Based on Module 2: Lecture Materials & Resources and experience, please answer the following questions:
- Describe dermatitis, diagnostic criteria, and treatment modalities
- Describe the drug therapy for Conjunctivitis and Otitis Media
- Discuss Herpes Virus infections, patient presentation, and treatment
- Describe the most common primary bacterial skin infections and the treatment of choice.
Common Dermatologic, Ocular, and Infectious Conditions: Diagnosis and Treatment
Dermatitis: Description, Diagnostic Criteria, and Treatment
Dermatitis is an umbrella term for inflammatory skin conditions, the most common of which include atopic dermatitis, contact dermatitis (allergic and irritant), and seborrheic dermatitis. Dermatitis often presents as erythema, pruritus, vesiculation, oozing, and scaling of the skin (Lehman et al., 2019). Atopic dermatitis is associated with a personal or family history of atopy, asthma, or allergic rhinitis. Contact dermatitis occurs due to exposure to allergens or irritants, while seborrheic dermatitis is linked to Malassezia yeast and presents in sebum-rich areas.
Diagnosis is primarily clinical and based on history and physical exam findings. Key criteria for atopic dermatitis include pruritus, typical lesion morphology and distribution (e.g., flexural areas in adults), and chronic relapsing course. Diagnostic confirmation may involve patch testing for contact dermatitis or skin scraping to rule out other conditions (Lehman et al., 2019).
Treatment involves identifying and avoiding triggers, restoring the skin barrier with emollients, and controlling inflammation. Topical corticosteroids remain the first-line treatment for acute flares. In cases of atopic dermatitis, calcineurin inhibitors (e.g., tacrolimus) may be used for sensitive areas. Antihistamines can help reduce pruritus, while severe cases may require systemic therapies such as cyclosporine or biologics like dupilumab (Lehman et al., 2019).
Drug Therapy for Conjunctivitis and Otitis Media
Conjunctivitis, commonly known as pink eye, can be viral, bacterial, or allergic in origin. Bacterial conjunctivitis typically presents with purulent discharge and is treated with topical antibiotics such as erythromycin, polymyxin B-trimethoprim, or fluoroquinolones (Glanville & Nemeth, 2020). Viral conjunctivitis, often caused by adenovirus, is self-limiting and managed supportively with lubricants and cold compresses. Allergic conjunctivitis is treated with antihistamines or mast cell stabilizers like olopatadine.
Otitis media, especially acute otitis media (AOM), is prevalent in children and typically follows an upper respiratory infection. It is characterized by ear pain, fever, and a bulging, erythematous tympanic membrane. The first-line treatment is amoxicillin unless there is a history of resistance, in which case amoxicillin-clavulanate is preferred. For penicillin-allergic patients, alternatives include cefdinir or azithromycin (Lieberthal et al., 2013).
Herpes Virus Infections: Presentation and Treatment
Herpes simplex virus (HSV) infections are caused by HSV-1 (oral herpes) and HSV-2 (genital herpes). Patients often present with painful vesicular lesions on the lips or genital area, preceded by a prodrome of tingling or burning. Primary infections may include systemic symptoms like fever and malaise, whereas recurrent episodes are generally milder (Jameson et al., 2018).
Diagnosis is clinical but may be confirmed via PCR or viral culture. Antiviral therapy with acyclovir, valacyclovir, or famciclovir is effective for both initial and recurrent episodes. Chronic suppressive therapy may be indicated in patients with frequent recurrences or to reduce transmission risk. Herpes zoster, caused by reactivation of varicella-zoster virus, presents as a painful, unilateral dermatomal rash and is treated with antivirals and pain control (Jameson et al., 2018).
Primary Bacterial Skin Infections and Preferred Treatments
The most common primary bacterial skin infections are impetigo, cellulitis, and folliculitis. Impetigo, often caused by Staphylococcus aureus or Streptococcus pyogenes, appears as honey-colored crusted lesions and is treated with topical mupirocin or oral antibiotics for widespread cases. Cellulitis presents as a painful, red, swollen area, usually unilateral, and is treated with oral cephalexin or clindamycin for MRSA coverage. Folliculitis is a superficial infection of hair follicles, often due to S. aureus, and can be treated with topical antibiotics or antiseptic washes (Stevens et al., 2014).
In conclusion, understanding the etiology, presentation, and appropriate treatment of common dermatologic and infectious conditions allows healthcare providers to deliver effective, evidence-based care, ensuring prompt relief and preventing complications.
References
Glanville, J., & Nemeth, J. (2020). Bacterial and viral conjunctivitis: Diagnosis and management. American Family Physician, 102(8), 475-483.
Jameson, J. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Loscalzo, J. (2018). Harrison’s Principles of Internal Medicine (20th ed.). McGraw-Hill Education.
Lehman, J. S., Heidelberger, P. A., & Miller, R. A. (2019). Dermatitis: Diagnosis and management in primary care. American Family Physician, 100(11), 645-653.
Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., … & Tunkel, D. E. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999.
Stevens, D. L., Bisno, A. L., Chambers, H. F., Dellinger, E. P., Goldstein, E. J. C., Gorbach, S. L., … & Wade, J. C. (2014). Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 59(2), e10-e52.