Integumentary

1. System Overview

🧬 Normal Anatomy & Physiology (Short & Clean)

• Layers

  • Epidermis – avascular, keratinized stratified squamous epithelium

    • Cells: keratinocytes, melanocytes, Langerhans cells, Merkel cells

  • Dermis – vascular connective tissue

    • Collagen, elastin, blood vessels, nerves, hair follicles, sebaceous & sweat glands

  • Subcutaneous tissue – fat + connective tissue

    • Insulation, energy storage, padding, anchors skin

• Functions

  • Protection – barrier vs. trauma, pathogens, UV, chemicals

  • Thermoregulation – vasodilation/vasoconstriction, sweating

  • Sensation – pain, temp, touch, pressure, vibration

  • Metabolic – vitamin D synthesis

  • Immune – Langerhans cells, normal flora

  • Fluid balance – prevents excessive fluid loss

🏠 Homeostasis

• Intact skin + normal flora → ↓ infection

• Adequate perfusion → oxygen & nutrient delivery for healing

• Normal thermoregulation → stable core temperature

• Balanced nutrition + protein → collagen synthesis & repair

• ↓ Injury & pressure → intact integrity

👵 Age-Related Changes (Geri-Focus)

• Thinning epidermis & dermis

  • ↑ fragility → easy bruising & tearing

  • Slower wound healing

• ↓ melanocytes → uneven pigmentation, ↑ skin cancer risk

• ↓ sebaceous & sweat gland activity → dry skin (xerosis) → itching → excoriations

• ↓ elasticity & subQ fat → wrinkles, less padding over bony prominences → ↑ pressure injury risk

• ↓ sensation → burns, injuries unnoticed

• ↓ immune response → ↑ infection risk, atypical presentations

• Geri NCLEX cues

  • Small trauma → big skin tear 🚨

  • “Just a little itching” + excoriations → look for infection

  • Dehydration + dry skin + poor mobility → HIGH pressure injury risk 🔴

2. Key Disorders (High-Yield)

I’m prioritizing what’s most testable. If your exam throws something random, it will still trace back to these patterns.

2.1 Pruritus & Xerosis (Itching & Dry Skin)

A. Quick Definition

• Pruritus – subjective sensation of itching → leads to scratching.

• Xerosis – abnormally dry skin, very common in older adults.

B. Priority Pathophysiology (Short)

• Trigger (dryness, histamine release, systemic disease, meds)
  ➡ stimulates peripheral nerve fibers
  ➡ itch sensation → scratching
  ➡ skin barrier disruption → excoriations, infection risk

C. Clinical Manifestations

• Early/mild

  • Dry, flaky skin (esp. extremities)

  • Itching, worse at night

  • Scratch marks

• Severe

  • Excoriations, crusts

  • Secondary infection (erythema, warmth, tenderness, purulent drainage)

  • Sleep disturbance, anxiety

D. Labs/Diagnostics

• Usually clinical.

• If systemic cause suspected:

  • 🧪 LFTs (cholestasis)

  • 🧪 BUN/Cr (uremic pruritus)

  • 🧪 Thyroid, glucose (endocrine)

E. Complications – 🔴

• Skin breakdown → cellulitis

• Sleep deprivation → fatigue, mood changes

• Chronic scratching → lichenification, hyperpigmentation

F. Priority Nursing Interventions (FIRST → NEXT → AVOID)

• FIRST

  • Assess cause (new meds? soaps? systemic disease?)

  • Trim nails, consider cotton gloves at night (safety)

• NEXT

  • Lukewarm baths, pat dry → apply emollient immediately (within 3 min) 💧

  • Use mild soap or soap substitutes; avoid fragrances

  • Cool compresses, menthol/calamine as ordered

  • Antihistamines for severe itching (watch sedation in older adults)

• ALWAYS AVOID

  • Hot baths, vigorous rubbing

  • Scented lotions, alcohol-based products

  • Overuse of topical steroids (skin atrophy)

G. Evaluation (Better vs Worse)

• Improving

  • ↓ scratching, intact skin

  • ↓ subjective itch rating

  • Better sleep

• Worsening

  • New redness, warmth, pus → likely infection 🚨

  • Increased areas of open skin → risk for cellulitis

H. Patient Teaching (NCLEX traps)

• Moisturize right after bathing, not “whenever I remember.”

• Use lukewarm water, not hot.

• Avoid wool/rough fabrics; choose cotton.

• If antihistamines cause drowsiness → no driving, no alcohol.

I. Geriatric Considerations

• Very common due to xerosis + meds + ↓ renal/hepatic function.

• Sedating antihistamines → falls, confusion 🔴

• Gentle handling to avoid skin tears.

J. Medications Table (Core)

2.2 Contact & Atopic Dermatitis (Eczema)

A. Quick Definition

• Contact dermatitis – inflammatory reaction of skin to external agent (irritant or allergen).

• Atopic dermatitis – chronic, relapsing inflammatory skin disease associated with atopy (asthma, allergic rhinitis).

B. Priority Patho

• Allergen/irritant exposure
  ➡ local inflammatory response
  ➡ erythema, edema, vesicles, weeping or scaling
  ➡ chronic scratching → lichenification

C. Clinical Manifestations

• Contact

  • Localized redness, edema, vesicles, weeping

  • Clear border where contact occurred (e.g., under watchband)

• Atopic

  • Chronic, intensely pruritic patches

  • Flexural areas (antecubital, popliteal), face, neck

  • Dry, scaly, lichenified skin

D. Diagnostics

• Usually clinical.

• Patch testing for allergen identification if needed.

E. Complications 🔴

• Secondary bacterial infection (yellow crust, warmth, pain)

• Sleep disturbance, impaired quality of life

F. Priority Interventions

• FIRST

  • Remove/avoid offending agent (jewelry, fragrance, latex).

• NEXT

  • Moisturizers; lukewarm baths, gentle cleansers

  • Topical corticosteroids as prescribed

  • Antihistamines for itching

  • Wet dressings for acutely weeping lesions

• AVOID

  • Scratching, hot water, harsh soaps

  • “Spot treating” large areas with high-potency steroids for long periods → atrophy

G. Evaluation

• ↓ erythema, edema, vesicles

• ↓ pruritus, improved sleep

• No signs of infection

H. Patient Teaching (Mistakes NCLEX loves)

• “If I can’t see a rash it means I’m cured” ❌ – atopic dermatitis is chronic/relapsing.

• Use regular emollient care even when skin looks good.

• For steroids: thin layer, limited time, not a moisturizer.

• Avoid triggers: fragrances, nickel, certain soaps, wool.

I. Geriatric Considerations

• More dryness & barrier impairment → milder irritants cause big reactions.

• Watch steroid-induced skin atrophy → tears & bruising.

J. Medication Highlights (Topicals)

• Topical corticosteroids (hydrocortisone, triamcinolone, clobetasol)

  • AEs: skin atrophy, telangiectasias, striae with chronic use

  • HOLD / call provider: skin thinning, ulceration, signs of systemic absorption.

• Calcineurin inhibitors (tacrolimus ointment) – if in text

  • No steroid atrophy; avoid in immunocompromised.

  • Photosensitivity: use sunscreen.

2.3 Psoriasis

A. Quick Definition

• Chronic, immune-mediated inflammatory disease → hyperproliferation of keratinocytes → thick, scaly plaques.

B. Priority Patho

Genetic + immune trigger
➡ T-cell activation, cytokines
➡ rapid turnover of epidermis
➡ thickened plaques with silvery scales; systemic inflammatory burden.

C. Clinical Manifestations

• Well-demarcated red plaques with silvery scales, typically:

  • Extensor surfaces (elbows, knees), scalp, sacrum

• Auspitz sign – pinpoint bleeding when scales removed 💡

• Nail pitting, onycholysis

• Psoriatic arthritis (joint pain, stiffness)

D. Diagnostics

• Usually clinical; biopsy if uncertain.

E. Complications 🔴

• Psoriatic arthritis → joint damage

• Psychosocial distress, body image issues

• From therapy: systemic immunosuppressant AEs (hepatic, renal, infection)

F. Priority Interventions

• FIRST

  • Assess extent, joint involvement, impact on ADLs & body image.

• NEXT

  • Topical corticosteroids, vitamin D analogs, coal tar as ordered

  • Phototherapy (UVB) with eye & skin protection

  • Systemic agents for severe disease (methotrexate, cyclosporine, biologics – if in your lecture)

• AVOID

  • Abrupt withdrawal of systemic steroids → rebound flares

  • Trauma to plaques (Koebner phenomenon)

G. Evaluation

• ↓ plaque thickness, redness, scaling

• Improved joint mobility

• Improved psychosocial functioning

H. Teaching

• Chronic disease: focus on control, not “cure.”

• Adherence to regimen is critical; flares with stopping meds.

• Sunscreen is still needed even with phototherapy orders (follow timing instructions).

• Watch for signs of infection if on immunosuppressants.

I. Geriatrics

• Polypharmacy + comorbidities → methotrexate & cyclosporine require careful monitoring.

• Falls risk with joint pain and stiffness.

J. Medication Table – Psoriasis (Core)

2.4 Bacterial Skin Infections (Cellulitis, Impetigo)

A. Quick Definitions

• Cellulitis – acute infection of dermis/subQ tissue (often strep or staph).

• Impetigo – superficial bacterial infection, honey-colored crusts, highly contagious.

B. Patho

Break in skin
➡ bacteria invade
➡ local inflammation ± systemic signs.

C. Clinical Manifestations

• Cellulitis

  • Red, warm, tender, swollen area; indistinct borders

  • May have fever, chills, malaise

• Impetigo

  • Vesicles → rupture → honey-colored crusts, often face or extremities

D. Labs/Diagnostics

• Usually clinical; wound culture if needed.

• For severe cellulitis: CBC, blood cultures.

E. Complications 🔴

• Spread to bloodstream → sepsis

• Necrotizing fasciitis (rapidly progressing pain, bullae, systemic toxicity) 🚨

• Post-strep complications (rare)

F. Priority Nursing Interventions

• FIRST

  • Mark borders with skin pen to monitor spread.

  • Assess systemic signs (fever, tachycardia, hypotension).

• NEXT

  • Administer antibiotics on time.

  • Elevate affected limb (↓ edema).

  • Warm, moist compresses as ordered.

  • For impetigo: contact precautions, keep lesions covered.

• AVOID

  • Squeezing lesions; sharing towels, linens.

G. Evaluation

• ↓ redness, swelling, pain

• Stable VS; no fever

• No new lesions

H. Teaching

• Finish full course of antibiotics.

• Hand hygiene; don’t share personal items.

• When to call provider: fever, increasing redness beyond line, pain out of proportion.

I. Geriatrics

• May present with confusion and malaise before obvious local signs.

• High risk for sepsis; monitor VS closely.

J. Meds (Brief)

• Oral/IV antibiotics according to culture.

• Watch for C. difficile with broad-spectrum antibiotics.

2.5 Viral: Herpes Zoster (Shingles)

A. Quick Definition

• Reactivation of varicella-zoster virus (chickenpox) in sensory nerve ganglia → painful, unilateral vesicular rash along dermatome.

B. Patho

Latent VZV in dorsal root ganglia
➡ reactivation with ↓ immunity
➡ viral spread along nerve
➡ dermatomal vesicular eruption.

C. Clinical Manifestations

• Prodrome: burning/tingling, pain along dermatome

• Then clusters of clear vesicles on erythematous base, unilateral, not crossing midline

• Crusting in 7–10 days

• Postherpetic neuralgia (persistent pain)

D. Diagnostics

• Usually clinical; Tzanck smear or viral culture if needed.

E. Complications 🔴

• Ophthalmic zoster → eye involvement → vision loss 🚨

• Disseminated zoster in immunocompromised

• Postherpetic neuralgia (severe chronic pain)

F. Priority Interventions

• FIRST

  • Assess eye involvement (lesions tip of nose, eye pain) → urgent ophthalmology.

  • Implement airborne + contact precautions for disseminated or immunocompromised.

• NEXT

  • Antivirals (acyclovir, valacyclovir) within 72 hours to shorten course.

  • Pain control (NSAIDs, opioids, neuropathic meds).

  • Keep lesions clean, dry; nonadherent dressings if needed.

• AVOID

  • Contact with pregnant women, infants, immunocompromised (if lesions active).

G. Evaluation

• Lesions crusting, pain decreasing

• No new lesions

• No eye involvement

H. Teaching

• “I can’t spread shingles, but I can spread chickenpox” – people without immunity can get varicella.

• Don’t scratch; avoid sharing linens.

• Vaccine (zoster) for older adults prevention (per B&S mention).

I. Geriatrics

• Higher risk of shingles and postherpetic neuralgia.

• Zoster vaccine strongly recommended.

J. Meds Brief

• Acyclovir/valacyclovir – adjust dose in renal impairment; ensure hydration.

2.6 Fungal: Tinea & Candidiasis

Key points only

• Warm, moist areas: skin folds, groin, feet, under breasts, mouth, vagina.

• Tinea pedis – athlete’s foot; cracking, scaling between toes.

• Candidiasis – erythematous, moist patches with satellite lesions.

Red flags: fungal infection in immunocompromised or diabetics → high risk for systemic spread.

First actions: keep area dry, topical antifungals, treat underlying cause (hyperglycemia, moisture, obesity).

2.7 Parasitic: Pediculosis (Lice) & Scabies

• Lice

  • Nits on hair shafts; intense scalp itching.

  • Treat all close contacts; wash linens in hot water; bag non-washables.

• Scabies

  • Burrows, intense itching worse at night; web spaces of fingers, wrists, waistline.

  • Permethrin cream neck down, leave on per order; treat all household.

Red flag: crusted scabies in immunocompromised → heavy infestation + high transmission.

2.8 Drug Reactions & SJS/TEN

A. Definition

• Drug eruptions – range from mild exanthematous rash to life-threatening Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN).

B. Patho (priority)

Drug hypersensitivity
➡ immune-mediated keratinocyte apoptosis
➡ epidermal detachment.

C. Clinical

• Mild: morbilliform rash, pruritus.

• SJS/TEN:

  • Flu-like prodrome, fever

  • Painful, widespread erythema

  • Blisters, mucosal involvement (mouth, eyes, genitals)

  • Epidermal detachment, positive Nikolsky sign

D. Emergencies 🔴

• SJS/TEN → similar to burns:

  • Massive fluid loss, infection, sepsis, multi-organ failure

E. FIRST Action

• STOP the suspected drug immediately 🚨

• Notify provider before you grab lotion or give anything else.

• Support ABCs; anticipate transfer to ICU/burn unit.

F. Nursing Priorities

• Large-bore IV access → fluids

• Strict aseptic technique; prevent infection

• Pain management

• Eye care, oral care

• Temperature control (hypothermia risk)

G. Evaluation

• No new lesions after drug stopped

• Stable VS, adequate UOP, no sepsis.

H. Teaching

• Never re-take the offending drug.

• Wear alert bracelet; inform all HCPs.

2.9 Skin Cancers: BCC, SCC, Melanoma, Kaposi Sarcoma

Patterns

• Basal cell carcinoma (BCC) – most common, least deadly; pearly papule, telangiectasia, rarely metastasizes.

• Squamous cell carcinoma (SCC) – scaly, erythematous plaques or nodules; can metastasize.

• Melanoma – malignant tumor of melanocytes; high metastatic potential.

• Kaposi sarcoma – vascular malignancy; red-purple macules, plaques, nodules; often associated with immunosuppression.

ABCDE of melanoma 💡

• A – Asymmetry

• B – Border irregular

• C – Color variation

• D – Diameter > 6 mm

• E – Evolving (changing)

Red flags

• Any changing mole, bleeding, non-healing lesion.

• Melanoma with nodes, systemic symptoms.

First actions

• Full skin exam.

• Teach self-exam & sun protection.

• Prompt referral for biopsy of suspicious lesions.

3. System-Wide Red Flags & Emergencies (What to Do FIRST)

🔥 Dermatologic Emergencies

1. SJS/TEN

   • Recognize: painful widespread erythema, mucosal involvement, sheet-like skin detachment, fever.

   • FIRST: stop offending drug, stabilize ABCs, start IV, notify provider, anticipate burn-unit level care.

   • Do NOT: apply random topical products that could obscure assessment; ignore fever.

2. Rapidly spreading cellulitis / necrotizing fasciitis

   • Recognize: severe pain out of proportion, rapidly expanding erythema, bullae, crepitus, systemic toxicity.

   • FIRST: mark borders, VS, alert provider STAT, prep for IV antibiotics and possible surgery.

   • Do NOT: delay for warm compresses or oral meds only.

3. Herpes zoster ophthalmicus

   • Recognize: shingles on face/around eye, lesions on nose tip, eye pain or vision changes.

   • FIRST: urgent ophthalmology consult, antivirals, eye protection.

   • Do NOT: brush it off as “just shingles.”

4. Exfoliative dermatitis / erythroderma

   • Recognize: generalized redness & scaling of entire body, chills, fever, pruritus.

   • FIRST: assess VS, temp, fluid status; large-bore IV; keep warm; contact provider; think burns-level care.

   • Do NOT: underestimate fluid loss risk.

5. Malignant melanoma with new neuro/resp symptoms

   • Recognize: headache, cough, SOB, weight loss.

   • FIRST: report to provider; anticipate imaging, oncologic workup.

4. Priority Algorithms (For Your Weak Areas)

4.1 Basic Triage for Skin Patients

Step 1 – ABC always

• Airway compromised? (facial swelling, tongue swelling, anaphylaxis?)
  ➡ See FIRST, prepare epinephrine, airway support.

• Breathing issues? (wheezing, SOB, stridor)
  ➡ PRIORITY over isolated skin issues.

• Circulation? (hypotension, tachycardia, sepsis signs)
  ➡ PRIORITY.

If ABC stable → look for:

• SJS/TEN, extensive burns-like lesions → high priority.

• Infection with systemic signs (fever, rigors, confusion).

• Eye involvement in herpes zoster.

4.2 Fluid Balance Red Flags in Skin Conditions

• Think FVD if:

  • Large weeping dermatitis

  • Exfoliative disorders

  • SJS/TEN

• Watch:

  • 🧪 ↑ BUN, Cr; ↓ UOP

  • Tachycardia, hypotension, dry mucous membranes

• FIRST: notify provider; anticipate IV fluids; strict I&O.

4.3 “Which Patient Do I See FIRST?” (Skin Edition)

Rank highest → lowest:

1. Patient on sulfa drug with painful, blistering rash & fever.

2. Shingles on face with eye pain.

3. Diabetic with new cellulitis, fever, increasing redness.

4. Elderly with pressure injury, afebrile.

5. Stable psoriasis asking about moisturizer.

5. Pharm Integration (Global)

Common meds touching this system:

• Topical & systemic corticosteroids

• Antihistamines (pruritus, urticaria)

• Antivirals (acyclovir, valacyclovir)

• Antifungals (nystatin, clotrimazole, fluconazole)

• Antibiotics (for cellulitis, impetigo)

• Systemic immunosuppressants (methotrexate, cyclosporine) for severe psoriasis

• Isotretinoin (severe acne)

Expected vs Dangerous

• Expected: mild local burning with topical steroids/antifungals, dryness with acne meds.

• Dangerous:

  • Steroids → skin atrophy, systemic Cushingoid effects with chronic/high dose.

  • Isotretinoin → teratogenic, psych effects, ↑ lipids, hepatotoxic.

  • Methotrexate → bone marrow suppression, hepatotoxic.

  • Sulfa drugs/allopurinol/anticonvulsants → SJS/TEN.

Elderly Considerations

• Higher sensitivity to sedating antihistamines.

• Renal/hepatic impairment → adjust doses.

• Increased risk of falls from sedation and hypotension.

6. Teaching & Documentation Traps

Patient Statements – Correct vs Incorrect

• ❌ “If I don’t itch anymore, I can stop using my moisturizing routine.”
  ✅ Teach: continue routine to prevent flares.

• ❌ “My steroid cream is just lotion; I can use it forever.”
  ✅ Teach: limited duration, thin layer, risk of atrophy.

Discharge Teaching – Must Include

• How to recognize infection: redness, warmth, purulent drainage, fever.

• When to call provider vs go to ED (e.g., blistering rash + fever).

• Medication schedules, duration.

Documentation Musts

• Exact location, size, appearance of lesions (use anatomical terms).

• Stage pressure injuries correctly.

• Document teaching given & patient response.

Delegation – Do NOT Delegate

• Initial assessment of new rash.

• Evaluation of response to new topical/systemic med.

• Teaching about SJS/TEN warning signs.

• Staging pressure injuries.

7. Fluid/Electrolyte Links (Integumentary)

Skin disorders that can affect F/E:

• Extensive burns-like conditions (SJS/TEN, exfoliative dermatitis).

• Large areas of weeping eczema or wounds.

• Fever and diaphoresis with acute infections.

Potential Changes

• Na⁺: can drop with excessive sweating or large fluid losses.

• K⁺: may rise with tissue breakdown or fall with GI losses from systemic illness.

• Ca²⁺/Mg²⁺: less directly skin-related; more about overall nutrition & albumin.

• pH/ABGs: sepsis from skin infection → metabolic acidosis.

What to Monitor FIRST

• VS, mental status.

• UOP; daily weights.

• Basic metabolic panel (Na, K, Cr, BUN).

• Signs of hypovolemia (tachycardia, hypotension).

8. Geriatric Variations (Skin)

• Thin, fragile skin → careful tape use, lifting, transfers.

• High pressure injury risk:

  • Immobility, poor nutrition, incontinence.

• Blunted inflammatory response:

  • May NOT have fever with infection; look for confusion, functional decline.

• Polypharmacy:

  • More drug eruptions, interactions.

• Hydration:

  • Encourage fluids (unless restricted), moisturizers.

9. High-Yield Tables (Mini)

9.1 Common Skin Red Flags

9.2 Basic Med Traps

10. Final Exam “Must-Memorize List”

Top 10 Disorders (Integumentary)

1. Pruritus/xerosis (esp. older adults)

2. Contact & atopic dermatitis

3. Psoriasis

4. Bacterial infections (cellulitis, impetigo)

5. Viral – herpes zoster

6. Fungal infection (tinea, candidiasis)

7. Lice & scabies

8. Drug eruptions, SJS/TEN

9. Skin cancers (BCC, SCC, melanoma, Kaposi sarcoma)

10. Pressure injuries (risk, staging basics)

Top 10 Red Flags

1. Painful blistering rash + fever (SJS/TEN)

2. Rash + mucosal involvement

3. Rapidly spreading cellulitis with systemic signs

4. Shingles on face/eye involvement

5. Generalized erythema/scaling (exfoliative)

6. Non-healing lesion, bleeding mole

7. New confusion in elder with skin infection

8. Extensive weeping lesions + tachycardia/hypotension

9. Severe itching with open excoriations → infection risk

10. Immunocompromised patient with any unusual lesion

Top 10 Labs

1. CBC (infection, drug toxicity)

2. BUN/Cr (FVD, nephrotoxic drugs)

3. LFTs (methotrexate, isotretinoin)

4. Electrolytes (Na, K) in severe exfoliative states

5. Culture & sensitivity for wounds

6. Skin biopsy (cancers, uncertain lesions)

7. Patch testing (allergic dermatitis)

8. Viral culture/serology for herpes (if needed)

9. Fungal scrapings (KOH prep)

10. Glucose (candidiasis, poor wound healing)

Top 10 Nursing Interventions

1. Protect skin (pressure relief, gentle handling).

2. Moisturize appropriately (especially geriatric).

3. Timely administration of antibiotics/antivirals.

4. Patient education on infection signs.

5. Early recognition & escalation of dermatologic emergencies.

6. Accurate skin & wound documentation.

7. Implement isolation/contact precautions when needed.

8. Manage pruritus (nonpharm + pharm).

9. Support psychosocial/body image issues.

10. Teach sun protection & self-skin exams.

Top 5 Teaching Points

1. ABCDE of melanoma & monthly skin self-exam.

2. Moisturizing & gentle cleansing routine (lukewarm water, mild soap).

3. Proper use of topical steroids (thin layer, short-term, not a lotion).

4. Drug reactions – stop drug & call provider for blistering/febrile rashes.

5. Infection signs & when to seek urgent care.

Top 5 Geriatric Considerations

1. Thin, fragile skin → high risk for tears & pressure injuries.

2. Dryness + decreased sensation → unrecognized injury.

3. Atypical infection signs (confusion > fever).

4. Sedating meds → falls, confusion.

5. Slower healing; emphasize nutrition & pressure relief.

11. NCLEX Pattern Recognition – “If You See → Think”

• “Painful target lesions + mucosal involvement + recent new med” → SJS/TEN 🚨

• “Unilateral dermatomal vesicular rash” → Herpes zoster

• “Honey-colored crusts on child’s face” → Impetigo

• “Red plaques with silvery scales on extensor surfaces” → Psoriasis

• “Itchy burrows in finger webs, worse at night” → Scabies

• “Pearl-like, rolled-border lesion on sun-exposed area” → BCC

• “Irregular, multicolored mole, changing over time” → Melanoma

• “Dry, thin, fragile skin, bruises, tears easily” in elder → HIGH pressure injury risk

• “Rash after starting antibiotic; pruritic, no mucosal lesions, stable VS” → likely mild drug eruption (monitor, notify provider; not emergent).

• “New rash + systemic signs (fever, hypotension, confusion)” → sepsis suspicion → ABC, cultures, IV fluids, antibiotics.