Sycosis Vulgaris

1. It is a pyogenic infection of the whole hair follicles causative organism : staph aureus Sex and age : males after puberty Site : beard and moustache Morphology : discrete , erythematous follicular papules or pustules from which hair emerge perifollicular edema Course : chronic with remission and relapses . Sycosis vulgaris

2. Differential diagnosis : Taenia barbae Psudo-folliculitis Herpes simplex Impetigo Treatment : Local : Local compresses Local antibiotic on the beard and nose General : - Cloxacillin ( anti- staph )

3. Def : superficial mild chronic infection of the skin Etiology : coryneobactrium minutissimum Site : feet , groins, axillae , and submammary areas, which mimics epidermal dermatophyte infections Predisposing factor : Obisity , DM occlusive clothing/shoes Anaemia Hyperhydrosis Increased humidity Erythrasma (Greek, "red spot")

4. Clinical picture : Subjective symptoms : Non - itchy disfigurement Mild irritation in the grion Morphology : - Dry , slightly scaly yellowish brown patches with sharply defined irregular border The border is not active Localization : Flexures , axillae , inner aspect of the thighs , umbilicus Anal cleft , under the beast in obese females Bilatral

5. Erythrasma : groins Sharply marginated , brownish-red, slightly scaling macular patch on the medial thigh (infectious intertrigo ) appears bright coral-red when examined with a Wood's lamp.

6. Erythrasma : webspace This macerated interdigital webspace The webspace is the most common site for erythrasma in temperate climates

7. DD : intertrigo Pitryasis versicolar Taenia cruris : erythematous scaly patch with active border Seborrheic dermatitis Psoriasis Candidal dermatitis

8. Laboratory Examinations Wood's Lamp demonstration of the characteristic coral-red fluorescence Direct Microscopy Negative for fungal forms on KOH preparation of skin scraping. In the webspaces of the feet, concomitant interdigital tinea pedis may also be present. Gram or Giemsa stains may show fine bacterial filaments. Bacterial Culture Heavy growth of Corynebacterium . Staph aureus , group A strep, and Candida infection. In some cases, concomitant Pseudomonas aeruginosa webspace infection (feet) is also present. Diagnosis Clinical findings, absence of fungi on direct microscopy, positive Wood's lamp examination.

9. Treatment : General : Erythromycin 1gm daily for 2w , Local : local antifungal : e g T olnaftate twice daily for 2-3w Imidazole derivative cream twice daily for 2-3w Sodium fusidate ointment, Benzoyl peroxide (2.5%) gel daily after showering for 7 days

10. ( PK) presents as defects in the thickly keratinized skin of the plantar foot with eroded pits of variable depth, caused by Kytococcus sedentarius . Age Young adults & Sex Males > females Predisposing Factors as erythrasma K. sedentarius produces proteases which digest keratin. Skin Symptoms Usually asymptomatic. Foot odor, sliminess of feet. Uncommonly, itching, burning, tenderness. Often mistaken for tinea pedis . Skin Lesions Crater-like pits in stratum corneum Involved areas are white when stratum corneum is fully hydrated Symmetric or asymmetric involvement of both feet Pitted Keratolysis (Keratolysis Sulcata )

11. Pitted keratolysis : plantar The stratum corneum shows loss of keratinization with well- dermarcated margins , Pitted keratolysis : toe Pitted epidermis of an intertriginous toe, associated with hyperhidrosis

12. Def : abscess is an acute or chronic localized inflammation, associated with a collection of pus and tissue destruction A furuncle is an acute, deep-seated, red, hot, tender nodule or abscess that evolves from a staphylococcal folliculitis A carbuncle is a deeper infection composed of interconnecting abscesses usually arising in several contiguous hair follicles. Abscess , Furuncle , and Carbuncle

13. Etiology : Causative organism : staph aureus Predisposing factors : Pressure ,friction ,irritation of skin in exposed areas and extensor surface Chronic S. aureus carrier state ( nares , axillae , perineum, vagina) Diabetes mellitus Obesity Poor hygiene & Bactericidal defects (e.g., chronic granulomatous disease) Chemotactic defects Hyper- IgE syndrome (Job's syndrome) HIV disease, especially MRSA infection

14. Clinical picture : Morphology : Perifollicular , tender , hot nodules with erythematous surface within few days transformed into necrotic core (remnant of hair follicle ) Localization affect area contain hair follicles : face , neck , back , axilla , arms and anorectal region Symptoms : The lesion is painfull , throbbing pain . Fever , mild constitutional symptoms Carbuncles may be accompanied by low-grade fever and malaise .

15. Furuncle: S. aureus Soft-tissue swelling of the forehead with central abscess formation, nearing rupture Furuncles: S. aureus Multiple areas of folliculitis in the moustache extending to become furuncles

16. Multiple furuncles: Multiple , painful ulcerated nodules on the buttocks of a 20-year-old male, occurring during hospitalization for ulcerative colitis. Carbuncle: S. aureus A very large, inflammatory plaque with pustules, on the neck. Infection extends down to the fascia and has formed from a confluence of many furuncles.

17. DD : Acne vulgaris Bockhart impetigo Herpes simplex Sweat rash Treatment : Local measures : - hot compressing - pirecing the pointed surface to discharging pus - cleaning the area by local antibiotic - a void occlusive dressing 2. General : antibiotic as penicillin & flucloxacillin .

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