Chapter 053. Eczema and Dermatitis (Part 10)

Ecthyma is a variant of impetigo that causes punched-out ulcerative lesions. It may result from neglected or inadequately treated impetigo. Treatment of both ecthyma and impetigo involves gentle debridement of adherent crusts, which is facilitated by the use of soaks and topical antibiotics, in conjunction with appropriate oral antibiotics. Furunculosis is also caused by S. aureus, and this disorder has gained prominence in the last decade because of CA-MRSA. A furuncle, or boil, is a painful, erythematous, nodule that can occur on any cutaneous surface. The lesions may be solitary but are most often multiple. Patients frequently believe they...
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Chapter 053. Eczema and Dermatitis (Part 10) Chapter 053. Eczema and Dermatitis (Part 10) Ecthyma is a variant of impetigo that causes punched-out ulcerative lesions.It may result from neglected or inadequately treated impetigo. Treatment of bothecthyma and impetigo involves gentle debridement of adherent crusts, which isfacilitated by the use of soaks and topical antibiotics, in conjunction withappropriate oral antibiotics. Furunculosis is also caused by S. aureus, and thisdisorder has gained prominence in the last decade because of CA-MRSA. Afuruncle, or boil, is a painful, erythematous, nodule that can occur on anycutaneous surface. The lesions may be solitary but are most often multiple.Patients frequently believe they have been bitten by spiders or insects. Familymembers or close contacts may also be affected. Furuncles can rupture and drainspontaneously or may need incision and drainage, which may be adequate therapyfor small solitary furuncles without cellulitis or systemic symptoms. Wheneverpossible, lesional material should be sent for culture. Current recommendations formethicillin-sensitive infections are β-lactam antibiotics. Therapy for CA-MRSAwas discussed previously (see Atopic Dermatitis). Warm compresses and nasalmupirocin are helpful therapeutic additions. Severe infections may require IVantibiotics. Table 53-5 Common Skin Infections Clinical Etiologic Treatmen Features Agent t Impetigo Honey-colored Group A Systemic crusted papules, Streptococcus and or topical plaques, or bullae Staphylococcus antistaphylococc aureus al antibiotics Dermatophytos Inflammatory Trichophyto Topicalis or noninflammatory n, azoles, systemic annular scaly plaques; Epidermophyton, griseofulvin, may have hair loss; or Microsporum terbinafine, or groin involvement spares scrotum; sp. azoles hyphae on KOH preparation Candidiasis Inflammatory Candida Topical papules and plaques albicans and other nystatin or with satellite pustules, Candida species azoles; systemic frequently in azoles for intertriginous areas; resistant disease may involve scrotum; pseudohyphae on KOH preparation Tinea Hyperpigment Malassezia Topicalversicolor ed or hypopigmented furfur selenium sulfide scaly patches on the lotion or azoles trunk; characteristic mixture of hyphae and spores on KOH preparation (spaghetti and meatballs) Erysipelas and Cellulitis See Chap. 119 Dermatophytosis Dermatophytes are fungi that infect skin, hair, and nails and includemembers of the genera Trichophyton, Microsporum, and Epidermophyton. Tineacorporis, or infection of the relatively hairless skin of the body (glabrous skin),may have a variable appearance depending on the extent of the associatedinflammatory reaction (see Fig. 52-11). Typical infections have an annularappearance that patients refer to as ringworm. Deep inflammatory nodules orgranulomas occur in some infections—especially in those infectionsinappropriately treated with mid- to high-potency topical glucocorticoids.Involvement of the groin (tinea cruris) is more common in males than females. Itpresents as a scaling, erythematous eruption sparing the scrotum. Infection of thefoot (tinea pedis) is the most common dermatophyte infection and is often chronic;it is characterized by variable erythema, edema, scaling, pruritus, and occasionallyvesiculation. Involvement may be widespread or localized but generally involvesthe web space between the fourth and fifth toes. Infection of the nails (tineaunguium or onychomycosis) occurs in many patients with tinea pedis and ischaracterized by opa ...