Skin and Eyes diseases

• Common Types of Skin Problems

  • Lesion: abnormal skin appearance
  • Vesicles: small fluid-filled lesion
  • Macule: flat, reddened lesion
  • Pustule: raised pus-filled lesion (ex. acne, pimple)
  • Blister: separation of the epidermis from the dermis
• Folliculitis

  • Inflammation of hair follicles is usually caused by skin microbes (ex. S.aureus)
  • This leads to the formation of pustules (pimples)
• Staphylococcal Scalded Skin Syndrome (SSSS)

  • Caused by a rare strain of S.aureus whose toxin causes the epidermis to blister and peeled
  • If infection becomes septic or systemic, can lead to shock and death. (potentially fatal)
  • Affects mostly children under 5, especially neonates(newborns) but recurrence is unlikely due to the high antigenic property of the toxin.
  • Treatment with intravenous antibiotics.
• Methicillin Resistant Staph Aureus (MRSA)

  • Infection by a rare strain of S.aureus(gram-positive) that is resistant to many antibiotics including strong methicillin.
  • If MRSA enters a cut, it usually starts off as a warm, pus-filled, and painful ulcer that does not heal.
  • If the infection becomes septic or spread to other areas, it is serious and can result in septic shock and death
  • FYI, Health Care Associated MRSA vs. Community Associated MRSA(ex. athletes that require contact with others like football)
• Scarlet Fever

  • Caused by Streptococcus pyogenes and mostly occurs in children between 5~15 years old.
  • Signs/symptoms: severe sore throat, high fever, bright red tongue, and sunburn-like rash
  • This can lead to serious immune-complex disease (ex. glomerulonephritis) (kidney damage), rheumatic fever endocarditis(heart valve damage)
• Erysipelas

  • Caused by S.pyogenes and occurs mainly in those who are immunocompromised or unhealthy (other adults, young children, diabetics, obese, alcoholics)
  • Signs/symptoms: large red rash usually on face or legs, fever, chills, general malaise
  • Not typically virulent but can lead to fatal sepsis if untreated.
• Impetigo

  • Caused mostly by Staph aureus, but can be attributed to Streptococcus pyogenes, and Corynebacterium as well.
  • It is highly contagious and commonly occurs in children under 5, mostly males
  • Signs/symptoms: red sores around the nose and mouth which are filled with pus and burst to become brown crusts
  • Prevention is key involving frequent hand washing and avoiding direct contact with the infected.
• Necrotizing fasciitis

  • A rare and “non-contagious” infection caused mostly by Strept.pyogenes., though those with underlying conditions (diabetes, cancer, immunocompromised) are most at risk
  • Toxins cause the breakdown of the fascia, the connective tissue that surrounds muscles, etc. leading to putrefaction (decay or rotting) and sapremia.
  • FYI, avoid hot tubs and other bodies of water if you have a cut on the body
• Acne

  • Caused primarily by skin microbe Propionibactrium feeding on oil and other skin barriers.
  • Leads to inflammation of hair follicles resulting in acne/pimple/pustule If the pustule is deep underneath the skin, it can result in cystic acne (abscess), which can scar the face.
  • FYI, reducing sebum production, keeping the face dry, and taking antibiotics helps in serious cases of acne.
• Gas gangrene

  • Usually caused by strict anaerobic Clostridium perfingens
  • Signs/symptoms: fever, tachycardia, and “air under the skin”
  • Occurs in cases where there is an open wound or trauma and usually on the arms or legs
  • Exotoxin produced by bacteria break down tissues are release various gases and toxic wastes
  • This leads to sepsis/putrefaction/sapremia if not treated.
  • Treatments include debridement, excision, amputation, hyperbaric, oxygen therapy, and antibiotics.
• Rubella (German Measles/3 days Measles)

  • Causes mild flu-like symptoms(general malaise), low-grade fever, swollen lymph nodes, and rashes that start in the face and spread downward
  • Harmful to the fetus especially in the first trimester as it can lead to miscarriage, stillbirth, or birth abnormalities
  • It’s one of the most common causes of congenital (선천적인, 타고난) deafness
  • Immunity via MMR vaccine is highly recommended for children and sexually active women, but questionable for an un-infected pregnant woman
• Measles or Rubeola

  • Highly contagious and causes flu-like symptoms, rashes, high fever, and the formation of Koplik’s spot on the inside of the cheek
  • Signs/symptoms: more severe and last longer about 2~3 weeks.
  • Like smallpox, humans are the only known host
  • FYI, in rare cases, can lead to otitis media, sinusitis, pneumonia, encephalitis, deafness, organ damage, and fetal-related problems
  • Prevention is key via MMR vaccine at 18 months and another at age 4~5. Otherwise rest and vitamin A are helpful
• Chickenpox

  • Varicella-zoster virus that is generally benign
  • Signs/symptoms: mild flu-like with itchy rash that blisters within 3 weeks
  • Aspirin is not recommended for children as it can lead to complications such as Reye’s syndrome and Guillain-Barre syndrome though rare…
  • Reye’s syndrome causes inflammation of the brain and liver and has been associated with taking aspirin and other antipyretics by children and teens.
  • Guillain-Barre syndrome is due to the immune system attacking nerves leading to paralysis etc.
• Shingles

  • Shingles is the “re-activation” of dormant chickenpox virus, mostly in older adults (60 years old+)
  • Shingles cause very painful rash occurring typically on the right or left side of the torso.
  • Vaccine/treatment
  • Vaccine inhibits the reactivation of the virus and helps lessen the symptoms/signs and duration of the disease
  • Vaccine recommended for older susceptible adults
• Smallpox

  • Caused by 2 types of varicella-zoster virus, variola major and variola minor, the former being much more virulent (30% death rate)
  • Symptoms/signs: flu-like symptoms, maculopapular rash(raised flat rash) which scars after healing.
  • Death usually from viremia, pneumonia, over-active immune response, and secondary infection
  • Humans are the only animals that harbor the “smallpox” virus, which was named to differentiate it from the great pox (syphilis)
  • Not routinely vaccinated except for those at high risk.
• Cowpox

  • Causes symptoms similar to smallpox but much more benign and milder.
  • Was used to vaccinate against smallpox by Edward Jenner who is credited with “discovering” vaccination.
  • FYI, the word “vaccination” comes from the Latin word “vaccines” meaning from or of a vow.
• Molluscum Contagiosum

  • The virus causes non-painful raised bumps (papules) and is commonly observed in children under 10 years old
  • In healthy individuals, the bumps usually fade away, so treatment is not necessary
  • It is spread via direct contact.
• Human Papilloma Virus (HPV)

  • A family of viruses that is associated with:
  • Skin warts
  • Genital warts
  • Cancer (ex. anal and penile in men, cervical and anal in women)
  • Transmission via direct contact and according to the CDC, about 80 million (1/4) are infected.
  • Vaccine:
  • Gardasil and Cervarix protect against most HPV associated with cervical cancer
  • Vaccines work only if not already exposed to the viruses, but regardless it’s recommended that vaccines administer to everyone under 40+
• Ringworm (Tinea)

  • Superficial infection with fungus which feeds on the keratin of the skin, nails, and hair
  • Occurs mostly in athletes, particularly wrestlers
  • Causes an enlarging red ring on the skin, but symptoms vary depending on the infection site
  • Fungus thrives in moist, warm areas (ex. locker rooms, swimming pools, skin folds)
  • Types of tinea include: Pedio (foot) / Unguium(nail) / Corporis(body) / Capitis(head) / Cruris(groin)
• Ringworm (Tinea)

  • Superficial infection with fungus which feeds on the keratin of the skin, nails, and hair
  • This occurs mostly in athletes, particularly wrestlers
  • Causes an enlarging red ring on the skin, but symptoms vary depending on the infection site
  • Fungus thrive in moist, warm areas (ex. locker rooms, swimming pools, skin folds)
  • Types of tinea include: Pedio (foot) / Unguium(nail) / Corporis(body) / Capitis(head) / Cruris(groin)
• Sporotrichosis (Rose Gardener’s Disease)

  • A rare disease caused by fungus sporothrix found in soil. plants, moss, etc
  • Entrance of spores onto cuts results in bumps and lesions which enlarge if untreated.
  • More serious if spores are inhaled or fungus gets disseminated in blood, though rare.
• Candidiasis

  • Yeast infection by Candida cervesciae
  • More info in the Urogenito chapter
• Aspergillosis

  • Caused by Aspergillus mold and causes lung infection in susceptible or vulnerable people (ex. elderly, children, immunocompromised)
  • Can be serious if leads to pneumonia and is the main culprit of “mold” in people’s homes.
• Opthalmia neonatorum

  • Conjunctivitis in newborns is caused usually by Neisseria gonorrhea and Chlamydia
  • 0.5% erythromycin or (silver nitrate) was usually applied to the newborn eyes within an hour to prevent blindness.
• Bacterial conjunctivitis (pinkeye)

  • Typically caused by skin microbes (ex. Staph, Strep, Gonococcal and Chlamdydia)
  • In most cases, results in pus-like discharge and severe pain in the eyes
  • Easily treated with antibiotic eye drops.
• Trachoma

  • The leading cause of preventable blindness (1 million worldwide)
  • Caused by repeated infection of Chlamydia trachomatis in the eyes, which damages the cornea
  • Affects mostly the very poor in developing countries living under unsanitary conditions.
• Onchocerciasis (River Blindness)

  • The second leading cause of infectious blindness, behind trachoma
  • Caused by a roundworm or nematode
  • Black flies carrying nematode larvae transmit the disease to humans
  • In humans, the nematode larvae crawl under the skin (intensely itchy) and can get to the eyes
  • When the nematode dies, the human host immune system initiates an inflammatory response to the bacteria, causing tissue damage to the eyes.
• Chigger dermatitis

  • Caused by larval form of mites(saliva)
  • After finding a host, the mites inject digestive enzymes into the skin to break down skin cells, which then consume, causing skin inflammation, irritation, swelling, and rash
  • After feeding the larval mites detach from the skin and develop into adult mites and feed only on plant debris.
• Scabies

  • Caused by microscopic Sarcoptes mites that burrow under the skin, causing intense itching.
  • The itching is an immune response to an unknown mite’s allergen.
• Spider Bites (FYI)

  • 2 common venomous spiders in the US are the black widow and brown recluse
  • Black widow venom is neurotoxic and affects the CNS with symptoms/signs of severe muscle cramps, abdominal pain, weakness, and tremor
  • The brown recluse toxin has a tissue necrotic effect with symptoms/signs of severe pain at the bite site, severe itching, nausea, vomiting, fever, and muscle pain.