Bacterial Infections

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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.

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

Treatment Drugs

  • Benzoyl peroxide gel 2.5-10% topically 1- 2 times daily
  • Doxycycline, 50-l00mg orally daily for 6 weeks in severe cases

Supportive

  • Wash the affected parts with carbolic soap and water 2 to 3 times daily
  • Avoid the use of cosmetics
  • Diet should include plenty of fruits and vegetables
  • Avoid fatty foods

Abscess

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 orally. 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

Impetigo

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 children.
• Cloxacillin, orally:
o Adults: 250 - 500mg 6 hourly for 5 days
o Children: 125 -250mg 6 hourly for 5 days or
• Erythromycin, orally:
o Adults: 250 - 500mg 6 hourly for 5 days
o 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

Eczema

Description

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


Classification of Eczema:

  • Endogenous
    • Atopic (inherited disposition)
    • Seborrhoeic
    • steatosis
    • Discoid (nummular)
    • Unclassified
  • Exogenous
    • Allergic contact dermatitis
    • Primary irritant dermatitis
    • Photo dermatitis

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 0.1% 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 0.03% 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 bathing.
• Antifungal cream such as Miconazole twice a day when fungal elements seen on microscopy.
• 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