1|MANAGEMENT OF PATIENTS WITH DERMATOLOGIC PRO BLEMS

BACTERIAL SKIN INFECTIONS Treatment Modalities

Impetigo – superficial infection of the skin 1. Symptomatic
characterized by honey-colored crusts 2. Antiviral drugs
3. Analgesics
4. Anti-inflammatory
Etiologic Agent:
Nursing Management:
1. Staphylococci, streptococci, or multiple bacteria
▪ Provide instructions (antiviral medications, analgesics & anti-inflammatory
2. Bullous impetigo – S. Aureus
drugs, lesion care, dressings, and hand hygiene)
▪ Keep patient comfortable
▪ Strict isolation
Mode of Transmission ▪ Apply cool, wet dressing w/ NSS to pruritic lesions
• Direct and Indirect contact ▪ Prevent secondary infections
▪ Prevent entrance of microorganism into the lesion especially if they break
Treatment Modalities
▪ Do not delay pain relievers (neuralgic pain)
1. Systemic Antibiotic Therapy ▪ Diversional activities
– Non-bullous – Benzathine penicillin or oral penicillin
– Bullous – penicillinase resistant penicillin ( cloxacillin [Cloxapen], dicloxacillin
[Dycill]) ❖ Herpes simplex – appearance of sores & blisters
2. Topical Antibacterial therapy – mupirocin (Bactroban)
Nursing Management/ Prevention and Control
1. Bathe once a day with bactericidal soap
2. Cleanliness and good hygiene
3. Use individual towel and washcloth
4. Avoid contact with infected people
Folliculitis, Furuncles and Carbuncles
Manifestations:
Etiologic Agent: Staphylococci
Mild to Moderate
Folliculitis – arises within Furuncle (boil) - a deep Carbuncle - an abscess of the skin & 1. Oral herpes – gingivostomatitis
the hair follicles form of folliculitis SQ tissue that invades several follicles 2. Labial herpes – “cold sores” or “fever blisters” (3-10days)
3. Ocular herpes – herpetic keratitis ➔ blindness
4. Cutaneous herpes – any part of the body
5. Erythema multiforme – an allergic reaction of the skin
6. Genital herpes – one of the most common STI

Treatment Modalities
1. Do not rupture
2. Systemic antibiotic therapy (after C&S)
• Oral claxacillin & dicloxacillin (1st line)
• Cephalosporin & erythromycin
3. Incision and drainage
Nursing Management
1. Supportive treatment (fluids, fever reduction)
2. Warm, moist compress
3. Clean surrounding area with antibacterial soap and apply antibacterial ointment
4. Proper handling of soiled dressing Severe to Fatal
5. Observe standard precaution 1. Newborns – neonatal herpetic infection
VIRAL SKIN INFECTIONS 2. Eczema varicelliform eruption – most common in individuals with atopic
dermatitis
❖ Herpes Zoster (Shingles) – acute viral infection of the
3. Encephalitis
sensory nerve caused by a variety or chickenpox virus
Etiologic Agent: Varicella zoster (V-Z virus)
Incubation Period: Unknown (believed to be 13-17 days)
Period of Communicability: A day before the appearance of the first rash until 5 to 6
after the last crop
Treatment Modalities
Mode of Transmission:
1. Oral antiviral – acyclovir, famicyclovir, valacyclovir
– Direct contact (droplet and airborne)
2. Personal hygiene
– Indirect contact
3. Restore F&E balance
Clinical Manifestations 4. Isolation (eczema herpeticum or neonatal herpes)
• Red rashes➔ vesicles ➔ pustule ➔ crust (unilateral; + pruritus) 5. Universal precaution
• Burning or stabbing pain (1-5days prior to rashes) – worst at night, intensified by
movement
• Corneal anesthesia (CN5): Gasserian ganglionitis
• Paralysis of the facial nerve (CN7) & vesicles in the external auditory canal:
Ramsay Hunt Syndrome (severe ear pain, facial nerve paralysis, vertigo, hearing
loss, mild general encephalitis)
Diagnosis:
1. Characteristic skin rash
2. Tissue culture
3. Smear of vesicle fluid
4. Microscopy
2|MANAGEMENT OF PATIENTS WITH DERMATOLOGIC PRO BLEMS

FUNGAL SKIN INFECTIONS Etiologic Agent:

❖ Tinea Flava (Tinea alba/ Tinea vesicolor) – a common, benign, superficial, Pediculosis humanos (capitis) - head lice
cutaneous infection characterized by hypopigmentation or hyperpigmentation Pediculosis humanos (corporis) - body lice
Phthirus pubis - pubic/crab lice
Pediculosis capitis (head lice) Pediculosis corporis (body lice) Pediculosis pubis (pubic/ crab lice)

Etiologic Agent: Malassezia furfur (normal human flora that can be an opportunistic
pathogen)
Incidence: puberty age (men & women equal)
Manifestations Treatment:
• Abnormal pigmentation (white to reddish brown) Head Lice
• Fine, dust-like scale covers the lesions • Dusting the scalp with 1% malathion powder
• Mild pruritus • Massage gamma benzene hexachloride shampoo on the scalp for 4 minutes then rinse
Treatment Modalities Body Lice
Topical antifungal agents: • Laundry (dry clean) or boil the clothing a beddings
• Micoconazole • Good body hygiene
• Ciclopirox colamine Crab Lice
• Propylene terbinafine • Kwell or Gamene (lindane) cream or lotion
• Benzoyl peroxide • Rub crotaminon (Eurax, Geigy) into the affected area and repeat after a week
Nursing Management • Simultaneously treat the person who had sexual contact with the patient
1. Use clean cloth and wash towel daily • Remove remaining nits mechanically
2. Dry all skin areas and folds thoroughly
3. Wear clean, cotton clothing next to the skin
❖ Scabies – age-old skin infection caused by itch mite

❖ Tinea barbae (Barber’s itch) - colonization of the bearded areas of the face and
neck

Etiologic Agent: Sarcoptes scabiei

Incubation Period: The itch mite may burrow under the skin and lay ova within 24 hours
Etiologic Agent: Trichophyton mentaggrophytes, trichophyton verrocosum Period of Communicability: Entire period that the host is infected
Mode of Transmission Mode of Transmission
1. Contact with cattle, dogs or other animals 1. Direct transmission of an infected individual
2. Indirect contact – shavers used in barber shops 2. Sleeping in an infested bed or wearing infested clothing
3. Contact with dogs, cats and small animals
Manifestations
Manifestations
1. Mild superficial – erythema, papules and pustules
• Itching (more pronounce at night)
2. Inflammatory or deep – pustular and kerion crusting around the hair (loose and • Lesions are slightly elevated, straight or twitching burrows, thread-like that are
brittle); permanent alopecia either brown or black in color (5 to 6 mm in length)
3. Circinate variety – spreading vesiculopustular border with central scaling Common sites: spaces between fingers, warm folds of the skin
Management Males: External genitalia
• Systemic antifungal (2-3 weeks) – griseofulvin, ketoconazole, fluconazole, Females: Crotch area, around nipples, peri-umbilical area
itraconazole, terbinafine Infants: Head and neck
• Secondary lesions: Vesicles, papules, pustules, excoriations and crusts
❖ Tinea Corporis/ Trichophytosis (Ringworm) • Bacterial super infection may result from constant excoriation of burrows &
papules
Diagnostic Procedure
➢ A drop of mineral oil placed over the burrow, followed by a superficial
scraping and examination of expressed material under a low-power
microscope, may reveal the mite, ova, or mite feces
2 Types:
1. Dry type – with rounded macular areas of reddish or yellowish-brown color in varying
size to as large as a coin; sometimes elevated above the skin
2. Moist type – less common; may arise from the dry lesion and rapidly becomes
pustular Treatment
Prevention and Control • Pediculicide ( 5% permethrin cream, Crotamiton or lindane lotion)
1. Avoid contact with infected animal ✓ Instruct patient to take a warm, soapy bath; allow skin to cool; apply for 5
2. Avoid sharing comb or razors consecutive nights to entire body, not including the face or scalp; leave on
3. Observe personal hygiene for 12 to 24 hours
• Neosporin ointment 4-5x/day
PARASITIC SKIN INFECTIONS
• Eurax and Kwell may also be effective
❖ Pediculosis (Phthiriasis)
– Three varieties of these flattened, wingless insects commonly attack man, • Wash clothing and bedding in hot water and dry in a hot dryer
although some infect the lower forms of animals and may become • Treat all contacts at the same time
temporarily deposited upon human host • Pruritus may continue for several weeks and does not mean retreatment is required
• Perform terminal disinfection
• Avoid contact with infected persons