CCP S3 Integumentary Flashcards
macule
patch
papule
plaque
nodule
vesicle
pustule
bullae
petechiae
purpura
ecchymosis
scale
crust
fissure
erosion
ulceration
scar
excoriation
3 layers of the skin
hypodermis, dermis, and epidermis.
role of The skin
- serves as a barrier to the external environment (innate immune system)
- protects against external toxins and microbes (innate immune system)
- plays a role in fluid and electrolyte homeostasis and temperature homeostasis
define Primary skin lesions
lesions arising directly from the underlying disease process
define Secondary skin lesions
result from scratching, treatment, healing, or complicating infection
Nikolsky’s sign
Gentle rubbing of the skin results in sloughing of the top layer of the epidermis
Macule
Flat, circumscribed, pigmented area
<0.5 cm in diameter
Patch
Flat, circumscribed, pigmented area
>0.5 cm in diameter
Papule
Elevated, solid, palpable lesion of variable color
<0.5 cm in diameter
plaque
Elevated, solid, palpable lesion of variable color
>0.5 cm in diameter
Nodule
Solid, palpable, SC lesion
<0.5 cm in diameter
Vesicle
Elevated, thin-walled, circumscribed, clear fluid-filled lesion
<0.5 cm in diameter
Pustule
Elevated, circumscribed, purulent fluid-filled lesion
Any
Bullae
Elevated, thin-walled, circumscribed, fluid-filled lesion
>0.5 cm in diameter
Petechiae
Flat, erythematous or violaceous non-blanching lesion
<0.5 cm in diameter
Purpura
Erythematous or violaceous non-blanching lesion; may be palpable
>0.5 cm in diameter
Scale
Thickened area of epithelium
any size
Crust
Dried area of plasma proteins
any size
Fissures
Deep cracks in skin surfaces
any size
Erosions
Disruption of surface epithelium
any size
Ulcer
Deep erosion extending into dermis
any size
Excoriation
Linear erosions typically secondary to scratching or rubbing
any size
Hyperpigmentation
Increase in melanin-containing epidermal cells
any size
Lichenification
Abnormally dense layer of keratinized epidermal cells
any size
SJS vs TENS diagnosis
SJS/TENS are the same disease on a spectrum. differentiated by BSA affected
SJS = <10% of the BSA
TENS = >30% BSA
SJS–TENS overlap syndrome occurs when 10%-30% BSA is involved
vesicles, blisters, peeling, and mucous membrane involvement w/ positive Nikolsi Sign with a flu-like prodrome
Stevens-Johnson Syndrome (SJS)
one of the only interventions shown to improve outcomes in SJS/TEN
transfer to a tertiary burn center
Therapeutic Considerations in SJS/TEN
- Discontinue offending agent.
- supportive care (crystalloid resuscitation, wound management, prevention of secondary infection)
- transfer to burn unit
- High-dose IVIG, plasmapheresis, or both may be indicated for patients with severe TEN or SJS
Erythema, dark-red purpuric macules, target lesions, flaccid blisters, confluent erythema, sheet-like sloughing, and mucosal erosions affecting >30% BSA
Toxic Epidermal Necrolysis (TEN)
risk factors for necrotizing soft tissue infection
- IVDU
- Recent surgery, childbirth, or other soft tissue wounds and trauma
- Diabetic foot ulcers and decubitus ulcers
- Wounds occuring in an aquatic environment
- Varicella infection
- Peripheral arterial disease
- Diabetes
- Cirrhosis
most common pathogen identified in NSTI
Group A Streptococcus (GAS)
type 2 NSTI
Monomicrobial (type II) necrotizing infection is most commonly caused by group A Streptococcus (GAS)(and other beta-hemolytic streptococci). It may occur in any age group and in individuals with no underlying comorbidities.
type 1 NSTI
Polymicrobial (type I) necrotizing infection is caused by aerobic and anaerobic bacteria. It usually occurs in older adults and/or in individuals with underlying comorbidities including diabetes.
Skin Crepitus
- skin that feels crackly when it is palpated
- suggests that gas is present in the soft tissues.
- This suggests necrotizing infection
risk factors for cellulitis
- Skin barrier disruption due to trauma
- Skin inflammation (eczema, radiation therapy)
- Edema due to impaired lymphatic drainage
- Edema due to venous insufficiency
- Obesity
- Immunosuppression (diabetes, steroids or HIV)
- Breaks in the skin between the toes
- Preexisting skin infection (such as tinea pedis, impetigo, varicella)
what is toxic shock syndrome?
bacteria produce superantigens that are able to activate large numbers of T lymphocytes, resulting in the massive release of inflammatory mediators, including interleukins, tumor necrosis factors, and interferon
Diagnostic criteria for streptococcal toxic shock syndrome
- Presence of group A streptococcal infection
- Hypotension
- Two of the following:
- renal impairment
- liver abnormalities
- acute respiratory distress syndrome
- Coagulopathy
- necrotic soft tissue infection
- rash
Clinical manifestations that suggest a necrotizing infection
- signs of systemic toxicity, including abnormal vital signs,
- severe pain or pain out of proportion to physical findings,
- altered mental status,
- rapidly advancing infection,
- crepitus,
- hemorrhage,
- sloughing,
common medication causes for SJS/TENS
- sulfa drugs
- nonsteroidal antiinflammatory drugs (NSAIDs),
- penicillin,
- aspirin,
- barbiturates,
- phenytoin,
- carbamazepine,
- allopurinol.
