Skin disorders Flashcards
Eczema ➔
Dermatitis
Bacterial Infections ➔
Cellulitis, Impetigo, Abscess
Viral Infections ➔
Herpes & Warts
Tick Borne Illnesses ➔
Lyme Disease & Rocky Mountain Spotted Fever
Parasitic Infections ➔
Scabies & Lice
Fungal Infections ➔
Ringworm & Athlete’s Foot
Yeast ➔
Candidiasis
Immune Disorders ➔
Psoriasis, Lupus, Scleroderma
7 common types of eczema =
atopic dermatitis
dyshidrotic dermatitis
stasis dermatitis
contact dermatitis
hand dermatitis
neurodermatisis
nummular eczema
atopic dermatitis
most common
inflammation that includes rash, itching, and dryness
dyshidrotic dermatitis
tiny blisters that can itch severely on the hands and feet
stasis dermatitis
discoloration common to the ankle area and lower limbs
contact dermatitis
irritation or an allergic rash after touching something
hand dermatitis
chapped skin, dark patches, scales, and more on the hands
neurodermatisis
stress-linked intensely itchy patches that come and go
nummular eczema
round and itchy spots often appearing on injured dry skin
Eczema =
Inflammatory skin conditions = itching, redness, skin lesions
Patient education is key to break the “itch-scratch” cycle
autoimmune disorder
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
EcZema: Diagnosis
No laboratory tests
Clinical features: appearance, itchiness, spread of lesions
Differential Diagnosis -> refer to medical provider
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
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
Eczema: Precautions
Physical modalities
Avoid use of rubbing alcohol
Latex gloves (other materials too, therabands), fragrances, laundry detergents, lotions and soaps
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
Contact Dermatitis =
inflammation that occurs when substances touching the skin cause irritation or an allergic reaction (90% OF ALL OCCUPATIONAL SKIN CONDITIONS)
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
Atopic Dermatitis:
chronic, relapsing, and inflammatory condition that results in itchy, inflamed, irritated skin, hereditary tendency, common with asthma and hay fever
Dermatitis: possible impairments/consequences
Skin integrity
Circulation
Pain
Sensation
Gait
Joint ROM
Muscle strength
Functional mobility
Self-care
Dermatitis not treated by PT =
PT should be able to recognize the condition:
Observe
Document
Refer as needed
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
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
