2. BACTERIAL SKIN INFECTIONS

3. NORMAL FLORA OF SKIN Gm + COCCI  STAPHYLOCOCCUS  MICROCOCCUS Gm + RODS  PROPIONIBACTIRIUM  CORYNEBACTIRIUM Gm –VE RODS  ACINETOBACTER

4. ROLE OF NORMAL FLORA  DEFENCE AGAINST BACTERIAL INFECTION THROUGH BACTERIAL INTERFERENCE  PRODUCTION OF FREE FATTY ACIDS(FFA) FROM SKIN LIPIDS

5. STAPHYLOCOCCUS AUREUS  ANTERIOR NARES 35 %  PERIANAL SKIN 20 %  AXILLARY SKIN 5-10 %  TOE WEBS 5-10 %

6. REDUCTION OF CARRIAGE  MUPIROCINE OINTMENT INTRANASALLY FOR 5 DAYS  ORAL RIFAMPICIN 600mg 7-10 DAYS  CLINDAMYCIN 150mg/day FOR 3 MONTHS

7. STAPHYLOCOCCUS DISEASES  Impetigo  Ecthyma  Scalded skin syndrome  Furunculosis  Folliculitis  Carbuncle  Sycosis

8. STREPTOCOCCUS DISEASES  Impetigo  Ecthyma  Erysipelas  Cellulitis  Scarlet fever  Intertrigo

9. IMPETIGO  CONTAGIOUS SUPERFICIAL INFECTION OF THE SKIN  ORGANISIMS: STAPHYLOCOCCUS AUREUS, STREPTOCOCCUS  PEAK SEASON: LATE SUMMER  AGE: PRESCHOOL & YOUNG SCHOOL AGE  EXISTING SKIN DISEASE: SCABIES, PEDICULOSIS

10. CLINICAL FEATURES  VESICLE ON ERYTHEMATOUS BASE  RUPTURES - SERUM EXUDES  YELLOWISH BROWN CRUST  PERIPHERAL EXTENSION  HEALS WITHOUT SCARRING

15. TREATMENT TOPICAL ANTIBIOTICS  NEOMYCIN  BACITRACIN  FUCIDIC ACID  MUPIROCIN SYSTEMIC ANTIBIOTICS  IF WIDESPREAD OR SEVERE

16. ECTHYMA PYOGENIC INFECTION OF THE SKIN CHERACTERISED BY FORMATION OF CRUST BENEATH WHICH ULCERATION OCCURS

17. AETIOLOGY  STAPH. AUREUS, STREPTOCOCCUS  POOR HYGIENE  MALNUTRITION  OTHER PREDISPOSING FACTORS

18. CLINICAL FEATURES  BULLAE OR PUSTULE  HARD CRUST  PURULENT IRREGULAR ULCER  HEALS WITH SCARRING  BUTTOCKS, THIGHS AND LEGS

20. TREATMENT  SAME AS FOR IMPETIGO

21. INFECTIONS INVOLVING HAIR FOLLICLES  FOLLICULITIS  FURUNCLE  CARBUNCLE

22. FOLLICULITIS INFLAMMATORY CONDITION OF THE HAIR FOLLICLE WITH CHANGES CONFINED TO OSTIUM

23. AETIOLOGY  BACTERIAL: STAPHYLOCOCCAL  FUNGAL: TRICHOPHYTON RUBRUM  CHEMICAL: TAR  DRUGS: STEROIDS

24. CLINICAL FEATURES  SMALL FOLLICULAR PAPULE OR PUSTULE  RARELY PAINFUL  HEALS WITHOUT SCAR

28. TREATMENT  REMOVE UNDERLYING CAUSE  TOPICAL ANTISEPTICS  TOPICAL ANTIBIOTICS  SYSTEMIC ANTIBIOTICS

29. FURUNCLE ACUTE USUALLY NECROTIC AND DEEP SEATED INFECTION OF HAIR FOLLICLE

30. AETIOLOGY  STAPH. AUREUS  SEBORRHOEIC / ATOPIC INDIVIDUALS  DIABETICS  SCABIES  HIV  MALNUTRITION

31. CLINICAL FEATURES  SMALL FOLLICULAR NODULE  TENDER  LOCALIZED NECROSIS  HEALS WITH SCARRING  FEVER & MILD CONSTITUTIONAL SYMPTOMS  CAVERNOUS SINUS THROMBOSIS

36. TREATMENT  GENERAL MEASURES  SYSTEMIC ANTIBIOTICS  TOPICAL ANTIBIOTICS  ANALGESICS

37. CARBUNCLE DEEP SEATED INFECTION OF A GROUP OF CONTIGUOUS HAIR FOLLICLES

38. AETIOLOGY  STAPH. AUREUS  MIDDLE AGED MEN  DIABETES, MALNUTRITION  CARDIAC FAILURE  DRUG ADDICTS  PROLONGED STEROIDS  ERYTHRODERMA

39. CLINICAL FEATURES  HARD RED PAINFUL NODULE  MULTIPLE DISCHARGING FOLLICULAR SINUSES  NECROSIS OF INTERVENING SKIN  DEEP ULCER WITH PURULENT FLOOR  BACK OF NECK, SHOULDERS, HIPS, THIGH  FEVER  SEPTICAEMIA

41. TREATMENT  SYSTEMIC ANTIBIOTICS  TOPICAL ANTIBIOTICS  ANTIPYRETICS/ ANALGESICS  SURGICAL INTERVENTION WHEN INDICATED  REMOVAL OF UNDERLYING CAUSE

42. CELLULITIS ACUTE, SUBACUTE OR CHRONIC INFECTION OF LOOSE CONNECTIVE TISSUE PERTICULARLY SUBCUTIS

43. AETIOLOGY  STREPTOCOCCI  H. INFLUENZA  STAPH. AUREUS  PSEUDOMONAS

44. CLINICAL FEATURES  ERYTHEMA  SWELLING  HOT & TENDER  ILL-DEFINED MARGINS  CONSTITUTIONAL SYMPTOMS

48. COMPLICATIONS  FASCIITIS  MYOSITIS  GANGRENE  SUBCUTANEOUS ABSCESSES  SEPTICAEMIA

50. TREATMENT  APPROPRIATE ANTIBIOTICS  ANALGESICS  REST  TREATMENT OF COMPLICATIONS

51. ERYSIPELAS  EDGES WELL DEMARCATED, RAISED  BLISTERING COMMON  MORE SUPERFICIAL INVOLVEMENT  FACE COMMON SITE  RESPONSE TO TREATMENT RAPID

54.  Common skin condition affecting the skin folds such as under the arms, in the groin and between the toes.  Erythrasma does not usually cause any symptoms.  It presents as a slowly enlarging patches of pink or brown dry skin.  Caused by  Corynebacterium minutissimum.

55.  Diagnosis confirmed by Wood’s lamp examintation which turns erythrasma to fluoresce a coral-pink colour.  Erythrasma can be treated with antiseptic and topical antibiotic such as: fusidic acid cream Clindamycin solution. Erythromycin lotion.

56. VIRAL INFECTIONS OF SKIN

57. VIRAL WARTS  HUMAN PAPILLOMA VIRUS  DNA – VIRUS 50-55nm  77 DIFFERENT TYPES

58. CONT’D  INFECT SQUAMOUS EPITHELIA  CAUSE CELL PROLIFERATION -- PAPILLOMA  DYSPLASIA / NEOPLASIA

59. TYPES  Common warts  Plane warts  Filiform warts  Plantar warts  Acuminate warts

60. COMMON WARTS  HPV - 2  FIRM PAPULES / PLAQUES  ROUGH HORNY SURFACE  SYMPTOMLESS  SITES - BACK OF HANDS, FINGERS, ANYWHERE ON SKIN  65% DISAPPEAR IN 2 Yrs

67. PLANE WARTS  HPV 3, 10  SMOOTH, FLAT OR SLIGHTLY ELEVATED  1- 5 mm ROUND OR POLYGONAL  FACE AND BACK OF HANDS

70. FILIFORM WARTS  FINGER-LIKE PROJECTIONS  FACE, NECK AND SCALP  COMMONLY IN MALES

72. PLANTAR WARTS  HPV 1, 2, 4, 57  SMALL SHINING SAGO GRAIN LIKE PAPULE  USUALLY PAINFUL HYPERKERATOTIC  PRESSURE AREAS OF SOLE, PALMS  MOSAIC PATTERN

76. ACUMINATE WARTS  HPV- 6, 11, 16 ; VENERIALLY ACQUIRED  MUCO-CUTANEOUS JUNCTIONS AND INTERTRIGINOUS AREAS  SOFT, PINK, MOIST SURFACE  PEDUNCULATED OR CAULIFLOWER LIKE  MACERATION - INFECTION, MALODOUR

78. DIAGNOSIS  HISTOLOGY  ELECTRON MICROSCOPY  IMMUNOHISTOCHEMISTRY (TYPE SPECIFIC ANTIBODIES)  PCR

79.  SPONTANEOUS RESOLUTION  GENERAL MEASURES TREATMENT  AVOIDANCE OF SHARED TOWELS AND SHOES  AVOID BITING NAILS  ADEQUATE PLASTIC STRAPPING AT SWIMMING POOL

80. DESTRUCTIVE MODALITIES  Electrocautery  Cryotherapy  Salicylic acid  Podophyllin  Surgical methods  CO2 Laser

81. Other modalities  Cimetidine  Retinoids  Interferon  Imiquimod  Antiviral therapy (cidofovir)  Intralesional bleomycin

82. MOLLUSCUM CONTAGIOSUM  Caused by MCV-1, MCV-2  Mainly in children  Direct contact  Discrete shiny, pearly white, rounded papules  Umbilicated centers

83. TREATMENT  General measures  Topical Retinoids  Puncture with wooden probe dipped in tincture iodine  Cryotherapy  Electrocautery  CO2 Laser

85. HERPES SIMPLEX  Herpes virus hominis  Type 1, 2  Persist in sensory nerve ganglia  Spread: Direct contact, droplets

86. CLINICAL FEATURES  Sub-clinical  Age 1-5 years  Incubation period 5 days  Fever, malaise, dribbling of saliva  Gums - swollen, inflamed Primary infection

87. Cont’d  Vesicles, ulcers  Tongue, pharynx, palate, buccal mucosa  Regional lymph nodes – enlarged & tender  Recovery in 2 weeks

88. Cont’d  Herpes genitalis  Kerato-cunjunctivitis  Inoculation herpes simplex

89. Recurrent infection  50% type 1, 95% type 2  Smaller vesicles  Close grouping  No constitutional symptoms  Buccal mucosa not affected

93. TRIGGERING FACTORS  Minor trauma  Febrile illnesses  UV radiation  Dental surgery  Pre-menstrual period  Emotional stress

94. COMPLICATIONS  Cranial Nerve palsies e.g. Bell's palsy  Eczema herpeticum  Erythema multiforme  Encephalitis

96. TREATMENT  Mild, uncomplicated : no treatment or topical antiseptic  Severe primary infection : antiviral therapy (Acyclovir 200mg 5 times/day)  Recurrent : topical antiviral

97. CHICKEN POX  HERPES VIRUS VARICELLAE  DROPLET INFECTION  2 -10 YEARS  INCUBATION PERIOD : 14-17 DAYS

98. CLINICAL FEATURES  FEVER, MALAISE, RASH  MORBILIFORM ERYTHEMA  PAPULES, VESICLES  PUSTULES WITH RED AREOLA  DRY CRUST, PINK DEPRESSION  HEALS WITHOUT SCARRING

99. Sign (dewdrop on a rose petal)

100. Papules & vesicles

101. Polymorphic lesions

102. Chickenpox & bullous impetigo

103. Large pustules & umbilicated lesions

105. COMPLICATIONS  SECONDRY INFECTION  ENCEPHALITIS  HEPATITIS  PNEUMONIA  ARTHRITIS  SEPTICAEMIA  STEVENS - JOHNSON SYNDROME

106. TREATMENT  REST  ANALGESICS  SOOTHING ANTISEPTICS  DAILY BATHING  ANTIBIOTICS FOR SECONDARY BACTERIAL INFECTION  ANTIVIRAL THERAPY

107. HERPES ZOSTER(SHINGLES)  HERPES VIRUS VARICELLAE  INCIDENCE INCREASES WITH AGE  PATIENTS ARE INFECTIOUS

108. CLINICAL FEATURES  FIRST MENIFESTATION – SEVERE PAIN  HEADACHE, MALAISE, LOCALISED TENDERNESS  GROUPED RED PAPULES IN DERMATOMAL PATTERN  VESICLES, PUSTULES

109. Cont’d  MUCOUS MEMBRANE INVOLVEMENT  LYMPHADENOPATHY  RECOVERY 2-4 WEEKS  OCCASIONALLY PAIN NOT FOLLOWED BY ERUPTION

110. Cont’d  THORACIC - 53%  CERVICAL - 20%  TRIGEMINAL - 15%  LUMBOSACRAL - 11%

113. Disseminated lesions

114. COMPLICATIONS  FACIAL PALSY  SENSORY LOSS  MENINGOENCEPHALITIS  POST HERPETIC NEURALGIA (PHN)

115. TREATMENT  BED REST  ANALGESICS  LOCAL ANTISEPTICS  TOPICAL ANTIBIOTICS  ANTIVIRAL THERAPY  TREATMENT OF PHN