Dermatology Primer

Selected Skin Diseases and Treatment

Tailored for the Athletic Trainer
Prepared by Dr. Garth Russo 6.December.2002
Dermatology: Common Pathology

Infectious
Bacterial
Viral
Fungal
Parasitic
Immunologic
Inflammatory
Allergic
Acne
Bacterial Infections
• Staphylococcus aureus and Streptococcus pyogenes account
for the vast majority of skin infections
• Staph and strep have historical and contemporary significance
• Both are part of the normal flora of our skin
• A wide variety of bacteria are associated with unique
circumstances (e.g.. meningitis, tetanus, anthrax, syphilis)
• Bacterial infections are generally opportunistic and locally
tissue destructive stimulating inflammation and pus formation
• Antibiotic resistance issues are significant
Folliculitis
Cellulitis
Impetigo
Boil/Furuncle/Abscess/Carbuncle
Folliculitis: Common
Small pustules located at the base of hairs within
the follicle structure. Generally a staph infection.
Symptoms are generally mild and the course can
be self limited. The condition can be recurrent and
frustrating regardless of treatment.
Warm moist skin (bathing suits)and irritation of
skin (shaving, chafing, drying) are risk factors
Treatment consists of oral or topical antibiotics,
general skin care, support.
The benefit of antibacterial soaps is suspect and
potentially harmful
Folliculitis: Common
Folliculitis: Special Circumstances
Hot tub Folliculitis
• Caused by Pseudomonas aeruginosa found in hot
tubs that are poorly cleaned, especially wooden.
• Appears much like common folliculitis 1-2 days
after exposure, lesions become larger and more
varied in size
• Can be most evident where bathing suits rub
• Very superficial and self limited
• May occasionally be treated with oral antibiotics,
ciprofloxacin or Augmentin
Hot Tub Folliculitis
Folliculitis: Special Circumstances
Pseudofolliculitis barbae (razor bumps)
Tightly curled hairs embed into skin and irritate it
generating raised, reddened papule or pustule
Treated by allowing hair to grow out, using hair growth
inhibitors.
Acne keliodalis
Inflammation from a folliculitis at base of neck,
generally in back, or a pseudofolliculitis makes a
keloid, or hypertrophic scar.
Treated with primary prevention, antibiotics, or local
steroid injections.
Pseudofolliculitis barbae
Acne Keliodalis
Cellulitis
A superficial infection of the skin by a bacteria, usually strep or
staph
Appears as a reddened, raised, tender or painful area with
sharply defined margins. May generate fever, flu symptoms
Often associated with skin trauma
Generally not associated with drainage but can weep
Will progress, if not treated, to a deeper infection
Necrotizing fasciitis (“flesh eating bacteria”)
Treated with antibiotics, generally cephalexin, erythromycin,
dicloxicillin, Augmentin
Cellulitis
Impetigo
The most common skin infection in children
Characterized by various forms; bullous, vesicular, or
pustular. Very superficial
Caused by staph or strep bacteria, and form is often a
function of which bacteria is present
Bullous form is usually staph
Vesicular form begins small and ruptures to form a
characteristic “honey” crust
Can be quite contagious and patients will often auto-infect
themselves by scratching
Treated with anti-staph/strep antibiotics. Topical
mupiricin (Bactroban) effective
Impetigo
Boil, Furuncle, Abscess, Carbuncle
Deeper skin infection with staph or strep bacteria.
Hallmark is tissue destruction, marked inflammatory
response, central necrosis and pus accumulation
Carbuncle is generally a term used for interconnected
abscesses, furuncle if abscessed follicles
Hidradenitis suppurativa is a carbuncle of apocrine
sweat glands, usually in the axilla
The hallmark of treatment is surgical, I&D. Anti-
staph/strep antibiotics are also useful
Abscess
Carbuncle
Furuncle
Hidradenitis Suppurativa
Viral Infections
Herpes Simplex I
Herpes Simplex II
Cutaneous Herpes
Varicella (Chicken Pox)
Vaccinia (Small Pox)
Papiloma Virus (Warts)
Molluscum Contageosum
Viral Exanthems
Herpes Simplex
HSV I
Oral Herpes, fever blister
HSV II
Genital herpes
Cutaneous Herpes
Herpes Gladiatorum
Treatment: Antiviral drugs; reverse transcriptase
inhibitors (RTI’s); acyclovir (Zovirax),
famcyclovir (Famvir) valcyclovir (Valtrex).
Topical acyclovir, penciclovir (Denavir),
docosanol (Abreva)
Response is varied and timing is important for all
Herpes
Virus
Behavior
Oral Herpes
Genital Herpes
Cutaneous Herpes:
Herpes Gladiatorum
Varicella Virus
Chicken Pox
Shingles

• The Varicella virus is in the Herpes Virus family

• Most attained immunity by active infection in past, now vaccine
• Varicella is very dangerous to fetus if pregnant mom gets infected, or
to immunocompromised
• Shingles is a consequence of primary infection, dermatomal
distribution
• Prevention: Varicella vaccine: Children, single dose; Adult, two
separated by 4-6 months
• Shingles associated with post herpetic neuralgia
• Treatment with RTI’s, skin care, anti itch or anti-pain meds, colloid
(oatmeal baths)
• In both cases patients are infectious until lesions crust
Chicken Pox

Chicken pox are characterized by vesicles on a red base of varying shapes and levels of development. There may be
mild fever and flu like symptoms but generally patients are not too sick. Complications, however include pneumonia,
meningitis, encephalitis, and overwhelming sepsis.
Resolution generally occurs by 7 to 10 days.
Shingles
Variola: Smallpox
Smallpox
Eradicated from the US 1949, world (Somalia) in 1977
Two clinical forms; Variola minor and major
Potential weapon of mass destruction
Warts
Common wart
Plantar Wart
Genital Wart
• There are many many species of wart virus
• Can be located anywhere, and different species like different
sites.
• Treatment is generally similar:
 Tissue destruction by freezing, burning, excision, acids, laser
 Chemotherapy; podophyllin
 Immunotherapy; imiquimod, bleomycin, interferon
 Mechanical; smothering/tape
• Can be self limited. 66% of warts resolve within a year
• Some strains are associated with cervical cancer
Common Wart: Verucca Vulgaris
Plantar Wart
Genital Warts
Molluscum Contagiosum
Very contagious pox virus infection, sexually transmittable with reports of
transmission through shared towels and gym equipment. Generally self limited,
made worse by shaving. Can last for months and treatment is usually by tissue
destruction, freezing, acid, needle curettage.
Viral Exanthems
Fungal Infections
• Fungal infections are generally opportunistic, less
communicable (except T. Capitis), more superficial
• Prefer warm, moist, or thickly keratinized skin
• Causes are trichophyton and microsporum species referred to
as dermatophytes. Occasionally yeast or candida
• Generic lesions are inflammatory and appear eczematous,
flaky, red, itchy

Tinea Corporis (on the body)

Tinea Pedis (on the foot)
Tinea Cruris (in the groin area)
Tinea Capitis (on the head)
Fungal Infections:Treatment
Topical antifungal creams are the mainstay of
therapy
Lamisil, Lotrimin, Mycelex, etc. All OTC
Often topical steroids will be used to lessen
inflammatory response. Mycolog, Lotrisone
Tinea versicolor: use of Selsun shampoo, selenium
sulfide common, also oral antifungal in a single dose;
ketoconazole 400mg po once.
Oral therapies needed for nail infections, advanced
athlete’s foot, scalp infections.
Lamisil, Sporonox, Nizoral (ketoconazole),
Griseofulvin, Diflucan all have a place and unique
dosing regimens based on location and type of fungus
Tinea Corporis: Ringworm
Tinea Versicolor
Tinea Pedis: Athlete’s Foot
Tinea Cruris
Tinea Capitis
Tinea Unguium
Parasites:
Scabies
Scabies: Treatment
Lindane (Kwell)
Crotamiton (Eurax)
Permethrin 5% (Elimite)

• Itch is often out of proportion to rash

• Incubation period is about 1 month
• Treatment may have to be repeated in a week
• Clothing and bedding should be washed with hot water
• Intimate contacts should be considered for treatment
• Secondary infection of lesions is common
Immunologic Processes
Inflammatory Conditions
Allergic Responses
Acne
Inflammatory Conditions
Inflammatory Conditions
Eczema
Psoriasis
Contact Dermatitis
Pityriasis Rosea

• Essentially all of these conditions respond to topical and/or

oral steroids
• General principles include skin protection and moisturizers
• Therapy for psoriasis can include immune modulating drugs
like methotrexate, and/or UV therapies, and can be both toxic
and complex
Eczema
Psoriasis
Psoriasis
Contact Dermatitis
Rhus Dermatitis (poison ivy)
Tape Adhesive Dermatitis
Latex Sensitivity

• This class of different conditions accounts for the

majority of occupational skin disease in the US
• A patient can develop sensitivity at any time
• Avoidance is cornerstone of therapy
Contact Dermatitis
Contact Dermatitis
Pityriasis Rosea
Allergic Reactions
Urticaria (hives)

• Urticaria are classically associated with histamine release

generating the “wheal and flare” response typical of a hive
• Cause is typically a drug, food, sting or bite but can be
mechanical, stress related, viral or autoimmune
• Can be acute or chronic
• May represent part of more systemic allergic and life
threatening process
• Treatment includes epinephrine, oral antihistamines, steroids,
cool compresses and avoidance
Urticaria: Hives
Acne
Acne Vulgaris
Other Acne
Rosacea

• Acne is a mixture of mechanical and inflammatory processes

• Treatment involves:
 topical products that dry, irritate, or promote more rapid skin
turnover
 Removal of any external causes (occupational, mechanical,
steroids)
 Oral or topical antibiotics that suppress proprionobacterium
acnes growth
 Oral retinoids (Accutane)that alter sebum production more
permanently
Acne Vulgaris
Closed Comedone (whitehead)
Open Comedone (blackhead)
Pustular Acne
Nodulocystic Acne
Cystic Acne
Papulopustular Acne
Other Acne
Steriod Acne
Neonatal Acne
Occupational Acne
Acne Mechanica
Acne Cosmetica
Excoriated Acne
Steroid Acne
Mechanical/Occupational Acne
Rosacea