Alterations in the Integumentary System Flashcards
what are primary and secondary lesions?
Primary: Retain original appearance
Secondary: Appearance is modified by normal progress over time or by external agents, such as scratching; may look dissimilar to the original lesion
Lesion Descriptions
Features of lesion should be noted:
-Size
-Symmetry
-Color
-Shape
-Number
-Distribution
Rubella versus rubeola?
Rubella
-Diffuse Macular rash
-Mild febrile state
-Cold-like symptoms
-Incubation 14-21 days
-Severe teratogenic effects in unborn fetus
-Immunization for prevention
Rubeola
-Morbillivirus
-Incubation 7-20 days
-Macular, blotchy rash
-Fever of >100°F
-Koplik spots on buccal mucosa
-photosensitivity
what is chicken pox
-Caused by varicella zoster virus
-3 stages of lesions: macule, vesicle, granular scab
-Rash starts on trunk & spreads to limbs
-Pruritus, cold-like symptoms
-Tx: antipyretic drugs, lukewarm baths, antihistamines, topical antipruritics
-Vaccination currently recommended
what is Scarlet fever?
-Systemic reaction to toxins produced by group A beta-hemolytic streptococci
-Pink skin rash on neck, chest, axillae, groin, & thighs
-Flushed face with circumoral pallor, fever, N/V, strawberry tongue
-Complications can develop
-PCN is treatment of choice
what is strawberry tongue?
Swollen, red, bumpy appearance.
what is verrucae (warts)?
-Common benign papillomas caused by HPV
-Exaggeration & irregular thickening of normal skin composition
-May resolve spontaneously if immunity develops
-Current tx: surgical removal by laser, liquid nitrogen, cryotherapy or salicylic acid paint/plaster
what is herpes simplex virus?
Two types of herpes virus infect the skin
1. HSV-1: Lesions common on lips, face, & mouth
2. HSV-2: Lesions in genital area
-Begin with burning or tingling sensation followed by vesicles, fever blisters, progress to pustules, ulcers, crusts & erythema
-Analgesics tx pain; antivirals shorten duration of outbreaks
what is herpes zoster (shingles)?
-Acute localized inflammatory dse of dermatome segment of skin caused by varicella zoster (chickenpox)
-Results from reactivation of the latent virus
-Extremely painful
-Eruption of vesicles unilaterally on erythematous base
-Systemic antiviral tx ASAP, preferably within 48 hrs
-Clears in 2-3 wks
what is impetigo?
-Acute contagious skin disease (bacteria) characterized by vesicles, pustules & yellowish crusts
-Etiology: Usually staphylococci or streptococci
-Tx: Topical application of 2% mupirocin ointment
-Oral abx used for those with large area of infxn & febrile
what is leprosy (hansen’s disease)?
-Chronic infectious dse caused by Mycobacterium leprae
-Dx is made with skin biopsy
-Effects skin, nerves, mucous membranes, causes disfigurement
-Can take 2 to 10yrs for symptoms to present
-Usually responsive to sulfone drugs
what is syphilis?
-STI caused by Treponema pallidum
-Primary syphilis: single chancre on genitalia
-Secondary syphilis: Disseminated rash
-Serum antibodies & exam of pustules for spirochete required for dx
-PCN is very effective tx
what are yeast infections? etiology? tx?
Etiology: most common Candida albicans
Tx: Topical antifungals or systemic tx may be used
Thrush
-White lesions with milky discharge, found in mouth
-Often d/t eradication of normal flora
-Tx: nystatin mouth rinse & clotrimazole troches
Intertrigo
-Irritant dermatitis on skin
-Infants & bedridden pts
what are scabies?
-parasitic infection
-Small erythematous papules overlying dry scaly crust
-Caused by a burrowing mite (Prefers finger webs, wrists, umbilicus, groin)
-Causes intense itching
-Hatch into larve in 3-4 days
what is rocky mountain spotted fever?
-Caused by tick that carries Rickettsia rickettsii; most states have reported cases
-Initial bite appears as papule or macule with or without central punctate area
-HA, fever, N/V, & muscle aches occur within 4-8days
-Tx requires hospitalization & abx therapy
what is lyme disease?
-Etiology: Bite of tick carrying spirochete B. burgdorferi
-Symptoms: Multiple, affecting skin, nervous system, heart, & musculoskeletal system
-Single or multiple erythematous papules that itch, burn, or sting; flulike symptoms, bulls eye rash pattern
-Abx therapy required
what are fleas?
-Bites appear as small erythematous macules, erythematous papules, wheals, or vesicle
-Diethyltoluamide or pyrethrin insect repellents effective in preventing infestation
-Managed with soothing shake lotions or topical steroids
what is lice?
-parasitic infection
Phthirus pubis (crab lice), Pediculus capitis (head lice) & Pediculus corporis (body lice) most common in humans
-Surface dwelling, usually readily seen
-Eradication possible with permethrin cream rinse or pyrethrin & piperonyl butoxide liquid, gel, or shampoo
what is chiggers?
-Mites that reside in grass or bushes (common in south)
-Puncture of skin produces pruritic papules; secondary lesions are excoriations from scratching, may become infected by bacteria
-Tx is palliative; insect repellent encouraged for prevention
what are bedbugs?
-Cimex lectularius is reddish brown insect that turns purple after feeding on human blood; nocturnal feeders
-Produces painless, pruritic oval or oblong wheal with small hemorrhagic punctum at center; multiple lesions
-Topical antipruritics are used for treatment
-Professional extermination is advised
what are mosquito bites?
-raised, itching red lesion; usually occurring 8-12 hrs after bite
-Severe skin reactions are rare
-Insect repellents recommended for prevention, local antipruritics used for tx
what is acne vulgaris? etiology? tx?
-Disease of pilosebaceous unit
-Etiologies: Sex hormones, heredity, bacterial flora of skin, occlusion
-Pathogenesis: Sludging of oils, loose skin cells deposited which cause an obstruction of the follicular canal.
-Tx aimed at causing peeling of the stratum corneum
what is seborrheic dermatitis?
-Scaling & erythema (redness) in areas of oil gland concentration
-Cradle cap in newborns
-Dandruff in adults
-Controlled with topical medications
what is psoriasis? Etiology? Patho? CM?
Chronic, relapsing, proliferative skin disease.
Etiology is unknown, possibly auto immune
Pathogenesis
-Dermis & epidermis thicken
-Cellular proliferation & inflammation
Manifestations
-Silvery plaques, redness
what are the types of allergic skin responses? atopic dermatitis? Contact dermatitis? Drug eruptions?
Atopic dermatitis (eczema)
-Highest incidence children: Oozing, crusting, itching
-In adults: Dry scaling
Contact dermatitis
Cutaneous rxn to topical irritant, hypersensitivity to specific antigen
-Poison Ivy
-erythema, swelling, itching
Drug eruptions
occur within 1 wk of drug exposure
-Maculopapular rash
-Women>men
-Rxs implicated; -cillins & cephalosporins
what is sunburn and photosensitivity?
-Extremely harmful due to short UV wavelength
-Manifestations: erythema, pain, heat, blistering, edema & tenderness
-Severe: chills, fever, nausea, generalized discomfort
-Prevention: limit exposure, sunscreen, protective clothing
-Tx: Cold water baths/compresses, topical steroids
Effects of Sunlight
-Produces direct local effects on skin in form of elastotic syndromes, keratoacanthomas, premalignant dses, basal cell epitheliomas, and squamous cell epitheliomas
-Indirect and direct sunlight can produce malignant melanomas
what is vitiligo? Tx?
-Pigment disappears from patch of skin; sudden onset; may be associated with pernicious anemia, diabetes & hyperthyroidism
-Tx may consist of topical immunomodulating agents as well as use of various types of ultraviolet light
what is albinism?
-Lack of melanin/pigmentation in skin/hair d/t inborn error in metabolism
-Eyes may show nystagmus & lack of pigment of fundi
-Sunscreens & protective clothing used to prevent UV damage
what are pressure ulcers? RF? what are the stages?
-Most common in bedridden or elderly patients
-Skin: small vessels occluded-> ischemia-> cell necrosis
-Tx: Reinforce preventative measures, nutrition, infection control, wound care
Risk factors:
Immobility
-Friction
Malnutrition
Excessive moisture
Neurological factors
Peripheral vascular impairment
Age
Fever/infection
Medications
Extrinsic factors
-Pressure
-Shear
-Foreign objects in bed
Stages:
Stage 1: Reddening of skin. Does not disappear when pressure relieved
Stage 2: Superficial circulatory & tissue damage. May appear as blister
Stage 3: Destruction of subcutaneous layers
Stage 4: Destruction of subcutaneous capillaries, muscle mass & possibly bone
what is burn injury? causes? how are the depths classified?
Causes
Heat (dry or moist), Electricity, Chemicals, Friction, Radiant or electromagnet energy
Integument Effects of Burn Injury
2 phases
1st is immediate–direct cellular injury
2nd is delayed–progressive dermal ischemia
Superficial (1st degree)
-Involves epidermis; reddened, blister formation
Superficial partial thickness (2nd degree)
-Epidermis to level of dermis
-Blistered, red to pale ivory, very painful
Deep Partial thickness (deep 2nd degree)
-Involves entire dermis, hair follicles intact
-Mottled appearance
-Tactile & pain sensors absent or diminished
Full thickness (3rd degree)
-Entire epidermis, dermis & underlying subcutaneous tissue
-White, dry, hard, leathery
-Painless
-May require skin grafting
4th degree
-Involved muscle, bone or both
-High voltage electricity, prolonged exposure to intense heat
