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SysPath 400 - Integumentary System 1

Terms in this set (90)

Impetigo
-What is it?
-Characterized by?
-superficial infection of skin
-characterized by pustules that rupture, leaving behind honey-coloured scabs
Common location of Impetigo:
-faces, arms & legs of small children
common causes of Impetigo
streptococci or staphylococcus aureus
Is Impetigo contagious?
Highly contagious
How do you treat Impetigo?
responds to antibiotics and usually heals without any scars
Ecthyma
NOT IN NOTES
-Ulcerative pyoderma of the skin caused by bacteria such as Pseudomonas (most common isolate), Streptococcus pyogenes, and Staphylococcus aureus.
-Extends into dermis
-Often referred to as a deeper form of impetigo.
-Causes include insect bites and an ignored minor trauma.
-Treated with antibiotics
Cellulitis
-___________ disease that affects ___________ layers of the skin
-characterized locally by ____________, ______________, _______________ and _______________
-Some areas look ___________________ and small _______________ may develop
-"_______________ _________________"
-Systemic sx may include _____________, _________________, and ______________, ___________________
-Group _____ ________________ can cause blistering in _______________ and __________________ layers
-Usually ________________ - damage to _______________ of skin prcedes it
-Bacterial disease that affect deep layers of the skin
-characterized locally by swelling, tenderness, warmth and redness
-some areas may look bruised and small blisters may develop
-"red streak"
-systemic symptoms may include fever, chills and headache, lymphadenopathy
-Group A strep can cause blistering in superficial and deep layers
-Usually unilateral - damage to integrity of the skin precedes it
most common cause Cellulitis
m/c streptococcal
occasionally staphylococcus (if there is already an open wound present)
How do you treat Cellulitis?
oral antibiotics
Cellulitis vs DVT
Similar when in lower calf (we won't be able to differentiate)
Erysipelas
-commonly appears on the ___________, ____________ or _____________
-____________, _______________, ______________, _______________/_______________ rash
-________________ ____________around the infected area may become ________________ and _______________
-____________________ lesion of skin with _______________ _______________, ________________ border
-More ____________________ than ________________, tends to be more _____________________
-_______________ ___________________ appearance of skin
-Systemic sx - ____________, ________________, _________________, ______________, ___________ and general _______________
• commonly appears on the face, arm, or leg
-Red, warm, swollen, painful/tender rash
- lymph nodes around the infected area may become enlarged and painful (lymphadenopathy, possible lymphedema)
-Erythematous lesion of skin w/ sharply demarcated, raised border
-More superficial than cellulitis, tends to be more raised
-Orange peel appearance of skin
-Systemic sx - fever, chills, vomiting, H/A, fatigue, and general malaise
common cause Erysipelas:
Streptococcus
How do you treat Erysipelas?
• antibiotics (oral or injection if severe)
Folliculitis
-inflammation of the ___________ ______________
-typically involves ______________ areas
-______________ enters ______________ ________________, a small amount of ____________ develops in _________ ____________, and they become _____________ and _______________
-Presentation: blocked ______________ ______________ that become ____________, ______________ and surrounded by a small amount of _______________
- inflammation of the hair follicle
- typically involves hairy areas
-bacteria enters hair shaft, a small amount of pus develops in hair follicles, and they become irritated and red
-Presentation: blocked hair follicles that become irritated, red, and surrounded by a small amount of pus
-MC affected areas: hairy areas
Folliculitis - sx and tx
Sx:
-"_____________" around hair follicle
-possible ____________
Tx, prognosis:
-topical ____________
-Infection damages _______________ and hair can be easily ____________ _____________
-Potential for ________-_______________ hairs
-Spread of infection can lead to ___________ (_______________)
Symptoms
"Pimple" around a hair follicle
Possible pruritis (itchy skin)
Treatment and Prognosis
Tx: topical antibiotic
Infection damages follicle and hair can easily be pulled out
Potential for in-grown hairs
Spread of infection can lead to a boil (faruncle)
common cause Folliculitis:
Staphylococcus Aureus
What happens if Folliculitis infection extends into the surrounding tissue?
faruncle (boil) develops
Faruncles (Boils)
-large, ___________, ___________, ___________ areas caused by deep _______________ around hair _____________ (when good _____________ goes bad)
-Usually has _____________ in center and when lanced a ___________, slightly blood substance oozes
-Presentation: _______________, _____________, ____________, _______________ and ______________ nodule with ________________ around a ________________ follicle
-Lesion with central accumulation of ___________
-____________, ____________ exudate
• large, tender, swollen raised areas caused by deep infection around hair follicles ("when good folliculitis goes bad!")
• usually has pus in center and when lanced a white, slightly bloody substance oozes
• Presentation: large, red, hot, swollen, and tender nodule or abscess around a hair follicle
•Lesion w/ central accumulation of pus
•White, bloody exudate
where are Faruncles commonly found
face, neck, breast & buttocks
treatment for Faruncles
Treatment and Prevention
-Keep the skin clean and use antibacterial soap
-Warm compress to speed healing
-May clear on own; often requires draining
-Ab for large, sensitive, or recurrent boils
Prognosis
-Recurrent boils: furunculosis
-Rx Ab for months
-Boils have potential for scarring, deep abscess, and sepsis
recurrent and troublesome boils:
furunculosis
Are Faruncles (boils) contagious?
No
Carbuncles
-What are they?
-Presentation: one large ______________ or ____________ of ________________
-Most common affected area?
-More common in men women?
-Systemic sx?
-Clustered, interconnected enlarged boils
-Presentation: one large abscess or cluster of boils
-MC affected areas: neck
-More common in men vs. women
-Systemic sx: possible fever and fatigue d/t more serious infection
where are Carbuncles commonly found?
neck
are Carbuncles more common in men or women?
Men
Are Folliculitis/Faruncles/Carbuncles common or uncommon?
Very common
Treatment of Folliculitis/Faruncles/Carbuncles:
-Keep skin clean
-Antibacterial soap
-Moist heat may help drain a boil
-Boil located near nose (very painful) may need antibiotics to prevent spread of infection to brain
-Long term antibiotics if chronic problem
Hidradenitis Suppurativa
-Chronic, scarring _______________ of _____________ (_______________) glands
-M/C affected areas: (4)
-M/C organism (acute vs chronic)
-Blockage of __________ _______________ leads to inflammation, _______________ overgrowth and ____________
Definition
-Chronic, scarring inflammation of apocrine (sweat) glands
-MC affected areas: axillae, groin, anus, and around the nipples
Cause
-MC organism: staphylococcus aureus in acute, proteus in chronic
-Blockage of apocrine ducts leads to inflammation, bacterial overgrowth, and scarring
Cause of Hidradenitis Suppurativa
Acute: Staphylococcus Aureus
Chronic: Proteus
S&S Hidradenitis Suppurativa & tx
Sx:
-swollen, tender _________ resembling ____________
-____________ followed by sudden, random draining of pus
-In chronic cases: ____________-like fibrotic ___________ d/t inflamed ___________ ____________ together
-pain and ___________ odour
-Tx/prognosis:
-Drug therapy usually _____________ ______________, but may be rx __________ and _____________
-Warm __________________ to drain
-_________________ ___________________ ______________ for prophylaxis
-Often leads to significant ______________-
Symptoms
-Swollen, tender masses resembling abscesses
-Pain followed by sudden, random draining of pus
-In chronic cases: cord-like fibrotic band d/t inflamed nodules adhering together
-Pain and foul odor
-Treatment and Prognosis
-Drug therapy not usually beneficial, but may be Rx Ab and steroids
-Warm compress to drain
-Laser hair removal for prophylaxis
-Often leads to significant scarring
name for fungal pathogens
dermatophytes
are fungal infections common?
are they contagious?
Yes - extremely common
Yes - highly contagious
Where do fungal infections reside?
-Occupy ____________, _____________ layer of the skin
-______________, ____________ areas where skin surfaces meet = ideal medium
-b/t __________, ____________, ___________, under the _________, ____________, ___________
-Occupy dead, topmost layer of skin
-Warm, moist areas where skin surfaces meet = ideal medium
-b/t toes, nails, groin, under the breast, head, feet
Tinea Pedis
-_______________ ________________, AKA as ____________ foot
-Presentation: _______________, _____________, ________________ of feet that cause itching and /or ______________
-Can be mild or _______________
-M/C affected area:
-Chronic infection with fissure can lead to secondary ________________ infection
-foot ringworm- also known as "athlete's foot"
-Presentation: scaling, fissuring, red rash of feet that cause itching an/or burning
-Can be mild or severe
-MC affected area: between toes, esp. 4th web
-Chronic infection with fissures can lead to secondary bacterial infection
Tinea
-Common ______________ infection classified by the ______________
-Feed off ____________ and _______________
-Spread via infected ______________, ________________, and ___________________
-Contagious?
-Presentation:
-Produce __________________ enzyme causing ______________, _____________nails, _________________ hairs
-Risk factors:
-Common fungal infection classified by the location
-Feed off of keratin and sweat
Spread via infected soil, animals, and persons
-Contagious
-Presentation: circular rash surrounded by an outer ring
-Produce keratolytic enzyme causing scaling, crumbling nails, breaking hairs
-Risk factors: immunosuppression, hyperhidrosis, tight clothing
Tinea Unguium
-ringworm of the ___________
-Ungual = _________________
-Presentation: starts as ____________/________________ discolouration of ___________ nail
-Nail becomes ________________, _____________, ________________ and _______________
-M/C affected area:
-ringworm of the nail
-Ungual = nail
-Presentation: starts as white/yellow discolouration of lateral nail
-Nail becomes brittle, thick, lusterless, and deformed
-MC affected area: toenails
Tinea Corporis
-ringworm of the body
-Corpus = body
-Presentation: itchy, scaling, pink-to-red rings with a clear area in the center
-Gradually expands and margin raises
-Can develop anywhere on body
-Contraindications: massage
Tinea Cruris
-ringworm of the _________________ - AKA "_____________ ________________"
-presentation: _________________, ______________, _______________, _____________ ______________
-Occasionally ___________ ______________
-Can spread to _______________ and ______________
-M/C men or women?
-ringworm of groin - aka "jock itch"
-"Jock Itch" = infection of the groin
-Presentation: painful, itchy, scaling, red rash
-Occasionally small blisters
-Can spread to buttocks and thighs
-More common in men, during warm weather, and with exercise
Tinea Capitis
-ringworm of the scalp
-Capitis = scalp
-Presentation: itchy, scaling, red rash and/or hair loss in circular patch
-MC reason for hair loss in children
Treatment of Fungal Infections:
• keep clean and dry
• antifungal creams/powders
• corticosteroid cream to relieve pain and itching
Candidiasis
aka: Yeast Infection
Definition
-Fungal infection of skin and mucous membranes
-MC affected areas: groin, mouth, and b/t digits
Causes
-Candidia albicans, a vaginal/intestinal yeast and natural flora
Risk factors
-immunosuppression, hyperhidrosis, incontinence, excessive Ab and/or corticosteroid use
-Being pregnant, obese, diabetic, and/or a child
What causes Candidiasis?
-Fungus Candidas
-normal to digestive tract & vagina
-usually harmless
What can cause Candidas yeast to get out of control causing Candidiasis?
-weakened immune system
-warm/moist environment (not clean)
-Antibiotics that kill other bacteria that keep Candida in check
Who is commonly infected with Candidiasis?
-pregnant
-obese
-children
-diabetics
What are the 3 common types of Candidiasis?
Vaginal Candida
Penile Candida
Oral Thrush
Vaginal Candidiasis
Vaginal Candida Infections (yeast infection)
Presentation: white or yellow vaginal discharge with burning, itching, and redness of the groin
Penile Candida
Penile Candida Infections
Presentation: painful red, scaling lesions with raised, white border on the underside of the penis
Common in diabetics and men with infected sexual partners
Oral Thrush
Oral Candida Infections (aka Thrush)
Presentation: painful, cream-coloured patches that adhere to oral mucosa; bleed when scraped off
Common in children and/or immunocompromised persons
Diagnoses & Treatment Candidiasis:
Diagnosis
-Dx based on observation of distinctive rash/pasty discharge
Treatment
-Antifungal creams
-Vaginal suppositories
-Medicated mouth wash
-Keep skin dry to clear and prevent return
-Plain talcum powder
Parasitic Infections
-caused by tiny insects or worms that burrow into skin
-some temporary (part of their life cycles)
-others permanent residents that lay eggs and reproduce
Scabies
-AKA _______________ ________________
-______________ infestation of the itch mite called ______________ ___________________
-_____________ mite ____________ under ___________ layer of skin and lays ____________
-______________ mites hatch in a few days and then ______________
-Presentation:
-Worse at ____________, worse after a _______________
-M/C affected areas
-Rarely above _____________
-Easily spreads via _____________ to _____________, can live longer than ____________ days without host
aka: Itch Mites
-Mite infestation of the itch mite sacroptes scabiei
-Female mite burrows under top layer of skin and lays eggs
-Young mites hatch in a few days and then burrow
-Presentation: severe, persistent pruritis and tiny, red pimple-like rash with wavy lines
-Worse at night, worse after a bath
-MC affected areas: lower abdomen, back, groin, elbow/knee/arm pit
-Rarely above neck
-Easily spreads skin to skin; can live longer than two days w/o host
Name of Scabies mite:
Sarcoptes Scabiei
Scabies - dx and tx
Diagnosis
-Based on history of pruritis and observation of rash
Treatment
-Permethrin cream for mites and hydrocortisone cream for pruritis
-Persons in contact should be co-treated
-Wash all bedding and clothes in hot water
-Fumigation not necessary
How does scabies spread?
-close contact, sleep together/near one another.
-female itch mites burrow under topmost layer of skin and deposits eggs;
-young mites (larvae) hatch in a few days
Pediculosis
-AKA "________________ ________________"
-What is a louse?
-Presentation:
-Scratching can _______________ integrity of skin and cause secondary ____________ infection
aka: "Lice Infestation"
-Louse: barely visible mite that cannot jump or fly and can affect any area of the skin
-Presentation: severe itching in the area of infestation
-Scratching can disrupt integrity of skin and cause secondary bacterial infection
What are the 3 different kinds of lice?
-Head Lice
-Body Lice
-Pubic Lice (crab)
Head Louse
-AKA
-how is it spread?
(Pediculus humanus capitis)
spread by personal contact and by shared personal items; common in schools
Body Louse
-AKA
-Less easily ___________, usually infect people who have poor ____________- and those in close ___________
-Size?
(Pediculus humanus corporis)
less easily transmitted, usually infect people who have poor hygiene and those living in close quarters
Largest louse
Pubic Louse
-AKA?
-AKA?
(Phthirus pubis)
aka: Crabs
infestation of genital area typically spread by sexual contact
Wide, short body that resembles crabs
Treatment for Pediculosis
Treatment
-Medicated cream, lotion, or shampoo
-Reapplication q 10 days to kill newly hatched lice
-Daily combing to remove eggs
-Re-infection possible
-Fomite control: disinfect personal objects and vacuum
Warts
-Caused by?
-more than _____________ types of HPV
-Three affect the skin:............
-Classified by ___________ and ____________
-Thrive in ________, ____________ environments
-Easily spread from one ___________ part to another on the ___________ person
-Not usually contagious, unless ______________ to skin integrity
-Exception to lack of contagious?
-Human Papillomavirus
The Basics
-More than 150 types of HPV
-Three affect the skin: common, plantar, flat
-Classified by position and shape
-Thrive in warm, moist environments
-Easily spread from one body part to another on the same person
* Not usually contagious, unless damage to skin integrity
*Exception: genital warts
-Can affect any age; more common in children
-Can be painless or can cause nerve pain
-Can be isolated or clustered growths
What causes Warts?
-Human Papillomavirus (HPV)
-150 diff types of HPV
What are the different types of warts?
Plantar warts
Flat warts
Common warts
Venereal warts
Common Warts
-AKA?
-Presentation:
-M/C affected areas
(verruca vulgaris)
Presentation: firm growths w/ rough surface and sharply demarcated border; round or irregular; yellow, brown, or grayish in colour; < ½ inch
MC affected areas: fingers, nails, knees, face, and scalp
Flat Warts
-Presentation:
-Common in what population?
-M/C affected area
Presentation: groups of smooth, yellow-brown spots; more common in kids
MC affected area: face
Plantar Warts
Presentation: painful, "seeded" lesions that flatten with pressure and have pinpoint bleeding when trimmed
MC affected area: sole of feet
Venereal Warts/Genital Warts
-AKA?
(Condylomata Acuminata)
Most common STI
Highly contagious
Presentation: soft, fleshy, cauliflower-like growths around the vagina, penis, or rectum
MC cause of cervical and penile cancers
Treating external warts does not influence development of cancer
Treatment of warts
-Most resolve w/o any intervention
-Salicylic and/or lactic acid soln.
-Cryotherapy (liquid nitrogen) and/or laser
-Excision/curettage
-Plantar warts: excision and chemical injection
Measles
-AKA
-highly _____________ ______________ infection
-Spread via _____________ droplets
-Presentation: including the 3 Cs
-Prodromal, pathognomonic "______________ _____________" = white cluster lesions on the ___________ mucosa
-Infectious period:
-Vaccine?
(Rubeola)
-Highly contagious viral infection
-Spread via respiratory droplets
-Presentation: fever, characteristic rash, and "3 Cs" cough, coryza (inflammation of mucus membrane of the nose), conjunctivitis
-Prodromal, pathognomonic "Koplik spots" white cluster lesions on the buccal mucosa
-Infectious period: 2-4 days before rash - until rash clears
-Vaccine has reduced occurrence of epidemics
-name for white spots that appear in mouth with Measles (Rubeola) at same time as face rash
Koplik's spots
Symptoms of Measles (Rubeola)
-________ weeks incubation period before sx appear
-high fever and 3 ________s
-1-2 week incubation period before systemic sx appear
-High fever and 3 Cs
-Prodromal spots and intensified sx 2-4 days before rash
-Rash first appears as flat, irregular red areas on the sides of the neck
-Raises and spreads cephalocaudad
-Serious complications rare in healthy children
-Potential for pneumonia and encephalitis
-Pregnancy: miscarriage, prematurity, or LBW baby
When is a person infectious with German Measles (Rubella)?
-7 days before rash appears to 7 days after it disappears
-an infant infected before birth can be infectious for many months after birth
Rubella
-"German Measles "
-Mild, self limiting viral infection
-Spread via respiratory droplets
-Presentation: mild fever, rose pink coloured rash, lymphadenopathy (differentiates from measles)
-Prodromal "Forchheimer spots": small, red petechia (small red or purple spots) on soft palate
-Not pathognomonic (i.e. specific to a disease) - also seen in scarlet fever
-Infectious period: 7 days prior to rash - 7 days after rash disappears
-Vaccine available
Who is most at risk with Rubella?
pregnant women- can lead to miscarriage, stillborn birth or severe
birth defects
Rubella Sx
Widespread rash of rose pink macules
Begins at neck and spreads cephalocaudal
Fades in 3 days
Systemic sx: mild illness, lower grade fever, lymphadenopathy of head and neck, occasional joint pain
Complications
Rare cases can develop encephalitis
Measles vs Rubella
What causes Chickenpox?
Varicella-Zoster virus
Chickenpox
-Varicella Zoster
-Highly contagious viral infection
-Spread via respiratory droplets and/or direct person to person contact
-Presentation: itchy clusters of small raised or flat spots that turn to fluid filled blisters and crust over
-Prodromal sx: mild or absent in kids; fever, malaise, and backpain in adults
-Infectious period: 2 days before rash - 6 days after onset of rash
Complications
-Pneumonia and encephalitis - rare
-Pregnancy: congenital systems
-Vaccine available
Can a person who gets Chickenpox get it again?
No, but they can get Shingles
What can reactivate Shingles?
Stress
Weak immune system
Certain drugs
Idiopathic
Shingles
(Herpes Zoster)
-Flare up of latent varicella-zoster virus
Virus dormant in ganglia after initial infection
-Immunosuppression, stress, age
-MC in people > 50, can occur at any age
-Not contagious
-Presentation: severely painful skin eruption of fluid filled blisters in a dermatomal pattern of involved nerve root
-Prodrome: dermatomal tenderness and paresthesia
-3-5 average days before rash
-Vaccine available for people >60
Shingles
-Sx
-Complications
Symptoms
-Rash: red, linear cluster of fluid filled vesicles
-Dermatomal pattern (resides in dorsal root ganglion)
-Very sensitive: pain w/ even light touch
-Dry and crust in 7 days and clear ~2-3 weeks
-Pain resolves when vesicles crust over
-Systemic sx: malaise, nausea, diarrhea, fever, difficulty urinating
-Complications: post hepatic neuralgia - long term dermatomal pain
-Recurrence is rare, but possible
-Unilateral
T/F; in order to have shingles (herpes zoster), a person must have 1st have had chickenpox (varicella zoster)?
True: Must have had chickenpox
Can you have shingles repeatedly?
• 1 attack usually gives lifelong immunity
• <4% have further attacks
How many types of HSV are there? What's the difference?
HSV 1 = above the waist (m/c: mouth/lips)
HSV 2 = below the waist (m/c: genitals)
Herpes simplex virus (HSV)
-Highly contagious, recurrent viral infection
-Spread via direct person to person contact
-70% r/t asymptomatic shedding
-Presentation: painful, small, fluid-filled blisters on the skin of mucous membranes
Describe HSV 1:
HSV-1: Oral herpes
Spread via oral secretions
MC affected areas: "above the waist" - mouth, face, ocular lesions
Describe HSV 2
HSV-2: Genital herpes
Spread via genital secretions
MC affected areas: "below the waist" - genital ulcers
Neonatal herpes infection
Symptoms of Herpes Simplex Virus
-Primary infection: lymphadenopathy, fever, malaise, and paresthesia for 24 hours before rash
-Rash: painful vesicles surrounded by reddish rim that turn to pustules, erode, and crust over
-Latent virus remains in sensory DRG
-Recurrent infection: 2-24 hours of burning, itching, crawling, tingling in a dermatomal pattern
-Stress, fever, UV exposure, immunosuppression, menstruation
-Can be active, but asymptomatic
Herpes Simplex Virus - sx and tx
Diagnosis
Location helpful for dx
Blood test, cultures, or biopsy can confirm dx - often unnecessary
Treatment
Keep area clean and dry
Topical antiviral creams sometimes effective
Oral medications - daily or acute - may suppress eruptions
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