skin disorders

skin trauma

contusion, ecchymosis, petechiae, abrasion, laceration

contusion

skin discoloration caused by blow, trauma, or suction
usually bleeding in superficial tissue

ecchymosis

appears similar to bruise, caused by leaking of blood into subcutaneous tissue
caused by trauma causing rupture of the deeper capillaries

petechiae

tiny red or purple spots on skin, caused by bleeding under skin
can be caused by trauma or bacterial infections

abrasion

scraping away superficial layers of skin usually by friction/shear

laceration

deeper than abrasion, irregular tear of skin d/t trauma

dermatitis

eczema, allergic or contact dermatitis

eczema

aka atopic dermatitis, chronic inflammatory disease that causes itching, dryness, redness, and inflammation of skin
go through periods of flares and remission, begins in childhood and improves with age, not contagious

eczema cause

unknown, family member with eczema, hay fever, or asthma increases risk

eczema treatment

daily skin care: lukewarm bath, unscented soaps, pat skin dry, moisturizing creams, protect from skin irritants
target inflammation: eliminate triggers, manage stress, avoid scratching/rubbing, maintain level indoor temp, get enough sleep
meds: corticosteroid creams, immunosuppressants, antihistamines
phototherapy: UVA or UVB light waves

allergic or contact dermatitis

mast cell response from coming into contact with allergen or irritant

bacterial infections

impetigo, cellulitis, necrotizing fasciitis, hidradenitis suppurativa

impetigo

superficial bacterial infection of epidermis, common in children, highly contagious, usually in areas not covered by clothing
bacteria enters through break in skin (most common staphylococcus aureus and streptococcus pyogenes)

impetigo s/s

starts as red area of skin that develops into pus-filled vesicle/blister, ruptures and leaves honey-colored crust

impetigo treatment

antibiotics, keep area covered

cellulitis

bacterial infection involving deeper layers of skin, most commonly from staphylococcus aureus and streptococcus pyogenes

cellulitis presentation

redness, edema, warmth to touch, tenderness
most common LE, typically unilat

cellulitis treatment

antibiotics, limb elevation to decrease swelling

necrotizing fasciitis

bacterial infection that results in death of body’s skin and soft tissue layers
life threatening: high mortality, sudden onset and rapid spread, biggest factor is time from onset to debridement

necrotizing fasciitis risk factors

poor immune function, obesity, alcoholism, IV drug use, PAD

necrotizing fasciitis sx

severe pain, fever, purple-colored skin in area affected, usually occurs in areas of decreased blood flow (limbs and perineum)

necrotizing fasciitis treatment

debridement surgery to remove infected tissue to clear margins, antibiotics

hidradenitis supprativa

noncontagious, inflammatory condition characterized by pus filled bumps or boils and tunnels in and under skin, often in axilla or inguinal area starting in hair follicles

HS cause

unknown, 1/3 have family member with HS
females > males, afr am > white, smokers and obese individuals, appears age 20-40

HS treatment

address lifestyle factors: smoking, weight loss
wear loose clothing to avoid friction, keep areas clean, warm compress, antibiotics

viral disorders

herpes 1 and 2, herpes zoster

herpes 1 and 2

herpes 1: cold sore, spread by direct contact, treat with antivirals
herpes 2: STI, vesicular, can be fatal to newborns, no cure but treat with antivirals
can occur anywhere

herpes zoster

reactivation of varicella virus (lies dormant in cerebral ganglia or ganglia of posterior nerve root), biggest risk is age
contagious to those that have not had chickenpox, prevention with shingles vaccine for 50+

herpes zoster symptoms

burning, itching, painful that develops into a vesicular
follows dermatome, considered disseminated if > 20 vesicules outside primary dermatome

herpes zoster treatment

antivirals within 72 hrs onset

herpes zoster complications

pain can last months-years (post-herpetic neuralgia), can cause serious eye issues if spreads to eye or involves CN III

warts

common, caused by HPV, spread through direct contact
hands, fingers, soles of feet most common
treated with cryotherapy, salicylic acid, OTC treatment

ringworm

fungal infection of skin, can affect humans and animals, spread through direct contact
sx: itchiness, ring shaped areas

ringworm treatment

typically can treat with OTC antifungal creams

immune disorders

psoriasis, scleroderma, dermamyositis, pyoderma gangrenosum

psoriasis

chronic disease in which skin cells multiply too quickly resulting in red, scaly patches of skin from overactive immune system

psoriasis risk factors

family hx, more common adults

psoriasis s/s

thick red skin with silvery scales, often itches or burns, typically on elbows, knees, scalp, or trunk
periods of flares and remissions

psoriasis treatment

no cure, can lead to psoriatic arthritis
topical therapy (corticosteroid or coal tar), injected or oral steroids, methotrexate, phototherapy

scleroderma

autoimmune connective tissue that leads to fibrosis of skin and other parts of body resulting in thickened, hard skin

morphea

related to scleroderma, patches of firm, oval shapes that stay in one area

linear scleroderma

lines of thickened, different colored skin that extend down the arm or leg

types of scleroderma

localized: only involves skin and structures directly beneath
systemic: involves many systems in the body

scleroderma cause

unknown, female > male, ages 30-50, more severe afr am

scleroderma treatment

depends on form, typically medications (corticosteroids, analgesics, and immunosuppressants)
PT and OT to prevent contractures, exercises, joint protection

CREST syndrome

calcium deposits, Raynaud’s, esophageal dysfunction, sclerodactyly, teleangiectasis
associated with scleroderma

scleroderma precaution

as blood vessels become damaged can develop pulm arterial HTN leading to right HF
PT/OT need to closely monitor BP and watch for SOB

dermatomyositis/polymyositis

disorders of body’s connective tissue, causes weakness of arms and legs
unknown cause, thought to be immune reaction of body against own tissue, women > men, ages 5-15 or 40-60

dermatomyositis sx

skin rash, swelling around eye (may look bruised or purplish), swelling at base and sides of fingernails, splitting of skin on fingers

dermatomyositis treatment

corticosteroids, immunosuppressants

pyoderma gangrenosum

rare chronic inflammatory disease, poorly understood
unknown cause, autoimmune diseases found in 50% of cases, often see acute exacerbation in response to minor trauma

pyoderma gangrenosum

usually starts as painful nodule, progress unpredictably (slowly progress into larger and spreading wounds, explosive destruction of skin with rapid spread and pain, fever, hemorrhagic blisters, purulent drainage)
erythematous halo with dusky red purple border, painful, purulent exudate

most common sites for PG

LE, trunk - buttocks and abdomen

PG treatment

corticosteroids, conservative debridement, topical therapy to maintain moist wound bed

benign growths

seborrheia keratosis, actinic keratosis, moles

seborrheia keratosis

age spots
brown, black or tan growths
usually on face, neck, chest, and back

actinic keratosis

rough scaly patch on skin, usually caused by years of sun exposure, see after age 40
can lead to squamous cell carcinoma

moles

small dark spots caused by cluster of melanocytes
usually round or oval, < 1/4 “ in diameter, flat or slightly raised
most harmless but can become cancerous

skin cancers

basal cell, cutaneous squamous cell, melanoma, karposi’s sarcoma
most common type of CA in US, more common people with lighter skin but more deadly darker skin
skin cells grow and multiply in unorderly and disorganized fashion

skin CA risk factors

sun exposure, family hx, tanning bed use, use of drugs that increase sensitivity to light
cSCC: immunosuppressed, cigarette smoking
melanoma: increased moles, fair or light skinned

basal cell carcinoma

most common, begins in basal cells on sun-exposed areas, grows slowly so usually curable
shiny bump, open sores, red patch, areas that look like scars, or crusty area with depression in middle

squamous cell carcinoma

begins in squamous cells on sun-exposed areas
begins as firm pink/red nodule or scaly, crusted flat lesion, sometimes described as pimple that increases in size

melanoma

most serious, can metastasize, can develop anywhere
brown pigmented patch or bump, mole that changes in color, size, or bleeds

ABCDE

asymmetry, border, color, diameter, evolving
to identify melanoma

Kaposi’s sarcoma

cancer that forms on lining of blood and lymph vessels, in those that are immunocompromised (HIV increases risk)
purplish spots on legs, feet, or face
caused by human herpesvirus 8