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Rovner

INFECTIOUS DISEASES OF THE SKIN

  1. Viral
    1. Herpes simplex (types I and II)
      1. Primary
      2. Recurrent
    2. Zoster--reactivated Varicella
    3. Molluscum Contagiosum
    4. Human Papilloma Virus
      1. Warts
      2. Condyloma acuminata
      3. Cervical dysplasia
      4. Laryngeal polyps
    5. Exanthems
      1. nonspecific--similar to morbilliform drug reaction
      2. specific
        1. Fifth Disease--Parvovirus
        2. Sixth Disease (Roseola)--HSV VI
        3. Hand, foot and mouth disease--Coxsackie virus
        4. ?Pityriasis Rosea ?HSV VII
  2. Bacterial
    1. Impetigo
      1. Staph aureus, NOT Strep
      2. Honey colored crusts, erosions with a red base
      3. May be bullous
      4. Treatment:
        1. Systemic antibiotics
        2. Topical antibiotics ineffective except Bactroban!
    2. Cellulitis
      1. Staph, Strep, H. influenza (children)
      2. Tender, bright red dermal plaques with indistinct borders
      3. Constitutional symptoms--fever, arthralgias, malaise
    3. Erysipelas
      1. Strep usually causative
      2. Extremely well demarcated red indurated plaques
      3. Recurrence is frequent
    4. Mycobacteria
      1. Leprosy--M. leprae
        2.

        Tuberculoid

        Borderline

        Lepromatous

        TT

        BT

        BB

        BL

        LL
      2. Atypical Mycobacterium--
            1. M. marinum
            2. Fish tank (swimming pool) granuloma
    5. Pseudomonas--hot tub folliculitis
    6. Disseminated
      1. Gonococcemia
        1. rare, painful hemorrhagic pustules
        2. palms and soles
        3. septic arthritis
      2. Meningococcemia
        1. gun metal grey hemorrhagic pustules
        2. EXTREMELY DANGEROUS
      3. Rickettsia--Rocky Mountain Spotted Fever
        1. wood tick vector
        2. acral hemorrhagic papules
  3. Fungal
    1. Superficial
      1. Dermatophytes
        1. "ringworm, athlete's foot, jock itch"
        2. annular scaling pink plaques with central clearing
        3. Skin--Tinea corporis, cruris, pedis, etc.
        4. Hair--Tinea capitis
        5. Nail--Tinea unguium
        6. 3 genera
          1. Trichophyton spp
          2. Epidermophyton
          3. Microsporum spp
        7. Diagnosis--KOH slide
        8. Treatment
          1. topical--imidazoles
          2. systemic--griseofulvin, ketoconazole
      2. Candida--C. albicans
        1. bright red plaques with satellite pustules
        2. skin: moist intertriginous areas (groin, glans, angles of mouth)
        3. oral: thrush
        4. Treatment: nystatin, imidazoles (NOT griseofulvin)
      3. Pityrosporum
        1. P orbiculare, ovale
        2. normal commensal in oily areas
        3. Tinea Versicolor (Malassezia furfur)
        4. Folliculitis
    2. Deep
      1. Begin as self limited acute respiratory infection with fever, cough with eventual spread to skin (in rare instances)
      2. Histoplasmosis
        1. oral lesions
        2. Ohio River basin
        3. Erythema multiform, Erythema nodosum
      3. Blastomycosis
        1. Eastern USA
        2. vegetative, verrucous plaques
      4. Coccidioidomycosis
        1. Pacific Southwest
        2. EM, EN
      5. Paracoccidioidomycosis--Amazon basin
      6. Sporotrichosis--verrucous papules, nodules, plaques

    peat moss, rose thorns

  4. Infestations
    1. Scabies--Sarcoptus scabii
    2. Pediculosis
      1. capitus--head lice
      2. corporis--body lice (organisms found in seams of clothes only, not on body)
      3. pubis
        1. pubic lice "crabs"
        2. also may affect eyelashes
  5. Parasites
    1. Cutanea larva migrans (creeping eruption)
    2. Schistosomiasis--(duck itch, swimmer's itch)
  6. Spirochetes
    1. Syphilis--Treponema pallidum
      1. a. Primary--chancre: painless, indurated ulcer at inoculation site, RPR negative
      2. Secondary--Pityriasis rosea like rash 1 to 6 months after 10 infection
        1. brown macules on palms and soles
        2. mucous patches
        3. Condyloma lata
        4. RPR positive; spirochetes recoverable from all lesions
        5. latent--RPR remains positive; no lesions
      3. Tertiary--5 to 30 years after latency
        1. gumma
        2. arthritides
        3. cardiac, neurologic involvement
    2. Lyme Disease
      1. Borrelia burgdorferii
      2. deer tick vector
      3. triphasic course:
        1. 10--Erythema chronicum migrans
        2. 20--Fever, arthritis
        3. 30--Late sequelae (cardiac, neurologic)