fluctuance vs induration fluctuance vs induration

Calor, dolor, rubor, and tumor: Heat, pain, redness, and swelling. Pertinent physical exam findings, often performed in the Sim position, include erythema of the surrounding skin, superficial or deep mass with tenderness to palpation, tenderness on . Sensation Intact vs Hypoesthesia (decreased sensation) or Numbness (absent sensation. The cause of seborrheic keratosis is unknown, but genetic mutations read more , actinic keratoses Actinic keratoses Chronic affects of sunlight include photoaging, actinic keratoses, and skin cancer. Plain radiography, ultrasonography, computed tomography, or magnetic resonance imaging may show soft tissue edema or fascial thickening, fluid collections, or soft tissue air. Figure 1: Abscess in an African American patient They are caused read more or peripheral arterial disease Peripheral Arterial Disease Peripheral arterial disease (PAD) is atherosclerosis of the extremities (virtually always lower) causing ischemia. Verywell Health's content is for informational and educational purposes only. Monomicrobial necrotizing fasciitis caused by streptococcal and clostridial infections is treated with penicillin G and clindamycin; S. aureus infections are treated according to susceptibilities. Thrombopoietin helps control the number of circulating platelets by stimulating the bone marrow to produce megakaryocytes read more ), vasculitis Overview of Vasculitis Vasculitis is inflammation of blood vessels, often with ischemia, necrosis, and organ inflammation. Treatment of necrotizing fasciitis involves early recognition and surgical debridement of necrotic tissue, combined with high-dose broad-spectrum intravenous antibiotics. Diagnosis read more commonly form plaques. Reference induration measurements were categorized as follows: 0-4mm, 5-9mm, 10-14mm, and 15+mm. Diagnostic testing should be performed early to identify the causative organism and evaluate the extent of involvement, and antibiotic therapy should be commenced to cover possible pathogens, including atypical organisms that can cause serious infections (e.g., resistant gram-negative bacteria, anaerobes, fungi).5, Specific types of SSTIs may result from identifiable exposures. Diagnosis read more , some drug eruptions, some dermatophyte infections Overview of Dermatophytoses Dermatophytoses are fungal infections of keratin in the skin and nails (nail infection is called tinea unguium or onychomycosis). In one prospective study, beta-hemolytic streptococcus was found to cause nearly three-fourths of cases of diffuse cellulitis.16 S. aureus, P. aeruginosa, enterococcus, and Escherichia coli are the predominant organisms isolated from hospitalized patients with SSTIs.17 MRSA infections are characterized by liquefaction of infected tissue and abscess formation; the resulting increase in tissue tension causes ischemia and overlying skin necrosis. Data Sources: A PubMed search was completed using the key term skin and soft tissue infections. Moving in waves. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Ulcers result from loss of the epidermis and at least part of the dermis. There is no specific read more . Reticulated lesions have a lacy or networked pattern. Psoriasis frequently exhibits this phenomenon, as may lichen planus Lichen Planus Lichen planus is a recurrent, pruritic, inflammatory eruption characterized by small, discrete, polygonal, flat-topped, violaceous papules that may coalesce into rough scaly plaques, often accompanied read more , often resulting in linear lesions. For example, diabetes increases the risk of infection-associated complications fivefold.14 Comorbidities and mechanisms of injury can determine the bacteriology of SSTIs (Table 3).5,15 For instance, Pseudomonas aeruginosa infections are associated with intravenous drug use and hot tub use, and patients with neutropenia more often develop infections caused by gram-negative bacteria, anaerobes, and fungi. This photo shows a lipoma on the extremity. Keloids are more frequent read more are hypertrophic scars that extend beyond the original wound margin. Red skin (erythema) can result from many different inflammatory or infectious diseases. Indurated skin generally has the following signs: The indurated areas commonly appear on the hands and face, but can also be found on the chest, back, abdomen, breasts, or buttocks. Physical examination demonstrates 3 cm of warm, blanching erythema without induration or fluctuance. When examining the color of skin, health care practitioners should note that the natural color of a patient's skin can change the appearance of colors. Skin lesions are an important feature of the unusual syndrome of chronic meningococcemia, characterized by recurrent cycles of fever, arthralgia, and rash over a period of 2 to 3 months. Xanthomas, which are yellowish, waxy lesions, may be idiopathic or may occur in patients who have lipid disorders. Induration or drainage suggests a fistula or abscess. Symptoms. Use to remove results with certain terms Induration. Fluctuance is a sign of purulence within the abscess cavity, although in some cases this finding may be difficult to detect, owing to induration and depth of the lesion. Wheals are a common manifestation of hypersensitivity to drugs, stings or bites, autoimmunity, and, less commonly, physical stimuli including temperature, pressure, and sunlight. 2. (See also Evaluation of the Dermatologic Patient Evaluation of the Dermatologic Patient History and physical examination are adequate for diagnosing many skin lesions. All Rights Reserved. Important information to obtain from history includes Personal or family read more and Diagnostic Tests for Skin Disorders Diagnostic Tests for Skin Disorders Diagnostic tests are indicated when the cause of a skin lesion or disease is not obvious from history and physical examination alone. The term maculopapular is often loosely and improperly used to describe many red rashes; because this term is nonspecific and easily misused, it should be avoided. Metastasis is correlated with depth of dermal invasion. She has worked in the hospital setting and collaborated on Alzheimer's research. Cutaneous tumors are often pink or red. Monday to Friday. o [ abdominal pain pediatric ] Cellulitis, abscess, or both are among the most common skin and soft tissue infections [].Cellulitis (which includes erysipelas) manifests as an area of skin erythema, edema, and warmth; it develops as a result of bacterial entry via breaches in the skin barrier [].A skin abscess is a collection of pus within the dermis or subcutaneous space. Symptoms, usually severe, include headache, nausea, vomiting, photophobia read more ), calciphylaxis Calciphylaxis All patients undergoing long-term renal replacement therapy (RRT) develop accompanying metabolic and other disorders. Culture purulent fluid 5. They vary in size, typically 1 to 3 cm in length, but are sometimes much larger. Diagnosis is by clinical evaluation and biopsy. Port-wine stains are capillary vascular malformations that are present at birth and that manifest read more , and the rashes of rickettsial infections Overview of Rickettsial and Related Infections Rickettsial diseases (rickettsioses) and related diseases (anaplasmosis, ehrlichiosis, Q fever, scrub typhus) are caused by a group of gram-negative, obligately intracellular coccobacilli. Verrucous lesions have an irregular, pebbly, or rough surface. Indistinct margins of involvement Lymhangitis is often absent (infection is in deep fascia rather than skin) Rapidly progressive despite use of antibiotics Fever may be present in only 40% of the cases due to masking effect of NSAIDs, steroids and antibiotics. Mild PAD may be asymptomatic or cause intermittent claudication; severe PAD read more ), infections, and vasculitis Cutaneous Vasculitis Cutaneous vasculitis refers to vasculitis affecting small- or medium-sized vessels in the skin and subcutaneous tissue but not the internal organs. Indurated skin has a hard, resistant feeling. describe a time when you were treated unfairly. Examples include molluscum contagiosum Molluscum Contagiosum Molluscum contagiosum is characterized by clusters of pink, dome-shaped, smooth, waxy, or pearly and umbilicated papules 2 to 5 mm in diameter caused by molluscum contagiosum virus, a poxvirus read more and herpes simplex Herpes Simplex Virus (HSV) Infections Herpes simplex viruses (human herpesviruses types 1 and 2) commonly cause recurrent infection affecting the skin, mouth, lips, eyes, and genitals. Study with Quizlet and memorize flashcards containing terms like Expand the following abbreviation into the full medical term. Skin Lesion (Bullae) Oral mucosa may be involved. -4+ = unsustained clonus. Papules are elevated lesions usually < 10 mm in diameter that can be felt or palpated. Identify area of maximal fluctuance 3. Superficial Infections: Cellulitis and Erysipelas. Discoid lupus erythematosus Variant Forms of Lupus Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women. Ulceration can be a complication. With spread read more . Rubella is a contagious viral infection that may cause adenopathy, rash, and sometimes constitutional symptoms, which are usually mild and brief. Baylor University Medical Center Proceedings. KALYANAKRISHNAN RAMAKRISHNAN, MD, ROBERT C. SALINAS, MD, AND NELSON IVAN AGUDELO HIGUITA, MD. The four classical signs of inflammation, originally recorded by the Roman encyclopedist Celsus in the 1st century A.D. Distribution is random or patterned, symmetric or asymmetric. An excoriation is a linear erosion caused by scratching, rubbing, or picking. According to guidelines from the Infectious Diseases Society of America, initial management is determined by the presence or absence of purulence, acuity, and type of infection.5, Topical antibiotics (e.g., mupirocin [Bactroban], retapamulin [Altabax]) are options in patients with impetigo and folliculitis (Table 5).5,27 Beta-lactams are effective in children with nonpurulent SSTIs, such as uncomplicated cellulitis or impetigo.28 In adults, mild to moderate SSTIs respond well to beta-lactams in the absence of suppuration.16 Patients who do not improve or who worsen after 48 hours of treatment should receive antibiotics to cover possible MRSA infection and imaging to detect purulence.16, Adults: 500 mg orally 2 times per day or 250 mg orally 3 times per day, Children younger than 3 months and less than 40 kg (89 lb): 25 to 45 mg per kg per day (amoxicillin component), divided every 12 hours, Children older than 3 months and 40 kg or more: 30 mg per kg per day, divided every 12 hours, For impetigo; human or animal bites; and MSSA, Escherichia coli, or Klebsiella infections, Common adverse effects: diaper rash, diarrhea, nausea, vaginal mycosis, vomiting, Rare adverse effects: agranulocytosis, hepatorenal dysfunction, hypersensitivity reactions, pseudomembranous enterocolitis, Adults: 250 to 500 mg IV or IM every 8 hours (500 to 1,500 mg IV or IM every 6 to 8 hours for moderate to severe infections), Children: 25 to 100 mg per kg per day IV or IM in 3 or 4 divided doses, For MSSA infections and human or animal bites, Common adverse effects: diarrhea, drug-induced eosinophilia, pruritus, Rare adverse effects: anaphylaxis, colitis, encephalopathy, renal failure, seizure, Stevens-Johnson syndrome, Children: 25 to 50 mg per kg per day in 2 divided doses, For MSSA infections, impetigo, and human or animal bites; twice-daily dosing is an option, Rare adverse effects: anaphylaxis, angioedema, interstitial nephritis, pseudomembranous enterocolitis, Stevens-Johnson syndrome, Adults: 150 to 450 mg orally 4 times per day (300 to 450 mg orally 4 times per day for 5 to 10 days for MRSA infection; 600 mg orally or IV 3 times per day for 7 to 14 days for complicated infections), Children: 16 mg per kg per day in 3 or 4 divided doses (16 to 20 mg per kg per day for more severe infections; 40 mg per kg per day in 3 or 4 divided doses for MRSA infection), For impetigo; MSSA, MRSA, and clostridial infections; and human or animal bites, Common adverse effects: abdominal pain, diarrhea, nausea, rash, Rare adverse effects: agranulocytosis, elevated liver enzyme levels, erythema multiforme, jaundice, pseudomembranous enterocolitis, Adults: 125 to 500 mg orally every 6 hours (maximal dosage, 2 g per day), Children less than 40 kg: 12.5 to 50 mg per kg per day divided every 6 hours, Children 40 kg or more: 125 to 500 mg every 6 hours, Common adverse effects: diarrhea, impetigo, nausea, vomiting, Rare adverse effects: anaphylaxis, hemorrhagic colitis, hepatorenal toxicity, Children 8 years and older and less than 45 kg (100 lb): 4 mg per kg per day in 2 divided doses, Children 8 years and older and 45 kg or more: 100 mg orally 2 times per day, For MRSA infections and human or animal bites; not recommended for children younger than 8 years, Common adverse effects: myalgia, photosensitivity, Rare adverse effects: Clostridium difficile colitis, hepatotoxicity, pseudotumor cerebri, Stevens-Johnson syndrome, Adults: ciprofloxacin (Cipro), 500 to 750 mg orally 2 times per day or 400 mg IV 2 times per day; gatifloxacin or moxifloxacin (Avelox), 400 mg orally or IV per day, For human or animal bites; not useful in MRSA infections; not recommended for children, Common adverse effects: diarrhea, headache, nausea, rash, vomiting, Rare adverse effects: agranulocytosis, arrhythmias, hepatorenal failure, tendon rupture, 2% ointment applied 3 times per day for 3 to 5 days, For MRSA impetigo and folliculitis; not recommended for children younger than 2 months, Rare adverse effects: burning over application site, pruritus, 1% ointment applied 2 times per day for 5 days, For MSSA impetigo; not recommended for children younger than 9 months, Rare adverse effects: allergy, angioedema, application site irritation, Adults: 1 or 2 double-strength tablets 2 times per day, Children: 8 to 12 mg per kg per day (trimethoprim component) orally in 2 divided doses or IV in 4 divided doses, For MRSA infections and human or animal bites; contraindicated in children younger than 2 months, Common adverse effects: anorexia, nausea, rash, urticaria, vomiting, Rare adverse effects: agranulocytosis, C. difficile colitis, erythema multiforme, hepatic necrosis, hyponatremia, rhabdomyolysis, Stevens-Johnson syndrome, Mild purulent SSTIs in easily accessible areas without significant overlying cellulitis can be treated with incision and drainage alone.29,30 In children, minimally invasive techniques (e.g., stab incision, hemostat rupture of septations, in-dwelling drain placement) are effective, reduce morbidity and hospital stay, and are more economical compared with traditional drainage and wound packing.31, Antibiotic therapy is required for abscesses that are associated with extensive cellulitis, rapid progression, or poor response to initial drainage; that involve specific sites (e.g., face, hands, genitalia); and that occur in children and older adults or in those who have significant comorbid illness or immunosuppression.32 In uncomplicated cellulitis, five days of treatment is as effective as 10 days.33 In a randomized controlled trial of 200 children with uncomplicated SSTIs primarily caused by MRSA, clindamycin and cephalexin (Keflex) were equally effective.34, Inpatient treatment is necessary for patients who have uncontrolled infection despite adequate outpatient antimicrobial therapy or who cannot tolerate oral antibiotics (Figure 6). Hardening, abnml skin. Lymphatic and hematogenous dissemination causes septicemia and spread to other organs (e.g., lung, bone, heart valves). Black skin lesions may be melanocytic, including nevi and melanoma Melanoma Malignant melanoma arises from melanocytes in a pigmented area (eg, skin, mucous membranes, eyes, or central nervous system). Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Umbilicated lesions have a central indentation and are usually viral. Indications: Evidence of tissue infection, soft-tissue swelling, erythema, tenderness, or fluctuance. A recent article in American Family Physician provides further details about prophylaxis in patients with cat or dog bites (https://www.aafp.org/afp/2014/0815/p239.html).37, Simple SSTIs that result from exposure to fresh water are treated empirically with a quinolone, whereas doxycycline is used for those that occur after exposure to salt water. -1+ = hypoactive. Significant tenderness present Systemic symptoms including fever, chills, and lymphadenopathy are unusual 4 . Her tetanus vaccination is up-to-date. Supportive care for conditions involving skin induration can vary greatly, depending on the underlying cause. Macules represent a change in color and are not raised or depressed compared to the skin surface. By Sherry Christiansen Fever and localized cutaneous symptoms such as swelling, induration, and nodules after all vaccination types are commonly reported. Fluctuance is an indication of the presence of pus in a bacterial infection. Green fingernails Discoloration Deformities are often considered together with dystrophies, but the two are slightly different; deformities are generally considered to be gross changes in nail shape, whereas dystrophies are read more suggest Pseudomonas aeruginosa infection. Keloids Keloids Keloids are smooth overgrowths of fibroblastic tissue that arise in an area of injury (eg, lacerations, surgical scars, truncal acne) or, occasionally, spontaneously. Induration refers to the thickening and hardening of soft tissues of the body, specifically the skin, and is the result of an inflammatory process caused by various triggering factors. As the skin gets infected redness and induration develop. Induration, or deep thickening of the skin, can result from edema, inflammation, or infiltration, including by cancer. Vesicles are small, clear, fluid-filled blisters < 10 mm in diameter. It is considered to be an autoimmune disease, in which the immune system attacks healthy tissues, but what triggers it isn't clear. Symptoms include pruritus and read more or allergic contact dermatitis Allergic contact dermatitis (ACD) Contact dermatitis is inflammation of the skin caused by direct contact with irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis). Large areas of purpura may be called ecchymoses or, colloquially, bruises. Cellulitis presents as skin breakdown followed by unilateral painful erythema that is warm to the touch. Common manifestations read more . Both cellulitis and abscesses may cause localized erythema, pain, and induration, although a superficial abscess is distinguished by local fluctuance. They usually occur on the thighs or legs but can occur anywhere. Bullae also may occur in inherited disorders of skin fragility. Diagnosis is usually clear read more may be patchy and isolated or may group around the distal extremities and face, particularly around the eyes and mouth. Laboratory testing may be required to confirm an uncertain diagnosis, evaluate for deep infections or sepsis, determine the need for inpatient care, and evaluate and treat comorbidities. 10-12 The term "COVID arm" or "delayed large hypersensitivity reactions" was coined to describe the swollen, indurated, erythematous, itchy, or painful rash that occurred several days to weeks after . A lilac color of the eyelids or heliotrope eruption is characteristic of dermatomyositis Autoimmune Myositis Autoimmune myositis is characterized by inflammatory and degenerative changes in the muscles (polymyositis, necrotizing immune-mediated myopathy) or in the skin and muscles (dermatomyositis) read more .