skin disorders

Question 1

what is eczema?

Answer 1

Inflammatory skin conditions = itching, redness, skin lesions

Patient education is key to break the “itch-scratch” cycle

Question 2

what are the stages to eczema?

Answer 2

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

Question 3

what are the precautions and limitations of eczema

Answer 3

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

Question 4

what are interventions and goals for a patient with dermatitis?

Answer 4

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

Question 5

what are the common referral and treatments for dermatitis

Answer 5

PCP
Immunologist
Dermatologist

Patient education to eliminate triggers
Topical or systemic therapy  Corticosteroid, immunosuppressants, antihistamines
Daily care  mild soaps, lotions, cooler showers

Question 6

what is Cellulitis

Answer 6

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

Question 7

How do you asses cellulitis?

Answer 7

Mark outer boundaries
Refer to PCP or ED depending on severity and speed of spreading

Question 8

what is impetigo?

Answer 8

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

Question 9

what is a skin abscess?

Answer 9

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

Question 10

look at the photos for the skin abscess examples

Answer 10

slide 25

Question 11

what is herpes type 1

Answer 11

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

Question 12

what is herpes type 2?

Answer 12

Vesicular genital eruption
Spread by sexual contact

Question 13

what is herpes zoster

Answer 13

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

Question 14

what is the treatment for herpes infections

Answer 14

antivirals, corticosteroids for skin inflammation

Contagious to individuals who have not had chickenpox (e.g. grandchildren, daycare)
Contraindications: heat & ultrasound

Question 15

what is Lyme disease?

Answer 15

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

Question 16

what are the interventions of Lyme disease?

Answer 16

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*

Question 17

what is scabies?

Answer 17

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

Question 18

what is lice

Answer 18

parasitic infection
Lice: head, body, genitals; bite marks, redness, & nits
Treatment: shampoo with permethrin; removal of nits
very contagious

Question 19

what is ring worm?

Answer 19

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

Question 20

what is athletes foot?

Answer 20

Athlete’s Foot: foot typically between the toes
Itching, inflammation, erythema, pain, pruritus
Transmission: direct contact
Treatment: antifungal cream

Question 21

what is yeast?

Answer 21

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

Question 22

what is psoriasis?

Answer 22

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

Question 23

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

Answer 23

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

Question 24

what is lupus erythematosus?

Answer 24

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

Question 25

what is scleroderma?

Answer 25

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