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DISORDERS OF THE SKIN

Compiled by Sr.Navuta

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UNIT OBJECTIVES

Explain the following:

- causes of common skindisorders

- pathophysiological changesassociated with skin problems

- signs and symptoms of the

diseases.- appropriate terms

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OBJECTIVES CONTD

Describe the following in relationto indications, purpose,preparation and support ofpatient and family:

- diagnostic procedures

- therapeutic procedures- corrective/surgical procedures

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STATISTICS ANALYSIS

FIJI 317 outpatients, seen atCWMH and P.J. Twomey Hosp.

in April & May, 2001.

- fungal infection 77patients

- Psoriasis 41

- Dermatitis 60- Scabies 21

- Viral infection 13

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STATISTICS ANALYSIS, CONT.

Race: Indian 174 (55%), Fijian122 (38%), other 21 (7%).

88% of psoriasis pts were of

Indian background66% of the pts with fungal

infections were ethnic Indians

All 21 scabies patients wereFijians

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OUTLINE OF DISEASE NOTE TAKING

Name and definition of disease

Etiology/epidemiology

PathophysiologyClinical manifestations

Diagnostic testsPatient/family education

Complications of the disease

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MINOR SKIN IRRITATIONS

Dryness: common problem especially inolder adults.

Pruritis (itching)

Sunburn: first degree or superficial burn

Urticaria (hives)

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DIAGNOSIS OF SKIN DISEASE

General history race, familyhistory

Special history onset, site,character

Examination good light,thorough examination

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SKIN DISORDERS IN CHILDREN

Infants Vascular & pigmented birthmarks

- abnormal migration of or

proliferation of melanocytes- Mongolian spots caused by

selective pigmentation, usually on

the buttock or sacral region ofAsians & blacks

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INFANTS CONTD

Diaper rash

- macules on the buttocks &

anogenital areas, or- Beefy, red, excoriated skin surfaces

in the diaper area.

-> ammonia & urine products

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INFANTS CONTD

Prickly heat

-

exposure of skin to warm,humid environment

- Can occur at any age group

Rx: remove excess clothing, coolskin with warm water baths, dryskin with powder.

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INFANTS CONTD

Cradle Cap greasy crust or scaleformation on the scalp

- caused by infrequent & inadequatewashing of the scalp

Rx: mild shampoo, gentle combing toremove the scales, apply oil before

scrubbing.

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PROBLEMS AFTER 24 HOURS

Pemphigus

- caused by a staphylococcus or

streptococcus- Mother could be having a boil

- Highly contagious to baby

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BOILS AND ABSCESSES

Caused by staphylococcus

May need I&D

Rx: IMI crystalline pencillin100,000/kg body weight 2 doses

per day

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TODDLERS & SCHOOL AGE

MeaslesLeprosy

ScabiesBoilsTinea vesicolor

Atopic eczema Impetigo

Chicken pox

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FUNGAL DISEASE OF SKIN (MYCOSES)

Tinea superficial mycosis

Dermatophyte infection of skin,hair or nails

Especially in hot, humid

climates and covered skinTypes include: vesicolor, cruris,

pedis and capitis

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TREATMENT

Topical: Whitfields ointment,

castellani paint.

Systemic: griseofulvin, lamisil(terbinafine)

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CANDIDA

A yeast mycosis, especially in

diabetics or immunologicaldeficiency

Mouth, vagina: painful erosions

with white patchesBody folds moist, beef-red

patches; maybe present in nappy

rashNails and nailfolds (paronychia)

Can lead to systemic disease

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TREATMENT

Topical: gentian violet 1% aqueous

solution, nystatin cream

Systemic: nizoral (ketoconazole),nystatin, amphotericin B

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PARASITIC INFESTATIONS

Scabies

Spread by skin-to-skin contact with

infested person Easily gets secondarily infected

Caused by femaleitch mite

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TREATMENT

Treat all contacts on the sameday

Apply lotion to the whole body,except the head; repeat in 1week

Benzyl benzoate or Lyclear(permethrin 2%)

Babies 10% sulphur ointment

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PEDICULOSIS (LICE)

Head lice spread by head-to-head contact

Lice survive for 1-2 days off thescalp

Other species cause pubic andbody infestation

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TREATMENT

Treat all family and contacts onthe same day and repeat oneweek later.

Lotion more effective thanshampoo

Fine tooth comb examination ofwet hair to remove lice and nits

Organic phosphates

Herbal preparation (unproven)

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BACTERIAL INFECTIONS

Impetigo

Very superficial, highly contagious

May complicate eczema, scabies,lice, scratches or other breaks inskin

Multiple lesions especially aroundmouth and nose

Heals without scarring

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FOLLICULITIS FURUNCLES (BOILS) -

CARBUNCLE

Staphylococcal infection starting in

hair follicle

Check for diabetes in patients withrepeat attacks

Volcanos: small medium - large

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ERYSIPELAS AND CELLULITIS

Spreading streptococcalinfection causing hot, tender

and swollen red skinErysipelas more superficial

with well-defined advancing

edge. Especially on face

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CELLULITIS

Affects deeper tissue with lessobvious edge. Especially on the

legMaybe preceded by fever,

rigors

Look for a point of entry ofstreptococcus ( a break in theskin such as a crack between

toes)

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TREATMENT OF STAPHYLOCOCCAL AND

STREPTOCOCCAL INFECTION

Wash with antiseptic soap

Use gentian violet or topical

antibiotic on lesions

Oral antibiotics if systemic

symptoms present or diseaseextensive. IV A/B if symptoms

severe.

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CONTD

Drain tense boils or carbuncles

Rest and elevation for cellulitis

Look for underlying pathology

(eczema, scabies, tinea,oedema) or nasal carriage ofstaphylococcus in patients

getting recurrent infection

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WARTS AND VIRAL INFECTIONS

Warts

Caused by Human Papilloma Virus

(HPV), a pox virus Extremely common especially in

children. Clear up without treatment

in 1-2 years. More resistant inadults

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CONTD

On the face, warts maybe

finger-like (digitate) or flat(plane)

On the anal and genital areathey may produce largecauliflower-like masses.Associated with increased riskof anogenital cancer.

Plantar warts maybe painful

from pressure walking

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HERPES SIMPLEX COLD SORE, FEVER

BLISTERS

Caused by a DNA virusRecurrent attacks very common,

triggered by fever or sunburn

Grouped vesicles which rapidlyprogress to pustules

Healing in 2 weeksComplications eczema, systemic

disease including encephalitis,

corneal involvement

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HERPES ZOSTER SHINGLES

Same virus as chicken pox(varicella)

Pain distribution of a nerve may

occur a few days before vesiclesappear

The cornea maybe affected and

become ulcerated in herpes zosterof the 5th cranial nerve

Pain may persist after the skin has

healed

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PAPULOSQUAMOUS DISEASE

Psoriasis

sharply-circumscribed chronicscaly plaques with inceased

redness (in light skinnedpatient.

Often positive family history

Scalp, elbows, knees andsacral area are most oftenaffected and symmetrical

1

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FIGURE 67-15PSORIASIS VULGARIS IN A CAUCASIAN CLIENT (A) AND IN AN AFRICAN-

AMERICAN CLIENT (B)

http://../Local%20Settings/Temporary%20Internet%20Files/OLKC/MENU.PPT

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PIGMENTARY DISORDERS

Vitiligo

milk-white macules/patches from

loss of melanocytes (the cells in

the skin which produce melanin,the normal brown-black pigment)

Symmetrical, particularly over bony

prominences; also round the eyes,mouth, genitals.

Hair on affected skin is white

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PITYRIASIS ALBA

Very common pale (not white)round patches on the face of

childrenEdges of the patches are quite

fuzzy, unlike vitiligo.

Mild form of atopic eczemaGets better by the teens and

requires no treatment

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MELASMA (CHLOASMA)

Macular hyperpigmentation on the

face forehead, cheekbones, upper

lip seen quite frequently inpregnancy and in women on thecontraceptive pill.

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ALBANISM

Genetic disorderThe enzyme that produces the

melanin is absent

Whole skin is white as the hair,iris and the retina

Patients burn easily in the sunProtection from the sun is

lifelong

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LEPROSY

4 types: lepromatous,tuberculoid, borderline,disseminate

Tuberculoid leprosy usuallyhave one or two lesions

- hypopigmented macules with

sharp edges- Hairless, sweating absent &

reduced sensation

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TREATMENT OF LEPROSY

Drugs: dapsone, rifampicin .etc.

Education mainly on changed

body image.

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DERMATITIS

Acute dermatitis Itch plus redness, swelling,

papules, vesicles/bullae,

exudate, crusting

Chronic dermatitis

* Itch plus less acute features;more scaling, pigmentation,thickening

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ACNE

Universal in teenagers butcommon in adult life

Causes: Genes + hormones, notdiet, dirt.

Lesions: comedones (whiteheads

and blackheads), papules,pustules, nodules, cysts

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TREATMENT OF ACNE

Depends on type, extent andseverity of lesions

THE END