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      Allergic/Irritation conditions        Herpes Simplex Herpes Zoster Verruca Molluscum Contagiosum 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. 2. 3. 4. No bigger than an eraser tip Stand out mole on the back Irregular border 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 