NURSING INTERVENTION OF

PATIENTS WITH SKIN

DISORDERS
 Anatomy And Physiology Overview

Integumentary system is composed of:

1. Skin

2. Hair

3. Nails
 The Skin
 Is the largest organ system of the body

 Covers approximately an area of 1.2 to 2.3

meters squared

 Accounts for approximately 16% of body

weight

 Thickness varies from 0.1 to 1 mm

 Skin function
Protect underlying tissue by acting as a surface barrier to
the external environment.
Barrier against pathogens, mechanical trauma to
underlying tissue & excessive water loss)
Temperature /heat regulation

Fluid balance – stratum corneum has capacity to absorb

water.
 Skin function cont’d…
Provides sensory perception- nerve endings in the skin
supply information to the brain (pain, heat, cold, touch,
pressure & vibration)

Vitamin production (Vitamin. D)

Immune response function
Mirrors emotion, e.g. anger or embarrassment
 Layers of the Skin

Three layers:

1.Epidermis

2.Dermis

3.Subcutaneous tissue
 1. Epidermis

 Outermost layer of stratified epithelial cells

 Composed predominantly of keratinocytes

 Thickness 0.1 mm on the eyelids to about 1 mm on the palms of

the hands and soles of the feet

 Devoid of blood vessels

 Divided into two layers:

 An outer horny layer of dead keratinized cells--is almost

completely replaced every 3 to 4 weeks

 An inner cellular layer where both melanin and keratin are

Keratin:

Is the principal hardening ingredient of the hair

and nails

An insoluble, fibrous protein that forms the

outer barrier of the skin

Has the capacity to repel pathogens and

prevent excessive fluid loss from the body
Melanin

Colors the skin and hair

Produced by special cells of the epidermis –
Melanocytes

The more melanin in the tissue, the darker is the color

Its production is controlled by melanocyte-
stimulating hormone --released from Anterior
Pituitary (hypothalamus)
Melanin serves to absorb UV rays & protect person from sun
burn & gives the black color of skin
Two other cells common to the epidermis:

 Merkel cells -- receptors that transmit stimuli to

the axon through a chemical synapse (sensory
message)

 Langerhans cells -- play a significant role in

cutaneous immune system reactions

 Transport the antigens to the lymph system to

activate the T-lymphocytes.
The Skin
 2. Dermis

Makes up the largest portion of the skin, providing

strength and structure
Composed of two layers:
Papillary dermis
 Lies directly beneath the epidermis
 Composed primarily of fibroblast cells capable of
producing one form of collagen, a component of
connective tissue
Reticular layer
 Lies beneath the papillary layer
 Produces collagen and elastic bundles
 2. Dermis Cont’d…

Also made up of:

 Blood Vessels
 Lymph vessels
 Nerves
 Sweat glands
 Sebaceous glands
 Hair roots
Often referred to as the “true skin”
 2. Dermis Cont’d…Glands of the Skin

Sebaceous glands
 Associated with hair follicles
 Their ducts empty sebum(i.e., oily secretion)
onto the space between the hair follicle and
the hair shaft
 For each hair there is a sebaceous gland, the
secretions of which lubricate the hair and
render the skin soft and pliable
 2. Dermis Cont’d… Glands…
Sweat glands
 Found in the skin over most of the body surface
 Are heavily concentrated in the palms of the hands
and soles of the feet
 Body parts devoid of sweat glands:
 Glans penis
 Margins of the lips
 External ear
 Nail bed
 2. Dermis Cont’d… Glands…

Types of sweat glands:

A. Eccrine sweat glands

 Found in all areas of the skin

 Their ducts open directly onto the skin surface
 Release a thin, watery secretion called sweat
into its narrow duct

 Sweat is composed of predominantly water

and contains about one half of the salt
content of the blood plasma
 2. Dermis Cont’d… Glands…

A. Eccrine sweat glands Cont’d…

 Sweat is in response to elevated ambient

temperature and elevated body temperature

 The rate of sweat secretion is under the control of

the sympathetic nervous system

 Excessive sweating of the palms and soles, axillae,

forehead, and other areas may occur in response to
pain and stress
B. Apocrine sweat glands
 Are larger
 Located in the axillae, anal region, scrotum, and labia
majora
 Their ducts generally open onto hair follicles
 Become active at puberty
 In women, they enlarge and recede with each menstrual
cycle
 Produce a milky sweat that is sometimes broken down by
bacteria to produce the characteristic underarm odor
 Specialized apocrine glands called ceruminous glands are
found in the external ear, where they produce cerumen
(i.e., wax)
 3. Subcutaneous Tissue--hypodermis

 Innermost layer of the skin

 Primarily adipose tissue
 Provides a cushion between the skin
layers, muscles, and bones
 Promotes skin mobility
 Molds body contours
 Insulates the body (Provides shock absorption)
 Skin color
Normal skin color is contributed by three
pigments

 Melanin- brown black pigment in epidermis

 Carotene- yellow orange pigment in dermis

 Hemoglobin- oxygen binding pigment of RBC

 Hair
 An outgrowth of the skin

 Present over the entire body except for

the palms and soles

 Consists of hair root (in dermis) and hair

shaft (projecting beyond the skin)

 Grows in a cavity called a hair follicle

 Nails

 Grows from its root, which lies under a thin fold of

skin called the cuticle
 Protects the fingers and toes
 Growth is continuous throughout life, with an
average growth of 0.1 mm daily
 Growth is faster in fingernails than toenails and
tends to slow with aging
 Complete renewal:
170 days for fingernail
12 to 18 months for toe nails
Nail plate gets its pink color from the vascular nail bed
to which the plate is firmly attached

The angle between the proximal nail fold and the nail
plate is normally less than 180°
 Assessment of skin

Inspection
Palpation
Requirements
Good light :day light if possible
Pen light- to highlight lesions
Warm and private room
Done glove
Drape
 Common Alterations In Skin Color
Melanin (naturally occurring brown
pigment)
Increased in exposed areas or points
of pressure:
 Palmar creases
 Recent scars
 Some pituitary tumors
Decreased in:
 Albinism (congenital inability to Albinism
form melanin)
 Vitiligo (acquired loss of
melanin)
 Alterations in Skin Color Cont’d…
Cyanosis
 Bluish discoloration in the lips, mucous
membranes, and nails

 Results from an increased amount of un-

oxygenated hemoglobin

 Types:

i. Central cyanosis
ii. Peripheral Cyanosis
 Alterations in Skin Color Cont’d…

i. Central cyanosis
 Results from low oxygen level in the blood

 Best identified in the lips, oral mucosa, and tongue

 Causes:
Advanced lung diseases
Chronic heart diseases
Abnormal hemoglobin
 Alterations in Skin Color Cont’d…

ii. Peripheral cyanosis

Usually occurs with normal arterial oxygen
level
May be caused by:
 Anxiety

 Exposure to cold

 Venous obstruction
 Alterations in Skin Color Cont’d…

Jaundice
 Yellowish discoloration of the sclera, conjunctiva, lips,
hard palate, undersurface of the tongue, tympanic
membrane, palmar or plantar surface and skin
 Results from increased serum bilirubin concentration
(>2–3 mg/dL)
 Liver dysfunction
 Hemolysis
Jaundice
 Skin Moisture

 Palpate all non-mucous membrane skin surface for

moisture using the dorsal surfaces of hands
 Excessive moisture or perspiration (hyperhidrosis) is
usually caused by:
 Hyperthermia
 Infection
 Hyperthyroidism
 Strong emotions
 Excessive dryness (xerosis) often occurs in dehydration
 Bromidrosis (body odor) is usually caused by bacterial
decomposition of perspiration on the skin.
 Temperature
Palpate with back (dorsum) of hand, noting uniformity of
warmth
Abnormal findings
 Generalized hyperthermia
 fever, hyperthyroidism
 Generalized hypothermia
 shock, hypothyroidism
 Localized hyperthermia
 infection, inflammation or cellulitis
 Localized hypothermia
 arteriosclerosis
 Texture
Evaluate the texture of the skin using finger pad
Quality, thickness, flexible, roughness or smoothness
Texture is not uniform:
 Palms and soles are usually thicker than other
areas, which are smooth, soft, and flexible
 Wrinkled, leathery skin in the elderly results from
the normal aging process
Abnormal finding:
 Generalized roughness  hypothyroidism
 Skin Mobility and Turgor (elasticity)
Skin turgor is the skin's ability to change shape and
return to normal (elasticity)

Measures the elasticity of skin to determine the degree

of hydration

Lift a fold of skin and note the:

 Ease with which it lifts up (mobility)
 Speed with which it returns into place (turgor)
Skin turgor
 Skin Mobility and Turgor Cont’d…
Failure of the skin to reassume its normal contour or
shape after being pinched indicates dehydration

Edema
 Palpate dependent areas (sacrum, feet, ankles) for
mobility by applying pressure with fingers for 5
seconds, noting degree of indentation (pitting)
 Dependent edema gives the skin a stretched, shiny
appearance
 Skin Mobility and Turgor Cont’d…

 The degree of pitting edema reflects the depth of

indentation in centimeters (1+ to 5+)

 Edema is usually caused by direct trauma or

impairment of venous return
Assessing for Edema
 Skin Mobility and Turgor Cont’d…

Normal Findings
 Absence of indentation in dependent
areas

 The resilience (elasticity) of the skin to

spring back to its previous state after
being pinched
Tenderness
 Palpate skin surface for tenderness using the dorsal
surfaces of the hands and fingers.

 Skin is normally non-tender

 Discrete tenderness may indicate local infections such
as carbuncles, cellulites, boils

 Generalized tenderness may indicate systemic illness

such as allergic reaction
 Assessment of Nails

Inspect and palpate the fingernails and

toenails and note:
Color
Shape
Lesions
 Hair
 Inspect and palpate the hair
 Note its quantity, distribution,
and texture
Abnormal findings:
 Alopecia refers to hair loss—
diffuse, patchy, or total
 Sparse hair in hypothyroidism
 Fine silky hair in
hyperthyroidism
 Skin lesion

Skin lesion
 Lesion is a physical change in a body part that is the
result of illness or injury.
 The most prominent characteristics of dermatological
problems
 80-100% of PLWH develop dermatological conditions
 May be very disabling, disfiguring and even life-
threatening
 vary in size, shape, and cause and are classiffed
according to their appearance and origin.
 Skin lesions can be described as primary or secondary.
 Type(s) of skin lesions

Skin Lesion

Primary Lesion Secondary Lesion

Non- Palpable Lesion Fluid Filled

palpable Lesion
Lesion
Above Skin Below Skin
Lesion Lesion
 Skin Lesions Cont’d…
Type(s) of skin lesions
I. Primary Lesions
 May arise from Previously
freckle
Normal Skin
a. Non-palpable
Macule
 Small flat spot < 1.0 cm in
diameter vitiligo
e.g., freckle
Patch
 Patch--Flat spot >=1.0 cm
e.g., vitiligo, stage 1 of
pressure ulcer
stage 1 of pressure ulcer
 Skin Lesions Cont’d…

b. Palpable
Papule: is a circumscribed, solid
elevation of skin with no visible
fluid with <0.5 cm in diameter
e.g. insect bites, warts
Plaque: Solid, elevated lesion
>0.5 cm in diameter
e.g., psoriasis
 Skin Lesions Cont’d…
lipoma
Nodule: Solid and
elevated; extends
deeper than
papule into the
dermis or
subcutaneous
tissues, 0.5–2.0 cm

e.g., lipoma,
erythema, cyst
 Skin Lesions Cont’d…

c. Fluid-Filled Cavities
within the Skin
Vesicle —Up to 1.0 cm;
filled with serous fluid
Example: herpes
simplex
Bulla —1.0 cm or larger;
filled with serous fluid
Example: 2nd-degree
burn
 Skin Lesions Cont’d…

Pustule —Filled with pus

Examples: acne,
impetigo
 Skin Lesions Cont’d…

II. Secondary Lesions

Result From Changes in

Primary Lesions

a. Above the Skin Surface

Scale—A thin flake of

exfoliated epidermis

Examples: dandruff, dry

skin
 Skin Lesions Cont’d…
Crust —The dried
residue of serum,
pus, or blood
Example: impetigo
 Skin Lesions Cont’d…
b. Below the Skin Surface
Erosion—Loss of the
epidermis; surfaces moist
but does not bleed
Example: moist area after
the rupture of a vesicle

Fissure —A linear crack in

the skin
Example: athlete’s foot
 Skin Lesions Cont’d…

Ulcer: depressed lesion of the epidermis and upper

papillary layer of the dermis;
may bleed and scar
e.g., stage 2 pressure ulcer
INFLAMMATORY AND ALLERGIC SKIN CONDITIONS
 Eczema
• An inflammation of the skin characterized by reddening
and itching and the formation of scaly or crusty patches
that may leak fluid.
• The word ‘eczema’ comes from the Greek for ‘boiling’ a
reference to the tiny vesicles (bubbles).
 Eczema….
• Eczema is not a specific disease.
• It is characterized by a vicious cycle of inflammation –
itch – scratch.
• Dermatitis and eczema are terms that may be used
interchangeably to describe a group of disorders with a
characteristic appearance.
 Eczema….
• Eczema most commonly causes dry, reddened skin that
itches or burns
• Intense itching is generally the first symptom in most
people with eczema.
• Sometimes, eczema may lead to blisters and oozing
lesions, but eczema can also result in dry and scaly
skin.
• Repeated scratching may lead to thickened, crusty skin.
Acute eczema
• Is recognized by its:
 Weeping, scaling and crusting
 blistering usually with vesicles but, in aggressive cases,
with large blisters
 Redness, papules and swelling usually with an ill-
defined border; and
 Vesicles, scales, crusts appear alone or together.
subacute eczema

-erythema
-crusting
-scaling
Chronic eczema
• May show all of the above changes but in general is:
 less vesicular and exudative
 more scaly, pigmented and thickened
 more likely to show lichenification dry leathery
thickened state, with increased skin markings, secondary
to repeated scratching or rubbing; and more likely to
fissure.
 Dermatitis
It is simple inflammation of the skin characterized by the
presence of :
-papules
-vesicles
-erythema
-edema
-exudation
- itching
• Dermatitis can be classified as atopic and contact dermatitis.
Atopic dermatitis
It is itchy recurrent skin lesion characterized by having
allergic back ground of hayfever, asthma, urticaria in
general.
Clinical manifestation
 Erytematous itchy lesion on the flexural area → lichenification.

 dryness of the skin

 Young onset
 Relapsing course
 Ictiosis
70
Infants= it is localized on the face,scalp,upper trunk and
napkin area.

Adults:- flexural areas of the limbs

- eye lid
-forehead
-side of the neck
Differential diagnosis
- contact dermatitis
-seboreic dermatitis
- scabies
Treatment -topical steroids
- control aggravating factors
- anti histamines
 Contact dermatitis
• Is an acute or chronic inflammation of the skin
that is cause by exposure to chemical ,physical or
biologic agent.
• Two types of contact dermatitis
I-Allergic contact dermatitis
II- Irritant contact dermatitis
 I. Irritant contact dermatitis (ICD)
• ICD is non-immunologic inflammation of the skin caused by
contact with physical or chemical agents.
• Can occur in any individual following exposure to an irritant
substance.
• The severity of skin inflammation is determined by the nature,
concentration &length of exposure to the substance.
• Some host factors that predispose to develop irritant contact dermatitis are:
 Dryness of the skin, breaks in the skin, moisture, friction &pressure
 Common chemical irritants

- Solvents (alcohol, xylene , turpentine ,esters, acetone,

ketones, and others).
-Metalworking fluids (neat oils, water-based metalworking
fluids with surfactants)

- Latex; kerosene;ethylene oxide

- Topical medications and cosmetics
- Alkalines(drain cleaners, strong soap with lye residues).
 Occupations associated with irritant contact dermatitis
Hairdressing
Medical, dental, veterinary
Cleaning
Agriculture, forestry
Food preparation
printing and painting
Metal work
Mechanical engineering
Construction
Clinical features
• Macular erythema, hyperkeratosis or fissuring
• Glazed, parched or scalded appearance of the
epidermis
• Healing process on withdrawal
 II. Allergic contact dermatitis
• Allergic Contact Dermatitis is an inflammatory response of the
skin to an antigen that can cause discomfort or embarrassment.
• It is due to delayed hypersensitivity reaction to exogenous
allergens.
• There are estimated to be more than 1000 contact sensitizers
in plants, biologic
products,metals,dyes,textiles,shoes,jewelery,cosmotics,topical
medication,industerial raw chemicals.
 Predisposing factors to develop allergic contact
dermatitis are :
• The presence of Infected, inflammed, injured skin
which causes increase penetrance of the contact allergen
through the skin.
• Genetic susceptibility
• Allergic contact Dermatitis can be classified as acute,
subacute and chronic
Clinical features
• Acute contact dermatitis manifests by
erythematous, indurated plaque or with fluid filled
vesicles or bullae on an edematous skin
• Subacute contact dermatitis is characterized by
less edema and formation of papules, excoriations
and scaling
• Chronic eczema is characterized by scaling, skin
fissuring and lichenfication.
 Common allergens implicated include the following
Nickel - metal frequently encountered in jewelry and buttons on
clothing
Gold - precious metal often found in jewelry

Balsam of Peru - a fragrance used in perfumes and skin lotions,

derived from tree resin.
Neomycin - a topical antibiotic common in first aid creams and
ointments, cosmetics, deodorant, soap and pet food
Fragrance mix - found in foods, cosmetic products, insecticides,
antiseptics, soaps, perfumes and dental products
 Sites of ACD
Common sites: ear lobes, face, neck, wrist, eye lid, genital
area, umbilicus, axillary areas, hand &feet.
• allergic reaction to hair cosmetics can occur as contact
dermatitis to the face or neck.
• Allergic reaction to the palms occurs on the dorsum of the
hand.
• Allergic reaction to the shoes occur on the dorsum of the
foot.
 ICD ACD

Very common Much less common

Prior exposure to substance :-not Essential

required
It occurs at Site of direct contact It occurs at Site of direct contact
& distant sites

Every indvidual is susptible Only some inidviduals are

genetically susceptible
Dry,fissured skin lesion Papulovesicles,edema
Rapid onset (4-12hrs at first 24hrs or longer after exposure (no
exposure) lesion on 1st.exposue)
Treatment
Topical steroids:
• First line
• Triamcinolone acetonide, thin films applied BID
initially, reduce to once daily as lesions remit.
Alternative
• Hydrocortisone, thin films applied on face, axillae,
breasts, groins and perianal area twice daily initially,
reduce as the lesion’s remits. Or Mometasone, thin
films applied QD
Systemic
• Systemic steroids (for severe, recalcitrant and
generalized cases)
 Prednisone,0.5mg/kg P.O. QD for 1-2 weeks.
 Treatment
Preventive measures for irritant contact dermatits
• Decrease exposure to soaps,detergents,bleaches.
• Avoid abrasive soaps
Preventive measures for allergic contact dermatitis
are:-
• Identify &Avoidance of the allergen
• Wear protective gloves
PSORIASIS
 Psoriasis …

• Psoriasis is a chronic, noncontagious, multisystem,

inflammatory disorder.
• Patients with psoriasis have a genetic predisposition for
the illness, which most commonly manifests itself on
the skin of the elbows, knees, scalp, lumbosacral areas,
intergluteal clefts, and glans penis.
 Etiology
• Psoriasis involves hyperproliferation of the keratinocytes
in the epidermis, with an increase in the epidermal cell
turnover rate.
• The cause of the loss of control of keratinocyte turnover
is unknown.
• However, environmental, genetic, and immunologic
factors appear to play a role
 Types of Psoriasis
Erythrodermic psoriasis
• an exfoliative psoriatic state in which the disease
progresses to involve the total body surface.
• It appears pink or red in people with chronic psoriasis
after infections or after exposure to certain medications,
including withdrawal of systemic corticosteroids.
 Types…
Pustular Psoriasis
• Is rare, occurring in less than 5% of people afflicted with
psoriasis.
• It is characterized by raised, pus-filled bumps (pustules)
on the skin.
• The pustules can appear within hours after the skin's
surface becomes red and itchy; they occur in waves,
scaling and healing in a few days and then reappearing.
 Types…
Inverse Psoriasis
• Also known as flexural psoriasis occurs in the folds of the
skin, such as those found in the armpits, groin and under
the breasts.
• Most prevalent in people who are overweight, and it's
aggravated by friction and sweating.
• Appearing as smooth, sometimes shiny patches rather than
the scaly lesions seen in other types of psoriasis, areas
affected by inverse psoriasis are red, inflamed, and tender
 Types…
Guttate Psoriasis
• It is the second most common type of psoriasis
• Characterized by widespread small, red spots on the skin.

• Most common in children and younger adults, the spots

come on suddenly, quite often after some kind of
bacterial or viral infection, and usually appear across the
trunk and on the limbs.
99
 Types…
Plaque Psoriasis:
• Is the most common form of psoriasis
• It is characterized by hard, red, raised patches on the skin
that have a silvery white, scaly coating.
• Plaques can remain as separate, isolated areas or join
together to form a larger plaque; they appear most often
on the elbows, knees, and lower back.
 Types…
Psoriatic arthritis (PsA) is a chronic systemic
inflammatory disorder characterized by joint
inflammation.
• PsA is relatively common
 Types…
Nail Psoriasis: Can take several forms:
• Pitting: discrete, well-circumscribed depressions on nail
surface
• Subungual hyperkeratosis: silvery white crusting under
free edge of nail with some thickening of nail plate
• Onycholysis: nail separates from nail bed at free edge
• ‘Oil-drop sign’: pink/red colour change on nail surface
 Types…

• Scalp psoriasis: affects approximately 50% of patients,

presents with erythematous raised plagues with silvery
white scales on the scalp.
 Clinical Manifestations

• Lesions appear as red, raised patches of skin covered

with silvery scales
• Bilateral symmetry is a feature
• When the nails are involved, with pitting, discoloration,
crumbling beneath the free edges, and separation of the
nail plate.
• Sudden onset of many small areas of scaly redness

• Pain (especially in erythrodermic psoriasis

• Pruritus (especially in guttate psoriasis)
• Afebrile (except in pustular or erythrodermic psoriasis in
which the patient may have high fever)
• Ocular findings approximately in 10% of the patients.

redness due to conjuctivitis and blepharitis

tearing
 Diagnosis
• Physical examination
• Clinical features
• Laboratory findings

• ESR is usually normal (except in pustular and

erythrodermic psoriasis).
• Uric acid level may be elevated in psoriasis (especially
in pustular psoriasis)
• Fluid from pustules is sterile with neutrophilic
infiltrate.
• Perform fungal studies.
 Treatment of psoriasis

• No permanent cure for psoriasis

• Various types of treatment modalities are available that
control the severity of the condition
• The main categories of drugs that are used to treat the
symptoms of psoriasis include corticosteroids, vitamin
D3 analogs (calcipotriene), coal tar products, retinoids
(tazarotene) and anthralin.
 These medications are helpful in:

• Reducing the inflammation of the skin

• Decreasing the formation of scales and
• Enhancing normal skin formation
Complications of psoriasis
The burning sensation or pain

Increased risk of lymphoma

Cardiovascular and ischemic heart disease

Mitral valve prolapse

ACNE VULGARIS
• Acne vulgaris is a chronic inflammatory disease of the
pilosebaceous follicles.
• A common follicular disorder affecting the susceptible
pilosebaceous gland (hair follicle)
• Most commonly found on the face, neck and upper trunk
• Common skin condition in the adolescent and young
adults b/n ages 12 and 35
• It is characterized by comedones (i.e., primary acne
lesions), and by papules, pustules, nodules, and cysts.
• A common skin disease that affects 85-100% of people at
some time during their lives.
• It is characterized by non-inflammatory pustules or
comedones, and by inflammatory pustules, and nodules
in its more severe forms.
• Affects the areas of skin with the densest population of
sebaceous follicles;
• These areas include the face, the upper part of the chest,
and the back.
 Causes

• Interplay between:

• Hormonal (androgen)
• Heridetary
• Bacteria( proprionobacterium acnes)
• Environmental factors
 Pathophysiology
• During childhood, the sebaceous glands are small and
virtually nonfunctioning.
• These glands are under endocrine control, especially by
the androgens.
• During puberty, androgens stimulate the sebaceous
glands, causing them to enlarge and secrete a natural
oil, sebum, which rises to the top of the hair follicle
and flows out onto the skin surface.
• In adolescents who develop acne, androgenic
stimulation produces a heightened response in the
sebaceous glands so that acne occurs when
accumulated sebum plugs the pilosebaceous ducts.
• This accumulated material forms comedones.
 Types of Acne

• Comedonal
• Papulopustular
• Nodulocystic

• Why is this important?

– Directs treatment options
 Comedonal Acne
 Closed comedones (whiteheads)
– Sebum accumulation results in a
white papule visible at the skin
surface
 Open comedones (blackheads)
– Plug protrudes from canal and
turns dark
• Non-inflammatory
• Usually responds to topical
keratolytic
Comedonal acne
 Papulopustular Acne

• Papules/Pustules
– Follicular wall ruptures
– Releases sebum and
bacteria into dermis

• Topical agents alone usually

insufficient
• Consider topical retinoids
plus systemic antibiotics
 Acne Vulgaris
Moderate papulopustular
 Nodulocystic Acne
• Soft nodules that are
secondary comedones from
repeated ruptures,
reencapsulations and
abscess formations
• Painful and disfiguring
• Psychological impact
• Treatment consists of topical
agents, oral antibiotics or
isotretinoin
Nodulocystic acne
 Classification of acne
• Acne is usually graded as mild, moderate, or severe based
on the number and type of lesions

• Mild ≈ comedones (noninflammatory lesions) are

the main lesion. Papules and pustules may be
present but are small and few in number.
• Moderate ≈moderate number of papules and
pustules, comedones are present mild lesions can

be present on the trunk.

Mild acne and Moderate acne
• Moderately severe ≈ numerous papules and pustules are
present, usually with many comedones and occasional
larger, deeper nodular inflamed lesions.
• Widespread affected areas usually involve the face, chest
and back.
• Severe ≈ nodulocystic acne and acne conglobata with
many large, painful nodular or pustular lesions are
present, along with many smaller papules, pustules and
comedones.
Moderately severe acne
Severe acne
 Clinical Manifestations
• The primary lesions of acne are comedones.
• Closed comedones (i.e., whiteheads) are obstructive
lesions formed from impacted lipids or oils and keratin
that plug the dilated follicle
• They are small, whitish papules with minute follicular
openings that generally cannot be seen
• The color of open comedones (ie, blackheads) results
not from dirt, but from an accumulation of lipid,
bacterial, and epithelial debris.

• Although the exact cause is unknown, some closed

comedones may rupture, resulting in an inflammatory
reaction caused by leakage of follicular contents (eg,
sebum, keratin, bacteria) into the dermis.
• This inflammatory response may result from the action
of certain skin bacteria, such as Propionibacterium
acnes, that live in the hair follicles and break down the
triglycerides of the sebum into free fatty acids and
glycerin.
• The resultant inflammation is seen clinically as
erythematous papules, inflammatory pustules, and
inflammatory cysts
 Diagnostic Findings
• History
• Physical examination
• Evidence of lesions characteristic of acne
• Age
 Medical Management
The goals of management are to:

• Reduce bacterial colonies

• Decrease sebaceous gland activity

• Prevent the follicles from becoming plugged

• Reduce inflammation, and minimize scarring

• Combat secondary infection

• Eliminate factors that predispose the person to acne.

• The therapeutic regimen depends on the type of lesion
(e.g., comedonal, papular, pustular, cystic).
• There is no predictable cure for the disease, but
combinations of therapies are available that can
effectively control its activity.
• Topical treatment may be all that is needed to treat mild
to moderate lesions and superficial inflammatory lesions
Nutrition and hygiene therapy
• Maintenance of good nutrition equips the immune
system for effective action against bacteria and
infection.
• For mild cases of acne, washing twice each day with
a cleansing soap may be all that is required.
• These soaps can remove the excessive skin oil and
the comedo in most cases
• Providing positive reassurance, listening attentively, and
being sensitive to the feelings of the patient with acne
are essential contributors to the patient’s psychological
well-being and understanding of the disease and
treatment plan.
• Acne medications contain salicylic acid and benzoyl
peroxide, both of which are very effective at removing
the sebaceous follicular plugs.
 Topical pharmacologic therapy

Benzoyl Peroxide
• Widely used because they produce a rapid and
sustained reduction of inflammatory lesions.
• Depress sebum production and promote breakdown
of comedo plugs.
• Produce an antibacterial effect by suppressing P.
acnes
Vitamin A acid (tretinoin)
– Applied topically
– Used to clear the keratin plugs from the
pilosebaceous ducts.
– Forces out the comedones, and
– Prevents new comedones
Topical Antibiotics
• Suppress the growth of P. acnes
• Reduce superficial free fatty acid levels
• Decrease comedones, papules, and pustules
• Common topical preparations include TTC,
clindamycin, and erythromycin.
 Education
• Improvement occurs over 2-5 months
• Face, upper arms and legs tend to respond more quickly than
those on the trunk
• Retinoids should be applied at bedtime
• Clinda/Erythromycin are applied in the morning
• Combination therapy is BEST!

– Avoid using topical antibiotic alone

– Should combine with antibacterial agent such as benzoyl
peroxide or oral antibiotic
• Soaps, detergents, and astringents remove sebum from
the skin surface but do not alter sebum production
• Avoid repetitive mechanical trauma
• Avoid occlusive clothing and refrain from rubbing
their faces or picking their skin
• Water-based cosmetics and hair products are less
comedogenic than oil-based products
Scabies
• Scabies is an infestation of the skin by the itch
mite Sarcoptes scabiei.
• The disease is most commonly found in people
living in substandard hygienic conditions and in
people who are sexually active.
• The mites frequently involve the fingers, and
hand contact may produce infection
Clinical Manifestations

• It takes approximately 4 weeks from the time of contact for the

patient’s symptoms to appear.
• The patient complains of severe itching caused by a delayed type
of immunologic reaction to the mite
• A magnifying glass and a penlight are held at an oblique angle to
the skin while a search is made for the small, raised burrows
created by the mites.
• The burrows may be multiple, straight or wavy brown or
black, threadlike lesions, most commonly observed between
the fingers and on the wrists.
• Other sites are the extensor surfaces of the elbows, the
knees, the edges of the feet, around the nipples, in the
axillary folds, under pendulous breasts, and in or near the
groin or gluteal fold, penis, or scrotum.
• Red, pruritic eruptions usually appear between adjacent skin
areas
• However, the burrow is not always visible
• One classic sign of scabies is the increased itching that
occurs during the overnight hours, perhaps because the
increased warmth of the skin
• Hypersensitivity to the organism and its products of
excretion also may contribute to the pruritus.
• If the infection has spread, other members of the family and
close friends also complain of pruritus about 1 month later.
• Secondary lesions are quite common and include vesicles,
papules, excoriations, and `crusts.
Assessment and Diagnostic Findings
• The diagnosis is confirmed by recovering S. scabiei or
the mites’ by-products from the skin.
• A sample of superficial epidermis is scraped from the top
of the burrows or papules with a small scalpel blade.
Medical Management

• The patient is instructed to take a warm, soapy bath or shower to

remove the scaling debris from the crusts and then to pat the skin dry
thoroughly and allow it to cool.
• A prescription scabicide, 5% permethrin, is considered the medication
of choice.
• It is applied thinly to the entire skin from the neck down, sparing only
the face and scalp (which are not affected in scabies).
• The medication is left on for 12 to 24 hours, after which the patient is
instructed to wash thoroughly.
• One application may be curative, but it is advisable to repeat the
treatment in 1 week
Nursing Management
• The patient should wear clean clothing and sleep between freshly laundered bed
linens.
• All bedding and clothing should be washed in hot water and dried on the hot
dryer cycle.
• If bed linens or clothing cannot be washed in hot water, dry cleaning is advised.
• After treatment is completed, the patient may apply an ointment, such as a
topical corticosteroid, to skin lesions because the scabicide may irritate the skin.
• The patient’s hypersensitivity does not cease on destruction of the mites.
• Pruritus may continue for several weeks as a manifestation of hypersensitivity,
particularly in people who are atopic (allergic).
• The patient is instructed not to apply more scabicide, because it will cause
more irritation and increased itching, and not to take frequent hot showers,
because they can dry the skin and produce pruritus.
• Oral antihistamines such as diphenhydramine or hydroxyzine can help
control the pruritus.
• If a secondary infection is present, treatment with oral antibiotic agents
may be indicated.
• All family members and close contacts should be treated simultaneously to
eliminate the mites.
• Some scabicides are approved for use in infants and pregnant women.
• If scabies is sexually transmitted, the patient may require treatment for
coexisting STI.
INFECTIONS OF THE SKIN
 Bacterial infections
Viral infections

Fungal infections
Parasitic infections
BACTERIAL SKIN INFECTIONS
 IMPETIGO
• Superficial infection of the skin caused by
staphylococci, streptococci, or multiple bacteria.
• Presents as either a primary pyodermal of intact skin or a
secondary infection due to preexisting skin disease or
traumatized skin.
• The exposed areas of the body, face, hands, neck, and
extremities are most frequently involved.
• Impetigo is contagious
• Occurs in individuals of all ages. However, children
younger than 6 years have a higher incidence of
impetigo than adults
• Particularly common among children living in poor
hygienic conditions.
• Chronic health problems, poor hygiene, and malnutrition
may predispose an adult to impetigo.
• Two main clinical forms are recognized:

Non-bullous impetigo and Bullous impetigo.

Bullous impetigo
• Infection of the skin caused by S. aureus, is
characterized by the formation of bullae(large, fluid-
filled blisters) from original vesicles.
• Most common in neonates and infants and developed in
the body folds that are subjected to friction.
 Clinical manifestations

Non-bullous impetigo
• The characteristic lesion is a fragile vesicle or pustule that readily
ruptures and becomes a honey-yellow, adherent, crusted papule or
plaque and with minimal or no surrounding redness
• Usually occurs on hands and face unless secondary infection exists
(cellulites).
• Lesions develop on either normal or traumatized skin or are
superimposed on a preexisting skin condition (e.g., scabies,
varicella, atopic dermatitis).
• The non-bullous form is usually caused by group A-β streptococcus
Bullous impetigo:
• The characteristic lesion is a vesicle that develops into a
superficial flaccid bulla on intact skin, with minimal or no
surrounding redness.
• Initially, the vesicle contains clear fluid that becomes
turbid.
• The roof of the bulla ruptures, often leaving a peripheral
collarette of scale if removed; it reveals a moist red base.
Medical Management
• Systemic antibiotic therapy
• It reduces contagious spread
• Treats deep infection, and
• Prevents acute glomerulonephritis
• In nonbullous impetigo, benzathine penicillin or oral
amoxacyllin or Ampicillin can also be used
• Bullous impetigo is treated with a penicillinase-resistant
penicillin (e.g., cloxacillin, dicloxacillin).
• In penicillin-allergic patients, erythromycin is an
effective alternative.
• The underlining skin conditions such as eczemas,
scabies, fungal infection, or pediculosis should be
treated.
Clinical manifestation
start as a small, red, raised, painful pimple
progresses and involves the skin and subcutaneous fatty tissue;
tenderness, pain, and surrounding cellulitis

The characteristic pointing of a boil follows in a few days.

the center becomes yellow or black, and the boil is said to
have “come to a head.”

Diagnoses
 History
 Clinical finding
Furuncle…
 Management
Systemic therapy is required for furunclosis of the face or when
generalized symptoms or impairment of the immune system are
present.
Penicillenase resistant are preferable
• First line:

Cloxacillin: Adults: 500 mg P.O. QID for 7 to 10 days

• Alternatives

Erythromycin : Adults: 500mg PO QID for 7 to 10 days or

Cephalexin: Adults: 250 to 500mg QID for 7 to 10 days

 Nursing Management
The boil or pimple should never be squeezed
Bed rest is advised for patients who have boils on the
perineum or in the anal region
When the pus has localized and is fluctuant, a small incision
Soiled dressings are handled according to standard
precautions
Warm, moist compresses increase vascularization and
hasten resolution of the furuncle or carbuncle
 Carbuncle
Is an abscess of the skin and subcutaneous tissue that
represents an extension of a furuncle that has two or more
furuncles with separate heads
Appear most commonly in areas where the skin is thick
and inelastic; the back of the neck and the buttocks are
common sites
Cause
Staphylococci aureus, streptococci or group A streptococci.
Carbuncle…..
s/s
The extensive inflammation frequently prevents a
complete walling off of the infection
High fever
pain
Leukocytosis, and even extension of the infection to
the blood stream.
Diagnoses
 History
 Clinical finding
Carbuncle…..
 Management
First line

• Cloxacillin; Adults; 500mg P.O., QID for 7 to 10 days.

Alternatives

• Erythromycin; Adults; 500mg P.O., QID for 7 to 10 days OR

• Cephalexin; Adults; 250 to 500mg QID for 7 to 10 days.

In addition incision and drainage is usually necessary

VIRAL SKIN INFECTIONS
 Viral Skin Infections

1. Herpes Zoster
Is an infection caused by the varicella-zoster virus
Characterized by a painful vesicular eruption along the area of
distribution of the sensory nerves from one or more posterior
ganglia
Cause
Varicella-zoster virus
Pathogenesis
After a case of initial infection with varicella-zoster
viruses, lie dormant inside nerve cells near the brain and
spinal cord
Later, when these latent viruses are reactivated, they
travel by way of the peripheral nerves to the skin, where
the viruses multiply and create a red rash of small, fluid-
filled blisters
The inflammation is usually unilateral, involving
the thoracic, cervical, or cranial nerves in a band
like configuration.
It is assumed that herpes zoster reflects lowered
immunity

The clinical course varies from 1 to 3 weeks

c/m
Eruption of red rash of small, fluid-filled blisters
Eruption accompanied or preceded by pain
radiate over the entire region supplied by the affected nerves
The pain may be burning, lancinating (ie, tearing or sharply
cutting), stabbing, or aching.
Some patients have no pain, but itching and tenderness may
occur over the area
In immunosuppressed patients, the disease may be severe and
the clinical course acutely disabling
The Goals Management
To relieve the pain
To reduce or avoid infection, scarring, and postherpetic neuralgia
and eye complications

Pain is controlled with analgesics

Systemic corticosteroids may be prescribed for patients older than
age 50 years to reduce the incidence and duration of postherpetic
neuralgia

the patient should be referred to an ophthalmologist immediately

to prevent the possible sequelae of keratitis, uveitis, ulceration,
and blindness for eye involvement.
 Pharmacological management
Topical
• Gentian violet 1% or
• Calamine Lotion 5%
Systemic:
• Acyclovir, 400-800mg P.O. 5 times daily for 7 days or
• IV Acyclovir 5-10mg/kg body weight every 8 hours for 7 days
Neuralgia
• Prednisone 15-30mg daily or
• oral carbamazepine 100-200mg/day or
• phenytoin 100mg/day or
• Amitriptylline 25 mg at bedtime increasing the
dosage to 75 mg for 3-5 days
2. Herpes Simplex

is a common skin infection.

There are two types of the causative virus, which are
identified by viral typing
Type I virus (HSV-I), which occurs above the waist and
causes a fever blister
Type II virus (HSV-II), which occurs below the waist and
causes genital herpes
About 85% of adults worldwide are seropositive for herpes type 1
Pathogenesis

Exposure to HSV at mucosal surfaces or abraded

skin sites permits entry of the virus into cells of
the epidermis and dermis and initiation of viral
replication.

HSV acquisition is associated with sufficient viral

replication to permit infection of either sensory or
autonomic nerve endings.
On entry into the neuronal cell, transported intra-
axonally to the nerve cell bodies in ganglia.

During the initial phase of infection, viral replication

occurs in ganglia and contiguous neural tissue.
Virus then spreads to other mucocutaneous surfaces via
peripheral sensory nerves.

After resolution of primary disease, infectious HSV can

no longer be cultured from the ganglia.

The mechanism of reactivation from latency is unknown.

 c/m
Oral-Facial Infections
• Gingivostomatitis and pharyngitis are the most common c/m of
first-episode HSV-1 infection,
– most commonly seen among children and young adults
• Lesions may involve the hard and soft palate, gingiva, tongue, lip,
and facial area
• HSV-1 or HSV-2 infection of the pharynx usually results in
exudative or ulcerative lesions of the posterior pharynx and/or
tonsillar pillars
• HSV-1 and varicella-zoster virus (VZV) have been implicated in
the etiology of Bell's palsy (flaccid paralysis of the mandibular
portion of the facial nerve)
c/m…..
Genital Infections
• In First-episode ; Pain, itching, dysuria, vaginal and urethral
discharge, and tender inguinal lymphadenopathy are the
predominant local symptoms
• Widely spaced bilateral lesions of the external genitalia are
characteristic lesion
• Lesions may be present in varying stages, including vesicles,
pustules, or painful erythematous ulcers.
• Recurrency ; urethritis without external genital lesions.
 Medical Management
There is no complete cure for herpes simplex, recurrences will happen.
Topical acyclovir ointment is the drug of choice for primary lesions, to
suppress the multiplication of vesicles.
It does not benefit secondary lesions
Systemic acyclovir may be recommended for severe or frequent attacks (six or
more attacks per year) or for patients who are immunosuppressed
Acyclovir, 200 mg P.O.5 times daily or 400mg qid for 7 days. Children <2
years: half adult dose three time daily for 7 days
Antibiotics may be indicated for secondary infections
Do not share ………
 Fungal (Mycotic) Infections

The most common fungal skin infection is tinea, also

called ringworm because of its characteristic appearance

of ring or rounded tunnel under the skin.

Tinea is superficial fungal infections (Dermatophytes)

usually affect all parts of the skin from head to toes.

• Infection of the scalp - tinea capitis

• Infection of the skin of the trunk and extremities -

tinea corporis
• Infection of the axillae or groin - tinea cruris
• Infection of the nails - tinea unguium (onychomycosis)
• Infection of the palms and soles - tinea palmo-plantaris

• Infection of the cleft of the fingers and toes - tinea

interdigitalis
 1. TINEA PEDIS: ATHLETE’S FOOT

is the most common fungal infection.

It is especially prevalent in those who use communal
showers or swimming pools
It may appear as an acute or chronic infection on the
soles of the feet or between the toes.
• Three types: chronic plantar scaling, acute vesicular, and interdigital

Chronic plantar scaling will have slight redness and mild to

severe scaling; fold lines on sole appear to have white powder
because of scaling; there may be toenail involvement; itching is
usually not present
Acute vesicular appears as a sudden eruption of small, painful,
itchy vesicles; may also accompany chronic plantar scaling
Interdigital is characterised by macerated skin with fissures
between the toes (usually between the fourth and fifth toes) and
frequently erythema
c/m

The toenail may also be involved.

Lymphangitis and cellulitis occur occasionally
when bacterial superinfection occurs.

Sometimes, a mixed infection involving fungi,

bacteria occurs
 Medical Management
During the acute, soaks of potassium permanganate solutions
are used to remove the crusts, scales, and debris and to reduce
the inflammation.

Topical antifungal agents (eg, miconazole, clotrimazole) are

applied to the infected areas.
Topical therapy is continued for several weeks because of the
high rate of recurrence
 Nursing Management

The patient is instructed to keep the feet as dry as

possible, including the areas between the toes.
For people whose feet perspire excessively,
perforated shoes
Plastic- or rubber-soled footwear should be avoided
Antifungal powder applied twice daily helps to keep
the feet dry
 2. TINEA CORPORIS: RINGWORM OF THE BODY
• The typical ringed lesion appears on the face, neck, trunk, and
extremities
c/m
• Erythematous macule that progresses to rings of vesicles or scale
with a clear center that appears alone or in clusters
• Usually occurs on exposed areas of body;
• Can be moderately to intensely itchy Infected pet is common
source of infection
TINEA CORPORIS…..

Medical Management
• Topical antifungal medication may be applied to
lesion
• Oral antifungal agents are used only in extensive
cases.
• Topical corticosteroids are prescribed for itching.
 Nursing Management
• The patient is instructed to use a clean towel
and washcloth daily.
• Because fungal infections thrive in heat and
moisture, all skin areas and skin folds that
retain moisture must be dried thoroughly.
• Clean cotton clothing should be worn next to
the skin.
 3. TINEA CAPITIS: RINGWORM OF THE SCALP

• Ringworm of the scalp is a contagious fungal

infection of the hair shafts and a common cause
of hair loss in children.
• Any child with scaling of the scalp should be
considered to have tinea capitis until proven
otherwise.
C/m
• one or several round, red scaling patches.
• Small pustules or papules may be seen at the edges of such
patches.
• As the hairs in the affected areas are invaded by the fungi, they
become brittle and break off at or near the surface of the scalp,
leaving bald patches or the classic sign of black dots,
• which are the broken ends of hairs.
• Because most cases of tinea capitis heal without scarring, the hair
loss is only temporary.
 Medical Management
• Systemic antifungals are prescribed because of high
relapse rate with topical agents
• Oral corticosteroids are indicated to help prevent alopecia.
• Topical agents can be used to inactivate organisms on the
hair.
• The hair should be shampooed two or three times weekly,
and a topical antifungal preparation should be applied to
reduce dissemination of the organisms.
 Nursing Management
• Because tinea capitis is contagious, the patient and
family should be instructed to set up a hygiene regimen
for home use.
• Each person should have a separate comb and should
avoid exchanging hats and other headgear.
• All infected members of the family must be examined
because familial infections are relatively common.
• Household pets should also be examined.
 4. TINEA CRURIS: RINGWORM OF THE GROIN

• Tinea cruris (ie, jock itch) is ringworm infection of the

groin, which may extend to the inner thighs and buttock
area.
• It occurs most frequently in obese people, and those who
wear tight underclothing.
• The incidence of tinea cruris is increased among people
with diabetes.
c/m
• Lesion first appears as a small red scaly patch
and then progresses to a sharply demarcated
plaque with elevated scaly or vesicular borders;
• itching can range from absent to severe
TINEA CRURIS….

Medical and Nursing management

• Mild infections may be treated with topical medication
such as clotrimazole, miconazole, or terbinafine for at
least 3 to 4 weeks to ensure eradication of the infection.
• Oral antifungal agents may be required for more severe
infections.
• Heat, friction, and maceration (from sweating)
predispose the patient to the infection.
• Instructs the patient to avoid excessive heat and
humidity as much as possible and to avoid wearing
nylon underwear, tight-fitting clothing, and a wet bathing
suit.
• The groin area should be cleaned, dried thoroughly, and
dusted with a topical antifungal agent such as tolnaftate.
 5. TINEA UNGUIUM: Ringworm of Nails

• Tinea unguium is a chronic fungal infection of

the toenails or, less commonly the fingernails.
• It is usually associated with long-standing
fungal infection of the feet.
C/m
• The nails become thickened, friable (ie, easily
crumbled) and lusterless.
• In time, debris accumulates under the free edge
of the nail.
• Ultimately, the nail plate separates.
• Because of the chronicity of this infection, the
entire nail may be destroyed. 
 Medical and nursing management

• Systemic antifungals are rarely given for toenail

involvement, but may be prescribed for fingernail
involvement.
• Topical antifungals are usually ineffective.

• Nail may have to be surgically removed (nail avulsion).

• Explain high relapse rate to patient.

• Keep nails neatly trimmed and buffed flat; gently scrape
out any nail debris
 Management of Tinea infection – National
guideline
Topical
• The application of topical anti-fungals is usually enough for
Tinea corporis and cruris.
First line:
• Whitfield’s ointment applied twice a day until the infection
clears (usually for 2-3 weeks).
Dosage forms: Ointment, 3% salicylic acid with 6% benzoic acid
in 25 gm pack
OR
• Clotrimazole cream or ointment.
- Applied 2-3 times daily until the lesion heal (usually for 2-3
weeks) .
 Mangement of Tinea infection – national
guideline
Systemic Therapy:
• First Line therapy
1. Griseofulvin
• Adult < 50 kg body weight, 500 mg p.o. daily after food
• > 50 kg body weight ,500 mg p.o. twice daily after food

2nd Line
• i. Ketoconazole
• ii. Itraconazole
• iii. Miconazole
Leishmaniasis
Parasites disease of the skin and mucous membrane or a
chronic systemic disease caused by a number of species of the
genus leishmania.
Transmission is through the bits of the female phlebotomine
(sand flies).
Etiology
For cutaneous and mucosal leishmaniasis
Leishmania tropica
Leishmania aethopica.
Leishmania major and leishmania infantum
For visceral leishmaniasis
Leishmania donovani
Leishmania infantum
Leishmania tropica and leishmania chagasi
Leishmaniasis exists in two main forms in Ethiopia:
1. visceral
2. cutaneous

Visceral leishmaniasis (VL) is one of the most important

public health diseases present in five regions of the
country; the disease is known to be endemic in:

• Metema plains, S. Gondar, and Welkite areas in

Amhara regional state

• Humera plains in Tigray regional state

• The Omo plains, the Aba Roba and Weyto River
Valley in SNNP regional state
• The Moyale area and Genale river basin in the
Oromia regional state, and
• Afder and Liban zones in Ethiopian Somali
region
 CUTANEOUS LEISHMANIASIS
• The skin lesions commonly occurs on uncovered
body sites :face, arms or legs.
• Initally start as papule over several weeks to few
months it will become nodule, plaque or ulcerated
with central crust formation .
 Diffuse cutaneous leishmaniasis
• A primary lesion becomes wide spread with multiple
non ulcerating nodules involving entire body surface.
 Mucocutaneous leishmaniasis
• Leishmaniasis can result in severe destruction
of the mucosa, nasal septum and other
cartilages .
• Complications are obstruction of upper
airways .
Mucocutaneous leishmaniasis
 Visceral leishmniasis
• Visceral leishmniasis (KALAZAR) is mainly affects the
reticulo-endothelial systems (spleen , BM, liver,
lymphnodes).
• One of the Common opportunistic infection in HIV.

• Splenomegally, anaemia ,fever, wasting & imbalance of

serum proteins.
Visceral leishmniasis….
POST KALAZAR DERMAL LEISHMANIASIS

 lesions usually appear with in a year after a

course of therapy for visceral leishmaniasis.

Consists of macular, papular & nodular lesions

on the face,trunk & extremities.

Diagnosis

⋆ Demonstration of the parasite (blood or tissue)

⋆ culture
⋆ Serologic test
Treatment
Pentavalent antimonial agents or pentamidine or
amphotercin.
Dose: Pentavalent antimony compounds: 20mg/kg/d for

28days IM, IV
Amphoterica B :2-5mg/kg/d IV

Pentamidine :4mg/kg thrice weekly for 15-30 doses (IV,IM)

Prevention and control
Personal protection measures
Avoidance of out door activities when sand flies are most
active
Use of screen and bed nets:
Wearing of protective clothing
Application of insect repellent
Treatment of cases
THE END