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Skin diseases disorders conditions

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It contains all the skin disorders.

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Skin diseases disorders conditions

  1. 1. “Disorders, Conditions, and Diseases” THE INTEGUMENTARY SYSTEM Presented By: Mr. Mahesh Chand F.Y.M.Sc. Nursing Guide: Mr. Pravin Dani Professor
  2. 2.  Introduction of the Integumentary system.  Anatomy and physiology of the skin.  Causes of the skin disorders.  Common disorders with their signs and symptoms.  Diagnostic findings.  Nursing Diagnosis  Management  References
  3. 3.  Disease- an abnormal condition of the body or the mind that causes dysfunction or discomfort.  Disorder- a functional abnormality, or disturbance.  Condition- a state of being, in health, a disease, such as a heart condition.
  4. 4.  The prevalence of skin disease in India is 10 to 12 percent of the total population with Eczema and Psoriasis being the major contributors. Due to pollution, ultraviolet light, and global warming, photosensitive skin disorders like pigment darkening, sunburn, skin cancers, and infectious diseases are increasing at a faster pace. A one percent reduction in ozone leads to a two to four percent increase in the incidence of tumors.
  5. 5. According to Ankit Goyal, Program Manager, Healthcare Practice, Frost & Sullivan, "The ecosystem for skin care treatment is witnessing a great change in demand patterns. Gone are the days, when skin care was limited to treatment of common skin diseases. The emergence of cosmetic and anti-aging treatments has changed the face of the skin care industry. The number of these cosmetic procedures is expected reach 18 to 20 lakh by 2015 in India.
  6. 6.  In 2013, with prevalence rate of 10 percent, the population affected across India from skin disease is estimated at nearly 15.1 crore. It is estimated that at a CAGR of 12 percent about 18.8 crore people is likely to suffer from skin disease by 2015".  At present, there are about 6,000 dermatologists catering to a population of over 121 crore. This means that for every 100,000 people, only 0.49 dermatologists are available in India as compared to 3.2 in many states of the US."
  7. 7.  Integumentary system is composed of the skin and accessory structures  Copyright 2003 by Mosby, Inc. All rights reserved.
  8. 8.  The largest organ of the body  Varies in thickness from 1/50 inch (0.5 mm) in the eyelids to 1/4 inch (6.3 mm) in the soles of the feet  Changes in the skin often indicate the presence of other body system disorders including anemia, respiratory disorders, liver disorders, cancer, and shock Copyright 2003 by Mosby, Inc. All rights reserved.
  9. 9. Copyright 2003 by Mosby, Inc. All rights reserved.
  10. 10.  Epidermis  Outermost layer of the skin that is composed of a surface of dead cells with an underlying layer of living cells  Dermis  Called the “true” skin; the dermis contains the blood vessels and nerves Copyright 2003 by Mosby, Inc. All rights reserved.
  11. 11.  Skin has hair in all areas except the soles of the feet and palms of the hands  Hair serves to block foreign particles from entering the body through structures such as the nose and eyes  The visible portion is called the shaft  The hair follicle is the root with its covering Copyright 2003 by Mosby, Inc. All rights reserved.
  12. 12.  Three types of glands in the skin  Sebaceous glands (oil)  Sudoriferous glands (sweat)  Ceruminous glands  Function is to help regulate the body temperature and excrete body wastes Copyright 2003 by Mosby, Inc. All rights reserved.
  13. 13. Functions of the SKIN  Protects the other body systems from injury and infection  Sensation  Fluid Balance  Temperature regulation  Vitamin Production (D)
  14. 14.  Bacterial infection  Viral infection  Fungal infection  Skin to skin contact  Cosmetics
  15. 15. ““Disorders,Disorders, Conditions, andConditions, and Diseases”Diseases”
  16. 16. Psoriasis is a long-lasting autoimmune disease characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly. They may vary in severity from small and localized to complete body coverage. Psoriasis is estimated to affect 2–4% of the population of the western world Causes:  Genetic  Life style  Microbes eg.  Candida albicans  Hiv  Medications eg. beta blockers,, NSAIDS
  17. 17. Clinical menifestations:  Psoriatic arthritis eg. Hips, knees, spine (spondylitis), and sacroiliac joint  Nail changes  Pustular psoriasis appears as raised bumps filled with noninfectious pus.  Other skin lesion Diagnosis: Skin biopsy or scraping may be performed to rule out other disorders and to confirm the diagnosis. Management: Topical agents eg.  mineral oil, petroleum jelly, calcipotriol Phototherapy Systemic agents Surgery:  removal of the tonsils may benefit people with chronic plaque psoriasis, guttate psoriasis, and palmoplantar pustulosis
  18. 18.  Acne vulgaris (or simply acne) is a long-term skin disease that occurs when hair follicles become clogged with dead skin cells andoil from the skin. Acne vulgaris is a common skin disease that affects 85-100% of people at some time during their lives.  Acne is characterized by areas of blackheads, whiteheads, pimples, and greasy skin, and may result in scarring. The resulting appearance can lead to anxiety, reduced self-esteem and, in extreme cases, depression or thoughts of suicide  Causes:  Genetic  Harmonal  Infectious  Diet  Smoking  Psychosocial
  19. 19. Signs And symptoms  Typical features of acne include seborrhea (increased oil secretion), microcomedones, comedones, papules, pustules, nodules (large papules), and in many cases scarring.The appearance of acne varies with skin color. It may result in psychological and social problems. Management:  Diet  Medications eg.Benzoyl peroxide, retinoids,antibiotics
  20. 20.  Dermatitis, also known as eczema, is inflammation of the skin. It is characterized by itchy, erythematous, vesicular, weeping, and crusting patches. The term eczema is also commonly used to describe atopic dermatitis also known as atopic eczema. Causes: Are unclear Signs and symptoms:  Dermatitis symptoms include itching, stinging and a burning sensation. Papules and vesicles are commonly present. The small red bumps experienced in this type of dermatitis are usually about 1 cm in size, red in color and may be found symmetrically grouped or distributed on the upper or lower back, buttocks, elbows, knees, neck, shoulders, and scalp.
  21. 21. Diagnosis:  History and physical examination.  skin biopsy may be useful Management: There is no known cure for eczema, with treatment aiming to control symptoms by reducing inflammation and relieving itching.  Moisturizers  Medications eg. Carticosteroids  Light therapy
  22. 22. The word "dermatitis" means inflammation of the skin. It results from exposure to allergens (allergic contact dermatitis) or irritants (irritant contact dermatitis). Phototoxic dermatitis occurs when the allergen or irritant is activated by sunlight. Causes:  Irritant contact dermatitis  Allergic  Photoxic Signs and symptoms: Red rash, blisters, Itchy, burning skin
  23. 23.  Diagnosis:  patch tests one of various methods commonly known as allergy testing. Management:  Self care  Medications eg-histamine, corticosteroids
  24. 24.  Athlete's foot (also known as ringworm of the foot, tinea pedum, and moccasin foot) is a common and contagious skin disease that causes itching, scaling, flaking, and sometimes blistering of the affected areas. Its medical name is tinea pedis,a member of the group of diseases or conditions known as tinea, most of which are dermatophytoses (fungal infections of the skin, hair, or nails). Causes: It can caused by fungi Trichophyton rubrum or T. mentagrophytes,but may also be caused by Epidermophyton floccosum. Transmission : (direct or indirect)
  25. 25.  Diagnosis: Athlete's foot can usually be diagnosed by visual inspection of the skin and by identifying less obvious symptoms such as itching of the affected area. If the diagnosis is uncertain, direct microscopy of a potassium hydroxide preparation of a skin scraping (known as a KOH test) can confirm the diagnosis of athlete's foot and help rule out other possible causes, such as candidiasis, pitted keratolysis, erythrasma, contact dermatitis, eczema, or psoriasis. A Wood's lamp (black light), although useful in diagnosing fungal infections of the scalp. Treatment: Topical eg.  miconazole nitrate, clotrimazole, tolnaftate Oral eg.  Terbinafine, Fluconazole or itraconazole
  26. 26. Urticaria (from the Latin urtica, "nettle" from urere, "to burn"), commonly referred to as hives, is a kind of skin rash notable for pale red, raised, itchy bumps. Hives may cause a burning or stinging sensation. Causes:  Drug induced: Due to codeine, dextroamphetamine, aspirin, ibuprofen, penicillin,  Infection or environmental agent  Food  Excersice Management: The mainstay of therapy for both acute and chronic urticaria is patient education, avoiding triggers, and antihistamines.
  27. 27. ROSACEA Rosacea is a chronic skin condition characterized by facial redness, small and superficial dilated blood vessels on facial skin, papules, pustules, and swelling. Rosacea affects all ages and has four subtypes, three affecting the skin and the fourth affecting the eyes (ocular type). Causes: The exact cause of rosacea is unknown Signs and symptoms: The main symptoms of this facial condition include red or pink patches, visible broken blood vessels, small red bumps, red cysts, and pink or irritated eyes.
  28. 28.  Diagnosis: Most people with rosacea have only mild redness and are never formally diagnosed or treated. No single, specific test for rosacea is known. Treatment:  Medications: eg.  ivermectin and azelaic acid creams and brimonidine, doxycycline, and isotretinoin by mouth.  Laser: Dermatological vascular laser (single wavelength) or intense pulsed light (broad spectrum) machines offer one of the best treatments for rosacea. CO2 lasers can be used to remove excess tissue caused by phymatous rosacea
  29. 29.  Vitiligo (vit-ill-EYE-go)  is a chronic skin condition characterized by portions of the skin losing their pigment. It occurs when skin pigment cells die or are unable to function. the cause of vitiligo is unknown. Research suggests vitiligo may arise from autoimmune, genetic, oxidative stress, neural, or viral causes.  Signs and symptoms: White patches appear on the skin in different parts of the body. The only sign of vitiligo is the presence of pale patchy areas of depigmented skin which tend to occur on the extremities. The patches are initially small, but often grow and change shape
  30. 30. An ultraviolet light can be used in the early phase of this disease for identification and to determine effectiveness of treatment. Skin with vitiligo, when exposed to a black light, will glow blue. In contrast, healthy skin will have no reaction. Treatment: Immune mediators: Topical preparations including glucocorticoids (such as 0.05% clobetasol or 0.10% betamethasone) and calcineurin inhibitors (such as tacrolimus or pimecrolimus) are considered to be first-line vitiligo treatments. Phototherapy: Phototherapy is considered to be a second-line treatment for vitiligo. Exposing the skin to UVB light from UVB lamps is the most common treatment for vitiligo. Skin camouflage: In mild cases, vitiligo patches can be hidden with makeup or other cosmetic camouflage solutions.
  31. 31. Impetigo is a contagious bacterial skin infection most common among preschool children.People who play close contact sports, such as wrestling are also susceptible, regardless of age.  It is also known as school sores. Causes: It is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes The infection is spread by direct contact with lesions or with nasal carriers. The incubation period is 1–3 days after exposure toStreptococcus and 4–10 days for Staphylococcus.
  32. 32. Diagnosis: Impetigo is usually diagnosed based on its appearance. It generally appears as honey-colored scabs formed from dried serum, and is often found on the arms, legs, or face. Treatment: The disease was treated with an application of the antiseptic gentian violet. Today, topical or oral antibiotics are usually prescribed. Mild cases may be treated with bactericidal ointment, such as mupirocin. Severe cases require oral antibiotics, such as dicloxacillin, flucloxacillin, or erythromycin. Alternatively, amoxicillin combined with clavulanate potassium, cephalosporins (first-generation) and many others may also be used as an antibiotic treatment.
  33. 33.  A boil, also referred to as a skin abscess, is a localized infection deep in the skin. A boil, also called a furuncle, is a deep folliculitis, infection of the hair follicle. It is most commonly caused by infection by the bacterium Staphylococcus aureus, resulting in a painful swollen area on the skin caused by an accumulation of pus and dead tissue. Causes: Bacteria eg. staphylococci Family History Poor immune system eg. Hiv/dm/malnutrition Signs and symptoms: Boils are bumpy, red, pus-filled lumps around a hair follicle that are tender, warm, and very painful.  A yellow or white point at the center of the lump can be seen when the boil is ready to drain or discharge pus.
  34. 34.  A boil may clear up on its own without bursting, but more often it will need to open and drain. This will usually happen spontaneously within two weeks. Regular application of a warm moist compress, both before and after a boil opens, can help speed healing.  Antibiotic therapy may be recommended for large or recurrent boils 
  35. 35.  A skin abscess, a collection of pus that forms inside the body. It is usually caused by bacterial infection, most commonly with Staphylococcus aureus or Streptococcus pyogenes, which can turn lethal.  Causes: The initial cause of a carbuncle can often not be determined. Triggers that make carbuncle infections more likely include rashes such as folliculitis; friction from clothing or shaving; having hair pulled out, such as sites where clothing or furniture grab at hairs; generally poor hygiene; poor nutrition; or weakening of immunity. Poor nutrition may be an important factor – for example, persons with diabetes and immune system diseases are more likely to develop infections 
  36. 36. The carbuncle may be the size of a pea or as large as a golf ball. It may be red and irritated, and might hurt when touched. It may also grow very fast and have a white or yellow center. It may crust or spread to other skin areas. Sometimes other symptoms may occur, such as fatigue, fever and a general discomfort or sick feeling. Itching may occur before the carbuncle develops. Treatment: Antibiotics is useful.
  37. 37.  Ringworm is not, as its name suggests, caused by a worm.  Characterized by round lesions (rings) and early belief that the infection was caused by a parasite (worm), the term ringworm was born. Causes: Fungi thrive in moist, warm areas, such as locker rooms, tanning beds, swimming pools, and skin folds. Symptoms:  Red, scaly, itchy or raised patches  Patches may be redder on outside edges or resembles a ring  Patches that begins to ooze or develop blister  Bald patches may develop, when the scalp is affected  On nail it may be thicker discolored or begin to crac
  38. 38. Antifungal treatments include topical agents such as miconazole, terbinafine, clotrimazole, ketoconazole, or tolnaftate applied twice daily until symptoms resolve — usually within one or two weeks. Topical treatments should then be continued for a further 7 days after resolution of visible symptoms to prevent recurrence. In severe cases or scalp ringworm, systemic treatment with oral medications may be given.
  39. 39.  A wart is a small, rough growth resembling a cauliflower or a solid blister.caused by human papillomavirus(HPV) infection. Causes: Warts are caused by the human papilloma virus (HPV). There are about 130 known types of human papilloma viruses. Common warts – HPV types 2 and 4 (most common); also types 1, 3, 26, 29, and 57 and others. It typically occurs on humans' hands or feet but often in other locations
  40. 40. Medication:eg. Salicylic acid, Bleomycin Procedures:  Keratolysis, of dead surface skin cells usually using salicylic acid, blistering agents, immune system modifiers ("immunomodulators"), or formaldehyde.  Surgical curettage of the wart;  Laser treatment 
  41. 41.  A keloid is the formation of a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen. It is a result of an overgrowth of granulation tissue at the site of a healed skin injury which is then slowly replaced by collagen type 1. Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to the colour of the patient's flesh or red to dark brown in color. Causes: Most skin injury types can contribute to scarring. This includes acne scars, burns, chickenpox scars, ear piercing, scratches, surgical cuts or vaccination sites.
  42. 42. Keloids expand in claw-like growths over normal skin.They can occur as a result of severe acne or chickenpox scarring, infection at a wound site, repeated trauma to an area, excessive skin tension during wound closure or a foreign body in a wound. Treatment: The best treatment is prevention in patients with a known predisposition. This includes preventing unnecessary trauma or surgery. Cryotherapy or Cryosurgery is an application of extreme cold to treat keloids.
  43. 43.  MRSA (methicillin resistant staphylococcus aureus) is a type of staphylococcus bacteria (staph) that is resistant to beta-lactam antibiotics. MRSA is contagious and can cause life-threatening infection.  MRSA is spread by coming in contact with an infected person. Risk factors:  hospitalization (current or within the past year)  dialysis  weakened immune system
  44. 44. Generalized feeling of ill health (malaise),rash, headaches, muscle aches, chills, fever, Fatigue, Cough, shortness of breath, chest pain. Diagnosis:  Blood culture  Urine culture  sputum culture  Culture of skin infection Treatment: MRSA can be sensitive to other antibiotics. Intravenous antibiotics are used to treat severe infections. Not all CA-MRSA infections are treated with antibiotics. The doctor may choose to drain an abscess, rather than treat with antibiotics.
  45. 45.  Gangrene (or gangrenous necrosis) is a type of necrosis caused by a critically insufficient blood supply. This potentially life-threatening condition may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood supply to the affected tissues, which results in cell death. Diabetes and long-term smoking increase the risk of suffering from gangrene Causes: Gangrene is caused by a critically insufficient blood supply (e.g., peripheral vascular disease) or infection.  It is associated with diabetes and long-term tobacco smoking. This condition most commonly occurs in the lower extremities (legs and feet).
  46. 46.  The method of treatment is generally determined by the location of affected tissue and extent of tissue loss. The best treatment for gangrene is revascularization (i.e., restoration of blood flow) of the afflicted organ, which can reverse some of the effects of necrosis and allow healing.  Other treatments include antibiotic therapy, wound care, debridement and surgical amputation.
  47. 47.  Harlequin-type ichthyosis is a severe genetic skin disease, which causes thickening of the stratum corneum of the epidermis. It is the most severe form of congenital ichthyosis, characterized by a thickening of the keratin layer in fetal human skin.  The harlequin-type designation comes from the diamond shape of the scales at birth caused by severe hyperkeratosis. The disease can be diagnosed in the uterus by way of fetal skin biopsy or by morphologic analysis of amniotic fluid cells obtained by amniocentesis.
  48. 48.  Sufferers feature severe cranial and facial deformities. The ears may be very poorly developed or absent entirely, as may the nose. The eyelids may be everted (ectropion), The lips are pulled back by the dry skin (eclabium).  Joints are sometimes lacking in movement, and may be below the normal size.   Hypoplasia is sometimes found in the fingers.   Polydactyly has also been found on occasion. Treatment: Constant care is required to moisturise and protect the skin
  49. 49.  Scleroderma, also known as systemic sclerosis, is a chronic systemic autoimmune disease characterised by hardening (sclero) of the skin (derma). In the more severe form, it also affects internal Causes: Scleroderma is caused by genetic and environmental factors
  50. 50.  Cardiovascular: Raynaud's phenomenon palpitations, irregular heart rate.hypertension and congestive heart failure  Digestive: GERD,indigestion, loss of appetite, diarrhoea alternating with constipation,   Pulmonary: progressive worsening of shortness of breath, chest pain  Musculoskeletal: joint, muscle aches, loss of joint range of motion.  Genitourinary: erectile dysfunction, dyspareunia, scleroderma renal crises and kidney failure. Treatment:There is no cure for scleroderma, although relief of symptoms is often achieved. These include- Raynaud's phenomenon with vasodilators such as calcium channel blockers, alpha blockers. Digital ulcers with phosphodiesterase 5 inhibitors Pulmonary arterial hypertension with endothelin receptor antagonists. Gastrooesophageal reflux disease with antacids 
  51. 51.  Alopecia areata (AA), also known as spot baldness, is an autoimmune disease in which hair is lost from some or all areas of the body, usually from the scalp due to the body's failure to recognize its own body cells and destroys.  Alopecia areata affects both males and females. This type of hair loss is different than male- pattern baldness, an inherited condition.
  52. 52.  The area of hair loss may tingle or be painful.  The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other.  Nails may have pitting.  The underlying skin is unscarred and looks superficially normal.  These patches can take many shapes, but are most usually round or oval. Treatment: If the affected region is small, it is reasonable to only observe the progression of the illness, as the problem often spontaneously regresses and the hair may grow back In cases of severe hair loss, limited success has been shown from treating AA with the corticosteroids clobetasol or fluocinonide, corticosteroid injections, or cream
  53. 53. BURNSBURNS Caused by radiation, sun, boiling water, chemicals, fire or electricity RULE OF NINES –RULE OF NINES – Measures percent of body burned. Body divided into 11 area, each is 9% of body surface.
  54. 54.  Burns are categorized by severity as first, second, or third degree.  First degree burns are similar to a painful sunburn, causing redness and swelling to the tissues.  The damage is more severe with second degree burns, leading to blistering and more intense pain. Damage is found in deeper tissues.  The skin turns white and loses sensation with third degree burns. The entire depth of tissue is affected. Scarring is permanent, and depending on the extent of the burning, may be fatal.  Burn treatment depends upon the location, total burn area, and intensity of the burn.
  55. 55. FIRST DEGREEFIRST DEGREE  Superficial  Skin red and dry  Involves only epidermis Rx – cold water  Healing within one week
  56. 56. SECOND DEGREESECOND DEGREE  Epidermis and dermis  Pain, swelling, redness and blistering  Skin may be exposed to infection Rx – pain medication, dry sterile dressing  Healing within 2 weeks
  57. 57. THIRD DEGREETHIRD DEGREE  Epidermis, dermis and subcutaneous layers  Symptoms – loss of skin, blackened skin  May be life threatening
  58. 58. In its most basic sense, skin grafting is the transplanting of skin and, occasionally, other underlying tissue types to another location of the body
  59. 59.  Skin cancer is the most common form of cancer in the United States.  More than one million skin cancers are diagnosed annually.Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.  One in five Americans will develop skin cancer in the course of a lifetime.  Basal cell carcinoma (BCC) is the most common form of skin cancer; about one million of the cases diagnosed annually are basal cell carcinomas. basal cell carcinomas are rarely fatal, but can be highly disfiguring
  60. 60.  Squamous cell carcinoma (SCC) is the second most common form of skin cancer. More than 250,000 cases are diagnosed each year, resulting in approximately 2,500 deaths.  Basal cell carcinoma and squamous cell carcinoma are the two major forms of non-melanoma skin cancer. Between 40 and 50 percent of Americans who live to age 65 will have either skin cancer at least once.  About 90 percent of non-melanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.  Up to 90 percent of the visible changes commonly attributed to aging are caused by the sun.
  61. 61.  Basal cell cancer most often appears on sun-exposed areas such as the face, scalp, ears, chest, back, and legs.  The most common appearance of basal cell cancer is that of a small dome-shaped bump that has a pearly white color.  Blood vessels may be seen on the surface.  Basal cell cancer can also appear as a pimple-like growth that heals, only to come back again and again.  A very common sign of basal cell cancer is a sore that bleeds, heals up, only to recur again.
  62. 62.  A firm, red nodule on your face, lower lip, ears, neck, hands or arms.  A flat lesion with a scaly crust on your face, ears, neck, hands or arms.  A new ulceration or raised area on a pre-existing scar or ulcer.  An ulcer or flat, white patch inside your mouth.  A red, raised patch or ulcerated sore in the anus or on your genitals.
  63. 63.  A highly malignant type of skin cancer that arises in melanocytes, the cells that produce pigment.  Melanoma usually begins in a mole.  A popular method for remembering the signs and symptoms of melanoma is the mnemonic "ABCD":  Asymmetrical skin lesion.  Border of the lesion is irregular.  Color: melanomas usually have multiple colors.  Diameter: moles greater than 6mm are more likely to be melanomas than smaller moles. Rx – surgical removal of melanoma and surrounding area and chemotherapy
  64. 64.  History collection  Physical examination  Blood examination  skin biopsy  Immunofluorescence  Patch testing  Skin scraping  Tzanck smear  Wood’s light examination  Clinical Photographs
  65. 65.  Impaired skin integrity  Acute pain  Risk for infection  Risk for imbalanced nutrition less than body requirement  Anxiety  Knowledge deficiate
  66. 66. MEDICAL:  Topical pharmacological therapy such as Benzoyl peroxide wash, gel , Benzulfoid cream, salicylic acid, differen.  Systemic Therapy such as oral antibiotics (erythromycin, penicillin, minocin), Harmones, Antiandrogens, oral contraceptives, corticosteroids.
  67. 67. SURGICAL: Extraction of comedo contents, drainage of pustules and cysts, excision of sinus tracts and cysts, cryothrapy, Laser resurfacing of scars.  Cancer  Moh’s microscopic surgery  Electro surgery  Cryosurgery  Radiation
  68. 68.  Mohs surgery, also known as chemosurgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer. During the surgery, after each removal of tissue and while the patient waits, the tissue is examined for cancer cells. That examination informs the decision for additional tissue removal. Mohs surgery is one of the many methods of obtaining complete margin control during removal of a skin cancer.  Electrosurgery is the application of a high-frequency electric current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue.
  69. 69.  Cryosurgery (cryotherapy) is the use of extreme cold in surgery to destroy abnormal or diseased tissue.The term comes from the Greek words cryo ("icy cold") and surgery meaning "hand work" or "handiwork". Cryosurgery has been historically used to treat a number of diseases and disorders, especially a variety of benign and malignant skin conditions.  Radiation is the emission or transmission of energy in the form of waves or particles through space or through a material medium.
  70. 70.  Use antiseptic solutions to cleanse the skin and reduce bacterial content and prevent spread.  Wear gloves when giving care to patients with impetigo.  Instruct patient and family to breath at least once daily with bacteria soap.  Encourage cleanliness and good hygiene practices to prevent spread of lesion from one skin to another and from one person to another person.
  71. 71.  Instruct patient and family not to share bath towels and washcloths and to avoid physical contact between the infected person and other person until lesion heal.  Monitoring and managing potential complications  Relieving pain  Promoting Nutrition  Promoting Home and community based care.
  72. 72.  The aim of the present study was to explore the effect of the topical application of calcipotriol on the expression levels of zinc finger protein A20 and nuclear factor-κB (NF-κB) in the skin lesions of patients with psoriasis vulgaris.
  73. 73.  The calcipotriol ointment was topically applied twice a day for 6 weeks by 26 patients with psoriasis vulgaris. At the end of weeks 2, 4 and 6 after the first application of calcipotriol ointment, the clinical efficacy and Psoriasis Area and Severity Index (PASI) score were compared with those prior to treatment.  The expression of zinc finger protein A20 and NF-κB in the skin lesions prior to and following treatment with calcipotriol was measured by immunohistochemical staining and western blotting. At the end of week 6, the clinical effectiveness rate of calcipotriol was higher compared with that at the end of weeks 2 and 4 (χ2 =8.12 and 9.06, respectively; P<0.05). 
  74. 74.  The PASI score declined significantly at the end of weeks 2, 4 and 6 (t=9.37, 10.54 and 12.43; P<0.05, 0.05 and 0.001, respectively). At the end of week 6, the expression levels of zinc finger protein A20 and NF-κB were significantly lower compared with those prior to treatment (χ2 =3.65 and 4.17, respectively; P<0.01). The expression levels of the two proteins were higher in the skin lesions of patients with psoriasis vulgaris prior to the initiation of treatment than in the skin of a normal control group.
  75. 75.  Following the 6-week treatment with calcipotriol, the expression levels of the two proteins in the psoriasis skin lesions were significantly lower than they were prior to treatment (P<0.01). Thus, the present study found that in addition to the typical pathway of NF-κB being targeted in the treatment of psoriasis with calcipotriol, the zinc finger protein A20 may also modulate the inflammatory response of psoriasis.
  76. 76.  Text book of medical surgical Nursing Brunner & Siddarth’s 11th edition Walter Kluwer Publication Page no.1922-2039  Lewis’s Medical Surgical Nursing assessment and management of clinical problems, Elesvier publication Page No. 446-504 Textbook of Anatomy Ross and willson  www.haspi.org  www.wikipedia/wiki/integumentrysysyem  https://en.wikipedia.org/wiki/psoriasis  https://en.wikipedia.org/wiki/Gangrene
  77. 77.  https://en.wikipedia.org/wiki/Acne  https://en.wikipedia.org/wiki/Dermatitis  https://en.wikipedia.org/wiki/Atheletefoot  http://www.biospectrumindia.com/biospecindia/news/214117 /around-19-crore-indians-suffer-skin-diseases-2015-frost- sullivan#sthash.lqi1sMvC.dpuf.  http://www.biospectrumindia.com/biospecindia/news/214117 /around-19-crore-indians-suffer-skin-diseases-2015-frost- sullivan#sthash.lqi1sMvC.dpuf

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