alterations in the skin

lecture 4

1st line of defense

skin

the skin is…

the largest organ of the body and has 2 layers, the dermis and the epidermis

dermis

2 layers and contains melanin

epidermis

5 layers

albinism

a recessive congenital disorder which the body lacks melanin production

albinism causes…

white skin and hair, lack of pigment in iris of eye, and people affected must avoid sunlight

functions of the skin

protective barrier, senses temp, pressure, and pain changes, regulates temp, excretes fluid and electrolytes, stores fat, synthesizes vitamin D, provides a sight for drug absorption, prevents excessive fluid loss

skin lesions

helpful to make a diagnosis and can be caused by many things including systemic disorders, infections, allergies, and drug reactions

what should a nurse know about lesions?

location of lesions, time the lesions has been present, any changes, appearance, pain, itching

Dermatitis (eczema) ATOPIC

chronic inflammation results from response to allergens

inherited tendency

Dermatitis (eczema) ATOPIC is caused by

eosinophilia and increased serum IgE keves

IgE is an immunoglobin that triggers histamine

Dermatitis (eczema) ATOPIC potential complications

secondary infections due to scratching

Dermatitis (eczema) CONTACT

exposure to allergen, chemical, or mechanical irritation

Dermatitis (eczema) ATOPIC signs and symptoms

common during infancy

rash is erythematous (red) with serous exudate (drainage)

occurs on face, chest, and shoulders

rash is dry, scaly, and pruritic

thick leathery patches

Dermatitis (eczema) CONTACT signs and symptoms

itching

redness

swelling

vesicles

Dermatitis (eczema) treatment

elimination of aggravating agent

topical glucocorticoids (steroid)

hydrocortisone cream

antihistamines - can help with itching

psoriasis

chronic inflammatory skin disorder that affects 1-3% of the population

genetic

onset in teen years

marked by remission and exacerbations

cases can vary

What is psoriasis the result of?

results from abnormal T cell activation

excessive proliferation of keratinocytes

cellular proliferation increases leading to thickening of skin

psoriasis signs and symptoms

red patches of skin covered with silvery scales

small, scaling spots

dry, cracked skin that may bleed

itching, burning, or soreness

thickened, pitted, or ridged nails

swollen and stiff joints

psoriasis treatments

corticosteroids

immunosuppressants

tar preparations

antimetabolic methotrexate

exposure to sunlight

humira

how does sunlight help psoriasis

slows cell division and reproduction

slows immune response

vitamin D

hives (urticaria)

hypersensitivity reaction to drugs, food, fish, or certain fruit

release of histamine

raised lesions

pruritic

can develop into obstructed airway

treatment for hives

over the counter antihistamines and corticosteroids

cellulitis

infection of the dermis and subcutaneous tissue

S. Aureus

occurs in lower extremities

causes redness, swelling, pain, possible sepsis

treatments for cellulitis

antibiotics

impetigo

common infection in infants and children

S. Aureus - highly contagious in neonates

lesions on face

transmission may occur through close contact or through fomites

pruritus

small red vesicles

honey colored crusts

impetigo treatments

topical antibiotics

systemic administration if lesions are extensive

acne

multifactorial inflammatory disease affecting pilosebaceous follicles

bacteria colonize follicles

inflammatory response results

caused by Propionibacterium acnes

acne treatment

antibiotics

oral contraceptives (birth control can reduce oils in skin)

erythromycin

vitamin A acid: retinoic acid

benzoyl peroxide

clindamycin

Isotretinoin

varicella zoster virus / shingles patho

caused by the same virus as chicken pox

after chickenpox ends, virus lays inactive in nerve ganglia

shingles is a reactivation of that virus

reactivation causes virus to travel along nerve pathways to skin

reactivation not fully understood

varicella zoster virus / shingles signs and symptoms

pain, burning, numbness, or tingling

sensitivity to touch

red rash (doesn’t cross the midline of the body)

fluid filled blisters that break open and crust over

itching

symptoms can last between 2-6 weeks

varicella zoster virus / shingles treatment

contact precautions (gown and gloves)

vaccination (shingrix and zostavax (not in u.s.))

no guaranteed prevention, but will shorten duration and severity

medications (Acyclovir, Famciclovir, Valacyclovir)

herpes simplex

type 1 - cold sores - most common

herpes simplex signs and symptoms

fever blisters near lips

primary infection may be asymptomatic

spread by direct contact with fluid from lesions

virus can remain in the saliva for weeks after lesions heal

herpes simplex treatments

antiviral medications

tinea

fungal skin infection (mycoses)

may be transmitted from cats, dogs, or other humans

circular bald patch

redness or scaling may be present

oral or topical antifungals

tinea pedis

athletes foot

tinea capitis

ringworm

skin cancer

a sore that doesn’t heal

change in shape, size, color, or texture of a lesion, especially an expanding, irregular circumference or surface

new moles or odd shaped lesions that develop

a skin lesion that bleeds repeatedly, oozes fluid, or itches

guidelines to reduce risk of skin cancers

reducing sun exposure at midday and early afternoon

covering up with clothing

remain in shade

protect face and neck

apply sunscreen or sunblock

protect infants and children

basal cell carcinoma

sunlight exposure

pearly lesion of skin commonly on head and face

rarely mestasizes

surgical excision (mohs procedure)

fluorouracil cream

squamous cell carcinoma

painless, malignant tumor of the epidermis

lesions most commonly found on exposed areas of the skin and oral cavity

excellent prognosis when lesion is removed within reasonable time

invasive type arises from premalignant condition

malignant melanoma

highly metastatic form of skin cancer

develops in melanocytes (mole)

often appears as multicolored lesions with irregular border

grows quick

change in shape, color, size, texture

may bleed

surgical removal, radiation, and chemo

skin cancer treatment

biopsy for definitive diagnosis

the earlier the better

Scabies

invasion of mites which burrow in the skin and lay eggs

spread by close contact

have to have a host

tiny, light brown lines

small vesicles

erythema

pruritic

inflammation

keratoses

benign lesions

associated with aging or skin damage

often found on face or trunk

common in fair skinned people

kaposi sarcoma

type of skin caner

used to be rare

more prominent now because of HIV infection

individuals who are not HIV positive can still have it

kaposi sarcoma treatment

combination of radiation, chemo, surgery, and biologic therapy

kaposi sarcoma signs and symptoms

nonpruritic lesions

nonpainful

lesions progress to large, irregular shaped plagues or nodules

acute necrotizing fasciitis

flesh eating disease

mix of aerobic and anaerobic microbes: S aureus and streptococcus

rapid tissue invasion and reduced blood supply to tissue

need aggressive antimicrobial therapy, fluid replacement, excision of infected tissue, possible amputation

acute necrotizing fasciitis signs and symptoms

infected area that increases rapidly

fever

painful

dermal gangrene

possible organ failure

hypotension