Transcript Issues of the Skin

Infections of the Skin
Lice, Scabies, Pinworm, Ringworm, Impetigo
Bacterial
p. 694 (9th ed)
p. 227-228 (10th ed)
• IMPETIGO CONTAGIOSA—
• Appearance:
maculovesicular lesion;
ruptures easily; crusts form;
itchy!
• Etiology: Staphylococci
• Management: carefully
remove crusts with solution;
apply topical antibiotic
ointment; may need PO or
IV antibiotics.
• Contagious!--CONTACT
precautions indicated if
hospitalized.
Bacterial
•
MRSA:
http://www.cdc.gov/mrsa
/
• Appearance:often appears
as atopic dermatitis in
nares and under fingernails
Furuncle or Carbuncle
• Etiology: Methicillin
Resistant Staph Aureus
• Management: provide
washcloths & towels
separate from other family
members. Soak in tub with
½ c bleach w/ 5inches of
water. Apply mupirocin
(Bactroban) to nares bid
for 2-4 wks. May require
I&D and hospitalization
Viral Infections
p. 696 9th ed.
p. 229 10th ed.
• Warts
• Herpes Simplex type 1
• Herpes Simplex type 2
• Herpes zoster, Shingles
• Molluscum contagiosum
Fungal infections
p. 228-30 10th ed.
• Dermatophytoses—Ringworm
also referred to as Tinea Capitis, or
Tinea Corporis, or Tinea cruris, or
Tinea Pedis
• Appearance: ring-like shape,
scaly, unilateral, non-pruritic
except tinea cruris
• Etiology: filamentous fungi—
Trichophyton, Microsporum, &
Epidermophyton
• Management: Oral
GRISEOFULVIN, topical
antifungal creams e.g.
clotrimazole; nystatin, or
miconazole, wet compresses or
soaks
Scabies
p. 232 10th ed.
•
Appearance: maculopapular lesions in
any skin fold: between fingers, inside
elbow, axilla, inguinal area. Watch for
discrete papules, burrows, or vesicles
•
Etiology: scabies mite, Sarcoptes scabiei.
Mite burrows into stratum corneum of
epidermis.
•
Management:Apply scabicide—drug of
choice is permethrin 5% cream (Elimite).
2oz for adults and 1oz for children.
Massage into all skin surfaces. May use
lindane 1% cream—only if others are
ineffective.
•
Ivermectin—PO used if topical is not
effective. It is NOT recommended for
children <5 yrs or <15kg. Treat all family
members and friends who have been in
contact.
•
Wash all linens in hot water and dry in
hot setting of dryer.
•
Itching will persist for 2-3 weeks so
lotions and antihistamines may be helpful
ENTEROBIASIS—
Pinworms p.620-1 9th ed.
P.225-6 10th ed.
• Appearance:
Etiology: nematode
Enterobius vermicularis.
Crowded conditions, in
classrooms and daycare
centers favor
transmission.
• Manifestations: gen’l
irritability, restlessnes,
poor sleep, bed-wetting,
distractibility, short
attention span, peranal
dermatitis and pruritis,
• Diagnosis: Tape test: clear,
transparent tape is placed around the
end of a tongue depressor. Press
firmly against perianal region early in
the morning before bath or BM. Place
specimen in jar or plastic bag for
examination.
• Treatment: Anthelmintics are med of
choice. (If pyrantel pamoate is RX,
teach parents that BM & emesis will be
bright red.) Treat ALL family
members with oral med and
repeat dose in 2 weeks to
eradicate eggs.
• Wear pajamas and underwear to
sleep, take a bath every day, and
wash (not shake) all bedding in
HOT water and nightclothes
(pajamas) after treatment to help
prevent reinfection. .
PEDICULOSIS CAPITIS (Head Lice)
(p. 233-236 10th ed.)
• Appearance:see photos
• Etiology:Pediculosis humanus capitis—a
common parasite in school-age children.
Louse is blood-sucking. Eggs(nits) are
laid at night and attach to the hair shaft
• Manifestations: itching is only
symptom. Often seen in occiput of
scalp, behind the ears, nape of neck.
• Management:Apply pediculicides and
manual removal of nits. Drug of choice:
permethrin 1% cream rinse (Nix)—
kills lice and nits. No RX needed.
Retreat in 7-10 days. Daily removal of
nits with metal nit comb essential. Wash
all clothing and bedding in HOT WATER
and DRY setting on Dryer. Vacuum
everything. See p. 699 (9th ed) for more
Aren’t you glad to
have healthy skin??
The End