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134 Cards in this Set
- Front
- Back
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what is the most common inflammatory skin disorder? |
eczematous dermatitis |
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what are the different forms of eczematous dermatitis? |
- irritant contact dermatitis -allergic contact dermatitis -atopic dermatitis |
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subjective data for eczematous dermatitis? |
-itching may or may not be present -those with atopic dermatitis often report allergy history (allergic rhinitis, asthma) |
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pathophysiology for eczematous dermatitis? |
-common factor of the various forms is intercellular edema and epidermal breakdown
-excoriation from scratching predisposes to infection and causes crust formation
-three stages: acute, subacute, and chronic |
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objective data for acute phase of eczematous dermatitis? subacute phase? chronic stage? |
acute= erythematous, pruritic, weeping vesicles
subacute= erythema and scaling
chronic= thick, lichenified, pruritic plaques
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atopic dermatitis as part of the objective data for eczematous dermatitis? |
during childhood, lesions involve flexures, the nape, & the dorsal aspects of the limbs; in adolescence & adulthood, lichenified plaques affect the flexures, head and neck |
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what is folliculitis? |
inflammation and infection of the hair follicle and surrounding dermis |
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what is a furuncle (boil)? |
a deep-seated infection of the pilosebaceous unit |
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what is cellulitis? |
diffuse, acute, infection of the skin and subcutaneous tissue |
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what is tinea (dermatophytosis)? |
group of noncandidal fungal infections that involved the stratum corneum, nails or hair |
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subjective data for furuncle (boil)? |
acute onset of tender red nodule that becomes pustular |
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objective data for furuncle (boil)? |
-skin red, hot, tender -center of lesion fills with pus and forms a core that may rupture spontaneously or require surgical incision -sites commonly involved are face and neck, arms, axillae, breasts, thighs, and buttocks |
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pathophysiology of furuncle (boil)? |
-staphylococcus aureus most common organism -initially, a small perifollicular abscess that spreads to the surrounding dermis and subcutaneous tissue - may occur singly or in multiples; when infection involves several adjacent follicles, a coalescent purulent mass or carbuncle forms |
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pathophysiology of folliculitis? |
presence of inflammatory cells within the wall and ostia of the hair follicle creates a follicular-based pustule -inflammation can be either superficial or deep; deep folliculitis can result from chronic lesions of superficial folliculitis or from lesions that are manipulated -persistent or recurrent lesions may result in scarring and permanent hair loss |
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subjective data of folliculitis? |
acute onset of papules and pustules associated with pruritus or mild discomfort; may have pain with deep folliculitis |
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risk factors for folliculitis? |
frequent shaving, immunosuppression, preexisting dermatoses, long-term antibiotic use, occlusive clothing and/or occlusive dressings, exposure to hot humid temperatures, DM, obesity and use of EGRF inhibitor medications |
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objective data for folliculitis? |
-primary lesion small pustule 1-2cm in diameter that is located over a pilosebaceous orifice and may be perforated by a hair -pustule may be surrounded by inflammation or nodular lesions; after pustule ruptures, a crust forms -may have suppurative drainage with deep folliculitis -any hair-bearing site can be affected; most often is face, scalp, thighs, axilla, inguinal area |
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pathophysiology of cellulitis? |
majority of cases caused by streptococcus progenies or S. aureus |
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subjective data for cellulitis? |
-break in skin, such as a fissure, cut, laceration, insect bite, or puncture wound -pain and swelling at the site -may have fever |
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objective data for cellulitis? |
-skin red, hot, tender, and indurated (feels firm); borders are not well demarcated -lymphangitic streaks and regional lymhadenopathy may be present |
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subjective data for tinea (dermatophytosis)? |
may report pruritus |
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pathophysiology for tinea (dermatophytosis)? |
-infection of dermatophytes, typically acquired by direct contact with infected humans or animals; invade skin & survive on dead keratin -lesions classified according to anatomic location & can occur on nonhairy parts of body (tinea corporis), on groin & inner thigh (tinea cruris), on scalp (tinea capitis), on feet (tinea pedis) & on nails (tinea unguium) |
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objective data for tinea (dermatophytosis)? |
-lesions vary in appearance and may be papular, pustular, vesicular, erythematous, or scaling -secondary bacterial infection may be present -microscopic examination of skin scraping with KOH solution shows presence of hyphae -infected nails are yellow and thick and may separate from the nail bed |
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what is pityriasis rosea? |
self-limiting inflammation of unknown cause |
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pathophysiology of pityriasis rosea? |
-sudden onset with occurrence of a primary (herald) oval or round plaque -eruption occurs 1-3 weeks later & lasts for several weeks -not infectious or contagious |
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subjective data for pityriasis rosea? |
-pruritus may be present with the generalized eruption -herald lesion often missed |
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objective data for pityriasis rosea? |
-lesions usually pale, erythematous, & macular with fine scaling, but may be papular or vesicular -lesions devlop on extremities & trunk; palms & soles not involved, & facial involvement is rare - trunk lesions characteristically distributed in parallel alignment following the direction of the ribs in a christmas tree like pattern |
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what is psoriasis? |
chronic and recurrent disease of keratin synthesis |
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subjective data for psoriasis? |
-may have pruritis -concerns about appearence |
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objective data for psoriasis? |
-characterized by well-circumscribed, dry, silvery, scaling papules & plaques -lesions commonly occur on back, buttocks, extensor surfaces of the extremities, and scalp |
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pathophysiology for psoriasis? |
-multifactorial origin with genetic component and immune regulation -characterized by increased epidermal cell turnover, increased numbers of epidermal stem cells, & abnormal differentiation of keratin expression leading to thickened skin with copious scale |
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what is rosacea? |
chronic inflammatory skin disorder |
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pathophysiology for rosacea? |
-lasts for years, with episodes of activity followed by quiescent periods of variable length -caused unknown; occurs most often in persons with fair complexion |
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subjective data for rosacea? |
-itching always present -many report a stinging pain associated with flushing episodes -common triggers: exposure to sun, cold weather, sudden emotion, including laughter or embarrassment, hot beverages, spicy foods, and alcohol |
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objective data for rosacea? |
-eruptions appear on forehead, cheeks, nose, and occasionally about the eyes -characterized by telangiectasia, erythema, papules, and pustules that occur particularly in the central area of the face -tissue hypertrophy of the nose (rhinophyma) may occur: sebaceous hyperplasia, redness, prominent vascularity, & swelling of skin of nose |
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although rosacea resembles acne, __are never present? |
comedones |
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what is herpes zoster (shingles)? |
varicella-zoter viral (VZV) infection |
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what is herpes simplex? |
infection by herpes simplex virus (HSV) |
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what is acanthuses nigricans (An)? |
a nonspecific reaction pattern associated with obesity, certain endocrine syndromes, or malignancies or as an inherited disorder |
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pathophysiology for herpes zoster (shingles)? |
-VZV morphologically and antigenically indention to the virus causing varicella (chicken pox) -dormant viral particles (since original episode of varicella) in the posterior spinal ganglia or cranial sensory ganglia become activated |
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subjective data for herpes zoster (shingles)? |
pain, itching, or burning of the dermatome area usually precedes eruption by 4-5 days |
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objective data for herpes zoster (shingles)? |
single dermatome, that consists of red, swollen plaques or vesicles that become filled with purulent fluid |
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pathophysiology of herpes simplex? |
-two different virus types cause the infection: type 1, usually associated with oral infection, and type 2, with genital infection -crossover infections are becoming common |
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subjective data for herpes simplex? |
tenderness, pain, paresthesia, or mild burning at infected site before onset of the lesions |
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objective data for herpes simplex? |
grouped vesicles appear on an erythematous base and then erode, forming a crust -lesions last 2-6 weeks |
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pathophysiology for drug eruptions? |
-immunologically mediated cutaneous reactions to medications include IgE-dependent cytotoxic, immune complex, and cell-mediated hypersensitivity reactions -nonimmunologically mediated reactions include direct release of mast cell mediators and idiosyncratic reactions |
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objective data for drug eruptions? |
-most common: discrete or confluent erythematous macules & papules on the trunk, face, extremities, palms, or soles of feet -rash fades in 1-3 weeks |
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subjective data for drug eruptions? |
-rash appears from 1 to several days after taking a drug -pruritus characteristic |
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subjective data for acanthosis nigricans? |
-may report history of obesity, endocrine disorders -appearence in childhood, at puberty, or early adulthood associated with being or inherited forms -appearance in older adult associated with malignancy |
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pathophysiology for acanthosis nigricans? |
-insulin resistance & hyperinsulinism may lead to & activation of insulin-like GF receptors, promoting epidermal growth -inherited form: rare, autosomal dominant trait with no obesity or associated endocrinopathies -Malignant form: result from secretion of tumor products with insulin-like activity or transforming growth factor alpha, which stimulates keratinocytes to proliferate |
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objective data for acanthosis nigricans? |
-symmetric, brown thickening of skin w/ plaques or patches of thickened skin w/ velvety or slightly verrucous texture -lesions range in severity from slight discoloration of small area to extensive involvement of wide areas -most common site is axillae, but changes may be observed in other flexural areas of neck, groin, & arms -involvement of dorsal & palmar hands or mucosal surfaces may indicate malignant association |
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pathogen for cutaneous anthrax? |
spore-forming bacterium Bacillus anthracis |
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communicability of cutaneous anthrax? |
direct person-to-person spread extremely unlikely |
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incubation for cutaneous anthrax? |
up to 12 days following deposition of organism into skin with previous abrasion |
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skin lesions with cutaneous anthrax? |
pruritic macule or paule that enlarges into a round ulcer by day 2 -central necrosis develops with a painless ulcer covered by black eschar, which dries and falls off in 1-2 weeks -may be accompanied by 1-3 mm vesicles that discharge clear or serosanguineous fluid |
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accompanying symptoms for cutaneous anthrax? |
lymphangitis; lymphadenopathy |
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pathogen for small pox? |
variola virus |
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communicability for small pox? |
-direct transmission by infected saliva droplets
-most infectious during the first week of illness -however, some risk of transmission lasts until all scabs have fallen off
-contaminated clothing or bed linen could also spread the virus |
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skin lesions for small pox? |
-rash appears 2-3 days after systemic symptoms, first on the mucosa of mouth & pharynx, face & forearms, spreading to trunk & legs -starts with flat red lesions that evolve at same rate (compared with varicella, which matures in crops) -lesions become vesicular, then pustular and begin to crust early in the second week |
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what is the most common form of skin cancer? |
basal cell carcinoma |
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what is the second most common skin cancer? |
squamous cell carcinoma |
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what will a gram-stian show for bacillus anthracis (cause of cutaneous anthrax)? |
gram-positive rods |
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subjective data for squamous cell carcinoma? |
-persistent sore or lesion that has not healed or that has grown in size -may have crusting and/or bleeding |
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subjective data for basal cell carcinoma? |
-persistent sore or lesions that has not healed -may have crusting -may itch |
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objective data for squamous cell carcinoma? |
-elevated goeth with a central depression -wartlike growth; may have crusting, may bleed -scaly red patch with irregular borders may have crusting, may bleed -open sore; may have crusting |
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pathophysiology for basal cell carcinoma? |
-cancer arises in the basal layer of the epidermis -occurs in various clinical forms: nodular, pigmented, cystic, sclerosing, & superficial -occurs most frequently on exposed parts of the body--the face, ears, neck, scalp and shoulders |
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objective data for basal cell carcinoma? |
-shiny nodule that is pearly or translucent; may be pink, red, or white, tan, black, or brown -reddish patch or irritated area, frequently occurring on chest, shoulders, arms, or legs -pink growth with slightly elevated rolled border & crusted indentation in center; as growth slowly enlarges, tiny blood vessels may develop -scarlike area that is white, yellow, or waxy, and often has poorly defined borders; skin appears skinny & taut |
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pathophysiology for squamous cell carcinoma? |
-this malignant tumor arises in the epithelium -lesions occur most commonly in sun-exposed areas, particularly the scalp, back of hands, lower lip, and ear; rim of ear and lower lip are especially vulnerable |
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what is malignant melanoma? |
lethal form of skin cancer that develops from melanocytes |
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pathophysiology of malignant melanoma? |
-melanocytes migrate into skin, eye, CNS, & mucus membrane during fetal development -less than 1/2 of melanomas develop from nevi; the majority arise de novo from melanocytes |
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subjective data for malignant melanoma? |
-new mole or preexisting mole that has changed -new pigmented lesion that has irregularites -history of melanoma -history of dysplastic or atypical nevi -family history of melanoma |
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what is kaposi's sarcoma? |
a neoplasm of the endothelium and epithelial layer of the skin |
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pathophysiology of kaposi's sarcoma? |
-caused by karposi's sarcoma herpes virus 8 (KSHV) -indivuduals infected w/ KSHV are more likely to develop KSHV if their immune system is compromised -commonly associated with HIV |
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subjective data for kaposi's sarcoma? |
-characteristic skin lesions -may report periogeral lymphedema -may be presenting symptom of HIV/AIDS |
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objective data for kaposi's sarcoma? |
-cutaenous lesions are characteristically soft, vascular, bluish-purls, and painless -lesions may be macular or paular and may appear as plaques, keloids, or ecchymotic areas -KS lesions may be limited to skin or involve the mucosa, viscera, and lymph nodes or any organ |
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what is alopecia areata? |
sudden, rapid, patchy loss of hair, usually from the scalp or face |
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pathophysiology of alopecia areata? |
-cause unknown; genetic-envrionemtnal interaction may trigger the disease -any hair-bearing surface may be affected -regrowth begins in 1-3 months; the prognosis for total regrowth is excellent in cases with limited involvement |
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subjective data for alopecia areata? |
-sudden, rapid, patchy hair loss -may also report nail pitting -may have family history |
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objective data for alopecia areata? |
-hair loss is in sharply defined round areas -the hair shaft is poorly formed and breaks off at the skin surface |
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pathophysiology of scarring alopecia? |
skin disorders of the scalp or follicles result in scarring and destruction of hair follicles & permanent hair loss |
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subjective data for scarring alopecia? |
-may have other concurrent skin or systemic disorders |
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objective data for scarring alopecia? |
-patchy hair loss -scalp may be inflamed -hair follicles may be pustular or plugged |
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pathophysiology for traction alopecia? |
-prolonged tension of the hair from traction breaks the hair shaft -follicle is not damaged and the loss is reversible |
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subjective data for traction alopecia? |
-history of wearing certain hairstyles such as braids or from using hair rollers and hot combs |
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objective data for traction alopecia? |
-patchy hair loss that corresponds directly to the area of stress -scalp may or may not be inflamed |
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what is hirutism? |
growth of terminal hair in women in the male distribution pattern on the face, body, and pubic area |
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pathophysioogy of hirsutism? |
-caused by high androgen levels (from ovaries or adrenal glands) or by hair follicles that are more sensitive to normal androgen levels; free testosterone is the androgen that causes hair growth |
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subjective data for hirsutism? |
-excessive hair growth on face or body -onset, severity, and rate depend on underlying cause |
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objective data for hirsutism? |
-presence of thick, dark terminal hairs in androgen-sensitive sites: face, chest, areola, external genitalia, upper and lower back, butt, inner thigh, and line alba -may or may not be accompanied by other signs of virilization |
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what is paronychia? |
inflammation of the paronychium |
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what is onychomycosis? |
fungal infection of the nail |
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what is an ingrown nail? |
nail pierces the lateral nail fold and grows into the dermis |
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pathophysiology for paronychia? |
-invasion of bacteria b/w the nail fold and the nail plate -can occur as an acute or chronic process |
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subjective data for paronychia? |
-acute: history of nail trauma or manipulation; acute onset -chronic: history of repeated exposure to moisture, ex. through hand-washing; evolves slowly initially with tenderness and mild swelling |
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pathophysiology of onychomycosis? |
the fungus grows into the nail plate, causing it to crumble |
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objective data for onychomycosis? |
-in most common form, the distal nail plate turns yellow or white as hyperkeratotic debris accumulates, causing nail to separate from nail bed -pitting does not occur, distinguishing ir from psoriasis |
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pathophysiology of ingrown nails? |
-caused by lateral pressure of poorly fitting shoes, improper or excessive trimming of the lateral nail plate, or trauma |
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what is a subungal hematoma? |
trauma to the nail plate severe enough to cause immediate bleeding and pain |
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what is leukonychia punctatta? |
white spots in the nail plate |
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what is the pathophysiology of leukonychia punctatta? |
-occur as a result of minor injury or manipulation of the cuticle -injury at the cuticle damages the nail matrix (area of nail growth) -either resolve spontaneously or grow out |
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what is median nail dystrophy? |
nail deformity as result of nail picking or biting habit |
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objective data for median nail dystrophy? |
horizontal sharp grooving in a band that extends to the tip of the nail |
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what is onycholysis? |
loosening of the nail plate with separation from the nail bed that begins at the distal groove |
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pathophysiology of onycholysis? |
associated most commonly with minor trauma to long fingernails -other causes include psoriasis, Candida or Pseudomonas infections, medications, allergic contact dermatitis, and hyperthyroidism |
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subjective data for onycholysis? |
-painless separation of the plate from the bed |
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objective data for onycholysis? |
nonadherent portion of the nail opaque with a white, yellow, or green tinge |
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What is Koilonychia (spoon nails)? |
central depression of the nail with lateral elevation of the nail plate |
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pathophysiology of koilonychia? |
associated with iron deficiency anemia, syphillus, fungal dermatoses, and hypothyroidism |
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objective data for koilonychia? |
concave curvature and spoon appearence |
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what is beau lines? |
transverse depression in the nail bed |
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pathophysiology for beau lines? |
-temporary interruption of nail formation, due to systemic disorders -assoicated with coronary occlusion, hypercalcemia, and skin disease |
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what is white banding (terry nails)? and its pathyphysiology? |
-transverse white bands
-associated with cirrhosis, chronic CHF, adult-onset DM, and age -speculated that occurs as part of aging and that associated diseases "age" the nail |
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what is psoriasis? and is pathophysiology? |
-chronic and recurrent disease of keratin synthesis
-nail involvement usually occurs simultaneously with skin disease but may occur as an isolated finding |
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objective data for psoriasis? |
-pitting, onycholysis, discoloration, and subungal thickening -yellow scaling debris often accumulates, elevating the nail plate -severe psoriasis of the matrix & nail bed results in grossly malformed nails and splinter hemorrhages |
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what are warts? |
epidermal neoplasms caused by viral infection |
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objective data for warts? |
-occur at the nail folds and extend under the nail -longitudinal nail groove in the nail may occur from warts located over the nail matric |
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what is digital mucous cysts? |
cystlike structures contain a clear jelly-like substance |
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pathophsyiology of digital mucous cysts? |
-cysts on the proximal nail fold are not connected to the joint space or tendon sheath; they result from localized fibroblast proliferation; compression go the nail-matrix cells induces a longitudinal nail groove -cysts located on the dorsal-lateral finger at the DIP joint are caused by herniation of tendon sheaths or joint linings & are related to ganglion and synovial cysts |
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what is pruritic urticarial papules and plaques of pregnancy (PUPPP)? |
a benign dermatosis that usually arises late in the 3rd trimester of a first pregnancy |
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objective data for PUPPP? |
-erythematous, urticaria-like paplues and plaques on abdomen, thighs, buttock, arms -periumbilical area is spared -usually no lesions on face, palms, or soles -often halos of blanching surround the papules -small vesicles may be present but larger bullae do not occur & would suggest the more rare herpes gestationis |
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what is herpes gestationis (pemphigoid gestationis)? |
rare autoimmune disorder of pregnancy |
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what is seborrheic dermatitis? |
chronic, recurrent, erythematous scaling eruption localized in areas where sebaceous glands are concentrated (ex. scalp, back, & intertriginous & diaper areas) |
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when does seborrheic dermatitis most commonly occur? |
in infants within the first 3 months of life |
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objective data for seborrheic dermatitis? |
-scalp lesions are scaling, adherent, thick, yellow, and crusted ("cradle cap") and can spread over the ear and down the nape of the neck -lesions elsewhere are erythematous, scaling, and fissured |
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pathophysiology of miliaris rubra ("prickly heat")? |
-caused by sweat retention from occlusion of sweat ducts during periods of heat and high humidity -results from immaturity of skin strucutres -overdressed babies are susceptible to this in the summer |
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what is impetigo? pathophsyiology? |
-common, contagious superficial skin infection
-caused by staphylococcal infection and/or infection of the epidermis |
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objective data for impetigo? |
-initial lesion is small erythematosus macule that changes into a vesicle or bulla with a thin roof -lesion crusts with a characteristic honey color from the exudate as the vesicles rupture -may have regional lympadenopathy |
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pathophysiology of chickenpox (varicella)? |
-caused by the VZV -VZV communicable by direct contact, droplet transmission, and airborne transmission -incubation period 2-3 weeks: the period of communicability lasts from 1 or 2 days before onset of rah until lesions have crusted over -after primary infection, VZV remains dormant in sensory nerve roots for life |
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pathophysiology of measles (rubeola)? |
-measles virus infects by invasion of the respiratory epithelium -both endothelial and epithelial cells are infected -incubation period is commonly 18 days; the period of communicability lasts from a few days before fever to 4 days after appearance of rash |
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objective data fro measles (rubeola)? |
-koplik spots (discrete white macular lesions) on the buccal mucosa -macular rash develops on face and neck -maculopapular lesions on trunk and extremities in irregular confluent patches -rash lasts 4-7 days |
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what are german measles (rubella) and what is the pathophysiology? |
-mild, febrile, highly communicable viral disease
-spread in droplets that are shed from respiratory secretions of infected persons -patients are most contagious while rash is erupting, but may shed virus from throat from 10 days before until 15 days after onset of rash -incubation period is 14-23 days |
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bruising associated with abuse occurs where? in comparison to toddlers and children who bruise themselves accidentally who do so where? |
-abuse= over soft tissue
-accidentally= over bony prominences |
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what is solar keratosis (actinic keratosis)? |
squamous cell carcinoma confined to the epidermis |
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where are the lesions for solar keratosis (actinic keratosis) most common? |
on the dorsal surface of the hands, arms, neck, and face |
