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Questions and Answers

Which color fluorescence is observed during a Wood's light examination in certain dermatological conditions?

Blue fluorescence

Yellow fluorescence

Green fluorescence

Coral red fluorescence (correct)

What is a primary treatment method for acute paronychia?

UV light therapy

Oral antihistamines

Topical corticosteroids

Drainage of pus (correct)

What predisposing factor is NOT associated with angular cheilitis?

Ill-fitting dentures

Increased physical activity (correct)

Excessive salivation

Old age

Which systemic treatment is recommended for widespread or recalcitrant lesions?

Systemic erythromycin Signup and view all the answers

In chronic paronychia, which group is most commonly affected?

Adult women in caregiving occupations Signup and view all the answers

What is the most common form of impetigo?

Ordinary impetigo contagiosum Signup and view all the answers

Which of the following organisms is NOT a causative agent of impetigo?

E. coli Signup and view all the answers

Where is ordinary impetigo most commonly located on the body?

Around the mouth and nose Signup and view all the answers

What is a hallmark characteristic of the crusts formed in impetigo?

Yellowish-brown, honey-colored crusts Signup and view all the answers

What is the most serious complication associated with post-streptococcal infections following impetigo?

Post-streptococcal glomerulonephritis Signup and view all the answers

How is the diagnosis of impetigo primarily established?

Based on clinical presentation Signup and view all the answers

Which group is most commonly affected by bullous impetigo?

Neonates and infants Signup and view all the answers

What typically occurs to the roof of the bulla in bullous impetigo?

It collapses rather than ruptures. Signup and view all the answers

What is the primary local treatment method for pediculosis and scabies?

Gentle removal of crust using olive oil Signup and view all the answers

Which of the following is NOT a systemic antibiotic indicated for widespread lesions?

Fusidic acid Signup and view all the answers

What is the initial lesion of ecthyma characterized by?

A vesicle with an erythematous base and halo Signup and view all the answers

Which group of patients is most commonly affected by ecthyma?

Immunocompromised patients Signup and view all the answers

What is the common complication associated with ecthyma?

Cellulitis Signup and view all the answers

The chronic form of folliculitis known as sycosis barbae primarily occurs in which area?

Beard area Signup and view all the answers

What is the healing characteristic of the initial lesion in acute superficial folliculitis?

Heals without scarring Signup and view all the answers

Which clinical feature is indicative of ecthyma after crust removal?

Saucer-shaped ulcer Signup and view all the answers

What is the characteristic progression of lesions in a carbuncle?

Hard nodules that become pustular and necrotic Signup and view all the answers

Which treatment is recommended for managing systemic infections associated with abscesses?

Systemic antibiotics Signup and view all the answers

What is a common site for carbuncle lesions?

Back of the neck Signup and view all the answers

Which group of individuals is most susceptible to developing carbuncles?

Diabetics and immunocompromised individuals Signup and view all the answers

What distinguishes pseudofolliculitis from other forms of folliculitis?

It involves ingrown hairs due to shaving. Signup and view all the answers

What is the primary form of treatment for sycosis barbae?

Topical antiseptics and antibiotics Signup and view all the answers

What is the initial characteristic of acne keloidalis?

Firm dome-shaped follicular papules Signup and view all the answers

Which diagnostic method can confirm a case of tinea barbae?

KOH test and fungal culture Signup and view all the answers

What is the primary cause of erysipelas?

Haemolytic Streptococci Signup and view all the answers

What is the typical clinical presentation of cellulitis?

Ill-defined, indurated, red, tender hot area Signup and view all the answers

Which of the following is a complication of recurrent erysipelas?

Lymphoedema Signup and view all the answers

Which antibiotic is considered the drug of choice for treating erysipelas?

Penicillin Signup and view all the answers

What is a characteristic feature of erythrasma?

Well-defined reddish-brown patches Signup and view all the answers

What is a common site for cellulitis to occur?

Leg Signup and view all the answers

What is a common treatment for bacterial intertrigo?

Frequent washing with antiseptic lotion Signup and view all the answers

Which of these is NOT a cause of intertrigo?

Loneliness Signup and view all the answers

Study Notes

Pyogenic Skin Diseases

Caused mainly by Staph.aureus and Strept.Pyogenes
Can be primary cause of skin diseases ("primary pyoderma")
Can cause secondary infection of other skin diseases ("secondary pyoderma")

Impetigo

Most common bacterial infection of the skin
More common in children 5-10 years old, especially in summer
Commonest form is "ordinary impetigo contagiosum" (70%)
Usually caused by Staphylococcus aureus and/or Group A beta-hemolytic Streptococci
Often located on the face, especially around the mouth and nose, as well as extremities
Frequently occurs on the scalp, complicating pediculosis (head lice)

Impetigo Clinical Picture

Initial lesion is a thin-walled vesicle on an erythematous (reddened) base
Vesicles rupture quickly, leaving yellowish-brown, honey-colored crusts
Crusts dry and separate, leaving erythema that fades without scarring
May leave temporary hypo- or hyperpigmentation
Regional lymphadenopathy is common (swollen lymph nodes)

Bullous Impetigo

Acute blistering infection caused by Staph aureus
Affects mainly neonates and infants
Most common affected site is the trunk
Can spread and become generalized

Bullous Impetigo Clinical Picture

Initial lesion is a small flaccid bulla with a faint rim of surrounding erythema
Bulla contains yellow turbid fluid
Roof of the bulla collapses rather than ruptures, retaining fluid
Fluid desiccates, forming a thin flat crust
Central healing and peripheral extension may form a circinate (ring-shaped) lesion
Regional lymph nodes are usually not enlarged

Diagnosing Impetigo

Primarily based on clinical presentation
Gram stain and cultures are needed to identify the specific bacterial pathogen
Sensitivity testing determines appropriate antibiotic

Impetigo Complications

Spread of infection to other sites or individuals
Post-streptococcal glomerulonephritis (most serious complication) occurs 2-3 weeks after acute infection

Treating Impetigo

Treatment of predisposing factors, like pediculosis and scabies
Local Treatment:
- Gentle removal of crusts using olive oil
- Antiseptic solutions like potassium permanganate 1/8000
- Topical antibiotics like fusidic acid cream in localized lesions
Systemic Treatment:
- Broad-spectrum antibiotics in widespread lesions (5-7 days)
- Beta-lactamase resistant antibiotics like amoxicillin/clavulonate, ampicillin/cloxacillin, cephalexin, or azithromycin

Ecthyma (Ulcerative Impetigo)

Deeper form of pyogenic skin infection that heals by scar formation
Mainly caused by streptococci (less by staphylococci)
Most common site is the lower extremities (shin of tibia)

Ecthyma Clinical Picture

Mainly affects children, neglected elderly, lymphedematous patients, and immunocompromised individuals
Initial lesion is a vesicle with an erythematous base and surrounding halo
Lesion enlarges to 0.5-3 cm in size and ruptures, leaving a dark adherent crust
Crust is surrounded by a rim of erythematous indurated (hardened) area
Removal of the crust reveals a saucer (dish) shaped ulcer with a raised, indurated, violaceous (purple) margin
Base extends deeply into the dermis
Heals with scar formation
Local lymphadenopathy may be present

Ecthyma Complications

Cellulitis and osteomyelitis occur infrequently
Rarely systemic symptoms and bacteremia

Treating Ecthyma

Treatment of predisposing factors
Appropriate antibacterial therapy (similar to impetigo but for 10-14 days)

Folliculitis

Infection of the pilosebaceous apparatus (hair follicles) mostly by staphylococci

Classifications of Folliculitis

1. Acute Folliculitis:
- I. Acute superficial folliculitis (Bockhart’s impetigo):
  - Found on scalp and extremities, also seen on face
  - Occurs at any age, more frequent at school age
  - Initial lesion is a thin-walled yellowish-white domed pustule at the follicular orifices, pierced by a hair
  - Heals without scarring
- II. Acute deep folliculitis (Furunculosis or boils):
  - Found on face, neck, axilla, and buttocks
  - Occurs at any age
  - Affects deeper parts of hair follicles, leading to central suppuration (pus formation) and formation of the core
  - Initial lesions are single or multiple hard, tender nodules that enlarge and become painful, then pustular and necrotic
  - Healing after discharge of the necrotic core may be complicated by scarring and post-inflammatory hyperpigmentation
- III. Carbuncle:
  - Most common sites are back of neck, shoulders, buttocks, and thighs
  - Adults, mainly diabetics and immunocompromised individuals are susceptible
  - Initial lesion is an indurated, tender circumscribed area with deep staphylococcal infection of a group of adjacent follicles
  - Subsequent perforation of the hair follicles leads to local spread of infection
  - Mass necrosis of the infected tissue with expulsion of necrotic material to the outside through multiple openings
2. Subacute & Chronic Folliculitis:
- I. Sycosis barbae:
  - Found in beard area, affects adult males
  - Initial lesion is recurrent, discrete inflammatory papules or pustules in the beard area pierced by hairs
  - If neighboring follicles are affected, a plaque studded with pustules may result
- II. Acne keloidalis (folliculitis keloidalis):
  - Most commonly involves the occipital area of the scalp
  - Occurs mostly in adult males
  - Initial lesion is in the form of small pustules, followed by firm, dome-shaped follicular papules
  - Papules slowly enlarge and coalesce, forming keloid-like plaques

Treating Acute Folliculitis

I. Acute Superficial Folliculitis:
- Topical antiseptics
- Topical antibiotics for localized lesions
- Systemic antibiotics for disseminated lesions
II. Acute Deep Folliculitis:
- Warm compresses: may enhance maturation, drainage, and resolution of infection
- Incision and drainage: of fluctuant lesions
- Systemic antibiotics: for large and recurrent lesions, and lesions with surrounding cellulitis
III. Carbuncle:
- Surgical drainage
- Appropriate topical and systemic antibiotics

Treating Subacute & Chronic Folliculitis

I. Sycosis barbae:
- Topical antiseptics like chlorhexidine
- Topical antibiotics
- Systemic antibiotics for resistant cases
II. Acne keloidalis:
- Local or intralesional corticosteroids
- Topical antibiotics like fusidic acid cream for pustular lesions
- Systemic antibiotics are rarely indicated

Pseudofolliculitis

Non-infectious, inflammatory condition (foreign body reaction to hair) caused by ingrowing hairs
Occurs in people who shave, especially men with curled hair
Papules and pustules commonly occur on the anterolateral aspect of the neck or angle of the jaw in men
Affects women who shave, especially in the groin area

Tinea barbae

Fungal infection
Inflammatory papules and pustules on beard area with loosened hair
KOH and culture positive for fungus

Erysipelas

Infection of the dermis with significant lymphatic involvement caused by haemolytic Streptococci
Organism reaches the dermis through a wound or small abrasion
Commonest sites are face and legs

Erysipelas Clinical Picture

Incubation period of 1-5 days
Sudden onset of fever, rigors, and malaise
Eruption follows a few hours to one day later
Skin shows redness, hotness, swelling, and pain
Lesion is a well-demarcated red area
Lesion has an advancing edge, surface may show vesicles, pustules, or bullae

Cellulitis

Acute or subacute inflammation of the deep dermis and subcutaneous tissue
Deeper infection than erysipelas
Occurs most commonly as a complication of a wound or skin lesion
Commonest site is the leg
Ill-defined, indurated, red, tender, hot area of skin appears at the affected site
Systemic symptoms (fever, malaise)

Erysipelas vs. Cellulitis

Erysipelas: Well-demarcated, superficial, lymphatic involvement, sharp advancing edge
Cellulitis: Ill-defined, deeper, subcutaneous involvement, diffuse spread

Erysipelas Complications

Recurrent erysipelas can lead to lymphoedema (swelling due to lymphatic blockage)
Nephritis (inflammation of the kidneys)
Subcutaneous abscess
Septicaemia (rare)

Treating Erysipelas

Rest in bed and antipyretics (fever reducers)
Penicillin is the drug of choice (given for 10-14 days)
Other antibiotics (e.g. Macrolides like azithromycin or erythromycin) may be used if the patient is allergic to penicillin

Intertrigo

Inflammation of skin folds (e.g. behind the ears, under the breasts, axillae, groin)
Common in obese persons

Causes of Intertrigo

Streptococcal intertrigo: Longitudinal painful fissure at the angle of skin folds, skin around is red, moist, and may be crusted
Simple intertrigo due to friction
Contact dermatitis
Flexural psoriasis
Seborrheic dermatitis
Tinea cruris (jock itch)
Candidal intertrigo (yeast infection)
Erythrasma

Treating Bacterial Intertrigo

Frequent washing with antiseptic lotion like potassium permanganate solution 1/8000
Topical antibiotic cream
Systemic antibiotics

Erythrasma

Mild chronic, localized, superficial infection of intertriginous areas
Caused by Corynebacterium minutissimum
Well-defined reddish-brown patches with no active edge, covered with fine scales
May be asymptomatic or associated with mild itching

Diagnosing Erythrasma

Wood's light examination: Coral red fluorescence

Treating Erythrasma

Topical antifungal and topical antibiotic (e.g. erythromycin, clindamycin, fusidic acid, mupirocin)
Systemic erythromycin (for widespread or recalcitrant lesions)

Paronychia

Inflammation of the nail folds
Can be acute or chronic

Acute Paronychia

Common, especially in children
Follows minor trauma
Affected digit is red, swollen, and painful
Compression of the nail fold may drain pus

Chronic Paronychia

Involves nail folds of adult women
Occupational paronychia is common in food handlers and cleaning personnel
Represents a contact reaction to irritants or allergens
Secondary infection by Candida or bacteria is common

Treating Paronychia

Drainage of pus
Systemic and topical antibiotics

Angular Cheilitis (Angular Stomatitis)

Inflammation of the angle of the mouth (perlèche)
Characterized by maceration (softening), erythema, and fissuring of the oral commissures (corners of the mouth)

Predisposing Factors for Angular Cheilitis

Excessive salivation
Ill-fitting dentures
Debilitating diseases and old age

Treating Angular Cheilitis

Correction of predisposing factors
Topical antifungal and/or topical antibiotic cream
Vitamin B-complex

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