Integumentary System

What is pruritis?

• Itching

• Causes: dermatologic disease, hyperthyroidism, DM, kidney/liver disease, drug allergy, dry skin

• PT Notes: scratching → inflammation → infection → scar

  • Rub vs scratch, 2nd laundry rinse, soothing soaps, cool baths, loose clothing

What is urticaria?

• Hives

• Vascular reaction causing wheals with pruritus

• Cause: Histamine release due to allergy, sun, infection

• Tx: antihistamines

What is a rash?

• Skin eruption, often raised & itchy

• Causes: sun, allergens, meds, heat

• RED FLAG: butterfly rash (Lupus), rash on breast (Paget’s disease)

What are blisters?

• Elevated lesion containing serous/bloody fluid

• Separation of epidermis & dermis

• Causes: friction, burns. ischemia, trauma, meds, infection

• PT note: DO NOT REMOVE if hemorrhagic or stable heel blister

• RED FLAG: unexplained blisters → possible cancer or autoimmune disease

What is xerosis?

• Xeroderma

• Excessive dry skin → cracks, flakes, peeling

• AVOID: harsh soaps, low humidity

• Care: moisturize within 2 min of bathing, use humidifier, pat dry

What is contact dermatitis?

• Skin comes into contact with something that causes irritation or an allergic reaction

• Exposure related & additive

• Agents: adhesives, fragrances, dyes, latex, topicals, wool fats, plants, jewelry, US gel, medical devices

• S/Sx: pruritis, erythema, edema, extend or mimic object, can progress to blisters, weeping, crusting

• PT note: always check skin before/after equipment use & document any changes

What is eczema?

• Chronic skin inflammation, remitting/relapsing

• Triggers: allergens, irritants, meds, stress

• Tx: topicals, humidifiers, reducing bathing

• PT note: watch for skin breakdown, polypharmacy effects

What is incontinence-associated dermatitis (IAD) / Moisture-Associated Skin Damage (MASD)?

• Causes: excess moisture (urine, feces, sweat)

• Problem: bacterial growth, inflammation, infection

• Tx: clean/dry, high-quality briefs, caregiver training, proper bathing/cleaning

What is intertriginous dermatitis?

• Dermatitis of skin folds

• Cause: skin rubbing, moisture

• Population: obese, muscular, babies

• Tx: keep clean/dry, reduce friction

What is cellulitis?

• Bacterial infection of skin & sub-q tissue

• Risks: age, immunosuppresant, edema, open wound, surgery, poor hygiene, close living conditions

• S/Sx: advancing erythema, edema, high temp, pain, tenderness, chills, red streaks

• Tx: topical/oral/IV antibiotics, debridement, hydration & nutrition

• Untreated → lymphangitis, abscess, systemic infection

What is Herpes zoster (shingles)?

• Reactivation of dormant viral infection (chickenpox)

• Risks: immunocompromised state, age, severe cold, stress, malignancy, organ transplant, RA, CA/chemo

• S/Sx: skin eruption, blisters, unilateral dermatomal distribution, hearing/vision/taste deficits

• Tx: MD referral, meds, topicals, supportive care

• PT note: vaccine, contact precautions, early recognition, education, relaxation techniques, pain management

What is tinea corporis?

• Ringworm

• Fungal infection → ring shaped pigmented patch

• Cause: direct/indirect contact, animal to human

• Tx: clean/dry skin, topicals, advanced Rx

• PT note: can look similar to CA

What is tinea pedis?

• Athlete’s foot

• Fungal infection in the foot

• S/Sx: erythema, peeling, pruritis, inflammation, pain, odor

• Tx: dry, clean, well ventilated shoes, creams, powder, Rx

What is scabies?

• Parasitic infection from mites (female deposits eggs)

• Highly contagious, spreads quickly

• Causes: direct/indirect contact

• 30-60 days before symptoms show

• S/Sx: small burrow/ridge w / tiny blister, inflammation, pruritis

• Tx: hot water, wash/dry cleaned, disinfection, scabicide, oral meds when topicals don’t work

• PT note: wear PPE

What is pediculosis?

• Lice

• Parasitic infection of scalp

• Cause: direct/indirect contact, close living conditions

• S/Sx: severe pruritis

• Tx: OTC topicals, shampoos, hot water wash

What is skin cancer?

• Most common type of CA in US

• Risks: sun exposure, light skin, tanning beds, genetics

• PT role: screen areas patients can’t see, refer early

What are nevi?

• Moles → benign tumors

• Aggregation of melanocytes

• Increased risk of CA in area of frequent irritation

• PT note: look for change in size, color, shape, texture, bleeding, pruritis, peeling, location → REFER

What is actinic/solar keratosis?

• Abnormal cell growth from years of sun exposure

• Premalignant tumors

• S/Sx: defines, rough, dry, crusty, raised, sandpaper patch

• Low risk of malignant degeneration without treatment

• Tx: topicals, surgery, cryosurgery, electrotherapy

What are nonmelanoma cancers?

• Basal cell carcinoma (BCC)

• Squamous cell carcinoma (SCC)

What are melanoma cancers?

CA that develops from melanocytes

What is basal cell carcinoma (BCC)?

• Slow growing tumor from basal cells

• Rarely goes beyond skin

• Causes: sun/tanning bed exposure

• Risks factors: immunosuppresion, genetics, burns, previous BCC

• S/Sx: pink, pearly, brown, glossy, black, flat, elevated rolled edges, central ulceration, telangiectasia, painless

• Tx: excision, chemo, radiation, laser, topicals

What is squamous cell carcinoma (SCC)?

• 2nd most common skin CA in light toned skin

• Arises from squamous cells

• In situ = confined to skin

• Invasive = aggressive (lymph node, distant metastasis)

• Risk factors: men, sun exposure, premalignant lesions, radiation, scar tissue

• S/Sx: diffuse margins, indurated plaque/nodule, red flesh color, surrounding scale

• Tx: same as BCC (excision), early treatment!

What is a Marjolin’s ulcer?

• BCC/SCC from chronic wounds (burns, pressure ulcers, animal bites)

• PT note: refer non-healing wounds; assess unusual tissue

What is malignant melanoma (MM)?

• Originates from melanocytes

• Risk factors: family hx, fair skin, light hair/eyes, males <50, elderly, multiple abnormal moles, weak immune system, tanning beds, hx of sunburn

• Worse survival rates for blacks & hispanics

• S/Sx: irregular border, flat vs raised, flat freckle, variable pigmentation, itching, bleeding, peeling, colors

• Dx: biopsy, CT, MRI, etc.

• Tx: surgical excision, chemo, meds/topicals, transdermal patch, radiation

What is acral lentiginous melanoma (ALM)?

• Most common melanoma in black people

• Causes: genetic mutation, not sun exposure

• S/Sx: palms of feet & hands, under nail beds

• COD of Bob Marley

What is the ABCDE method of early melanoma detection?

• Asymmetry (uneven edges, lopsided)

• Border (irregular, scalloped, diffuse)

• Color (black, brown, red, blue, pink)

• Diameter (larger than pencil eraser)

• Evolution (changes, itches, bleeds)

What is merkel cell carcinoma?

• More aggressive CA than MM

• Rapidly enlarging, firm, pink or skin-colored growth

• Painless

• Tx: patient education, avoid skin exposure

What is psoriasis?

• Chronic, genetic, inflammatory, autoimmune disease

• Keratinocyte life cycle = 3-4 days (too fast)

• S/Sx: well-defined erythematous plaques, silvery scale, pain, nail buildup, itching, burning, soreness, bleeding, swollen/stiff joints

• Risk factors: young adults, tissue injury, bites, infection, meds, pregnancy, stress, smoking, ETOH, dry skin, heart disease, metabolic disorders, IBS, depression

• Tx: topicals (corticosteroids), immunosuppressants, steroids, photosensitizing meds/phototherapy, education, lifestyle changes

• PT note: poor tissue healing from immunosppressants, higher risk of skin infections, arthritis

What is systemic sclerosis?

• Autoimmune connective tissue disease

• Progressive deposition of collagen

• S/Sx: fibrosis of skin/joints/blood vessels/organs, thick skin, muscle atrophy/weakness, decreased ROM

• Risk factors: autoimmune dysfunction, environment, chemical exposure, smoking, women

• Tx: no cure, meds, exercise, skin protection, stress management

• PT note: pressure relief, education, exercise, aquatic therapy, screen for organ involvement

What is Raynaud’s phenomenon?

• Form of sclerosis

• Can be 1st s/sx of systemic sclerosis

• S/Sx: sudden blanching, cyanosis, erythema in fingers/toes due to vasospasm

• Causes: stress, cold

• Tx: relaxation & warming

• PT note: pain control, keep warm, stress management