CASE Sta Barbara

8/6/2019 CASE Sta Barbara

1/29

Western Visayas Sanitarium

January 31, 2011


2/29

yA.C

y9 months old/FemaleyNew Lucena

yCC: white patches on the face


3/29

y 5 months prior to consult, mother noted white patchon the right preauricular area of the patient. Motherdidnt bother to seek consult.

y 4 months prior to consult, white patches were noted tohave increase in size. No consult done. No remediesgiven.

y 3 months prior to consult, lesions spread to the frontal

and orbital areas. No change in color of the lesions. Noconsult done and no medications given.


4/29

y 2 months prior to consult, there was progression of thesize of the lesions involving the cheek areas. Noconsult done. No medications were given.

y Persistence of signs until the day of consult promptedthe mother to seek consult.

y Pertinent negatives: pruritus, crusting, no previous useof topical cream or ointments


5/29

y Prenatal

y Mother started her Prenatal check-up at 4 monthsAOG at a LocalBrgy HealthCenter and regularly thereafter. No maternal illnesses

y Natal

y Born full term via NSD at the Health Center asssited by a midwifey Postnatal

y No complications after birth

y No previous hospitalizations

y Feeding

y Breastfed until present. Started supplementary feeding withformula milk at 4 months of age

y Immunization

y Completed c/o LHC


6/29

y

No previous hospitalizationsy No food and drug allergic reactions


7/29

y No bronchial asthma

y No allergies

y No same lesions noted within the family


8/29

y Patient was active and playful

y VITAL SIGNSy CR: 112y RR: 36

y Temp: 36.8


9/29

y SKINy Brown and dry

y White macular lesions diffusely distributed over the

frontal, orbital and maxillary areas


10/29

yHEENTy Normocephalic , whitish macular lesions on the face

y Pearly white sclerae, pinkish conjuctiva

y No ear and nasal dischargesy Moist lips and buccal mucosa

y No cervical lymphadenopathies


11/29

y CHESTy Symmetrical chest expansion

y Clear breath sounds

y Normal cardiac rate and regular rhythm

y Adynamic precordium

y No murmurs noted


12/29

y ABDOMENy Round

y Normoactive bowel sounds

y Soft, non-tendery No masses


13/29

y EXTREMITIESy Grossly normal

y No lesions noted

y Capillary refill time < 2 seconds


14/29

y T/CPityriasis versicolor

D

ifferentialsy Vitiligo

y Seborrheic dermatitis


15/29

y KOH smear

y Ketoconazole 2% cream OD x 2 weeks

y Sulfur soap wash BID


16/29


17/29

y chronic asymptomatic scaling epidermomycosisassociated with the superficial overgrowth of thehyphal form ofMalassezia furfur, characterized by

well-demarcated scaling patches with variablepigmentation, occurring most commonly on the trunk.


18/29

Etiologyy M. furfur(previously known as Pityrosporum ovale, P.

orbiculare) is a lipophilic yeast that normally resides in

the keratin of skin and hair follicles of individuals atpuberty and beyond. It is an opportunistic organism,causing pityriasis versicolor andMalassezia folliculitisand is implicated in the pathogenesis of seborrheic

dermatitis.Malassezia infections are not contagious;rather, overgrowth of resident cutaneous flora occursunder certain favorable conditions.


19/29

Age ofOnsety Young adults. Less common when sebum production

is reduced or absent; tapers off during fifth and sixth

decades.


20/29

y Malassezia changes from the blastospore form to themycelial form under the influence of predisposingfactors. Dicarboxylic acids formed by enzymatic

oxidation of fatty acids in skin surface lipids inhibittyrosinase in epidermal melanocytes and thereby leadto hypomelanosis. The enzyme is present in theorganism.


21/29

Duration of Lesionsy Months to years.

Skin Symptomsy Usually none.Occasionally, mild pruritus. Individuals

with PV usually present because of cosmetic concernsabout the blotchy pigmentation.


22/29


23/29

Distributiony Upper trunk, upper arms, neck, abdomen, axillae,

groins, thighs, genitalia. Facial, neck, and/or scalp

lesions occur in patients applying creams/ointments ortopical glucocorticoid preparations.


24/29

Hypopigmented

y Vitiligo, pityriasis alba, postinflammatoryhypopigmentation, tuberculoid leprosy.

Scaling Lesionsy Tinea corporis, seborrheic dermatitis, pityriasis rosea,

guttate psoriasis, nummular eczema.


25/29


26/29


27/29


28/29

Diagnosisy Clinical findings, confirmed by positive KOH

preparation findings.

Course and Prognosisy Infection persists for years if predisposing conditions

persist. Dyspigmentation persists for months afterinfection has been eradicated.


29/29

Topical agents

Selenium sulfide (2.5%) lotion or shampooApply daily to affected areas for 10 to 15 min, followed byshower, for 1 week

Ketoconazoleshampoo Applied same as selenium sulfide shampoo

Azole creams (ketoconazole, econazole, micronazole,clotrimazole)

Apply qd or bid for 2 weeks

Terbinafine 1% solution Apply bid for 7 days

Systemic therapy

Ketoconazole 400 mg stat (take 1 h before exercise)

Fluconazole 400 mg stat

Itraconazole 400 mg stat

Secondaryprophylax

is Ketoconazoleshampoo once or twice a weekSelenium sulfide (2.5%) lotion or shampoo

Salicylic acid/sulfur bar

Pyrithionezinc (bar or shampoo)

Ketoconazole400 mg PO monthly

CASE Sta Barbara

Documents

Transcript of CASE Sta Barbara