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54 Cards in this Set
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Environmental hazards to skin include (sun exposure, irritants and allergens, and radiation)
when should you tell a patient to apply sunscreen? |
where spf 15 daily
20-30 minutes before going out, and every 2-3 hours always after swimming even if it says waterproof |
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What drugs cause photosensitivity?
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antidepressants, antihistamines, antifungals, diuretics, NSAIDS, antimicrobials
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Irritant dermatititis
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chemicals irritating the skin
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Allergic dermatitis?
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antigen specific hypersensitivity. Topical solutions often have fragrances and preservatives that can be irritating.
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Radiation?
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this exposure will cause hyperpigmentation, dryness, and desquamation (shedding of the outer layer of skin)
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What are the benefits of the following activities to a persons skin?
sleep: exercise: hygiene: nutrition: |
sleep: is restorative also there is less itching while sleeping so therefore less scratching
exercise: increases circulation hygiene: the acdity of the skin and sweat protects against bacterial growth. Most soaps neutralize the skin leaving it unprotected so use mild shampoos, only enough to remove the excess odor and oil. Using a moisturizer right after a bath will help seal in moisture and decrease itching nutrition: Vit B def. = erythema, bullae, seborrhea lesions Vit A promotes healthy cell structure and wound healing (none: dry and poor wound healing) Vit C helps connective tissue and healing Vit K provides clotting factors. Bruising is indicates a deficiency of vit k Protien promotes cell growth and wound healing. |
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Malignant Skin Neoplasms
What puts a pt. at increased risk? Can dark people still develop cancer? |
Fair skin, Blonde or red hair, blue or green eyes
Family History: chronic exposure to the sun, tanning, living near the equator Dark skinned people can still develop cancer. It is often found on their palms, soles and mucous membranes most often. |
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Nonmelanoma skin cancers
3 most common are... |
actinic keratosis
basal cell carcinoma squamous cell carcinoma |
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What are the most common areas to get nonmelanoma skin cancers?
Is death common with these? |
on exposed areas: head, neck, face, arms, hands
no but they and their removal can cause disfigurement. |
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Actinic Keratosis:
type: population afflicted: appearance: tx: |
Actinic Keratosis:
type: premalignagt squamous population afflicted: older white adults appearance: irregular shape, red papule, indistinct borders, hard scaly skin on top. tx: cryosurgery, surgical removal, chemical pealing agents, needs to be biopsied in any case. |
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Basal Cell
(most common skin cancer but least deadly) type: population affected: appearance: Tx: |
Basal Cell Carcinoma
type: locally invasive malignancy population affected: middle to older adults appearance: pearly, papule that may ulcerate if untreated which can cause a lot of tissue destruction Tx: excision, cryosugery, radiation therapy, topical chemo |
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What is the most common skin cancer yet the least deadly?
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basal cell carcinoma
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Squamous cell carcinoma:
type: common cuase: population affected: appearance: Tx: |
Squamous Cell Carcinoma
type: malignancy of keritonizing epidermal cells Common cause: SUN population affected: sun worshippers appearance: may start as a scaly plaque and later become a firm nodule, with indistinct boarders, and may ulcerate with time. Opaque Tx: surgical excision, radiation therapy, cryosurgery. |
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Malignant Melanoma
Arise from where? Metastisize easily? Consists of what percentage of skin cancer? What are the four types? It is the most deadly skin cancer |
anywhere
very easily 4% but are the most deadly kind SSM, LMM, ALM, NM |
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What is the most deadly skin cancer?
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Malignant melanoma
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4 types of malignant melanoma's
SSM LLM ALM NM |
SSM (superficial spreading melanoma)-most common and most curable, occurs on sun exposed areas (legs, upper back) often a preexisting mole that changes
LLM (Lentigo Malignant melanoma) - face of elderly, flat brown irregular patch that changes after many years. ALM (acralentinginous melanoma)- soles and palms and mucous membranes, asians and dark skinned people NM (nodular melanoma)- men and anywhere on the body, aggressive and invades rapidly. |
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Malignant Melanoma
Clinical Manifestations: typified by ABCD's women men |
Assymetry, borders, color, diameter (if irregular and changing thats a bad sign)
women: often seen in lower legs and back men: often seen in trunk head and neck tumor lesions are often dark brown or black |
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Malignant Melanoma
Collaborative Care: |
NEVER shave biopsies for malignant melanoma. It must be excised.
Tumor thickness tells us about disease progression Use Breslow Measurement: tumor depth Use Clark level to describe the number of layers involved. |
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Malignant Melanoma
Treatment (in general 4 stages): If in Lymph nodes: |
Malignant Melanoma TREATMENT
4 Criteria: depends upon the site, the stage, pt. age, and pts. general health Lymph nodes: surgery then chemo (interferon or radiation therapy), gene therapies and immune therapies. |
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Malignant Melanoma
Staging involves five levels. Tumor size nodal involvement metastasis |
0 : confined to one place in epidermis
1 : determined by depth and involved layers of skin 2: same as above 3: lmph nodes involved (45% 5 year survival rate) 4: Metastasis to organs (provide palliative care) |
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Skin infections and infestations
most often cause by what bacteria? primary infection indicates what? secondary "? risks to contracting a skin infection or infestation? Lifestlye choices that prevent them? |
staphylococcus aureus or streptococci
primary: break in skin secondary: damaged skin are secondary to disease risks: moisture, corticocosteriod use, antibiotic use, chronic diseases (i.e. diabetes) prevention: good hygeine and health will prevent this, avoid spreading infections. |
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Impetigo
cause: 1st or 2nd: contagious?: population: characteristics: tx: |
Impetigo
cause: staph, strep or both 1st or 2nd: primary contagious?: highly population: low SE characteristics: begin as raised then flatten (honey colored crust surrounded by erythema), puritic, on face and around nose and mouth. tx: oral antibx. Warm saline soaks to remove crusts, topical abx cream, can lead to glomulonephritis if untreated. |
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Cellulitis
cause: 1st or 2nd: characteristics: tx: |
Cellulitis
cause: strep or staph 1st or 2nd: a secondary complication but can be a primary infection following a break in skin characteristics: hot tender, erythmateous and edemateous with diffuse borders, chills, malaise, and fever. tx: moist heat, immobilization, elevate, oral abx, may need to be hospitalized if bad, if untreated it can lead to gangrene. |
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Faruncle
common? cause: etiology: location of inflammation: single or multiple? tx: |
Faruncle
common? very common cause: staph but can be caused by other bacteria or fungi etiology: damage to hair follicle allows bacteria to enter deeper into tissues of the follicle and subcut tissue location of inflammation: anywhere in a hair follicle on body but most common in face neck, butt, armpit, and thighs single or multiple? both tx: incision, drainage, packing, oral ABX, infection control because of drainage, warm moist compress, antibx soap of little help. |
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Viral infections can be localized or as a result of an inflammatory response to a viral infection.
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herpes simplex, zoster and then warts are the most common viral infections
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Herpes simplex
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HSV1 (coldsores) or HSV2 (genital) recurrent and lifelong. Exacerbated by sun, stress, trauma, menses, systemic infections,
they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years. The first outbreak usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. Other signs and symptoms during the primary episode may include a second crop of sores, and flu-like symptoms, including fever and swollen glands visual inspection if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be diagnosed between outbreaks by the use of a blood test. Blood tests, which detect antibodies to HSV-1 or HSV-2 infection, can be helpful, although the results are not always clear-cut. There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners. Transmitted by droplet and contact with virus containing fluid, cervical secreations, saliva |
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Herpez zoster
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shingles
first sign is a tingling or burning pain after several days or a week a rash of fluid filld blisters similar to chicken pox forms and it appears in one area on one side of the body.The most common location for shingles is a band, called a dermatome, spanning one side of the trunk around the waistline. Anyone who has had chickenpox is at risk for shingles. Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles. While it isn't a life-threatening condition, shingles can be very painful. Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and lessen the chance of complications. However, shingles is a serious threat in immunosuppressed individuals — for example, those with HIV infection or who are receiving cancer treatments that can weaken their immune systems. People who receive organ transplants are also vulnerable to shingles because they are given drugs that suppress the immune system A person with a shingles rash can pass the virus to someone, usually a child, who has never had chickenpox, but the child will develop chickenpox, not shingles. A person with chickenpox cannot communicate shingles to someone else. Shingles comes from the virus hiding inside the person's body, not from an outside source. |
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Fungal infections
are identified by? |
.. scraping and KOH
Do a microscopic scraping and then add potassium hydroxide to the slide |
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Candida Albicans
impacts what areas? who is at increased risk? s/s: appearance? Tx: |
Candida Albicans
impacts what areas? warm moist areas (groin, submammary folds, oral mucosa, between fingers and toes) who is at increased risk? Chemo pts., HIV, diabetes, or organ donor pts. s/s:cheesy plaque or with vaginitis its red and is painful itchy and discharges appearance on skin? papular red rash with pinpoint satelite lesions around edges. tx: microscopic exam, nystatin, suppositories, abstinence, hygiene (keep clean and dry) |
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(Tinea Coporaris/capitis/pedis) Ringworm
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common especially in children, caused by dermatophytes
risk increase: long term wetness of skin, minor skin and nail injuries, poor hygeine contagious; same as small pox s/s:inthicng, ring shaped red colored skin rash. tx: keep skin dry and clean, antibx and dr. visit with severe, cool compresses help with discomfort, 4 weeks to clear. |
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Athletes foot
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Interdigital scaling and breaking of skin. Redness blistering, itchy or painful. Tx topical antifungal cream, spray or powder.
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Onychomycosis
more often on which nails? appearance? often results from untreated what? mild infections affecting less than 80 % of two nails may respond to what? cure requires what? what is the most effective method to treat? sometimes the nail has to be removed |
feet nails
appearance? brittle thick borken crumbling yellowish discolored nails often results from untreated what? tinea pedis (foot ringworm) mild infections affecting less than 80 % of two nails may respond to what? topical antifungal cure requires what? oral antifungal what is the most effective method to treat? combo of oral and topical antifungal. sometimes the nail has to be removed |
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What are the keys to preventing infestations and insect bites?
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prevention includes
being aware of risks in the environment maintaining good hygeine routinely inspecting skin hair and nails. |
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Pediculosis capitis: nit (egg) (LICE)
S/S: tX: Pt teaching: school policy on nits vs. American Academy of Pediatrics |
Pediculosis capitis: nit (egg) (LICE)
S/S: tickling, itching, and sores on the head tX: OTC shampoos, washing all clothing, and bed linens in hot water cycle. Pt teaching: the above and disenfecting combs and brushes, as well as the furniture and floor should be vaccumed. school policy on nits vs. American Academy of Pediatrics ? after first treatment the AAP says kid should return to school but dead eggs may still remain in hair and the school wants all of those gone before the kid returns |
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Scabies:
spread progression appearance tx pt teaching with lindane |
burrow in skin to produce intense itching which tends to be worse at night,
spread: sexual contact is the most common just shaking hands wont do it but a mother hugging a child can do it. Progression: they can live up to a month but they can lay eggs repeating the cycle endlessly. Appearance: papules, not every bump is a bug, they appear all over but mostly in crevices, only 10 to 15 mites even though there are hundreds of bumps. tx: mite killer (Elimite) applied from neck down and left on over night a cheaper alternative is 1 oz of lindane pt teaching with lindane: it can cause seizure so dont apply if wet and wash off after 8 hours or do this with the neonate crowd and child under 2, wash linens frequently. |
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Allergic Dermatologic Problems
testing, how is a positive indicated? |
whether it be through history, possible exposure, or patch testing a positive sign is indicated by...
appliation of allergen to the skin that illlictis redness, papules, or vesicles. |
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allergic contact dermatitis
what causes a rash/reaction? |
the first exposure sensitizes the skin and the second exposure is what will produce a reaction but there must be at least that first exposure before a reaction can occur.
beyond plants causing reactions, so can hair dyes, straighteners, metals in jewelry, tanning agents in leather, latex, citrus fruit, fragrances in soaps, shampoos, lotions, and cosmetics. |
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Irritant Contact dermatitis
whats goin on? perpetrators: |
Irritant Contact dermatitis
a substance comes into contact directly with your skin and damages it. perpetrators: many chemicals, cleaning products and solvesnts. |
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What types of people are most likely to develop contact dermatitis?
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people with other skin conditions such as ecxzema.
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How can one tell the difference between allergic contact dermatitis and irritant contact dermatitits?
a red rash is usually the reaction and there is a difference in the time that this rash appears. |
allergic- usually confined to the area where the trigger actually touched the skin. takes 1-2 days for rash to show
irritant - will probably be more widespread on the skin. Rash will show immediately. These tend to be more painful than itchy. |
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How to prevent/tx allergic or contact irritant dermatitits?
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avoid touching the trigger
wash with soap and cool water if immediately after exposure if blistering develops apply a cold moist compress 30 min 3x day Calamine lotion and cool oatmeal baths may relieve itching use of oral antihistamines such as diphenhydramine Corticosteriods can be applied topically but not antihistamines because it might be an allergy For mild cases a hydrocortisone cream may be sufficient IF its over a large area than an oral corticosteriod or perscription strength antihistamines. |
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Drug Allergen Induced Skin Reactions
when does the immune response occur? most drug allergies cause what? most common drug allergens? Angioedema is when what occurs? What is a wheal? What should the pt. avoid with this condition? What drugs should be used for tx? |
Drug Allergen Induced Skin Reactions
when does the immune response occur? after the second exposure most drug allergies cause what? rashes and hives most common drug allergens? Sulfa's, anticonvulsants, insulin preps (animal sources), and iodinated x-ray contrast dyes (anaphylactoid reactions) Angioedema is when what occurs? swelling or welts that occur mostly around the face especially the lips and eyes, but can also occur hands feet and throat. and they itch What is a wheal? swelling on the surface of the skin into red or skin colored welts with clearly defined edges What should the pt. avoid with this condition? hot showers, tight clothing, hot sex What drugs should be used for tx? antihistamines (diphenhydramin) is considered most effective. If its really severe then Epi may be needed |
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Acne
how do you subdue acne if you have it? |
clean your skin gently wash once or twice daily with soap and water to remove excess oil from skin. An acne cleanser purchas OTC can be helpful. Avoid scrubbing too abrasively because this can actually irritate the skin and cause acne to worsen. try not to touch your skin. avoid the sun.
stress doesnt cause acne but it can make it worse. cystic acne causes scars because its deeper. no one know what causes it. hormones play a role. |
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Psoriasis
a skin disease that causes itchy or sore patches of thick, red skin and silvery scales. Cuased by a problem with your immune system. What can make it worse? |
infections
stress dry skin certain medicines |
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Dermatologic Problems
what is treated with UV light and sometimes enhanced with photosensitizing drugs? how often do patients attend and how long are they in the closet undressed with just underwear and goggles? |
atopic dermatitis, psoriasis, cutaneous lymphoma, pruritus
two to five times a week for seconds to minutes (about 15-25 visits gets results) |
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Dermatologic Problems (cont'd)
Diagnostic and surgical therapy skin scraping |
skin scraping: Scrape with blade to get surface cells good for evaluation of fungus or infestations
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Dermatologic Problems (cont'd)
Diagnostic and surgical therapy curettage |
curettage: scooping and removal of tissue with a circular cutting edge. Ggod for soft skin tumors and lesions 9warts), anesthetize area, henostasis, sent for biopsy.
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Dermatologic Problems (cont'd)
Diagnostic and surgical therapy punch biopsy |
Punch Biopsy: removal of small lesions smaller than 0.5cm. Outline it, anesthatize, cores out the lesion. hemostasis provided. Larger sites need sutures.
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Dermatologic Problems (cont'd)
Diagnostic and surgical therapy cryosugery |
Cryosurgery: subfreezing tempto remove noncancerous and brecanerous lesions (wartsskintags, seborrheic keritosis. Liquid nitrogen is most often used, freeze the cell, it lyses, dies and soughs off., stings a bit, but then becomes red, blisters, scabs and soughs off., leaves hypopigmented area that looks like a scar.
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Dermatologic Problems (cont'd)
Diagnostic and surgical therapy Moh's surgery |
Excision is surgical removal.
Mohs surgery: microscopic removal of cutaneous malignancy. Tissue is removed in thin layers so that the margins can be mapped to make sure that there is no remaining tumor. It is sent off to path, once an answer is received, they may have to take more until they have clean margins. Lengthy. |
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Dermatologic problems
Ambulatory and Home Care wet-dressing |
wet dressing: used when there is oozing from skin or to relieve itching. penetrance of topical meds helps
to help with removal of scales and crusts... put dressing in prescribed solution, squeeze until not dripping then apply to lesion. if for oozing wound, usually 3x a day for 20 min. Do this for longer if its for a more serious reason (inflamation, debrediment etc.) |
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Dermatologic problems
Ambulatory and Home Care bath |
bath: antipuretic, medicated for large surfacetemp comfortable for patient. 15-20 minutes soaks 4x a day. pat dry immediately and apply creams and moisturizers as perscribed.
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Dermatologic problems
Ambulatory and Home Care topical |
thin layerspread evenly, if med is oily, use a dressing to protect clothing
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Dermatologic problems
Ambulatory and Home Care pruritus |
avoid vasodilation (heat rubbing) dont allow to become dry it will itch more, a cool envrionment (vasocconstricts to relieve itching), topical medications can be used to numb (menthol, phenol, camphor, anihistamines, wet dressings).
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