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Cal destes factores non é considerado un factor de risco para a enfermidade?
Que tratamento é utilizado para aliviar o dolor asociado á enfermidade?
Cales son as características da vacina Zostavax?
Canto tempo hai que esperar entre as dúas doses de Shingrix?
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Que situación require derivación a un oftalmólogo?
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Cal dos seguintes factores non é un factor predispoñente para a portación de S. aureus?
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Que tratamento é apropiado para un paciente con éctima grave?
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Cal é un síntoma característico do ántrax?
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Que tipo de infección é Erisipela?
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Que antibiótico non se menciona como tratamento para o ántrax?
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Cal é o tratamento máis adecuado para a foliculitis profunda?
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Cales son os síntomas característicos da foliculitis superficial?
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Cal é a principal causa do forúnculo?
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Cales son os factores predispoñentes a ter foliculitis?
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Que tratamento non é apropiado para a foliculitis?
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Quais son as condicións asociadas a flácidas e halo costroso?
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Que tipo de herpes está asociado a episodios recurentes?
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Cal é a forma ulcera do herpes que pode xurdir após unha infección?
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Cal das seguintes condicións non está mencionada como neoplásica?
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Que tipo de dor se relaciona frecuentemente co herpes post herpético?
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Que bacterias son responsables do impétigo vulgar?
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Que manifestacións son características do impétigo ampollar?
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Cales son os antibióticos tópicos recomendados para o tratamento do impétigo vulgar?
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Que sinal clínico é característico do síndrome de pele escaldada estafilocócica (SPEE)?
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Canto tempo normalmente leva a recuperación do impétigo ampollar?
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Que pacientes son máis propensos a desenvolver impétigo ampollar?
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Que tratamento sistémico é eficaz para alérxicos á penicilina no tratamento do impétigo?
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Que tipo de lesións aparecen primeiro no impétigo vulgar?
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Study Notes
Herpes Zoster Risk Factors
- Age (50% in patients over 60 years old)
- Female sex
- Prodromal pain
- Severe pain
- Severe, widespread rash
Herpes Zoster Treatment
- General: Loose cotton clothing, maintain social activities
-
Medications:
- Tricyclic antidepressants
- Gabapentin/Pregabalin
- Opioids
- Lidocaine 5% patches
- Referral to pain management specialist
Herpes Zoster Prevention and Referral
- Zostavax: Live attenuated vaccine, more concentrated than varicella vaccine (now discontinued)
-
Shingrix: Recombinant zoster virus vaccine
- Can be given to immunosuppressed patients
- 2 doses separated by 2-6 months
-
Referral to specialist if:
- More than 1 dermatome affected
- Hemorrhagic or necrotic lesions
- Involvement of the ophthalmic branch (refer to ophthalmologist, leave ointment)
- Widespread lesions
- Immunocompromised patient
Impetigo Vulgar
- Caused by Staphylococcus aureus and Streptococcus pyogenes
- Frequently seen in exposed areas (face), periorificial (mouth, nose)
-
Clinical Presentation:
- Erythematous macule → vesicle → pustule → erosion
- Superficial crust with yellow crust (melicerica)
-
Differential Diagnosis:
- Herpes simplex
- Eczema
- Insect bites
- Chickenpox
Impetigo Vulgar Treatment
-
Local Management:
- Local cleansing and debridement
-
Topical Antibiotics:
- Mupirocin 2% 3 times a day
- Fusidic acid 2% twice a day for 1 week, chloramphenicol
-
Systemic Antibiotics:
- First-generation cephalosporins: cefadroxil (30 mg/kg/day divided every 12 hours for 10 days)
- Flucloxacillin (50 mg/kg/day divided every 8 hours)
-
Penicillin allergy:
- 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
-
Clinical Presentation:
- Vesicles rapidly transform into flaccid, transparent bullae
- Sharp margins without an erythematous halo
- Halo of scales
- Bullae rupture easily, leaving a dry, shiny erosion with a thin crust
- Heals faster than impetigo vulgaris
-
Complications:
- If epidermolytic toxin spreads hematogenously, it can lead to Staphylococcal Scalded Skin Syndrome (SSSS), a generalized form of bullous impetigo
Staphylococcal Scalded Skin Syndrome (SSSS)
-
Clinical Presentation:
- Patient has impaired general state: abrupt onset of irritability and fever
- Macular erythema starts on the face (periorificial) and folds
- Sensitive skin, generalized rash, Nikolsky sign (+) (skin peels off with friction)
- Wrinkled skin, 24-48 hours: flaccid bullae detach, large erosive areas with moisture that dries → thin crust, desquamation (in folds) 3-5 days
- Includes hands and feet, crusts and fissures (radiating) around the mouth
- Pathology: Necrosis of keratinocytes
SSSS Treatment
- Primary Goal: Eradicate the infectious focus
-
Treatment:
- Intravenous antibiotics (cloxacillin, vancomycin if MRSA)
- Skin and electrolyte management
- Diagnosis and management of carriers (mupirocin nasal)
SSSS Differential Diagnosis
- Scarlet fever
- Kawasaki disease
- Staphylococcal toxic shock syndrome
- Toxic Epidermal Necrolysis (TEN) (due to medications)
Folliculitis
-
Superficial Folliculitis:
- Involves the distal portion of the hair follicle
- Papules or pustules 1-4 mm in diameter on an erythematous base, pruritic
-
Deep Folliculitis:
- Involves the deeper portion of the hair follicle
- Erythematous, tender papules of larger size with central pustules
- Can extend to surrounding tissue → furuncle
-
Differential Diagnosis:
- Acne
- Pilonidal cyst
- Sycosis
Folliculitis Treatment
-
Reduce Predisposing Factors:
- Hygiene
- Medications (e.g., corticosteroids)
-
Local Measures:
- Washing 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
- Abscess: Located in any area, whereas furuncle involves hair follicle, and carbuncle is a cluster of furuncles.
-
Furuncle:
- Occurs more frequently in adolescents and young adults, due to S. aureus
- More frequent in areas of friction, face, neck (nape), armpits, buttocks, thighs and perineum
- Predisposing factors: S. aureus carriage, diabetes mellitus (DM), obesity, immunosuppression, tight clothing, hyperhidrosis, poor hygiene
-
Carbuncle:
- Involves subcutaneous tissue, firm swelling with openings that drain pus on the surface
- More commonly found in the nape, back, and thighs.
- Symptoms: Fever, pain
- Complications: Scarring
- More common in: Diabetics
Abscess, Furuncle, Carbuncle Treatment
-
Local Management:
- Local heat and drainage
-
Systemic Antibiotics:
- Cloxacillin or flucloxacillin
- First-generation cephalosporin
- Amoxicillin-clavulanate
- Penicillin allergy: macrolide or clindamycin
Ecthyma
-
Clinical Presentation:
- Ulcerative form of non-bullous impetigo, involvement of epidermis and dermis
- More frequently seen on the lower extremities (dorsum of the feet and anterior legs)
- Few lesions
-
Treatment:
- Mild cases: topical macrolides or clindamycin
-
Severe or facial cases: IV antibiotics
- Penicillin sodium (2-4 million units every 6 hours) + cloxacillin (1 g every 6 hours) OR
- First-generation cephalosporin (cefazolin 1-2 g every 8 hours) OR
- If responds well after 72 hours: cefadroxil (1 g every 12 hours) orally
- Penicillin allergy: lincomycin IV and then orally
-
Chronic ulcer associated with Ecthyma: Cover for anaerobes and gram-
- Metronidazole + ciprofloxacin
-
Recurrences:
- Benzathine penicillin (1.2 million units monthly) for 6 months or erythromycin (250 mg every 12 hours) for 3 months
Erysipelas
-
Clinical Presentation:
- Infection of the dermis and superficial lymphatic plexus (more superficial than cellulitis)
- Caused by S. pyogenes (usually group A beta-hemolytic streptococcus)
-
Risk Factors:
- Age (more common in elderly)
- Underlying medical conditions (diabetes, alcoholism, malnutrition)
- Impaired immune system
- Skin trauma (cuts, scratches, insect bites)
- Recent surgery or invasive procedures
- Lymphedema
-
Clinical Presentation:
- Well-demarcated, raised, erythematous plaque
- Tenderness and pain
- Edema
- Often involves the face, lower legs, and arms
-
Treatment:
- Penicillin V (250-500 mg orally four times a day)
- Patients with penicillin allergy: cephalexin (250-500 mg by mouth four times a day)
- For severe cases: intravenous penicillin or ceftriaxone
- The duration of treatment is typically 10 days.
Erysipelas Complications
- Cellulitis
- Lymphangitis
- Sepsis
- Brain abscess (rare)
Skin Infections: Summary of Organisms
- Impetigo vulgaris: Staphylococcus aureus (most common) and Streptococcus pyogenes.
- Bullous impetigo: Staphylococcus aureus.
- Ecthyma: Streptococcus pyogenes, but Staphylococcus aureus can also be involved.
- Erysipelas: Streptococcus pyogenes.
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Description
Este cuestionario aborda os factores de risco, tratamento e prevención do herpes zoster, así como a identificación de síntomas e a importancia de refíos a especialistas. É fundamental entender como tratar e minimizar os riscos asociados a esta condición para mellorar a calidade de vida dos pacientes.
