Common skin infections PowerPoint Presentation

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COMMON SKIN INFECTIONS Presented By Shalina Shaik PGY 2 Emory Family Medicine

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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

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Causative Organisms Bacterial Fungal Viral Parasitic

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Very common Range from annoying to deadly infections Mostly caused by Staph aureus and Strep Bacterial Skin Infections

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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)

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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

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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

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Furuncle Carbuncle

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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 I&D Oral abx (dicloxacillin or cephalexin) if fever

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Acute Paronychia

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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

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Impetigo contagiosa (Non bullous form)

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Impetigo (Bullous form)

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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 <2yrs) 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

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Cellulitis

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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. I&D if fluctuant May turn into necrotizing fascitis – medical emergency

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MRSA Infections – on the rise Community associated – MRSA in children in daycare Athletes Military recruits Healthcare associated –MRSA Resistant to multiple abx, send for C&S 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

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Erythrasma Coral pink florescence

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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, Wood’s lamp : coral pink fluorescence Tx: oral erythromycin 1-2 weeks Abx soap to prevent recc

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Fungal Skin infections

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Tinea capitis Tinea corporis

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Tinea unguim Tinea pedis

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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

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Tinea cont.. T. corporis :Itchy, annular patch, well defined edge, scaling more obvious at the edges( central clearing) T.pedis / Athlete’s foot T. unguim : onycholysis, subungual hyperkeratosis, dystrophy/pigmentary changes T.capitis

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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

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Kerion

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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)

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hypopigmented Pityriasis versicolor

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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.

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Cutaneous Candidiasis

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Diaper Candidiasis

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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

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Chronic Paronychia

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Chronic paronychia Swollen, tender boggy nail folds Caused by Candida albicans ( 95%) Wet alkaline work Excess manicuring/Dishwashers/Bartenders/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

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Common Viral Skin Infections

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Common wart Plantar wart

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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,trichloroacetic acid Destructive methods: cryo, electro, laser excision/curretage Prevention: Gardasil vaccine

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Herpes labialis Herpetic gingivostomatitis

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Herpetic whitlow

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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( >6/yr) should receive daily supressive tx Herpetic whitlow, no I & D ( risk of bact superinfection or systemic spread.

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Molluscum contagiosum

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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)

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Hand Foot And Mouth Disease

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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

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Common Parasitic Skin Infestations

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Scabies

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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

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Chiggers

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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)

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