Dermatology/integumentary system Flashcards
ecchymoses
bruising
petechiae
pinpoint red or purple spots caused by bleeding under the skin
Etiology of petechiae
- can be brought on by coughing, vomiting, distress
- it’s the breaking of capillary (via force)
- platelets aren’t working so there’s bleeding under the skin
what are the 2 big reasons we get concerned when we see petechiae?
1) meningitis (most common)
2) idiopathic thrombocytopenci pupura (ITP)
How do you test if the red or purple spots are petechiae?
press to see if it blanches (if yes, it IS petechiae)
what is a secondary lesion?
lesion caused from a primary lesion caused by scratching or rubbing
macule
small, flat, circumscribed skin spot (not raised or depressed)
papule
a small, raised, solid pimple or swelling, often forming part of a rash on the skin and typically inflamed but not producing pus.
which two bacterias normally harbor on the skin
staph and strep
how do bacterial skin infections come about?
any process leading to a breach in the skin barrier (trauma, abrasions, shaving, insect bites, scratching) can predispose to development of a skin infection bc staph and strep are found on the skin
What are the 3 most common bacterial skin infections?
- impetigo
- folliculitis, furuncle, carbuncle
- cellulitis
what is impetigo
- papules that progress to vesicles surrounded by erythema and then become pustules and break down to form thick adherent crusts (honey golden appearance)
- lesions usu involve face (most common) and extremeties, usu in clusters
- PRURITIC
- most likely staph or strep
In what demographic is impetigo most common?
ages 2-5 years
what is the treatment for impetigo
- Topical antibiotics (mupirocin) and/or
- Oral antibiotics (cephalosporins) (if infection is near eyes or if widespread)
- **handwashing is KEY to prevent spread
furuncle
boil
folliculitis
inflammation of hair follicles
carbuncle
A group of pus-filled bumps forming a connected area of infection under the skin.
Folliculitis, furuncles, carbuncles…what are they?
- starts with infection of hair follicle
- purulent material extends to the dermis and into the subcutaneous tissue
- starts by small abscess formed (furuncles) leads to carbuncles (several inflamed follicles into a single inflammatory mass)
Where are folliculitis, furuncles, carbuncles typically seen? And what causes them?
- seen in areas exposed to friction and perspiration (back of neck, face, axillae, buttocks
- often caused by old razor or HOT TUBS!
What is the Tx of Folliculitis, furuncles, carbuncles?
- warm compresses (promotes drainage)
- incision and drainage (“I and D”)
- obtain culture to r/o MRSA
- NEVER SQUEEZE (can push infection deeper)
- role of antibiotics is not yet clear
What is cellulitis?
inflammation of skin and subcutaneous tissues and may involve upper dermis and superficial lymphatics - usually a complication of a wound or trauma
Signs and Sx of cellulitis
- skin erythema
- edema
- WARMTH
- inflammation of regional lymph nodes
- “streaking”
- fever
Which types of cellulitis are more severe?
periorbital and perianal cellulitis (these require hospitalization
-periorbital cellulitis often starts out as conjunctivitis
what is the treatment for cellulitis?
- elevation of affected area
- rest and immobilization of affected area
- oral antibiotics
- IV antibiotics (if involved area is near joint, eyes or face
What is the nursing management for cellulitis?
- ***HANDWASHING (very contagious)
- clothing directly touching affected area needs to be cleaned in HOT water and changed daily
- discard razors
- prevent spread of infection (caution child against touching involved area)
two most common viral skin infections?
- warts
2. herpes simplex (1 and 2)
What are the common causes of warts? (2)
HPV and verruca plataris (plantar warts)
what is a wart?
- well-circumscribed, gray or brown, elevated, firm papules
- rough texture
Where are warts mostly seen?
in exposed areas (fingers, hands, face)
-may be single or multiple
Can you treat warts with antibiotics?
no! (it’s a virus)
Why are warts difficult to treat (3 reasons)
- it can hide inside cells (intracellular parasites)
- they can be dormant for a while and then “wake up”
- you can’t treat with antibiotics
What is the treatment for warts?
- destructive therapy (surgical removal by dermatology)
- cryotherapy with liquid nitrogen
- laser, lactic retinoic and saliclylic acid solutions (typically OTC and not as effective)
What are the 2 types of Herpes Simplex Virus?
Differentiate btwn the 2
- Type 1: cold sores, fever blisters (90% of ppl have this!)
- Type 2: genital
- both are characterized by clustered, grouped, burning, itching vesicles (vesicles form a crust)
- sores typically have spontaneous healing after 8-10 days
where is HSV typically seen?
-lips, nose, genitalia and buttocks
What is the treatment for HSV?
- topical therapy: Penciclovir (may shorten duration, must use asap after outbreak)
- oral antiviral: Acyclovir (earlier you start Tx the better)
- Valacyclovir (Valtrex): used for recurrent genital herpes
For how long is HSV contagious?
for 1 week after outbreak
Name 3 common fungal skin infections
- Tinea capitis (ringworm on scalp)
- tinea corporis (ringworm on body)
- tinea pedis (ringworm on feet/athletes foot)
What is tinea capitis?
-ringworm on scalp
-scaly, circumscribed patches w areas of alopecia (hair loss is usu in circular pattern)
-may be pruritic
-
How is tinea capitis spread?
- child-to-child directly or via shared hats, combs, brushes, barrettes, rollers
- may also be transmitted from household pets (*esp CATS)
How long does tinea capitis typically last?
can last months to years
In what demographic is tinea capitis more common?
- high incidence in prepubertal children (2-10 yrs)
- 5x more likely in boys
- more common in populations with coarse hair
What is the treatment for tinea capitis?
- Oral antifungal: Griseofluvin
- If a “kerion” is present (boggy inflammation d/t allergic Rx to fungus) then a 7-10 day course of prednisone is added to regimen
Education about oral antifungal GRISEOFLUVIN
- must be given for 6-12 weeks
- should be taken with high fat or it won’t absorb (advise to take w whole milk)
What is tinea corporis?
- ringworm on body
- Generally round or oval, erythematous scaling patch that spreads peripherally and clears centrally; may involve nails
- multiple lesions, may be pruritic
How is tinea corporis transmitted?
-direct contact or contact with inanimate objects. USU FROM ANIMAL ORIGIN (infected pets)
Which areas of the body are typically impacted with tinea corporis?
-Non-hairy body parts (face, trunk, under arms)
What is the Tx of tinea corporis?
- Daily application of topical antifungals (clotrimazole, micronazole), should be applied for 3x/day for at least 2 weeks (plus 1-2 weeks after no sign of lesions bc it tends to come back)
- may need oral GRISEOFULVIN (if topical is ineffective)
What is tinea pedis?
- ringworm of the feet (aka athletes foot)
- intensely pruritic erythematous vesicles or bullae btwn toes and on soles of feet
- often follow activities that cause feet to sweat
- may be intermittent, recurrent or chronic
- –chronic tinea pedis (if untreated) can cause scaling and spread to nails)
What is the Tx of tinea pedis/athletes foot?
- Topical antifungal cream for 4 weeks (interdigital)
- chronic tinea pedis may require oral antifungal therapy (up to 8 weeks)
Nursing management and recommendations for ringworm/tinea
- emphasize good health and hygiene
- avoid exchanging grooming items, headgear, SHOES
- affected child should have their own towel
- protective head cap can be used to prevent spreadingi fungus to bedding
- household pets should be examined for fungus
- important to keep areas clean and dry as much as possible (aerate!!)
- change socks daily
When can a child with ringworm return to school?
-Child may return to school after 24 hours on antifungal meds (even though the ringworm or fungus infection may still be visible)
What is dermatitis?
inflammatory changes in the skin
what are the two types of dermatitis? Differentiate btwn the 2.
- contact: transmitted by touching (e.g. poison ivy)
—anyone can get it who touches it - atopic: immunoglobulin response/it’s genetic (e.g. asthma and eczema)
–not everyone will get this, you need to have an underlying genetic predisposition
We CANT distinguish by looking at it. Need a thorough Hx!
Atopic dermatitis is also known as
eczema
What is atopic dermatitis (eczema)?
- Appears to involve genetic defect in the proteins supporting the epidermal barrier
- May have elevated IgE levels- associated with asthma and higher sensitivity to allergens
- Environmental allergens, irritants, and microbes penetrate skin and come in contact with immune cells leading to release of proinflammatory mediators
Triggers of atopic dermatitis (eczema)?
- Triggered by food allergens, environmental allergens, topical irritants
- also linked to family Hx of asthma
Which parts of body are most commonly affected by atopic dermatitis (eczema)?
- Involves antecubital fossae and popliteal fossae (most common areas)
- also neck, areas around eyes, fronts of ankles
- hands, face and scalp (common sites for infantile eczema)
When do most children have first onset of eczema?
-Majority have onset before age 5
what are the clinical manifestations of eczema (atopic dermatitis)?
- red, scaly, crusted lesions
- pruritic
- can include vesicles
- may have scratch marks
- generally dry skin throughout
- Involves antecubital fossae and popliteal fossae (most common areas)
- also neck, areas around eyes, fronts of ankles
What is the treatment of eczema (atopic dermatitis)
- eliminate exacerbating factors (excessive bathing (too much water can make it worse), low humidity, emotional stress, overheating of skin, exposure to detergent
- Maintain skin hydration (aquaphor, eucerin, petroleum jelly) [apply 2-3 times per day]
- control pruritis (antihistamines)
- therapy for inflammation (corticosteroids)
- management of infections (antibiotics (if rash becomes infected)
Is eczema contagious?
nope
What is contact dermatitis
-inflammatory Rx of the skin d/t chemical substances (natural or synthetic)
Most common type of contact dermatitis seen in peds?
-diaper dermatitis
Signs and Sx of contact dermatitis?
-erythema, bullae, swollen base, constant pruritis
Common causes of contact dermatitis
- diaper dermatitis
- plants (poison ivy)
- irritants (wool, furs, metals, oils, dyes, cosmetics, perfumes, soaps)
Where is contact dermatitis typically seen on the body?
-in an exposed region (face, neck, back of hands, forearms, lower legs
What is diaper dermatitis
- type of contact dermatitis
- prolonged, repetitive exposure to urine, feces, soaps, friction
- peak age is 9-12 months
- convex surfaces or in-folds of skin are often SPARED if from urine or feces (good way to distinguish btwn contact and atopic derm)
Nursing management of diaper dermatitis
- avoid irritant! (goes for all types of dermatitis)
- wetness and fecal irritant: change diaper frequently and leave open to air in btwn diaper changes
- use superabsorbent disposable diapers
- AVOID WIPES AND PERFUMED SOAPS
- use water and mild soap to clean and then leave open to air before putting diaper back on
Name 3 common skin disorders due to mite/insect contact
- scabies
- head lice
- lyme disease
What is scabies?
- an infestation of the skin cased by scabies mite (sarcoptes scabei)
- highly contagious!!!
How is scabies transmitted?
DIrect contact (person to person)
- crowded conditions increase the prevalence
- more common in winter than in summer
what are the clinical manifestations of scabies?
- itching (often severe and worse at night)
- small, erythematous, papules
- typically seen in btwn fingers, hands and wrist, feet and ankles
- HOCKEY STICK/burrows presentation COMMON
What is the Tx of scabies?
- Topical Permethrin cream: ALL OVER BODY (head to toe!)
- cream applied over night (8-14 hours) and washed off in AM
- rash takes a few days to go away but itching should be gone after Tx and no NEW lesions should be forming
Nursing management of scabies
- entire household should be treated
- control of transmission
- –scabies survives for 24-36 hours (longer in cold) without human contact
- -all clothing, bedding, stuffed animals must be bagged for more than 36 hrs (to suffocate mites) and then washed in hot water, hot dryer, or dry cleaning
what is Pediculosis capitis (head lice)?
- Head louse is gray-white, 2-4mm insect, legs attach to hair and mouth suck blood from the scalp
- eggs “nits” cement firmly to the base of the hair (eggs are white and more visible) eggs hatch in 8 days
what is the lifespan of female louse (lice)
about 1 month (she lays 7-10 eggs/day
For how long can lice survive off the body?
more than 48 hours!
How are head lice transmitted?
- from person to person or on items such as hats, caps, scarves, coats
- lice do NOT jump or fly!
What are the clinical manifestations of head lice?
- most are asymptommatic
- itching may occur
- nits can be seen on hair shafts, behind ears, nape of neck
- (can be distinguished from dandruff bc the nits STICK firmly to hair)
What is the Tx for head lice?
- Topical Pediculicide (Rid, Nix)
- –wash hair w shampoo, rinse and towel dry (repeat 2x, more effective)
- –apply insecticide cream or gel liberally to scalp and leave on for 10 min before rinsing w water
- –wet-comb to remove lice (add a lubricant: oil, cream rinse) every 2-3 days
- –hot air Tx (30 min of hot air-100% effective)
- Do not need to treat entire household unless you can see lice on them or unless they share a bed
- home remedies (mayonnaise, oils, petroleum jelly, oils, vinegar, butter, alcohol DO NOT KILL LOUSE EGGS
Nursing mngment of head lice
prevent head lice spread!!
- examine everyone in household for lice
- anyone who sleeps in same bed should be treated
- clothing, bedding and towels used within 48 hrs before Rx should be washed in hot water and dried in dryer on hot setting
- vacuum carper, furniture and car seats
- **items that can’t be washed or vacuumed can be sealed inside a plastic bag for TWO WEEKS
- boil combs, brushes, hair accessories for 10 min
When can a child with head lice go back to school?
after one Tx with insecticide (you still might be able to SEE lice but they’re dead and no longer contagious
What is lyme disease?
-tick borne illness caused by the spirochete borrelia burgdoferi which enters the skin and bloodstream through the saliva and feces of the ticks, especially the deer tick
What are the 3 clinical stages of lyme disease?
- ERYTHEMA MIGRANS at site of bite (within 1 month following tick bite (66%)-Cutaneous phase
- EARLY DISSEMINATED DISEASE (multiple erythema migrans lesions - 23%) - occurs 3 to 10 weeks after innoculation; neurologic and/or cardiac (0.5%) findings can occur several weeks after cutaneous phase
- LATE LYME DISEASE is associated with arthritis (7%) involving 1 or a few large joints (esp knee) and/or neurologic problems (4%) (encephalopathy). May develop months to a few yrs after initial infection
What are the clinical manifestations of lyme disease?
o erythema migrans lesion: characteristic annular (circular) red rings (bull’s eye appearance)
o Serologic test IgM antibodies and IgG antibodies to B.burgdorferi
o Body takes 6 wks to mount an immunoglobulin response, so if check immediately (1st 6 weeks after bite), may give you a false negative
- lesion is described as “burning,” feels warm to the touch, and occasionally is pruritic.
-The single annular rash may be associated with fever, myalgia, headache, or malaise.
If someone was bitten by a tick and suspects lyme disease, when should you advise them to go get tested?
o Educate ppl to wait 6 weeks to get tested
o **Signs & Sx may appear up to 32 days after the initial bite.
What is the Tx for Lyme disease?
-children under 8 yo (amoxicillin)
-children over 8 yo (doxycycline)
-Tx is 14-21 days
Other at-home comfort treatments: lavender oil, citronella oil
Nursing management
Educate parents on PREVENTION!
• Protect children from exposure to ticks (esp when in woods)
• wear light colored clothing (ticks can be better spotted)
• Tuck pant legs into socks
• Wear long-sleeved shirts tucked into pants
• Perform regular tick checks
• Bug sprays with DEET can help
-educate parents about how to remove ticks (grasp firmly with tweezer pull straight out)
