Common Skin Disorders

Question 1

What is dermatitis? What causes it? (3)

Answer 1

dermatitis aka eczema
- caused by:

1) contact/allergic (poison ivy, adhesive tape)
2) actinic: photosensitivity, reaction to sunlight, UV
3) atopic: etiology unknown, associated with hereditary or psychological disorders

Question 2

Your patient has a history of eczema and asks you what else they can do for their flare up. How should you respond?

Answer 2

Have you talked with your doctor about this? On any meds? (could be taking corticosteroids or immunosuppressants or antihistamines)

Daily care = hydration/lubrication of skin

Question 3

How does one get a bacterial skin infection?

Answer 3

bacteria entering a portal in the skin (like an abrasion or puncture wound)

Question 4

What is impetigo? Is it contagious?

Answer 4

superficial skin infection caused by staph or strep
- associated with inflammation, small pus-filled vessicles, and itching

YES CONTAGIOUS

Question 5

Your patient presents with a closely defined area of redness, which is hot to the touch. What is the indication that you believe it’s NOT cellulitis?

Answer 5

cellulitis is red/hot/edematous, but it’s NOT well defined

- usually poorly defined and widespread

Question 6

What does management of cellulitis include?

Answer 6

ANTIBIOTICS (since it’s a bacterial infection)
elevation
cool/wet dressings

Question 7

What populations are at increased risk for cellulitis?

Answer 7

elderly, individuals with diabetes, wounds, malnutrition, or on steroid therapy are at increased risk

Question 8

What is an abcess?

Answer 8

cavity containing pus and surrounded by inflammed tissue

Question 9

What’s the difference between herpes 1 and herpes 2?

Answer 9

1 = cold sores, on face or mouth
2 = genital, spread by sexual contact, can be fatal to newborns

Question 10

A patient comes into your clinic with back pain, presenting with a diagnosis of shingles. What modality is contraindicated in this case?

Answer 10

heat and ultrasound is contraindicated as they’ll increase symptoms

Question 11

Where do patients with shingles have pain?

Answer 11

along a peripheral or cranial dermatome, progressing to papules along that distribution

Question 12

What other symptoms may accompany shingles?

Answer 12

GI issues
eye pain/vision issues (with CN involvement)
fever
chills
malaise

Question 13

What precautions should be taken when working with a person with a fungal infection?

Answer 13

standard precautions (wash hands/glove)

Question 14

What is tinea corporis?

Answer 14

ringworm

Question 15

What is tinea pedis?

Answer 15

athletes foot (typically found between the toes)
- needs to be treated cause can progress to cellulitis or bacterial infection if untreated

Question 16

Psoriasis can also be associated with what kind of pain?

Answer 16

joint pain

Question 17

What can be a precipitating factor for psoriasis exacerbation?

Answer 17

trauma
pregnancy
infection
cold weather
smoking
anxiety/stress

Question 18

Can PT be used to treat psoriasis?

Answer 18

modalities can be used: UV light, combination UV light with oral photosensitizing drugs

Question 19

What is Lupus?

Answer 19

chronic, progressive autoimmune inflammatory disorder of connective tissues
- can be discoid (skin only) or systemic

Question 20

With systemtic lupus, what are all the systems that are affected?

Answer 20

skin
joints
kidneys
heart
nervous system
mucous membranes

Question 21

You have a patient with chronic systemic lupus. What issues should you be looking out for?

Answer 21

• any indication of kidney/heart/nervous issues
• side effects of corticosteroids: edema, weight gain, acne, HTN, bruising, osteoporosis, myopathy, tendon rupture, diabetes

Question 22

So what are the side effects of corticosteroids again?

Answer 22

myopathy, tendon rupture, weight gain, acne, HTN, osteoporosis

Question 23

What autoimmune disease presents with butterfly rash?

Answer 23

lupus

- butterfly rash is on the face

Question 24

What auntoimmune disease is commonly accompanied by Raynaud’s phenomenon?

Answer 24

scleroderma

- lupus can have it occur too, but more common in scleroderma

Question 25

What does scleroderma present like?

Answer 25

taut, firm skin that’s edematous and firmly bound to subcutaneous tissues
- late visceral and pulmonary hypertension involvement

Question 26

What are PT’s main goals for a patient with scleroderma?

Answer 26

slow development of contracture and deformity

Question 27

A patient arrives at your clinic with scleroderma. What precautions should you take?

Answer 27

take vitals and stress they do this often at home since acute HTN can occur

sensitive to pressure, so watch for that with manual

Question 28

What internal organs are commonly involved with diffuse systemic scleroderma?

Answer 28

heart, kidney, lungs

- almost same as lupus, which is kidney/heart/nervous

Question 29

What is polymyositis?

Answer 29

CT disease characterized by edema, inflammation, and degeneration of muscles
- primarily proximal muscles: shoulder/pelvic girdle, neck

Question 30

What causes polymyositis?

Answer 30

unknown; autoimmune reaction affecting muscle tissue with degeneration/regeneration, atrophy, and inflammatory infiltrates

Question 31

T/F: polymyositis has a rapid onset.

Answer 31

true, severe onset that may require ventilatory assistance

Question 32

You have a patient come into your clinic with polymyositis. What precautions should you take as far as exercise?

Answer 32

additional muscle fiber damage occurs with too much exercise

- but they do need exercise d/t pressure ulcers and contractures from prolonged bed rest

Question 33

What are the goals of PT management of polymyositis?

Answer 33

fatigue management/energy conservation
exercise at low levels without overload
positioning to prevent contractures/ulcers

Question 34

What might a patient first experience with polymyositis?

Answer 34

difficulty lifting head from pillow, muscle ache/sensitivity, fatigue, malaise, weight loss, fever

Question 35

What type of benign tumor can lead to squamous cell carcinoma?

Answer 35

actinic keratosis

- flat, round, or irregular lesion covered by dry scale on sun-exposed skin

Question 36

What is a benign tumor that you commonly see on the trunk of older individuals, that often is untreated unless causing irritation?

Answer 36

seborrheic keratosis

Question 37

What would indicate that a common mole may be changing into melanoma?

Answer 37

new swelling, redness, scaling, oozing, bleeding

Question 38

When examining a mole for melanoma, what clinical rule helps you identify what to look for?

Answer 38

ABCDE

• asymmetry: uneven edges, lopsided
• border: irregular with poorly defined edges
• color: variations in color
• diameter: >6mm
• evolving (or elevation)

Question 39

What are the different types of autoimmune skin disorders? (4)

Answer 39

1) psoriasis
2) lupus
3) scleroderma
4) polymyositis

Question 40

What are the 4 different malignant skin tumors?

Answer 40

1) basal cell carcinoma
2) squamous cell carcinoma
3) malignant melanoma
4) karposi’s sarcoma

Question 41

What’s the difference between basal cell and squamous cell carcinoma?

Answer 41

Basal = raised area with red area of eczema, indented center or thickened area of skin; rarely metastasizes

Squamous = poorly defined margins, red flat area, grows quickly, common on sun-exposed areas; much higher risk to metastasize

Question 42

What can cause lingual or mucosal squamous cell carcinoma?

Answer 42

alcohol and tobacco use

Question 43

What are risk factors for melanoma?

Answer 43

family history, intense year-round sun exposure, fair skin/freckles, changing moles esp. if over 50yo

Question 44

What is karposi’s sarcoma?

Answer 44

lesions of endothelial cell origin d/t human herpes virus 8

Question 45

What causes basal cell carcinoma?

Answer 45

sun exposure

Question 46

How can you limit a contusion’s effects?

Answer 46

aka bruise (skin not broken)
- immediately apply heat