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Toronto Notes 2019 Infections Dermatology D31
Treatment for Warts
• firstlinetherapies
■ salicylic acid preparations (patches, solutions, creams, ointments), cryotherapy, topical cantharone
• secondlinetherapies
■ topical imiquimod, topical 5-fluorouracil, topical tretinoin, podophyllotoxin
• thirdlinetherapies
■ curettage, cautery, surgery for non plantar warts, CO2 laser, oral cimetidine (particularly children), intralesional bleomycin (plantar warts), trichloroacetic acid, diphencyprone
• othervirusesassociatedwithskinchanges,suchasmeasles,roseola,fifthdisease,etc. • seePediatrics,PediatricExanthems,P51
Yeast Infections
CANDIDIASIS
Etiology
• manyspeciesofCandida(70-80%ofinfectionsarefromCandidaalbicans)
• opportunisticinfectioninthosewithpredisposingfactors(e.g.trauma,malnutrition,immunodeficiency)
Candidal Paronychia
• clinicalpresentation:painfulredswellingofperiungualskin
• management:topicalagentsnotaseffective;oralantifungalsrecommended
Candidal Intertrigo
• clinicalpresentation
■ macerated/eroded erythematous patches that may be covered with papules and pustules, located in
intertriginous areas often under breast, groin, or interdigitally
■ peripheral “satellite” pustules
■ starts as non-infectious maceration from heat, moisture, and friction
• predisposingfactors:obesity,DM,systemicantibiotics,immunosuppression,malignancy
• management:keepareadry,terbinafine,ciclopiroxolamine,ketoconazole/clotrimazolecreambiduntil
rash clears
PITYRIASIS (TINEA) VERSICOLOR
Clinical Presentation
• asymptomaticsuperficialfungalinfectionwithbrown/whitescalingmacules
• affectedskindarkerthansurroundingskininwinter,lighterinsummer(doesnottan) • commonsites:upperchestandback
Pathophysiology
• microbeproducesazelaicacid→inflammatoryreactioninhibitingmelaninsynthesisyieldingvariable pigmentation
• affinityforsebaceousglands;requirefattyacidstosurvive
Etiology
• Pityrosporumovale(Malasseziafurfur)
• alsoassociatedwithfolliculitisandseborrheicdermatitis
• predisposingfactors:summer,tropicalclimates,excessivesweating,Cushing’ssyndrome,prolonged
corticosteroid use
Investigations
• clinicaldiagnosisbutcanperformmicroscopicexamination,KOHprepofscalesforhyphaeandspores
Management
• ketoconazoleshampooorcreamdaily
• topicalterbinafineorciclopiroxolaminebid
• systemicfluconazoleoritraconazolefor7difextensive
Sexually Transmitted Infections
SYPHILIS
Clinical Presentation
• characterizedinitiallybyapainlessulcer(chancre)
• followinginoculation,systemicinfectionwithsecondaryandtertiarystages
Etiology
• Treponemapallidum
• transmittedsexually,congenitally,orrarelybytransfusion
Oral Terbinafine (Lamisil®) is not effective because it is not secreted by sweat glands