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181. Fungal skin infection - scalp

-Caribbean children. The clinical features of fungal scalp infection vary depending on the degree of inflammatory response, and include: Scaling and itch of the scalp, patches of hair loss. Skin erythema, pustules, crusting, and lymphadenopathy. Painful, pustular boggy masses, which may have a thick crust (kerion). Associated fungal infection at other sites. Assessment of suspected fungal scalp infection should include skin and hair sampling for fungal microscopy and culture, to confirm the diagnosis (...) and identify the underlying cause. Management of fungal scalp infection should include: Advice on self-care strategies including surface crust removal; discarding or disinfecting objects that can transmit infection; inspecting other family members or household pets for signs of infection. In adults, starting oral antifungal treatment before or after fungal microscopy and culture results are back, depending on clinical judgement. In children, starting oral antifungal treatment if there is a confirmed

2018 NICE Clinical Knowledge Summaries

182. Conjunctivitis - infective

? The clinical features of conjunctivitis include: Acute onset conjunctival erythema. Discomfort which may be described as ‘grittiness’, ‘foreign body’ or ‘burning’ sensation. Watering and discharge which may cause transient blurring of vision. It is difficult to differentiate viral and bacterial conjunctivitis clinically. Bacterial conjunctivitis may be associated with: Purulent or mucopurulent discharge with crusting of the lids which may be stuck together on waking. If discharge is mucopurulent

2018 NICE Clinical Knowledge Summaries

183. Acne vulgaris

sunlight and solariums) — if sun exposure is unavoidable, an appropriate sunscreen or protective clothing should be used. Adverse effects Skin irritation including discomfort, blistering of skin, burning, crusting, dryness, peeling, erythema, oedema, pruritus, stinging, contact dermatitis and temporary changes of skin pigmentation. Eye irritation. Increased sensitivity to UV light — if sun exposure is unavoidable, an appropriate sunscreen or protective clothing should be used. Interactions Systemic

2018 NICE Clinical Knowledge Summaries

184. Shingles

, and, unlike other rashes, does not cross the midline of the body. The vesicles then burst, releasing varicella-zoster virus, and crust over within 7–10 days. Healing occurs over 2–4 weeks, and often results in scarring and permanent pigmentation in the affected area. The location of symptoms depends on the affected nerve: In immunocompetent people, the infection usually occurs on the thorax, with dermatomes T1 to L2 most commonly affected. In immunocompromised people, symptoms can be more widespread (...) — a superficial infection of the hair follicles, which develop into small inflammatory papules or pustules. Impetigo — presents with vesicles, which can rupture and crust. See the CKS topic on for more information. Insect bite or sting — there may be local symptoms (such as pain, swelling, and erythema) and symptoms that may indicate a systemic reaction (such as urticaria, rhinitis, wheezing, abdominal pain, vomiting, and dizziness). See the CKS topic on for more information. Scabies — an intensely itchy skin

2018 NICE Clinical Knowledge Summaries

185. Pubic lice

, crusting and matting of eyelashes and conjunctivitis. Visible lice or nits in any area with coarse body hair (most often the pubic area, less commonly the axillae, chest, abdomen, perianal area, beard area, eyelashes and eyebrows). Rust-coloured flecks of faecal material may be seen. Skin lesions such as: Small blue macules (‘maculae cerulae’) or red papules — may be seen at feeding sites. Lichenification and hyperpigmentation of pruritic areas — may occur in chronic infestation. Basis (...) on . Dermatophyte infection — for more information, see the CKS topic on . Folliculitis. Seborrheic dermatitis — scales or crusts can be brushed off unlike nits. Conjunctivitis or blepharitis (if eyelashes are involved) — for more information, see the CKS topics on , and . Head or body lice — for more information on head lice see the CKS topic on . Basis for recommendation Basis for recommendation Information on the differential diagnosis of pubic lice is based on expert opinion from review articles

2018 NICE Clinical Knowledge Summaries

186. Eczema - atopic

of oral corticosteroids should be considered. If eczema is weeping, crusted, or there are pustules, with fever or malaise, secondary bacterial infection should be considered, and antibiotic treatment should be prescribed. Providing appropriate information on the nature of eczema and advice on the importance of adherence to skin care measures and avoidance of trigger factors (where possible) are essential for disease maintenence and management of flares. Immediate hospital admission should be arranged (...) activity may be continuous. The term 'atopic' is used to describe a group of conditions (eczema, asthma, hay-fever, and food allergy) that are linked by an increased activity of the allergy component of the immune system [ ]. The term 'eczema' comes from the Greek word 'to boil' and is used to describe itchy, red, dry skin which can sometimes become weeping, blistered, crusted, scaling, and thickened [ ]. [ ; ; ; ; ; ] Causes What causes it? There is no known single cause for atopic eczema

2018 NICE Clinical Knowledge Summaries

187. Impetigo

release exudate forming a golden/brown crust. Non-bullous impetigo is usually asymptomatic but may be mildly itchy. The area around the mouth and nose is most commonly affected, although other areas of the face and the extremities may also be involved. Bullous impetigo most commonly affects infants, although older children and adults can also be affected. It presents with flaccid fluid filled vesicles and blisters (often with a diameter of 1-2cm) which can persist for 2-3 days. These blisters rupture (...) leaving a thin flat yellow/brown crust. Lesions most often occur on the flexures, face, trunk and limbs and can be particularly widespread in infants. Systemic features (such as fever and lymphadenopathy) may occur if large areas of skin are affected. Diagnosis of impetigo is usually clinical but swabs (of exudate from a moist lesion or de-roofed blister) for culture and sensitivities should be considered in cases which are persistent despite treatment, recurrent, or widespread; or when MRSA

2018 NICE Clinical Knowledge Summaries

188. Nappy rash

Often the nappy area is spared as this area is so well hydrated and not accessible to excoriation from scratching. A tendency to dry skin, a positive family history of atopic eczema, and rash affecting other skin areas such as the flexures may suggest the diagnosis. See the CKS topic on for more information. Eczema herpeticum Disseminated herpes simplex virus (HSV) infection presents with painful crops of uniform vesicles or blisters on an erythematous base which become pustular and crust over

2018 NICE Clinical Knowledge Summaries

189. Chickenpox

Chickenpox Chickenpox - NICE CKS Share Chickenpox: Summary Chickenpox is an acute disease, predominantly occurring in childhood. It is caused by varicella-zoster virus and is characterized by a vesicular rash, and often fever and malaise. Up to 90% of susceptible contacts develop the disease. Transmission is by personal contact or droplet spread, with an incubation of 1–3 weeks. Chickenpox is infectious from 1–2 days before the rash appears until the vesicles are dry or have crusted over (...) occur on the palms and soles, and mucous membranes, with painful and shallow oral or genital ulcers. Vesicles appear in crops. Crusting occurs usually within 5 days, and crusts fall off after 1–2 weeks. Laboratory tests are rarely required in primary care. For treatment of symptoms, the following can be considered: Paracetamol. Topical calamine lotion. Chlorphenamine (avoid in certain groups, for example pregnant and breastfeeding women, and children less than 1 year of age). If serious

2018 NICE Clinical Knowledge Summaries

190. HIV infection and AIDS

causes rapid onset of severe dental pain. There may be an unpleasant taste in the mouth, fever, and malaise. See the CKS topic on for further information. Oral herpes simplex These are painful lesions that begin as vesicles, then ulcerate and crust. See the CKS topic on for further information. Gastrointestinal conditions HIV infection may cause: Oesophageal candidiasis Symptoms include retrosternal pain or dysphagia, and oral candidiasis is also likely to be present. Diarrhoea This is very common

2018 NICE Clinical Knowledge Summaries

191. Corticosteroid-eluting bioabsorbable stent or spacer insertion during endoscopic sinus surgery to treat chronic rhinosinusitis

4 of 75 5 Safety Safety This section describes safety outcomes from the published literature that the Committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the interventional procedure overview. 5.1 Crusting, granulation and scarring of the middle turbinate 1 week after the procedure was reported in 1 patient in a randomised controlled trial (RCT) of 105 patients treated by a corticosteroid-releasing bioabsorbable stent in 1 side (...) , but was considered to be exacerbated by presence of crusting sticking to the stent. The condition resolved without sequelae after stent removal. 5.3 Infection at 2-week follow-up was reported in 1 patient in the RCT of 105 patients treated by a corticosteroid-releasing bioabsorbable stent in 1 side and a non-corticosteroid-releasing bioabsorbable stent in the other. The patient was treated with a prednisone taper and antibiotics. The infection resolved without sequelae. 5.4 Peri-orbital cellulitis was reported

2016 National Institute for Health and Clinical Excellence - Interventional Procedures

192. Epidemiologic and Ecologic Investigations of Monkeypox, Likouala Department, Republic of the Congo, 2017. (PubMed)

Epidemiologic and Ecologic Investigations of Monkeypox, Likouala Department, Republic of the Congo, 2017. Monkeypox, caused by a zoonotic orthopoxvirus, is endemic in Central and West Africa. Monkeypox has been sporadically reported in the Republic of the Congo. During March 22-April 5, 2017, we investigated 43 suspected human monkeypox cases. We interviewed suspected case-patients and collected dried blood strips and vesicular and crust specimens (active lesions), which we tested

Full Text available with Trip Pro

2019 Emerging Infectious Diseases

193. A computational fluid dynamics analysis of the effects of size and shape of anterior nasal septal perforations. (PubMed)

A computational fluid dynamics analysis of the effects of size and shape of anterior nasal septal perforations. Nasal septal perforations (NSPs) often cause bleeding, crusting, obstruction, and/or whistling. The objective was to analyze the impact of anterior NSP size and shape on nasal physiology using computational fluid dynamics (CFD).A 3-dimensional model of the nasal cavity was constructed from a radiologically normal CT scan using imaging software. Anterior NSPs (ovoid (ONSP): 0.5, 1, 2 (...) and water vapor flux were highest posteriorly and lowest anteriorly, generally increasing with size in those regions. RNSPs had greater heat and water vapor flux compared to corresponding size ONSPs. Resistance decreased by 10% or more from normal only in the 3 cm ONSP. Maximum water content was achieved more posteriorly in larger NSP nasal cavities.High wall shear and heat and water vapor flux in posterior perforation regions may explain the crusting most commonly noted on posterior NSP edges

2019 Rhinology

194. Comparing biosignatures in aged basalt glass from North Pond, Mid-Atlantic Ridge and the Louisville Seamount Trail, off New Zealand. (PubMed)

is known about the relationship between the physical and chemical nature of the habitat and the prevalent types of biosignatures. Here, we report and compare strongly variable biosignatures from two different oceanic study sites. We analyzed rock samples for their textural biosignatures and associated organic molecules. The biosignatures from the 8 Ma North Pond Region, which represents young, well-oxygenated, and hydrologically active crust, are characterized by little textural diversity. The organic (...) propose that diverse biosignatures in oceanic crust may form during different stages of crustal evolution.

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2018 PLoS ONE

195. Kate Harding: Life after a loss— “Onwards . . . There is no other way”

the obligatory trip to the GMC’s gleaming and soulless offices in Manchester, where I arrived one morning in mid-January to have my identity confirmed, in order to get back to earning a crust. Because of the GMC’s association with Richard’s depression and subsequent death, this was an emotional journey (his decline was certainly multifactorial, and I would never go so far as to paint him as a “victim of the GMC;” but the letter of notification stating that he’d had a complaint made against him some 18 months

2018 The BMJ Blog

196. MKSAP: 32-year-old man with an intermittent pruritic rash

to conditions in which there is evidence of extensive bacterial infection. Clinical signs of bacterial infection typically include weeping of serous fluid, pustules, honey-colored crusting, unexplained worsening of dermatitis, or failure to respond to correct therapy. There is no indication for treatment with systemic antibiotics in this patient. Oral prednisone should be considered only in severe, acute exacerbations of atopic dermatitis and not for regular management. Chronic oral glucocorticoid treatment

2019 KevinMD blog

197. Various modifications of a vascularized nasoseptal flap for repair of extensive skull base dural defects. (PubMed)

encountered no wound complication in this series, while crusting at the donor site required daily nasal toilette and frequent debridement until the completion of mucosalization, which usually takes 8 to 12 weeks after surgery.CONCLUSIONSExtended nasoseptal flaps are a reliable and versatile option that can be used to reconstruct extensive skull base dural defects resulting from destruction by large invasive tumors or complex endoscopic endonasal surgery. An extended nasoseptal flap that includes

2019 Journal of Neurosurgery

198. Pearls and pitfalls of bathing in atopic dermatitis. (PubMed)

Pearls and pitfalls of bathing in atopic dermatitis. The latest guidelines of the American Academy of Dermatology suggest bathing as an advantageous nonpharmacologic intervention for regular skin care of patients with atopic dermatitis. Regular bathing with water can hydrate the skin, remove scale, crust, irritants, and allergens, enhance penetration of topical agents, and potentially reduce bacterial colonization. However, it is still unclear whether the addition of oils, emollients, and other

2019 Allergy and Asthma Proceedings

199. Novel technique for nasal septal button insertion: the sutured rosette. (PubMed)

Novel technique for nasal septal button insertion: the sutured rosette. 1.Septal button placement can be challenging. 2.The sutured rosette technique involves folding one flange into a rosette shape, securing it with suture and cutting the suture to release the rosette into a full flange once in proper positioning. 3.The sutured rosette technique is a novel approach to easily placing a septal button while improving crusting and nasal congestion. This article is protected by copyright. All

2019 Clinical Otolaryngology

200. Outcomes of Nasal Septal Perforation Repair Using Combined Temporoparietal Fascia Graft and Polydioxanone Plate Construct. (PubMed)

Symptom Evaluation (NOSE) scores were assessed.A total of 17 patients (12 women and 5 men; mean [SD] age, 45 [15] years) were included. The causes of perforations were iatrogenic (9 [53%]), rheumatologic (2 [12%]), and unknown or idiopathic (6 [35%]). Patients most commonly presented with nasal crusting (12 [71%]), whistling (9 [53%]), nasal obstruction (9 [53%]), and epistaxis (5 [29%]). Mean (SD) perforation size was 0.99 (1.04) cm2. Mean (SD) postoperative follow-up was 6.1 (4.1) months. A total

2019 JAMA facial plastic surgery

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