DISORDERS OF THE SKIN

Compiled by Sr.Navuta

UNIT OBJECTIVES
Explain -

the following: causes of common skin disorders pathophysiological changes associated with skin problems signs and symptoms of the diseases. appropriate terms

OBJECTIVES CONTD

Describe the following in relation to indications, purpose, preparation and support of patient and family: - diagnostic procedures - therapeutic procedures - corrective/surgical procedures

STATISTICS ANALYSIS
FIJI

317 outpatients, seen at CWMH and P.J. Twomey Hosp. in April & May, 2001. fungal infection 77patients Psoriasis 41 Dermatitis 60 Scabies 21 Viral infection 13

STATISTICS ANALYSIS, CONT.

Race:

Indian 174 (55%), Fijian 122 (38%), other 21 (7%). 88% of psoriasis pts were of Indian background 66% of the pts with fungal infections were ethnic Indians All 21 scabies patients were Fijians

OUTLINE OF DISEASE NOTE TAKING

Name

and definition of disease Etiology/epidemiology Pathophysiology Clinical manifestations Diagnostic tests Patient/family education Complications of the disease

MINOR SKIN IRRITATIONS

Dryness: common problem especially in older adults. Pruritis (itching) Sunburn: first degree or superficial burn Urticaria (hives)

DIAGNOSIS OF SKIN DISEASE

General history race, family history

Special history onset, site, character Examination good light, thorough examination

SKIN DISORDERS IN CHILDREN

Infants Vascular & pigmented birthmarks - abnormal migration of or proliferation of melanocytes - Mongolian spots caused by selective pigmentation, usually on the buttock or sacral region of Asians & blacks

INFANTS CONTD
Diaper

rash - macules on the buttocks & anogenital areas, or - Beefy, red, excoriated skin surfaces in the diaper area. -> ammonia & urine products

INFANTS CONTD
Prickly

heat - exposure of skin to warm, humid environment - Can occur at any age group Rx: remove excess clothing, cool skin with warm water baths, dry skin with powder.

INFANTS CONTD Cap greasy crust or scale formation on the scalp - caused by infrequent & inadequate washing of the scalp Rx: mild shampoo, gentle combing to remove the scales, apply oil before
Cradle

scrubbing.

PROBLEMS AFTER 24 HOURS

Pemphigus -

caused by a staphylococcus or streptococcus Mother could be having a boil Highly contagious to baby

BOILS AND ABSCESSES

Caused

by staphylococcus May need I&D Rx: IMI crystalline pencillin 100,000/kg body weight 2 doses per day

TODDLERS & SCHOOL AGE

Measles
Leprosy Scabies

Boils
Tinea

vesicolor Atopic eczema Impetigo Chicken pox

FUNGAL DISEASE OF SKIN (MYCOSES)

Tinea superficial mycosis Dermatophyte infection of skin, hair or nails Especially in hot, humid climates and covered skin Types include: vesicolor, cruris, pedis and capitis

TREATMENT
Topical:

Whitfields ointment, castellani paint. Systemic: griseofulvin, lamisil (terbinafine)

CANDIDA A yeast mycosis, especially in diabetics or immunological deficiency Mouth, vagina: painful erosions with white patches Body folds moist, beef-red patches; maybe present in nappy rash Nails and nailfolds (paronychia) Can lead to systemic disease

TREATMENT
Topical:

gentian violet 1% aqueous solution, nystatin cream Systemic: nizoral (ketoconazole), nystatin, amphotericin B

PARASITIC INFESTATIONS

Scabies Spread by skin-to-skin contact with infested person Easily gets secondarily infected Caused by female itch mite

TREATMENT
Treat

all contacts on the same

day Apply lotion to the whole body, except the head; repeat in 1 week Benzyl benzoate or Lyclear (permethrin 2%) Babies 10% sulphur ointment

PEDICULOSIS (LICE)

lice spread by head-tohead contact Lice survive for 1-2 days off the scalp Other species cause pubic and body infestation
Head

TREATMENT
Treat

all family and contacts on the same day and repeat one week later. Lotion more effective than shampoo Fine tooth comb examination of wet hair to remove lice and nits Organic phosphates Herbal preparation (unproven)

BACTERIAL INFECTIONS
Impetigo Very superficial, highly contagious May complicate eczema, scabies, lice, scratches or other breaks in skin Multiple lesions especially around mouth and nose Heals without scarring

FOLLICULITIS FURUNCLES (BOILS) CARBUNCLE

Staphylococcal

infection starting in

hair follicle Check for diabetes in patients with repeat attacks Volcanos: small medium - large

ERYSIPELAS AND CELLULITIS

Spreading

streptococcal infection causing hot, tender and swollen red skin Erysipelas more superficial with well-defined advancing edge. Especially on face

CELLULITIS
Affects

deeper tissue with less obvious edge. Especially on the leg Maybe preceded by fever, rigors Look for a point of entry of streptococcus ( a break in the skin such as a crack between toes)

TREATMENT OF STAPHYLOCOCCAL AND STREPTOCOCCAL INFECTION

Wash

with antiseptic soap Use gentian violet or topical antibiotic on lesions Oral antibiotics if systemic symptoms present or disease extensive. IV A/B if symptoms severe.

CONTD
Drain

tense boils or carbuncles Rest and elevation for cellulitis Look for underlying pathology (eczema, scabies, tinea, oedema) or nasal carriage of staphylococcus in patients getting recurrent infection

WARTS AND VIRAL INFECTIONS

Warts Caused by Human Papilloma Virus (HPV), a pox virus Extremely common especially in children. Clear up without treatment in 1-2 years. More resistant in adults

CONTD
On

the face, warts maybe finger-like (digitate) or flat (plane) On the anal and genital area they may produce large cauliflower-like masses. Associated with increased risk of anogenital cancer. Plantar warts maybe painful from pressure walking

HERPES SIMPLEX COLD SORE, FEVER BLISTERS

Caused

by a DNA virus Recurrent attacks very common, triggered by fever or sunburn Grouped vesicles which rapidly progress to pustules Healing in 2 weeks Complications eczema, systemic disease including encephalitis,
corneal involvement

HERPES ZOSTER SHINGLES

Same

virus as chicken pox (varicella) Pain distribution of a nerve may occur a few days before vesicles appear The cornea maybe affected and become ulcerated in herpes zoster of the 5th cranial nerve Pain may persist after the skin has healed

PAPULOSQUAMOUS DISEASE

Psoriasis sharply-circumscribed chronic scaly plaques with inceased redness (in light skinned patient. Often positive family history Scalp, elbows, knees and sacral area are most often affected and symmetrical

FIGURE 67-15
PSORIASIS VULGARIS IN A CAUCASIAN CLIENT (A) AND IN AN AFRICANAMERICAN CLIENT (B)

PIGMENTARY DISORDERS

Vitiligo

milk-white macules/patches from loss of melanocytes (the cells in the skin which produce melanin, the normal brown-black pigment) Symmetrical, particularly over bony prominences; also round the eyes, mouth, genitals. Hair on affected skin is white

PITYRIASIS ALBA
Very

common pale (not white) round patches on the face of children Edges of the patches are quite fuzzy, unlike vitiligo. Mild form of atopic eczema Gets better by the teens and requires no treatment

MELASMA (CHLOASMA)
Macular

hyperpigmentation on the face forehead, cheekbones, upper lip seen quite frequently in pregnancy and in women on the contraceptive pill.

ALBANISM
Genetic

disorder The enzyme that produces the melanin is absent Whole skin is white as the hair, iris and the retina Patients burn easily in the sun Protection from the sun is lifelong

LEPROSY
4

types: lepromatous, tuberculoid, borderline, disseminate Tuberculoid leprosy usually have one or two lesions - hypopigmented macules with sharp edges - Hairless, sweating absent & reduced sensation

TREATMENT OF LEPROSY
Drugs:

dapsone, rifampicin .etc. Education mainly on changed body image.

DERMATITIS

Acute dermatitis Itch plus redness, swelling, papules, vesicles/bullae, exudate, crusting Chronic dermatitis * Itch plus less acute features; more scaling, pigmentation, thickening

ACNE
Universal

in teenagers but common in adult life Causes: Genes + hormones, not diet, dirt. Lesions: comedones (whiteheads and blackheads), papules, pustules, nodules, cysts

TREATMENT OF ACNE
Depends

on type, extent and severity of lesions

THE END