Week 5

Skin Diseases and Disorders

Psoriasis
▪ Description
▪ A chronic, noninfectious inflammatory skin
disease marked by the appearance of discrete
pink or red lesions surmounted by characteristic ▪ Diagnostic Procedures
silvery scaling
▪ Observation of the skin, skin
▪ Etiology biopsy, careful medical history
▪ Occurs more frequently between 15 and 50 ▪ Treatment
▪ Signs/Symptoms
▪ Exposure to UV light;
▪ Thick, flaky scaling; affected areas appear dry, corticosteroid creams,
cracked and encrusted non-steroidal creams; Careful
▪ 5 types: plaque psoriasis (inflamed raised red Skin Hygiene
lesions covered in white scaly patches found on
elbows, knees and back), guttate psoriasis (small
▪ Complementary Therapy
red spots on torso and limbs), inverse psoriasis ▪ Foods high in omega-3 fatty acids
(smooth shiny red lesions in armpits, under and vitamin supplements
breasts and skin folds), pustular psoriasis (white
pus-filled blisters surrounded by reddened skin), ▪ Prognosis
erythrodermic psoriasis (fiery-red skin that peels
in sheets) ▪ Controllable, remissions and
exacerbations frequently occur
Urticaria (Hives)
▪ Description
▪ Inflammatory reaction of capillaries
beneath a localized area of skin
▪ Etiology
▪ Frequently results following ingestion
of certain foods or allergic reactions to
insect stings; heat, cold, water and
sunlight exposure
▪ Signs/Symptoms
▪ Pale, raised wheals on the skin possibly
surrounded by erythema; intense
itching
▪ Diagnostic Procedures
▪ Medical history, sensitization testing
▪ Treatment
▪ Antihistamines, epinephrine,
hydrocortisone creams and lotions
▪ Prognosis
▪ Repeated exposure may lead to
anaphylactic reaction
▪ Prevention
▪ Avoid causative agents
Acne Vulgaris
▪ Description
▪ Inflammatory disease of sebaceous
glands and hair follicles; characterized
by comedones, papules and pustules
▪ Etiology
▪ Genetic predisposition
▪ Signs/Symptoms
▪ Open or closed comedone, rupture of
the acne plug, inflammation, and acne
pustules; scars if chronic irritation
continues over time
▪ Diagnostic Procedures
▪ Medical history and observation of
lesions
▪ Treatment
▪ Goals: reduce bacterial count, decrease
sebaceous gland activity, prevent the
follicle from becoming inflamed;
antibacterial solution applied to the
skin, orally administered antibiotics, or
both
Rosacea
▪ Description
▪ Chronic inflammatory condition that
causes erythema, flushing or redness, and
formation of red pustules on the face
▪ Etiology
▪ Genetic predisposition and environmental
factors
▪ Signs/Symptoms
▪ Flushing of cheeks, forehead, nose or chin;
small red pustules form; nose may enlarge
▪ 3 phases: 1. Pre-rosacea (blush or flush
easily) 2. Vascular rosacea (skin becomes
sensitive and small vessels on cheeks and
nose swell 3. Inflammatory rosacea (small
red pustules on cheeks, nose, forehead,
and chin)
▪ Diagnostic Procedures
▪ Physical examination and medical
history
▪ Treatment
▪ Goal: reduction of inflammation using
topical creams or lotions containing
tretinoin, benzoyl peroxide, and azelaic
acid; oral antibiotics (tetracycline,
erythromycin, minocycline)
▪ Prevention
▪ Reduce flare-ups by wearing sunscreen,
protect face from wind, avoid
overheating, use gentle facial cleansers
and refrain from drinking alcohol
Keratosis Pilaris
▪ Description ▪ Diagnostic Procedures
▪ Painless, skin-colored bumps that may ▪ Dermatologist consultation, physical
redden and form rough patches of skin examination

▪ Etiology ▪ Treatment
▪ Usually before age 10, worsens with ▪ Removal of built-up keratin; lotions,
puberty creams, or ointments; topical steroids

▪ Signs/Symptoms
▪ Small, evenly spaced papules on upper
arms, thighs, buttocks and sometimes
the face
Alopecia Areata
▪ Description
▪ Absence or loss of hair; hair shafts are
gone but hair follicles are preserved
▪ Diagnostic Procedures
▪ Visual examination, detailed health
history, examination of skin/oral mucosa
and biopsy

▪ Etiology ▪ Treatment
▪ Intralesional corticosteroid injection
▪ Abnormal immune response
▪ Prognosis
▪ Signs/Symptoms ▪ Variable; spontaneous regrowth is
common
▪ Painless round areas of hair loss
without signs of inflammation ▪ Prevention
▪ None
Folliculitis/Furuncles/Carbuncles
▪ Description
▪ Folliculitis: infected hair follicle
▪ Furuncle: abscess involving the entire hair
follicle and adjacent subcutaneous tissue
▪ Carbuncle: several furuncles developing in
adjoining hair follicles with multiple
drainage sinuses
▪ Etiology
▪ Infection by staphylococcal bacteria
▪ Signs/Symptoms
▪ Affected area may be extremely painful,
tender and swollen; abscess may
eventually enlarge, soften and open
discharging pus and necrotic material;
erythema and edema may persist for days
or weeks
▪ Diagnostic Procedures
▪ Made on basis of appearance of characteristic
lesion; slight leukocytosis; gram stains of
purulent content reveal causative organism
▪ Treatment
▪ Boil should never be squeezed; clean infected
area with soap and water; hot compresses
should be applied; antibiotic agents frequently
prescribed; surgical incision and drainage
▪ Prognosis
▪ The condition may recur for months or years;
complications include bacteremia
▪ Prevention
▪ Good personal hygiene and prevention of
infectious process
Pediculosis
▪ Description ▪ Diagnostic Procedures
▪ Visual examination
▪ Infestation with lice on the body, scalp
and pubic area ▪ Treatment
▪ Scalp: Permethrin cream rinse;
▪ Etiology ▪ Body: wash with soap and water; clothing and
bedding must be washed or dry cleaned
▪ Lice feed on human blood and lay eggs
▪ Pubic: creams, lotions or shampoos
in body hair or clothing
▪ Prognosis
▪ Signs/Symptoms ▪ Excellent with treatment but complications
include severe pruritus, pyoderma, and
▪ Intense pruritus and evidence of nits on dermatitis
hair shafts; lice on clothing or skin; ▪ Prevention
excoriation of patches of skin and
▪ Good hygiene, avoid contact with infested
pyoderma persons, don’t share combs, brushes or
clothing
 Dermatophytoses
▪ Description
▪ Diagnostic Procedures
▪ Chronic, superficial fungal infection; tinea capitis (scalp),
tinea corporis (body), tinea unguium (nails), tinea pedis ▪ Dependent on the location and
(feet), or tinea cruris (groin) appearance of the skin lesion;
▪ Etiology suspected lesions may be cultured
▪ Caused by several species of fungi, transmitted by direct to isolate the fungus
contact with the fungus or its spores; infection more
likely if skin is traumatized ▪ Treatment
▪ Signs/Symptoms ▪ Apply topical fungicidal medication;
▪ Tinea Capitis: persistent, contagious infection; slight oral medications may be
itching of the scalp
prescribed; loose-fitting clothing
▪ Tinea Corporis: (ringworm) occurs on exposed skin should be worn and changed
surfaces; lesions ringed and scaled with small vesicles
frequently
▪ Tinea Unguium: starts at the tip of one or more toenails;
nail appears lusterless, brittle, and hypertrophic ▪ Personal hygiene
▪ Tinea Pedis: (athlete’s foot) persistent itching—most
common symptom; burning, stinging, and pain ▪ Prognosis
▪ Tinea Cruris: (jock itch) may be associated with tinea ▪ All forms tend to be chronic and
pedis, occurs among male athletes, characterized by persistent
red, raised , itching lesions
▪ Prevention
▪ Proper hygiene practices
Candidiasis
▪ Description
▪ Yeast infection commonly affecting
mucous membranes
▪ Etiology
▪ Direct contact with secretions
▪ Change in bacterial flora (recent
antibiotic use)
▪ Symptoms
▪ Skin: Scaly, red, papular rash
(diaper rash)
▪ Mouth (thrush): Patches on the
tongue, mouth or pharynx
▪ Vagina: Abnormal discharge, itchy
▪ Diagnostic Procedures
▪ Clinical observation and personal
history
▪ Treatment
▪ Antifungal drugs
▪ Prognosis
▪ Good; chronic infection may occur
▪ Prevention/Control
▪ Observing good personal hygiene
Scabies
▪ Description
▪ Skin infection that results from the
infestation by the itch mite
▪ Etiology
▪ Infection caused by the itch mite; mites
live in the skin of humans causing
chronic infection
▪ Signs/Symptoms
▪ Itching intensifies at night; lesions
excoriated and may appear threadlike;
appear between fingers, on wrists, on
elbows, in the axilla, at the waist, on
nipples, buttocks, and genitalia
▪ Diagnostic Procedures
▪ Visual examination
▪ Treatment
▪ Application of a
pediculicide-permethrin, left on for 8 to
12 hours a day for 5 days; antipruritics
and oral antihistamines may reduce
itching
▪ Prognosis
▪ Good. Intense scratching may lead to
secondary bacterial infection
▪ Prevention
▪ Practice good hygiene
Impetigo
▪ Description ▪ Diagnostic Procedure
▪ Contagious skin infection marked by a ▪ Characteristic lesions; yellow crust
vesicle or bulla that becomes pustular,
ruptures and forms a yellow crust ▪ Treatment
▪ Antibiotics: topical and/or oral
▪ Etiology
▪ Streptococcal or staphylococcal ▪ Prognosis
bacteria; predisposing factors: poor ▪ Good
hygiene, malnutrition, anemia
▪ Prevention
▪ Signs/Symptoms
▪ Good hygiene and avoidance of
▪ Lesions begins as macules, vesicles, and infected people
pustules. Primary lesions rupture
leaving honey-colored liquid; liquid
hardens and thick yellow crust forms
over the infected site; most common
on the mouth, nose, neck, or
extremities.
Warts
▪ Description
▪ Benign circumscribed, elevated skin
lesions resulting from hypertrophy of
the epidermis; common, plantar, flat,
filiform, or periungual warts
▪ Etiology
▪ Caused by infection from papilloma
viruses; usually through direct contact
▪ Signs/Symptoms
▪ Usually asymptomatic except when
they occur on weight-bearing areas;
tenderness and itching
▪ Diagnostic Procedures
▪ Visual examination
▪ Treatment
▪ Removed with Carbon Dioxide, applied
laser therapy, salicylic acid plasters,
surgical excision, cryosurgery,
keratolytic agents
▪ Prognosis
▪ Spontaneous cures occur 50% of the
time; warts may resist treatment;
secondary infection and scarring are
possible
▪ Prevention
▪ Avoid touching any warts
Vitiligo
▪ Description
▪ Melanocytes are destroyed or cease
producing melanin which results in
depigmentation or white patches on
the skin and mucous membranes
▪ Etiology
▪ Autoimmune disorder
▪ Signs/Symptoms
▪ Depigmentation or white spots appear
on areas exposed to sunlight such as
the face, lips, hands, and feet
▪ 3 patterns: 1. focal pattern: one or a
few areas 2. segmental pattern: affects
only one side of the body 3. generalized
pattern: symmetrically on both sides of
the body
▪ Diagnostic Procedures
▪ Physical examination, medical history
of sunburn, trauma, premature graying,
stress or physical illness 2 to 3 months
before depigmentation occurred and
family history of vitiligo
▪ Treatment
▪ Topical corticosteroids; ultraviolet A
therapy; micropigmentation or
tattooing
▪ Prognosis
▪ Chronic condition with unpredictable
prognosis
▪ Prevention
▪ None
Scleroderma
▪ Description
▪ Progressive, chronic, connective tissue
disease characterized by diffuse fibrosis of
the skin and internal organs; degenerative
and fibrotic changes in skin, blood vessels,
skeletal muscles, and internal organs
▪ Etiology
▪ Appears to be an autoimmune disorder
▪ Signs/Symptoms
▪ Raynaud phenomenon: discoloration of
fingers or toes after exposure to change in
temperature; followed by pain, stiffness,
swelling of fingers and joints; calcium
deposits appear in connective tissue; skin
becomes thick, shiny, and taut;
contractures develop, GI symptoms:
heartburn, diarrhea, constipation, weight
loss, malabsorption
▪ Diagnostic Procedures
▪ Typical cutaneous clinical picture; hand,
chest and GI imaging may show
systemic changes
▪ Treatment
▪ Chemotherapy with
immunosuppressive drugs;
corticosteroids and colchicine;
vasodilators and antihypertensive
drugs (Raynaud phenomenon) digital
ulcerations require immediate
treatment
▪ Prognosis
▪ Variable; poor with death usually
resulting from renal, cardiac, or
pulmonary failure
▪ Prevention
▪ None; avoid cold, stress, and trauma
Seborrheic Dermatitis
▪ Description
▪ Chronic functional disease of the
sebaceous glands marked by an
increase in the amount and often
alteration in the quality of the
sebaceous secretion
▪ Etiology
▪ Idiopathic disease; may occur when
individuals have a disease of the
nervous system
▪ Signs/Symptoms
▪ Skin eruptions on areas of the scalp,
eyelids, cheeks, beard, chest, axillae,
groin, or trunk that produce dry moist
or greasy scales; lesions are brown,
yellow, or red; scaling by the scalp is
commonly known as dandruff
▪ Diagnostic Procedures
▪ Medical history and observation of the
characteristic lesions; must be
differentiated from psoriasis
▪ Treatment
▪ Gentle shampooing with mild shampoo
is helpful in treating cradle cap;
shampoos containing tar or salicylic
acid are helpful
▪ Prognosis
▪ Chronic condition; prognosis is good,
given effective treatment that controls
the disease
▪ Prevention
▪ None
Contact Dermatitis
▪ Description
▪ Any acute skin inflammation caused by
direct action of various irritants on the
surface of the skin
▪ Etiology
▪ Wide variety of animal, vegetable, and
mineral substances may induce contact
dermatitis: drugs, acids, alkaloids, and
resins from plants like poison ivy,
poison oak or poison sumac
▪ Signs/Symptoms
▪ Erythema and the appearance of small
skin vesicles that ooze, scale, itch, burn,
or sting; affected area may be hot and
swollen
▪ Diagnostic Procedures
▪ Appearance of inflamed area of skin;
medical history
▪ Treatment
▪ Skin surface must be thoroughly
cleansed of suspected irritant; topical
corticosteroid lotions or creams
▪ Prognosis
▪ Generally self-limiting; problems recur
if individuals re-expose themselves to
the irritant
▪ Prevention
▪ Avoidance of known irritants
Atopic Dermatitis (Eczema)
▪ Description ▪ Diagnostic Procedures
▪ Inflammation of the skin accompanied ▪ Observation of the skin and medical
history
by intense itching
▪ Treatment
▪ Etiology
▪ Local and systemic agents; careful daily
▪ Appears to have allergic or hereditary skin care and total avoidance of known
components irritants; topical corticosteroid creams and
ointments; skin moisturizers;
▪ Signs/Symptoms phototherapy

▪ Pruritus, severe characteristic lesions ▪ Prognosis

on the face, neck, upper trunk, and ▪ Good, but the disorder is often hard to
bends of the knees and elbows; may control
cause vesicular and exudative eruptions ▪ Prevention
in children and dry leathery vesicles in
▪ Avoidance of known irritants
adults
Cold Sores and Fever Blisters (HSV-1 or 2)
▪ Description
▪ Skin eruptions occurring about the
perimeter of the mouth, lips and nose
or on mucous membrane within the
mouth
▪ Etiology
▪ Produced by herpes simplex virus type
1. Virus lies dormant within the body
and reactivated during times of
lowered resistance or emotional and
physical stress
▪ Signs/Symptoms
▪ Characteristic lesions are small pale
vesicles appearing individually or in
clusters, especially on the lips or about
the mouth. Lesions eventually break
forming ulcers or crusts. Crust then falls
off and redness goes away
▪ Diagnostic Procedures
▪ Individuals characteristic lesions
▪ Treatment
▪ Strictly symptomatic: valacyclovir will
shorten the outbreak and lessen
recurrence; lesions should be kept dry and
clean as possible and protected from
trauma; topical analgesics or ointments
may be applied to relieve burning and
itching and increase healing; antibiotic
ointments may be recommended to
prevent secondary infection of open
lesions
▪ Prognosis
▪ Resolve within 1 to 3 weeks; HSV-1
resumes dormancy
▪ Prevention
▪ Avoiding intimate contact with persons
with visible cold sores
Herpes Zoster (Shingles)
▪ Description
▪ Acute inflammatory eruption of highly
painful vesicles on the trunk of the
body or occasionally on the face; adults
over 50 primarily infected
▪ Etiology
▪ Reactivation of the varicella-zoster
virus, the same virus that causes
chicken pox
▪ Signs/Symptoms
▪ Pain along the course of the affected
nerve, usually occurring 1 to 3 days
before appearance of lesions. Skin
eruption begins as an erythematous
maculopapular rash develops quite
rapidly into vesicles; site of lesions is
usually on one side of the trunk of the
body
▪ Diagnostic Procedures
▪ Characteristic pattern of painful lesions
▪ Treatment
▪ Antivirual drug therapy; sedatives,
analgesics, antipruritics; antibiotics may
be given to prevent secondary infection
▪ Prognosis
▪ Usually good; runs its course within 7
to 10 days; severe pain may persist for
weeks or months after lesions resolve
▪ Prevention
▪ For those over age 50, a vaccine is
recommended
Skin Cancer
▪ Description
▪ Basal cell carcinoma, squamous cell
carcinomas, malignant melanoma
(neoplasm composed of abnormal
melanocytes)
▪ Etiology
▪ Repeated exposure to ultraviolet rays;
radiation exposure, chronic skin
irritation and inflammation, exposure
to carcinogens; genetic factors
▪ Signs/Symptoms
▪ Most common sites are sun-exposed
areas: face, chest, back, ears, forearms,
back of hands; squamous cell
carcinomas characterized by firm, red
nodules with visible scales
▪ Malignant melanoma may be found in
non-sun exposed areas. ABCDEs of skin
cancer.
▪ Diagnostic Procedures
▪ Medical history, careful observation of
the skin noting characteristic lesions,
physical exam, and biopsy of the
lesions
▪ Treatment
▪ Surgery, radiation therapy, curettage,
cryosurgery, laser therapy,
electrodesiccation, Mohs micrographic
surgery
▪ Related to the level of dermal invasion
and thickness of the lesion. Poorer if
melanoma grows vertically rather than
horizontally
▪ Prognosis
▪ Cure rate improved if detected and
treated in early stages
▪ Prevention
▪ Avoid overexposure to the sun