V. antibiotics Stasis Dermatitis Cellulitis Recurrent cellulitis Cellulitis Elephantiasis nostras • Infection of dermis and subcutis (i.e., fat), usually bacterial, due to break in skin (e.g., tinea pedis in a verruciformis diabetic) • Cause: Staph aureus and Group A strep most common; but, can be any organism. – Culture not of use unless ulcerated • Signs: rubor (erythema), dolor (pain), calor (heat), tumor (swelling/edema) • Sequelae: fibrosis of lymphatics lymphedema and recurrent cellulitis Necrotizing Fasciitis Cellulitis Therapy • Healthy adult: antibiotics po • Surgical emergency • early and aggressive • Comorbidity: diabetes, venous stasis, HIV debridement – Need i.v. antibiotics • i.v. broad-spectrum – Careful about switching to p.o. too soon antibiotics – Sometimes needs two weeks of i.v. abx • tissue culture – Leg elevation less edema better distribution of drug to target • Trace border to monitor improvement Meningococcemia: DIC Meningococcemia • Derm Emergency (notify State Dept. of Health) • Cause: Neisseria meningitidis (lives in nasopharynx) (Gram negative diplococci) • Prodrome: mild upper respiratory infection • Signs: meningitis; septic shock; sharply angulated slate-gray purpura signaling disseminated intravascular coagulation (DIC) • Therapy: droplet/contact isolation; blood culture; penicillin G • Prophylaxis of contacts: rifampin, ciprofloxacin Spirochetal Diseases: Ixodes scapularis (formerly Lyme Disease dammini) (deer tick) • Cause: Borrelia burgdorferi (spirochete) via bite of Ixodes (deer tick) – Tick must be attached > 18 hours for transmission • Three stages – 1) erythema chronicum migrans – 2) carditis (AV block) and neuritis (Bell’s palsy) – 3) arthritis male nymph • Therapy: doxycycline or amoxicillin • Prophylaxis female – Doxycycline 200mg po once at time of tick bite – Vaccine in endemic areas adult – Insect repellent if outdoors (DEET = N,N-diethyl-m- toluamide) Features of Syphilis Right Bell’s Palsy • Primary Syphilis: 18-21 days after infection (or bad Botox? :O) – (cf: RPR + at 5-6 weeks after infection; FTA-Abs + earlier) • Secondary Syphilis: 6 weeks - 4 months after infection • Tertiary Syphilis: 3-5 years after infection Therapy: •Test for HIV • Report to NYSDOH • Benzathine Penicillin G - 2.4 million units – IM –1o and 2o – one dose –3o – 3 doses one week apart – BEWARE!!! Not Bicillin (penicillin G benzathine and penicillin G procaine) • Need probenecid to maintain blood levels of PCN G procaine • Doxycycline 100mg po bid x 2 weeks Syphilis: Treponema pallidum (spirochete) Secondary Syphilis – Palms • Primary: chancre – painless, indurated • Secondary: the great imitator – Palms/soles (like erythema multiforme) – Papulosquamous (like pityriasis rosea) – Mucous patch in mucosal surfaces – Condyloma latum (NOT viral warts) • Latent: no rash • Tertiary: gumma (rubbery, ulcerated nodule), CNS (tabes dorsalis – posterior column demyelination) • Congenital: TORCH infection, many signs Secondary syphilis mimicking a morbilliform drug rash Secondary Syphilis - Papulosquamous Secondary Syphilis – Secondary Mucous Patch Syphilis - Condyloma Latum • Moist, verrucous plaques Tertiary Syphilitic Gumma Dermatophytes • Organisms: Trichophyton rubrum most common; Microsporum canis and T. tonsurans also common • Name of infection corresponds with anatomic location – Foot: tinea pedis – Hand: tinea manuum – Hair/Scalp: tinea capitis – Face: tinea facialis – Beard: tinea barbae – Body: tinea corporis – Groin: tinea cruris – Nail: tinea unguium Tinea corporis (“ring worm”) Dermatophytes • Nothing to do with worms • Symptoms: pruritic • Diagnosis: via KOH (potassium hydroxide) and/or culture Black-dot Tinea Capitis Kerion Look closely to see black dots where hairs broke off near the scalp Tinea unguium Tinea Unguium (vs. onychomycosis) • Tinea unguium refers to dermatophyte infection of the nail • Onychomycosis is any fungal infection of the nail (i.e., candida, molds, or dermatophytes) • Therapy: Nail lacquers don’t work! Tinea pedis Moccasin Tinea Pedis • Types: moccasin; interdigital • Differential diagnosis: psoriasis, eczema Interdigital Tinea Pedis One hand, Two feet: Tinea manuum and pedis No scale indicating sparing of one hand Scale indicating infection Tinea cruris (“jock itch”) Dermatophyte: Antifungal Therapy • Spares the scrotum; no satellite lesions • (vs. candidal intertrigo affects scrotum) • Topical: for limited area (i.e., groin, small area on body) and tinea capitis (shampoo, adjunctive) • Oral: tinea unguium, tinea manuum, tinea capitis (definitive), extenisve tinea corporis • Topically, terbinafine is most effective, but any topical will do. • Orally, terbinafine is most effective (except for Microsporum). What is the dose of fluconazole to treat this infection if it Terbinafine 250mg p.o. extends into the esophagus? Type of Tinea Duration of A. 150mg po qd x one dose Therapy Vaginal candidiasis Pedis/corporis/cruris/manum Two-four weeks B. & C. 100-200mg po qd x 1-2 weeks Unguium - fingernails Six weeks Oropharyngeal candidiasis Capitis/barbae Six weeks D. 200-400mg po qd x 2-3 weeks Unguium - toenails Twelve weeks Esophageal candidiasis E. 800mg po once, then 400mg qd x 3 weeks Candidemia Candidal Intertrigo cf. Oral Hairy Leukoplakia (EBV) Candidal Diaper Dermatitis Candidal Angular Chelitis Pearl: If recurrent after topical clotrimazole, use nystatin 100,000 unit/mL p.o. 2mL (peds) or 5mL (adults) qid x 3-5 days Candidal Paronychia Candidemia Candida Chronic between nail inflammation plate and of proximal proximal nail nail fold fold Candidal sepsis in a neutropenic patient. Pityriasis versicolor Pityrosporum orbiculare KOH: Tinea versicolor (aka Malassezia furfur) (misnomer! It’s not a dermatophyte.) Look closely for the fine scale. Spaghetti And Meatballs hypopigmentation hyperpigmentation Labial Herpes Primary Herpes Simplex Virus Infection Erythematous base crop of vesicles Herpes Simplex Virus Genital Herpes • Viral shedding occurs in normal-appearing skin The crop of vesicles • Diagnosis: often becomes a crop of erosions with – Tzanck smear (multinucleated giant cells) scalloped border. • Not distinguish HSV from VZV – Direct Fluorescent Antibody: sequentially Still with an incubate slide with smeared vesicle in erythematous base. fluorescent anti-HSV & anti-VZV antibodies – Viral culture Atopic Dermatitis of Face Multinucleated giant cell Xerosis indicates poor barrier with susceptibility to viral infection (see next slide) Eczema Herpeticum Eczema Herpeticum Disseminated HSV Herpes Associated Erythema Multiforme Herpes Zoster (Shingles) Disseminated VZV Primary dermatome Stops at midline Disseminated
Load more

Recommended publications
  • Reporting of Diseases and Conditions Regulation, Amendment, M.R. 289/2014
    THE PUBLIC HEALTH ACT LOI SUR LA SANTÉ PUBLIQUE (C.C.S.M. c. P210) (c. P210 de la C.P.L.M.) Reporting of Diseases and Conditions Règlement modifiant le Règlement sur la Regulation, amendment déclaration de maladies et d'affections Regulation 289/2014 Règlement 289/2014 Registered December 23, 2014 Date d'enregistrement : le 23 décembre 2014 Manitoba Regulation 37/2009 amended Modification du R.M. 37/2009 1 The Reporting of Diseases and 1 Le présent règlement modifie le Conditions Regulation , Manitoba Règlement sur la déclaration de maladies et Regulation 37/2009, is amended by this d'affections , R.M. 37/2009. regulation. 2 Schedules A and B are replaced with 2 Les annexes A et B sont remplacées Schedules A and B to this regulation. par les annexes A et B du présent règlement. Coming into force Entrée en vigueur 3 This regulation comes into force on 3 Le présent règlement entre en vigueur January 1, 2015, or on the day it is registered le 1 er janvier 2015 ou à la date de son under The Statutes and Regulations Act , enregistrement en vertu de Loi sur les textes whichever is later. législatifs et réglementaires , si cette date est postérieure. December 19, 2014 Minister of Health/La ministre de la Santé, 19 décembre 2014 Sharon Blady 1 SCHEDULE A (Section 1) 1 The following diseases are diseases requiring contact notification in accordance with the disease-specific protocol. Common name Scientific or technical name of disease or its infectious agent Chancroid Haemophilus ducreyi Chlamydia Chlamydia trachomatis (including Lymphogranuloma venereum (LGV) serovars) Gonorrhea Neisseria gonorrhoeae HIV Human immunodeficiency virus Syphilis Treponema pallidum subspecies pallidum Tuberculosis Mycobacterium tuberculosis Mycobacterium africanum Mycobacterium canetti Mycobacterium caprae Mycobacterium microti Mycobacterium pinnipedii Mycobacterium bovis (excluding M.
    [Show full text]
  • Abscess Prevention
    ABSCESS PREVENTION ▪ Chest pains may occur if infection How do you soak/use Avoiding abscesses goes to heart or lungs compresses? • Wash your hands and the injection site. What should I do if I get ▪ Use warm/hot water (that doesn’t burn your skin) • Use alcohol pads and wipe an abscess? ▪ Soak in tub of plain hot water or hot back & forth (rub hard) over ▪ Treat at home with warm soaks water with Epsom salts injection site to remove dirt. only if: ▪ Use hot, wet, clean washcloth and - No red streaks hold on abscess, if abscess cannot • Then use another new alcohol - Skin not hot and puffy be soaked in tub pad for the final cleaning. ▪ Soak abscess 3 to 4 times a day for ▪ Go to a clinic if abscess: 10-15 minutes each time, if possible What is a skin abscess? - Not improving, especially ▪ Cover with a clean dry bandage after after 5-7 days soaking ▪ Pocket of pus - Gets bigger and/or very ▪ soaking/using compresses ▪ Often found at injection sites, but STOP painful when abscess starts draining can be found elsewhere - Is hot and puffy ▪ More likely with Red streaks start spreading skin-popping from the abscess-go ASAP! muscling What about missing a vein ▪ Go to emergency room if: ▪ May occur even after you stop Chest pain antibiotics? injecting High fever, chills ▪ Take all antibiotics, if Infection looks like it is How do you know it’s an spreading fast prescribed, even if you feel better abscess? ▪ Take antibiotics after you fix (if ▪ using heroin) ▪ Pink or reddish lump on skin ▪ Do not take antibiotics with ▪ Tender or painful Warning
    [Show full text]
  • Fungal Infections from Human and Animal Contact
    Journal of Patient-Centered Research and Reviews Volume 4 Issue 2 Article 4 4-25-2017 Fungal Infections From Human and Animal Contact Dennis J. Baumgardner Follow this and additional works at: https://aurora.org/jpcrr Part of the Bacterial Infections and Mycoses Commons, Infectious Disease Commons, and the Skin and Connective Tissue Diseases Commons Recommended Citation Baumgardner DJ. Fungal infections from human and animal contact. J Patient Cent Res Rev. 2017;4:78-89. doi: 10.17294/2330-0698.1418 Published quarterly by Midwest-based health system Advocate Aurora Health and indexed in PubMed Central, the Journal of Patient-Centered Research and Reviews (JPCRR) is an open access, peer-reviewed medical journal focused on disseminating scholarly works devoted to improving patient-centered care practices, health outcomes, and the patient experience. REVIEW Fungal Infections From Human and Animal Contact Dennis J. Baumgardner, MD Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI; Center for Urban Population Health, Milwaukee, WI Abstract Fungal infections in humans resulting from human or animal contact are relatively uncommon, but they include a significant proportion of dermatophyte infections. Some of the most commonly encountered diseases of the integument are dermatomycoses. Human or animal contact may be the source of all types of tinea infections, occasional candidal infections, and some other types of superficial or deep fungal infections. This narrative review focuses on the epidemiology, clinical features, diagnosis and treatment of anthropophilic dermatophyte infections primarily found in North America.
    [Show full text]
  • Syphilis Staging and Treatment Syphilis Is a Sexually Transmitted Disease (STD) Caused by the Treponema Pallidum Bacterium
    Increasing Early Syphilis Cases in Illinois – Syphilis Staging and Treatment Syphilis is a sexually transmitted disease (STD) caused by the Treponema pallidum bacterium. Syphilis can be separated into four different stages: primary, secondary, early latent, and late latent. Ocular and neurologic involvement may occur during any stage of syphilis. During the incubation period (time from exposure to clinical onset) there are no signs or symptoms of syphilis, and the individual is not infectious. Incubation can last from 10 to 90 days with an average incubation period of 21 days. During this period, the serologic testing for syphilis will be non-reactive but known contacts to early syphilis (that have been exposed within the past 90 days) should be preventatively treated. Syphilis Stages Primary 710 (CDC DX Code) Patient is most infectious Chancre (sore) must be present. It is usually marked by the appearance of a single sore, but multiple sores are common. Chancre appears at the spot where syphilis entered the body and is usually firm, round, small, and painless. The chancre lasts three to six weeks and will heal without treatment. Without medical attention the infection progresses to the secondary stage. Secondary 720 Patient is infectious This stage typically begins with a skin rash and mucous membrane lesions. The rash may manifest as rough, red, or reddish brown spots on the palms of the hands, soles of the feet, and/or torso and extremities. The rash does usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed.
    [Show full text]
  • Disseminated Mycobacterium Tuberculosis with Ulceronecrotic Cutaneous Disease Presenting As Cellulitis Kelly L
    Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Disseminated Mycobacterium Tuberculosis with Ulceronecrotic Cutaneous Disease Presenting as Cellulitis Kelly L. Reed DO Lehigh Valley Health Network, [email protected] Nektarios I. Lountzis MD Lehigh Valley Health Network, [email protected] Follow this and additional works at: http://scholarlyworks.lvhn.org/medicine Part of the Dermatology Commons, and the Medical Sciences Commons Published In/Presented At Reed, K., Lountzis, N. (2015, April 24). Disseminated Mycobacterium Tuberculosis with Ulceronecrotic Cutaneous Disease Presenting as Cellulitis. Poster presented at: Atlantic Dermatological Conference, Philadelphia, PA. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact [email protected]. Disseminated Mycobacterium Tuberculosis with Ulceronecrotic Cutaneous Disease Presenting as Cellulitis Kelly L. Reed, DO and Nektarios Lountzis, MD Lehigh Valley Health Network, Allentown, Pennsylvania Case Presentation: Discussion: Patient: 83 year-old Hispanic female Cutaneous tuberculosis (CTB) was first described in the literature in 1826 by Laennec and has since been History of Present Illness: The patient presented to the hospital for chest pain and shortness of breath and was treated for an NSTEMI. She was noted reported to manifest in a variety of clinical presentations. The most common cause is infection with the to have redness and swelling involving the right lower extremity she admitted to having for 5 months, which had not responded to multiple courses of antibiotics. She acid-fast bacillus Mycobacterium tuberculosis via either primary exogenous inoculation (direct implantation resided in Puerto Rico but recently moved to the area to be closer to her children.
    [Show full text]
  • Borrelia Burgdorferi and Treponema Pallidum: a Comparison of Functional Genomics, Environmental Adaptations, and Pathogenic Mechanisms
    PERSPECTIVE SERIES Bacterial polymorphisms Martin J. Blaser and James M. Musser, Series Editors Borrelia burgdorferi and Treponema pallidum: a comparison of functional genomics, environmental adaptations, and pathogenic mechanisms Stephen F. Porcella and Tom G. Schwan Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, NIH, Hamilton, Montana, USA Address correspondence to: Tom G. Schwan, Rocky Mountain Laboratories, 903 South 4th Street, Hamilton, Montana 59840, USA. Phone: (406) 363-9250; Fax: (406) 363-9445; E-mail: [email protected]. Spirochetes are a diverse group of bacteria found in (6–8). Here, we compare the biology and genomes of soil, deep in marine sediments, commensal in the gut these two spirochetal pathogens with reference to their of termites and other arthropods, or obligate parasites different host associations and modes of transmission. of vertebrates. Two pathogenic spirochetes that are the focus of this perspective are Borrelia burgdorferi sensu Genomic structure lato, a causative agent of Lyme disease, and Treponema A striking difference between B. burgdorferi and T. pal- pallidum subspecies pallidum, the agent of venereal lidum is their total genomic structure. Although both syphilis. Although these organisms are bound togeth- pathogens have small genomes, compared with many er by ancient ancestry and similar morphology (Figure well known bacteria such as Escherichia coli and Mycobac- 1), as well as by the protean nature of the infections terium tuberculosis, the genomic structure of B. burgdorferi they cause, many differences exist in their life cycles, environmental adaptations, and impact on human health and behavior. The specific mechanisms con- tributing to multisystem disease and persistent, long- term infections caused by both organisms in spite of significant immune responses are not yet understood.
    [Show full text]
  • WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/05 (2006.01) A61P 31/02 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/CA20 14/000 174 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 4 March 2014 (04.03.2014) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (26) Publication Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (30) Priority Data: ZW. 13/790,91 1 8 March 2013 (08.03.2013) US (84) Designated States (unless otherwise indicated, for every (71) Applicant: LABORATOIRE M2 [CA/CA]; 4005-A, rue kind of regional protection available): ARIPO (BW, GH, de la Garlock, Sherbrooke, Quebec J1L 1W9 (CA). GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (72) Inventors: LEMIRE, Gaetan; 6505, rue de la fougere, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, Sherbrooke, Quebec JIN 3W3 (CA).
    [Show full text]
  • Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G
    Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G. Bellew, DO, PGY3; Chad Taylor, DO; Jaldeep Daulat, DO; Vernon T. Mackey, DO Advanced Desert Dermatology & Mohave Centers for Dermatology and Plastic Surgery, Peoria, AZ & Las Vegas, NV Abstract Management & Clinical Course Discussion Conclusion Pyogenic granulomas are vascular hyperplasias presenting At the time of the periungal eruption on the distal fingernails, Excess granulation tissue and pyogenic granulomas have It has been reported that the resolution of excess as red papules, polyps, or nodules on the gingiva, fingers, the patient was undergoing isotretinoin therapy for severe been described in both previous acne scars and periungal granulation tissue secondary to systemic retinoid therapy lips, face and tongue of children and young adults. Most nodulocystic acne with significant scarring. He was in his locations.4 Literature review illustrates rare reports of this occurs on withdrawal of isotretinoin.7 Unfortunately for our commonly they are associated with trauma, but systemic fifth month of isotretinoin therapy with a cumulative dose of adverse event. In addition, the mechanism by which patient, discontinuation of isotretinoin and prevention of retinoids have rarely been implicated as a causative factor 140 mg/kg. He began isotretinoin therapy at a dose of 40 retinoids cause excess granulation tissue of the skin is not secondary infection in areas of excess granulation tissue in their appearance. mg daily (0.52 mg/kg/day) for the first month and his dose well known. According to the available literature, a course was insufficient in resolving these lesions. To date, there is We present a case of eruptive pyogenic granulomas of the later increased to 80 mg daily (1.04 mg/kg/day).
    [Show full text]
  • Ingrown Nail/Paronychia Referral Guide: Podiatry Referral Page 1 of 1 Diagnosis/Definition
    Ingrown Nail/Paronychia Referral Guide: Podiatry Referral Page 1 of 1 Diagnosis/Definition: Redness, warmth, tenderness and exudate coming from the areas adjacent to the nail plate. Initial Diagnosis and Management: History and physical examination. In chronic infection appropriate radiographic (foot or toe series to rule out distal phalanx osteomyelitis) and laboratory evaluation (CBC and ESR). Ongoing Management and Objectives: Primary care should consist of Epsom salt soaks, or soapy water, and antibiotics for ten days. If Epsom salt soaks and antibiotics are ineffective, the primary care provider has the following options: Reevaluate and refer to podiatry. Perform temporary avulsion/I&D. Perform permanent avulsion followed by chemical cautery (89% Phenol or 10% NaOH application – 3 applications maintained for 30 second intervals, alcohol dilution between each application). Aftercare for all of the above is continued soaks, daily tip cleaning and bandage application. Indications for Specialty Care Referral: After the reevaluation at the end of the antibiotic period the primary care provider can refer the patient to Podiatry for avulsion/ surgical care if they do not feel comfortable performing the procedure themselves. The patient should be given a prescription for antibiotics renewal and orders to continue soaks until avulsion can be performed. Test(s) to Prepare for Consult: Test(s) Consultant May Need To Do: Criteria for Return to Primary Care: After completion of the surgical procedure, patients will be returned to the primary care provider for follow-up. Revision History: Created Revised Disclaimer: Adherence to these guidelines will not ensure successful treatment in every situation. Further, these guidelines should not be considered inclusive of all accepted methods of care or exclusive of other methods of care reasonably directed to obtaining the same results.
    [Show full text]
  • Abscesses Are a Serious Problem for People Who Shoot Drugs
    Where to Get Your Abscess Seen Abscesses are a serious problem for people who shoot drugs. But what the hell are they and where can you go for care? What are abscesses? Abscesses are pockets of bacteria and pus underneath you skin and occasionally in your muscle. Your body creates a wall around the bacteria in order to keep the bacteria from infecting your whole body. Another name for an abscess is a “soft tissues infection”. What are bacteria? Bacteria are microscopic organisms. Bacteria are everywhere in our environment and a few kinds cause infections and disease. The main bacteria that cause abscesses are: staphylococcus (staff-lo-coc-us) aureus (or-e-us). How can you tell when you have an abscess? Because they are pockets of infection abscesses cause swollen lumps under the skin which are often red (or in darker skinned people darker than the surrounding skin) warm to the touch and painful (often VERY painful). What is the worst thing that can happen? The worst thing that can happen with abscesses is that they can burst under your skin and cause a general infection of your whole body or blood. An all over bacterial infection can kill you. Another super bad thing that can happen is a endocarditis, which is an infection of the lining of your heart, and “septic embolism”, which means that a lump of the contaminates in your abscess get loose in your body and lodge in your lungs or brain. Why do abscesses happen? Abscesses are caused when bad bacteria come in to contact with healthy flesh.
    [Show full text]
  • Intra-Abdominal Ventriculoperitoneal Shunt Abscess from Streptococcus Pyogenes After Pharyngitis with Scarlet Fever
    NEURO ISSN 2377-1607 http://dx.doi.org/10.17140/NOJ-1-107 Open Journal Case Report Intra-Abdominal Ventriculoperitoneal Shunt *Corresponding author Abscess from Streptococcus Pyogenes Edward A. Monaco 3rd, MD, PhD Assistant Professor after Pharyngitis with Scarlet Fever: Case Department of Neurological Surgery University of Pittsburgh Medical Center, Suite F158, 200 Lothrop Report and Review of the Literature Street, Pittsburgh, PA 15213, USA Tel. 412-647-6777 Stephanie H. Chen and Edward A. Monaco 3rd* Fax: 412-647-6483 E-mail: [email protected] Department of Neurological Surgery, University of Pittsburgh Medical Center, Suite F158, 200 Lothrop Street, Pittsburgh, PA 15213, USA Volume 1 : Issue 1 Article Ref. #: 1000NOJ1107 ABSTRACT Article History Received: November 13th, 2014 Objective: Infection is one of the most frequent complications of ventriculoperitoneal shunts. th Accepted: December 15 , 2014 However, Streptococcus pyogenes (Group A Streptococcus, GAS) as a causative agent appears th Published: December 16 , 2014 to be extremely rare. We present an unusual case of a peritoneal shunt infection due to GAS that occurred after pharyngitis with scarlet fever. Case Description: A 31 year-old woman with congenital shunt-dependent hydrocephalus pre- Citation sented with fever, vomiting, and acute abdominal symptoms several weeks after being treated Chen SH, Monaco EA 3rd. Intra-ab- dominal ventriculoperitoneal shunt for pharyngitis and scarlet fever. She was found to have a large intra-abdominal peritoneal abscess from Streptococcus pyo- catheter-associated abscess that grew out GAS. genes after pharyngitis with scarlet Results: The patient’s shunt was externalized at the clavicle and the cerebrospinal fluid (CSF) fever: Case report and review of the was sterile.
    [Show full text]
  • Onychomycosis/ (Suspected) Fungal Nail and Skin Protocol
    Onychomycosis/ (suspected) Fungal Nail and Skin Protocol Please check the boxes of the evaluation questions, actions and dispensing items you wish to include in your customized protocol. If additional or alternative products or services are provided, please include when making your selections. If you wish to include the condition description please also check the box. Description of Condition: Onychomycosis is a common nail condition. It is a fungal infection of the nail that differs from bacterial infections (often referred to as paronychia infections). It is very common for a patient to present with onychomycosis without a true paronychia infection. It is also very common for a patient with a paronychia infection to have secondary onychomycosis. Factors that can cause onychomycosis include: (1) environment: dark, closed, and damp like the conventional shoe, (2) trauma: blunt or repetitive, (3) heredity, (4) compromised immune system, (5) carbohydrate-rich diet, (6) vitamin deficiency or thyroid issues, (7) poor circulation or PVD, (8) poor-fitting shoe gear, (9) pedicures received in places with unsanitary conditions. Nails that are acute or in the early stages of infection may simply have some white spots or a white linear line. Chronic nail conditions may appear thickened, discolored, brittle or hardened (to the point that the patient is unable to trim the nails on their own). The nails may be painful to touch or with closed shoe gear or the nail condition may be purely cosmetic and not painful at all. *Ask patient to remove nail
    [Show full text]