Dominican Republic

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Dominican Republic

• Common Health Problems

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Skin Disorders

• Fungal Infections (Candidiasis, Tinea)
• Contact Dermatitis
• Scabies
• Parasites

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Fungal Infections Candidiasis

• Erythematous, well-demarcated, maculopapular
  eruptions
• Satelite lesions
• Pruritic

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Fungal Infections Candidiasis

• Treatment
• Clotrimazole 2 cream
• Miconazole cream
• Educate on importance to keep areas at risk (skin
  folds, groin area) dry and clean.
• Do not use hydrocortisone cream
• --(produces a burning sensation)

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Candidiasis
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Oral Candidiasis
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Oral Candidiasis

• Treatment
• Nystatin oral (if available)
• Avoid sweets until mouth clears up (yeast feeds
  on sugars)

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Fungal InfectionsTinea

• Erythematous, scaling area with discrete border
  and central clearing
• Usually very pruritic

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Fungal InfectionsTinea

• Treatment
• Tinea Corporis Miconazole or Clotrimazole bid x
  2 weeks.
• Tinea Capitis more difficult to treat with
  topical agents. Usually po treatment is not
  available for us to take, so an attempt at
  treatment with cream is acceptable.
• Educate on proper hygiene and that it is
  contagious (no sharing caps, towels, etc.)

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Contact Dermatitis

• Erythematous, and edematous area
• Usually localized and itches
• Area is usually asymmetrical (not found in
  exactly the same spot on both sides of the body)
• Area affected will relate to something the
  patient has contacted

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Contact Dermatitis
This is a close-up of a dermatitis reaction. It
consists of a large, red (erythematous) lesion
(plaque) with numerous small pus-filled areas
(pustules).
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Contact Dermatitis
This is a typical early appearance of a poison
ivy rash, located on the leg. These early
lesions consist of multiple small blisters, often
in a line where the skin has brushed against the
poison ivy plant.
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Contact Dermatitis

• Treatment
• Calamine Lotion (if vesicles or weeping to dry it
  up)
• Topical Steroid creams (NOT used on the face)
• Oral Antihistamines (may be warranted if itching
  is severe)
• Removal of offending agent (if identifiable)

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Scabies

• Primary lesions
• typical burrows, vesicles and papules
• Secondary lesions chronic cases with scratching,
  scaling and erythema (this can be difficult to
  distinguish from parasites as the scratching and
  scaling make the burrows -black dots- difficult
  to identify. This is frequently the presentation
  of scabies in the D.R.)
• VERY pruritic
• Highly Contagious

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Scabies
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Scabies

• Ivermectin 100 mcg/kg as a single oral dose
• May need Benadryl cream or po for the severe
  itching
• Educate on no sharing of clothing, towels. Also,
  bed linens need to be washed (if they have the
  resources to do so.)

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Parasites

• Tips to help you distinguish parasites from
  scabies
• Bites/irritation ABOVE the neck (this will clue
  you into the rest of the skin irritation on the
  body being parasites)
• Hard nodules under skin
• Hair-like fibers in the skin
• May have Sores/open lesions that do not heal

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Parasites

• Treatment
• Every patient we see will be treated with a
  standard dose of anti-parasitic medication.
  (Infants and young children will be given the
  Ivermectin based on a calculation of their
  estimated weight.)
• VERY important to educate on drinking clean water
  and clean foods as well as personal sanitation.
• Mild to moderate diarrhea is expected. If severe
  enough to cause concern for dehydration, patient
  may be given an anti-diarrheal medication.

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Antibiotic Use for Skin Infections

• If scratching has become so severe that a break
  in the skin has lead to a strep or staph
  infection
• Folliculitis
• Impetigo
• Abscesses
• Severe Boils

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Gripe

• A general complaint for flu-like symptoms, nasal
  congestion, allergies, sore throat, ear
  stuffiness.
• Requires further investigation of the root cause
  of the patients problem
• The most common complaint!!!

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Gripe (contd)

• Know which symptoms you are treating
• Congestion
• Do your ears feel full?
• Is your nose stuffy? (I.e. stopped up)
• Congestion can be relieved with Decongestants
• Sinus congestion
• Do they have tenderness upon palpation of the
  sinuses, above and below the eyes?
• This along with fever may indicate a need for
  antibiotic therapy.

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Gripe (contd)

• Allergy Symptoms
• Runny nose
• Watery eyes
• Itchy eyes
• Itchy nose
• May also have a red, scratchy throat
• Itchy ears
• Sneezing
• May have cough due to irritation

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Sore Throat

• Post Nasal Drip
• See drainage in the back of the throat
• Frequently accompanied by clearing of the throat
  or an irritating cough
• Strep Throat
• Very red throat
• Petechiae on Soft Palate
• May have exudate on tonsils
• Must be treated with an antibiotic

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Gripe

• Treatment
• Congestion
• Phenylephrine (Sudafed PE)
• Preferable for those with high BP
• Pseudoephedrine (Sudafed)
• Dimetapp Cold and Allergy (for children)

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Gripe

• Treatment
• Allergy Symptoms (Antihistamines)
• Sedating Diphenhydramine(Benadyl),
  Chlorpheniramine, Zyrtec, Tavist
• Nonsedating Claritin, Allegra, Clarinex,
  Alavert
• Dimetapp Cold and Allergy is a wonderful
  combination antihistamine and decongestant for
  children.

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Gripe

• Treatment
• Antitussives (for cough) and Expectorants
• Guaifenesin (Robitussin, Mucinex)

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When to use Antibiotics with Gripe Complaints

• Suspect Bacterial infections
• Sinus pressure with fever
• Strep throat or a severe tonsillitis
• Ear infection (Otitis Media)
• External ear infection (Otitis Externa) swollen,
  tender ear canal
• Swollen cervical lymph nodes
• High fever (usually above 100.4)

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Anemia

• Common manifestations
• Dizziness
• Weakness
• Pallor
• Frequent complaint of young women and elderly
  women

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Anemia

• Treatment
• Give Vitamins with iron

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Vaginal InfectionsBacterial vs Fungal

• Ask the following questions
• Discharge? If yes, color and amount?
• Foul odor?
• Itching?
• This will lead you to distinguish between an
  actual bacterial vaginal infection and a yeast
  infection. This is important because treatment
  is different for each of these.

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Bacterial Vaginal Infection

• Vaginal discharge (color varies gray, greenish,
  yellowish)
• May have a foul odor

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Bacterial Vaginal Infection

• Treatment
• Must be treated with an antibiotic

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Fungal Vaginal Infection

• May complain of burning with urination (be sure
  to rule out a UTI)
• White, curdy discharge
• Very Very itchy

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Fungal Vaginal Infection

• Treatment
• Clotrimazole vaginal cream
• Miconazole vaginal cream
• Do NOT give an antibiotic for this. This can
  potentially make the itching much worse.