In immunocompromised patients: see page 214.
Recurrent herpes labialis
Spontaneous resolution within 7 to 10 days. An antiseptic (chlorhexidine or polyvidone iodine) may be applied; paracetamol PO if necessary.
Both forms of herpes are contagious: do not touch Buy Amoxicillin 500mg Online lesions (or wash hands afterwards); avoid oral contact.
Other infectious causes
Tonsillitis (page 53), diphtheria (page 55), measles (page 189).
For scarlet fever (strawberry tongue associated with a skin rash): phenoxymethylpenicillin (pencillin V) PO for 10 days Children under 1 year: 250 mg/day in 2 divided doses Children from 1 to 5 years: 500 mg/day in 2 divided doses Children from 6 to 12 years: 1 g/day in 2 divided doses Adults: 2 g/day in 2 divided doses
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Stomatitis
Stomatitis from scurvy (vitamin C deficiency)
Clinical features
Bleeding gums, associated in infants with lower limb pain caused by subperiosteal haemorrhage. It is common in contexts of poor food quality or in populations completely dependent on food aid (refugee camps).
Treatment
ascorbic acid (vitamin C) PO
Children: 150 to 200 mg/day in 3 or 4 divided doses Adults: 500 to 750 mg/day in 3 or 4 divided doses
The treatment is continued until symptoms improve (1 to 2 weeks), then Buy Azelaic Acid a preventive treatment (children and adults: 25 to 50 mg/day) is given as long as the situation requires.
Other lesions resulting from a nutritional deficiency
Other vitamin deficiencies may provoke mouth lesions: angular stomatitis of the lips and glossitis from vitamin B2 (riboflavin), niacin (see Pellagra, page 118) or vitamin B6 (pyridoxine) deficiencies.
Iron deficiency may also provoke angular stomatitis (see Anaemia, page 37).
Give the corresponding vitamins at curative doses. Multivitamins are insufficient to treat true vitamin deficiencies.
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CHAPTER 4
Skin diseases
*
Dermatology 97
Scabies 98
Lice (pediculosis) 101
Superficial fungal infections 103
Bacterial skin infections 105
Cutaneous anthrax 109
Treponematoses 111
Leprosy 113
Herpes simplex and herpes zoster 116
Other skin disorders 117
4. Skin diseases
Dermatology
Skin diseases, particularly infectious skin diseases, are very common. They purchase ivermectin for humans must be treated individually or collectively, but must also be considered as indicators of the sanitary condition of a population. A high prevalence of infectious skin diseases may reflect a problem of insufficient water quantity and lack of hygiene in a population.
Dermatological examination
Observe the type of lesion:
Macule: flat, non palpable lesion that is different in colour than the surrounding skin
Papule: small (< 1 cm) slightly elevated, circumscribed, solid lesion
Vesicle (< 1 cm), bulla (> 1 cm): clear fluidfilled blisters
Pustule: vesicle containing pus
Nodule: firm, elevated palpable lesion (> 1 cm) that extend into the dermis or subcutaneous tissue.
Erosion: loss of the epidermis that heals without leaving a scar
Excoriation: erosion caused by scratching
Ulcer: loss of the epidermis and at least part of the dermis that leaves a scar
Scale: flake of epidermis that detaches from the skin surface
Crust: dried serum, blood, or pus on the skin surface
Atrophy: thinning of the skin
Lichenification: thickening of the skin with accentuation of normal skin markings
Look at the distribution of the lesions over the body; observe their arrangement: isolated, clustered, linear, annular (in a ring). Ask if the lesions are itchy.
Look for a possible cause: Buy mebendazole 100mg insect bites; scabies, lice, other parasitic skin infections; contact with plants, animals, jewellery, detergents, etc.
Ask about any ongoing treatment: topical, oral or parenteral.
Look for local or regional signs (secondary infection, lymphangitis, adenopathy, erysipelas) and/or systemic signs (fever, septicaemia, distant infectious focus).
Consider the sanitary condition of the family Buy Cephalexin, particularly for contagious skin diseases (scabies, scalp ringworm, lice).
Check tetanus vaccination status.
Patients with skin disease often present late. At this stage, primary lesions and specific signs may be masked by secondary infection. In these cases, it is necessary to reexamine the patient, after treating the secondary infection, in order to identify and treat the underlying skin disease.
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Scabies
Scabies
Scabies is a cutaneous parasitosis due to the presence of the mite Sarcoptes scabiei hominis within the epidermis. It exists in two forms: ordinary scabies, relatively benign and moderately contagious; and crusted scabies, favoured by immune deficiency, extremely contagious and refractory to conventional treatment. Person to person transmission takes place chiefly through direct skin contact, and sometimes by indirect contact (sharing clothing, bedding). The challenge in management is that it must include simultaneous treatment of both the patient and close contacts, and at the same time, decontamination of clothing and bedding of all persons undergoing Buy Terbinafine 250mg treatment, in order to break the transmission cycle.
Clinical features
Ordinary scabies
In older children and adults
Itching, worse at night, very suggestive of scabies if close contacts have the same symptom
and
Typical skin lesions:
Scabies burrows (common): fine wavy lines of 5 to 15 mm, corresponding to the tunnels made by the parasite within the skin. Burrows are most often seen in the interdigital spaces of the hand and flexor aspect of the wrist, but may be present on the areolae, buttocks, elbows, axillae. The back and the face are spared. Burrows may be associated with vesicles, corresponding to the entry point of the parasite in the skin.
Scabies nodules (less common): reddishbrown nodules, measuring 2 to 20 mm, on the genitals in men, persisting after effective treatment (they are not necessarily indicative of active infection).
and/or
Secondary skin lesions: resulting from scratching (excoriations, crusts) or superinfection (impetigo).
Typical lesions and secondary lesions may coexist, or specific lesions may be entirely
masked by secondary lesions.