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Chapter 46 Disorders of Skin Integrity and Function

Chapter 46 Disorders of Skin Integrity and Function. Skin Infections. Superficial fungal infections Ringworm, athlete’s foot Attack the keratinized (dead) cells Inflammatory reaction to toxins causes most signs and symptoms Deep fungal infections Candidiasis, sporotrichosis

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Chapter 46 Disorders of Skin Integrity and Function

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  1. Chapter 46Disorders of Skin Integrity and Function

  2. Skin Infections • Superficial fungal infections • Ringworm, athlete’s foot • Attack the keratinized (dead) cells • Inflammatory reaction to toxins causes most signs and symptoms • Deep fungal infections • Candidiasis, sporotrichosis • Attack living tissue • May attack other organs

  3. Bacterial Skin Infections • Impetigo • May lead to post-streptococcal hypersensitivity reactions • These can cause glomerulonephritis

  4. Viral Skin Infections • Verrucae (warts) • Benign neoplasms (papillomas) • Herpes simplex (cold sores) • Herpes zoster (shingles) • Herpes invades dorsal root ganglia • Caused when chickenpox herpesvirus is reactivated • Travels out nerve to skin and causes a new inflammation

  5. Question Which of the following microbes cause warts? • Fungus • Virus • Bacteria • Any of the above may cause warts.

  6. Answer • Virus Warts are caused by viruses; they’re benign neoplasms (abnormal tissue growths).

  7. Scenario Mrs. K is worried about her complexion… • She says she always had good skin, but now her face itches and burns on the right side, and there are red lumps on one side of her forehead Question • What are the possible causes?

  8. Acne • Disorder of sebaceous glands • Related to: • Hormonal stimulation of sebaceous glands • Increased number of sebaceous cells • Increased sebum production • Inflammatory response to bacteria in sebum

  9. Allergic and Hypersensitivity Dermatoses • Type I allergies • Atopic eczema • Urticaria (hives)

  10. Type I Allergies Type I allergies are mediated by IgE Discussion • What cells must be involved in this process? • On the first exposure to the allergen? • On repeated exposure? • When the allergen binds to IgE? • What inflammatory mediators are involved? How?

  11. Question Which chemical mediator is released by mast cells as part of the inflammatory response? • Histamine • Leukotriene • Cytokine • All of the above

  12. Answer • Histamine Histamine (stored in mast cells) is one of the first substances to be released during the inflammatory response. Histamine release results in bronchoconstriction, mucosal edema, and increased mucus production.

  13. Autoimmune Urticaria In autoimmune urticaria, the client creates anti-IgE antibodies Discussion • How would this cause hives? • How would a deficiency in complement inhibitor cause hives? • Why would antihistamines help? • Why would corticosteroids help?

  14. Drug-Induced Skin Eruptions • Erythema multiforme • Occurs after herpes simplex; self-limiting • Stevens-Johnson syndrome • Skin detaches from body surface; <10% of body affected • Toxic epidermal necrolysis • >30% of epidermis detaches • 30%–35% mortality rate

  15. Papulosquamous Dermatoses • Psoriasis • Pityriasis rosea • Lichen planus

  16. Activated Psoriasis T cells growth attract factors neutrophils and monocytes keratinocytes enter and blood the vessels grow papules create create inflammation papules

  17. Burns • First-degree: outer layers of epidermis • Second-degree: epidermis and dermis • Partial-thickness: only part of dermis • Full-thickness: entire dermis • Third-degree full-thickness • Extends into subcutaneous tissue • May damage muscle, bone, blood vessels

  18. Scenario Mr. D was boiling water and the pot tipped over on him… • He has painful, bright pink, blistering burns over most of his left arm and chest Question • How would you categorize this burn?

  19. Scenario (cont.) Mr. D's burns are pink but the rest of his body looks pale, and he has a rapid heart rate… • His pulses are weak • Bowel sounds are absent • Respiration is rapid Question • What has caused these signs?

  20. Complications of Burns • Burn shock • Respiratory system dysfunction • Hypermetabolic response • Renal insufficiency • Gastric ulceration • Sepsis • Constriction of areas under circumferential burns • Systemic infection

  21. Scenario A woman was severely burned and she has been in the hospital for eight days Question • Why would she be developing: • Increased urine production? • Weight loss? • Increased temperature? • GI bleeding?

  22. Question Treatment for third-degree burn patients includes all but which of the following? • Fluid replacement • Removal of dead tissue/eschar • Antibiotics • Aloe

  23. Answer • Aloe Patients suffering from third-degree (full thickness) burns lose fluid through the skin and are prone to infection. They must receive fluid replacement and antibiotics to fight or prevent infection. Dead tissue (eschar) must be removed daily (debridement) in order to prevent infection. Because third-degree burns destroy the epidermis, the application of topical aloe would serve no purpose.

  24. Pressure Sores External Shear pressure bends blood obstructs blood flow vessels Friction ischemia to skin damages dermis/ tissue damage epidermis interface

  25. melanin oxidized - Ultraviolet radiation TAN hits melanocytes more melanin produced - delayed tanning some UV reaches lower skin layers immune DNA cells damage damaged inflammatory mediators released sunburn

  26. Sun Exposure • Sun exposure increases the risk of skin cancer • Cumulative sun exposure increases risk of: • Basal cell carcinoma • Squamous cell carcinoma • Severe sun exposure with blistering increases risk of: • Malignant melanoma

  27. Malignant Melanoma • Cancers arising from melanocytes • Asymmetry • Border irregularity • Color variegation • Diameter >0.6 cm • Evolving change over time

  28. Types of Melanomas • 70% are superficial spreading • Raised edges; grow horizontally and vertically • Ulcerate and bleed • 15%–30% are nodular • Dome-shaped, blue-black • 4%–10% are lentigo maligna • Slow growing, flat • 2%–4% acral lentiginous • On palms, soles, nail beds, mucous membranes

  29. Question Which type of skin cancer is associated with the worst prognosis? • Basal cell • Squamous cell • Malignant melanoma • Ependymal cell

  30. Answer • Malignant melanoma Malignant melanoma begins in the melanocytes, and possesses all of the characteristic features associated with cancer (asymmetry, irregular border, many colors, and a diameter >0.6 cm) as defined by the American Cancer Society. Basal cell cancer has the best prognosis, and squamous cell cancer has a good prognosis as long as it is detected early.

  31. Skin Conditions of Infancy • Birthmarks • Diaper dermatitis • Prickly heat • Cradle cap • Infectious disease rashes • Roseola (herpesvirus) • Rubeola (measles) • Rubella (German measles) • Varicella (chickenpox)

  32. Skin Disorders of the Elderly • Actinic (solar) damage • Keratoses: premalignant lesions • Lentigines: liver spots • Vascular lesions • Angiomas • Telangiectases • Venous lakes

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