Copyright © 2015 Cengage Learning ®. Chapter 18 Integumentary System Diseases and Disorders

Copyright © 2015 Cengage Learning®.

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– Helps stabilize temperature, fluid, and

electrolyte balance– Three layers:

• Epidermis• Dermis• Subcutaneous



– The epidermis – outer layer – has five layers– The cells of this layer are call stratified

squamous epithelial cells– Most of these cells are keratinocytes and

melanocytes– Melanocytes – contain melanin, skin-coloring

pigment– Dermis is the deeper layer– Consist of connective tissue and a variety of

cell shapes– Blood vessels and nerves are in this layer



– Subcutaneous layer is deeper than dermis– Blood vessels and fat cells – protect against cold– Embedded in the dermis and extending to the

epidermis are the sebaceous, apocrine, and eccrine sweat glands

• Sebaceous produce oil called sebum• Apocine are located in areas of the axilla, breast,

umbilicus, anus, and genital areas• Eccrine are found throughout the body and help

regulate heat

– Hair follicles in dermal layer – extend through epidermis


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


Infectious Diseases: Viral

• Herpes– Common types:

• Herpes simplex 1– Fever blisters– Cold sores

• Herpes simplex 2/herpes genitalis– Genital herpes

• Herpes varicella– Chickenpox

• Herpes zoster– Shingles


Infectious Diseases: Viral• Verrucae

– Also known as warts– Chronic condition– Occur in multiples and differ in size, shape, and

appearance– Often resistant to treatment– Types:

• Appearance on hands and fingers of children– Common warts

• Appearance on sole of foot– Plantar warts

• Sexually transmitted– Genital warts


Infectious Diseases: Viral

• Measles

– Highly contagious– Childhood disease– Maculopapular skin rash

– (Detailed information in Chapter 20)


Infectious Diseases: Bacterial• Impetigo

– Highly contagious skin disease– Affects face and hands of children– Cause:

• Streptococcus and Staphylococcus

– Symptoms:• Vesicles• Pustules that rupture

– Producing yellow crust over lesions

– Treatment:• Cleansing• Antibiotic ointment


Infectious Diseases: Bacterial• Folliculitis

– Inflammation and infection of hair follicle– Cause:

• Staphylococcus

– Symptoms:• Small pustules surrounding hair

– Treatment:• Antibiotic cream or oral medications depending on

severity


Infectious Diseases: Bacterial• Abscess, furuncle, and carbuncle

– Encapsulated lesion with inflammation and infection

– Abscess• Localized collection of pus in any tissue

– Furuncle• An abscess occurring in the skin, commonly called a

boil

– Carbuncle• Larger abscesses, interconnected furuncles, less

common


Infectious Diseases: Bacterial

• Abscess, furuncle, and carbuncle– Cause:

• Commonly Staphylococcus• Lowered immunity• Poor personal hygiene

– Symptoms:• Extreme pain

– Treatment:• Warm compresses• Opened and surgically drained• Antibacterial medications


Infectious Diseases: Bacterial• Cellulitis

– Diffuse or spreading inflammation of skin and subcutaneous tissue

– Causes:• Streptococcus or Staphylococcus

– Symptoms:• Pain, redness, swelling, warmth, tenderness of

involved skin

– Treatment:• Oral antibiotics

– Prevention:• Good handwashing• Cleansing of open areas on skin


Infectious Diseases: Bacterial• Erysipelas

– Acute infection of dermis extending to fat tissue

– Causes:• Most commonly group A Streptococcus

– Symptoms:• Fatigue, chills, fever, headaches, vomiting• Infected skin consistency similar to an orange peel

– Treatment:• Oral or IV antibiotics


Infectious Diseases: Bacterial• Lyme disease

– Multisystem infections transmitted to humans through bite of infected deer tick

– Symptoms:• Flu-like symptoms• Arthritis• Malaise• Chills• Fever• Bull’s eye skin rash

– Treatment:• Antibiotics


Infectious Diseases: Bacterial• Methicillin-resistant Staphylococcus

aureus (MRSA)– A strain of bacteria that is resistant to the antibiotics

commonly used to treat staphylococcal infections– Both health care– and community-acquired– Symptoms:

• Small red bumps that resemble pimples or boils• Progress to abscess – progress to blood-borne infection

(sepsis)• Symptoms of sepsis:

– Rash, fever, chills, headaches, joint pain, shortness of breath– Can be life-threatening and requires immediate medical

attention


Infectious Diseases: Bacterial• Methicillin-resistant Staphylococcus

aureus (MRSA)

– Diagnosis:• Culture and sensitivity

– Treatment:• Intravenous vancomycin

– **Even though vancomycin is currently effective, there are signs that some MRSA bacteria are building resistance to this medication also.


Infectious Diseases: Fungal• Tinea

– Fungal infection also known as ringworm that infects warm, moist areas of body

– Feeds on perspiration and dead skin

– Types:• Tinea corporis

– Affects smooth skin on arms, legs, and body

• Tinea pedis– Athlete’s foot

• Tinea cruris– Jock itch


Infectious Diseases: Fungal• Tinea

– Types: (continued)• Tinea unguium

– Affects fingernails or toenails

• Tinea capitis– Affects scalp

• Tinea barbae– Affects bearded areas

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


Infectious Diseases: Fungal

• Tinea– Diagnosis:

• Microscopic examination of skin scrapings

– Treatment:• Keep affected area clean and dry• Antifungal medications• Used consistently for a long period of time

– These infections commonly recur and become a chronic problem.


Infectious Diseases: Fungal• Candidiasis

– Commonly called yeast infection– Can be superficial or systemic and life-threatening– Cause:

• Candida• Antibiotic therapy that disrupts normal flora

– Symptoms:• Depend on location

– Mouth – thrush Patches of white infection– Baby buttocks – diaper rash Red, inflamed scaly rash– Fingernails – onychomycosis Itchy skin with blisters and

pustules– Vagina – vaginitis White, cheesy vaginal discharge

(Chapter 17)

– Treatments: Antifungal medications


Infectious Diseases: Parasitic• Pediculosis

– Infestation with lice– Types of lice: head, body, pubic– Symptoms:

• Severe itching

– Treatment:• Eradicating pediculosis is difficult• Bathing and shampooing with medicated shampoo

– E.g., Kwell

• Dry cleaning or washing all clothing• Cleaning and treating furniture


Infectious Diseases: Parasitic• Scabies

– Infestation by itch mite– Cause:

• Sarcoptes scabiei, tiny parasite

– Symptoms:• Intense itching• Slightly elevated, grayish-white lines

– Treatment:• Lindane cream (Kwell) to entire body


Scabies

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


Metabolic Diseases• Acne vulgaris

– Inflammation of sebaceous glands and hair follicles

– Cause:• Metabolic, occurs at puberty

– Symptoms:• Comedones, blackhead

– Treatment:• Cleansing• Over-the-counter (OTC) treatments• In severe cases, antibiotics, steroids, and Retin-A

preparations


Metabolic Diseases• Seborrheic dermatitis

– A common type of dermatitis affecting sebaceous glands

– Also known as cradle cap in infants– Also known as dandruff when affecting scalp– Symptoms:

• Reddened skin • Greasy-looking yellowish scales

– Treatment:• Medicated shampoo• Steroid lotion or creams


Metabolic Diseases• Sebaceous cyst

– A closed sac of oily, cheese-like material under the skin

– Commonly develop on scalp, neck, groin– Special type:

• Pilonidal cyst

– Cause:• Sebaceous gland becomes blocked and sebum

collects under the skin

– Treatment:• Incising and draining• Surgical removal


Hypersensitivity or Immune Diseases• Eczema

– Inflammation of skin, not dangerous, not contagious, not curable

– Cause:• Occurs in individuals with genetic predisposition to

allergies

– Symptoms:• Dry, leathery skin lesions• Itching• Redness


Hypersensitivity or Immune Diseases• Eczema

– Symptoms: (continued)• Vesicles• Pustules• Scales• Crusting

– Treatment:• Topical cortisone creams• Antihistamines• Sedatives• Avoidance of sunlight


Hypersensitivity or Immune Diseases• Urticaria

– Vascular reaction of the skin– Also known as hives or nettle rash

– Causes:• Irritants such as insect bites, pollen, or plants

– Symptoms:• Severe itching

– Treatment:• Antihistamines• Avoidance of allergen


Hypersensitivity or Immune Diseases• Contact dermatitis

– Acute or chronic allergic reaction of skin– Causes:

• Cosmetics• Laundry products• Jewelry

– Symptoms:• Pain• Small, red, localized lesions to vesicular lesions;

example: Poison ivy

– Treatment:• Topical medications• Antihistamines to relieve itching


Hypersensitivity or Immune Diseases

• Scleroderma

– Autoimmune reaction

– Hardening, thickening, and shrinking of connective tissues

• Including skin

**More information can be found in Chapter 5


Idiopathic Diseases• Psoriasis

– Very common, chronic skin disease– Affects individuals ages 15 to 35– Has periods of remission and exacerbation– Cause:

• Unknown but some hereditary basis does exist

– Symptoms:• Rapid replacement of epidermal cells• Red, raised lesions with distinct borders and silvery

scales• Scales generally appear on elbows, knees, and scalp


Idiopathic Diseases

• Psoriasis– Treatment:

• Medications– Control itching

» Creams containing coal tar

– Remove scaling» Salicylic acid

– UV light treatments– Steroids– Oatmeal baths to loosen the scales


Idiopathic Diseases• Rosacea

– A chronic skin condition – Characterized by inflammation and redness of

the forehead, nose, cheeks, and chin– It is not dangerous or life-threatening

– Cause:• Unknown• Blush easy, fair skinned, female • 30 – 50 years old• Enlargement of the blood vessels just under the skin


Idiopathic Diseases• Rosacea

– Symptoms:• Facial skin appears red with swelling or skin eruptions

similar to acne vulgaris• Red, bulbous nose• Spider-like vessels called telangiectasia• Bloodshot, irritated, watery eyes

– Treatment:• No known cure• Identify triggers that cause exacerbations of the

condition• Avoid sun exposure, prolonged exertion in hot weather• Avoid stress, spicy foods, alcohol, and hot beverages• Antibiotic ointments to control skin eruptions


Benign Tumors• Seborrheic keratosis

– Benign overgrowth of epithelial cells– One of the most common benign growths in

older adults– Cause:

• Unknown, but does appear to be age related

– Symptoms:• Tan or brown growths on hands, arms, and face• Warty scale appearance

– Treatment:• Curettage

– Scraping off


Benign Tumors• Keloid

– Raised, firm, irregular-shaped scar tissue following trauma or surgery

– Cause:• Overgrowth of collagen during connective tissue

repair• More common in the black population

– Treatment:• Surgical removal is usually not effective because it

results in the growth of another keloid• Radiation, steroids, and cryotherapy may be helpful


Benign Tumors• Hemangioma

– Congenital benign tumor of small blood vessels that form purplish birthmark

– Appear on the face and neck– Cause:

• Unknown

– Common types:• Port wine stain• Strawberry hemangioma• Cherry hemangioma

– Treatment:• Usually not necessary, many disappear by age 5• Surgical removal


Premalignant and Malignant Tumors• Actinic keratosis

– Premalignant condition– Common in fair-skinned individuals– Cause:

• Excessive exposure to the sun

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

– Treatment:• Topical medication

– E.g., Retin-A

• Curettage• Cryotherapy


Premalignant and Malignant Tumors• Basal cell carcinoma

– Most common type of skin cancer– Most often affects fair-skinned, blonde, blue- or

gray-eyed individuals– Slow-growing, locally invading tumor that does

not metastasize– Cause:

• Unknown, result of genetic and environmental (sun exposure) factors

– Symptoms:• Appearance varies; smooth, shiny bump, pink to pearly

white

– Treatment:• Surgical removal


Premalignant and Malignant Tumors• Squamous cell carcinoma

– Less common than basal cell– Tends to grow more rapidly, becomes

metastatic

– Cause:• Tends to occur in sun-exposed areas

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

– Treatment:• Wide surgical excision• Radiation


Premalignant and Malignant Tumors• Malignant melanoma

– Most serious type of skin cancer– Responsible for the majority of skin cancer

deaths– Rarely occurs before age 20– May be related to severe sunburn as child– Symptoms:

• Change in size and color of mole

– Treatment depends on degree of spread:• Wide surgical excision• Radiation• Chemotherapy


Premalignant and Malignant Tumors• Kaposi’s sarcoma

– Malignant vascular skin tumor– Cause:

• Not highly malignant except in the case of AIDS

– Symptoms:• Bluish-red patches that grow under the skin

– Treatment:• Treat AIDS• Liquid nitrogen• Radiation• Chemotherapy


Abnormal Pigmented Lesions• Types:

– Ephelis• Freckle• Indicates skin damage due to sunburn

– Lentigo• Liver spot• Occur on face, neck, and back of the hands in older

adults

– Nevus• Mole• Can be brown, black, or pink-colored• Due to a collection of melanocytes


Abnormal Pigmented Lesions• Types:

– Albinism• Hereditary disorder• Decrease or total absence of pigment in skin, hair,

and eyes

– Vitiligo• Destruction of melanocytes in small or large patches

of skin

– Melasma• Dark patches of skin on face, especially the cheeks• Common in pregnant females and those taking birth

control pills• Usually disappears after delivery or discontinuation of

medication


Diseases of the Nails• Disease can cause abnormal shape,

thickness, and color• Causes:

– Most commonly fungal and bacterial infections• Bacterial infection of the skin around the nail is

paronychia• Fungal infections frequently affect the feet, chronic,

cause nail deformity

• Treatment:– Bacterial infections treated with antibiotics– Fungal infections treated with antifungal

medications


Diseases of the Hair

• Hair color, texture, and distribution are genetically determined and influenced by hormones

• Hirsutism– Excessive growth of hair– In the female, may be caused by hormone

abnormalities Alopecia– Partial or complete hair loss


Diseases of the Hair• Male-patterned baldness

– Common cause of hair loss in men– An inherited trait passed to males by their

mothers– Can be seen in mother’s brothers (maternal

uncles)– Symptoms:

• Begins around age 30 with receding front hairline

– Treatment:• Growth can be restored by certain special

medications• Wig, toupee, hair transplant


Trauma – Mechanical Skin Injury• Abrasion

– Scraping away skin surface – friction or rug burns

• Blunt trauma– Individual is struck by items such as hammers,

is thrown into objects, or has fallen– Often causes a large bruise called a contusion

• Avulsion– Portion of skin is pulled away or torn– Usually occurs when tissue is caught in

machinery


Trauma – Mechanical Skin Injury• Crush trauma

– Tissue caught between two hard surfaces– Usually involves fingers, hands, feet, toes

• Caught in doors or between objects

• Puncture injury– Sharp object forced into tissue – Knife, nail, glass, metal

• Potential for tetanus

• Laceration– Cut in skin caused by sharp object – knife,

razor, glass


Trauma – Thermal Skin Injury• Thermal skin injury

– Due to excessive heat or cold– Injury can range from mild to severe– Severe injury can be life-threatening

• Hyperthermia– Body overheated due to excessive exposure to

sun or heat– Types:

• Heat exhaustion• Heat stroke


Trauma – Thermal Skin Injury• Heat exhaustion

– Commonly occurs with excessive exercise in a warm environment

– Symptoms:• Profuse perspiration, loss of salt and water leading to

dehydration• Cool, moist skin• Weakness, nausea• Muscle cramps• Body temperature is normal

– Treatment:• Place individual in cool place• Fluid and salt replacement• Transport to the hospital


Trauma – Thermal Skin Injury• Heat stroke

– More serious than heat exhaustion– Body’s temperature regulation fails– Symptoms:

• Temperature above 105 degrees F• Skin red and hot; NO perspiration• Nausea, weakness• Mental confusion – loss of consciousness –

convulsions• Without rapid treatment, brain damage and death

can result

– Treatment:• Rapid cooling with cold water• Immediate transport to hospital


Trauma – Thermal Skin Injury• Burns

– Cause:• Can be caused by fire, steam, hot liquids, chemicals,

electricity• Burns are classified by depth of skin injury• Main complications are fluid loss and infection

– Treatment:• Depends on the degree and type of burn• Cooling of tissue with cool water to prevent further

burning• Analgesics• Antibiotics• Surgical debridement


Trauma – Thermal Skin Injury• First-degree burns

– Fairly common– Pain, redness, swelling of skin– Involve only the epidermis– Often result of sunburn– Heals usually within a week

• Second-degree burns– Also called partial-thickness burns– Involve epidermis and dermis– Extreme pain, redness, blisters, open wounds


Trauma – Thermal Skin Injury• Second-degree burns (continued)

– Usually heal in 2-3 weeks– Infection can lead to third-degree wound

• Third-degree burns– Also called full-thickness burns– Involve the epidermis, dermis, exposing layers of

fat, muscle, and bone– Burn areas are painless due to nerve destruction– Characterized by charred and broken tissue layers– Treatment often includes grafting– Scarring and deformity are common


Trauma – Thermal Skin Injury• Hypothermia

– Body’s core temperature falls below 95 degrees F

– Symptoms:• Extreme shivering• Mental confusion• Blue or cyanotic extremities• Weak pulse

– Treatment:• Remove wet clothing• Warm body with warm blankets; drink warm liquids• Immediately transport to a hospital


Trauma – Thermal Skin Injury

• Frostbite– Freezing of tissue – Usually on face, fingers, toes, ears

– Symptoms:• Affected area is painless and white • Warming the skin leads to pain and redness

– Treatment:• Rapid warming in warm water baths• Emergency treatment at a medical facility


Trauma – Electrical Injury

• Electrical injury– Causes:

• Unprotected or inadequately insulated electrical wiring

• Contact with lightning

– Damage has point of entry and exit

– Common cause of death is from respiratory and cardiac arrest


Trauma – Radiation Injury

• Radiation injury– Ionizing radiation

• X-rays• Sunlight

– Causes:• Exposure to sunlight• Tanning beds• Prolonged exposure to sun or tanning beds causes

the skin to become prematurely dry, brittle, and wrinkled and to lose elasticity

• Causes the skin to appear much older than its natural age


Trauma – Pressure Injury• Decubitus/pressure ulcer

– Commonly called a bedsore or pressure sore

– Cause: • Affects bony areas of body

– E.g., heels, sacrum, elbows

• Increased pressure in these bony areas slows blood flow and leads to ischemia and necrosis

– Prevention:• Frequent turning and repositioning• Massaging of affected area to improve circulation


Trauma – Pressure Injury• Corns and calluses

– Protective hyperplasias of tissue– Main difference in corn and callus is location– Corns

• Found on feet• Often painful• Due to ill-fitting shoes• Can be surgically removed

– Calluses• Not usually painful• Most common on hands• Protect the hands form repeated injury


Trauma – Insect Bites and Stings• Insect bites and stings

– Vary from bloodsucking to stings– May cause swelling and itching at site– Insect bites can transmit disease– Symptoms:

• Venom or poison may cause allergic reaction• Range from mild to severe• Severe reaction called anaphylaxis

– Treatment:• Hydrocortisone cream• Antihistamine; analgesic• Emergency medical treatment; CPR and call 911


Spider Bites• Black widow

– Most commonly known poisonous spider– Only the female bites, usually when disturbed

or trying to protect her eggs– Cause:

• The venom of the spider is a protein that affects the victim’s nervous system

– Symptoms:• Acute pain at the site, abdominal pain, nausea,

fainting, dizziness– Treatment:

• Cold compresses• Pain relievers


Spider Bites• Brown recluse spider

– Very dangerous – Also called fiddleback, violin spider and brown

fiddler– Very reclusive; bite only when threatened– Cause:

• Venom is extremely poisonous• Bites are rarely fatal, but deaths have been reported

– Symptoms:• Severe pain, itching, fever, nausea, muscle pain

– Treatment:• Application of ice pack• Analgesic medications• Seek medical treatment


Rare Diseases• Elephantiasis

– Hypertrophy of skin and subcutaneous tissue giving it an elephant-like appearance

• Inflammation of lymphatic system results in fluid accumulation

• Cause:– Parasitic worm– Most common in tropical areas such as central

Africa– Spread by mosquitoes and bloodsucking flies


Effects of Aging

• Thinning of epidermal layer– Retains less water, which leads to easy tearing

and dryness

• Xerosis: sweat and sebaceous glands do not function as well

• Skin lesions are common• Seborrheic dermatitis, rosacea, and

psoriasis are frequently seen disorders


Effects of Aging

• Thickening of nails• Thickening and increased brittleness

of hair• Loss and graying of hair• Skin lesions

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Copyright © 2015 Cengage Learning ®. Chapter 18 Integumentary System Diseases and Disorders