INFECTIOUS DISORDERS OF THE SKIN

Objectives 1. Describe and discuss infectious disorders of the skin as to definition, etiology, pathophysiology, signs and symptoms, diagnosis, medical and nursing management. . 2. Apply the nursing process for clients with severe disorders. 3. Recognize systemic disorders with dermatologic symptoms.

INFECTIOUS DISORDERS OF THE SKIN Bacteria, viruses, fungi, or parasites can cause infectious disorders of the skin. Treatment includes topical and systemic medications. Preventing the spread of infection to others is important.

Bacterial Infection 1. Impetigo – An inflammatory disease of the skin; characterized by pustules. Causes & Symptoms Impetigo is most frequently caused by the bacteria Staphylococcus aureus, also known as "staph," and less frequently, by group A beta-hemolytic streptococci, also known as "strep." These bacteria are highly contagious. Impetigo can quickly spread from one part of the body to another through scratching. It can also be spread to other people if they touch the infected sores or if they have contact with the soiled clothing, diapers, bed sheets, or toys of an infected person. Such factors as heat, humidity, crowded conditions, and poor hygiene increase the chance that impetigo will spread rapidly among large groups.

IMPETIGO

Diagnosis Observation of the appearance, location and pattern of sores is the usual method of diagnosis. Fluid from the vesicles can be cultured and examined to identify the causative bacteria.

Treatment Uncomplicated impetigo is usually treated with a topical antibiotic cream such as mupirocin (Bactroban). Oral antibiotics are also commonly prescribed. Patients are advised to wash the affected areas with an antibacterial soap and water several times per day, and to otherwise keep the skin dry. Scratching is discouraged, and the suggestion is that nails be cut or that mittens be worn—especiallly with young children. Ecthyma is treated in the same manner, but at times may require surgical debridement, or removal of the affected area.

2. Folliculitis is the inflammation of one or more hair follicles 2. Folliculitis is the inflammation of one or more hair follicles. The condition may occur anywhere on the skin. Causes Most carbuncles and furuncles and other cases of folliculitis develop from Staphylococcus aureus. Folliculitis starts when hair follicles are damaged by friction from clothing, blockage of the follicle, or shaving. In most cases of folliculitis, the damaged follicles are then infected with the bacteria Staphylococcus (staph) Treatment Topical antiseptic treatment is adequate for most cases Some patients may benefit from systemic flucloxacillin Topical antibiotics such as mupirocin ointment

Folliculitis

3. Furuncle/Carbuncle - A boil 3. Furuncle/Carbuncle - A boil. A tender pus-filled area of skin usually caused by infection with the bacterium Staphylococcus aureus. A furuncle is a very contagious skin infection and precludes participation in contact or collision sports. Treatment Warm moist compresses encourage furuncles to drain, which speeds healing. Gently soak the area with a warm, moist cloth several times each day. Deep or large lesions may need to be drained surgically by the health care provider. Never squeeze a boil or attempt to lance it at home because this can spread the infection and make it worse. Antibacterial soaps and topical antibiotics are of little benefit once a furuncle has formed. Systemic antibiotics may help to control infection

Furuncle

Furuncles and Carbuncles Physiology and Etiology Skin infections; diabetes mellitus Assessment Findings Painful pustule surrounded by erythema Fever, anorexia, weakness, and malaise Exudate identifies the infectious organism Medical and Surgical Management Hot wet soaks Antibiotics Surgical incision and drainage

Skin Disorders: Furuncles, Furunculosis, and Carbuncles Nursing Management Strict aseptic technique Client teaching Avoid Picking and squeezing furuncle Touching infected areas Hygiene measures Wash hands; use separate face cloths Wash clothing separately from family laundry

Viral Infection 1. Shingles - Varicella-zoster virus An acute viral infection characterized by inflammation of the sensory ganglia of certain spinal or cranial nerves and the eruption of vesicles along the affected nerve path. It usually strikes only one side of the body and is often accompanied by severe neuralgia. Also called herpes zoster. Assessment Findings Fever, headache; vesicles; itching Medical Management Oral or topical acyclovir; corticosteroids Nursing Management Avoidance of contact with those who have not had chicken pox; cool or warm compresses or warm showers

Shingles

Skin Disorders: Shingles Figure 71-9 Reactivation of the varicella-zoster virus

2. Herpes Simplex - A recurrent viral disease caused by the herpes simplex virus a. type one - marked by the eruption of fluid-containing vesicles on the mouth, lips, or face. b. type two - marked by the eruption of fluid-containing vesicles on the genitals Treatment Acyclovir (Zovirax) is the drug of choice for herpes infection and can be given intravenously or taken by mouth or ointment but is not very useful in this form. A liquid form for children is also available.

Herpes Simplex

Fungal Infections 1. Tinea corporis - A superficial fungal infection of the nonhairy skin of the body, most prevalent in hot, humid climates. Tinea corporis (often called ringworm of the body) is a common skin disorder, especially among children. However, it may occur in people of all ages. It is caused by mold-like fungi called dermatophytes. Fungi thrive in warm, moist areas. Poor hygiene, long-term wetness of the skin (such as from sweating) and minor skin and nail injuries raise your risk for a fungal infection. Tinea corporis is contagious. You can catch the condition if you come into direct contact with someone who is infected, or if you touch contaminated items such as combs, clothing, shower floors and walls, or pool surfaces. The fungi can also be spread by pets. (Cats are common carriers).

Tinea Corporis

2.Tinea Capitis (Scalp ringworm) Tinea capitis usually occurs mostly in children and results in scaling and patchy hair loss. It is epidemic in many African American communities. The scalp can look quite moth-eaten but with the right treatment the hair will grow back normally and will not result in permanent hair loss.

Tinea Capitis Scalp

Tinea Pedis In most cases, the skin becomes white, soft and peels away between the toes (especially between the fourth and little toes). It may infect the sole of the foot resulting in peeling, scaling, itching and sometimes blistering. Only one, or both feet may be involved.

Tinea Pedis

Tinea Cruris (Jock itch) Some subjects with tinea pedis also develop a rash in the groin (tinea cruris), especially if they tend to sweat a lot. It is common and affects men more often than women. It has an itchy spreading red border.

Tinea Cruris

Treatment Tinea infections can be treated by a variety of different medications. For tinea pedis, cruris, and corporis, creams such as Lamisil-AT and Micatin AF can be bought over the counter at a pharmacy. Prescription creams are stronger, faster and require fewer applications. Sometimes oral medications are necessary. These are very effective, and include griseofulvin (Grispeg, Fulvicin), Lamisil (terbinafine), Sporonox (itraconazole), and Diflucan (fluconazole). Tinea capitis, and chronic tinea pedis are difficult to eradicate completely and require oral treatment.

Parasitic Infestations Pediculosis - Infested with lice.

Pediculosis DIAGNOSIS Head and pubic lice infestations are diagnosed by finding lice or viable eggs (nits) on examination. Excoriations and pyoderma also may be present. TREATMENT Topical Agents - Over-the-counter agents approved by the U.S. Food and Drug Administration (FDA) belong to the pyrethrum group of insecticides (pyrethroids). Both 4 percent piperonyl butoxide­0.33 percent pyrethrins (e.g., Rid, Pronto) and 1 percent permethrin (Nix) are safe and effective. Experts consider permethrin as the treatment of choice. Oral Agents. Ivermectin (Stromectol), in an oral dose of 200 mcg per kg, effectively kills nymphs and lice, but not eggs. To kill newly hatched nymphs, a second dose should be given seven to 10 days after the first dose..

Scabies Scabies refers to an infestation by the itch mite, Sarcoptes scabiei. Mites are small eight-legged parasites (in contrast to insects, which have six legs). They are tiny, just 1/3 millimeter long, and burrow into the skin to produce intense itching which tends to be worse at night. The mites which cause scabies are not visible with the naked eye but can be seen with a magnifying glass or microscope

                                                                                                                        

Treatment Apply a mite-killer like permethrin (brand name: Elimite). These creams are applied from the neck down, left on overnight, then washed off. This application is usually repeated in seven days. An alternative treatment is 1 ounce of a 1% lotion or 30 grams of cream of lindane, applied from the neck down and washed off after approximately eight hours. Since lindane can cause seizures when it is absorbed through the skin, it should not be used if skin is significantly irritated or wet, such as with extensive skin disease, rash, or after a bath. As an additional precaution, lindane should not be used in pregnant or nursing women or children younger than 2 years old. Lindane is only recommended if patients cannot tolerate other therapies or if other therapies have not been effective.

2. An oral medication, ivermectin, is an effective scabicide that does not require creams to be applied. 3. Antihistamines, such as diphenhydramine (Benadryl) can be useful in helping provide relief from itching. 4. Wash linens and bedclothes in hot water. Because mites don't live long away from the body, it is not necessary to dry-clean the whole wardrobe, spray furniture and rugs, and so forth. 5. Treat sexual contacts or relevant family members (who either have either symptoms or have the kind of relationship that makes transmission likely).

Pemphigus Pemphigus is a group of autoimmune diseases of the skin and/or mucous membranes that cause burn-like lesions or blisters that do not heal. The body attacks proteins called desmogleins in the cells of the skin and mucous membranes. When this happens, the cells become separated from each other. This creates blisters which lead to sores on the skin and in the mouth.

Pemphigus

Treatment    Severe cases of pemphigus are treated similarly to severe burns. Treatment may require hospitalization, including care in a burn unit or intensive care unit. Treatment is aimed at reducing symptoms and preventing complications. Intravenous fluids, electrolytes, and proteins may be required. Mouth ulcers, if severe, may mean intravenous feeding is needed. Anesthetic mouth lozenges may reduce the pain of mild to moderate mouth ulcers. Antibiotics and antifungal medications may be appropriate to control or prevent infections. Systemic therapy as early as possible is required to control pemphigus, but side effects from systemic therapy are a major complication. Treatment includes corticosteroids,the anti-inflammatory drug dapsone, or medications that suppress the immune system (such as azathioprine, methotrexate, cyclosporin, cyclophosphamide, or mycophenolate mofetil). Some antibiotics are also effective, particularly minocycline and doxycycline. Intravenous immunoglobulin (IVIg) is occasionally used. Plasmapheresis is a process whereby antibody-containing plasma is removed from the blood and replaced with intravenous fluids or donated plasma. Plasmapheresis may be used in addition to the systemic medications to reduce the amount of antibodies in the bloodstream. Localized treatment of ulcers and blisters may include soothing or drying lotions, wet dressings, or similar measures.

Exfoliative Dermatitis Exfoliative dermatitis is widespread scaling of the skin, often with itching (pruritus), skin redness (erythroderma), and hair loss. It may occur in severe cases of many common skin conditions, including eczema, psoriasis, and allergic reactions. A person with erythroderma or exfoliative dermatitis often needs hospital care or admission to an intensive-care burn unit.

EXFOLIATIVE DERMATITIS Localized symptoms include erythema, severe pruritis, extensive scaling, skin sloughing. Affects the entire body. Chills, fever, and malaise. Treatment includes fluids, corticosteroids, antibiotics, medicated baths, analgesia.

Exfoliative Dermatitis