Bacterial infections

Impetigo Folliculitis Sycosis Furncle Carbuncle Erythiplas Cellulitis erythrasma

contagiosa barbae
Etiology Cocci + poor Stap aureus ( Staph aureus ( Infection of Diabetes Inflammation INF of lower Corynebactrium
hygiene & infection of folliculitis of lower part of of upper dermis ( staph minutissimum (
moisture or upper part of the beard area the hair dermis ( B aureus – strpt DM )
scabies & hair follicle ) follicle hemolytic stept pyogenes
pediculosis )
C/P 1- Ordinary Follicular Follicular Red papules Multiple deep Erythrematous As erythiplas Reddish brown
2- Bullous : new pustules pustules & boils open on tender swollen but illdefined patches in
born – staph papules surface by area with border interriginous
infection – fistulae sharp border areas /
may be fatal + Give red
3- Circinate : constitutional S fluorescence
extension of with wood’s
ordinary light
4- Ulcerative :
crust & scars
Complications Post streptococcal Lymphedema
glomerulonephritis
Treatment Topical antiseptics Same Same Same Incision & Erythromycin Aggressive Topical AB and
+ topical drainage + AB antifungal ?
antibiotics and systemic AB systemic AB
systemic if sever

Herpes simplex
Aetioligy HSV I : herpes libialis
HSV II : herpes progenitalis
C/P 1- HSV I :
a. superficial vesicles
perioroficail → ulcers →
swollen gums &
lymphadenopathy +
constitutional manifestations
b. recurrent attacks in lips & face
less sever
c. ocular type
d. herpitic witlow : in fingers
very painful
2- HSV II : vesicles on genitals
and ulcers / if pregnant → CS
Complications 2ry infections / eye cimolications /
CNS : encephalitis / erythema
multiforme / cancer cervix
Treatment  Antiseptic lotions
 Acyclovir cream 5 times
daily 5 days
 IDU for eye lesions
 Acyclovir tab 200 mg 5 X 5
Viral infections
Herpes zoster
Varicella Zoster virus
Vesilces along distribution of a
sensory nerve + local LNs
enlargement – leave scar – give
permenant immunity
DANGEROUS in :
Bilateral
Old age
Gangrenous
Recurrent
Eye complication ? post herpitic
neuralgia
1- Topical : drying AS lotion
/ Acyclovir cream
2- Systemic : Acyclovir 800
mg 5 X 7 - Analgesics
Warts Mollascum contagiosum
Human papilloma virus Pox virus
1- Common warts : Dome shaped papule with
verroucus papules central umblication and
2- Plane warts : flat topped white chessy material if
papules squeezed – can be sexual
3- Filiform warts :
peduculated
4- Digitiform warts : finger
like
5- Planter warts : foot =
tender – grow inward
6- Genital warts : moist
foul smelling in MM &
skin
Oncogenicity ( cervical cancer )
1- Cautery : electro- cryo – Cauterization
laser – chemical
2- Podophyllon resin in
alcohol : for veneral
3- Radiotherapy
4- Autosuggestion
 Fungal infections
Dermatophytes Yeasts
Tinea capitis Tinea circinata Tinea pedis Other types Pityriasis versicolor Candidiasis
Cause Trichophyta & Trichophyta & Trichophyta & 1- Tinea cruris : Malassezia furfur Candida albicans
microspore microspore epidermophyta scrotum not the pathogenic form
involed of pityrrosporum
2- Tinea axillaris orbiculare
C/P 1- Scaly type :child – Annular patches Sodden white 3- Tinea barbae Macule hypo or 1- Cutaneous
bal patch with with active edge and macerated skin with 4- Tinea mannum : hyper pigmented candidiasis :
scales healing centre – bad dour between in palm with fine scales in a. Intertrigo :
2- Black dot : hair itching is common toes 5- Tinea uguium : upper chest arms – i. Axilla & groin
breaks leave dots on exposed surfaces onchomycosis → In summer ii. Eriosio
3- Kerion : also adult thickened interdigitalis
with boggy greenish nails mastocytica
swelling & iii. Angular
pustules → chelitis
cicatricial alopecia iv. Napkin
4- Favus : diffuse dermatitis
loss of hair with b. Paronychia : nail
mousy odour fold tender – nail
yellow crusts → corrugated
cicatricail alopecia 2- Mucosalcandidiasis :
oral thrush – vulvo
vaginitis - balanitis
Diagnosis 1- Wood’s : DD : herald patch Wood’s light gives
green yellow
2- LM Parker ink stain :
3- Culture on spagitti & meatballs
saburoud appearance
Treatment Topical alone is Topical antifungal 2 1- Tincture iodine 1-Systemic : 1- Topical : castellani
useless daily + systemic 1% ketoconazole paint – nystatin
( ketoconazole grisofulvin for 3 W 2- Systemic 200X10 oint
shampoo + antifunal in 2-Topical : Na 2- Systemic :
griseofulvin tab for 2 sever cases hyposulphide – mycostatin oral
months imidazole – zinc drops – Azoles –
pyrithione – white amphotericin B in
field – tincture sever
iodine
Scaly erythematous lesions
Psoriasis
Etiology Lack of UV rays
- Hemolytic infection
- Hypocalcemia
- Pregnancy
- Trauma / psychogenic
C/P Erythematous papule with
shiny scales – lossely adherent
– bleed on removal ( Auspiz )
Clinical types 1- Psoriasis vulgaris
a. Skin : in extensors – back
b. Scalp psoriasis
c. Nail psoriasis : bi;aterla
pitting hyperkeratotic nail
d. Flexural type : scaling is
absent
2- Erythrodermic
3- Arthropathic
4- Pustular : sterile pustules
Treatment 1- Local : coal tar – Anthralin
0.5% - corticosteroids –
salicylic acid 5% -
calcipotriol – PUVA – laser
2- Systemic : for extensive
psoriasis : Methotrexate –
retinoids – cyclosporine –
corticosteroids – PUVA oral
Lichen planus
- Psychological
- Liver disease
- Sunrays
- Antimalairial – gold
Flat topped polyangular
violaceous itchy papules with
adherent scales in flexor areas
with sever pruritis
1- Ordinary LP
2- Actinic LP : in sun exposed
area in summer
3- Mucosal : reticulate network
– ulcerative laesion –
precancerous
4- LP of the scalp : cicatricai
alopecia
1- Antihistaminics
2- Steroids & aalcylic loacally
3- Steroids – retinoids and
cyclosporine systemically
4- Actinic : sunscreens 0
chloroquine 200mg /day
5- Mucosal : steroids – acitrtin –
chloroquine
Discoid Lupus erythematousus Pityriasis rosea
Chronic scaly erythematous Considered exanthematous
eruption in skin reaction for upper respiratory
viral infection ( HHV 6-7 )
Erythematous plaques + adherent Herald patch ( outer
scales + dilated pilosebaceous erythematous zone –
orifices ( stippling ) + intermediate scaly one –
telangectesia + thin atrophic scar healing center ) parallel to rib
→ cicatricial alopecia in sun / 2ry eruption give
exposed areas chrismats tree appearance &
jacket with short sleeves
1- Ordinary type
2- Inverted type : occur
distal
3- Abortive type : only
herald
4- Papular type : more
elevated
5- Flexural type
1- Sun screens 1- PT reassurance
2- Systemic photoprotectives ( 2- Avoid hot baths
chloroquine ) 3- Calamine lotion
3- Corticosteroids ( local – 4- Oral antihistaminics ,
systemic – intralesional ) topical corticosteroids and
UVB
 Allergic Dermatoses
Eczema urticaria Erythema multiforms Drug eruptions
May be genetic in types as atopic & 1- Exogenous : foods as fish- 1- Genetic factors Allergy to the drug
allergic contact dermatitis chocolate / drugs as penicillin 2- Infections : HSV
injected or ingested / pollens
3- DRUGS : NSAIDs
2- Endogenous : infection –
parasites – SLE – lymphoma – 4- Autoimmune : SLE
pregnancy 5- Malignancy : lymph
1- Contact dermatitis : 1- Ordinary urticaria 1- EM minor : only 1- Urticarial &
a. 1ry irritant dermatitis : any individual 2- Facticious : very mild – limmted to skin – no angioedema
b. Allergic contact dermatitis : type IV
in genetic susceptile
follow trauma or mild mucosal 2- Erythroderma (
2- Discoid eczema : well defined 3- Cholinergic : itchy involvement – no exfoliative dermatitis )
3- Atopic eczema : genetic with FH sensation after sweating systemic involvement 3- Photosensitive drug
a. Infantile : on cheeks & hands with wheals on scalp –neck 2- EM major : extensive reaction
b. Childhood : on flexures upper chest mucosal and systemic 4- Acneform eruptions
c. Adult : hyperpigmentation &
lichenification
4- Physical : either solar – involvement → death ( steroids )
4- Stasis eczema : venous insufficiency → pressure – cold –heat 5- Fixed drug eruption
edema oozing vesiculation itching 5- Popular : due to insect bite : with sulfonamides &
5- Seborrheic eczema : by malassezia in infants & children / NSAIDs / fixed to the
furfur wheal then papule over it drug & site /
a. Infantile type : scales on scalp &
diaper area
permengnate colored
b. Aadult : from androgens on macule vesicles &
sebaceous glands eruption
-acute eczema : erythema –swelling – Sudden appearance of elevated Primary lesion : iris ( target ) Acute atypical inflammatory
vesicles edematous lesion varies in size lesion erythematous annukar eruptions suside after
-chronic eczema : lichenification & transient for few hours ring with central vesicle / in stoppage of drug
excoriations mucosa : may form painful
HGE bullae & erosions
1- Acute : drying antiseptic lotion & 1- local : cold 3- Local : compresses –
corticosteroid cream witth compresses –calamine calamine lotion –
hydrous base – systemic lotion – steroids steroids – antiseptics
antihistaminics & corticosteroids 2- Systemic : oral 4- Systemic :
2- Chronic : local corticosteroids antihistaminic → antihistaminics –
cream parentral AH → oral steroids – antibiotics
3- Atopic : + topical steroids → parentral 5- Major needs
immunomodulators & UVB steroids → adrenaline hospitalization and
4- Seborrheic : antidandruff SC or IM TTT of complications
shampoo
 Vitiligo ALopecia Acne
Etiology Melanocytes are destroyed and disappear 1- Cicatricial : mechanical trauma – Block of follicular opening by KCs –
from epidermis due to : fungal inection DLE – lichen planus dilatation of the lower part – disruption
1- Autoimmune : antimelanocyte AB 2- Non cicatricial : of the epithelium – discharge into the
precipitated by psycho or a. Telogen : postpartum – dermis – inflammation especially with
mechanical trauma nutritional deficiency propionobacterium acnes lead to papule
2- Neurogenic L melanocytotoxic b. Anagen : cytotoxic – pastule nodulocystic lesions
substances from nerve endings retinoids – mercury
3- Chemical : melanocytotoxic c. Familial baldness :
substances from rubber gloves etc overactivity 5alfa reductase
4- UV rays d. Areata : genetic factors –
immunological actors
Types 1- Focal vitilgo 1- Cicatricial 1- Mild ; comedones – no papules
2- Unilateral vitilgo 2- Non cicatricail : telogen effulfium – 2- Moderate : comedones – paules –
3- Generalized vitilgo anagen effluvium – androgenitic pustules
4- Universal vitiligo alopecia – alopecia areata ( patchy – 3- Sever : nodules & cysts
marginaalis – ophiasis – totalis –
universalis )
DD DD : tinea versicolor – pityriasis alba-
postinflammatory hypopigmentation
Tratment 1- Phoyototherapy : PUVA 1- topical ; local irritants – 1- topical : erythromycin lotion –
2- Steroids & immunomodulators corticosteroids cream – PUVA – retinoids – benzyl peroxide –
3- Surgical : punch gafting & tissue minoxidil azelic acid
culture 2- systemic : antidepressant – 2- systemic : antibiotics (tetracycline)
4- camouflage corticosteroids + retinoids – dapsone & steroids (
sever )

The following topics has to be studied from the department book : leprosy & protozoal infections

Prepared by
Mahmoud abdel Ghany Behairy