Skin infections

• Impetigo "School Sores"


  Mainly in kids, bullous or non-bullous vesicles, yellow crusts, painful, itchy, red
• Cause of impetigo


  Skin barrier issue allowing Staphylococcus aureus and/or Streptococcus pyogenes to enter
• Prevention and management of impetigo


  1. Contagious, no school until rash clears

  2. Hygiene - incl. don't share towels, short nails
• Medications for impetigo


  • Local skin sores: Topical antibiotic (mupirocin 2%)
  • Multiple areas: Oral antibiotic (di/flucloxacillin)
• Staphylococcus aureus


  Commonly found in human microbiome (skin/nose), opportunistic bacteria, Methicillin Resistant strains (MRSA), can cause mild infections (impetigo) or severe infections (septicaemia, pneumonia)
• Streptococcus pyogenes


  Group A streptococci, certain strains opportunistic, high fatality risk in developing countries (ie rheumatic heart disease), can cause mild infections (impetigo) or severe infections (necrotising fasciitis, strep toxic shock syndrome)
• 92% of ARF diagnosis in Australia between 2017-2021 were among Indigenous Australians
• Folliculitis, boils and carbuncles


  Opportunistic Staphylococcus aureus (+/- Streptococcus pyogenes) infects a follicle
• Prevention and management of folliculitis, boils and carbuncles


  Warm compress 4-5x daily
• Medications for folliculitis, boils and carbuncles


  Antibiotics: di/flucloxacillin (prevent recurrence)
• Styes (hordeolum)


  Internal or external, localised, swollen upper or lower lid, painful, sensitive – pus filled lesion
• Cause of styes


  Staphylococcus (90-95%)
• Prevention and management of styes


  Usually spontaneous resolution, warm compresses 5-10 mins
• Bites and Clenched Fist wounds

  Collect patient history, examine wound, Human bite/wound: S. aureus, Eikenella, Streptococcus, anaerobic bacteria, Animal bite/wound: S. aureus, Pasteurella species, Capnocytophaga etc
• Prevention and management of bites and clenched fist wounds

  Cleaning and irrigation in the first 8hrs
• Medications for infected bites and clenched fist wounds


  ABs for infected bites, deeper wounds, cats, which present after 8hrs, Broad spectrum ab eg. amoxicillin+clavulanic
• Staphylococcus Scalded Skin Syndrome

  Rare, severe superficial blistering skin condition with detachment of the epidermis, Fever, malaise, irritation, Redened, peeling skin

  
• Cause of Staphylococcus Scalded Skin Syndrome


  Toxins in staphylococcal aureus disrupt adhesion between cells, Diabetes, CKD, immunocomp.
• Prevention and management of Staphylococcus Scalded Skin Syndrome

  Antibodies to the toxins acquired during childhood, lower prevalence in older children. Plus renal development – lower clearance of toxins in young children, Pain control, support skin care
• Medications for Staphylococcus Scalded Skin Syndrome


  Ab's fluclox/cefalexin, clindamycin, avoid Topical CS
• Diabetic foot infections


  Local - swelling, erythema, tenderness, warmth, purulent discharge, Peripheral artery disease, neuropathy and trauma to foot cause ulcerations and infections, Peripheral neuropathy consequences, Staph aureus, streptococci, chronic infections
• Prevention and management of diabetic foot infections


  Multidisciplinary approach (nursing, podiatry, vascular, pharmacist GP)
• Medications for diabetic foot infections


  Di/ fluclox.; amoxicillin + clauvulanic acid OR cephalexin + metronidazole, Severe infections: (iv)piperacillin + tazobactam OR ticarcillin+clavulanate +/- Vancomycin, Compression for circulation
• Sodium fusidate (Fucidin)


  Staphylococcal skin infections on specialist advise, Not recommended as it can promote resistance, Oral therapy used for MRSA, For mild skin infections (impetigo) showed similar efficacy
• Silver Sulfadiazine (Flamazine)


  Burn wound, leg ulcers and pressure sore infections
• Acne (acne vulgaris)


  Inflammatory condition – comedones, pustules, papules on face, And areas with more sebaceous glands, ie: forehead, cheeks, chin, back and chest
• Cause of acne


  Increased sebum production, Propionibacterium acnes proliferates, Inflammation
• Sodium fusidate (Fucidin)


  Topical antibacterial medicine for staphylococcal skin infections on specialist advice, not recommended as it can promote resistance, oral therapy used for MRSA, showed similar efficacy for mild skin infections (impetigo)
• Silver Sulfadiazine (Flamazine)


  Topical antibacterial medicine for burn wound, leg ulcers and pressure sore infections
• Acne (acne vulgaris)


  • Inflammatory condition with comedones, pustules, papules on face and areas with more sebaceous glands (forehead, cheeks, chin, back and chest)
  • Caused by increased sebum production and Propionibacterium acnes proliferation leading to inflammation
• Prevention and management of acne


  Clear lesions, prevent scarring
• Medications for acne


  • Topical antibacterial (benzyl peroxide, azelaic acid, clindamycin, dapsone, adapalene)
  • Topical retinoids (adapalene, isotretinoin, tazarotene, tretinoin)
  • Oral antibiotics (tetracyclines, erythromycin)
  • Oral retinoid (isotretinoin)
  • Oral hormonal (cyproterone with ethinylestradiol, spironolactone)
• Topical retinoids


  • Treatment of choice for comedone and inflammatory acne, expel mature comedones, reduce microcomedone formation, and exert anti-inflammatory effects
  • Teratogenic, irritating to skin so introduced gradually, apply to entire affected area, common side effects include erythema, dryness, peeling, irritation, may take months for best effects
• Oral antibiotics for acne


  Used for their anti-inflammatory effect in moderate to severe inflammatory acne, cautions include safety and microbiome
• Oral isotretinoin


  Modulates cell proliferation and differentiation, reduces sebum secretion, used for severe acne or moderate acne responding poorly to other treatments (cystic acne), counselling includes teratogenicity, precautions with psychiatric history, absorption with food, dry skin/lips/eyes/mucous membranes, regular blood tests, no vitamin A supplements, no alcohol, no blood donating, avoid waxing/dermabrasion
• Oral hormonal treatments for acne


  • Cyproterone with ethinylestradiol (combined oral contraceptive) decreases sebum secretion influenced by androgenic activity in women, contraindicated in certain conditions, side effects include breakthrough bleed, nausea, vomiting, breast enlargement, mood changes, fluid retention, thrush
  • Spironolactone (aldosterone agonist) may be used as an adjunct to hormonal treatment
• Consider early referral to a dermatologist for oral isotretinoin if acne is scarring, presents in a patient with a family history of severe scarring acne, is resistant to other treatments, or repeatedly relapses, or has a marked negative emotional and social effect
• ADAPALENE in topical preparations containing 0.1% or less of adapalene is scheduled for the treatment of acne vulgaris in adults and in children over 12 years of age
• Counselling for topical acne treatments includes: wash area with warm water and soap substitute/mild soap, apply a thin layer to affected areas (not just pimples) and gently rub in, avoid contact with eyes, lips and sensitive areas, use oil free moisturisers and toners, minimise picking lesions as this may create scarring, ensure adequate oral hydration and review diet
• OTC product examples for acne


  • Benzoyl peroxide
  • Azelaic acid