HERLIN HOBAYAN

1.) Identify the different types of skin rashes or lesions

Macules- are flat, non-palpable lesions usually < 10 mm in diameter. Macules represent a change in color and are not
raised or depressed compared to the skin surface. A patch is a large macule.

Papules - are elevated lesions usually < 10 mm in diameter that can be felt or palpated. 

Plaques - are palpable lesions > 10 mm in diameter that are elevated or depressed compared to the skin surface.
Plaques may be flat topped or rounded.

Nodules - are firm papules or lesions that extend into the dermis or subcutaneous tissue.

Bullae - are clear fluid-filled blisters > 10 mm in diameter.

Pustules- are vesicles that contain pus. Pustules are common in bacterial infections and folliculitis and may arise in some
inflammatory disorders 

Urticaria (wheals or hives) is characterized by elevated lesions caused by localized edema. Wheals are pruritic and red.
Wheals are a common manifestation of hypersensitivity to drugs, stings or bites, autoimmunity, and, less commonly,
physical stimuli including temperature, pressure, and sunlight. The typical wheal lasts < 24 hours.

Scale is heaped-up accumulations of horny epithelium that occur in disorders (scaly)

Crusts (scabs) consist of dried serum, blood, or pus.

Erosions are open areas of skin that result from loss of part or all of the epidermis. 

Ulcers result from loss of the epidermis and at least part of the dermis.

Petechiae are nonblanchable punctate foci of hemorrhage.

Purpura is a larger area of hemorrhage that may be palpable. Palpable purpura is considered the hallmark of
leukocytoclastic vasculitis.

2.) Recognize common skin infections based on clinical manifestations

Staphylococci: Staphylococcus aureus.

1. FURUNCLE – An extension of folliculitis and is also known as boil. It is characterized by larger and painful nodules with
underlying collection of dead and necrotic issue
2. CARBUNCLE – Represents a coalescence of furuncles that extends into the subcutaneous tissue with multiple sinus
tracts

3. FOLLICULITIS – Pyogenic infection involving the hair follicle. It is characterized by localized painful inflammation and
heals rapidly after draining the pus.
4. STY or HORDEOLUM – Folliculitis occurring at the base of the eyelids.

5. STAPHYLOCOCCAL SCALDED SKIN SYNDROME (Ritter’s Disease) – Primarily a disease found in newborns and
young children. It is manifested by sudden onset of perioral erythema that covers the whole body within two days
6. IMPETIGO – Infection is common in young children and primarily involves the face and the limbs. Initially it starts as a
flattened red spot which later becomes a pus – filled vesicle that ruptures and forms crust.

Streptococci: Streptococcus pyogenes

1. PYODERMA (Impetigo) – A purulent skin infection that is localized and commonly involves the face, and
the upper and lower extremities. It starts as vesicles then progresses to pustules.

2. ERYSIPELAS (St. Anthony ’s fire) – Patients manifest with localized raised areas associated with pain,
erythema, and warmth.

3. CELLULITIS – Involves the skin and subcutaneous tissue. It is also manifested as local inflammation with
systemic signs.

4. NECROTIZING FASCIITIS – Involves the deep subcutaneous tissue and is also known as flesh – eating.

Pseudomonas aeruginosa

- It is commonly associated with colonization of burn wounds and characterized by blue – green pus that
exudes a sweet grape – like odor. Other skin infections are folliculitis, and secondary infections in individuals
with acne and nail infections resulting from immersion in contaminated water.

 Clostridium perfringens

- It causes massive hemolysis and bleeding and tissue destruction.

 Bacillus anthracis

- Anthrax is a disease of herbivores. The skin infection, cutaneous anthrax, is the most common form. It is
characterized by painless papules at the site of inoculation that become ulcerative, and later develops necrotic
eschar. It also associated with painful lymphadenopathy and edema.

 Tinea versicolor (pityriasis versicolor)

- The lesions are scaly with a dry, chalky appearance, and usually appear on the face, neck trunk and arms.

 Tinea nigra

- The lesions involve the palms and soles and are described as gray to black, well – demarcated macules.
Cutaneous Mycoses or Dermatophytosis

1. TINEA PEDIS – athlete’s foot (feet)

2. TINEA CAPITIS – scalp

3. TINEA CORPORIS – body

4. TINEA CRURIS/ JOCK ITCH – groin

5. TINEA MANUS – hands

6. TINEA BARBAE – beard

7. TINEA UNGUIUM/ ONYCHOMYCOSIS

– nail
 Subcutaneous Mycoses
- The infection initially involves the deeper layers of the dermis and subcutaneous tissue then
later the bone.

Warts

1. SKIN WARTS – benign, self – limiting proliferation of the skin that undergoes spontaneous
resolution. These warts may be flat, dome – shaped, or plantar.

2. GENITAL and ANOGENITAL WARTS – also known as condylomataacuminata

Herpes Simplex Infections

1. GINGIVOSTOMATITIS – the primary infection, primary caused by HSV – 1. It presents as

vesicles that rupture and ulcerates. Lesions are seen in the buccal mucosa, palate,
gingivae, pharynx, and the tongue. The most striking feature is gingivitis. Gingivostomatitis
is common during childhood.

2. HERPES LABIALIS (Fever Blister or Cold Sore) – represents recurrent mucocutaneous

HSV infection. This is caused by HSV – 1 and 2. Lesions are usually located at the
vermillion borders of the lips. Lesions are vesicular, they rupture then form an ulcer and
later form crusts. Recurrences are less severe than the primary infection and often occur
on the same site.

3. HERPETIC WHITLOW – HSV infection involving the fingers and caused by both HSV
types 1 and 2

4. ECZEMA HERPETICUM – HSV infection occurring in children with eczema. This only
shows that HSV can be an opportunistic pathogen. It can also cause a superimposed
infection in burns.

5. HERPES GLADIATORUM – HSV infection of the body and is usually acquired during
wrestling or playing rugby.

3. Differentiate the characteristics of the causative organisms/agents of each skin infections;

Skin infections Characteristic of the causative organism/ agents

 1. Impetigo Propionibacterium acne
2. Acne Propionibacterium acne
3. Carbuncles, Furuncles, Follicullitis Streptococcus aureus
4. Cellulitis Staphylococcus pyogenes
5. Erysipelas Streptococcus pyogenes
6. Necrotizing Fascitis Staphylococcus aureus, Streptococcus pyogenes,
Other bacteria or fungi
7. Staphylococcal Scalded skin syndrome Staphylococcus aureus
(SSSS)
8. Gas Gangrene Clostridium perfringens
9. Cutaneous Mycoses Trichophyton, Microsporum, and Epidermphyton.
a. Tinea Capitis
b. Tinea Barbae
c. Tinea Corporis
d. Tinea Crucis
e. Tines Pedis
f. Tinea Manuum
g. Tinea Unguium
10. Superficial Mycoses a. Cutaneous Infections - Trichophyton,
Microsporum, and Epidermophyton
b. Superficial Infection (Tineaversicolor) -
Malasseria furfur

4. Make a tabulation of the types of skin rashes or lesions with the corresponding causative agent,
laboratory diagnosis, treatment, DOC and prevention of each skin lesions.

Skin lesions Causative agent Laboratory Treatment Drug of Prevention

diagnosis choice

Acne Propionibacterium Acne is Taking Antibiotics None

acnes diagnosed by a medicine or (topical or
simple visual visiting oral),
inspection by
 your doctor. dermatologist isotretinion.
There is no test
for acne. Rarely
a doctor may
take a swab or
scraping of a
lesion or
pustule for
microbiological
examination or
culture to rule
out other
sources of
infection.

Impetigo Staphylococcus Routinely based Taking Topical Hygiene

aureus and on clinical medicine mupirocin, practice
streptococcus signs, when oral
pyogenes necessary, cephalexin
culture and
gram stain,
coagulase and
catalase tests,
multitest
systems, PCR

cellulitis Streptococcus Microscopy, Taking Penicillin Common

pyogenes culture and medicine sense and
bacitracin test good wound
care are the
best ways
to prevent
bacterial
skin
infections,
including
cellulitis.
Clean all
minor
injuries that
break the
 skin with
soap and
water.
Clean all
minor cuts
and injuries
that break
the skin
(like blisters
and
scrapes)
with soap
and water.

Carbuncles, Staphylococcus Laboratory Taking Beta-lactam Wash your

aureus identification medicine like penicillin hands
Furuncles,
includes before
follicullitis
microscopic eating and
examination after using
and culture. the
bathroom.
Shower
often to
keep your
skin free of
bacteria.
Avoid
squeezing
boils or
rubbing any
broken skin.
Wash
clothes,
sheets, and
towels
regularly in
hot water.

Erysipelas Streptococcus Microscopy, Taking Penicillin Common

pyogenes culture and medicine sense and
bacitracin test. good wound
 care are the
best ways
to prevent
bacterial
skin
infections,
including
erysipelas.
Clean all
minor
injuries that
break the
skin with
soap and
water.
Clean all
minor cuts
and injuries
that break
the skin
(like blister
and
scrapes)
with soap
and water.

Necrotizing Staphylococcus Microscopy, Taking Penicillin There’s no

fasciitis aureus, culture, and medicine sure way to
streptococcus bacitracin test. prevent a
pyogenes, and necrotizing
other bacteria or fascilitis
fungi infection.
However,
you can
reduce your
risk with
basic
hygiene
practices.
Wash your
hands
 frequently
with soap
and treat
any wounds
promptly,
even minor
ones. If you
already
have a
wound, take
good care
of it.

Staphylococcal Staphylococcus Histological Taking Immediate Eliminate

scalded skin aureus sections, culture medicine systemic carriers in
syndrome antibiotics contact with
(SSSS) (cloxacillin or neonates
cephalexin)

Gas gangrene Clostridium Gram stain, CT taking Penicillin Clean

perfringens scans, clinical medicine and wounds,
picture clindamycin, debride
surgical dead
removal, tissues
oxygen
therapy
Cutaneous Trichophyton, Diagnosis is Taking Antifungal Keeping the
mycoses microsporum, and based on the medicine drugs such skin clean
1. Tinea epidermphyton clinical as azoles and dry, as
capitis appearance of (miconazole, well as
2. Tinea the lesions, clotrimazole, maintaining
barbae direct econazole). good
3. Tinea microscopic hygiene.
corporis examination
4. Tinea and culture.
crucis
5. Tines
pedis
6. Tinea
manuum
7. Tinea
unguium