Disorders of Skin integrity and function Flashcards
Tinea (fungal infection) and appearance
- Tinea corpus: ringworm
- Children most prone
- Transmission is from kittens, puppies, other children
Appearance
- Circular/oval lesions on trunk, back buttocks
- Red papule with sharp border
- Pruritus, mild burning, erythema
Tinea Capitis and appearance
-Most common for children
-Usually scalp and shaft of hair
Appearance
-Primary lesions
- gray, round, hairless patches
Inflammatory type
-Delayed hypersensitivity
-Pustular, scaly, round
-Can evolve to bacterial infection
Tinea Pedis and appearance
-Athlete’s foot
-Between toes, soles/sides of feet
Risk
-Males > females
-Barefoot in public swimming pools, sauna’s etc.
-Sharing area/clothes with someone with infection
-Recurrance with exercise/sweating
Appearance
-Mild to inflamed lesion
-Possible exudate
-Painful, pruritus
-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 sign of human immunodeficiency virus (HIV)
Appearance
-Red rash with well-defined border
-Pruritus, burning
-Can form pustules, infection
Impetigo
-Common in infant and young children
-Usually d/t staphylococci or streptococci
-Highly contagious
Appearance
-Small vesicle on face (usually)
-Ruptures honey-colored serous that hardens and crusts
-Pruritis
-Multiplies with scratching
Cellulitis and manifestations
-Deeper infection of dermis and subcutaneous tissue
-Normal skin flora or exogenous bacteria
-Transmission via previous skin opening/injury
-Handling fish
-Swimming
-Animal bites
Manifestations
-red, edematous, shiny
-Possible fever, pain
-Can result in septicemia if not treated properly
Necrotizing Fasciitis and risks
Rare bacterial infection Usually streptococcal but can be others Involves deep skin and facial plane of subcutaneous tissues Infection that starts on the surface but grows inward Risks Immunocompromized Cancer Diabetes Recent major infection
Necrotizing Fasciitis manifestations & Treatment
Manifestations
red, swollen, painful area that expands quickly
Signs/symptoms of inflammation/infection
Progresses to sepsis
Treatment needs to be immediate
Antibiotics – high doses
Surgical debridement
Verrucae (warts) Transmission and appearance
Benign human papillomavirus (HPV) lesion Invades keratinocytes Multiple kinds/shapes/sizes Transmission Direct contact via break in skin Sexual contact for genital warts Non-genital warts common
Appearance
Small, gray-white to tan flat papules with rough surface
Herpes Simplex (cold sore) & transmission/appearance
-Associated with oropharynx 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 results in Type 2)
Appearance of HS Type 1
-burning, tingling pustules that crust and heal
-Common on face, mouth, nasal septum
-More often and sever if immunosuppressed
Herpes Zoster (shingles) & risks
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 varicell –zoster infection Age HIV, immunosuppression Malignancies Corticosteroid/chemo/radiation therapy
Herpes Zoster (cont) manifestations and complications
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: non-inflammatory & inflammatory
Lesions of face, neck, back (usually) d/t increased testosterone during puberty
85% of teens
Self-esteem issues
Familial connection
Non-inflammatory Sebaceous glands plug up Blackheads: melanin moves into gland Whitehead: pale, fatty acid irritation Inflammatory Pustules, nodules, cysts
Rosacea
-Chronic inflammatory skin disorder of UKE
-Usually affects middle-aged adults, women
Manifestations
-Repeated “blushing” episodes, eventually remains
-Usually nose, cheeks
-Inflammatory facial pustules, nodules, edema
-Dry itchy burning eyes
-Telangiectasia (spider veins)
-Skin thickens and is sensitive to heat
Psoriasis and manifestations
-Chronic skin inflammation
-3rd decade onset
Risk: heredity, age
Manifestations
-Well-defined red plaques with silver scales (flat or raised)
-Elbows, knees, scalp, lumbosacral, intragluteal cleft
Hyperkeratosis: epidermal thickening over time permanent damage to capillaries leads to bleeding points under scales
Ultraviolet Radiation Damage
UVA (not absorbed by ozone)
- Deep penetration, immediate effect (tan)
UVB (most absorbed by ozone)
- Delayed response, more genotoxic (burn)
- d/t free radical formation
- damage to cellular proteins & DNA
-Effects of both are temporary and reversible but research links them to causing skin cancer
Explain sunburn and SPF
Sunburn: mild to severe
- red, burning, peeling, itchiness, blistering
SPF (Sun Protection Factor)
Chemical
Physical
Thermal Injury: 1st degree burns
- Outer epidermis
- Pink/red/dry/painful
- Usually without blister (like sunburn)
- Skin can still “function”
- Heals in 3-10 days
More serious with infants/elderly
Second Degree Burns
Epidermis & dermis
- Partial-thickness
- Red, painful, moist, blister 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
- Mottled pink/red or waxy with flat, dry blisters, edema
- Loss of sensation possible
- Scarring
- 1 month to heal
Third Degree Burns
- 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
Complications of Burns
- Hemodynamic
Injury to capillaries & surrounding tissues
Fluid loss = hypovolemic shock (vascular, interstitial, cellular) - Respiratory
Smoke inhalation
CO, toxins, ammonia, chlorine, sulfur dioxide
Damage mucosa = bronchospasm, edema - Thermal injury
- Resulting pneumonia, pulmonary embolism, pneumothorax, etc…
Burn Complications (cont)
- Hypermetabolic response
Catecholamine and cortisol released in response to stress
– muscle/fat wasting, glucose stores depleted
- Heat production is increased d/t heat losses from burned area - Sepsis
- burn site ideal for microorganism growth - Circumferential burns
- Encircle body or body part
-Healing to “eschar” constricts and must be removed/lyzed to prevent compartment syndrome
Eschar
- Remnant of burned cells/tissue
- Leathery
- Prevents normal healing
Treatment of Burns
- Active cooling
- Fluids
- Hemodynamic balance
- Nutrition
- Analgesia
- Wound care (may include removal of eschar)
> Protection
- Antimicrobial
- Skin grafts
- Autograft: from own body
- Homograft: from another person (alive or not)
- Heterograft: from another species
- Synthetic
> Physiotherapy
Psychological support
Decubitus Ulcers
Pressure
- Over bony prominences
- Immobility
- Compromised integument (disease, age)
Shearing Forces
- Skeleton moves; skin doesn’t
- 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: risk & manifestations
-Melanocytic tumor typically sun-exposed areas
-Rapid progression
Risk
-Increased UV light exposure; h/o blistering sunburns
-Family history of MM; h/o dysplastic nevus syndrome
-Fair hair & skin, freckles
-Immunosuppression
Manifestations
-Slightly raised, irregular border and surface
-Independent or from previous nevi
-May have erythema, tenderness, ulceration, bleeding
-Often mottled (red/white/blue)
Malignant Melanoma: Growth and diagnosis
Growth
1. Radial: horizontal spread in epidermis
- Vertical:
- Invades deeper dermis
- Raised dome lesion
- Increased risk of metastasis
Diagnosis A = asymmetry B = border irregularity C = color variegation D = diameter > 6mm E = evolution
Basal Cell Carcinoma: risks & manifestations
-Neoplasm of basal layer of epidermis
-Most common neoplasm, rarely metastasizes
-Slow-growing
Risk
-Fair skin, h/o sun exposure
Manifestations
-Nodular: small flesh- colored/pink smooth translucent nodule enlarging over time
Superficial: scaly erythematous patch/plaque
Squamous Cell Carcinoma & Risk and manifestations
-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
-Men; rare if of African descent
Manifestations
-Red-scaling, slightly elevated, irregular border
-Shallow chronic ulcer, crusts
-Can metastasize if not excised early
