Pediculosis capitis RX
1. 1% permethrin (Nix) - most effective
Macule 2
- Flat
- Change in skin color
Papule 4
- Raised
- Solid
... [Show More] lesion
- Change is skin color
- <0.5cm
Plaque (3)
- Raised
- Solid
- >0.5 cm
Nodule (2)
- Solid
- 0.5-2cm
Tumor (2)
- Solid
- >2cm
Vesicle
- Raised
- Fluid
- <0.5cm
Bulla
- Raised
- Fluid
- >0.5cm
Abscess= furuncle= boil
Deep skin infection of the hair follicle
Confluent or Coalescen
Multiple lesions blending together
Reticular Pattern
Netlike pattern
Lichenification
Skin thickening usually found over pruritic or friction area
Annular
Ring formation
Cellulitis
Description
SX (7)
- Acute infection of the skin
- SX: redness, edema, warm, fever & pain on the face of legs
*puss= MRSA
Cellulitis: TX
Without purulence &
With
1. MSSA
- Cephalexin (Keflex)
- Cefadroxil
-Clindamycin*
2. MRSA
I&D 1st line THEN
- TMP-SMX
- Clindamycin*
- Teracycline
- Linezolid
x5-10 days
Folliculitis
Description
Classic presentation
Etiology
RF
TX
- Superficial OR deep infection/irritation of the hair follicles.
- Follicullar pustules or papules on hair-bearing areas
- Staph most common
- Shaving, tight jeans, poor hygiene
- Bacroban small area OR Keflex for large
Carbunculosis:
Description
Deep coalescence lesions of several inflamed follicles that form a purulent mass
Carbunculosis TX (2)
1. I& D
2. Consider Abx if fever or systemic sx present or initial tx failed (TMP-SMX)
Impetigo
Description
TX
- Superficial infection of the skin that begins as small
superficial vesicles. Vesicles rupture and form honey-colored crusts. (Bullous and nonbullous)
- Topical for small Oral for Large; Mupirocin (Bactroban) or retapamulin (Altabax) BID x 5 days
* children should avoid school until 48 hrs after abx or until bolsters become dry
Ecthyma:
Description
TX
- It is a deep form of impetigo; characterized by crusted sores beneath which ulcers form (Affects butt, thighs, legs, ankle, feet)
RX
MSSA=
- dicloxacillin
- cephalexin
OR
MRSA=
- doxycycline
- clindamycin
- TMP-SMX
Bites (cat, dog, human) TX (5)
1. Copious Irrigation
2. Cautious debridement
3. Leave wound open (unless on face)
4. Tetanus/Rabies
5. Abx prophylaxis
4.
RX for Cat Bite Prophylaxis
- Augmentin 3-5 days
- PCN allergy use doxycycline
Tinea capitis
- Head
- TX = oral
Griseofulvin RX 4-6 wks
Tinea Corporis
- Body
- Topical "conazole" creams x 2wks
*Clotrimazole-Betamethasone Cream 1-0.5% BID
*hydroxyzine for itching
Tinea cruris
- Jock (man)
- Topical
"conazole" creams x 2 weeks
Tinea pedis
- Feet
- Topical x 6 weeks
Tinea unguium
- Fingernail/Toe
- Oral 6-8 weeks plus
Topical (Ciclopirox) 48wks QD
Pityriasis Versicolor
- Axilla,
shoulders, chest, back (sebum rich areas)
- Well marginated lesions in varying colors, rare itching, lesions do not tan!
- Ketaconazole 2% Shampoo (leave on 5mins)x 1
or
Selenium sulfide 2.25% Shampoo (leave on 10min) x 7days
Description of fungal infection
-Central clearing
-Circular plaque
-Oval Patch
-Annular Ring
-Dry, erythematous scales
*Hyphae or buds under microscope
Herpes Zoster:
Description
- A reactivation of the varicella-zoster virus (chickenpox virus) that has lain dormant in nerve cells.
- This involves the skin of a single dermatome or less commonly, several dermatomes.
Herpes Zoster:
Prodrome SX
- 1-10 days
- Itching
Burning
Photophobia
Herpes Zoster:
Acute Phase
- 3-4 days
- Maculopapular rash which progresses to grouped vesicles on an erythematous base, and then pustules in 3-4 days. Successive crops of vesicles may appear for a week
Herpes Zoster:
Convalescent Phase
- Within 2-3 weeks, rash resolves
- Pain (burning, throbbing, or stabbing)
Herpes Zoster:
Complications
- Postherpetic neuralgia is pain >1m after rash has resolved. Common in older adults
Herpes Zoster:
Shingrix
- >50
- 2 IM doses 2-6months apart
- Non-attuniated
- Contraindicated: Pregnancy, severe immunocompromised
- Highly effective
Herpes Zoster:
Transmission
Patients who have shingles are not able to transmit shingles to other susceptible patients. They may only transmit the chickenpox virus to susceptible patient
Herpes Zoster:
TX (2)
Refer
1. Antiviral (<72hr of sx or if new lesions appear >72hr) x 7 days high dose
2. Analgesics; NSAIDS or narcotics for severe pain, topical lidocaine
3. Urgent consultation of ophthalmologist for dermatomes involving the eye* or send to ER
* Prophylactic oral corticosteroids have not shown to prevent the development of PHN: 3-week tapering dose may modestly reduce duration of pain and neurologic involvement
Herpes Zoster:
Expected course
- Resolution of acute phase usually 14-21 days
- Postherpetic neuralgia may last for months
Lyme Disease:
Description
- Complex, multisystem disease transmitted by the Ixodid tick*
- Tick must be attached for 36-48hrs before transmission (groin, armpit, scalp) [Show Less]