INTEGUMENTARY DISEASES

A. Leprosy
o Hansen’s Disease
o Is an ancient disease and is a leading cause of permanent physical disability
among the communicable diseases.
o A chronic mildly communicable disease that mainly affects the skin, the
peripheral nerves, the eyes and mucosa of the upper respiratory tract
o Is a chronic systemic infection characterized by progressive cutaneous lesions
⮚ Signs and Symptoms
a. Early Signs and Symptoms
o Change in the skin color- either reddish or white
o Loss of sensation on the skin lesion
o Decrease /loss of sweating and hair growth over the lesion
o Thickened and or painful nerves
o Muscle weakness or paralysis of extremities
o Pain and redness of the eyes
o Nasal obstruction or bleeding
o Ulcers that do not heal
b. Late signs and symptoms
o Loss of eyebrow (madarosis)
o Inability to close eyelids (lagophthalmos)
o Clawing of fingers and toes
o Contractures
o Sinking of the nose bridge
o Enlargement of the breast in males or gynecomastia
o Chronic ulcers
⮚ Infectious Agent
o Mycobacterium leprae an acid fast, rod-shaped bacillus which can be
detected by Slit Skin Smear (SSS)
⮚ Method of Transmission
o Airborne – inhalation of droplets/ spray from coughing and sneezing of
untreated leprosy patient.
o Prolonged skin to skin contact
⮚ Incubation period
o It varies from few months to many years
o Lepromatous patients may be infectious for several years
⮚ Three distinct forms
o Lepromatous leprosy
● Most serious type
● Most infectious
● Causes damage to the respiratory tract, eyes and testes as well as the
nerve of the skin
● Lepromin test is negative but the skin lesions contain large amount of
Hansen’s bacilli
● Slow involvement of the peripheral nerves, with some degree of
anesthesia and loss of sensation and gradual destruction of the nerves
o Tuberculoid Leprosy
● Affects the peripheral nerves and sometimes the surrounding skin,
especially on the face, eyes, and testes as well as the nerves and the
skin
● Lepromin test is positive, but the organism is rarely isolated from the
lesions
● Macules are elevated with clearing at the center and more clearly
defined than in the lepromatous form
o Borderline (Dimorphous)
● Has the characteristics of both lepromatous and tuberculoid leprosy

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 ⮚ Susceptibility
o Children especially 12 years old and below are more susceptible
⮚ Diagnostic test
o Slit Skin Smear
o Blood test (RBC, ESR, Albumin, Cholesterol levels)
⮚ Prevention
o Avoidance of prolonged skin-to-skin contact especially with a lepromatous case
o Children should avoid close contact with active, untreated leprosy case
o BCG vaccination
o Good personal hygiene
o Adequate nutrition
o Health Education
⮚ Management and Treatment
o Ambulatory chemotherapy through the use of Multi-drug therapy
o Domiciliary treatment as embodied in RA 4073 which advocates home
treatment
o RA 4073 treatment of leprosy in government skin clinic, RHU or by duly licensed
physician
⮚ Treatment Modalities
o Sulfone Therapy
o Rehabilitation, Recreational and occupational therapy
o Multiple Drug Therapy
✔ Multibacillary (Rifampicin, Clofazimine, Dapsone)
o Infectious type
o Duration of treatment (24 to 30 months)
✔ Paucibacillary (Rifampicin and Dapsone)
o Tuberculoid and Indeterminate
o Non-infectious types
o Duration of treatment (6-9 months)
⮚ Nursing Management
o Isolation and medical asepsis should be carried out
o Full, nutritious diet
o Give analgesics, sedatives and antipyretic as needed
o Provide emotional support during treatment
o Provide skin care and assist with treatment and rehabilitation of affected
extremities
o For eye dryness, patient may use tear substitute daily and protect their eyes
⮚ PHN Responsibilities
o Health education of patients, families and community on the nature of the
disease, symptomatology and its transmission.
o Advocate healthful living through proper nutrition, adequate rest, sleep and
good personal hygiene.
o BCG vaccination esp. of infants and children

B. Rubeola (Measles)
⮚ Description: it is an acute contagious and exanthematous disease that usually affects
children who are susceptible to upper respiratory tract infection
⮚ Etiologic Agent : Filterable virus of measles (Paramyxoviridae)
⮚ Source of Infection : Secretion of nose and throat of infected persons
⮚ Mode of transmission:
o Droplet spread / direct contact with infected persons
o Indirect contact (articles with secretions)
o Airborne
⮚ Incubation period: 8 to 13 days, usually about 10 days
⮚ Period of Communicability: starts before the prodrome and lasts until 4 days after the
rash appear
⮚ Clinical manifestations

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 o Koplik’s spots- pathognomonic sign
o Pre-eruptive stage
✔ Fever
✔ Catarrhal symptoms- (rhinitis, conjunctivitis, photophobia, coryza)
✔ Stimson’s line (red line in the lower conjunctiva
o Eruptive Stage
✔ Macula-papular rash
✔ High grade fever
✔ Anorexia and irritability
✔ Throat is red and extremely sore
o Convalescence Stage
✔ Rashes fade away
✔ Fever subsides
✔ Desquamation begins
✔ Symptoms subside and appetite is restored
⮚ Diagnostic Procedures
o Nose and throat swab
o Urinalysis
o Blood exams (single raised IgM or rise in IgG)
⮚ Treatment Modalities
o Anti-viral drug (Isoprenosine)
o Antibiotics
o Oxygen inhalation
o IV fluids
⮚ Complications
o Bronchopneumonia
o Otitis media
o Pneumonia
o Nephritis
o Encephalitis
⮚ Susceptibility, Resistance and Occurrence
o All persons are susceptible
o Babies born of mothers who had the disease before the baby is born are
immune for the first months of life
o Permanent acquired immunity- is usually after attack of measles
⮚ Methods of Prevention and Control
o Avoid exposing children to any person with fever or with acute catarrhal
symptoms.
o Isolation of cases from diagnosis until about 5-7 days after the onset of the rash
o Disinfection of all articles soiled with secretion of nose and throat
o Encouragement by health department and by private physician of
administration of measles immune globulin to susceptible infants and children
under 3 years of age in families or institutions where measles occurs
o Live attenuated and inactivated measles virus vaccines have been tested and are
available for use in children with no history of measles, at 9 months of age or
soon thereafter
o MMR vaccine (15 months); 2nd Dose (11 to 12 years old)
⮚ PHN Responsibilities
o Emphasize the need for immediate isolation when early catarrhal symptoms
appear
o If immune serum of globulin is available (gamma Globulin), explain this to the
family and refer to physician or clinic giving this service
o Observe closely the patient for complications during and after the acute stage
o Teach, demonstrate, guide and supervise adequate nursing care indicated
o Explain proceedings, in proper disposal of nose and throat discharges
o Teach concurrent and terminal disinfection
⮚ Nursing Care

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 o Protect eyes of patients from glare of strong light as they are apt to be inflamed.
o Keep the patient in an adequately ventilated room but free from drafts and
chilling to avoid complications of pneumonia
o Teach, guide and supervise correct technique of giving sponge bath for comfort
of patient.
o Check for corrections of medication and treatment prescribed by physician

C. Varicella (Chicken pox)

⮚ Description:
o acute infectious disease of sudden onset with slight fever, mild constitutional
symptoms and eruptions which are macula-papular for a few hours, vesicular
for3-4 days and leaves granular scabs
o Lesions are more on covered than on exposed parts of the body and may appear
on scalp and mucous membrane of upper respiratory tract.
⮚ Etiologic Agent : Human (alpha) herpesvirus 3 (varicella- zoster virus), a member of the
Herpesvirus group
⮚ Source of Infection
o Secretion of respiratory tract of infected persons.
o Lesions of the skin are of little consequences
o Scabs themselves are not infective
⮚ Mode of Transmission
o Direct contact or droplet spread
o Indirect through articles freshly soiled by discharges of infected persons
o Airborne
⮚ Incubation Period
o 2-3 weeks, commonly 13 to 17 days
⮚ Period of Communicability
o Not more than one day before and more than 6 days after the appearance of
the first crop of vesicles.
⮚ Diagnostic Test
o Isolation of the virus from the vesicular fluid within the first 3 to 4 days of the
rash
o Serum antibodies is present in 7 days after onset
⮚ Congenital varicella results in:
o Hypoplastic deformities and scarring of limbs
o Retarded growth
o CNS and ophthalmic manifestations
⮚ Nursing considerations
o Strict isolation
o Tell the patient not to scratch the lesions
o Teach the client and the family how to apply topical antipruritic medications
correctly
⮚ Susceptibility, Resistance and Occurrence
o Universal among those not previously attacked. Severe in adults. An attack
confers long immunity
o Second attacks are rare. Probably 70% have the disease by the time they are 15
years of age.
o Not common in early infancy
o Methods of Prevention and Control
o Case over 15 years of age should be investigated to eliminate possibility of
smallpox.
o Report to local authority.
o Isolation
o Concurrent disinfection of throat and nose discharges.
o Exclusion from school for 1 week after eruption first appears and avoid contact
with susceptible

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o Vaccine- Varicella- zoster immune globulin (VZIG). It should be given within 10
days of exposure