Disease

Etiology

Risk Factors

Transmission

Clinical Manifestations DDx Most individuals are seborrheic asymptomatic. Pruritis of dermatitis, scalp, neck, ears. Pyoderma, posterior auricular and cervical lymph node enlargement, 2 bacterial infection and fever. Nits on hair shaft.

Pediculosis Infestation of capitis pediculus humunus capitis louse (head louse). Lice grasp onto the hair follicle and feed on blood from the scalp.

Close quarters, a louse or nit (egg) is schools, Females > transferred from males, Whites > individual to individual blacks, sharing with close contact, brushes, combs, brushes, combs, hats, or hats. other objects that the contaminated individual contacted. Lice do not jump or fly, but crawl very fast. Are viable for 24-36 hours off of a host. Pediculosis infestation of the Poverty, crowding, Sharing clothing with corporis pediculus humunus low personal body lice on it. humunus louse (body hygiene, homeless. losue). Which love on clothing and visit the host's skin to feed on blood.

intense itching especially at night, skin changes around waist, axillary folds, groin (anywhere clothing seams contact skin.) hemorrhagic lesions or wheals from fresh bites, postinflammatory hyperpigmentation, 2 staph infections. itching in pubic area, lower abdomen, upper thighs and buttocks. Maculae cerulae

scabies, atopic dermatitis, pruritis secondary to systemic illness, bedbug bites

Pediculosis Infestation of pubis phthirus pubis louse (crab louse) in the pubic region and on pubic hair. Usually transmitted sexually

teens and young adults, crowded living conditions, homelessness, sharing towels/linens

sexually transmitted, sharing contaminated towels or linens

contact dermatitis, tinea infection, scabies

Scabies

Infestation of the skin by sarcoptes scabiei mite, which burrows under the skin. Sensitization reaction to excretions of the mite

nursing homes, crowding homelessness, winter, multiple sex partners, immunodeficiency

intimate contact (often mother to child, or sexual contact in young adults) , infrequently by contaminate bedding or clothing

intense itch especially at Tinea, Exzema, night, burrows, small Atopic dermatitis, papules with Pediculosis excoriations. Distribution around axilla, waist, pubic region, flexor surfaces or wrists, between the fingers, just proximal to patella, and soles of feet. Could have 2 bacterial infections. Crusts and fissures, see above malodorus lesions, itching minimal or absent Clinical Manifestations DDx well demarkated lesions, oval finely scaly macules, papules or patches, upper chest, back and upper extremities. Various colors can be hyper or hypopigmetned, lesions do not tan, erythematous and mildly pruriticenlarging patch slowly velvety texture. Seborrheic dermatitis, pityriasis rosea, vitiligo, erythrasma, secondary syphilis

* Crusted Scabies*

see above

AIDS, lymphoma, elderly, Downs Syndrome Risk Factors

see above

Disease Tinea Versicolor

Etiology Superficial fungal infection caused by the nondermatophytes Malassezia globosa and M. furfur.

Transmission

Hot and humid not contagious, weather , excessive overgrowth of normal sweating, topical flora skin oils,

Tinea Capitis

Dermophyte infection of the scalp, usually from epidermophyton, trichophyton, or microsporum fungi. The predominate organism infecting the scalp is T. tonsurans which causes black dot, and M. canis which causes gray patch.

around puppies and Cats, dogs, kittens, kittens (Black dot), puppies, sharing hats, cats and dogs (gray combs, brushes patch), African american children

seborrheic on scalp dermatitis, alopecia, Black dot:hairs broken off at the scalp, alopecia, painful lymphadenopathy Gray Patch: hairs break off 1-2 mm forn scalp, short hairs have frosted appearance Boggy pus filled lump with painful enlarged lymph nodes (kerion)

Tinea Corporis

Dermatophyte Diabetes, HIV, infection on the skin, immunosupressed primarially individuals, Tricophyton sp. wrestlers (T.C. Gladitorium)

Skin to skin contact, pruritic, circular or oval contraction from kittens, erythematous annular puppies, lesion, scaling patch or plaque that spreads centrifugally, central clearing, raised border

Granuloma annulare, nummular eczema, cutaneous SLE, psoriasis, pityriasis rosea

Tinea cruris

Dermatophyte infection on the skin, special form of T, corporis, Tricophyton Rubrum

men, activity usually self innoculation involving excessive from T. pedis. sweating, DM, obesity, immunodeficiency

Disease

Etiology

Risk Factors immunodeficiency, activites that cause feet to sweat, chronically wet feet.

Transmission often picked up from floor with wet feet that are not allowed to completely dry.

Erythematous patch high on inner thigh opposite the scrotum, centrifugal spreading with partial central clearing, slightly elivated border, can extend down thigh, pubic region and buttocks, spares scrotum.Manifestations Clinical Well Chronic: pruritic, often in 3rd and 4th interdigital spaces, extension onto soles and top of feet (Mocassin distribution). Acute:intensely pruritic, painful vesicles, lymphangitis. Maceration (wrinkly look of skin when wet for long periods) can also be

Erythrasma, seborrheic dermatitis, candidal interigo

DDx Chronic: foot eczema, plantar psosriasis. Acute:Dyshidrotic eczema, insect bites

Tinea pedis common Dermatophyte infection of the foot most often caused by Trichophyton species often accompanies T. manuum and T. cruris can be acute or chronic

Onychomy Fungal infection of cosis the nail. Toenails are typically infected with dermatophytes (trichophyton rubrum) fingernails are often infected with yeast (candida). Infection can be distal subungual, proximal subungual, white superficial

Diaper dermatitis

Distal subungual: great toe involvement, whitish yellow discoloration of diatal corner of toe, spreading wide and proximally, keratinous debris collect btwn nail and bed. Proximal subungual: starts proximally and extends distally with same nail characteristics. Superficial White: soft, dull white sopts on surface of nail inflammatory skin wearing a diaper friction, wet/dry cycle, Irritant: erythema and eruption that (young or old), wet opportunistic infection of scaling on skin surfaces develops in the diapers on for vaginal/GI normal flora in direct contact with diaper covered extended period, diaper. Candidal: beefy region, primarially an diarrhea, formula red plaques satellite irritant contact fed infants, broad pustules and superficial dermatitis spectrum antibiotics pustuals that involve the skin folds. Allergic: well demarcated erythema, papules with scales, vessicles or erosions, "cowboy holster" pattern to rash Etiology Risk Factors Transmission

immunodeficiency, AIDS (Proximal subungual esp), T. pedis, frequent moisture exposure

exposure of nail to fungus in immunocomprimized individuals and in those with chronically moist hands/ feet

Psoriasis, Eczematous conditions, Trauma, Onychogryphosis

seborrheic dermatitis, atopic dermatitis, impetigo, herpes, psoriasis, scabies

Disease

Clinical Manifestations DDx

cutaneous candida albicans candidiasis opportunistic infection of skin occurs often in skin folds when host defenses, physiology, microenvironment or normal flora become altered.

increased skin friction, increased moisture, immunodeficiency, obesity, clothing that chafes skin.

overgrowth of fungus that is part of the normal flora of Gi tract, vagina, oral cavity.

candida intertrigo: T. Cruris, dermatitis, infectious and erythasma inflammatory condition of two closely opposed skin surfaces. Erythematous, macerated plaques and erosions with peripheral scaling, erythematous satellite papulopustules. Pustules easily ruptured, erythematous base with surrounding collarette epidermis, often painful and pruritic. lesions in genetal area can be present on the scrotum.

Diagnostics Visualization of live lice! Nits on hair shaft within 1/4" of scalp. Visualization under wood's lamp, nits appear pale blue.

Referral Usually none needed, Refer to dermatologist if it does not respond to treatment within 2-3 weeks.

1st line Wet Combing to remove nits, topical pediculoscides: permethrin (1 or 5%), Benzyl Alcohol 5%; oral Ivermectin

2nd line Topical pediculoscides: Malathion lotion 1% (ovide)

Treat contacts? Examine household members, treat if infested. Treat bedmates prophylactically. Vacuum furniture/carpet where person was, high heat wash or dry clean all clothes, bedding, combs, stuffed animals, etc that the individual came in contact with.

visualize lice or nits on usually none needed clothing (usually along Refer to seams) dermatologist if it does not respond to treatment within 2-3 weeks.

bathe thoroughly, heat wash/ dryclean/ discard clothing and bed linens, antihistamine, steroid for intense itching, antibiotic for 2 infection

Malathion lotion 1% (ovide), address socioeconomic factors for poor hygiene

visualize lice or nits in pubic region/ affected area.

Refer to dermatologist if it does not respond to treatment within 2-3 weeks.

Topical pediculocides, Malathion lotion 1% shaving, heat washing (ovide), Ivermectin potentially touched orally items. *Screen for STD's*

Treat sexual partners, no need to treat non-sexual household members without signs of infestation

History and distrubition of lesions, burrows (if visible), adhesive tape test, skin scraping

Refer to dermatologist if continued reinfestation occurs

Permethrin cream 5%: Malathion lotion 1% rub in skin form neck (ovide), Ivermectin to soles of feet, leave orally on 8-14 hrs then shower off, repeat in 12 weeks

treat close contacts prophylactically, hot wash and dryclothing and linens. Unless all infected individuals are treated reinfestation is likely

see above

Refer to dermatology Permethrin cream 5% if treatment is as above AND ineffetive Ivermectin orally Referral 1st line Selenium Sulfide Shampoo 2.5%, or Ketoconazole shampoo 2% applied for 10 minutes and rinsed thoroughly daily for 12 weeks and once weekly thereafter. Keep skin as dry as possible. Oral anitviral: Griseofluvin 500mg microsized daily with a fatty meal x 8-12 weeks. Asymptomatic carriers: Selenium Sulfide 2.5% 3x/week x 4 weeks.

increased oral dose

treat close contacts prophylactically.

Diagnostics

2nd line Ketoconazole oral with sweat inducing excersize after taking, Itraconazole (Sporanox) orally, sun exposure

Prognosis/Complications High rate or recurrence because organism is a human skin colonizer. Pigment changes may persist, recurrences are common.

KOH (Spaghetti and Refer to meatballs), golden dermatologist if Dx yellow color under uncertian or wood's lamp, culture is uncontrollable with non useful treatment.

KOH (Spaghetti and meatballs), culture, M. canis fluoresces bright green under wood's lamp

Refer to dermatologist if Dx uncertian or uncontrollable with treatment.

Oral antiviral: Terbinafine 250mg daily x 2-4 weeks Asymptomatic carriers: oral therapy

reoccurence if treatment not completed. Permanent hairloss if left untreated. side effects of griseofulvin include gastrointestinal distress, headache, and urticaria.

KOH, culture, physical exam findings

Refer to dermatologist if lesion does not respond to treatment within 4 weeks.

topical antifungals: imidazole applied to affected area BID, until resolves and 1 week past resolution. T.C. Gladitorium: oral Griseofluvin 500mg microsized daily with a fatty meal x2 weeks Topical antifungal: imidazole applied to affected area BID, until resolves and 1 week past resolution, talcum powder, avoid tight clothing, treat concomitant T. pedis 1st line Topical antifungals BID x 2-4 weeks, if maceration present burrows solution (1% aluminum acetate dressing) 20min TID Avoid prolonged wet feet, wear shower shoes

oral Griseofluvin 500mg microsized daily with a fatty meal x2 weeks, Oral Terbinafine 250mg daily x 2-4 weeks

KOH, culture

Refer to dermatologist if Dx uncertian or uncontrollable with treatment.

Oral antifungals: One week of either itraconazole, 200 mg daily, or terbinafine, 250 mg daily

athletes should not participate in contact for 2 weeks, or without lesion covered. Complications include extension of infection into hair folicles, pyoderma. Usually responds promptly to conservative topical therapy or to an oral agent within 4 weeks. Usually responds promptly to topical or oral treatment, but recurrence is often experienced.

Diagnostics KOH, history and physical exam

Referral Refer to dermatologist if Dx uncertian or uncontrollable with treatment.

2nd line Oral antifungal: Terbinafine x 2 weeks or Itraconazole x 1-2 weeks

Prognosis/Complications Onychomycosis and T. manuum often accompany T. pedis. Secondary bacterial infections. With treatment will normally clear in a few weeks, recurrence accurs often.

KOH of nail scrapings, Refer to nail culture!!!, physical dermatologist if Dx exam findings uncertian or uncontrollable with treatment.

dont treat unless Hx of cellulitis with ipsilateral toenail involvement, DM with toenail involvement, pain, cosmetic reasons. Protective nail care. Topical treatments usually dont work!!

Terbinafine 250mg daily x 6 weeks (fingernails), 12 weeks (toenails) or Intraconazole for yeast 200mg daily x 6 weeks (fingernails), 12 weeks (toenails).

Long term recurrence of 2050%. Long time to clear completely (weeks to months).

KOH, physical exam

If appropriately treated but recurrent refer to endocrine/immunolo gy for possible immunological workup.

Remove irritant, address aggrevating factors, topical barriers, powders

antifungal ointment if candidal dermatitis

Irritant contact dermatitis can progress into candidal dermatitis if left untreated for more than 3 days. Persistant candidal infections despite appropriate care can indicate immunosuppression, DM

Diagnostics

Referral

1st line

2nd line

Prognosis/Complications

KOH, pattern and distribution of lesions

Refer to dermatologist if Dx uncertian or uncontrollable with treatment.

topical antifungals BID until symptom free, Nystatin will work for candida!! drying agents after course of antifungals, address predisposing factors

Oral antifungals: itraconazole 200 mg twice daily for 14 weeks dependent on location

range from the easily cured to the intractable and prolonged. Secondary infections can occur.