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Sycosisvulgaris ,[object Object]
causativeorganism: staph aureus
Sexandage :males after puberty
Site: beard and moustache
Morphology :   discrete , erythematous follicular papules or pustules from which hair emerge  perifollicular edema  ,[object Object],[object Object]
Local antibiotic on the beard and nose General :     - Cloxacillin  ( anti- staph )
Def :        superficial mild chronic infection of the skin Etiology :coryneobactriumminutissimum Site : feet, groins, axillae, and submammary areas, which mimics epidermal dermatophyte infections Predisposing factor  : Obisity , DM  occlusive clothing/shoes Anaemia Hyperhydrosis Increased humidity  Erythrasma(Greek, "red spot")
Clinical picture :  Subjective symptoms : ,[object Object]
Mild irritation in the grionMorphology  :  - Dry , slightly scaly yellowish brown patches with  sharply defined irregular  border  ,[object Object],Localization :  Flexures , axillae , inner aspect of the thighs , umbilicus  Anal  cleft , under the beast in obese females  Bilatral
Erythrasma: groins Sharply marginated, brownish-red, slightly scaling macular patch on the medial thigh (infectious intertrigo) appears bright coral-red when examined with a Wood's lamp.
Erythrasma: webspaceThis macerated interdigitalwebspaceThe  webspaceis the most common site for erythrasma in temperate climates
DD :  intertrigo Pitryasisversicolar Taeniacruris  : erythematous scaly patch with active border  Seborrheic dermatitis  Psoriasis  Candidal dermatitis
Laboratory Examinations Wood'sLamp     demonstration of the characteristic coral-red fluorescence DirectMicroscopy Negative for fungal forms on KOH preparation of skin scraping. In the webspaces of the feet, concomitant interdigitaltineapedis may also be present. Gram or Giemsa stains may show fine bacterial filaments. BacterialCulture Heavy growth of Corynebacterium. Staph aureus, group A strep, and Candida infection.  In some cases, concomitant Pseudomonas aeruginosawebspace infection (feet) is also present. Diagnosis Clinical findings, absence of fungi on direct microscopy, positive Wood's lamp examination.
Treatment :  General :  Erythromycin 1gm daily for 2w , Local :              local antifungal : e g  Tolnaftatetwice daily for 2-3w  Imidazole derivative cream twice daily for 2-3w  Sodium fusidate ointment, Benzoylperoxide (2.5%) gel daily after showering for 7 days
Pitted Keratolysis (Keratolysis Sulcata) (PK) presents as defects in the thickly keratinized skin of the plantar  foot with eroded pits of variable depth, caused by Kytococcussedentarius. AgeYoung adults    &  Sex  Males > females Predisposing Factors    as erythrasma K. sedentarius produces proteases  which digest keratin. Skin Symptoms Usually asymptomatic. Foot odor, sliminess of feet. Uncommonly, itching, burning, tenderness.  Often mistaken for tineapedis. Skin Lesions  Crater-like pits in stratum corneum Involved areas are white when stratum corneum is fully hydrated  Symmetric or asymmetric involvement of both feet
Pitted keratolysis: plantar The stratum corneumshows loss of keratinization with well-dermarcatedmargins,  Pitted keratolysis: toePitted epidermis of an intertriginous toe, associated with hyperhidrosis
Abscess, Furuncle, andCarbuncle Def : abscessis an acute or chronic localized inflammation, associated with a collection of pus and tissue destruction A furuncle is an acute, deep-seated, red, hot, tender nodule or abscess that evolves from a staphylococcal folliculitis A carbuncleis a deeper infection composed of interconnecting abscesses usually arising in several contiguous hair follicles.
Etiology : Causativeorganism : staph  aureus Predisposingfactors:  Pressure ,friction ,irritation of skin in exposed areas and extensor  surface  Chronic S. aureuscarrier state (nares, axillae, perineum, vagina)  Diabetes mellitus Obesity  Poor hygiene  &  Bactericidal defects (e.g., chronic granulomatous disease)  Chemotactic  defects  Hyper-IgE syndrome (Job's syndrome)  HIV disease, especially MRSA infection

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Sycosis Vulgaris

  • 1.
  • 4. Site: beard and moustache
  • 5.
  • 6. Local antibiotic on the beard and nose General : - Cloxacillin ( anti- staph )
  • 7. Def : superficial mild chronic infection of the skin Etiology :coryneobactriumminutissimum Site : feet, groins, axillae, and submammary areas, which mimics epidermal dermatophyte infections Predisposing factor : Obisity , DM occlusive clothing/shoes Anaemia Hyperhydrosis Increased humidity Erythrasma(Greek, "red spot")
  • 8.
  • 9.
  • 10. Erythrasma: groins Sharply marginated, brownish-red, slightly scaling macular patch on the medial thigh (infectious intertrigo) appears bright coral-red when examined with a Wood's lamp.
  • 11. Erythrasma: webspaceThis macerated interdigitalwebspaceThe webspaceis the most common site for erythrasma in temperate climates
  • 12. DD : intertrigo Pitryasisversicolar Taeniacruris : erythematous scaly patch with active border Seborrheic dermatitis Psoriasis Candidal dermatitis
  • 13. Laboratory Examinations Wood'sLamp demonstration of the characteristic coral-red fluorescence DirectMicroscopy Negative for fungal forms on KOH preparation of skin scraping. In the webspaces of the feet, concomitant interdigitaltineapedis may also be present. Gram or Giemsa stains may show fine bacterial filaments. BacterialCulture Heavy growth of Corynebacterium. Staph aureus, group A strep, and Candida infection. In some cases, concomitant Pseudomonas aeruginosawebspace infection (feet) is also present. Diagnosis Clinical findings, absence of fungi on direct microscopy, positive Wood's lamp examination.
  • 14. Treatment : General : Erythromycin 1gm daily for 2w , Local : local antifungal : e g Tolnaftatetwice daily for 2-3w Imidazole derivative cream twice daily for 2-3w Sodium fusidate ointment, Benzoylperoxide (2.5%) gel daily after showering for 7 days
  • 15. Pitted Keratolysis (Keratolysis Sulcata) (PK) presents as defects in the thickly keratinized skin of the plantar foot with eroded pits of variable depth, caused by Kytococcussedentarius. AgeYoung adults & Sex Males > females Predisposing Factors as erythrasma K. sedentarius produces proteases which digest keratin. Skin Symptoms Usually asymptomatic. Foot odor, sliminess of feet. Uncommonly, itching, burning, tenderness. Often mistaken for tineapedis. Skin Lesions Crater-like pits in stratum corneum Involved areas are white when stratum corneum is fully hydrated Symmetric or asymmetric involvement of both feet
  • 16. Pitted keratolysis: plantar The stratum corneumshows loss of keratinization with well-dermarcatedmargins, Pitted keratolysis: toePitted epidermis of an intertriginous toe, associated with hyperhidrosis
  • 17. Abscess, Furuncle, andCarbuncle Def : abscessis an acute or chronic localized inflammation, associated with a collection of pus and tissue destruction A furuncle is an acute, deep-seated, red, hot, tender nodule or abscess that evolves from a staphylococcal folliculitis A carbuncleis a deeper infection composed of interconnecting abscesses usually arising in several contiguous hair follicles.
  • 18. Etiology : Causativeorganism : staph aureus Predisposingfactors: Pressure ,friction ,irritation of skin in exposed areas and extensor surface Chronic S. aureuscarrier state (nares, axillae, perineum, vagina) Diabetes mellitus Obesity Poor hygiene & Bactericidal defects (e.g., chronic granulomatous disease) Chemotactic defects Hyper-IgE syndrome (Job's syndrome) HIV disease, especially MRSA infection
  • 19.
  • 20. Furuncle: S. aureus Soft-tissue swelling of the forehead with central abscess formation, nearing rupture Furuncles: S. aureusMultiple areas of folliculitisin the moustache extending to become furuncles
  • 21. Carbuncle: S. aureusA very large, inflammatory plaque with pustules, on the neck. Infection extends down to the fascia and has formed from a confluence of many furuncles. Multiple furuncles: Multiple, painful ulcerated nodules on the buttocks of a 20-year-old male, occurring during hospitalization for ulcerative colitis.
  • 22. DD : Acne vulgaris Bockhart impetigo Herpes simplex Sweat rash Treatment : Local measures : - hot compressing - pirecing the pointed surface to discharging pus - cleaning the area by local antibiotic - a void occlusive dressing 2. General : antibiotic as penicillin & flucloxacillin .