Factores de risco e tratamento do herpes zóster

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

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.