Chapter 28: Skin Disorders

Chapter 28: Skin Disorders
© 2011 McGraw-Hill Higher Education. All rights reserved.

Skin Lesions Defined Skin pigment - melanin Variations may be due to anatomic, physiologic or pathophysiologic changes in skin blood flow Normal skin appearance Altered by external and internal factors Cellulitis Infectious inflammation of deep skin structures © 2011 McGraw-Hill Higher Education. All rights reserved.

Skin Trauma Mechanical Forces that Cause Injury Friction Compression
Shearing Stretching Scraping Tearing Avulsing Puncturing © 2011 McGraw-Hill Higher Education. All rights reserved.

Friction and Pressure Problems
Hyperkeratosis of the Hands and Feet Etiology Friction and pressure over bony protuberances Painful when subcutaneous fat becomes inelastic Sign and Symptoms Thickening, of horny layer of skin, ovular, elongated and brown Painful with pressure © 2011 McGraw-Hill Higher Education. All rights reserved.

Management Avoid emery boards and pumice as the increase in friction will stimulate skin to produce added callus Use moisturizer Pair off callus with scalpel Padding Prevention Cushioning devices; wearing 2 socks Lubricants to reduce friction, shaving calluses For calluses on hands, special gloves or protective gear © 2011 McGraw-Hill Higher Education. All rights reserved.

Blisters Etiology Result of a shearing force that produces a raised area that accumulates with fluid Signs and Symptoms Hot spot, sharp burning sensation, painful Superficial area of skin raised with clear fluid Prevention Use of dust or powder or lubricant to reduce friction Tubular socks, 2 pairs of socks if feet are sensitive or perspire excessively Appropriate shoes that are broken in Padding and lubricants © 2011 McGraw-Hill Higher Education. All rights reserved.

Management (intact blister) Leave intact for 24 hours Clean with antiseptic Cut small incision to drain fluid (large enough that it won’t re-seal) Note in some states this is considered a surgical technique, placing ATC in violation of certain practice acts Prevent refilling with a pressure pad Clean again with antiseptic Use doughnut to prevent irritation Monitor for infection, replace wet bandaging Debridement can be performed when tenderness is gone © 2011 McGraw-Hill Higher Education. All rights reserved.

Management (open/torn blister) Keep clean to avoid infection Keep skin in place and apply non-adhering sterile dressing and padding Monitor daily for infection Management (denuded blister) If blister is torn 1/2 inch or more remove skin flap Clean and expose area, apply antiseptic with occlusive dressing Second skin can be applied to raw area © 2011 McGraw-Hill Higher Education. All rights reserved.

Soft Corns and Hard Corns Etiology Caused by pressure of improperly fitting shoes and anatomic abnormalities Soft corns are the result of pressure and perspiration, also associated with exostosis Signs and Symptoms Hard corns form on the tops of toes and tend to be painful and dry Soft corns result in thickening of skin, white and sometimes painful (between 4th and 5th toes) Prevention Wear properly fitting shoes Management Surgical removal if painful Padding; maintain clean dry feet; wear appropriate shoes © 2011 McGraw-Hill Higher Education. All rights reserved.

Excessive Perspiration (hyperhidrosis) Etiology Syrup-like perspiration, high in sodium chloride Increases risk of other skin irritation Makes adherence of bandages difficulty Management Use of astringent such as alcohol or an absorbent powder Aluminum chloride or electric current can be used to treat condition © 2011 McGraw-Hill Higher Education. All rights reserved.

Chafing of Skin Etiology Occurs particularly in patients that are obese or heavy limbed Result of friction and maceration of skin in climate of heat and moisture Signs and Symptoms Separation of keratin from granular layer of skin Causes oozing wounds that crust and crack Management Clean area with soap and water and treat with medicated solution and hydrocortisone cream Prevention Keep skin dry, clean, and friction free For the groin, soft, loose, cotton underwear is recommended © 2011 McGraw-Hill Higher Education. All rights reserved.

Xerotic (Dry) Skin Etiology Drying of skin due to exposure of cold, excessive bathing, decrease in humidity causing skin to lose water Signs and Symptoms Dry skin w/ variable redness and scaling; itching Management Prevent water loss and replace lost water Bathe in tepid water, use moisturizer If condition worsens, refer to physician © 2011 McGraw-Hill Higher Education. All rights reserved.

Ingrown Toenails Etiology Generally occurs in great toe Nail grows laterally into skin Result of lateral pressure from shoes, poor nail trimming, and repeated trauma © 2011 McGraw-Hill Higher Education. All rights reserved.

Signs and Symptoms Pain and swelling Penetrated skin becomes inflamed and purulent with lateral nail fold swollen and irritated Management Conservative management includes soaking the inflamed toe in warm water (20 minutes) Place cotton under edge of nail to clear from skin If chronic, remove wedge of nail and apply antiseptic compress until inflammation resides Physician may take more aggressive approach Prevention Properly fitting shoes and socks are essential Weekly toenail trimming (cut straight across) Leave nail long enough to clear skin © 2011 McGraw-Hill Higher Education. All rights reserved.

Wounds Abrasions Scraping of skin against rough surface (top surface of skin is worn away) Increased probability of infection due to exposure of dirt and foreign material Clean and debride Punctures Direct penetration of skin with pointed object Must be referred to physician © 2011 McGraw-Hill Higher Education. All rights reserved.

Lacerations Object tears tissue, giving wound appearance of jagged edge (sometimes result of blunt trauma) Presents environment susceptible to infection Skin Incision Smooth cut in skin - not jagged Skin Avulsion Skin torn away from body (should be placed in moist gauze w/in a plastic bag that is then immersed in cold water) Transport to hospital with patient for possible reattachment © 2011 McGraw-Hill Higher Education. All rights reserved.

Skin Bruises Result of blunt trauma; causes disruption of superficial blood vessels and results in black and blue discoloration Treatment requires RICE to control hemorrhaging © 2011 McGraw-Hill Higher Education. All rights reserved.

Wound Management All wounds must be assumed contaminated Pay close attention to all universal precautions Clean all wounds with soap and water to minimize infection Apply a dressing with antiseptic (unless physician examination is necessary) Lacerations and punctures should be treated by a physician Use of occlusive dressings Minimizes scab formation, perceived pain from exposed nerves, cost and time effective, provide adequate barrier Antibiotic ointment used to prevent secondary infection (SEE TABLE 28-4 for added instruction) © 2011 McGraw-Hill Higher Education. All rights reserved.

If the wound is discharging serum (fluid) to dressing should be changed regularly When drainage has stopped = no need for dressing Wound should be cleaned with hydrogen peroxide or Betadine Effective against bacteria and not harmful to fibroblasts Antibacterial ointment should be used to limit bacterial growth and to prevent dressing from adhering to wound Proper care = minimized inflammatory response with quick healing and reduced scarring © 2011 McGraw-Hill Higher Education. All rights reserved.

Suturing Dependent on severity Determined by physician Are underlying tissues exposed or is there significant bleeding? Should be put in as soon as possible Within 12 hours following injury Utilize fine suture material and minimal tightening Limits additional damage, inflammation and scarring Large areas or slow healing areas = larger material to be left in longer Occasionally steri-strips or butterfly bandages will suffice © 2011 McGraw-Hill Higher Education. All rights reserved.

Alternative techniques involves use of skin adhesive/glue Creates a bond across the wound edges allowing for appropriate healing Can be used to replace small sutures Seals out infection Easy to use, provides water resistant protective coating Long term cosmetic outcome is comparable to traditional repair methods © 2011 McGraw-Hill Higher Education. All rights reserved.

Athletic Training Clinic Practice in Wound Care
Use clean and sterile instruments Clean hands thoroughly and use gloves Sterilize in and around skin lesion Use a non-medicated covering if athlete is to be sent for medical attention Utilize butterfly bandage if suture not required Avoid touching any part of sterile dressings that will contact the wound Place medication on pad Secure the dressing in place © 2011 McGraw-Hill Higher Education. All rights reserved.

Bacterial Infections Bacteria are single celled micro-organisms Spherical, doublets, and spirochetes Staphylococcus Gram positive bacteria that appears in clumps in skin and upper respiratory tract Streptococcus Chain bacteria often associated with systemic disease and skin infections Bacillus Spore forming, aerobic, and occasionally mobile Can cause systemic damage © 2011 McGraw-Hill Higher Education. All rights reserved.

Methicillin-Resistant Staphylococcus Aureus (MRSA)
Etiology Strains of staphylococcus bacteria that are resistant to some antibiotics Often occurs in individuals that are already sick, in hospital and are ill, have open wounds, or burns Can occur outside of hospital setting as well Signs & Symptoms Redness, swelling, tenderness of infection site Some may carry MRSA and not exhibit symptoms Management Antibiotics (higher dose) provided intravenously Treatment lasts several weeks © 2011 McGraw-Hill Higher Education. All rights reserved.

Impetigo Contagiosa Etiology Caused by A-beta-hemolytic streptococci, S aureus or combination of these bacteria Spread through close contact Signs and Symptoms Mild itching and soreness followed by eruption of small vesicles and pustules that rupture and crust Generally develops in body folds that are subject to friction Management Cleansing and topical antibacterial agents Systemic antibiotics © 2011 McGraw-Hill Higher Education. All rights reserved.

Signs and Symptoms Pustule that becomes reddened and enlarged as well as hard from internal pressure Pain and tenderness increase with pressure Most will mature and rupture Management Care involves protection from additional irritation Referral to physician for antibiotics Keep patient from contact with other team members while boil is draining © 2011 McGraw-Hill Higher Education. All rights reserved.

Carbuncles Etiology Similar in terms of early stage development as furuncles Signs and Symptoms Larger and deeper than furuncle and has several openings in the skin May produce fever and elevation of WBC count Starts hard and red and over a few days emerges into a lesion that discharges yellowish pus Management Surgical drainage combined with the administration of antibiotics Warm compress is applied to promote circulation © 2011 McGraw-Hill Higher Education. All rights reserved.

Folliculitis Etiology Inflammation of hair follicle Caused by non-infectious or infectious agents Moist warm environment and mechanical occlusion contribute to condition Pseudofolliculitis (PFB) © 2011 McGraw-Hill Higher Education. All rights reserved.

Signs and Symptoms Redness around follicle that is followed by development of papule or pustule at the hair follicle Followed by development of crust that sloughs off with the hair Deeper infection may cause scarring and alopecia in that area Management Management is much like impetigo Moist heat is used to increase circulation Antibiotics can also be used depending on the condition © 2011 McGraw-Hill Higher Education. All rights reserved.

Hidradenitis Suppurativa Etiology Primary inflammation event of the hair follicle resulting in secondary blockage of the apocrine gland Signs and Symptoms Begins as small papule that can develop into deep dermal inflammation Management Avoid use of antiperspirants, deodorants and shaving creams Use medicated soaps and systemic antibiotics © 2011 McGraw-Hill Higher Education. All rights reserved.

Acne Vulgaris Etiology Inflammatory disease of the hair follicle and the sebaceous glands Sex hormones may contribute Signs and Symptoms Present with whiteheads, blackheads, flesh or red colored papules, pustules or cysts If chronic and deep = may scar Psychological impact Management Topical and systemic agents used to treat acne Sometimes the use endogenous hormones is required Mild soaps are recommended © 2011 McGraw-Hill Higher Education. All rights reserved.

Paronychia and Onychia Etiology Caused by staph, strep and or fungal organisms that accompany contamination of open wounds or hangnails Damage to cuticle puts finger at risk Onychia is an infection of the nail bed itself, while paronychia involves the lateral nail fold Signs and Symptoms Rapid onset; painful with bright red swelling of proximal and lateral fold of nail Accumulation of purulent material w/in nail fold Management Soak finger or toe in hot solution of Epsom salt 3 times daily Topical antibiotics, systemic antibiotics if severe May require pus removal through skin incision © 2011 McGraw-Hill Higher Education. All rights reserved.

Tetanus Infection (lockjaw) Etiology Acute infection of the CNS and muscles caused by tetanus bacillus Bacteria enters through the blood and open wounds Signs and Symptoms Stiffness of the jaw and muscles of the neck Muscles of facial expression produce contortion and become painful Fever may become markedly elevated Management Treat in intensive care unit Childhood immunization © 2011 McGraw-Hill Higher Education. All rights reserved.

Fungal Infections Group of organisms that include yeast and molds which are usually not pathogenic Grow best in unsanitary conditions with warmth, moisture and darkness Infections generally occur in keratinized tissue found in hair, nails and stratum corneum Dermatophytes (Ringworm fungi) Cause of most skin, nail and hair fungal infections © 2011 McGraw-Hill Higher Education. All rights reserved.

Tinea of the Scalp (tinea capitis) Signs and Symptoms Ringworm of the scalp begins as a small papule that spreads peripherally Appears as small grayish scales resulting in scattered balding Easily spread through close physical contact Management Topical creams and shampoos are ineffective in treating fungus in hair shaft Systemic antifungal agents are replacing older agents due to increased resistance Some topical agents are used in conjunction © 2011 McGraw-Hill Higher Education. All rights reserved.

Tinea of the Body (tinea corporis) Signs and Symptoms Commonly involve extremities and trunk Itchy red-brown scaling annular plaque that expands peripherally Management Topical antifungal cream © 2011 McGraw-Hill Higher Education. All rights reserved.

Tinea of the Nail (tinea unguium/ onychomycosis) Signs and Symptoms Fungal infection of the nail -- found commonly in those engaged in water sports or who have chronic athlete’s foot Nail becomes thick, brittle and separated from its bed Management Some topical antifungal agents have proved useful Systemic medications are most effective Surgical removal of nail may be necessary if extremely infected © 2011 McGraw-Hill Higher Education. All rights reserved.

Tinea of the Groin (tinea cruris) Etiology Symmetric red-brown scaling plaque with snake-like border Signs and Symptoms Mild to moderate itching May progress to secondary bacterial infection © 2011 McGraw-Hill Higher Education. All rights reserved.

Management Treat until cured Will respond to many of the non-prescription medications Medications that mask symptoms should be avoided Failure to respond to normal management may suggest a non-fungal problem (such as bacteria) and should be referred to a physician May require additional topical medications and oral prescriptions © 2011 McGraw-Hill Higher Education. All rights reserved.

Athlete’s Foot (tinea pedis) Etiology Most common form of superficial fungal infection Trichophyton species are most common cause of athlete’s foot Webs of toes may become infected by a combination of yeast and dermatophytes Signs and Symptoms Extreme itching on soles of feet, between and on top of toes Appears as dry scaling patch or inflammatory scaling red papules forming larger plaques May develop secondary infection from itching and bacteria Management Topical antifungal agents and good foot hygiene © 2011 McGraw-Hill Higher Education. All rights reserved.

Candidiasis (Moniliasis) Etiology Yeast-like fungus that can produce skin, mucous membrane and internal infections Ideal environment includes hot humid weather, tight clothing, and poor hygiene Signs and Symptom Infections w/in body folds Presents as beefy red patches and possible satellite pustules White, macerated border may surround the red area; deep painful fissures may develop at skin creases Management Maintain dry area Use antifungal agents to clear infection © 2011 McGraw-Hill Higher Education. All rights reserved.

Tinea Versicolor Etiology Caused by a yeast Appears commonly in areas in which sebaceous glands actively secrete body oils Signs and Symptoms Fungus produces multiple, small, circular macules that are pink, brown, or white Commonly occur on chest, abdomen, and neck Do not tan when exposed to sun and usually are asymptomatic Management Straightforward treatment - recurrences are common Use selenium shampoo (Selsun) and topical econazole nitrate (or something similar) When microorganism has been eradicated, re-pigmentation of the area will occur © 2011 McGraw-Hill Higher Education. All rights reserved.

Viral Infections Ultramicroscopic organisms that require host cells to complete their life cycle May stimulate cell chemically to produce more virus until host cell dies Lies within bud-like structure that does not damage cell or virus, w/out causing infection A number of skin infections are caused by viruses © 2011 McGraw-Hill Higher Education. All rights reserved.

Herpes Simplex Labialis, Gladiatorum, and Herpes Zoster Etiology Highly contagious and is usually transmitted directly through a lesion in the skin or mucous membrane Resides in sensory nerve neurilemmal sheath following initial outbreak Recurrent attacks stimulated by sunlight, emotional disturbances, illness, fatigue, or infection Type I vs. Type II Signs and Symptoms Early indication = tingling or hypersensitivity in an infected area 24 hours prior to appearance of lesions Local swelling followed by outbreak of vesicles Patient may feel ill w/ headache, sore throat, swollen lymph glands and pain in area of lesions © 2011 McGraw-Hill Higher Education. All rights reserved.

Signs and Symptoms (continued) Vesicles generally rupture in 1-3 days spilling serous material Heal in generally days If an athlete has an outbreak they should be disqualified from competition due to contagious nature of condition Management Herpes simplex lesions are self limiting - reduce pain and promote early healing Use of antiviral drugs can reduce recurrence and shorten course of outbreak Complications Can lead to secondary infection if not managed carefully © 2011 McGraw-Hill Higher Education. All rights reserved.

Verruca Virus and Warts
Variety of forms exist verruca plana (flat wart), verruca plantaris (plantar wart), and condyloma acuminatum (venereal wart) Different types of human papilloma virus have been identified Uses epidermal layer of skin to reproduce and grow Wart enters through lesion in skin © 2011 McGraw-Hill Higher Education. All rights reserved.

Common Wart Signs and Symptoms Small, round, elevated lesion with rough dry surfaces Painful if pressure is applied May be subject to secondary bacterial infection Management If vulnerable, they should be protected until treated by a physician Use of electrocautery, topical salicylic acid or liquid nitrogen are common means of managing this condition © 2011 McGraw-Hill Higher Education. All rights reserved.

Plantar Warts Etiology Spread through papilloma virus Signs and Symptoms Located on sole of foot, or adjacent to areas of abnormal weight bearing Areas of excessive epidermal thickening Discomfort, point tenderness Hemorrhagic puncta (black seeds) Management In general, protect and prevent spreading Pair away callus and apply Keratolytic Following season, wart can be removed by freezing it or by electrodessication (maintain protection until removal) © 2011 McGraw-Hill Higher Education. All rights reserved.

Molluscum Contagiosum Etiology Poxvirus infection which is more contagious than warts (especially during direct body contact) Signs and Symptoms Small, flesh or red colored, smooth-domed papules with central umbilication Management Physician referral is necessary Cleansing and destructive procedure (counterirritant such as cantharidin, surgical removal or cryosurgery) © 2011 McGraw-Hill Higher Education. All rights reserved.

Allergic, Thermal, and Chemical Skin Reactions
Allergies are immunologically mediate responses to molecules in dyes and proteins against which the body’s immune system is sensitized Allergens may be food, drugs, clothing, dusts, pollens, plants, animals, heat, cold, or light The skin will reflect an allergy in many ways such as reddening and swelling of the tissue, urticaria or hives, burning or itching Athletic trainers must recognize gross signs of allergic responses and be prepared to remove allergens and treat topically or systemically with antipruritic agents © 2011 McGraw-Hill Higher Education. All rights reserved.

Contact Dermatitis (allergic and irritant) Etiology Plants are the most common cause (poison ivy, poison oak, sumac, ragweed, primrose) Topical medications Chemicals found in fragrances and preservatives of soaps, detergents Signs and Symptoms Onset may range from 1 day to 1 week Redness, swelling, formation of vesicles that ooze fluid and form crust, constant itching May change from redness and blistering to erythematous scaling, lichenified papules and plaques Management Avoid allergen Tap water compresses or soaks, topical corticosteroids © 2011 McGraw-Hill Higher Education. All rights reserved.

Milaria (Prickly Heat) Etiology Continued exposure to heat and moisture causing retention of perspiration by sweat glands Signs and Symptoms Itching and burning vesicles and pustules Occurs most often on arms, trunks, and bending areas of the body Management Avoidance of overheating, frequent bathing with non-irritating soap, wearing loose-fitting clothing and use of antipruritic lotions © 2011 McGraw-Hill Higher Education. All rights reserved.

Chilblains (pernio) Etiology Caused by excessive exposure to cold Signs and Symptoms Tissue does not freeze but reacts with edema, reddening and possibly blistering along with a sensation of burning and itching after exposure to cold Management Exercise and gradual warming of the part Massage and application of heat are contraindicated Some systemic drugs can be used in severe cases © 2011 McGraw-Hill Higher Education. All rights reserved.

Sunburns Etiology Inflammatory response to injury caused by ultraviolet solar radiation Must be cautious of physical characteristics, chemicals, food and drugs that make individuals more susceptible Signs and Symptoms Varies from erythema to severe blistering May experience shock if severe enough Can cause malfunctioning of organs w/in the skin Will appear 2-8 hours following exposure, with symptoms becoming most severe at 12 hours S&S will dissipate w/in hours © 2011 McGraw-Hill Higher Education. All rights reserved.

Sunburns (continued) Management Can be prevented through the use of sunscreen (sun protection factor or SPF) Filters ultraviolet light Water/sweat resistant sunscreen is recommended Treat a burn according to the degree of inflammation Cool water, aloe based solutions Moisturizers can help with dryness and peeling OTC’s can help with pain and discomfort Severe burns require physician assistance © 2011 McGraw-Hill Higher Education. All rights reserved.

Infestation and Bites Scabies Etiology Caused by mites which cause extreme nocturnal itching (tunnels and lays eggs) Signs and Symptoms Appear as dark lines between fingers and toes, body flexures, nipples and genitalia Excoriations, pustules and papules caused by itching tends to hide true cause Skin develops hypersensitivity to the mite Management Permethrin 5% is treatment of choice Washing of bedding and clothes is necessary Topical corticosteroids may be necessary to treat itching © 2011 McGraw-Hill Higher Education. All rights reserved.

Lice (Pediculosis) Etiology Manifestation by the louse (louse of head, pubic region and body) Signs and Symptoms Bites cause itching dermatitis through subsequent scratching -- promotes pustule and excoriations to develop Management Cure is rapid with use of any number of agents Good hygiene is paramount To prevent re-infestation all clothing and bedding should be washed in hot soapy water or discarded © 2011 McGraw-Hill Higher Education. All rights reserved.

Fleas Etiology Small wingless insects that suck blood Can transmit systemic diseases Signs and Symptoms Great deal of discomfort can be felt if come into contact with a high number of fleas Concentrate bites on ankles and lower legs Management Following a bite, itching must be prevented with antipruritic lotion Avoid scratching to prevent secondary infection Insecticides can also be effective © 2011 McGraw-Hill Higher Education. All rights reserved.

Ticks Etiology Parasitic insects that have an affinity for blood Carriers of a variety of microorganisms that can transmit Rocky Mountain spotted fever and Lyme disease Signs and Symptoms Headaches, fever, malaise, myalgia, and rash, petechiae and purpura, enlarging annular red ring w/ or w/out central red papule Management Remove tick (mineral oil or fingernail polish) Grasping head of tick is an acceptable method Systemic treatment is necessary to prevent morbidity and mortality associated with RMSF and Lyme disease © 2011 McGraw-Hill Higher Education. All rights reserved.

Mosquitoes Etiology Blood suckers that produce bites than can be irritating, itchy, painful Can pass along blood-borne illnesses May be a major health hazard (West Nile virus) Signs and Symptoms Small reddish papule with associated itching Management Topical medication Use of repellents can also be used on the skin to prevent contact with mosquitoes © 2011 McGraw-Hill Higher Education. All rights reserved.

Stinging Insects Etiology Bees, wasps, hornets, yellow jackets -- inflict venomous sting Hypersensitive individuals may experience an allergic reaction Signs and Symptoms If an allergic reaction occurs an increase in heart rate and breathing will occur, along with chest tightness, dizziness, sweating and even LOC Anaphylactic reaction Hives, sensation of warmth, asthma symptoms, swelling of mouth and throat, difficulty breathing, vomiting, diarrhea, cramping, blood pressure changes © 2011 McGraw-Hill Higher Education. All rights reserved.

Insect Stings (continued) Management To prevent, avoid wearing scented lotions or shampoos, brightly colored clothes, jewelry, suede, or leather, and avoid going barefoot. If an patient is susceptible to anaphylactic reactions instructions on use of an EpiPen are necessary If uncomplicated, the stinger should be removed with tweezers or a credit card and soothing medications should be applied Soap detergent will also lessen symptoms In cases of anaphylactic reaction immediate physician referral is necessary © 2011 McGraw-Hill Higher Education. All rights reserved.

Spider Bites Etiology Typically not dangerous to humans Rarely bite more than once Must be concerned with black widow and brown recluse Signs and Symptoms Pain, small puncture wounds, redness, itching and swelling that lasts a couple days Present with center blister, a red ring and then a white ring Bite from venomous spider may result in muscle pain and cramps, weakness, sweating, headache, anxiety, nausea, vomiting, difficulty breathing and increased blood pressure © 2011 McGraw-Hill Higher Education. All rights reserved.

Management Washing the wound and applying antibiotic ointment Seek medical attention if infection presents, ulcer does not heal, nausea, vomiting, fever or rash occur If muscle cramping occurs the patient should go to the nearest emergency facility © 2011 McGraw-Hill Higher Education. All rights reserved.

Other Skin Conditions Pityriasis Rosea Etiology Acute inflammatory skin rash of unknown origin Occurs between the ages of 10-35 May be the result of a virus Can be spread to other individuals – but usually only occurs once in a lifetime Signs and Symptoms Single pinkish-red patch (herald patch) on the chest or back © 2011 McGraw-Hill Higher Education. All rights reserved.

Signs and Symptoms Within 2 days-3 weeks a secondary macular eruption occurs on chest or upper extremities Red and scaly with a clearing in the center Management Typically doesn’t require treatment Gradually disappears over 2-10 week period Antipruritics may help with itching Anti-inflammatories may be used to reduce itching and rash © 2011 McGraw-Hill Higher Education. All rights reserved.

Psoriasis Etiology Exact cause is unknown -- genetic factors may play a role in condition Infection, smoking, some drugs and possible hormonal factors may cause an outbreak Signs and Symptoms Lesion begins as reddish papules that progress to plaques Lesions progress to yellowish white scaly condition that tends to be located on the elbows, knees, trunk, genitalia, and umbilicus © 2011 McGraw-Hill Higher Education. All rights reserved.

Psoriasis (continued) Management Teaching patient self management Glucocorticoids and kerolytic agents can be used in conjunction with each other Long term oral medications may be necessary Counseling may be necessary for psychological aspects of condition © 2011 McGraw-Hill Higher Education. All rights reserved.

Skin Cancer Etiology Exposure to sun Malignant tumor that grows in skin Accounts for 50% of all cancers Basal cell and squamous cell carcinoma Malignant melanoma – high mortality rate as it often spreads to other parts of the body Signs & Symptoms Basal cell carcinoma Found in areas often exposed to sun Small, shiny bump Often found in individuals with light eye color, complexion and hair © 2011 McGraw-Hill Higher Education. All rights reserved.

Squamous cell carcinoma Appears as nodules, red, scaly patches of skin Often found on lips, ears and face Develops commonly in fair-skinned people Malignant melanoma Begins as mole Moles present at birth and those that are atypical tend to have a greater change of becoming malignant May show the following characteristics Asymmetry Border (irregular or jagged) Color (variations throughout mole Diameter (larger than pencil eraser) Often appear on fair-skinned men and women © 2011 McGraw-Hill Higher Education. All rights reserved.

Management If the athletic trainer suspects that a patient has skin cancer, the patient should be referred immediately Surgery is common (90% of cases) Cryosurgery, excision, Mohs’ microscopically controlled surgery Non-surgical treatment Laser, radiation, chemotherapy Regular skin exams are important Take notice of changes in skin and moles Crucial to detecting malignant melanoma © 2011 McGraw-Hill Higher Education. All rights reserved.

Chapter 28: Skin Disorders

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