Bacterial Infections

Description

This is a condition caused by blocked sebaceous glands. It usually begins at or after puberty. The most affected parts are the face, neck, back and chest.

Signs and Symptoms

Occurs in mild form as blackheads and whiteheads (open comedones and closed comedones) and more severe form as nodular lesions, with or without infection.

Treatment

According to the severity of disease. Can be classified as mild, moderate, or severe. Mild forms treated with topical antibiotic and topical retinoid. Moderate form treated with the topical agents in the mild form plus oral doxycycline, minocycline, or azithromycin. The severe form is treated with an oral retinoid. Avoid retinoids in pregnancy.

Pharmacological

• Benzoyl peroxide gel 5-10% topically 1- 2 times daily
• Tretinoin cream 025% - 0.1% topically, preferably at night
• clindamycin cream can apply twice
• Doxycycline, 50-l00mg orally daily
• Isotretinoin 5-1mg/kg orally. Often given as monotherapy for severe acne. Avoid in pregnancy. Confirm that the patient is not pregnancy before initiating the treatment.

Description

This is a collection of pus in the dermis and subcutaneous fat layer of the skin. It occurs as a result of infection
of the hair follicles commonly caused by Staphylococcus aureus.

Signs and Symptoms

The skin surrounding the affected hair follicle becomes red, hot, swollen and tender to touch. In severe cases,
there will be fever and involvement of the local lymph nodes

Treatment

Supportive

• Encourage patient to maintain good general hygiene
  • Apply hot compression 3-4 times daily until abscess is ready for draining.

   

Pharmacological

Cloxacillin

• Adults; 250 - 500mg 6 hourly for 5 days,
• Children; 125 - 250mg orally 6 hourly five days

     OR

Erythromycin

• Adults: 250 - 500mg orally 6 hourly for 5 days,
• Children:125-250mg orally 6 hourly for 5 days

Surgery

• Incision and drainage
• In cases of multiple abscesses, non-response to antibiotic therapy or an abscess in a diabetic, refer to a specialist.

Description

This is a superficial infection of the epidermal layer of the skin by aureus commonly but Streptococcus species may also be involved. Painful vesicles and pustules break down to form scabs or crusts. Impetigo starts on the face and may spread to the neck, hands and legs. It usually occurs in children.

Treatment

Supportive

• Keep fingernails short
• Soak and clean pustules with water and soap

Pharmacological

• Mupirocin ointment TDS for 5 days, for mild forms of the non-bullous form in
• Cloxacillin, orally:
  • Adults: 250 - 500mg 6 hourly for 5 days
  • Children: 125 -250mg 6 hourly for 5 days or
• Erythromycin, orally:
  • Adults: 250 - 500mg 6 hourly for 5 days
  • Children; 125 -250mg 6 hourly for 5 days
• The patient should be referred to the next level if there is no improvement after 2 weeks

Description

Eczema is an inflammatory rash which may be due to endogenous or exogenous factors.

Classification of Eczema

• Endogenous
  • Atopic (inherited disposition)
  • Seborrhoeic
  • Asteatosis
  • Discoid (nummular)
  • Unclassified
• Exogenous
  • Allergic contact dermatitis –Primary irritant dermatitis –photodermatitis

Atopic eczema

Description

This is a condition characterised by an itchy, rough, dry skin. In babies, it occurs mainly in the areas surrounding the knees, elbows and neck whereas in older children and adults it can occur on any part of the body. The itching is intense at night and could become chronic and infected. Where possible the causative factor should be determined before commencing treatment.

Treatment

Supportive

• Recommend 100% cotton clothing
• Keep skin hydrated with Oil bath and short baths
• The patient should avoid scratching

Pharmacological

• Emollient cream, topically 1-3 times daily

        OR

• Tacrolimus ointment (0.03% for children, and 1% for adults), topically 1 to 2 times a day. Can be used for a longer duration than steroids.
• Triamicinolone cream or Betamethasone 1%, topically twice daily for 7 days (for severe or non-responsive cases)

  OR

  • Hydrocortisone in, topically twice daily for 7 days ss

  NB: A cocktail can be made by mixing 3tubes of triamicinolone or the alternative in a 500g of emollient cream) Cetrizine or Chlorpheniramine for very itchy cases

  Avoid known irritants e.g. soap, woollen clothing. If there is no improvement in the acute condition after 2 weeks refer to a specialist.

   

Seborrhoeic eczema

Description

This is a condition characterized by thick adherent scales presenting as a diffuse scaly scalp (dandruff). It may also affect other parts of the body which tend to be oily e.g. facial skin nasolabial folds, eyebrows, eyelashes, external ears, and centre of the back. Variable pruritis and vesicular or scaly lesions may be present. Infantile seborrhoeic eczema occurs in early infancy 24 weeks after birth. Begins with cradle cap (scaly scalp surrounding the anterior fontanelle), spreads to the face, axilla, neck and nappy area. The rash is non-itchy and gets better without leaving marks.

Treatment

• Triamicinolone cream or Hydrocortisone 1% cream, topically twice daily o Maintenance: once or twice a week as required
• Tacrolimus 03% or 0.1% cream can be used once daily for 4weeks
• Zinc oxide cream, topically 1-3 times daily after bathing especially in the nappy area or
• Aqueous cream, topically 1-3 times daily after
• Antifungal cream such as Miconazole twice a day when fungal elements seen on
• Ketoconazole shampoo twice to three times weekly

To reduce scaling and itching of the scalp use keratolytic or antifungal containing shampoos once or twice weekly. Refer patients who do not respond to treatment or have acute oozing eczema to a specialist.