Bacterial Infections

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.

Clinical features

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

Drugs
• 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

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

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 Drugs
• 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

Supportive
• Keep fingernails short
• Soak and clean pustules with water and soap
• The patient should be referred to the next level if there is no improvement after 2 weeks

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

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

Drugs

• Aqueous cream, topically 1-3 times daily after bathing or
• Zinc oxide cream, topically 1-3 times daily after bathing
• Betamethasone 1%, topically twice daily for 7 days (for severe or non-responsive cases) or
• Hydrocortisone in, topically twice daily for 7 days
• Zinc and Coal Tar Paste, topically 1 -2 times daily (in chronic cases)
• Chlorpheniramine 4mg 2 times a day
• Erythromycin 500mg 4 times a day for 7 days

Supportive

• Keep fingernails short
• Keep skin hydrated with Oil bath
• The patient should avoid scratching
• Avoid exposure of affected parts to sunlight
• Avoid known irritants e.g. soap, swollen clothing. If there is no improvement in the acute condition after 2 weeks refer to a specialist.

Seborrhoeic eczema

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 Drugs

• Hydrocortisone 1% cream, topically twice daily; Maintenance; once or twice a week as required
• 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.

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.