Unit 12: Skin Disorders

Unit 12: Skin Disorders

Introduction

  • Established at Alverno College in 1887

  • Covers various skin disorders, their classification, diagnostic tests, common types, and their implications.

Classification of Skin Disorders

Basic Classifications

  • Acute: Symptoms appear suddenly and last a short time.

  • Chronic: Symptoms persist over a long period.

  • Infectious: Caused by pathogens like bacteria, viruses, fungi.

  • Inflammatory: Result from immune response to stimuli.

  • Neoplastic: Involves tumors, both benign and malignant.

Further Classifications

  • Causes:

    • Caused by exposure to environmental stresses and/or injury to skin.

    • Not all skin abnormalities indicate skin disorders; may reflect disease processes elsewhere in the body.

Lesions

  • Observable changes from normal skin structure categorized as:

    • Primary Lesions:

    • Arise from previously healthy skin.

      • Examples:

        • Macules

        • Patches

        • Papules

        • Nodules

        • Tumors

        • Vesicles

        • Pustules

        • Bullae

        • Wheals

    • Secondary Lesions:

    • Result from changes in primary lesions.

      • Examples:

        • Crusts

        • Scales

        • Lichenification

        • Scars

        • Keloids

        • Excoriation

        • Fissure

        • Erosion

        • Ulcers

Lifespan Considerations

Newborns

  • Skin covered by vernix caseosa in utero to protect from amniotic fluid, loss of fluids, and has various properties:

    • Anti-infective

    • Thermoregulatory

    • Antioxidant

    • Moisturizing

    • Wound-healing

  • Conditions present at birth:

    • Milia

    • Mild acne

    • Erythema toxicum

    • “Stork bites”

    • Congenital nevi

    • Mongolian or café-au-lait spots

    • Port-wine stains

    • Hemangiomas

  • Infant skin is 40–60% thinner than adult skin with little subcutaneous fat.

  • Allows increased absorption of harmful chemicals and topical medications.

  • More susceptible to bacterial infections due to higher water content than adult skin.

Children

  • Proportionately larger body surface area (BSA) than adults, leading to:

    • Greater risk for hypothermia and dehydration.

    • More rapid absorption of toxins through thinner skin.

  • Common viral infections include:

    • Erythema infectiosum

    • Pityriasis rosea

    • Roseola infantum

Diagnostic Tests

  • Skin biopsy

  • Cultures on tissue samples, drainage and exudate, lesions, serum

  • Scratch, intradermal, patch tests to identify allergens

  • Nasal cultures

Common Skin Disorders

Types of Disorders

  • Bacterial

  • Fungal

  • Viral

  • Dermatitis

  • Insect and spider bites

  • Infestations

  • Acne vulgaris

Contact Dermatitis

  • An inflammatory disorder characterized by damage to dermis and epidermis.

  • Symptoms:

    • Red, pruritic rash occurring where skin contacted allergen or irritant.

  • Types:

    • Allergic: Hypersensitivity response.

    • Irritant: Comes from contact with chemicals, soaps, dyes, detergents, metals, perfumes.

Common Skin Disorders: Bacterial

Disorders

  • Common bacterial disorders include:

    • Impetigo:

    • Non-bullous: caused by Streptococcus or Staphylococcus, characterized by red papules that progress to blisters (bullae) and pustules that develop honey-colored crust.

    • Bullous: Caused by Staphylococcus, characterized by delicate bullae that break, causing separation of dermis and epidermis.

    • Folliculitis

    • Cellulitis

    • Scalded Skin Syndrome

Treatment for Bacterial Disorders

  • Use of topical or systemic antibiotics (ABX)

  • Emphasis on hand-washing and hygiene

  • May require dilute bleach baths

  • Some cases may necessitate hospitalization

Bacterial Agents

  • Common bacteria involved include:

    • Staphylococci

    • Streptococci

    • MRSA (Methicillin-resistant Staphylococcus aureus)

Transmission

  • Infections typically occur through invasion and toxicity on susceptible skin.

  • Self-inoculation is common.

Common Skin Disorders: Viral

Viral Agents

  • Caused by various viruses

Transmission

  • Involves invasion & toxicity either in susceptible skin or oropharyngeal mucosa.

  • Can be transmitted through contact with respiratory droplets.

Disorders include:

  • Verruca (warts)

  • Herpes Simplex I and II

  • Varicella

  • Molluscum Contagiosum

Treatment for Viral Disorders

  • Antiviral medications for Herpes Simplex Virus (HSV)

  • Hand washing and hygiene to prevent spread

  • Destruction of warts for verruca

Viral Skin Disorders: Molluscum Contagiosum

  • Characterized by small, dome-shaped, shiny bumps, often with a central dimple.

  • Bumps can become red, swollen, or pus-filled; scratching may cause spreading.

  • Eczema-like skin develops around the molluscum.

Viral Skin Disorders: Hand, Foot, and Mouth Disease

  • Typically caused by Coxsackievirus.

  • Signs and symptoms include:

    • Fever

    • Sore throat

    • General malaise

    • Painful, red blister-like lesions on the tongue, gums, and inside of cheeks

    • Rash on palms, soles, and possibly buttocks, may blister but is not itchy.

    • Irritability in infants and toddlers, loss of appetite.

Common Skin Disorders: Fungal

Types of Fungal Disorders

Disorders include:

  • Tinea Capitis (scalp)

  • Tinea Corporis (body or nails)

  • Tinea Cruris (groin)

  • Tinea Pedis (feet)

  • Thrush (oral)

  • Candidiasis (vaginal, diaper dermatitis)

Treatment for Fungal Disorders

  • Use of topical or systemic antifungal medications.

Fungal Agents

  • Often caused by dermatophytes like tinea or Candida.

Transmission

  • Invades susceptible skin, hair, or nails and may be transmitted from infected animals.

Diagnosis

  • Typically confirmed through microscopic examination.

Common Skin Disorders: Infestation

Condition: Scabies

  • Infestation agent: Sarcoptes scabiei

  • Transmission: Prolonged close contact, resulting in the mite burrowing into the epidermis and depositing eggs.

  • Clinical manifestations include:

    • Intense pruritus

    • Excoriation and visible burrows

    • Discrete inflammation between finger webs, neck folds, groin

  • Treatment:

    • Scabicide (Permethrin 5% cream) for those over 2 months old, left for 8-14 hours.

    • High-heat hygiene of linens and clothing.

    • Supportive care for pruritus may last 2-3 weeks.

Condition: Pediculosis Capitis (Head Lice)

  • Infestation agent: Pediculus humanus capitis

  • Transmission: Close contact allows the female louse to obtain blood and deposit eggs onto the hair shaft.

  • Clinical manifestations include:

    • Intense pruritus of the scalp, particularly behind ears or nape of neck.

    • Presence of nits (eggs) attached to hair shafts.

  • Treatment:

    • Use of pediculicide (Permethrin 1% cream, OTC), repeat in one week, and treat affected family members.

    • Education and support for families concerning management and school attendance.

Unit 13: Burns

Overview of Burns

  • Majority of burns from contact with thermal agents such as hot liquids, surfaces, or flames.

  • Younger children are more susceptible to scald burns, while older children face more flame burns.

  • Wound characteristics depend on several factors:

    • Extent of injury

    • Total body surface area (TBSA) affected

    • Depth of injury (superficial to full-thickness)

    • Severity of injury (classified as major, moderate, or minor)

Assessment

  • Burns affecting the face, hands, and perineum correlate with greater morbidity and mortality.

  • Essential to assess for dyspnea, stridor, and hoarseness indicating possible inhalation injury.

  • Assess extent of burned body surface:

    • Rule of Nines for adults (simplified estimation).

    • Lund-Browder chart for a more accurate measure, especially in children.

Assessment for Children: Lund Browder Chart

  • Careful measurement of burned areas segmented by age in years.

  • Specific areas and corresponding percentage of TBSA for different age groups.

Classification of Burns

Types of Burns

  • Superficial (1st degree):

    • Affects only the outer layer of the dermis.

    • Symptoms include erythema and pain lasting up to 48 hours.

    • Healing time: Approximately 1 week with no scarring; treated with cool compresses and aloe vera.

  • Partial Thickness (2nd degree):

    • Involves the epidermis and part of the dermis.

    • Symptoms include blisters and edema, painful.

    • Healing time: 14-21 days with potential for extensive scarring; requires cleaning and application of silver sulfadiazine.

  • Full Thickness (3rd degree):

    • Extends through the epidermis, dermis, and subcutaneous tissue.

    • Appears dry, pearly white, or charred, with lack of sensation due to destroyed nerve endings.

    • Healing: No re-epithelialization; surgical excision and grafting are necessary, along with fluid resuscitation to prevent hypovolemic shock.

  • Fourth Degree Burns:

    • Involves underlying structures such as muscle, fascia, and bone.

Nursing Care Management of Pediatric Burns

Prevention

  • Emphasizes safety education as a primary step in prevention.

Acute Phase

  • Treat shock and manage pulmonary status by establishing and maintaining an airway, and performing fluid replacement therapy.

Recovery Phase

  • Evaluate and treat wound during recovery:

    • Appropriate dressing, pain management, and positioning are necessary.

    • Nutritional support should be prioritized to aid healing.

    • Provide family and patient support throughout the process.

Rehabilitation Phase

  • Begins once permanent wound closure has been achieved.

  • Goals include preventing complications and addressing scarring and psychological issues related to burn injuries.