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  2. 2. presentation outline Objectives Introduction of integumentary system Allergic and inflammatory conditins of the skin Bacterial Infectious of the skin Viral skin infections Fungal skin infections 2/7/2023 By Zewude M 2
  3. 3. objectives By the end of this session, the learner will be able to Define integumentary system List common integumentary disorder Describe allergic and inflamatory condition of the skin Explain infectious of the skin (bacterial,viral and fungal) 2/7/2023 By Zewude M 3
  4. 4. WHAT IS INTEGUMENTARY SYSTEM? 2/7/2023 By Zewude M 4
  5. 5. Integumentary system  The integumentary system is the largest organ of the body that forms a physical barrier between the external environment and the internal environment  The integumentary system includes :- Skin Hair Nails Glands (sweat and exocrine glands) 2/7/2023 By Zewude M 5
  6. 6. Skin  The skin is one of the largest organs  The skin is composed of three layers: epidermis, dermis, and subcutaneous tissue .  The epidermis is an outermost layer  It ranges in thickness from about 0.05 mm on the eyelids to about 1.5 mm on the of the hands and soles of the feet. 2/7/2023 By Zewude M 6
  7. 7. Skin The dermis makes up the largest portion of the skin, the connective tissue between the epidermis and subcutaneous tissue. It provides strength and structure in the form of collagen and elastic fibers. 2/7/2023 By Zewude M 7
  8. 8. Skin The subcutaneous tissue, or hypodermis, is the innermost layer of the skin. It promotes skin mobility, molds body contours, and insulates the body. 2/7/2023 By Zewude M 8
  9. 9. Functions of the Skin Protection Sensation Fluid balance Vitamin production Immune response function 2/7/2023 By Zewude M 9
  10. 10. Integumentary disorder 2/7/2023 By Zewude M 10
  11. 11. Inflammatory and allergic conditions 2/7/2023 By Zewude M 11
  12. 12. Allergic skin conditions Allergic skin conditions are caused by allergens. When an allergen is responsible for triggering an immune system response, this results in an allergic skin condition. Some of these allergens are physical agents which evoke an immune response by way of contact with the skin and some are food-stuffs ,insect bites,and drugs taken systemically. 2/7/2023 By Zewude M 12
  13. 13. Cont… Allergic skin conditions include Urticaria (Hives) Allergic contact dermatitis, Atopic dermatitis, Hand dermatitis, Photo allergic reactions 2/7/2023 By Zewude M 13
  14. 14. Urticaria (Hives)  Hives are an inflammation of the skin triggered when the immune system releases histamine.  This causes small blood vessels to leak, which leads to swelling in the skin.  Swelling in deep layers of the skin is called angioedema.  There are two kinds of urticaria, acute and chronic.  Acute urticaria occurs at times after eating a particular food or coming in contact with a particular trigger. 2/7/2023 By Zewude M 14
  15. 15. Cont… It can also be triggered by non-allergic causes such as heat or exercise, medications, foods, insect bites or infections Chronic urticaria is rarely caused by specific triggers and so allergy tests are usually not helpful. Chronic urticaria can last for many months or years. Although they are often uncomfortable and sometimes painful, hives are not contagious. 2/7/2023 By Zewude M 15
  16. 16. Cont… Signs and symptoms include:- Skin reactions, including hives and itching flushed or pale skin Low blood pressure (hypotension) Constriction of the airways and A swollen tongue or throat, which can cause wheezing and trouble breathing 2/7/2023 By Zewude M 16
  17. 17. Management of hives Avoid aggravating factors such as avoiding excessive heat, spicy foods or alcohol. Aspirin and other NSAIDs should be avoided as they often make symptoms worse. Medications like non-drowsy antihistamines are often used to reduce the severity of the itch Steroids decrease redness, pain, and swelling. Epinephrine is used to treat severe allergic reactions such as anaphylaxis. 2/7/2023 By Zewude M 17
  18. 18. Nursing Management Administer Epinephrine if the patient has anaphylaxis. Provide oxygen. Monitor respiration and prepare for intubation. Educate patients on the avoidance of allergen. Be ready to perform CPR. Monitor vital signs. 2/7/2023 By Zewude M 18
  19. 19. 2/7/2023 By Zewude M 19
  20. 20. Inflammatory Skin Conditions Skin inflammation is a sign of an immune response in the body. It includes Psoriasis. Seborrheic dermatitis Eczema Acne 2/7/2023 By Zewude M 20
  21. 21. Psoriasis  Named from Greek word “Psora meaning itch”.  Psoriasis is a chronic inflammatory multisystem disorder of the skin.  Psoriasis is a common, noncommunicable skin disease, with no clear cause or cure.  The negative impact of this condition on people’s lives can be immense 2/7/2023 By Zewude M 21
  22. 22. Psoriasis • Psoriasis is typically characterized by the appearance of silvery plaques that most commonly appear on the skin over the elbows, knees, scalp, lower back, and buttocks. • Onset may occur at any age • Psoriasis is characterized by periods of remission and exacerbation throughout life . 2/7/2023 By Zewude M 22
  23. 23. Psoriasis  Psoriasis is classified as mild, moderate and severe  Although the primary manifestation of this noncommunicable disease tends to involve the skin,  psoriasis may involve the oral cavity, eyes (including the lids, conjunctivae, and corneas), and joints 2/7/2023 By Zewude M 23
  24. 24. Psoriasis • Pathophysiology • Current evidence supports an autoimmune basis for psoriasis. • Periods of emotional stress and anxiety aggravate the condition, and trauma ,infections, and seasonal and hormonal changes may also serve as triggers 2/7/2023 By Zewude M 24
  25. 25. Psoriasis • Pathophysiology • In this disease, the epidermis becomes infiltrated by activated T cells and cytokines • Resulting in both vascular engorgement and proliferation of keratinocytes. • Epidermal hyperplasia results. 2/7/2023 By Zewude M 25
  26. 26. Psoriasis Pathophysioligy • These epidermal cells tend to improperly retain their nuclei, crippling their ability to release lipids that encourage cellular adhesion. • This results in rapid turnover of poorly matured cells that do not adhere well to each other, resulting in the classic presentation of plaque like lesions that have a silvery, scaly, flaky appearance 2/7/2023 By Zewude M 26
  27. 27. Psoriasis Clinical Manifestations • Psoriasis may range in severity from a cosmetic source of annoyance to a Physically disabling and disfiguring disorder • Dry, itchy, raised skin patches (plaques) covered with scales. • Lesions appear as red, raised patches of skin covered with silvery scales. • The scaly patches are formed by the buildup of living and dead skin. • The patches are not moist and may be pruritic 2/7/2023 By Zewude M 27
  28. 28. Psoriasis Complications Psoratic arthritis of multiple joints occurs in up to 42% of people with psoriasis, most typically after the skin lesions appear (Nicpon, 2017). • skin color changes (post-inflammatory hypopigmentation or hyperpigmentation). • Eye conditions, such as conjunctivitis, blepharitis • Type 2 diabetes.(A 2018 study on mouse and human skin indicates that skin inflammation from psoriasis can result in insulin resistance, which is a risk factor for type 2 diabetes) 2/7/2023 By Zewude M 28
  29. 29. Psoriasis Medical Management • The goals of management are to slow the rapid turnover of epidermis, • to promote resolution of the psoriatic lesions, and to control the natural cycles of the disease. • There is no known cure. • Management of emotional factors should be addressed as part of the overall treatment of psoriasis. 2/7/2023 By Zewude M 29
  30. 30. Psoriasis Medical Management • Three types of therapy are commonly indicated: • topical, corticosteroids • phototherapy, and • systemic. Methotrexate, a systemic cytotoxic agent, is the first-line drug for treating moderate to severe psoriasis 2/7/2023 By Zewude M 30
  31. 31. Psoriasis Nursing Management • Give education on factors which can aggravate psoriasis include stress, infection, trauma and dry skin. • Smoking and alcohol may trigger or exacerbate it, so patients should be encouraged to give up or cut back • Many patients need reassurance that the condition is not infectious, not a reflection of poor personal hygiene, and not skin cancer. 2/7/2023 By Zewude M 31
  32. 32. 2/7/2023 By Zewude M 32
  34. 34. Bacterial Infections: Pyodermas  pyodermas is pus-forming bacterial infections of the skin.  may be primary or secondary.  Primary skin infections originate in previously normal- appearing skin and are usually caused by a single organism.  Secondary skin infections arise from a preexisting skin disorder or from disruption of the skin integrity  In either case, several microorganisms may be implicated (eg, Staphylococcus aureus, group A streptococci). 2/7/2023 34 By Zewude M
  35. 35. Cont…  The most common primary bacterial skin infections are: Impetigo Folliculitis. Folliculitis may lead to furuncles or boil carbuncles 2/7/2023 35 By Zewude M
  36. 36. Impetigo Impetigo is a superficial bacterial infection of the skin caused by  Streptococci Staphylococci Multiple bacteria The lesions begin as small red macular (spot), which quickly become discrete thin walled vesicles that soon rapture and become covered with loose adherent honey yellow crust.  The crusts are easily removed and reveal smooth, red moist surfaces on which new crusts soon develop. 2/7/2023 36 By Zewude M
  37. 37. Impetigo There are two types of impetigo:-  nonbullous (i.e., impetigo contagiosa) and  bullous impetigo. Nonbullous impetigo represents a host response to the infection, whereas a  staphylococcal toxin causes bullous impetigo and no host response is required to manifest clinical illness 2/7/2023 By Zewude M 37
  38. 38. Impetigo Bullous impetigo, a more deep-seated infection of the skin caused by S. aureus,  is characterized by the formation of bullae (ie, large, fluid-filled blisters) from original vesicles.  The bullae rupture, leaving raw, red areas. 2/7/2023 By Zewude M 38
  39. 39. Impetigo • The exposed areas of the body face, hands, neck, and extremities are most frequently involved. Impetigo is contagious and may spread to other parts of the patient’s skin or to other • Members of the family who touch the patient or use towels or combs that are soiled with the exudate of the lesions. 2/7/2023 39 By Zewude M
  40. 40. Impetigo impetigo is seen at all ages it is particularly common among children living in poor hygienic conditions. It often follows  pediculosis capitis (head lice),  scabies (itch mites),  herpes simplex,  insect bites, poison ivy, or eczema. 2/7/2023 40 By Zewude M
  41. 41. Impetigo Chronic health problems, poor hygiene, and malnutrition may predispose an adult to impetigo. Some people have been identified as asymptomatic carriers 2/7/2023 By Zewude M 41
  42. 42. Impetigo Common signs and symptoms: - Small lesions which are vesicular or bullous Red macules followed by thin adherent honey- yellow crust Crust are easily removed Itching and oozing when vesicle is ruptured . 2/7/2023 42 By Zewude M
  43. 43. 2/7/2023 43 By Zewude M
  44. 44. Impetigo Medical Management • Systemic antibiotic therapy is the usual treatment. • It reduces contagious spread, treats deep infection, and prevents acute glomerulonephritis (ie, kidney infection), which may occur as an aftermath Of streptococcal skin diseases. 2/7/2023 44 By Zewude M
  45. 45. Impetigo Medical management • In nonbullous impetigo, benzathine penicillin or oral penicillin may be prescribed. • Bullous impetigo is treated with a penicillinase- resistant penicillin (eg, cloxacillin, • In penicillin-allergic patients, erythromycin is an effective alternative. 2/7/2023 By Zewude M 45
  46. 46. Impetigo Nursing Management • Educate how to apply topical antiseptic cream or antibiotics • Advise on personal hygiene • Relief pain by using non steroidal anti inflammatory drugs (NSAIDS) 2/7/2023 By Zewude M 46
  47. 47. Impetigo Nursing management • Adminster Systematic antibiotic therapy • Clean the wound with antiseptic preparation to reduce bacterial content • After crusts are removed, topical medication will be used eg neomycin or tetracycline or mupirocin is applied 2/7/2023 By Zewude M 47
  48. 48. Folliculitis, Furuncles, and Carbuncles 2/7/2023 48 By Zewude M
  49. 49. Folliculitis • Folliculitis is an inflammatory condition of the cells within the wall and ostia of the hair follicles. • Lesions may be superficial or deep. • Single or multiple papules or pustules appear close to the hair follicles. 2/7/2023 49 By Zewude M
  50. 50. 2/7/2023 By Zewude M 50
  51. 51. Folliculitis • Folliculitis commonly affects the beard area of men who shave, as well as women’s legs, if they shave. Other areas include the • axillae, trunk, pubic area and buttocks 2/7/2023 51 By Zewude M
  52. 52. 2/7/2023 52 By Zewude M
  53. 53. 2/7/2023 By Zewude M 53
  54. 54. Follicullitis signs and symptoms include: Clusters of small red bumps or white-headed pimples that develop around hair follicles Pus-filled blisters that break open and crust over. Itchy, burning skin. Painful, tender skin. A large swollen bump or mass 2/7/2023 By Zewude M 54
  55. 55. Folliculitis Management • The only entirely effective treatment is to avoid shaving. • Other treatments include using special lotions or antibiotics. • If the patient must remove facial hair, a depilatory cream or electric razor may be used. 2/7/2023 55 By Zewude M
  56. 56. Folliculitis Management • Clean the affected skin. • Gently wash the infected skin twice a day with antibacterial soap. • Use a clean washcloth and towel each time and don't share your tow • Warm compress 2/7/2023 By Zewude M 56
  57. 57. Folliculitis Management • Before a treatment plan is devised, it is important to consider the etiology of the folliculitis, severity, and distribution of the lesions. • For uncomplicated superficial folliculitis, use of antibacterial soaps • For refractory or deep lesions with a suspected infectious etiology, empiric treatment with oral antibiotics that cover gram-positive organisms should be considered. 2/7/2023 By Zewude M 57
  58. 58. Folliculitis • If systemic antibiotics are indicated, coverage should include S aureus since it is the most common pathogen. • Because this organism may be penicillin resistant, dicloxacillin or a cephalosporin are the initial choices of therapy 2/7/2023 By Zewude M 58
  59. 59. Furuncles • A furuncle (boil) is an acute inflammation arising deep in one or more hair follicles and spreading into the surrounding dermis. • This inflammation is a deep form of folliculitis. • Furunculosis refers to multiple or recurrent lesions. • Furuncles may occur anywhere on the body • but are more prevalent in areas subjected to irritation, pressure, friction, and excessive perspiration, such as the back of the neck, the axillae, and the buttocks. 2/7/2023 59 By Zewude M
  60. 60. Furuncles • A furuncle may start as a small, red, raised, painful pimple. • Frequently, the infection progresses and involves the skin and subcutaneous fatty tissue, causing tenderness, pain, and surrounding cellulitis. • The area of redness and induration represents an effort of the body to keep the infection localized. 2/7/2023 60 By Zewude M
  61. 61. Furuncles • The bacteria (usually staphylococci) produce necrosis of the invaded tissue. • The characteristic pointing of a boil follows in a few days. • When this occurs, the center becomes yellow or black, and the boil is said to have “come to a head.” 2/7/2023 By Zewude M 61
  62. 62. 2/7/2023 By Zewude M 62
  63. 63. Furuncles Clinical presentation • The lesion develops into a hard, red, tender nodule which often brusts, discharging ,pus and frequently a solid core of necrotic tissue. • It is rarely accompanied by systemic symptoms, when the lesions are multiple 2/7/2023 By Zewude M 63
  64. 64. Furuncles Management • For simple furuncle, the primary treatment is usually the application of warm, moist packs • Topical antibiotic cream • Systemic antibiotic for multiple lesions • Can be drain if severe 2/7/2023 By Zewude M 64
  65. 65. Carbuncles • A carbuncle is an abscess of the skin and subcutaneous tissue that represents an extension of a furuncle that has invaded several follicles and is large and deep seated. or • A carbuncle is a red, swollen, and painful cluster of boils that are connected to each other under the skin • A carbuncle is palpable and can range in size to be as small as a pea or as large as a ball 2/7/2023 65 By Zewude M
  66. 66. Carbuncle • It is usually caused by a staphylococcal infection. • Carbuncles appear most commonly in areas where the skin is thick and inelastic; • the back of the neck and the buttocks are common sites. • Furuncles and carbuncles are more likely to occur in patients with underlying systemic diseases, such  as diabetes or hematologic malignancies, and  in those receiving immunosuppressive therapy for other diseases. 2/7/2023 By Zewude M 66
  67. 67. 2/7/2023 By Zewude M 67
  68. 68. 2/7/2023 By Zewude M 68
  69. 69. carbuncle Clinical manifestation • start as red, painful bumps. • The carbuncle fills with pus and develops white or yellow tips that weep, ooze, or crust. • Over a period of several days, many untreated carbuncles rupture, discharging a creamy white or pink fluid. 2/7/2023 By Zewude M 69
  70. 70. carbuncle Clinical manifestation • Deep carbuncles are more likely to cause significant scarring. • Other carbuncle symptoms include • fever, fatigue, and a feeling of general sickness. • Swelling may occur in nearby tissue and lymph nodes, especially lymph nodes in the neck, armpit, or groin. 2/7/2023 By Zewude M 70
  71. 71. Carbuncle Medical management • In treating carbuncle, it is important not to rupture or destroy the protective wall of induration that localizes the infection. • The boil or pimple should never be squeezed. • Systemic antibiotic therapy, selected by culture and sensitivity study, is generally indicated. • Oral dicloxacillin and cephalosporins are first-line medications. • If MRSA is suspected, antibiotic agents selected may include clindamycin, trimethoprim–sulfamethoxazole, or minocycline 2/7/2023 By Zewude M 71
  72. 72. Carbuncle Nursing management • fever reduction, and • other supportive treatments are indicated for patients who are acutely ill from infection. • Warm, moist compresses hasten resolution of the furuncle or carbuncle • Adminster antibiotics and antpain 2/7/2023 By Zewude M 72
  73. 73. Carbuncle Nursing management • The surrounding skin may be cleaned gently with antibacterial soap, and • An antibacterial ointment may be applied. • Soiled dressings are handled according to standard precautions. 2/7/2023 By Zewude M 73
  74. 74. VIRAL SKIN INFECTIONS 2/7/2023 By Zewude M 74
  75. 75. Herpes Zoster • Herpes zoster, also called shingles, • is an infection caused by the varicella zoster virus (VZV), which are members of a group of deoxyribonucleic acid (DNA) viruses. • The disease is characterized by a painful vesicular eruption along the area of distribution of the sensory nerves (i.e., dermatome) from one or more posterior ganglia. 2/7/2023 By Zewude M 75
  76. 76. Herpes Zoster • After a case of chickenpox, or primary varicella, runs its course, the VZV responsible for the outbreak lies dormant inside nerve cells near the brain and spinal cord. • Later, when these latent viruses are reactivated because of declining cellular immunity, they travel by way of the peripheral nerves to the skin, • where the viruses multiply and create a red rash of small, fluid-filled blisters. 2/7/2023 By Zewude M 76
  77. 77. Cont… • Herpes zoster develops over the lifetime of about 10% to 20% of all adults who had chickenpox earlier in life, usually after 50 years of age. • The rates of occurrence tend to be the same in both men and women. • There is an increased frequency of herpes zoster infections in patients with weakened immune systems 2/7/2023 By Zewude M 77
  78. 78. Herpes Zoster Clinical manifestations • In some patients the pain is absent and • in some patients itching and tenderness may occur over the area. • The lesions are grouped vesicles appear on the red and swollen skin following dermatone. • The early vesicles contain serum and later, rupture and form crusts. • The inflammation is usually unilateral, involving the thoracic, cervical and cranial nerves. 2/7/2023 By Zewude M 78
  79. 79. Clinical manifestation • The clinical course varies from 1 to 3 weeks. • If an ophthalmic branch of trigeminal nerve is involved the patient may have painful eye. • In eye it causes keratitis, uveitis, ulceration and blindness. • Herpes zoster in healthy adult is usually localized and benign, however, • in immuno suppressed patient, the disease may be severe 2/7/2023 By Zewude M 79
  80. 80. 2/7/2023 By Zewude M 80
  81. 81. Herpes Zoster Medical Management • Herpes zoster infection can be arrested if oral antiviral agents such as  acyclovir (Zovirax),  valacyclovir (Valtrex), or  famciclovir (Famvir) are given within 24 hours of the initial eruption. • IV acyclovir may be indicated in patients who are immunocompromised 2/7/2023 By Zewude M 81
  82. 82. Management The goals of herpes zoster management are • to relieve the pain and • to reduce or avoid complications, which include infection, scarring, and eye complications. • Analgesic agents • Systemic corticosteroids 2/7/2023 By Zewude M 82
  83. 83. Nursing Management • The patient and family members are instructed about the importance of • taking antiviral agents as prescribed and • in keeping follow-up appointments with the primary provider. • The patient is educated about how to apply dressings or medication to the lesions and to follow proper hand hygiene techniques to avoid spreading the virus. 2/7/2023 By Zewude M 83
  84. 84. Nursing mng’t • Diversionary activities and relaxation techniques are encouraged to ensure restful sleep and to alleviate discomfort. • A caregiver may be required to assist with dressings, particularly if the patient is an older adult and unable to apply them. 2/7/2023 By Zewude M 84
  85. 85. Herpes Simplex • Herpes simplex is a common skin infection. • There are two types of the causative virus, which are identified by viral typing.HSV1 and HSV2 • Herpes simplex type 1 occurs on the skin of the lips, mouth, gums, or tongue (or on the skin around the mouth) and • Type 2 occurs in the genital area, but both viral types can be found in both locations. 2/7/2023 By Zewude M 85
  86. 86. Herpes Virus Type 2 Infection (Herpes Genitalis) • Herpes simplex virus 2 (HSV2) is a recurrent, lifelong viral infection that causes herpetic lesions (blisters) on the external genitalia and occasionally the vagina and cervix. • It is a STI but possibly may also be transmitted • asexually from wet surfaces or by self-transmission (i.e., touching a cold sore and then touching the genital area). • The initial infection is usually very painful and blisters may take 2 to 4 weeks to heal, but it can also be asymptomatic. 2/7/2023 By Zewude M 86
  87. 87. HSV 2 • Over 87% of infected individuals are unaware of their infection; • most HSV transmission occurs from asymptomatic viral shedding • Recurrences can be associated with stress, or inadequate rest or poor nutrition, or any situations that tax the immune system. 2/7/2023 By Zewude M 87
  88. 88. Cont… • Close human contact by the mouth, oropharynx, mucosal surface, vagina, or cervix appears necessary to acquire the infection. • Other susceptible sites are skin lacerations and conjunctivae. • When viral replication diminishes, the virus ascends the peripheral sensory nerves and remains inactive in the nerve ganglia. • Another outbreak may occur when the host is subjected to stress 2/7/2023 By Zewude M 88
  89. 89. Pathophysiology of HSV 2/7/2023 By Zewude M 89
  90. 90. Clinical Manifestations • Itching and pain occur as the infected area becomes red and edematous. • Infection may begin with macules and papules and progress to vesicles and ulcers. • The vesicular state often appears as a blister, which later coalesces, ulcerates, and encrusts. • Inguinal lymphadenopathy (enlarged lymph nodes in the groin), • minor temperature elevation 2/7/2023 By Zewude M 90
  91. 91. Clinical Manifestations • malaise • headache • myalgia (aching muscles) • dysuria (pain on urination) are often noted. • pain 2/7/2023 By Zewude M 91
  92. 92. Medical Management • Currently, there is no cure for genital herpes infection, but treatment is aimed at relieving the symptoms. • Management goals include preventing the spread of infection • making patients comfortable, decreasing potential health risks, and initiating a counseling and education program. 2/7/2023 By Zewude M 92
  93. 93. Medical Management • Three oral antiviral agents • acyclovir (Zovirax), • valacyclovir (Valtrex), and • famciclovir (Famvir)—can suppress symptoms and shorten the course of the infection • Analgesics and a saline compress can provide additional relief of symptoms 2/7/2023 By Zewude M 93
  94. 94. Nursing Management • Patient education is an essential part of nursing care of the patient with a herpes infection. • This includes an adequate explanation about the infection and how it is transmitted, • strategies to minimize spread of infection, • the importance of adherence to the treatment regimen, and self-care strategies. 2/7/2023 By Zewude M 94
  95. 95. Nursing management • proper hand hygiene, the use of barrier methods with sexual contact, and adherence to prescribed medication regimens 2/7/2023 By Zewude M 95
  96. 96. Fungal (Mycotic) Skin Infections • A fungal infection, also called mycosis, is a skin disease caused by a fungus. • There are millions of species of fungi. • They live in the dirt, on plants, on household surfaces, and on your skin. • In some cases, they affect only the skin and its appendages (hair and nails). • In other cases, internal organs are involved, and the diseases may be life threatening. 2/7/2023 By Zewude M 96
  97. 97. Cont.. • There are varies types of ring worm or tinea and • they are named according to the site of involvement as: • Tinea infections affect the feet commonly called athletes foot or tinea pedis • Fungal infection of head- tinea capitis. • Fungal infection of the body including face, neck & extremities - tinea corporis. • Fungal infection of groin -Jock itch, or tinea cruris • Fungal infection of the nail -tinea unqum. 2/7/2023 By Zewude M 97
  98. 98. Tinea pedis (Ringworm of the feet: Athlete’s foot) Fungal infection of foot is one of the common fungal infections and it may appear as an acute or chronic infection to the soles of the feet or the space between the toes There are dry scaly types of lesion. Others are vesicular type of lesion The third group is macerated lesion between toes, especially between the third, fourth and, fifth toes. 2/7/2023 By Zewude M 98
  99. 99. Cont… Mode of transmission  Contact with an infected person i.e. sharing patient shoes and socks, or in showers or swimming pools . Clinical manifestation In acute stage there will be Itching and burning sensation. The nail may also be involve with chronic infection • Lymphangitis & cellulitis may be seen when bacterial super infections occurs. 2/7/2023 By Zewude M 99
  100. 100. Tenia pedis 2/7/2023 By Zewude M 100
  101. 101. Medical management • Topical antifungal (Miconazole, clotrimazole) applied to the infected area. • Topical therapy is continued for at least 8 weekes weeks, because of recurrence. 2/7/2023 By Zewude M 101
  102. 102. Nursing mng’t • Keep the foot clean and dry daily • tell the patient to use clean socks • Moisture encourages the growth of fungi, the pt is instructed to keep the feet as dry as possible • Pieces of cotton can be placed between the toes at night to absorb moisture. • Clean shoes daily or boil soaks. • Advise the patient to wear light and open foot wear • Apply dusting powder such as zinc oxide powders for the purpose of drying 2/7/2023 By Zewude M 102
  103. 103. Tinea corporis  Ringworm of the body (tinea corporis) is a rash caused by a fungal infection  They are known to cause an intense inflammatory reaction in humans because they are not normally adapted to living on human hosts. Mode of transmission  Through contact with patient or through contact with object, the patient has used that. 2/7/2023 By Zewude M 103
  104. 104. Cont…  Clinical manifestation Typical annular ringed lesion is produced with an advancing scaly border and central clearing or scaly patches with well defined margin.  It is associated with purities. itchy, circular rash with clearer skin in the middle 2/7/2023 By Zewude M 104
  105. 105. Tenia corporis 2/7/2023 By Zewude M 105
  106. 106. Medical Management • Topical antifungal medication may be applied to small areas of lesion • Griseofulvin is used in extensive cases but has side effect include photo sensitivity, skin rashes, headache & nausea. • In those patient who have resistance to griseofulvin give ketoconazole 2/7/2023 By Zewude M 106
  107. 107. Nursing intervention Give education to :- • use clean towel & wash cloth daily. • All area and skin folds that retain moist must be dried thoroughly • The patient has to wear clean cotton cloth next to the skin 2/7/2023 By Zewude M 107
  108. 108. Tinea capitis (Ringworm of the scalp) • Ringworm of the scalp is a contagious fungal infection of the hair shafts and common cause of hair loss • Mode of transmission • Making contact with an infected person’s, such as using of hat, comb and brush of diseased person. 2/7/2023 By Zewude M 108
  109. 109. Cont… Clinical manifestation • one or several round patches of redness and scaling are present on scalp • Small pustules or papules may be seen at the edges of such patches. • As the hair in the affected areas are invaded by the fungi, the fungi become brittle and often break off at or near the surface of the scalp, resulting in patchy loss of hair. • Most cases of tinea capitis heal without scarring, so the hair loss is temporary. • It could be complicated by secondary bacterial infection 2/7/2023 By Zewude M 109
  110. 110. Medical Management • Griseofulvin and other anti fungal agents are administered systemically • The hair should be shampooed two or three times weekly with antifungal shampoo. 2/7/2023 By Zewude M 110
  111. 111. Nursing intervention • Patient and family should be advised to set up a hygienic regimen for home use • Family member should have a separate comb & brush • All infected members of the family & household must examined and treated. 2/7/2023 By Zewude M 111
  112. 112. Tinea cruris (jock itch) • Tinea cruris is a ringworm infection of the groin, which may extend to the inner thighs and buttock area. • It most frequently occurs in young, obese person and those who wear tight under clothing 2/7/2023 By Zewude M 112
  113. 113. Cont… Clinical manifestation • Itching may be severe, or the rash may be asymptomatic • The lesion consists of erythematous plaque with well defined margin & cleared center • Rarely the lesion may have a vesicle formation at the borders and satellite vesicle lesions are rarely present could be complicated by secondary Candidal infection. 2/7/2023 By Zewude M 113
  114. 114. Tenia capitis 2/7/2023 By Zewude M 114
  115. 115. Management General measure • Drying powder eg. Miconazole nitrate should be dusted in to the involved area in a patient with perspiration or occlusion of skin due to obesity. • Under wear should be loose – fitting • Advice to wear light cotton underwear. • Iron or boil underwear and change daily. 2/7/2023 By Zewude M 115
  116. 116. Cont… • Clean affected area daily and keep it dry. • Topical medication such as clotrimazole ketoconazol, miconazole cream will be used for 3 to 4 wks • Terbenatin cream is curative in over 80% of cases twice daily for 7 days • Systematic treatment griseofulvin 2/7/2023 By Zewude M 116
  117. 117. 2/7/2023 By Zewude M 117
  118. 118. THANK YOU!! 2/7/2023 By Zewude M 118

Editor's Notes

  • An allergen is a substance that can cause an allergic reaction
    A skin allergy is when skin becomes irritated because the immune system reacted to something that is usually harmless
  • Cytokines are small proteins that are crucial in controlling the growth and activity of other immune system cells and blood cells