1. Acne is a common skin disorder of hair follicles and sebaceous glands caused by excess sebum production, abnormal keratinization, and P. acnes bacteria. It presents with inflamed lesions like papules, pustules, and nodules on the face, neck, back and chest. 2. Pemphigus vulgaris is a chronic autoimmune blistering disease caused by IgG antibodies. It presents with flaccid blisters that rupture easily, causing raw areas and possible infection. 3. Psoriasis is a chronic inflammatory skin condition characterized by red, scaly plaques, often located on the scalp, elbows, knees, and

1. ACNE DISORDER
PEMPHIGUS VULGARIS
PSORIASIS

2. ACNE DISORDERS:
Acne is a common disorder of
pilosebaceous (hair & sebaceous) structure, as
they opens to the skin surface through pore.
These glands produce sebum, a lipid substance,
Acne may be inflammatory & non-inflammatory

4. ACNE VULGARIS
It is most common type among all skin
disorders, more common in adolescents & young
to middle age adults.

5. Causes:
1. Excessive sebum production
2. Abnormal keratinization of follicular epithelium
3. Propionibacterium acne- anaerobic bacteria
cause acne

6. (Follicular hyperkeratinization (abnormally rapid
shedding of skin cells) in the sebaceous gland
and follicular infundibulum (uppermost section
of the hair follicle, near the opening of the pores)
can be considered one of the crucial events in the
development of acne lesions.)

8. 3. Predisposing factor:
1. Change in hormones during puberty, menstrual
cycle
2. Genetic- family history increases the occurrence
of acne
3. Psychological factors: stress
4. Infections by propionibacterium acnes
5. High glucose load diet & cow’s milk worsening
acne. Chocolate, salt, high fat diet are not
associated with acne

9. Pathophysiology:
Sebaceous glands stimulated by various factors
They secrete sebum which flow out on to skin
surface
Pilosabaceous ducts got plugged
Comedones appeared

10. Clinical Manifestation:
 Lesions form on face, neck, back, chest &
shoulders
 Comedons (black & white heads, pustules,
papules nodules)
 Open comedons-black heads are inflamed
lesions. Inflammation occur after manipulation
 Nodules are the hall mark of serious acne &
deep scaring may result.
 Inflammatoty acne lesions include white
comedons, erythematous pustules & cysts
 In severe cases: cysts are formed, pigmentation
changes occur which lead to darkening of skin &
severe scarring also occur

13. ACNE ROSACEA:
• It is a chronic, inflammatory skin eruptions
Occur more often in middle & older adults.
• It is characterised by erythema, papules,
pustules & tetangiectases (blood vessels visible
near the surface of skin) occurs on face
especially the nose. Patient may have burning &
itching sensations

14. Precipitating factors:
1. More common in fair people
2. Tea, coffee, alcohol, caffeine containing
products, sun light, exposure to extreme cold &
hot spicy foods & emotional stress

15. Clinical Manifestation:
1. This disease start with erythema over the
cheeks & nose.
2. Patients have facial flushing, blushing,
redness, burning, red bumps & small cysts

17. 3. Chronic cases: skin color changes to dark
red & pores become enlarged & sebaceous
hyperplasia of nose (rhinophyma) present.

18. ACNE CONGLOBATA
It is uncommon & unusually severe type
of acne of unknown cause that starts in middle
adulthood. It is characterised by burrowing &
interconnecting abscesses & irregular scars.

19. Clinical Manifestation:
 Comedones, papules, pustules, nodules,
cysts & scars occur on back, buttocks & chest.
 Comedons have multiple opening & have
serous to purulent discharge with a foul odour.

21. Diagnostic Evaluation:
 Acne is diagnosed from location &
appearance of lesions.
 If pustules present culture of drainage taken
to rule out viral & bacterial infections

22. Medical Management:
1. Diet therapy:
High glucose load diet & triggering food
are limited, otherwise no dietary restricted are
imposed on person
2. Anti-acne medicines:
 Tretinoin (Retin A)
 Isotretinoin or benzoyl peroxide preparations.
 Azelaic acid

23. 3. Antibiotics:
Erythromycin
Tetracycline
Clindamycin
This medicines can be used along with tretinoin
therapy. Topical & oral preparation can be used.

24. Nursing Responsibilities in giving Anti-acne
medicines:
1. Cautiously it has to be given to pregnant
woman as its absorption put the foetus at risk
2. Do not administer to persons with eczema or
those who are hypersensitive to sun
3. Educate the person regarding application of
Tretinoin
4. Use the cream in test area to check sensitivity
5. Pea-sized amount of cream is sufficient for entire
face
6. Apply the cream to dry, clean skin

25. 7. Do not apply cream to eyes, mouth, angle of
nose & mucous membrane
8. Avoid frequent face wash (not more than 3
times), and do not use skin preparations like after
shave, lotion, alcohol, menthol
9. This medicine cause temporary stinging
10. Skin where you apply cream will be red & may
peel, this is normal reaction
11. Use sunscreen & umbrella as it increased
sensitivity
12. Isotretinoin pills should be taken with food. It
cause dryness of eyes- patient will face difficulty
while wearing lenses

26. Nursing Management:
1, Teach patient to wash the face with soap at
least twice a day
2. Shampoo the hair 2-3 times a week to
prevent oiliness
3. Advice patient to eat well balance diet
4. Avoid sun exposure or use sun screen lotion,
hat & umbrella
5. Do regular exercise & yoga
6. Avoid manipulation of lesions like squeezing

27. 7. Avoid frequent touching of face & comedones
8. Maintain strict compliance with treatment as
it last for 2-3 months
9. Advice to do stress reduction strategies like
yoga, medications, relaxation exercise.

28. PEMPHIGUS VULGARIS
• It is chronic disorder of skin & oral
mucous membrane characterised by blister
(bullae) formation.
• It is an autoimmune disorder & associated
with IgG antibodies
• Blister (bullae) forms from antigen-antibody
reactions

29. • (Autoimmune disease happens when the body's
natural defense system can't tell the difference
between your own cells and foreign cells,
causing the body to mistakenly attack normal
cells)
• (Antigen-antibody interaction, or antigen-
antibody reaction, is a specific chemical
interaction between antibodies produced by B
cells of the white blood
cells and antigens during immune reaction)

31. Risk factor:
 More common in middle & older adults of all
races & backgrounds
 Administration of certain drugs penicillamine &
captropil precipitate the disease.
(Penicillamine is used as a form of
immunosuppression to treat rheumatoid arthritis.)
(Captopril is an angiotensin converting enzyme (ACE)
inhibitor prescribed for treating high blood
pressure, heart failure, and for
preventing kidney failure due to high blood
pressure)

32. Clinical Manifestation:
 Blister appear in mouth & scalp firstly &
then spread in crops or waves to larger area of
body including face, back, chest, umbilicus &
groin
 Ulceration of blisters present. Blister form in
epidermis & cause dermis cells to separate above
basal layer
 Rupture of blister take place & result in
denuded skin, crusting & oozing of fluid with a
musty odor.
 Pain in lesion present

34.  Nikolsky’s sign present
(Nikolsky sign is a skin finding in which the top
layers of the skin slip away from the lower layers
when rubbed).
 Septicemia occur due to superadded
infection of staphylococcus aureus
 Fluid & electrolyte imbalance due to fluid
loss

35. (Septicemia is a bacterial infection spread
through the entire vascular system of the body).

36. Diagnostic Evaluation:
1. Assessment, family history, medical history.
2. Immunofluorescence microscopy determine
the presence of IgG antibodies in epidermis

37. Medical Management:
1. Topical corticosteroids used for treatment
2. Systematic corticosteroids or
immunosuppressive agents (Azathioprine,
cyclophosphamide ) are prescribed.
 Patient is instructed to take medicine after
meals & antacids should be taken to prevent
gastric ulcers.
 Weight, blood glucose, blood pressure &
fluid balance (edema) should be checked to
evaluate side effects of steroids

38. 3. Plasmapheresis is used to remove the
antibodies from serum for a treatment of
pemphigus vulgaris
(Immunosuppressive agents: An agent that
decreases the body's immune responses. It
reduces the body's ability to fight infections and
other diseases)

39. Nursing Management:
1. Relief the discomfort from blister:
 Oral hygiene done frequenly by mouth wash
as it remove debris & soothe ulcers
 Scalp, chest, mucous membranes should be
carefully examined for blisters
 Avoid commercial mouth wash
 Lip should be kept moist with application of
lip balm
 Maintain humidity of environmental air by
cool mist

40. 2. Enhance Skin healing:
 Cool, wet dressing or bathe provided
 Skin should be dried properly after bathing &
large amount of non-irritating powder sprinkled
to allow free movement of patient
 Keep the patient warm to prevent hypothermia
3. Reduce anxiety & improve coping
 Listen to the doubts & worries of patient
 Give sufficient time to express feelings
 Reassure the patient & family members
 Involve family members in care as it provides
support to patient

41. Complications:
1. Infection & sepsis by candida albicans &
staphylococcus aureus
2. Fluid volume deficit due to oozing of fluid from
ruptured blister
Role of a Nurse:
1. Observe signs of infection like fever, chills as
systemic infection & topical infection (redness)
2. Environmental sanitation maintained to reduce
infection. Mopping should be done instead of
dusting

42. 3. Strict intake/output chart maintained.
4. Cool, non-irritating fluids should be given to
person to maintain oral intake (apple or grape
juice)
5. High calorie, high protein, like milkshakes
should be given to patient to maintain energy
level.

43. PSORIASIS
Psoriasis is a chronic, non-infectious,
recurrent erythematous inflammatory disorder
involving keratin synthesis.
It is characterised by raised, reddened, round
circumscribed plaques covered by silvery white
scales.

44. (Keratin: a fibrous protein forming the main
structural constituent of hair)
(Synthesis. α-keratin synthesis begins near focal
adhesions on the cell membrane. ... This results
in a fully matured, non-vascular keratin cell.
These fully matured, or cornified, alpha-keratin
cells are the main components of hair, and the
epidermis layer of the skin).

45. RISK FACTOR:
1. Family history: Genetic predisposition contribute
disease which cause over production of keratin
2. Environmental factors: Seasonal changes &
sunburn, sunlight contributes the disease occurrence
3. Hormonal fluctuations: Steroid withdrawal and
drugs like corticosteroids, lithium & chloroquine
also triggers the onset of disease.
4. Kobner’s reaction: Lesions result form trauma after
surgery or excoriation also precipitate the occurance
of disease.
5. Anxiety & stress

46. Clinical Manifestation:
 Eruptions, lesions occur on scalp, elbows,
knees, genitalia & sacral regions. This are well
defined erythematous plaques with silvery white
scales
 They are asymmetrical
 Lesions are small & called guttate psoriasis
& painful tissues formed.
 It affects nails & yellow or brown
discoloration results & nail plate may separate.
Pustular lesions occur on palm & soles

49. Diagnostic evaluations:
 Skin biopsy done to check inflammatory &
non-inflammatory disorders
 Ultrasound done to find changes in stratum
corneum

50. Treatment:
1. Topical medicine-corticosteroids, tar
preparations, anthralin & retinoids are used for
treatment. These drugs decrease inflammation &
suppress psoriatic cell activity.
 Corticosteroids topical injections can be
injected into lesions
 Tar preparations (Ester, psorigel, Fototar)
also anti-inflammatory & suppress mitotic
activity
 Topical anthralin applied to plaque patches &
left for 8-12 hours & it affect mitotic activity

51. ( Mitotic activity: Having to do with the presence
of dividing (proliferating) cells).

52.  Calcipotriene (Dovonex) used as short term
& long term treatment of psoriasis
 Tarorac retinoid used to treat mild to
moderate psoriasis
2. Photo chemotherapy:
Used for generalized psoriasis.
In photo chemotherapy, a light activated drug
methoxsalen is used. It inhibits the DNA
synthesis & prevent all mitosis & decrease
hyperkeratosis.

53.  Drug administered orally & after 2 hours ultra
violet rays given.
 Treatment is given 2-3 times a week. Cover
eyes with sunglasses during treatment, treatment
cause tanning & sunlight to be avoided for 8-12
hours.
3. Ultra violet light:
Used for generalized psoriasis, decreases
growth rate of epidermis cells,
Given 3 times a day & a measured in few
seconds of exposure, erythema response occurs in
about 8 hours.
Eye protection given during treatment

55. Nursing Management:
1. Maintenance of skin integrity
 Teach patient regarding skin care
 Advice patient not to scratch & pull scales
 Patient should take warm water for bathing
not a hot water
 Dry the skin by blotting with towel instead
of rubbing with towel
 Lubricate the skin with coconut oil as it
gives relief & comfort to sore
 Gently rub lesions in circular motion with
the help of clean wash clothe

56.  Apply the prescribed medicines in a thin layer
 Occlusive dressing should be applied for 8
hours
 Keep away the medicine from eyes & mucous
membrane or in skin fold, if it goes, wash it
immediately
3. Develop self acceptance:
 Listen to the patient & provides sufficient time
to verbalize feelings
 Use therapeutic communication like nodding
so that patient feel confident & being accepted

57.  Asses coping strategies of patient & help the
patient use them in an effective way
 Teach patient regarding techniques to avoid
stress
 Social interaction of person prompted
through involvement of family members in skin
care
 Advice patient to meet other people having
similar problem

58. Complications:
 Psoriatic arthritis: Patient have psoriatic
lesion along with involvement of sacroiliac &
distal joints of finger