Download - SKIN2 NFK 202
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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
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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