ch. 65 skin, hair, and nail

  1. Disorders of the Skin, Hair, and Nails

    • Skin disorders can deeply affect a person's self-image, requiring empathic support for coping with chronic or acute conditions.

    • Body ornamentation, such as tattoos and piercings, may lead to complications and carries both personal and social implications.

  2. Gerontologic Considerations

    • Decreased epidermal replacement rates cause excessive skin drying in older adults, leading to pruritus and increased infection risk.

    • Daily bathing may not be necessary; applications of lotion or cream can help.

    • Early assessment and treatment of any skin lesions are crucial to prevent complications.

    • Careful assessment for conditions like scabies and head lice is vital, especially for cognitive-limited older adults, as symptoms can manifest atypically (e.g., confusion or agitation).

    • Scratching can risk skin breakdown in older adults with thinner skin tissue.

  3. Skin Disorders

    • Dermatitis:

      • General inflammation of the skin, often presenting as red rashes and pruritus (itching).

      • Types include allergic dermatitis (due to sensitivities) and irritant dermatitis (due to harmful substances).

    • Pathophysiology and Etiology:

      • Allergic contact dermatitis is caused by reactions to substances like drugs and cosmetics.

      • Irritant dermatitis occurs due to strong chemicals damaging skin integrity.

    • Assessment Findings:

      • Symptoms include redness, swelling, itching, and sometimes blistering.

    • Diagnosis and Management:

      • Diagnosis through visual examination; detailed history may help identify offending substances.

      • Treatment involves removing irritants and can include medications like topical corticosteroids.

    • Acne Vulgaris:

      • Inflammatory disorder of sebaceous glands and hair follicles, commonly associated with puberty.

      • Caused by hormonal changes increasing sebum production.

      • Symptoms include comedones (blackheads) and inflamed lesions.

      • Medical Management:

      • Non-prescription cleansers and topical medications like tretinoin may help.

      • Severe cases may require antibiotics, isotretinoin, or surgical methods like dermabrasion.

    • Rosacea:

      • Chronic disorder resulting in facial redness and visible blood vessels, often exacerbated by environmental factors.

      • Management includes lifestyle modifications and various topical or oral medications.

    • Furuncles, Furunculosis, and Carbuncles:

      • Furuncle: boil; multiple boil instances = furunculosis; carbuncle: furuncle with pus drainage.

      • Typically result from skin infections, often associated with conditions like diabetes.

    • Psoriasis:

      • Chronic inflammatory disorder characterized by rapid skin cell proliferation causing scaly lesions.

      • Treatment aims to control symptoms through topical treatments or systemic therapies.

    • Scabies:

      • Contagious disease caused by mites, often requiring diagnostic tests to confirm.

      • Treatment involves scabicides and emphasizes thorough hygiene.

    • Dermatophytoses (Fungal Infections):

      • Superficial fungal infections, including tinea (ringworm), have various types depending on the affected body part.

      • Management typically involves antifungal treatments.

    • Herpes Zoster (Shingles):

      • Reactivation of the varicella-zoster virus, causing painful skin eruptions.

      • Treatment includes antiviral medications and supportive care.

    • Skin Cancer:

      • Types: basal cell carcinoma (most common), squamous cell carcinoma, melanoma (most deadly).

      • Diagnosis typically involves biopsy; treatment methods vary based on cancer type.

    • Client and Family Education:

      • Essential for teaching about skin care, potential risks with body ornamentation, and signs of issues requiring medical attention.

  4. Body Ornamentation

    • Tattoos:

      • Risk of complications like infection, allergies, and local reactions.

      • Removal is challenging and may not restore skin to original appearance.

    • Body Piercing:

      • Risks include infections and complications affecting overall health and appearance.

      • Emphasis on proper hygiene and care during the healing process.

  5. Scalp and Hair Disorders

    • Seborrhea and Dandruff:

      • Non-inflammatory conditions often linked to seborrheic dermatitis.

      • Management typically involves medicated shampoos and possibly corticosteroids.

    • Alopecia:

      • Overview of types: Alopecia areata (autoimmune) and androgenetic alopecia (genetic).

      • Treatment options vary and can include medications and hair restoration procedures.

    • Pediculosis (Head Lice):

      • Identification through symptoms (itching); management involves medicated shampoos and meticulous combing for lice and nits.

  6. Nail Disorders

    • Onychomycosis:

      • Fungal infection affecting nails; often requires systemic antifungal therapy for resolution.

    • Onychocryptosis (Ingrown Toenails):

      • Contributing factors include nail shape and improper trimming.

      • Treatment may involve antibiotics and possibly surgical correction if recurring.

  7. Key Points for Study:

    • Understanding the relationships between skin conditions, body practices, and overall health.

    • Importance of patient education in preventing and managing skin, hair, and nail disorders, including necessary lifestyle modifications and treatment adherence.