Factores de risco e tratamento do herpes zoster

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Questions and Answers

Cal destes factores non é considerado un factor de risco para a enfermidade?

Dolor prodrómico

Idade superior a 60 anos

Sexo masculino (correct)

Rash severo e diseminado

Que tratamento é utilizado para aliviar o dolor asociado á enfermidade?

Antihistamínicos

Antibióticos

Anticonvulsivantes

Opioides (correct)

Cales son as características da vacina Zostavax?

Vacuna de subunidades

Vacuna recombinante

Vacuna viva atenuada (correct)

Vacuna inactivada

Canto tempo hai que esperar entre as dúas doses de Shingrix?

2-6 meses Signup and view all the answers

Que situación require derivación a un oftalmólogo?

Compromiso da rama oftálmica Signup and view all the answers

Cal dos seguintes factores non é un factor predispoñente para a portación de S. aureus?

Baixa temperatura corporal Signup and view all the answers

Que tratamento é apropiado para un paciente con éctima grave?

Hospitalización e ATB por vía ev Signup and view all the answers

Cal é un síntoma característico do ántrax?

Lesións de pus na área afetada Signup and view all the answers

Que tipo de infección é Erisipela?

Infección da dermis e plexo linfático superficial Signup and view all the answers

Que antibiótico non se menciona como tratamento para o ántrax?

Cefalosporina de 1° xeración Signup and view all the answers

Cal é o tratamento máis adecuado para a foliculitis profunda?

Antibióticos orais como flucloxacilina Signup and view all the answers

Cales son os síntomas característicos da foliculitis superficial?

Pápulas ou pústulas de 1-4 mm de diámetro Signup and view all the answers

Cal é a principal causa do forúnculo?

Infección por estafilococo Signup and view all the answers

Cales son os factores predispoñentes a ter foliculitis?

Pele seca e deshidratación Signup and view all the answers

Que tratamento non é apropiado para a foliculitis?

Aplicación de pomadas con corticoides Signup and view all the answers

Quais son as condicións asociadas a flácidas e halo costroso?

Gingivoestomatitis e ectima Signup and view all the answers

Que tipo de herpes está asociado a episodios recurentes?

Herpes labial Signup and view all the answers

Cal é a forma ulcera do herpes que pode xurdir após unha infección?

Post herpética Signup and view all the answers

Cal das seguintes condicións non está mencionada como neoplásica?

Herpes labial Signup and view all the answers

Que tipo de dor se relaciona frecuentemente co herpes post herpético?

Neuralgia Signup and view all the answers

Que bacterias son responsables do impétigo vulgar?

Estafilococo aureus e estreptococo piógeno Signup and view all the answers

Que manifestacións son características do impétigo ampollar?

Vesículas que se tornan rápidamente en ampollas flácidas Signup and view all the answers

Cales son os antibióticos tópicos recomendados para o tratamento do impétigo vulgar?

Mupirocina e ácido fusídico Signup and view all the answers

Que sinal clínico é característico do síndrome de pele escaldada estafilocócica (SPEE)?

Signo de Nikolsky positivo Signup and view all the answers

Canto tempo normalmente leva a recuperación do impétigo ampollar?

3 a 5 días Signup and view all the answers

Que pacientes son máis propensos a desenvolver impétigo ampollar?

Lactantes e recién nacidos Signup and view all the answers

Que tratamento sistémico é eficaz para alérxicos á penicilina no tratamento do impétigo?

Eritromicina Signup and view all the answers

Que tipo de lesións aparecen primeiro no impétigo vulgar?

Mácula eritematosa que evoluciona a vesícula Signup and view all the answers

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.