Ch. 46 Disorders of Skin Integrity and Function Flashcards
What is tinea corpus?
Ringworm
Who is most prone to tinea corpus (ringworm)?
Children.
How is tinea corpus (ringworm) transmitted?
Transmission from kittens, puppies, and other children.
What is the appearance of tinea corpus? (ringworm)
Circular/oval lesions on trunk, back, buttocks Red papule with sharp border Central clearing Pruritus, mild burning, erythema
What is tinea capitis?
Fungal infection on the head. Usually on scalp and shaft of hair.
What is the appearance of primary tinea capitis lesions?
Primary lesions are gray, round, hairless patches.
What is the appearance of the inflammatory type of tinea capitis?
Delayed hypersensitivity
Pustular, scaly, round
Can evolve to bacterial infection
What is tinea pedis?
Athlete’s foot. It occurs between the toes, soles/sides of feet.
What are the risk factors for tinea pedis?
Men Barefoot in public swimming pools, saunas, etc Sharing area/clothes with someone with infection Recurrance with exercise/sweating
What is the appearance of tinea pedis (Athlete’s foot)?
Mild to inflamed lesion
Possible exudate
Painful pruritis
Foul odor
What is candidiasis?
Yeast-like fungus: Candida albicans Normally in GI tract, mouth, vagina Thrives in warm, moist areas of skin Oral infection can be d/t long-term antibiotic use initial sign of human immunodeficiency virus (HIV)
What is the appearance of candidiasis?
Red rash with well defined border
Pruritus, burining
Can form pustules, infection
What is impetego?
Common in infant and young children
Usually d/t staphylococci or steptocci
What is the appearance of impetego?
Small vesicles on face (usually)
Ruptures honey-colored serous that hardens and crusts
Pruritus
Multiplies with scratching
What is cellulitis?
Deeper infection of dermis and subcutaneous tissue
Normal skin flora or exogenous bacteria
How is cellulitis transmitted?
Transmission via previous skin opening/injury
Handling fish
Swimming
Animal bites
What are the manifestations of cellulitis?
Red, edematous, shiny
Possible fever, pain
Can result in septicemia
if not treated properly
What is necrotizing fasciitis?
Rare bacterial infection.
Usually streptococcal but can be others.
Involves deep skin and facial plane of subcutaneous tissues.
What are the risks for necrotizing fasciitis?
Immunocompromised
Cancer
Diabetes
Recent major infection
What are the manifestations of necrotizing fasciitis?
Red, swollen, painful area that expands quickly
Signs/symptoms of inflammation/infection
Progressive to sepsis
What is the treatment for necrotising fasciitis?
Needs to be immediate
Antibiotics - high doses
Surgical debridement
What are verrucae?
Warts.
Benign human papilloma virus lesion
There are multiple kinds/shapes/sizes
How are verrucae (Warts) transmitted?
Direct contact via break in skin
Sexual contact for genital warts
Non-genital warts are common
What is the appearance of verrucae (warts)?
Small, gray-white to tan flat papules with rough surface
What is herpes simplex (cold sore) associated with?
Associated with oropharynx infections (Type 1)
What are the triggers of herpes simplex outbreaks?
Stress, menses, infection, UV burns
How is herpes simplex transmitted?
It is transmitted while active.
Direct contact with infected saliva
Skin contact via athletics/dentistry/healthcare
Sexual contact (usually results in Type 2)
What is the appearance of herpex simplex type 1 (cold sores)?
Burning, tingling pustules that crust and heal
Common on face, mouth, nasal septum
More often and severe if immunocompromised
What is herpes zoster?
Shingles.
Result of reactivation of latent varicella-zoster virus infection dormant in dorsal root ganglia since primary childhood infection. It travels up the dermatome. It is only transmitted when active.
What are the risk factors for shingles?
History of chicken pox varicella-zoster infection Age HIV, immunosuppression Malignancies Corticosteroid/chemo/radiation therapy
What are the manifestations of herpes zoster?
Burning pain, pruritis Sensitive skin Vesicles form, erupt, Crust, fall off 2-6 weeks
What are the complications of herpes zoster?
Neuralgia 1-3 months after skin clears (common)
Blindness if contact with eyes (permanent, rare)
What is acne vulgaris?
Lesions of face, neck, back (usually) d/t increased testosterone during puberty
85% of teens
Self-esteem issues
Familial connection
What is non-inflammatory acne vulgaris?
Sebaceous glands plug up
Blackheads: melanin moves into gland
Whitehead: pale, fatty acid irritation
What is inflammatory acne vulgaris?
Pustules, nodules, cysts
What is rosacea?
Chronic inflammatory skin disorder of UKE
Usually affects middle-aged adults, women
What are the manifestations of rosacea?
Repeated “blushing” episodes, eventually remains
Usually nose, cheeks
Inflammatory facial pustules, nodules, edema
Dry, itchy, burning eyes
Telangiectasia
Skin thickens and is sensitive
to heat
What is psoriasis?
Chronic skin inflammation
3rd decade onset
What are the risk factors for psoriasis?
Heredity, age
What are the manifestations of psoriasis?
Elbows, knees, scalp, lumbosacral, intragluteal cleft
Well-defined red plaques with silver scales
Hyperkeratosis: epidermal thickening over time. Permanent damage to capillaries leads to bleeding points under scales.
What is UVA (and what does it do)?
Ultraviolet radiation not absorbed by ozone. Deep penetration and immediate effect (tan).
What is UVB?
Ultraviolet mostly absorbed by ozone.
Delayed response, more genotoxic (burn)
d/t free radical formation
damage to cellular proteins and DNA
What is a first degree thermal burn?
Outer epidermis Pink/red/dry/painful Usually without blister (like a sunburn) Skin can still “function” Heals in 3-10 days
More serious with infants/elderly
What is a second degree burn?
Epidermis and dermis is involved.
What is a partial-thickness second degree burn?
Red, painful, moist, blister that weep
Sensitive to touch/heat/air
Intact blisters help maintain body fluids
Heals in 1-2 weeks
What is a full-thickness second degree burn?
Hair follicles and sweat glands remain intact
Mottled pink/red or waxy with flat, dry blisters, edema
Loss of sensation possible
Scarring
1 month to heal
What is a third degree burn?
Involves subcutaneous tissue, possible muscle & bone.
Waxy white/yellow/or tan/brown/black
Extensive edema
Can be no pain but seldom exists without 1st and 2nd degree burn pain
In burns, what is the “rule of nines”?
Head & neck 9% Each arm 9% (x2) Each leg 18% (x2) Anterior trunk 18% Posterior trunk 18% Perineum 1%
What are the hemodynamic complications of burns?
Injury to capillaries & surrounding tissues
Fluid loss = hypovolemic shock
What are the respiratory complications of burns?
Smoke inhalation
CO, toxins, ammonia, chlorine, sulfur dioxide
Damage to mucosa = bronchospasm, edema
Thermal injury
Resulting pneumonia, pulmonary embolism, pneumothorax, etc
What are the hypermetabolic response complications of burns?
Catecholamine and cortisol released in response to stress
Muscle/fat wasting, glucose stores depleted
Heat production is increased due to heat losses from burned area
Why is sepsis a serious complication of burns?
Burn site is ideal for microorganism growth.
What are circumferential burns?
Encircle body or body part. Healing to “eschar” constricts (leathery) and must be removed/lysed. (Escharotomy/fasciotomy)
What are the treatments of burns?
Active cooling Fluids Hemodynamic balance Nutrition Analgesia Wound care
What are ways to protect burn wounds?
Antimicrobial Skin grafts Autograft (from own body) Homograft (from another person, alive or not) Heterograft (from another species) Synthetic
What are decubitus ulcers? (What causes them)
"bedsores" Pressure Shearing forces Friction Moisture
What are nevi?
Moles. Congenital or acquired benign skin tumors.
What is the appearance of nevi?
Pigment or not
Flat or elevated
Hairy or non-hairy
What are melanocytic/junctional/compound nevi?
Dysplastic nevi
Rough/pebbly surface, irregular shape
Capacity to transform into malignant melanoma, usually related to increased size
What is malignant melanoma?
Melanocytic tumor typically sun-exposed areas
Rapid progression
What are the risks for malignant melanoma?
Increased UV light exposure; h/o blistering sunburns
Family history of MM; h/o dysplastic nevus syndrome
Fair hair & skin, freckles
Immunosuppression
What are the manifestations of malignant melanoma?
Slightly raised, irregular border and surface
Independent or from previous nevi
May have erythema, tenderness, ulceration, bleeding
Often mottled (red/white/blue)
What two directions can malignant melanoma grow?
Radial (horizontal)
Vertical (down in to deeper dermis)
There is an increased risk of metastasis in vertical growth.
How is malignant melanoma diagnosed? (ABCDE)
Diagnosis A = asymmetry B = border irregularity C = color variegation D = diameter >6mm E = evolution
What is basal cell carcinoma?
Neoplasm of basal layer of epidermis
Most common neoplasm, rarely metastasizes
Slow-growing
What are the risk factors for basal cell carcinoma?
Fair skin, history of sun exposure
What are the manifestations of basal cell carcinoma?
Nodular: small flesh-colored/pink smooth translucent nodule enlarging over time
Superficial: scaly erythematous patch/plaque
What is squamous cell carcinoma?
Malignant tumor on sun-exposed area
Confined to epidermis for long periods, then converts to “invasive” stage
Usually older population
What are the risk factors for squamous cell carcinoma?
UV exposure
Arsenic, industrial tar, coal, paraffin
Men; rare if of African descent
What are the manifestations of squamous cell carcinoma?
Red-scaling, slightly elevated, irregular border
Shallow chronic ulcer, crusts
Can metastasize if not excised early
