DISEASES OF TISSUE AND INTEGUMENTARY SYSTEM

Senior A&P

Janet J. Nelson RN

Systemic Lupus Erythematosus

Lupus is one of many disorders of the immune system known as autoimmune diseases. This leads to inflammation and damage to various body tissues. Lupus can affect many parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain.

Lupus is a complex disease, and its cause is unknown.

Women between age of 25 and 50 are at high risk for SLE.

SLE cont.

Each person with lupus has slightly different symptoms that can range from mild to severe and may come and go over time. However, some of the most common symptoms of lupus include painful or swollen joints (arthritis), unexplained fever, and extreme fatigue. A characteristic red skin rash—the so-called butterfly or malar rash—may appear across the nose and cheeks.

Diagnosis of SLE is difficult

Characteristics of Lupus At least four of the following symptoms are usually present for a diagnosis to be made:

Red, butterfly-shaped rash on the face, affecting the cheeks Typical skin rash on other parts of the body Sensitivity to sunlight (for example, rash or persistent burn) Mouth sores Joint inflammation (arthritis) Fluid around the lungs, heart, or other organs (serositis) Kidney dysfunction Low white blood cell count, low red blood cell count, or low platelet count Nerve or brain dysfunction Positive results of a blood test for antinuclear antibodies Positive results of a blood test for antibodies to double-stranded DNA, to

phospholipids, or smith antibody

KAPOSI’S SARCOMA

A sarcoma of connective tissues Several types: Classic, African, Transplant-Related and

AIDS related Disease where malignant cells form in the tissue lining of the

lymph vessels under the skin or in mucous membranes. Dx: Biopsy with/without scope Rx: Excision, Radiation. Chemotherapy Px: Eventually in almost all AIDS (epidemic) KS spreads

throughout the body. May be fatal as extensive lung damage occurs.

AIDS patient with oral KS

Cutaneous Kaposi's Sarcoma

Progressive Systemic Scleroderma (Systemic Sclerosis)

Systemic sclerosis is a rare chronic disease of unknown cause characterized by diffuse fibrosis, degenerative changes, and vascular abnormalities in the skin, joints, and internal organs (especially the esophagus, lower GI tract, lung, heart, and kidney). Raynauds Phenomena.

Immunologic mechanisms and heredity play a role in etiology.

Systemic sclerosis (SSc) is about 4 times more common among women than men.

SSc continued

Female 34 years of age. Aggressive form of scleroderma with widespread skin involvement. Total elimination of the facial expression, numerous red spots (capillaries near skin), pointy nose, microstomia. Notice claw like form of the hand

      

LYME DISEASE

Lyme disease (LD) is an infection caused by Borrelia burgdorferi, a type of bacterium called a spirochete that is carried by deer ticks.

These ticks are typically about the size of a sesame seed.

View American Lyme Disease Foundation website for photo of tick, map of deer ticks, spirochete transmission poster, Erythema Migrans and video of tick removal.

http://www.aldf.com/lyme.shtml#removal

ACNE

Acne is a common skin disease that causes pimples. Pimples form when hair follicles under your skin clog up. Most pimples form on the face, neck, back, chest and shoulders. Anyone can get acne, but it is common in teenagers and young adults.

No one knows exactly what causes acne. Hormone changes, such as those during the teenage years and pregnancy, probably play a role. There are many myths about what causes acne.

http://www.skincarephysicians.com/acnenet/myths.html

Acne continued

The cause of acne is unknown, it is believe the follow play a part in acne. The hormone increase in teenage years (this can cause the oil glands to plug

up more often) Hormone changes during pregnancy Starting or stopping birth control pills Heredity (if your parents had acne, you might get it, too) Some types of medicine

Acne continued

Treatments are ever changing. Laser, and light treatment, medication, and microdermabrasion.

TINEA

Tinea is a fungus that can grow on your skin, hair or nails. As it grows, it spreads out in a circle, leaving normal-looking skin in the middle. This makes it look like a ring. At the edge of the ring, the skin is lifted up by the irritation and looks red and scaly.

Fungal infection is spread by direct contact or indirect contact e.g. showers, locker rooms or pets

Tinea locations reveal name

TINEA TINEA TINEA

CAPITIS CORPORIS UNGUIUM

More Tineas

TINEA TINEA TINEA

PEDIS CRURIS BARBAE

ECZEMA

Eczema is a term for several different types of skin swelling. Eczema is also called atopic dermatitis. Most types cause red, swollen and itchy skin. Factors that can cause eczema include other diseases, irritating substances, allergies and genetic makeup. Eczema is not contagious.

The most common type of eczema is atopic dermatitis. It is an allergic condition that makes your skin dry and itchy. It is most common in babies and children.

Eczema cannot be cured, but you can prevent some types of eczema by avoiding irritants, stress and the things you are allergic to.

Eczema continued

IMPETIGO

Impetigo is a skin infection caused by bacteria. Usually the cause is staphylococcal (staph) but sometimes streptococcus (strep) can cause it, too. It is most common in children between the ages of two and six. MRSA is an increased concern.

The infection is spread by direct contact with lesions (wounds or sores) or nasal discharge from an infected person. Scratching may spread the lesions. Satellite lesions are common.

Treatment is with oral and/or topical antibiotics

Impetigo signs & symptoms

The nose and mouth are common sites of impetigo in children. But any non-intact skin is an opportunity for infection. If the infective organism is methicillin resistant, it is known as MRSA.

PSORIASIS

Psoriasis is a chronic, autoimmune disease that appears on the skin. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious.

The most common form, plaque psoriasis, appears as raised, red patches or lesions covered with a silvery white buildup of dead skin cells.

Treatment is palliative and varies from patient to patient. Including OTC, topical RX, light therapy, Oral RX (used with caution because of side effects)

Psoriasis tends to run in families and it usually appears between the ages of 10 and 45.

Psoriasis continued

SCABIES (7 Years Itch)

Human scabies is caused by an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies.

The most common symptoms of scabies, itching and a skin rash, are caused by sensitization (a type of “allergic” reaction) to the proteins and feces of the parasite. Severe pruritus, especially at night, is the earliest and most common symptom of scabies.

Scabies continued

Common sites include “warm areas”. Track marks may be visible.

TX: Topical RX and care to prevent spread

FOLLICULITIS

Folliculitis is an infection of the hair follicles. Also known as hot tub folliculitis and barber's itch.

Folliculitis results is a tender red spot, often with a surface pustule. Folliculitis can be due to infection, occlusion, irritation and specific skin diseases.

Furuncle vs. carbuncle

Severe furuncle

HERPES ZOSTER

Shingles, also called herpes zoster, is a painful skin rash caused by the varicella zoster virus (VZV). VZV is the same virus that causes chickenpox.

"Shingles" is a syndrome characterized by a painful, unilateral vesicular rash, usually restricted to a dermatomal distribution.

It is unknown why the VZV lies dormant in the spinal dorsal root ganglia until reactivation results.

The rash is in a unilateral,and may be erythematous, vesicular, pustular, or crusting, depending on the stage of disease. The patient complains of pain as the dorsal root ganglion is affected.

Shingles continued

Treatment includes antiviral &/or analgesics. Varicella vaccine for children may decrease chances of shingles. (more data to yet be provided) Research is working on a Herpes Zoster vaccine.

Herpes Simplex (Cold Sore)

The herpes simplex viruses comprise 2 distinct types of DNA viruses, HSV-1 and HSV-2.

HSV-1 infections are spread via respiratory droplets or direct exposure to infected saliva. HSV-2 usually is transmitted via genital contact. The contact must involve mucous membranes or open or damaged skin.

ALLERGIC REACTIONS

Urticaria (hives) are localized, pale, itchy, pink wheals (swellings) that can burn or sting. They are part of an allergic reaction and are very common.

The most common foods that cause urticaria are: nuts, chocolate, shellfish, tomatoes, eggs, berries, and milk. Fresh foods cause hives more often than cooked foods. Food additives and preservatives may also cause hives.

Almost any medication -- prescription or over-the-counter -- can cause hives.

Anaphylatic shock is critical and may lead to death

Urticaria

Allergic Contact Dermatitis

ACD is inflammation of the skin manifested by varying degrees of erythema, edema, and vesiculation. It is a delayed type of induced sensitivity (allergy) resulting from cutaneous contact with a specific allergen to which the patient has developed a specific sensitivity.

ACD is common with latex, nickel, hair dye and rhus plants.

Treatment is palliative and attempts to determine allergen and avoid in the future.

ACT continued

ACT due to Poison Ivy Nickel Allergy

BASAL CELL CARCINOMA

Basal cell carcinoma (BCC) is the most common skin cancer in humans. Basal cell cancer tumors typically appear on sun-exposed skin, are slow growing, and rarely metastasize.

In nearly all cases, the recommended treatment modality for basal cell carcinoma is surgery.

A 72-year-old woman consulted for this nodular lesion on her nose. The lesion was biopsied and diagnosed as basal cell carcinoma.

A 72-year-old woman consulted for this nodular lesion on her nose. The lesion was biopsied and diagnosed as basal cell carcinoma.

SQUAMOUS CELL CARCINOMA

Cutaneous squamous cell carcinoma (SCC) is the second most common form of skin cancer and frequently arises on the sun-exposed skin.

High-risk SCC carries a significant risk of metastasis and, as such, requires careful evaluation and treatment.

Most SCCs are readily treated in the physician's office by surgical or destructive methods (e.g. cryosurgery).

Most SCCs are readily treated with an expectation of cure. The 3-year disease-specific survival rate has recently been estimated to be 85%; this rate approaches 100% for lesions with no high-risk factors, but it decreases to 70% for patients with at least 1 risk factor.

SCC continued

MELANOMA

Melanoma is a malignancy of melanocytes located predominantly in the skin, but also found in the eyes, ears, GI tract, leptomeninges (arachnoid and pia mater), and oral and genital mucous membranes.

Melanoma accounts for only 4% of all skin cancers; however, it causes the greatest number of skin cancer–related deaths worldwide (74%)

The warning signs of early melanoma has been achieved successfully through the use of the ABCDE criteria for a changing mole

Some skin cancer terms

Actinic Keratoisis

Moh surgery http://

www.skincancer.org/skin-cancer-information/mohs-surgery/mohs-surgery-saving-face

ABCDE of a nevus

A- Asymmetry: Normal moles or freckles are completely symmetrical. If you were to draw a line through a normal spot, you would have two symmetrical halves. In cases of skin cancer, spots will not look the same on both sides.

B- Border: A mole or spot with blurry and/or jagged edges. C- Color: A mole that is more than one hue is suspicious and

needs to be evaluated by a doctor. Normal spots are usually one color. This can include lightening or darkening of the mole.

D- Diameter: If it is larger than a pencil eraser (about 1/4 inch or 6mm), it needs to be examined by a doctor. This is includes areas that do not have any other abnormalities (color, border, asymmetry).

E- Elevation: Elevation means the mole is raised above the surface and has an uneven surface.

Taking risks to tan?

“The alarming reality of indoor tanning is the percentage of teens that are using tanning booths,” says Darius Karimipour, M.D., dermatologist and clinical assistant professor in the University of Michigan Health System’s department of Dermatology.

Approximately 80 percent of sun exposure and damage occurs before the age of 18, says Karimipour.

Tanning booths usually have about 95 percent ultraviolet A light and 5 percent ultraviolet B light, says Karimipour. Ultraviolet B has long been linked to sunburns and skin cancer, while ultraviolet A was associated more with aging the skin. But now ultraviolet A is linked to skin cancer and genetic damage to the skin.”

BURNS in review

Remember some classify burns into a 4th degree where muscle, ligaments, tendons, nerves, blood vessels, and bones are injured. Burns can result from thermal heat, electrical, chemical or radiation. The seriousness of a burn is determined by: the depth, size, cause, affected body area, age, and health of the burn victim and any other injuries that occurred.

Grafts

Autograft Homograft (Allograft) Heterograft (Xenograft) CEA (Integra)

GLOSSARY OF TERMS

alopecia erythema comedo vesicle bulla furuncle/carbuncle Keloid Nevus