Dermatologic Problems/ Integumentary System

1. Dermatologic Problems/ Integumentary System

3. Physical Examination • Obtain history • WHATS UP • Inspection • Palpation • Gloves are worn during examination

4. Physical Examination • Observe for: • Color • Temperature • Moisture • Dryness

5. Physical Examination • Skin texture (rough-smooth) • Lesions • Vascularity • Mobility • Texture of hair and nails • Skin turgor

6. Physical Examination • Color • Varies from person to person • Ivory-deep brown • Pigmentations r/t • Sun exposure • Fevers • Sunburn, inflammation- • Pink or • Reddish hue • Pallor • Decreased skin tones

7. Physical Examination • Color • Vascularity • Observed in • Conjunctivae • Mucous membranes • Bluish hue • Cyanosis = cellular hypoxia • Jaundice • Yellow pigment • sclera • mucous membrane

8. Physical Examination • Color • Dark skinned persons • Have reddish base and undertones • Buccal mucosa, tongue, lips,nails normally appear pink • Cyanosis-skin assumes grayish cast • Age related changes

9. Physical Examination • Types of dressings • Wet-dry dressings • Moisture-retentive dressings • Already impregnated with moisture • Occlusive dressings • Cover wound

10. Physical Examination • Topical medications • Lotions, suspensions • Clear solutions, liniment, • Powders, creams, • Gels, pastes, • Ointments, sprays, • Corticosteroids etc.

11. Abrasion – skin is rubbed or scraped off Lacerations – torn, ragged, irregular edges made by blunt objects Avulsions – the tearing away of tissue from a body part Incisions – cuts made by sharp cutting instruments Punctures – caused by objects that penetrate tissue while leaving a small surface opening  Amputations – traumatic is the nonsurgical removal of a limb from the body Wounds

12. Wound Healing • 1st intention • 2nd intention • 3rd intention

13. Diagnostic Tests/Treatments • Cultures • Skin biopsy • Wood’s light examination • Skin testing (allergies) • Open wet dressing/other dressings • Therapeutic baths • Topical meds

14. Herpes Zoster {Shingles} • Acute inflammatory and infectious disorder • Painful vesicular eruption • Bright red edematous plaques along the nerve from one or more posterior ganglia

15. Herpes Zoster {Shingles} cont’d • Eruption follows the course of the nerve • Almost always unilateral

16. Herpes Zoster {Shingles} cont’d • Cause • Varicella-zoster virus (like chicken-pox) • Incubation period 7-21 days • Vesicles appear in 3-4 days • Occur posteriorly • Progress anteriorly & peripherally • Along dermatome • Duration 10 days to 5 weeks

17. Herpes Zoster {Shingles} cont’d • Occurs most frequently in • Elderly • Immunosuppressed • Malignancy or injury to spinal or cranial nerve

18. Herpes Zoster {Shingles} cont’d • Complications • Facial and acoustic nerve involvement • Hearing loss • Tinnitus • Facial paralysis • Vertigo • painful

19. Herpes Zoster {Shingles} cont’d • Complications • Full thickness skin necrosis and scarring • Systematic infection from scratching, causing virus to enter blood stream

20. Herpes Zoster {Shingles} cont’d • Medical treatment • Control outbreak • Reduce pain and discomfort • Prevent complications • Acyclovir (Zovirax) IV, PO, topically • Corticosteroids • Antihistamines • Antibiotics

21. Herpes Zoster {Shingles} cont’d • Nursing Care • Cool compresses two-three times per day • Help cleanse and dry lesions • Measures to decrease itching • Medication

22. Parasitic Skin Infections (PSI) • Higher risk situations? • Poor hygiene • Living in close quarters

23. Pediculosis- Lice (PSI) • Infestation by human lice • Pediculosis capitis-head • Pediculosis corporis-body • Pediculosis pubis- pubic or crab

24. Pediculosis (PSI) • Parasite • Approximately 2-4 mm • Female lays eggs-hundreds-nits • Deposit on hair shaft base

25. Pediculosis (PSI) • Symptoms • Pruritus • Excoriation • Vectors of other diseases • Typhus • Recurrent fever

26. Pediculosis Capitis (PSI) • More common in women • Sides and back of scalp • Assess for • Visible white flecks (nits) • Matting and crusting of scalp • Foul odor

27. Pediculosis Capitis (PSI) • Treatment • Pediculicides • Hand pick or comb nits out • Launder bed linens & vacuum • Seal items in plastic bags for 14 days • Repeat above in 10-14 days

28. Pediculosis Corporis (PSI) • Lice live and lay eggs in clothing • Itching • Assess for • Excoriation on • Trunks • Abdomen • Extremities

29. Pediculosis Pubis (PSI) • Intense pruritis • Vulvar region • Peri-rectal • More compact • Crab-like appearance

30. Pediculosis Pubis (PSI) • Contracted from • Infested bed linens • Sexual intercourse • May also infest • Axilla • Eyelashes • Chest

31. Pediculosis (PSI) • Treatment • Chemical killing • Clean linens with hot water and soap • Dry-clean • Fine-tooth comb • Treat social contacts

32. Scabies (PSI) • Contagious skin disease • Mite infestation • Transmitted by • Close-prolonged contact with • Infested companion • Infested bedding

33. Scabies (PSI) • Characterized by • Epidermal curved or linear ridges • Follicular papules • Pruritus Palms • More intense and unbearable at night • White visible epidermal ridges by • Mite burrowing into outer layers of skin

34. Scabies (PSI) • Hypersensitivity reaction • Excoriated erythematous papules • Pustules, crusted lesions • Elbows • Axillary folds • Lower abdomen • Buttocks, thighs • Between fingers • Genitalia

35. Scabies (PSI) • Treatment • Topical sulfur preparations • One-two applications daily • Launder personal items • No disinfectant

36. Ringworm - an infection caused by a fungus Jock itch – form of ringworm on groin area Athlete’s foot – fungal infection of foot (feet) Fungus live and spread on the top layer of the skin and on the hair grow best in warm, moist areas, contagious via skin-to-skin contact with a person or animal that has it or when you share things like towels, clothing, or sports gear. You can also get ringworm by touching an infected dog or cat, although this form of ringworm is not common. Ringworm (PSI)

37. Psoriasis • Lifelong disorder • Exacerbations • Remissions • Cannot be cured

38. Psoriasis • Pathophysiology • Scaling disorder • Underlying dermal inflammation • Abnormality in proliferation of epidermal cells in outer skin layers • Normal – 28 days to shed cells • Psoriasis Cells shed every 4-5 days

39. Psoriasis • Cause-unknown • Genetic predisposition • Environmental factors • May appear after skin trauma • Sunburn • Surgery

40. Psoriasis • Improves in warmer climates • Aggravated by • Infections • Streptococcal throat infection • Candida infections • Hormonal changes • Psychological stress

41. Psoriasis • Assessment • History • Family history • Age at onset • Disease progression • Pattern of recurrences • Gradual or sudden

42. Psoriasis Vulgaris {Ordinary/Common} • Most common • Thick erythematous papules or plaques • Surrounded by silvery white scales

43. Psoriasis Vulgaris {Ordinary/Common} • Common sites • Scalp • Elbows • Trunk • Knees • Sacrum • Extensor surfaces of limbs

44. Skin Cancers • Overexposure to sunlight • Common skin cancers • Squamous cell carcinoma • Basal cell carcinoma • Melanoma

45. Actinic Keratosis • Pre-malignant lesions • Cells of epidermis • Chronically sun-damaged skin • Can lead to squamous cell carcinoma

46. Squamous Cell Carcinoma • Malignant neoplasms of epidermis • Invade locally • Potentially metastic • Ear • Lip • External genitalia • Cause • Repeated irritation or injury

47. Basal Cell Carcinoma • Basal cell layer of epidermis • Lesions go unnoticed • Metastasis rare • Underlying tissue destruction progresses to underlying vital structure

48. Melanomas • Pigmented malignant lesions • Originate in melanin-producing cells of epidermis

49. Melanomas • Risk factors • Genetic predisposition • Excessive exposure to UV light • Precursor lesions resembling unusual moles • Highly metastatic • Survival depends on early diagnosis and treatment

50. Skin Cancers • Incidence/Prevalence • Light skinned persons • Outside work • Higher altitudes • Chemical carcinogens