Rosacea is a chronic skin condition causing flushing and pimple-like lesions on the face. Risk factors include light skin, age 30-50, and stress. Symptoms include redness, pimples, and thickened skin on the nose. Treatment focuses on avoiding triggers and using oral antibiotics or topical metronidazole. Squamous cell carcinoma is a type of skin cancer arising from sun-exposed skin. Risk is highest in older, fair-skinned males with outdoor jobs. Lesions appear scaly or raised and can ulcerate if untreated. Treatment may include surgery, radiation, or chemotherapy depending on the size and location of the lesion. Both conditions require protecting skin from

1. SKIN ERUPTION AND
SQUAMOUS CELL CARCINOMA

2. ROSACEAA
chronic skin eruption, rosacea produces flushing and dilation of the small blood vessels in the face, especially
around the nose and cheeks. Papules and pustules may also occur but without the characteristic comedones of acne vulgaris.
Rosacea is most common in White women of age 30 to 50. When it occurs in men, however, it is usually more
severe and commonly associated with rhinophyma, which is characterized by dilated follicles and thickened, bulbous skin
on the nose. Ocular involvement may result in blepharitis, conjunctivitis, uveitis, or keratitis. Rosacea usually spreads
slowly and rarely subsides spontaneously.
Although the exact cause of rosacea is unknown, stress, infection, vitamin deficiency, menopause, and endocrine
abnormalities can aggravate the condition. Spicy foods; physical activity; sunlight; hot beverages, such as tea or coffee;
tobacco; alcohol; and extreme heat or cold can also aggravate rosacea, producing the characteristic flushing.

3. Signs and Symptoms
• Periodic flushing across the central oval of the face
• Telangiectasia
• Papules
• Pustules
• Nodules
• Rhinophyma is commonly associated with severe untreated rosacea but may also occur alone. Initially,
rhinophyma appears on the lower half of the nose and produces red, thickened skin and follicular enlargement.
It is found almost exclusively in men older than age 40.

5. Treatment
• Prevention through avoidance of aggravating factors
• Oral tetracycline or erythromycin in gradually decreasing doses over 1 to 2 months for the acneiform component of
rosacea
• Oral minocycline or doxycycline isotretinoin for resistant cases and in those with severe disease
• Topical metronidazole gel to help decrease papules, pustules, and erythema
• Sulfacet-R lotion, available in flesh tones, to control pustules and hide redness; can be used alone or with oral antibiotics
• Lasers or other light therapy, dermabrasion to remove skin or electrolysis to destroy large, dilated blood vessels and
remove excess tissue (in patients with rhinophyma)
Nursing Considerations
• Instruct the patient to avoid hot beverages, spicy foods, alcohol, extended sun exposure, and other possible causes of
flushing.
• Assess the effect of rosacea on body image. Because it is always apparent on the face, your support is essential.
• Tell the patient to avoid topical hydrocortisone preparations because they worsen rosacea.

6. HEALTH EDUCATION
• Assist the patient in identifying and eliminating aggravating factors. If stress and anxiety seem to trigger the disease,
teach relaxation techniques and encourage him to use them often.
• Instruct the patient to use meticulous handwashing and personal hygiene to avoid irritating and aggravating the
condition. To prevent infection, stress the importance of not picking or squeezing the lesions.
• Provide directions for antibiotic therapy, and tell the patient to report any adverse effects.
• Instruct the patient to wear sunscreen with an SPF of 15 or higher to protect his face from the sun.
• Tell the patient to protect his face in the winter with a scarf or ski mask.
• Have the patient avoid irritating his facial skin by not rubbing or touching it too much.
• Advise the patient to avoid facial products that contain alcohol or other skin irritants.
• When using moisturizer with a topical medication, instruct the patient to apply the moisturizer after the medication
has dried.
• Caution the patient to use products that are labeled noncomedogenic. These will not clog oil and sweat gland
openings (pores) as much.
• Advise the patient to avoid overheating.
• Instruct the patient to avoid alcohol

7. SQUAMOUS CELL CARCINOMA
Squamous cell carcinoma of the skin is an invasive tumor arising from keratinizing epidermal cells
and has the potential for metastasis. It occurs most commonly in fair-skinned White males older than age 60
and is the second most common form of skin cancer.
Outdoor employment and residence in a sunny, warm climate (southern United States and Australia,
for example) greatly increase the risk of squamous cell carcinoma.
Lesions on sun-damaged skin tend to be less invasive with less tendency to metastasize than lesions
on unexposed skin. Notable exceptions are squamous cell lesions on the lower lip and the ears; almost
invariably, these are markedly invasive metastatic lesions with a poor prognosis.
A premalignant lesion may progress with induration and inflammation of the pre-existing lesion.
When arising from normal skin, the nodule grows slowly on a firm, indurated base. If untreated, this nodule
eventually ulcerates and invades underlying tissues.

9. Review this chart to help you differentiate among diseases associated with premalignant skin lesions, including their
causes, the people at risk, lesion descriptions, and treatment.
Comparing Premalignant Skin Lesions

10. Signs and Symptoms
• Areas of chronic ulceration, especially on sun-damaged skin
• Lesions on the face, ears, and dorsa of the hands and forearms and on other sun-damaged skin areas
• Lesions that may appear scaly and keratotic with raised, irregular borders
• In late disease, lesions that grow outward (exophytic), are friable, and tend toward chronic crusting
• Pain, malaise, and anorexia and resulting fatigue and weakness (as the disease progresses and metastasizes to
the regional lymph nodes)

11. Treatment
• Mohs surgery if lesions are 2 cm or larger, or have recurred on the face, mucosal, membranes, or genitals
• Wide surgical excision or curettage and electrodesiccation, for smaller lesions; radiation therapy, for older or
debilitated patients; chemotherapy; and chemosurgery, for resistant or recurrent lesions
• Chemotherapeutic agent fluorouracil (Efudex) in various strengths (1%, 2%, and 5%) as a cream or solution
• Fluorouracil continued only until lesions reach the ulcerative and necrotic stages (usually 2 to 4 weeks); then,
application of corticosteroid preparation such as an anti-inflammatory agent; complete healing within 1 to 2 months.

12. Nursing Considerations
• Disfiguring lesions are distressing. Accept the patient as he is to increase his self-esteem and to strengthen a caring relationship.
• Listen to the patient’s fears and concerns. Offer reassurance, when appropriate. Remain with the patient during periods of severe stress and
anxiety.
• Help the patient and his family set realistic goals and expectations.
• Assess the patient’s readiness for decision making, and then involve him in making choices and decisions related to his care. Provide
positive reinforcement for the patient’s efforts to adapt.
• Coordinate a consistent care plan for changing the patient’s dressings. A standard routine helps the patient and his family learn how to care
for the wound.
• To promote healing and prevent infection, keep the wound dry and clean.
• Try to control odor with balsam of Peru, yogurt flakes, oil of cloves, or other odor-masking substances, even though they may be
ineffective for long-term use. Topical or systemic antibiotics also temporarily control odor and eventually alter the lesion’s bacterial flora.
• Provide periods of rest between procedures if the patient fatigues easily.
• Be prepared for the adverse effects of radiation therapy, such as nausea, vomiting, hair loss, malaise, and diarrhea.
• Provide small, frequent meals that are high in protein and calories if the patient is anorexic. Consult with the dietitian to incorporate foods
that the patient enjoys.

13. HEALTH TEACHING
• Explain all procedures and treatments to the patient and his family. Encourage the patient to ask questions, and answer them
as completely as possible.
• Instruct the patient to avoid excessive sun exposure to prevent recurrence. Direct him to wear protective clothing (hats, long
sleeves) when he is outdoors.
• Urge the use of a strong sunscreen to protect the skin from ultraviolet rays. Agents containing para-aminobenzoic acid,
benzophenone, and zinc oxide are most effective. Instruct the patient to apply these agents 30 to 60 minutes before sun
exposure as well as to use lip screens to protect the lips from sun damage
• .Advise the patient to relieve local inflammation from topical fluorouracil with cool compresses or with corticosteroid
ointment.
• Teach the patient to regularly examine the skin for precancerous lesions and to have these removed promptly.
• If appropriate, direct the patient and his family to support services, such as social workers, psychologists, and cancer support
groups.
• Tell the patient to be careful to keep fluorouracil away from the eyes, scrotum, or mucous membranes. Warn the patient to
avoid excessive exposure to the sun during the course of treatment because it intensifies the inflammatory reaction. Possible
adverse effects of treatment include postinflammatory hyperpigmentation.

14. THANK YOU
REFERANCE
LippincottVISUAL
NURSING
A Guide to Diseases,
Skills, and Treatments
Third Edition