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PNP #2 > SKIN DISORDERS > Flashcards

SKIN DISORDERS Flashcards

1
Q

Layers of the skin

A
  • Epidermis—avascular
  • Dermis
  • Subcutaneous tissue (hypodermis)
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2
Q

Epidermis

A

 Five layers—vary in thickness
 Keratin: Waterproofing of the skin
 Melanin: Skin pigment—determines skin color
• Production depends on multiple genes and environment
 Albinism : Lack of melatonin production
 Vitiligo: Small areas of hypopigmentation
 Melasma: Patches of darker skin

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3
Q

Dermis

A

Connective tissue
- Contains elastic and collagen fibers

-Flexibility and strength of the skin

-Contains nerves and blood vessels:
Includes sensory receptors for:
Pressure
Touch
Pain
Heat
Cold
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4
Q

Appendages of the Skin

A

 Hair follicles
-Stratum basale—hair-producing
• Arrector pili muscle associated with hair follicle
 Sebaceous glands
-Produce sebum
• Secretion increases at puberty—influence of sex hormones
 Sweat glands
-Eccrine—all over body
-Apocrine
• Axillae, scalp, face, external genitalia

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5
Q

Skin lesions may be caused by:

A 
	Systemic disorders
•	Liver disease
	Systemic infections
•	Chickenpox
	Allergies to ingested food or drugs
	Localized factors
•	Include exposure to toxins
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6
Q

Types of lesions

A 
	Location
	Length of time lesion has been present
	Changes occurring over time
	Physical appearance
•	Color
•	Elevation
•	Texture
•	Type of exudate
	Presence of pain or pruritus (itching)
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7
Q

Pruritus

A

Release of histamine in a hypersensitivity response causes marked pruritus

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8
Q

Diagnostic Tests for Skin Lesions

A

 Culture and staining of specimens:Bacterial infections: microscopic and direct observations AND Specific procedures for fungal or parasitic infections
 Biopsy: Detection of malignant changes
• Safeguard prior to or following removal of skin lesions
 Blood tests: Helpful in diagnosis of conditions caused by allergy or abnormal immune reaction
 Skin testing using patch or scratch method

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9
Q

General Treatment Measures

A 
	General Treatment Measures Pruritus
-Topical agents to reduce sensation
-May be treated by antihistamines or glucocorticoids 
	Avoidance of allergens
-Reduce risk of recurrence 
	Infections 
-May require antibiotic treatment
	Precancerous lesions
-Surgery, laser therapy, electrodessication, cryosurgery
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10
Q

Contact Dermatitis

A

Pruritic rash develops at site a few hours after exposure.

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11
Q

Urticaria (Hives)

A

 Result of type I hypersensitivity
-Ingestion of substances
• Examples: shellfish, drugs, certain fruits
 Lesions are highly pruritic.
 Hives are often part of anaphylaxis!
-Check for swelling around mouth and check airway.
-Administer EpiPen or other first aid as required.

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12
Q

Atopic Dermatitis (Eczema)

A

 Atopic—inherited tendency
 Common problem in infancy
-Rash is erythematous, with serous exudate.
-Commonly occurs on face, chest, and shoulders
 In adults, rash is dry, scaly, and pruritic, often on flexor surfaces.

 Chronic inflammation results from response to allergens.
-Eosinophilia and increased serum IgE levels
 Potential complication—secondary infections
 Treatment
-Topical glucocorticoids, antihistamines

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13
Q

Psoriasis

A

 Chronic inflammatory skin disorder
 Onset usually in the teenage years
 Psoriasis results from abnormal T cell activation.
–Excessive proliferation of keratinocytes
–Cellular proliferation is greatly increased.
 Lesions found on face, scalp, elbows, knees
–Itching or burning sensations
 Treatment
–Glucocorticoids, tar preparations, antimetabolites

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14
Q

Pemphigus

A

 Autoimmune disorder
 Autoantibodies disrupt cohesion between epidermal cells.
-Causes blisters (bullae) to form
-Skin sheds, leaving area painful and open to secondary infection.
-May be life-threatening if extensive (e.g., Stevens-Johnson syndrome)
 Systemic glucocorticoids and immunosuppressants

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15
Q

Scleroderma

A

 May occur as skin disorder
 May be systemic and affect viscera
 Primary cause unknown
-Increased collagen deposition is observed in all cases.
-Inflammation and fibrosis with decreased capillary networks
• Hard, shiny, tight, immovable areas of skin
• Impaired movement of mouth and eyes
 May cause renal failure, intestinal obstruction, respiratory failure caused by distortion of tissues

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16
Q

Skin Infections

A

 May be caused by bacteria, viruses, fungi, other types of microbes, parasites
 Caused by opportunistic microbes
 Minor abrasions or cuts
 Serious infections may develop.
 Causative organism needs to be identified for appropriate treatment

17
Q

Cellulitis (erysipelas)

bacterial infections

A

 Infection of the dermis and subcutaneous tissue
 Usually secondary to an injury
 May be iatrogenic
 Causative organism
• Usually Staphylococcus aureus
• Sometimes Streptococcus
 Frequently in lower trunks and legs
• Especially in individuals with restricted circulation in the extremities; also in immunocompromised individuals
• Area becomes red, swollen, and painful
• Red streaks may develop, running along lymph vessels proximal to infected area

18
Q

Furuncles (boils)

A

 Usually caused by S. aureus
• Begins at hair follicles
• Face, neck, back
• Frequently drains large amounts of purulent exudate
 Autoinoculation
• Squeezing boils can result in spread of infection to other areas of the skin.
 Carbuncles
• Collection of furuncles that coalesce to form a large infected mass

19
Q

Impetigo

A

 Common infection in infants and children
-May also occur in adults
-S. aureus—highly contagious in neonates
 Lesions commonly on face
 Transmission may occur through close physical contact or through fomites
 Pruritus common
-Leads to scratching and further spread of infection

20
Q

Impetigo: Treatment

A

 Topical antibiotics in early stages
 Systemic administration if lesions are extensive
-Antibiotic-resistant strains of S. aureus are increasing in numbers.
• Local outbreaks of infection may result.

21
Q

Acute Necrotizing Fasciitis

A

 Mixture of aerobic and anaerobic bacteria usually at site of infection
 Severe inflammation and tissue necrosis
-Usually caused by virulent strain of gram-positive, group A beta-hemolytic Streptococcus
-Bacteria secrete toxins that break down fascia and connective tissue, causing massive tissue destruction.
 Often a history of minor trauma or infection in the skin and subcutaneous tissue of an extremity

 Delay in treatment—greater tissue loss, potential amputation, higher probability of mortality
 Systemic toxicity develops with fever, tachycardia, hypotension, mental confusion, disorientation, possible organ failure
 Treatment
-Aggressive antimicrobial therapy, fluid replacement
-Excision of all infected tissue; amputation

22
Q

Leprosy (Hansen’s Disease)

A

 Caused by Mycobacterium leprae
 Chronic disease classified into three major types
 Clinical signs and symptoms vary.
-Generally affects skin, mucous membranes, and peripheral nerves
-Damage can lead to loss of limbs.
 Mechanism of pathogenicity largely unknown
 Diagnosis through microscopic examination of skin biopsy
 Treatment primarily with antibiotics

23
Q

Herpes Simplex

A

 Herpes simplex type 1 (HSV-1)
-Most common cause of cold sores or fever blisters
 Herpes simplex type 2 (HSV-2)—genital herpes
 Both types of HSV cause similar effects.
 Primary infection may be asymptomatic
-Virus remains latent in sensory nerve ganglia.
 Recurrence may be triggered by:
-Common cold, sun exposure, stress

24
Q 
Herpes Simplex (Cont.)
SPREAD
A

 Spread by direct contact with fluid from lesion
 Spread of infection to others possible prior to appearance of lesions
 Potential complication
-Spread of virus to eye
• Keratitis
-Herpetic whitlow
• Painful infection of the fingers

25
Q

Verrucae (Warts)

A

 Human papillomavirus (HPV) types 1 to 4
-Frequently develop in children and young adults
 Plantar warts are common.
 Spreads by viral shedding of the skin surface
 May resolve spontaneously with time
 Genital warts (HPV types 6 and 11)

26
Q

Fungal Infections (Mycoses)

A

 Most are superficial
-Candida infection is associated with diabetes.
-May spread systemically in immunocompromised individuals
 Diagnosed from skin scrapings
-Become fluorescent in ultraviolet light
-Microscopic examination
-Culturing of samples

27
Q

Tinea capitis

A

Infection of the scalp

Common in school-age children

Erythema may be apparent.

Oral antifungal medication

28
Q

Tinea corporis

A

Infection of the body, particularly of nonhairy parts
Round lesion with clear center (ringworm)
Pruritus may be present.
Topical antifungal medication

29
Q

Tinea pedis

A

Athlete’s foot—involves the feet, particularly the toes
Associated with swimming pools and gymnasiums
May be part of normal flora that becomes opportunistic
Secondary bacterial infection may occur
Topical antifungal medication

30
Q

Tinea unguium

A

Infection of the nails, particularly the toenails
Nails turn white, then brown.
Nail thickens and cracks.
Infection tends to spread to other nails.

31
Q

Scabies

A 
Invasion by mite Sarcoptes scabiei
Female burrows into epidermis
-Lays eggs over a period of several weeks
Male dies after fertilizing the female
Female dies after laying the eggs.
Larvae migrate to skin surface. 
-Burrow into skin in search of nutrients
-Intensively pruritic!
Larvae mature and cycle is repeated
Burrows appear on skin as tiny, light brown lines.
32
Q

Pediculosis (lice)

A 
Pediculus humanus corporis—body louse
Pediculus humanus capitis—head louse
Pediculus humanus pubis—pubic louse
Female lice lay eggs on hair shafts.
After hatching, louse bites human host, sucking blood for production of ova
Excoriations result from scratching.
33
Q

Keratoses (skin tumors)

A

 Benign lesions usually associated with aging or skin damage.
 Seborrheic keratoses
-Proliferation of basal cells
• Lead to oval elevation
• May be smooth or rough
 Actinic keratoses
-On skin exposed to ultraviolet radiation
-Commonly in fair-skinned persons
-Lesion appears as pigmented, scaly patch

34
Q

Guidelines to Reduce Risk of Skin Cancers

A

Reducing sun exposure at midday and early afternoon

Covering up with clothing
Remaining in shade
Wearing broad-brimmed hats to protect face and neck

Applying sunscreen or sunblock

Protecting infants and children from exposure and sun damage to skin

35
Q

Squamous Cell Carcinoma

A

Painless, malignant tumor of the epidermis

Lesions most commonly found on exposed areas of the skin but also in oral cavity

  • -Face and neck
  • -Base of tongue

Excellent prognosis when lesion is removed within reasonable time

Invasive type arises from premalignant condition.

36
Q

Malignant Melanoma

A 
	Highly metastatic form of skin cancer
	Develops in melanocytes
-From a nevus (mole)
	Often appear as multicolored lesion with irregular border
-Grow quickly 
-Change in shape, color, size, texture
-May bleed
	Treatment: surgical removal and radiation plus chemotherapy
37
Q

The ABCD of Melanoma

A

Melanoma is suspected in any nevus that shows:

  • Change in appearance
  • Change in border
  • Change in color
  • Increase in diameter
38
Q

Kaposi’s Sarcoma

A

 Occurs in those with AIDS and other immunodeficiencies
 May affect viscera as well as skin
 Malignant cells arise from endothelium in small blood vessels
–Purplish macules
–Nonpruritic, nonpainful
 In immunocompromised patients, lesions develop rapidly over upper body.
 Combination of radiation, chemotherapy, surgery, biological therapy

PNP #2 (10 decks)

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