Chapter 28 - Skin Disorders Flashcards
Epidermis
acts as a barrier against invading microorganisms, foreign particles from dirt and debris, chemicals, & UV rays
migration of keratinocytes
stratum corneum - stratum granulosum - stratum spinosum - stratum basale
melanocytes
synthesize and transfer to keratinocytes the pigment melanin, which blocks solar radiation
langerhans cells
aid immune system by collecting & presenting to lymphocytes foreign substances
Dermis
composed of connective tissue, provides mechanical support to epidermis and contains blood vessels,nerves, sweat glands, hair follicles, and sebaceous glands
Adnexal structures
hair, sebaceous glands, eccrine glands
sebaceous glands secrete
sebum
sweat glands
cools the surface of the body and internal organs (eccrine glands and apocrine glands)
nails
the nail matrix (white semilunar structure) synthesizes the keratinaceous nail plate
cafe au lait spots
areas of increased melanin; appear pale brown
pale/red skin
may be hereditary
cellulitis
infectious inflammation of deep skin structures
erythema and increased warmth
primary lesions
macules, papules, nodules, tumors, cysts, wheals, vesicles, bull, pustules
secondary lesions
excoriations (result from primary lesions that have been manipulated)
hyperkeratosis
epidermal skin layer increases in thickness where constant pressure/friction is applied externally
hyperkeratosis etiology
skin is less pliable and mechanical stress on hyperkeratotic skin can result in tears or cracks in the epidermis that are painful and could result in infection
hyperkeratosis prevention
properly fitted shoes and cushioning
hyperkeratosis s/sx
callus may be ovular, elongated, brownish, and or slightly elevated
hyperkeratosis management
exposure to rubbing/shearing forces should be minimized; use moisturizers, possibly carefully shave down calluses
blisters
shearing forces produce a raised area that contains a collection of fluid below/within epidermis
blisters etiology
sports associated with horizontal shearing
blisters prevention
talcum powder/petroleum jelly, socks/well fitted shoes, second skin or mole skin
blisters s/sx
sharp, burning sensation where “hot spot” is formed; may contain clear liquid or blood (blood blisters result when deeper skin is disrupted)
blisters management
leave blister intact for first 24 hours, then disperse fluid (do not cut off skin), clean and place a doughnut pad around dressed blister
soft corns and hard corns
types of hyperkeatosis
hard corns etiology
most serious - caused by pressure of shoes, hammertoes are usually associated with hard corns that form on top of deformed toes
soft corns etiology
result of the combo of wearing narrow shoes and excessive foot perspiration - usually b/w 4 and 5 toes
corns prevention
wear properly fitted shoes
soft corn s/sx
appears a circular piece of thickened, white, macerated skin
hard corn s/sx
on top of hammer toes, bony prominence is pushed against top of shoe
macerated
softened by wetting
corn management
properly fitted shoes and socks, small feet pad, keep toes separated
hyperhidrosis
excessive perspiration
hyperhidrosis etiology
emotional excitement often worsens sweating; palms sweat is syrup like; increases possibility of skin irritation and makes adherence of bandages difficult; calluses and blisters more likely to occur
hyperhidrosis management
using an astringent (alcohol) or an absorbent powder; aluminum chloride
chafing etiology
occurs in athletes who obese or have large limbs,
fiction/maceration (softening) of the skin in a climate of heat and moisture
chafing prevention
keep skin dry, clean, and friction free; groin - wear loose, soft cotton underwear
chafing s/sx
oozing wounds that develop into crusting and cracking lesions
chafing management
chafed area should be cleaned daily with soap and water, a medicated solution, and applying hydrocortisone cream
xerotic (dry) skin etiology
athletes exposed to the weather and who bathe often; decrease in humidity along with cold winds causes the skin to lose water
xerotic skin s/sx
skin appears dry with variable redness and scaling may be itching or cracking of skin
xerotic skin management
prevent water loss and replace lost water (shower once per day, use moisturizing soaps, use lotions)
Ingrown Toenails
nail grows into the lateral nail fold and enters the skin
ingrown toenails etiology
results from lateral pressure of poorly fitting shoes, improper trimming, or trauma
ingrown toenails prevention
properly fitted shoes and sock, cutting toenails straight across
ingrown toenails s/sx
skin swells and is painful, may grow purulent
ingrown toenail management
soak in hot water, lift nail from soft tissue and insert a piece of cotton
abrasion
top layer of skin is worn away, exposing capillaries;
would is easily infected is not cleaned
punctures
may introduce tetanus bacillus into bloodstream
lacerations
sharp/pointed objects tears the tissues - susceptible to severe infection
skin incision
cut is smooth
skin avulsions
skin is torn from the body; keep avulsed tissue for possible reattachment
skin bruises
ecchymosis results from disruption of superficial blood vessels (RICE)
wound management
clean all wounds with soap and water, dress it with antiseptic
most lacerations/puncture wounds should be treated by a physician
who decides if sutures are required
a physician
staphylococcus
genus of gram-positive bacteria that commonly appear in clumps on the skin and in the upper respiratory tract. common cause of skin infection
streptococcus
also a genus of gram-positive bacteria, appears in long chains. some species are among the most dangerous bacteria that affect humans (scarlet fever), often cause skin infections
impetigo contagiosa
primarily in children in late summer and early fall (bacterial)
impetigo contagiosa etiology
caused by streptococci or S. aureus - spread rapidly by close contact (wrestling)
impetigo contagiosa s/sx
mild itching and soreness, followed by eruption of small vesicles and/or pustules that rupture to form honey-colored crusts - often develops in body folds subject to friction
impetigo contagiosa management
thoroughly clean crusted area and apply topical antibacterial agent
furunculosis: medical term for _______
boils
furunculosis etiology
infections of the hair follicle that usually result in pustule formation (staphylococci)
furunculosis s/sx
back of neck, face, buttocks most affected
pustules may be enlarged, reddened and hard from internal pressure
most will mature and rupture spontaneously, emitting pus - DO NOT SQUEEZE
pustules on the face can be dangerous, especially if they drain into veins that lead to brain
furunculosis management
protect furuncle from further irritation, administer antibiotics, keep athlete from contact with team while boil is draining
carbuncles
develop from staphylococci. similar to furuncles
carbuncles s/sx
carbuncles are larger and deeper and usually have several openings in the skin
could cause a systemic infection
carbuncles generally seen around
back of neck
first a dark red, hard area and in a few days emerges
into a lesion that discharges yellowish-red pus
carbuncles management
surgical drainage combined with antibiotics administration
folliculitis
inflammatory condition of the hair follicle (beard, scalp, groin, buttocks)
folliculitis etiology (occlusive, PFB, infectious)
caused by no infections or infections agents
occlusive: moist/warm environments
psuedofolliculitis barber (PFB) - penetration of skin by curved hair
Infectious: bacteria, yeast, mites
folliculitis s/sx
redness around follicle, development of a papule or pustule at the follicle opening,
may cause scarring/permanent baldness in the affected area
folliculitis management
apply noise heat intermittently to increase circulation, antibiotics may be applied locally
hidradenitis suppurativa
chronic inflammatory condition of the apocrine glands or large sweat glands
hidradenitis suppurativa etiology
often occurs in axilla, scrotum, labia major, and nipples
exact cause is unknown
hidradenitis suppurative s/sx
begins as small papule
grow to size of small tumor filled purulent material
deep dermal inflammation can occur - causing large abcesses
hidradenitis suppurativa management
avoid use of antiperspirants/deodorants, shaving creams
use medicated soaps
apply prescribed antibiotic lotion
acne vulgaris
inflammatory disease involving hair follicles and sebaceous glands
acne vulgaris etiology
characterized by close comedones (whiteheads), open comedones (blackheads), papule, pustules, and cysts; sex hormones may contribute
acne vulgaris s/sx
face, neck, back
deep lesions may scar
athlete may have emotional issues
acne vulgaris management
variety of topical and systemic agents (antibiotics), manipulation of hormone levels, washing with mild soaps, use cosmetics that are non-comedogenic
paronychia and onychia
purulent infection of the proximal and/or lateral nail folds
paronychia and onychia etiology
staphylococci, streptococci and fungal organisms that accompany contamination of open wounds/hangnails;
common in football lineman; loss of cuticle is a risk factor
paronychia and onychia s/sx
painful, bright red swelling of nail fold (acute);
accumulation of purulent material
paronychia and onychia management
soak affected finger in hot water with epsom salts, topical antibiotics, removal of purulent material may have to be done through a skin incision
tetanus infection etiology
tetanus (lockjaw) is an acute infection of the CNS by tetanus bacillus
tetanus infection s/sx
stiffness of the jaw and muscles of the neck, muscles of facial expression become painful, muscles of back and extremities become tetanic, fever elevates, can be fatal
tetanus infection management
acute infection - treat in an intensive care unit, must get shot,
immunization should start at age 6 and get given every 5-10 years
Fungal infections
group of organisms that include yeasts and molds
ringworm (tinea)
superficial fungi infection takes place in superficial keratinized tissue found in hair/nails and the stratum corner of the epidermis
Dermatophytes
Ringworm Fungi
many different variations
cause of most skin, nail, and hair fungal infections; belong to 3 genera: Microsporum, Trichophyton, Epidermophyton
tinea capitis
ringworm of the scalp; common in children
tinea capitis s/sx
small pap
tinea capitis management
creams typically
tinea unguium/ onychomycosis
ringworm of the nail; seen in water athletes or chronic athletes foots
tinea unguium/ onychomycosis s/sx
nail becomes thickened, brittle, and separated from its bed (trauma predisposes)
tinea unguium/ onychomycosis management
creams typically do not penetrate nail; often systemic antifiungals or surgical removal of nail is required
tinea curries/ “Jock Itch”
ringworm of the groin
tinea curries/ “Jock Itch” etiology
bilateral and often symmetric red-brown scaling plaque with a snakelike border
tinea curries/ “Jock Itch” s/sx
mild to moderate itching, resulting in scratching and the possibility of a secondary bacterial infection
tinea curries/ “Jock Itch” management
will respond to OTC meds (ointments most commonly used); secondary bacterial infection is common and oral prescription may be necessary
Erythrasma
a bacterial infection, may mimic tinea curries but lacks scaling
tinea pedis/athletes foot
tricophyton species are the most common causes
tinea pedis/athletes foot etiology
itchy, dry, scaling infection of the sole of the foot; web-space infection between toes often caused by T. mentangrohpytes with the yeast Candida
tinea pedis/athletes foot s/sx
extreme itching on sole of foot, between and on top of toes, appears as a dry, scaling patch or inflammatory , scaling red papule that may coalesce to form larger plaques; secondary bacterial infection from itching is possible
tinea pedis/athletes foot management
topical antifungals, *good foot hygiene
candidiasis (Moniliasis)
yeastlike fungus that can produce skin, mucous membrane, and internal infections
candidiasis (Moniliasis) etiology
occurs if the environment is right (hot and humid weather, tight nothing, and poor hygiene)
candidiasis (Moniliasis) s/sx
occurs in body folds (axilla, groin); both candidate and non candidate intertrigo present as beefy red patches but candidate can be distinguished by its satellite pustules.
candidiasis (Moniliasis) management
maintain a dry area, anti-fungal creams
tinea versicolor
common fungal infection of young adults
tinea versicolor etilogy
caused by yeast Malassezia furor (a normal part of the skin’s flora, occurring in areas where sebaceous glands actively secrete body oils
tinea versicolor s/sx
multiple, small, circular macule that are pink, brown, or white. They commonly occur on the abdomen, neck, and chest. the lesions do not tan when exposed to the sun and are asymptomatic
tinea versicolor management
selenium sulfide shampoo, or topical econazole nitrate
Herpes Simplex Labialis, Gladiatorum, and Herpes Zoster
Type 1 is extra genital
type 2 is genital
Herpes Simplex Labialis, Gladiatorum, and Herpes Zoster etiology
highly contagious and usually transmitted directly through a lesion on the skin or mucous
membrane; after the initial outbreak, it remains dormant and further attacks may be triggered by sunlight,
emotional distress, illness, fatigue, infection.
Herpes Simplex Labialis, Gladiatorum, and Herpes Zoster s/sx
local swelling followed by appearance of vesicles; vesicles generally rupture in 1-3 days, spilling out serous material that will form a yellowish crust (lesions heal in 10-14 days)
general malaise with sore throat and lymph gland swelling may occur
herpes simplex gladiators
herpes simplex gladiatorum
lesions on the side of the face neck or shoulders (wrestlers)
Herpes Simplex Labialis, Gladiatorum, and Herpes Zoster management
therapy usually directed at reducing pain and promoting early healing; antiviral drugs may shorten the course and reduce the recurrence of outbreaks
Herpes Simplex Labialis, Gladiatorum, and Herpes Zoster complications
can lead to secondary infection (kerato-conjunctivitis=inflammation of cornea and conjunctiva that could lead to loss of vision)
Verruca plana
flat wat
verruca plantaris
plantar wart
Condyloma acuminatum
venereal wart
verruca viras and warts
The human papillomavirus uses the skinUs epidermal layer for reproduction and growth. The verruca wart enters
the skin through a lesion that has been exposed to contaminated fields, floors, clothing, or other warts
common wart
verruca vulgaris and plans are prevalent on the hands of children
common wart s/sx
appears as a small, round, elevated lesion with rough, dry surfaces; may be painful if pressure applied; warts are subject to secondary bacterial infection (esp. warts on hands and feet)
common wart managment
topical salicylic acid or liquid nitrogen and electrocautery
plantar warts
found on the sole of the foot; can be spread to hands or other body parts
plantar warts s/sx
appear as an area with excessive epidermal thickening and cornification; produce general discomfort and point tenderness; major characteristic is hemorrhagic puncta (look like clusters of small black seeds)
plantar warts management
application of a keratolytic, liquid nitrogen or electrodessication, protect with a donut pad
molluscum contagiosum
poxvirus infection; more contagious than warts (especially during direct body contact activity) - must be immediately referred to a physician
molluscum contagiosi s/sx
small flesh or red-colored smooth-domed papules with a central umbilication
molluschi contagiosum management
thorough cleansing and using a destructive procedure (use of a powerful counterirritant, surgical removal of the lesion, or cryosurgery using liquid nitrogen)
allergic reactions
an allergy is an immunologically mediated reaction to allergen molecules against which the body’s immune system has been previously sensitized
Contact dermatitis:
allergic contact dermatitis represents an immunologically mediated reaction to a foreign substance, while irritant contact dermatitis represents a non-immunologic reaction to a chemical irritant
contact dermatitis etiology
most common plant causes include poison ivy, poison oak, sumac, ragweed, and primrose; chemicals; adhesive in athletic tape
contact dermatitis s/sx
skin reacts with redness, swelling, and the formation of vesicles that ooze fluid and form a crust. A constant itch develops (increased with heat and made worse by rubbing); secondary infection as a result of scratching is common; over time, appearance may change to erythematous, scaling, lichenified papules and plaques
contact dermatitis management
identify and avoid irritant (may require extensive testing); topical corticosteroids
milaria (prickly heat)
occurs most often during the hot season in athletes who perspire profusely and who wear heavy clothing
milaria (prickly heat) etiology
continued exposure to heat and moisture causes retention of perspiration by the sweat glands and subsequent miliaria
milaria (prickly heat) s/sx
itching and burning vesicles and pustules (arms, trunk, bending areas of the body)
milaria (prickly heat) management
avoidance of overheating, frequent bathing with a non-irritating soap, wearing loose-fitting clothing, and the use of antipruritic lotions
chilblains (pernio) etiology
common type of dermatitis caused by excessive exposure to cold
chilblains (pernio) s/sx
tissue does not freeze but reacts with edema, reddening, possibly blistering, and a sensation of burning and itching after exposure to cold
chilblains (pernio) management
exercise and a gradual warming of the part; massage and application of heat are contra-indicated
Burns
may result from excessive exposure to thermal, chemical, electrical, or radiation sources
sunburn
represents an inflammatory response to UV radiation-induced skin damage
sunburn etiology
thin, white skin tends to absorb more radiation than more pigmented individuals; medications may also cause an adverse response to sun exposure
sunburn s/sx
appears 2-8 hours after exposure; prevention by sunscreen is recommended; continued overexposure to sunlight may result in chronic skin thickening, damage, and skin cancer
sunburn management
mild burns are treated using cool water in a shower or bath; aloe-based compounds are also beneficial; moderate and severe burns can be relieved by a tub bath with cornstarch
Psoriasis etiology
relatively common chronic disease of the skin that causes itching (exact cause is unknown); certain conditions such as infection, smoking, some drugs, climate and may be hormonal factors may cause an outbreak
Psoriasis s/sx
lesions begin as reddish papule that collectively form plaques with distinctive borders; lesions may progress to a yellowish-white, scaly appearance; most likely to occur on elbows, knees, scalp, genitalia, and trunk (particularly around umbilicus)
Psoriasis management
topical glucocorticoids with a kerolytic agent
scabies etiology
caused by mite Sarcopotes Scabiei which produces extreme nocturnal itching; the mite burrows a tunnel into the skin to deposit its eggs
scabies s/sx
burrows appear as dark lines between the fingers, toes, body flexures, nipples, and genitalia
scabies management
topical application of permethrin (Elimite); all bedding and clothing should be washed with hot water; secondary infection due to itching is common
Lice (Pediculosis) etiology
head lice (Pedicures humans capitis), pubic lice (Phthirus pubis), or body lice (Pedicures humans corporis - lays eggs in seams of clothing)
Lice (Pediculosis) s/sx
the louse’s bite causes an itching dermatitis (itching provokes pustules and excoriations)
Lice (Pediculosis) management
NIX (synthetic pyrethroid permethrin) shampoo/cream; wash all clothes and bedding in hot water
Fleas etiology
fleas are small, wingless insects that suck blood; individually, bites cause only minor discomfort
fleas s/sx
a large number of biting fleas will be very uncomfortable; most fleas bite in patterns of three and concentrate their bits on the ankle and lower leg
fleas management
prevent itching with an antipruritic lotion (calamine or a topical corticosteroid). scratching could result in secondary infection
Ticks etiology
parasitic insects that are carriers of a variety of micro-organisms that can cause Rocky Mountain spotted fever or Lyme disease (can become easily attached to athletes because they live in grass and bushes)
Ticks s/sx
RMSF & Lyme disease are characterized by headache, fever, malaise, myalgia, and rash
RMSF
petechiae and purapura (small dark spots that retain their color when pressure is applied) localized to the distal arms, legs, hands, and feet
Lyme disease
erythema chronicum migrans (annular red ring) is the typical rash of Lyme disease
Ticks management
apply mineral oil or fingernail polish to the tick body, at which time it will remove its head (and can thus be removed by grasping or pulling the tick by its head)
Mosquitos etiology
unless a carrier of a disease, it produces a bite that causes milk discomfort, usually attached to lights, dark clothing, and warm, moist skin
mosquitoes s/sx
the bite produces a small reddish papule; multiple bites may lead to a great deal of itching
mosquitoes mangement
topical medication to relieve itching (calamine lotion or topical corticosteroids); repellants
stings etiology
hypersensitive athletes may respond with an allergic reaction that may be fatal (must be closely monitored in case of anaphylactic reaction); stings to the head, face, and neck are particularly dangerous
stings s/sx
increased heart rate, fast breathing, chest tightness, dizziness, sweating, and even LOC
stings management
in uncomplicated situations, the stinger must be removed with tweezers, apply detergent soap
spider bite etiology
bite marks are usually too small to be seen; spiders don’t bite more than once
black widow bite
shiny black spider with red to orange colored markings (hour glass shape, on belly)
brown recluse bite
violin-shaped body with long legs
spider bite s/sx
pain, small puncture wounds, redness, itching, and swelling that last a few days; the wound will have a center blister surrounded by a red ring and then a white ring. the blister breaks leaving a scab
severe muscle pain and cramps in back, shoulders, and abdomen, weakness, vomiting, fever, or rash
spider bite management
rash eventually goes away over a 2-10 week period; anti-inflammatory medications may be necessary to stop itching or make the rash go away
Pityriasis rosea etiology
acute inflammatory skin rash of unknown origin that occurs most often in people ages 10-35. Most common in spring and fall; not a sign of internal disease, nor is it caused by a fungus, bacteria, or allergy;
Pityriasis rosea s/sx
a single pinkish-red patch called a ‘herald patch’ that appears on the chest or bak and enlarges over several days. within 2-3 weeks, a secondary macular eruption occurs on the trunk over the ribs and on the upper extremity; lesions are red and scaly with a clearing in the center – appear in a symmetrical distribution over the trunk and deformities
Pityriasis rosea management
rash eventually goes away over a 2-10 week period; anti-inflammatory medications may be necessary to stop itching or make a rash go away
