Transcript of Dermatologic Problems/ Integumentary System. Sweat glands Apocrine gland Found chiefly in the axilla...
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- Dermatologic Problems/ Integumentary System
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- Sweat glands Apocrine gland Found chiefly in the axilla and
genital regions. They open into the hair follicle and stimulated by
emotional stress. Eccrine glands They are widely distributed and
they directly open into the skin and help to controlee the body
temperature through sweat production.
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- Physical Examination Obtain history Inspection Palpation Gloves
are worn during examination
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- The skin color depends on the melanin pigment, genetically
determined and it increases by sunlight. Oxyhemoglobin Bright red
pigment predominates. present in capillaries and arteries.
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- Carotene is golden yellow pigment found in subcutaneous fat and
heavily keratinized area such as palms and soles.
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- Deoxyhemoglobin darker and blue pigment occurs when
oxyhemoglobin looses its oxygen
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- Hair Vellus hair-short, fine inconspicuous and unpigmented
Terminal hair coarser, thicker,more conspicuous and pigmented.
Scalp hair and eyebrows
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- Physical Examination Observe for: Color Temperature Moisture
Dryness
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- Physical Examination Skin texture (rough-smooth) Lesions
Vascularity Mobility Texture of hair and nails Skin turgor
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- Physical Examination Color Varies from person to person
Pigmentations Sunburn, inflammation- Pink or Reddish hue Pallor
Decreased skin tones
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- Physical Examination Color Vascularity Observed in Conjunctivae
Mucous membranes Bluish hue Cyanosis = cellular hypoxia Jaundice
Yellow pigment sclera mucous membrane
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- Physical Examination Color Dark skinned persons Have reddish
base and undertones Buccal mucosa, tongue, lips,nails normally
appear pink Cyanosis-skin assumes grayish cast Age related
changes
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- Physical Examination Topical medications Lotions, suspensions
Clear solutions, liniment, Powders, creams, Gels, pastes,
Ointments, sprays, Corticosteroids etc.
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- Wounds Abrasion skin is rubbed or scraped off Lacerations torn,
ragged, irregular edges made by blunt objects Avulsions the tearing
away of tissue from a body part Incisions cuts made by sharp
cutting instruments Punctures caused by objects that penetrate
tissue while leaving a small surface opening Amputations traumatic
is the nonsurgical removal of a limb from the body
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- petechiaetelangiectasia:purpura Vascular Lesions
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- Psoriasis well demarcated, raised, red, scaly plaques typically
elevated, >10 mm with thick silvery scale hyperproliferation,
inflammation of dermis and epidermis common, ~1 to 5% population
bimodal onset 16-22 & 57-60 yrs unknown cause, ~50% familial
non-mendelian inheritance, associated MHC CW6, B13, B17
environmental trigger; injury, sunburn, HIV, haem Strep., stress,
alcohol, drugs; blockers chloroquine
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- Clinical Variants Plaque psoriasis; large well- demarcated
plaques usually on arms, legs, back or scalp is the most common
form Gutate psoriasis; lesions appear as multiple small red raised
scaly patches, usually all over the trunk. Occurs in young people
following a Strep throat infection.
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- Pityriasis Rosea mild inflammatory skin disease diffuse scaly
plaques or papules unknown cause, virus suspected mostly women
10-35 yr, peaks in cooler months begins with herald patchon trunk
centripetal eruption 7 -14 days later prodromal malaise and
headache Rose or fawn coloured, raised edge collarette (tinea)
Remits in 5 weeks, recurrence rare, sun hastens resolution
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- Lichen Planus hepatitis C liver disease graft versus host
disease recurrent, pruritic, inflammatory rash small polygonal flat
violaceous papules may coalesce in scaly patches often accompanied
by oral lesions T cell autoimmune reaction to basal keratinocytes +
genetic disposition triggered by a variety of blockers
antimalarials NSAIDS drugs; symetrically distributed on wrists,
legs trunk, penis
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- Insect Bites A variety of insect bite can cause a blisters;
fleas (pets) bedbugs scabies, knats/midges, bees wasps more common
in young children sometimes misdiagnosed eg as chickenpox.
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- Dermatitis superficial inflammation of the skin characterized
byredness oedema oozing crusting scaling (vesicles) Eczema used
interchangeably with dermatitis pruritis
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- chronic phase, scratching rubbing causes skin to lichenify may
become generalised, often present in flexural creases associated
food intolerance, wool, sensitivity to sweating often improves by
age 5; early asthma, Atopic Dermatitis
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- Diagnostic Tests/Treatments Cultures Skin biopsy Woods light
examination Skin testing (allergies)
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- Herpes simplex is a common viral infection that presents with
localised blistering There are two main types of herpes simplex
virus (HSV), although there is considerable overlap. Type 1, which
is mainly associated with facial infections (cold sores or fever
blisters) Type 2, which is mainly genital (genital herpes)genital
herpes
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- Recurrences can be triggered by: Minor trauma to the affected
area Other infections including minor upper respiratory tract
infections Ultraviolet radiation (sun exposure) Hormonal factors
(in women, flares are not uncommon prior to menstruation) Emotional
stress Operations or procedures performed on the face Dental
surger
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- Herpes Zoster {Shingles} Acute inflammatory and infectious
disorder Painful vesicular eruption Bright red edematous plaques
along the nerve from one or more posterior ganglia
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- Herpes Zoster {Shingles} contd Eruption follows the course of
the nerve Almost always unilateral
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- Cause Varicella-zoster virus (like chicken-pox) Incubation
period 7-21 days Vesicles appear in 3-4 days Occur posteriorly
Progress anteriorly & peripherally Along dermatome Duration 10
days to 5 weeks
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- Occurs most frequently in Elderly Immunosuppressed Malignancy
or injury to spinal or cranial nerve
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- Complications Facial and acoustic nerve involvement Hearing
loss Tinnitus Facial paralysis Vertigo painful
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- Complications Full thickness skin necrosis and scarring
Systematic infection from scratching, causing virus to enter blood
stream
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- Medical treatment Control outbreak Reduce pain and discomfort
Prevent complications Acyclovir (Zovirax) IV, PO, topically
Corticosteroids Antihistamines Antibiotics
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- Parasitic Skin Infections (PSI) Higher risk situations? Poor
hygiene Living in close quarters
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- Pediculosis- Lice (PSI) Infestation by human lice Pediculosis
capitis-head Pediculosis corporis-body Pediculosis pubis- pubic or
crab
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- Scabies (PSI) Contagious skin disease, caused by itch mite
Sarcoptes scabiei. Transmitted by Close-prolonged contact with
Infested companion Infested bedding
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- Scabies (PSI) Characterized by Epidermal curved or linear
ridges Follicular papules Pruritus Palms More intense and
unbearable at night White visible epidermal ridges by Mite
burrowing into outer layers of skin
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- Scabies (PSI) Hypersensitivity reaction Excoriated erythematous
papules Pustules, crusted lesions Elbows Axillary folds Lower
abdomen Buttocks, thighs Between fingers Genitalia
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- Scabies (PSI) Treatment Topical sulfur preparations One-two
applications daily Launder personal items No disinfectant
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- scabies
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- Ringworm (PSI) Ringworm - an infection caused by a fungus Jock
itch form of ringworm on groin area Athletes foot fungal infection
of foot (feet) Fungus live and spread on the top layer of the skin
and on the hair grow best in warm, moist areas, contagious via
skin-to-skin contact with a person or animal that has it or when
you share things like towels, clothing, or sports gear. You can
also get ringworm by touching an infected dog or cat, although this
form of ringworm is not common.
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- Tinea vesicular
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- Psoriasis Lifelong disorder Exacerbations Remissions Cannot be
cured
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- Psoriasis Pathophysiology Scaling disorder Underlying dermal
inflammation Abnormality in proliferation of epidermal cells in
outer skin layers Normal 28 days to shed cells Psoriasis Cells shed
every 4-5 days
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- Psoriasis Cause-unknown Genetic predisposition Environmental
factors May appear after skin trauma Sunburn Surgery
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- Psoriasis Improves in warmer climates Aggravated by Infections
Streptococcal throat infection Candida infections Hormonal changes
Psychological stress
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- Psoriasis Assessment History Family history Age at onset
Disease progression Pattern of recurrences Gradual or sudden
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- Psoriasis Vulgaris {Ordinary/Common} Most common Thick
erythematous papules or plaques Surrounded by silvery white
scales
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- Psoriasis Vulgaris {Ordinary/Common} Common sites Scalp Elbows
Trunk Knees Sacrum Extensor surfaces of limbs
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- Skin Cancers Overexposure to sunlight Common skin cancers
Squamous cell carcinoma Basal cell carcinoma Melanoma
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- Actinic Keratosis Pre-malignant lesions Cells of epidermis
Chronically sun-damaged skin Can lead to squamous cell
carcinoma
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- Squamous Cell Carcinoma Malignant neoplasms of epidermis Invade
locally Potentially metastic Ear Lip External genitalia Cause
Repeated irritation or injury
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- Basal Cell Carcinoma Basal cell layer of epidermis Lesions go
unnoticed Metastasis rare Underlying tissue destruction progresses
to underlying vital structure
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- Melanomas Pigmented malignant lesions Originate in
melanin-producing cells of epidermis
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- Melanomas Risk factors Genetic predisposition Excessive
exposure to UV light Precursor lesions resembling unusual moles
Highly metastatic Survival depends on early diagnosis and
treatment
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- Skin Cancers Prevention Avoid exposure to sunlight Use of
sunscreen SPF30 or greater
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- Skin Cancers Assessment Age Race Family history Removal of skin
growths
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- Skin Cancers Assessment Change in Size, Color, Sensation Of any
Mole, Birthmark, Wart, Scar Hair-bearing areas of body
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- Skin Cancers Interventions: Radiation therapy Elderly Large,
deeply invasive basal cell tumors Poor risk for surgery Malignant
melanoma resistant May be used in combination with systemic
chemotherapy
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- Pressure Ulcers Etiology
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- Pressure Ulcers Etiology Immobility Impaired sensory perception
or cognition Decreased tissue perfusion Decreased nutritional
status Friction and shear Increased moisture
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- Pressure Ulcers Stages
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- Pressure Ulcers Stages Stage I Non-blanchable erythema Tissue
swelling C/O discomfort Stage II Break in skin Epidermis Dermis
Necrosis
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- Pressure Ulcers Stages Stage III Subcutaneous tissue Deep
crater With undermining Without undermining Stage IV Underlying
structures May have large undermined area
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- Burns 1 st degree partial- thickness (superficial) 2 nd degree
partial- thickness (deep) 3 rd degree full- thickness
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- Chemical burns Electrical burns Thermal burns Sunburn
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- Burns Tests Wound cultures CBC, BUN, glucose, electrolytes,
urine studies Interventions IV fluid replacement
Antibiotic/antimicrobial agents Analgesics
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- Nails Paranychia Koilonychias
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- Clubbing
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- pick-like depressions in the nails (nail pitting) are common in
people who have psoriasis a condition characterized by scaly
patches on the skin.
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- Terry's nails most of the nails appear white except for a
narrow pink band at the tip. Terry's nails can sometimes be
attributed to aging. In other cases, Terry's nails can be a sign of
a serious underlying condition, such as liver disease, congestive
heart failure, kidney failure or diabetes.