Herpes Zoster e Impetigo Vulgar

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Questions and Answers

Cal é un dos factores de risco principais para a infección por virus zoster?

Idade superior a 60 anos (correct)

Sexo masculino

Idade inferior a 30 anos

Episodios previos de herpes simples

Que tipo de vacina é o Zostavax?

Vacina sintética

Vacina viva atenuada (correct)

Vacina recombinante

Vacina inactivada

Cal é un dos tratamentos recomendados para a dor asociada ao virus zoster?

Antibióticos

Esteroides orais

Antihistamínicos

Antidepresivos tricíclicos (correct)

Cando debería derivarse a un paciente a un oftalmólogo en relación ao virus zoster?

Compromiso da rama oftálmica Signup and view all the answers

Cal é a función dos parches de lidocaína 5% no tratamento do herpes zoster?

Aliviar a dor Signup and view all the answers

Que antibiótico endovenoso é recomendado para o tratamento de MRSA?

Vancomicina Signup and view all the answers

Cal é a principal característica da foliculite profunda?

Pápulas eritematosas sensibles maiores con pústulas no centro Signup and view all the answers

Cales son os antibióticos tópicos recomendados para a foliculite?

mupirocina 2% e ácido fusídico Signup and view all the answers

Que patoloxía non forma parte do diagnóstico diferencial mencionado?

Micosis cutánea Signup and view all the answers

Cal é a principal medida para corrigir a foliculite?

Corrixir factores predispoñentes Signup and view all the answers

Que bacteria é responsable do impetigo vulgar?

Estafilococo aureus Signup and view all the answers

Cal é a localización máis frecuente do impetigo ampollar?

Nos pliegues Signup and view all the answers

Que tipo de lesión cutánea é característico do impetigo vulgar?

Maculas eritematosas Signup and view all the answers

Cal é o tratamento tópico recomendado para o impetigo?

Mupirocina 2% 3 veces ao día Signup and view all the answers

Que sinal clínico indica a presenza do síndrome de pel escaldada estafilocócica (SPEE)?

Signo de Nikolsky positivo Signup and view all the answers

Cal é un dos antibióticos sistémicos indicados para pacientes alérxicos á penicilina?

Eritromicina Signup and view all the answers

Que condición cutánea pode aparecer como consecuencia da difusión da toxina epidermolítica en impetigo ampollar?

Síndrome de pel escaldada estafilocócica Signup and view all the answers

Cal é o tratamento adecuado para o eccema en casos graves?

Cloxacilina ou flucloxacilina Signup and view all the answers

Cal é a característica das ampollas en impetigo ampollar?

Flácidas e transparentes Signup and view all the answers

Que factores predispoñen á infección por S. aureus?

Obesidade Signup and view all the answers

Onde é máis común a localización das infeccións por S. aureus?

Cara e axilas Signup and view all the answers

Que tipo de tratamento é indicado para o ectima asociado a unha úlcera crónica?

Metronidazol combinado con ciprofloxacino Signup and view all the answers

Que carácter ten a lesión na erisipela en comparación coa celulite?

É unha infección superficial da dermis Signup and view all the answers

Que síntomas clínicos son característicos desta infección por estreptococos do grupo A?

Vesículas, ampollas e pústulas Signup and view all the answers

Que tratamento é recomendado para casos graves de infección por estreptococos do grupo A?

Antibióticos endovenosos Signup and view all the answers

Cales son as características da placa eritematosa asociada a esta infección?

Eritematosa, brillante e quente Signup and view all the answers

Que antibiótico pode usarse como alternativa se o paciente é alérxico á penicilina?

Cefadroxilo Signup and view all the answers

Cal é a semellanza entre a erisipela e a celulitis?

Ambas son infeccións cutáneas Signup and view all the answers

Que características distinguen a erisipela da celulitis?

Ten bordes netos e palpábeis Signup and view all the answers

Cal é a duración típica do tratamento antibiótico sistémico para esta infección?

10 días Signup and view all the answers

Cual destes organismos é menos probable que cause infección por estreptococos do grupo A?

Escherichia coli Signup and view all the answers

Study Notes

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

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Description

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.