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- 1. Lecture Notes Classroom Activity to Accompany Diseases of the Human Body Fifth Edition Carol D. Tamparo Marcia A. Lewis 8 Skin Diseases and Disorders
- 2. Copyright © 2011 by F.A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise— without written permission from the publisher.
- 3. 3 I’d get a tattoo if I had any skin tight enough to draw on. —Maxine
- 4. 4 Common Signs and Symptoms of Skin Diseases and Disorders • Skin eruptions • Pruritus • Erythema • Pain • Swelling • Inflammation
- 5. 5 Psoriasis • Description • Chronic, noninfectious, inflammatory pink or red lesions of skin with characteristic silvery scaling • Occurs more often between ages 15 and 30
- 6. 6 Psoriasis • Etiology • Not known • Genetic; autoimmune indications • Precipitated by trauma, infections, hormonal changes, stress, climate
- 7. 7 Psoriasis • Signs and symptoms • Epidermal cells produced 6 to 9 times faster than normal • Thick, flaky scaling of skin that appears dry, cracked, encrusted • Pruritus is common
- 8. 8 Psoriasis • Diagnostic procedures • Careful medical history • Observation of skin appearance
- 9. 9 Psoriasis • Treatment • Palliative • Avoid precipitating factors • Ultraviolet (UV) A or UV-B light • Coal tar preparations, corticosteroid creams • Open, wet dressings • Biologic agents • Intralesional therapy
- 10. 10 Psoriasis Complementary therapy •Foods high in omega-3 fatty acids •Vitamin supplements •Aloe vera applications •Stress reduction strategies
- 11. 11 Psoriasis Client communication •Teach careful skin hygiene; scale removal •Do not mix over-the-counter medications with prescribed medications and creams •Do not pick at the scabs
- 12. 12 Psoriasis • Prognosis • Controllable, but not curable; unsightly lesions cause psychological distress; can progress to exfoliative psoriasis, an acute condition • Prevention • None known
- 13. 13 Psoriasis • Psoriasis is characterized by red lesions with 1. Runny pustules 2. Silvery scales 3. Firm nodules 4. Yellow crust
- 14. 14 Acne Vulgaris • Description • Inflammatory disease of sebaceous glands, hair follicles • Comedos, papules, pustules appear on skin • More common in adolescence
- 15. 15 Acne Vulgaris • Etiology • Not known • May be follicular occlusion, androgen- stimulated sebum production • Hormonal disturbances, endocrine disorders, corticosteroid drugs
- 16. 16 Acne Vulgaris • Signs and symptoms • Acne plugs appear as comedos; rupture spreads inflammation to dermis • Diagnostic procedures • History • Age • Skin observation
- 17. 17 Acne Vulgaris •Treatment • Reduce bacterial infection; prevent inflammation • Antibacterial solutions applied to skin • Oral antibiotic therapy
- 18. 18 Acne Vulgaris Complementary therapy •Reduce intake of saturated fats, increase fiber •Get fresh air, exercise •Use non–oil-based makeup •Use facial mask preparations made with egg whites
- 19. 19 Acne Vulgaris Client communication •Teach skin hygiene •Eat balanced diet •Watch for candidiasis symptoms if antibiotic therapy is used •OTC medications containing salicylic acid and benzoyl peroxide are effective
- 20. 20 Acne Vulgaris • Prognosis • Disease is persistent, emotionally upsetting • Usually resolves over time • Permanent scarring can occur • Prevention • None known
- 21. 21 Rosacea • Description • Chronic inflammatory condition that causes erythema and formation of pustules on the face • Etiology • Not known • Likely a combination of genetics and environment • More common in those with fair complexions between ages 30 and 50 • Premenopausal women more likely then men to develop symptoms
- 22. 22 Rosacea • Signs and symptoms • Flushing of the cheeks, forehead, and chin • Small red pustules may appear • Rhinophyma may occur • Burning, redness of the eyes, and excessive tearing may occur
- 23. 23 Rosacea • Diagnostic procedures • Detailed medical history • Physical examination of affected area
- 24. 24 Rosacea • Treatment • Topical creams or lotions • Oral antibiotics • Laser surgery
- 25. 25 Rosacea Complementary therapy •No significant therapy is indicated Client communication •Avoid products that contain alcohol, acids, and other irritants
- 26. 26 Rosacea • Prognosis • Chronic condition • Good with early treatment • Prevention • Use of sunscreen; avoid overheating • Use gentle facial cleansers
- 27. 27 Rosacea • Rosacea may cause thickening and misshaping of the 1. facial skin 2. eyelids 3. nose 4. lips
- 28. 28 Furuncles and Carbuncles • Furuncle: a boil involving the hair follicle and the surrounding tissue • Carbuncle: several furuncles developing in adjoining follicles with multiple drainage sites • Common on hairy body parts where there is irritation, pressure, friction, or moisture
- 29. 29 Pediculosis • Skin infestation with lice • Pediculosis corporis: body lice • Pediculosis capitis: head lice • Pediculosis pubis: pubic lice
- 30. 30 Decubitus Ulcers • Description • Localized area of dead skin, subcutaneous tissue • Etiology • Impaired blood supply to affected area from persistent skin pressure • Often seen in debilitated, unconscious, or paralyzed persons • Elderly clients at risk
- 31. 31 Decubitus Ulcers • Signs and symptoms • Shiny, red skin over a bony prominence • Blisters, erosions • Necrosis, ulcerations occur that easily become infected
- 32. 32 Decubitus Ulcers • Diagnostic procedures • Visual examination of lesion • Culture of wound if necessary
- 33. 33 Decubitus Ulcers • Treatment • Alleviate skin pressure • Provide careful skin hygiene • Keep area dry, clean • Topical antibiotics • Surgery to remove ulcer in some cases
- 34. 34 Decubitus Ulcers Complementary therapy • A paste of vitamin E oil, zinc oxide, goldenseal powder applied to area • Natural light Client communication • Frequent movement, ambulation is essential • Keep skin clean and dry
- 35. 35 Decubitus Ulcers • Prognosis • Healing process is slow, tedious • Immediate treatment is important • Prevention • Frequent repositioning, gentle massage, use of pressure-relieving devices
- 36. 36 Dermatophytoses • Description • Chronic superficial fungal infection • Tinea capitis – scalp • Tinea corporis – body • Tinea unguium – nails • Tinea pedis – feet • Tinea cruris – groin
- 37. 37 Dermatophytoses • Etiology • Several species of fungus that invade the keratinous layer • Direct contact with fungus or spores • Infection can occur when skin is chafed, roughened, abraded, or in cases of poor hygiene
- 38. 38 Dermatophytoses • Signs and symptoms • Tinea capitis: contagious infection often in children; may be asymptomatic or slight itching with gray, round, scaly lesions • Tinea corporis: occurs in those exposed to infected domestic animals; lesions are ringed with scales and vesicles; also called ringworm • Tinea unguium: usually asymptomatic until the nail becomes brittle, lusterless, and thick
- 39. 39 Dermatophytoses • Signs and symptoms(cont.) • Tinea pedis: persistent itching, burning, stinging; sole can become fissured; athlete’s foot • Tinea cruris: red, raised, sharply defined, itching lesions in the groin; jock itch
- 40. 40 Dermatophytoses • Diagnostic procedures • Dependent on location and appearance • Culture to determine type of fungus • KOH examination
- 41. 41 Dermatophytoses • Treatment • Apply topical antifungal • Keep affected skin as dry and clean as possible
- 42. 42 Dermatophytoses Complementary therapy • Apply tea tree oil or liquid grape seed extract 3 or 4 times a day Client communication • Avoid infection by being cautious of environment
- 43. 43 Dermatophytoses • Prognosis • All forms are chronic and persistent; reoccurrence is common • Prevention • Proper hygiene practices
- 44. 44 Impetigo • Description • Contagious skin infection marked by fluid- filled blisters that become pustular, rupture, form a yellow crust
- 45. 45 Impetigo • Etiology • Strep or staph bacteria enters through cut or lesion • Poor hygiene, malnutrition, anemia may predispose • More common among infants, small children
- 46. 46 Impetigo • Signs and symptoms • Lesions begin as macules, vesicles, pustules • Pruritus • Lesions rupture, serous liquid hardens to form a crust • Most common on mouth, nose, neck, extremities
- 47. 47 Impetigo • Diagnostic procedures • Visualization of lesions • Microscopic Gram stain of vesicle fluid provides confirmation
- 48. 48 Impetigo • Treatment • Antibiotics (topical and/or oral) • Thorough cleansing of lesions 2 to 3 times a day • Highly contagious
- 49. 49 Impetigo Complementary therapy •None Client communication •Teach about contagion, protection •Show client how to clean the lesions, apply medications
- 50. 50 Impetigo • Prognosis • Good • Prevention • Good hygiene; avoidance of those infected; highly contagious
- 51. 51 Impetigo •Impetigo can be caused by 1. Staph or strep bacteria 2. Varicella virus 3. Escherichia bacteria 4. Herpes simplex virus
- 52. 52 Vitiligo • Description • Depigmentation of the skin due to destruction of melanocytes • Etiology • Not known • Appears to be genetic or autoimmune • Affects both genders and all races equally
- 53. 53 Vitiligo • Signs and symptoms • White spots appear on areas exposed to sunlight • Spots also appear in the groin, armpits, navel, genital, and rectal areas • May be accompanied by premature graying of scalp and facial hair, eyebrows, and eyelashes
- 54. 54 Vitiligo • Diagnostic procedures • Detailed physical examination and history • Skin biopsy with microscopic examination
- 55. 55 Vitiligo • Treatment • Topical corticosteroids • Psoralen and ultraviolet A therapy • Monobenzene application • Skin grafts • Tattooing, especially around lips
- 56. 56 Vitiligo Complementary therapy •40 mg of gingko biloba taken 3 times a day Client communication •Provide emotional support •Advise the use of self-tanners and make- up to cover white spots
- 57. 57 Vitiligo • Prognosis • Chronic • Unpredictable • Prevention • None
- 58. 58 Seborrheic Dermatitis • Description • Chronic disease of sebaceous glands common in infants • Appears as cradle cap or diaper rash
- 59. 59 Seborrheic Dermatitis • Etiology • Idiopathic • May occur with nervous system diseases
- 60. 60 Seborrheic Dermatitis • Signs and symptoms • Skin eruptions on scalp, eyelids, cheeks, groin, or trunk area • Produces dry, moist, or greasy scales • Diagnostic procedures • Detailed history and observation of lesions • Rule out psoriasis
- 61. 61 Seborrheic Dermatitis • Treatment • Shampoo containing salicylic acid or zinc pyrithione • Hydrocortisone creams
- 62. 62 Seborrheic Dermatitis Complementary therapy •Avoid any known allergens Client communication •Teach scrupulous skin hygiene •Keep skin as dry as possible
- 63. 63 Seborrheic Dermatitis • Prognosis • Chronic condition • Good with effective treatment • Prevention • None known
- 64. 64 Contact Dermatitis • Description • Acute skin inflammation caused by direct contact with offending substance that creates an allergic response
- 65. 65 Contact Dermatitis • Etiology • Wide variety of animal, vegetable, mineral substances • Plants • Certain metals in jewelry • Contact with wool or latex
- 66. 66 Contact Dermatitis • Signs and symptoms • Erythema • Small skin vesicles that ooze, scale, itch, burn • Diagnostic procedures • Inflamed appearance • Medical history • Patch test to determine irritant
- 67. 67 Contact Dermatitis • Treatment • Thorough skin cleansing to remove irritant • Topical corticosteroid lotions or creams
- 68. 68 Contact Dermatitis Complementary therapy •Remove offending irritant Client communication •Teach client how to avoid irritant •Careful label reading
- 69. 69 Contact Dermatitis • Prognosis • Self-limiting • Problem recurs if exposed to offending irritant • Prevention • Avoid offending irritant
- 70. 70 Latex Allergy • Description • A form of dermatitis, the result of hypersensitivity to latex products
- 71. 71 Latex Allergy • Etiology • Any latex products or products containing even small amounts of latex • Persons with asthma or other allergies are at risk • Medical, dental professionals also at risk
- 72. 72 Latex Allergy • Signs and symptoms • Itchy skin • Swollen lips • Nausea • Diarrhea • Red, swollen eyes • Signs of anaphylactic shock, such as hypotension, tachycardia, difficulty breathing, bronchospasm • Anaphylactic shock is medical emergency
- 73. 73 Latex Allergy • Diagnostic procedures • Blood test for latex sensitivity (measures immunoglobulin E [IgE] antibodies) • Treatment • Avoidance of products containing latex • Proper skin cleansing following exposure
- 74. 74 Latex Allergy Complementary therapy •None Client •Inform individuals of the many latex products •Instruct on use of epinephrine auto injector
- 75. 75 Latex Allergy • Prognosis • Good with avoidance of latex • Risk increases with each exposure • Prevention • Avoid all latex-containing products • Wear an ID tag, be prepared with epinephrine auto injector • Seek latex-free environments
- 76. 76 Atopic Dermatitis (Eczema) • Description • Skin inflammation • Produces intense itching • Etiology • Idiopathic • Allergic or hereditary components suspected
- 77. 77 Atopic Dermatitis (Eczema) • Signs and symptoms • Can cause vesicular, exudative eruptions in children • Dry, leathery vesicles in adults • Pruritus • Lesions on face, neck, upper trunk, bends of knees, elbows
- 78. 78 Atopic Dermatitis (Eczema) • Diagnostic procedures • Skin observation • History revealing family tendency • Elevated IgE
- 79. 79 Atopic Dermatitis (Eczema) • Treatment • Local and systemic agents for pruritus • Careful skin care • Avoidance of known irritants • Topical corticosteroid creams and ointments • Humidifiers
- 80. 80 Atopic Dermatitis (Eczema) Complementary therapy • Identify and avoid any food, plant, metal, chemical irritants • Calendula lotion or aloe vera gel may be beneficial • Adults can take 500 mg of black currant oil twice a day; children may take only one-half that dose for 6 to 8 weeks
- 81. 81 Atopic Dermatitis (Eczema) Client communication •Watch for secondary infections •Suggest ways to avoid irritant
- 82. 82 Atopic Dermatitis (Eczema) • Prognosis • Good, but disorder is frustrating to control • Prevention • Avoid known irritant
- 83. 83 Herpes Zoster (Shingles) • Description • Acute, inflammatory, painful vesicles usually on the trunk of the body; occasionally on the face • Primarily affects adults over age 50
- 84. 84 Herpes Zoster (Shingles) • Etiology • Reactivation of the varicella zoster virus (VZV) that causes chickenpox • Trigger is unknown
- 85. 85 Herpes Zoster (Shingles) • Signs and symptoms • Pain along affected nerve, usually 1 to 3 days prior to maculopapular rash that becomes vesicles • Region around area is very painful • Diagnostic procedures • Characteristic pattern of painful lesions • Isolation of virus in cell cultures can confirm, if uncertain
- 86. 86 Herpes Zoster (Shingles) • Treatment • With early diagnosis, valacyclovir can prevent progression of rash, visceral complications • Sedatives, analgesics, antipruritics • Antibiotics if vesicles are infected
- 87. 87 Herpes Zoster (Shingles) Complementary therapy • Topical application of licorice root gel may be helpful • Application of TENS to nerves can relieve pain Client communication • Teach proper skin care, how to prevent infection
- 88. 88 Herpes Zoster (Shingles) • Prognosis • Good; does not recur • Shingles runs its course within 7 to 10 days • Can persist for weeks or months • Prevention • For those over age 60 vaccination with weakened chickenpox virus
- 89. 89 Herpes Zoster (Shingles) • Shingles appears 1. Primarily on the face 2. At the site of infection 3. Along a nerve tract 4. On the palms of the hands
- 90. 90 Malignant Melanoma • Description • Neoplasm of epidermis and dermis • Incidence has tripled in past 20 years
- 91. 91 Malignant Melanoma •Description (cont.) • Occurs in four forms • Superficial spreading: most common, occurs anywhere on body; circular, flat, elevated lesions • Lentigo maligna: occurs on exposed skin areas; slowly evolves; lesions are brown or black
- 92. 92 Malignant Melanoma • Description (cont.) • Nodular: occurs on any site; invades tissue below dermis; looks like blood blister • Acral-lentiginous: occurs where hair follicles are absent; appears as irregular pigmented macules; becomes invasive early; appears as dark brown, flat or blue-black, raised lesion
- 93. 93 Malignant Melanoma • Etiology • Unknown, though ultraviolet light is suspect • Excessive sun exposure and blistering burns in childhood • Those with fair complexion, light hair, blue eyes more at risk • Signs and symptoms • Lesions have irregular borders, diverse colors
- 94. 94 Malignant Melanoma • Diagnostic procedures • Biopsy of suspicious skin lesions that are then staged to determine treatment
- 95. 95 Malignant Melanoma • Treatment • Surgical excision, chemotherapy • Radiation therapy for metastatic disease • Immunotherapy for advanced stages in clinical trials
- 96. 96 Malignant Melanoma Complementary therapy • Therapies are best if approved and integrated into traditional therapies Client communication • Avoid excessive sun exposure; use sunscreen when outdoors
- 97. 97 Malignant Melanoma • Prognosis • Determined by level of dermal invasion • Poor if metastasis occurs; good if detected and treated early • Prevention • Avoid overexposure to the sun and ultraviolet rays • Seek prompt treatment of suspicious skin lesions
- 98. 98 Credits Publisher: Margaret Biblis Acquisitions Editor: Andy McPhee Developmental Editors: Yvonne Gillam, Julie Munden Backgrounds: Joseph John Clark, Jr. Production Manager: Sam Rondinelli Manager of Electronic Product Development: Kirk Pedrik Electronic Publishing: Frank Musick The publisher is not responsible for errors of omission or for consequences from application of information in this presentation, and makes no warranty, expressed or implied, in regard to its content. Any practice described in this presentation should be applied by the reader in accordance with professional standards of care used with regard to the unique circumstances that may apply in each situation.