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47 Cards in this Set

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Scabies is an intensely pruritic, highly contagious (skin-to-skin) skin infection caused by what organism?*
Sarcoptes scabiei var. hominis
What is the characteristic lesion in Scabies?
Burrows!*

tends to be between fingers, on volar side of wrist, or on sides of hands
What do you look for in the microscope for a diagnosis of scabies?*
Mite, eggs, or fecal pellets (scybala)
How do you treat scabies?
*Need to treat the patient AND close physical contacts stops reinfection*

Topicals*
-Permethrin 5% Cream (Elimite, Acticin)
-Once at night, then repeat in 1 week (from neck down)
-Lindane Lotion (Kwell)
-Malathion
-Eurax (for pruritis)

Systemic: for those who fail or cannot tolerate topical therapy.
-Ivermectin (Stromectol) 200 microgm/kg twice (two weeks apart)
How is head lice transmitted?*
Direct: by direct head-to-head contact with infected individuals

Indirect: by contact with infected shared towels, brushes, combs and hats
What are the symptoms/signs of head lice?*
-typically confined to scalp, sometimes back of neck and behind ears
-commonly PRURITUS
-may have lymphadenopathy
-occasionally have HS reaction to saliva (red macules/papules and hives - "pediculid")
What is the typical transmission for "Crabs" (pubic lice)?*
Sexual contact
When is lice suspected?
When a patient presents with itching in a localized area with no apparent rash.
How is the diagnosis of lice made?
Either by careful visual exam or ID nit/egg on microscope
What is the treatment for lice?
 Permethrin (Elimite (Rx)/Nix (OTC)) (was underlined)
 Lindane (Kwell (Rx))
 Pyrethrins (Rid, A200 (OTC)
 Ivermectin (Stromectol (Rx))

*It’s important to treat with medications and then consider mechanical removal as some nits may survive medical treatment.*

• Fomite control*
-Clean bed linens, pillows, towels, clothing and hats
-Vacuum rugs, furniture, mattresses, and car seat
What are the 2 major subgroups of skin fungal infections?
Dermatophytes and yeasts
Which tinea can be a/w a lot of inflammation?
Tinea capitis *kerion* type
Systemic fungal infections are MC in what people?
Immunocompromised
What are the most common pathogens in superficial "tineas" dermatophyte infections?
Trichophyton rubrum and Trichophyton torWhansurans
Where does tinea pedis usually occur?
between 4th and 5th toes* and plantar foot
Tinea pedis is very rare in what age group?
Children under 16 years old
What is the most common risk factor for tinea unguium?
Trauma in an isolated nail
What is the MC presentation of tinea unguium?
Distal subungual (invasion at hyponychium), caused by dermatophyte, nail may appear yellow
What does "two foot one hand disease" mean?
Tinea unguium or tinea manum occuring in fingernails, toenails, and plantar foot. commonly seen in dominant hand used to scratch feet

If there isn't feet involvement, rethink diagnosis.
What is the treatment for tinea unguium? What should be noted about this tx?
Topical is NOT very effective. Use systemic such as terbinafine, which has the highest cure rate. It is given for 3 months, but you won't see new disease-free nail for about 1 year. There is a risk of HEPATOTOXICITY with this drug!

(tinea unguium is difficult to clear up and has high recurrence rate)
How do you distinguish a fungal nail infection from other nail infections?
Use KOH and look for hyphae
With tinea cruris, where should you scrape for the KOH stain?
Scrape at the outer scaly area!
Which is more likely to affect the scrotum/penis -> candida or tinea cruris?
Candida! Tinea cruris usually does NOT
Tinea cruris is more common in (males/females).
Males. rarely seen in females
Which is brighter red -> candida or tinea cruris?
Candida
How does tinea corporis present?
"ringworm" - annular pattern w/ slightly raised, fine scaling along border with central clearing
When is KOH required?
pretty much always do it!
Name for raised, red plaque with perifollucular pustules caused by a deeper dermatophyte infection?
Majocchi's granulomas (tinea profunda)

(a deeper tinea corporis)
How are Majocchi's granulomas (tinea profunda) normally caused?
May occur secondary to topical corticosteroid application; decrease the ability of the immune system to respond to the fungal infection (since they are immunosuppressants)

Patients often use whatever cream they had left over from a previous Rx or something OTC. The danger of self treatment
What is the tx for superficial tinea corporis?
topical antifungals
What is important to do if you find tinea corporis?
Look for dermatophyte infections elsewhere!
What patients are more likely to get tinea capitis?
Kids under 12 (but very rare in infants), and a higher incidence in African Americans
What dermatophyte infection is the result of a "revved up" immune system and appears red and boggy, sometimes with pustules?
Kerion (of tinea capitis)
What is the #1 tx for tinea capitis (other than Kerion)?
Oral griseofulvin

Topical antifungals are of very little value
What is the tx for Kerions?
Prednisone x1-2 weeks
T/F

Even after treatment, the hair lost in tinea capitis is unlikely to grow back.
False!

it will grow back after treatment
Cervical lymphadenopathy is often associated with what dermatophyte infection?
Tinea capitis
Fungal infection in men who shave?
Tinea barbae
Common in people who do "wet work"
Paronychia candida albicans infection
What is a + bolster sign and what is it seen in?
a bump at proximal nail fold area, seen in candida paronychia
What is the treatment for candida paronychia?
topical or systemic anti-candidals, but note that oral Nystatin does NOT have good coverage for candida

Also, avoid wet work or wearing cotton gloves under latex gloves
What is a good way to distinguish candida intertrigo from dermatophyte infections?
VERY RED + SATELLITE LESIONS

bright red, moist denuded skin
satellite lesions are minute papules/pustules separated by normal skin from main eruption
How do you treat candida intertrigus?
Dry out the moist area! He said to avoid powders (gooey mess) and use low temp blow dryer instead

(also topical or systemic antifungals)
Name for candida infection occurring at sides of mouth/oral commissure?
Angular cheilitis (aka Perleche)
Candidal infection of mucosa of mouth or vagina is called what?
Thrush
How does thrush present?
loosely adherent white patches with bright red mucosa
Inhaled corticosteroids used to treat asthma may predispose individuals to what fungal infection?
Oral Thrush (candida in oral mucosa)