Herpes Zoster e Impetigo Vulgar

Herpes Zoster (Shingles)

• Risk Factors:

  • Age (50% over 60 years old)
  • Female sex
  • Prodromal pain
  • Severe pain
  • Severe, disseminated rash

• Treatment:

  • General: Loose cotton clothing, maintain social activities
  • Tricyclic antidepressants
  • Gabapentin/Pregabalin
  • Opioids
  • Lidocaine 5% patches
  • Referral to pain specialists

• Prevention and Referral:

  • Zostavax Vaccine: Live attenuated virus, more concentrated than varicela vaccine
  • Shingrix Vaccine: Recombinant zoster virus
    • No longer in use
    • Can be given to immunosuppressed individuals
  • Referral necessary for:
    • Patients over 500 years old
    • More than 1 dermatome
    • Hemorrhagic or necrotic lesions
    • Involvement of the ophthalmic branch (refer to ophthalmologist, leave ointment)
    • Disseminated lesions
    • Immunocompromised patients

Impetigo Vulgar

• Caused by: Staphylococcus aureus and Streptococcus pyogenes
• Commonly seen in: Exposed areas (face), periorificial (around the mouth and nose)
• Stages:
  • Erythematous macula (red spot)
  • Vesicle (small fluid filled blister)
  • Pustule (pimple with pus)
  • Erosion (loss of surface tissue)
• Characteristics: Superficial, covered with a yellowish crust (honey-like)
• Differential Diagnosis: Herpes simplex, eczema, insect bites, varicella (chickenpox)

Treatment for Impetigo Vulgar

• Local care: Cleansing and crust removal
• Topical Antibiotics:
  • Mupirocin 2% 3 times a day
  • Fusidic acid 2% twice a day for 1 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
  • Penicillin allergy:
    • Erythromycin 30-50 mg/kg/day divided every 6 hours
    • Azithromycin 10 mg/kg/day for 5 days

Impetigo Bullosa (Bulla)

• More common in: Skin folds. Frequent in young children.

• Caused by: Staphylococcus aureus

• Commonly seen in: Face and body. Seen in infants and newborns, especially in diaper areas.

• Characteristics:

  • Vesicles rapidly change into flaccid, transparent blisters (bullae).
  • Blisters have sharp margins with no erythematous halo.
  • Blisters are surrounded by scales.
  • Blisters rupture easily, leaving a dry, shiny erosion, covered with a thin crust.
  • Heals faster than Impetigo Vulgar.

• Complications: If epidermolytic toxin spreads hematogenously, it can lead to Staphylococcal Scalded Skin Syndrome (SSSS), a generalized form of bullous impetigo.

SSSS (Staphylococcal Scalded Skin Syndrome)

• Signs and Symptoms:
  • General malaise: Sudden onset, irritability, and fever
  • Macular erythema: Begins on the face (periorificial) and in skin folds
  • Sensitive skin
  • Generalized rash
  • Nikolsky Sign (positive): Skin peels off with gentle friction
  • Wrinkled skin
  • 24-48 hours: Flaccid blisters appear, detach, and leave large erosive areas.
  • Erosive areas become moist, then dry and form a thin crust.
  • Desquamation (shedding skin) occurs in 3-5 days, involving hands, feet, and perineum.
  • Perioral crusts and fissures: Indicates keratinocyte necrosis.

SSSS Treatment

• Eradicate infectious focus:
  • Intravenous antibiotics (Cloxacillin, Vancomycin if MRSA)
  • Skin and fluid electrolyte management
  • Diagnose and manage carriers (Mupirocin nasal ointment)

SSSS Differential Diagnosis

• Scarlet fever
• Kawasaki disease
• Staphylococcal toxic shock syndrome
• TEN: Toxic Epidermal Necrolysis (caused by medications)

Folliculitis

• Superficial Folliculitis:

  • Location: Distal portion of the hair follicle.
  • Appearance: Papules or pustules (1-4 mm diameter)on an erythematous base.
  • Symptoms: Pruritis (itchiness)

• Deep Folliculitis:

  • Location: Extends to surrounding tissue
  • Appearance: Erythematous, sensitive papules, larger in size with central pustules
  • Possible complications: Can progress to furuncle (boil)

Folliculitis Differential Diagnosis

• Treatment:
  • Address 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: Occurs in any area.
• Furuncle: Involves the hair follicle.
• Anthrax: Multiple furuncles.

Furuncle

• Commonly seen in: Adolescents and young adults.
• Caused by: S. aureus. Anaerobic bacteria can be present in the groin.
• Most commonly affected areas: Areas of friction (face, neck (nape), axillae, buttocks, thighs, and perineum)
• Predisposing factors: S. aureus carriage, diabetes, obesity, immunosuppression, tight clothing, hyperhidrosis, poor hygiene.

Anthrax

• Involves: Subcutaneous tissue.
• Appearance: Firm swelling with multiple drainage points on the surface.
• Commonly seen in: The nape, back, and thighs.
• Signs and Symptoms: Cervical lymphadenopathy (swollen lymph nodes in the neck), pain.
• Complications: Scarring.
• Increased risk in: Diabetes.

Furuncle/Anthrax Treatment

• Local heat and drainage.
• Systemic antibiotics:
  • Cloxacillin or Flucloxacillin
  • First-generation cephalosporin
  • Amoxicillin-clavulanate
  • Penicillin allergy: Macrolides/Clindamycin

Ecthyma

• Ulcerative form of non-bullous impetigo.
• Involves: Epidermis and dermis.
• Commonly seen in: Lower extremities (dorsum of feet and anterior legs)
• Characteristic: Few lesions.
• Treatment:
  • Localized:
    • Macrolides or Clindamycin
  • Severe or Facial: Hospitalization and intravenous 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
    • After 72 hours of good response: Cefadroxil 1 g every 12 hours (orally)
    • Penicillin allergy: Lincomycin intravenously, then orally
  • Chronic Ulcers:
    • Cover anaerobic and gram-negative bacteria
    • Metronidazole + Ciprofloxacin
  • Recurrences:
    • Benzathine penicillin 1.2 million units monthly for 6 months
    • Erythromycin 250 mg every 12 hours for 3 months.

Erysipelas

• Infections of the dermis and superficial lymphatic plexus.
• Superficial to Cellulitis.
• Caused by: Streptococcus pyogenes (beta-hemolytic group A), less frequently by S. aureus, S. pneumoniae, and H. influenzae.
• Clinical Presentation:
  • Acute onset: Fever, chills, and cervical lymphadenopathy.
  • Appearance: Erythematous, shiny, edematous, hot, and tender plaque that spreads rapidly.
  • "Orange-peel skin".
  • Edges: Well defined and palpable (unlike cellulitis, which has diffuse, non-palpable edges).
  • May have vesicles, blisters, bullae, pustules, or superficial purpuric lesions.

Erysipelas Treatment

• Systemic antibiotics for 10 days:
  • Flucloxacillin or Cefadroxil
  • Penicillin allergy: Macrolides or Clindamycin
• Severe or Facial: Hospitalization and intravenous antibiotics
  • Penicillin sodium 2-4 million units every 6 hours
  • No response after 48 hours: Add Cloxacillin
  • First-generation cephalosporin 1-2 g every 8 hours
  • Favorable response after 72 hours: Cefadroxil 1 g every 12 hours orally

Este cuestionario trata sobre factores de risco, tratamento e prevención do Herpes Zoster (cobreiro) e Impetigo vulgar. Aprenderás sobre as vacinas, síntomas e recomendacións de referencia para pacientes. É unha oportunidade para revisar o teu coñecemento sobre estas condicións médicas.