Section 3 -- Skin Pathologies Flashcards
Do all skin pathologies lead to impaired skin integrity? The FC nurse must keep in mind that .
No
What must the foot care nurse keep in mind?
Any time there are breaks in the skin or protrusions that vary from the normal foot structure, there is potential for bacterial invasion, infection or irritation from pressure.
What must the foot care nurse do to prevent problems like bacterial invasion, infx or irritation from pressure do not occur?
Ax any abnormalities of the foot
Teach appropriate preventative strategies
Tinea Pedis (athlete’s foot)
Definition Site Etiology Presentation Complications
A superficial fungal infection of the skin of the foot
Web spaces (most commonly 4th - 5th), Frequently occur simultaneously on both the nails and the skin
Dermatophyte, majority = Trichphyton Rubrum, Sweaty feet confined in tight shoes (warm & damp)
Whitish maceration in the web space, often accompanied with a specific odour, Scaly rash that usually causes itching, stinging and burning, Fissures may be noted between the toes, Yeast Candida Albicans is frequently noted in the web spaces
If not treated, may cause a rash/itching on other parts of the body (legs – tinea corporis; groin – tinea cruris), Often recurrent as the fungus survives under the toenails and reappears when conditions are favourable
A superficial fungal infection of the skin of the foot
Tinea Pedis (athlete’s foot)
Heloma Durum (hard corn)
Definition Site Appearance Etiology Risk factors - who is most prone and why Complications
A circumscribed area of discrete thickening over a bony prominence
Anywhere on the foot but most often occur on the lateral aspect of the 5th digit
Conical with its base superficial and its apex (points inward) penetrating to deeper structures,
Thrombotic areas related to capillary loops entrapped in the keratosis,
Bursa formation between the keratosis and the bony prominence and sinuses leading into the joint spaces, Pain - dull ache to sharp
Result of the integumentary system’s normal physiological response to pressure or friction. Accelerated cell growth forming a hyperkeratotic lesion over a bony prominence in response to increased pressure, shearing or friction.
OA - dry skin, vascular inadequacies, more years of mechanical stresses, decreased fat/thinner skin, gait abnormality, toe deformities, pressure from ill-fitting shoes
Pain r/t pressure on nerve endings; Ulceration beneath the corn, which can lead to infection
A circumscribed area of discrete thickening over a bony prominence
Heloma Durum (hard corn)
Heloma Molle (soft corn)
Site
Presentation
Complications
Etiology
Corn found in the interdigital spaces where enlargement and deformities of the joint cause abnormal rubbing and pressure and the web space becomes macerated. These corns are called “soft” because the area remains moist.
Occurs interdigitally, most often between 4th and 5th digits
Pain d/t proximity to nerves that run along the inside of the toe. The friction caused by the toe rubbing against the corn can irritate the nerve.
In most cases this abnormal pressure on the digits will cause an inflammatory process to develop in the area, resulting in pain and swelling.
Stress combined with moisture retention, Associated with shoe pressure and/or joint deformity.
Found in the interdigital spaces where enlargement and deformities of the joint cause abnormal rubbing and pressure and the web space becomes macerated.
Heloma Molle (soft corn) These corns are called “soft” because the area remains moist.
Heloma Milliare (seed corn)
Definition
Site
Presentation
Complications
Tiny “bead-like” corn occurring in single or multiple configurations.
Usually found on the plantar aspect
Usually accompanied by dry skin. Usually painless.
Can be painful in large clusters or on weight bearing areas. Very painful if located on pressure points over bone.
Tiny “bead-like” corn occurring in single or multiple configurations.
Heloma Milliare (seed corn)
Neurovascular Corn
Site
Presentation
Complications
Usually found on areas with a lot of friction
Often mistaken for plantar warts.
Painful on direct pressure
Usually found on areas with a lot of friction. Painful on direct pressure and are often mistaken for plantar warts.
Neurovascular Corn
Tyloma (callus)
Site
Etiology
Presentation
Complications
Thickening (hyperkeratosis) of the epidermis due to friction or pressure
Develop on weight-bearing areas of the foot where the fat pads (subcutaneous tissue) have thinned or deformities have changed the weight-bearing pattern of the foot.
Occur naturally as a result of repeat shearing, pressure and/or friction; Poorly fitting footwear and gait abnormalities can lead to callus formation
Flat and cover a larger area of the skin as compared to corns; With calluses, skin striations pass through the lesion; Usually not painful, except maybe when direct pressure applied; May lead to feeling of pain/burning* sensation in feet d/t irritated nerve endings beneath callus
With prolonged, abnormal friction, keratotic cells continue to accumulate; this may lead to pressure then pain
Can thicken to the extent that they fissure and then become vulnerable to infections
Thickening (hyperkeratosis) of the epidermis due to friction or pressure
Tyloma (callus)
Tylomas may lead to feeling of pain/burning in foot. What else might a burning sensation be indicative of?
diabetes, anemia, vitamin deficiency, decreased circulation
Fissures
Moist or dry cracks in the epidermis at sites where the skin is under tension and may extend to and involve the dermis with the potential for infection. Moist fissures are often found interdigitally while dry fissures are found around the heel margins.
Moist or dry cracks in the epidermis at sites where the skin is under tension and may extend to and involve the dermis with the potential for infection. Moist fissures are often found interdigitally while dry fissures are found around the heel margins.
Fissures
Verruca Plantaris (plantar wart)
Site Etiology How long to develop? Treatment? Presentation What will often form around the wart? Similar in appearance to? Complications
A benign epidural tumour that is caused by the human papilloma virus
Usually develops on the plantar surface, the forefoot is more likely to be affected than the rear foot.
HPV invades the epidermis. The virus enters the body through microscopic openings in the epidermis.
May develop over a period of days, weeks or several months.
65% - 80% of warts disappear without treatment.
Cauliflower like appearance, vary in size from dot to 1/2 inch, May be individual, grouped or mosiac lesions, Black dots may be seen d/t capillary thrombosis (clotting), Skin striations widen out and go around the wart
Similar appearance to hard corns
A callus will often form around the wart, disrupting the junction between the dermis and epidermis
Frequently asymptomatic, Potentially painful if located on pressure points or if skin surfaces are pinched together
A benign epidural tumour that is caused by the human papilloma virus
Verruca Plantaris (plantar wart)
Corns VS Warts
Age Site Pain Appearance Course Cause
Middle to old VS children and teens
Almost exclusively over pressure points (bony prominences) VS any part of the foot, but most common on plantar surface
Painful with direct pressure VS painful when pinched or squeezed
Continuation of skin striation over the lesion VS Skin striation widen out around the lesion
Usually only resolve when causative pressure is relieved VS 65-80% resolve without Tx
Mechanical stress VS virus
Hyperhidrosis
Definition
May be associated with?
More commonly associated with?
Excessive production of sweat usually from the soles of the feet.
There are 250,000 sweat glands in each foot and they produce up to a cup of sweat a day. For people who exercise and play sports regularly, the feet can produce even more sweat.
Although it may be associated with infections, allergies or emotional stress, the most common cause is poorly ventilated hosiery or shoes.
Excessive production of sweat usually from the soles of the feet.
Hyperhidrosis
Bromhidrosis
Why is this not common in the elderly.
Profuse perspiration or sweating characterized by a foul odour (bacterial invasion).
This is not common in the elderly because of the decrease in the number of sweat glands.
Profuse perspiration or sweating characterized by a foul odour (bacterial invasion).
Bromhidrosis
Tinea Pedis (athlete’s foot)
Definition
A superficial fungal infection of the skin of the foot
