Dominican Republic

1. Dominican Republic Common Health Problems

2. Skin Disorders • Fungal Infections (Candidiasis, Tinea) • Contact Dermatitis • Scabies • Parasites

3. Fungal Infections Candidiasis • Erythematous, well-demarcated, maculopapular eruptions • Satelite lesions • Pruritic

4. 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)

5. Candidiasis

6. Oral Candidiasis

7. Oral Candidiasis • Treatment: • Nystatin oral (if available) • Avoid sweets until mouth clears up (yeast feeds on sugars)

8. Fungal InfectionsTinea • Erythematous, scaling area with discrete border and central clearing • Usually very pruritic

9. 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.)

10. 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”

11. 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).

12. 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.

13. 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)

14. 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

15. Scabies

16. 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.)

17. 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

18. 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.

19. 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

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

21. Gripe (cont’d) • 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.

22. Gripe (cont’d) • 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

23. 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

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

25. 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.

26. Gripe • Treatment: • Antitussives (for cough) and Expectorants: • Guaifenesin (Robitussin, Mucinex)

27. 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)

28. Anemia • Common manifestations: • Dizziness • Weakness • Pallor • Frequent complaint of young women and elderly women

29. Anemia • Treatment • Give Vitamins with iron

30. 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.

31. Bacterial Vaginal Infection • Vaginal discharge (color varies: gray, greenish, yellowish) • May have a foul odor

32. Bacterial Vaginal Infection • Treatment • Must be treated with an antibiotic

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

34. 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.