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Chapter 053. Eczema and Dermatitis (Part 10)

Ecthyma is a variant of impetigo that causes punched-out ulcerative lesions. It may result from neglected or inadequately treated impetigo. Treatment of both ecthyma and impetigo involves gentle debridement of adherent crusts, which is facilitated by the use of soaks and topical antibiotics, in conjunction with appropriate oral antibiotics. Furunculosis is also caused by S. aureus, and this disorder has gained prominence in the last decade because of CA-MRSA. A furuncle, or boil, is a painful, erythematous, nodule that can occur on any cutaneous surface. The lesions may be solitary but are most often multiple. Patients frequently believe they. | Chapter 053. Eczema and Dermatitis Part 10 Ecthyma is a variant of impetigo that causes punched-out ulcerative lesions. It may result from neglected or inadequately treated impetigo. Treatment of both ecthyma and impetigo involves gentle debridement of adherent crusts which is facilitated by the use of soaks and topical antibiotics in conjunction with appropriate oral antibiotics. Furunculosis is also caused by S. aureus and this disorder has gained prominence in the last decade because of CA-MRSA. A furuncle or boil is a painful erythematous nodule that can occur on any cutaneous surface. The lesions may be solitary but are most often multiple. Patients frequently believe they have been bitten by spiders or insects. Family members or close contacts may also be affected. Furuncles can rupture and drain spontaneously or may need incision and drainage which may be adequate therapy for small solitary furuncles without cellulitis or systemic symptoms. Whenever possible lesional material should be sent for culture. Current recommendations for methicillin-sensitive infections are 0-lactam antibiotics. Therapy for CA-MRSA was discussed previously see Atopic Dermatitis . Warm compresses and nasal mupirocin are helpful therapeutic additions. Severe infections may require IV antibiotics. Table 53-5 Common Skin Infections Clinical Features Etiologic Agent Treatmen t Impetigo Honey-colored crusted papules plaques or bullae Group A Streptococcus and Staphylococcus aureus Systemic or topical antistaphylococc al antibiotics Dermatophytes is Inflammatory or noninflammatory annular scaly plaques may have hair loss groin involvement Trichophyto n Epidermophyton or Microsporum Topical azoles systemic griseofulvin terbinafine or spares scrotum hyphae on KOH preparation sp. azoles Candidiasis Inflammatory papules and plaques with satellite pustules frequently in intertriginous areas may involve scrotum pseudohyphae on KOH preparation Candida albicans and other Candida species Topical .