The Integumentary system

1
The Integumentary system

• CHAPTER 6
• DISEASES AND CONDITIONS OF THE INTEGUMENTARY
  SYSTEM
• Dr. Jay Shahed

2
PREVIEW

• It is made up of the skin and its
• accessory organs
• Hair
• Nails
• Glands.

3
The skin

• One of the human bodies largest organs.
• It has an amazing ability to protect the body,
  yet is still susceptible to a number of different
  diseases and conditions.

4

• Seborrheic Dermatitis

5

• increased sebum produced by sebaceous glands
• Most frequent locations
• eyebrows, eyelids, side of nose, behind ears

6
ETIOLOGY

• IDIOPATHIC-hereditary-emotional
  stress-food/diet

7
Signs and symptoms

• Red area with yellow center
• Itchy
• Greasy and scaly lesions

8
DIAGNOSIS

• physical examBlood/urine cultureAllergy
  testBiopsy (severe cases)

9
TREATMENT

• Cortisone 0.5 topicalSpecial
  Shampoo(zinc/tar/sulfur)
• -most frequently occurs in infants

10

• Contact Dermatitis

11
Etiology

• Contact with a substancethat causes an allergic
  reaction

12
Signs and symptoms

• Erythema
• Edema
• Small Vesicles dilation
• Itching
• Sting feeling
• Example-plants poison ivy, oak, sumac-dyes,
  soap, tissue, metals (nickel), jewelry, latex,
  drugs, detergents, make-up

13
DIAGNOSIS

• Appearance
• Past History
• Patch Allergy Test

14
TX

• Cortisone Cream 1
• Medrol (oral )
• for six days

15

• Atopic Dermatitis
• (Eczema)

16
ETIOLOGY

• -Family history
• -IDIOPATHIC-Inherited-allergic
  connection-sensitivity to milk, orange juice

17
Signs and Symptoms

• Red rash
• Dry white erupted vesicles
• Itchy face, neck, elbows, knees

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DIAGNOSIS

• Medical History
• Family History
• Allergy Test

19
TREATMENT

• Topical CortisoneAntihistamineTranquilizers
  SedativesAntibiotics if infection

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• Psoriasis

21
ETIOLOGY

• stress and anxiety
• Climate
• change in temperature and humidity
• AUTOIMMUNE

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Most Common LOCATIONS

• Scalp
• Joints
• Trunk

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SS

• Thick, flaky, red patches with white scales
• Dry plaques/pustules
• Occasional itching and soreness

24
DX

• Appearance
• Biopsy

25
TX

• NO CURE
• Factors that can help
• U.V. light
• Steroids (methox-salen)
• Antihistamines
• Oatmeal Bath
• If Severe chemotherapy and etretinate
• AVOID etretinate with pregnant women

26

• Acne
• Vulgaris

27
General Characteristics

• Inflammation of sebaceous
• glands and hair follicles to formpustules and
  boils

28
CHARACTERISTICS

• Most frequently found
• Face
• Neck
• Shoulders
• Chest
• Back
• Common during adolescence

29
ETIOLOGY

• Unknown
• Hormonal changes (endocrine)
• Hereditary
• Food/allergies
• Psychological
• Steroids

30
TREATMENT

• Topical or systemic antibiotics
• Keratolytic agents
• UV light
• Vitamin A (promotes drying)

31

• Herpes Zoster (Shingles)

32
ETIOLOGY

• Varicella - zoster Virus

33
CHARACTERISTICS

• Incubation period 7-10 days Duration
• 10-15 weeks
• patterned and painful vesicles
• It follows the course of peripheral nerves

34
Diagnosis

• Vesicle culture
• Blood culture

35
TREATMENT

• Analgesics
• Sedatives
• Anitpruritics
• Steroids (medrol)
• Zovirax (Acyclovir)
• Idoxuridine (eye)

36

• Impetigo

37
ETIOLOGY

• Streptococcus or Staphylococcus aureus
• Insect bite
• Poor hygiene
• Anemia
• Malnutrition

38
Characteristics

• Contagious
• Superficial infection
• Early vesicles with thick, dry yellow crusts
• Most frequent locations
• Face, trunk, and arms

39
DX

• TZANCK TESTGRAM STAIN

40
TX

• Systemic antibiotics
• Cleaning

41

• Furuncles
• and
• Carbuncles

42
Classifications

• Furuncle
• 1 boil
• Carbuncles
• multiple boils

43
Etiology

• Staphylococcus Aureus

44
SS

• Redness
• Swelling
• Pain

45
Diagnosis

• Appearance and characteristics
• Blood/urine analysis

46
TX

• Hot compresses
• For comfort
• Drainage
• Surgical incision drainage
• Antibiotics

47
Disorders with a higher Risk Factor

• Nephritis
• GI disorders
• Poor hygiene
• Diabetes mellitus

48

• Erysipelas
• (Cellulitis)

49
ETIOLOGY

• Streptococcus
• Staphylococcus
• via small cut or lesion

50
Signs and symptoms

• Erythema
• Pitting edema
• Hot and tender skin
• May have fever if systemic
• Most frequently found on lower extremities

51
Diagnosis

• Physical exam
• Blood culture

52
TX

• Immobilization
• MgSO4 Compress to cool skin
• Warm compress to increase circulation
• Antibiotics
• Analgesics
• Hospitalization if severe

53

• Dermatophytoses (Tinea)

54
Characteristics

• Fungal infections
• Classified by body regions
• Marked boarders with clear center
• Fungal infection from direct contact with
  spores.

55
DX

• Appearance
• Location
• Culture

56
TX

• Anti-fungal medications
• Clean and dry infected area
• Cover with loose clothing

57
TINEA CAPITIS

• Affect the SKULL
• Round gray scaly lesions
• Epidemic (children)
• Pruritis
• Usually asymptomatic

58
TINEA CORPORIS (RINGWORM)

• Affect the BODY
• Round, ringed, scaly vesicles
• Get from direct contact with animals (cats)
• Hot/humid climate

59
TINEA UNGUIUM

• Affect the Nails
• Hypertrophic, thickened, brittle or lusterless
  nails

60
TINEA PEDIS (Athletes Foot)

• Intense burning, itching, between toes
• Fissures
• Wetness

61
TINEA CRURIS (Jock Itch)

• Affect the groin area
• Raised red, itchy vesicular patches
• Well defined boarders
• Associated with Tinea Pedis in athletes
• More frequent in the summer
• Associated with tight underwear

62

• Decubitus Ulcers (Pressure Ulcers)
• (Bed sores)

63
Characteristics

• Localized at dead skin
• Early signs are shiny skin
• Redness
• Erosions
• Necrosis
• Infected ulcers

64
General Characteristics

• Most frequently occurs in paralyzed or
  debilitated people who lie in one position for
  extended periods of time.
• Appears over bony prominence with long
  immobilization

65
Pathophysiology

• Impaired blood supply to area
• Prolonged pressure to area

66
DX

• Visual Examination
• Culture of organism causing infection

67
TX

• Debridment agents
• Irrigation with antiseptic solutions
• Absorbable gelatin sponge
• Granulated sugar
• Antibiotics
• Karaya gum patches

68

• Scabies (Mites)
• and
• Pediculosis (Lice)

69
Characteristics

• Highly contagious parasitic insects
• Scabies ( Mites )
• rash on hand, breast, armpit, waist, genitals
• Pediculosis ( Lice )
• wheal, eggs (nits) on hair, skin or
  clothesother family members usually involved

70

• Types of species
• MITES
• Sacrcoptes scabiei
• LICE
• Pediculus humanus capitis (Louse)
• P. humanus corporis
• P. pubis (crab)

71
Signs and Symptoms

• Itching
• Sensation of something crawling on skin

72
DX

• Visual examination

73
TX

• Special shampoo and comb for 7-10 days ( Sulfur )
• Steroids
• Oral antibiotics if another infection occurs
• Treat all other family members involved
• Wash all clothes, furniture, carpet

74

• Skin Cancer

75

• Seborrheic Keratosis

76
General Characteristics

• BENIGN
• Tan-Brown, greasy papules or plaques
• Unknown cause
• Increased size may indicate internal malignancy
  (stomach)

77
TX

• Cryosurgery
• Curettage

78

• Dermatofibroma

79
Characteristics

• BENIGN
• ASYMPTOMATIC
• Could be found all over
• Caused by viral infection or insect bite
• Could develop after trauma.
• Raised scaly, hard, pinkish, brown

80

• Keratoacanthoma

81
General Characteristics

• BENIGN
• Could be caused by a virus
• Smoothed raised, dome with central crust
• Can disappear spontaneously or can scar

82
TX

• Fluorouracil
• anti-neoplastic medication
• Corticosteroid injection

83

• Keloids
• Hypertrophic Scars

84
General Characteristics

• BENIGN
• Occurs after trauma or surgery
• Large thick scar
• Regresses with time
• Treat with steroids or surgery

85

• Epidermal Cyst
• (Sebaceous cyst)

86
General Characteristics

• BENIGN
• Filled with thick fluid
• May get infected
• Might burst and reoccur

87
Treatment

• surgical excision
• Antibiotics

88

• Acrochordon
• (Skin Tag)

89
General Characteristics

• BENIGN
• Short stalked dark brown growth on neck or Axilla

90
Treatment

• excised by surgery

91

• Actinic Keratosis

92
General Characteristics

• PREMALIGNANT
• More dangerous
• Occurs on sun exposed areas of body
• Forms lesions on head and well vascularized areas

93
Treatment

• Retin A vitamin
• Fluorouracil
• Desiccation

94

• Skin Carcinomas
• (Malignancies)

95
General Characteristics

• Changes in tissue
• 95 are due to overexposure to sun
• Confirmed by biopsy

96
TREATMENT

• GOAL to treat
• eliminate cancerous lesions
• -surgery
• Most are completely cured with early detection.
• AVOID SUN
• Use sunscreen
• SPF 15 or greater

97

• Basal Cell Carcinoma

98
General Characteristics

• Occurs in deepest layer of epidermis
• Account for 1 of 4 newly discovered cancers
• Fair skinned people are at highest risk
• Occurs anywhere on body, especially on sun
  exposed areas-RARELY METASTASIZE

99

• Squamous Cell Carcinoma

100
General Characteristics

• Occurs in surface layer of epidermis.
• Firm, fleshy, red, hard-surfaced nodules with
  scales
• Locations
• lips, ears, hands
• MORE LIKELY TO METASTASIZE

101

• Malignant Melanoma

102
General Characteristics

• Most serious type
• Life threatening
• Least common type
• Rarely occurs before adolescence
• Signs
• changes in tissue (ABCDs)
• METASTISIZE THROUGHOUT BODY

103

• Abnormal
• Skin Pigmentation

104

• Albinism

105
General Characteristics

• Rare inherited disease
• Melanocytes dont produce melanin
• Pale skin, white hair
• Pink/blue eyes
• Must stay out of sun

106

• Vitiligo

107
General Characteristics

• May be an immune condition
• Pale irregular patches of skin which may change
  size or shape

108

• Melasma (Chloasma)

109
General Characteristics

• In women during hormonal changes
• I.e pregnancy, birth control pill
• Dark patches on face
• Goes away after hormones stabilized

110

• Hemangiomas

111
General Characteristics

• Benign lesions of blood vessels in dermis
• Blue/red/purple marks on skin
• I.e. Port Wine Stain

112

• Nevi
• (Moles)

113
General Characteristics

• Dark spot on skin
• Dense collection of melanocytes

114

• Seborrheic Warts

115
General Characteristics

• Middle age
• Crusty greasy surface
• Not real warts

116

• Pityriasis

117
General Characteristics

• Uncommon
• Fungal infection
• Causes patches of flaky, light/dark skin to
  develop

118

• Abnormal Suntan

119
General Characteristics

• Caused by drugs and certain diseases

120

• Alopecia
• (Baldness)

121
General Characteristics

• Hair loss
• Temporary or permanent
• Gradual or sudden

122
ETIOLOGY

• Aging
• Hereditary
• Thyroid disease
• Anemia
• Chemotherapy
• Familial on moms side

123
DX

• Visual examination
• Male pattern of baldness

124
TX

• Monoxidil
• Applied topically
• Hair transplant
• Both are EXPENSIVE

125

• Folliculitis

126
Pathology

• Infective pustular lesions around the hair
  follicle.

127
ETIOLOGY

• Bacterial infection
• Might be caused by shaving

128
Signs and Symptoms

• In mild cases
• Itching
• Discomfort
• Usually asymptomatic
• Common in young adults

129
DX

• Culture
• shows presence of Staphylococcus aureus

130
TX

• Topical antiseptic
• Systemic antibiotic
• If Severe
• incision or drainage

131

• Corns
• and
• Calluses

132
General Characteristics

• Extremely common
• Hyperplastic areas
• Tenderness and pain
• Corns more painful
• due to pressure, friction, or impaired
  circulation

133
DX

• Visual exam
• Doctor rarely needs to be involved

134
TX

• Relieve pressure and friction points
• Using
• pads, sponge rings, chemical agents, surgical
  removal
• Patients with diabetes mellitus should consult a
  physician immediately

135

• Verrucae
• (Warts)

136
General Characteristics

• Elevated growths of epidermis
• Most common site
• planter of the foot.
• But it could be anywhere on body
• Itchy small, hard, white/pink surface
• Pruritus
• Not a serious health risk

137
General Characteristics

• Viral
• Spread by touch
• Contact with skin from a wart
• Consult physician if penile or vulvalar warts or
  after age 45
• Could develop into skin cancer

138
TX

• Most disappear naturally
• Paints, creams, plasters
• Surgical removal
• Cryosurgery
• ( freezing with nitrous oxide)
• Electrodesiccation

139

• Deformed
• or
• Discolored Nails

140
Etiology

• Pressure on nail
• Poor circulation
• Bacteria
• Heart problems
• Lung cancer

141
DX

• Physical examination
• Medical history
• Blood chemistry test
• Usually resolves itself when underlying problem
  corrected
• self-help with chemicals
• Doctor assistance

142

• Paronychia

143
General Characteristics

• Infection of skin around nail
• Edema
• Redness
• Painful
• Discharge from nail
• Deformed or discolored nails

144
ETIOLOGY

• Infection by bacteria or fungus
• Occurs in people that has their hands often in
  water.

145
DX

• Physical exam
• History of symptoms
• Culture
• to determine whether bacterial or fungal

146
TX

• Antibiotics
• Anti fungal cream or ointment
• Takes several months to heal