2.1 Disorders of Tissue Integrity and Function Flashcards
Define Rashes
temporary eruptions of the skin
Define lesion
A traumatic or pathologic loss of normal tissue continuity, structure, or function.
What are rashes associated with?
childhood diseases, heat, diaper irritation, or drug-induced reactions
The components of a rash are often referred to as the _____
lesions
Rashes can be described as:
blanched, erythematosus, hemmorhagic, pigmented or purpuric.
What can lead to lichenification?
repeated rubbing and scratching
what is lichenification?
a thickened, leathery, and rough skin characterized by prominent markings
What is excoriation?
a raw denuded area caused by breakage of the epidermis
What is the difference between primary lesions and secondary lesions?
Primary lesions arising previously from normal skin.
May develop as Secondary lesions resulting from other disease conditions.
Define blisters
vesicles or fluid-filled papules
What lesions are caused by friction?
blisters, calluses, & corns
How do blisters occur?
When there is a disruption of the intracellular junctions (between skin layers) results in accumulation of fluid between skin layers
Can also be caused by extreme temperature (burns, frostbite) or exposure to chemicals
Define calluses
hyperkeratotic plaques
How do calluses occur?
When hyperplasia of keratinized cells with increased adhesion resulting in hyperkeratosis and decreased skin shedding
What are corns also known as?
Helomas
Define corns
small, well-circumscribed thickening of keratinous skin
What is a heloma durum?
Associated with corns: central, hard core; occur on dry, flat surfaces of skin; usually painful
What is heloma molle?
Associated with corns: soft; more common between toes and stay moist, keeping the surrounding skin soft; usually not as painful
Define pruritus
defined as an unpleasant sensation of the skin that provokes the urge to scratch. Can be mild to severe.
What is the sensation of pruritus conducted by?
Type C neurons (small, mylenated) that transmit the signal to the brain
In pruritus, what is released by mast cells to activate itch receptors?
Histamine and tryptase
What can activate itch receptors?
Opioids and substance P
What can cause local activation of itch receptors?
Bradykinin and bile salts
Scratching is a ______ to pruritis.
spinal reflex
What are 2 concerns when scratching due to pruritis?
- often not localized and does not relieve pruritus
- can result in skin damage from excessive scratching
What are 2 antipruritics that can be used to help alleviate itching?
diphenhydramine & hydrocortisone
Define xerosis
dry skin
what causes xerosis?
dehydration of sebaceous glands in the stratum corneum
In what population is xerosis most common in?
Older adults. due to again, there are decreased secretions to help moisturize skin
Xerosis can lead to ____
pruritis, intense itching which results in damage
What should we do to prevent pruritis and xerosis?
- prevent friction
- prevent exposure to pruritic agents (avoid things that have reactions to & things such as poison oak/ivy)
- prevent drying of skin
How do pigmentary skin disorders arise?
malfunctioning in the melanocytes
If there is an absence of melanin production, this can result in
vitiligo and albinism
Define vitiligo
Melanocytes are not producing enough melanin which results in white patches on skin that are very localized area of skin. It is more common in dark pigmented people of all races; can occur in white people but not as often.
vitiligo can appear in any age but usually occurs some time after the age of, _______
20 years old
Etiology of vitiligo
unknown. Maybe related to genetics and autoimmunity.
Define albinism
A genetic disorder that is either complete or partial congenital absence of pigmentation in the skin, hair and eyes. Found in all races.
If there is an increase of melanin production, this can result in
mongolian spots & melasma
Define melasma
characterized by darkened facial macules. Common in all skin types but even more common in brown skinned people in Asia, Indian and south America.
Occurs in men but more common in women. Particularly during pregnancy or when taking contraceptives.
Define mongolian spots
Noticeable at birth and characterized as darkened skin as a result in increase melanin.
What are dermatomycoses?
Superficial fungal infections
What are the 2 types of dermatomycoses discussed?
Tinea & Candidal infections (yeast)
Define tinea pedis
“athletes foot” fungal infection of the feet.
Define tinea unguium
fungal infection of the fingernails and toenails, and the nail bed (onychomycosis)
Define tinea corporis
fungal infection of the arms, legs, and trunk
define tinea cruris
“jock itch” - fungal infection of the groin area
tip to help remember: “curtis” the jock has an itch
define tinea manuum
fungal infection of the hands and palm area
tip to help remember: a man (manuum) has bigger hands & palms
define tinea faciei
“face fungus”
define tinea capitis
fungal infection of the scalp and hair
tip to help remember: you wear a baseball cap (capitis) over your scalp and hair
define tinea barbae
fungal infestation of facial hair
tip to help remember: men grow facial hair and have to visit the barber (barbae)
define candidal infections
also known as “yeast infections” can occur on the skin and also oral and genital candiditis.
Primary topical antifungals
Azoles and non-azoles
How does Clotrimazole work?
alters cell permeability resulting in death of fungal cells
What is the prototype of topical antifungal
Clotrimazole
pharmacokinetics of clotrimazole
since applied topically, it is not absorbed systemically
Should not be used for prolonged periods of times to avoid tissue damage and resistance
Difference between primary bacterial infections and secondary bacterial infections?
Primary infection are superficial.
Secondary infections are deep cutaneous infections (more likely to see these cases)
What are the 2 types of primary bacterial infections?
impetigo & ecthyma
Define impetigo
A primary infection that appears as a small vesicle or pustule or as a large bulla on the face or elsewhere
Define ecthyma
ulcerative form of impetigo
List characteristics of secondary bacterial infections
- infected ulcer
- cellulitis
- treated with targeted antibiotics based upon what the organism that is causing the infection
What are the 3 viral infections discussed?
- Human papilllomavirus
- Herpes simplex virus
- Herpes zoster (“shingles”)
Define human papillomas
HPV & causes verrucae (warts) which are common beign papillomas.
Define herpes simplex virus
Type 1: spread by infected saliva. Causes oral herpes, canker sores, mouth sores
Type 2: genital herpes
Define herpes zoster
“shingles”
caused by reactivation of latent varicella-zoster virus (chicken pox) within the sensory dorsal root ganglia
Occurs in people with older age, poor immune function, and those who have had chicken pox before 18 months of age.
What does herpes zoster cause?
Postherpetic neuralgia which can be treated with anticonvulsants like gabapentin.
Basically the nerve body goes to the skin ending and produce noticeable blisters
Is a shingle vaccine available?
YES QUEEN
Define noninflammatory acne
Comedones which are plugs of materials that accumulate in sebaceous glands that open to the skin surface.
Comedones referred to as white heads and black heads
Define inflammatory acne
Papules, pustules, and in severe cases, cysts
Believed to develop from the escape of sebum into the dermis and the irritating effects of the fatty acids contained in the sebum
What are the 2 primary types of acne?
Acne vulgaris & acne conglobata
Define acne vulgaris
chronic inflammatory disease of the pilosebaceous unit
List the treatments for acne vulgaris
benzoyl peroxide (antimicrobial and comedolytic)
retinoids (increases cell turnover)
topical antibiotics (tetracycline, erythromycin, and clindamycin)
What would be the antibiotic to treat moderate to severe acne vulgaris?
oral tetracycline
What would be the antibiotic to treat severe acne vulgaris?
Isotretinoin
very effective but has many side effects. Patients have to be monitored very closely.
define acne conglobata
comedones or cysts have multiple openings, large abscesses, and interconnecting sinuses.
Discharge is odoriferous, serous or mucoid, and purulent
What type of people are affected by acne conglobata?
people with anemia with elevated WBC counts, sedimentation rates, and neutrophil counts
What are some treatments for acne conglobata?
debridement, systemic corticosteroids, oral retinoids, and systemic antibiotics
Define rosacea
chronic inflammatory process accompanied by vascular instability with leakage of fluid and inflammatory mediators into the dermis
What is rosacea accompanied by?
GI symptoms (H. pylori)
What is the treatments for rosacea?
Treated with acne meds. Topical metronidazole commonly used.
What are the 4 types of Rosacea?
Erythematotelangiectatic
Papulopustular
Ocular
Phymatous
Types of allergic and hypersensitivity dermatoses:
Contact dermatitis
Define contact dermatitis
Results from cell-mediated, type IV hypersensitivity response
Irritant contact dermatitis is caused by chemicals that irritate the skin
May be treated with anipruritics (antihistamine or corticosteroid)
Define contact dermatitis
Results from cell-mediated, type IV hypersensitivity response
Irritant contact dermatitis is caused by chemicals that irritate the skin
May be treated with antipruritics (antihistamine or corticosteroid)
3 Types of allergic and hypersensitivity dermatoses:
Contact dermatitis
Atopic dermatitis
Nummular eczema
Define contact dermatitis
Results from cell-mediated, type IV hypersensitivity response
Irritant contact dermatitis is caused by chemicals that irritate the skin
May be treated with antipruritics (antihistamine or corticosteroid)
Define atopic dermatitis
“atopic eczema”
inflammatory skin disorder that is characterized by poorly defined erythema, edema, vesicles, and weeping at the acute stage
Lichenification in the chronic stage
Treatment is multifaceted and includes use of emollients and topic corticosteroids
Define nummular eczema
coin-shaped papulovesicular patches involving the arms and legs
Lichenification and secondary bacterial infections are common
Define nummular eczema
coin-shaped papulovesicular patches involving the arms and legs
Lichenification and secondary bacterial infections are common
Define urticaria
“hives”
pale erythematous, blanchable, raised, itchy papules or plaques
What does immunologic urticaria or “hives” result in?
IgE hypersensitivity response where there is a release of histamine which causes hyper-permeability of capillaries in outer layers of skin
What does nonimmunologic urticaria or “hives” result in?
stress, temperature extremes, vibration.
Example: morphine and neuropeptides (associated with psychological hives)
Where do angiodemas occur?
in DEEP layers
Can be life-threatening if obstructs airway
What is a treatment for angiodemas?
antihistamines or leukotriene receptor blockers
What are drug-induced skin eruptions?
Systemic drugs that cause generalized skin lesions
Topical drugs are usually responsible for localized contact dermatitis types of rashes
Can result in skin detachment
3 Bullous skin lesions that caus drug-induced skin eruptions
Erythema multiforme minor
Stevens-johnson syndrome
Toxic epidermal necrolysis
Define papulosquamous dermatoses
Skin disorders characterized by scaling papules and plaques
- psoriasis
- pityriasis rosea
- lichens planus
3 types of arthropod infestations
- scabies
- pediculosis
- Ticks
3 types of arthropod infestations
- scabies
- pediculosis
- Ticks
Define scabies
infestation of the skin by the human itch mite
treated with permethrin or malathion
Define pediculosis
aka Lice - permethrin or malathion
Rocky mountain spotted fever comes from ticks, what bacteria is it caused from? What is the treatment?
Rickettsia
Doxycycline
What does permethrin or malathion treat?
Scabies and pediculosis
What does doxycycline treat?
Rocky mountain spotted fever
Lyme disease
Lyme disease comes from ticks, what bacteria is it caused from? What is the treatment?
Borrelia
Doxycycline
Lyme disease comes from ticks, what bacteria is it caused from? What is the treatment?
Borrelia
Doxycycline
Define UVC rays
short (100-289 nm)
do not pass earth’s atmosphere
Define UVB rays
290 to 320 nm
responsible for nearly all skin effects of sunlight
Define UVA rays
321 to 400 nm
can pass through window class, are more commonly referred to as sun tanning rays
Define UVA rays
321 to 400 nm
can pass through window class, are more commonly referred to as sun tanning rays
What are the acute effects of UV rays?
Short lived and reversible
- erythema
- pigmentation
- injury to langerhans cells and keratinocytes
What are chronic effects of UV rays?
- Directly damaging skin cells
- Accelerating the effect of aging on skin
- Producing changes that predispose the development of skin cancer
When a sunburn occurs, what layers of the skin are experiencing excessive UV radiation?
epidermal and dermal layers
Sunburn is a result in what kind of reaction?
Erythematous inflammatory reaction
What are the symptoms of severe sunburn?
inflammation, blistering, weakness, chills, fever, malaise, and pain
Define photosensitive
exaggerated response to UV light when the drug is taken in combination with sun exposure
Define pressure ulcers
ischemic lesions of the skin and underlying structures caused by unrelieved pressure
oxygen is not being delivered well to the tissue causing an ulcer
What 4 factors contribute to the development of pressure ulcers?
- pressure
- shear force
- friction
- moisture
4 ways to prevent pressure ulcers
- Identifying at-risk persons who need preventative measures and the specific factors placing them at risk
- Maintaining and improving tissue tolerance to prevent injury
- Protecting against the adverse effects of external mechanical forces (i.e. pressure, friction, and shear)
- Reducing the incidence of pressure ulcers through educational programs
Define nevi
aka moles - benign tumors of the skin that predispose individual to cancer
2 types of nevi
nevocellular nevi
dysplastic nevus
dysplastic nevus has a great tendency to what?
transform into cancer cells
3 major types of skin cancer
- Malignant melanoma
- basal cell carcinoma
- Squamous cell carcinomas
Define malignant melanoma
rapidly progressing malignant tumor of the melanocytes
Define Basal cell carcinoma
neoplasm of the nonkeratinizing cells of the basal layer of the epidermis
most common skin cancer in white-skinned people
Define squamous cell carcinomas
second most frequently occurring malignant tumors of the outer epidermis
4 types of melanomas
- superficial spreading
- nodular
- lentigo maligna
- acral lentiginous
Define superficial spreading melanoma
characterized by raided-edge nevus with lateral growth
Define nodular melanoma
26.45!!!!!!
