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Digital dermatitis is a polymicrobial disease involving treponemes and other anaerobes. Treponemes are the bacterium most commonly found in lesions. Their abundance increases as the lesion progresses. They account for 94% of bacterial sequences detected in chronic lesions.
Treatment of lesions of digital dermatitis is done by topical application of agents to the affected skin. The skin should be cleaned and kept dry prior treatment. Topical oxytetracycline (OTC) is often referred as the most reliable treatment as cows treated with OTC have a good recovery rate. Bandaging the lesion is often undertaken but there is no evidence of any benefit and bandaging can provide the anaerobic environment which supports the spirochaetes.. Systemic antibiotics are not needed.
Control and prevention of digital dermatitis relies on prompt detection, isolation and treatment of affected cattle. Group hoof disinfection can be achieved via the passage of the cows through footbaths of antimicrobial solutions. Slurry build-up should be avoided since organic matter can impair the antimicrobial efficacy of the footbath solutions. Regular footbaths should be organised, using formalin, copper sulphate or a thymol-based disinfectant. While regular footbathing can help prevent hoof infections, occasional flare-up of active M2 lesions can happen.
The skin should be cleaned and kept dry, and topical antibiotics can be applied to the area. Systemic antibiotics are not needed.
Control relies on prompt detection, isolation and treatment of affected cattle. Footpaths should be kept as dry as possible and slurry build-up should be avoided. Regular footbaths should be organised, using formalin, copper sulphate or a thymol-based disinfectant. In 2013, a safer and alternative to chemicals for hoof baths called Thymox Technology was proven, through field testing, to kill the main bacteria causing digital dermatitis.
When visiting a doctor, the basic diagnosis procedure applies. This includes checking the patient's medical history and medical record for risk factors, a medical interview during which the doctor asks questions (such as about itching and scratching), and a physical examination. Athlete's foot can usually be diagnosed by visual inspection of the skin and by identifying less obvious symptoms such as itching of the affected area.
If the diagnosis is uncertain, direct microscopy of a potassium hydroxide preparation of a skin scraping (known as a KOH test) can confirm the diagnosis of athlete's foot and help rule out other possible causes, such as candidiasis, pitted keratolysis, erythrasma, contact dermatitis, eczema, or psoriasis. Dermatophytes known to cause athlete's foot will demonstrate multiple septate branching hyphae on microscopy.
A Wood's lamp (black light), although useful in diagnosing fungal infections of the scalp (tinea capitis), is not usually helpful in diagnosing athlete's foot, since the common dermatophytes that cause this disease do not fluoresce under ultraviolet light.
There are differential diagnosis' for erythrasma which includes psoriasis, candidasis, dermaphytosis, and interigo. The diagnosis can be made on the clinical picture alone. However, a simple side-room investigation with a Wood's lamp is additionally useful in diagnosing erythrasma. The ultraviolet light of a Wood's lamp causes the organism to fluoresce a characteristic coral red color, differentiating it from other skin conditions such as tinea versicolor, which may fluoresce a copper-orange color. Another route to differentiate erythrasma would be through bacterial and mycology related cultures to compare/contrast normal results to these findings. These are both non-invasive routes.
Erythrasma is often mistakenly diagnosed as dermatophytic infection which is a fungal infection and not a bacterial infection. The difference here is that fungi are multicellular and eukaryotes while bacteria are single celled prokaryotes. This is vital to differentiate because of the way they reproduce will indicate how the infection will spread throughout the human body.
Recent research for Erythrasma is mainly focused on the treatments and which methods work best to treat the patient depending on the severity of the condition. In a 2016 study performed by Prathyusha Prabhakar and H. Hema, they looked into comparing 2% clotrimazole cream and 2% Fusidic cream in treating erythrasma. This was a one year long hospital based study in South India that resulted in stating that the groin was the most common site for the symptoms of itching and discloloration being predominant and also mostly in men. The general conclusion made was that topical 2% fusidic acid cream was found to be more effective than 2% clotrimazole cream in patients with erythrasma. The topical 2% clotrimazole cream was more effective only when an associated fungal infection was present.
Another study performed in early 2017 by Tanya Grewal and Philip Cohen looked directly at mupirocin 2% ointment monotherapy. This study was done with nine males who showed a presence of erythrasma at bilateral inguinal folds, medial thighs, and axillae. After initial diagnosis by Wood lamp's examination to confirm the diagnosis, the antibiotic cream was distributed. Mupirocin is a topical antibiotic that is usually used to treat Streptococcus and Staphylococcus infections. After 2-4 weeks of use, the erythrasma seemed to clear up. They were able to conclude that the application of 2% Mupirocin ointment monotherapy twice a day, everyday is a great consideration for a first line of treatment for erythrasma.
A study done in 2011 by M. Inci and G. Serarslan revolved around detecting the frequency and risk factors of interdigital erythrasma in patients who were possibly diagnosed with Tinea pedis. The study was done with 122 people who had a confirmed diagnoses of erythrasma through the Wood's lamp method. The results showed that erythrasma was more prevalent in males who were over the age of 40 years. Their conclusions were that erythrasma is a common condition and can also easily mimic other infections such as tinea pedis and that gram staining is a better tool to differentiate the bacteria and it's mechanism than the Wood's lamp method.
There are several preventive foot hygiene measures that can prevent athlete's foot and reduce recurrence. Some of these include keeping the feet dry, clipping toenails short; using a separate nail clipper for infected toenails; using socks made from well-ventilated cotton or synthetic moisture wicking materials (to soak moisture away from the skin to help keep it dry); avoiding tight-fitting footwear, changing socks frequently; and wearing sandals while walking through communal areas such as gym showers and locker rooms.
According to the Centers for Disease Control and Prevention, "Nails should be clipped short and kept clean. Nails can house and spread the infection." Recurrence of athlete's foot can be prevented with the use of antifungal powder on the feet.
The fungi (molds) that cause athlete's foot require warmth and moisture to survive and grow. There is an increased risk of infection with exposure to warm, moist environments (e.g., occlusive footwear—shoes or boots that enclose the feet) and in shared humid environments such as communal showers, shared pools, and treatment tubs. Chlorine bleach is a disinfectant and common household cleaner that kills mold. Cleaning surfaces with a chlorine bleach solution prevents the disease from spreading from subsequent contact. Cleaning bathtubs, showers, bathroom floors, sinks, and counters with bleach helps prevent the spread of the disease, including reinfection.
Keeping socks and shoes clean (using bleach in the wash) is one way to prevent fungi from taking hold and spreading. Avoiding the sharing of boots and shoes is another way to prevent transmission. Athlete's foot can be transmitted by sharing footwear with an infected person. Hand-me-downs and purchasing used shoes are other forms of shoe-sharing. Not sharing also applies to towels, because, though less common, fungi can be passed along on towels, especially damp ones.
A diagnosis of perioral dermatitis is typically made based on the characteristics of the rash. A skin biopsy is usually not required to make the diagnosis but can be helpful to rule out other skin diseases which may resemble perioral dermatitis. Extended patch testing maybe useful to also rule out allergic contact causes.
Some sources claim that diaper rash is more common with cloth diapers. Others claim the material of the diaper is relevant insofar as it can wick and keep moisture away from the baby's skin, and preventing secondary "Candida" infection. However, there may not be enough data from good-quality, randomized controlled trials to support or refute disposable diaper use thus far. Furthermore, the effect of non-biodegradable diapers on the environment is a concerning matter for public policy.
Possible treatments include minimizing diaper use, barrier creams, mild topical cortisones, and antifungal agents. A variety of other inflammatory and infectious processes can occur in the diaper area and an awareness of these secondary types of diaper dermatitis aids in the accurate diagnosis and treatment of patients.
Interdigital dermatitis appears as an infections of the skin between the claws and is usually very mild. There may be fluid or a scab in that area, and there is rarely lameness. There is then progression to the heels which become raw and cattle will experience pain. Chronic cases will show changes of the hoof including hyperplasia of the interdigital tissues and muscle atrophy in the affected limb. The horn may become underrun.
Diagnosis is principally based on history and clinical signs. It is very rare that attempts are made to isolate the bacteria.
With no particular affinity to any particular ethnic group, seen in all age groups and equally amongst males and females, the precise prevalence is not known.
The aim of treatment is to relieve the allergy-induced itch and to remove the fleas from the pet and its home environment. In some cases, secondary bacterial or yeast infections will also need treatment before the itching subsides. Environmental flea control includes using flea foggers or bombs, vacuuming, and treating pet bedding by washing on a hot cycle (over 60 degrees Celsius) in the washing machine. The current on-pet treatment recommended by veterinary dermatologists is spinosad (Comfortis) monthly and nitenpyram (Capstar or generics) every 48 hours until improvement.
Many pets with FAD may also have other allergies, such as allergies to food, contact allergies, and atopic dermatitis.
Since contact dermatitis relies on an irritant or an allergen to initiate the reaction, it is important for the patient to identify the responsible agent and avoid it. This can be accomplished by having patch tests, one of various methods commonly known as allergy testing. The top three allergens found in patch tests from 2005–06 were: nickel sulfate (19.0%), Myroxylon pereirae (Balsam of Peru, 11.9%), and fragrance mix I (11.5%).
The patient must know where the irritant or allergen is found to be able to avoid it. It is important to also note that chemicals sometimes have several different names, and do not always appear on labels.
The distinction between the various types of contact dermatitis is based on a number of factors. The morphology of the tissues, the histology, and immunologic findings are all used in diagnosis of the form of the condition. However, as suggested previously, there is some confusion in the distinction of the different forms of contact dermatitis. Using histology on its own is insufficient, as these findings have been acknowledged not to distinguish, and even positive patch testing does not rule out the existence of an irritant form of dermatitis as well as an immunological one.
The prevalence of nummular dermatitis in the United States is approximately 2 per 1,000. It is considered a disease of adulthood, for it is rare in children.
Atopic dermatitis is typically diagnosed clinically, meaning it is diagnosed based on signs and symptoms alone, without special testing. Several different forms of criteria developed for research have also been validated to aid in diagnosis. Of these, the UK Diagnostic Criteria, based on the work of Hanifin and Rajka, has been the most widely validated.
Treatment may include corticoids, astringents, and keratolytics. Dermatoses tend to be recurrent unless the use or contact can be avoided. Discontinuation of the instrument is curative in almost all cases, but usually impractical.
Keeping the skin clean and dry, as well as maintaining good hygiene, will help larger topical mycoses. Because fungal infections are contagious, it is important to wash after touching other people or animals. Sports clothing should also be washed after use.
The diagnosis of flea allergy dermatitis is complicated by the grooming habits of pets. Cats in particular are very efficient at grooming out fleas, often removing any evidence of infestation. Fleas begin biting within 5 minutes of finding a host, and there are no flea treatments that kill fleas before biting occurs.
Once pederin is on the skin from the initial beetle contact, it may also be spread elsewhere on the skin. "Kissing" or "mirror-image" lesions where two skin areas come in contact (for example, the elbow flexure) are often seen. Washing the hands and skin with soap and water is strongly recommended, if contact with a rove beetle has occurred.
Initial skin contact with pederin shows no immediate result. Within 12–36 hours, however, a reddish rash (erythema) appears, which develops into blisters. Irritation, including crusting and scaling, may last from two to three weeks.
One study reported best results with a treatment regimen that combined topical steroids with oral antihistamines and antibiotics. The authors hypothesized that antibiotics were helpful because of the possible contamination of skin by pederin-producing bacteria.
Systemic mycoses due to opportunistic pathogens are infections of patients with immune deficiencies who would otherwise not be infected. Examples of immunocompromised conditions include AIDS, alteration of normal flora by antibiotics, immunosuppressive therapy, and metastatic cancer. Examples of opportunistic mycoses include Candidiasis, Cryptococcosis and Aspergillosis.
Diagnosis of nummular dermatitis largely clinical. Biopsies are typically not necessary, and cannot be used to rule out other atopic dermatitis or other eczemas. However, patch testing may be employed to rule out irritants (contact dermatitis) as a cause. In children, nummular dermatitis is commonly confused with tinea corporis.
Diagnosing allergic contact dermatitis is primarily based on physical exam and medical history. In some cases doctors can establish an accurate diagnosis based on the symptoms that the patient experiences and on the rash's appearance. In the case of a single episode of allergic contact dermatitis, this is all that is necessary. Chronic and/or intermittent rashes which are not readily explained by history and physical exam often will benefit from further testing.
A patch test (contact delayed hypersensitivity allergy test) is a commonly used examination to determine the exact cause of an allergic contact dermatitis. According to the American Academy of Allergy, Asthma, and Immunology, "patch testing is the gold standard for contact allergen identification".
The patch test consists of applying small quantities of potential allergens to small patches and which are then placed on the skin. After two days, they are removed and if a skin reaction occurred to one of the substances applied, a raised bump will be noticeable underneath the patch. The tests are again read at 72 or 96 hours after application.
Patch testing is used for patients who have chronic, recurring contact dermatitis. Other tests that may be used to diagnose contact dermatitis and rule out other potential causes of the symptoms include a skin biopsy and culture of the skin lesion.
Other rashes that occur in a widespread distribution can look like an id reaction. These include atopic dermatitis, contact dermatitis, dyshidrosis, photodermatitis, scabies and drug eruptions.
Defatting can be prevented by wearing appropriate protective clothing such as gloves, lab coats and aprons when working regularly with defatting agents. Prolonged skin contact or chronic defatting of the skin increases the possibility for developing irritant contact dermatitis and has the potential to worsen pre-existing skin conditions. Patients with chronic dermatitis are advised to use non-irritating soaps and dishwashing liquids sparingly and to choose those with a neutral pH and minimal defatting capability.