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Questions and Answers
Que grupo de idade ten un risco elevado de padecer a enfermidade relacionada co virus zoster?
Cal é un tratamento recomendable para o alivio do dor severo asociado co virus zoster?
Que vacina é considerada desfasada e pode ser administrada a pacientes inmunosuprimidos?
Cal das seguintes condicións require derivar a un oftalmólogo?
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Cal é a dose recomendada para a vacina Shingrix contra o virus zoster?
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Que tratamento é adecuado para un caso grave de ectima?
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Cal dos seguintes factores non é un factor predispoñente para a portación de S aureus?
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Cal dos seguintes síntoma non está asociado co antrax?
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Que tipo de infección é a erisipela?
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Que tratamento é recomendado para cubrir anaerobios en asociación cunha úlcera crónica?
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Cal é o antibiótico endovenoso recomendado para o tratamento de MRSA?
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Que tipo de foliculite se caracteriza por pápulas eritematosas sensibles e pústulas na porción distal do folículo piloso?
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Cal é a principal medida de tratamento para as foliculitis?
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Cal é a principal diferencia entre un forúnculo e un absceso?
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Cales son os antibióticos tópicos recomendados para o tratamento da foliculite?
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Que bacteria son responsables do impetigo vulgar?
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Que tratamento tópico se recomenda para o impetigo vulgar?
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Cales son as principais características do impetigo ampollar?
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Que condición se pode desenvolver se a toxina epidermolítica do impetigo buloso se difunde de forma hematóxica?
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Cal é o principal síntoma do síndrome de pel escaldada estafilocócica (SPEE)?
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Que tipo de tratamento antibiótico sistémico se recomenda para pacientes alérxicos a penicilina?
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Que condición se caracteriza por un signo de Nikolsky positivo?
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A que grupo de idade é máis común o impetigo ampollar?
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Cal é a clínica característica do erisipela?
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Que tratamentos antibióticos son recomendados para o erisipela?
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Cales son os síntomas que caracterizan a infección por estreptococo do grupo A?
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Que se debe considerar ao hospitalizar un paciente con erisipela?
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Cál é a principal diferenza entre erisipela e celulitis?
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Que signo é indicativo de erisipela na piel?
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Ao tratar un paciente con erisipela, que antibiótico se pode usar se hai alerxia a PNC?
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Cales son as possíveis complicacións da erisipela sen tratamento adecuado?
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Study Notes
Risk factors for Herpes Zoster (Shingles)
- Age (50% over 60 years old)
- Female sex
- Prodromal pain
- Severe pain
- Severe, disseminated rash
Herpes Zoster Treatment
- General Treatment:
- Cotton and loose clothing
- Maintain social activities
- Medication:
- Tricyclic antidepressants
- Gabapentin/pregabalin
- Opioids
- Lidocaine 5% patches
- Refer to a pain clinic if pain is severe
Herpes Zoster Prevention
-
Zostavax vaccine:
- Live attenuated virus, more concentrated than varicella vaccine
- Discontinued
-
Shingrix vaccine:
- Recombinant zoster virus
- Can be given to immunocompromised patients
- 2 doses separated by 2-6 months
- For individuals 50 years old or older
Herpes Zoster Referral
- More than 1 dermatome affected
- Hemorrhagic, necrotic lesions
- Involvement of the ophthalmic branch:
- Refer to an ophthalmologist
- Use eye ointment
- Disseminated lesions
- Immunocompromised patients
Impetigo Vulgar
- Caused by Staphylococcus aureus and Streptococcus pyogenes
- Commonly seen in exposed areas (face), periorificial (mouth, nose)
- Characterized by:
- Erythematous macule → vesicle → pustule → erosion
- Superficial crust with a yellowish color (honey-colored)
- Differential diagnosis:
- Herpes simplex
- Eczema
- Insect bites
- Varicella
Impetigo Vulgar Treatment
- Local hygiene and crust removal
- Topical antibiotics:
- Mupirocin 2% three times a day
- Fusidic acid 2% twice a day for one week
- Chloramphenicol
- Systemic antibiotics:
- First-generation cephalosporin (Cefadroxil) 30 mg/kg/day divided every 12 hours for 10 days
- Flucloxacillin 50 mg/kg/day divided every 8 hours
- If allergic to penicillin:
- Erythromycin 30-50 mg/kg/day divided every 6 hours
- Azithromycin 10 mg/kg/day for 5 days
Bullous Impetigo
- More common in skin folds, especially in young children.
- Caused by Staphylococcus aureus.
- Commonly seen on the face, body, and in infants and newborns, it can also affect the diaper area.
- Characterized by:
- Rapid progression of vesicles to flaccid and transparent bullas
- Sharp margins with no erythematous halo
- Halo of scales
- Easily rupture, leaving a dry, shiny erosion with a fine crust
- Heals more rapidly than impetigo vulgaris
Staphylococcal Scalded Skin Syndrome (SSSS)
- Occurs when the epidermolytic toxin diffuses hematogenously, resulting in a generalized form of bullous impetigo.
SSSS Features
- Patient has general malaise: abrupt onset of irritability and fever
- Macular erythema that begins on the face (periorificial) and in skin folds
- Skin sensitivity
- Generalized rash
- Nikolsky's sign (+): Skin sloughs off with friction
- Wrinkled skin
- Flaccid bullas develop in 24-48 hours and detach, leaving large erosive areas with moisture that dries, forming thin crusts
- Desquamation (in skin folds) for 3-5 days
- Hands and feet are also involved
- Crusts and radiating fissures around the mouth
- Indicates keratinocyte necrosis
SSSS Treatment
- Eradicate the infectious focus
- Intravenous antibiotics (Cloxacillin, Vancomycin for MRSA)
- Skin care and electrolyte management
- Diagnosis and management of carriers (Mupirocin nasal)
Differential Diagnosis of SSSS
- Scarlet fever
- Kawasaki disease
- Staphylococcal toxic shock syndrome
- Toxic epidermal necrolysis (TEN) (caused by a drug)
Folliculitis
- Inflammation of the hair follicle
Superficial Folliculitis
- Involves the distal portion of the hair follicle
- Papules or pustules 1-4 mm in diameter on an erythematous base
- Pruritus
Deep Folliculitis
- Involves the hair follicle and surrounding tissue
- Erythematous and tender papules larger in size with central pustules
- Can extend into the surrounding tissue, leading to a furuncle (boil)
Folliculitis Differential Diagnosis
- Herpes simplex
- Syphilis
- Acne vulgaris
- Gram-negative folliculitis (hot tub folliculitis)
Folliculitis Treatment
- Correct predisposing factors such as humidity, skin irritation
- Wash with antibacterial soaps (triclosan or chlorhexidine 1%)
- Topical antibiotics:
- Mupirocin 2%, Fusidic acid for 7-10 days
- Oral antibiotics:
- Flucloxacillin: for extensive, resistant, or recurrent cases.
Abscess, Furuncle, Carbuncle
- An abscess is located in any area of the body, a furuncle involves hair follicles, and a carbuncle is a cluster of furuncles.
Furuncles
- Typically seen in adolescents and young adults
- Caused by Staphylococcus aureus, anaerobic bacteria may occur in the inguinal region
- More common in areas subject to friction: face, neck (nape), axillae, buttocks, thighs, and perineum
- Predisposing factors: Staphylococcus aureus carriage, diabetes mellitus, obesity, immunosuppression, tight clothing, hyperhidrosis, poor hygiene
Carbuncles
- Involve subcutaneous tissue
- Hard swelling with multiple openings that drain pus on the surface
- Commonly seen in the nape, back, thighs
- Symptoms: generalized malaise, pain
- Can leave scars
- Diabetcis are more susceptible to carbuncles.
Furuncle and Carbuncle Treatment
- Local heat and drainage
- Systemic antibiotics:
- Cloxacillin or flucloxacillin
- First- generation cephalosporin
- Amoxicillin-clavulanate
- If allergic to penicillin, macrolides/clindamycin
Ecthyma
- Ulcerated form of non-bullous impetigo
- Involves the epidermis and dermis
- More common in the lower extremities (dorsal feet and anterior legs)
- Usually only a few lesions
- Treatment:
- Macrolides or clindamycin.
- Severe or facial cases require hospitalization and intravenous antibiotics:
- Penicillin sodium 2-4 million units every 6 hours plus Cloxacillin 1 g every 6 hours or
- First-generation cephalosporin: Cefazolin 1-2 g every 8 hours
- If responds well after 72 hours, switch to cefadroxil 1 g every 12 hours orally.
- For penicillin allergy: intravenous lincomycin followed by oral administration
- Chronic ulcers require coverage for anaerobes and gram-negatives:
- Metronidazole + Ciprofloxacin
- If recurrent infections, use penicillin benzathine 1.2 million units monthly for 6 months or erythromycin 250mg every 12 hours for 3 months
Erysipelas
- Infection of the dermis and superficial lymphatic plexus (more superficial than cellulitis)
- Caused by Streptococcus pyogenes (group A beta-hemolytic) and less commonly by Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae
- Presents with:
- Generalized malaise, fever, chills (acute onset)
- Erythematous, shiny, edematous, warm, and tender plaque that rapidly spreads
- ‘Orange peel’ appearance
- Well-defined, palpable margins (unlike cellulitis which has diffuse, non-palpable borders)
- Superficial vesicles, bullae, pustules, and/or purpuric lesions
Erysipelas Treatment
- Systemic antibiotics for 10 days:
- Flucloxacillin or cefadroxil
- If allergic to penicillin, use macrolides or clindamycin
- Severe or facial cases require hospitalization and intravenous antibiotics:
- Penicillin sodium 2-4 million units every 6 hours
- If no improvement after 48 hours, add cloxacillin
- First-generation cephalosporin: 1-2 g every 8 hours.
- If responds favorably after 72 hours, switch to cefadroxil 1 g every 12 hours orally.
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Description
A quiz sobre os factores de risco, tratamento e prevención do Herpes Zoster proporciona unha visión xeral dos síntomas, tratamentos e vacinas relevantes. A información incluída axuda a comprender mellor como abordar esta condición e a importancia da prevención. Ideal para estudantes de saúde e profesionais que buscan ampliar os seus coñecementos sobre o tema.
