Integument: Acute Conditions Flashcards
infectious
bacterial: boils, impetigo, infected hair follicles
fungal: ringworm, athlete’s foot, jock itch, nail infection
parasitic: ticks, mites, lice
viral: cold sores, fever blisters (herpes simplex), chicken pox, warts (HPV til proven otherwise), shingles (herpes zoster), measles (rubeola), german measles (rubella)
inflammatory
injury from sun exposure combo of overactive glands, increased hormones, infection (acne, rosacea) disorders w/ itching cracking/discomfort: atropic dermatitis contact dermatits seborrheic dermatitis stasis dermatitis psoriasis
bacterial skin infections
occur when break in skin’s defenses
most common: staphylococcus, streptococcus
many mild/slef-lmiting
serious = deep/systemic (require oral/parenteral ABX)
fungal skin infections
tinea pedis (athlete's foot) tinea cruris (jock itch) tinea capitis (ringworm of scalp) tinea unguium (nails ) TX w/ opical antifungals in immunocompromised patients = serious (require oral/parenteral antifungals)
viral skin infections
child hood: varicella, rubeola, rubella (koplik spots in mouth)
adult: (erpes zoster (shingles) herpes simplex (cold sores/genital lesions)
TX: topical/oral antiviral therapy w/ acyclovir
cellulitis
diffuse painful inflam of skin/subcutaneous layers
break in skin from injury
most common from: streptococcus/staphylococcus MRSA
cellulitis RF
athletes children residents of long-term care facilities IV drug users prior MRSA exposure
cellulitis s/s
painful, red, swollen area of skin hot tender to touch fever & chills vesicles, bullae, plaques (w/ staphylococcus) tachycardia hypotension confusion headache lymphadenitis lymphangitis
cellulitis DX
physical exam
cultures
blood tests
cellulitis TX
manage/prevent spread of infection
topical/oral/IV ABX
pain meds
teaching: TX/prevention
impetigo
acute highly contagious skin infection nonbullous impetigo (impetigo contagiosa) [smaller blisters] vs bullous impetigo [large blisters]
impetigo etiology
group A strep & staphylococcus aureus (staph)
enter skin > create pus-filled blister that bursts and leaves crust
colinization ^ by high temp, humidity, preexisting skin disorders, young age and recent ABX use
transmission is rapid, must be treated quickly
impetigo s/s
red pimples
fluid-filled blisters
oozing rash w/ yellow crusts (honey-crusted lesions)
bacteria live under crust/in blisters
impetigo DX and TX
physical exam, culture
TX: prescription ointments, oral ABX, teaching
folliculitis
inflammation of hair follicle
can be infectious (bac/virus/fungi/parasite)
noninfectious (trauma, inflamm, damaged/blocked follicles) or autoimmune
folliculitis s/s
puritus
burning
mild discomfort
multiple, small papules/pustules w/ a red base around hair follicle, break/crust over
folliculitis DX/TX
based on s/s
TX depends on etiology
furuncles
boil
extension of folliculitis or infection of sebaceous gland
carbuncle
cluster of infected hair follicles
furnucles/carbuncle patho
primary S. aureous & MRSA
F: infection spreads down hair shaft thru follicle and into dermis
C: cluster coalesces to form lesion filled w/ pus, dead tissue, fluid
furuncles & carbuncles s/s
area firm/red/painful
tips white
purulent drainage
furuncles & carbuncles DX/TX
exam, culture TX: moist head oral ABX incision/drainage hygiene
candidiasis
infection of skin/mucous membranes with any species of candida
mouth, throat, lungs, vagina, folds of skin, bowel
usually secondary condition
candida is normal but warmth/moisture/breaks in epidermis can cause infection
life-threatening if in bloodstream
candidiasis s/s
thrush: white covering tongue, mouth, throat
vaginal: itching, foul odor, white discharge
balanitis: flattened pustules, edema, burning, tenderness
diaper rash: dark red patches in skin folds, fluid-filled spots
candidiasis Dx/Tx
physical exam skin scraping
antifungal drugs
tinea
ringworm contagious (different types of fungi) superficial infections (dermatophytoses) named by location on body spread by direct contact thrive in warm, damp environments
tinea s/s
scaly plaque with erythema crust papules vesicles bullae
tinea DX
skin scrapings fungal culture polymerase chain reaction assay skin biopsy wood light exam
tinea TX
OTC
prescription meds
contact dermaitis
inflam/irritation of skin (hypersensitivity response)
caused by contact w/ irirtant or allergen
irritants 80% of cases, allergic (immune response)
contact dermatitis s/s (irritant vs allergic)
irritant: hyperemia, itching, skin lesions, vesicular/pustular skin eruptions, itching
allergic: weeping vesicles, hives, itching
contact dermatitis DX/TX
full exam/history “use” test, skin biopsy
TX: avoidance of cause, OTC meds, home remedies, witch hazel cream, st. John’s wort
seborrheic dermatitis
chronic skin inflam w/ exacerbations and remissions
papulosquamous disorder on sebum glands
seborrheic dermatitis s/s
rounded/irregular/circular lesions w/ yellow/brown-gray greasy scales
itching
seborrheic dermatitis DX/TX
skin biopsy, fungal culture
TX: ketoconazole, naftifine, ciclopirox creams, gels
calcineurin inhibitors, sulfur or sulfonamide combos, propylene glycol
seborrheic dermatitis locations
head, ears, third eye, around nose, under boobs, bellybutton, pubic areas, asscrack
exfoliative dermatitis
widespread skin inflamm from preexisting skin disorders, drugs, cancer or unknown
exfoliative dermatitis s/s
erythematous and scaly patches that spread pruritus malaise chills
exfoliative dermatitis DX/TX
dermatologist, skin biopsy ketoconanzole naftifine ciclopirox creams/gels calcineurin inhibitors sulfur/sulfonamide combos propylene glycol
urticaria
hives
welts on skin that often itch
acute urticaria more common than chronic urticaria
urticaria causes
reactions to drugs contact w/ allergens exposure to water emotional stimuli physical stimuli etc
urticaria patho
IgE releases histamine, bradykinin, leukotrienes, prostaglandins
causes extravasation of plasma into dermis
urticaria s/s
sudden appearance of pale wheals or papules that cause severe itching
urticaria DX/TX
allergy testing, skin biopsy antihistamines calamine lotion cortisone creams (itching) topical emollients/aluminum acetate (dry skin)
lichen planus
noncontagious inflammatory disorder of skin, mouth, nails, scalp, mucous membranes
unknown cause, may be allergic or autoimmune response
lichen planus s/s
slow/quick onset
rash w/ flat-topped, firm, reddish to purple bumps w/ symmetrical sides & sharp border
wickham striae
itching
lichen planus DX/TX
skin biopsy and lab work
TX: might not be needed, no cure
oral antihistamines, corticosteroids, retinoic acid, PUVA therapy
necrotizing fasciitis
“flesh-eating disorder”
rapidly spreading infection caused by bacteria
caused by a mix of aerobic/anaerobic organisms
start from contagious ulcer/wound/untreated skin infection
comp of surgery/abscess
occlusion of small subQ vessels = tissue ischemia > infarction > necrosis
necrotizing fasciitis s/s
skin red/hot/swollown malodorous pain speticemia gangrene
necrotizing fasciitis TX
ABX surgical debridement pain control amputation of limbs hyperbaric oxygen
toxic epidermal necrolysis
inflammation of skin caused by poison
w/ spots = widespread w/ detachment of epidermis/eorsion (30%)
w/out spots = erythema no lesions (10%)
toxic epidermal necrolysis etiology
rxn to drugs/bacterial infection/malginancy/graft-versus-host disease
vaccinations
toxic epidermal necrolysis s/s
flulike symptoms rash large blisters in center rash ruptures skin peels off
toxic epidermal necrolysis DX and TX
HX (including when drug started symptom onset), amount of body-surface area affected, macules
TX: discontinuation of offending drug, supportive care
SJS
rare disorder
cell death causes epidermis to separate from dermis
milder TEN
can be caused by 200 meds/infectious causes/delayed hypersensitive rxn
SJS s/s
flulike symptoms
symmetric burning rash
red, purple target lesions
SJS TX
stop all non-essential meds fluid replacement nutrition wound & eye care pain meds antihistamines ABX topical steroids
Bee & Wasp Stings
vespids vs apids
females have the sting/venom
human body releases histamine in response to venom (venoms contain hyaluronidase that causes it to spread)
bee/wasp sting s/s
swelling redness itching mild pain anaphylactic rxn
bee/wasp stings TX
remove stinger
apply cool compress immediately to site
oral/topical antihistamines, analgesics
emergency management of anaphylaxis
tick bites
blood sucking arachnids (parasites)
embed head into skin and grow as they feed
RF: outdoor activities, contact w/ animals
tick bites s/s
allergy: rxn
associated disease: flulike symptoms, rash over entire body, neck stiffness, swollen lymph nodes
lyme disease: red bump w/ ringed red rash resembling bullseye, fever, HA, fatigue
rocky mountain spotted fever: dots on ankles & wrists
tick bites TX
remove tick with tweezers swab bite w/ alcohol if severe = topical antihistamines/corticosteroids calamine lotion & benzocaine spray ice pack tests for tick disease acute lyme disease = ABX
pediculosis
lice infestation of parts of body/clothing with lice eggs/larvae/adults pediculosis humanus capitis pediculosis humanus corporis pthiriasis most do not cause disease
pediculosis s/s
pruritus
itching/sores from scratching
visable body lice in crevices/skin folds
prediculosis DX
s/s of nits
wood lamp, yllow-green fluorescence of lice/nits
pediculosis tx
pediculicides
nit comb
wash clothes & linens
scabies
intense pruritic rash caused by a mite
very contatious via upholstery/linens
sarcoptes scabei burrous into skin adn lays eggs
scabies s/s DX TX
rash & itching
physical exam/skin scraping
TX: antiscabies meds, antihistamine
permethrin
antiparasitic (scabicide, pediculicide)
kills parasites as a cream/lotion (1% = lice, 5% = mites)
should remain on hair/scalp 10 min b4 removal
mites itching 2-3 wks even after cure
SE: few systemic effects, local rxn: pruritis/rash/transient tingling/burning/stinging/erythema/edema
contra: premature infants, <2 yrs, skin with abrasions/rash/inflammation, cautions over inflamed skin, asthma, lactating women
B
acne vulgaris
formation of comedones, papules, pustules, nodoules, cysts when hair follicles/sebaceous glands become inflammed due to obstruction
80% adolescents & over 30
noniflammatory vs inflammatory vs mixed
acne vulgaris causes
seborrhea: overproduction of sebum by oil glands
abnormal formation of keratin that blocks oil glands
androgens: stimulate sebum production
acne vulgaris TX
OTC: benzoyl peroxide
prescriptive TX: tretinoin, oral contraceptives, ABX
rosacea
progressive disorder
onsent 30-50 yrs
unknown cause
various triggers (stress, hot drinks, spicy food, heat, exercise, vasodilating drugs etc)
rosacea s/s
small papules w/out pus
flushed face around nose/cheeks
soft tissue of nose may swell (rhinophyma)
chronic red rash involving central part of face (recurring, persistent, transient)
telangiectasia
swollen red, eye problems
enlarged nose
rosacea RF
female/fair-skinned
>30
smoking
family history
rosacea TX
skin care ABX retinoids cosmetic procedures gentle massage
tretinoin
anti-acne
decreases comedone formation & increases extrusion of comedones
4-8 wks to improve, 5-6 mo for max benefit
SE: redness, scaling, erythema, crusting/peeling of skin, high doses: bone pain/fever/HA/n/v/rash/stomatitis/pruritus/sweating/ocular disorders
BBW: off-label TX for acute promyelocytic leukemia = birth defects if PO
contra: avoid OTCacne meds causing excessive drying of skin, direct exposur to sunglight/UV lamps, do not admin if allergic to fish
interx: tetracylcines flurquinolones sulfonamides (phototoxicity)
C (topcial) oral (D)
isotretinoin
anti acne
TX severe, scarring acne that’s unresponsive
SE: dry skin & mucous membranes
BBW: must register w/ iPLEDGE program/familiar w/ drug’s toxicity before use, need pregnancy testing throughout/contraception can’t donate blood
contra: HX depression, suicidal ideation, pregnancy, patients sign consent regarding suicide risk, vitamin A allergy
interx: tetracyclines, vit A, st. john’s wort
X
brittle nails
easily crack/chip/split/peel
onychoschizia: brittle/soft nails w/ splitting
brittle nail causes
aging long-term nail polish use exposure to moisture/dryness disease chemo chemical
brittle nail prevention
keep nails short
avoid nail polish remover w/ acetone
use gloves to avoid getting wet
use emollients
nail infections
onchymycosis (fungal)
yeasts
molds
nail infection s/s
white, yellow spot under tip of nail
appears dull/distorted/thickens
pain and ordor
nail infection RF
nail injury or surgery diabetes weakened immune system blood circulatory problems athlete's foot
nail infections TX
oral antifungals
laser & light-based therapies
ultrasound
nail trauma/loss
cut, torn smashed nail
crushing = subungual hematoma
nail lifts completely from bed
RF: diabetes, circulatory problems, AIDS, chemo
nail trauma/loss s/s and TX
pain, bleeding swelling, warmth
dressing, stitches, ABX
