VL Dermatologie PDF

## VL Dermatologie ### 1 Einführung - Haut - Largest organ in the human body (~2m²) - Functions: outer boundary of environment, body temperature regulation, fluid balance, sense of touch, cosmetic image, physical/emotional state, heat and cold sensation, vitamin production, excretion, protection against micro-organisms, radiation, and mechanical impact, odor carrier... - Patient examination - General condition, nutritional status, constitution, vigilance - Inspection of skin, skin appendages, and mucous membranes - Basic tool: structure of the skin, definitions and meanings, morphology and its description - More complex evaluation: use of diagnostics ### Effloreszenzen - **Primary Effloreszenzen** (on primary intact skin)! - **Macula**: visible, but not palpable - **Papula**: palpable, visible - If > 10 mm: **Nodus/Nodulus**: node - **Urtica**: wheal: edema in the upper skin layers - If confluent: **Plaque** - **Vesicula**: vesicle: fluid-filled cavity within - If > 5 mm: **Bulla**: bulla - If with pus: **Pustel**: pustule - **Secondary Effloreszenzen** (on primary damaged skin)! - **Squama**: scale: deposits of detachable horny cell complexes; coarse or finely lamellar - **Kruste**: dried secretion, usually on erosions - With leukocyte inflammation: yellowish discoloration (purulent crust formation) - usually bacterial - With deeper substance defects involving vessel wall damage: brownish discoloration (hemorrhagic crust formation) - **Erosion**: substance defect, may include some or all layers of the epidermis - Special form: mechanically induced "excoriation" (e.g. abrasion, scratching effects) - **Ulcus**: substance defect that also affects deeper layers of skin (→ poorer healing tendency) - **Rhagade**: painful fissure (like "desert floor" / "knife stab"), reaching into the dermis; almost always on dry skin - On semi-mucous membranes and mucous membranes: "fissure" - **Cicatrix**: scar: defect healing, with atrophy (e.g., acne scars: inward) or hypertrophy (outward growing) ### Parasites - **Leishmaniasis** (syn. Baghdad, Delhi, Aleppo, or Oriental sore) - Pathogen: _Leishmania spp._ (most common: _L. infantum_) - example for protozoan infection - Vectors: sandflies (NB: always stay close to the ground → hotel rooms from the 2nd floor!) Reservoir: rodents - Annually approx. 1 million new cases worldwide, > 2/3 in 6 countries (Afghanistan, Algeria, Brazil, Colombia, Iran, Syria) - Clinic is determined by _L._ subspecies and immune defense - Cutaneous / mucocutaneous / disseminated cutaneous / visceral leishmaniasis (maximal variant) - **Clinic** - Onset: 1 week / 1 month after sandfly bite; then acute infection - Skin appearance: erythematous papule - livid edge - central ulcer - crust - **Therapy** - Local - Wait and see (CAVE: not on face as scar healing is poor!) - Otherwise: paromomycin ointment 2x daily (very expensive!) - NO longer cryotherapy/heat therapy / intralesional antimonoproparates - Systemic - Antimmonials - Liposomal amphotericin B - .. Fluconazole (200 mg/d over 6 weeks), Miltefosin (2 mg/kg body weight/d for 28 d) ### Epizoonoses - Caused by arthropods - Insects: lice (_Pediculosis_, _Phthiriasis_), bedbugs - Arachnids: mites (_Scabies_), ticks ### Pediculosis, Phthiriasis (Lice) - Types: - Head louse (_Pediculus humanus capitis_), body louse (_Pediculus humanus corporis_), pubic louse (_Phthirus pubis_) - Lice lay 80 - 100 eggs → nits (0.8 mm) - Blood meals every 2-3 h; but can starve for 1 week - **Pediculosis capitis (Head louse)** - Common disease, especially in kindergarten, school; transmission from person to person; lice sit in the hair (_capillitium_ - hairy scalp - **Clinic** - Bites: itchy papules as a reaction to louse saliva - Possibly "louse eczema" on the neck - **Diagnosis**: meticulous search, retroauricular, wet combing - 8 d → after 2 - 3 weeks - **Therapy**: elimination of lice and nits; after 1 day already no risk of transmission - Pyrethroids (neurotoxic to parasites; first resistance) - Silicone derivatives (4% solution; "death by suffocation") - **Procedure**(8-day cycle): - Day 1: Treatment; wet combing - Day 5: Wet combing - Day 8: Treatment; wet combing - Day 13: Wet combing - Day 17: Control combing - **Pediculosis corporis (Body louse)** - Common disease of social marginal groups and in crisis areas; lice sit in worn clothing - **Clinic** - Bites: itchy papules as a reaction to louse saliva - Linear scratch marks ("scratch excoriations"), " _Cutis vagantium_ " = "vagrant skin" - Small scars, hyper- and hypopigmentation - CAUTION: Transmission of Rickettsioses (e.g. typhus fever) - **Phthiriasis pubis (Pubic louse)** - Transmission usually during intercourse, "bed neighbors"; spread through laundry, bedding, etc. - Lice sit in the genitoanal pubic hair, armpit hair, rarely in the scalp, eyebrows, eyelashes, not in the beard - **Clinic** - Milder itching → less scratching - Typical bleeding: _maculae coeruleae_ (blue spots) ### Skabies (Scabies Mites) - Scabies mite = _Sarcoptes scabiei_ var. _hominis_; transmission only from person to person (close contact) - Female mite 0.3 -0.4 mm; egg-laying (approx. 50 eggs) in tunnel-like passages (_stratum corneum_) - Eggs → larvae (after 3-5d) → nymphs → adults - **Clinic** - Itching: 3-6 weeks after first contact (like "allergy"), particularly strong in the warmth - Predominant sites: interdigital folds, edges of hands and feet, nipples, penis - Secondary eczema: papules, scratch marks; secondary bacterial infections (pustules, crusts) - **Diagnosis** - Search for and find the passages / mites, with a light microscope (20-40 times) → dragon-fly pattern (triangle) of the mites - Can be seen - ! Only the detection of mites is conclusive - **Therapy** - MdW = 5% permethrin (synthetic pyrethroid) + ivermectin (weight-adjusted 200 µg/kg body weight) - Apply to the entire body → leave for 8 - 12 h → repeat after 1 week, if necessary, repeat again after 2 weeks - + anti-inflammatory therapy & skin care ### Viruses - **Human papillomaviruses (HPV)** - Infection of epithelial cells in the skin and mucous membranes - > 150 genotypes, 50% of infections are genital - Transmission from person to person; distinction from high-risk HPV - Diseases: genital warts > cervical cancer > head & neck cancer > anal cancer > vaginal and vulvar cancer - Vaccines: capsid protein L1 HPV (6, 11), 16, 18 - **Warts = Verrucae** - Virus-induced benign, regressing hyperplasias - 60% spontaneous regression within the first 2 years - Localizations - Hands: _Verrucae vulgares_ - Feet: _Verrucae plantares_ - Genitals: _Condylomata acuminata_ = genital warts (= venereal warts) - Therapy - Not too aggressive (spontaneous remissions) - Wart beds and tumors removed (CAVE: immunosuppressed patients) - **Human Herpesviruses!!** - 8 human Herpesviruses - 1 = HSV-1 (Herpes simplex virus 1) - 2 = HSV-2 (Herpes simplex virus 2) - 3 = VZV (Varicella-zoster virus) - 4 = EBV (Epstein-Barr virus) - 5 = (h)CMV (human cytomegalovirus) - 8 = KSHV (Kaposi's sarcoma herpesvirus) - Subfamily - α-Herpesviruses: HSV-1, HSV-2, and VZV (HHV-3) - β-Herpesviruses: CMV (HHV-5), HHV-6, and HHV-7 - γ-Herpesviruses: EBV (HHV-4) and KSHV (HHV-8) - Despite immune response, lifelong persistence in the host; reactivation from latency possible - **Herpes simplex viruses (HSV-1, HSV-2)** - Neurotropic and dermatotropic; primary and secondary infections - Nearly 100% prevalence - Variety of clinical presentation; complications up to sepsis and encephalitis - **Gingivostomatitis herpetica = Stomatitis aphthosa** - Most frequent primary HSV infection - Particularly in young children (90% subclinical); droplet infection → incubation period = 2 - 7 d - Virus replication → blisters → viremia → (partial) immunity; healing usually after 10 d - **Clinic** - Acute fever; vesiculo-aphthous oral mucosa - Very painful stomatitis (oral thrush), " _Foetor ex ore_ " - Lymph node swelling - Sometimes parenteral nutrition necessary - Complication: herpes meningoencephalitis - Recurrences: herpes recidivans in loco - **Varicella-zoster virus (VZV)** - **Varicella = Chickenpox ** - Frequent (~500,000/year) - Droplet infection - highly contagious ("carried by the wind") - 1. Viremia → 2 weeks 2. Viremia → Exanthem - **Clinic** - Prodrome with fever, headache - Red maculae → papules → blisters with red halo - Over several days ("Heubner's starry sky") - Typically: scalp, hands and feet - Erosions on oral mucosa - Complications: VZV pneumonia, VZV meningitis - **Diagnosis**: clinical findings (possibly direct immunofluorescence, serology, PCR, histopathology) - **Therapy**: topical drying; rarely inhibition of virus replication (acyclovir) - **Prevention**: live vaccine for children (11 - 15 months); also as PEP - **Zoster = shingles** - Frequent (~25% of all people) - Reactivation of VZV from the sensitive ganglia, particularly in immunosuppressed individuals and in old age (NB: only contagious with close contact) - **Clinic** - Pain - Segmental arrangement along dermatomes: raised erythema → herpes-like blisters → crusts - Consequences: post-herpetic neuralgia, ophthalmological complications with involvement of the _N. nasociliaris_ - **Diagnosis**: clinical features, PCR, histopathology - **Therapy**: always systemic antiviral, topical drying - **Prevention**: active immunization (14x VZV vaccine = "Zostavax"); also as PEP ## 2 Mykologie, bakterielle Dermatosen, Venerologie ### 1 Mykoses - WHO classification - Dermatophytes (Trichophyton, Microsporium, Epidermophyton ) - Yeasts (_Malassezia_, _Candida_) - Molds (Aspergillus, Penicillium ) - Predisposing factors in the host - Diabetes mellitus - Immunodeficiencies, immunosuppressants, antibiotics - Nicotine, alcohol - Heat, humidity #### Dermatophytes - Genera: _Trichophyton_, _Microsporium_, _Epidermophyton_ - Geophilic = earth-loving (_M. gypseum_) - e.g. in gardeners and other occupations who deal a lot with soil - Zoophilic = animal-loving (_M. canis_, _T. verrucosum_) - e.g. guinea pigs (almost 100% from pet shops have a fungus!) - Humans = wrong host → stronger reaction - Anthropophilic = human-loving (_T. rubrum_) - Humans = natural host → clinically less striking (through adaptation) #### Epidemiology - _T. rubrum_: dominant pathogen in Germany - _M. canis_: dominant in Southern Europe (z.B. on cats) - _M. audouinii_: currently re-emerging - _T. tonsurans_: almost the only pathogen of _T. capitis_ in the USA - Mycoses caused by dermatophytes are the most frequent infectious diseases: 50% of 50-year-olds have a fungus in the area of the feet #### Tinea - Pathogen: _Trichophyton_ (especially _rubrum_) - Clinic: scaling, marginal, redness, multiple foci, pustules - _Tinea manum_ / _pedis_: hyperkeratotic type (finely lamellar scaling, typically only on one hand/foot) vs. interdigital type - Other types: _Tinea barbae_, _capitis_, _faciei_, _corporis_... - NB: Tinea corporis can lead to scarring alopecia - Mycological diagnosis - Wet mount - Culture - Conclusive: detection of fungi - Material collection: at the border between healthy and diseased (marginal zone); prior disinfection (not antimycotic!), sufficient material, microscope slide with 10-15% KOH, cover slip - Kimmig-, Sabouraud-2%-Glucose-Agar - Antimicrobial additives: antibiotics, chlorhexidine (so that other skin bacteria do not grow) - Incubation at 25°C for 3 - 6 weeks (some fungi grow very slowly) #### Yeasts - **_Malassezia spp_** - _Malassezia furfur_ = _P. ovale_ - **_Candida spp_** - _Candida albicans_, _C. dublinensis_, _C. glabrata_, _C. tropicalis_ #### Pityriasis versicolor - Pathogen: _Malassezia furfur_ - Commensal pathogen on the scalp - Clinic: small, finely lamellar scaling with reversible pigment changes - Occurrence, e.g. in cooks in thick clothes at the hot stove, with a lot of sweating - Not contagious - Microscopy: "spaghetti and meatballs" = hyphae + fruit bodies - Diagnosis: tape strip removal #### Candidosis - _Candida spp._ - Facultative pathogens; > 60 genera - Involvement: skin / mucous membranes vs. systemic involvement - Clinic - Oral candidiasis - think of immunosuppression! - Plaque type (removable) - Angle of mouth type: " _Perlèche_ " - Intertriginous candidiasis: wherever skin rubs against skin, can rub and warmth/humidity prevails (e.g. submammary, inguinal) - Larger erosions + satellite erosions #### Therapy of mycoses - Topical (t) vs. systemic (s) - **Allylamines** - Terbinafine (t/s) - Currently the most commonly used - CAVE: does not work on yeasts! - **Azoles** - Clotrimazole (t), itraconazole (s - broadest spectrum), fluconazole (s) - **Polyenes** - Amphotericin B (t/s), Nystatin (t) - Mainly used against yeast infections - **Benzofuran derivative** - Griseofulvin (s) - Only effective against dermatophytes ## 2 Bacterial Dermatoses ### Erysipelas (cellulitis) - Mostly _Streptococcus_ - Only effective against dermatophytes - Entry point often interdigital (tinea pedis); therefore, the occurrence is usually always unilateral - In the initial stage: decreased AZ, fever, chills - Redness, warmth, asymmetrical "flame-shaped" swelling, lymphadenitis, lymphangitis - Recurrences with lymphatic obstruction → complication = elephantiasis; also sinus vein thrombosis - Diagnosis: leukocyte, ESR and CRP elevation; ASL and α-DNAse antibodies; Differential blood count, temperature; not biopsy - Therapy: penicillin i.v. (3x 5-10 million IU short infusion), if no response cephalosporins of the 1st & 2nd generation ### _S. aureus_ - 80% resistant to penicillin → systemic therapy (β-Lactamase-resistant penicillins, macrolides or cephalosporins of the 1st & 2nd generation) #### a. Impetigo contagiosa - Mixed infection, _S. aureus_ > _S. pyogenes_ - Mostly affects young children - RF: impaired skin barrier (injury, atopic dermatitis), poor hygiene - Honey-colored crusts; spread through scratching - Therapy - Systemic antibiotics - Topical treatment: if nasal colonization + topical therapy - Thorough hygiene, washing of clothes and bedding at 60°C #### b. Follicular staphylococcal pyoderma - Infection of individual or multiple hair follicles - _Folliculitis_ (pustule only in the hair follicle outlet) → _furuncle_ (entire hair follicle) → _carbuncle_ (multiple hair follicles) - Occurrences: worldwide, frequently in tropical and subtropical regions - RF: poor hygiene, occlusion, microtrauma, diabetes mellitus, atopic dermatitis #### c. Staphylococcal Lyell-Syndrome - Production of exfoliative toxins - Serine proteases: cleavage of desmoglein 1 - Loss of desmosomal adhesion of keratinocytes - → detachment of skin layers (optically similar to scalding) - Therapy - Topical antiseptics, fusidic acid-containing external applications - Systemic β-Lactamase-stable antibiotics - In widespread lesions: treatment like burn victims - ! No glucocorticosteroids (would promote bacterial growth ) ### Borreliosis - Stadieneinteilung!! - 1. Early localized: Erythema migrans, lymphadenosis cutis benigna - 2. Early disseminated: Erythemata migrans, possibly neurological symptoms, carditis, arthritis - 3. Late stage: Acrodermatitis chronica atrophicans, arthritis, CNS involvement - Therapy - Early localized or disseminated, without neurological symptoms - Doxycycline 2 x 100 mg/20 days = MDW - Amoxicillin 3 x 1000 mg/20 days in children < 9 years - Cefuroxime axetil 3 x 500 mg/20 days - Early disseminated, neurological symptoms - Ceftriaxone i.v. 1 x 2 g/20 days - Late stage - Doxycycline 2 x 100 mg/28 days without neurological symptoms - Ceftriaxone i.v. 1 x 2 g/20 days with neuroborreliosis ### Venerology - Venereal diseases = STD (sexually transmitted diseases) = Sexually transmitted infections - Anonymous reporting only for HIV and syphilis (exception: gonorrhea in Saxony) #### a. HIV - Epidemiology (more detailed below) - 2015: 3900 new infections; 1200 diagnoses not until severe illness; 110 cases i.v. drugs; 460 deaths from HIV-related diseases - Highest incidence: Hamburg, Berlin, Bremen - 84,700 people HIV+ in Germany, of whom 60,700 with HIV therapy; estimated 12,600 HIV+ do not know about their status - #### b. Syphilis = Lues - Epidemiology - Increasing incidence (about 3000 cases / year between 2005-2010, but already 7000 cases in 2015) - Incidence in men 16 times higher than in women (94% of diagnoses); 85% MSM - Highest incidence: Berlin, Hamburg, Munich, Frankfurt - Syphilis connata in Germany only very rarely - Lues acquista - Classification based on time of infection - usually correlation with stages - Early syphilis < 1 year after infection, Late syphilis > 1 year or unknown - NB: Neurosyphilis refers to any neurological manifestation of syphilis (especially severe, but not exclusively, in stage IV) - **Lues I** - **Primary lesion:** hard chancre = _**_ _ulcus durum_ **_in the area of the entry port - Genital (painless) or oral (painful or painless - then always syphilis; DD _ulcus molle_) - Clean (not fibrinous) - Possibly unilateral lymph node swelling - Systemic dissemination → various clinical manifestations ( "monkey of skin diseases") - **Early syphilis** - **Lues II** - Flu-like symptoms (headache, fever, generalized lymph node swelling) - Polymorphic exanthem (macular, then papular), often on the palms and soles - _Condylomata lata_ = moist, broad-based, erosive, papules (highly contagious) - Mucosal plaques (if mucous membranes are involved) - _Angina specifica_ : purulent tonsillitis - _Alopecia areolaris_ (non-scarring hair loss) - **Late syphilis** - Early or late latency: months, years or lifelong dormant phase - Lesions: diffuse, chronic, due to excessive immune reaction of the body - _Gummae_: firm, elastic, nodular swellings of the skin with a "gum-like" consistency - Granulomatous or tuberous-pigmented ("venereal rosary") - Cardiovascular: (aortic) aneurysm, _mesoortitis luetica_ (damage to the aortic wall) - Sometimes lifelong but can also heal completely - CNS (no longer contagious) - _Tabes dorsalis_ (demyelination of the posterior columns), _opticus atrophy_, progressive paralysis - **Lues III** - **Primary lesion:** granulomatous - **II: maculopapular exanthem** - **III:** - **Diagnosis of _Treponema pallidum_ ** - Detection of motile spirochetes in dark-field microscopy - Detection of treponemal DNA by PCR - Serological diagnosis!! - Screening test - Confirmatory test - Assessment of the need for treatment - Treatment monitoring - TPPA/TPHA test (AB against AG of _T. pallidum_), rapid plasma reagin (RPR) test - FTA-Abs test (immunofluorescence) or _Treponema_ Western blot (WB) - IgM ELISA (therapy only if positive) or WB, 19S-IgM-FTA-Abs test - VDRL test with titration (not specific), IgM ELISA (possibly false-positive) - **Congenital syphilis** - Transmission of _T. pallidum_ after placental development (4th-5th month) in cases of active syphilis in the mother - Rare due to routine screening in early pregnancy (TPPA) and medication-based prevention - Possible consequences for the child - Stillbirth - Symptoms of Lues II at birth (e.g. macular exanthem) - No symptoms at birth, but seropositivity as an adult (_Lues connata tarda_) - _Hutchinson triad_: barrel-shaped incisors, saddle nose, keratitis parenchymatosa - Therapy: |Stage | Therapy | Duration, Dosage | Alternatives | |---|---|---|---| | Early syphilis | Benzathin penicillin i.m | 1x on day 1 (2.4 million IU) (in HIV depending on CSF findings) | Ceftriaxone i.v. (2g) Doxycycline p.o. (200 mg) Azithromycin p.o. (single 2 g administration) Ceftriaxone i.v. (2g) | | Late syphilis | Benzathin penicillin i.m. | 3x on day 1+8+15 (2.4 million IU)| | | Neurosyphilis| Penicillin G i.v. | 6x, 21 days long (5 million IU) | Ceftriaxone i.v. (2g)| | | | **CAVE: Jarisch-Herxheimer reaction** 2-6 h after penicillin administration: release of endotoxins and cytokines (e.g. TNF-α, IL-6) Fever up to 40°C; flu-like symptoms Danger in older patients with granulomatous changes in late stages: intracranial pressure, aortic rupture Prevention: prednisolone 1 mg/kg body weight 30-60 minutes before therapy onset| | | | | | **c. Ulcus molle** Pathogen: _Hämophilus ducreyi_ Very painful (DD: _ulcus durum_) Occurrence: mainly tropics, subtropics | | | | | | | **Therapy** MdW: Ceftriaxone 250 mg i.m. Alternatively: azithromycin 1g p.o. single dose, ciprofloxacin, erythromycin Resistance: penicillin, tetracycline, sulfamethoxazole, co-trimoxazole, erythromycin | | | | | | **d. Gonorrhoea** Pathogen: _Neisseria gonorrhoeae_ Notifiable only in Saxony; sharply increasing trend 91% of isolates from men | | | | | | | **Epidemiology** | | | | | | | **Clinic** _Bonjour-Tropfen_: purulent discharge, esp. in the morning Possibly urethritis, cervicitis, pharyngitis, proctitis, arthritis + many other manifestations In women → possibly sterility! DD in monoarthritis: Borreliosis, psoriasis, gonorrhoea | | | | | | | **Diagnosis** Swabs from the affected organ (urethral, endocervical, oral, anal) Smear: intracellular and extracellular gram-negative diplococci (= Neisseria) Culture: Thayer-Martin medium Antigen detection, DNA detection with PCR/LCR | | | | |* | | **Therapy** Ceftriaxone (1 g i.v.) + azithromycin (1.5 g p.o.) - almost no resistance; partner treatment +! cultural analysis Resistance (2015 in Germany: 2.2%) especially against ciprofloxacin NB: Listerine may also help Control after 2 weeks | | | | #### e. Chlamydias (seminar) - Pathogen: _Chlamydia trachomatis_ - Epidemiology - (Second-) most frequent STD, high prevalence, 1-3 weeks incubation period, duration of contagiousness unclear - Different serotypes: - A-C - Trachoma ("eye") / D-K - ocular genital infections / L1-L3 - _lymphogranuloma venerum_ #### Urethritis (D-K) - Clinic - Urethritis, cervicitis, conjunctivitis - Symptoms (females): often asymptomatic; otherwise vaginal discharge, dysuria, intermenstrual bleeding, post-coital bleeding - Therapy - Doxycycline (2x 100 mg/d, over 7 d) or azithromycin (1x 1g) - Alternatives: other macrolides, fluoroquinolones - Caution: management - no intercourse until completion of treatment (or at least after 7 d) - DD: Urethritis (= dysuria + at least 4 WBCs / BF 1000 in the urethral smear) - _Chlamydia trachomatis_: abundant leukocytes, no bacteria (as obligate intracellular) - _N. gonorrhoeae_: intracellular diplococci #### Lymphogranuloma venerum (L1-L3) - Clinic - Inflammation in the genital area with swollen lymph nodes - Untreated: progression to genitoanorectal syndrome (chronic-abscessing, fistulating inflammations with strictures) - Therapy - Doxycycline (2 x 100 mg/d, over 21 d) or azithromycin (1x 1g) or other - Symptomatically: bed rest, cooling, NSAIDs... #### f. Mycoplasmas (seminar) - Pathogen - _M. pneumoniae_: atypical pneumonia - _Mycoplasma hominis_: urogenital colonization: cervicitis, endometritis - _Ureaplasma urealyticum_: urogenital colonization: urethritis, prostatitis (?) - _Mycoplasma genitalium_: urethritis, cervicitis - Therapy (similar to chlamydia) - Doxycycline (2 x 100 mg/d, over 7 d) or azithromycin (1x 1g) - Alternatives: other macrolide, fluoroquinolones ### Summary: Therapies !! |Illness| Pathogen| Therapy | |---|---|---| | Erysipel|A-Streptococci|penicillin i.v., if no response cephalosporins of the 1st & 2nd generation| | Impetigo contagiosa|S. aureus > S. pyogenes|systemic antibiotics, possibly topical treatment in case of nasal colonization| | Staphylococcal Lyell-Syndrome |S. aureus|systemic β-Lactamase-stable antibiotics (cephalosporins of the 1st generation, otherwise clindamycin or macrolides; for MRSA vancomycin)| | Syphilis| T. pallidum| Early localized, no neurological symptoms: Doxycycline 2x 100 mg/20 days Early disseminated, neurological symptoms: Ceftriaxone i.v. 1x 2 g/20 days Late stage: Doxycycline (without neurological) or ceftriaxone (with neurological) | | Borreliosis|Borrelia| Early syphilis: Benzathin-penicillin i.m. 1x (on day 1) (alternative: Doxy or Ceft) Late syphilis: Benzathin-penicillin i.m. 3x (on day 1 + 8 + 15) (alternative: Ceftriaxone i.v.) Neurosyphilis: Penicillin G i.v. for 21 days (alternative: Ceftriaxone i.v.) | | Ulcus molle| Hämophilus ducreyi |Ceftriaxone 250 mg i.m. | | Gonorrhoea |Neisseria gonorrhoeae|Ceftriaxone (1 g i.v.) + Azithromycin (1.5 g p.o.); NB: Listerine helpful ! Partner treatment Resistance (2015 in Germany: 2.2%) especially against ciprofloxacin | | Chlamydias|Chlamydia trachomatis|Doxycycline (2 x 100 mg/d, over 7 d) or azithromycin (1x 1g) | | Mycoplasmas|Mycoplasmas|Doxycycline (2 x 100 mg/d, over 7 d) or azithromycin (1x 1g) |

VL Dermatologie PDF

Document Details

Tags

Related

Summary

Full Transcript

Upgrade to continue