Chapter 50: Coordinating Care for Patients with Skin Disorders

Skin

- largest organ of the body

- two layers: epidermis and dermis

subcutaneous tissue

composed of adipose tissue (fat), connective tissue, blood vessels, lymphatic vessels, and nerves

- Anchor dermis, provide insulation, and protection

natural flora

- __________ ___________ of skin protects against harmful microorganisms

- Penetration of skin from repeated exposure to environmental hazards, trauma, or chronic disease weakens the skin's protective function, increases likelihood of skin breakdown, and places pt at risk for infection

depth

tissue

- Skin and soft tissue infections categorized by:

- ___________ of infection

- ___________ involved

- Interventions necessary to resolve the infection

antibiotic

cellulitis

folliculitis

furuncles

- Uncomplicated bacterial skin infections

- Respond to _____________ therapy alone

- Surgical drainage with or without antibiotic therapy

- Include superficial ______________ (diffuse spreading infection of dermis and subcutaneous tissues), _______________ (inflammation of hair follicles), impetigo, _______________ (boils), simple abscesses, and minor wound infections

- caused by Staphylococcus Aureus and Streptococcus pyogenes

debridement

necrotizing

dermis

fascia

- Complicated bacterial skin infections

- Invasion of deeper tissues and require _______________

- ________________ soft tissue infections are wounds containing dead tissue that provides an optimum medium for bacterial growth and require surgical intervention

- Can involve ____________ and subcut tissues (necrotizing cellulitis), _____________ (necrotizing fasciitis), and muscle

bacterial skin infections

- Methicillin-resistant Staphylococcus Aureus (MRSA) infections

- community acquired or health-care acquired (CA-MRSA more common)

- CA-MRSA begins as a localized infection from a break in the skin among healthy individuals who have not been hospitalized

- Both transmitted through direct contact with colonized skin or surface of a shared item where MRSA is present

- Postop MRSA infections can occur as surgical site infections, chest infections, or bloodstream infections (BSIs; bactremia)

- the risk of MRSA infection after surgery is generally low but affects up to 33% of patients after certain types of surgery

polymicrobial

- complicated infections and necrotizing soft issue infections are usually ____________________.

impetigo

- Highly contagious

- Affects infants and children

- MRSA, group A strep

Children will be told to stay home from school

At least 24 hours after antibiotics

- Can be very contagious - do not touch the sores and then touch someone else

- Given through close contact, warm and humid weather, broken cut, any other type of dermatitis

- Older adults - with diabetes or weakened immune system

- Can also have it

mupirocin

- treatment for impetigo

- topical _______________.

kidney

scratching

impetigo

- wounds are result in cellulitis, ___________ problems, scarring

- make sure nails are trimmed to prevent ______________ which can lead to scarring.

honey like

- impetigo

- red sores that will burst and show as ____________ ___________.

clean

cuts

gauze

hot

gloves

nails

- Prevention of impetigo

- Skin ___________

- Wash _________ or scrapes

- Prevent spread by washing affected area with mild soap and water and cover lightly with _____________

- Wash clothing and linen every day with _________ water

- Wear ___________ when applying ointment and wash hands after

- Cut ___________

- Encourage frequent hand washing

- Keep child home

heat

mupirocin

clindamycin

benzoyl peroxide

2

- Folliculitis

Treatment:

- Moist __________

- Topical ______________

- ________________ lotion or gel

- _____________ _____________ wash when showering for 5-7 days to increase healing

- If caused by MRSA, they normally do _____ antibiotics

follicles

heat

drainage

mupirocin

- Furuncle

- Occurs deep in _______________.

- Caused by MRSA

- Tx:

- Small - moist ________

- Large - incision and _______________ and antibiotics

- Furunculosis - ________________.

community acquired MRSA

- Can cause infection in healthy and young people

- Associated with poor hygiene, overcrowded living, sharing contaminated objects, previous infection with MRSA, trauma

- Spreads easily

- Tx:

- Vancomycin

- Linezolid, clindamycin

- Ceftaroline fosamil

- Can lead to sepsis, organ damage, or death

- Can cause recurrent infections and exposure to other people

non-necrotizing cellulitis

- Microorganisms find entry through skin breaches

- Gram-positive bacteria such as methicillin-sensitive Staphylococcus aureus (MSSA) and S pyogenes are isolated about 50% of the time.

- Typically streptococcal and staphylococcal

- Presentation

- Erythema

- Warmth

- Edema

- Localized pain

cellulitis

- Identified by rapidly spreading erythema, warmth, localized pain, and edema with possible inflammation of the regional lymph nodes.

- Acute phase with intense erythema

- Treatment - antibiotics

- Symptoms:

- Swelling

- Tenderness

- Pain

- Warmth

- Fever

- Blisters

- Swollen lymph nodes

necrotizing infections

- involving the fascia are more common because of the fascia's poor blood supply and limited immune function, which allows pathogens to spread rapidly along the fascial plane.

necrotizing infections (potentially life threatening)

- Spread rapidly and destroy a significant amount of tissue

- Usually polymicrobial

- Very serious, possibly life-threatening

- Penetrate and spread throughout the dermis, subcutaneous tissues, fascia, and muscles.

- Necrotizing infections- involving the fascia are more common because of the fascia's poor blood supply and limited immune function, which allows pathogens to spread rapidly along the fascial plane.

- Presentations

- Mild at first

- Left untreated:

- Fever

- Tachycardia

- Pain that is disproportionate to physical findings

- Disorientation

- Lethargy

- Hypotension

- Necrotizing fascitis

- Erythematous skin with firmness in underlying tissues

- Edema

- Vascular occlusion

- Ischemia

- Tissue necrosis with resulting anesthesia of necrotizing infections

- Sepsis

- Most common sites

- Abdomen

- Lower extremities

- Perineum

- Fournier's gangrene is the descriptive name given for a necrotizing fasciitis fo the genital or perineal area

- MRSA typically colonizes in the anterior nares of the patient

pain

hypo

erythematous

vascular

necrosis

lower

perineum

necrotizing infections potentially life-threatening:

- Presentations

- Mild at first

- Left untreated:

- Fever

- Tachycardia

- _________ that is disproportionate to physical findings

- Disorientation

- Lethargy

- _________tension

- Necrotizing fascitis

- ________________ skin with firmness in underlying tissues

- Edema

- ______________ occlusion

- Ischemia

- Tissue _____________ with resulting anesthesia of necrotizing infections

- Sepsis

- Most common sites

- Abdomen

- ____________ extremities

- _______________: Fournier's gangrene is the descriptive name given for a necrotizing fasciitis fo the genital or perineal area

mupirocin

chlorohexidine

- prevention of bacterial infections

- _____________ ointment alone or in combination with ________________ gluconate baths.

ulcerations

fungal

stasis

venous

arterial

lymph

- susceptibility to bacterial infections:

- Acute or chronic skin __________________

- _____________ infections

- Venous ____________ disease

- Alterations in _______________ drainage

- Obesity

- _____________ compromise to the skin

- ____________ node resection

- Immunocompromised state

poor

overcrowded

contaminated

MRSA

young

homosexual

tattoo

- MRSA infections are frequently associated with:

- _________ hygiene

- __________________ living conditions

- Skin-to-skin contact

- Sharing of _______________ objects

- Previous ___________ infections

- Trauma

- Demographic group:

- Children

-_________ adults

- Minorities

- Low-socioeconomic groups

- _______________ males

- Athletes

- Prisoners

- Day-care workers

- ________________ recipients

short course

variable

- management of bacterial infections:

- __________ ___________ therapy for uncomplicated infection

- ______________ treatment duration for complicated infection

blood culture

CBC

C reactive

debridement

nasal

biopsy

DX testing for bacterial skin infections

- ___________ ____________ and sensitivity

- _________ with differential

- Serum lytes

- _____ ____________ protein

- Monitors inflammation

- CT

- Surgical exploration and ______________

- Followed by broad-spectrum antibiotics

- __________ swab

- Testing for colonization of MRSA

- Quantitative tissue ______________

- An invasive test in which a piece of tissue below the surface of the wound is obtained and sent for quantitative gram stain and culture

- Considered gold standard for finding wound pathogens

antibiotics

culturing

tissue

- Complications of bacterial skin infections.

- Overuse and misuse of ____________

- Incorrect wound _____________ techniques

- Leads to the misidentification of the virulent bacteria, worsening infection, and bacteremia

-__________ loss

- Multitude of future surgeries

- Possible death

antibiotics

debridement

- TX for cellulitis and MRSA

- Systemic ________________

- For MRSA-antibiotics that are known not to have resistance

- Wound ____________________.

herpes simplex virus

are common, lifelong viral infections

- Usually acquired and transmitted asymptomatically through body fluids or skin-to-skin, skin-to-mucosa, or mucosa-to-mucosa contact

- Can cause a herpetic whitlow

- Painful lesions on the fingers

- Occurs when the herpes virus is introduced through breaks in the skin

- Occur on skin, mucous membranes, central nervous system, and genital tract

- primary and secondary infections

type 1 herpes simplex

- found on face, oral cavity, lips, and skin. (like fever blisters)

- Typically occur at a young age because of sharing utensils and cups

type 2 herpes simplex

- STD resulting in painful anogenital lesions

- Most people infected do not know that they have it and can shed the virus intermittently within the genital tract

- Usually transmitted by someone who is asymptomatic or unaware that he or she was ever infected

primary herpes

- describes the first time an individual is infected with the herpes virus

- Can occur through direct contact with an individual with HSV who is asymptomatic, is in the prodromal (early) stage of the disease, or has active oral or genital infections, secretions, or lesions.

2

cervical

lip

asymptomatic

- Manifestations of primary infection of herpes simplex

- Occur within _____ weeks of viral transmission

- Fever

- Malaise

- Myalgias

- Anorexia

- Irritability

- _____________ or inguinal lymphadenopathy

- Lesions can involve the _______, face, mucous membranes of the mouth, pharynx, or genitals.

- May be ________________ (doesn't mean it cannot be spread)

secondary herpes simplex

- recurrent

- HSV infections occur following an exogenous or endogenous trigger that reactivates the dormant virus.

ultraviolet

milder

redness

subsides

immune

- type 2 herpes simplex

- Triggers are individually specific but commonly occur in response to ________________ light exposure, febrile illnesses, and stress.

- The virus is then transferred from the ganglia back to the initial site of inoculation via the peripheral nerve.

- Typically ___________ than primary and usually preceded by a prodrome of a burning, itching, or tingling sensation where the lesion eventually occurs.

- An area of ___________ first appears on the lips or genitals followed in about 2 days with the appearance of multiple fluid-filled vesicles.

- The pain usually ______________ once the vesicles rupture.

- Number of lesions is dependent on the individuals ____________ status

lab

- GH (genital herpes) infection confirmed by __________ analysis. (HSV1/HSV2)

virological

______________ and type specific serological testing for herpes simplex.

- appropriate for someone seeking medical attention because of the presence of mucocutaenous (a region of the body where mucosa traditions to skin) lesions or ulcers

viral

- __________ culture and PCR testing are preferred for individuals with active lesions; however their sensitivity decreases as the lesions start to heal

- for herpes simplex

PCR

________ testing is preferred for detecting HSV in spinal fluid

negative

-- a ____________ viral culture or PCR test does not negate infection because viral shedding can be intermittent.

glycoprotein G-based

- serological type specific __________________ ___-___________ assays obtained from capillary or serum blood samples accurately distinguish HSV-1 from HSV-2.

- ordered by providers for those patients who have recurrent genital symptoms with negative HSV cultures, a clinical diagnosis of GH without lab confirmation, a partner with GH, a person presenting for STD testing with a hx of multiple sex partners, persons with HIV, or homosexual males.

anogenital

- the presence of type specific HSV-2 antibodies implies that the individual acquired GH through _____________ sexual contact, and it is necessary to provide the appropriate education and counseling for individuals who are seropositive for HSV-2.

systemic antiviral chemotherapy

- treatement for herpes (not a cure)

- Can be directed at first or recurrent episodes as well as daily suppressive therapy, and options should be discussed with the patient.

- Important to stress that the medications do not eradicate the latent virus.

- Decreased frequency and severity of recurrences are based on continued use of suppressive therapy.

- Suppressive therapy has shown to decrease the risk of transmitting HSV-2 to sexual partners.

- Three antiviral medications, acyclovir, valacyclovir, and famciclovir have shown clinical benefit in the treatment of GH

isolated

embarrassed

fear

- complications of herpes simplex

- Effect on quality of life due to psychosocial stress

- Patients report feeling ____________, devastated, and _______________- because of the diagnosis.

- ___________ of transmitting it to others.

HIV

- an infection with HSV-2 is a major risk factor for the acquisition and transmission of __________.

epithelial

bacterial

- complication of herpes simplex

- loss of skin integrity

- open _______________ lesions

- risk of _____________ infections

30

acyclovir

C-section

- complication of herpes simplex in pregnant women

- Complication of disseminated neonatal herpes carries a mortality rate of up to ______%

- In first or second trimester, they will put you on an antiviral (_________________)

- ___-________________ recommended form of delivery

oral

condoms

- transmission complication of herpes simplex

- __________ sex is not safer sex

- ________________ during an outbreak do not prevent the spread.

herpetic whitlow

- happens a lot in health care workers

- complication of herpes simplex

- herpes virus introduced through a skin break

- Common on fingers of health-care workers

- Treatment: antiviral tabs within 48 hours of symptom

- Use ibuprofen for pain

- Do not use contact lenses

- Can spread to patients, especially if they are immunosuppressed

3-10

vesicles

3-5

immunosuppressed

genital

droplets

- herpes simplex:

- Outbreak lasts about ____-______ days

- _______________ will be fluid filled

- They will burst and then dry

- Contagious for about ____-_______ days

- Severity of outbreak increased with age or if you are ___________________________.

- ________________ herpes will continue to recur throughout the lifetime

- Can be spread through respiratory __________________.

herpes zoster

- Reactivation of varicella-zoster virus in those who had chickenpox

- Resides in the dorsal root ganglia

- Multiple lesions in a segmental distribution

- Treatment: antiviral drugs

- Prevent: shingrix vaccine

- Separate pts with fluid filled blisters until they have crusted over

- Can have cerebral palsy, lesions on the eyes, etc.

- Vaccine usually given in 2 doses

fungal infections

- common in humans

- Caused by dermatophytes (aerobic fungi) and yeast

- Spread directly from person to person, animal contact, or indirectly through contact with inanimate objects

- do not spread beyond the epidermis

- Dermatophytes are found in living soil, animals, and humans; aerobic fungi that feed on dead keratin on skin, hair, and nails

- superficial cutaneous infection

dermatophytes

- are aerobic fungi that infect stratum corneum (top, dead layer of skin) and survive on keratin, and therefore cannot survive on mucosal surfaces

- Presents asymmetrically on pt, affecting one foot or one hand

- Fungal infections proliferate in warm, moist environments, the groin, feet, axillae, and skinfolds are primary places for infection

- synonyms for this are dermatophytosis, tinea, and ringworm

- found in living soil, animals, and humans; aerobic fungi that feed on dead keratin on skin, hair, and nails

- Risk factors for thes include presence of fungal infection in family, male gender, farmers and manual laborers, and use of immunosuppressants

tinea (worms)

is used to describe fungal infections caused by dermatophytes and precedes the anatomical location of infection (_________ pedis is feet/athlete's foot, ____________ capitis is head)

- only one answer

yeast (candidiasis)

most commonly causes oral or vaginal thrush

pedis

onychomycosis

- Most common fungal infections are tinea ____________ (most common and occurs in athletes a lot) and __________________ (fungal infection of nails; highest incident for health-care visit)

onychomycosis

- more prevalent with advancing age, because of decreased vascular flow, difficulty in grooming nails and maintaining foot hygiene, frequent nail injuries, and diabetes

- Those older than 45 are affected, and more frequent in men (bc men have a greater participation in manual labor and sports which require tight-fitting shoes)

scalp

- fungal _____________ infections are more frequent in lower socioeconomic status.

candida

- can be easy to treat or could be fatal

- 3 out of 4 women experience of vulvovaginal yeast infection, and half of all women will have more than one in a lifetime

- Risk factors: tight fitting or synthetic fiber clothing, douching to frequently, and contamination with bacteria from the rectum because yeast thrives in warm, moist environments on skin and mucous membranes of GI tract and vagina

- Treated with OTC antifungal meds (Monistat) for 1-7 days

- 12% of hospital acquired blood stream infections (BSIs) are caused by this.

- This could be to increased empirical use of antimicrobials; cancer, organ transplants, chemotherapy, invasive procedures

- Additional risk factors: Candida colonization, renal failure, severity of illness, need for TPN

toe

- Occluded area (_________ spaces) are at most risk for infection, and an identifiable characteristic of dermatophyte infections is an active, raised border

yeasts

- _____________ multiply by budding and thrive in warm, moist environments on the skin and mucous membranes of GI tract and vagina

fungal

- ____________ infections may present as scaling rashes, plaques, vesicles, or pustules

tines capitis

- Site: scalp

- S/sx: scaling of scalp, broken hair at scalp line, alopecia

- Dx: physical findings (scaling, adenopathy, alopecia, pruritus); KOH microscopy

- Medical management

- Oral antifungals to penetrate hair shafts (terbinafine [Lamisil])

tinea corporis

- Site: body

- S/sx: annular patches or plaques with advancing, raised border and central clearing

- Dx

- Clinical appearance

- KOH microscopy

- Fungal culture, used as an adjunct to KOH for dx, is more specific than KOH for detecting a dermatophyte infection; if clinical suspicion is high, yet the KOH result is negative, a fungal culture should be obtained

antifungals

azoles

2

- medical management for tinea corporis

- Topical ______________

- Topical ______________ (ketoconazole, clotrimazole, miconazole, allylamines, terbinafine)

- Topical therapy applied to lesion and at least ______ cm beyond are once or twice a day for at least 2 weeks

tinea cruris (jock itch)

- Site: groin

- S/sx: sharply delineated, symmetrical red to reddish-brown plaques with central clearing; border with pustules and vesicles; pruritis; scrotum spared

- Dx: evaluate feet bc same thing causes tinea pedis; differentiate from Candida intertrigo, which does not have central clearing

- Tx

- Topical antifungal (terbinafine [Lamisil], butenafine [Lotrimin])

- Using topical antifungal agents of the imidazole or allylamine family

tinea faciei

- Site: face

- S/sx: annular rash with raised margins, pruritis

- Dx:

- Clinical appearance: most frequently misdiagnosed entity among cutaneous fungal infections; atypical clinical features support separation of this disease from tinea corporis

- Tx

- Topical antifungals (butenafine, clotrimazole [Mycelex]); topical antifungal agents (ciclopirox, terbinafine)

tinea pedis

- Site: feet

- s/sx: maceration of interdigital skin of feet, diffuse dry scaling of soles of feet

- Dx: clinical appearance, KOH microscopy if needed

- Tx: keep feet dry and ventilated, topical antifungals (terbinafine), severe gets oral antifungals

tinea versicolor (pityriasis)

- Site: upper chest, back, upper arms

- S/sx: scaly patches of different colors (erythema, hypo or hyperpigmented)

- Dx: Wood's lamp, KOH microscopy

- Tx

- Topical antifungals (terbinafine) or ketoconazole

- Selenium sulfide shampoo (Selsun Blue)

- Oral "azole" antifungals for resistant or recurrent

- OTC meds like clotrimazole and miconazole, ketoconazole shampoo

onychomycosis

- Site: nails

- S/sx: yellow, brittle, thick nails with subungual hyperkeratosis

- Dx: clinical appearance, KOH microscopy

debridement

antifungals

ciclopirox

laser

avulsion

- Tx of onychomycosis

- Topical antifungals with ________________

- Oral ____________________ (terbinafine, itraconazole, fluconazole)

- Topical therapy

- ________________ olamine 8% nail lacquer solution

- Efinazconazole 10% topical solution

- Tavaborole 0.5% topical solution, an oxaborole solution

- Oral therapy

- Terbinafine, itraconazole

- Nonpharm tx

- __________ tx, photodynamic therapy, nail _______________, chemical removal with 40-50% urea compound used with very thick nails, removal of nail plate as an adjunct to oral therapy

Oral thrush (oropharyngeal candidiasis)

- Site: mouth - tongue, inner chick (buccal mucosa), inner lip, gums (gingiva)

- S/sx: creamy white plaques on erythematous mucous membranes; thick white coating of tongue, inner cheeks, inner lips, or gums

- Dx: s/sx, visual inspection

nystatin

fluconazole

- treatment for oral thrush (candidiasis)

- Oral antifungal liquids (swish and swallow) or lozenge such as ____________

- May be treated topically (nystatin) or ingested in liquid form (_________________)

vulvovaginal candidiasis

- Site: vagina, vulva

- S/sx: thick, cottage cheese-like vaginal discharge; pruritis

- Dx: s/sx

- Take sample of vaginal secretions and look at sample under microscope to see if an abnormal number of Candida organisms are present

- Tx: topical and intravaginal antifungals

intertrigo

- Site:

- Skinfolds: worsened by heat, moisture, lack of air

- Common inflammatory condition affecting areas of skin that are in contact with each other

- Caused by combo of frictional rubbing, increased temp, and moisture

- S/sx: maceration from moisture; erosions from skin surfaces rubbing together; erythema, itching and burning; satellite lesions

- Dx: s/sx

- Tx: eliminate causative factors when possible, separate skinfolds, keep skin dry, topical antifungal powder (nystatin)

antifungal

- ______________ Agents treat fungal infections.

KOH

- __________ microscopy is more sensitive than a fungal culture

- Scraped skin from affected area is placed on a slide and viewed through microscope after adding a drop of 10-20% KOH solution; presence of hyphae confirms dx

wood's lamp

- __________ __________ exam uses a UV light held close to skin in a darkened room is helpful in dx tinea versicolor

- Fungus fluoresces a pale yellow to white

tight

bare

contaminated

- prevention of fungal infections

- avoidance of the causative factors.

- wearing __________ shoes for prolonged periods, moisture and perspiration, contact of surfaces with __________ skin, sharing _______________ personal items

washing

dry

incontinence

dressings

- prevention of fungal infections:

- Hand ______________, elimination of sharing personal items

- Keep skinfolds ___________ and clean, frequent turning of bed-bound pts to enhance airflow, timely cleansing and drying of __________________ and wound exudates

- Separate skin folds with _________________ to prevent infection or infantigo

invasive

proliferate

ICU

- complications of fungal infections:

- High mortality rate of an _____________ candida infection

- Occur when fungal infections are not tx promptly and allowed to ________________

- Prompt dx of candida infections in an _________ is difficult because of time needed for finalization, thus delaying tx and increasing risk of mortality

candida

0.5

corticosteroids

- prediction tools for fungal infections

- ________________ colonization index requires acquisition of surveillance cultures from multiple pt body sites a few times per week up to daily while pt is in ICU

- Ratio of number of body sites that grow same species of Candida divided by number of body sites tested

- Index of _________ identifies those colonized and are great risk of developing invasive candidiasis

- Other risk identification scales consider admitting dx, use of _______________________ or other immunosuppressive meds, abx use, parenteral nutrition, and presence of an invasive central venous cath

KOH

ketoconazole

- tinea corporis (ringworm)

- dx with _________ microscopy

- Tx with topical ________________.

scalp

broken

KOH

- Tinea Capitis

- Scaling of ____________, alopecia, and ______________ hair at the scalp line

- Dx: physical findings and ____________ microscopy

- Tx: topical antifungals (itraconazole, terbinafine, fluconazole) and oral antifungals (terbinafine (lamisil))

tinea manus

- -dermatophyte infection of the nails can result in onycholysis

- Also occurs in toenails

- Yellow, brittle, hyperextratosus (thickening) under the nail

laser

avulsion

- treatment for tinea manus:

- Topical antifungals

- Oral antifungals

- __________ therapy

- Phototherapy

- Mechanical, chemical, or surgical nail _____________

nystatin

diabetes

- treatment for candida albicans (thrush)

- Meticulous cleanliness

- Antifungal agents

- Ketoconazole

- ______________ - swish and swallow

- Oral Fluconazole

- Can happen in people that have ________________, obesity

psoriasis

- Lifelong inflammatory disorder characterized by exacerbations and remissions of raised, scaling, erythematous plaques usually seen on extensor surfaces of body

- - Unknown etiology and no cure

- Patients feel better in warmer climates with sun exposure

- UV radiation kills rapidly proliferating skin cells

- Infections, medications, stress, trauma, and hormonal changes can aggravate the disease

- Less common in Asian or African descent

- Men and women are equally likely to develop this , and mean age of onset is 28 with a range of 15-35 years

- Immune disorder

- Causes chronic inflammation of skin

- Thick, raised red patches with silvery, flaking scales

- Interaction of multiple genes, immune system, and environmental influences

- Epidermal thickness with an increased vascularity and increased inflammation are the main pathological aspects of psoriasis

- New epithelial cells are continually made in the basal layer of epidermis, and it take approx. 28 days for these new cells to reach the surface of skin; in psoriasis, this process is accelerated for unknown reasons, and more skin cells are made than shed, which then become scaly plaques on surface of skin

dermal capillaries

- _________ ___________ become tortuous and dilated, causing the red appearance under scaly plaques; this is the last aspect of psoriasis to resolve after tx

elbows

scalp

- mostoften psoriatic plaques are on _______________, knees, legs, palms, soles of feet, __________________, trunk, and face

30

- Onset of psoriasis before age _______ is linked with more severe cutaneous manifestations, serious psychosocial impact, and a family x of disease

- Can develop psoriatic arthritis, a complication that causes inflammation, pain, and stiffness of joints

plaque

- symptom of psoriasis

- well-circumscribed, thick, reddened papules or plaques with silvery scaling flakes

guttate

- symptom of psoriasis

small plaques 2-10 mm in diameter appear in a centripetal distribution (starting from face and extremities and moving toward the trunk); initial presentation of psoriasis in children; eventually develop chronic plaque psoriasis

erythroderma

- symptom of psoriasis

- involves most or all of the skin; occur when psoriatic plaques become confluent and extensive or may be an indication of unstable psoriasis exacerbated by infection, meds, or corticosteroid withdrawal; leads to inability to thermoregulate (hypothermia and heart failure)

psoriatic arthritis (PSA)

- is a common manifestation of psoriasis

- Genetic component interacts with environmental or other random factors to precipitate the disease

- Involves joints of hands and spine

- Nail involvement is common and presents as pitting, onycholysis (lifting of nail away from nail bed) and splinter hemorrhages under nail

biopsy

ESR

rheumatoid

diagnosis of psoriasis:

- No specific lab tests

- Plaque psoriasis diagnosed on basis of s/sx

- Some forms of psoriasis mimic other disorders, so dermatologist may need to perform a skin _______________ for definitive dx

- Is PsA is suspected, serum inflammatory markers like CRP and _________ are elevated

- _______________ factor is not found in PsA, so this can differentiate it from RA

symptoms

quality

- goals of treatment for psoriasis include:

- reduce _____________, control disease, and improve _______________ of life.

moisturizing

- treatment for psoriasis:

- _________________ ointments, gels, creams

- For mild to moderate psoriasis; moisturizing plaques minimize scaling, decrease itching, keep skin hydrated

corticosteroids

- treatment for psoriasis

- Fast acting; decrease inflammation and itching; vasoconstrictive to decrease redness; prevent formation of new lesions

- Apply an occlusive dressing after applying a corticosteroid cream

- Do not put the cream in skin folds - it makes an environment for yeast infection

coal tar preparations

- treatment for psoriasis

- creams and shampoos

- Suppresses cell division and decreases inflammation, applied twice daily