SKIN/INTEGUMENTARY SYSTEM (ASSURED A)

SKIN/INTEGUMENTARY SYSTEM (ASSURED A) Name Cause Signs/Symptoms Diagnostics Treatments Concerns Rocky Mtn. Spotted Fever Dog/Wood Tick bite Rickettsia rickettsii Petechiae starting on hands/feet progressing to t ...

SKIN/INTEGUMENTARY SYSTEM (ASSURED A) Name Cause Signs/Symptoms Diagnostics Treatments Concerns Rocky Mtn. Spotted Fever Dog/Wood Tick bite Rickettsia rickettsii Petechiae starting on hands/feet progressing to trunk 3rd day after high fever, severe headache, myalgia, conjunctival injection, n/v, arthralgia Antibody titers to rickettsia Punch biopsy CBC, LFT, CSF Doxycycline 500mg BID x 21d Can be fatal (3-9%) Highest in southeastern/south central regions of US Actinic Keratosis Slow-growing; Dry, round, red-colored lesions on skin that do not heal; usually sun-exposed areas. Small number lesions – cryotherapy Large numbers – flurouracil cream (5%) (5FU cream ) Pre-cancerous Precursor to squamous cell carcinoma Psoriasis Inherited; excessive mitotic grown of epithelial cells Pruritic plaques “fine-silvery scales” found over elbows, scalp, knees, gluteal folds Auspitz sign: Pinpoint areas of bleeding remain in the skin when a plaque is removed. Topical steroids, Topical retinoids (tazoratene), Tar preparations UVB light and topical tar may induce remissions Guttate psoriasis: severe form resulting from Gp A strep infection Tinea Versicolor Yeast - Pityrosporum orbiculare or Pityrosporum ovale. Hypopigmented round macules on chest/shoulders/back; appear after skin is tanned from sun asymptomatic KOH slide : hyphae & spores “spaghetti & meatballs” Topical selenium sulfide Ketoconazole (Nizoral) BID x 2w Oral antifungals Atopic Dermatitis (Eczema) Inherited pruritic rash Pruritic rash on hands, flexural folds, and neck; exacerbated by stress and environment Starts as small vesicles that rupture leaving red, weeping lesions that become licenhified and itchy Topical steroids: Mild – hydrocortisone 1- 2.5% Medium – triamcinolone Med/High potency (Halog) x 10d Oral antihistamines for pruritis Skin lubricants/hydrating baths to alleviate dryness Formation of fissures and risk of infection Acute cellulitis Skin infection (staph) of the dermis and underlying tissues 2 forms: purulent/nonpurulent Purulent: Gm + staph aureus (MRSA), lower leg, Non-purulent due to strep I&C if boils CBC if fever Anon-purulent – dicloxacillin QID x10d; Cefalexin or Clindamycin x 10d MRSA: Doxycycline or Clindamycine Td booster if >5yrs Refer if s/s don’t resolve, cellulitis not responding to tx, spreading quickly, DM, immunocompromised Osteomyelitis, sepsis Erysipelas Subtype of cellulitis from Gp A strept Sudden onset one hot, indurated, red lesion with clear demarcation. Usually on lower legs or cheeks Hospitalization for infants, immunocompromised Bite wounds Dogs & Cats (P. multicoda) gram negative Humans (Eikenella corrodens) Human bite dirtiest of all Cats higher risk of infection than dogs Rabies: skunks, raccoons, foxes, coyotes: Immune globulin and vaccine Quarantine domestic animals for up to 10d Augmentin 850mg x 10d Clean, no sutures, tetanus Follow-up 24-48 hours Watch for closed-fist injury (infection of the joints) 80% cat bites become infected Hidradenitis Suppurative Bacterial infection of axillary sebaceous gland Staph aureous (Gm +) Acute onset painful, large, red nodules and papules under one or both axilla that become abscessed C & S of drainage Amoxicillin or Dicloxacillin PO BID x10d Muproprion to lower nares and under fingernails x2w Antibacterial soap to axilla and groin Avoid deodorant Recurrences and scars SKIN/INTEGUMENTARY SYSTEM SKIN/INTEGUMENTARY SYSTEM Name Cause Signs/Symptoms Diagnostics Treatments Concerns Impetigo Gm + strep infection More common in children and teens Acute onset itchy, pink-red lesions that become bullous, crusty and maculopapular (honeycolored) Contagious and pruritic: worse in warm weather 2 types: bullous and nonbullous C & S of crusts/wounds Cephalexin or dicloxacillin QID x 10d Azithromycin if PCN allergic 250 x 5d or clindamycin x10d If small amt of lesions – mupirocin ointment 2% x10d Meningiococcemia Nisseria Menengitides Gm - sudden onset of sore throat, cough, fever, headache, stiff neck, photophobia, and changes in LOC abrupt onset of petechial to hemorrhagic rashes Lumbar puncture : CSF Blood/throat cultures CT or MRI of brain Rocephin 2G IV q12h Vancomycin IV q12h Hospital isolation and supportive tx Close contact prophylaxis: Riphampin q12h x2d and meningococcal vaccine Medical emergency – REFER College students in dorms Erythema Migrans (Lyme disease) Borrelia burgdorferi (tick) Expanded red rash with central clearing (bullseye), feels hot to touch and rough texture; common areas belt line, axilla, popliteal, groin FLU-LIKE symptoms Rash appears 7-14d after tick bite Spontaneously resolves Serum antibody titers (IgM and IgG) Doxycycline BID or Tetracycline BID x 14d Systemic infection with organ shutdown Guillian-Barre Migratory arthritis Varicella Zoster Herpes-zoster (Chickenpox or Shingles) Fever, pharyngitis, malaise Chickenpox: Pruritic vesicular lesions beginning at head expanding to trunk Shingles: lesions at various stages along dermatome Viral culture PCR for ZDV Vaccine: >60 Tzank smear confirms shingles Acyclovir (zovirax) x 5d Valacyclovir x 10d Post-herpetic neuralgia Herpes zoster opthalmicus (corneal blindness) Pityriasis Rosea Unknown Self-limiting; asymptomatic Fine sclaes following skin lines: “Herald patch” or “Christmas Tree” patch Koplick spots None – self-limiting Rule our secondary syphilis Scabies Sarcoptes scabiei Severe pruritic rash, worse at night, between webs of toes and fingers, axillae, groin, breasts, butt, penis Rash appears in linear burrows – can last up to 4 weeks Wet mount of scraped rash to view eggs under microscope Permethrin 5% cream to entire body – wash off after 8-12h Treat everyone in household; clothes/bedding should be washed in hot water Tinea Infections (Dermatophytosis) yeast Capitis – head (most common) Pedis – foot Corporis – body Cruris – jock itch Manuum – hands Barbrae – beard KOH slide for hyphae and spores OTC topicals “ozole” Oncyhomycosis Yeast Yellow thickening of nail – great toe most common Fungal cultures of nail Oral fluconazole 150-300mg weekly Lamisil weekly for several weeks Monitor LFTs Acne Vulgaris Inflammation of the sebaceous gland High androgen levels, bacteria, genetics Open condomes (blackheads), closed condomes (whiteheads), small papules and pustules Mild: Prescription meds: Isotretinoin (Retin-A), benzoyl peroxide with erythromycin (Benzamycin) cream, clindamycin topical (Cleocin). Mod: Prescription topicals + tetracyclines (after age 13) Oral contraceptives: Yaz or Desogen Before age 13 tetracycline can stain teeth permanently Accutane category X – females 2 forms of birth control