Dermatology

Anatomy

Skin Infections Bacterial

Impetigo Folliculitis Furuncle Carbuncle Cellulitis Acne

Fungal /Parasitic Tinea Pedis Tinea Cruris Tinea Versicolor Tinea Corporis Toenail fungus Pediculosis Scabies

Skin Infections Viral

Herpes Simplex Herpes Zoster Verruca Molluscum Contagiosum

Allergic/Irritation conditions Dermatitis Hives Eczema Psoriasis Sebacous Cysts Frostbite

Other Skin checks - moles Sunburn Striae

Impetigo

Impetigo Superficial bacterial infection of the skin Most commonly Staph or Strep Thin vesicles with honey colored crusting Usually on face, hands, neck & extremities Spread occurs via contact from fingers,

towels, clothing Tx: Topical antibiotics, severe infections

need oral

Folliculitis

Folliculitis Superficial or deep infection of the hair

follicle (Barbae, hot tub) Usually result of Staph infection May also occur as a result of

contact/plugging with oil, dirt, sweat, etc Rash appears as small, dome shaped

yellow pustules with a hair shaft in the center

Tx: good hygiene, topical antibotics

Furuncle

Furuncle (Boil) Deep extension of superficial folliculitis

into the dermis and subcutaneous tissue Cause – Staph 1-5 cm red/tender nodule which may

contain pus Tx:

Simple lesions- warm compress Severe infections – drainage & antibiotics

Carbuncle

Carbuncle Large deep abscess that is a progression

of a furuncle May be 3-10 cm in size Can present c fever/chills Tx: drainage & antibiotics

Cellulitis

Cellulitis An acute inflammation of the skin S/S: redness, swelling, warmth, & tenderness of

affected area within 1-2 days of injury Cause Staph or Strep, complication of

wound/trauma The borders are well defined and change rapidly Immediate attention (blood test, IV antibiotics) Facial cellulitis can cause visual damage if

spreads to the eyes

NEVER MISS THIS ONE!!!!

Acne

Acne Obstruction of sebaceous follicles (oil glands) Open comedones or closed comedones Usually on the face, chest, back Causes:

Stressful events (hormonal changes) Friction acne Oil based cosmetics NO correlation between chocolate, chips or colas

Tx: topical +/or oral antibiotics

MRSA

MRSA Methicillin-resistant Staphylococcus aureus “super-bug” – caused by staph, unnecessary antibiotic use Outwits all but the most powerful of drugs – vancomycin Enters through cuts & wounds Types: CA (community acquired) or HA (Hospital acquired) S/S: small red bumps that resememble pimples, quicky turn

to painful abscesses that can burrow deep into the body, swelling, redness, pus

Risk Factors: recent hospitalization, long-term care, recent antiobiotic use, young age, contact sports, sharing towels, weak immune system, living in groups, health-care workers

Dx: Tissue sample – 48hrs Tx: trial & error c strong antiobiotics Prevention: WASH HANDS, surfaces, cover wounds, use

only personal items

Tinea Pedis

Tinea Pedis Fungal infection - Athlete’s Foot Rash presents as vesicles/erosions on the

soles of the foot as well as between toes Dx: examine scraping under microscope Tx: antifungal cream/powders

(micronazole), keep feet dry

Tinea Cruris

Tinea Cruris Fungal infection – Jock itch Red/scaly rash on inner thighs/inguinal

creases; occasionally the buttock, not scrotum or labia

Common in obese patients & athletes in tight fitting clothes

Common in hot/humid weather Tx: topical antifungal creams

Tinea Versicolor

Tinea Versicolor Fungal infection of the skin Multiple patchy lesions (oval shape c fine scales)

either light in color or brown Typically occurs on the back, neck, chest,

shoulders More prominent in the summer when the affected

areas do not tan Recurrence is common Tx: Topical antifungal

Tinea Corporis

Tinea Corporis Fungal infection of skin - Ring Worm Well defined circular patches with scaly borders Found on non-hairy surfaces – face, arms, legs,

truck Occurs after contact c another person/object that

is carrying the fungus Common confused c eczema Tx: topical antifungals (Micronazole, ketoconazole

not Nystatin)

Toenail Fungus

Toenail Fungus S/S:yellow, think nails, painful, brittle, more likely in toenails

d/t dark, moist environment Tx: Lamisil, vicks, takes 6-12 months

Pediculosis

Pediculosis Lice; six-legged wingless insect The louse is a grayish/black colored insect ~4mm

long The nits are gelatinous white color ~.8mm long Can be found in the head, body or pubic hair They pierce the skin and secrete saliva which

causes itching, lay eggs close to scalp Spread by shared hats, towels, combs, bedding,

clothing, upholstery & headphones Tx: Shampoo – Nix, Rid; fine tooth comb, boil

clothing/bedding, dry cleaning

Scabies

Very contagious STD Intense itchy rash, with linear burrows Tx: Kwell or Elimite (topical creams) Wash bedding/clothing in HOT water &

stored for 2-3 days

Herpes Simplex

Herpes Simplex Viral infection either Type I OR Type II “You can’t kill it and it won’t kill you” Clear papules c superficial ulcerations/erosions May cause fever, lymph node enlargement,

burning pain Lesions will crust over in 5-14 days Tx: analgesic for pain, oral antiviral (acyclovir)

Herpes Zoster

Herpes Zoster Shingles, a reactivation of varicella zoster

(Chicken pox) virus It remains in the cells of nerve roots in an inactive

state (after exposure as a youth) Unknown reasons for reactivation

Re-exposure to virus Immunosuppressant issue Some drugs

Result in vesicles on a red base in a band-like distribution

Painful rash, prickly nerve pain Tx: symptomatic, pain, calamine lotion

Verruca

Verruca Warts; caused by human papillomavirus Verruca plantaris – Verruca vulgaris – Round, flesh colored and grow to be

yellow-ish tan 1cm or more wide 65% will resolve spontaneously Tx: destruction of epidermal cells that

contain virus; cryogenically, chemically

Molluscum Contagiosum

Molluscum Contagiosum Viral infection of skin/mucous membrane Single or multiple flesh colored, dome

shaped papules c central umbilication Found on face, trunk, extremities,

lips/tongue, genitals Very contagious – self and others Common in swimmers/wrestlers Tx: curettage, silver nitrate to chemically

burn the lesions

Dermatitis

Dermatitis Inflammation of the superficial dermis/epidermis Atopic Dermatitis:

Heriditary disorder – may also have Hx of asthma, allergic rhinitis, rash Usually along cheeks, face, trunk, extensor surfaces of extremities Dry and papular rash, scratching makes it worse, d/t loss of natural oils

in skin Aggravated by stress, anxiety, dry conditions Tx: good lotions & rehydration of skin

Contact Dermatitis: Papular and itchy rash resulting from contact c an allergen Commonly – nickel (cheap jewelry, buckles), soaps, perfumes,

cosmetics, posion ivy/oak Tx: Cortisone cream (anti-inflammatory agent)

Hives

Hives An allergic reaction resulting in histamine release Well defined wheals (solid elevations c central

clearing) Extremely itchy & may result in angioedema Allergy can be to virtually anything Tx: antihistamines

Eczema

Eczema Dryness of the epidermis Usually seen on extremities/trunk Worse in winter or when bath too much Rash is itchy, red, scaly, patchy c a

cracked appearance 2ndary bacterial infections d/t scratching Tx: lotion/creams to hydrate, topical

corticosteroids

Proper Skin Care Frequency of showers Not so much soap/appropriate type Use creams, not lotions

Psoriasis

Psoriasis Inherited skin disorder of increased epidermal cell

turnover & thickening of the epidermis Thick silvery scales Common on the elbows, knees & feet Tx:

UV light or high potency corticosteroids Severe cases need to be hospitalized for a tar ointment

or methotrexate

Sebaceous Cysts

Sebaceous Cysts Solitary skin nodules as a result of proliferation of

epidermal cells that secrete protein called keratin Contains pasty, cheesy looking secretion Common on eyelids, neck, face, trunk, scalp Benign slow growing lesions No treatment necessary unless problems c ADLs

Frostbite

Frostbite Actually freezing of tissue @ cold temps Generally affects the exposed area (Toes, feet,

fingers, nose, cheeks, ears) Skin becomes cold, waxy, white, gray, black Early stages – chillblaines-redness, painful Late stages – cyanosis, gangrene, edema, no pain Tx: cover c warm compress, rapid re-warming in

water, hands between legs, armpits Avoid pressure on tissue, even light

Skin Checks – Moles/Cancer

Moles/Cancer Look for:

1. No bigger than an eraser tip 2. Stand out mole on the back 3. Irregular border 4. different colors

Think of outdoor sports Tennis, golf, soccer

Males – check the head Females – check the ears and lips

Sunburn

Sunburn Superficial burn – only epidermis >15 suncreen 10-2pm is most intese hours, worse in

snowy, watery environments Every time you burn c blisters….increases

your chances of getting skin cancer 4x Tx: analgesic sprays, lotion…..not oil

based

Striae

Striae A streak or a linear scar Results from rapidly developing tension in

the skin Common in pregnancy or when you gain

weight fast…..steroid use