ASSISTANT PROFESSOR & CONSULTANT Common skin infection Dr GHADA BIN SAIF ASSISTANT PROFESSOR & CONSULTANT DERMATOLOGIST KSU & KKUH

Bacterial: Impetigo, Erysipelas, Cellulitis, Erythrasma Mycobacterial: TB Viral: Warts, Molluscum contagiosum, H.simplex, H.zoster Fungal: Candida, Dermatophyte inf., Pityriasis versicolor Protozoal: Leishmaniasis

Bacterial

Impetigo Superficial cut. Inf. Staph, gp A strept or both Child, AD

Mx: Remove crust Localized:Topical Abx (bacroban) Severe or Strept (prevent post strept. Glomerulonephritis): Semisynthetic Penicillin : 7-10 d Erythromycine (sensitive) Augmentin (face) 1st generation cephalosporin

Erysipelas Sharply demarcated unilateral, red oedematous. Face Beta hemolytic gp A Strept. Minor abrasion— sup. Lymph vessels +-Leucocytosis & fever

Mx Swab Cold compressor Oral penicillin Erythromycin Augmentin 1st generation cephalosporin

Cellulitis Deeper involvement of the SC Raised, hot, tender, erythematous Strept. Pyogenes, staph.aureus Cut , abrasion or ulcer Palpable, tender LN Fever, leucocytosis

Treat according to culture & patient Strept: Mx Swab +- Bl culture Treat according to culture & patient Strept: Semisynthetic Penicillin Erythromycin Augmentin ( face : H. influenzae)

Erythrasma Corynebacterium minutissimum Red, brown, asymptomatic, flexoral

Mx Swab wood’s lamp: coral-red fluorescence Topical: imidazoles (miconazole) or erythromycin Oral erythromycin X 7 d

Mycobacterial Tuberculosis

Lupus vulgaris Commonest 1ry inf., good natural immunity Heamatogenous spread Apple jelly nodule--scar Tuberculoid granuloma Mx: bx, AFB Local ttt Anti TB

Viral

Wart HPV (DNA) Common wart Hand Child Koebner phenomenon

Plane wart Plantar wart Face , back of hands sole

Genital wart Condylomata accuminata Penile, vulvar skin, mm, perianal area Sexual partner Child---sexual abuse Some: oncogenic:16, 18

Mx : Involute spontaneously Cryotherapy Topical: SA, TCA Electrocautary Laser

Molluscum contagiosum Pox virus Child Face, neck Central punctum Hunderson-patterson bodies Mx: curettage, cryotherapy

Herpes simplex Group of small blister HSV-1- H. labialis HSV-2- genital herpes Herpetic whitlow—(? pyogenic lesion) Eczema herpeticum

Mx: Smear---viral particles Topical Acyclovir (early) :Genital, Recurrent, immune suppressed, neonatal, Ecz.H.

Herpes zoster Chickenpox virus Adult Prodromal pain—dermatomal (blisters)—post-herpetic neuralgia Ramsey-Hunt syndrome : Ophth div. + Geniculate ganglia---Ear pain + blisters Mx: Smear Analgesia, drying agent Acyclovir: immune suppressed, wide spread

Superficial mycosis Deep mycosis Fungal Superficial mycosis Deep mycosis

Candidiasis Candida albican (normal commensal of GIT) Napkin candidosis & Intertrigo (satellite lesions) Paronychia Chronic candidal granuloma MM: Oral Vulvovaginitis-irritation, discharge Systemic Chronic mucocutaneous candidiasis

Mx: Swab Alter moist warm environment Nystatin-containing cream Imidazole (Daktarin, canastein) Oral antifungal (itraconazole): immune suppressed

Dermatophyte infection Skin Hair Nails

Tinea pedis Adult (athlete’s) Toe webs , instep T.rubrum, T.mentagrophytes

Tinea ungum T.rubrum, T.mentagrophytes

Tinea corporis: Trunk Active edge T.rubrum

T.cruris

T.manun

Tinea capitis Well circumscriped pruritic scaling area of hair loss Black dot (T.tonsurans) Gray patch (M.audouinii), Kerion (T.verrucosum) Favus (T.schoenleinii)

Mx: Scraping, hair plug---KOH Education Topical (terbinafine, daktarin) Oral (Griseofulvin, terbinafine, itraconazole): extensive, Hair, nail

Pityriasis versicolor Malassezia furfur (hyphea) Pityrosporum orbiculare (yeast) Trunk Hypopig. (in dark skin) Mx: Wood’s lamp Scraping Topical imidazol (nizoral) Recurrence

Protozoal Leishmaniasis

Transmit: sand fly Painful nodule—ulcer Exposed site

Mx: Leishmanin test, Bx Cryotherapy Pentavalnt antimony local injection Systemic pentavalent antimony

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