Transcript ch 28

Chapter 28: Skin Disorders
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Figure 28-1
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Skin Lesions Defined
• Skin pigment - melanin
– Variations may be due to anatomic,
physiologic or pathophysiologic changes in
skin blood flow
• Normal skin appearance
– Altered by external and internal factors
• Cellulitis
– Infectious inflammation of deep skin
structures
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Figure 28-3
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Figure 28-4
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Skin Trauma
• Mechanical Forces that Cause Injury
– Friction
– Compression
– Shearing
– Stretching
– Scraping
– Tearing
– Avulsing
– Puncturing
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Friction and Pressure
Problems
• Hyperkeratosis of the Hands and Feet
– Etiology
• Friction and pressure over bony protuberances
• Painful when subcutaneous fat becomes
inelastic
– Sign and Symptoms
• Thickening, of horny layer of skin, ovular,
elongated and brown
• Painful with pressure
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– Management
• Avoid emery boards and pumice as the
increase in friction will stimulate skin to produce
added callus
• Use moisturizer
• Pair off callus with scalpel
• Padding
– Prevention
• Cushioning devices; wearing 2 socks
• Lubricants to reduce friction, shaving calluses
• For calluses on hands, special gloves or
protective gear
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• Blisters
– Etiology
• Result of a shearing force that produces a
raised area that accumulates with fluid
– Signs and Symptoms
• Hot spot, sharp burning sensation, painful
• Superficial area of skin raised with clear fluid
– Prevention
• Use of dust or powder or lubricant to reduce
friction
• Tubular socks, 2 pairs of socks if feet are
sensitive or perspire excessively
• Appropriate shoes that are broken in
• Padding and lubricants
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– Management (intact blister)
• Leave intact for 24 hours
• Clean with antiseptic
• Cut small incision to drain fluid (large enough
that it won’t re-seal)
– Note in some states this is considered a surgical
technique, placing ATC in violation of certain practice
acts
•
•
•
•
•
Prevent refilling with a pressure pad
Clean again with antiseptic
Use doughnut to prevent irritation
Monitor for infection, replace wet bandaging
Debridement can be performed when
tenderness is gone
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– Management (open/torn blister)
• Keep clean to avoid infection
• Keep skin in place and apply non-adhering
sterile dressing and padding
• Monitor daily for infection
– Management (denuded blister)
• If blister is torn 1/2 inch or more remove skin
flap
• Clean and expose area, apply antiseptic with
occlusive dressing
• Second skin can be applied to raw area
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• Soft Corns and Hard Corns
– Etiology
• Caused by pressure of improperly fitting shoes and
anatomic abnormalities
• Soft corns are the result of pressure and
perspiration, also associated with exostosis
– Signs and Symptoms
• Hard corns form on the tops of toes and tend to be
painful and dry
• Soft corns result in thickening of skin, white and
sometimes painful (between 4th and 5th toes)
– Prevention
• Wear properly fitting shoes
– Management
• Surgical removal if painful
• Padding; maintain clean dry feet; wear appropriate
shoes
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• Excessive Perspiration (hyperhidrosis)
– Etiology
• Syrup-like perspiration, high in sodium chloride
• Increases risk of other skin irritation
• Makes adherence of bandages difficulty
– Management
• Use of astringent such as alcohol or an
absorbent powder
• Aluminum chloride or electric current can be
used to treat condition
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• Chafing of Skin
– Etiology
• Occurs particularly in patients that are obese or heavy
limbed
• Result of friction and maceration of skin in climate of heat
and moisture
– Signs and Symptoms
• Separation of keratin from granular layer of skin
• Causes oozing wounds that crust and crack
– Management
• Clean area with soap and water and treat with medicated
solution and hydrocortisone cream
– Prevention
• Keep skin dry, clean, and friction free
• For the groin, soft, loose, cotton underwear is
recommended
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• Xerotic (Dry) Skin
– Etiology
• Drying of skin due to exposure of cold,
excessive bathing, decrease in humidity
causing skin to lose water
– Signs and Symptoms
• Dry skin w/ variable redness and scaling;
itching
– Management
• Prevent water loss and replace lost water
• Bathe in tepid water, use moisturizer
• If condition worsens, refer to physician
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• Ingrown Toenails
– Etiology
• Generally occurs in great toe
• Nail grows laterally into skin
• Result of lateral pressure from shoes, poor nail
trimming, and repeated trauma
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– Signs and Symptoms
• Pain and swelling
• Penetrated skin becomes inflamed and purulent
with lateral nail fold swollen and irritated
– Management
• Conservative management includes soaking the
inflamed toe in warm water (20 minutes)
• Place cotton under edge of nail to clear from skin
• If chronic, remove wedge of nail and apply
antiseptic compress until inflammation resides
– Physician may take more aggressive approach
– Prevention
• Properly fitting shoes and socks are essential
• Weekly toenail trimming (cut straight across)
• Leave nail long enough to clear skin
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Wounds
• Abrasions
– Scraping of skin against rough surface (top
surface of skin is worn away)
– Increased probability of infection due to
exposure of dirt and foreign material
– Clean and debride
• Punctures
– Direct penetration of skin with pointed
object
– Must be referred to physician
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• Lacerations
– Object tears tissue, giving wound
appearance of jagged edge (sometimes
result of blunt trauma)
– Presents environment susceptible to
infection
• Skin Incision
– Smooth cut in skin - not jagged
• Skin Avulsion
– Skin torn away from body (should be placed
in moist gauze w/in a plastic bag that is then
immersed in cold water)
– Transport to hospital with patient for possible
reattachment
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• Skin Bruises
– Result of blunt trauma; causes disruption
of superficial blood vessels and results in
black and blue discoloration
– Treatment requires RICE to control
hemorrhaging
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Wound Management
• All wounds must be assumed contaminated
• Pay close attention to all universal precautions
• Clean all wounds with soap and water to minimize
infection
• Apply a dressing with antiseptic (unless physician
examination is necessary)
• Lacerations and punctures should be treated by a
physician
• Use of occlusive dressings
– Minimizes scab formation, perceived pain from
exposed nerves, cost and time effective, provide
adequate barrier
• Antibiotic ointment used to prevent secondary
infection (SEE TABLE 28-4 for added instruction)
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• If the wound is discharging serum (fluid) to
dressing should be changed regularly
• When drainage has stopped = no need for
dressing
• Wound should be cleaned with hydrogen
peroxide or Betadine
– Effective against bacteria and not harmful to fibroblasts
• Antibacterial ointment should be used to limit
bacterial growth and to prevent dressing from
adhering to wound
• Proper care = minimized inflammatory response
with quick healing and reduced scarring
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Suturing
• Dependent on severity
– Determined by physician
– Are underlying tissues exposed or is there significant
bleeding?
• Should be put in as soon as possible
– Within 12 hours following injury
• Utilize fine suture material and minimal
tightening
– Limits additional damage, inflammation and scarring
• Large areas or slow healing areas = larger
material to be left in longer
• Occasionally steri-strips or butterfly bandages
will suffice
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• Alternative techniques involves use of
skin adhesive/glue
– Creates a bond across the wound edges
allowing for appropriate healing
– Can be used to replace small sutures
– Seals out infection
– Easy to use, provides water resistant
protective coating
– Long term cosmetic outcome is
comparable to traditional repair methods
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Athletic Training Clinic
Practice in Wound Care
•
•
•
•
Use clean and sterile instruments
Clean hands thoroughly and use gloves
Sterilize in and around skin lesion
Use a non-medicated covering if athlete is to
be sent for medical attention
– Utilize butterfly bandage if suture not required
• Avoid touching any part of sterile dressings
that will contact the wound
• Place medication on pad
• Secure the dressing in place
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Bacterial Infections
• Bacteria are single celled micro-organisms
– Spherical, doublets, and spirochetes
• Staphylococcus
– Gram positive bacteria that appears in clumps
in skin and upper respiratory tract
• Streptococcus
– Chain bacteria often associated with systemic
disease and skin infections
• Bacillus
– Spore forming, aerobic, and occasionally
mobile
– Can cause systemic damage
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Methicillin-Resistant
Staphylococcus Aureus (MRSA)
• Etiology
– Strains of staphylococcus bacteria that are resistant to
some antibiotics
– Often occurs in individuals that are already sick, in
hospital and are ill, have open wounds, or burns
– Can occur outside of hospital setting as well
• Signs & Symptoms
– Redness, swelling, tenderness of infection site
– Some may carry MRSA and not exhibit symptoms
• Management
– Antibiotics (higher dose) provided intravenously
– Treatment lasts several weeks
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• Impetigo Contagiosa
– Etiology
• Caused by A-beta-hemolytic streptococci, S
aureus or combination of these bacteria
• Spread through close contact
– Signs and Symptoms
• Mild itching and soreness followed by eruption
of small vesicles and pustules that rupture and
crust
• Generally develops in body folds that are
subject to friction
– Management
• Cleansing and topical antibacterial agents
• Systemic antibiotics
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• Furuncles
(Boils)
– Etiology
• Infection of
hair follicle
that results
in pustule
formation
• Generally
the result
of a staph.
infection
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– Signs and Symptoms
• Pustule that becomes reddened and enlarged
as well as hard from internal pressure
• Pain and tenderness increase with pressure
• Most will mature and rupture
– Management
• Care involves protection from additional
irritation
• Referral to physician for antibiotics
• Keep patient from contact with other team
members while boil is draining
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• Carbuncles
– Etiology
• Similar in terms of early stage development as
furuncles
– Signs and Symptoms
• Larger and deeper than furuncle and has several
openings in the skin
• May produce fever and elevation of WBC count
• Starts hard and red and over a few days emerges
into a lesion that discharges yellowish pus
– Management
• Surgical drainage combined with the
administration of antibiotics
• Warm compress is applied to promote circulation
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• Folliculitis
– Etiology
• Inflammation of
hair follicle
• Caused by noninfectious or
infectious agents
• Moist warm
environment and
mechanical
occlusion
contribute to
condition
• Pseudofolliculitis
(PFB)
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– Signs and Symptoms
• Redness around follicle that is followed by
development of papule or pustule at the hair
follicle
• Followed by development of crust that sloughs
off with the hair
• Deeper infection may cause scarring and
alopecia in that area
– Management
• Management is much like impetigo
• Moist heat is used to increase circulation
• Antibiotics can also be used depending on the
condition
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• Hidradenitis Suppurativa
– Etiology
• Primary inflammation event of the hair follicle
resulting in secondary blockage of the apocrine
gland
– Signs and Symptoms
• Begins as small papule that can develop into
deep dermal inflammation
– Management
• Avoid use of antiperspirants, deodorants and
shaving creams
• Use medicated soaps and systemic antibiotics
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• Acne Vulgaris
– Etiology
• Inflammatory disease of the hair follicle and the
sebaceous glands
• Sex hormones may contribute
– Signs and Symptoms
• Present with whiteheads, blackheads, flesh or red
colored papules, pustules or cysts
• If chronic and deep = may scar
• Psychological impact
– Management
• Topical and systemic agents used to treat acne
• Sometimes the use endogenous hormones is
required
• Mild soaps are recommended
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• Paronychia and Onychia
– Etiology
• Caused by staph, strep and or fungal organisms that
accompany contamination of open wounds or hangnails
• Damage to cuticle puts finger at risk
• Onychia is an infection of the nail bed itself, while
paronychia involves the lateral nail fold
– Signs and Symptoms
• Rapid onset; painful with bright red swelling of proximal
and lateral fold of nail
• Accumulation of purulent material w/in nail fold
– Management
• Soak finger or toe in hot solution of Epsom salt 3 times
daily
• Topical antibiotics, systemic antibiotics if severe
• May require pus removal through skin incision
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• Tetanus Infection (lockjaw)
– Etiology
• Acute infection of the CNS and muscles caused
by tetanus bacillus
• Bacteria enters through the blood and open
wounds
– Signs and Symptoms
• Stiffness of the jaw and muscles of the neck
• Muscles of facial expression produce contortion
and become painful
• Fever may become markedly elevated
– Management
• Treat in intensive care unit
• Childhood immunization
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Fungal Infections
• Group of organisms that include yeast and
molds which are usually not pathogenic
• Grow best in unsanitary conditions with
warmth, moisture and darkness
• Infections generally occur in keratinized
tissue found in hair, nails and stratum
corneum
• Dermatophytes (Ringworm fungi)
– Cause of most skin, nail and hair fungal
infections
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• Tinea of the Scalp (tinea capitis)
– Signs and Symptoms
• Ringworm of the scalp begins as a small
papule that spreads peripherally
• Appears as small grayish scales resulting in
scattered balding
• Easily spread through close physical contact
– Management
• Topical creams and shampoos are ineffective
in treating fungus in hair shaft
• Systemic antifungal agents are replacing older
agents due to increased resistance
• Some topical agents are used in conjunction
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• Tinea of the Body (tinea corporis)
– Signs and Symptoms
• Commonly involve extremities and trunk
• Itchy red-brown scaling annular plaque that expands
peripherally
– Management
• Topical antifungal cream
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• Tinea of the Nail (tinea unguium/
onychomycosis)
– Signs and Symptoms
• Fungal infection of the nail -- found commonly in
those engaged in water sports or who have
chronic athlete’s foot
• Nail becomes thick, brittle and separated from its
bed
– Management
• Some topical antifungal agents have proved
useful
• Systemic medications are most effective
• Surgical removal of nail may be necessary if
extremely infected
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• Tinea of the
Groin (tinea
cruris)
– Etiology
• Symmetric redbrown scaling
plaque with
snake-like border
– Signs and
Symptoms
• Mild to moderate
itching
• May progress to
secondary
bacterial infection
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– Management
• Treat until cured
• Will respond to many of the non-prescription
medications
• Medications that mask symptoms should be
avoided
• Failure to respond to normal management may
suggest a non-fungal problem (such as
bacteria) and should be referred to a physician
• May require additional topical medications and
oral prescriptions
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• Athlete’s Foot (tinea pedis)
– Etiology
• Most common form of superficial fungal infection
• Trichophyton species are most common cause of
athlete’s foot
• Webs of toes may become infected by a
combination of yeast and dermatophytes
– Signs and Symptoms
• Extreme itching on soles of feet, between and on
top of toes
• Appears as dry scaling patch or inflammatory
scaling red papules forming larger plaques
• May develop secondary infection from itching and
bacteria
– Management
• Topical antifungal agents and good foot hygiene
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• Candidiasis (Moniliasis)
– Etiology
• Yeast-like fungus that can produce skin, mucous
membrane and internal infections
• Ideal environment includes hot humid weather, tight
clothing, and poor hygiene
– Signs and Symptom
• Infections w/in body folds
• Presents as beefy red patches and possible satellite
pustules
• White, macerated border may surround the red area;
deep painful fissures may develop at skin creases
– Management
• Maintain dry area
• Use antifungal agents to clear infection
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• Tinea Versicolor
– Etiology
• Caused by a yeast
• Appears commonly in areas in which sebaceous glands
actively secrete body oils
– Signs and Symptoms
• Fungus produces multiple, small, circular macules that
are pink, brown, or white
• Commonly occur on chest, abdomen, and neck
• Do not tan when exposed to sun and usually are
asymptomatic
– Management
• Straightforward treatment - recurrences are common
• Use selenium shampoo (Selsun) and topical econazole
nitrate (or something similar)
• When microorganism has been eradicated, repigmentation of the area will occur
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Viral Infections
• Ultramicroscopic organisms that require
host cells to complete their life cycle
– May stimulate cell chemically to produce
more virus until host cell dies
– Lies within bud-like structure that does not
damage cell or virus, w/out causing
infection
• A number of skin infections are caused
by viruses
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• Herpes Simplex Labialis, Gladiatorum, and
Herpes Zoster
– Etiology
• Highly contagious and is usually transmitted directly
through a lesion in the skin or mucous membrane
• Resides in sensory nerve neurilemmal sheath
following initial outbreak
• Recurrent attacks stimulated by sunlight, emotional
disturbances, illness, fatigue, or infection
• Type I vs. Type II
– Signs and Symptoms
• Early indication = tingling or hypersensitivity in an
infected area 24 hours prior to appearance of lesions
• Local swelling followed by outbreak of vesicles
• Patient may feel ill w/ headache, sore throat, swollen
lymph glands and pain in area of lesions
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– Signs and Symptoms (continued)
• Vesicles generally rupture in 1-3 days spilling
serous material
• Heal in generally 10-14 days
• If an athlete has an outbreak they should be
disqualified from competition due to contagious
nature of condition
– Management
• Herpes simplex lesions are self limiting reduce pain and promote early healing
• Use of antiviral drugs can reduce recurrence
and shorten course of outbreak
– Complications
• Can lead to secondary infection if not managed
carefully
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Verruca Virus and Warts
• Variety of forms exist
– verruca plana (flat wart), verruca plantaris
(plantar wart), and condyloma acuminatum
(venereal wart)
• Different types of human papilloma virus
have been identified
– Uses epidermal layer of skin to reproduce
and grow
• Wart enters through lesion in skin
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• Common Wart
– Signs and Symptoms
• Small, round, elevated lesion with rough dry surfaces
• Painful if pressure is applied
• May be subject to secondary bacterial infection
– Management
• If vulnerable, they should be protected until treated
by a physician
• Use of electrocautery, topical salicylic acid or liquid
nitrogen are common means of managing this
condition
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• Plantar Warts
– Etiology
• Spread through papilloma virus
– Signs and Symptoms
• Located on sole of foot, or adjacent to areas of
abnormal weight bearing
• Areas of excessive epidermal thickening
• Discomfort, point tenderness
• Hemorrhagic puncta (black seeds)
– Management
• In general, protect and prevent spreading
• Pair away callus and apply Keratolytic
• Following season, wart can be removed by
freezing it or by electrodessication (maintain
protection until removal)
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• Molluscum Contagiosum
– Etiology
• Poxvirus infection which is more contagious than
warts (especially during direct body contact)
– Signs and Symptoms
• Small, flesh or red colored, smooth-domed
papules with central umbilication
– Management
• Physician referral is necessary
• Cleansing and destructive procedure
(counterirritant such as cantharidin, surgical
removal or cryosurgery)
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Allergic, Thermal, and
Chemical Skin Reactions
• Allergies are immunologically mediate responses
to molecules in dyes and proteins against which
the body’s immune system is sensitized
• Allergens may be food, drugs, clothing, dusts,
pollens, plants, animals, heat, cold, or light
• The skin will reflect an allergy in many ways such
as reddening and swelling of the tissue, urticaria
or hives, burning or itching
• Athletic trainers must recognize gross signs of
allergic responses and be prepared to remove
allergens and treat topically or systemically with
antipruritic agents
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• Contact Dermatitis (allergic and irritant)
– Etiology
• Plants are the most common cause (poison ivy, poison
oak, sumac, ragweed, primrose)
• Topical medications
• Chemicals found in fragrances and preservatives of soaps,
detergents
– Signs and Symptoms
• Onset may range from 1 day to 1 week
• Redness, swelling, formation of vesicles that ooze fluid
and form crust, constant itching
• May change from redness and blistering to erythematous
scaling, lichenified papules and plaques
– Management
• Avoid allergen
• Tap water compresses or soaks, topical corticosteroids
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© 2011 McGraw-Hill Higher Education. All rights reserved.
• Milaria (Prickly Heat)
– Etiology
• Continued exposure to heat and moisture
causing retention of perspiration by sweat
glands
– Signs and Symptoms
• Itching and burning vesicles and pustules
• Occurs most often on arms, trunks, and
bending areas of the body
– Management
• Avoidance of overheating, frequent bathing with
non-irritating soap, wearing loose-fitting
clothing and use of antipruritic lotions
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• Chilblains (pernio)
– Etiology
• Caused by excessive exposure to cold
– Signs and Symptoms
• Tissue does not freeze but reacts with edema,
reddening and possibly blistering along with a
sensation of burning and itching after exposure
to cold
– Management
• Exercise and gradual warming of the part
• Massage and application of heat are
contraindicated
• Some systemic drugs can be used in severe
cases
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• Sunburns
– Etiology
• Inflammatory response to injury caused by
ultraviolet solar radiation
• Must be cautious of physical characteristics,
chemicals, food and drugs that make
individuals more susceptible
– Signs and Symptoms
• Varies from erythema to severe blistering
• May experience shock if severe enough
• Can cause malfunctioning of organs w/in the
skin
• Will appear 2-8 hours following exposure, with
symptoms becoming most severe at 12 hours
• S&S will dissipate w/in 72-96 hours
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• Sunburns (continued)
– Management
• Can be prevented through the use of
sunscreen (sun protection factor or SPF)
– Filters ultraviolet light
– Water/sweat resistant sunscreen is recommended
• Treat a burn according to the degree of
inflammation
• Cool water, aloe based solutions
• Moisturizers can help with dryness and peeling
• OTC’s can help with pain and discomfort
• Severe burns require physician assistance
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• Scabies
Infestation and Bites
– Etiology
• Caused by mites which cause extreme nocturnal
itching (tunnels and lays eggs)
– Signs and Symptoms
• Appear as dark lines between fingers and toes, body
flexures, nipples and genitalia
• Excoriations, pustules and papules caused by itching
tends to hide true cause
• Skin develops hypersensitivity to the mite
– Management
• Permethrin 5% is treatment of choice
• Washing of bedding and clothes is necessary
• Topical corticosteroids may be necessary to treat
itching
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© 2011 McGraw-Hill Higher Education. All rights reserved.
• Lice (Pediculosis)
– Etiology
• Manifestation by the louse (louse of head,
pubic region and body)
– Signs and Symptoms
• Bites cause itching dermatitis through
subsequent scratching -- promotes pustule and
excoriations to develop
– Management
• Cure is rapid with use of any number of agents
• Good hygiene is paramount
• To prevent re-infestation all clothing and
bedding should be washed in hot soapy water
or discarded
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• Fleas
– Etiology
• Small wingless insects that suck blood
• Can transmit systemic diseases
– Signs and Symptoms
• Great deal of discomfort can be felt if come into
contact with a high number of fleas
• Concentrate bites on ankles and lower legs
– Management
• Following a bite, itching must be prevented with
antipruritic lotion
• Avoid scratching to prevent secondary infection
• Insecticides can also be effective
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• Ticks
– Etiology
• Parasitic insects that have an affinity for blood
• Carriers of a variety of microorganisms that can
transmit Rocky Mountain spotted fever and Lyme
disease
– Signs and Symptoms
• Headaches, fever, malaise, myalgia, and rash,
petechiae and purpura, enlarging annular red ring
w/ or w/out central red papule
– Management
• Remove tick (mineral oil or fingernail polish)
– Grasping head of tick is an acceptable method
• Systemic treatment is necessary to prevent
morbidity and mortality associated with RMSF
and Lyme disease
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Lyme Disease
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• Mosquitoes
– Etiology
• Blood suckers that produce bites than can be
irritating, itchy, painful
• Can pass along blood-borne illnesses
– May be a major health hazard (West Nile virus)
– Signs and Symptoms
• Small reddish papule with associated itching
– Management
• Topical medication
• Use of repellents can also be used on the skin
to prevent contact with mosquitoes
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• Stinging Insects
– Etiology
• Bees, wasps, hornets, yellow jackets -- inflict
venomous sting
• Hypersensitive individuals may experience an
allergic reaction
– Signs and Symptoms
• If an allergic reaction occurs an increase in
heart rate and breathing will occur, along with
chest tightness, dizziness, sweating and even
LOC
• Anaphylactic reaction
– Hives, sensation of warmth, asthma symptoms,
swelling of mouth and throat, difficulty breathing,
vomiting, diarrhea, cramping, blood pressure
changes
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• Insect Stings (continued)
– Management
• To prevent, avoid wearing scented lotions or
shampoos, brightly colored clothes, jewelry,
suede, or leather, and avoid going barefoot.
• If an patient is susceptible to anaphylactic
reactions instructions on use of an EpiPen are
necessary
• If uncomplicated, the stinger should be
removed with tweezers or a credit card and
soothing medications should be applied
• Soap detergent will also lessen symptoms
• In cases of anaphylactic reaction immediate
physician referral is necessary
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• Spider Bites
– Etiology
• Typically not dangerous to humans
• Rarely bite more than once
• Must be concerned with black widow and brown
recluse
– Signs and Symptoms
• Pain, small puncture wounds, redness, itching
and swelling that lasts a couple days
• Present with center blister, a red ring and then a
white ring
• Bite from venomous spider may result in muscle
pain and cramps, weakness, sweating,
headache, anxiety, nausea, vomiting, difficulty
breathing and increased blood pressure
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Management
– Washing the wound
and applying
antibiotic ointment
– Seek medical
attention if infection
presents, ulcer does
not heal, nausea,
vomiting, fever or
rash occur
– If muscle cramping
occurs the patient
should go to the
nearest emergency
facility
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Other Skin Conditions
• Pityriasis Rosea
– Etiology
•
•
•
•
Acute inflammatory skin rash of unknown origin
Occurs between the ages of 10-35
May be the result of a virus
Can be spread to other individuals – but usually
only occurs once in a lifetime
– Signs and Symptoms
• Single pinkish-red patch (herald patch) on the
chest or back
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• Signs and Symptoms
– Within 2 days-3 weeks a
secondary macular
eruption occurs on chest
or upper extremities
– Red and scaly with a
clearing in the center
• Management
– Typically doesn’t require
treatment
– Gradually disappears over
2-10 week period
– Antipruritics may help with
itching
– Anti-inflammatories may
be used to reduce itching
and rash
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Psoriasis
– Etiology
• Exact cause is unknown -- genetic factors may
play a role in condition
• Infection, smoking, some drugs and possible
hormonal factors may cause an outbreak
– Signs and Symptoms
• Lesion begins as reddish papules that progress
to plaques
• Lesions progress to yellowish white scaly
condition that tends to be located on the
elbows, knees, trunk, genitalia, and umbilicus
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Psoriasis
(continued)
– Management
• Teaching patient
self management
• Glucocorticoids and
kerolytic agents can
be used in
conjunction with
each other
• Long term oral
medications may
be necessary
• Counseling may be
necessary for
psychological
aspects of condition
© 2011 McGraw-Hill Higher Education. All rights reserved.
Skin Cancer
• Etiology
– Exposure to sun
– Malignant tumor that grows in skin
• Accounts for 50% of all cancers
• Basal cell and squamous cell carcinoma
• Malignant melanoma – high mortality rate as it often
spreads to other parts of the body
• Signs & Symptoms
– Basal cell carcinoma
• Found in areas often exposed to sun
• Small, shiny bump
• Often found in individuals with light eye color, complexion
and hair
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– Squamous cell carcinoma
• Appears as nodules, red, scaly patches of skin
• Often found on lips, ears and face
• Develops commonly in fair-skinned people
– Malignant melanoma
• Begins as mole
– Moles present at birth and those that are atypical
tend to have a greater change of becoming
malignant
– May show the following characteristics
» Asymmetry
» Border (irregular or jagged)
» Color (variations throughout mole
» Diameter (larger than pencil eraser)
• Often appear on fair-skinned men and women
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Management
– If the athletic trainer suspects that a patient
has skin cancer, the patient should be
referred immediately
– Surgery is common (90% of cases)
• Cryosurgery, excision, Mohs’ microscopically
controlled surgery
– Non-surgical treatment
• Laser, radiation, chemotherapy
– Regular skin exams are important
– Take notice of changes in skin and moles
• Crucial to detecting malignant melanoma
© 2011 McGraw-Hill Higher Education. All rights reserved.