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Skin Disorders Chapter 52
Terms in this set (88)
What are some functions of the skin ?
Protection Sensory processing
Temperature regulation Chemical synthesis
What are the layers of the skin ?
Dermis , epidermis , sub q tissue
What parts make up the skin ?
Hair -Sebaceous Glands
Nails -Sudoriferous (Sweat) Glands
Receptors -Blood Vessels
What are some age related changes of the skin ?
Wrinkles; Dryness; Paleness; Lentigines; Senile purpura; Senile Angiomas; Seborrheic Keratoses; Acrochordons; Hair; Nails
What would some labs report if there is a skin disorder ?
Fungus , bacteria , viruses
What are some diagonistic tests for skin disorders ?
Skin biopsy , scratch and patch test , woods light examination , postassium hydroxide test
Drug therapy for skin disorders ?
Topical and systemic medications (corticosteroids, antihistamines, antibiotics, antifungals, antiviral agents, scabicides & pediculicides, anesthetics, emollients, ointments, powders, lotions, antiseborrheic agents, antiseptics, keratolytics)
What is a wet dressing ?
used to apply a solution to a lesion; have cooling & soothing effect; some used to debride
Other skin therapies
Therapeutic Baths: used to relieve inflammation & itching and to aid in removal of crusts & scales
Surgical Excision: laser therapy; cryosurgery; electrodesiccation
Radiation Therapy: used for malignant lesions
Photochemotherapy: psoralen methoxsalen & type A UV light
inflammation of the skin characterized by itching, redness, & lesions
exposure to allergens or irritants, heredity, emotional stress (eczema)
Allergic contact, primary irritant, atopic, or seborrheic
Prevention: avoid irritants; protect skin
Signs & Symptoms-itching & rash or lesions (dry, flaky scales, yellow crusts, red, fissures, macules, papules, vesicles
Treatment for dermatitis
Infections can be common
basic: relieve itching, alleviate discomfort, decrease inflammation, control crusting, prevent infection & further damage
antihistamines, analgesics, antipruritics, steroids (topical; tub baths & wet dressing)
inflammation of skin cells or connective tissue, due to generalized infection (Staphylococcus, Streptococcus)
Prevention: good hygiene; decrease cross infections
Signs & Symptoms
initial: localized area of inflammation that becomes more generalized; warmth, redness, edema, pain, tenderness, fever
Diagnostic Tests: C&S; blood cultures
Medical Treatment: topical/systemic antibiotics; debridement
common disorder of sebaceous glands & hair follicles (face, chest, upper back, shoulders)
most common: hormonal changes-ducts plugged
comedones (closed/whiteheads; open/blackheads;); scarring due to inflammation
papules, pustules, nodules, cysts, abscesses
Treatment for acne
topical agents benzoyl peroxide; antibiotics; Vitamin A; 3-6 weeks to improve; Accutane (**)
systemic antibiotics & isotretinoin severe case
Estrogen therapy (OC)
Nursing Care: wash face daily; care with medications
skin condition of middle to older age; redness on face
Furuncles; Furunculosis; Carbuncles
Cause of these is skin infections with organisms that usually exist harmlessly on the skin surface. When an injury occurs, microorganisms can enter and colonize the skin
Raised, painful pustule surrounded by erythema; feels hard to the touch; exudes pus after a few days and later a core.
Hot wet soaks; antibiotics in some instances; surgical I&D
Furuncles = boils
Carbuncles : group of boil
Furunculosis = chronic boils on the skin
chronic inflammatory skin disorder in which keratinocytes proliferate abnormally fast (shed in 27 days vs. 4-5 days)
exacerbations (aggravating factors) & remissions(sun & humidity); cause unknown but strong family history, certain drugs can contribute
Rapid proliferation of epidermal cells
red papules that join to form plaques
silvery scales; dry or brittle hair; itching
Common in adulthood
BRIGHT RED SCALY SKIN
Treatment for psoriasis
secondary infections; psoriatic arthritis
can become severe & widespread
basic: decrease proliferation, inflammation, itching, scaling
topical: steroids, salicylic acid, keratolytics, coal tar, anthralin, UV light, chemo
mite (Sarcoptes scabiei); intimate or prolonged skin contact, or prolonged contact with infected clothing, etc. burrows
: intense itching; skin burrows
Complications: lesions, vesicles, pustules, excoriations, bacterial superinfections
Diagnostic Tests: shavings for evaluation
Medical Treatment: topical scabicides; antipruritics; corticosteroids
superficial fungal infection of the skin, occurs when an impairment of the skin integrity occurs in a warm moist environment
Fungal infection on scalp
Ringworm of the body
Toenail fungus :Nails: onychomycosis and onychocryptosis (ingrown toenail)
common viral infection; recurs repeatedly
HSV1(above the waist); HSV2(gential areas)
primary: direct contact, respiratory droplet, fluid exposure (dormant in nerve ganglia)
Prevention: avoid stressors; contact with infected lesions
Signs & Symptoms- cold sores and fever blisters
prodromal phase(burning or tingling)
erytherma, swelling, vesicles & pustules 1-2 days; burn, itch, painful (contagious)
Herpes complications and treatment
in the vagina during childbirth
eyes can become severely infected if touch contaminated area and then eyes
Diagnostics: cultures of lesions definitive
Medical Treatment: no complete cure
topical acyclovir: (Zovirax) (newer: Denavir, Abreva)
oral acyclovir; antibiotics; topicals to lesion
Herpes Zoster - Shingles
acute inflammatory & infectious disorder; painful vesicular eruption on bright red edematous plaques, along distribution of nerves from one or more posterior ganglia
appears identical to varicella-zoster virus that causes chicken pox; dormant-reactivated; incubation 7-21 days; 10 days -5 weeks
Prevention: avoid contagious person
Signs and Symptoms
vesicles, plaques, itching, fever, pain,ulcers
immunosuppressed people are at a high risk for shingles
Never crosses the midline .
Can damage the optic nerve
Complications and treatment for shingles
Post-herpetic neuralgia, persistent pain, hyperesthesia (weeks-months); ophthalmic herpes zoster serious
Diagnostic Tests: clinical picture & cultures
control outbreak, reduce pain, prevent complications: acyclovir, analgesics, steroids, antihistamines, antibiotics
pediculosis capitis - parasite
pediculosis corporis - parasite
pediculosis pubis- parasite
pubic or crab lice
acute/chronic; serious; bullae of various sizes on normal skin/mucous membranes
etiology unknown; autoimmune process
Signs & Symptoms: blisters; pain; burning; itching; foul odor
Complications: bacterial super infection; high morbidity & mortality
Diagnostic Tests: +Nikolsky's sign- pushed down on the skin and the skin seperates itself, skin is falling apart
Medical Treatment: corticosteroids; cytotoxic agents; analgesics; antipruritics; diet
Benign: Cysts; Seborrheic keratosis; Keloids; Pigmented nevi; Warts; Hemangiomas (angiomas)
Basal cell carcinoma: most common type of skin cancer; sun-exposed areas; "pearly" or transparent papule; metastasis rare
Squamous cell carcinoma: mainly on lower lip, neck, tongue, head, hands; truly invasive carcinoma
causative factors: overexposure to ultra-violet rays (sunlight); others
Types of plastic and reconstructive surgery
a dark pigment of the skin created in epidermal cells
What cells are in charge of immune responses in the skin ?
What coats the skins leaving a oily barrier ?
Senile Angiomas ?
Cherry spot , start at the age of 30 increase with age
Senile Purpura ?
Large purple bruises that resolve very slowly
What is the main complaint of skin disorders ?
Discomfort , pruritus , color changes ,lesions , hair loss , abnormal hair growth
What reflects from increased levels of bilirubin in the blood ?
Jaundice skin , decreased liver functions
Used to diagnosis VIRAL infections, herpes
Diagnosis fungal infections
90 % of the time wet dressings are applied to what ?
Woods light test
Black light testing of the skin
Used to detech mites
identify allergens , common irritants
How long are wet dressing left on the skin for ?
What diseases are relieved with photothephy ?
Vitaligo , psoriasis , chronic eczema
Dissolve keratin , and slow bacterial growth
What is the medical term for atopic dermatitis ?
There are three stages includes : red oozing , crusty rash , intense itching , scaling skin , fine scales may look silver ,
In the chronic stage skin becomes brownish gray
Have immune dysfunction, treated with steroids , or immunosuppressant's, family history of hay fever , asthma food allergies
group of boils
CHRONIC inflammatory disease, usually affects scalp , eyelids , lips , ears, axillae , groin , gluteal ,
Scalp is called dandruff
CAUSE IS UNKNOWN
may be caused by a yeast infection caused by emotional stress and CNS disorder
inflammation of the skin where two skin surfaces touch : axillae , abdominal ,skinfolds , the area is usually red and weeping
caused by heat , friction , moisture between two body parts that lead to yeast or bacteria ( candida albicans )
common in long term health care centers
What is the medical term for a yeast infection ?
infection of the deep fascial structures under the skin , aerobic and anaerobic , it secretes enzymes that destroys tissue including blood vessels ,
infection may progress into large amount of tissue disease
Cured by IV meds , topical meds , amputations and skin graphs
Chronic autoimmune condition - blisters develop on the face , back , chest groin and umbilicus ,
Have foul smell ,
Potassium baths , oatmeal baths , immunosuppressant's and steroids
Nonmelanoma Skin Cancers ?
Basal cell carcinoma , squamous cell carcinoma
What increases the risk for developing melanoma ?
severity of the sunburn
Skin cancer is most common in what race ?
pre cancerous lesions , face , neck , forearms , can become cancer if not treated , avoid sunexposure , plauques , surgical excision
What important thing to keep in mind with psoriasis ?
Comfort , clean and dry
Basal Cell Carcinoma ( nonmelanoma )
painless , nodular lesion with a pearly look , related to sun exposure , rarely METES , but needs to be removed
Squamous Cell Carcinoma( nonmelanoma )
scales and raised lesion , most often seen with people that abuse alcohol and tobacco use , GROW RAPIDLY AND METES , around the oral cavity
DEADLY CANCER , found anywhere on the body but mostly where they are sun exposed , very dark uneven macule , needs to be removed and have chemo immunotherapy
Curaneous T - cell lymphoma
migration of malignant T cells to the skin , can devlop mycosis fungoides and sezary syndrome , looks like eczema , TUMORS , can spread to sites
Malignancy of blood vessels , red blue , purple macules , pain swelling , itching , seen on legs face and mouth . SEEN IN PATIENTS WITH HIV
What is the most common treatment for nail disorders ?
3-6 months of oral antifungal or antibacterial
What are the different types of burns ?
Chemical , electrical , radiation , inhalation
How are burns classified ?
By size and depth , size = percentage of body surface , depth = partial thickness or full thickness
How is burn size estimated ?
Rules of nines , or the lund and browder method
What is the percentages of head burns in infants vs adults ?
Infant = 19%, adult - 7%
What is the most common type of skin cancer ?
basal cell carcinoma
What are the medical term for 1st , 2nd and 3rd degree burns ?
1st degree burn = superficial ( epidermis ) partial thickness
2nd degree burn = deep partial thickness
3rd and 4th degree = full thickness
punch , incisional , shave biopsy
What causes psoriasis the main cause
rapid proliferation of skin cells
follows the nerve dosent cross the midline , pain can last months , scarring can happen
can cause major depression and suicidal
Either type of herpes can cause ?
Oral or genital infections
Sunburn can multiply your chance of skin cancer by ?
about a 1000 %
What are the stages of burn recovery ?
Emergent- fluid stabilization
Acute- wounds closed
Rehabilitation - after wounds heal
what is phototherapy with psoralen and UVA (PUVA) used for?
a treament that uses a combinatiion of oral or toipical 8-methoxypsoralem and UVA (log wave ultraviolet light)
to treat vitiligo, psoriasis, and cutaneous T-cell lymphoma.
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