Dermatology

Anatomy

Skin Infections

Bacterial

Impetigo
Folliculitis
Furuncle
Carbuncle
Cellulitis
Acne

Fungal /Parasitic

Tinea Pedis
Tinea Cruris
Tinea Versicolor
Tinea Corporis
Toenail fungus
Pediculosis
Scabies

Skin Infections

Viral

Allergic/Irritation conditions

Herpes Simplex
Herpes Zoster
Verruca
Molluscum Contagiosum
Dermatitis
Hives
Eczema
Psoriasis
Sebacous Cysts
Frostbite

Other

Skin checks - moles

Sunburn
Striae

Impetigo

Impetigo
Superficial bacterial infection of the skin
Most commonly Staph or Strep
Thin vesicles with honey colored crusting
Usually on face, hands, neck & extremities
Spread occurs via contact from fingers,
towels, clothing
Tx: Topical antibiotics, severe infections
need oral

Folliculitis

Folliculitis
Superficial or deep infection of the hair
follicle (Barbae, hot tub)
Usually result of Staph infection
May also occur as a result of
contact/plugging with oil, dirt, sweat, etc
Rash appears as small, dome shaped
yellow pustules with a hair shaft in the
center
Tx: good hygiene, topical antibotics

Furuncle

Furuncle (Boil)
Deep extension of superficial folliculitis
into the dermis and subcutaneous tissue
Cause Staph
1-5 cm red/tender nodule which may
contain pus
Tx:

Simple lesions- warm compress

Severe infections drainage & antibiotics

Carbuncle

Carbuncle
Large deep abscess that is a progression
of a furuncle
May be 3-10 cm in size
Can present c fever/chills
Tx: drainage & antibiotics

Cellulitis

Cellulitis

An acute inflammation of the skin

S/S: redness, swelling, warmth, & tenderness of
affected area within 1-2 days of injury
Cause Staph or Strep, complication of
wound/trauma
The borders are well defined and change rapidly
Immediate attention (blood test, IV antibiotics)
Facial cellulitis can cause visual damage if
spreads to the eyes
NEVER MISS THIS ONE!!!!

Acne

Acne

Obstruction of sebaceous follicles (oil glands)

Open comedones or closed comedones
Usually on the face, chest, back
Causes:

Stressful events (hormonal changes)

Friction acne
Oil based cosmetics
NO correlation between chocolate, chips or colas

Tx: topical +/or oral antibiotics

MRSA

MRSA

Methicillin-resistant Staphylococcus aureus

super-bug caused by staph, unnecessary antibiotic use
Outwits all but the most powerful of drugs vancomycin
Enters through cuts & wounds
Types: CA (community acquired) or HA (Hospital acquired)
S/S: small red bumps that resememble pimples, quicky
turn to painful abscesses that can burrow deep into the
body, swelling, redness, pus
Risk Factors: recent hospitalization, long-term care, recent
antiobiotic use, young age, contact sports, sharing towels,
weak immune system, living in groups, health-care workers
Dx: Tissue sample 48hrs
Tx: trial & error c strong antiobiotics
Prevention: WASH HANDS, surfaces, cover wounds, use
only personal items

Tinea Pedis

Tinea Pedis
Fungal infection - Athletes Foot
Rash presents as vesicles/erosions on the
soles of the foot as well as between toes
Dx: examine scraping under microscope
Tx: antifungal cream/powders
(micronazole), keep feet dry

Tinea Cruris

Tinea Cruris
Fungal infection Jock itch
Red/scaly rash on inner thighs/inguinal
creases; occasionally the buttock, not
scrotum or labia
Common in obese patients & athletes in
tight fitting clothes
Common in hot/humid weather
Tx: topical antifungal creams

Tinea Versicolor

Tinea Versicolor

Fungal infection of the skin

Multiple patchy lesions (oval shape c fine scales)

either light in color or brown
Typically occurs on the back, neck, chest,
shoulders
More prominent in the summer when the affected
areas do not tan
Recurrence is common
Tx: Topical antifungal

Tinea Corporis

Tinea Corporis

Fungal infection of skin - Ring Worm

Well defined circular patches with scaly borders

Found on non-hairy surfaces face, arms, legs,
truck
Occurs after contact c another person/object that
is carrying the fungus
Common confused c eczema
Tx: topical antifungals (Micronazole, ketoconazole
not Nystatin)

Toenail Fungus

Toenail Fungus

S/S:yellow, think nails, painful, brittle, more likely in

toenails d/t dark, moist environment
Tx: Lamisil, vicks, takes 6-12 months

Pediculosis

Pediculosis

Lice; six-legged wingless insect

The louse is a grayish/black colored insect ~4mm
long
The nits are gelatinous white color ~.8mm long
Can be found in the head, body or pubic hair
They pierce the skin and secrete saliva which
causes itching, lay eggs close to scalp
Spread by shared hats, towels, combs, bedding,
clothing, upholstery & headphones
Tx: Shampoo Nix, Rid; fine tooth comb, boil
clothing/bedding, dry cleaning

Scabies

Very contagious STD

Intense itchy rash, with linear burrows
Tx: Kwell or Elimite (topical creams)
Wash bedding/clothing in HOT water &
stored for 2-3 days

Herpes Simplex

Herpes Simplex
Viral infection either Type I OR Type II
You cant kill it and it wont kill you

Clear papules c superficial ulcerations/erosions

May cause fever, lymph node enlargement,
burning pain
Lesions will crust over in 5-14 days
Tx: analgesic for pain, oral antiviral (acyclovir)

Herpes Zoster

Herpes Zoster

Shingles, a reactivation of varicella zoster

(Chicken pox) virus
It remains in the cells of nerve roots in an
inactive state (after exposure as a youth)
Unknown reasons for reactivation
Re-exposure to virus
Immunosuppressant issue
Some drugs

Result in vesicles on a red base in a band-like

distribution
Painful rash, prickly nerve pain
Tx: symptomatic, pain, calamine lotion

Verruca

Verruca
Warts; caused by human papillomavirus
Verruca plantaris
Verruca vulgaris
Round, flesh colored and grow to be
yellow-ish tan
1cm or more wide
65% will resolve spontaneously
Tx: destruction of epidermal cells that
contain virus; cryogenically, chemically

Molluscum Contagiosum

Molluscum Contagiosum
Viral infection of skin/mucous membrane
Single or multiple flesh colored, dome
shaped papules c central umbilication
Found on face, trunk, extremities,
lips/tongue, genitals
Very contagious self and others
Common in swimmers/wrestlers
Tx: curettage, silver nitrate to chemically
burn the lesions

Dermatitis

Dermatitis

Inflammation of the superficial dermis/epidermis

Atopic Dermatitis:

Heriditary disorder may also have Hx of asthma, allergic rhinitis, rash

Usually along cheeks, face, trunk, extensor surfaces of extremities
Dry and papular rash, scratching makes it worse, d/t loss of natural
oils in skin
Aggravated by stress, anxiety, dry conditions

Tx: good lotions & rehydration of skin

Contact Dermatitis:

Papular and itchy rash resulting from contact c an allergen

Commonly nickel (cheap jewelry, buckles), soaps, perfumes,
cosmetics, posion ivy/oak
Tx: Cortisone cream (anti-inflammatory agent)

Hives

Hives

An allergic reaction resulting in histamine release

Well defined wheals (solid elevations c central
clearing)
Extremely itchy & may result in angioedema
Allergy can be to virtually anything
Tx: antihistamines

Eczema

Eczema
Dryness of the epidermis
Usually seen on extremities/trunk
Worse in winter or when bath too much
Rash is itchy, red, scaly, patchy c a
cracked appearance
2ndary bacterial infections d/t scratching
Tx: lotion/creams to hydrate, topical
corticosteroids

Proper Skin Care

Frequency of showers
Not so much soap/appropriate type
Use creams, not lotions

Psoriasis

Psoriasis

Inherited skin disorder of increased epidermal cell

turnover & thickening of the epidermis
Thick silvery scales
Common on the elbows, knees & feet
Tx:

UV light or high potency corticosteroids

Severe cases need to be hospitalized for a tar ointment
or methotrexate

Sebaceous Cysts

Sebaceous Cysts

Solitary skin nodules as a result of proliferation of

epidermal cells that secrete protein called keratin
Contains pasty, cheesy looking secretion
Common on eyelids, neck, face, trunk, scalp

Benign slow growing lesions

No treatment necessary unless problems c ADLs

Frostbite

Frostbite

Actually freezing of tissue @ cold temps

Generally affects the exposed area (Toes, feet,
fingers, nose, cheeks, ears)
Skin becomes cold, waxy, white, gray, black
Early stages chillblaines-redness, painful
Late stages cyanosis, gangrene, edema, no
pain
Tx: cover c warm compress, rapid re-warming in
water, hands between legs, armpits
Avoid pressure on tissue, even light

Skin Checks
Moles/Cancer

Moles/Cancer

Look for:

1.
2.
3.
4.

No bigger than an eraser tip

Stand out mole on the back
Irregular border
different colors

Think of outdoor sports

Tennis, golf, soccer

Males check the head

Females check the ears and lips

Sunburn

Sunburn
Superficial burn only epidermis
>15 suncreen
10-2pm is most intese hours, worse in
snowy, watery environments
Every time you burn c blisters.increases
your chances of getting skin cancer 4x
Tx: analgesic sprays, lotion..not oil
based

Striae

Striae
A streak or a linear scar
Results from rapidly developing tension in
the skin
Common in pregnancy or when you gain
weight fast..steroid use