Question | Answer |
Nevi (moles) | – Rounded, well-defined borders
– Less than 5 mm; May be flat or raised;
– May be singular or in groups |
Seborrheic Keratoses | – Benign overgrowth and thickening of cornified epithelium
– Age-related-Adults > 50: on face and trunk
- Cosmetic concern
– Smooth or flaky-tan, yellow, darker brown |
Psoriasis | - Chronic auto-immune skin disorder
- Raised, reddened, round circumscribed plaques covered by
silvery white scales
- Most common type is plaque psoriasis - AKA (psoriasis vulgaris)
- Occurs most often in Caucasians; as child or middle 30’s. |
Precipitating factors for Psoriasis | – Certain drugs may act as trigger
– Family history
– Skin trauma from surgery
– Sunburn
– Excoriation
– Sunlight
– Stress
– Seasonal changes
– Hormone fluctuations
– Steroid withdrawal |
Hyperkeratosis | – Abnormal keratin comes to outer layer of skin at greater rate
- Produces abnormal cells with inflammatory response
– Found over elbows, knees, scalp
– Appear purple in darker-skinned patients |
Manifestations of Hyperkeratosis | - Characteristic lesions -silvery leathery plaques; May weep
- Nails pitting, yellow/brown discoloration; separation from bed
- Psoriatic arthritis |
Psoriasis Diagnosis | - Skin biopsy-If atypical
- Ultrasound of skin |
Psoriasis Treatments | • Based on type, extent/location, pt age, degree of
disfigurement
• No cure
• Topical medications
• Oral immunosuppressants, if needed
• Sunlight
• Phototherapy
• Photochemotherapy |
Topical Psoriasis Medications | Corticosteroids-anti-inflammatory-better with occlusive dressing |
Topical Psoriasis Medications | Tar preparations –decrease cell growth and inflammation: those from coal tar stain black with strong odor; Anthralin-made from coal tar without stain or have odor-used as shampoo |
Topical Psoriasis Medications | Vitamin D derivative |
Phototherapy (Psoriasis Treatments) | - Used sunlight in past, but can now use controlled UVB or UVA
rays -gradually increasing dosage
- UVB-decreases growth of epidermal cells
- PUVA-w/lotion to make more sensitive/use of UVA rays
- Eyes must be shielded; Must prevent severe sunburn |
Photochemotherapy (Psoriasis Treatments) | - Oral administration of chemo agent followed w/UVA exposure
- High success rate with side effects of aging of exposed skin, risk
of melanoma and altered immune function |
Priorities of care for Psoriasis | – Ensure adequate treatment of underlying process
– Support physical and psychological responses
– Provide emotional support
– Teach patient and caregivers strategies for self-care |
Pyoderma | – Infection that occurs when a break in the skin allows invasion
by pathogenic bacteria |
Common infections of skin | – Gram-positive Staphylococcus aureus (MRSA)
– Beta-hemolytic streptococci |
Folliculitis | - Starts at hair follicles
- Caused by S. aureus
- Scalp and extremities; Pustules surrounded by area of erythema |
Furuncles | - Called boils-down hair shaft into dermis
- Cysts may drain substantial amounts of purulent drainage |
Carbuncle | - Group of infected hair follicles
- Common in hot, humid climates |
Cellulitis | - Reddened circle or streaks
- Localized infection of dermis, subcutaneous tissue
- Substance released (Spreading factor) breaks down barriers
that usually localize infections |
Methicillin-resistant Staphylococcus aureus (MRSA) infection | - Skin, urine lungs and blood |
Diagnosis of MRSA | - Culture and sensitivity
- Culture drainage from cleansed wound or blood culture
- Test culture from external nares to identify carriers |
Treatment of MRSA | Antibiotic based upon sensitivity results, topical/oral or IV; Vancomycin IV-requiring trough drug levels for therapeutic doses prior to admin |
Dermatophytes (Fungal Infection) | - Tinea-like warm moist locations
- Ringworm, athlete’s foot, jock itch-from direct contact |
Candidiasis | - Caused by fungus Candida albicans
- AKA moniliasis
- Found in moist skinfolds and mouth
- Occurs from use of broad spectrum antibiotics that kill normal
skin flora and allows candida to grow
- Diabetes, immunodeficiencies, AIDS, chemotherapy |
Vaginal infection (Yeast) | - Odorless, thick cheesy discharge with itching and irritation |
Diagnosis of Fungal Infection | - Inspection and report
- Cultures; Microscopic examination using KOH
- Examination of skin with ultraviolet light (Wood's lamp) |
Medications for Candidiasis | Vaginal or skin treatment with topical cream (nystatin, miconazole) or oral fluconazole x 3 d
– Oral candidiasis-Mycostatin swish and swallow |
Herpes simplex 1 -(above the waist) | - Skin and mucous membranes- forms vesicle (blister)
– Lips, face and mouth
– Initial infection often severe
– Spread by contact, kissing, oral sex during outbreak
- May have systemic sxs-fever, malaise |
Herpes simplex 1 (HSV-1) | - Virus lives in nerve ganglia:
- Lesion heals in 10-14 days-if immune system healthy
- Virus lies dormant and may have recurrent lesions
- Triggers-sunlight, menstruation, injury, stress
- Oral acyclovir used to treat current outbreak |
Herpes simplex 2-Genital herpes | - Caused by HSV-2 (below the waist)-first outbreak most severe
- Spread by contact, sexual activity: (may have Herpes simplex 1 with oral sex)
- Same treatment, progression and dormancy as type 1 |
Herpes zoster (Shingles) | - Caused by reactivation of varicella zoster (herpes virus causing chickenpox)
- Most common in adults over 60, patient's with leukemias, lymphomas,
immunocompromised, HIV-may be first sign |