Integumentary System Diseases and Disorders

Name: Integumentary System Diseases and Disorders
Uploaded: 2017-07-04T18:03:49+00:00
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Description: Integumentary System Diseases and Disorders

Integumentary System Diseases and Disorders
Chapter 18 Integumentary System Diseases and Disorders

Anatomy and Physiology
Skin Largest organ of body First line of protection for body against invading organisms Provides sense of touch, heat, cold, and pain Helps stabilize temperature, fluid, and electrolyte balance Three layers: Epidermis Dermis Subcutaneous

Skin The epidermis – outer layer – has five layers The cells of this layer are call stratified squamous epithelial cells Most of these cells are keratinocytes and melanocytes Melanocytes – contain melanin, skin-coloring pigment Dermis is the deeper layer Consist of connective tissue and a variety of cell shapes Blood vessels and nerves are in this layer

Skin Subcutaneous layer is deeper than dermis Blood vessels and fat cells – protect against cold Embedded in the dermis and extending to the epidermis are the sebaceous, apocrine, and eccrine sweat glands Sebaceous produce oil called sebum Apocine are located in areas of the axilla, breast, umbilicus, anus, and genital areas Eccrine are found throughout the body and help regulate heat Hair follicles in dermal layer – extend through epidermis

Common Signs and Symptoms
Skin lesions Pain Pruritus Edema Erythema Inflammation

Diagnostic Tests Biopsy Culture and sensitivity Blood tests
Microscopic smear examinations

Infectious Diseases: Viral
Herpes Large family of viruses Symptoms: Inflammation of skin Clusters or fluid-filled vesicles Periods of remission and exacerbation No cure Remains in affected individual’s body for life

Herpes Common types: Herpes simplex 1 Fever blisters Cold sores Herpes simplex 2/herpes genitalis Genital herpes Herpes varicella Chickenpox Herpes zoster Shingles

Verrucae Also known as warts Chronic condition Occur in multiples and differ in size, shape, and appearance Often resistant to treatment Types: Appearance on hands and fingers of children Common warts Appearance on sole of foot Plantar warts Sexually transmitted Genital warts

Measles Highly contagious Childhood disease Maculopapular skin rash (Detailed information in Chapter 20)

Infectious Diseases: Bacterial
Impetigo Highly contagious skin disease Affects face and hands of children Cause: Streptococcus and Staphylococcus Symptoms: Vesicles Pustules that rupture Producing yellow crust over lesions Treatment: Cleansing Antibiotic ointment

Folliculitis Inflammation and infection of hair follicle Cause: Staphylococcus Symptoms: Small pustules surrounding hair Treatment: Antibiotic cream or oral medications depending on severity

Abscess, furuncle, and carbuncle Encapsulated lesion with inflammation and infection Abscess Localized collection of pus in any tissue Furuncle An abscess occurring in the skin, commonly called a boil Carbuncle Larger abscesses, interconnected furuncles, less common

Abscess, furuncle, and carbuncle Cause: Commonly Staphylococcus Lowered immunity Poor personal hygiene Symptoms: Extreme pain Treatment: Warm compresses Opened and surgically drained Antibacterial medications

Cellulitis Diffuse or spreading inflammation of skin and subcutaneous tissue Causes: Streptococcus or Staphylococcus Symptoms: Pain, redness, swelling, warmth, tenderness of involved skin Treatment: Oral antibiotics Prevention: Good handwashing Cleansing of open areas on skin

Erysipelas Acute infection of dermis extending to fat tissue Causes: Most commonly group A Streptococcus Symptoms: Fatigue, chills, fever, headaches, vomiting Infected skin consistency similar to an orange peel Treatment: Oral or IV antibiotics

Lyme disease Multisystem infections transmitted to humans through bite of infected deer tick Symptoms: Flu-like symptoms Arthritis Malaise Chills Fever Bull’s eye skin rash Treatment: Antibiotics

Methicillin-resistant Staphylococcus aureus (MRSA) A strain of bacteria that is resistant to the antibiotics commonly used to treat staphylococcal infections Both health care– and community-acquired Symptoms: Small red bumps that resemble pimples or boils Progress to abscess – progress to blood-borne infection (sepsis) Symptoms of sepsis: Rash, fever, chills, headaches, joint pain, shortness of breath Can be life-threatening and requires immediate medical attention

Methicillin-resistant Staphylococcus aureus (MRSA) Diagnosis: Culture and sensitivity Treatment: Intravenous vancomycin **Even though vancomycin is currently effective, there are signs that some MRSA bacteria are building resistance to this medication also.

Infectious Diseases: Fungal
Tinea Fungal infection also known as ringworm that infects warm, moist areas of body Feeds on perspiration and dead skin Types: Tinea corporis Affects smooth skin on arms, legs, and body Tinea pedis Athlete’s foot Tinea cruris Jock itch

Tinea Types: (continued) Tinea unguium Affects fingernails or toenails Tinea capitis Affects scalp Tinea barbae Affects bearded areas Symptoms: Itching, cracking, and weeping of the skin

Tinea Diagnosis: Microscopic examination of skin scrapings Treatment: Keep affected area clean and dry Antifungal medications Used consistently for a long period of time These infections commonly recur and become a chronic problem.

Candidiasis Commonly called yeast infection Can be superficial or systemic and life-threatening Cause: Candida Antibiotic therapy that disrupts normal flora Symptoms: Depend on location Mouth – thrush Patches of white infection Baby buttocks – diaper rash Red, inflamed scaly rash Fingernails – onychomycosis Itchy skin with blisters and pustules Vagina – vaginitis White, cheesy vaginal discharge (Chapter 17) Treatments: Antifungal medications

Infectious Diseases: Parasitic
Pediculosis Infestation with lice Types of lice: head, body, pubic Symptoms: Severe itching Treatment: Eradicating pediculosis is difficult Bathing and shampooing with medicated shampoo E.g., Kwell Dry cleaning or washing all clothing Cleaning and treating furniture

Infectious Diseases: Parasitic
Scabies Infestation by itch mite Cause: Sarcoptes scabiei, tiny parasite Symptoms: Intense itching Slightly elevated, grayish-white lines Treatment: Lindane cream (Kwell) to entire body

Scabies Photo courtesy Robert A. Silverman, MD, Pediatric Dermatology, Georgetown University

Metabolic Diseases Acne vulgaris
Inflammation of sebaceous glands and hair follicles Cause: Metabolic, occurs at puberty Symptoms: Comedones, blackhead Treatment: Cleansing Over-the-counter (OTC) treatments In severe cases, antibiotics, steroids, and Retin-A preparations

Metabolic Diseases Seborrheic dermatitis
A common type of dermatitis affecting sebaceous glands Also known as cradle cap in infants Also known as dandruff when affecting scalp Symptoms: Reddened skin Greasy-looking yellowish scales Treatment: Medicated shampoo Steroid lotion or creams

Metabolic Diseases Sebaceous cyst
A closed sac of oily, cheese-like material under the skin Commonly develop on scalp, neck, groin Special type: Pilonidal cyst Cause: Sebaceous gland becomes blocked and sebum collects under the skin Treatment: Incising and draining Surgical removal

Hypersensitivity or Immune Diseases
Eczema Inflammation of skin, not dangerous, not contagious, not curable Cause: Occurs in individuals with genetic predisposition to allergies Symptoms: Dry, leathery skin lesions Itching Redness

Eczema Symptoms: (continued) Vesicles Pustules Scales Crusting Treatment: Topical cortisone creams Antihistamines Sedatives Avoidance of sunlight

Urticaria Vascular reaction of the skin Also known as hives or nettle rash Causes: Irritants such as insect bites, pollen, or plants Symptoms: Severe itching Treatment: Antihistamines Avoidance of allergen

Contact dermatitis Acute or chronic allergic reaction of skin Causes: Cosmetics Laundry products Jewelry Symptoms: Pain Small, red, localized lesions to vesicular lesions; example: Poison ivy Treatment: Topical medications Antihistamines to relieve itching

Scleroderma Autoimmune reaction Hardening, thickening, and shrinking of connective tissues Including skin **More information can be found in Chapter 5

Idiopathic Diseases Psoriasis Very common, chronic skin disease
Affects individuals ages 15 to 35 Has periods of remission and exacerbation Cause: Unknown but some hereditary basis does exist Symptoms: Rapid replacement of epidermal cells Red, raised lesions with distinct borders and silvery scales Scales generally appear on elbows, knees, and scalp

Idiopathic Diseases Psoriasis Treatment: Medications Control itching
Creams containing coal tar Remove scaling Salicylic acid UV light treatments Steroids Oatmeal baths to loosen the scales

Idiopathic Diseases Rosacea A chronic skin condition
Characterized by inflammation and redness of the forehead, nose, cheeks, and chin It is not dangerous or life-threatening Cause: Unknown Blush easy, fair skinned, female 30 – 50 years old Enlargement of the blood vessels just under the skin

Idiopathic Diseases Rosacea Symptoms: Treatment:
Facial skin appears red with swelling or skin eruptions similar to acne vulgaris Red, bulbous nose Spider-like vessels called telangiectasia Bloodshot, irritated, watery eyes Treatment: No known cure Identify triggers that cause exacerbations of the condition Avoid sun exposure, prolonged exertion in hot weather Avoid stress, spicy foods, alcohol, and hot beverages Antibiotic ointments to control skin eruptions

Benign Tumors Seborrheic keratosis
Benign overgrowth of epithelial cells One of the most common benign growths in older adults Cause: Unknown, but does appear to be age related Symptoms: Tan or brown growths on hands, arms, and face Warty scale appearance Treatment: Curettage Scraping off

Benign Tumors Keloid Raised, firm, irregular-shaped scar tissue following trauma or surgery Cause: Overgrowth of collagen during connective tissue repair More common in the black population Treatment: Surgical removal is usually not effective because it results in the growth of another keloid Radiation, steroids, and cryotherapy may be helpful

Benign Tumors Hemangioma
Congenital benign tumor of small blood vessels that form purplish birthmark Appear on the face and neck Cause: Unknown Common types: Port wine stain Strawberry hemangioma Cherry hemangioma Treatment: Usually not necessary, many disappear by age 5 Surgical removal

Premalignant and Malignant Tumors
Actinic keratosis Premalignant condition Common in fair-skinned individuals Cause: Excessive exposure to the sun Symptoms: Wart-like lesions on sun-exposed areas Treatment: Topical medication E.g., Retin-A Curettage Cryotherapy

Basal cell carcinoma Most common type of skin cancer Most often affects fair-skinned, blonde, blue- or gray- eyed individuals Slow-growing, locally invading tumor that does not metastasize Cause: Unknown, result of genetic and environmental (sun exposure) factors Symptoms: Appearance varies; smooth, shiny bump, pink to pearly white Treatment: Surgical removal

Squamous cell carcinoma Less common than basal cell Tends to grow more rapidly, becomes metastatic Cause: Tends to occur in sun-exposed areas Symptoms: Firm red nodule with crusts or slightly elevated plaque Treatment: Wide surgical excision Radiation

Malignant melanoma Most serious type of skin cancer Responsible for the majority of skin cancer deaths Rarely occurs before age 20 May be related to severe sunburn as child Symptoms: Change in size and color of mole Treatment depends on degree of spread: Wide surgical excision Radiation Chemotherapy

Kaposi’s sarcoma Malignant vascular skin tumor Cause: Not highly malignant except in the case of AIDS Symptoms: Bluish-red patches that grow under the skin Treatment: Treat AIDS Liquid nitrogen Radiation Chemotherapy

Abnormal Pigmented Lesions
Types: Ephelis Freckle Indicates skin damage due to sunburn Lentigo Liver spot Occur on face, neck, and back of the hands in older adults Nevus Mole Can be brown, black, or pink-colored Due to a collection of melanocytes

Abnormal Pigmented Lesions
Types: Albinism Hereditary disorder Decrease or total absence of pigment in skin, hair, and eyes Vitiligo Destruction of melanocytes in small or large patches of skin Melasma Dark patches of skin on face, especially the cheeks Common in pregnant females and those taking birth control pills Usually disappears after delivery or discontinuation of medication

Diseases of the Nails Disease can cause abnormal shape, thickness, and color Causes: Most commonly fungal and bacterial infections Bacterial infection of the skin around the nail is paronychia Fungal infections frequently affect the feet, chronic, cause nail deformity Treatment: Bacterial infections treated with antibiotics Fungal infections treated with antifungal medications

Diseases of the Hair Hair color, texture, and distribution are genetically determined and influenced by hormones Hirsutism Excessive growth of hair In the female, may be caused by hormone abnormalities Alopecia Partial or complete hair loss

Diseases of the Hair Male-patterned baldness
Common cause of hair loss in men An inherited trait passed to males by their mothers Can be seen in mother’s brothers (maternal uncles) Symptoms: Begins around age 30 with receding front hairline Treatment: Growth can be restored by certain special medications Wig, toupee, hair transplant

Trauma – Mechanical Skin Injury
Abrasion Scraping away skin surface – friction or rug burns Blunt trauma Individual is struck by items such as hammers, is thrown into objects, or has fallen Often causes a large bruise called a contusion Avulsion Portion of skin is pulled away or torn Usually occurs when tissue is caught in machinery

Trauma – Mechanical Skin Injury
Crush trauma Tissue caught between two hard surfaces Usually involves fingers, hands, feet, toes Caught in doors or between objects Puncture injury Sharp object forced into tissue Knife, nail, glass, metal Potential for tetanus Laceration Cut in skin caused by sharp object – knife, razor, glass

Trauma – Thermal Skin Injury
Due to excessive heat or cold Injury can range from mild to severe Severe injury can be life-threatening Hyperthermia Body overheated due to excessive exposure to sun or heat Types: Heat exhaustion Heat stroke

Heat exhaustion Commonly occurs with excessive exercise in a warm environment Symptoms: Profuse perspiration, loss of salt and water leading to dehydration Cool, moist skin Weakness, nausea Muscle cramps Body temperature is normal Treatment: Place individual in cool place Fluid and salt replacement Transport to the hospital

Heat stroke More serious than heat exhaustion Body’s temperature regulation fails Symptoms: Temperature above 105 degrees F Skin red and hot; NO perspiration Nausea, weakness Mental confusion – loss of consciousness – convulsions Without rapid treatment, brain damage and death can result Treatment: Rapid cooling with cold water Immediate transport to hospital

Burns Cause: Can be caused by fire, steam, hot liquids, chemicals, electricity Burns are classified by depth of skin injury Main complications are fluid loss and infection Treatment: Depends on the degree and type of burn Cooling of tissue with cool water to prevent further burning Analgesics Antibiotics Surgical debridement

First-degree burns Fairly common Pain, redness, swelling of skin Involve only the epidermis Often result of sunburn Heals usually within a week Second-degree burns Also called partial-thickness burns Involve epidermis and dermis Extreme pain, redness, blisters, open wounds

Second-degree burns (continued) Usually heal in 2-3 weeks Infection can lead to third-degree wound Third-degree burns Also called full-thickness burns Involve the epidermis, dermis, exposing layers of fat, muscle, and bone Burn areas are painless due to nerve destruction Characterized by charred and broken tissue layers Treatment often includes grafting Scarring and deformity are common

Hypothermia Body’s core temperature falls below 95 degrees F Symptoms: Extreme shivering Mental confusion Blue or cyanotic extremities Weak pulse Treatment: Remove wet clothing Warm body with warm blankets; drink warm liquids Immediately transport to a hospital

Frostbite Freezing of tissue Usually on face, fingers, toes, ears Symptoms: Affected area is painless and white Warming the skin leads to pain and redness Treatment: Rapid warming in warm water baths Emergency treatment at a medical facility

Trauma – Electrical Injury
Causes: Unprotected or inadequately insulated electrical wiring Contact with lightning Damage has point of entry and exit Common cause of death is from respiratory and cardiac arrest

Trauma – Radiation Injury
Ionizing radiation X-rays Sunlight Causes: Exposure to sunlight Tanning beds Prolonged exposure to sun or tanning beds causes the skin to become prematurely dry, brittle, and wrinkled and to lose elasticity Causes the skin to appear much older than its natural age

Trauma – Pressure Injury
Decubitus/pressure ulcer Commonly called a bedsore or pressure sore Cause: Affects bony areas of body E.g., heels, sacrum, elbows Increased pressure in these bony areas slows blood flow and leads to ischemia and necrosis Prevention: Frequent turning and repositioning Massaging of affected area to improve circulation

Trauma – Pressure Injury
Corns and calluses Protective hyperplasias of tissue Main difference in corn and callus is location Corns Found on feet Often painful Due to ill-fitting shoes Can be surgically removed Calluses Not usually painful Most common on hands Protect the hands form repeated injury

Trauma – Insect Bites and Stings
Vary from bloodsucking to stings May cause swelling and itching at site Insect bites can transmit disease Symptoms: Venom or poison may cause allergic reaction Range from mild to severe Severe reaction called anaphylaxis Treatment: Hydrocortisone cream Antihistamine; analgesic Emergency medical treatment; CPR and call 911

Spider Bites Black widow Most commonly known poisonous spider
Only the female bites, usually when disturbed or trying to protect her eggs Cause: The venom of the spider is a protein that affects the victim’s nervous system Symptoms: Acute pain at the site, abdominal pain, nausea, fainting, dizziness Treatment: Cold compresses Pain relievers

Spider Bites Brown recluse spider Very dangerous
Also called fiddleback, violin spider and brown fiddler Very reclusive; bite only when threatened Cause: Venom is extremely poisonous Bites are rarely fatal, but deaths have been reported Symptoms: Severe pain, itching, fever, nausea, muscle pain Treatment: Application of ice pack Analgesic medications Seek medical treatment

Rare Diseases Elephantiasis
Hypertrophy of skin and subcutaneous tissue giving it an elephant-like appearance Inflammation of lymphatic system results in fluid accumulation Cause: Parasitic worm Most common in tropical areas such as central Africa Spread by mosquitoes and bloodsucking flies

Effects of Aging Thinning of epidermal layer
Retains less water, which leads to easy tearing and dryness Xerosis: sweat and sebaceous glands do not function as well Skin lesions are common Seborrheic dermatitis, rosacea, and psoriasis are frequently seen disorders

Effects of Aging Thickening of nails
Thickening and increased brittleness of hair Loss and graying of hair Skin lesions

Integumentary System Diseases and Disorders

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