Skin and Sensory (Final) Flashcards
Contact Dermatitis
• acute inflammatory reaction triggered by direct exposure to an irritant or allergen-producing substance; not contagious or life threatening
• varies in severity depending on substance, are affected, exposure extent, and individual sensitivity
• usually resolves in 2-4 weeks
Irritant Contact Dermatitis
doesn’t involve the immune system but triggers the inflammatory response
produces a similar reaction to a burn
Irritant Contact Dermatitis Causes
chemicals
plants
body fluids
rubber gloves
soaps
Irritant Contact Dermatitis Manifestations
erythema
edema
pain
pruritus
vesicles
Allergic Contact Dermatitis
sensitization occurs on first exposure and subsequent exposures produce type IV cell-mediated hypersensitivity
Allergic Contact Dermatitis Causes
metals
chemicals
adhesives
cosmetics
plants
Allergic Contact Dermatitis Manifestations
appear 24-48 hrs after exposure
pruritus
erythema
edema
small vesicles
Atopic Dermatitis (Eczema)
chronic inflammatory condition with an inherited tendency; may be accompanied by asthma and allergic rhinitis
most common in infants and usually resolves by early adulthood; characterized by remissions and exacerbations
exact cause unknown but may result from immune system malfunction (similar to hypersensitivity reactions ie IgE elevation)
Atopic Dermatitis Complications
secondary bacterial skin infections
neurodermatitis (permanent scarring and discoloration from chronic scratching)
eye problems (conjunctivitis)
may affect any area but pattern exhibited tends to be age specific
YOUNG CHILDREN: FACE, SCALP, HANDS, FEET
OLDER CHILDREN/ADULTS: KNEES AND ELBOWS
Atopic Dermatitis Manifestations
may be worsened by environmental factors like food allergens, airborne allergens, Staphylococcus aureus colonizations on skin, topical products, sweating, and rough fabrics
red to brownish-gray skin patches
pruritus, which may be severe especially at night
vesicles
thickened (lichenified), cracked or scaly skin
irritated, sensitive skin from scratching
Urticaria (Hives)
raised erythematous skin lesions (welts)
occurs when histamine release is initiated by these substances or conditions
usually short lived and harmless
Urticaria Causes
Type I hypersensitivity reaction often triggered by food (shellfish, nuts) and medicine (antibiotics)
emotional stress
excessive perspiration
diseases (autoimmune, leukemia)
infections (mono)
Urticaria Manifestations
welts that blanch and pruritus
diffuse welts may grow large, spread and fuse together
can impair breathing if around face and progress to anaphylaxis and shock
Psoriasis
common chronic inflammatory condition that affects skin cell life cycle, specifically keratinocytes
cellular proliferation is significantly increased, causing cells to build up too rapidly on skins surface; buildup leads to thickening of dermis and epidermis because dead skin cells cannot shed fast enough
may take days-weeks for symptom to emerge during flare ups
Psoriasis Causes
exact cause unknown, but thought to be multifactorial
environmental factors
trauma
infections
obesity
excessive alcohol
certain meds
genetic
immunologic factors
autoimmune process in which T lymphocytes mistake normal skin cells as foreign
Psoriasis Onset
family tendency observed; severity varies (weakened immune system)
most frequently between 15-35 years and may be sudden or gradual
REMISSIONS AND EXACERBATIONS; MAY ALSO HAVE ARTHRITIS
Psoriasis Exacerbation Causes
bacteria or viral infections in any location
dry air/dry skin
skin injuries
certain meds (antimalaria agents, beta blockers, lithium)
stress
too little/too much sunlight
excessive alcohol
Psoriasis Papules
begins as small red papule, often on elbows, knees and trunk but can appear anywhere
Erythrodermic
intense erythema that covers a large area
Guttate
small pink-red spots
Inverse
erythema and irritation that occurs in armpits, groin, and skin folds
Plaque
thick, red patches covered by flaky, silver white scales (MOST COMMON)
Pustular
white blisters surrounded by red, irritated skin
Psoriasis Manifestations
pruritus
genital lesions
joint pain or aching (if arthritis present)
nail changes (thickening, yellow brown spots, pits on nail surface, separation of nail from base)
dandruff
Infectious Integumentary Disorders
skin infections are common
organisms gain access through breach in skin or mucous membranes which triggers inflammation
can occur in any skin layer or structure, may be acute or chronic, severity varies, resolves with treatment
Bacterial Infections
can be caused by any of the normal flora, mild to life threatening
staphylococcus and streptococcus genera are common culprits
Folliculitis
bacterial infection involving hair folllicles
tender, swollen areas that form around hair follicles often on neck, boobs, butt and face
Furuncles
bacterial infection beginning in hair follicles and then spread into surrounding dermis; most common on face, neck, axilla, groin, butt, back
starts as a firm, red painful nodule that develops into a large painful mass which frequently drains large amounts of purulent exudate
Carbuncles
a cluster of furuncles
Impetigo
common and highly contagious bacterial infection; can spread throughout body through self transfer of exudate
can occur without apparent skin breach but typically arises from break in skin
typically caused by staphylococci, which produce a toxin that attacks collagen and promotes spread
Impetigo Manifestations
lesions usually begin as small vesicles that enlarge and rupture, forming characteristic honey colored crust
pruritus
lymphadenopathy
Cellulitis
bacterial infection that occurs deep in the dermis and subQ tissue; appears as a swollen, warm and tender area of erythema
usually results from direct invasion of pathogens through break in skin especially where contamination is likely or spreads from existing infection
Cellulitis Manifestations and Complications
M: indicators of infections (*fever, leukocytosis, malaise, arthralgia**
C: necrotizing fasciitis, septicemia, septic shock
Necrotizing Fasciitis
a rare but serious bacterial infection that can aggressively destroy skin, fat, muscle and other tissue
typically results from highly virulent strain of gram-positive, group A beta-hemolytic streptococcus that invades through a minor cut or scrape; bacteria release toxins that directly destroy tissue, disrupt blood flow and break down tissue
Necrotizing Fasciitis Wound
first sign may be a small, reddish painful area that quickly evolves into a painful bronze or purple colored patch
center of lesion may become black and necrotic with exudate
wound may grow in less than an hour
Necrotizing Fasciitis Manifestations and Complications
M: fever, tachycardia, hypotension, confusion
C: gangrene, multi system organ failure, shock
Herpes Simplex Type 1
typically affects lips, mouth and face beginning in childhood; can involve the eyes leading to conjunctivitis
can result in meningoencephalitis
transmitted by contact with infected saliva, primary infection may be asymptomatic
HSV 1 Pathogenesis
- after primary infection, virus remains dormant in sensory nerve ganglion to the trigeminal nerve until is is reactivated
- reactivation may result from infection, stress, immunosuppression, or sun exposure (painful blisters or ulcerations that are preceded by burning or tingling sensation)
- lesions may resolves spontaneously within 3 weeks, but healing can be accelerated with the administration of oral or topical antiviral agents
Herpes Zoster (Shingles)
varicella-zoster virus, appears in adulthood years after a primary infection of varicella in childhood
virus lies dormant on a cranial/spinal nerve dermatome until activated years later; virus affects this nerve only giving the condition its typical unilateral manifestations
Shingles Manifestations
pain
paresthesia
red/silvery vesicular rash that develops in along over the area innervated by affected nerve (nose sit of the head or torso)
extremely sensitive skin
pruritus
rash may persist for weeks to months
Shingles Complications
neuralgia
blindness
vaccines are available to prevent both varicella and herpes zoster
Rubella (German/3-Day Measles)
RNA virus enters bloodstream through respiratory route; mild in most children
Rubella Manifestations
enlarged cervical and postauricular lymph nodes
low grade fever
headache
sore throat
runny nose
cough
faint pink to red maculopapular rash caused by virus dissemination to the skin
Rubeola (Red Measles)
highly contagious acute viral disease of childhood (droplet transmission)
no symptoms in incubation period (7-12 days)
Rubeola Manifestations
high fever
malaise
enlarged lymph nodes
runny nose
conjunctivitis
barking cough
rash that develops over head and spreads distally over the trunk, extremities, hands and feet
characteristic pinpoint white spots (Koplik) found over buccal mucosa
Roseola
herpesvirus 6 or 7 infection; 6 months to 2 yrs of age
intubation of 5-15 days followed by sudden onset of fever that lasts 3-5 days
after fever, erythematous macular rash that lasts about 24 hrs (usually doesn’t require treatment)
Tinea (Ringworm/Athletes Foot)
parasitic infection that causes several types of superficial fungal infections
typically manifests as a circular, erythematous rash accompanied by pruritus and burning
Tinea Capitis
the scalp; common in school aged children
hair loss at site is common
Tinea Corporis
involving the body
Tinea Pedis
involving the feet especially the toes
Tinea Unguium
involving the nails, typically the toenails
begins at the tip of one or more nails and then usually spread to other nails
turns nails white and then brown causing them to thicken and crack
Scabies
result of mite infestation
male mites fertilize the females then die, female mites burrow into epidermis laying eggs over a period of several weeks through series of tracts and die after that
Scabies Process
- larvae hatch from eggs and migrate to skin surface
- larvae burrow in search of nutrients and mature to repeat cycle
- burrowing appears as small, light brown streaks on skin
- burrowing and fecal matter left by the mites triggers the inflammatory process, leading to erythema and pruritus
transmission of close contact
Pediculosis (Lice Infestation)
small brown insects that feed off human blood
females lay nits on hair shaft close to scalp (appear as white, small, iridescent shells on hair)
after hatching, the life bite and suck on blood
bite size develops as highly pruritic macule or papule
CLOSE CONTACT!!
Skin Cancer
most frequent cancer in the US; more prevalent in males, whites, fair complexion, family history
early detection is crucial
Basal Cell Carcinoma
most common; develops from abnormal growth of cells in lowest layer of epidermis
rarely metastasizes
Squamous Cell Carcinoma
involves changes in the squamous cells found in the middle layer of epidermis
Melanoma
melanocytes; least common type but most serious
often metastasizes
Skin Cancer Suspicious Features
ABCD (larger than 6 mm)
any skin growth that bleeds or will not heal
any skin growth that changes in appearance over time
Conjunctivitis
caused by viruses (most common), bacteria (staphylococcus, gonorrhea, chlamydia), allergens (pollen, dust), chemical irritants, trauma
can generate edema, pain, blurry vision, photophobia
Viral vs Bacterial Conjunctivitis
viral: watery, mucus like exudate
bacterial: yellow-green exudate
HIGHLY CONTAGIOUS THROUGH DIRECT CONTACT
Conjunctivitis Risk Factors
wearing contact lenses
contaminated makeup
ophthalmic meds
allergens and irritants typically produce redness, itching and excessive tearing
Acute Otitis Media
infection of middle ear; common in young children due to eustachian tubes being narrower, straighter and shorter and an immature immune system
begins as viral upper respiratory infection; more common in winter
fluid collection from viral infection provides prime medium for secondary bacterial growth, usually streptococcus pneumoniae and haemophilus influenza
Acute Otitis Media Risk Factors
childcare in group settings
feeding infants in supine position
environmental smoke exposure
pacifier use
orofacial deformities
history of allergic rhinitis
fluid accumulation in middle ear due to adenoid enlargement, usually due to inflammation
Acute Otitis Media Complications
effusions
rupture of tympanic membrane
scar tissue formation
conductive hearing loss
mastoiditis
cholesteatoma
meningitis
osteomyelitis
Acute Otitis Media Manifestations
ear pain
crying or irritability
rubbing or pulling at ear
mild hearing deficits
sleep disturbances
red and bulging tympanic membrane
indications of infection
purulent or clear exudate from external ear canal (if tympanic membrane ruptures)
n/v
diarrhea
headache
Glaucoma
group of eye conditions that lead to damage to the optic nerve; caused by increased intraocular pressure and decreased blood flow to the optic nerve
pressures inside the eye can climb when the outflow of aqueous humor becomes blocked or production of aqueous humor increased to an abnormal level (increased pressures cause ischemia and degeneration of the optic nerve)
SECOND LEADING CAUSE OF BLINDNESS (diabetic retinopathy is #1)
Open-Angle Glaucoma
most common type; intraocular pressure may increase gradually over an extended period of
*RISK FACTORS: FAMILY HISTORY AND AA**
because vision changes are gradual, can be overlooked or misdiagnosed as presbyopia
Open-Angle Glaucoma Manifestations
painless, insidious, bilateral changes in vision (tunnel vision, blurred vision, halos around lights, decreased color discrimination)
loss of peripheral vision (tunnel vision)
patients describe vision as looking through a straw or curtains are closing
Closed-Angle Glaucoma
result of a sudden blockage of aqueous humor outflow; can be acute, subacute or chronic and typically unilateral
without treatment, acute and narrow angle glaucoma can cause blindness
Closed-Angle Glaucoma Causes
traum,
sudden pupil dilation (exposure to bright light after prolonged darkness)
prolonged pupil dilation (meds for eye exams)
emotional stress
Closed-Angle Glaucoma Manifestations
usually sudden and worsening quickly
sudden and severe eye pain
headache
n/v
nonreactive pupil
redness
haziness of cornea
vision changes (halos around lights)
Cataracts
opacity or clouding of the lens; can occur as a congenital condition or develop later on
may affects one or both eyes and doesn’t always affect eyes symmetrically
Cataracts Risk Factors
family history
advancing age
smoking
UV light exposure (natural or artificial)
metabolic conditions (diabetes mellitus)
certain meds (corticosteroids)
eye injury
Cataracts Manifestations
cloudy, fuzzy, foggy or filmy vision
color intensity loss
diplopia
impaired night vision gradually progressing to impaired day vision
halos around lights
photosensitivity
frequent changes in eyeglass or contact lens prescriptions
Macular Degeneration
deterioration of the macular area of the retina caused by impaired blood supply to the macula that results in cellular waste accumulation and ischemia
Macular Degeneration Risk Factors
ADVANCING AGE
family history
being female and white
smoking
increased UV light exposure
decreased carotenoid intake
high fat diet
cardiovascular disease
hypertension
obesity
Macular Degeneration Manifestations
DRY FORM: blurry vision with loss of central vision
WET FORM: distortion of straight lines, dark spots in central vision, sudden loss of central vision
Ménière’s disease
disorder of the inner ear that results from endolymph swelling which stretches the membranes and interferes with the hair receptors in the cochlea and vestibule
peak incidence is 20-50 years
Ménière’s Disease Risk Factors
cause is unknown but mag be metabolic disturbances, hormonal imbalances, autoimmune, head injuries, otitis media, syphilis
allergic rhinitis
alcohol abuse
stress
fatigue
certain meds (aspirin)
respiratory infections
Ménière’s Disease Manifestations
attacks typically occur in waves of acute episodes that last several months followed by brief periods of relief (triggered by changes in barometric pressure; includes intermittent episodes of vertigo, tinnitus, unilateral hearing loss, and a sensation of fullness)
n/v
diarrhea
headache
uncontrollable eye movement
C: PERMANENT HEARING LOSS
Retinal Detachment
acute condition that occurs when retina separates from supporting structures
as vitreous humor collects underneath, the retina peels away from the underlying choroid; these detached areas may expand over time and the retina becomes ischemic and stops functioning causing vision loss
Retinal Detachment Pathogenesis
- vitreous humor leaks through retinal tear and accumulates underneath retina
- leakage can also occur through tiny holes where the retina has thinned due to aging or other retinal disorders
- less commonly, fluid can leak directly underneath retina without a tear or break
Retinal Detachment Causes
spontaneous
severe nearsightedness
trauma
diabetes mellitus
inflammation
degenerative aging changes
scar tissue
Retinal Detachment Manifestations
typically painless flashes of light in peripheral visual field
blurred vision
floaters
darkening vision (like curtain drawing across a visual field)
Tinnitus
hearing abnormal noises in the ear
may be described as a ringing, buzzing, humming, whistling, roaring or blowing
Tinnitus Associations
presbycusis
exposure to excessive noise
cerumen impaction
otosclerosis
ménière’s disease
stress
head injury
acoustic neuroma
atherosclerosis
hypertension
carotid stenosis
arteriovenous malformation
caffeine
ototoxic meds (many antibiotics, aspirin, chemo, diuretics)
Vertigo
illusion of motion; NOT THE SAME AS DIZZINESS
n/v
Peripheral Vertigo
there is a problem with vestibular labyrinth, semicircular canals or vestibular nerve
Peripheral Vertigo Causes
certain meds (amino-glycoside antibiotics)
head injuries
ménière’s disease
nerve compression
infections
inflammation
Central Vertigo
there is a problem in the brain (brain stem or cerebellum)
Central Vertigo Causes
arteriosclerosis
certain meds (anti seizure agents and aspirin)
alcohol
migraines
MS
seizures
