skin disorders Flashcards
what is eczema?
Inflammatory skin conditions = itching, redness, skin lesions
Patient education is key to break the “itch-scratch” cycle
what are the stages to eczema?
Three stages of the disease
1. acute
2. subacute
3. chronic
can occur in infancy, childhood, adult
Acute: red, oozing, crusting rash, extensive erosions, exudate
Subacute: erythematous skin, scaling scattered plaque
Chronic: thickened skin, fibrotic papules, post inflammatory pigment changes
Often a relapsing stage as well
Most common skin problem, affects 10% of US population
what are the precautions and limitations of eczema
Precautions:
Physical modalities
Avoid use of rubbing alcohol
What else can a clinical setting do to minimize triggers?
Functional limitations:
Inability to tolerate stress; cold, dry air, or allergens without rash, itching, and dry skin
Limitation of the use of some modalities
what are interventions and goals for a patient with dermatitis?
Dermatitis not treated by PT
PT should be able to recognize the condition
Observe
Document
Refer as needed
Depending on severity and setting/role, may need to:
Change dressings
Apply topical agents
Apply compression therapies
Fit orthotics/prosthetics appropriately (e.g. modify type of prosthetic socks-refer to prosthetist)
Movement related goals secondary to the condition
Ability to perform physical tasks
Pt education recurrence of condition, secondary impairments, self-management
Pain reduction
Soft tissue swelling, inflammation reduction
Increase tolerance to positions & activities; monitor use of splints/braces as appropriate
Facilitate wound healing decrease complications associated with soft tissue & circulatory disorders
what are the common referral and treatments for dermatitis
PCP
Immunologist
Dermatologist
Patient education to eliminate triggers
Topical or systemic therapy Corticosteroid, immunosuppressants, antihistamines
Daily care mild soaps, lotions, cooler showers
what is Cellulitis
Cellulitis is a bacterial infection of the skin: presents with poorly demarcated erythema, edema, warmth, and tenderness
Common diagnosis: often difficult to diagnose & difficult to treat
Medical Management: antibiotics, elevation, cool & wet dressing
Untreated spreads quickly, lymphangitis, gangrene, abscess & sepsis
Higher Risk for older adults, malnutrition, diabetic wounds, lymphedema, steroid therapy
How do you asses cellulitis?
Mark outer boundaries
Refer to PCP or ED depending on severity and speed of spreading
what is impetigo?
Superficial skin infection caused by staph or strep
Common in US
Clinical Manifestation inflammation, small pus-filled vesicles, itching
Highly contagious common in infants/children and older adults
Requires immediate medical attention
Treated w/ antibiotics; isolate from public
what is a skin abscess?
Cavity containing pus surrounded by inflamed tissue
Result of localized infection
Commonly caused by staph infection
Medical management drain that thing! Antibiotics
People who live in crowded conditions, have poor hygiene or chronic skin diseases, or whose nasal passages contain Staphylococcusare more likely to have repeat episodes of folliculitis or skin abscesses
look at the photos for the skin abscess examples
slide 25
what is herpes type 1
itching and soreness followed by eruption of skin on face and mouth ‘cold sore’
Spread by contact
Treatment: antiviral therapy, no close contact when lesions are present
what is herpes type 2?
Vesicular genital eruption
Spread by sexual contact
what is herpes zoster
aka “Shingles”
Caused by varicella-zoster (chicken pox virus) virus reactivated after laying dormant for years
Associated with pain & tingling of affected spinal or cranial nerves
Fever, chills, malaise, GI disturbances
what is the treatment for herpes infections
antivirals, corticosteroids for skin inflammation
Contagious to individuals who have not had chickenpox (e.g. grandchildren, daycare)
Contraindications: heat & ultrasound
what is Lyme disease?
bacterial infection transmitted by ticks
on risk-locations in the US: northeast coast, Wisconsin & Minnesota, and norther California & southern Oregon
Clinical Manifestation:
red bump, ‘bulls-eye’ rash
flu-like symptoms myalgia, arthralgia, fever, headache, fatigue, motor or sensory radiculoneuritis, neck stiffness
cardiac symptoms fluctuating degree of atrioventricular block, myopericarditis, mild left ventricular dysfunction, cardiomegaly or fatal pancarditis
Dx: characteristic clinical findings (above) and culture of B. burgdorferi
what are the interventions of Lyme disease?
Physical Therapy Intervention
Management of muscle and joint pain
Management of fatigue
Manual Techniques
Exercise Prescription
Requires an Integrative Approach to treatment
34% of a population-based, retrospective cohort were ill an average of 6.2 years after antibiotic treatment*
62% of a retrospective evaluation of 215 Lyme disease patients from Westchester County, NY, remained ill an average of 3.2 years after antibiotic treatment*
what is scabies?
a parasitic infection
Scabies: mites burrow into the skin and lay eggs; cause inflammation & itching
Treatment: scabicides (topical and oral meds)
Critical complication is septicemia
Resource poor and tropical areas-most common
very contagious
what is lice
parasitic infection
Lice: head, body, genitals; bite marks, redness, & nits
Treatment: shampoo with permethrin; removal of nits
very contagious
what is ring worm?
Ringworm: involves hair, skin, and nails
dermatophytosis or tinea
Ring shaped patches with vesicles itchy
Transmission: direct skin-skin contact
Treatment: topical or oral antifungal
what is athletes foot?
Athlete’s Foot: foot typically between the toes
Itching, inflammation, erythema, pain, pruritus
Transmission: direct contact
Treatment: antifungal cream
what is yeast?
Candidiasis common in skin folds due to excessive moisture
Clinical Manifestation
Oral “thrush”; oral patches, redness, soreness
Genital erythema, inflammation, itching, burning with urination, pain, discharge
Topical redness, rash, soreness
Treatment: antifungals, silver infused dressing for skin folds
what is psoriasis?
immune disorder
Overview: skin disease that causes red, itchy scaly patches _ most common on the knees, elbows, trunk & scalp
Common chronic condition _ no cure, management only; flare ups common
Pathogenesis: The life cycle of skin cells greatly accelerates _ leads to a build up of dead cells on the epidermis
S/S:
Red patches of skin covered with thick, silvery scales
Small scaling spots more typical in children
Dry, cracked skin may bleed or itch
Itching, burning
Thickened, pitted or ridged nails
Swollen & stiff joints psoriatic arthritis
Can you explain the where to refer for psoriasis, the etiology, triggers, risk factors, complications, and is it common to see the disease pop up again
Referral to PCP: if condition is undiagnosed or is increasing in severity
Etiology: hereditary, associated immune disorders
Triggers: Infection, weather, injury to skin, stress, smoking, heavy alcohol consumption, certain medications, rapid withdrawal of corticosteroids
Risk Factors: family history, stress, smoking
Complications: psoriatic arthritis, eye conditions, obesity, type II DM, HTN, CVD, other autoimmune diseases
Exacerbations and remissions are common
what is lupus erythematosus?
Chronic progressive autoimmune inflammatory disorder _ connective tissue
Characteristic red rash & scaly plaques
Discoid lupus erythematosus (DLE): affects only skin; scarring of face, ears, scalp; flares with sun exposure
Systemic lupus erythematosus (SLE): affects organs
Treatment: no cure; topical corticosteroid for skin; salicylates for fever and joint pain; immunosuppressants for severe symptoms
what is scleroderma?
Autoimmune connective tissue & rheumatic disease _ causes inflammation in the skin & body _ leads to tight, hard skin
can affect one area or it can be systemic
two main types:
Localized scleroderma: skin and structures directly under the skin
Systemic scleroderma:
affects many systems of the body, most serious type, can damage blood vessels & internal organs
Diagnosis
Medical history: current and past symptoms
Physical exam
No single test for scleroderma
Treatment
Based on scleroderma type and body areas affected
Medication decrease swelling, manage pain, control secondary symptoms
Regular dental care causes dry mouth & damage oral connective tissue magnifies tooth decay
Physical Therapy pain management, muscle strength, activity management/strategies, ROM (e.g. hand function), exercise rx for anti-inflammatory benefits
