DOCSLIB.ORG

Skin Disease and Disorders

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Skin Disease and Disorders Sports Dermatology Robert Kiningham, MD, FACSM Department of Family Medicine University of Michigan Health System Disclosures/Conflicts of Interest ◼ None Goals and Objectives ◼ Review skin infections common in athletes ◼ Establish a logical treatment approach to skin infections ◼ Discuss ways to decrease the risk of athlete’s acquiring and spreading skin infections ◼ Discuss disqualification and return-to-play criteria for athletes with skin infections ◼ Recognize and treat non-infectious skin conditions in athletes Skin Infections in Athletes ◼ Bacterial ◼ Herpetic ◼ Fungal Skin Infections in Athletes ◼ Very common – most common cause of practice-loss time in wrestlers ◼ Athletes are susceptible because: – Prone to skin breakdown (abrasions, cuts) – Warm, moist environment – Close contacts Cases 1 -3 ◼ 21 year old male football player with 4 day h/o left axillary pain and tenderness. Two days ago he noticed a tender “bump” that is getting bigger and more tender. ◼ 16 year old football player with 3 day h/o mildly tender lesions on chin. Started as a single lesion, but now has “spread”. Over the past day the lesions have developed a dark yellowish crust. ◼ 19 year old wrestler with a 3 day h/o lesions on right side of face. Noticed “tingling” 4 days ago, small fluid filled lesions then appeared that have now started to crust over. Skin Infections Bacterial Skin Infections ◼ Cellulitis ◼ Erysipelas ◼ Impetigo ◼ Furunculosis ◼ Folliculitis ◼ Paronychea Cellulitis Cellulitis ◼ Diffuse infection of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin – Triad of erythema, edema, and warmth in the absence of underlying foci ◼ S. aureus or S. pyogenes Erysipelas Erysipelas ◼ Superficial infection of the dermis ◼ Distinguished from cellulitis by the intracutaneous edema that produces palpable margins of the skin. – May appear thick and dimpled – May have associated systemic symptoms ◼ S. pyogenes (group A strep) Skin Infections Impetigo Impetigo ◼ Superficial dermatologic infection characterized by honey – colored crusting of the overlying skin – Bullous, non-bullous, ecthyma ◼ Staphylococcus aureus or Streptococcus pyogenes (group A streptococci) Folliculitis Folliculitis ◼ Infection of the hair follicle that remains superficial - localized to the epidermis ◼ S. aureus, Candida species, Pseudomonas aeruginosa (whirlpools, hot tubs) enterobacter (rare) ◼ Pseudofolliculitis barbae Pseudofolliculitis Barbae ◼ Inflammation and foreign body reaction from curled-in hair ◼ May get a bacterial superinfection Skin Infections Furuncle Furuncle ◼ Begins as an infection of the hair follicle, but spreads deeper into the dermis and subcutaneous tissue ◼ Forms a perifollicular abscess ◼ Almost always caused by S. aureus Furuncle/Carbuncle ◼ Carbuncle: deeper and wider lesions with interconnecting subcutaneous abscesses arising from infection of several neighboring hair follicles – May have systemic symptoms Great Toe Paronychia Paronychia ◼ Soft tissue infection around a nail ◼ Acute paronychia is usually due to S. aureus or S. pyogenes ◼ Chronic can be due to Candida species ◼ Herpes simplex causes herpetic whitlow Herpetic Whitlow Skin Infections Herpes Simplex (Herpes Gladiatorum) ◼ 39% of skin infections in NCAA injury surveillance ◼ Occurs when skin protective barrier is broken ◼ Transmitted primarily by repetitive skin-to-skin contact ◼ Vesicles usually appear within 3-5 days of direct skin-to-skin contact Treatment of Herpes Infections ◼ Self-limiting illness. Anti-viral therapy may reduce duration of illness and limit transmission by inhibiting viral replication ◼ Start anti-viral at very first sign of an outbreak ◼ Acyclovir 400mg tid, valacyclovir 1 gm bid ◼ 7-10 days for initial outbreak, 5 days for recurrent Case #4 ◼ 20 y.o. football player presents with a “spider bite” on his leg that has been present for 4 days. ◼ It is progressing in size and is uncomfortable ◼ Treated over the weekend in urgent care with Keflex with no improvement. CA - MRSA ◼ Typical presentation is a pustular lesion with central necrosis ◼ Pain is often out of proportion to the size and appearance of the lesion ◼ Patients often c/o of a “spider bite” Treatment of Skin Infections Beware of CA-MRSA ◼ Most S.aureus are beta-lactamase producing, so resistant to penicillin, but susceptible to cephalosporins and the penicillinase-resistant penicillins (nafcillin, oxacillin, dicloxicillin), or B- lactam-B-lactamase inhibitor combinations (e.g., amoxicillin- clavulanate) Treatment of Skin Infections Beware of CA-MRSA ◼ Increased prevalence of S.aureus that have the mecA gene that produces the penicillin-binding protein PBP2a ◼ Confers resistance to all currently FDA- approved B-lactams Treatment of Skin Infections Beware of CA-MRSA ◼ Study of University affiliated ERs found that 76% of skin/soft tissue infections caused by S. aureus – 59% of total due to MRSA – 77.8% of S. aureus were MRSA – 99% of MRSA were CA-MRSA CA-MRSA Treatment of Skin Infections Beware of CA-MRSA ◼ Class 1 infection – Lesion non-fluctuant – Patient afebrile, otherwise healthy ◼ Class 2 infection – Lesion fluctuant or pustular – Lesion < 5 cm in diameter – Patient afebrile, otherwise healthy Treatment of Skin Infections Beware of CA-MRSA ◼ Class 3 infection – Lesion > 5 cm in diameter – Patient toxic appearing or at least one unstable comorbidity or limb-threatening infection ◼ Class 4 infection – Sepsis syndrome of life-threatening infection (necrotizing fasciitis) Treatment of Skin Infections Beware of CA-MRSA Key Point Incise and drain the lesion if possible! Treatment of Skin Infections Beware of CA-MRSA ◼ Incision and drainage alone without antibiotics has 90% cure rate ◼ Use 11 blade to create a wide opening ◼ Explore wound for loculations and pack ◼ Frequent follow-up for approximately 2 weeks Rajendran et al. Antimicrob Agents Chemother 2007;51:4044-4048 Treatment of Skin Infections Beware of CA-MRSA ◼ Class 1 infection – If no drainable abscess, prescribe first or second generation cephalosporin, semi- synthetic penicillin, macrolide, or clindamycin – Follow-up in 1-2 days to ensure response Treatment of Skin Infections Beware of CA-MRSA ◼ Class 2 infection – I&D the lesion – Frequent follow-up – If not healing within 7 days, empirically treat with TMP-SMX – Clindamycin and tetracycline are alternatives, although higher resistance Treatment of Skin Infections Beware of CA-MRSA ◼ Class 3 and 4 infections – Admit to hospital – Consult surgery for aggressive debridement – Start vancomycin IV – Consult infectious disease specialist Approach to Treatment of Skin Infections in Athletes ◼ Lesions can often not look “typical” because of scratching or rubbing. ◼ If you suspect HSV, un-roof a vesicle for culture (if possible) and treat empirically with oral anti-viral. ◼ I&D, if possible, is the treatment of choice. Send fluid for culture to look for MRSA. Approach to Treatment of Skin Infections ◼ Treat non-fluctuant lesions for MSSA with cephalosporin or amoxicillin- clavulante (augmentin). ◼ Monitor athletes daily for response. If fluctuant lesions appear, I&D them. If not responding, consider switching to oral MRSA antibiotic based on local sensitivities. Approach to Treatment of Skin Infections ◼ Avoid empiric treatment with oral anti- MRSA antibiotic unless there is a known MRSA outbreak on the team, or lesion has classic MRSA presentation and appearance. ◼ Avoid cephalosporin plus anti-MRSA empiric treatment. Case #5 ◼ 19 y.o. Baseball player presents with a lacy rash in his inguinal region ◼ He describes it as “itchy” and it exacerbates when he sweats Cutaneous Fungal Infections “Tinea” ◼ Dermatophytes survive on keratin in the stratum corneum ◼ Warm, moist environments promote fungal growth ◼ Tinea corporis in athletes is primarily spread by skin-to-skin contact ◼ Skin scales containing fungal spores can live outside the host on inanimate surfaces Tinea Crura and Pedis Tinea Corporis Treatment of Fungal Infections ◼ Topical treatment usually sufficient – Allyamines (terbinafine, naftifine): fungicidal – Imidazoles (clotrimazole, miconazole): fungistatic – 2-3 times a day for 3-28 days (or longer?) Treatment of Fungal Infections ◼ Oral anti-fungals for widespread lesions, multiple recurrences – Fluconazole 150 mg q wk for 3 weeks – Itraconazole 200 mg qD for 2 weeks – Terbinafine 250 mg qD for 2 weeks Treatment of Fungal Infections ◼ For tinea crura and pedis, keeping the areas as dry as possible are key for successful treatment and prevention of recurrence – Change underwear/socks frequently! Participation and Return to Play Guidelines ◼ Wrestling at all levels (HS, college, international) has specific rules governing criteria for participation and return to play for infectious skin diseases ◼ Other sports do not, but wrestling rules provide a conservative guideline Participation and Return to Play Guidelines ◼ Bacterial infections – Treatment for minimum 72 hrs – No new lesions within 48 hrs – No draining or “wet” lesions ◼ Herpetic infections – Systemic antiviral therapy for at least 120 hrs prior to competition – No new blisters for 72 hrs, no moist lesions Participation and Return to Play Guidelines ◼ Fungal infections – Minimum 72 hrs topical treatment for non-scalp, 2 weeks systemic for scalp, lesions Prevention of Skin Infections in Athletes ◼ Infection acquisition requires skin exposure to infectious agent with breakdown of normal skin barriers ◼ Prevention measures designed to minimize exposure and skin breakdown Prevention of Skin Infections
Load more

Recommended publications
  • 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]
  • Bacterial Skin Infections an Observational Study
    RESEARCH Geoffrey Spurling Deborah Askew David King Geoffrey K Mitchell MBBS, DTM&H, FRACGP, is Senior PhD, is Senior Research Fellow, MBBS, MPH, FRACGP, is Senior Lecturer, MBBS, PhD, FRACGP, FAChPM, Lecturer, Discipline of General Practice, Discipline of General Practice, Discipline of General Practice, University is Associate Professor, Discipline University of Queensland. g.spurling@ University of Queensland. of Queensland. of General Practice, University of uq.edu.au Queensland. Bacterial skin infections An observational study Bacterial skin infections such as impetigo and boils are Background common, contagious, often painful, and have the potential to We aimed to determine the feasibility of measuring resolution rates of recur. They are caused by Staphylococcus aureus and bacterial skin infections in general practice. occasionally by Streptococcus pyogenes, and are transmitted Methods by skin-to-skin contact, fomite contact or contact with nasal Fifteen general practitioners recruited patients from March 2005 to carriers.1 In the United Kingdom, incidence of skin infections October 2007 and collected clinical and sociodemographic data at in children in 2005 was approximately 75 per 100 000.2 Skin baseline. Patients were followed up at 2 and 6 weeks to assess lesion infection rates are likely to be higher in warmer climates. The resolution. only Australian data we found were for one Northern Territory Results Aboriginal Medical Service (Danila Dilba), which recorded 7.5 Of 93 recruited participants, 60 (65%) were followed up at 2 and 6 per 100 consultations for localised skin infections.3 weeks: 50% (30) had boils, 37% (22) had impetigo, 83% (50) were prescribed antibiotics, and active follow up was suggested for 47% Suggested risk factors for impetigo include: household crowding, (28).
    [Show full text]
  • Inflammatory Or Infectious Hair Disease? a Case of Scalp Eschar and Neck Lymph Adenopathy After a Tick Bite
    Case Report ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2021.35.005688 Adherent Serous Crust of the Scalp: Inflammatory or Infectious Hair Disease? A Case of Scalp Eschar and Neck Lymph Adenopathy after a Tick Bite Starace M1, Vezzoni R*2, Alessandrini A1 and Piraccini BM1 1Dermatology - IRCCS, Policlinico Sant’Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Italy 2Dermatology Clinic, Maggiore Hospital, University of Trieste, Italy *Corresponding author: Roberta Vezzoni, Dermatology Clinic, Maggiore Hospital, University of Trieste, Italy ARTICLE INFO ABSTRACT Received: Published: April 17, 2021 The appearance of a crust initially suggests inflammatory scalp diseases, although infectious diseases such as impetigo or insect bites should also be considered among April 27, 2021 the differential diagnoses. We report a case of 40-year-old woman presentedB. Burgdorferi to our, Citation: Starace M, Vezzoni R, Hair Disease Outpatient Service with an adherent serous crust on the scalp and lymphadenopathy of the neck. Serological tests confirmed the aetiology of while rickettsia infection was excluded. Lyme borreliosis can mimic rickettsia infection Alessandrini A, Piraccini BM. Adherent and may present as scalp eschar and neck lymphadenopathy after a tick bite (SENLAT). Serous Crust of the Scalp: Inflammatory Appropriate tests should be included in the diagnostic workup of patients with necrotic or Infectious Hair Disease? A Case of Scalp scalpKeywords: eschar in order to promptly set
    [Show full text]
  • Coexistence of Antibodies to Tick-Borne
    Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 98(3): 311-318, April 2003 311 Coexistence of Antibodies to Tick-borne Agents of Babesiosis and Lyme Borreliosis in Patients from Cotia County, State of São Paulo, Brazil Natalino Hajime Yoshinari/+, Milena Garcia Abrão, Virginia Lúcia Nazário Bonoldi, Cleber Oliveira Soares*, Claudio Roberto Madruga*, Alessandra Scofield**, Carlos Luis Massard**, Adivaldo Henrique da Fonseca** Laboratório de Investigação em Reumatologia (LIM-17), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo 455, 3º andar, 01246-903 São Paulo, SP, Brasil *Embrapa Gado de Corte, Campo Grande, MS, Brasil **Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brasil This paper reports a case of coinfection caused by pathogens of Lyme disease and babesiosis in brothers. This was the first case of borreliosis in Brazil, acquired in Cotia County, State of São Paulo, Brazil. Both children had tick bite history, presented erythema migrans, fever, arthralgia, mialgia, and developed positive serology (ELISA and Western-blotting) directed to Borrelia burgdorferi G 39/40 and Babesia bovis antigens, mainly of IgM class antibodies, suggestive of acute disease. Also, high frequencies of antibodies to B. bovis was observed in a group of 59 Brazilian patients with Lyme borreliosis (25.4%), when compared with that obtained in a normal control group (10.2%) (chi-square = 5.6; p < 0.05). Interestingly, both children presented the highest titers for IgM antibodies directed to both infective diseases, among all patients with Lyme borreliosis. Key words: lyme borreliosis - lyme disease - spirochetosis - borreliosis - babesiosis - coinfection - tick-borne disease - Brazil Babesiosis is a tick-borne disease distributed world- The first case of babesiosis in a healthy person, with wide, caused by hemoprotozoans of the genus Babesia, intact spleen, was reported in 1969 in a woman from Nan- which infects wild and domestic animals, promoting eco- tucket Island (Massachusetts, USA)(Wester et al.
    [Show full text]
  • Nonbacterial Pus-Forming Diseases of the Skin Robert Jackson,* M.D., F.R.C.P[C], Ottawa, Ont
    Nonbacterial pus-forming diseases of the skin Robert Jackson,* m.d., f.r.c.p[c], Ottawa, Ont. Summary: The formation of pus as a Things are not always what they seem Fungus result of an inflammatory response Phaedrus to a bacterial infection is well known. North American blastomycosis, so- Not so well appreciated, however, The purpose of this article is to clarify called deep mycosis, can present with a is the fact that many other nonbacterial the clinical significance of the forma¬ verrucous proliferating and papilloma- agents such as certain fungi, viruses tion of pus in various skin diseases. tous plaque in which can be seen, par- and parasites may provoke pus Usually the presence of pus in or on formation in the skin. Also heat, the skin indicates a bacterial infection. Table I.Causes of nonbacterial topical applications, systemically However, by no means is this always pus-forming skin diseases administered drugs and some injected true. From a diagnostic and therapeutic Fungus materials can do likewise. Numerous point of view it is important that physi¬ skin diseases of unknown etiology cians be aware of the nonbacterial such as pustular acne vulgaris, causes of pus-forming skin diseases. North American blastomycosis pustular psoriasis and pustular A few definitions are required. Pus dermatitis herpetiformis can have is a yellowish [green]-white, opaque, lymphangitic sporotrichosis bacteriologically sterile pustules. The somewhat viscid matter (S.O.E.D.). Pus- cervicofacial actinomycosis importance of considering nonbacterial forming diseases are those in which Intermediate causes of pus-forming conditions of pus can be seen macroscopicaily.
    [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]
  • Bacterial Infections Diseases Picture Cause Basic Lesion
    page: 117 Chapter 6: alphabetical Bacterial infections diseases picture cause basic lesion search contents print last screen viewed back next Bacterial infections diseases Impetigo page: 118 6.1 Impetigo alphabetical Bullous impetigo Bullae with cloudy contents, often surrounded by an erythematous halo. These bullae rupture easily picture and are rapidly replaced by extensive crusty patches. Bullous impetigo is classically caused by Staphylococcus aureus. cause basic lesion Basic Lesions: Bullae; Crusts Causes: Infection search contents print last screen viewed back next Bacterial infections diseases Impetigo page: 119 alphabetical Non-bullous impetigo Erythematous patches covered by a yellowish crust. Lesions are most frequently around the mouth. picture Lesions around the nose are very characteristic and require prolonged treatment. ß-Haemolytic streptococcus is cause most frequently found in this type of impetigo. basic lesion Basic Lesions: Erythematous Macule; Crusts Causes: Infection search contents print last screen viewed back next Bacterial infections diseases Ecthyma page: 120 6.2 Ecthyma alphabetical Slow and gradually deepening ulceration surmounted by a thick crust. The usual site of ecthyma are the legs. After healing there is a permanent scar. The pathogen is picture often a streptococcus. Ecthyma is very common in tropical countries. cause basic lesion Basic Lesions: Crusts; Ulcers Causes: Infection search contents print last screen viewed back next Bacterial infections diseases Folliculitis page: 121 6.3 Folliculitis
    [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]
  • Sexually Transmitted Diseases
    Sexually Transmitted Diseases by John H. Dirckx, M.D. significant proportion of the modern practice of adult using condoms and avoiding high-risk behaviors such as anal gynecology and urology is devoted to the prevention, intercourse—and by limiting the number of sex partners. Adiagnosis, and treatment of sexually transmitted dis- The overall incidence of sexually transmitted infections eases (STDs), because of both the high prevalence of these has increased substantially during the past generation, and diseases and their almost exclusive involvement of the repro- some diseases have shown a marked increase. Several factors ductive systems in both sexes. have contributed to these changing statistics. The discovery in A sexually transmitted disease is any infectious disease the 1940s that penicillin could cure syphilis and gonorrhea and that is transmitted from one person to another through sexual the development during the 1950s of safe and effective oral contact, taking that phrase in its broadest sense. Venereal dis- contraceptives paved the way for the sexual revolution of the ease (VD), a synonymous term, has now largely fallen out of 1960s. Against a background of civil unrest, widespread drug use, as has the euphemism social disease. It is worth empha- abuse, and radical feminism, that revolution led to social sizing that the only thing all STDs have in common is their acceptance of sexual promiscuity, popularization of oral and mode of transmission. In other respects they vary widely anal sex, and definition of overt homosexuality as normal among themselves. The common tendency to lump them all behavior. together yields a biologically invalid concept that invites con- Other factors favoring sexual promiscuity have been the fusion and misunderstanding.
    [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]