Podcast
Questions and Answers
Cal dos seguintes factores de risco é considerado común para a dor severa?
Cal dos seguintes factores de risco é considerado común para a dor severa?
Que tratamento debería considerarse para un paciente cunha dor severa que non responde a analxésicos básicos?
Que tratamento debería considerarse para un paciente cunha dor severa que non responde a analxésicos básicos?
Que vacina está en desuso para a prevención do virus zoster?
Que vacina está en desuso para a prevención do virus zoster?
Que acción se debe tomar en caso de compromiso da rama oftálmica debido ao virus zoster?
Que acción se debe tomar en caso de compromiso da rama oftálmica debido ao virus zoster?
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Cantos doses de Shingrix son necesarias para a prevención efectiva do virus zoster?
Cantos doses de Shingrix son necesarias para a prevención efectiva do virus zoster?
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Que tipo de condición está relacionada con 'gingivoestomatitis'?
Que tipo de condición está relacionada con 'gingivoestomatitis'?
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Cal dos seguintes termos describe un tipo de neuralxia?
Cal dos seguintes termos describe un tipo de neuralxia?
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Que condición non está mencionada como relacionada co herpes?
Que condición non está mencionada como relacionada co herpes?
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Cual é un exemplo de unha complicación do herpes?
Cual é un exemplo de unha complicación do herpes?
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Que tipo de condición se clasifica como 'neoplasicos'?
Que tipo de condición se clasifica como 'neoplasicos'?
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Cal é a principal diferenza entre a foliculite superficial e a foliculite profunda?
Cal é a principal diferenza entre a foliculite superficial e a foliculite profunda?
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Que antibiótico é recomendado para o tratamento da foliculite profunda cando se considera un caso resistente?
Que antibiótico é recomendado para o tratamento da foliculite profunda cando se considera un caso resistente?
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Cal das seguintes opcións non é parte do diagnóstico diferencial para a foliculite?
Cal das seguintes opcións non é parte do diagnóstico diferencial para a foliculite?
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Que medida é fundamental para o tratamento da foliculite, ademais do emprego de antibióticos?
Que medida é fundamental para o tratamento da foliculite, ademais do emprego de antibióticos?
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Cal é a función principal da mupirocina nasal no contexto de portadores?
Cal é a función principal da mupirocina nasal no contexto de portadores?
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Cal é un síntoma característico da infección por pyogenes?
Cal é un síntoma característico da infección por pyogenes?
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Cales son os antibióticos recomendados como tratamento sistémico para a infección?
Cales son os antibióticos recomendados como tratamento sistémico para a infección?
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Que cambio sería necesario se non hai resposta despois de 48 horas de tratamento?
Que cambio sería necesario se non hai resposta despois de 48 horas de tratamento?
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Cal sería a principal diferencia entre erisipela e celulitis?
Cal sería a principal diferencia entre erisipela e celulitis?
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Que clase de lesión cutánea é típica na erisipela?
Que clase de lesión cutánea é típica na erisipela?
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Que paciente debería ser hospitalizado para tratamento por vía intravenosa?
Que paciente debería ser hospitalizado para tratamento por vía intravenosa?
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Cales son os signos de inicio agudo da infección?
Cales son os signos de inicio agudo da infección?
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Que aspectos son característicos das lesións cutáneas na erisipela?
Que aspectos son característicos das lesións cutáneas na erisipela?
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Que microorganismo causa o impétigo vulgar?
Que microorganismo causa o impétigo vulgar?
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Cales son as fases da evolución cutánea do impétigo vulgar?
Cales son as fases da evolución cutánea do impétigo vulgar?
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Cual é o tratamento tópico recomendado para o impétigo vulgar?
Cual é o tratamento tópico recomendado para o impétigo vulgar?
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Que característica diferencial ten o impétigo ampollar comparado co impétigo vulgar?
Que característica diferencial ten o impétigo ampollar comparado co impétigo vulgar?
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Que ocorre se a toxina epidermolítica do estafilococo aureus se difunde de forma hematógena?
Que ocorre se a toxina epidermolítica do estafilococo aureus se difunde de forma hematógena?
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Cales son os síntomas iniciais do síndrome de piel escaldada estafilocócica (SPEE)?
Cales son os síntomas iniciais do síndrome de piel escaldada estafilocócica (SPEE)?
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Que antibiótico sistémico se recomenda para pacientes alérxicos á penicilina?
Que antibiótico sistémico se recomenda para pacientes alérxicos á penicilina?
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Cual é o principal síntoma que se observa co signo de Nikolsky na SPEE?
Cual é o principal síntoma que se observa co signo de Nikolsky na SPEE?
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Study Notes
Risk Factors for Shingles
- 50% of those over 60 years old will develop shingles
- Women are more likely to get shingles
- Prodomal pain before the rash is a risk factor
- Severe pain is a risk factor
- Severe and widespread rash is a risk factor
Treatment for Shingles
- Wear loose-fitting cotton clothing
- Maintain social activities
- Tricyclic antidepressants
- Gabapentin/Pregabalin
- Opioids
- 5% lidocaine patches
- Referral to a pain clinic
Shingles Prevention and Referral
- Zostavax: live attenuated virus, contains a higher concentration than the varicella vaccine
- Shingrix: Recombinant zoster virus, can be given to immunocompromised patients
- It is recommended to get the Shingrix vaccine if you are 50 years old or older
- Two doses are recommended, separated by 2-6 months
Referral for Shingles
- More than one dermatome affected
- Hemorrhagic or necrotic lesions
- Ophthalmic branch involvement
- Refer to an ophthalmologist
- Immunosuppressed patients
Impetigo Vulgar
- Caused by Staphylococci aureus and Streptococci pyogenes
- Commonly found in exposed areas, such as the face, periorificial area of the mouth and nose.
- Presents as an erythematous macule, followed by a vesicle, pustule, and erosion
- Superficial crusting is a characteristic finding, with the crust being yellow and honey-colored (melicerica)
- Differential diagnoses include herpes simplex, eczema, insect bites, and varicella
Impetigo Vulgar Treatment
- Local hygiene and debridement
- Topical antibiotics:
- Mupirocin 2% 3 times a day
- Fusidic acid 2% twice a day for 1 week
- Chloramphenicol
- Systemic antibiotics:
- 1st generation cephalosporin (Cefadroxil) 30mg/kg/day divided every 12 hours for 10 days
- Flucloxacillin 50mg/kg/day divided every 8 hours
- If penicillin allergic:
- Erythromycin 30-50mg/kg/day divided every 6 hours
- Azithromycin 10mg/kg/day for 5 days
Bullous Impetigo
- More common in folds and young children
- Caused by Staphylococcus aureus
- Commonly found on the face and body
- In infants and newborns, it can occur in the diaper area.
- Vesicles quickly progress to flaccid, transparent bullas
- Bullous lesions have sharp margins without an erythematous halo
- A halo of scales may be present
- Bullous lesions rupture easily, leaving behind dry, shiny erosions
- Healing is faster than impetigo vulgaris
- If the epidermolytic toxin spreads hematogenously, it can lead to Staphylococcal Scalded Skin Syndrome (SSSS)
- SSSS presents as a generalized form of bullous impetigo.
Staphylococcal Scalded Skin Syndrome (SPEE)
- Patients present with systemic involvement: sudden onset of irritability and fever
- Macular erythema, which often starts around the mouth and in folds
- Skin is sensitive and the rash generalizes
- Nikolsky's sign (+) (skin peels off with friction)
- Wrinkled skin
- Formation of flaccid bullas 24-48 hours after the onset
- Large erosive areas that are moist and eventually crust over
- Thin crusts are shed, with desquamation (particularly in folds) 3-5 days after onset
- Hands and feet are also involved
- Crusting and radiating fissures (particularly around the mouth)
- SPEE leads to keratinocyte necrosis
Treatment of Staphylococcal Scalded Skin Syndrome (SPEE)
- Eradicate the infectious focus
- Intravenous antibiotics (cloxacillin, vancomycin if MRSA)
- Skin and fluid management
- Diagnosis and treatment of carriers (nasal mupirocin)
Differential Diagnoses of Staphylococcal Scalded Skin Syndrome (SPEE)
- Scarlet fever
- Kawasaki disease
- Staphylococcal toxic shock syndrome
- Toxic epidermal necrolysis (TEN)
Folliculitis
- Inflammation of the hair follicle
- Divided into superficial and deep folliculitis
Superficial Folliculitis
- Affects the distal portion of the hair follicle
- Small papules or pustules (1-4mm in diameter) are present, with an erythematous base
- Pruritus is common
Deep Folliculitis
- Causes erythematous and tender papules of larger size with central pustules
- Can extend to the surrounding tissue, forming a furuncle
Folliculitis Differential Diagnosis
- Multiple differential diagnoses.
Treatment of Folliculitis
- Correct predisposing factors
- 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, Anthrax
- Abscess is a localized collection of pus
- Furuncle is an abscess involving a hair follicle
- Anthrax: clusters of furuncles
- Commonly caused by Staphylococcus aureus (furuncle) and, less commonly, Streptococcus pyogenes (beta-hemolytic group A)
Furuncle
- Occurs in adolescents and young adults
- Presents with cellulitis, fever, and chills
- Rash is erythematous, shiny, edematous, warm and tender, with rapid progression
- 'Orange peel' appearance characterized by well-defined and palpable borders
- Vesicles, bullae, pustules, and purpuric superficial lesions are present
- Differentiation from cellulitis is important as cellulitis is diffuse and not palpable
Treatment of Furuncle
- Systemic antibiotics for 10 days:
- Flucloxacillin or cefadroxil
- If penicillin allergy: macrolides or clindamycin
- Hospitalization for severe or facial cases: IV antibiotics
- Penicillin sodium 2-4 million units every 6 hours
- If no response after 48 hours: add cloxacillin
- 1st generation cephalosporin 1-2g every 8 hours
- If patient responds favorably after 72 hours: cefadroxil 1g every 12 hours orally
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Description
Este cuestionario analiza os factores de risco para desenvolver herpes zóster, así como os tratamentos e as medidas de prevención recomendadas. Aprenderás sobre a importancia das vacinas e a derivación adecuada en pacientes complicados. Ideal para profesionais da saúde e interesados na epidemioloxía das enfermidades virais.
