Hair, Skin, and Nails

explain how skin acts as a two way barrier

Contains body fluids and prevents dehydration of internal body components

Keeps out infectious organisms and toxic substances, also protecting internal structures from mechanical injury

primary skin lesions

Arise from previously normal skin and include circumscribed, flat, nonpalpable changes in skin color;

palpable, elevated solid masses;

and circumscribed, superficial elevation of the skin formed by free fluid in a cavity within the skin layer

secondary skin lesions

◦ Result from changes in primary lesions and include lesions that produce a loss of skin surface

misc. skin lesions includes

lichenification, scars, atrophy, excoriations, burrows, comedo, telangiectasias, and nevi

lichenification

thickened leathery discolored patch of skin

burrows

linear track like lesions, assoc with mites

comedo

clogged hair follicle

telangietasias

small diluted blood vessels visible on the skin

nevi

mole/birthmark

what are the 5 types of pathological conditions of the skin

Inflammatory conditions

Infectious conditions

Adverse cutaneous drug reactions

Infestations

Cancer

what are the Inflammatory Conditions of the Skin

contact dermatitis

acne

eczema

diaper rash

Contact dermatitis

Any rash which develops because of a substance contacting the skin (will either be irritant or allergic)

example of an irritant that could cause contact dermatitis

harsh chemicals

example of an allergic cause of contact dermatitis

latex

acne

Self-limiting inflammation of the pilosebaceous unit which presents as pimples, blackheads, cysts, and pustules

eczema

Broad term describing a variety of inflammatory skin conditions

diaper rash

Acute inflammatory condition around the buttocks, genitalia, perineum, and abdomen

can you treat diaper rash otc?

you can recommend some soothing creams but to treat it need Rx

what are some infectious conditions of the skin

measles

chickenpox

shingles

impetigo

fungal

measles are mostly due to ___ origin

viral

how are measles transmitted

a air, blood, and through sexual contact

what is the primary risk factor for developing measles

not being vaxxed

presentation of measles

Disseminated, erythematous rash that generally begins on the anterior scalp line and behind the ears

spread of measles

Within hours spreads quickly over the face before extending down the trunk and to the extremities

describe Koplik’s spots

associated with measles, small red dots on the buccal mucosa with a small white center

tx for measles otc

only symptom management, bed rest, analgesics, antipyretics etc

do not rec ___ if a pt has a fever and a viral infection due to risk of rye syndrome

aspirin

death due to measles can be due to ___ after the infection

bacteria pneumonia and encephalitis / meningitis

chickenpox is also called

varicella

chicken pox is preventable if pt is

vaxxed

which virus causes chicken pox

varicella-zoster

how is chickenpox transmitted

direct contact or airborne droplets

primary risk factor of chicken pox

exposure to an individual with a known varicella infection

clinical presentation of chickenpox

Disseminated (concentrated on trunk and face) erythematous rash that progresses rapidly from papules to vesicles (elliptical dewdrops), pustules, and crusts

when is a person with chicken pox considered to be infectious

from 2 days before the onset of the rash until all the vesicles have crusted (typically 4-6 days after rash onset)

tx of chickenpox otc

only symptom management

otc tx for chicken pox for itchyness

oral antihistamines (like benedryl)

otc preferred tx for chickenpox

APAP (tylenol)

shingles is also called

herpes zoster

what is shingles

Reactivation of varicella-zoster virus, which remains latent in an individual’s dorsal root ganglion cells following primary infection or vaccination

risk factors for shingles

aging and immunosuppression

clinical presentation of shingles

Unilateral eruption along thoracic, cranial, lumbar, or sacral dermatome

shingles often happens after

pain in the dermatome prior to rash eruption (described as burning, itching, or paresthesia)

singles erythematous papules and plaques progress to

blisters

how to prevent shingles/ reduce the severity of pain in pts who get the disease

vaccination

pain in the area of the shingles infected area can last for

months to years after the rash has been gone

postherpetic neuralgia

pain from the shingles infection that lasts for months to years after the rash has been erradicated

tx for shingles

antivirals

NSAIDs

opioids

pregabalin

gabapentin

tetracyclines

tetracyclines are used specifically for which infectious condition of the skin

post herpetic neuralgia

imeptigo is caused by which two bacteria

s. pyogenes and s, aureus

impetigo is an infection of the

epidermis

clinical presentation of impetigo

Serous fluid or purulent exudate from lesions can cause autoinoculation and formation of satellite lesions on other parts of the body

The exudate dries and forms honey brown or golden yellow crusts

where is impetigo usually found

face, extremities, butt

risk factors of impetigo

Warm temperature with high humidity

Breakage in skin

Crowded living condition and/or poor hygiene

tx for impetigo otc

topical mupirocin

most common fungal infections of the skin

Tinea pedis (athlete’s foot)

Tinea corporis (ringworm)

Tinea cruris (jock itch)

Candidiasis

Tinea pedis

athletes foot

tinea corporis

ringworm

tinea cruris

jock itch

tx for fungal skin infections

topical antifungal for at least 4 weeks

examples of adverse cutaneous drug reactions

drug induced urticaria, angioedema, and anaphylaxis

Exanthematous drug eruption

Fixed drug eruption

Stevens-Johnson Syndrome

Drug-induced photosensitivity

when can adverse cutaneous drug reactions occur

most in 24-48 hours after first dose, can take up to 2 weeks after stopping the drug too

signs of Drug-Inducted Urticaria, Angioedema, and Anaphylaxis

Difficulty breathing

Flushing

Hypotension

Laryngeal edema

Large wheals (pale pink or red raised areas of skin

symptoms of Drug-Inducted Urticaria, Angioedema, and Anaphylaxis

Abdominal pain

Burning sensation, especially of the palms and soles

Dizziness

Fatigue

Headache

Nausea and vomiting

Pruritus

Drug-induced urticaria, angioedema, and anaphylaxis are mostly due to ___ reactions

immunological hypersensitivity

Urticaria is also know as

hives or wheals

Exanthematous Drug Eruption

Macropapular drug eruption

Exanthematous Drug Eruption presentation

Macules and papules are symmetrically distributed on the extremities and trunk and often coalesce to give a very diffuse presentation

Exanthematous Drug Eruption is common with which drugs

cephalosporins, erythromycin, penicillins, sulfonamides, and others

fixed drug eruption presentation

only one lesion appears within 8 hours of taking the drug

Presents as erythema and progresses from macules to

bullae inflammatory in nature

One of the most serious drug-related cutaneous diseases

Stevens-Johnson Syndrome

Stevens-Johnson Syndrome presentation

Lesions are widespread and cover most of the body, including mucous membranes

more severe variant of Stevens-Johnson Syndrome

toxic epidermal necrolysis

the Prodromal rash due to Stevens-Johnson Syndrome eventually leads to …

sloughing of large areas of epidermal tissue

tx for Stevens-Johnson Syndrome

Discontinue offending drug, and treat as third-degree burn procedures, prevention and treatment of septic infection

Drug-Induced Photosensitivity

Cutaneous adverse reaction to systemic or topical drugs (or chemical) in which UV radiation strikes the skin and converts drugs in the tissues into either toxic or allergic substances

presentation of Drug-Induced Photosensitivity

eczema-like condition

Drug-Induced Photosensitivity typically follows…. and is immunological mediated

topical application of a drug

Drug-Induced Photo-allergy requires previous _____ and presents as an _____

sensitization

exaggerated sunburn

examples of infestations of the skin

scabies and pediculosis

types of pediculosis (lice)

head, body, public

head lice

pediculosis capitis

body lice

pediculosis corporis

public lice

pediculosis pubis

types of skin cancer

basal cell carcinoma

squamous cell carcinoma

melanoma

Translucent, shiny papule or nodule or single ulceration with a rolled border is a sign/symptom of which type of skin cancer

BCC

Single papule or plaque that continues to grow is a sign of which skin cancer

SCC

melanoma signs and symptoms are assessed using which acronym

ABCDE

melanoma assessment with ABCDE:

A stands for?

Asymmetry

melanoma assessment with ABCDE:

B stands for?

Border is irregular

melanoma assessment with ABCDE:

C stands for?

Color is changed or mottled

melanoma assessment with ABCDE:

D stands for?

Diameter is greater than 6 mm (end of a pencil)

melanoma assessment with ABCDE:

E stands for?

Evolving in size, shape, or color over time

what are the different conditions of the hair

infectious folliculitis

fungal infections

alopecia

where does infectious folliculitis commonly occur

body parts that are shaved

most causative organisms of infectious folliculitis

S. aureus and P. aeruginosa

how does infectious folliculitis present

Furuncles are deep-seeded folliculitis

Carbuncles (boils) form from the coalescence of adjacent furuncles and can penetrate beyond the dermis into the subcutaneous layer

what organism causes furuncles that are deep seeded in infectious folliculitis

s. aureus

fungal infections of the hair include

tinea capitis

tinea barbae

tx for hair conditions

Topical treatment with mupirocin or triple-antibiotic ointment or oral antibiotics for folliculitis

Furuncles and carbuncles typically require drainage of the lesion, with possible systemic antibiotic