These are the most difficult warts to remove. Peel
away the keratotic tissue and apply a concentrated
phenol solution. Follow this with an application
of nitric acid, and cover it with a salicylic acid
plaster and adhesive bandage. Repeat this treat-
ment every 5 days; it normally takes from three
to seven treatments for complete resolution.
Patients may be referred to a dermatologist for
other wart removal techniques, such as freezing
and elect rosurgical or surgical excision.
This is a superficial staph or strep skin
SYMPTOMSNormally lesions consist of
small pustules, but they may be larger with
rupturing and crusting. The lesions may remain
localized but are often autoinoculated over large
areas. It is most commonly found in children.
Impetigo may appear on apparently healthy skin,
but sometimes complicates other skin infections.
TREATMENTTopical antibiotics will
normally result in prompt resolution. Gentle but
thorough washing to remove any crust and debris
should precede the application of ointment. If left
untreated, impetigo may result in cellulitis or
furunculosis. These complications should be
treated with systemic antibiotics.
Furuncles and Carbuncles
A furuncle (boil) is an acute tender inflamma-
tion around perifollicular areas that is caused by
staphylococci. Carbuncles are goups of furuncles
adjacent to one another.
SYMPTOMSA furuncle has a single core
of necrotic tissue. The core exudes a purulent fluid
and is most commonly found on the neck, axillae,
and buttocks. These lesions are extremely
painful. A carbuncle has two or more cores with
multiple drainage sites and deep suppuration.
There may be extensive sloughing of the tissues
with large scar formation. A fever may be
present and the patient is often prostrated.
Carbuncles occur more frequently in men.
TREATMENTA single furuncle should be
treated with moist heat to facilitate pointing.
Once it has pointed, incise and attempt to remove
the central core. Implant an iodoform pack to
promote drainage and to prevent premature
healing. Systemic antibiotics are indicated. Large
furuncles and carbuncles require special care in
debridement to avoid spreading the infection.
Refer severe cases to a dermatologist.
This is a spreading inflammation of the tissues,
which usually affects the skin and subcutaneous
tissues. Streptococcus and staphylococcus are the
SYMPTOMSThese include fever, chills,
malaise, headache, acute pain upon palpation,
and swollen, red, and warm areas. Regional
lymphangitis or lymphadenitis is common. Severe
cases will often result in septicemia or bacteremia.
TREATMENTPlace the affected part at
rest and elevate. Bed rest is indicated if the
condition is severe. Apply moist heat and
administer erythromycin or lincomycin systemi-
cally. Continue the treatment until the symptoms
have ceased for 5 days.
This condition is the result of a staphylococcal
infection of hair follicles. Sycosis barbae is a
chronic and recalcitrant type better known as
barbers itch. It appears in the bearded area and
is aggravated by shaving.
SYMPTOMSBurning and itching are
common, and manipulation of hair causes pain.
TREATMENTApply hot packs to the
affected area. Apply topical antibiotics, and give
systemic antibiotics if the areas around the eyes,
nose, or mouth are involved (dangerous triangle).
Ringworm of the scalp is a highly contagious
fungal infection usually affecting school children.
SYMPTOMSIt is characterized by small
gray lesions in which the hair is broken off, scant,
or without luster. It may involve all or a part of
TREATMENTGriseofulvin is definitive and
0.5 g should be administered twice daily with
meals for 4 to 8 weeks or a single dose of 2 to
6 g repeated every 3 to 4 weeks.