Duke PA Fungal and Viral Infections of the Skin
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| unique group of fungis that infect keratinized epithelium including hair and nails | dermatophytic infections
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| three genera of fungi responsible for dermatophytic infections | microsporum, trichophyton, and epidermophyton
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| aka ringworm | dermatophytic infections
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| dermatophytic infection of the feet characterized by erythema, scaling, vesicles and maceration | tinea pedis
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| tinea pedis is more common in __ | males
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| erythema, scale and papules on heels, soles and lateral borders of foot | moccasin tinea pedis
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| topical treatment for tinea pedis | must use for 2-4 weeks, imidazoles, allylamines
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| oral treatment for tinea pedis | use for 2-6 weeks for severe/refractory cases imidazoles, allylamines (must monitor liver function)
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| non-pharmacologic treatment for tinea pedis | air
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| aka jock itch | tinea cruris
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| sub-acute or chronic infection of the groin/medial thighs | tinea cruris
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| differential for tinea cruris | candidiasis, erythrasma
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| subacute infection of neck, trunk, and or extremities-lesions vary in size but are plaques with sharp borders, smaller pustules or vesicles may appear within the borders. central clearing is common | tinea corporis
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| candida is less likely to spare the __ | scrotum
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| infection of the scalp, most common in children, especially ages 6-10 years, rare in adults, often asymptomatic | tinea capitus
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| tinea capitus must be treated __ | systemically
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| what may be used to treat tinea capitus | griseofulvin, imidazoles or Lamisil
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| infection involving sites where maceration and occlusion create a warm, moist environment. | intertriginous candidiasis
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| predisposing factors for intertriginous candidiasis | obesity, diabetes, hyperhydrosis, steroid use
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| treatment of intertriginous candidiasis | nystatin, imidazoles, glucocorticoids used sparingly to calm the inflammatory response
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| intertriginous candidiases | large body folds (under breasts, ab folds, axillea, groin-worsened by tight/abrasive clothing/poor hygiene) small body folds (web spaces of fingers and toes, angles of mouth)
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| intertriginous candidiasis of angles of mouth | angular cheilitis
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| chronic, often asymptomatic, scaling superficial skin infection. Etiologic agent malasezzia furfur found as normal skin flora in persons >15yrs especially in skin sites with high sebaceous activity | tinea (Pityriasis) versicolor
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| places where you don't want to put topical steroids | face, groin, axilla
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| multiple well-demarcated hyper or hypo pigmented macules with fine scaling, common sites are upper trunk, axilae, groin, thighs. | tinea (Pityriasis) versicolor
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| examination of this scale under microscope reveals yeast and pseudohyphae (spaghetti and meatballs) | tinea (Pityriasis) versicolor
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| application of oils/grease on the face, neck and scalp will facilitate the development of | tinea (Pityriasis) versicolor
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| topical treatment of tinea versicolor | selenium sulfide 2.5% daily x7 days then weekly
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| oral treatment of tinea versicolor | ketoconazole (can use single does therapy), fluconazole, itraconazole
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| etiologic agents of subcutaneous fungal infections (saphrophytes found in soil, vegetation especially in warm tropical climates) | sporothrix, exophila, fonsecaea, madurella, pseudallescheria
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| generalized skin eruptions secondary to systemic infection-common in children, adolescents | viral exanthems
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| most common viral exanthems in childhood | rubeola (measles), rubella (german measles), varicella (chicken pox), roseola, erythema infectiousum (fifth disease)
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| type of exanthem characterized by generalized erythema, worse in body creases | scarlatiniform
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| type of exanthem that is maculopapular | morbiliform
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| type of exanthem that is characterized initially by vesicles, may evolve to papules->pustules->erosions | vesicular
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| Common systemic viral illness characterized by oral lesions (erosions) and vesicular exanthem limited to distal extremities | hand foot mouth disease
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| etiologic agent of hand-foot and mouth disease | coxsackie virus
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| hand foot and mouth disease has epidemic outbreaks every __ years | 3
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| aka cold sores, fever blisters | herpes labialis
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| treatment for herpes labilalis | penciclovir (topical), acyclovir, valacyclovir
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| manifestation of herpes simplex often seen in health care professionals, especially dentists. also in daycare providers, lesions can be exquisitely painful | herpetic whitlow
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| viral skin infection caused by pox virus, distinct flesh colored or pearly white papules 1-2mm with umbilicated centers. very common in children and sexually active adults. Lesions will usually resolve spontaneously | molluscum contagiosum
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| complication of varicella-zoster virus infection | ophthalmic, hemiplegia
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| distribution of varicella zoster virus infection | single dermatone thoracic>trigeminal>lumbosacral>cervical
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| treatment for varicella-zoster virus infection | high dose acyclovir, valacyclovir, famciclovir. ideally started within 72 hours of lesion eruption
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| tx in patients with shingles that are greater then 50 years old offer | prednisone
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| pain treatment for post herpetic neuralgia | gabapentin, pregabalin, tricyclics, topicals (capsaicin, lidocaine)
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