Transcript File - Medical Assisting SPSCC

Lecture Notes
8
Skin Diseases and
Disorders
Classroom Activity to Accompany
Diseases of the Human Body
Fifth Edition
Carol D. Tamparo
Marcia A. Lewis
Copyright © 2011 by F.A. Davis Company. All rights
reserved. This product is protected by copyright. No part
of it may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means—electronic,
mechanical, photocopying, recording, or otherwise—
without written permission from the publisher.
I’d get a tattoo if I had any skin
tight enough to draw on.
—Maxine
3
Common Signs and Symptoms
of Skin Diseases and Disorders
• Skin eruptions
• Pruritus
• Erythema
• Pain
• Swelling
• Inflammation
4
Psoriasis
• Description
• Chronic, noninfectious, inflammatory pink or
red lesions of skin with characteristic silvery
scaling
• Occurs more often between ages 15 and 30
5
Psoriasis
• Etiology
• Not known
• Genetic; autoimmune indications
• Precipitated by trauma, infections, hormonal
changes, stress, climate
6
Psoriasis
• Signs and symptoms
• Epidermal cells produced 6 to 9 times faster
than normal
• Thick, flaky scaling of skin that appears dry,
cracked, encrusted
• Pruritus is common
7
Psoriasis
• Diagnostic procedures
• Careful medical history
• Observation of skin appearance
8
Psoriasis
• Treatment
•
•
•
•
•
•
•
Palliative
Avoid precipitating factors
Ultraviolet (UV) A or UV-B light
Coal tar preparations, corticosteroid creams
Open, wet dressings
Biologic agents
Intralesional therapy
9
Psoriasis
Complementary therapy
• Foods high in omega-3 fatty acids
• Vitamin supplements
• Aloe vera applications
• Stress reduction strategies
10
Psoriasis
Client communication
• Teach careful skin hygiene; scale removal
• Do not mix over-the-counter medications
with prescribed medications and creams
• Do not pick at the scabs
11
Psoriasis
• Prognosis
• Controllable, but not curable; unsightly
lesions cause psychological distress; can
progress to exfoliative psoriasis, an acute
condition
• Prevention
• None known
12
Psoriasis
• Psoriasis is characterized by red
lesions with
1.
2.
3.
4.
Runny pustules
Silvery scales
Firm nodules
Yellow crust
13
Acne Vulgaris
• Description
• Inflammatory disease of sebaceous glands,
hair follicles
• Comedos, papules, pustules appear on skin
• More common in adolescence
14
Acne Vulgaris
• Etiology
• Not known
• May be follicular occlusion, androgenstimulated sebum production
• Hormonal disturbances, endocrine disorders,
corticosteroid drugs
15
Acne Vulgaris
• Signs and symptoms
• Acne plugs appear as comedos; rupture
spreads inflammation to dermis
• Diagnostic procedures
• History
• Age
• Skin observation
16
Acne Vulgaris
• Treatment
• Reduce bacterial infection; prevent
inflammation
• Antibacterial solutions applied to skin
• Oral antibiotic therapy
17
Acne Vulgaris
Complementary therapy
• Reduce intake of saturated fats, increase
fiber
• Get fresh air, exercise
• Use non–oil-based makeup
• Use facial mask preparations made with
egg whites
18
Acne Vulgaris
Client communication
• Teach skin hygiene
• Eat balanced diet
• Watch for candidiasis symptoms if
antibiotic therapy is used
• OTC medications containing salicylic acid
and benzoyl peroxide are effective
19
Acne Vulgaris
• Prognosis
• Disease is persistent, emotionally upsetting
• Usually resolves over time
• Permanent scarring can occur
• Prevention
• None known
20
Rosacea
• Description
• Chronic inflammatory condition that causes erythema and
formation of pustules on the face
• Etiology
• Not known
• Likely a combination of genetics and environment
• More common in those with fair complexions between ages 30
and 50
• Premenopausal women more likely then men to develop
symptoms
21
Rosacea
• Signs and symptoms
• Flushing of the cheeks, forehead, and chin
• Small red pustules may appear
• Rhinophyma may occur
• Burning, redness of the eyes, and excessive
tearing may occur
22
Rosacea
• Diagnostic procedures
• Detailed medical history
• Physical examination of affected area
23
Rosacea
• Treatment
• Topical creams or lotions
• Oral antibiotics
• Laser surgery
24
Rosacea
Complementary therapy
• No significant therapy is indicated
Client communication
• Avoid products that contain alcohol, acids,
and other irritants
25
Rosacea
• Prognosis
• Chronic condition
• Good with early treatment
• Prevention
• Use of sunscreen; avoid overheating
• Use gentle facial cleansers
26
Rosacea
• Rosacea may cause thickening and
misshaping of the
1. facial skin
2. eyelids
3. nose
4. lips
27
Furuncles and Carbuncles
• Furuncle: a boil involving the hair follicle and the
surrounding tissue
• Carbuncle: several furuncles developing in
adjoining follicles with multiple drainage sites
• Common on hairy body parts where there is
irritation, pressure, friction, or moisture
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Pediculosis
• Skin infestation with lice
• Pediculosis corporis: body lice
• Pediculosis capitis: head lice
• Pediculosis pubis: pubic lice
29
Decubitus Ulcers
• Description
• Localized area of dead skin, subcutaneous
tissue
• Etiology
• Impaired blood supply to affected area from
persistent skin pressure
• Often seen in debilitated, unconscious, or
paralyzed persons
• Elderly clients at risk
30
Decubitus Ulcers
• Signs and symptoms
• Shiny, red skin over a bony prominence
• Blisters, erosions
• Necrosis, ulcerations occur that easily
become infected
31
Decubitus Ulcers
• Diagnostic procedures
• Visual examination of lesion
• Culture of wound if necessary
32
Decubitus Ulcers
• Treatment
• Alleviate skin pressure
• Provide careful skin hygiene
• Keep area dry, clean
• Topical antibiotics
• Surgery to remove ulcer in some cases
33
Decubitus Ulcers
Complementary therapy
• A paste of vitamin E oil, zinc oxide, goldenseal
powder applied to area
• Natural light
Client communication
• Frequent movement, ambulation is essential
• Keep skin clean and dry
34
Decubitus Ulcers
• Prognosis
• Healing process is slow, tedious
• Immediate treatment is important
• Prevention
• Frequent repositioning, gentle massage, use
of pressure-relieving devices
35
Dermatophytoses
• Description
• Chronic superficial fungal infection
• Tinea capitis – scalp
• Tinea corporis – body
• Tinea unguium – nails
• Tinea pedis – feet
• Tinea cruris – groin
36
Dermatophytoses
• Etiology
• Several species of fungus that invade the
keratinous layer
• Direct contact with fungus or spores
• Infection can occur when skin is chafed,
roughened, abraded, or in cases of poor
hygiene
37
Dermatophytoses
• Signs and symptoms
• Tinea capitis: contagious infection often in children; may be
asymptomatic or slight itching with gray, round, scaly lesions
• Tinea corporis: occurs in those exposed to infected domestic
animals; lesions are ringed with scales and vesicles; also
called ringworm
• Tinea unguium: usually asymptomatic until the nail becomes
brittle, lusterless, and thick
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Dermatophytoses
• Signs and symptoms(cont.)
• Tinea pedis: persistent itching, burning,
stinging; sole can become fissured; athlete’s
foot
• Tinea cruris: red, raised, sharply defined,
itching lesions in the groin; jock itch
39
Dermatophytoses
• Diagnostic procedures
• Dependent on location and appearance
• Culture to determine type of fungus
• KOH examination
40
Dermatophytoses
• Treatment
• Apply topical antifungal
• Keep affected skin as dry and clean as
possible
41
Dermatophytoses
Complementary therapy
• Apply tea tree oil or liquid grape seed extract 3 or
4 times a day
Client communication
• Avoid infection by being cautious of environment
42
Dermatophytoses
• Prognosis
• All forms are chronic and persistent;
reoccurrence is common
• Prevention
• Proper hygiene practices
43
Impetigo
• Description
• Contagious skin infection marked by fluidfilled blisters that become pustular, rupture,
form a yellow crust
44
Impetigo
• Etiology
• Strep or staph bacteria enters through cut or
lesion
• Poor hygiene, malnutrition, anemia may
predispose
• More common among infants, small children
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Impetigo
• Signs and symptoms
• Lesions begin as macules, vesicles, pustules
• Pruritus
• Lesions rupture, serous liquid hardens to
form a crust
• Most common on mouth, nose, neck,
extremities
46
Impetigo
• Diagnostic procedures
• Visualization of lesions
• Microscopic Gram stain of vesicle fluid
provides confirmation
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Impetigo
• Treatment
• Antibiotics (topical and/or oral)
• Thorough cleansing of lesions 2 to 3 times a
day
• Highly contagious
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Impetigo
Complementary therapy
• None
Client communication
• Teach about contagion, protection
• Show client how to clean the lesions,
apply medications
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Impetigo
• Prognosis
• Good
• Prevention
• Good hygiene; avoidance of those infected;
highly contagious
50
Impetigo
• Impetigo can be caused by
1. Staph or strep bacteria
2. Varicella virus
3. Escherichia bacteria
4. Herpes simplex virus
51
Vitiligo
• Description
• Depigmentation of the skin due to destruction of
melanocytes
• Etiology
• Not known
• Appears to be genetic or autoimmune
• Affects both genders and all races equally
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Vitiligo
• Signs and symptoms
• White spots appear on areas exposed to
sunlight
• Spots also appear in the groin, armpits,
navel, genital, and rectal areas
• May be accompanied by premature graying
of scalp and facial hair, eyebrows, and
eyelashes
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Vitiligo
• Diagnostic procedures
• Detailed physical examination and history
• Skin biopsy with microscopic examination
54
Vitiligo
• Treatment
• Topical corticosteroids
• Psoralen and ultraviolet A therapy
• Monobenzene application
• Skin grafts
• Tattooing, especially around lips
55
Vitiligo
Complementary therapy
• 40 mg of gingko biloba taken 3 times a
day
Client communication
• Provide emotional support
• Advise the use of self-tanners and makeup to cover white spots
56
Vitiligo
• Prognosis
• Chronic
• Unpredictable
• Prevention
• None
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Seborrheic Dermatitis
• Description
• Chronic disease of sebaceous glands
common in infants
• Appears as cradle cap or diaper rash
58
Seborrheic Dermatitis
• Etiology
• Idiopathic
• May occur with nervous system diseases
59
Seborrheic Dermatitis
• Signs and symptoms
• Skin eruptions on scalp, eyelids, cheeks, groin, or trunk
area
• Produces dry, moist, or greasy scales
• Diagnostic procedures
• Detailed history and observation of lesions
• Rule out psoriasis
60
Seborrheic Dermatitis
• Treatment
• Shampoo containing salicylic acid or zinc
pyrithione
• Hydrocortisone creams
61
Seborrheic Dermatitis
Complementary therapy
• Avoid any known allergens
Client communication
• Teach scrupulous skin hygiene
• Keep skin as dry as possible
62
Seborrheic Dermatitis
• Prognosis
• Chronic condition
• Good with effective treatment
• Prevention
• None known
63
Contact Dermatitis
• Description
• Acute skin inflammation caused by direct
contact with offending substance that creates
an allergic response
64
Contact Dermatitis
• Etiology
• Wide variety of animal, vegetable, mineral
substances
• Plants
• Certain metals in jewelry
• Contact with wool or latex
65
Contact Dermatitis
• Signs and symptoms
• Erythema
• Small skin vesicles that ooze, scale, itch,
burn
• Diagnostic procedures
• Inflamed appearance
• Medical history
• Patch test to determine irritant
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Contact Dermatitis
• Treatment
• Thorough skin cleansing to remove irritant
• Topical corticosteroid lotions or creams
67
Contact Dermatitis
Complementary therapy
• Remove offending irritant
Client communication
• Teach client how to avoid irritant
• Careful label reading
68
Contact Dermatitis
• Prognosis
• Self-limiting
• Problem recurs if exposed to offending
irritant
• Prevention
• Avoid offending irritant
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Latex Allergy
• Description
• A form of dermatitis, the result of
hypersensitivity to latex products
70
Latex Allergy
• Etiology
• Any latex products or products containing
even small amounts of latex
• Persons with asthma or other allergies are at
risk
• Medical, dental professionals also at risk
71
Latex Allergy
• Signs and symptoms
•
•
•
•
•
•
Itchy skin
Swollen lips
Nausea
Diarrhea
Red, swollen eyes
Signs of anaphylactic shock, such as hypotension,
tachycardia, difficulty breathing, bronchospasm
• Anaphylactic shock is medical emergency
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Latex Allergy
• Diagnostic procedures
• Blood test for latex sensitivity (measures
immunoglobulin E [IgE] antibodies)
• Treatment
• Avoidance of products containing latex
• Proper skin cleansing following exposure
73
Latex Allergy
Complementary therapy
• None
Client
• Inform individuals of the many latex
products
• Instruct on use of epinephrine auto injector
74
Latex Allergy
• Prognosis
• Good with avoidance of latex
• Risk increases with each exposure
• Prevention
• Avoid all latex-containing products
• Wear an ID tag, be prepared with
epinephrine auto injector
• Seek latex-free environments
75
Atopic Dermatitis (Eczema)
• Description
• Skin inflammation
• Produces intense itching
• Etiology
• Idiopathic
• Allergic or hereditary components suspected
76
Atopic Dermatitis (Eczema)
• Signs and symptoms
• Can cause vesicular, exudative eruptions in
children
• Dry, leathery vesicles in adults
• Pruritus
• Lesions on face, neck, upper trunk, bends of
knees, elbows
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Atopic Dermatitis (Eczema)
• Diagnostic procedures
• Skin observation
• History revealing family tendency
• Elevated IgE
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Atopic Dermatitis (Eczema)
• Treatment
• Local and systemic agents for pruritus
• Careful skin care
• Avoidance of known irritants
• Topical corticosteroid creams and ointments
• Humidifiers
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Atopic Dermatitis (Eczema)
Complementary therapy
• Identify and avoid any food, plant, metal,
chemical irritants
• Calendula lotion or aloe vera gel may be
beneficial
• Adults can take 500 mg of black currant oil twice
a day; children may take only one-half that dose
for 6 to 8 weeks
80
Atopic Dermatitis (Eczema)
Client communication
• Watch for secondary infections
• Suggest ways to avoid irritant
81
Atopic Dermatitis (Eczema)
• Prognosis
• Good, but disorder is frustrating to control
• Prevention
• Avoid known irritant
82
Herpes Zoster (Shingles)
• Description
• Acute, inflammatory, painful vesicles usually
on the trunk of the body; occasionally on the
face
• Primarily affects adults over age 50
83
Herpes Zoster (Shingles)
• Etiology
• Reactivation of the varicella zoster virus
(VZV) that causes chickenpox
• Trigger is unknown
84
Herpes Zoster (Shingles)
• Signs and symptoms
• Pain along affected nerve, usually 1 to 3 days prior
to maculopapular rash that becomes vesicles
• Region around area is very painful
• Diagnostic procedures
• Characteristic pattern of painful lesions
• Isolation of virus in cell cultures can confirm, if
uncertain
85
Herpes Zoster (Shingles)
• Treatment
• With early diagnosis, valacyclovir can prevent
progression of rash, visceral complications
• Sedatives, analgesics, antipruritics
• Antibiotics if vesicles are infected
86
Herpes Zoster (Shingles)
Complementary therapy
• Topical application of licorice root gel may be
helpful
• Application of TENS to nerves can relieve pain
Client communication
• Teach proper skin care, how to prevent infection
87
Herpes Zoster (Shingles)
• Prognosis
• Good; does not recur
• Shingles runs its course within 7 to 10 days
• Can persist for weeks or months
• Prevention
• For those over age 60 vaccination with weakened
chickenpox virus
88
Herpes Zoster (Shingles)
• Shingles appears
1. Primarily on the face
2. At the site of infection
3. Along a nerve tract
4. On the palms of the hands
89
Malignant Melanoma
• Description
• Neoplasm of epidermis and dermis
• Incidence has tripled in past 20 years
90
Malignant Melanoma
• Description (cont.)
• Occurs in four forms
• Superficial spreading: most common, occurs
anywhere on body; circular, flat, elevated lesions
• Lentigo maligna: occurs on exposed skin areas;
slowly evolves; lesions are brown or black
91
Malignant Melanoma
• Description (cont.)
• Nodular: occurs on any site; invades tissue below
dermis; looks like blood blister
• Acral-lentiginous: occurs where hair follicles are
absent; appears as irregular pigmented macules;
becomes invasive early; appears as dark brown,
flat or blue-black, raised lesion
92
Malignant Melanoma
• Etiology
• Unknown, though ultraviolet light is suspect
• Excessive sun exposure and blistering burns in
childhood
• Those with fair complexion, light hair, blue eyes
more at risk
• Signs and symptoms
• Lesions have irregular borders, diverse colors
93
Malignant Melanoma
• Diagnostic procedures
• Biopsy of suspicious skin lesions that are
then staged to determine treatment
94
Malignant Melanoma
• Treatment
• Surgical excision, chemotherapy
• Radiation therapy for metastatic disease
• Immunotherapy for advanced stages in
clinical trials
95
Malignant Melanoma
Complementary therapy
• Therapies are best if approved and integrated
into traditional therapies
Client communication
• Avoid excessive sun exposure; use sunscreen
when outdoors
96
Malignant Melanoma
• Prognosis
• Determined by level of dermal invasion
• Poor if metastasis occurs; good if detected and
treated early
• Prevention
• Avoid overexposure to the sun and ultraviolet rays
• Seek prompt treatment of suspicious skin lesions
97
Credits
Publisher: Margaret Biblis
Acquisitions Editor: Andy McPhee
Developmental Editors: Yvonne Gillam, Julie Munden
Backgrounds: Joseph John Clark, Jr.
Production Manager: Sam Rondinelli
Manager of Electronic Product Development: Kirk Pedrik
Electronic Publishing: Frank Musick
The publisher is not responsible for errors of omission or for consequences from application of information in this
presentation, and makes no warranty, expressed or implied, in regard to its content. Any practice described in this
presentation should be applied by the reader in accordance with professional standards of care used with regard to the
unique circumstances that may apply in each situation.
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