Issues in Dermatology. Rhonda Lesniak, PhD, ARNP, FNP-BC, NCSN

Transcription

1 Issues in Dermatology Rhonda Lesniak, PhD, ARNP, FNP-BC, NCSN

2 Anatomy of the Skin

3 Functions Protect Fluid balance Absorption Synthesis of Vitamin D Sensation/communication with external environment Thermoregulation Immunity Excretion

4 Physical Assessment Approach: head-to-toe, anterior, posterior, and lateral; or by region as you assess other systems Techniques: inspection and palpation Maintain universal precautions General survey with vital signs and head-to-toe scan

5 Inspection of the Skin Color Moisture Temperature Texture Mobility/turgor Lesions

6 Palpation of the Skin Moisture Temperature Texture Mobility and Turgor Surface characteristics of any lesions

7 Descriptions of Lesions Anatomical location Size Color Type of lesion ( papule, macule, vesicle) Blanching or pulsation of vascular lesions Surface characteristics, exudate Arrangement, configuration, and distribution

8 History How and when did the rash/lesion occur? Is it a single lesion or multiple lesions? Where is rash located? Describe it? Use of OTC agents? PMH of this problem before? Has this child been exposed to any contagious illness? Relationship of skin lesion to season, heat, cold, drugs, occupation, chemicals? Any new soaps, detergents, perfumes, or lotions? Exposure to plants, shrubs, ivy? Any associated symptoms? Cold, flu, fever? Acute ( headache, chills, fever) or Chronic (fatigue, weakness, anorexia)? Are the child s immunizations up to date?

9 Types of Skin Lesions Macule- flat discoloration (freckle) >1cm=patch (vitiligo) Papule- elevated solid lesion (nevus) >1cm= plaque (psoriasis) Wheal- circumscribed area of skin edema (hive) Nodule- solid lesion that can be level, elevated, or beneath skin Vesicle- elevation of the skin containing serous fluid (varicella) Bullae- fluid filled >1cm (blister) Pustule- vesicle like with purulent content (impetigo, acne) Fissure- linear crack into epidermis (athletes foot) Ulcer- deeper loss of epidermis and dermis (pressure soar) Scale- thin flake of epidermis (dandruff, psoriasis) Lichenification- thickening and roughing of skin (chronic scratching)

10 Glossary of Terms Diameter < 1 cm Description Diameter > 1 cm Macule- flat circumscribed discoloration of the skin- Patch Papule- elevated circumscribed solid lesion- Plaque Nodule- solid lesion that can be level with, above, Tumor or beneath the skin Vesicle- circumscribed elevation of the skin Bullae containing serous fluid Petechiae circumscribed skin deposit of blood Purpura or heme-pigments

11 Primary Lesions May arise from previously normal skin Macules, patch, papule, plaque, nodule, wheal, vesicle, bulla, pustule

12 Macules Flat, circumscribed, nonpalpable Small-up to 1 cm Freckle Petechia Patch Flat spot 1 cm or larger

13

14

15 Patch Flat Nonpalpable >1 cm Examples- Birthmark Café-au-lait spot Mongolian spot Port wine stain Tinea versicolor Vitiligo

16 Papules Palpable elevated solid mass Up to 1 cm Examples: Elevated nevus Basal call carcinoma Seborrheic keratosis

17

18

19 Plaque Elevated superficial lesion 1 cm or larger Coalesced papules Examples: Eczema Psoriasis

20 Nodule Marble like lesion Larger than.5 cm Deeper and firmer than papule Examples: Lipoma Cyst

21

22 Wheal Irregular Transient Superficial Example: Hives

23

24 Vesicle Circumscribed superficial elevation of the skin formed by free fluid Up to 1 cm Filled with serous fluid Examples: Herpes simplex Blister

25 Bulla Larger lesion > 1 cm Circumscribed, elevated Filled with serous fluid Examples: Blister 2 nd degree burn

26

27 Pustule Circumscribed, elevated Filled with fluid Examples: Acne Impetigo

28

29

30

31 Secondary Lesions Result from changes in primary lesions Erosions, crust, ulcer, scale, fissure

32

33

34

35

36

37 Atopic Dermatitis

38 Skin Lichenification

39 Excoriation

40 SHAPE Round Oval Polygonal Annular Iris Serpiginous Umbilicated

41 ARRANGEMENT Annular- in a ring (lyme disease) Confluent or coalescent- multiple lesions blending together (multiple skin conditions) Reticular- netlike cluster (multiple) Dermatomal- along a neurocutaneous dermatome (herpes zoster) Linear- in streaks (poison ivy)

42 DISTRIBUTION Extent- isolated, localized, regional, generalized, universal Pattern- symmetrical, exposed areas, sites of pressure, follicular localization, random

43 Round or oval

44 Discrete

45 Grouped

46 Linear

47 confluent

48

49 Distribution of lesions Diffuse/generalized Scattered Localized Regional Extensor surfaces (psoriasis) Flexor surfaces (intertrigo) Dermatome (herpes zoster) Hair areas (herpes type, pediculosis pubis) Intertriginous areas (folds of skin-diaper rash) Sun exposed areas

50 Inspection of Hair Color Quantity Distribution Texture Condition of scalp Lesions or pediculosis

51 Inspection of Nails Color Condition Angle of attachment Abnormalities

52

53

54

55 Palpation of Hair & Nails Scalp mobility Scalp tenderness, masses Texture of hair & nails Capillary refill

56 TYPES of TINEA Ringworm Tinea capitis- scalp. Can have alopecia. Topical does not work, must use systemic therapy- Grisactin Tinea pedis- most common, interdigital. Athletes foot Tinea Corpris- ringworm of body- annular lesions with scaly border Tinea Cruris- fan shaped, red scaly patches on groin, jock itch Tinea Unguium- onychomycosis, nails. Need lengthy systemic drug. Difficult to treat topically. Tinea Manuum- hand Tinea Versicolor- fine scales on lesions, usually hypopigmented skin. Treatment- Selsun Blue or Head and Shoulders- apply for 20 mins/day for two weeks and wash off. Ketoconazole 400mg BIDx1 day

57 Tinea Corporis

58 Tinea Pedis

59 Tinea Cruris

60 Tinea Capitis

61 Tinea Versicolor

62 Tinea Incognito

63 Tinea Incognito

64 Tinea Unguinum

65 Vitiligo

66 SKIN INFESTATIONS Scabies- tend to burrow in areas of warmth. excoriated papules on the interdigital area, axillary folds, the belt line, areolae, the scrotum, and the penis Close personal contact with an infected person is usually needed to contract this communicable disease. Prescribing Elimite (preferred treatment) requires pt teaching that the itching often persists for a few weeks after successful treatment. Must be applied from the neck down overnight (left on 8-14 hours to be effective).

67 Scabies

68 SCABIES

69 Cutaneous Larva Migrans

70 Cutaneous Larva Migrans

71 Pediculosis

72 Cat Scratch Fever

73 Impetigo

74 Impetigo

75 Cellulitis Inflammation Infection of the skin and soft tissues Most common organism is group A beta-hemolytic streptococci and S. aureus At risk= diabetes, circulatory problems, liver disease, skin disorders with break in skin such as psoriasis Inflammation causes swelling, red, warmth, and pain. May also cause streaking and/or drainage of clear fluid or pus Treatment includes elevate to relieve pain, cool, wet compresses, and PCN resistant antibiotic such as Cephalexin Return for treatment if not improved by 2-3 days of antibiotic therapy

76 Cellulitis

77 Cellulitis

78 Viral Infections Herpes simplex- Type I is above waist; Type II is below. Resides latent in nerve roots. Reactivated by sun, trauma, infections, fever or stress. Lesions are grouped vesicles on a red base, painful, lasts 7-10 days. Type I lesions are on lips, face, mouth or throat. Type II are on penis, vulva, or anus with headache, fever, fatigue. Treatment no cure. Acyclovir or Valtrex are most often used

79 Herpes Simplex Type I

80 Viral Infections Varicella- chicken pox, highly contagious, airborne droplets or fluid. Contagious two days prior to lesion formation. Vaccine available. Treat with oral antivirals for 5days. Considered safe once all vesicles are crusted over. Herpes Zoster- shingles, grouped linear vesicles on one side. Can not get zoster from someone else with zoster. Can get chicken pox if never had it. Runs course in 4 weeks. Treatment is symptomatic for pain and itching, hot soaks and calamine lotion. May prescribe antivirals.

81 Chickenpox (Varicella)

82 Herpes Zoster (Shingles)

83 Herpes Zoster (Shingles)

84 Herpes Zoster

85 Smallpox

86 Coxsackie Virus - Hand, Foot, & Mouth Disease

87 Erythema Infectiosum

88 Viral Exanthems First disease Measles virus Rubeola, Measles, Hard measles, 14-day measles, Morbilli Second disease Streptococcus pyogenes Scarlet Fever, Scarlatina Third disease Rubella virus Rubella, German measles, 3-day measle Fourth disease possibly Staphylococcus aureus Filatow-Dukes' Disease, Staphylococcal Scalded Skin Syndrome, Ritter's disease Fifth disease Erythrovirus (Parvovirus) B19 Erythema infectiosum Sixth disease Human Herpes Virus 6B or Human Herpes Virus 7 Exanthem subitum, Roseola infantum, "Sudden Rash", rose rash of infants, 3- day fever

89 Fifth Disease

90 Pityriasis Rosea

91 Pityriasis Rosea

92 Roseola

93 Roseola Infantum

94 Rubeola - Measles

95 Rubella German Measles

96 Molluscum Contagiosum

97 Molluscum Contagiosum

98 Scarlet Fever

99 Scarlet Fever

100 Scarlet Fever

101 DERMATITIS Atopic dermatitis or eczema is a type one hypersensitivity reaction. Most common sites for the adult is flexor surfaces; Infant is the face Diagnosis includes presence of itching and scratching Most important type of skin care is application of lubricants, minimizing skin dryness by limiting soap and water exposure, and avoiding offending agents Common trigger agent for contact dermatitis is nickel

102 Contact Dermatitis Poison Ivy

103 ECZEMA

104 Eczema

105 URTICARIA Condition in which eruptions of wheals or hives occur most often in response to an allergen Most common cause is a Type I hypersensitivity reactioneosinophilia Most effective treatment is avoidance of the offending agent, as well as antihistamines and steroids

106 SUSPICIOUS MOLES The American Cancer Society has proposed the mnemonic ABCD Asymmetry Border irregularity Color variation Diameter greater than 6mm Evolution can be added. The history of a changing mole is the single most important historical reason for close evaluation and possible referral

107 ACNE ROSACEA More common in middle age to older adult Causes changes in skin color, enlarged pores, and thickening of the soft tissue of the nose Skin lesion classified as pustular

108 Rosacea

109 Rosacea Granulomatous

110 Rosacea

111 Rosacea Steroid