1. Chapter 46 Disorders 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. Psoriasis Activated T cells growth attract factors neutrophils and
monocytes
keratinocytes
enter
and blood
the
vessels grow
papules
create
create
papules
inflammation

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.) His pulses are weak Bowel sounds are absent
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
Friction
vessels
ischemia to skin
damages
dermis/
tissue damage
epidermis
interface

25. Ultraviolet radiation
melanin oxidized -
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. Author: Please add title.

29. 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

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

31. 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.

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

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