Skin Disorders Flashcards
Explain the structure and function of the skin
Three layers:
- Epidermis:
a. Stratum corneum: (horny layer) prevents intrusion of microorganisms
b. Melanin: prevents intrusion of UV radiation - Dermis: protects against physical trauma
a. Appendages: contains eccrine & apocrine sweat glands, hair, nails & sebaceous glands - Subcutis: stores fat & regulates heat
What are cafe au lait spots?
AKA: Macules
Areas of increased melanin which can result in pale brown areas of the skin.
Harmless, but sometimes can be a sign of neurofibromatosis
What is neurofibromatosis?
a genetic disorder of the nervous system that primarily affects the development and growth of the nerve cell tissues
Presence of 6 or more cafe au lait spots of 1.5 cm or more in diameter is diagnostic of neurofibromatosis
What is cellulitis? Characteristics?
Cellulitis: infectious inflammation of deep skin structures
Characteristics: reddening of the skin, increased warmth
Secondary Skin Lesion: Scales.
Description of and give an example
Scales:
Flakes of skin
Example: Psoriasis
Secondary Skin Lesion: Crust.
Description of and give an example
Crust:
Dried fluid or exudates on the skin
Example: Impetigo
Secondary Skin Lesion: Fissure.
Description of and give an example
Fissure:
Skin crack
Example: Chapping
Secondary Skin Lesion: Excoriation
Description of and give an example
Excoriation:
Superficial Crack
Example: Abrasion
Secondary Skin Lesion: Erosion
Description of and give an example
Erosion
loss of superficial epidermis
Example: Scratch
Secondary Skin Lesion: Ulcer
Description of and give an example
Ulcer:
destruction of the entire epidermis
Example: Pressure sore
Secondary Skin Lesion: Scar
Description of and give an example
Scar:
healing of the dermis
Example: vaccination, laceration
What is hyperkeratosis? Caused by? Where do you see it?
Hyperkeratosis:
excessive growth/thickening of the stratum corneum (or horny layer) of the epidermis
Characteristic of callus formation.
Caused by: constant friction & pressure
Seen in: the soles of the feet and palms of the hands
How do you manage hyperkeratosis (callus) of the feet and hands?
Discourage use of: emery files or pumice stones
Management:
1. Moisturizers or keratolytic agents.
Examples of keratolytic agents:
25% urea (Ultramide), lactic acid (Lachydrin) or salicylic acid
- Can trim w/ a callus trimmer.
- Cushioning devices such as wedges, doughnuts, and arch supports
What is a sebaceous cyst
- A cyst filled with cebum. Usually found on the scalp
Describe blisters and how do you prevent them
- Shearing forces produce raised area that contains fluid below or within epidermis
- Superficial blister has clear liquid vs blood blister with deeper tissue disruption
- Prevention: Talcum powder or petroleum jelly, two pairs of socks, Correct size shoe
How do you manage intact blisters
- Leave intact and keep clean for 24 hours
- Then drain fluid with scalpel cut, apply antibiotic ointment
- Dress and place doughnut pad around blister.
- Monitor for infection and replace dressing as needed
How do you manage torn blisters
- Keep clean, soap and water
- If less than half of skin is removed from blister, apply liquid antiseptic and lay flap back down then apply antibiotic
- Then apply dressing and doughnut pad…monitor
- If more than half the skin is removed, remove flap with sterile scissors
- Clean with soap and water, liquid antiseptic, Apply second skin dressing
What is macerated skin
Skin softened by exposure to wetting
Describe the etiology and signs and symptoms of Corns
- Soft and Hard corns are hyperkeratoses caused by friction, caused by pressure of improperly fitting shoes and other anatomic abnormalities
- Soft Corn appears as a circular piece of thickened, white, macerated skin on the lateral side of the fifth toe
- Hard Corns appear as hard and dry, with a callus that is sharply demarcated on the tops of hammertoes
How do yo manage Corns
- Proper fitting shoes
- Felt pad to act as buffer between corn and shoe
- Keep area clean and dry to prevent maceration in the case of soft corns
What is Xerotic skin, what are signs and symptoms, and management
- Xerotic skin is dry skin, common in winter
- Skin appears dry, variable redness and scaling, may crack and develop fissures
- Management: Moisturizing soaps, lotion, very severe warrants physician referral
Describe the wounds: Abrasions, Punctures, Lacerations, Incisions, Avulsions, and Bruises
- Abrasion: Occur when skin is scraped against a rough surface
- Puncture: Direct penetration, can introduce tetanus
- Laceration: Sharp objects tear skin, jagged appearance
- Incision: Similar to laceration but cut is smooth, like from knife
- Avulsion: Occur when skin is torn from body
- Bruise: After blunt trauma, skin not broken but soft tissue is traumatized
How do you manage an open wound
- Clean with soap and water, apply antiseptic and dress wound
- If laceration is severe enough or if it is a puncture should be treated by physician
What are the signs of wound infection
- Red, swollen, hot, and tender tissue
- Swollen and painful lymph glands near the area of infection
- Mild fever and headache
When are sutures needed
- Generally when underlying tissues such as fat, tendon, bone, or vessels are exposed
What is Methicillin Resistant Staphylococcus aurea (MRSA)? Signs and Symptoms/ Management?
- Bacterial infection of Staphylococcus that is resistant to methicillin and several other antibiotics
- Results in redness, swelling, an tenderness at the site of the infection
- MRSA can only be treated with antibiotics delivered into a vein
- Common in wrestling and football
What is Impetigo Contagiosa? Signs and symptoms/ Management?
- Extremely common bacterial infection, skin disease primarily observed in children
- Characterized by mild itching, soreness, eruption of small vesicles and pustules that rupture and form HONEY COLORED crust
- Treat by washing and dressing 4-5x a day, use antibiotic ointment and use isolated clothing and towels to prevent spread
- Common in wrestling
What are Furuncles? Signs and symptoms/ Management?
- Infection of the hair follicle that result in pustule formation
- Enlarged pustule, reddened, hard from internal pressure
- Usually erupt and resolve on their own, should not be squeezed because that can force the infection into adjacent tissues
- Use antibiotic ointment and prevent contact from other team members while it is draining
What are Carbuncles? Signs and symptoms/ Management?
- Similar to furuncle; Also developed from staphylococci
- Carbuncles are larger, deeper, have several openings in the skin
- Discharges yellowish- red pus from a number of places
- Most common treatment is surgical drainage with use of antibiotics
What is Folliculitis? Signs and symptoms/ Management?
- Inflammatory condition of the hair follicle, caused by either infectious or noninfectious agents
- Starts with redness around the hair follicle and followed by development of papule or pustule at the follicle opening
- Treatment includes moist heat to improve circulation, use of antibiotic ointment applied locally
- Pseudofolliculitis barbae is a type of this that is common in African American due to penetration of the epidermis by curved hair
What is Acne Vulgaris? Signs and symptoms/ Management?
- Inflammatory disease involving the hair follicles and sebaceous glands
- Characterized by closed comedones (whiteheads) and open comedones (blackheads), papules, pustules and cysts
- Treated with a variety of Topical and systemic antibiotics
- Topical: clindamycin Systemic: Tetracycline
- Severe, Cystic acne treated with systemic retinoid Accutane (can cause birth defects)
- Avoid drying agents like alcohol
- “Noncomedogenic” soap and products should be used: Don’t block the hair follicles
What are Paronychia and Onychia? Signs and symptoms/ Management?
- Develop from staph and fungal organisms, contaminate open wounds or hangnails
- Paronychia: Rapid onset with painful, bright red swelling of lateral nail fold, Soft tissues around the nail
- Onychia: Infection of the nail itself
- Treat by soaking affected finger in hot solution of betadine or boric acid 3x daily and use antibiotic ointments
- Uncontrollable cases can be treated by physician; surgical
What is Tetanus(Lockjaw)? Signs and symptoms/ Management?
- Acute infection of muscles and CNS caused by tetanus bacillus found in soil, saliva, or feces
- Enters the body by deep laceration or puncture wound
- First sign is stiffness of jaw muscles and neck
- Followed by fever, can be fatal
- Acute tetanus infection should be treated in the ICU; Childhood immunization important
What Tinea of the Scalp (Tinea Capitis)? Signs and symptoms/ Management?
- Tinea (Ringworm) of the scalp most common in children
- Small, grayish scales resulting in scattered bald patches
- Primary source are contaminated animals, barber clippers and scissors and combs
- Systemic antifungals such as itraconazole
- Topical creams and shampoos are ineffective
What Tinea of the Body (Tinea Corporis)? Signs and symptoms/ Management?
- Involves extremities and trunk
- Presents as itchy, red brown, Scaling, annular (ring shaped) plaque that expands peripherally and clears centrally
- Treatment of topical antifungal once or twice a day
What Tinea of the Nail (Tinea Unguium/ Onychomycosis)? Signs and symptoms/ Management?
- Fungal infection of toenails or fingernails
- Nails become thickened, brittle, and separated from its bed
- Systemic antifungals (lamisil) most effective but must be used for 3 months
What Tinea of the Groin (Tinea Cruris)? Signs and symptoms/ Management?
- Commonly called jock itch
- Appears as symmetrical red-brown scaling plaque with snakelike (serpiginous) border
- May resemble outline of a butterfly in the groin area
- Will respond to nonprescription medications
- Ointments commonly used
- Failure to respond to treatment may suggest a non fungal infection such as erythasma and should be referred
- Erythrasma, a bacterial infection can mimic this but lacks scaling
What Athletes Foot (Tinea Pedis)? Signs and symptoms/ Management?
- Most common form of superficial fungal infection
- Extreme itching on sole of foot and between and on top of toes
- Dry, scaling patch or inflammatory, scaling red papules that may coalesce and form larger plaques
- Topical Antifungals are effective in treatment; Major factor is good foot hygiene
What Candidiasis? Signs and symptoms/ Management?
- A skin mucous membrane, or internal infection caused by the yeastlike fungus “Candida Albicans”
- Occurs when weather is hot and humid and tight clothing rubs, as well as poor hygiene is present
- Infection of body folds such as axilla and groin
- Appear as beefy red patches
- Treat the area by drying it, using antifungal creams
What Tinea Versicolor? Signs and symptoms/ Management?
- Fungal infection typically appears as multiple, small, circular macules that are pink, brown, or white
- Common on abdomen, neck, and chest
- Do not tan when exposed to sun
- Treat with selenium sulfide
What are the common viruses that attack the skin
- Herpes Simplex
- Herpes Zoster
- Verruca
- Molluscum Contagiosum
What is Herpes Simplex? Signs and symptoms/ Management?
- Viral Infection
- Highly contagious and usually transmitted directly through lesion in the skin or mucous membrane
- Patients experience tingling or hypersensitivity in the affected area 24 hours prior to eruption of lesions
- Local swelling occurs, followed by appearance of vesicles
- Herpes Lesions are self limiting, no skin to skin contact in athletes until lesions have crusted and dried
What is Verruca plana? Signs and symptoms/ Management?
- “Verruca” is Virus causing warts
- Verruca plana is the common wart and is prevalent on hands of children
- Appears as small, round, elevated lesion with rough dry surfaces
- Treat with Liquid Nitrogen, Topical Salicyilic acid, and Electrocautery
What Verruca Plantaris ? Signs and symptoms/ Management?
- Plantar Wart
- Found on soles of foot on or adjacent to areas of abnormal weight bearing
- Seen as areas of epidermal thickening and cornification
- Major characteristic is hemmorhagic puncta, which look like clusters of small black seeds
- Protect wart against infection, until removal should be protected by donut pad
What is Molluscum Contagiosum? Signs and symptoms/ Management?
- Poxvirus infection, more common than warts, particularly during direct body contact activities
- Appears as small, red, or flesh colored, smooth domed papules with a central umbilication
- Patient must be referred to physician
How do allergic skin reactions present
- Present as “urticaria” or hives which appear red, edematous elevations of the skin, characterized by a burning or itching sensation
- Delayed hypersensitivity can manifest acute dermatitis which appears as itchy red papules, plaques, and vesicles
What is contact dermatitis
- Allergic skin reaction, caused by different substances
- Most commonly Poison Ivy, Oak, Sumac, Ragweed and Primrose
- Presents with redness and swelling and formation of vesicles that ooze fluid and form a crust
What is Miliaria (Prickly heat)? Signs and symptoms/ Management?
- From continued exposure to heat and moisture causes retention of perspiration by sweat glands
- Results in redness, itching, and burning vesicles and pustules
- Treat with avoidance of overheating, frequent bathing with non irritating soap, loose fitting clothing and use of antipruritic lotions
What are Scabies? Signs and symptoms/ Management?
- Skin disease caused by a mite
- Produces extreme nocturnal itching
- Mite burrows a tunnel into skin and deposits eggs
- Burrows appear as dark lines between fingers, toes, body flexures, nipples, and genitalia
- Treat with Permethrin cream
What are Lice (pediculosis)? Signs and symptoms/ Management?
- Infestation by the louse, could be “head” louse, “body” louse, or “crab” louse
- Bite of the louse creates itching and subsequent scratching provokes pustules and excoriations
- Treat with Permethrin (NIX is over the counter brand)
What are Ticks? Signs and symptoms/ Management?
- Can cause rocky mountain spotted fever or lyme disease
- To remove, mineral oil or fingernail polish can be applied to body at which time it will withdraw its head
What Pityriasis Rosea? Signs and symptoms/ Management?
- Initially a single pinkish red patch somewhere on the back or chest and over several days enlarges to a few centimeters
- Lesions are red and scaly with a clearing in the center
- Most cases do not need treatment
What is Psoriasis? Signs and symptoms/ Management?
- Lesions begin as reddish papules that collectively form plaques with distinctive borders
- Treat with topical glucocorticoids
What are the 3 most common types of skin cancer
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
- Malignant Melanoma
Discuss location of skin affected by Basal and Squamous cell carcinoma and Malignant Melanoma
- Basal Cell: Starts in basal cell layer of epidermis
- Squamous Cell: Starts in the middle, or squamous layer of skin
- Malignant Melanoma: Starts in the Melanocytes
- Malignant Melanoma has high mortality rate because it tends to metastasize
Describe the appearance of Basal Cell and Squamous cell carcinoma
- Basal Cell: Small, Shiny bump or nodule on the skin
- Squamous Cell: Appears as nodules or red, scaly patches of skin
Describe the Appearance of malignant melanoma
- Usually begin as a mole, which turns cancerous and spreads quickly
- ——-ABCD’s of Malignant Melanoma——-
- Assymetry: One half of the mole does not match the other
- Border: The edges are irregular and ragged
- Color: Color varies throughout the mole
- Diameter: Mole is larger than a pencil eraser
