Fungal and Viral Infections of the skin
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| what classifies fungal infections | depth of penetration
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| ____ are the most common fungal infections of the skin | dermatophytic infections.
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| 3 genera of fungi responsible for dermatophytic infections | microsporum, trichophyton, epidermophyton
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| Three routes to acquire a dermatophytic infections | person to person, animal to human, environmental
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| Predisposing factors to Tinea | atopy, steroid use, dry skin, occlusion, high humidity
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| Scales are usually suggestive of | fungal etiology
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| Dermatophytic infection of the feet characterized by erythema, scaling, vesicles and maceration | Tinea pedis. Bacterial secondary infection is common. Predisposing factors: hot/humid weather, sweating, occlusion (by shoes), contaminated floors. Involvement of toe nails is common
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| Tinea pedis is most common in which population? | males
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| Types of Tinea Pedis | Interdigital, Moccasin, Inflammatory/bullous (fluid filled that burst)
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| Tx for Tinea Pedis | Topical: imidazole (1%), allylamines (lamasil). Oral: for severe refractory cases, imidazole, allylamines, long tx? monitor LFTs (at least baseline). Treat any secondary infection
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| Jock itch is AKA | tinea cruris. Sub-acute or chronic infection of the groin/medial thighs. well-demarcated line between involved and uninvolved
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| If scrotum and inner thigh is involved, consider | candida. Also may see satellite lesions and less scales.
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| how should ointment be applied | make sure to also apply ointment wider than the borders of the lesion
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| Central clearing is typical of | tinea lesions
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| Population in which tinea capitus is most common | Most common in children, espeicially AA boys, ages 6-10 years; rare in adults
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| Only tinea infection that must be treated systemically | tinea capitus. Needs oral tx. Griseofulvin, Imidazoles, Lamisil. therapy for 6-12 weeks. For kerion, secondary infection abx must be added to regimen
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| infection accompanied by swollen, painful nodules associated with tinea capitus | kerion
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| If you see something like tinea capitus that is erythematous and oozing, think | impetigo
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| Candidiasis forms | cutaneous (intertrigo), mucocutaneous (oropharyngeal, genital), nail, systemic
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| Tx for intertriginous candidiasis | nystatin, imidazoles, glucocorticoids used sparingly to calm inflammatory response. Patients may c/o of itchy and PAIN (tx w/steroid)
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| Intertrigionous candidiasis at mouth corners is called | angular cheilitis
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| Lamisil works only on | dermatophytes. NOT ON YEAST
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| Nystatin works only | yeast. NOT ON DERMATOPHYTES
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| Imidazoles work on | yeast AND dermatophytes
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| Candidiasis features | satellite regions, burns, stings. no odor
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| What helps Tinea Versicolor grow? | oil. Etiologic agent: Malasezzia furfu
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| Common sites of Tinea Versicolor | upper trunk, axillae, groin, thighs, applications of oils/grease: face, neck & scalp
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| Spaghetti and meatballs | Tinea Versicolor.
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| Patient information in treating Tinea Versicolor? | Only works on symptoms, not the appearance.
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| Think about ________ in patients who have dirty wounds that aren't getting better | Subcutaneous fungal infections
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| Viral Exanthems presentation | Generalized skin eruption secondary to systemic infection. Prodrome present. Ask if they were sick before the rash. Common in children and adolescents
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| Viral exanthems can be accompanied by | oral lesions (enathems)
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| Most common viral exanthems in childhood | rubeola (measles), rubella, varcella, roseola, erythema infectiousum (fifth's dz)
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| Generalized Erythema with sandpaper feel, but no discrete lesions suggests | Scarlatiniform viral exanthem
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| You should see all stages of lesions in which disease? | chicken pox
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| Etiology of Hand-Foot-Mouth dz | Coxsackie virus. epidemic outbreaks q3 years. Lesions on hands and feet don't usually hurt much, but the ones in the mouth are painful
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| Grouped vesicles on erythamtous base | Herpes simplex
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| tx for herpes simplex | penciclovir (topical), acyclovir (cream and ointment), valacyclovir
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| Herpes lesions near fingernails | herpetic whitlow
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| Any time you see a large, single ulcer think | herpes and do a culture
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| In teenages, make sure they have had what vaccination or illness? | Chicken pox; can be life-threatening
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| Most worrisome complication of Shingles | Post-herpetic Neuralgia; oral steroids may prevent
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| Shingles | eruptions along a single dermatome, not itchy, painful
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| Tx for Shingles | High dose acyclovir for 7 days. Ideally start within 72 hours of eruption of lesions. Offer prednisone to patients 50 years and older to reduced likelihood of PHN
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| Vaccine newly approved for preventing shingles | Zosatvax; live vaccine. Medicare Part D covers. Anyone over 60, this is considered health maintenance
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| Viral skin infection caused by pox virusDistinct flesh colored or “pearly white”papules (1-2 mm) with umbilicated centers | molluscum contagiosum. Very common in children, sexually active adults. Transmission in skin to skin contact. Resolves spontaneously, but may take months. May be itchy and can autoinnoculate
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