Integumentary infections Flashcards
Atopic dermatitis: Definition
- chronic or relapsing inflammatory skin disease
- Characterized by pruritus
Atopic dermatitis Risk factors
- Multifaceted - include genetic, immunologic and environmental factors
- Family history and aberrant skin barrier gene coding
- Can go along with allergic reaction sometimes
Atopic Dermatitis: clinical manifestations
- rash: Red, oozing, crusting, mainly on flexor side
- Xerosis: dry skin
- Pruritus: itching
- Typically rash spares diaper area
Atopic dermatitis: medical management
Medical management
- Topicals (lanolin): coat the skin to add protection
- Systemic medications (antibiotics, antihistamines, antimicrobials, corticosteroids, immunosuppressants, nonsteroidals)
- UV irradiation: dries out the skin
- Education: controlling and minimizing triggers
- Goal of treatment: break inflammatory cycle causing dryness, cracking, itching and scratching
Atopic dermatitis: PT concerns
- Caution with modalities, gels, creams, soaps, cleansers
- Avoid agents containing alcohol as it can dry out the skin making it crack/open to further infection/irritation
Contact dermatitis: definition
a local inflammatory reaction due to external exposure
Contact dermatitis: risk factors
immunocompromised
Contact dermatitis: Clinical manifestations
- Erythema: reddening of skin
- Pruritus
- Edema
- Wheals
- Maculopapular vesicles
Medical management of contact dermatitis
- Examination, patch testing for allergens, topicals, antihistamines
- Removal of agent
- Similar to AD
PT concerns for contact dermatitis
- Prosthetics, silicone, gels, lotions, soaps, cleaning products
- Learn what to avoid
Eczema and dermatitis: definition
periods of remittance and relapse of superficial itch, inflammation of the skin
Eczema and dermatitis types
- Types: seborrheic (scalp), nummular (discoid = disc shaped), and stasis dermatitis (related to circulation usually)
- relapsing/remitting
Eczema and dermatitis: risk factors
Risk factors:
- Common in children and adults
- Can be genetic
- Medications
- Stasis dermatitis = venous hypertension/venous insufficiency)
Eczema and dermatitis: Clinical manifestations:
Discoid lesions, circular
Red itchy patches
Eczema and dermatitis: Medical management:
- Topical to bring down the superficial irritation
- Regulation BP/cholesterol if its related to circulation
PT concerns for eczema and dermatitis
- modalities can irritate
Rosacea:
Definition
chronic facial disorder of middle-aged and older people; condition caused by vascular and inflammatory componenets)
Rosacea: Risk factors:
no known cause
Rosacea: Clinical manifestations:
- Acneiform rosacea can occur with papules (oil in it), pustules and oily skin
- Cheeks, nose and chin have persistent rosy appearance
- Pustules, papules, burning or stinging
- Fascia edema
- Certain things may cause it to flare up
Rosacea: Medical management:
- Topical or systemic therapy
- Pulsed dye lasers to seal superficial vessels and help with discoloration
Incontinence-associated dermatitis:
Definition:
damage from chronic exposure to urine of feces
incontinence-associated dermatitis:
Clinical manifestations:
- Person may be uncomfortable in seated position or positions that put pressure on genital area
- Burning, itching or tingling
- Erosion of skin and maceration
incontinence-associated dermatitis: Medical management
- Gentle cleaning, moisture barrier cream, pressure relief
- High-grade moisture-wicking underpads
Skin bacterial infections
- Impetigo contagiosa - contagious
- Pyoderma - contagious
- Folliculitis (pimple/boil) = contagious but minimal chance of spread
- Cellulitis - contagious
Skin viral infections
- Verrucae (warts) - contagious, self inoculable
- Verruca plantaris (plantar wart) - contagious; self inoculable
- Herpes type 1: cold sore = contagious
- Herpes 2: genital = contagious
- varicella -zoster virus: contagious (chickenpox)
Skin fungal infections
- Tinea corporis (ringworm): person to person, animal to personal, object to person
- Tinea capitis (scalp) = person to person, animal to person
- Tinea cruris (jock itch) = person to person, animal to person
- Tinea pedis (athletes foot) = transmission to other people rare
- Candidiasis = person-person; transmitted during birth from mother to neonate
Impetigo definition
superficial skin infection, highly contagious, more in children 2-6 or older adults commonly caused by staph or strep.
Impetigo: risk factors
Risk factors:
- Poor hygiene
- Close contact
- Malnutrition
- Minor skin trauma
Impetigo Clinical manifestations:
- Erythematous macules (flat spots) that develop into papular lesions of vesicles (small blisters)
- Become pustular (pus-filled)
- Itching and scratching of vesicles after they break/crust
Impetigo Medical management:
- Self-limiting with good hygiene
- Topical and or systemic antibiotics (cover both staph/strep)
PT concerns for impetigo
highly contagious
Cellulitis:
Definition:
rapidly spreading bacterial infection of skin and subcutaneous tissue most common in extremities
cellulitis: risk factors
Risk factors:
Immunocompromised
Older adults
Venous insufficiency
Thrombophlebitis
Obesity
Surgery
Substance abuse
Open wounds
cellulitis Clinical manifestations:
Pain
Erythema
Edema
Elevated temperature of affected skin
fever/chills
Malaise
Most commonly affects extremities
cellulitis: Medical management:
Intravenous antibiotic infusion
Debridement
Cellulitis: PT concerns:
Monitor progression
Education
Wound care
Warts (verrucae)
Definition:
common, benign viral infections of skin and adjacent mucus membranes caused by human papillomaviruses
Warts verrucae: Risk factors:
Usually direct contact
Warts Verrucae: Clinical manifestations:
Depends on type and location
Verruca vulgaris (hands nad extremities)
Plantar (foot) - no drainage and occur on pressure points
Warts verrucae: Medical management:
Diagnosis on visual exam
OTC salicylic acid
Surgical removal
Cryotherapy
Laser
Chemical cautery
Oral medications
Immunotherapy
Ringworm (tinea corporis)
- fungal
- scales forming circular lesions with clear centers - commonly in hair, skin or nails
- Transmission with direct contact
Athletes foot (tinea pedis)
- peeling, itching, strong odor
Yeast (candidiasis)
- wet moist areas; bright red rash with tiny macules and papules, scaly
Medical management of fungal infections
Medical management: antifungal cream or oral antifungal medications
PT concerns with fungal infections
PT concerns: education hygiene
Parasitic infections of the skin
Scabies: highly contagious, spread by mites
Lice
Scabies: clinical presentation
- Intense pruritus (worse at night), excoriated skin, one or more burrows with vesicle at one end
- Direct or indirect contact
- Flexor surface of wrist, web spaces of fingers, axilla, waistline, nipples (females), genitalia (males), umbilicus
Scabies: treatment
Treatment; removal of mites - scabicide ) permethrin of lidane
Pediculosis (lousiness) - lice/human pediculus humanus parasite
- Severe itching, eczematous changes, white or gray nits (eggs) at base of hair follicle
- Spread by direct or indirect contact
- Diagnosis: inspection
- Treatment: disinfectant solution (shampoo or soap containing permethrin)
Seborrheic Keratosis
- where is it?
- when is it likely to occur?
- Describe characteristics
- treatment:
- Basal cells
- Usually middle age
- Waxy, smooth, or raised
- After inflammatory dermatosis
- Don’t treat unless they become itchy/painful
- Treatment: cryotherapy
Nev
- Aggregation of melanocytes
- Usually doesn’t spread
bleed/itch = could be a problem
Benign lesions of the skin
- serborrheic keratosis
- nevi
Premalignant lesions
- actinic keratosis (solar keratosis)
- Bowen disease
Actinic keratosis (solar keratosis)
- Caused by
- incidence
- characteristics
- treatment
- UV rays
- Nearly 100% older caucasian population
- Well-defined crusty patch (3-6mm)
- Treatment: 5-fluorouracil, masoprocol cream, cryotherapy, curettage (cutting out)
- Avoid sun
- Can be multicolored - ask have you noticed a change in this
Bowen Disease definition
Squamous cell in situ or SCC in situ
Definition: nonmelanoma skin cancer
Bowen disease: risk factors
Risk factors:
- fair-skinned men >50
- Sun
- Chemical exposure (arsenic)
- HPV
- Associated with internal malignancy
Bowen disease clinical manifestations
Clinical manifestation
Persistent, brown to reddish brown, scaly plaque with well-defined margins
Bowen disease: Medical management:
surgical removal,
cryosurgery,
curettage
5-fluorouracil
bowen disease: PT concerns:
Potential to become invasive and metastasize
Malignant non melanoma carcinoma
- basal cell carcinoma
- squamous cell carcinoma
Basal cell carcinoma: Definition
slow growing epithelial
Basal cell carcinoma: Etiologic and risk factors:
Sun exposure
Caucasian
Head and neck
Basal cell carcinoma: Clinical manifestations:
Red
Crusty
Non-healing
Basal cell carcinoma: Medical management:
Biopsy
Excision
Chemotherapy
Basal cell carcinoma:PT concerns:
Potential to metastasize
Caution with contamination
Modalities
Patient education
Squamous cell carcinoma: Definition and incidence:
2nd most common, epidermal keratinocytes, caucasian, ear, face, lips, dorsum of hand and nose
Squamous cell carcinoma: Risk factors:
Sun exposure
Squamous cell carcinoma: Clinical manifestations
Red to flesh colored surrounded by scaly tissue
Poorly defined margins
Discolored
Raised and crusty over
Squamous cell carcinoma: Medical management - diagnosis
Biopsy
CT
MRI
Blood work: change in WBCs
Squamous cell carcinoma: PT concerns:
Metastasis (lymph node)
Caution with modalities and contamination
education with patient
Malignant melanoma: definition
invasive melanomas
Malignant melanoma: risk factors
- UV exposure (intensity>duration)
- Personal or family history of melanoma
- Fair skin, light hair, blue/green eyes
- Presence of marked freckling on upper back, nevi, congenital melanocytic nevi
- Ultraviolet radiation exposure
- Immune suppression
- Genetic disorder: xeroderma, pigmentosum
- Age: older adults or individuals younger than 30
- Being male
Malignant melanoma: Clinical manifestation:
70% from pre existing nevi
Most common on head, neck, trunk, legs
Raised, changing appearance,
Pruritus
Hyperkeratosis
Malignant melanoma: Medical Management
Excision
Oral chemotherapy
Immunotherapy
Malignant melanoma: PT concerns:
Potential to metastasize
Caution with contamination, modalities
Education with patient
Malignant melanoma: Types:
- Superficial spreading melanoma: 70% of all cutaneous melanomas
- Nodular melanoma: most aggressive
- Lentigo maligna melanoma
- Acral lentiginous melanoma
Kaposi Sarcoma: definition
Connective tissue malignancy, 4 types
- Older Mediterranean or Eastern European men (classic),
- Younger African (endemic)
- Organ transplant (iatrogenic),
- Individuals with HIV (epidemic)
Kaposi Sarcoma: Etiologic and Risk Factors-
Immunocompromised, male,
herpes virus
Kaposi Sarcoma Clinical Manifestations-
usually Leg,
early- pink mistaken for bruise or nevi, later red/purple/blue macules-> ulcers,
itching
Kaposi Sarcoma: Medical Management- (diagnosis and treatment)
biopsy, CT, MRI
Tx.
Antiviral therapy, chemotherapy, surgical removal, laser,
cryotherapy
Kaposi Sarcoma: PT Concerns-
Potential to metastasize,
caution with friction, and open areas.
Prevent infection, education
Psoriasis: Definition:
Chronic genetic recurrent inflammatory dermatosis, equal general incidence across lifespan, remitting/recurring
Psoriasis: risk factors
Genetic link
Immune system dysregulation
Rapid skin turnover that can cause build up
Psoriasis: clinical manifestations
Well-defined erythematous plaques covered with silvery scale
Does not spread
Psoriasis: Medical management
- Dx
- Tx
- Diagnosis history/presentation
- Treatment: topical corticosteroids, vitamin D, UVB treatment (control flaky), oral meds - methotrexate, psoralens, retinoids
Psoriasis:PT concerns
Skin care
Maintain mobility
Complications from immunosuppressants
Long term corticosteroid use
Lupus Erythematosus: definition
cutaneous (discoid) incidence increases with age 60-69, women: men = 10:1
Systemic women:men = 3:1 characteristic rash – butterfly rash that spreads across nose and cheeks
Lupus Erythematosus: Risk factors
Unknown, autoimmune defect
Thought to be related to infection or genetic
Lupus Erythematosus: clinical manifestations
- Cutaneous (Discoid) raised, red, smooth plaques
- Follicular plugging: white, oily discharge
- Central atrophy
- Face, scalp, ears, neck, arms
- Fatigue, arthralgia, anemia, arthritis
- Acute cutaneous LE,
- Butterfly rash over nose and cheeks and forehead
- Rash on extensor surface of arms, widespread erythema and bullous lesion (concentrated in an area and has fluid)
- Cardiovascular changes, pulmonary changes live and kidney
Lupus Erythermatosus: medical management
- Topical
- Intralesional or systemic medication
- Plaquenil for pulmonary inflammation
Lupus Erythermatosus: PT concerns
Variable presentation
Caution with exercise intensity during flares
Skin care
Education
Watch for multisystem involvement
Systemic Sclerosis:
definition/incidence:
Previously called scleroderma,
autoimmune disease affecting connective tissue → fibrosis of the skin, joints, blood vessels and internal organs
Women (3):men (1) onset around 20-50
Systemic Sclerosis: Risk factors
Dysfunctional connective tissue repair following injury
Systemic Sclerosis: clinical manifestations
- B/L non pitting edema in fingers and hands
- Thick, hardening skin
- change in pigmentation and skin mobility
- thinning –> ulcerations –> raynauds
- Mulitsystem involvement
Systemic Sclerosis: medical management
Difficult to diagnosis, antibody presence
CT, skin presentation
Symptoms management
Medications
Exercises, joint protection techniques
Skin protection techniques
Stress management
Systemic sclerosis: PT concerns
Possible multisystem presentation
Education
Maintain mobility (stress strain curve)
Raynaud phenomenon
Vascular vasoconstriction usually with cold exposure
Sudden blanching, cyanosis and erythema of fingers and toes
Hands/feet become white, numb, and then bluish
During rewarming, fingers and toes become painful
Polymyositis and dermatomyositis: definition/incidence
Idiopathic inflammatory disease of muscle
More common in women than men
Polymyositis and dermatomyositis: risk factors
Cause unknown, autoimmune
Related to environmental or genetic factors
Polymyositis and dermatomyositis: clinical manifestations
- Exacerbations and remissions
- characterized by symmetric and progressive proximal weakness (pelvis, neck, pahryns)
- Gottron papules of gottron sign
Polymyositis and dermatomyositis: Medical management -diagnosis
Diagnosis difficult - progressive symmetric weakness
Labs (CK)
biopsy
EMG
Polymyositis and dermatomyositis: PT concerns
Skin lesions
Immunosuppressed
Other system involvement
Education
Prevention of decreased mobility
Cold injuries: definition
Cold (frostbite) can be superficial or deep and hypothermia
Cold injuries risk factors
Prolonged exposure to cold
Lack of insulating body fat
Advanced age
Homelessness
drug/alcohol abuse
Various peripheral vascular vasoconstriction disease
Diabetes
Altered mental status
Improper clothing
Improper use of cryotherapy
Cold injuries: clinical manifestations
- Nose, cheeks and/or ears initial vasoconstriction
- Freezing with ice formation on tissues
- Additional injury with thawing
- Superficial: burning, tingling, numbness, swelling and mottled blue, gray skin color
- Deep: skin becomes white until thawed and then turns purplish blue, produces pain, blisters, tissue necrosis and gangrene
Cold injuries: medical management
- Diagnosis with history and presenting symptoms
- Localized superficial
- Slow rewarming
- Avoid rubbing or massage
- Deeper or more severe needs medical treatment - topical aloe vera cream
- Foam dressings to maintain moisture and provide insulation
Burns: defintion
68% of patients with burns are males
Most occur at home
Children vulnerable
burns: risk factors
Exposure to thermal, chemical, electrical or radiation source
25% or greater of total body surface will have systemic response
Burns clinical manifestations
Superficial to full thickness (down to muscle)
Burns: medical management
Depends on type and extent
Major burn treatment 3 phases:
- Emergent and resuscitation phase: right then and there of injury
- Acute phase: other systems kick in
- Rehabilitation phase: mobilizing
Burns PT concerns
- Infection
- Multisystem involvement
- Prevention mobility restrictions
- More deep = more systemic
What is the burn chart used for kids called
Pediatric burn chart = pediatric scald burn/corresponding lund and browder chart
What other complications can arise from burns and what systems?
- Urinary: fluids maintained and need to get things out of body (look for change in urine0
- Respiratory: excess fluids puts pressure on the lungs; can also burn the lungs
- Peripheral vascular: overload + swelling
- Infection: increase risk
- GI: exchanging in GI therefore it is in high alert with filtering
Pressure injuries: risk factors
- Poor health
- Poor nutrition
- Decrease mobility
- Neuropathy
- Skin perfusion
- Microclimate
- Prolonged pressure
- Shearing
Clinical manifestation sof pressure injuries
Over bony prominences
Circular pattern
Necrotic tissue
Medical management of pressure injuries
- Clinical observation
- Eliminate cause
- Wound care - topical antimicrobials/antibiotics
- Surgical removal of tissue/repair and replace tissue
PT concerns of pressure injuries
- Prevent breakdown
- Turning schedules, wound care
- Caution with transfers
- Bed mobility and positioning
Pigmentation disorders: definition
Altered melanin primary or secondary
Pigmentation disorders: risk factors
External
Other exogenous pigments
clinical manifestations of pigmentation disorders
- Hyperpigmentation pigmented nevi
- Mongolian spots
- Juvenile freckles
- Lentigines (liver spots = darker) from sun exposure
- Cafe au lait spots (flattened areas of dark skin)
Early melanoma detection
A: asymmetry
B: borders - clear and even is good
C: color - multicolored is not good
D: Diameter - bigger than an eraser
E: evolution - changing over time
Cutaneous sarcoidosis defintion
- Abnormal masses or growths (granulomas)
- 20% of diagnoses get skin lesions, women, scandinavians, african americans, more serious
Cutaneous sarcoidosis risk factors
genetic
Cutaneous sarcoidosis clinical manifestations
Raised patches, deep lumps
Open sores
Granulomas
Skin, lung, live, lymph nodes, eyes
Cutaneous sarcoidosis medical management
- X-ray, CT other
- Corticosteroids, immunosuppressants
- Methotrexate, azathioprine, hydroxychloroquine, tumor necrosis factor alpha
PT concerns fo cutaneous sarcoidosis
- Progression may limit motion
- Fatigue
- Other system involvement
Blistering disease: Definition:
middle aged or older adults all races, unknown cause
Blistering disease: Risk factors
None
Blistering disease: Clinical manifestations:
Formation of flaccid bullae or blisters, oral mucous membranes or scalp
Blistering disease: Medical management
Depends- hospitalization, symptomatic
Corticosteroids, intravenous antibiotics
Blistering disease: PT concerns:
Protect open areas, caution with modalities, gels and creams
