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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 46 Disorders of Skin Integrity and Function.

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Presentation on theme: "Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 46 Disorders of Skin Integrity and Function."— Presentation transcript:

1 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 46 Disorders of Skin Integrity and Function

2 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Bacterial Skin Infections Impetigo –May lead to post- streptococcal hypersensitivity reactions –These can cause glomerulonephritis

4 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following microbes cause warts? a.Fungus b.Virus c.Bacteria d.Any of the above may cause warts.

6 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b.Virus Warts are caused by viruses; they’re benign neoplasms (abnormal tissue growths).

7 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Allergic and Hypersensitivity Dermatoses Type I allergies –Atopic eczema –Urticaria (hives)

10 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which chemical mediator is released by mast cells as part of the inflammatory response? a.Histamine b.Leukotriene c.Cytokine d.All of the above

12 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer a.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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Papulosquamous Dermatoses Psoriasis Pityriasis rosea Lichen planus

16 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Psoriasis Activated T cells growth factors keratinocytes and blood vessels grow create papules attract neutrophils and monocytes enter the papules create inflammation

17 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Scenario (cont.) Mr. D's burns are pink b ut 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Complications of Burns Burn shock Respiratory system dysfunction Hypermetabolic response Renal insufficiency Gastric ulceration Sepsis Constriction of areas under circumferential burns Systemic infection

21 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Treatment for third - degree burn patients includes all but which of the following? a.Fluid replacement b.Removal of dead tissue/eschar c.Antibiotics d.Aloe

23 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer d.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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Pressure Sores External pressure obstructs blood flow ischemia to skin tissue damage Shear bends blood vessels Friction damages dermis/ epidermis interface

25 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Ultraviolet radiation hits melanocytes melanin oxidized - TAN some UV reaches lower skin layers immune cells damaged inflammatory mediators released DNA damage sunburn more melanin produced - delayed tanning

26 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Malignant Melanoma Cancers arising from melanocytes Asymmetry Border irregularity Color variegation Diameter >0.6 cm Evolving change over time

28 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which type of skin cancer is associated with the worst prognosis? a.Basal cell b.Squamous cell c.Malignant melanoma d.Ependymal cell

31 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer c.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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Skin Conditions of Infancy Birthmarks Diaper dermatitis Prickly heat Cradle cap Infectious disease rashes –Roseola (herpesvirus) –Rubeola (measles) –Rubella (German measles) –Varicella (chickenpox)

33 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Skin Disorders of the Elderly Actinic (solar) damage –Keratoses: premalignant lesions –Lentigines: liver spots Vascular lesions –Angiomas –Telangiectases –Venous lakes


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