Scribd
Upload
22 views58 pages

Skin Infections

Uploaded by

zekarias wondafrash
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
22 views58 pages

Skin Infections

Uploaded by

zekarias wondafrash
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 58

Skin Infections and cancer

By
Dr. yasir hassan
Erysipelas and Cellulitis

• Spreading bacterial infection of the skin

• Erysipelas involves the dermis and


upper subcutaneous tissue

• Cellulitis involves the deep


subcutaneous tissue
Risk factors

• Immunosuppression
• wounds
• leg ulcers
• toeweb intertrigo
• minor skin injury
Presentation
• Most common in the lower limbs

• Local signs of inflammation – swelling erythema,


warmth ,pain

• Lymphangitis

• Systemically unwell with fever, malaise or rigors, particularly


with erysipelas

• Erysipelas is distinguished from cellulitis by a well-defined,


red raised border
Erysipelas
Cellulitis
Management
Antibiotics (e.g. flucloxacillin or benzylpenicillin)

Supportive care including


• Rest
• leg elevation
• sterile dressings
• analgesia
Complications

• Local necrosis
• abscess
• septicaemia
Staphylococcal scalded skin syndrome

• Commonly seen in infancy and early childhood

Cause :
• Production of a circulating epidermolytic
toxin from phage group II, benzylpenicillin-
resistant (coagulase positive) staphylococci
Presentation
• worse over the face, neck, axillae or
groins
• A scald-like skin appearance
• followed by large flaccid bulla
• Perioral crusting is typical
• intraepidermal blistering
• Lesions are very painful
Management
• Antibiotics (e.g. a systemic
penicillinase-resistant penicillin,
fusidic acid, erythromycin or
cephalosporin)

• Analgesia
Superficial fungal infections

• dermatophytes (tinea/ringworm)

• yeasts (e.g. candidiasis,


malassezia)

• moulds (e.g. aspergillus)


dermatophytes
Tinea corporis (trunk and limbs)
• Itchy, circular or annular
lesions with a clearly defined,
raised and scaly edge
Tinea cruris (groin and natal cleft)
• Very itchy, similar to tinea
corporis
Tinea pedis (athlete’s foot)
• moist scaling and
fissuring in toewebs
Tinea manuum (hand)
• scaling and dryness
in the palmar
creases
Tinea unguium (nail)
• yellow
discolouration,
thickened and
crumbly nail
Tinea capitis (scalp)
• patches of broken
hair, scaling and
inflammation
Tinea incognito (inappropriate treatment of
tinea infection with topical or systemic
corticosteroids)
• Ill-defined and less scaly lesions
Candidiasis (candidal skin infection)

white plaques on mucosal areas, erythema with


satellite lesions in flexures
Pityriasis/Tinea versicolor (infection with
Malassezia furfur)
• Scaly pale brown patches on upper trunk that
fail to tan on sun exposure
• usually asymptomatic
diagnosis
• Dermatophytes : skin scrapings, hair
or nail clippings

• yeasts : skin swabs


Management
• Topical antifungal agents (e.g. terbinafine cream)

• Oral antifungal agents (e.g. itraconazole) for severe,


widespread, or nail infections

• Avoid the use of topical steroids – can lead to tinea


incognito

• Correct predisposing factors where possible (e.g.


moist environment, underlying immunosuppression)
Scabies

• Scabies is caused by the mite Sarcoptes scabiei


• spread by prolonged skin contact.
• It typically affects children and young adults.
• The scabies mite burrows into the skin, laying its eggs
in the stratum corneum.

The intense pruritus associated with scabies is due to a


delayed type IV hypersensitivity reaction to
mites/eggs which occurs about 30 days after the
initial infection.
Features

• Widespread pruritus.
• Linear burrows on the side of fingers,
interdigital webs and flexor aspects of the
wrist.
• In infants the face and scalp may also be
affected.
• Secondary features are seen due to scratching:
excoriation, infection.
Diagnosis

by demonstrating Sarcoptes scabiei


on skin scrapings.
Management
• Permethrin 5% is first-line
• Malathion 0.5% is second-line
• Antihistamine
• Ivermectin

Pruritus persists for up to 4-6 weeks


post eradication.
advices
• Avoid close physical contact with others until treatment is
complete.

• All household and close physical contacts should be treated at


the same time, even if asymptomatic.

• Launder, iron or tumble dry clothing, bedding, towels, etc., on


the first day of treatment to kill off mites.

• Apply the insecticide cream or liquid to cool, dry skin.

• Pay close attention to areas between fingers and toes, under


nails, armpit area, creases of the skin such as at the wrist and
elbow.
skin cancer
can be divided into:

• non-melanoma (basal cell carcinoma and


squamous cell carcinoma)

• melanoma (malignant melanoma).


Basal cell carcinoma

• Most common malignant skin tumour

• A slow-growing, locally invasive malignant


tumour of the epidermal keratinocytes

• normally in older individuals

• only rarely metastasises


Risk factors

1. UV exposure
2. history of frequent or severe sunburn in
childhood
3. skin type I (always burns, never tans)
4. increasing age
5. male sex
6. Immunosuppression
7. previous history of skin cancer
8. genetic predisposition
Presentation
Various morphological types including :
1/nodular (most common)
• small, skin-coloured papule or nodule with
surface telangiectasia, and a pearly rolled
edge
• the lesion may have a necrotic or ulcerated
centre (rodent ulcer)
• Most common over the head and neck
2/superficial (plaque-like)
3/cystic
4/morphoeic (sclerosing)
5/keratotic
6/pigmented
Management
1. Surgical excision - treatment of choice
2. Radiotherapy - when surgery is not
appropriate
3. Cryotherapy
4. Curettage and cautery
5. Topical photodynamic therapy
• Complications : Local tissue invasion
and destruction
Squamous cell carcinoma

• A locally invasive malignant tumour of the


epidermal keratinocytes or its appendages

• has the potential to metastasise

• Presentation : Keratotic (e.g. scaly, crusty), ill-


defined nodule which may ulcerate
Risk factors
1. excessive UV exposure
2. pre-malignant skin conditions (e.g.
actinic keratoses)
3. chronic inflammation (e.g. leg ulcers,
wound scars)
4. immunosuppression
5. Genetic predisposition
Management
• Surgical excision - treatment of
choice

• Radiotherapy - for large, non-


resectable tumours
Malignant melanoma

• An invasive malignant tumour of the


epidermal melanocytes

• which has the potential to metastasise

• More common on the legs in women and


trunk in men
Risk factors
1. excessive UV exposure
2. skin type I (always burns, never tans)
3. history of multiple moles or atypical
moles
4. family history or previous history of
melanoma
Presentation
The ‘ABCDE Symptoms’ rule:

• Asymmetrical shape
• Border irregularity
• Colour irregularity
• Diameter > 6mm
• Evolution of lesion (e.g. change in size and/or
shape)
• Symptoms (e.g. bleeding, itching)
Types
1. Superficial spreading melanoma :

• common on the lower limbs

• in young and middle-aged adults

• related to intermittent high intensity UV


exposure
2.Nodular melanoma

• common on the trunk

• in young and middle aged adults

• related to intermittent high-intensity UV exposure


3.Lentigo maligna melanoma

• common on the face

• in elderly population

• related to long-term cumulative UV exposure


4.Acral lentiginous melanoma :

• common on the palms, soles and nail beds

• in elderly population

• no clear relation with UV exposure


Management
• Surgical excision - definitive
treatment
• Radiotherapy may sometimes be
useful
• Chemotherapy for metastatic disease
Prognosis
Recurrence of melanoma based on Breslow
thickness (thickness of tumour):

• <0.76mm thick – low risk

• 0.76mm-1.5mm thick – medium risk

• >1.5mm thick – high risk


TNM classification
(primary Tumour, regional Nodes, Metastases)
5-year survival rates

• stage 1 (T <2mm thick, N0, M0) - 90%

• stage 2 (T>2mm thick, N0, M0) – 80%

• stage 3 (N≥1, M0) – 40- 50%

• stage 4 (M ≥ 1) – 20-30%

You might also like