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Skin Disorders

Lyme Disease

Lyme disease is an infection caused by the spirochete Borrelia burgdorferi, acquired from a tick bite. Ticks live in wooded areas and survive by attaching to a host.

Signs and Symptoms

· First stage

Skin DisordersSymptoms can occur several days to months following the bite. A small red pimple develops that spreads into a ring-shaped rash. Rash may be large or small or may not occur at all. Flulike symptoms occur such as headaches, stiff neck, muscle pains and fatigue.

· Second stage

This stage occurs several weeks following the bite. Joint pain, neurological and cardiac complications occur.

· Third Stage

The large joints become involved and arthritis progresses.

Medical Interventions

· The tick is removed with tweezers and washes the skin with antiseptic and the tick is disposed by flushing it down the toilet.

· A blood test is obtained after 4 to 6 weeks of bite to detect the presence of the disease. Testing in this time is not reliable.

· The antibiotics are only administered if the disease is confirmed.

· The patient is instructed to avoid areas that contain ticks such as wooded grassy areas, especially in the summer months and to wear long-sleeved tops, long pants, closed shoes and hats while outside.

· The patient is also instructed to spray the body with tick repellent before going outside and examine body when returning inside.

Scabies

Scabies is a parasitic skin infection caused by an infestation of the Sarcoptes scabei or itch mite. Scabies is endemic among school children and institutionalized populations because of close personal contact.

The risk factors are personal contact with infected person or contact with a contaminated article. Usually, there is a one month delay of symptoms between the initial infestation and onset of pruritus in the host.

Signs and Symptoms

· Erythematous papules and pustules

· Threadlike, brownish, linear burrows up to 1cm long

· Secondary lesions consist of vesicles, crusts, reddish-brown nodules and excoriations

· Intense pruritus of itchiness that worsens at night

Treatment

· Topical steroids or antihistamines are administered to relieve itching.

· Topical antiscabies creams or lotions such as lindane, crotamiton or permethrin 15% are prescribed.

· Lindane should not be used in children younger than 2 years of age because of the risk of seizures and neurotoxicity.

· The antiscabies preparation is thinly applied to the entire skin from the neck down and leave on for 12 to 24 hours as prescribed. The face and scalp are not usually affected. The medication is removed by washing it with soap and water.

· The patient is instructed to wash all bedding and clothing in hot water and dried on the hot dryer cycle or dry cleaner.

Herpes Zoster (shingles)

Shingles is an acute viral infection of the dorsal nerve root ganglion caused by the varicella-zoster virus. It can be a reactivation of the varicella-zoster virus or exposure to varicella-zoster or can occur during any immunocompromised state.

Diagnosis is determined by visual examination, skin cultures and skin stains that identify the organism and by an antinuclear antibody blood test that will produce a positive result. Herpes zoster is contagious to individuals who have not had chickenpox.

Signs and Symptoms

· Clustered skin vesicles along the trunk, thorax or face

· Fever

· Neuralgia and burning

· Pruritus

· Paresthesia

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