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patho
acute and chronic skin disorders ch 40 and 41
| Question | Answer |
|---|---|
| acute skin conditions | bacterial or fungal infection contact with offending organism or allergen medications possible transition to chronic skin conditions life-threatening inflammatory disorders |
| chronic skin conditions | long term, may or may not resolve viral infection |
| acute skin disorders | pain from damage to first layer of skin immune system and intact skin protect body alterations in tissue perfusion can lead to damage or necrosis |
| acute skin disorders - immune system and intact skin protect body | impaired tissue integrity leads to immune response immune response from allergy and inflammation can lead to lack of lack of tissue integrity |
| bacterial skin infections cellulitis | diffuse painful inflammation of skin and subcutaneous layers induces by a bacterial infection that enters through a break in the skin (cut, scrape, burn, or surgical incision, or bug bite). adult pop. |
| cellulitis CM | painful, red, swollen area of the skin; hot tender to touch fever and chills (large inflammatory response) vesicles, bullae, plaques (with staphylococcus) tachycardia, hypotension, confusion, headache lymphadenitis and lymphangitis |
| lymphadenitis | inflammation of lymphatic system |
| lymphangitis | inflammation of lymph nodes |
| bacterial skin infections impetigo | superficial acute, highly contagious skin infection (cannot go to daycare or park) |
| impetigo etiology and pathogenesis | colonization facilitated by high temperature, humidity, pre-existing skin disorders, young ages (2-5), recent antibiotic Tx |
| bacterial skin infections furuncle | extension of folliculitis or infection of sebaceous gland. down hair shaft through follicle and into dermis |
| bacterial skin infections carbuncle | cluster (2 or more) of infected hair follicles. the cluster coalesces to form lesion filled with pus, dead tissue, fluid |
| fungal skin infection candidiasis | infection of skin or mucous membranes with any species of Candida (C. albicans most common) mouth, throat, lungs, vagina, folds of skin, bowel usually secondary condition |
| fungal skin infection candidiasis etiology and pathogenesis | candida normal in skin and mucous membranes warmth, moisture, breaks in epidermis can cause infection life threatening if in the blood stream |
| fungal skin infection candidiasis CMs | thrust: white covering of tongue, mouth, throat vaginal yeast infection: itching foul odor, white discharge balanitis: flattened pustules, edema, burning, tenderness diaper rash: dark red patched in skin folds; fluid filled spots |
| fungal skin infection Tinea | contagious infection by different types of fungus superficial infection; called dermatophytoses names by the location on the body |
| tinea pedis | athelete's foot, which affects the feet with symptoms like itching, scaling, and blisters between the toes |
| tinea cruris | jock itch, a rash in the groin area |
| tinea capitis | ringworm on the scalp, causes itchy, red patches and hair loss |
| tinea corporis | ringworm on the body, appearing as a ring-shaped rash |
| tinea versicolor | discolored, scaly, and dry patches on the skin |
| necrotizing fasciitis | "flesh eating disorder" rapidly spreading infection caused by aerobic and anaerobic bacteria |
| necrotizing fasciitis etiology and pathogenesis | starts from contagious ulcer, wound, untreated skin infection, complication of surgery, abscess. occlusion of small subcutaneous vessels; tissue ischemia, infarction, necrosis. |
| Stevens-Johnson Syndrome | rare disorder of skin and mucous membranes. cell death causes epidermis to seperate from the dermis |
| Stevens-Johnson Syndrome etiology | -over 200 medications can increase the risk factor: allopurinol, anticoagulants (like lamotrigine, carbamazepine, and phenytoin), sulfonamides (some antibiotics), and certain NSAIDs and antivirals. -infectious causes -delayed hypersensitivity rxn |
| Stevens-Johnson Syndrome CMs | flulike symptoms symmetric burning rash; red, purple |
| Toxic Epidermal Necrolysis (TEN) | inflammation of skin caused by poison |
| TEN with spots | widespread with detachment of epidermis, erosion more than 30% of body surface area |
| TEN without spots | widespread with erythema, no lesions more than 10% of body surface area |
| Toxic Epidermal Necrolysis (TEN) etiology | reactions to drugs; bacterial infection; malignancy; graft-versus-host disease; vaccinations |
| Toxic Epidermal Necrolysis (TEN) CMs | flulike symptoms rash; large blisters in center rash; ruptures; skin peels off |
| viral skin infections | chronic viral skin infection examples: herpes simplex virus varicella-zoster virus human papillomavirus |
| herpes simplex virus type 1 (HSV-1) | affects many different body regions occurs with decrease in immune system usually contracted during childhood then recurrences persist into old age |
| herpes labialis | lips, cold sores most common HSV-1 infection |
| herpetic keratitis | eye |
| herpetic whitlow | digits or hands |
| herpes gladiatorum | torso of wrestlers |
| herpetic sycosis | beard follicles |
| herpes simplex type 2 (HSV-2) | causes most sexually transmitted anogenital herpes (lesions on genitals, perineum, or anus) may cause cold sores (less common than 1) likely to get via sexual contact (young adult) 5th most common STD in the US - 1 in 6 people of both genders |
| herpes simplex virus type 1 and 2 etiology and pathogenesis: first contraction of virus | virus enters the skin or mucous membranes (thru micro tear) virus travels to sensory root ganglion virus becomes dormant and permanent resident of ganglion cell-mediated immune syst. is triggered |
| herpes simplex virus type 1 and 2 etiology and pathogenesis: recurrence of virus | cell-mediated immune system is triggered viral activation occurs virus travels from neuron to skin innervated by neuron virus enters dermal and epidermal cells viral replication caused recurrent rash outbreak |
| CM of HSV-1 and HSV-2 | asymptomatic herpes or mild fever usually begins w/ prodrome (flu symptoms) red, swollen skin or mucous membrane developes eruption of painful vesicles regions lymph nodes swell lesions open and form painful ulcers that crust and begin healing |
| primary genital herpes may cause | dysuria or urinary retention especially in women |
| herpes zoster | chronic viral skin condition affects about 1 million people aka shingles caused by varicella-zoster virus (VZV) (member of herpesvirus family. VZV also causes chickenpox) |
| first herpes zoster infection causes | chickenpox >each skin lesion contains viral particles. they travel to other structures (sensory dorsal-root ganglia or a CN) >viral particles become dormant for life |
| cell-mediated immunity | prevents virus reactivation in the form of HZ decreases with aging (increased risk for reactivation for VZV as HZ) |
| potential complications of HZ | postherepetic neuralgia (PHN) (most common) TIA and stroke encephalitis and aseptic meningitis chronic eye disorders and retinal necrosis bacterial superinfection of lesions cranial or peripheral nerve palsies pneumonitis hepatitis |
| diagnosis of HZ | history and physical examination >usually sufficient for Dx after rash appears >atypical or recurrent rashes (more than 1 episodes) (may require lab testing to identify) >laboratory testing (direct immunofluorescent assay. PCR assay) |
| warts | various types of human papillomavirus (HPV) can occur anywhere on skin or mucous membranes |
| malignant warts | most lesions caused by HPV are benign some HPV types are linked to dysplasia and cancer (genital HPV-most frequently occurring STD in the US) |
| pathogenesis of warts HPV | enters skin- small openings. infects epidermal basal layer. viral replication occurs @ cell nuclei HPV causes nuclear atypia (structural abnormality) nuclear atypia = epidermal cell changes (replication/ hyperproliferation of keratinocytes wart forms |
| skin disorders with a genetic basis | family Hx: most important risk factor for certain chronic skin diseases examples of skin disorders w genetic component: apotic dermatitis psoriasis hidradenitis suppurativa |
| eczema | general term describes inflammatory skin disorders includes atopic dermatitis (AD): most severe form of eczema |
| atopic dermatitis | chronic, recurrent, itchy, inflammatory disorder associated increased serum IgE affected individuals often have other atopic disorders (ex asthma, allergic rhinitis) most often affects kids may persist into adulthood |
| AD and susceptibility to infection | dysfunctional epidermal barrier |
| clinical manifestations of AD | exacerbation and remission of dry, itchy, and red skin begins in infancy constant pruritus - prevailing symptom, precedes eczematous rash skin excoriations and lichenification negative impact on overall QOL (sleep disturbances, depression) |
| psoriasis etiology | immune-mediated disease genetic and environmental causation |
| psoriasis pathogenesis | hyper-proliferation of keratinocytes decreased epidermal cell turnover rate inflammation proliferation of keratinocytes thickening of dermis and epidermis |
| psoriasis CM | plaque psoriasis - skin lesions usually round or oval, well-demarcated plaques |
| Hidradenitis Suppurativa etiology | genetic, immunological, hormonal, and environmental factors |
| Hidradenitis Suppurativa pathogenesis | occlusion of hair follicle via infundibular hyperkeratosis hyperplasia of follicular epithelium collection of cellular wastes cyst forms in apocrine sweat glands adjacent to hair follicle nodule opens beneath the skin and spreads laterally |
| Hidradenitis Suppurativa may lead to | abscess formation and sinus tract formation keloid-like scarring may occur |
| Hidradenitis Suppurativa CM | painful nodules, abscesses, and sinus tract formations lesions develop in skinfold areas |
Created by:
ago24