© 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 28: Skin Disorders

© 2011 McGraw-Hill Higher Education. All rights reserved.

Chapter 28: Skin Disorders

Figure 28-1© 2011 McGraw-Hill Higher Education. All rights reserved.

Skin Lesions Defined

• Skin pigment - melanin– Variations may be due to anatomic,

physiologic or pathophysiologic changes in skin blood flow

• Normal skin appearance– Altered by external and internal factors

• Cellulitis– Infectious inflammation of deep skin

structures© 2011 McGraw-Hill Higher Education. All rights reserved.

Figure 28-3© 2011 McGraw-Hill Higher Education. All rights reserved.

Figure 28-4


Skin Trauma

• Mechanical Forces that Cause Injury– Friction

– Compression– Shearing– Stretching– Scraping– Tearing– Avulsing

– Puncturing© 2011 McGraw-Hill Higher Education. All rights reserved.

Friction and Pressure Problems

• Hyperkeratosis of the Hands and Feet– Etiology

• Friction and pressure over bony protuberances• Painful when subcutaneous fat becomes

inelastic

– Sign and Symptoms• Thickening, of horny layer of skin, ovular,

elongated and brown• Painful with pressure


– Management• Avoid emery boards and pumice as the

increase in friction will stimulate skin to produce added callus

• Use moisturizer• Pair off callus with scalpel• Padding

– Prevention• Cushioning devices; wearing 2 socks• Lubricants to reduce friction, shaving calluses• For calluses on hands, special gloves or

protective gear


• Blisters– Etiology

• Result of a shearing force that produces a raised area that accumulates with fluid

– Signs and Symptoms• Hot spot, sharp burning sensation, painful• Superficial area of skin raised with clear fluid

– Prevention• Use of dust or powder or lubricant to reduce

friction• Tubular socks, 2 pairs of socks if feet are

sensitive or perspire excessively• Appropriate shoes that are broken in• Padding and lubricants


– Management (intact blister)• Leave intact for 24 hours• Clean with antiseptic• Cut small incision to drain fluid (large enough

that it won’t re-seal)– Note in some states this is considered a surgical

technique, placing ATC in violation of certain practice acts

• Prevent refilling with a pressure pad• Clean again with antiseptic• Use doughnut to prevent irritation• Monitor for infection, replace wet bandaging• Debridement can be performed when

tenderness is gone© 2011 McGraw-Hill Higher Education. All rights reserved.

– Management (open/torn blister)• Keep clean to avoid infection• Keep skin in place and apply non-adhering

sterile dressing and padding• Monitor daily for infection

– Management (denuded blister)• If blister is torn 1/2 inch or more remove skin

flap• Clean and expose area, apply antiseptic with

occlusive dressing• Second skin can be applied to raw area


• Soft Corns and Hard Corns– Etiology

• Caused by pressure of improperly fitting shoes and anatomic abnormalities

• Soft corns are the result of pressure and perspiration, also associated with exostosis

– Signs and Symptoms• Hard corns form on the tops of toes and tend to be

painful and dry• Soft corns result in thickening of skin, white and

sometimes painful (between 4th and 5th toes)

– Prevention• Wear properly fitting shoes

– Management• Surgical removal if painful• Padding; maintain clean dry feet; wear appropriate

shoes


• Excessive Perspiration (hyperhidrosis)– Etiology

• Syrup-like perspiration, high in sodium chloride• Increases risk of other skin irritation• Makes adherence of bandages difficulty

– Management• Use of astringent such as alcohol or an

absorbent powder• Aluminum chloride or electric current can be

used to treat condition


• Chafing of Skin– Etiology

• Occurs particularly in patients that are obese or heavy limbed

• Result of friction and maceration of skin in climate of heat and moisture

– Signs and Symptoms• Separation of keratin from granular layer of skin• Causes oozing wounds that crust and crack

– Management• Clean area with soap and water and treat with medicated

solution and hydrocortisone cream

– Prevention • Keep skin dry, clean, and friction free• For the groin, soft, loose, cotton underwear is

recommended


• Xerotic (Dry) Skin– Etiology

• Drying of skin due to exposure of cold, excessive bathing, decrease in humidity causing skin to lose water

– Signs and Symptoms• Dry skin w/ variable redness and scaling;

itching

– Management• Prevent water loss and replace lost water• Bathe in tepid water, use moisturizer• If condition worsens, refer to physician


• Ingrown Toenails– Etiology

• Generally occurs in great toe• Nail grows laterally into skin• Result of lateral pressure from shoes, poor nail

trimming, and repeated trauma


– Signs and Symptoms• Pain and swelling• Penetrated skin becomes inflamed and purulent

with lateral nail fold swollen and irritated

– Management• Conservative management includes soaking the

inflamed toe in warm water (20 minutes)• Place cotton under edge of nail to clear from skin• If chronic, remove wedge of nail and apply

antiseptic compress until inflammation resides– Physician may take more aggressive approach

– Prevention • Properly fitting shoes and socks are essential• Weekly toenail trimming (cut straight across)• Leave nail long enough to clear skin


Wounds• Abrasions

– Scraping of skin against rough surface (top surface of skin is worn away)

– Increased probability of infection due to exposure of dirt and foreign material

– Clean and debride

• Punctures– Direct penetration of skin with pointed

object– Must be referred to physician


• Lacerations– Object tears tissue, giving wound

appearance of jagged edge (sometimes result of blunt trauma)

– Presents environment susceptible to infection

• Skin Incision– Smooth cut in skin - not jagged

• Skin Avulsion– Skin torn away from body (should be placed

in moist gauze w/in a plastic bag that is then immersed in cold water)

– Transport to hospital with patient for possible reattachment


• Skin Bruises– Result of blunt trauma; causes disruption

of superficial blood vessels and results in black and blue discoloration

– Treatment requires RICE to control hemorrhaging


Wound Management• All wounds must be assumed contaminated• Pay close attention to all universal precautions• Clean all wounds with soap and water to minimize

infection• Apply a dressing with antiseptic (unless physician

examination is necessary)• Lacerations and punctures should be treated by a

physician• Use of occlusive dressings

– Minimizes scab formation, perceived pain from exposed nerves, cost and time effective, provide adequate barrier

• Antibiotic ointment used to prevent secondary infection (SEE TABLE 28-4 for added instruction)


• If the wound is discharging serum (fluid) to dressing should be changed regularly

• When drainage has stopped = no need for dressing

• Wound should be cleaned with hydrogen peroxide or Betadine– Effective against bacteria and not harmful to fibroblasts

• Antibacterial ointment should be used to limit bacterial growth and to prevent dressing from adhering to wound

• Proper care = minimized inflammatory response with quick healing and reduced scarring


Suturing• Dependent on severity

– Determined by physician– Are underlying tissues exposed or is there significant

bleeding?

• Should be put in as soon as possible– Within 12 hours following injury

• Utilize fine suture material and minimal tightening – Limits additional damage, inflammation and scarring

• Large areas or slow healing areas = larger material to be left in longer

• Occasionally steri-strips or butterfly bandages will suffice


• Alternative techniques involves use of skin adhesive/glue– Creates a bond across the wound edges

allowing for appropriate healing– Can be used to replace small sutures– Seals out infection– Easy to use, provides water resistant

protective coating– Long term cosmetic outcome is

comparable to traditional repair methods


Athletic Training Clinic Practice in Wound Care

• Use clean and sterile instruments• Clean hands thoroughly and use gloves• Sterilize in and around skin lesion• Use a non-medicated covering if athlete is to

be sent for medical attention– Utilize butterfly bandage if suture not required

• Avoid touching any part of sterile dressings that will contact the wound

• Place medication on pad• Secure the dressing in place


Bacterial Infections• Bacteria are single celled micro-organisms

– Spherical, doublets, and spirochetes

• Staphylococcus– Gram positive bacteria that appears in clumps

in skin and upper respiratory tract

• Streptococcus– Chain bacteria often associated with systemic

disease and skin infections

• Bacillus– Spore forming, aerobic, and occasionally

mobile– Can cause systemic damage


Methicillin-Resistant Staphylococcus Aureus (MRSA)

• Etiology– Strains of staphylococcus bacteria that are resistant to

some antibiotics– Often occurs in individuals that are already sick, in

hospital and are ill, have open wounds, or burns– Can occur outside of hospital setting as well

• Signs & Symptoms– Redness, swelling, tenderness of infection site– Some may carry MRSA and not exhibit symptoms

• Management– Antibiotics (higher dose) provided intravenously – Treatment lasts several weeks



• Impetigo Contagiosa– Etiology

• Caused by A-beta-hemolytic streptococci, S aureus or combination of these bacteria

• Spread through close contact

– Signs and Symptoms• Mild itching and soreness followed by eruption

of small vesicles and pustules that rupture and crust

• Generally develops in body folds that are subject to friction

– Management• Cleansing and topical antibacterial agents• Systemic antibiotics



• Furuncles (Boils)– Etiology

• Infection of hair follicle that results in pustule formation

• Generally the result of a staph. infection


– Signs and Symptoms• Pustule that becomes reddened and enlarged

as well as hard from internal pressure• Pain and tenderness increase with pressure• Most will mature and rupture

– Management• Care involves protection from additional

irritation• Referral to physician for antibiotics• Keep patient from contact with other team

members while boil is draining


• Carbuncles– Etiology

• Similar in terms of early stage development as furuncles

– Signs and Symptoms• Larger and deeper than furuncle and has several

openings in the skin• May produce fever and elevation of WBC count• Starts hard and red and over a few days emerges

into a lesion that discharges yellowish pus

– Management• Surgical drainage combined with the

administration of antibiotics• Warm compress is applied to promote circulation


• Folliculitis – Etiology

• Inflammation of hair follicle

• Caused by non-infectious or infectious agents

• Moist warm environment and mechanical occlusion contribute to condition

• Pseudofolliculitis (PFB)


– Signs and Symptoms• Redness around follicle that is followed by

development of papule or pustule at the hair follicle

• Followed by development of crust that sloughs off with the hair

• Deeper infection may cause scarring and alopecia in that area

– Management• Management is much like impetigo• Moist heat is used to increase circulation• Antibiotics can also be used depending on the

condition


• Hidradenitis Suppurativa – Etiology

• Primary inflammation event of the hair follicle resulting in secondary blockage of the apocrine gland

– Signs and Symptoms• Begins as small papule that can develop into

deep dermal inflammation

– Management• Avoid use of antiperspirants, deodorants and

shaving creams• Use medicated soaps and systemic antibiotics


• Acne Vulgaris– Etiology

• Inflammatory disease of the hair follicle and the sebaceous glands

• Sex hormones may contribute

– Signs and Symptoms• Present with whiteheads, blackheads, flesh or red

colored papules, pustules or cysts• If chronic and deep = may scar• Psychological impact

– Management• Topical and systemic agents used to treat acne• Sometimes the use endogenous hormones is

required• Mild soaps are recommended


• Paronychia and Onychia – Etiology

• Caused by staph, strep and or fungal organisms that accompany contamination of open wounds or hangnails

• Damage to cuticle puts finger at risk• Onychia is an infection of the nail bed itself, while

paronychia involves the lateral nail fold

– Signs and Symptoms• Rapid onset; painful with bright red swelling of proximal

and lateral fold of nail• Accumulation of purulent material w/in nail fold

– Management• Soak finger or toe in hot solution of Epsom salt 3 times

daily• Topical antibiotics, systemic antibiotics if severe• May require pus removal through skin incision


• Tetanus Infection (lockjaw)– Etiology

• Acute infection of the CNS and muscles caused by tetanus bacillus

• Bacteria enters through the blood and open wounds

– Signs and Symptoms• Stiffness of the jaw and muscles of the neck• Muscles of facial expression produce contortion

and become painful• Fever may become markedly elevated

– Management• Treat in intensive care unit• Childhood immunization


Fungal Infections

• Group of organisms that include yeast and molds which are usually not pathogenic

• Grow best in unsanitary conditions with warmth, moisture and darkness

• Infections generally occur in keratinized tissue found in hair, nails and stratum corneum

• Dermatophytes (Ringworm fungi)– Cause of most skin, nail and hair fungal

infections© 2011 McGraw-Hill Higher Education. All rights reserved.

• Tinea of the Scalp (tinea capitis)– Signs and Symptoms

• Ringworm of the scalp begins as a small papule that spreads peripherally

• Appears as small grayish scales resulting in scattered balding

• Easily spread through close physical contact

– Management• Topical creams and shampoos are ineffective

in treating fungus in hair shaft• Systemic antifungal agents are replacing older

agents due to increased resistance• Some topical agents are used in conjunction


• Tinea of the Body (tinea corporis)– Signs and Symptoms

• Commonly involve extremities and trunk• Itchy red-brown scaling annular plaque that expands

peripherally

– Management• Topical antifungal cream


• Tinea of the Nail (tinea unguium/ onychomycosis)– Signs and Symptoms

• Fungal infection of the nail -- found commonly in those engaged in water sports or who have chronic athlete’s foot

• Nail becomes thick, brittle and separated from its bed

– Management• Some topical antifungal agents have proved

useful • Systemic medications are most effective• Surgical removal of nail may be necessary if

extremely infected


• Tinea of the Groin (tinea cruris)– Etiology

• Symmetric red-brown scaling plaque with snake-like border

– Signs and Symptoms

• Mild to moderate itching

• May progress to secondary bacterial infection


– Management• Treat until cured• Will respond to many of the non-prescription

medications• Medications that mask symptoms should be

avoided• Failure to respond to normal management may

suggest a non-fungal problem (such as bacteria) and should be referred to a physician

• May require additional topical medications and oral prescriptions


• Athlete’s Foot (tinea pedis)– Etiology

• Most common form of superficial fungal infection• Trichophyton species are most common cause of

athlete’s foot• Webs of toes may become infected by a

combination of yeast and dermatophytes

– Signs and Symptoms• Extreme itching on soles of feet, between and on

top of toes• Appears as dry scaling patch or inflammatory

scaling red papules forming larger plaques• May develop secondary infection from itching and

bacteria

– Management• Topical antifungal agents and good foot hygiene


• Candidiasis (Moniliasis)– Etiology

• Yeast-like fungus that can produce skin, mucous membrane and internal infections

• Ideal environment includes hot humid weather, tight clothing, and poor hygiene

– Signs and Symptom• Infections w/in body folds

• Presents as beefy red patches and possible satellite pustules

• White, macerated border may surround the red area; deep painful fissures may develop at skin creases

– Management• Maintain dry area

• Use antifungal agents to clear infection© 2011 McGraw-Hill Higher Education. All rights reserved.

• Tinea Versicolor– Etiology

• Caused by a yeast• Appears commonly in areas in which sebaceous glands

actively secrete body oils

– Signs and Symptoms• Fungus produces multiple, small, circular macules that

are pink, brown, or white• Commonly occur on chest, abdomen, and neck• Do not tan when exposed to sun and usually are

asymptomatic

– Management• Straightforward treatment - recurrences are common• Use selenium shampoo (Selsun) and topical econazole

nitrate (or something similar)• When microorganism has been eradicated, re-

pigmentation of the area will occur© 2011 McGraw-Hill Higher Education. All rights reserved.


Viral Infections

• Ultramicroscopic organisms that require host cells to complete their life cycle– May stimulate cell chemically to produce

more virus until host cell dies– Lies within bud-like structure that does not

damage cell or virus, w/out causing infection

• A number of skin infections are caused by viruses


• Herpes Simplex Labialis, Gladiatorum, and Herpes Zoster– Etiology

• Highly contagious and is usually transmitted directly through a lesion in the skin or mucous membrane

• Resides in sensory nerve neurilemmal sheath following initial outbreak

• Recurrent attacks stimulated by sunlight, emotional disturbances, illness, fatigue, or infection

• Type I vs. Type II

– Signs and Symptoms• Early indication = tingling or hypersensitivity in an

infected area 24 hours prior to appearance of lesions• Local swelling followed by outbreak of vesicles• Patient may feel ill w/ headache, sore throat, swollen

lymph glands and pain in area of lesions© 2011 McGraw-Hill Higher Education. All rights reserved.


– Signs and Symptoms (continued)• Vesicles generally rupture in 1-3 days spilling

serous material• Heal in generally 10-14 days• If an athlete has an outbreak they should be

disqualified from competition due to contagious nature of condition

– Management• Herpes simplex lesions are self limiting -

reduce pain and promote early healing• Use of antiviral drugs can reduce recurrence

and shorten course of outbreak

– Complications • Can lead to secondary infection if not managed

carefully© 2011 McGraw-Hill Higher Education. All rights reserved.

Verruca Virus and Warts

• Variety of forms exist– verruca plana (flat wart), verruca plantaris

(plantar wart), and condyloma acuminatum (venereal wart)

• Different types of human papilloma virus have been identified– Uses epidermal layer of skin to reproduce

and grow

• Wart enters through lesion in skin© 2011 McGraw-Hill Higher Education. All rights reserved.

• Common Wart– Signs and Symptoms

• Small, round, elevated lesion with rough dry surfaces• Painful if pressure is applied• May be subject to secondary bacterial infection

– Management• If vulnerable, they should be protected until treated

by a physician• Use of electrocautery, topical salicylic acid or liquid

nitrogen are common means of managing this condition


• Plantar Warts– Etiology

• Spread through papilloma virus

– Signs and Symptoms• Located on sole of foot, or adjacent to areas of

abnormal weight bearing• Areas of excessive epidermal thickening• Discomfort, point tenderness• Hemorrhagic puncta (black seeds)

– Management• In general, protect and prevent spreading• Pair away callus and apply Keratolytic • Following season, wart can be removed by

freezing it or by electrodessication (maintain protection until removal)


• Molluscum Contagiosum – Etiology

• Poxvirus infection which is more contagious than warts (especially during direct body contact)

– Signs and Symptoms• Small, flesh or red colored, smooth-domed

papules with central umbilication

– Management• Physician referral is necessary• Cleansing and destructive procedure

(counterirritant such as cantharidin, surgical removal or cryosurgery)



Allergic, Thermal, and Chemical Skin Reactions

• Allergies are immunologically mediate responses to molecules in dyes and proteins against which the body’s immune system is sensitized

• Allergens may be food, drugs, clothing, dusts, pollens, plants, animals, heat, cold, or light

• The skin will reflect an allergy in many ways such as reddening and swelling of the tissue, urticaria or hives, burning or itching

• Athletic trainers must recognize gross signs of allergic responses and be prepared to remove allergens and treat topically or systemically with antipruritic agents


• Contact Dermatitis (allergic and irritant)– Etiology

• Plants are the most common cause (poison ivy, poison oak, sumac, ragweed, primrose)

• Topical medications• Chemicals found in fragrances and preservatives of soaps,

detergents

– Signs and Symptoms• Onset may range from 1 day to 1 week• Redness, swelling, formation of vesicles that ooze fluid

and form crust, constant itching• May change from redness and blistering to erythematous

scaling, lichenified papules and plaques

– Management• Avoid allergen• Tap water compresses or soaks, topical corticosteroids



• Milaria (Prickly Heat)– Etiology

• Continued exposure to heat and moisture causing retention of perspiration by sweat glands

– Signs and Symptoms• Itching and burning vesicles and pustules• Occurs most often on arms, trunks, and

bending areas of the body

– Management• Avoidance of overheating, frequent bathing with

non-irritating soap, wearing loose-fitting clothing and use of antipruritic lotions


• Chilblains (pernio)– Etiology

• Caused by excessive exposure to cold

– Signs and Symptoms• Tissue does not freeze but reacts with edema,

reddening and possibly blistering along with a sensation of burning and itching after exposure to cold

– Management• Exercise and gradual warming of the part• Massage and application of heat are

contraindicated• Some systemic drugs can be used in severe

cases© 2011 McGraw-Hill Higher Education. All rights reserved.

• Sunburns– Etiology

• Inflammatory response to injury caused by ultraviolet solar radiation

• Must be cautious of physical characteristics, chemicals, food and drugs that make individuals more susceptible

– Signs and Symptoms• Varies from erythema to severe blistering• May experience shock if severe enough• Can cause malfunctioning of organs w/in the

skin• Will appear 2-8 hours following exposure, with

symptoms becoming most severe at 12 hours• S&S will dissipate w/in 72-96 hours


• Sunburns (continued)– Management

• Can be prevented through the use of sunscreen (sun protection factor or SPF)

– Filters ultraviolet light– Water/sweat resistant sunscreen is recommended

• Treat a burn according to the degree of inflammation

• Cool water, aloe based solutions• Moisturizers can help with dryness and peeling• OTC’s can help with pain and discomfort• Severe burns require physician assistance


Infestation and Bites• Scabies

– Etiology• Caused by mites which cause extreme nocturnal

itching (tunnels and lays eggs)– Signs and Symptoms

• Appear as dark lines between fingers and toes, body flexures, nipples and genitalia

• Excoriations, pustules and papules caused by itching tends to hide true cause

• Skin develops hypersensitivity to the mite– Management

• Permethrin 5% is treatment of choice• Washing of bedding and clothes is necessary• Topical corticosteroids may be necessary to treat

itching



• Lice (Pediculosis) – Etiology

• Manifestation by the louse (louse of head, pubic region and body)

– Signs and Symptoms• Bites cause itching dermatitis through

subsequent scratching -- promotes pustule and excoriations to develop

– Management• Cure is rapid with use of any number of agents• Good hygiene is paramount• To prevent re-infestation all clothing and

bedding should be washed in hot soapy water or discarded


• Fleas– Etiology

• Small wingless insects that suck blood• Can transmit systemic diseases

– Signs and Symptoms• Great deal of discomfort can be felt if come into

contact with a high number of fleas• Concentrate bites on ankles and lower legs

– Management• Following a bite, itching must be prevented with

antipruritic lotion• Avoid scratching to prevent secondary infection• Insecticides can also be effective


• Ticks– Etiology

• Parasitic insects that have an affinity for blood• Carriers of a variety of microorganisms that can

transmit Rocky Mountain spotted fever and Lyme disease

– Signs and Symptoms• Headaches, fever, malaise, myalgia, and rash,

petechiae and purpura, enlarging annular red ring w/ or w/out central red papule

– Management• Remove tick (mineral oil or fingernail polish)

– Grasping head of tick is an acceptable method

• Systemic treatment is necessary to prevent morbidity and mortality associated with RMSF and Lyme disease


Lyme Disease


• Mosquitoes– Etiology

• Blood suckers that produce bites than can be irritating, itchy, painful

• Can pass along blood-borne illnesses– May be a major health hazard (West Nile virus)

– Signs and Symptoms• Small reddish papule with associated itching

– Management• Topical medication• Use of repellents can also be used on the skin

to prevent contact with mosquitoes


• Stinging Insects– Etiology

• Bees, wasps, hornets, yellow jackets -- inflict venomous sting

• Hypersensitive individuals may experience an allergic reaction

– Signs and Symptoms• If an allergic reaction occurs an increase in

heart rate and breathing will occur, along with chest tightness, dizziness, sweating and even LOC

• Anaphylactic reaction– Hives, sensation of warmth, asthma symptoms,

swelling of mouth and throat, difficulty breathing, vomiting, diarrhea, cramping, blood pressure changes


• Insect Stings (continued)– Management

• To prevent, avoid wearing scented lotions or shampoos, brightly colored clothes, jewelry, suede, or leather, and avoid going barefoot.

• If an patient is susceptible to anaphylactic reactions instructions on use of an EpiPen are necessary

• If uncomplicated, the stinger should be removed with tweezers or a credit card and soothing medications should be applied

• Soap detergent will also lessen symptoms• In cases of anaphylactic reaction immediate

physician referral is necessary


• Spider Bites– Etiology

• Typically not dangerous to humans• Rarely bite more than once• Must be concerned with black widow and brown

recluse

– Signs and Symptoms• Pain, small puncture wounds, redness, itching

and swelling that lasts a couple days• Present with center blister, a red ring and then a

white ring• Bite from venomous spider may result in muscle

pain and cramps, weakness, sweating, headache, anxiety, nausea, vomiting, difficulty breathing and increased blood pressure


• Management– Washing the wound

and applying antibiotic ointment

– Seek medical attention if infection presents, ulcer does not heal, nausea, vomiting, fever or rash occur

– If muscle cramping occurs the patient should go to the nearest emergency facility


Other Skin Conditions

• Pityriasis Rosea– Etiology

• Acute inflammatory skin rash of unknown origin• Occurs between the ages of 10-35• May be the result of a virus• Can be spread to other individuals – but usually

only occurs once in a lifetime

– Signs and Symptoms• Single pinkish-red patch (herald patch) on the

chest or back© 2011 McGraw-Hill Higher Education. All rights reserved.

• Signs and Symptoms– Within 2 days-3 weeks a

secondary macular eruption occurs on chest or upper extremities

– Red and scaly with a clearing in the center

• Management– Typically doesn’t require

treatment– Gradually disappears over

2-10 week period– Antipruritics may help with

itching– Anti-inflammatories may

be used to reduce itching and rash


• Psoriasis– Etiology

• Exact cause is unknown -- genetic factors may play a role in condition

• Infection, smoking, some drugs and possible hormonal factors may cause an outbreak

– Signs and Symptoms• Lesion begins as reddish papules that progress

to plaques• Lesions progress to yellowish white scaly

condition that tends to be located on the elbows, knees, trunk, genitalia, and umbilicus


• Psoriasis (continued)– Management

• Teaching patient self management

• Glucocorticoids and kerolytic agents can be used in conjunction with each other

• Long term oral medications may be necessary

• Counseling may be necessary for psychological aspects of condition


Skin Cancer• Etiology

– Exposure to sun– Malignant tumor that grows in skin

• Accounts for 50% of all cancers• Basal cell and squamous cell carcinoma• Malignant melanoma – high mortality rate as it often

spreads to other parts of the body

• Signs & Symptoms– Basal cell carcinoma

• Found in areas often exposed to sun• Small, shiny bump• Often found in individuals with light eye color,

complexion and hair


– Squamous cell carcinoma• Appears as nodules, red, scaly patches of skin• Often found on lips, ears and face• Develops commonly in fair-skinned people

– Malignant melanoma• Begins as mole

– Moles present at birth and those that are atypical tend to have a greater change of becoming malignant

– May show the following characteristics» Asymmetry» Border (irregular or jagged)» Color (variations throughout mole» Diameter (larger than pencil eraser)

• Often appear on fair-skinned men and women


• Management– If the athletic trainer suspects that a patient

has skin cancer, the patient should be referred immediately

– Surgery is common (90% of cases)• Cryosurgery, excision, Mohs’ microscopically

controlled surgery

– Non-surgical treatment• Laser, radiation, chemotherapy

– Regular skin exams are important– Take notice of changes in skin and moles

• Crucial to detecting malignant melanoma


Documents

© 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 28: Skin Disorders