PANCE Blueprint Dermatology (5%)

Bacterial Infections (PEARLS)

The NCCPA™ PANCE Dermatology Content Blueprint covers three dermatologic bacterial infections


Cellulitis (ReelDx) Acute bacterial skin and skin structure infection of the dermis and subcutaneous tissue; characterized by pain, erythema, warmth, and swelling. Margins are flat and not well demarcated.

  • Caused by Staphylococcus and Streptococcus in adults
  • H. influenzae or strep pneumonia in children

DX: culture taken of all purulent wounds and follow up in 48 hours

Treat mild cellulitis (MSSA) with Cephalexin or Dicloxacillin 

  • Cat bite with augmentin or doxycycline if PCN allergic
  • Puncture wound with Cipro (cover pseudomonas)

Treat methicillin-resistant Staphylococcus aureus infection (MRSA) with

  • Trimethoprim-sulfamethoxazole (TMP-SMZ) 1 DS tab PO BID
  • Clindamycin 300–450 mg PO
  • Doxycycline 100 mg PO BID
  • Intravenous Vancomycin or Linezolid

Cellulitis with erythematous tender swelling of the left lower extremity

Cellulitis with erythematous tender swelling of the left lower extremity

Erysipelas A distinct form of cellulitis notable for acute, well-demarcated, raised superficial bacterial skin infection with lymphatic involvement almost always caused by Group A strep (strep pyogenes)

  • Symptoms may include redness and pain at the affected site, fevers, and chills

DX: culture and sensitivity

TX:

  • Mild disease can be treated with Penicillin G (erythromycin/clindamycin for PCN allergy)
  • Moderate: Bactrim and penicillin/cephalexin
  • severe IMP or MER IV and linezolid BID or Vanco IV/Dapto IV

Erysipelas. This patient has large, confluent erythematous plaques. A bulla is present near the angle of her jaw.

Erysipelas. This patient has large, confluent erythematous plaques. A bulla is present near the angle of her jaw.

Impetigo Child < 6 y/o complaining of non-painful, pruritic lesions on the face

  • The main symptom is red sores that form around the nose and mouth. The sores rupture, ooze for a few days, then form a yellow-brown crust
  • “honey-colored” and weeping
  • Most commonly caused by S. aureus

Treatment is topical mupirocin, dicloxacillin, cephalexin for more severe illness

  • Complications: poststreptococcal glomerulonephritis

Impetigo with crusted patches around the mouth.

Impetigo with crusted patches around the mouth.

Dermatologic Infectious diseases (PEARLS) (Prev Lesson)
(Next Lesson) Cellulitis (ReelDx)
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