Describe a macule
flat, circumscribed, <1cm diameter, white, red or brown
what are macules the result of?
- A) hyperpigmentation (brown as in lentigos)
- B) depigmentation (vitiligo)
- C) vascular dilation (erythema)
flat, circumscribed >1cm diameter (large macules). Patches may have surface changes- slight scales or fine wrinkles...(eg Mongilion spots)
small, circumscribed, solid/firm elevated <1cm diameter.
What are some examples of Pauples?
wart, elevated mole, ringworm.
What are prodromal symptoms?
symptoms that occurred before the outbreak
what are some typical complaints of prodromal symptoms?
- -burning, tingling, pain
- -previous exposure to chicken pox/Hx of shingles
- -location on body of dermatophyte (fungal skin infection)
- -socical and environmental factors
- -Hx recent AB or immunosuppressand Rx
What Medical Hx puts a pt. at risk for skin infection?
- -nutritional deficiencies
What are primary lesions?
skin changes produced by a causative factor
flattened, raised lesion, surface area large in relation to height (i.e. psoriasis, sabborrheic keratosis). plateu-like elevation often formed by a convergence of pauples, as in psoriasis
- circumscribed infiltraiton of skin or sub-q tissue >1cm, wide and deeper than a papule.
- (i.e. cavernous hemangioma, lipoma (fatty tissue deposit))
Encapsulated, semisolid or fluid-filled mass in dermis or sub-q tissues (i.e. sebaceous cyst). A spherical or oval papule or nodule may be a cyst if, when palpated, is resilient (feels like an eyeball)
small <1cm superficail circumscribed elevation. Serous or blood-tinged fluid (i.e. chicken pox, herpes, poison ivy/oak, dermatitis, blisters, second degree burns)
vesicle >1cm. fluid filled bleb, blister (i.e. second degree burn)
vesicle filled w/ puss (cloudy or purulent fluid, WBC) may or may not be infected (i.e. acne, impetigo, folliculitis)
round or flat topped and irregular shape evanescent (shiny) lesions. Form acute accumulation or edema fluid in upper dermis (i.e. mosquito/insect bites, allergic reaction)
solid, circumscribed, elevated, round or ellipsoid, located deep in dermis or sub-q (i.e. dermatofibroma)
Define Secondary skin lesions
changes from alteration in primary lesions (i.e. rubbing, scratching, medication, invoultion)
Secondary skin lesion: scales are flakes of dead, cornified (hard/firm) tissue being shed. Theyare dry and ususlly white. (i.e. psoriasis, ringworm, peeling sunburn). Scales usually indicate inflammatory change and thikening of the epidermis.
- Secondary skin lestion: Crust: dried mass of serum, pus, dead skin, debris (broken vesicles or pustules)
- Crusts can be found surrmounting any lesion, i.e. eczema
- -other infectious dermatitis
What color characteristics will Crusts have?
yellow if from serum, green or yellow-green if from pus, brown or dark red if formed from blood
Crusts are characteristic of what kind of infection?
- Irregular shaped excavation (depth) caused by loss of substance w/ gradual disintergration and necrosis of tissue (i.e. decubiti, stage 3 pressure sore).
- Ulcers usually result from the impairment of vascullar and nutrient supply to the skin.
Deep linear split through epidermis into dermis, (i.e. chapping, athlete's foot). Fissures usually result when something/somewhere is moist and you add and infection to the area and it never gets dry= hard to heal
permanent dermal changes w/ production of excess collagen following damage to corium (i.e. vaccination, burn, deep scratch, cut, incision). A scar is the replacement of normal tissue by fibrous connective tissue at the site of injury to the dermis.
What are the majority of bacterial infections in the skin caused by?
staphylococcus or streptococcus
What is follicultitis?
a superficial staph infection of the upper hair follicle
What are Furuncles
boils caused by staph that are deep in the hair follicle
What are predisposing factors to Furuncles?
- *contact w/ oils, uncleanliness, maceration (skin area left wet)
- -common on face, neck, arms, legs, groin
- -Tx: warm compress (reduces inflammation and allows it to rupture)
- -ruptures: yellow purulent discharge (puss), then to serosanguinous fluid after hours/days
- -surgical Tx: incision and drainage (can also use topical AB, but first you need it to rupture)
- generalized nonfollicular infection- either staph or strep of deeper connective tissue.
- -teach pt. to bathe daily w/ antibacterial soap
- -allow to dry in-between Tx
- -position to promote circulation
- -teach to avoid tight garments
- -strict iso for MRSA (perform C&S to see if MRSA)
- -do not share contaminated articles
- -Tx: warm compress to incr. circulation and decr. swelling
Rx for cellulitis
- Usually topical cream is enough to treat cellulitis, but you may need po or iv AB
- -providoine-iodine and cream (i.e. silver sulfadiazine)
- -anti-inflammatory steroid Rx low to high doses
- -if severe po or IV AB necessary
Define Impetigo Contagiosa
- (superficail bacterial infection)
- -due to staph, strep, or both
- -begins as discolored spots then vesicles or bullae taht rupture leaving a superficail moist erosion and that germ laden fluid spreads to surrounding skin.
- -exudate dries and forms heavy, honey-colored crust and scabs
- -most often on face, hands, perineum
- -pruritis common
What is the Tx for Impetigo?
- -bacterial ointment topically, systemic if severe.
- -explain disease and Tx, hand washing esp.
- -soak crusts w/ warm water and remove crust carefully in order to get to the lesion, then apply AB ointment
Define FUNGAL infections
- Many affect sperficail skin and are fast multiplying.
- "tinea" = fungal infection
- -tenia pedis: athletes foot:
- maceration and fussures between toes, pinhead-size vesicles in the plantar area and pruritis
- -tinea manus: hands
- -tinea cruris: groin (jock itch)
- -tinea capitis-scalp
- sx: scaly, circumscribed patches, bald spots, itching
- -tinea barbae: beard area
Rx antifungal ointments/creams
- suffix "-azole" =anti-fungal medicine
- -clotrimazole, nystantin, ciclopirox, miconazole, econazole, tolnaftate, haloprogin, undecylenic acid
- -Tx of choice for dermophyte and yeast infection: antifunfal powders (Nystatin, tolnaftate) and oral preps (Nystatin, clotrimazole.
- -Yeast Candidasis-opportunistic infection of skin and mucous membranes (thrush in babies)
- atopic dermatits,sperficial inflammation
- -process involving epidermis
- -affected persons have lowered threshold for itching
- -lesions appear following irritation, itching, rubbing
- -appearance varies w/ age of child
- -family Hx of atopic dermatitis
What are the s/sx of eczema?
- -intense itch
- -unaffected skin dry
- -rough skin
What is urticaria?
An allergic rxn (rash, multiple swollen raised areas) that result from ezcema.
Describe the infantile form (2mo-3yr) of urticaria.
- General distribution, esp cheeks, scalps, trunk, extensor surface (outer area of elbows/knees) of extremeties
- -vesicles, papules
- -weep and ooze
- -crusting and scaling
Describe the childhood form of urticaria (up to about 12 yo)
- distributed flexural areas, antecubital & popliteal fossae, neck, wrists, ankles, feet
- -clusters sm. erythematous, flesh color papules or scaling patches
- -dry and hyperpigmented
What is lichenification?
Cutaneous thickening and hardening of skin from continued irritation (usually result of urticaria)
Describe the adolescent form of urticaria
- distribution: face, sides of neck, hands, feet, antecubital and popliteal fossae
- -color same as childhood
- -dry, thick lesion common
- -confluent papules
What is the Tx for eczema?
- Not curable, we just want to treat the itching.
- -decr. pruritis w/ antihistamines, mild baths
- -use mild soaps that hydrate skin w/ emollients, limit bathing (dries)
- -topical corticosteroid oint.
- -prevent sec. infection
- -diet modification-fingernails clean and short, gloves, mittens
- -do not overheat (causes itching)
What is a comedone?
- A noninflamed acne lesion.
- a) compact masses of keratin, lipids, fatty acids or bacteria
- b) closed= dilated follicular duct (whitehead)
- or open= blackhead
What are the characteristics of an inflamed acne lesion?
- -proliferation of P. acnes draws in neutrophils and dilates folicular wall
- -produces papules, pustules, nodules, cysts
- -possible scarring from macrophages that digest inflamed skin
- -secondary staph infection complicates lesion
Discuss Tretinoin (Retin-A)
- Tx for acne.
- -interrupts follicular keratinization (prevents it from closure/white-heads
- -s/e: skin irritation, burning
- -educ: wear sunscreen daily, apply sparingly
Discuss Benzoyl peroxide (antibacterial solution)
- -treats P. acnes bacteria
- -s/e: bleaches clothing (not skin)
- -less likely to cause antibiotic resistant bacteria (bc it's a topical AB)
Discuss systemic AB used to treat acne
- Tetracycline, doxycycline, erythromycin.
- -used for mod to severe cases
- -s/e: higher chance of antibiotic resistant strains
Discuss oral contraceptive pills in regards to acne Tx
- -used to treat mild to mod acne
- -ortho tri-cyclen FDA approved for females >14yo
- -highly tetrigenic, pt must be on birth control if also if on Acutane
- -20 wk Tx for remission of symptoms
- -s/e: dry eyes, skin, muc. memb., visual changes, HA, hyperlipidemia, mood changes, depression, suicidal ideation, severe birth defects
- -Nursing care: must have pre and during Tx preg. tests, and monitor for visual, mood changes
- -endemic infestation of scabies mite:
- -impregnated mite burrows intro stratum corneum of epidermis, lays eggs
- -Host (person) is sensitized to mite and inflammatory response occurs, 30-60 days after initial contact
What are the s/sx of SCABIES?
- -lesions: minute gray-brown, thread like burrow
- -black dot at end
- -eczamatous eruption-in infants it's distributed intradigit, in axilla, popliteal and inguinal areas
What is the Tx for SCABIES?
- Scabicide. Apply Kwell to cool, dry skin
- Treat all hosehold members.
- -ointment to decr. itch/prevent scratching
- -cut fingernails and keep clean
Define PEDICULOSIS (lice)
- -head, body, or pubic crab lice
- -oval shaped lice 2-4mm
- -lay hundreds of eggs= nits near hair shafts
- -common s/sx= pruritis that may lead to excoriation
- -Tx: lindane (Kwell or RID) topical malathion
- -must wash linen, clothes, hair wear, combs, use HOT water on articles