Management of Patients with Dermatologic

Chapter 56Management of Patients with Dermatologic Problems : 

Chapter 56Management of Patients with Dermatologic Problems

The Skin : 

The Skin Three layers Epidermis Dermis Subcutaneous fatty layer Glands Sebaceous glands (SEBUM) Sweat glands Eccrine glands Apocrine glands

Acne : 

Acne Chronic inflammatory disorder of hair follicles on the face and trunk Most common skin disorder in adolescents and young children Caused from increased sebum (oily substance) production and clogged ducts

Acne : 

Acne Treat according to severity Topical keratolytics (benzoyl peroxide) Topical retinoids (Retin-A) Oral antibiotics(tetracyclines)-mod. to sev. Oral Accutane (Oral retinoids) Estrogen-dominant oral contraceptive

Acne : 

Acne

Impetigo : 

Impetigo HIGHLY CONTANGIOUS epidermal infection Most common bacterial skin infection in children but seen in all ages Caused by staph, strep, or both Most commonly affects face, mouth, hands, neck, extremities, skinfolds Diagnosed by gram stain and culture Treat with topical (Bactroban) or oral antibiotics (PCN)

Folliculitis, Furuncles, Carbuncles : 

Folliculitis, Furuncles, Carbuncles Folliculitis- infection within the hair follicle Furuncle (boil)- inflammation arising deep in one or more hair follicles and spreading to surrounding dermis Carbuncle- abscess of skin and subcutaneous tissue Treatment: Antibiotics Warm compresses Antibacterial ointment

Viral – Herpes Zoster : 

Viral – Herpes Zoster AKA Shingles Caused by varicella zoster which also causes chickenpox Painful Treatment – Acyclovir, Valtrex, Famvir & Narcotics Isolate from people who have not had chickenpox

Viral – Herpes Simplex : 

Viral – Herpes Simplex Vesicle type lesion Type 1 Type 2 Signs/Symptoms – burning, tingling, pain Diagnosed with culture – identifies herpes but doesn’t differentiate between simplex & zoster Treatment – Zovirax (Acyclovir) or Valtrex

Ringworm : 

Ringworm Fungal infection affecting skin, hair, or nails Spreads from person-person, animal-person, object-person Diagnosed by microscopic examiniation Most common forms: Tinea Capitis (scalp) Tinea Corporis (body) Tinea Cruris (“jock itch”) Tinea Pedis (“athletes foot”) Tinea ungum (toenails)

Pediculosis capitis (Lice) : 

Pediculosis capitis (Lice) Lice live and reproduce only on humans Transmitted by direct hair-to-hair contact or indirect contact such as sharing hair accessories Causes itching; many complain of dandruff Treat with pediculicide shampoo- Lindaine (Kwell) or ovicidal rinse (Nix)

Scabies : 

Scabies HIGHLY CONTAGIOUS Spread through skin to skin contact S/S: rash, itching worse at night Lesions usually present around axillae, palms, wrists, head, abdomen, chest Lesions appear as linear, threadlike, grayish burrows, ending in a pinpoint vesicle Treat with scabicide: Elimite (5% permethrin lotion), Lindane (Kwell)

Scabies : 

Scabies All family members should be treated Antihistamines for itching Change clothing and bedding daily Nonwashable toys should be sealed in a plastic bag for 5-7 days

Contact Dermatitis : 

Contact Dermatitis Inflammation of the skin that occurs in response to direct contact with an allergen or irritant Common irritants include soaps, detergents, lotions, urine Treatment: rest, cool, wet dressing, corticosteriod ointment

Psoriasis (most common skin disease) : 

Psoriasis (most common skin disease) Lifelong disorder with exacerbations and remissions Treatment: Daily soaks and tepid, wet compresses Topical steroids Nonsteroidal treatments (used for large body) Vit D derivative calcipotriene (Dovonex)-monitor for Hypercalcemia Retinoids- tazarotene (Tazorac)- Cat. X drug Systemic corticosteriods Ultraviolet-A light

Cellulitis : 

Cellulitis Cellulitis Infection of the skin with some extension into subcutaneous tissue Treat with oral or IV antibiotics

Gerontology Considerations : 

Gerontology Considerations Dry skin Delayed wound healing Fatty tissue layer of skin diminishes Lines and wrinkles appear Increased sensitivity to temperature Seborrheic keratoses

Seborrheic Keratoses : 

Seborrheic Keratoses These lesions are superficial, non-invasive tumors that originate in the epidermis. Slightly elevated yellowish, brown or brownish-plaque rounded plaques, and are found typically on the shoulders, trunk, scalp, and face. Treatment is by shave excision.

Skin Cancer- most common malignant cancers and most preventable cancer : 

Skin Cancer- most common malignant cancers and most preventable cancer The three major types of skin cancer are: Basal cell carcinoma Squamous cell carcinoma Melanoma MENTION ACTINIC KERATOSES-precancerous skin lesions common in people with chronically sun damaged skin, such as older adults; small % of these turn into SCC. Appear as rough, scaly patches

Basal Cell Carcinoma : 

Basal Cell Carcinoma Least malignant and most common skin cancer Cells proliferate and invade the dermis and hypodermis (adjoining tissues) Slow growing and do not often metastasize Can be cured by surgical excision in 99% of the cases

Squamous Cell Carcinoma : 

Squamous Cell Carcinoma Arise most often on face, lower lip, ears, nose, forehead Grows rapidly and metastasizes if not removed Prognosis is good if treated by radiation therapy or removed surgically

Slide 22: 

(pictures of squamous cell cancer)

Melanoma : 

Melanoma Most lethal of all skin cancers Arises from pigment-producing melanocytes Color may vary from white, gray, brown, blue, black

Melanoma : 

Melanoma Melanomas have the following characteristics (ABCD rule) A: Asymmetry; the two sides of the pigmented area do not match B: Border is irregular and exhibits indentations C: Color (pigmented area) is black, brown, tan, and sometimes red or blue D: Diameter is larger than 6 mm (size of a pencil eraser) (larger than ¼ inch)

Skin Cancers: Interventions : 

Skin Cancers: Interventions Non-surgical management Drug therapy Chemotherapy Radiation therapy Limited to older clients with large, deeply invasive basal cell tumors or poor surgical risks Immunotherapy

Skin Cancer: Interventions : 

Skin Cancer: Interventions Surgical Management Cryosurgery Local application of liquid nitrogen Electrosurgery For small lesions with well defined borders Excision