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Overview of Integumentary Disorders
Disorders of the Nails Disorders
Clubbing – abnormal curving / increased angle at the nail bed (often related to O2 deficiency)
Koilonychia– “spoon nail” = malformation of the nail in which the outer surface is concaved or scooped out (often indicates iron deficiency anemia)
Onychia/Onychitis (onych = fingernail) = inflammation of the matrix of the nail
Onychocryptosis (onych = mail, crypt = hidden, osis = abnormal condition)
NDisorders of the Nails Continuedil Diseases and Disorders Onychomycosis = fungal infection of the nail
(myc= fungus) Onychophagia = nail biting (phagia = eating) Paronychia – infection of the skin fold at the
margins of a nail (par = along side) Subungual hematoma – collection of blood
under a nail
HaiDisorders of the Hairr Diseases and Disorders Hirsutism = excessive hairiness (hirsut = hairy) Abnormal Hair Loss
Alopecia = partial or complete loss of hair (alopec = baldness)
alopecia areatea = autoimmune disorder; well defined bald areas
alopecia capitis totalis alopecia universalis Female pattern baldness – hair thins in front and sides Male pattern baldness- Horseshoe shape area of hair
remains in the back and temples
Disorders of the Skin
Acne vulgaris – Caused by increased secretion of oil related to increased hormones during puberty
Albinism – Inherited disorder in which melanin is not produced
Athlete’s foot– Contagious fungal infection of the foot
Acne Vulgaris
Description: Self-limiting inflammatory process of the hair follicle and pilosebaceous glands
Cause/Incidence: Etiology unknown; predominately during adolescence
Manifestations: Inflammatory acne - pimples, pustule, nodules, and cysts Non-inflammatory: open and closed comedones
(blackheads or whiteheads) Treatment:
Drying agents - e.g., Benzoyl peroxide/Retin-A Topical antibiotic (clindamycin, erytromycin) Systemic antibiotic/Accutane
Disorders of the Integumentary System (continued) Cellulitis
– Bacterial infection of the dermis and subcutaneous layer of the skin
Chloasma– Patchy discoloration of the face
Cleft lip or cleft palate– Upper lip has a cleft where the nasal palate doesn’t meet properly
Contact dermatitis– Allergic reaction that may occur after initial contact or as an acquired response
Cellulitis
Description: A deep locally diffuse infection of the skin with systemic manifestations and life-threatening potential
Cause/Incidence: Usually involves face or an extremity. History of trauma, impetigo, recent otitis media, or
sinusitis In children less than 3 years, facial cellulitis frequently
is caused by Haemophilus influenza type b. Cellulitis of extremities is more often associated with S.
aureus and Group a Streptococci.
Cellulitis: Manifestations:
Most children look and feel ill, often febrile
Pitting edema over affected area
Classic signs of inflammation, redness, swelling, heat and tenderness/pain
Leucocytosis
Cellulitis
Management/Treatment: Systemic antibiotics Immobilization of affected area Incision and Drainage with culture
Nursing Considerations: warm compresses, elevation Non-occlusive dressing if skin rear or rupture
Disorders of the Skin (continued) Decubitus ulcers
– Sores or areas of inflammation that occur over bony prominences of the body
Eczema– Group of disorders caused by allergic or irritant reactions
Atopic Dermatitis (Eczema)
Description- An inflammatory dermatitis that refers to a descriptive category of dermatologic disorders. Eczema is characterized histologically by epidermal changes of intracellular edema, spongiosis, or vesiculation.
Cause/Incidence: Often inherited. Inhaled allergens or food allergens are thought to induce mast-cell responses.
ECZEMA: MANIFESTATIONS
Usually symmetrical, scaly, erythematous patches or plaques with possible exudate and crusting
Pruritus Unaffected skin dry and
rough. Chronically, relapsing
course Immediate skin test
reactivity. Elevated serum IgE
Atopic Dermatitis (Eczema) Management/Treatment
Burow solution (aluminum acetate) compresses. Topical Steroids Antihistamines to control itching Oral antibiotics is widespread breakdown or
infection Moderate amount of bathing followed by
application of a lubricating lotion Humidified heat in the winter.
Disorders of the Skin (continued) Fungal skin infections
– Skin infections that live on dead outer surface or epidermis
Furuncle– Boil, or bacterial infection of a hair follicle
Impetigo– Very contagious bacterial skin infection that occurs most often in children
Kaposi’s sarcoma– Form of cancer that originates in blood vessels and spreads to skin
Impetigo
Description: Contagious bacterial skin infection
Cause/Incidence: Staphylococcus, streptococcus or a combination of both. Incubation period is 7-10 days.
Types: Impetigo contagiosa (nonbullous) Bullous Impetigo
Impetigo
Manifestations: Small papule that becomes vesicular, pustular and then forms a honey-colored crust. Usually no
systemic manifestation.
Impetigo
Management/Treatment Topical bactericidal ointment. If no response to topical ointment in 72 hours:
give systemic antibiotics Good hand washing. Limit person to person
contact.
Nursing Considerations Measures to prevent the spread
Disorders of the Integumentary System (continued) Lupus
– Benign dermatitis or chronic systemic disorder
Psoriasis– Chronic skin disorder in which too many epidermal cells are produced. (lesions of psoriasis are plaques – solid raised area of skin > 0.5 cm in diameter)
Rashes– May result from viral infection, especially in children
Disorders of the Integumentary System (continued)
Scleroderma– Rare autoimmune disorder that affects blood vessels and connective tissues of the skin
Streptococcus – Non-motile bacteria that affect many parts of the body
Carcinoma
Cancerous Tumor
Basal Cell Carcinoma
Most common Least malignant Slow growing Papules that erode in the center Pearly edge 99% cure rate with early excision
Squamous Cell Carcinoma
In keratinocytes of stratum spinosum Scaly red papule (rounded elevation) Rapid growth Meets lymph Good cure rate if caught early followed by
radiation treatment
Malignant Melanoma
Cancer of melanocytes Most dangerous, death 1:4 cases Accounts for 5% of skin cancers Nevus mole becomes dark, spreads
unevenly, bleeds some Metastatic Cause: overexposure to UV radiation (sun or
tanning bed)
American Cancer Society ABCD Rule for Skin Cancer A – Asymmetry B – Border Irregularity C – Colors Different D – Diameter (larger than 6 mm –pencil
eraser)
Kaposi’s Sarcoma
Purple papules spread to lymph nodes and other organs
Opportunistic disease of AIDS
Disorders of the Skin (continued)
Vitiligo– Condition in which a loss of melanocytes results in whitish areas of skin bordered by normally pigmented areas
Warts (Verrucae)– Papule caused by human papillomavirus
Burns
Description: injury to skin and possibly subcutaneous tissue, caused by chemical, thermal, radiation or electrical causes
Cause/Incidence: May be accidental or non-accidental; second leading cause of injury child < 14
Types of Burns
Superficial (first degree) – no blisters, superficial damage to the epidermis (e.g., sun burned)
Partial Thickness (second degree) – blisters, superficial damage to the epidermis
Full Thickness (third degree) – damage to the epidermis, corium, and subcutaneous layers
Rule of Nines
Burns: Management
Skin Care: Promote healing/Prevent infection Pain Management Fluid Replacement High calorie, high carb, high protein diet Active/Passive ROM if possible Emotional Support
Overview of Communicable Disease/Rashes
Scarlet Fever: Manifestations
Sore throat, chills, fever, headache (occ. vomiting)
Erythematous papular rash on trunk and extremities (feels like sandpaper)
Strawberry “white” or “red” tongue
Circumoral pallor with erythema of lips, soles and palms
Scarlet Fever: Management
Management/Treatment: Antibiotics
Nursing Considerations: Bed rest during febrile stage Analgesics/Antipyretic Fluids Prevention of complications and control of
spread of disease
Communicable Diseases:Scabies Description: Contagious skin condition caused by
human mite - Sarcoptes scabiei
Incidence/Pathophysiology: Transmitted by close personal contact, Female mite burrow into outer layer of the epidermis to lay eggs, larvae hatch in several days and move toward the skin surface, Mite secretions, ova and feces are highly irritating so itching begins about 1 mo after infestation
Scabies: Manifestations
Intense pruritis, esp at rest/ bedtime
Infants/young child may be irritable, sleep fitfully
Lesions are linear, grayish burrows 1 to 10 cm long ending in a pinpoint vesicle, papule, or nodules
Skin excoriation from scratching
Scabies: Management
Management/Treatment: Scabicida medications crotamiton (Eurax),
permethrin 5% (Elimite), or lindane (Kwell, Scavene)
Oral antihistamines, soothing creams, lotions to reduce itching
Antibiotic is secondary infection Nursing Considerations:
Pt/family education Prevent spread: Treat all family/close
contacts, wash clothes/linens
Communicable Diseases:Varicella Description: A viral disease characterized
by a pruritic vesicular rash that appears in crops
Cause/Incidence: Varicella-zoster virus, transmitted by direct contact with vesicular fluid; Incubation period 14 to 21 days: Contagious day before rash appears to 1 week after first lesion crusted. Immunity from vaccination or disease
Varicella: Manifestations
Prodromal: mild fever and malaise for 24 hrs
Acute: Rash that progresses from macule to vesicle to crusts; eruptions last 5 days and lesions of all types are present at once
Varicella: Management
Management/Treatment: Varicella immunoglobulin for
immunocompromised pt within 72 to 96 hrs Antipruritic lotions
Nursing Considerations: Avoid Aspirin (assoc with Reyes) Prevent spread of infection Mitten hands if necessary Prevention: Vaccine
Communicable Diseases:Rubeola (“Red” Measles)
Description: Highly contagious, acute viral infection
characterized by fever, cough, coryza, conjunctivitis, maculopapular skin rash and Koplik’s spots
Cause/Incidence: Viral etiology; 7 to 14 day incubation, Communicable several days before rash appears to 5 days after rash; Immunity = vaccination or disease
Rubeola: Manifestations
Prodomal: fever, lethargy, cough, coryza, photophobia, Koplik’s spots on buccal mucosa
Acute: red, flat rash (lasting about a wk) begins behind ears, spreads to face, trunk, and extremities
Rubeola: Management
Management/Treatment: Symptomatic
Nursing Considerations: Monitor for complications - bacterial super-
infections, pneumonia, otitis media, encephalitis
Communicable Diseases:Rubella (German Measles)
Description: Mild disease characterized by
erythematous maculopapular discrete rash; postauricular and suboccipital lymphandenopathy
Cause/Incidence:RNA virus classified as rubivirus, transmitted by direct contact with nasopharyngeal secretions. Incubation - 14 to 21 days; Communicable 1 wk before and 5 days after onset of rash. Immunity=disease or vaccination
Rubella (German Measles): Continued
Manifestations: Prodromal: low grade fever, headache, sore throat
and cough Acute: Flat rash begins on face and spreads to
body; lasts 3 days
Management/Treatment: Antipyretics/symptomatic Complications: rare Prevent spread of infection
Communicable Diseases: Mumps (Parotitis)
Description: Viral, communicable disease characterized by swelling of the parotid glands
Cause/Incidence: Mumps virus; Transmission: droplet or direct contact; Incubation 14 to 21 days; Communicability:1 week before parotoid swelling until 1 week after swelling begins
Immunity: from disease or vaccination
Mumps: Manifestations
Prodromal: fever, headache, earache that worsens with chewing
Acute: Swelling of parotid glands
Mumps: Management
Management/Treatment: antipyretics fluids and soft diet
Nursing Considerations: Monitor for complications: Orchitis,
encephalitis, deafness Prevent spread Prevention: vaccination
Communicable Diseases: Roseola (exanthema subitum) Description:
mild, viral disease Cause/Incidence:
caused by herpes virus type 6 (HHV-6) common 6 mos to 2 yrs
Roseola: Continued
Manifestations: Starts with high fever > 103 and irritability lasting 2-
3 days Followed by rosy pink rash develops - first on trunk
then to neck, face, & extremities Cause/Incidence:
Control fever (febrile seizures common) Fluids
Fifth Disease - erythema infectiosum
Description: A communicable disease of childhood that causes a rash
Cause/Incidence: Etiology unknown; possibly spread thru resp tract; most contagious 1 week before rash appears. Once rash appears no longer contagious
Risk to developing fetus and to immuno-suppressed children
Treatment: supportive Complications rare: self-limiting arthritis or
arthragia, encephalitis, or myocarditis
Fifth Disease: Manifestations
Red rash on face that looks like “slapped cheeks”
Lacy pink rash on the backs of the arms and legs, torso, and buttock
Stevens-Johnson Syndrome
Description: an acute cutaneous disorder, severe form of erythema multiforme
Cause/Incidence: Possible hypersensitivity to certain drugs; secondary to resp infection
Management: Identification and elimination of underlying
cause (Antibiotic if necessary) Prevention of secondary infection Pain relief
Stevens-Johnson Syndrome: Manifestations Fever, malaise, cough, sore
throat, diarrhea, vomiting, chest pain, myalgia
Bulla with a grayish-white membrane on the mucous membranes of the lips, eyes, oral/nasal mucosa, genitalia, and rectum
Extensive skin lesions
Fungal Infections
Descriptions: Superficial infections that live on the skin and not “in” the skin.
Cause/Incidence: Fungi grow best in warm, moist places Causative fungi are usually opportunistic and
not usually pathogenic unless they enter a compromised host
Fungal Infections: Tinea Pedis
Description: - fungal infection of the foot (Althelete’s foot )
Cause/Incidence: Most common fungal infection. Caused by species of the genera Microsporum and Trichophyton. Transmitted by direct contact with skin containing fungi, and fungi in damp areas
Tinea Pedis: Continued
Manifestations: Interdigital lesions (fissures); Vesicles/erosions on instep, Pruritus, Diffuse scaling
Management: Miconazole, clortrimazole, or haloprogin Burrow solution compresses
Nursing Considerations: Teach foot hygiene Observe for secondary infection Prevent transmission
Fungal Infections: Ringworm (Tinea Capitis or Tinea Corporis) Description: A fungal infection of the scalp or body
Cause/Incidence: Microsporum and Trichophyton; transmitted by direct contact
Management: Oral grisofulvin Selenium Sulfate shampoo to reduce fungi on hair Topical antifungal agents - e.g.,Miconazole Antihistamine for itching Prevention of secondary infection Education regarding transmission
Ringworm: Manifestations
One or more irregular, erythematous, slightly raised, scaly patches
Lesions tend to spread but central clearing occurs resulting in “ring”
Pruritus
Fungal Infections: Candida
Description: A yeast infection that occurs in the mouth, esp in infants
Cause/Incidence: may be acquired in newborns from maternal vaginal infection or transmitted by poor hygiene
Manifestations: Oral thrush = white plaques on the mucous membrane; Diaper Dermatitis- char by “beefy” red erythematous areas with surrounding papules and pustules
Management: Nystatin; no isolation required