Dermatology

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Dermatology

• Mennonite College of Nursing at Illinois State
  University
• FNP 431 Crystal Smith, APN, CNP
• Common Dermatology Issues
• Power Point-University of Minnesota Medical
  Library Used with Permission

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Anatomy
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Skin Infections

• Bacterial
• Impetigo
• Folliculitis
• Furuncle
• Carbuncle
• Cellulitis
• Acne
• Fungal /Parasitic
• Tinea Pedis
• Tinea Cruris
• Tinea Versicolor
• Tinea Corporis
• Toenail fungus
• Pediculosis
• Scabies

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Skin Infections

• Viral
• Herpes Simplex
• Herpes Zoster
• Verruca
• Molluscum Contagiosum
• Allergic/Irritation conditions
• Dermatitis
• Hives
• Eczema
• Psoriasis
• Sebacous Cysts
• Frostbite
• Other
• Skin checks - moles
• Sunburn
• Striae

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Impetigo
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Impetigo

• Superficial bacterial infection of the skin
• Most commonly Staph or Strep
• Thin vesicles with honey colored crusting
• Usually on face, hands, neck extremities
• Spread occurs via contact from fingers, towels,
  clothing
• Tx Topical antibiotics, severe infections need
  oral

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Folliculitis
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Folliculitis

• Superficial or deep infection of the hair
  follicle (Barbae, hot tub)
• Usually result of Staph infection
• May also occur as a result of contact/plugging
  with oil, dirt, sweat, etc
• Rash appears as small, dome shaped yellow
  pustules with a hair shaft in the center
• Tx good hygiene, topical antibotics

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Furuncle
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Furuncle (Boil)

• Deep extension of superficial folliculitis into
  the dermis and subcutaneous tissue
• Cause Staph
• 1-5 cm red/tender nodule which may contain pus
• Tx
• Simple lesions- warm compress
• Severe infections drainage antibiotics

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Carbuncle
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Carbuncle

• Large deep abscess that is a progression of a
  furuncle
• May be 3-10 cm in size
• Can present c fever/chills
• Tx drainage antibiotics

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Cellulitis
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Cellulitis

• An acute inflammation of the skin
• S/S redness, swelling, warmth, tenderness of
  affected area within 1-2 days of injury
• Cause Staph or Strep, complication of
  wound/trauma
• The borders are well defined and change rapidly
• Immediate attention (blood test, IV antibiotics)
• Facial cellulitis can cause visual damage if
  spreads to the eyes

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Acne
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Acne

• Obstruction of sebaceous follicles (oil glands)
• Open comedones or closed comedones
• Usually on the face, chest, back
• Causes
• Stressful events (hormonal changes)
• Friction acne
• Oil based cosmetics
• NO correlation between chocolate, chips or colas
• Tx topical /or oral antibiotics

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MRSA
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MRSA

• Methicillin-resistant Staphylococcus aureus
• super-bug caused by staph, unnecessary
  antibiotic use
• Outwits all but the most powerful of drugs
  vancomycin
• Enters through cuts wounds
• Types CA (community acquired) or HA (Hospital
  acquired)
• S/S small red bumps that resememble pimples,
  quicky turn to painful abscesses that can burrow
  deep into the body, swelling, redness, pus
• Risk Factors recent hospitalization, long-term
  care, recent antiobiotic use, young age, contact
  sports, sharing towels, weak immune system,
  living in groups, health-care workers
• Dx Tissue sample 48hrs
• Tx trial error c strong antiobiotics
• Prevention WASH HANDS, surfaces, cover wounds,
  use only personal items

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Tinea Pedis
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Tinea Pedis

• Fungal infection - Athletes Foot
• Rash presents as vesicles/erosions on the soles
  of the foot as well as between toes
• Dx examine scraping under microscope
• Tx antifungal cream/powders (micronazole), keep
  feet dry

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Tinea Cruris
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Tinea Cruris

• Fungal infection Jock itch
• Red/scaly rash on inner thighs/inguinal creases
  occasionally the buttock, not scrotum or labia
• Common in obese patients athletes in tight
  fitting clothes
• Common in hot/humid weather
• Tx topical antifungal creams

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Tinea Versicolor
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Tinea Versicolor

• Fungal infection of the skin
• Multiple patchy lesions (oval shape c fine
  scales) either light in color or brown
• Typically occurs on the back, neck, chest,
  shoulders
• More prominent in the summer when the affected
  areas do not tan
• Recurrence is common
• Tx Topical antifungal

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Tinea Corporis
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Tinea Corporis

• Fungal infection of skin - Ring Worm
• Well defined circular patches with scaly borders
• Found on non-hairy surfaces face, arms, legs,
  truck
• Occurs after contact c another person/object that
  is carrying the fungus
• Common confused c eczema
• Tx topical antifungals (Micronazole,
  ketoconazole not Nystatin)

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Toenail Fungus
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Toenail Fungus

• S/Syellow, think nails, painful, brittle, more
  likely in toenails d/t dark, moist environment
• Tx Lamisil, vicks, takes 6-12 months

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Pediculosis
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Pediculosis

• Lice six-legged wingless insect
• The louse is a grayish/black colored insect 4mm
  long
• The nits are gelatinous white color .8mm long
• Can be found in the head, body or pubic hair
• They pierce the skin and secrete saliva which
  causes itching, lay eggs close to scalp
• Spread by shared hats, towels, combs, bedding,
  clothing, upholstery headphones
• Tx Shampoo Nix, Rid fine tooth comb, boil
  clothing/bedding, dry cleaning

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Scabies

• Very contagious STD
• Intense itchy rash, with linear burrows
• Tx Kwell or Elimite (topical creams)
• Wash bedding/clothing in HOT water stored for
  2-3 days

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Herpes Simplex
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Herpes Simplex

• Viral infection either Type I OR Type II
• You cant kill it and it wont kill you
• Clear papules c superficial ulcerations/erosions
• May cause fever, lymph node enlargement, burning
  pain
• Lesions will crust over in 5-14 days
• Tx analgesic for pain, oral antiviral (acyclovir)

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Herpes Zoster
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Herpes Zoster

• Shingles, a reactivation of varicella zoster
  (Chicken pox) virus
• It remains in the cells of nerve roots in an
  inactive state (after exposure as a youth)
• Unknown reasons for reactivation
• Re-exposure to virus
• Immunosuppressant issue
• Some drugs
• Result in vesicles on a red base in a band-like
  distribution
• Painful rash, prickly nerve pain
• Tx symptomatic, pain, calamine lotion

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Verruca
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Verruca

• Warts caused by human papillomavirus
• Verruca plantaris
• Verruca vulgaris
• Round, flesh colored and grow to be yellow-ish
  tan
• 1cm or more wide
• 65 will resolve spontaneously
• Tx destruction of epidermal cells that contain
  virus cryogenically, chemically

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Molluscum Contagiosum
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Molluscum Contagiosum

• Viral infection of skin/mucous membrane
• Single or multiple flesh colored, dome shaped
  papules c central umbilication
• Found on face, trunk, extremities, lips/tongue,
  genitals
• Very contagious self and others
• Common in swimmers/wrestlers
• Tx curettage, silver nitrate to chemically burn
  the lesions

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Dermatitis
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Dermatitis

• Inflammation of the superficial dermis/epidermis
• Atopic Dermatitis
• Heriditary disorder may also have Hx of asthma,
  allergic rhinitis, rash
• Usually along cheeks, face, trunk, extensor
  surfaces of extremities
• Dry and papular rash, scratching makes it worse,
  d/t loss of natural oils in skin
• Aggravated by stress, anxiety, dry conditions
• Tx good lotions rehydration of skin
• Contact Dermatitis
• Papular and itchy rash resulting from contact c
  an allergen
• Commonly nickel (cheap jewelry, buckles),
  soaps, perfumes, cosmetics, posion ivy/oak
• Tx Cortisone cream (anti-inflammatory agent)

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Hives
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Hives

• An allergic reaction resulting in histamine
  release
• Well defined wheals (solid elevations c central
  clearing)
• Extremely itchy may result in angioedema
• Allergy can be to virtually anything
• Tx antihistamines

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Eczema
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Eczema

• Dryness of the epidermis
• Usually seen on extremities/trunk
• Worse in winter or when bath too much
• Rash is itchy, red, scaly, patchy c a cracked
  appearance
• 2ndary bacterial infections d/t scratching
• Tx lotion/creams to hydrate, topical
  corticosteroids

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Proper Skin Care

• Frequency of showers
• Not so much soap/appropriate type
• Use creams, not lotions

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Psoriasis
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Psoriasis

• Inherited skin disorder of increased epidermal
  cell turnover thickening of the epidermis
• Thick silvery scales
• Common on the elbows, knees feet
• Tx
• UV light or high potency corticosteroids
• Severe cases need to be hospitalized for a tar
  ointment or methotrexate

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Sebaceous Cysts
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Sebaceous Cysts

• Solitary skin nodules as a result of
  proliferation of epidermal cells that secrete
  protein called keratin
• Contains pasty, cheesy looking secretion
• Common on eyelids, neck, face, trunk, scalp
• Benign slow growing lesions
• No treatment necessary unless problems c ADLs

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Frostbite
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Frostbite

• Actually freezing of tissue _at_ cold temps
• Generally affects the exposed area (Toes, feet,
  fingers, nose, cheeks, ears)
• Skin becomes cold, waxy, white, gray, black
• Early stages chillblaines-redness, painful
• Late stages cyanosis, gangrene, edema, no pain
• Tx cover c warm compress, rapid re-warming in
  water, hands between legs, armpits
• Avoid pressure on tissue, even light

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Skin Checks Moles/Cancer
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Moles/Cancer

• Look for
• 1. No bigger than an eraser tip
• 2. Stand out mole on the back
• 3. Irregular border
• 4. different colors
• Think of outdoor sports
• Tennis, golf, soccer
• Males check the head
• Females check the ears and lips

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Sunburn
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Sunburn

• Superficial burn only epidermis
• gt15 suncreen
• 10-2pm is most intese hours, worse in snowy,
  watery environments
• Every time you burn c blisters.increases your
  chances of getting skin cancer 4x
• Tx analgesic sprays, lotion..not oil based

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Striae
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Striae

• A streak or a linear scar
• Results from rapidly developing tension in the
  skin
• Common in pregnancy or when you gain weight
  fast..steroid use