Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 18 Integumentary System...

Chapter 18

Integumentary System Diseases and Disorders

Anatomy and Physiology

• Skin– Largest organ of body

– First line of protection for body against invading organisms

– Provides sense of touch, heat, cold, and pain

Anatomy and Physiology

• Skin– Helps stabilize temperature, fluid, and electrolyte balance

– Three layers:• Epidermis

• Dermis

• Subcutaneous

Animation

Click Here to Play Skin Animation

Common Signs and Symptoms

• Skin lesions

• Pain

• Pruritus

• Edema

• Erythema

• Inflammation

Diagnostic Tests

• Biopsy

• Culture and sensitivity

• Blood tests

• Microscopic smear examinations

Infectious Diseases: Viral

• Herpes– Large family of viruses

– Symptoms:• Inflammation of skin

• Clusters or fluid-filled vesicles

– Periods of remission and exacerbation

– No cure• Remains in affected individual’s body for life

• Herpes– Common types:

• Herpes simplex 1– Fever blisters

– Cold sores

• Herpes simplex 2/Herpes genitalis– Genital herpes

• Herpes– Common types:

• Herpes varicella– Chickenpox

• Herpes zoster– Shingles

Herpes Simplex Virus 1

Photo courtesy Robert A. Silverman, MD, Pediatric Dermatology, Georgetown University

• Verrucae– Also known as warts

– Chronic condition

– Occur in multiples and differ in size, shape, and appearance

– Often resistant to treatment

• Verrucae– Common types:

• Appearance on hands and fingers of children

• Appearance on sole of foot– Plantar warts

• Sexually transmitted– Genital warts

Verrucae

Photo courtesy Mark L. Kuss

Infectious Diseases: Bacterial

• Impetigo– Streptococcus and staphylococcus

– Affects face and hands of children

– Symptoms:• Vesicles

• Pustules that rupture– Producing yellow crust over lesions

• Impetigo– Treatment:

• Cleansing

• Antibiotic ointment

• Folliculitis– Inflammation and infection of hair follicle

– Common cause:• Staphylococcus

– Symptoms:• Small pustules surrounding hair

– Treatment:• Antibiotics

Folliculitis

• Abscess, furuncle, and carbuncle– Inflammation, infection, and formation of capsule prevent

spread of infection

• Cellulitis– Diffuse or spreading inflammation of skin and

subcutaneous tissue

– Causes:• Streptococcus

• Staphylococcus

• Cellulitis– Prevention:

• Good handwashing

• Cleansing of open areas on skin

• Erysipelas– Acute infection of dermis extending to fat tissue

– Causes:• Most commonly Group A streptococcus

– Treatment:• Oral or IV antibiotics

• Lyme disease– Multisystem infections transmitted to humans through bite

of infected deer tick

– Symptoms:• Flu-like symptoms

• Arthritis

• Malaise

• Lyme disease– Symptoms:

• Chills

• Fever

• Bull’s eye skin rash

– Symptomatic treatment:• Antibiotics

• Methicillin-resistant staphylococcus aureus (MRSA)– Both hospital- and community-acquired

– Diagnosed by culture and drug sensitivity testing

– Resistant to antibiotics commonly used

– Treatment:• Vancomycin

Infectious Diseases: Fungal

• Tinea– Also known as ringworm

– Infects warm, moist areas of body

– Feeds on perspiration and dead skin

– Symptoms:• Itching, cracking, and weeping of skin

• Tinea– Treatment:

• Keep affected area clean and dry

• Use antifungal agents

• Tinea– Types:

• Tinea corporis– Affects smooth skin on arms, legs, and body

• Tinea pedis– Athlete’s foot

• Tinea cruris– Jock itch

• Tinea– Types:

• Tinea unguium– Affects fingernails or toenails

• Tinea capitis– Affects scalp

• Tinea barbae– Affects bearded areas

Tinea Pedis

Photo courtesy Centers for Disease Control and Prevention

Tinea Unguium

• Candidiasis– Fungal infection

– Cause:• Candida

– Symptoms:• Red, itchy skin with blisters and pustules

– Treatment:• Antifungal medications

Infectious Diseases: Parasitic

• Pediculosis– Infestation with lice

– Treatment:• Bathing and shampooing with medicated shampoo

– E.g., Kwell

• Pediculosis– Types:

• Head

• Body

• Pubic

• Scabies– Caused by tiny mite

– Also known as seven-year itch

– Symptoms:• Slightly elevated, grayish-white lines

• Intense itching

• Vesicles

• Pustules

• Scabies– Treatment:

• Lindane cream to entire body

Scabies

Metabolic Diseases

• Acne vulgaris– Inflammation of sebaceous glands and hair follicles

– Symptoms:• Comedones

Metabolic Diseases

• Acne vulgaris– Treatment:

• Cleansing

• Over-the-counter (OTC) treatments

• In severe cases, antibiotics, steroids, and Retin-A preparations

Metabolic Diseases

• Seborrheic dermatitis– Affects sebaceous glands

– Also known as cradle cap in infants

– Also known as dandruff when affecting scalp

Metabolic Diseases

• Seborrheic dermatitis– Symptoms:

• Reddened, itchy areas

• Scales

– Treatment:• Wash and dry

• Steroid creams

Seborrheic Dermatitis

Metabolic Diseases

• Sebaceous cyst– Sebaceous gland becomes blocked and sebum collects

under skin

– Special type:• Pilonidal cyst

– Treatment:• Incising and draining

• Surgical removal

Hypersensitivity or Immune Diseases

• Eczema– Inflammation of skin

– Symptoms:• Itching

• Redness

• Vesicles

• Pustules

• Eczema– Symptoms:

• Scales

• Crusting

– Treatment:• Topical cortisone

• Antihistamines

• Sedatives

Eczema

• Urticaria– Also known as hives or nettle rash

– Vascular reaction of skin

– Causes:• Irritants

– Treatment:• Antihistamines

• Avoidance of allergen

• Contact dermatitis– Acute or chronic allergic reaction of skin

– Causes:• Cosmetics

• Laundry products

• Jewelry

• Contact dermatitis– Symptoms:

• Pain

• Small red localized lesions to vesicular lesions

• Scleroderma– Hardening, thickening, and shrinking of connective tissues

• Including skin

– Autoimmune reaction

Idiopathic Diseases

• Psoriasis– Chronic skin disease

– Symptoms:• Red, raised lesions with distinct borders and silvery scales

– Treatment:• Coal tar medications

• Ultraviolet light

• Steroids

Psoriasis

Idiopathic Diseases

• Rosacea– Chronic skin condition

– Symptoms:• Redness of forehead, nose, cheeks, and chin

– Treatment:• Avoid triggers

– E.g., sun exposure

– No cure

Benign Tumors

• Seborrheic keratosis– Benign overgrowth of epithelial cells

– Symptoms:• Tan or brown growths

• Warty scale appearance

– Treatment:• Curettage

– Scraping off

Benign Tumors

• Keloid– Raised, firm, irregular-shaped scar tissue following trauma

or surgery

– Treatment:• Surgical removal

Benign Tumors

• Hemangioma– Congenital benign tumor of small blood vessels that form

purplish birthmark

– Common types:• Port wine stain

• Strawberry hemangioma

• Cherry hemangioma

Premalignant and Malignant Tumors

• Actinic keratosis– Premalignant condition

– Common in fair-skinned individuals

– Symptoms:• Wart-like lesions on sun-exposed areas

• Actinic keratosis– Treatment:

• Topical medication– E.g., Retin-A

• Curettage

• Cryotherapy

• Basal cell carcinoma– Most common type of skin cancer

– Slow-growing, locally invading tumor that does not metastasize

– Treatment:• Surgical removal

Basal Cell Carcinoma

• Squamous cell carcinoma– Tends to occur in sun-exposed areas

– Symptoms:• Firm red nodule with crusts or slightly elevated plaque

– Treatment:• Wide surgical excision

• Radiation

Squamous Cell Carcinoma

• Malignant melanoma– Most serious type of skin cancer

– Symptoms:• Change in size and color of mole

– Rarely occurs before age 20

– May be related to severe sunburn as child

Malignant Melanoma

• Malignant melanoma– Treatment depends on degree of spread:

• Wide surgical excision

• Radiation

• Chemotherapy

• Kaposi’s sarcoma– Malignant vascular skin tumor

– Bluish-red cutaneous nodules

– Treatment:• Treat AIDS

• Liquid nitrogen

• Radiation

• Chemotherapy

Abnormal Pigmented Lesions

• Types:– Ephelis

• Freckle

– Lentigo• Liver spot

– Nevus• Mole

• Types:– Albinism

• Decrease or total absence of pigment in skin, hair, and eyes

– Melasma• Dark patches of skin on face

– Especially cheeks

• Types:– Vitiligo

• Destruction of melanocytes in small or large patches of skin

Diseases of the Nails

• Abnormal shape, thickness, and color

• Causes:– Most commonly fungal and bacterial infections

• Treatment:– Bacterial infections treated with antibiotics

– Fungal infections treated with antifungal medications

Diseases of the Hair

• Hirsutism– Excessive growth of hair

• Alopecia– Partial or complete hair loss

Mechanical Skin Injury

• Abrasion– Scraping away skin surface

• Blunt trauma– Contusion by item

• E.g., hammer, club

– Thrown into item• E.g., steering wheel, wall

• Avulsion– Skin or appendage pulled or torn

• Crush trauma– Tissue caught between two hard surfaces

• Puncture injury– Sharp object forced into tissue

• Laceration– Cut in skin caused by sharp object

Thermal Skin Injury

• Hyperthermia– Body overheated due to excessive exposure to sun or heat

– Types:• Heat exhaustion

• Heat stroke

Thermal Skin Injury

• Burns– First degree:

• Pain, redness, and swelling

– Second degree:• Pain, redness, swelling, blisters, and open wounds

– Third degree:• Charred and broken skin tissue

• Painless

Thermal Skin Injury

• Cold injuries– Not as severe or life-threatening as heat or burn injuries

– Low body temperature

Thermal Skin Injury

• Cold injuries– Symptoms:

• Extreme shivering

• Mental confusion

• Blue or cyanotic extremities

• Weak pulse

Thermal Skin Injury

• Cold injuries– Treatment:

• Remove wet clothing

• Warm body with warm blankets

• Drink warm liquids

– Frostbite• Freezing of tissue

– Usually on face, fingers, toes, and ears

Electrical Injury

• Causes:– Unprotected or inadequately insulated electrical wiring

– Contact with lightning

• Damage has point of entry and exit

Radiation Injury

• Ionizing radiation– E.g., x-rays

• Causes:– Exposure to sunlight

– Tanning beds

– Damage to skin

Pressure Injury

• Decubitus ulcer– Also known as bedsore or pressure sore

– Affects bony areas of body• E.g., heels, sacrum, elbows

– Treatment:• Frequent turning and repositioning

• Massaging of affected area to improve circulation

Pressure Injury

• Corns and calluses– Protective hyperplasias of tissue

– Corns• Often painful

• Most common on feet from ill-fitting shoe

• Can be surgically removed

Pressure Injury

• Corns and calluses– Calluses

• Not usually painful

• Most common on hands

Insect/Spider Bites

• May cause swelling and itching at site

• Venom or poison may cause allergic reaction

• Range from mild to severe– Requires calling 911 for immediate assistance

Insect Bites/Stings

• May be from mosquitoes, flies, fleas, wasps, hornets, yellow jackets, and ants

• Symptoms:– Swelling

– Itching

Insect Bites/Stings

• Usually mild reaction that disappears in hours or one day

• Sever allergic reaction may require immediate intervention

Spider Bites

• Black widow– Most common poisonous spider

• Brown recluse spider– Very dangerous

Spider Bites

• Treatment:– Ice

– Analgesics

– Prompt medical care

Rare Diseases

• Elephantiasis– Hypertrophy of skin and subcutaneous tissue

• Inflammation of lymphatic system results in fluid accumulation

• Causes:– Parasitic worm

Effects of Aging

• Thinning of epidermal layer– Retains less water

• Xerosis

• Decreased function of sweat and sebaceous glands

• Loss of elasticity

Effects of Aging

• Thickening of nails

• Thickening and increased brittleness of hair

• Loss and graying of hair

• Skin lesions

Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 18 Integumentary System...

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