Transcript Dermatology - My Illinois State

Dermatology
Mennonite College of Nursing at
Illinois State University
FNP 431 Crystal Smith, APN, CNP
Common Dermatology Issues
Power Point-University of Minnesota
Medical Library Used with Permission
Anatomy
Skin Infections
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Bacterial
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Impetigo
Folliculitis
Furuncle
Carbuncle
Cellulitis
Acne
Fungal /Parasitic
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Tinea Pedis
Tinea Cruris
Tinea Versicolor
Tinea Corporis
Toenail fungus
Pediculosis
Scabies
Skin Infections
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Viral
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Allergic/Irritation conditions
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Herpes Simplex
Herpes Zoster
Verruca
Molluscum Contagiosum
Dermatitis
Hives
Eczema
Psoriasis
Sebacous Cysts
Frostbite
Other
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Skin checks - moles
Sunburn
Striae
Impetigo
Impetigo
Superficial bacterial infection of the skin
 Most commonly Staph or Strep
 Thin vesicles with honey colored crusting
 Usually on face, hands, neck & extremities
 Spread occurs via contact from fingers,
towels, clothing
 Tx: Topical antibiotics, severe infections
need oral
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Folliculitis
Folliculitis
Superficial or deep infection of the hair
follicle (Barbae, hot tub)
 Usually result of Staph infection
 May also occur as a result of
contact/plugging with oil, dirt, sweat, etc
 Rash appears as small, dome shaped
yellow pustules with a hair shaft in the
center
 Tx: good hygiene, topical antibotics
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Furuncle
Furuncle (Boil)
Deep extension of superficial folliculitis
into the dermis and subcutaneous tissue
 Cause – Staph
 1-5 cm red/tender nodule which may
contain pus
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Simple lesions- warm compress
Severe infections – drainage & antibiotics
Carbuncle
Carbuncle
Large deep abscess that is a progression
of a furuncle
 May be 3-10 cm in size
 Can present c fever/chills
 Tx: drainage & antibiotics
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Cellulitis
Cellulitis
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An acute inflammation of the skin
S/S: redness, swelling, warmth, & tenderness of
affected area within 1-2 days of injury
Cause Staph or Strep, complication of
wound/trauma
The borders are well defined and change rapidly
Immediate attention (blood test, IV antibiotics)
Facial cellulitis can cause visual damage if
spreads to the eyes
Acne
Acne
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Obstruction of sebaceous follicles (oil glands)
Open comedones or closed comedones
Usually on the face, chest, back
Causes:
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Stressful events (hormonal changes)
Friction acne
Oil based cosmetics
NO correlation between chocolate, chips or colas
Tx: topical +/or oral antibiotics
MRSA
MRSA
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Methicillin-resistant Staphylococcus aureus
“super-bug” – caused by staph, unnecessary antibiotic use
Outwits all but the most powerful of drugs – vancomycin
Enters through cuts & wounds
Types: CA (community acquired) or HA (Hospital acquired)
S/S: small red bumps that resememble pimples, quicky
turn to painful abscesses that can burrow deep into the
body, swelling, redness, pus
Risk Factors: recent hospitalization, long-term care, recent
antiobiotic use, young age, contact sports, sharing towels,
weak immune system, living in groups, health-care workers
Dx: Tissue sample – 48hrs
Tx: trial & error c strong antiobiotics
Prevention: WASH HANDS, surfaces, cover wounds, use
only personal items
Tinea Pedis
Tinea Pedis
Fungal infection - Athlete’s Foot
 Rash presents as vesicles/erosions on the
soles of the foot as well as between toes
 Dx: examine scraping under microscope
 Tx: antifungal cream/powders
(micronazole), keep feet dry
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Tinea Cruris
Tinea Cruris
Fungal infection – Jock itch
 Red/scaly rash on inner thighs/inguinal
creases; occasionally the buttock, not
scrotum or labia
 Common in obese patients & athletes in
tight fitting clothes
 Common in hot/humid weather
 Tx: topical antifungal creams
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Tinea Versicolor
Tinea Versicolor
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Fungal infection of the skin
Multiple patchy lesions (oval shape c fine scales)
either light in color or brown
Typically occurs on the back, neck, chest,
shoulders
More prominent in the summer when the affected
areas do not tan
Recurrence is common
Tx: Topical antifungal
Tinea Corporis
Tinea Corporis
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Fungal infection of skin - Ring Worm
Well defined circular patches with scaly borders
Found on non-hairy surfaces – face, arms, legs,
truck
Occurs after contact c another person/object that
is carrying the fungus
Common confused c eczema
Tx: topical antifungals (Micronazole, ketoconazole
not Nystatin)
Toenail Fungus
Toenail Fungus
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S/S:yellow, think nails, painful, brittle, more likely in
toenails d/t dark, moist environment
Tx: Lamisil, vicks, takes 6-12 months
Pediculosis
Pediculosis
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Lice; six-legged wingless insect
The louse is a grayish/black colored insect ~4mm
long
The nits are gelatinous white color ~.8mm long
Can be found in the head, body or pubic hair
They pierce the skin and secrete saliva which
causes itching, lay eggs close to scalp
Spread by shared hats, towels, combs, bedding,
clothing, upholstery & headphones
Tx: Shampoo – Nix, Rid; fine tooth comb, boil
clothing/bedding, dry cleaning
Scabies
Very contagious STD
 Intense itchy rash, with linear burrows
 Tx: Kwell or Elimite (topical creams)
 Wash bedding/clothing in HOT water &
stored for 2-3 days
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Herpes Simplex
Herpes Simplex
Viral infection either Type I OR Type II
 “You can’t kill it and it won’t kill you”
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Clear papules c superficial ulcerations/erosions
May cause fever, lymph node enlargement,
burning pain
Lesions will crust over in 5-14 days
Tx: analgesic for pain, oral antiviral (acyclovir)
Herpes Zoster
Herpes Zoster
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Shingles, a reactivation of varicella zoster
(Chicken pox) virus
It remains in the cells of nerve roots in an
inactive state (after exposure as a youth)
Unknown reasons for reactivation
 Re-exposure to virus
 Immunosuppressant issue
 Some drugs
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Result in vesicles on a red base in a band-like
distribution
Painful rash, prickly nerve pain
Tx: symptomatic, pain, calamine lotion
Verruca
Verruca
Warts; caused by human papillomavirus
 Verruca plantaris –
 Verruca vulgaris –
 Round, flesh colored and grow to be
yellow-ish tan
 1cm or more wide
 65% will resolve spontaneously
 Tx: destruction of epidermal cells that
contain virus; cryogenically, chemically
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Molluscum Contagiosum
Molluscum Contagiosum
Viral infection of skin/mucous membrane
 Single or multiple flesh colored, dome
shaped papules c central umbilication
 Found on face, trunk, extremities,
lips/tongue, genitals
 Very contagious – self and others
 Common in swimmers/wrestlers
 Tx: curettage, silver nitrate to chemically
burn the lesions
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Dermatitis
Dermatitis
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Inflammation of the superficial dermis/epidermis
Atopic Dermatitis:
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Heriditary disorder – may also have Hx of asthma, allergic rhinitis,
rash
Usually along cheeks, face, trunk, extensor surfaces of extremities
Dry and papular rash, scratching makes it worse, d/t loss of natural
oils in skin
Aggravated by stress, anxiety, dry conditions
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Tx: good lotions & rehydration of skin
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Contact Dermatitis:
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Papular and itchy rash resulting from contact c an allergen
Commonly – nickel (cheap jewelry, buckles), soaps, perfumes,
cosmetics, posion ivy/oak
Tx: Cortisone cream (anti-inflammatory agent)
Hives
Hives
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An allergic reaction resulting in histamine release
Well defined wheals (solid elevations c central
clearing)
Extremely itchy & may result in angioedema
Allergy can be to virtually anything
Tx: antihistamines
Eczema
Eczema
Dryness of the epidermis
 Usually seen on extremities/trunk
 Worse in winter or when bath too much
 Rash is itchy, red, scaly, patchy c a
cracked appearance
 2ndary bacterial infections d/t scratching
 Tx: lotion/creams to hydrate, topical
corticosteroids
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Proper Skin Care
Frequency of showers
 Not so much soap/appropriate type
 Use creams, not lotions
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Psoriasis
Psoriasis
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Inherited skin disorder of increased epidermal cell
turnover & thickening of the epidermis
Thick silvery scales
Common on the elbows, knees & feet
Tx:
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UV light or high potency corticosteroids
Severe cases need to be hospitalized for a tar ointment
or methotrexate
Sebaceous Cysts
Sebaceous Cysts
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Solitary skin nodules as a result of proliferation of
epidermal cells that secrete protein called keratin
Contains pasty, cheesy looking secretion
Common on eyelids, neck, face, trunk, scalp
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Benign slow growing lesions
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No treatment necessary unless problems c ADLs
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Frostbite
Frostbite
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Actually freezing of tissue @ cold temps
Generally affects the exposed area (Toes, feet,
fingers, nose, cheeks, ears)
Skin becomes cold, waxy, white, gray, black
Early stages – chillblaines-redness, painful
Late stages – cyanosis, gangrene, edema, no
pain
Tx: cover c warm compress, rapid re-warming in
water, hands between legs, armpits
Avoid pressure on tissue, even light
Skin Checks – Moles/Cancer
Moles/Cancer
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Look for:
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1.
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No bigger than an eraser tip
Stand out mole on the back
Irregular border
different colors
Think of outdoor sports
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Tennis, golf, soccer
Males – check the head
 Females – check the ears and lips
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Sunburn
Sunburn
Superficial burn – only epidermis
 >15 suncreen
 10-2pm is most intese hours, worse in
snowy, watery environments
 Every time you burn c blisters….increases
your chances of getting skin cancer 4x
 Tx: analgesic sprays, lotion…..not oil
based
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Striae
Striae
A streak or a linear scar
 Results from rapidly developing tension in
the skin
 Common in pregnancy or when you gain
weight fast…..steroid use
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