Scalded Skin Syndrome

The patient was referred for a new itchy and tender bilateral groin lesions that the patient says will drain pus. He also has multiple other complaints. He gives a history of being allergic to DOXYCYCLINE. As previously stated, he has tender sites which can drain pus off and on in his groin for years. There is also history of facial acne and scalp acne since his late teens. He took Accutane during his 20s with improvement by history. He flared and repeated Accutane about one year after completing the first course by his history. He is bathing with unscented Dove and uses cocoa butter lotion. He also has a second problem of itching over his back, shoulders, and arms, and legs

BB’s skin presents as pink, warm and dry. No obvious signs or symptoms of abnormal bruising or lesions present however, the patient states that the skin has of late has

lacerations, burns - including friction burns and scalds, drowsiness, pressure sores, cowering and flinching, unexplained hair loss,

skin condition that staph is able to cause is cellulitis. It is more common in people who have a weakened immune system such as people who are immunocompromised, infants, and the elderly. Cellulitis is characterized by a red, warm patch on the skin paired with a fever. “The bacteria that cause cellulitis can spread rapidly, entering lymph nodes and your bloodstream. Recurrent episodes of cellulitis may cause chronic swelling of the affected limb” (Mayo, 2015). Cellulitis is spread extremely easily, and is a big issue within long term care facilities. The infection can be cured by antibiotics. However, there are cases reported stating that cellulitis is becoming resistant to some antibiotics. The doctor can order a culture to send to pathology.

HEENT are basically unrevealing. Temp in the office today is 98.4. The outer area of the mouth extending into the chin reveals macules, vesicles, copious purulent exudate forming honey- colored crust on a erythematous base. Skin on trunk, arms and legs is clear. No other symptomology

The patient points out a rash on the back of her neck that she states happened after

Skin and or soft tissue infections often occur following a break in normal skin integrity from either trauma or skin disease (Brown & Ebright, 2002). The vast majority of these infections are caused by the gram-positive bacteria Staphylococcus aureus, part of the normal flora existing on the skins surface. Abscess has been found to be the most commonly found SSTI in PWID (Brown & Ebright, 2002). Symptoms of abscess include pain and or tenderness at and around the site of infection, swelling, and redness topped with a pustule. If left untreated, spread and progression of the SSTI leading to tissue ischemia and death, gangrene, sepsis and death can occur (Brown & Pieper, 2002). Hospital treatment of a SSTI is costly. Analysis of the Nationwide Inpatient Sample by the Agency for Healthcare research estimated that in 2009, costs associated with hospital treatment of SSTI reached an estimated $4.8 billion, which is approximately $11,000 per patient (Suya et al., 2009).

John is a forty-five year old male who presented in the emergency room experiencing abdominal pain in the right lower quadrant of the ventral cavity. The pain is felt in the umbilical region, right iliac region, and right lumbar region. He is also experiencing pale skin and fatigue. John has a previous history of gastritis(inflammation of the stomach), gastroesophageal reflux disease(stomach acids coming into esophagus), and bradycardia (abnormally slow heart rate). After the laboratory drew blood, the doctor began examining John. Upon his examination, he discovered that John's epidermis was abnormally dry and flaky; this is also known as ichthyosis, proximal to the tibia and fibula. Once the blood work came back, the doctor found the source

The patient does state she has a lesion on her left calf that gets red and scaly. Sometimes it is there and sometimes it looks like it is almost gone away. It does not bleed.

The rash can appear in more than one place on the body at the same time.

Objective: leg skin is shiny and has several enlarged veins, otherwise, skin is pale and evenly pigmented, no lesions or excoriations, good turgor. Nails are light pink, adhere to nail bed with 160-degree angle. Hair is grey, shiny and full; amount and distribution

The 34-year old male patient with the presenting symptoms of discolored skin patches and nodules, deformity of the nose, loss of libido, hair loss, testicular atrophy, partial loss of pinprick and temperature sensation, and enlarged nerves, has a disease called lepromatous leprosy. Lepromatous leprosy is when there are a large number of bacteria found in the skin lesions.

After reading Kelly’s story I researched different skin infections that may cause a rash on a person. Four different infections I found were Scabies, Impetigo, also known as Indian Fire, Cellulitis, and Folliculitis (7). Scabies is a contagious rash caused by the itch mite Sarcoptes scabiei (6). Scabies is a rash that produces red itchy bumps (6). Impetigo is caused by Staphylococcus and Streptococcus bacteria (5). Impetigo is extremely contagious and is spread by close contact (5). Cellulitis can be caused by Staphylococcus and Streptococcus (4). Cellulitis is not contagious but causes a red heated rash in the area of infection (4). Lastly, Folliculitis was listed as a rash causing infection. Folliculitis is a skin infection that causes a rash around the hair follicles that look like red pimples (3). Although it can be caused by certain bacteria, causing damage to the hair follicles can cause this infection (8). The normal bacteria that causes Folliculitis is Staphylococcus aureus (3).

Fixed drug eruption (FDE) is a unique type of cutaneous adverse drug reaction. They were first described by Bourns1 in 1889 and later by Brocq2 as “eruption erythemato-pigmentee fixe”. It is characterised by the appearance of a single or multiple sharply demarcated violaceous erythematous plaques that may blister and is often associated with pruritus. The lesions generally leave behind some amount of residual hyperpigmentation. These lesions typically appear within 30 minutes to 24 hours of administration of the incriminated drug.1 The usual sites of involvement are hands, feet, genitalia and perianal region whereas it is seen less commonly around the mouth and trunk. There is a characteristic recurrence at the same sites on repeat administration

The release of two exotoxins from certain strains of S. aureus can lead to Staphylococcal scaled skin syndrome (SSSS), which is characterized by blistering skin. Invasion into the body can lead to more serious health problems including pneumonia (a frequent complication of influenza), mastitis, phlebitis (inflammation of the veins), meningitis, and urinary tract infections. If the bacterium is allowed to colonize even deeper tissues more serious conditions such as osteomyelitis and endocarditis may result. The most serious consequences of these deeper tissue infections occur when the bacterium invades the bloodstream leading to septic shock and possibly death.