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INFECTIONS AND INFESTATIONS Sexually Transmitted Diseases STDs with genital cutaneous manifestations include lymphogranuloma venereum, granuloma inguinale, herpes simplex, chancroid, molluscum contagiosum, HPV, and syphilis (Fig. These conditions are discussed in detail in Chapter 15.

Balanitis and Balanoposthitis Balanitis is an inflammatory disorder of the glans penis. When the process involves the preputial skin in uncircumcised men, it is termed balanoposthitis.

In children, bacterial infections are the predominant cause. Lipoprotein adult men, the cause may be intertrigo, ICD, Cellulitis is an infection of the deep dermis and subcutaneous tissues most Ethosuximide (Zarontin)- Multum caused by gram-positive organisms (S.

Ethosuximide (Zarontin)- Multum immunocompetent individuals, organisms usually gain entry to the site of infection through a break Ethosuximide (Zarontin)- Multum the skin barrier. In immunocompromised patients, a blood-borne route of infection is more common. Systemic signs of illness include fever, chills, and general malaise. Local signs include give smoking up (rubor), warmth (calor), pain (dolor), and swelling (tumor) at the site with indistinct borders (Fig.

Treatment includes systemic antibiotics with activity against S. The clinician may be forced to rely on known local antimicrobial sensitivity patterns, because obtaining satisfactory material for culture may be difficult. In cases associated with diabetes, mixed flora may be present and antibiotic coverage should be broadened. Marking the zone of cellulitis at the onset of therapy is an important step to allow progression and resolution of cellulites to be monitored during therapy.

Erysipelas is a superficial bacterial skin infection limited to the dermis with lymphatic involvement. This disease commonly occurs at the extremes of age and often involves the face. In contrast to the cutaneous lesion of cellulitis, erysipelas generally exhibits a raised and distinct border at the interface with normal skin.

The causative organism is usually S. Methadone (Methadone Oral Concentrate)- FDA Gangrene (Necrotizing Fasciitis of the Perineum) Fournier gangrene (FG) is a potentially life-threatening progressive infection of the perineum and genitalia (Morpurgo and Galandiuk, 2002).

In the genital region, most cases of FG are caused by mixed Chapter 16 Cutaneous Diseases of the External Genitalia Ethosuximide (Zarontin)- Multum B A D C F Figure 16-22. Genital lesions associated with sexually Ethosuximide (Zarontin)- Multum diseases.

A, Herpes simplex virus. Escherichia coli, Bacteroides Ethosuximide (Zarontin)- Multum. Risk factors for developing FG include underlying alcoholism, diabetes, cancer and malnutrition, Ethosuximide (Zarontin)- Multum age, recent urogenital or colorectal instrumentation or trauma, and Ethosuximide (Zarontin)- Multum peripheral vascular disease.

However, group A streptococcal necrotizing fasciitis can occur in healthy immunocompetent individuals.

The hallmark of FG is a rapid progression Ethosuximide (Zarontin)- Multum the signs and symptoms of cellulitis (erythema, swelling, and pain) to blister formation, to clinically visible ischemia, and ultimately to foulsmelling necrotic lesions (Fig. Infection may spread along fascial planes and hence the exterior skin findings may represent only a small proportion of the underlying infected and necrotic tissue.

The diagnosis of FG is a surgical emergency, as progression from genitalia to perineum to abdominal wall may occur Figure 16-23.

Spread of tissue infection is accompanied by an ever-increasing risk of bacterial septicemia, usually the eventual cause of death. The exclusion of FG therefore should be a priority Ethosuximide (Zarontin)- Multum every consultation for soft tissue infection of the genitalia. Pain out of proportion to 404 PART III Infections and Inflammation A B Figure 16-24. Fournier gangrene of the scrotum. A, Surface appearance of scrotum and perineum showing area of frank necrosis.

Gender, Extent of low dose bayer tissue debridement required to achieve margins of viable tissue. Note that the testes within their tunica vaginalis compartment are spared.

The skin may also exhibit a grayish cast or Ethosuximide (Zarontin)- Multum odor uncharacteristic of uncomplicated genital cellulitis.



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