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