Skin disorders Flashcards
6 parts to skin disorders
Fungal Infections Pigmented Lesions Viral Infections Bacterial Infections Skin Cancers Miscellaneous Disorders
2 Types of Fungal infections
Superficial skin lesions
Systemic Fungal Infections
3 ways of fungal transmission
Implementation: Tineas
Inhalation: cryptococcal
Taking antibiotics: candidiasis
T/F fungal infection are most common in the elderly and immuno-compromised
True
T/F Fungal infection Can proliferate more easily in patients with vascular indwelling catheters, organ transplant recipients and patients receiving chemo
True
4 types of Superficial fungal skin lesions
Tinea pedis
Tinea captitis
Tinea versicolor
Candidiasis
Superficial fungal infections includes what?
dermatophytes/fungi that infect hair, skin and nails
Candidiasis
Tineas
Fungal infections =
mycoses or dermatophytes
What is the treatment for Superficial fungal infections
Treatment: usually can be treated with topical antifungal preparations
Systemic antifungals needed for extensive areas or for treatment failures
2 types of common fungi
Yeast= Candida albicans
Superficial dermatophytes= Tineas
what is Tinea pedis
Dry, scaling pruritic lesions
May only affect skin in the web space between the toes
Risk factors for tinea pedis
Coming into contact with infected skin or fungus in the environment
prevention of tinea pedis
Use of shower shoes, cleaning tub/shower after each use may minimize transmission
treatment of tinea pedis
Topical antifungals in most cases. Most are OTC.
Systemic antifungals for resistant cases - oral or IV
4 characteristics of tinea capitis
can affect scalp, eyebrows or eyelashes
scaly erythematous lesions and hair loss
may cause permanent alopecia (baldness)
is the most common pediatric dermatophyte
treatment for tinea capitis
PO systemic anti-fungals bid for 4-6 weeks
Topicals are NOT effective
what is tinea versicolor
a ringworm that affects the skin of the upper chest, back, or arms
Is caused by a type of yeast that lives naturally on your skin
Rash occurs when the yeast grows out of control
risk factors of tinea versicolor
Hot climate, sweating a lot, oily skin, weakened immune system, NOT contagious
characteristics of tinea versicolor
Acidic bleach from the growing yeast causes skin discoloration.
Can be spots or patches that can be white, pink, red or brown,
treatment of tinea versicolor
Topical antifungals including shampoos such as Selsum Blue
what is candidiasis
Thrush/Yeast infection
risk factors for candidiasis
Immunosuppression (iatrogenic/acquired), antibiotic use
Appearance of candidiasis
may appear as white lesions in the mouth
Beefy red with satellite lesions in intertriginous areas
treatment for candidiasis
topical anti-fungal agents
3 systemic fungal infections that affect lungs
histoplasmosis, blastomycosis, pneumocystis
systemic fungal infection that affects lungs AND meninges
cryptococcosis
What is histoplasmosis
Fungal infection that mostly affects lungs
Histoplasma capsulatum = fungus that lives in the soil
Acquired when person breaths in the dust that contains the fungi
when does histoplasmossis occur
around 10 days after exposure
what are the symptoms of histoplasmosis
usually self-limiting and stays in the lungs
Systemic infections = may occur and can be fatal
what is the treatment for histoplasmosis
usually none unless severe or chronic disease occurs
Systemic antifungals usually to treat
what is blastomycosis
Caused by Blastomyces fungus
Typically affects the lungs
Acquired by breathing in the spores = AIRBORNE
symptoms for blastomycosis
Symptoms appear 3 weeks to 3 months after exposure
Most do NOT get sick
Flu-like symptoms can develop
treatment for blastomycosis
systemic antifungals for severe cases for 6 months to 1 year
what does pneumocystis cause
Causes a form of pneumonia: pneumocystis pneumonia
risk factors for pneumocyctis
immunocompromised
what causes pneumocystis
fungus is common in the environment; AIRBORNE
symtpoms of pneumocystits
mild, flu-like, pleuritic chest pain, fatigue
treatment for pneumocystis
treatment usually combo of 2 IV antifungals and corticosteroids
what is Cryptococcus meningitis
Fungus found in soil and bird droppings
Infection in the meninges rare in healthy people
Occurs in a few days to weeks from contact
symptoms of Cryptococcus meningitis
nausea/vomiting, change in mental status, lethargy, sensitivity to light
treatment of Cryptococcus meningitis
IV/PO antifungals
what is Cryptococcus: PULMONARY INFECTION
Acquired from inhalation of the fungus found in soil
Causes a severe pneumonia with respiratory failure
Incubation times vary from 2-11 months after exposure
symptoms of Cryptococcus: PULMONARY INFECTION
SOB, coughing, fever, mental status changes
treatment of Cryptococcus: PULMONARY INFECTION
PO/IV antifungals
2 types of pigmented lesions
melasma
vitiligo
what is melasma
Characterized by dark macules on the face
More common in women
Mask of pregnancy
Oral contraceptives
treatment of melasma
Avoid sun
Bleaching creams with hydroquinone
Tretinoin/Retin-A (vitamin A derivative
what is vitiligo
Acquired condition characterized by abnormalities in the production of melanin
Pigment disappears from a patch of skin
Occurs suddenly before or around the age of 21
Affected areas spread
treatment and cause for vitilgo
no treatments
casue unknown
4 Viral skin infections
Verrucae Vulgaris
Human papilloma
virus
Herpes Zoster
Herpes Simplex: HSV1/HSV2
what is Verrucae Vulgaris
common wart
transmission of Verrucae Vulgaris
low risk of person to person; higher risk with wet, macerated skin; nail biting, thumb suck can cause spread to nails
who is affected by Verrucae Vulgaris
children and young adults more commonly
symtpoms of Verrucae Vulgaris
unusual skin growth identified by person as a wart
treatment of Verrucae Vulgaris
usually self-limited and resolve on their own
Cryotherapy, duct tape, topical salicylic acid
what is Human papilloma virus
Considered an STD; many different types of HPV (over 200)
transmission of HPV
oral
vaginial
anal sex
treatment of hpv
anti-virals
Prevention and early diagnosis for HPV
Vaccine
pap smears
What is Herpes Zoster: shingles
Varicella zoster virus lies dormant on a dermatome segment after infection with chickenpox
what reactivates varicella zoster virus
Virus becomes reactivated by immunosuppression, stress, or illness
what is prodrome in shingles?
Prodrome: burning/tingling along dermatome and then rash develops with vesicles that dry and crust over
5 characteristics of shingles
Characteristics: vesicles on red base that follow along dermatomal distribution-asymmetric (does not cross midline)
Usually extremely painful
Clears in 2-3 weeks
Usually occurs in people over 50; can occur in anyone who has had chicken pox
Most contagious when vesicles are weeping
treatment for shingles
anti-virals
complications of shingles
post-herpetic neuralgia persistent pain in the area where the rash was
5 bacterial skin infections
Impetigo Abscess Furuncle Cellulitis MRSA (staph)
Causative agents for impetigo
Staphylococci & Streptococci
characteristics of impetigo
Organisms carried in the nose
Acute & CONTAGIOUS
appearance of impetigo
vesicles, pustules, honey-colored crust on red base
treatment of impetigo
Topical antibacterial = Bactroban
5 characteristics of Abcess
Skin inflamed and red with collection of pus
Area often raised with palpable borders
Tender
May drain purulent discharge or feel ‘fluctuant’ (fluid-filled)
Treatment for Abcess
incision & drainage (I&D) and antibiotics
Furuncle
Furuncle is a bacterial infection of HAIR FOLLICLE
carbuncle
Carbuncle is a painful, deep swelling of the skin caused by bacteria
Treatment for Fuuncle and carbuncle
I&D and antibiotics
what causes cellulitis
bacterial infection of skin and surrounding tissues (usually staph or strep bacteria)
May be an initial injury or wound that becomes infected and spreads to surrounding healthy tissue
May be caused by animal or insect bites
Often occurs on the lower extremities
Is cellulitits contagious
No
Appearance of cellulitits
red, painful, swollen and warm to the touch
Blisters may form on the skin
Treatment of cellulitis
PO systemic antibiotics, IV depending on severity
Methicillin resistant staph infection (mrsa)
MRSA is caused by a type of staph bacteria that is resistant to many antibiotics
Hospital acquired-MRSA
associated with invasive procedures, such as surgeries, IV tubing, artificial joints
Community acquired-MRSA
often begins as painful boil
how is mrsa transmited
person-to-person
High risk for MRSA
high school wrestlers, child-care workers, and people who live in crowded conditions
MRSA symptoms
warm to touch purulent drainage fever abscess can develop quickly Bacteria can burrow deep into the body potentially life-threatening infections of bones, joints, surgical wounds, bloodstream, heart valves and lungs
Treatment of MRSa
hospital acquired = IV vancomycin or Zyvox
Community acquired = Bactrim or dicloxacillin
Prophylaxis = Bactroban nasal ointment prior to surgery
3 types of skin cancers
Basal cell
Squamous cell
Melanoma
2 types of precancerous lesions
Actinic keratosis
Solar lentigos
Actinic Keratosis
Benign lesions
Due to damage by sun’s UV rays
Common in fair skin persons
Rough, scaly, red plaques
Solar lentios
Benign lesions
Also known as liver/age spots
basal cell carcinoma
Most common skin cancer in white-skinned people
Increased risk with sun exposure
Most curable usually a non-metastasizing, slow growing skin tumor
characteristics of basal cell
nodular form that begins as a small, flesh-colored or pink dome shaped bump
Translucent, shiny, pearly nodule
Eventually will form an ulcer surrounded by a shiny border
squamous cell carcinoma
2nd most frequent skin cancer
Increased risk with sun exposure
Curable with early treatment
Can metastasize to lymph nodes or internal organs
characteristics of squamous cell
red and scaling
Keratotic, slightly elevated lesion, with an irregular border, usually with shallow chronic ulcer
Melanoma
Cancer of the melanocytes
Malignant cells grow on the skin = radially spreading in the epidermis & vertically spreading deep into the dermis
Can also form internally, in the eyes, and under the nails
risk factors for melanoma
Family history of melanoma,
blond/red hair,
presence of freckling on the upper back,
history or more blistering sunburns before age 20,
history of more of 3 or more years of an outdoor job as a teenager
Where does melanoma orginiate on the body
Originates on skin surface but penetrates deeply into the skin
Invades the blood and lymphatic vessels ant then metastasizes to distant sites
characteristics of melanoma (ABCDE)
A: Asymmetrical: lesions vary in size and shape
B: Borders: are irregular
C: Color: varies from one area to another.
Shades of tan, brown, and black; sometimes white, red, or blue
D: Diameter: greater than 6 mm/size of a pencil eraser
E: Evolving: a mole or skin lesion that looks different from the rest or is changing in size, shape or color
Most deadly form of skin cancer
Superficial spreading type = 70%
Nodular form is the most aggressive
6 types of misc skin disorders
Eczema Stasis dermatitis Psoriasis Drug reactions Urticaria Angioedema
eczema
Group of skin conditions that cause the skin to become inflamed or irritated
Not contagious
Atopic eczema: most common type; inherited tendency to develop eczema, asthma, and hay fever
characteristics/symptoms of eczema
pruritis,
rash on face/back of knees/wrists/hands/feet,
skin very dry/thickened/scaly,
lesions may appear reddish and then turn burn;
lesions can ooze & crust over;
can be exacerbated by heat, cold, detergents, URI, and stress
eczema treatment
Relieve itching/prevent infection Lotions and creams to keep skin moist Cold compresses OTC hydrocortisone cream or prescription strength Immune modulator medications
Stasis dermatitis (Chronic venous insufficiency)
Condition found primarily in the lower extremities = also know as ‘venous eczema’
Cause: poor venous circulation
characteristics of statis dermatitis
More common in people over the age of 50
One way valves in legs fail and fluid and pressure builds up
Blood leaks out of the veins into the skin
symptoms of statis dermatitis
redness & scaling present
Ulcerations may develop and a secondary bacterial infection may occur
edema around the ankles is often 1st sign
Skin can appear reddish, yellowish, or brown color
Itching, pain, sores that ooze/crust/scale, thickened skin around the ankles/shins, hair loss on ankles or shins
treatment of statsis dermatitis
compression stockings, elevate feet above the heart, exercise, diuretics for edema, antihistamines for the itching, surgery to repair valves
Psoriasis
over-active immune system, may be autoimmune
Long-term, chronic condition
Most commonly begins in young adulthood
NOT contagious
Affects 1-3% of population
Most common in adults
Research shows that there is a link between psoriasis/obesity/cardiovascular diseases
characteristics of psoriasis
skin cells grow too quickly causing skin to be thick, white, silvery, or have red patches of skin plaques
Normal skin cells grow gradually and flake off about every q 4 weeks
treatment of psoriasis
keep skin moist, UV light phototherapy, corticosteroid creams/lotions, topical medications, immune modulating medications
T/F MOST drugs can cause a local or generalized skin eruption
True
Drug-induced skin reactions Appearance
typically, maculo-popular rash, bright red
Drug-induced skin reactions Distribution
usually starts on trunk, spreads to limbs, usually does not affect face
Itches and burns
May start at any time during course of drug therapy through 2-3 weeks post-medicinal course is completed
T/F Penicillins and cephalosporins often cause Drug-induced skin reactions
True
Urticaria/Hives
Manifestation of an allergic reaction
Characterized by edematous plaques that cause INTENSE ITCHING
Describe Urticaria lesions
raised pink/red areas surrounded by a paler halo that blanch with pressure
May see swelling of the tongue or pharynx, larynx usually spared
Common causes of Urticaria
food, drinks, medications, insect stings, viral infections, dust mites, exposure to pollen or chemicals
Histamine’s role in Urticaria
is mediator in most cases, causing hyper-permeabilty of the micro-vessels in the skin and allowing fluid to leak into the tissues causing edema and wheal formation
Angioedema
Severe form of urticaria
Will see thicker lesions from massive transudation of fluid into the dermis/subcutaneous tissue
Where does Angioedema usually affect
Typically affects the lips, periorbital area, hands, feet, penis, or scrotum
Potential complications of angioedema
airway obstruction due to laryngeal edema
