Skin disorders Flashcards by Brooke Routhier

Eczema ➔

Dermatitis

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Bacterial Infections ➔

Cellulitis, Impetigo, Abscess

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Viral Infections ➔

Herpes & Warts

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Tick Borne Illnesses ➔

Lyme Disease & Rocky Mountain Spotted Fever

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Parasitic Infections ➔

Scabies & Lice

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Fungal Infections ➔

Ringworm & Athlete’s Foot

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Yeast ➔

Candidiasis

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Immune Disorders ➔

Psoriasis, Lupus, Scleroderma

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7 common types of eczema =

atopic dermatitis
dyshidrotic dermatitis
stasis dermatitis
contact dermatitis
hand dermatitis
neurodermatisis
nummular eczema

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atopic dermatitis

most common

inflammation that includes rash, itching, and dryness

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dyshidrotic dermatitis

tiny blisters that can itch severely on the hands and feet

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stasis dermatitis

discoloration common to the ankle area and lower limbs

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contact dermatitis

irritation or an allergic rash after touching something

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hand dermatitis

chapped skin, dark patches, scales, and more on the hands

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neurodermatisis

stress-linked intensely itchy patches that come and go

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nummular eczema

round and itchy spots often appearing on injured dry skin

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Eczema =

Inflammatory skin conditions = itching, redness, skin lesions

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

autoimmune disorder

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Eczema: Contributing causes & trigger, which can limit activities and comfort

skin lesions
celiac disease
gluten sensitivity
circulation impairment
pain
edema
allergies
illness
diet/nutrition
contact with rough materials
dry skin/air
environmental irritants
water (hot)
extreme heat or cold
fragrances, air fresheners
stress

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EcZema: Diagnosis

No laboratory tests

Clinical features: appearance, itchiness, spread of lesions

Differential Diagnosis -> refer to medical provider

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Eczema: Stages

Three stages of the disease ➔ acute, subacute, chronic ➔ can occur in infancy, childhood, adult

Often a relapsing stage as well

Most common skin problem, affects 10% of US population

Acute: red, oozing, crusting rash, extensive erosions, exudate

Subacute: erythematous skin, scaling scattered plaque

Chronic: thickened skin, fibrotic papules, post inflammatory pigment changes

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Eczema: Signs/Symptoms

itching which may be severe, especially at night

small, raised bumps, which may leak fluid and crust over when scratched

rash, most common on face, back of knees, wrists, hands, and feet

thickened, cracked, or scaly skin

change in skin pigmentation making affected area lighter or darker

red to brownish-gray colored patches

areas with loss of hair and skin color changes

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Eczema: Precautions

Physical modalities
Avoid use of rubbing alcohol

Latex gloves (other materials too, therabands), fragrances, laundry detergents, lotions and soaps

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Eczema: functional limitations

Inability to tolerate stress; cold, dry air, or allergens without rash, itching, and dry skin

Limitation of the use of some modalities

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Contact Dermatitis =

inflammation that occurs when substances touching the skin cause irritation or an allergic reaction (90% OF ALL OCCUPATIONAL SKIN CONDITIONS)

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Seborrheic Dermatitis =

common skin disorder occurring in areas of concentrated sebaceous glands causing greasy, scaly, itchy red skin ➔ scalp, ears, eyebrows, chest (aka: cradle cap, dandruff if on scalp), NOT contagious

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Atopic Dermatitis:

chronic, relapsing, and inflammatory condition that results in itchy, inflamed, irritated skin, hereditary tendency, common with asthma and hay fever

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Dermatitis: possible impairments/consequences

Skin integrity
Circulation
Pain
Sensation
Gait
Joint ROM
Muscle strength
Functional mobility
Self-care

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Dermatitis not treated by PT =

PT should be able to recognize the condition:
Observe
Document
Refer as needed

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Dermatitis: 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

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Dermatitis: Intervention and Goals
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)

Dermatitis: common Referrals and treatment

PCP
Immunologist
Dermatologist

Patient education to eliminate triggers

Topical or systemic therapy ➔ Corticosteroid, immunosuppressants, antihistamines

Daily care ➔ mild soaps, lotions, cooler showers

Dermatitis: tests & measures to document

Pigmentation
Shape & size of skin involvement

Presence of rash, blistering, ecchymosis, hair growth, signs of infection

Skin temperature
Tissue mobility

Capillary refill, palpation of pulses ➔ circulation

Volume & girth measurements ➔ edema
Pain ➔ VAS scale
Gait
Sensation
Joint ROM
Strength
Functional mobility

Dermatitis: prognosis

Contact dermatitis usually clears up without complication within 2 -3 weeks ➔ may return with re-exposure to irritant

Seborrheic dermatitis & atopic dermatitis are chronic conditions that are likely to recur

Dermatitis: ICD – 10 Codes

Preferred Practice Pattern: 7B Impaired Integumentary Integrity Associated with Superficial Skin Involvement

Bacterial infection

Infectious agent enters through portals in the skin ➔ wounds, abrasions, punctures

Bacterial skin infection: cellulitis

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

cellulitis diagnosis:

Mark outer boundaries

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

Bacterial infection: 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

Bacterial infection: skin abscess

Cavity containing pus surrounded by inflamed tissue

Result of localized infection

Commonly caused by staph infection

Medical management ➔ drain that thing!

Antibiotics

Bacterial infection: skin abscess

risk factors:

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

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

Herpes Type 2 ➔

Vesicular genital eruption

Spread by sexual contact

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

Viral infections: Herpes 1, Herpes 2 & herpes Zoster

Treatment:

antivirals, corticosteroids for skin inflammation

Contagious to individuals who have not had chickenpox (e.g. grandchildren, daycare)

Contraindications: heat & ultrasound

Viral infection: warts

Human papilloma virus (HPV)

Transmission: direct contact

Common warts: skin ➔ hands

Plantar wart: pressure points on feet

Treatment: cryotherapy, acids, electrodessication, OTC meds

Lyme disease:

Bacterial infection transmitted to humans by ticks

Common risk-locations in the US: northeast coast, Wisconsin & Minnesota, and norther California & southern Oregon

Dx: characteristic clinical findings (above) and culture of B. burgdorferi

Lyme disease: 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

Lyme disease - Physical Therapy Intervention

Management of muscle and joint pain
Management of fatigue
Manual Techniques
Exercise Prescription

Requires an Integrative Approach to treatment

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

Lice:

head, body, genitals; bite marks, redness, & nits

Treatment: shampoo with permethrin; removal of nits

very contagious

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

Athlete’s Foot ➔

foot typically between the toes

Itching, inflammation, erythema, pain, pruritus

Transmission: direct contact

Treatment: antifungal cream

Candidiasis ➔

yeast

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

Immune disorders: psoriasis

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

Referral to PCP ➔ if condition is undiagnosed or is increasing in severity

Immune disorders: psoriasis 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

psoriasis Etiology & Risk factors:

Etiology: hereditary, associated immune disorders

Risk Factors: family history, stress, smoking

psoriasis triggers & complications:

Triggers: Infection, weather, injury to skin, stress, smoking, heavy alcohol consumption, certain medications, rapid withdrawal of corticosteroids

Complications: psoriatic arthritis, eye conditions, obesity, type II DM, HTN, CVD, other autoimmune diseases

Exacerbations and remissions are common

Plaque psoriasis ➔

most common, elbows, knees, lower back & scalp

Nail psoriasis ➔

Fingernails & toenails

Guttate psoriasis ➔

young adults & children, triggered by bacterial infection

Inverse psoriasis ➔

skin folds of the groin, buttocks & breasts, fungal infection triggers

Pustular psoriasis ➔

rare, defined pus-filled lesions

Erythrodermic psoriasis ➔

least common, can cover entire body

Psoriatic arthritis ➔

swollen, painful joints, varies in severity

psoriasis treatment:

Treatment: topical corticosteroids, immunosuppressants, stress reduction

Daily skin care ➔ mild nonfragrant soaps, lotions, avoid irritants (e.g. brisk drying, excessive sunlight, chlorine)

Immune disorders: 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

Immune disorders: 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

Immune disorders: scleroderma
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

scleroderma Signs/Symptoms

Localized:
Patches in firm, oval shapes

Lines of thickened/different colored skin ➔ esp. arms, legs

Systemic:
Rapid or gradual onset
Organ dysfunction
Fatigue

Scleroderma risk factors:

Gender: women > men (hormone differences?)

Age: usually appears between 30 – 50

Race: All races/ethnic groups, most severe in African American

Genetics: more likely to develop if a close relative has scleroderma

Environment: exposure to viruses, chemicals may play a role

Immune System Changes: potential overproduction of collagen

scleroderma Diagnosis

Medical history: current and past symptoms

Physical exam

No single test for scleroderma

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

scleroderma Patient Education

Warmth: dress in layers, gloves, socks
Avoid extreme cold temperatures
No smoking!
Sunscreen
Moisturizers
Humidifiers
Avoid hot baths & showers
Avoid harsh soaps & cleaners
Exercise regularly
Regular dental visits

Support groups ➔ educate family and friends

Mental health support

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Skin disorders Flashcards

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