Dermatology. Skin and soft tissue infections dermatitis

Август 8, 2022

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Dermatology. Skin and soft tissue infections dermatitis

Содержание

2. ATOPIC DERMATITIS itch usually a family history of atopy trigger factors Dust mite (common) Sweating Sand
3. ATOPIC DERMATITIS Criteria for diagnosis Itch Typical morphology and distribution Dry skin History of atopy Chronic
4. ATOPIC DERMATITIS ATOPIC STIGMATA Keratosis palmaris Dennie – Morgan fold Hertoghen’s sign Pityriasis Alba Palmar Hyperlinearity
5. ATOPIC DERMATITIS Management Education and reassurance Avoid irritants Improve skin condition Medication Topical corticosteroid therapy Topical
6. LICHEN SIMPLEX CHRONICUS Circumscribed thick plaques of lichenification Caused by repeated rubbing and scratching of previously
7. CONTACT DERMATITIS Site and shape suggest contact Dermatitis ranges from faint erythema to ‘water melon’ face
8. CONTACT DERMATITIS PATCH TEST
9. STASIS DERMATITIS risk factors: varicose veins high blood pressure obesity, vein surgeries multiple pregnancies a history
10. STASIS DERMATITIS clinical features: Bilateral redness in lighter skin tones that may appear brown, purple, gray
11. STASIS DERMATITIS Treatment compression stockings diuretics elevating legs above the heart for red or darker-colored, itchy
12. SEBORRHEIC DERMATITIS Adults Any age from teenage onwards Quite pruritic The head is a common area:
13. Kids Age of onset Mainly within first 3 months Itchiness Nil or mild Distribution Scalp, cheeks,
14. SEBORRHEIC DERMATITIS Management Likely to resolve on it’s own Soft baby brush and some baby oil
15. CELLULITIS Cellulitis is a common bacterial infection The most common bacteria causing cellulitis are Streptococcus pyogenes
16. CELLULITIS Erythematous, edematous and warm skin Risk factors: Anything that causes a break in the skin
17. CELLULITIS Treatment Non purulent: Cephalexin Cefazolin Purulent: TMP, Clindamycin or Tetracyclines Systemically ‘’toxic’’ – vancomycin or
18. OSTEOMYELITIS is mainly a disease of childhood Main organisms—S. aureus, S. pneumonia, Kingella kingae, Propionibacterium acnes
19. GAS GANGRENE necrotising soft tissue infection can involve skin and subcutaneous fat, fascia and muscle caused
20. GAS GANGRENE Clinical features sweet smelling odor edema, discoloration, ecchymosis blebs and hemorrhagic bullae ''dishwater pus''
21. GAS GANGRENE Management Debridement and excision with possible amputation Start benzylpenicillin 2.4 g IV, 4 hourly
22. NECROTIZING FASCIITIS Necrotising fasciitis is a very serious bacterial infection of the soft tissue and fascia
23. NECROTIZING FASCIITIS Treatment Immediate surgical debridement The third generation cephalosporins + Clinda
24. IMPETIGO caused by Streptococcus pyogenes or Staphylococcus aureus kids honey crusted lesions on the face Treatment
25. ERYSIPELAS is a superficial form of cellulitis involving the face – butterfly appearing rush an associated
26. DIFFERENTIAL DIAGNOSIS
27. TINEA Tinea pedis (Athlete’s foot) Red, itchy feet, maceration in between the toes Tinea cruris Jock
28. CELLULITIS Deep dermis and subcutaneous adipose tissue Indolent onset Localised symptoms Non-purulent or purulent Non-purulent: Beta-hemolytic
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Слайд 2

ATOPIC DERMATITIS
itch
usually a family history of atopy
trigger factors
Dust mite

(common)
Sweating
Sand (e.g. in sandpits)
Extremes of hot and cold
Rapid temperature changes
Soap, shampoo and water/frequent washing, especially in winter
Chlorinated water
Bubble baths
Infection (viral, bacterial, fungal)
Allergy
Stress/emotional factors

food allergies are rarely the main cause of the condition
lichenification may occur with chronic atopic dermatitis
flexures are usually involved
dryness is usually a feature

Слайд 3

ATOPIC DERMATITIS
Criteria for diagnosis
Itch
Typical morphology and distribution
Dry skin
History of atopy
Chronic

relapsing dermatitis

Слайд 4

ATOPIC DERMATITIS ATOPIC STIGMATA
Keratosis palmaris
Dennie – Morgan fold
Hertoghen’s sign
Pityriasis Alba
Palmar Hyperlinearity
Retroauricular

Fissuring

Слайд 5

ATOPIC DERMATITIS
Management
Education and reassurance
Avoid irritants
Improve skin condition
Medication
Topical corticosteroid therapy
Topical calcineurin inhibitors

(face, eyelids, neck, skin folds)
Secondary infection

Atopic triad

Слайд 6

LICHEN SIMPLEX CHRONICUS
Circumscribed thick plaques of lichenification
Caused by repeated rubbing and

scratching of previously normal skin
Due to chronic itch of unknown cause
At sites within reach of fingers (e.g. neck, forearms, thighs, vulva, heels, fingers)
May arise from habit
Treatment
Refrain from scratching
Topical corticosteroid ointment

Слайд 7

CONTACT DERMATITIS
Site and shape suggest contact
Dermatitis ranges from faint erythema to

‘water melon’ face oedema
Worse in peri-orbital region, genitalia and hairy skin
Think of Rhus, Grevillea or poison ivy allergy
if linear blisters on forearms and/or puffy eyes
Improvement when off work or on holiday

Treatment
Determine cause and remove it
Topical corticosteroid
Oral prednisolone for severe cases

Слайд 8

CONTACT DERMATITIS PATCH TEST

Слайд 9

STASIS DERMATITIS
risk factors:
varicose veins
high blood pressure
obesity, vein surgeries
multiple pregnancies
a history of

blood clots in the legs
congestive heart failure
kidney failure
certain lifestyle factors such as getting little physical activity or having a job that involves hours of sitting or standing

Слайд 10

STASIS DERMATITIS
clinical features:
Bilateral
redness in lighter skin tones that may appear

brown, purple, gray or ashen in darker skin tones
itching
scaling
dryness
a heavy or achy feeling after long periods of sitting or standing
increased risk of developing contact dermatitis

Слайд 11

STASIS DERMATITIS
Treatment
compression stockings
diuretics
elevating legs above the heart
for red or

darker-colored, itchy skin, dermatologists may prescribe a topical corticosteroid
topical or oral antibiotic if skin is infected

Слайд 12

SEBORRHEIC DERMATITIS
Adults
Any age from teenage onwards
Quite pruritic
The head is a common

area: scalp and ears, face, eyebrows, eyelids, nasolabial folds
Less involvement of inguinal areas
Scaling on scalp causing dandruff and/or erythematous patches
Worse with stress and fatigue
It is a chronic, recurring condition

Слайд 13

Kids
Age of onset Mainly within first 3 months
Itchiness Nil or

mild
Distribution Scalp, cheeks, folds of neck, axillae, folds of elbows and knees
Yellow-red greasy, crusted and scaling plaques on scalp and face
Napkin rash Common
Benign and self-limiting

SEBORRHEIC DERMATITIS

Слайд 14

SEBORRHEIC DERMATITIS
Management
Likely to resolve on it’s own
Soft baby brush and some

baby oil
Anti-fungal shampoos or cream
Topical steroids

Слайд 15

CELLULITIS
Cellulitis is a common bacterial infection
The most common bacteria causing cellulitis

are Streptococcus pyogenes (two-thirds of cases) and Staphylococcus aureus (one third)
Clinical features:
Cellulitis can affect any site, most often a limb and can be around the eye – periorbital cellulitis
unilateral
It can occur by itself or complicate an underlying skin condition or wound.

Слайд 16

CELLULITIS
Erythematous, edematous and warm skin
Risk factors:
Anything that causes a break in

the skin
Inflammatory skin conditions
Tinea pedis interdigitalis
Venous insufficiency or impaired lymphatic drainage
Immunosuppression
Obesity

Слайд 17

CELLULITIS
Treatment
Non purulent: Cephalexin Cefazolin
Purulent: TMP, Clindamycin or Tetracyclines
Systemically ‘’toxic’’ – vancomycin

or daptomycin

Слайд 18

OSTEOMYELITIS
is mainly a disease of childhood
Main organisms—S. aureus, S. pneumonia, Kingella

kingae, Propionibacterium acnes
Sources of infection—boils, abscesses, septic toes, surgical procedures
Diagnostic: X-Ray, rad MRI
Treatment: debridement

Слайд 19

GAS GANGRENE
necrotising soft tissue infection can involve skin and subcutaneous fat,

fascia and muscle
caused by clostridium species
diagnosis based on clinical and radiographic pictures

Слайд 20

GAS GANGRENE
Clinical features
sweet smelling odor
edema, discoloration, ecchymosis
blebs and hemorrhagic bullae
''dishwater pus''

discharge
crepitus
altered mental status

Слайд 21

GAS GANGRENE
Management
Debridement and excision with possible amputation
Start benzylpenicillin 2.4 g IV,

4 hourly + clindamycin
Hyperbaric oxygen if available

Слайд 22

NECROTIZING FASCIITIS
Necrotising fasciitis is a very serious bacterial infection of the

soft tissue and fascia
The bacteria multiply and release toxins and enzymes that result in thrombosis in the blood vessels.
The result is the destruction of the soft tissues and fascia.
There is poor adherence of tissue to the fascia on incising the site.
Necrotic tissue/pus oozes out of the fascial planes.
Dishwater-coloured fluid seeps out of the skin.
Typically, necrotising fasciitis does not bleed

Слайд 23

NECROTIZING FASCIITIS
Treatment
Immediate surgical debridement
The third generation cephalosporins
+ Clinda

Слайд 24

IMPETIGO
caused by Streptococcus pyogenes or Staphylococcus aureus
kids
honey crusted lesions on the

face
Treatment
Soak and remove crusts with saline or soap and water
Amoxicillin (clindamycin)

Слайд 25

ERYSIPELAS
is a superficial form of cellulitis involving the face – butterfly

appearing rush
an associated ‘flu-like’ illness and fever
caused by Streptococcus pyogenes
Treatment
Penicillin, amoxicillin, cefazolin, ceftriaxone

Слайд 26

DIFFERENTIAL DIAGNOSIS

Слайд 27

TINEA
Tinea pedis
(Athlete’s foot)
Red, itchy feet, maceration in between the toes
Tinea cruris

Jock itchy

Tinea corporis
(Ringworm)
Well described, circumscribed, moderately scaled with central cleaning

Tinea unguium
(Dermatophyte onychomycosis)

Tinea capitis
(Scalp ringworm)
hair loss, dry scaly areas, redness, and itch

Слайд 28

CELLULITIS
Deep dermis and subcutaneous adipose tissue
Indolent onset
Localised symptoms
Non-purulent or purulent
Non-purulent: Beta-hemolytic

streptococci
Purulent: Staph. aureus

ERYSIPELAS

Upper dermis and superficial lymphatic
Acute onset
Fever, chills and malaise
Clear demarcation
Often raised
Always non-purulent

Слайд 29

Слайд 30

Dermatology. Skin and soft tissue infections dermatitis

Содержание

ATOPIC DERMATITIS itchusually a family history of atopytrigger factors Dust mite

ATOPIC DERMATITIS Criteria for diagnosisItchTypical morphology and distributionDry skinHistory of atopyChronic

ATOPIC DERMATITIS ATOPIC STIGMATAKeratosis palmarisDennie – Morgan foldHertoghen’s signPityriasis AlbaPalmar HyperlinearityRetroauricular

ATOPIC DERMATITISManagementEducation and reassuranceAvoid irritantsImprove skin conditionMedicationTopical corticosteroid therapyTopical calcineurin inhibitors

LICHEN SIMPLEX CHRONICUSCircumscribed thick plaques of lichenificationCaused by repeated rubbing and

CONTACT DERMATITISSite and shape suggest contactDermatitis ranges from faint erythema to

CONTACT DERMATITIS PATCH TEST

STASIS DERMATITISrisk factors:varicose veinshigh blood pressureobesity, vein surgeriesmultiple pregnanciesa history of

STASIS DERMATITISclinical features:Bilateral redness in lighter skin tones that may appear

STASIS DERMATITISTreatmentcompression stockings diureticselevating legs above the heart for red or

SEBORRHEIC DERMATITISAdultsAny age from teenage onwardsQuite pruriticThe head is a common

KidsAge of onset Mainly within first 3 months Itchiness Nil or

SEBORRHEIC DERMATITISManagementLikely to resolve on it’s ownSoft baby brush and some

CELLULITISCellulitis is a common bacterial infectionThe most common bacteria causing cellulitis

CELLULITISErythematous, edematous and warm skinRisk factors:Anything that causes a break in

CELLULITISTreatmentNon purulent: Cephalexin CefazolinPurulent: TMP, Clindamycin or TetracyclinesSystemically ‘’toxic’’ – vancomycin

OSTEOMYELITISis mainly a disease of childhoodMain organisms—S. aureus, S. pneumonia, Kingella

GAS GANGRENEnecrotising soft tissue infection can involve skin and subcutaneous fat,

GAS GANGRENEClinical featuressweet smelling odoredema, discoloration, ecchymosisblebs and hemorrhagic bullae''dishwater pus''

GAS GANGRENEManagementDebridement and excision with possible amputationStart benzylpenicillin 2.4 g IV,

NECROTIZING FASCIITISNecrotising fasciitis is a very serious bacterial infection of the

NECROTIZING FASCIITISTreatmentImmediate surgical debridement The third generation cephalosporins+ Clinda

IMPETIGOcaused by Streptococcus pyogenes or Staphylococcus aureuskidshoney crusted lesions on the

ERYSIPELASis a superficial form of cellulitis involving the face – butterfly