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79 Cards in this Set
- Front
- Back
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What are the primary functions of the skin? |
protection sensation metabolism thermoregulation communication |
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What are the two most common skin problems with patients in nursing homes? |
xerosis: dry skin pruritus: dry skin becomes scaly and itchy, natural moisture is drawn out of the skin |
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What are the changes that occur to the skin as we age? |
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What is a rash? |
temporary eruptions of skin |
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What is a lesion? |
pathological or traumatic loss of normal tissue continuity, structure, or function |
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What are primary lesions? |
-the first things to appear -may progress to secondary lesions Macules, Patches, Papules, Plaques, Nodules, Tumors, Wheals, Vesicles, Bullae, Pustules |
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Pictures of primary lesions: |
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What primary lesions are nonpalpable, flat changes in skin color? |
Macule: small, < 1 cm Patch: larger, > 1 cm |
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What primary lesions are superficial elevations formed by fluid within a cavity or between tissue layers? |
Vesicle: <0.5 cm, serous-filled Bulla: vesicle > 0.5 cm Pustule: any size, filled with purulent material |
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What primary lesions are palpable, elevated solid masses? |
Papule: small, < 0.5 cm Plaque: larger, > 0.5 cm, can be coalescence of papules Nodule: 0.5-2.0 cm, deeper and firmer than papule Tumor: nodule >2 cm Wheal: localized skin edema, irregular, transient, superficial, variable size |
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What are secondary lesions? |
depressed and manifest below the plane of the skin Scales, crusts, excoriations/abrasions, fissures, erosions, ulcers, scars |
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What is the acronym for DERMATOLOGICAL? |
D: describe integrity E: Edema R: review sensory status M: moisture A: atrophic changes T: tugor, texture O: observe nail and hair quality L: look and feel for color and temperature variations O: observe skin folds and between toes G: gerontoderatological changes I: inquire about allergies and PMH C: callus A: assess vascular status L: lesions |
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What is eczema and dermatitis? |
inflammatory skin response to an injurious agent Eczema (endogenous) Dermatitis (exogenous) |
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What does the patient present with if they have eczema or dermatitis? |
-xerosis -poorly defined patches, papules, and plaques with or without scales -skin appears edematous -exoriations due to pruritus/constant scratching |
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What does the pt. present with if they have chronic eczema or dermatitis? |
-may have thickened skin (lichenification) -neck, flexor surfaces, eyelids, forehead, face, and dorsal of hands and feet |
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What is the treatment for eczema and dermatitis? |
identify and remove causative agents -pt. with suspected dermatitis should be referred to physician |
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What are the types of dermatitis, and the treatment considerations? |
Allergic: determine irritant and avoid exposure Contact: determine irritant and avoid exposure Hand: topical steroids Seborrheic: topical hydrocortisones Stasis: leg elevation, compression garments, exercise, topical agents |
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Picture of contact dermatitis: |
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What is Urticaria? |
Hives pruritic edematous pink or red wheals -can be acute or chronic -associated with foods, meds, allergens, or chemicals; cold pack or adhesive -if severe MD may prescribe antihistamine |
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What is Psoriasis? |
chronic, recurrent inflammatory disease -inherited -round, erythematous, dry, scaling plaques covered by silvery white scales -pusutlar and nonpustular types -pt. may also have psoriatic arthritis -NO CURE |
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What are the common locations of psoriasis? |
scalp, nails, extensor surfaces of extremities, elbows, knees, umbilical, and sacral regions |
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What is the treatment for psoriasis? |
NO CURE -can convert the disease from active to latent stage -systemic and topical steroids adn immunosuppressives -ultraviolet therapy, coal tar products |
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What are benign neoplasms and hyperplasias? |
-broad classification of a variety of skin conditions Be aware of -benign presentations -malignancies -other cutaneous diseases requiring immediate medical attention |
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What is the ABCDE method to detect melanomas? |
A: asymmetrical-most early melanomas B: border-most melanomas are uneven C: color- shades of brown, tan, black D: diameter >6mm, larger than common moles E: Elevation or Evolving- changing in size, shape, color, bleeding, crusting |
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What are Nevi? |
Moles if develop rapidly, change in size/color, weep, bleed, or are pruritic, refer to a physician |
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What are Mongolian spots? |
Congenital blue-gray macular lesions typically on the lumbosacral area -common in americanindian and asian infants -disappear in early childhood |
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Picture of Mongolian spot: |
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What are capillary hemangiomas? |
Disorder of blood vessels, benign, soft lesions -disappear by age 5 -bright red or deep purple vascular nodules or plaques |
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Picture of hemangiomas: |
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What are port-wine stains? |
Disorder of blood vessels Irregularly shaped, red, macular vascular malformations present at birth -commonly on neck, forehead, glabella, or eyelids -treatment usually not necessary but some do seek it (laser) |
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picture of port- wine stain: |
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What are cherry angiomas? |
Disorder of blood vessels -asymptomatic, bright red, domed lesions -benign -typically on the trunk -seen in older patients |
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picture of cherry angiomas: |
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What are seborrheic Keratosis? |
-most common benign epithelial tumors -initially flat, well-demarcated, small, brown bigmented areas -over time become raised, darker, with soft crumbly surface -common in elderly persons |
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What are skin tags? |
Cutaneous papillomas or fibromas -soft, round, skin color or tan or brown benign tumors ranging from 1 mm to 10 mm -these do not warrant medical treatment -common in elderly or obese -avoid torsion with manual therapy/modalities |
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What are lipomas? |
seborrheic keratosis/skin tags -single or multiple fatty tumors -develop slowly, easily movable beneath skin -painless |
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What are dermatofibromas? |
Seborrheic Keratosis and Skin tags -button like nodules -commonly on extremities -positive 'dimple sign' -pinching lesion creates dimple within lesion |
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How does skin cancer occur? |
exposure to ultraviolet rays, harsh weather conditions, leisure activities in the sun, and decreases ozone layer have contributed to increase in skin cancers |
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What are the types of skin cancers? |
Basal cell carcinoma Squamous cell carcinoma malignant melanoma Kaposi's sarcoma *should be referred to physician |
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What is the criteria of suspicious lesions (skin cancer) |
rapid growth over weeks to months diameter >6 mm changes in pigmentation inflamed margin irregular, ragged borders crust formation bleeding pruritus |
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What is basal cell carcinoma? |
•Most common form of skin cancer •Small, pink or flesh-colored nodules •Enlarge over time •May have central depression or ulcerate •Can be hard to distinguish from normal aging •Aggressively excised as can extend into deep tissues •Limited ability to metastasize •80% present on the head, neck, and face |
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What is squamous cell carcinoma? |
•Malignanttumor of the outer epidermis •Scaly,elevated lesions with irregular borders and shallow central ulcers •Intraepidermal(local) and invasive (metastatic)•40%of patients will have recurrence •2–6%will metastasize •Treatment:surgical excision or cryotherapy |
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Picture of basal cell and squamous cell carcinoma: |
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What are malignant melanomas? |
•Rapidlyprogressing, metastatic melanocyte CA•Irregularborders, uneven surfaces, black or brown •Red,inflamed, tender surrounding area •Maybleed or ulcerate •Allsuspicious tumors are surgically excised with wide margin, may require skingraft to close •Immunotherapy,chemotherapy, or radiation therapy may be initiated if the disease metastasizes •Early recognition is essential |
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Picture of benign vs. malignant melanomas: |
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What are Kaposi's Sarcoma? |
•Malignancyof cells lining blood vessels •KSis linked with Herpes virus 8 and HIV•Beginsas an ecchymotic-likemacule •Evolvesinto papules, plaques, nodules, and tumors of varying colors •Lesionscan be local or widespread •Mayinvolve lymph nodes •Noncontagiouseven if open |
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What are the normal skin color biochromes? |
4 -melanin (brown) -carotenoids (yellow) -oxyhemoglobin (red) -reduced hemoglobin (blue) *skin color is determined by combination of the above, but melanin is main determinant |
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What are the cutaneous pigmentary disorders? |
Albinism Vitilligo Melasma Ephilides (freckles) Lentigines (liver spots) |
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What is albinism? |
–Congenital disorder affecting skin, hair, and eyes –Lack the enzyme to synthesize melanin –Presents as pale or pink skin, yellow or white hair, and light-colored eyes –Individuals with disorder are highly susceptible to sunburn/sun damage |
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What is vitilligo? |
–Loss of melanocytes –Distinct borders on face, neck, axillae,extremities –Inherited and found in people withthyroid disease, pernicious anemia, and diabetes –Some patients have spontaneous repigmentation –Cosmetic interventions available |
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Picture of vitilligo: |
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What is Melasma? |
–Acquired light or brown hyperpigmentation –Frequently on the face –Causes: •Exposure to sunlight – this may also exacerbate the condition if already present •Pregnancy •Oral contraceptives •Idiopathic –May disappear after cessation of contraceptives or childbirth |
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What are Ephilides? |
Freckles –Indicatesskin damage from sun exposure –Monitorfor subtle changes that may indicate pathology |
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What are Lentigines? |
Liver Spots –Smallbrown lesions –Inareas frequently exposed to sun •Backof hands, neck, and face |
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What are the systemic disorders that affect the skin? |
Systemic Lupus Erythematosus Discoid Lupus Erythematosus Scleroderma |
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What is Systemic lupus erythematosus? |
•Women > Men, Caucasion < African American –Progressive disease mainly involving internal organs –Cutaneous involvement in 80% of cases •Butterfly facial rash •Nail changes •Macular eruptions on the trunk •Oral mucosa lesions |
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What is Discoid Lupus Erythematosus? |
–Chronic dermatological disease without organ involvement –Most commonly affects neck and face –Psoriasiform or annular skin lesions –Protect from sun with sunscreen and clothing –MD can prescribe topical corticosteroids |
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Picture of Discoid lupus erythematosus? |
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What is scleroderma? |
–Slow, progressive, inflammatory,incurable disorder –Involves the skin and internal organs –Skin becomes hard, smooth, hypopigmented, andstiff –Physical therapy interventions mayinclude daily ROM, manual therapy, warming modalities |
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Picture of scleroderma: |
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What are the common causes of cutaneous drug reactions? |
-sulfa-based drugs -penicillin -anticonvulsants -NSAIDs |
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What is TENS, Steven-Johnson Syndrome? |
Reaction to life-threatening adverse cutaneous drug reaction |
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What are the common bacterial integumentary infections? |
-Impetigo and Ecthyma -Abscess, furuncle, carbuncle -cellulitis |
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What is Impetigo and Ecthyma? |
S. aureas and S. pyogenes can cause superficial infections of the epidermis (impetigo) or extend into the dermis (ecythma) |
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What is impetigo? |
common nskin infection in children -bullous impetigo: most common form, blistering on exposed parts of the body that rupture, leaving crusted erosions that last days to weeks W |
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What is Ecthyma? |
frequently found on the LE of debilitatted pt. -last weeks to months |
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Picture of Impetigo/Ecthyma: |
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What is an abscess? |
begins as a tender red nodule that develops into purulent material with fluctuance -continuum of infectious severity due to S. aureus |
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What is a Furuncles? |
Boils firm, tender nodules near hair follicles, 1-2 cm in diameter |
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What is a Carbuncle? |
Deep extensions of two or more coalescing furuncles (boils) Treatment: antibiotics, moist heat, incision and drainage, topical agents and dressings |
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What is cellulitis? |
Acute infection of the dermis and subcutaneous tissue -localized tenderness and induration, along with fever, malaise, chills, and regional adenopathy -can be severe and require hospitalization -Treatment: superficial debridement, topical meds, and bandages may be administered |
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What are the common viral integumentary infections? |
-Varicella-Zoster (chickenpox & shingles) -Tinea Pedis (athletes foot) -Candidiasis (yeast infection) |
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What is the Varicella-Zoster virus? |
Human herpes virus that is responsible for Chicken pox and shingles -spread by airborne particles or by contact |
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What is chicken pox? |
Varicella-zoster virus Pruritic macules or papules that become vesicles -after infection, virus lies dormant in the dorsal root ganglia |
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What is shingles? |
Varicella-zoster virus When the virus is reactivated through illness or stress, causing erythematous papules and vesicles along the corresponding dermatome Treatment: use of antiviral agents or corticosteroids |
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What is Tinea Pedis? |
Athlete's foot –Affects primarily the interdigital spacesand plantar feet, but can be in other locations –Characterized by erythema, pruritus,scaling, maceration, and/or bulla formation –Contracted by walking barefoot or wearingocclusive footwear –Spores can live up to 1 year in skinscales –Treatment:antifungals (topical, sometimes systemic) –Prevention:proper foot hygiene and footwear |
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What is Candidiasis? |
Yeast infection –Candida normal microflora in the mouth,gastrointestinal tract, and vagina –Uncontrolled proliferation results inlocal infection especially in skin folds or under occlusive dressings –Red, pustular, well-defined scalingeruptions on skin –White, cheesy adherent masses on mucosa –High risk: those with decreased immunity,diabetes, infection, chronic steroid use, those who work with frequent exposureto water, long course of antibiotics –Treatment: antifungals (topical,sometimes systemic) –Prevention: proper hygiene, protect fromexcessive moistureviIAcnq2 |
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What are the causes of nail disorders? |
-trauma -infection -systemic disease |
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What is the treatment for nail disorders? |
-topical medications -if severe, surgical nail removal -if systemic cause, address underlying pthology |
