Initial treatment of non purulent, complicated cellulitis is:
Treatment of nonpurulent, complicated cellulitis can begin with a β-lactam, with methicillin-resistant Staphylococcus aureus (MRSA) coverage added if no response is observed. Empiric MRSA coverage is warranted in all other complicated skin and subcutaneous infections. Vancomycin is the mainstay of therapy, although it is inferior to β-lactams for methicillin-sensitive S. aureus (MSSA) and has a relatively slow onset of efficacy in vitro. Linezolid, daptomycin, tigecycline, and telavancin are other FDA-approved alternatives for MRSA treatment. Clindamycin is also approved for S. aureus; however, resistance may develop, and diarrhea can occur in up to 20% (Clostridium difficile related).
A 3-mm basal cell carcinoma (BCC) of the skin should be treated with:
Basal cell carcinoma (BCC) arises from the basal layer of nonkeratinocytes and represents the most common tumor diagnosed in the United States. Annually it accounts for 25% of all diagnosed cancers and 75% of skin cancers. The primary risk factor for disease development is sun exposure (ultraviolet [UV] B rays more than UVA rays) particularly during adolescence; however, other factors include immune suppression (ie, organ transplant recipients, human immunodeficiency virus [HIV] ), chemical exposure, and ionizing radiation exposure. BCC can also be a feature of inherited conditions such as xeroderma pigmentosa, unilateral basal cell nevus syndrome, and nevoid BCC syndrome. The natural behavior ofBCC is one of local invasion rather than distant metastasis. Untreated BCC can result in significant morbidity. Thirty percent of cases are found on the nose, and bleeding, ulceration, and itching are often part of the clinical presentation.
There are three types of cutaneous cysts: epidermal, dermoid, and trichilemmal. All of these benign entities comprise epidermis that grows toward the center of the cyst, resulting in central accumulation of keratin to form a cyst. All clinically appear as a white, creamy substance-containing subcutaneous, thin-walled nodule. Epidermal cysts are the most common cutaneous cyst and histologically characterized by mature epidermis complete with granular layer. Trichilemmal cysts are the second most common lesion; they tend to form on the scalp of females, have a distinct odor after rupture, histologically lack a granular layer, and have an outer layer resembling the root sheath of a hair follicle. Dermoid cysts are congenital, found between the forehead to nose tip, and contain squamous epithelium, eccrine glands, and pilosebaceous units, occasionally developing bone, tooth, or nerve tissue. The eyebrow is the most frequent site of presentation. These cysts are commonly asymptomatic but can become inflamed and infected, thus necessitating incision and drainage. After the acute phase subsides, the entire cyst should be removed to prevent recurrence.
More than half of patients treated for BCC will experience a recurrence within:
It is critical for each patient to have routine annual follow-up that includes full-body skin examinations. Sixty-six percent of recurrences develop within 3 years, and with a few exceptions occurring decades after initial treatment, the remaining recur within 5 years of initial treatment. A second primary BCC may develop after treatment and, in 40% of cases, presents within the first 3 years after treatment.
The primary risk factor for the development of squamous cell carcinoma (SCC) is:
Squamous cell carcinoma (SCC) is the second most common skin cancer, accounting for approximately 100,000 cases each year and generally afflicting individuals of lighter skin color. The primary risk factor and driving force for the development of this common cancer is UV exposure; however, other risks include environmental factors such as chemical agents, physical agents (ionizing radiation), psoralen and UVA (PUVA), HPV-16 and -18 infections (immunosuppression), and smoking. Chronic nonhealing wounds, burn scars, and chronic dermatosis are other risk factors, and many darker skin individuals who develop sec often have a history of one of these risk factors. Heritable conditions such as xeroderma pigmentosum, epidermolysis bullosa, and oculocutaneous albinism are predisposing risk factors.
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