integumentary system

dermatitis

inflammation of the skin that results in redness and itching

contact dermatitis

skin encounters an irritant which damages the skin itself (ex. substances, jewelry, plants)

contact dermatitis cause

increased exposure time and concentration of substance, physical agents (friction), chemical agents (detergent), metals (nickel), rubber products, sunscreens, products with fragrances

contact dermatitis clinical presentation

redness, pruritus, swelling, vesicles, oozing

contact dermatitis treatment

oatmeal baths, calamine lotion, cool-wet compress, antihistamines, prednisone (systemic steroids)

diaper dermatitis

common in infants and toddlers; may be caused by candida fungal infections or staphylococcus

diaper dermatitis clinical presentation

redness/irritation, edema, skin erosion

diaper dermatitis treatments

frequent diaper changes, cleansing of perineal area, skin barriers (thin layer), topical corticosteroids (short-term)

allergic variations of dermatitis - poison ivy

delayed hypersensitivity reaction results in allergic contact dermatitis

allergic variations of dermatitis - poison ivy risks

animal fur, tools, clothing, a lot of time outside or family members

allergic variations of dermatitis - poison ivy clinical presentation

rash, papules (raised), vesicles (blisters), bullae (large blister), facial edema + respiratory distress (airborne contact)

1-4 days after contact

allergic variations of dermatitis - poison ivy treatments

oral diphenhydramine, topical antihistamines, corticosteroids (prior to vesicles), topical immunosuppressants (long-term)

goes away on own (3wks)

seborrheic

inflammation on scalp; cradle cap

seborrheic risks

infant, overactive sebaceous glands, immunodeficiency

seborrheic clinical presentation

crusty-yellow scales on scalp, serous fluid, rash (not painful or itchy)

seborrheic treatments

self limiting, scalp care/emollients (loose scales), soft brush, ketocanazole shampoo if unresolved

atopic dermatitis

eczema; due to genetic and environmental factors that lead to immune system and epidermal dysfunction

atopic dermatitis risks

family hx, childhood

atopic dermatitis clinical presentation

pruritus, skin flaking, inflammation, infants (scalp, face, extremities), children/adolescents (elbows, back of knees, wrists, forearms)

atopic dermatitis treatments

hydration to skin (ointments), topical corticosteroids (clobetasol), tacrolimus ointment, prednisone (flare ups), OTC antihistamines, bath in dilute bleach bath (reduce infection)

medication reactions dermatitis

exanthematous (maculopapular) drug eruption; antibiotics typically induced rash

sensitization phase and elicitation phase

medication reactions dermatitis risks

liver and renal dysfunction, hx of viruses (ep-barr), immunodeficiencies

medication reactions dermatitis clinical presentation

not sensitized (7-10 days then rash), sensitized (1-3 days), erythema, macules, papules

similar to measles

medication reactions dermatitis treatment

withdrawal of med

insect bites/stings

immune response due to saliva or venom, typically localized

chiggers - wooded areas with tall grass, intense itch on sock/belt line

flies - anticoagulant property saliva

ticks - lyme disease, rocky mountain spotted fever

mites - scabies due to infestation from prolonged contact, under stratum corneum eggs

bark scorpion - htn, tachycardia, arrhythmias, myoclonus

insect bites/stings screening

travel history, recent activities, contact with animals

insect bites/stings risks

dark clothing, exposed skin, type o blood, ketones and lactic acid in blood

insect bites/stings clinical presentation

local inflammation, edema, itchy at site, single/dual puncture, hives, necrosis (brown recluse)

tick bite

distinctive circular rash (erythema migrans), fever, fatigue, body aches, untreated → neuro issues, joint pain, cardiac manifestations

insect stings

uncomplicated, local reactions, localized erythema and painful edema, increased swelling in large reactions

psoriasis

inflammatory disorder with innate and adaptive immune system involvement which leads to epidermal hyperplasia from excessive keratinocyte proliferation

psoriasis risks

environment (infections, trauma, stress, obesity, meds), genetics (HLA, type Cw6), winter

psoriasis clinical presentation

guttate psoriasis - small papules; scaly, round, red; group A strep

chronic plaque - round, well defined, bright red, covered with grey/white scale, symmetrical distribution, knees, elbows, scalp, face, or diaper

nail dystrophy, joint swelling

psoriasis treatments

topical corticosteroids, methotrexate (oral, suppress immune system), etanercept (inj), UV light

acne

involves epidermis, dermis, sebaceous glands, and androgens (these increase sebum production causing inflammation and proliferation of epidermis)

mild-childhood - 1 to 7, preadolescents - 7 to 12

acne risks

meds, excess sunlight, friction, endocrine conditions, genetics, high sugar foods, oil based products, emotions

acne - adolescents

1: open and closed comedones, 2: inflammatory papules, 3: pustules, 4: nodules and cysts

acne treatments

mild acne - benzoyl peroxide (topical), mod acne - oral abx (doxycycline 8+, azithromycin 8-), hormonal meds - spironolactone or oral contraceptives, isotretinoin for severe (iPLEDGE, photosensitivity, teratogenicity)

cellulitis

bacterial skin infection due to disruption of skin barrier from trauma (group A strep, MRSA), neutrophils and cytokines respond causing inflammation, proliferation of keratinocytes

cellulitis screening

recent travel, injuries, IV drug use, animal/bug bites

cellulitis risks

edema, obesity, immunosuppression, inflammatory conditions (psoriasis, dermatitis)

cellulitis clinical presentation

inflammation, erythema, warmth, pain, tenderness, common in lower extremities, vesicles/bullae

could lead to osteomyelitis or bacteremia → endocarditis

cellulitis diagnose

two of following: warmth, redness, swelling, tenderness of subq, and dermal tissue

cellulitis treatments

abx, clindamycin (MRSA), cephalexin (no MRSA)

thermal injury

superficial burns - only epidermis, mod pain (ex. sunburns)

partial thickness - superficial: painful, infection?, deep: more dermis, hair follicle damage, glandular tissue, and nerve endings; pressure = pain (ex. hot water)

full thickness - entire dermal layer and subq tissue, eschar (ex. extended contact with heat)

superficial burns clinical presentation

red, painful without blisters, blanch, epithelium peels

partial thickness clinical presentation

superficial - red, painful blisters that weep

deep - non-blanching, only pain with pressure

full thickness clinical presentation

white, gray, or charred black, no blisters, pay may not occur, scarring common

Wallace rule of nines

used to estimate total body surface area (TBSA) affected

head makes up 9%, each arm 9%, each leg 9%, front/back trunk each makes 18%

thermal injury treatments

minor burns: cooling, cleaning, preventing infection, and controlling pain

fluid resuscitation

escharotomy (procedure done to remove pressure and increase blood flow to an area with dead tissue)