12.10 Infectious and Dermatological Conditions
Key Takeaways
MRSA and impetigo spread by skin contact and shared items; cover wounds, clean surfaces, and never needle through infected skin.
Tuberculosis spreads through the air; latent TB is not contagious, but a cough of three weeks or more with night sweats and weight loss needs evaluation.
Shingles causes a painful one-sided band of blisters in a dermatome; fluid from the blisters can give chickenpox to people who are not immune.
Lyme disease often starts with an expanding red rash of 5 cm or more (erythema migrans) days to weeks after a tick bite.
Use the ABCDE rule for moles: asymmetry, irregular border, color variation, diameter over 6 mm, and evolving appearance.
12.10 Infectious and Dermatological Conditions
Quick Answer: For infectious diseases, know the mode of transmission, the key signs, and what protects you and your other patients. For skin conditions, know which are contagious, which need referral, and where not to needle. Never insert needles through infected, inflamed, or broken skin. Formal transmission-based precautions and disease reporting are covered in Section 16.4.
Bacterial Infections
| Infection | Spread | Key features and concerns |
|---|---|---|
| Group A strep throat | Respiratory droplets | Sudden sore throat, fever, swollen tender neck nodes, white patches on the tonsils, usually no cough; treated with antibiotics to prevent rheumatic fever |
| E. coli | Fecal-oral, contaminated food and water | Most strains are harmless. Shiga toxin-producing strains (such as O157:H7) cause bloody diarrhea and can cause kidney failure (hemolytic uremic syndrome), especially in children. E. coli is also the most common cause of urinary tract infections |
| MRSA | Skin contact and shared items (towels, razors, equipment) | Red, swollen, painful bumps or boils, often mistaken for spider bites; can become serious. Cover wounds, clean shared surfaces |
| Impetigo | Direct contact; very contagious | Honey-colored crusts, often around the nose and mouth in children; caused by Staph aureus or strep |
Foodborne Illness
Common causes include norovirus (the leading cause of foodborne illness in the United States), Salmonella (poultry and eggs), Campylobacter (undercooked poultry), Shiga toxin-producing E. coli, and Listeria (deli meats, unpasteurized soft cheese), which is especially dangerous in pregnancy. Seek medical care for bloody diarrhea, fever over 102°F, diarrhea lasting more than three days, vomiting that prevents keeping fluids down, or signs of dehydration.
Lyme Disease and Parasites
Lyme disease is transmitted by blacklegged (deer) ticks. Erythema migrans, an expanding red rash of 5 cm or more that may look like a bull's-eye, appears in most cases 3-30 days after the bite, often with fatigue, fever, and aches. Later stages can cause facial palsy, heart block, and arthritis, especially of the knee. It is treated with antibiotics such as doxycycline.
Parasitic infections include Giardia (contaminated water; greasy, foul-smelling diarrhea and bloating), pinworm (nighttime anal itching in children), and toxoplasmosis (cat litter and undercooked meat; a risk in pregnancy). Head lice and scabies are covered with skin conditions below.
Sexually Transmitted Infections (STIs)
- Chlamydia (the most commonly reported bacterial STI in the United States) and gonorrhea: often no symptoms, especially in women; can cause pelvic inflammatory disease and infertility.
- Syphilis: a painless sore (chancre), then a rash that can include the palms and soles; rates have risen sharply over the past decade.
- Herpes simplex (HSV): painful recurrent blisters; HPV: genital warts and cervical and other cancers (preventable by vaccine).
- HIV: bloodborne and sexual transmission; standard precautions protect the practitioner (Section 16.4).
Viral and Airborne Infections
| Infection | Key facts |
|---|---|
| Tuberculosis (TB) | Airborne. Latent TB has no symptoms and is not contagious. Active lung TB causes a cough of 3 weeks or more, coughing blood, fever, night sweats, and weight loss. Tested with a skin test (TST) or blood test (IGRA) |
| Shingles (herpes zoster) | Reactivation of the chickenpox virus. Pain or tingling, then a one-sided band of blisters in a dermatome that does not cross the midline. Blister fluid can give chickenpox to people who are not immune until the lesions crust. Shingles near the eye or on the tip of the nose needs urgent referral. The recombinant vaccine (Shingrix) is recommended in two doses for adults 50 and older |
| Measles | One of the most contagious airborne diseases. Fever, cough, runny nose, red eyes, white spots inside the cheek (Koplik spots), then a rash spreading from the hairline downward. Contagious from about 4 days before to 4 days after the rash. Two MMR doses are about 97% effective |
| Influenza | Droplet spread; sudden fever, body aches, cough, fatigue. Antivirals work best within 48 hours. Annual vaccination is recommended for everyone 6 months and older |
| Post-viral illness (including long COVID) | Fatigue, worsening after exertion, brain fog, shortness of breath, and dizziness on standing that persist for months after an infection |
Burns
| Depth | Appearance |
|---|---|
| Superficial (first degree) | Red and painful, no blisters (such as sunburn) |
| Partial thickness (second degree) | Blisters, red, moist, very painful |
| Full thickness (third degree) | White, leathery, or charred; may be painless because nerves are destroyed |
The rule of nines estimates burned area in adults: head 9%, each arm 9%, front of trunk 18%, back of trunk 18%, each leg 18%, perineum 1%. First aid: cool the burn with cool running water (not ice) for at least 10 minutes, do not break blisters, and cover with a clean nonstick dressing. Refer large burns, full-thickness burns, and burns of the face, hands, feet, genitals, or major joints. A moxibustion burn must be documented and managed the same way.
Contagious Skin Conditions
- Head lice: itching and nits on the hair shafts; spread by head-to-head contact, not a sign of poor hygiene.
- Scabies: intense itching that is worse at night, with tiny burrows in the finger webs, wrists, and waist; spread by prolonged skin contact. Launder linens.
- Fungal infections (tinea): ring-shaped, scaly patches (tinea corporis, or ringworm), athlete's foot (tinea pedis), and scalp ringworm (tinea capitis); spread by contact.
- Cellulitis: spreading red, warm, swollen, tender skin, often with fever; needs antibiotics. Rapid spread, severe pain out of proportion to the appearance, or a toxic-looking patient suggests necrotizing infection: 911.
Noncontagious Skin Conditions
- Acne: clogged follicles, inflammation, and bacteria; worsened by hormones and some medications.
- Eczema (atopic dermatitis): itchy, dry, inflamed skin in skin folds, often with asthma and allergies. Avoid needling active patches.
- Alopecia: patchy hair loss from autoimmune alopecia areata, pattern hair loss, or diffuse shedding after stress or illness (telogen effluvium); check thyroid and iron when appropriate.
- Moles: use the ABCDE rule for melanoma: Asymmetry, Border irregularity, Color variation, Diameter over 6 mm, Evolving size, shape, or color. Refer any changing or suspicious lesion, and do not needle into moles.
A patient has a painful red band of small blisters wrapping around the left side of the chest, which started after two days of burning pain in the same area. Which condition is most likely?
Impetigo
Shingles (herpes zoster)
Scabies with secondary infection
Contact dermatitis from clothing
A patient has had a cough for four weeks with night sweats, weight loss, and occasional blood in the sputum. Which condition must be considered, and how is it spread?
Influenza, spread by fecal-oral contact
Scabies, spread by prolonged skin contact
Lyme disease, spread by tick bites
Active tuberculosis, spread through the air
A mole on a patient's back is asymmetrical with irregular borders, several colors, and a diameter of about 8 mm, and the patient says it has changed recently. What should the practitioner do?
Needle around the mole in a circle to move the local Blood stasis
Apply moxibustion directly over the mole to warm and disperse the stagnant lesion
Advise prompt evaluation by a physician or dermatologist for possible melanoma
Reassure the patient that moles never become cancerous and need no follow-up
Which statement about MRSA skin infections is accurate for an acupuncture clinic?
It spreads mainly through the air, so an N95 mask alone fully protects the practitioner
It cannot survive on treatment tables, so routine surface cleaning is unnecessary
It spreads by skin contact and shared items, so clean surfaces, cover wounds, and avoid infected skin
It is a viral skin infection, so affected patients are treated with antivirals rather than antibiotics
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