SKIN INFECTIONS by hilen

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									Common Dermatological
Problems
In Residential Aged Care Facilities

Warning: Graphics are included in this presentation


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Skin Infections
 Normal skin flora
 Infectious agents
 Predisposing factors
 Resistant Infectious agents




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Folliculitis
  Folliculitis




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Boils & Carbuncles
 Note distinct lesions with pustules
 Carbuncles with multiple pustules per lesion




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Impetigo contagiosa
 Impetigo




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Cellulitis
  Limbs
  Redness. Swelling
  Increased warmth
  Tenderness
  Blistering
  Regional
  lymphadenopathy
  Abscess




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Cellulitis
.




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Medstat.med




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Viral infections
 Viral warts.
 Herpes simplex
 Herpes zoster




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Viral warts
 Viral Warts




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Viral warts
 Mosaic
 Plantar
 Subungual




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Genital warts
 Penile
 Vaginal
 Perianal




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Herpes simplex
 “Cold Sores”




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Herpes zoster
 Shingles




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Treating Shingles
 Timely diagnosis and treatment is
 essential to prevent secondary
 complications eg post-herpetic neuralgia
 Anti-viral therapy not subsidised on PBS
 (or effective) >72 hrs after rash
 appearance
 If shingles rash is suspected, contact
 patient’s LMO immediately

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Chickenpox
 Usually a paediatric disease
 Can occur when immune system compromised
 Treat with analgesics and topical anti-puritics eg
 Pinetarsol baths, calamine, local anaesthetics




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Tinea corporis




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Tinea corporis




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Tinea cruris




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Candidiasis




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Tinea pedis




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Tinea capitis




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Treating Tinea
 Usually use topical as first line eg clotrimazole
 Note directions eg three times a day and for
 fortnight after symptoms clear to avoid
 recurrence
 Can use systemic therapy if topical fails
 Can use topical cortisone as required if pruritis a
 problem but only in combination with anti-
 fungal.



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Tinea unguium




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Treating Tinea Unguium

 Loceryl used weekly or twice weekly effective
 Most topical therapy are ineffective due to poor
 nail penetration
 Can use systemic therapy also
   eg griseofulvin (3 months) or Lamisil (6 weeks)




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Candidiasis




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Treating Oral Thrush
 Topical therapy
   Nilstat Oral Drops 1mL in the mouth four times a day
   after food or Daktarin Oral Gel 1 tsp four times a day
   after food.




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Pityriasis versicolor




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Pityriasis Versicolor
  This is not contagious or dangerous
  Treat usually for for aesthetic reasons
  Use Pevaryl Foaming Solution
    At night for 3 consecutive nights and repeat in a month




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Non-Infective Disorders
 Contact Dermatitis (Irritant & Allergic)
 Atopic Dermatitis
 Psoriasis




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Irritant contact dermatitis




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Irritant contact dermatitis




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Occupational Irritant contact dermatitis




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Irritant contact dermatitis




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Contact dermatitis from adhesive plaster




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Predisposing factors in ICD
 Properties of irritant substance
   Acidity, solubility, detergent action
 Physical state
   Gas, liquid, solid
 Host factors
   Occlusion, sweating, pigmentation, dryness
   Activity, presence of other skin disease
                                         But wait, there’s more


                    The Pharmacy Guild of Australia NSW Branch
Predisposing factors in ICD


Environmental factors
  Temperature, humidity, friction, pressure,
 occlusion
Patient factors
  Age, gender, skin type.
   Genetic back ground.
   Atopy, increased susceptibility to skin irritation


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Common irritants:
*   Soaps and detergents
*   Fibrous glass
*   Hydrofluoric acid
*   Cement
*   Chromic acid
*   Phosphorus
*   Metal salts
*   Solvents
*   Fabrics
*   Plants
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 Allergic contact dermatitis:-

Definition:
 Caused when an allergen comes into contact with
previously sensitized skin.
 First exposure: these sensitizers do not usually
cause skin changes on first exposure but produce
the eczematous reaction after repeated exposures.
 Sensitization may begin with the first contact in
the case of strong sensitizers. E.g: poison ivy or
DNCB..
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Allergic contact dermatitis




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Contact allergic dermatitis
due to eyedrop preservatives




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Generalized dermatitis:-
Generalized or bizarre patterns of dermatitis caused
by:-
 Systemic exposure.
 Topical exposure to allergens that are ubiquitous in
environment eg: nickel, Formaldehyde, Balsam of
Peru, natural & synthetic rubber




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Air-born
contact
dermatitis




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 Clinical features of Contact dermatitis:

History:-
When contact dermatitis is suspected, the history
must include a detailed history of
 Environmental exposures, any exposures to
material such as plants, paint, dyes, cleaning
solution, soaps
 Any new product or plants are present in home or
during recreational activities.

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There needs to be a history of


 Hobbies.
 Applying any product or treatment to area
 Sun exposure
 If lesion or symptoms appear to be primarily in
exposed areas
 Other coworkers or family members affected
 If symptoms improve over weekends or vacation.

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      Hx                            ICD                                     ACD
What is chief             Mild pruritus or                            Very pruritic.
symptom?                  burning, or
                          discomfort.
When did the              Within min-hrs of                           Usually takes 6-24
symptoms start?           exposure.                                   hrs to produce sym


Is this the first time    Accurate Hx help to Same.
has this occurred?        narrow the
                          possibility.


Has the dermatitis        Localized to the                            Spread over time.
been spreading?           site of exposure.



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Atopic dermatitis




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Atopic Dermatitis
 More generalised that Contact
 Dermatitis
 Involves Atopy more and dry skin
 Usually treat with topical cortisone
 for flare ups and moisturisers for
 prevention


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Psoriatic Plaque




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Generalised Psoriasis




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Treating Psoriasis
 Usually involves topical cortisones
 (potent)
 Other systemic treatments for
 recalcitrant cases eg methotrexate,
 Neotigason etc




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Then, When all else fails…




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The End!
           Questions?
  Thank you for your attendance.




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