NR511 Midterm test(solved)

actinic keratosis AKs are small papules that can be flesh-colored or slightly hyperpigmented. Areas of skin that have AK feel rough and uneven to the touch due to hyperkeratosis and have been likened to feeling like sandpaper. The hyperkeratosis of these lesions is characteristically hard or spiny. AKs are found in areas of skin that have been chronically exposed to the sun. The diagnosis is clinical. The treatment includes topical therapy and cryosurgery. AKs are precancerous lesions that can progress to SCC. Any AK lesion that does not respond to treatment should be referred to a dermatologist for further evaluation. p. 249 Fungal Skin Infections - Candidiasis Infection with the organism Candida. The most common of which is Candida albicans. A cardinal sign of cutaneous candidal infections is a bright red rash with macules or satellite lesions seen on the borders. A cardinal symptom is pruritus and sometimes burning. The diagnosis is clinical. Treatment: Topical antifungals such as nystatin, clotrimazole, miconazole, naftifine, terbinafine, and ciclopirox are effective. Refer to a dermatologist only is not an improvement after treatments. balanitis The typical patient is a sexually active adult man with a reddish rash and itching on the glans penis. It is sometimes accompanied by penile burning after intercourse. Some patients will report having a female sexual partner who is being treated for a yeast infection or who has irritative vaginal symptoms or a male sexual partner with anogenital or perianal candidiasis. tinea corporis The typical patient will report a history of an erythematous round and elevated pruritic lesion that grows in size and starts to clear in the center—the classic shape of "ringworm." Sometimes, there is a history of another family member with the same infection, and patients may report a history of prior infection. The clinician should inquire about possible exposure through close contact with domesticated animals, such as cats or dogs. Tinea versicolor Most cases of tinea versicolor are recognized in the summer because the hypopigmented spots become more visible at that time of year, as they do not tan. Tinea versicolor is asymptomatic and has a gradual onset. Rarely, a patient will complain of mild pruritus. The typical patient is a teen or young adult, although tinea can occur at any age. People of African descent with tinea will complain of either light-colored (hypopigmented) or dark-colored (hyperpigmented) spots. In adults, the usual sites are on the back, upper chest, arms, and sometimes the neck and face. In children, the rash is more likely to be on the face or forehead. tinea pedis The typical patient is usually a male teenage athlete or an adult who comes to the clinic complaining of "athlete's foot" and strong foot odor. Most patients do not have pain with this infection unless it becomes secondarily infected with bacteria, causing cellulitis. The patient reports areas of macerated soft, whitened skin between the toes. Some patients will complain of concurrent infections on the hand (tinea manuum), on the body (tinea corporis), or under the toenails (tinea unguium). tinea cruris Tinea cruris (“jock itch”) is more common in men during warm weather. It is pruritic. Most lesions will show some lichenification from chronic scratching. The typical lesion is round to a half-circle and will spread to the inner medial upper thigh but spare the scrotum. The color of the lesion can vary from bright red to a dull discoloration. The lesions can become macerated from infection and scratching; they may become secondarily infected with bacteria or C. albicans. Cellulitis Cellulitis is a bacterial infection of the skin involving the dermis and subcutaneous tissue. Most cases are caused by group A beta-hemolytic Streptococcus or by S. aureus (gram-positive bacteria). The lower leg is usually the most common site of infection. The cheeks and the periorbital area are also common sites of involvement. Sometimes extensive edema will be present. Serious signs of systemic toxicity to look for include high fever, hypotension, tachycardia, marked leukocytosis, and associated lymphangitis. If these signs are present, the patient must be treated aggressively with hospitalization and parenteral antibiotics. Referral to a physician is recommended for severe or certain highly morbid cases of cellulitis. The diagnosis is clinical. Treatment: Penicillin VK, dicloxacillin, clindamycin, or cephalexin for 5 days or longer. Refer to an ER for IV antibiotics and/or debridement in moderate to severe cases. Folliculitis Folliculitis is a skin infection of the hair follicles. Bacteria infect the hair follicle at a superficial level, leading to erythematous papules and pustules. The main pathogens are gram-positive bacteria. Folliculitis represents the start of a continuum of skin infections. Deeper infections (as complications of folliculitis) can include the furuncle (boil) or carbuncle (multiple boils), A Gram stain and culture of purulent discharge is obtained by rupturing a pustule and taking samples of the exudate. The culture is useful to distinguish staphylococcal infections from others. treatment: mupirocin treatment twice daily for 5 days. In cases of MRSA colonization, retapamulin (Altabax) should be applied twice daily for 2 weeks. Referral for patients with recurrent or persistent infections that do not respond to a standard treatment regimen is recommended.