Disorders of skin integrity and function, chap 46 Flashcards
Tinea Corpus
Tinea (fungal infection)
Corpus: Ringworm
> children mostly prone
Transmission:
>kittens, puppies, other children
Appearance:
> Circular/oval lesions on trunk, back
> red, papule with sharp border
--> central clearing
> Pruritis, mild burning, erythritis
Tinea Capitus
Most common in children**
> usually scalp of shaft of hair
Appearance:
Primarily lesions
–> grey, round, hairless patches
Inflammatory Type:
>delayed hypersensitivity
>pustular, scaly, round
> can evolve to bacterial infection
Tinea Pedis
Athlete’s Foot- btwn toes, soles/sides of feet
Risk:
- Men
- Barefoot in public swimming pools, sauna, ect.
- Recurrence with exercise/sweating
Appearance:
- mild inflamed lesions
- Possible exudate
- Painful, pruritis
- Foul odor
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 signs of HIV
Appearance:
> red rash, well defined border
> pruritis, burning
> can form pustules, infection
Impetigo
BACTERIAL
> common in infant and young children
> usually d/t staphylococci or strep
Appearance:
- small vesicles on face (usually)
- ruptures honey colored serous that hardens and crusts
- Pruritis
- Multiplies with scratching
Cellulitis
BACTERIAL
> Deeper infection of dermis and SC tissue
> normal skin flora or exogenous bacteria
Transmission: bacteria
- handling fish
- -swimming
- animal bites
Manifestations:
- red, edematous, warmth, shiny, skin tight
- possible fever, pain
- can result in septicemia if not treated properly
Necrotizing Fascitits
> Rare bacterial infection
usually strep but can be others
Involves deep skin and facial plane of SC tissue
Risks: > immunocompromised > cancer > DM > recent mjr infections
Manifestations:
> red, swollen, painful area that wxpands quickly
> s and s of inflam / infection
> progress to sepsis
Tx:
> needs to be immediate
> antibiotics- high doses
> surgical debridement
Verrucae
Warts: VIRUS
> Benign human papillomavirus (HPV)
> multiple kinds/shapes/ sizes
> non-genital warts are common
Transmission:
- direct contact via break in skin
- sexual contact for genital warts
Appearance:
> small, grey-white to tan flat papules with rough surface
Herpes Simplex (cold sores)
VIRUS
> Associated with oropharyx infections (Type 1)
Triggers: stress, menses, infection, UV burns
Transmission: while active
- direct contact with infected saliva
- skin contact via athletics/ dentistry/ healthcare
- sexual contact (usually in type 2)
Appearance of HS type :
- burning, tingling pustules that crust and heal
- common of face, mouth, nasal septum
- More often and severe if immunocompromised
Herpes Zoster
VIRUS
Shingles
1. result of reactivation of latent varicella-zoster virus infection dormant in dorsal root ganglia since primary childhood infection
- travels up dermatome
- transmission when active
Risk:
- h/o chicken pox varicella-zoster infection
- age
- HIV, immunocompromised
- Malignancies
- corticosteriod/shemo/radiation therapy
Manifestations:
- burning pain, pruritis
- sensitive skin
- vesicles form, erupt, crust, fall off
- 2-6 weeks
Complications:
- Neuralgia 1-3 months after skin clears (common)
- Blindness if contact with eyes (permanent, rare)
Acne Vulgaris
PUSTULAR DISORDER > Lesions on face, neck, back and chest d/t increased testosterone after puberty --85% of teens -- self esteem issues -- familial connection
- Non-inflammatory
> Sebaceous glands plug up
– blackheads: melanin moves up into gland
– whiteheads: pale, fatty acid irritation - Infalmmatory
> Pustules, nodules, cysts
Rosacea
PUSTULAR DISORDER
> Chronic inflam skin disorder of UKE
> usually affects middle-aged adults: women
Manifestations:
> repeated “blushing” episodes, eventually remains
– Usually nose, cheeks
> Inflam facial pustules, nodules, edema
> dry itchy skin
> Telangiectasis (dilation of capillaries, spidery)
> skin thickens and is sensitive to heat/sun
Psoriasis
PAPULOSQUAMOUS DERMATOSIS
Chronic skin inflammation: autoimmune
> 3rd decade onset
Risk:
> heredity
> age
Manifestations:
- well-defined round plaques with silver scales
- - flat or raised - Elbows, knees, scalp, lumbosacral, intragluteal cleft
- Hyperkeratosis: epidermal layer of skin thickens over time. Permanent damage to capillaries lead to bleeding paints under scales
Ultraviolet Radiation Damage
(UVA not absorbed by ozone)
(UVB most absorbed by ozone)
- Delayed response, more genotoxic (burn)
- d/t free radicals formation
- damage to cellular proteins and DNA
Effects of both are temporary and reversible but research links them to causing skin cancer
Sunburn: mild to severe
> red, burning, blistering, peeling, itchiness
SPF: sun protection factor
> chemical - absorb sunlight
> physical - reflect sunlight
Thermal Injury
first degree burn
> outter epidermis >pink, red, dry, painful > usually without blister (like sunburn) > skin can still function > heals in 3-10 days
> more serous in infants and elderly
second degree burns
Dermis and epidermis
Partial thickness:
- red, painful, moist, blisters that weep
- sensitive to touch, heat, air
- intact blisters help maintain body fluids
- heals in 1-2 weeks
Full thickness:
- Epidermis and into deep dermis
- hair follicles and sweat glands remain intact and still function
- mottled pink/red or waxy with flat, dry blisters, edema
- loss of sensation possible
- Scarring
- one month to heal
Third degree burn
- involves SC tissue, possible muscle and bone
- waxy white/yellow/tan/black/brown
- extensive edema
- can be no pain, but seldom exists without some 1st degree and 2nd degree burn pain
Burn “rule of nines”
back 18%
front 18
each whole leg 18
each arm 9
head 9
Complications of Burns
- Hemodynamic:
> injury to caps and surrounding tissues
> fluid loss = hypovolemic shock - Respiratory
> smoke inhailation
– CO, toxins, ammonia, chlorine, sulfur dioxide
– damaged mucosa = bronchspasm, edema
– thermal injury to resp passage = pneumonia, puml embolism, pneumothorax, ect…. - Hypermetabolic response
> Catecholimine and cortisol released in response to stress
– muscle /fat wasting, glucose stores depleated
> Heat production is increased d/t heat loss from burn area - Sepsis
> burn site ideal for microorganism growth - Circumferential Burns
> encirculating the whole body or body part
> Healing to “eschar” constricts (leathery) and must be removed- lyzed
– Esharotomy/fasciotomy
Treatment of Burns
- Active cooling- hypermetabolic state, need to cool
- Fluids
- Hemodynamic balance
- Nutrition
- Analgesia
- Wound care
- Protection
- -Antimicrobial
- - Skin grafts
1) Autografts- from your own body
2) Homografts- from another person dead or alive
3) Synthetic grafts
- - Physiotherapy
- - Psychological Support
Decubitus Ulcers
- Pressure
- - over bony predominance
- - immobility
- - compromised integument (disease, age) - Shearing Forces
- - skeleton moves; skin doesnt. Skin can rip or damage
- - cell injury and thrombosis - Friction
- - elbow, heels - Moisture
- - weakens cell walls by changing pH of skin
Nevi
Moles
> congenital or acquired benign skin tumors
pigment or not
flat or elevated
hairy or non-hairy
> Melanocytic/junctional/compound nevi
Dysplastic nevi
– rough/pebbly surface, irregular shape
– capacity to transform into malignant melanoma usually related to increased size
Malignant Melanoma Nevi
> Melanocytic tumor typically sun-exposed areas
rapid progression
Risk:
>increased UV exposure; ho blistering sunburns
> family ho of MM; ho dysplastic nevus syndrome
> fair hair and skin, freckles
> immunocompromised
Manifestations:
> slightly raised, irregular border and surface
> independent or from previous nevi
> may have erythema, tenderness, ulceration, bleeding
> oftened mottled; red(inflammation), white(scar tissue formation), blue (malignant growth)
Growth:
> Radical
– horizontal spread in epidermis
> Vertical
- invades deeper dermis
- raised dome lesions
- increased risk of metastasis
Diagnosis: A- Asymmetry B- border irregularity C- color variation D- diameter > 6mm E- Evolution. Is it changing?
Basal Cell Carcinoma
> Neoplasm of basal layer of epidermis
Most common neoplasm***
rarely metastasizes
slow-growing
Risk:
> fair skin
>ho sun exposure
Manifestations:
> Nodular
– small flesh colored/pink smooth, thranslucent nodule enlarged over time
Superficial
– scaly erythematous patch/plaque
Squamous cell carcinoma
> malignant tumor on sun-exposed area
confined to epidermis for long periods, then converts to “invasive” stage
– usually older population
Risk:
- UV exposure
- Arsenic, industrial tar, coal, paraffin
- Black Men; rarely affected
Manifestations:
- red-scaling, slightly elevated, irregular border
- Shallow chronic ulcer, crusts
- Can metastasize if not excised early
