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Dermatology: Lecture 4 (Chapter 6, Part 3)

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Itchy, red, follicular papules and pustules
Crust, excoriation, and hyperpigmentation
are common secondary changes
Location: scalp, face, neck, trunk
Infants or adults
What is the presentation of Eosinophilic Folliculitis?
Infiltrate of eosinophils around the hair
follicle
Can be seen in association with certain medications, cancer, or immunosuppressed states such as HIV/AIDS or bone marrow transplant
Pathophysiology is unknown; one theory is overgrowth of Malassezia or Demodex
Other risk factors include male gender, warm/humid climate
What is the etiology of Eosinophilic Folliculitis?
Diagnosis:
Skin biopsy often done
Leukocytosis, eosinophilia, elevated IgE

Treatment:
Topical steroids or calcineurin inhibitors, NSAIDS, antihistamines, antifungals, antibiotics, phototherapy, retinoids
Folic acid, alpha linolenic acid, omega 3 fatty acids
HAART for HIV patients
How do we diagnose and treat Eosinophilic Folliculitis?
Inflamed nodule/pustule, may ulcerate
Can be anywhere on the body
Often associated with fever
What is the presentation of a Carbuncle?
Infection of a group of hair follicles with Staph aureus
Develops from a furuncle (infection of a single follicle)
What is the etiology of a Carbuncle?
Diagnose:
Clinical; culture often done
Treatment:
Warm compress, tea tree oil, antiseptic cleansers
Topical or oral antibiotics
I&D may be necessary
How do we diagnose and treat a Carbuncle?
Carbuncles
Carbuncles
Inflamed papules or plaques covered in honey colored crust
Bullous impetigo: fragile bullae, honey colored crust after lesions rupture
Very contagious; spreads by direct contact and fomites
What is the presentation of Impetigo?
Superficial skin infection with Strep pyogenes or Staph aureus
What is the etiology of Impetigo?
Diagnosis:
Clinical; culture often done
Treatment:
Topical antibiotics if mild (i.e. mupirocin)
Oral antibiotics if severe
Vinegar soaks, antiseptics, Echinacea, tea tree oil
If untreated, complications can occur (spread deeper into the skin & into the blood, post-strep GN)
Prevent spread of infection
How do we diagnose and treat Impetigo?
Impetigo
Impetigo
Warm, tender, inflamed, fluctuant nodule
Often associated with fever & malaise
What is the presentation of a skin abscess?
A collection of pus under the skin due to infection, most commonly Staph aureus (including MRSA) or Strep pyogenes
Risk factors: diabetes, immunosuppression (i.e. HIV), HS
What is the etiology of a skin abscess?
Diagnosis: Clinical. We can also do a culture or check CBC for leukocytosis
Treatment:
Warm compresses
Oral antibiotics
I&D often necessary
If left untreated, may develop systemic infection
How do we diagnose skin abscesses? How do we treat?
Abscess
Infection of lymphatic vessels.

Acute: Tender, inflammed red streaks across the lymphatic vessels towards the groin or axillae. Abscesses, blistering, fever and malaise.
Nodular: Papulonodular lesions along lymphatic vessels. These most commonly happen in the arms. May be tender, ulcerated; fever usually
What is the presentation of Lymphangitis?
Infection of the lymphatic vessels

Acute: Strep pyogenes > Staph
species
Nodular: Sporothrix schenckii, a
fungal organism found in plants
such as roses (sporotrichosis)
What is the etiology of Lymphangitis?
Acute form requires immediate treatment with antibiotics (often IV)
Antifungals for nodular form
Supplemetary: bromelain, proline, lysine, vitamin C
How do we treat Lymphangitis?
Lymphangitis
Lymphangitis (nodular)
Rapidly growing, soft, fleshy red papule or nodule that intermittently bleeds
Most common sites: oral mucosa, trunk, fingers/toe
What is the presentation of Pyogenic Granuloma?
Benign vascular skin tumor
Cause is unknown, but often develop at sites of trauma
What is the etiology of Pyogenic Granuloma?
Diagnosis: Clinical. May need biopsy to rule out cancer.
Treatment:
Self limited, but can recur
Surgical excision with cautery is tx of choice
Laser therapy also effective
How do we diagnose and treat Pyogenic Granuloma?
Itchy, well-demarcated red plaques with "satellite" papules
May also see erosions, pustules, scaling
Intertriginous distribution
What is the presentation of Candidiasis (Intertrigo)?
Skin infection with the yeast Candida, most commonly C. albicans
Risk factors: obesity, diabetes, antibiotic use, warm/moist skin, babies wearing diapers, immunosuppression
What is the etiology of Candidiasis (Intertrigo)?
Diagnosis: Clinical. KOH prep of skin scrapings.
Treatment:
Topical or oral antifungals
Probiotics, garlic serve a preventative role
Diet: limit simple carbs, increase fiber
How do we diagnose Candidiasis?
1. Manuum: Hands. These are itchy, scaly, annular red plaques.
2. Corporis: Body. Classic ringworm.
3. Cruris: Groin or jock itch. Symmetrical annular red plaques on the groin, buttocks, or inguinal folds. Tend to not be scaly.
4. Pedis: On the feet. These are scaly, eroded, macerated plaques. Interdigital spaces and plantar feet are affected.
5. Unguium (nails): Onychomycosis. Thickened, discolored, dystrophic nails.
What are the 5 presentations of Tinea?
Woods lamp exam makes it appear as a fluorescent green
KOH prep (+ for hyphae)
Fungal culture for hair/nail
How do we diagnose Tinea?
Topical or oral antifungals
Zinc, selenium, Burrow's wet dressings, powders, garlic, tea tree oil, worm wood, black walnut
Prevent spread of infection

DONT USE STEROIDS. Makes it worse.
How do we treat Tinea?
Pink or hypo/hyperpigmented macules coalescing into patches with fine scale on the upper arms, chest, back, and neck.

Asymptomatic or mildly itchy.
What is the Presentation of Tinea Versicolor?
Overgrowth of Malassezia furfur
What is the etiology of Tinea Versicolor?
Diagnosis:
Wood's lamp (white/yellow fluorescence)
KOH prep (hyphae and yeast ("spaghetti and meatballs"))
Treatment:
Zinc/selenium shampoos
Topical antifungals
What is the diagnosis and treatment of Tinea Versicolor?
Tinea Versicolor
Severely itchy; papules and crusted excoriations
Nits (tiny white eggs) on hair shafts
Named for location (capitis, corporis, pubis)
What is the presentation of Pediculosis?
Infestation of very small insects (i.e. lice, crabs) that feed on human blood
Spread by direct contact with hosts or fomites, & pubic lice are sexually
transmitted
What is the etiology of Pediculosis?
Diagnosis: Clinical with magnification
Treatment:
Nits are removed with gel & comb
Treatment options include vinegar solution, 1% permethrin lotion, lindane shampoo, oral ivermectin
Close contacts should also be treated
How do we diagnose and treat Pediculosis?
Grouped, itchy red papules or nodules with a central puncture point; frequently on the feet and legs
Crusty excoriations and erosions may develop from scratching
What is the presentation of Flee bites?
Lesions are self-limiting as long as the fleas are eradicated from pets and the home
Vaseline, menthol, camphor, calamine, ice, topical steroids, antihistamines, and essential oils for symptomatic relief
How do we treat Flea Bites?
Pruritic, papular rash w/burrows & excoriations
Distributed on hands, feet, buttocks, groin, body folds
Elderly or immunosuppressed can have a very severe form called Norwegian or crusted scabies
What is the presentation of Scabies?
Infestation w/S. scabiei, which burrows, lays eggs, & produces toxins
Spread through direct skin contact or fomites (i.e. linens)
What is the etiology of Scabies?
Diagnosis: Mites or egg visualized on microscopic exam of skin scrapings.
Treatment:
Close contacts and clothes/linens should also be treated
1% permethrin cream or oral ivermectin
Antihistamines and topical steroids for itch
How do we diagnose and treat Scabies?
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