1. CUTANEOUS INFECTIONS AND INFESTATIONS
DR. MOHAMMED ALSHAHWAN MD

2. BACTERIA
MYCOBACTERIA
VIRUS
FUNGUS
PARASITE Worm
Arthropod
Protozoa
STD (SEXUALLY TRANSMITTED DISEASE)

3. BACTERIAL
I. Impetigo
Superficial non-follicular infection due to staphylococcus and streptococcus
Children
not sick
pustule (honey-colored crust )
Face and Acral areas
Primary or secondary

5. II. Erysipelas
deep cutaneous infection (Dermal)
due to streptococcus after penetrating trauma ( CHRONIC LYMPHEDEMA)
sick
Face and Acral areas
Unilateral sharply demarcated edematous red plaque

7. III. Cellulitis deep cutaneous infection (up to SC FAT)
due to streptococcus after penetrating trauma ( CHRONIC LYMPHEDEMA)
sick
Face and Acral areas
Unilateral Diffuse (NOT well demarcated) edematous red plaque
Blood Culture in immuocompramized pts.

8. IV. Erythrasma Corynebacterium minutissimum (not contagious)
Asymptomatic
Flexures
well demarcated scaly reddish-brown patch with advancing edge.
Coral-red fluorescence

10. I.TUBERCULOSIS MYCOBACTERIAL Exogenous tuberculosis chancre
Direct extension
scrofuloderma
Hematogenous spread
lupus vulgaris

11. Lupus vulgaris Most common type of Cutaneous TB Children Female
Head and neck only
Red-brown nodules and plaques
(apple-jelly nodules) when it ulcerate it heal with unhealthy scar

13. II. LEPROSY
M.leprae
faceoral transmition
Close contact in endemic area (India)
Delay in presentation ( 20 years)

14. Classification of leprosy
Indeterminate stage
ill-defined hypopigmented anesthatic hairless dry patch
Tubercaloid leprosy
Few ( < 3) well demarcated scaly red anesthatic hairless dry annular plaques with central clearing
Adjacent nerve swelling

16. Lepromatous leprosy
Multiple diffuse symmetrical skin-colored to red-brown plaques and nodules
Leonine face
blindness
Peripheral neuropathy
Borderline leprosy

19. VIRAL INFECTION
WART
Human papilloma virus (HPV)
Direct contact
Asymptomatic transmition
Delay in presentation
Oncogenic potential (HPV 16 and 18)
High recurrence rate

20. CUTANOUS ( HPV 1 and 3 )
common wart
flat wart
planter wart
GENITAL (HPV 16 and 18)
classic
condyloma acuminata

25. GENITAL WART
*STD
*Oncogenic HPVs ( Cervical cancer)
*Usually more persistent and difficult to treat .

26. * Tissue destructive modalities
TREATMENT
* Tissue destructive modalities
Keratolytic (salicylic acid and podophyllin)
Cryotherapy ( Liquid nitrogen)
CO2 laser
* Pulse-dye laser
* Immunotherapy

27. MOLLUSCUM CONTAGIOSUM
POX virus
Direct contact
Asymptomatic transmition
Children
Genital type is STD

28. Multiple UMBLICATED skin colored or reddish papule affecting the face and extremities.
CURETTAGE is the treatment of choice for few lesions
KOH is the treatment of choice for multiple lesions.

31. ORF
POX virus
Contact with infected cattle or sheep
After 2 weeks of incubation a solitary expanding red papule with vesicle at the center which become necrotic at the end.
Patient develop IMMUNITY afterward

33. HERPES SIMPLEX
Human Herpes virus I and II
Direct contact
Asymptomatic transmition
Latency
High recurrence rate

34. CUTANEOUS ( HSV I )
orolibialis Initial
Herpatic whitlow Recurrence
herpes ophtalmicus
GENITAL ( HSV II )
Initial
Recurrence

35. Incubation period : 7- 10 days
Incubation period : days After hours of burning and tingling sensation the patient develop grouped vesicles on erythematous base which ulcerate within 24 hours.
The whole illness is around 7-10 days.

38. Tzank smear
Direct fluorescent antibody test
Viral culture
Blood serology

39. VARICELLAE ZOSTER VIRUS (VZV)
FACEORAL CHICKENPOX ( Children)
HERPES ZOSTER (Adult) is due to reactivation of VZV which was dorminant in nerve root ganglion

40. CHICKENPOX
Incubation period : 2 weeks
Prodrom of respiratory coryza followed by disseminated red macules with central vesicles.
The whole illness : 3 weeks
The patient contagious 5 days before and 5 days after skin eruption

42. HERPES ZOSTER
After hours of burning and tingling sensation the patient develop grouped vesicles on erythematous base which ulcerate within 24 hours.
The whole illness is around 7-10 days.
Post-herpetic neuralgia (PHN) which usually persist for around 4 weeks.

44. SERIOUS involvement It is almost always DERMATOMAL SPINAL (Thoracic )
CRANIAL ( Trigeminal)
SERIOUS involvement
1.Ophthalmic division of trigeminal nerve.
2. Geniculate ganglia (Ramsey-hunt syndrome)
3.Sacral ganglia.

45. Treatment
HERPES SIMPLEX
Acyclovir 200 mg five time a day for a week
HERPES ZOSTER
Acyclovir 800 mg five time a day for a week

46. FUNGAL DERMATOPHYTE Tinea Pedis (most common) 1.Erosive interdigitalis
2. Hyperkeratotic type(T. rubrum)
3. Inflammatory type(T.mentagrophyte)

48. Tinea corporis / Tinea cruris
1.Hyperkeratotic type (T. rubrum)
well-demarcated annular red hyperkeratotic plaque with central clearing (Ring worm)
2.Inflammatory type (T.mentagrophyte)
well-demarcated edematous red plaque with superimposed pustules

50. Tinea Capitis
1.Hyperkeratotic (black dot)
usually due to T. tonsurans
2. Inflammatory (Kerion)
usually due to M. canis complex
3. Favus
* Due to T. schoenleinii
* it characterized by the presence of Scutulae .

54. YEAST
Candidosis
Due to candida albicans
It is a commensal flora of the gut which become pathogenic when the immune status of the person changed

55. physiological (old age , neonate and pregnancy)
pathological ( DM, HIV and organ transplant)
Itrogenic (long course of Antibiotics)

56. MUCOSAL
1. Oral
oral thrush
angular chilitis
2. Genital
valvuvaginitis

57. CUTANEOUS
it favor wet areas
Candidal intertrigo ( Napkin rash)
peripherally spreading glazed red patch with scaly border and satellite pustules
Candidal paronychia

61. pityriasis versicolor
Due to Malassezia furfur
Asypmtomatic
Well-demarcated brown patches with branny over the trunk and upper extremities

63. 1. Scraping,Clipping and Hair blucking
KOH/microscopy Culture
2. Skin biopsy Histopathology with PAS stain
Culture

64. Topical Antifungal
Nystatin preparation (oral thrush)
Imidazoles e.g. cotrimazole and miconazole
Systemic Antifungal
Imidazoles e.g. Itraconazole and fluconazole
Allylamine e.g. Terbinafine
Griseovulvin

65. Indication of systemic treatment:
1.Tinea Capitis
2. Paronychia and Onychomycosis
3. Failure to respond to topical treatment
4. Immunocompramized pts.
5. Atypical presentations.

66. PROTOZOA
Lieshmaniasis
Protozoa called Lieshmania
Sand fly (premastigote)
Macrophage (Amastigote)
Lieshman-Donovan bodies

67. Localized Cutaneous Well-demarcated ulcerated nodule over the exposed areas after a trip to an endemic area ( H/o of insect bite)
Disseminated Cutaneous
Mucocutaneous
Visceral

69. Skin biopsy
Histopathology with Gimsa stain
Lieshman-Donovan bodies
Culture
PCR for DNA
Liesmanin test

70. Resolve spontaneously leaving a scar
Antimony(Pentostam) either Intralesional or Intramuscular to shrink the lesion

71. Mite called sarcoptes scabei
Scabies
Mite called sarcoptes scabei
which residue in burrows in the stratum corneum laying eggs then dieing and the eggs will maturate 2 weeks period and the cycle repeated.
Skin lesions are Secondary eczematous eruption due to immune reaction to the mite and eggs

75. When to suspect scabies ?
1.pruritus mainly at night
2. Other member of the family also having severe pruritus
3. Pruritus and skin eruption is more severe in the flexors
Document See the mite or eggs

76. Permethrin cream
Lindane cream
Malathion lotion
2.5% sulphur ointment

77. PEDICULOSIS
Head lice (Pediculosis Capitis)
Children
Body lice (Pediculosis Corporis)
Homeless people and vagrants
Pubic lice (Pediculosis Pubis)
STD ( partner should be treated)

80. The diagnosis can be conformed by seeing the lice eggs ( NITs)
Best treatment is SHAVING for head and pubic lice Alternatives:
Permethrin creame rinse
Malathion lotion

81. STD
Syphilis
Spirochete called Treponema Pallidum
After 1-4 weeks of Sexual contact
A third develop 1ry syphilis
After 4-8 weeks A third develop 2ry syphilis
After months to years A third develop 3ry syphilis

82. 1ry syphilis ( 1ry chancre)
Painless well-demarcated indurated genital ulcer with lymphadenopathy.
Serology is negative
Smear for :
Dark filed examination
Direct fluorescent antibody test

85. 2ry syphilis
Asymptomatic generalized monomorphic eruption with lymphadenpathy with characteristic involvement of the palms/soles and mucous membrane.
Serology is positive ( VDRL / RPR)
Skin biopsy for
Histopathology and stain
Culture

87. 3ry syphilis
Cuatneous
Well-demarcated nodules with or without ulceration mainly over the trunk “GUMMA” . Severe mutilation can happen when it involve the face
Serology is not reliable
Diagnosis can be made through skin biopsy

88. HUMAN IMMUNODEFICIENCY VIRUS
(HIV)
Retrovirus that affect the CD T-helper cells
Stages
1. Viral prodrome ( usually Asymptomatic)
2. ARC ( AIDS related complex)
3. AIDS

89. When to Suspect HIV ?
Generally, in case of severe Atypical disseminated stubborn Infection/Neoplasm.
1.severe seborrhoeic dermatitis/psoriasis
2.Oral hairy leukopakia.
3. Proximal Subungual onychomycosis.
4. Kaposi sarcoma
5. Eosinophilic folliculitis

94. THANK YOU