1. Tinea Capitus
    • -AKA scalp ringworm due to Trichophyton tonsurans
    • -Sx: bald patch on head; may have pustules and vesicles; keriods may deveop (deep boggy swelling); black dots from broken hairs
    • -Dx: Woods Lamp, KOH prep, culture
    • -Tx: P.O. Antifungals; steroids use for keroid, system Abx for secondary infection
  2. Tinea Barbae
    • -Ringworm of beard and mustache region
    • -Sx: pustule w/ purulent discharge on lip; hair loss in area and kerions
    • -Dx: fungal scraping and cultures
    • -Tx: topical antifungals, P.O. antifungals
  3. Tinea Pedis - Types
    • AKA Athlete's foot
    • 1. Interdigital - most common -- acute or chronic
    • 2. Moccasin - dry; often caused by T. rubrum
    • 3. Inflammatory - least common; vesicular
  4. Tinea Pedis
    -Age group
    • T. rubrum is most common; T.mentagrophytes causes inflammatory lesions
    • -common in 20-50 yo
    • -Males > females
  5. Tinea Pedis
    • -Sx: frequent pruritis, pain w/ secondary infection
    • -PE
    •      *Interdigital type: fissuring between toes; erytheme between 4th and 5th toe
    •      *Moccasin type: demarcated erythema, white scaling, hyperkeratosis
    •      *Inflammatory type: vesicles, bullae w/ clear fluid
  6. Tinea Pedis
    • -Dx: microscopy of Skin Scrape; woods lamp (neg. fluorescence rules out erythrasma), fungal culture
    • -Tx:
    • 1. Topical Antifungals (clotrimazole, miconazole, econazole -- 2-4 weeks)
    • 2. Environmental control - systemic agents for crazy infection
  7. Tinea Magnum
    • -AKA ringworm of the hands and feet
    • -Sx: erytheme, scaling, vesiculation, fissuring; pruritis; hand infection almost always comes w/ foot infection
    • -Tx: topical antifungals, envirnmental control, drying agents
  8. Tinea Corporis
    • AKA body ringworm
    • -Sx: lesions occur on exposed area of body; ring shaped lesions w/ central clearing
    •      *hx of exposure to cat probable
    •      *T.Rubrum most common pathogen
    • -Dx: microscopic exam KOH 
    • -Tx: topical antifungal 1-2weeks; ketoconazole orally for severe infection; prevention = avoid contact w/ infected pets
  9. Tinea Cruris
    • AKA Jock itch
    • -occurs more in males
    • -Sx: lesions in groin and gluteal cleft; none to severe pruritis
    • -Dx: peripherally spreading, demarcated, centrally clearing, erythematous macular lesions; assocated infectino on feet or toenails; Skin Scraping & KOH confirms Dx
    • -Tx: topical antifungals, drying powders, oral antifungal for severe case
  10. Tinea Versicolor
    • Mild superficial infection of skin, caused by Ptiyrosporin obiculare (yeast); often caused by hyperhidrosis and in areas that do not tan or hyperpigmentation
    • -Sx: trunk distrubution most common; lesions sharply defined, light coffee spots; may be hyper or hypopigmented
  11. Tinea Versicolor
    • -Dx:
    • 1. Woods Lamp -- reddish or green/yellow fluorescence
    • 2. Fungal Skin Scraping KOH -- short broad hyphae w/ cluster of spores (spaghetti and meatballs)
    • (Fungal cultures not helpful)
    • -Tx:
    • 1. Topical antifungals (expensive)
    • 2. Selenium Sulfide lotion 2.5%
    • 3. Oral antifungals for recurrent forms
    • 4. Other causes (DM, hyperthyroidism)
  12. Onychomycosis (Tinea Unguium)
    • Fungal infection of the nail by T.rubrum; toenails usually
    • -Sx: yellowish discoloration w/ yellow fragment; brittle, irregular, more than one digit usually involved
    • -Dx:
    • 1. Parts of nails clipped and examined for hyphae (KOH)
    • 2. Fungal culture - Sebourand's media
    • 3. Periodic Acid Schiff (PAS) stain of bad part
    • -Tx:
    • 1. Topicals (very low efficacy rate)
    • 2. Professional debridement; be careful w/ diabetics
    • 3. Oral antifungals; ltraconazole (Sporonox) 
  13. Folliculitis
    • Caused most commonly by Staph Aureus, gram- less common; occurs anywhere where there is hair
    • Sx: Erythematous papules w/ pustules around hair follicle; rupture of pustules leads to crusts; usually in clusters
    • -Dx: Gram stain, KOH, culture
    • -Tx:
    • 1. Bacterial: topical Abx, PO Abx, soap and water
    •      *P.aerogenosa (Hot Tub)
    •      *Gram neg: acne, benzyl peroxide wash, ampicillin
    •      *Fungal: topical or oral tx w/ itraconazole
  14. Furuncle
    -Predisposing factors
    • Deep inflammatory swelling w/ central purulence; caused by Staph Aureus; 
    • -Predisposing factors
    • 1. poor hygiene
    • 2 obesity
    • 3. diabetes mellitus
    • -Tx:
    • 1. Abx
    • 2. Hot soaks
    • 3. I&D if "ripe"
    • 4. Leave it alone or Referral
  15. Carbuncle
    • Coag. positive Staph Aureus; most serious form of a furncle cus it's mutiple continuous furncles
    • -Tx: PO antibiotics, topical treatment as for a furuncle
  16. Paronychia
    • Infection around nails caused by bacteria, Candida (asssoicated w/ immersion in water)
    • -PE: purulence around nail, erythema, tenderness
    • -Tx: I&D if area is "pointing," hot soaks, Abx and antifungals
  17. Cellulitis
    -portal of entry
    -risk factors
    • Acute spreading infection of dermal and subcutaneous tissues caused by GAS, Staph Aureus, H. influenza
    • -Portal of entry: through any muco-cutaneous site, underlying dermatoses (diseaes or issues), trauma and surgical wounds
    • -Risk factors: d
    • 1. drug and ETOH abuse
    • 2. cancer/chemo
    • 3. DM
    • 4. immunosuppression
    • 5. Renal failure
    • 6. Atherosclerosis
  18. Cellulitis
    • -Dx:
    • 1. red, hot, tender, edematous and shiny
    • 2. Border are sharply defined, irregular, and elevated
    • 3. lymphangitis
    • 4. lymphadeopathy regionally
    • -Tx
    • 1. Severe: parenteral Abx covering Strep and Staph
    • 2. Not severe: Dicloxacilli, Cephalosporin
  19. Erysipelas
    • Swollen cheeks or lower legs from inflammation; caused by GAS
    • -PE:
    • 1. erythematous painful red area w/ "peau d'orange" appearance
    • 2. hot to touch
    • 3. face is most frequent area effected
    • 4. dangerous if it begins at bridge of nose and spreads laterally producing bilateral lid edema
    • 5. may extend to orbit and sagital sinus w/ sinus thrombosis
  20. Erysipelas
    • -Tx:
    • 1. Systemic Abx (penicillin or erythromycin)
    • 2. If severe, use IV or IM
    • 3. If Staph suspected, use penicillinase-resistant Abx
  21. Impetigo
    • Superficial skin infection of epidermis caused by Strep pyogenes & Staph aureus
    • -Dx: non-bullous; transiet vesicles or pustules which rupture to form honeycomb crust
    •    *lab tests: Gram stain for Gram+ cocci in
    • -Tx: mupirocin ointment; need to treat nasal carriers (20-40% of adults are carries of S.aureus); oral Abx
  22. MRSA
    Type of S.aureus that is resistant to beta-lactum type Abx (methicillin, oxacillin, peniccilin, and amoxicillin)
  23. CA-MRSA (Community Acquired-Methicillin Resistant Staph Aureus)
    -Look for:
    • Infections acquired by ppl that have no been recently hospitalized or had medical procedures
    • -Look for:
    • 1. abscesses
    • 2. follicular pustules
    • 3. furuncles (boils)
    • 4. bullous impetigo - pus or fluid-filled bullae and vesiles
    • 5. non-bullous impetigo - crusted plaques and erosions
    • 6. cellulitis - circumscribed erythema, warmth, tenderness
  24. CA-MRSA
    • Obtain culture from infection site and sent to lab!!!! If S.aureus, needs to be tested to determine which Abx to use
    • -Dx: assume MRSA when severe furuncles or abscesses; consider MRSA in any skin or soft tissue infection; many w/ S. furunculosis believe it's a spider bite
    • -Tx: I&D and hotpacks  for abcesses; Abx 
  25. CA-MRSA medications
    • MSSA:
    • -cephalexin, dicloxacillin, clindamycin, amoxicillin
    • MRSA
    • -TMP-SMX, clindamcyin, minocycline; consider decolonization w/ mupiroci 2% ointment in nares
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