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Describe dermatitis, diagnostic criteria, and treatment modalities
Dermatitis is essentially an inflammatory reaction to an external factor. The skin reacts in an abnormal way to the external factor, sometimes there is a genetic factor playing a role in this as well. In many instances, dermatitis is an allergic response, but there are irritant forms of dermatitis that are not allergic in nature. With allergic contact dermatitis (ACD) a typical allergic response occurs, T cells are activated, which then release cytotoxins, cytokines, and chemokines, recruitment of immune cells like eosinophils and macrophages occurs. Atopic dermatitis shows an increase in immunoglobulin E and has a genetic factor that is attributed to the condition. Filaggrin (FLG) gene mutations are the genetic factor attributed to atopic dermatitis (Virginia Poole Arcangelo et al., 2017). Dermatitis is diagnosed based on clinical presentation. While there are tests that could be performed, such as blood work to determine eosinophil or immunoglobulin E levels, diagnosis is typically made based on what the provider sees (Kulthanan et al., 2021). In both irritant and allergic contact dermatitis, vesicles, pruritic blisters, and papules with line-like streaks may be observed. When it is an irritant causing dermatitis, the lesions will be localized to the area of exposure. When dermatitis is allergic in nature, the lesions may be less localized and more diffuse. Moisturizers should be applied liberally to improve skin hydration and repair damaged skin for those with irritant contact dermatitis. There are also barrier creams that can be utilized as well as switching to cotton and other soft fabrics. Prevention is key when it comes to contact dermatitis, however, when prevention is not achieved, there are therapeutics that can be utilized. For mild symptoms, oatmeal baths and cool compresses may alleviate symptoms. If these techniques do not alleviate the symptoms or if the symptoms are moderate to severe, medications may be utilized. Choosing the best medication option for the patient becomes essential. For instance, a patient may be opposed to putting a greasy ointment or gel on their face, a cream may be the best option for them. Ointments and gels are typically the best option as they provide the best protective barrier. Creams are a little more diluted and lotions are even more diluted. For the hair, an alcohol-based solution would be the best option as it can be applied without causing coating or clumping in the hair (Virginia Poole Arcangelo et al., 2017).
Conjunctivitis drug therapies are determined based on the type of conjunctivitis. For bacterial conjunctivitis, an ointment such as erythromycin or bacitracin is typically used.Vernal/Atopic and Seasonal conjunctivitis, or Hay Fever, can be treated with a topical antihistamine such as alcaftadine. The provider may decide to add a mild corticosteroid. If this is a recurrent issue for the patient, an antihistamine with mast cell stabilizer properties may be utilized and possibly the ophthalmic form of Toradol may be utilized for those with seasonal conjunctivitis. For viral conjunctivitis, topical antihistamines or artificial tears, or cold compresses. Giant Papillary Conjunctivitis is typically related to contact usage. Patients may be advised to change their contacts more frequently, use mast cell stabilizers, change the way they clean their contacts, or in severe cases, they may be advised to stop wearing contact lenses while they take a regiment of corticosteroids. For patients with keratoconjunctivitis sicca, or dry eye syndrome, is treated by trying to change the environmental factors that cause it, but if that is not successful, the patient may be prescribed artificial tears, ocular lubricants, cholinergics, and/or anti-inflammatory drops. For otitis media, the most common drug therapy prescribed is amoxicillin or amoxicillin-clavulanate. If a patient is allergic to penicillin based products, a cephalosporin or clindamycin may be prescribed in its place (Virginia Poole Arcangelo et al., 2017).
There are seven types of herpes viruses that can infect humans. The most commonly known being herpes simplex virus (HSV) types 1 and 2, and herpes-zoster virus, the cause of chickenpox and shingles. More uncommonly known forms of herpes includes Epstein-Barr virus, cytomegalovirus, and human herpes viruses types 6 and 8. Usually HSV-1 is associated with the waist and above, typically being found in the mouth, eyes, and on and around the lips. HSV-2 is typically associated with the genitals and below the waist. Lesions are typically found on the genitals of males and females. Varicella-zoster (chickenpox) is typically associated with children but people of any age can be infected, and shingles is the re-activated form of herpes-zoster that typically appears in the elderly who have had chickenpox in the past. Epstein-Barr is closely associated with mononucleosis, HHV-6 is associated with roseola, and HHV-8 is associated with Kaposi sarcoma. Patients with HSV-1 typically have painful, tingling, itchy, burning vesicles on the face, mouth, lips, or pharynx. There may be one vesicle or several vesicles over an erythematous area. The vesicles become pustules and then crust over and erode. Lesions typically recur at the same site. HSV-2 presents with the same type of presentation, only in the genital area. Patients with chickenpox present with fever and muscle pain, followed by itchy vesicles over an erythematous area. The vesicles typically appear first on the trunk and spread to the extremities and face. Patients with shingles usually have neuralgia first, then vesicles on an erythematous area appear. The vesicles are typically unilateral and mainly on the trunk. Patients may also experience fever, localized pain, and muscle aches (Virginia Poole Arcangelo et al., 2017). Epstein Barr Virus presents as infectious mononucleosis. Patients present with fever, myalgia, swollen neck lymph nodes, and sore throat (Bhattacharjee et al., 2022). Cytomegalovirus can be difficult to diagnose as it can present in many different ways. Some symptoms can include fever of unknown origin, fatigue, night sweats, and weight loss. These symptoms paired with lymphocytosis and/or liver enzyme disturbances can suggest cytomegalovirus (Schattner, 2024). Patients with HHV-6 typically present with fever, seizures, altered mental status, and a rash (King & Al Khalili, 2020). HHV-8 on the other hand is typically asymptomatic and only found through tissue biopsy. It can have mononucleosis-like symptoms, but this is not common (Rewane & Tadi, 2022). There are different medications that can be used to treat the different forms of herpes. The most common medications prescribed are topical solutions such as acyclovir and penciclovir and systemic therapies such as acyclovir, famciclovir, and valacyclovir (Virginia Poole Arcangelo et al., 2017).
The more commonly treated primary bacterial skin infections are impetigo, cellulitis, folliculitis, felons, and paronychias. The bacteria associated with these conditions may be staphylococcus aureus, group A streptococcus, haemophiles influenzae B, streptococcus pneumoniae, pseudomonas aeruginosa, klebsiella species, Enterobacter species, and Escherichia coli. Treatment for these and most bacterial skin infections are accomplished with broad-spectrum penicillins such as amoxicillin-clavulanate, 1st, 2nd, and 3rd generation cephalosporins such as cephalexin, cefaclor, and ceftriaxone, fluoroquinolones, such as levofloxacin, and others such as clindamycin, linezolid, and vancomycin (Virginia Poole Arcangelo et al., 2017).
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Question 1: Describe dermatitis, diagnostic criteria, and treatment modalities
Dermatitis refers to inflammation of the skin and manifests in several forms, including atopic dermatitis, contact dermatitis, and seborrheic dermatitis. It is characterized by symptoms like erythema, pruritus, dryness, and with few cases having vesicles. The diagnosis involves a detailed evaluation of the patient’s history, physical examination, and symptom presentation. For atopic dermatitis, specific diagnostic criteria include a chronic or relapsing pattern of eczema with lesions in the flexural areas such as the elbows or knees. Additionally, a personal or family history of asthma, allergic rhinitis, or eczema may also be present. Effective management depends on the type and severity of the condition (Makhmudovich, 2023).
Topical corticosteroids remain the first-line treatment to reduce inflammation and alleviate itching. They are applied in short courses to minimize side effects. Moisturizers are crucial for maintaining the skin barrier and preventing flare-ups. Regular use can help reduce the frequency of corticosteroid application. Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are preferred for long-term management and for treating sensitive areas like the face. Antihistamines are often used to relieve itching, particularly at night, though their effectiveness in addressing the root cause of dermatitis is limited. Lifestyle changes are equally important. Patients are encouraged to avoid triggers such as allergens, irritants, and harsh soaps, and to use gentle, fragrance-free skin care products (Makhmudovich, 2023).
Question 2: Describe the drug therapy for conjunctivitis and otitis media
For conjunctivitis, treatment strategies vary depending on the underlying cause. Bacterial conjunctivitis typically presents with symptoms like purulent discharge and redness. It is treated with topical antibiotics, such as erythromycin ophthalmic ointment or trimethoprim-polymyxin B eye drops. In severe cases or those involving systemic involvement, oral antibiotics may be required. Viral conjunctivitis is commonly caused by adenoviruses and presents with watery discharge and redness. Antibiotics are ineffective, so treatment focuses on supportive care, including artificial tears and cool compresses to relieve discomfort. Allergic conjunctivitis is associated with itching, redness, and tearing due to allergens like pollen or dust. Management includes topical antihistamines to reduce the allergic response. Severe cases may benefit from a short course of topical corticosteroids under close supervision to avoid complications like glaucoma or cataracts (Liu et al., 2024).
Otitis media is another common condition, with treatment differing based on the type and severity. Acute otitis media is usually caused by bacterial pathogens like Streptococcus pneumoniae or Haemophilus influenzae. First-line therapy includes amoxicillin, prescribed for 5-10 days depending on the patient’s age and severity of symptoms. If symptoms do not improve within 48-72 hours, or if the patient has a penicillin allergy, alternatives like amoxicillin-clavulanate or cefuroxime can be used. In patients with chronic or recurrent otitis media, patients with frequent episodes may require tympanostomy tubes to facilitate drainage and prevent recurrent infections (El Feghaly et al., 2023).
Question 3: Discuss Herpes Virus infections, patient presentation, and treatment
Herpes virus infections are caused by herpes simplex virus and varicella-zoster virus. HSV-1 is associated with oral or facial lesions, while HSV-2 typically causes genital lesions. Symptoms include clusters of painful vesicles on an erythematous base, which may be accompanied by systemic symptoms such as fever or malaise. Antiviral medications, including acyclovir, valacyclovir, and famciclovir, are the main medications for treatment. These medications help to reduce the severity and duration of outbreaks. For patients with frequent recurrences, suppressive therapy with daily antiviral medication is recommended to reduce the frequency of episodes (Zubchenko et al., 2022).
Varicella-zoster virus causes two distinct conditions: chickenpox and shingles. Chickenpox presents as a widespread, pruritic vesicular rash with fever and malaise. Reactivation of the virus later in life results in shingles, characterized by a painful, dermatomal rash. Treatment includes antiviral therapy (valacyclovir or acyclovir), which is most effective when initiated within 72 hours of rash onset. Pain management for postherpetic neuralgia may involve NSAIDs, opioids, or gabapentin (Zubchenko et al., 2022).
Question 4: Describe the most common primary bacterial skin infections and the treatment of choice
Primary bacterial skin infections include impetigo, cellulitis, and folliculitis. Impetigo is most often caused by Staphylococcus aureus or Streptococcus pyogenes. Mild cases can be treated with topical antibiotics such as mupirocin or retapamulin, while extensive lesions require oral antibiotics like cephalexin or clindamycin. Cellulitis is typically caused by Streptococcus pyogenes or Staphylococcus aureus, and presents as an erythematous, warm, and tender area of skin. Mild cases are treated with oral antibiotics, such as cephalexin or amoxicillin-clavulanate, while severe cases may require intravenous antibiotics like ceftriaxone. Folliculitis and furuncles are localized infections of hair follicles, usually caused by Staphylococcus aureus. Mild cases may resolve with warm compresses, but topical antibiotics like mupirocin are used for localized infections. For more severe or recurrent infections, oral antibiotics such as clindamycin or doxycycline are recommended (Buckley, 2021).
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