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UVB Rays
major factor in development of sunburn and non -melanoma skin cancers
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UVA Rays
contribute to carcinogenic effects of UVB
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Tanning beds use which type of ray?
UVA
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Drugs increasing Photosensitivity
- Anticancer – Methotrexate
- Antidepressants – Elavil, Sinequen
- Antidysrhythmics – Quinidine, Amiodarone
- Antihistamines – Benadryl
- Antimicrobials – Tetracycline, Azithromycin, Cipro
- Antifungals
- Antipsychotics – Thorazine
- Diuretics - Lasix, Hydrdiuril
- NSAIDS
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Role of Vitamin A in Integumentary System
Maintenance of skin cell structure and normal wound healing
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Deficiencies in Vitamin B result in...
Erythema and seborrhea-like lesions
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Role of Vitamin C
Connective tissue formation and normal wound healing
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Deficiencies in Vitamin C result in...
Symptoms of scurvy (petechiae, bleeding gums, purpura)
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Role of Vitamin K
Helps blood clotting
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Deficiencies in Vitamin K result in...
Bruising
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Role of Protein
Cell growth and wound healing
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Skin Changes in Diabetes II
- Velvety dark skin of neck and body folds
- Rash
- Impaired blood flow
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Risk Fx for Malignant Skin Neoplasms
- Fair skin
- red or blond hair
- blue or green eyes
- chronic sun exposure
- family history
- Living near equator
- outdoor occupations or recreation
- Smoking
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Actinic Keratosis
- Premalignant form of squamous cell carcinoma
- Typical lesion is irregular shaped, flat, slightly erythematous papule with indistinct borders and an overlying hard keratotic scale
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Treatments for Actinic Keratosis
- cryosurgery
- fluorouracil
- surgical removal
- Retin-A
- chemical peeling agents
- dermabrasion
- laser resurfacing
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Basal Cell Carcinoma
- Locally invasive malignancy arising from epidermal basal cells
- Most common type of skin cancer and the least deadly
- Small, slowly enlarging papule; borders semitranslucent or pearly with overlying erosion, ulceration and depression of center
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Treatments for Basal Cell Carcinoma
- Excisional surgery, Chemosurgery, electrosurgery, cryosurgery
- 90% cure rate
- Slow growing tumor that invades local tissue
- Metastasis rare
- Fluoracil and Imiquimod for superficial lesions
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Squamous Cell Carcinoma
- Less common that BCC but can be very aggressive, has the potential to metastasize and may lead to death
- Manifestations include thin, scaly, erythematous plaque without invasion into the dermis; firm nodules with indistinct borders, scaling and ulcerations early; covering of lesion with scales late
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Melanoma
- Tumor arising in melanocytes
- Can metastasize to any organ including brain and heart
- Most deadly skin cancer
- About 1/3 occur in existing moles and frequently occur on lower legs and backs of women and trunk, head and neck in men
- Continued production of melanin causes the lesions to appear dark brown or black.
- Change in the size, shaper or appearance of mole is major risk factor
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Risk Fx for Melanoma
- UV exposure or overexposure to artificial light such as tanning beds
- genetic factors such as a prior diagnosis of melanoma and having a first degree relative with melanoma
- immunosuppresion and exposure to environmental hazards such as herbicides
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Dysplastic Nevus
- Abnormal nevus pattern increases risk of melanoma
- Atypical moles that are larger than usual (>5mm across) with irregular borders and various shades of color
- May have same ABCD characteristics as melanoma but are less pronounced.
- Need to be assessed, evaluated and monitored as risk for melanoma increases greatly.
- Education on other risk factors and sun safety is imperative
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Risk Fx for Bacterial Skin Infections
- moisture
- obesity
- breaks in skin
- systemic corticosteroids
- antibiotics
- chronic diseases such as diabetes
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Most Common Microorganisms causing Bacterial Infections
- Staph
- group A B hemolytic strep
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Impetigo
- Vesicular lesions that develop crust surrounded by erythema, pruritis
- Can be caused by staph, group A b-hemolytic strep, or combination
- Associated with poor hygiene
- Contagious
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Treatment of Impetigo
Systemic Antibiotics such as Penicillin
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Cellulitis
- Inflammation of subcutaneous tissue possibly often following break in skin
- Strep and staph usual causative agents
- Deep inflammation of subcutaneous tissue from enzymes produced by bacteria
- Hot, tender, erythematous and edematous area with diffuse borders
- chills, malaise and fever indicate worsening
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Treatment of Cellulitis
- Moist heat
- immobilization and elevation
- systemic ABT
- (Could progress to gangrene if left untreated)
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Herpes Simplex Virus (1 and 2)
- Oral or genital HSV are recurrent lifelong viral infections that return to skin and mucous membranes to indicate recurrence when exacerbated by sunlight, trauma, menses, stress and systemic infection
- Both contagious, transmitted by respiratory droplets, or virus containing fluid such as saliva, cervical secretions
- Symptoms occur 3-7 days or more after contact
- Painful, local reaction of single or grouped vesicles on erythematous base; may be accompaned with fever, malaise
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Herpes Simplex Virus Treatment
- symptomatic medication, soothing moist compresses
- Antiviral agents such as acyclovir, famciclovir and Valtrex
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Herpes Zoster (Shingles)
- Activation of varicella-zoster virus
- Must be put on Contact Isolation
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Characteristics of Herpes Zoster
- linear distribution along a dermatome of grouped vesicles or erythematous base; usually unilateral on trunk, face, lumbosacral areas
- Burning, pain and neuralgia preceding outbreak with mild to severe pain during outbreak
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Treatment of Herpes Zoster
- Antiviral agents, analgesics, Neurontin may be given for severe neuralgia
- New vaccine available for adults >60 who previously had chicken pox
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Candidiasis
- Caused by Candida albicans
- Occurs in warm, moist areas such as groin, oral mucosa, sub mammary folds
- Common post chemotherapy, HIV infection, radiation. Organ transplantation related to depression of immune response
- Diabetes and obesity are common risk factors
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Characteristics of Candidiasis
- Mouth – White plaques that often coat the tongue
- Vagina – red, edematous, painful, white patches, vaginal discharge, pain on urination and intercourse
- Skin – papular erythematous rash
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Treatment of Candidiasis
- Nystatin in form of powder, suppository, oral lozenge
- hygiene (keep area clean and dry)
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Allergic Dermatitis
- Manifestation of a delayed hypersensitivity, absorbed agent acting as antigen
- Sensitization after several exposures
- Lesions appear 2-7 days after contact
- Red papules, usually pruritic
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Treatment of Allergic Dermatitis
- corticosteroids
- antihistamines
- skin lubrication
- elimination of allergen
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Urticaria
- Usually allergic phenomena that results from histamine response
- Erythema and edema in upper dermis
- Single lesions usually resolves in 24 hours
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Treatment of Urticaria
- removal of source
- antihistamine therapy
- cool compresses
- possibly systemic corticosteroids in severe cases
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Drug Reactions
- Hypersensitivity reaction to drug.
- Rash of any morphology, often red, macular and papular
- Abrupt onset
- May appear up to 14 days after cessation of drug
- Possibly pruritic
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Treatment of Drug Reactions
- With draw drug
- Antihistamines, corticosteroids
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Acne
- Inflammatory disorder of sebacious glands
- May persist into adulthood
- Associated with menses, use of corticosteroids, and androgen dominant birth control pills
- Non inflammatory lesions, including blackheads and whiteheads; papules and pustules most common on face, neck and upper back
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Treatment of Acne
- Treatment aimed at suppressing new lesions and minimizing scarring
- topical benzoyl peroxide or other antimicrobial topical retinoids, systemic antibitocis
- Acutane – contraindicated in women who are pregnant or at risk for pregnancy – has been known to produce birth defects in fetus
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Psoriasis
- Autoimmune Chronic dermatitis that involves excessively rapid turnover of epidermal cells
- Usually develops before age 40
- Family predisposition
- Silvery scaling plaques commonly on scalp, elbows, knees, palms soles and fingernails (intermittent or continuous)
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Treatment of Psoriasis
- Goal of treatment is to reduce inflammation and suppress rapid turnover of epidermal cells
- topical corticosteroids, tar, sunlight (UV rays alone or with other medications
- Systemic treatments include antimetabolites (methotrexate) or immunosuppressants ( cyclosporine, retinoid, remicade)
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Rhytidectomy
lifting and repositioning of the lower two thirds of the face and neck to improve appearance
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Blepharoplasty
eyelid lift
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Important Nursing Implications for Face Lifts
- Prevent hematoma formation – apply ice packs 24-48 hours to reduce swelling and decrease hematoma formation
- Avoid smoking and vigorous exercise
- Minimal pain is expected and infection is not a common complication
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Preoperative Management of Cosmetic Surgery
- Informed consent
- Realistic expectations of what surgery can accomplish (ex. face lift has no effect on deep wrinkling of forehead and temples, deep nasolabial grooves, or vertical lip wrinkles)
- Third phase of healing most surgeries not complete for one year
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Postoperative Management of Cosmetic Surgery
- Usually not extremely painful
- Infection not common but assess for signs and educate patient about signs upon discharge
- Monitor carefully for adequate circulation
- Supportive, compressive dressings and ice packs may be necessary during early postoperative period
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