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Cutaneous Candidiasis

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81. Guidelines for the Management of Genital Herpes in New Zealand

. (HSV infection can cause this condition.) • Autoimmune blistering disorders such as pemphigus and cicatrical pemphigoid, which are chronic. • Other genital infections lack the preceding vesicular stage, apart from varicella zoster infection which is unilateral. • Candidiasis and folliculitis produce pustules, which must be differentiated from HSV infection.12 Management of First Episode of Genital Herpes Patient presents with first episode of genital herpes Check symptom history, examine and take (...) of determining that the patient has a recurrent episode, but other genital conditions may mimic and/or coexist with recurrent herpes, and careful examination of the genitalia should always form part of the diagnostic procedure. • Common differential diagnoses include lichen sclerosus, fissuring due to candidiasis, folliculitis, bacterial skin infections, dermatitis and any other skin conditions that cause itching and fragility of the skin. • Uncommon conditions include erythemea multiforme, hidradenitis

2017 New Zealand Sexual Health Society

82. CRACKCast Episode 183 – The Immunocompromised Patient

colonized in the nares and skin with S. aureus that may predispose to skin infections with transient bacteremia, which can seed distant sites. Women diabetics with hyperglycemia are predisposed to vulvovaginal candidiasis. Diabetics are not more likely to have pneumococcal pneumonia but are more likely to become bacteremic and to have a higher mortality rate.” 11) What are 8 reasons renal failure patients have impaired immune function? What type of immunocompromise do they have? Often diabetic (see (...) above) Decrease barrier = Disruption of cutaneous barriers at vascular access sites and peritoneal dialysis catheter sites Uremic pruritus with excoriation epidermal and sweat gland atrophy Dryness Vesicular eruptions Reduced renal clearance of unknown toxins Nutritional deficiencies Immunosuppressive medications Chronic kidney failure = chronic state of immune hyporesponsiveness Neutrophils dysfunction = reduced mobility /chemotaxis/adherence/phagocytosis/intracellular bactericidal activity

2018 CandiEM

84. CRACKCast E120 – Dermatologic presentations

or vesicles should be treated with cool wet compresses of Domeboro or Burow’s solutions (aluminum acetate). Topical baths, available over the counter, may also be comforting. Systemic antihistamines, such as hydroxyzine and diphenhydramine, may help control pruritus; nonsedating antihistamines are preferred for use during the day. If present, secondary bacterial infection must also be treated. Know your ddx: Cutaneous candidiasis Contact dermatitis Atopic dermatitis Tinea cruris Intertrigo HSV (...) CRACKCast E120 – Dermatologic presentations CRACKCast E120 – Dermatologic presentations - CanadiEM CRACKCast E120 – Dermatologic presentations In , , by Adam Thomas October 23, 2017 This 120th episode of CRACKCast covers Rosen’s 9th edition, Chapter 110, Dermatologic presentations. The thought of a chief complaint with “rash” is enough to send shivers down some of our spines, yet so many systemic problems have cutaneous manifestations that are important to not miss. Shownotes – Key concepts You

2017 CandiEM

85. BSR guideline Management of Adults with Primary Sjögren's Syndrome

in the mouth with sore, ulcerated gums as a consequence of rubbing. Many patients suffer recurrent infections including parotitis, intraoral candidiasis and angular cheilitis. Dysarthria, dysphagia and dysgeusia (distorted sense of taste) are seen in established disease. The evidence surrounding periodontal disease in Sjögren’s is conflicting, with some studies suggesting an increased prevalence of periodontal disease [ ] but others not [ ]. Effective management of the dry mouth is important

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2017 British Society for Rheumatology

86. Biologic therapy for psoriasis

or subsequent biologic therapy fails in adults R21 When a person s psoriasis responds inadequately to a second or subsequent biologic agent seek advice from a clinician with expertise in biologic therapy and consider any of the following strategies: · reiterate advice about modifiable factors contributing to poor response (for example, obesity and poor adherence) · optimise adjunctive therapy (for example, switch from oral to sub-cutaneous methotrexate) · switch to an alternative biologic agent · consider (...) for biologic therapy for psoriasis 2017 19 IX Major congenital malformations reported in 3.6 5.0 % of women exposed to anti-TNF compared with 1.5 4.7 % in control groups (odds ratios [OR] = 1.32 1.64) · optimise adjunctive therapy (for example, switch from oral to sub-cutaneous methotrexate) · switch to an alternative biologic agent · consider non-biologic therapy approaches (for example inpatient topical therapy or standard systemic therapy) Transitioning to/between biologic therapies R25 When choosing

2017 British Association of Dermatologists

87. CRACKCast Episode 132 – HIV/AIDS

Kaposi’s sarcoma Extrapulmonary cryptococcosis Disseminated mycosis Atypical disseminated leishmaniasis Disseminated nontuberculous mycobacterial infection Extrapulmonary cryptococcosis including meningitis Box 124.3: Cutaneous Findings Highly Suggestive of HIV Disease Any WHO criteria for stage 4 HIV disease Facial molluscum in an adult Proximal subungual onychomycosis Herpes zoster scarring Oral hairy leukoplakia Bacillary angiomatosis Widespread dermatophytosis Severe seborrheic dermatitis See (...) are infected, the virus spreads to draining lymph nodes and infection is established, usually within 48 to 72 hours. [3] List 10 AIDS defining conditions Box 124.1 – AIDS-Defining Conditions Bacterial infections, multiple or recurrent Candidiasis of bronchi, trachea, or lungs Candidiasis of esophagus Cervical cancer, invasive Coccidioidomycosis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Cryptosporidiosis, chronic intestinal (>1 mo duration) Cytomegalovirus disease (other than liver

2017 CandiEM

88. Persistent Pain with Breastfeeding

- agnosis, and treatment of ankyloglossia: Methodologic re- view. Can Fam Physician 2007;53:1027–1033. 16. Wall V, Glass R. Mandibular asymmetry and breastfeeding problems: Experience from 11 cases. J Hum Lact 2006;22: 328–334. 17. Qi Y, Zhang Y, Fein S, et al. Maternal and breast pump factors associated with breast pump problems and injuries. J Hum Lact 2014;30:62–72. 18. Barankin B, Gross MS. Nipple and areolar eczema in the breastfeeding woman. J Cutan Med Surg 2004;8:126–130. 19. Schalock P, Hsu J (...) of women with clinical symptomsofductalcandidiasis.BreastfeedMed2009;4:57–61. 32. Graves S, Wright W, Harman R, et al. Painful nipples in nursing mothers: Fungal or staphylococcal? Aust Fam Physician 2003;32:570–571. 33. Hale T, Bateman T, Finkelman M, et al. The absence of Can- didaalbicansinmilksamplesofwomenwithclinicalsymptoms of ductal candidiasis. Breastfeed Med 2009;4:57–61. 34. Andrews JI, Fleener D, Messer S, et al. The yeast con- nection:IsCandidalinkedtobreastfeedingassociatedpain? Am J

2016 Academy of Breastfeeding Medicine

89. Practice Guidelines for the Diagnosis and Management of Aspergillosis

recommendation; low-quality evidence) . 35. Recombinant interferon-γ is recommended as prophylaxis in CGD patients (strong recommendation; high-quality evidence). Its benefit as adjunctive therapy for IA is unknown. 36. Surgery for aspergillosis should be considered for localized disease that is easily accessible to debridement (eg, invasive fungal sinusitis or localized cutaneous disease) (strong recommendation; low-quality evidence). The benefit for IA in other settings such as in the treatment (...) therapy should be considered ( strong recommendation; low-quality evidence ). What Are the Treatment Recommendations for Aspergillus Osteomyelitis and Septic Arthritis? Recommendation 54. Surgical intervention is recommended, where feasible, for management of Aspergillus osteomyelitis and arthritis, combined with voriconazole ( strong recommendation; moderate-quality evidence ). What Are the Treatment Recommendations for Cutaneous Aspergillosis? Recommendations 55. As cutaneous lesions may reflect

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2016 Infectious Diseases Society of America

90. Management of Nasopharyngeal Carcinoma

in the treatment of NPC. Other late toxicities post-radiotherapy are listed in Appendix 8. 8.1 Oral Complications The common oral complications post-radiotherapy are: • xerostomia (80% to 100%) 55-57, level II-3 • mucositis (60% from third to fourth week after the beginning of radiotherapy) 55, level II-3 • candidiasis (16% to 67%) 55-57, level II-3 It is essential that NPC patients receive dental assessment prior to radiotherapy to minimise post-treatment oral complications. The oral complications among NPC

2016 Ministry of Health, Malaysia

91. Acne clinical guideline

, J., Fung, K. et al. Development and validation of a comprehensive acne severity scale. J Cutan Med Surg . 2007 ; 11 : 211–216 | | | , x 9 Mallon, E., Newton, J.N., Klassen, A. et al. The quality of life in acne: a comparison with general medical conditions using generic questionnaires. Br J Dermatol . 1999 ; 140 : 672–676 | | | , x 10 Gupta, M.A., Johnson, A.M., and Gupta, A.K. The development of an Acne Quality of Life scale: reliability, validity, and relation to subjective acne severity (...) and global assessments. J Cutan Med Surg . 2006 ; 10 : 160–165 | | | , x 28 Bergman, H., Tsai, K.Y., Seo, S.J., Kvedar, J.C., and Watson, A.J. Remote assessment of acne: the use of acne grading tools to evaluate digital skin images. Telemed J E Health . 2009 ; 15 : 426–430 | | | , x 29 Min, S., Kong, H.J., Yoon, C., Kim, H.C., and Suh, D.H. Development and evaluation of an automatic acne lesion detection program using digital image processing. Skin Res Technol . 2013 ; 19 : e423–e432 | , x 30 Qureshi

2016 American Academy of Dermatology

92. Cellulitis - acute

to the dermal and subcutaneous tissues via disruptions in the cutaneous barrier. Risk factors include skin trauma, ulceration, and obesity. Complications of cellulitis include necrotizing fasciitis, sepsis, persistent leg ulceration, and recurrent cellulitis. Most episodes of cellulitis resolve with treatment, and major complications are absent. However, recurrence is common, and each episode increases the likelihood of subsequent recurrence. The diagnosis of cellulitis can usually be made on history (...) , but other areas, such as the upper limbs, face, ears, and trunk, can also be affected [ ]. [ ; ; ; ; ; ] Causes What causes it? Cellulitis develops when microorganisms gain entry to the dermal and subcutaneous tissues via disruptions in the cutaneous barrier. The most common causative organisms are: Streptococcus pyogenes . Staphylococcus aureus . Less common causative organisms include: Pseudomonas aeruginosa — following exposure to contaminated hot tubs, sponges, or nail puncture. Vibrio vulnificus

2019 NICE Clinical Knowledge Summaries

93. Refractory extrapulmonary sarcoidosis: infliximab

of 41According to specialists involved in this evidence summary, infliximab may be an option for some patients with severe, refractory extrapulmonary sarcoidosis (particularly cutaneous or neurological sarcoidosis); for example, those affected by disabling or disfiguring disease, or whose life expectancy is likely to be reduced. Regulatory status: Regulatory status: Use of infliximab for treating any manifestation of sarcoidosis is off-label. At the time of publication, 4 infliximab products are available (...) , Chapelon-Abric et al. 2015, Doty et al. 2005, Hostettler et al. 2011, Ørum et al. 2012, Panselinas et al. 2009, Russell et al. 2013, Sweiss et al. 2005 and Van Rijswijk et al. 2013): the disease resolved in 51 (33%), improved in 71 (46%), resolved or improved in 10 (with individual data for each outcome not reported, 6%), remained stable in 22 (14%) and deteriorated in 1 (1%). neurological sarcoidosis (n=52) resolved in 21 (40%) improved in 24 (46%) and remained stable in 7 (13%). cutaneous sarcoidosis

2017 National Institute for Health and Clinical Excellence - Advice

94. Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis

Force. Antibiotic prophylaxis is not recommended for patients at intermediate risk of IE, i.e. any other form of native valve disease (including the most commonly identified conditions: bicuspid aortic valve, mitral valve prolapse and calcific aortic stenosis). Nevertheless, both intermediate- and high-risk patients should be advised of the importance of dental and cutaneous hygiene ( Table ). These measures of general hygiene apply to patients and healthcare workers and should ideally be applied (...) of this healthcare-associated IE. In summary, these guidelines propose continuing to limit antibiotic prophylaxis to patients at high risk of IE undergoing the highest-risk dental procedures. They highlight the importance of hygiene measures, in particular oral and cutaneous hygiene. Epidemiological changes are marked by an increase in IE due to staphylococcus and of healthcare-associated IE, thereby highlighting the importance of non-specific infection control measures . , This should concern not only high-risk

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2015 European Society of Cardiology

95. Dyspepsia - proven peptic ulcer

— minor update. Subacute cutaneous lupus erythematosus has been added as a very infrequent adverse effect of proton pump inhibitors, in line with a Medicines and Healthcare products Regulatory Agency (MHRA) Drug Safety Update (2015). July 2015 — minor update. The prescribing information section for clarithromycin has been re-written for clarity. February 2015 — minor update. The prescribing information section was updated to provide additional information regarding the possible drug interaction

2018 NICE Clinical Knowledge Summaries

96. Palliative care - oral

required. Tests which should be considered include: Full blood count if neutropenia is suspected. Platelet count if spontaneous bleeding accompanies chemotherapy-induced mucositis. Iron, folate, and vitamin B12 levels if there is recurrent aphthous ulceration. A swab to check for candida infection if clinical features are suggestive. If there is persistent or recurrent oral candidiasis species typing and sensitivity testing may be helpful. Advice should be offered on measures to prevent oral problems (...) stick. Petroleum jelly on the lips may help to prevent lip cracking. A room humidifier or air conditioning can be used if needed. Pain should be managed symptomatically, using analgesics via a suitable route. Have I got the right topic? Have I got the right topic? From age 16 years onwards. This CKS topic covers the management of dry mouth, oral candidiasis, oral Herpes simplex infection, mouth ulcers, and regular mouth care in people requiring palliative care. Guidance is incorporated from

2018 NICE Clinical Knowledge Summaries

97. Bacterial vaginosis

. The characteristic appearance of the discharge is not specific for BV but supports the diagnosis. If the appearance of the discharge is not characteristic, consider , such as trichomoniasis or candidiasis. BV is not usually associated with soreness, itching, or irritation. If these symptoms are present, consider or co-infection with candidiasis or trichomoniasis. See the CKS topics on and for more information. Test the pH of the vaginal discharge to help distinguish between BV and other causes for symptoms (...) chlamydia screen to women younger than 25 years This recommendation is based on expert opinion in the PHE guideline [ ] and the BASHH guideline on the management of chlamydia [ ]. Differential diagnosis What else could it be? Differential diagnoses of bacterial vaginosis (BV) include: Other infections, such as: Candidiasis — characterized by a white, odourless, curdy discharge that may be associated with vulval itching and superficial soreness. See the CKS topic on for more information. Trichomoniasis

2018 NICE Clinical Knowledge Summaries

98. Dyspepsia - proven functional

. The content has been amended to include second-line drug regimens for Helicobacter pylori eradication, in line with the updated NICE guidance. The prescribing information section has been expanded to include antibiotics recommended for H. pylori eradication. The topic has also undergone significant restructuring. Previous changes Previous changes December 2016 — minor update. Subacute cutaneous lupus erythematosus has been added as a very infrequent adverse effect of proton pump inhibitors, in line (...) inhibitors (PPIs) are usually mild and reversible. Adverse effects include headache, diarrhoea, nausea, vomiting, abdominal pain, constipation, and dizziness. Less common adverse effects include dry mouth, peripheral oedema, sleep disturbance, fatigue, paraesthesia, arthralgia, myalgia, pruritus, and rash. Rare or very rare adverse effects include: Subacute cutaneous lupus erythematosus (SCLE), which can occur weeks, months, or years after exposure to a PPI. If suspected discontinue the PPI and seek

2018 NICE Clinical Knowledge Summaries

99. Impetigo

[ ; ; ; ; ]. Differential diagnosis What else might it be? Skin infections and infestations Bacterial skin infections such as cellulitis, ecthyma, erysipelas, staphylococcal scaled skin syndrome, and necrotizing fasciitis. For more information, see the CKS topic on . Fungal skin infections such as candidiasis, tinea corporis or tinea capitis. For more information, see the CKS topics on , , and . Parasitic infestations such as scabies. For more information, see the CKS topic on . Viral infections such as varicella (...) is negligible. Topical fusidic acid can be used during breastfeeding, but it should not be applied on the breast. A few cases of serious cutaneous reactions (e.g. DRESS syndrome, toxic epidermal necrolysis and Stevens-Johnson syndrome) have been reported with systemic sodium fusidate, usually appearing in the first weeks of treatment. [ ; ] Flucloxacillin Flucloxacillin Contraindications and cautions What are the contraindications and cautions for flucloxacillin? Do not prescribe flucloxacillin to people

2018 NICE Clinical Knowledge Summaries

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