36 terms

erythrasma, impetigo, scarlet fever, staphylococcal scalded skin syndrome

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Erythasma def
chronic bacterial infection that mimics epidermal dermatophyte infections (mimics fungal infection, txt as bacterial)
Erythrasma Causes
Corynebacterium minutissimum
-Gram positive bacillus
Age on Onset of Erythasma
adult
Predisposing for erythamsa
humid cutaneous microclimate: warm/humid, occlusive clothing/shoes, obesity, DM
Erythrasma clinical features
usually asymptomatic
occasionally a burning sensation, pruritus
Duration: weeks to months to years (CHRONIC)
Erythrasma Physical Exam
macule, sharply marginated; may be macerated, eroded or fissured, brownish-red, slightly scaling
Erythrasma common sites
toe webspaces>>groin folds >axillae
And.. intertriginous skin (skin on skin)
Erythrasma Dx
Wood's Lamp
-Characteristic coral-red fluorescence
Direct Microscopy
-Negative for fungal forms on KOH prep
Bacterial Cx
Corynebacterium growth
Erythrasma management
Prevent (wash w/ benzoyl peroxide),
less occlusive clothing,
keep skin dry;
Topical therapy: benzoyl peroxide gel, topical e-mycin gel;
Oral ABx
Impetigo actually means:
a scabby eruption that attacks
Impetigo causes
S. aureus, Streptococcus pyogenes (GAS, group A strep)
Impetigo gen characteristics
superficial and involves the epidermis;
crusted ulcers or erosions
Impetigo occurs at what age?
primary infections mostly children
secondary infections affects any age
What type of impetigo is common in children and young adults
Bullous impetigo
How common is impetigo?
10% Pt in general derm
Predisposing factors for Impetigo
-increased bacteria in warm temp and high humidity
-age (younger)
-prior ABx therapy
-improper managed minor trauma
-Presence of skin dz (atopic dermatitis)
-secondary infection develop eczema/scabies
Pathology of Impetigo
40% of adults are persistent normal S. aureus carriers; S. aureus found in 90% atopic dermatitis lesions; most important defense is an intact stratum corneum
Impetigo distribution
face, arms, legs (can be seen anywhere)
Impetigo primary/secondary lesion characteristics
Primary: vesicles/pustules
Secondary: YELLOW/HONEY-COLORED rust, erythema, erosions
vesicular before crusting
LAD may be present
Impetigo Management
Prevent: benzoyl peroxide soap bar
Give TOPICAL ABx therapy **
systemic therapy only if widespread
Scarlet Fever def
acute infection of the tonsils, skin by an exotoxin producing strain of GABHS associated w/ a toxigenic exanthem
Scarlet Fever Affects what age
Children
Etiology of Scarlet Fever
GABHS (strep pyogenes)
Incubation of Scarlet Fever
rash appears 1-3 days after infection onset
Scarlet Fever Physical Exam Signs
Impetiginous skin lesion
sand-paper like rash
pin-point papules
First noted on trunk
Pastia Lines (accentuated in folds)
Flushed Face (perioral pallor)
White Strawberry tongue--->red strawberry tongue
mnemonic for scarlet fever
6 S's
-streptococci
-sore throat
-swollen tonsils
-strawberry tongue (white first)
-sandpaper rash
-Sudamina? vesicles over hands, feet, abdomen
Scarlet Fever Physical Exam Signs
Impetiginous skin lesion
sand-paper like rash
pin-point papules
First noted on trunk
Pastia Lines (accentuated in folds)
Flushed Face (perioral pallor)
White Strawberry tongue--->red strawberry tongue
Management of Scarlet Fever
symptomatic
fluids, acetaminophen
Oral antimicrobial therapy
When you see strep w/ rash you think about...
Scarlet Fever
Staphylococcal-Scalded-Skin Syndrome def
toxin-mediated dz characterized by erythema and widespread detachment of epidermis
Staphylococcal Scalding Skin Syndrome resembles? and occurs in?
scalding; mainly in newborns, and infants <2; MOST COMMON in neonates under 3months
Staphylococcal Scalding Skin Syndrome Etiology and characteristics
S. aureus; Severity ranges from localized to generalized w/ extensive epidermolysis and desquamation
Physical Exam of Staph Scalding Skin Syndrome
Nikolsky's Sign: w/ gentle pressure, epidermis can be removed
Dx of staph scalding skin syndrome
direct microscopy, bacterial cx
Management of Staph Scalding skin syndrome
Hospitalization
-treat as burn
ABx
-may need fluids or stabilization
What is impetigo called if it extends into the dermis?
ecthyma