Skin Disorders

Disorders of the Skin

Health History Assessment

• demographics

• age, race, occupation, hobbies, socioeconomic status

• obtain medical and fam medical hx

• recent travel or exposure to new environments

• new medications?

• initial symptoms? - where did it start, how long has it been there

• current Symptoms

• recent life events

• previous treatments and effects?

• what makes it better or worse?

• seen any MDs for it?

• psychological impact of skin disorder?

Health Promotion Considerations

• Factors impacting skin health:

  • Sun exposure from outdoor activities, tanning booths.

  • Overuse of soap leading to skin irritation.

  • Occupational irritants.

  • Other diseases (e.g., syphilis, Kaposi’s Sarcoma, lupus).

Physical Assessment

• Ensure proper lighting and tools for assessment:

  • Skin Examination Parameters:

    • Color (pigmentation, blood supply, jaundice).

    • temp

    • odor

    • moisture

    • turgor

    • texture

Shingles (Herpes Zoster Virus)

Overview

• Herpes Zoster:

  • Reactivated previous chickenpox infection

  • clusters of vesicles following peripheral sensory nerves that do not cross the midline.

  • 2/3 lesions appear in the thoracic area

  • trigeminal nerve leads to facial symptoms - face / eye / scalp

Phases of Infection

• Pre-eruptive Phase: 48 hrs

  • HA

  • fatigue

  • fever

  • light sensitivity

• Acute Eruptive Phase:

  • HA

  • fatigue

  • fever

  • light sensitivity

  • severe pain

• Post-herpetic Neuralgia:

  • severe pain

  • tingling

  • burning

  • numbness

Treatment Options

• Often focuses on symptom management:

  • Cool compresses

  • calamine lotion

  • baking soda

  • Antivirals effective within 24-72 hr

    • Acyclovir

    • Valacyclovir

    • Famciclovir

  • Analgesics for long-term pain management

    • gabapentin

Prevention

• Vaccination recommended > 60

  • Provides 90% effectiveness against shingles and post-herpetic neuralgia.

    • immunity lasts 5-7 years

• shingrex @ 19 to help prevent

Isolation Precautions

• Standard precautions with airborne and contact precautions until lesions are dry and crusted.

  • Use of gown, gloves, respirators, eye protection.

  • Reverse airflow rooms for airborne precautions.

  • Proper hand hygiene practices

Pre-Cancerous Skin Lesions

• normal age related changes

• associated w/ overexposure to sunlight / UV light

• Seborrheic Keratosis:

  • rarely develop into malignancy

• Actinic Keratosis:

  • Most common pre-cancerous lesion

  • appears pink / reddish / brown

  • scaly macules or papules

Skin Cancer Overview

Squamous Cell Carcinoma

• uncontrolled growth of abnormal squamous cells in the epidermis

• causd by sun exposure or chronic irritation

• S / S:

  • scaly red patches

  • open sores

  • elevated growths with central depression

  • irregular shape

  • may crust or bleed

  • potential for metastasis

• Treatment: Early detection and removal

Basal Cell Carcinoma

• uncontrolled growth in basal layer of epidermis

• sun exposure and genetics, chronic irritation

• S / S:

  • pearly raised lesions with a depressed center

  • bleeding from center → crusting and scaling

• rarely metastasizes

• Treatment:

  • Varies based on tumor site and extent.

Melanoma

• abnormal growth of melanin-producing epidermal cells

• sun exposure and thinning ozone

• S / S:

  • irregular borders - red / white / blue tones

  • color variations

  • high metastasis rate

• Treatment:

  • Always excised

  • potential use of virotherapy.

ABCDEF Skin Cancer Criteria

• A: Asymmetry

• B: Border irregularity

• C: Color variation

• D: Diameter

• E: Evolution

• F: Feeling

Treatment Options for Skin Cancer - biopsy = only definitive way to diagnosis cancer

• Surgical excision

• Cryosurgery / freezing

• Curettage and electrodissection

• Topical agents

• Systemic chemotherapy

• Biotherapy (interferon)

Patient and Family Teaching for Skin Cancer

• avoid direct sunlight and tanning booths

• use sunscreen with UVA and UVB protection, reapply every 2 hours

• balanced diet.

• conduct monthly skin checks using a mirror

  • changes in pigmented areas

  • moles

  • new growths

  • changes in lesions

  • itching

  • pain

• periodic skin exams w/ derm