Skin Disorders

Chapter 68

Psoriasis

The skin cells grow too fast—up to 7x faster than normal—causing thick, scaly patches that are often on elbows, knees, scalp, trunk, lower back (sacrum), and sides of the arms and legs

Psoriasis Vulgaris

Red, thick skin with silvery scales

Exfoliative Psoriasis

Widespread redness and scaling; can cause dehydration or body temperature problems

Palmoplantar pustulosis

Red, thick patches with pus-filled bumps on hands and feet that crust over

Psoriasis Risk Factors

Infections, skin injuries, stress, certain medications, obesity, hormone changes, and genetics

Dermatitis

Skin inflammation (Itchy, red patches or rashes that don’t always have clear borders) caused by things that irritate or trigger the immune system

Eczematous (nonspecific)

Thick, dry or moist crusted patches, itchy, can appear symmetrically anywhere

Contact Dermatitis

Rash occurs only where skin touched the allergen/irritant; well-defined and localized

Atopic Dermatitis (eczema)

Chronic, itchy rash with thick, scaly patches; often on face, neck, upper body, and in skin folds (like elbows and behind knees)

Antihistamines

Reduce itching, redness, swelling

Nursing actions: Monitor for urinary retention

Client education: May cause drowsiness and sun sensitivity, so take systemic ones at night and avoid driving or machinery

Topical Immunosuppressants

Used if steroids don’t work; calm down inflammation

Nursing actions: Teach application, watch for redness/burning, don’t cover with occlusive dressings.

Client education: Stop using when rash clears, avoid if infection present, protect skin from sunlight/tanning beds.

Mild Psoriasis Lesion

Less than 5% of body surface area

Moderate Psoriasis Lesion

5–10% of body surface area

Severe Psoriasis Lesion

More than 10% of body surface area

Corticosteroids (Psoriasis Treatment)

Reduce inflammation and slow skin cell growth

Nursing Actions: Watch for skin thinning, stretch marks, or color changes

Tar Preparations (Psoriasis Treatment)

Reduce inflammation and slow skin cell growth

Nursing Actions: Monitor for irritation

Vitamin D Analogs (Psoriasis Treatment)

Regulate skin cell growth

Nursing actions: Watch for itching, redness, or elevated calcium levels

Vitamin A (Psoriasis Treatment)

Reduce inflammation, slow skin cell growth, and causes peeling

Nursing actions: Not for use in pregnancy; watch for burning or redness

Cytotoxic Medications

Slow down skin cell growth for severe cases

Nursing actions: Not for use in pregnancy; check liver and kidney function; watch for low blood counts

Patient education: avoid alcohol; reduce birth control effectiveness

Biologic Agents

Suppress the immune system to reduce psoriasis flare-ups

Nursing actions: Screen for latent TB and hepatitis B before starting; rotate injection sites; protect medication from light

Patient education: Avoid pregnancy and breastfeeding; lifelong treatment; higher cancer risk; do not get live vaccines while on therapy

Immunosuppressants

Used when other treatments fail

Nursing actions: Monitor kidney function and risk for infections.

Patient education: Short-term therapy (<6 months); monitor blood pressure; medication can cause hypertension

Narrow-band Ultraviolet B (UVB) Light Therapy

Can be implemented without medication application and requires fewer treatments

Laser Light Therapy

Used for mild to moderate psoriasis to target lesions directly and decrease exposure to surrounding skin

Photochemotherapy (PUVA)

Treatment where psoralen (methoxsalen) is taken before exposure to UVA light to slow skin cell growth in psoriasis

Client education: Wear eye protection during and 24 hours after treatment; report redness, swelling, or discomfort; long-term risks: early skin aging, cataracts, skin cancer; avoid direct sunlight 8–12 hours after treatment; use sunscreen

Macule

Flat, color change, <1 cm, non-palpable (freckle, petechiae)

Papule

Raised, solid, <1 cm, firm (elevated nevus)

Nodule

Raised, firm, deep, 1–2 cm (wart)

Vesicle

Fluid-filled, serous, <1 cm (blister, herpes, chickenpox)

Pustule

Pus-filled, size varies (acne)

Tumor

Solid, deep, >2 cm (epithelioma)

Wheal

Raised, irregular, edematous (insect bite)

Atrophy

Thinned, shiny, translucent skin (arterial insufficiency)

Erosion

Loss of epidermis, moist, no bleeding (ruptured vesicle)

Crust

Dried blood, serum, or pus (scab)

Scale

Flaky, exfoliating skin (dandruff, psoriasis, eczema)

Fissure

Linear crack in skin (tinea pedis)

Ulcer

Loss of epidermis and dermis, may bleed or scar (venous stasis ulcer, pressure injury)

Herpes Zoster Avoidance

Infants, pregnant women without chickenpox, and immunocompromised people

Herpes Zoster Comfort Measures

• Cool/moisten dressings (Burow’s solution) 30–60 min, 4–6 times/day

• Lotions (calamine) or colloidal oatmeal baths for itching

Pruritus Treatment

Moisturizers, antihistamines, oatmeal baths, avoid hot showers

Tinea Capitis Findings

Round bald patches, scaling, itching, brittle hair

Scleroderma Findings

Thick, hard, tight skin; shiny appearance; possible joint pain; Raynaud’s phenomenon; internal organ involvement

Corticosteroids

Reduce inflammation and immune response

Corticosteroids Side Effects

Weight gain, mood changes, high blood sugar, osteoporosis, infection risk

Scabies Findings

Severe itching (worse at night), thin burrow tracks (lines) in skin folds, wrists, between fingers

Applying Topical Corticosteroids

Apply a thin layer to clean, dry skin. Rub in gently. Avoid covering with occlusive dressings unless prescribed (↑ absorption). Don’t use long-term on face, groin, axilla (skin thinning)

Coal Tar Preparations

Slow down skin cell growth and reduce redness/itching.

Client Teaching For Coal Tar Preparations

Can sting or burn when applied. Can stain skin, clothes, and hair. Has a strong odor. Best to apply at night and wear old clothes/pajamas, gloves, or socks.