FUNCTION OF SKIN

Protection- Chemicals, UV, Mechanical forces, Water etc.

Homeostasis- Keeps fluid level balanced

Thermoreg. -  Body Temp

Sensory Reception- Pain, pressure, Pain

Vitamin D Production

Processing of Antigenic Substances- Immune status

Cosmetic Appearance

Macule

Skin color change without elevation

Papule

Lesion elevated less than a centimeter

Nodule

Larger than a Papule. Raised solid lesion extending deeper into dermis

Older Adult skin changes

Dry skin

--Epidermal thinning

-- Loss of elasticity and subcu fat

-- may see "cherry angiomas" -- Caused by very small broken capillaries. Round, small, usually on the trunk.

-- Seborheic keratoses- Black or brown in color. Itchy. Harmless.

-- Hair and nail growth is decreased

-- Loss of pigment causes graying of hair

-- Lentigines liver spots common on forearm and backs of hands . Due to sun exposure. 

Turgor

Tenting means ?

edema +1 = ?

edema +2 = ?

dehydration

+1  skin indented 2 mm

+2  skin indented 4 mm

Occlusive skin lubricant

prevent water loss due to evaporation and replace oils

Emollient skin lubrication 

soften and soothe skin, but water loss continues.

Vesicle

Elevated sharply defined lesion containing serous fluid. usually less than 1cm

Pustule

Elevated lesion less than 1 cm containing purulent material.  

Greater than 1 cm are described as boils, abscess, etc.

These changes make a primary legion a          

scale, crust, scar, lichenification, exoriation, fissure and atrophy

form secondary lesions

The dorsal side of the hand is used for               

Assessing skin temperature

White shiny patches in mouth/lip

precancerous

Leukoplacia

Skin assessment

Best ways to check for color?

• 
  
  •  Check inside of cheek for pallor.
  • Cyanosis- around mouth, fingertips
  • Jaundice- Look at sclera (whites of eyes)

• 
  
• Moisture

Clammy= Moist and cool

Diaphoretic= skin is cool

Long term smokers and Alcoholics might have this kind of skin.

Leathery

Single lesions occuring in close proximity to but separate from a large group of lesions is called a              

Satellite lesion

how would you describe a localized lesion?

Limited and clearly defined

how do you instruct a patient about the proper time to apply a topical lotion?

Immediately after washing

How do you perform and read patch testing?

Put a piece of tape with allergens on it. Read it 48 hrs later, 72hrs, 96hrs checking response to allergens. Must not be on anti-histamines or steroids.

What is a scratch test and what precaution must be taken when performing the scratch test?

Scratch skin w/ allergen and watch response. Must have epinephrine available

Pt teaching for Topical Corticosteroids

How when and where to apply ointment

Expected side effects

Side effects are more likely with Medium to High potency preparations.

Limits exposure to dirt, trauma & irratents etc.

Helps lesions heal faster (lets epithelium cells migrate across moist surfaces)

Enhanced absorption of topical ointments

Wound dressing

       A patient is prescribed UV therapy. What information needs to be collected before treatment can start?

• Complete med history
• Previous herpes simplex infections can be stimulated by UVL
• + hx of skin cancer. High risk.

Temporarily suppresses mitosis of the basal cell layer by inhibiting DNA mitosis

UV Therapy

Benefits of wet wrap/soaks/medicated baths

Moisture soften dry epidermis & aids in removing cellular debris. This increases healing and increases absorption of med.

--Risk of infection lowered by removal of debris

--Soak/bathe 15-20 min in warm tap h2o. ad Rx to H2O if if occlusive ordered, apply immediately after soak/bath otherwise, evaporation will occur

Cryotherapy

Electrodesiccation & curettage

Laser excision

Punch or excisionsl Biops

Are all Medical/Surgical management of Skin Lesions

--Crytherapy=freezing Lesion w/ liquid Nitrogen.

--Electrodesiccation - Mechanical and heat disruption of cells

Laser Excision - Light energy to vaporize Lesion

              that grow, change color, to black, bleed, or become irritated

Moles

usually irregularly shaped, flat, slightly red macule or papule with indistinct borders and overlying hard scale. caused by sun exposure

Actinic keratosis

Change in Color - red, white, blue, sudden darkening, mottled

Chang in diameter - especially sudden increase

Change in outline - especially development of irregular margins

Change in surface characteristics - such as scaliness, erosion, bleeding, ulceration, et

ALL THESE ARE WHAT?

DANGER SIGNALS SUGGESTIVE OF MALIGNANCY

a Pt has come in about a "freckle" on her arm.  It has recently started itching, it's more bumpy than it used to be and the border has become irregular.  What do these symptoms suggest?

These are all suggestive of malignancy

Cause - sun, scars, radiation, or genetic predisposition

S&S - usually nodular lesions: papule; well defined border; pearl texture, but may be flat.

      - painless, slow growing

Tx - Local excision.  Recurrence possible.  Almost never metastasizes, but can invade through tissue

Basal Cell Carcinoma

Cause - sun exposure

S&S

- Poorly marginated; edge often blends in surrounding skin; appearance varies

- rarely in dark skinned people

-grows more rapidly than basal cell

-May infiltrate and metastasize

TX- Surgical excision

Squamous cell carcinoma

Cause - Sun exposure

S&S - Change in skin lesion observed over a period of months

- usually: shade of brown, black or blue in one lesion, irregular raised surface, irregular perimeter, ulceration of surface and crusting

TX - wide excision

Malignant melinoma

Cherry Angioma

very small broken capillaries. Round, small, usually on the trunk.

Lentigines

Liver spots - Common on forearm and back of hands due to sun exposure

Amelenotic

Without melanin

Atopic Dermatitis

S&S - Red, oozing, crusting rash often appears in infancy.  Gradually becomes more thick and dry.  /BrownGrey, scaled

Treatment=Hydration of skin, avoid allergens

Stasis Dermatitis

~Venous insufficiency hypoxia

S&S - Itching Brown/stained skin.  Open Shallow lesions

Tx - Promote Venous return (elevate legs, pressure hose) etc.

Contact Dermatitis

Inflammatory Response to allergens

S&S: Itching, redness, vesicles, edema

Tx: Determine causing agent.  Cool compress for edema, no itching. 

Lyme Disease

Caused by tick bite.  

S&S: symptoms develop over days to months. 1st stage Small red pimple spreads into ring shaped rash.  Rash may be large, small, or absent.  Flue-like symptoms. Second stage:  Joint pain, neurological, cardiac complications.  3rd: Large joints involved (arthritis)

TX: Remove tick, wash bite. Blood test 4-6 weeks. DX confirmation = Antibiotics

Damage to tissues and blood vessels as result of prolonged exposure to cold. 

Numbness, paresthesia, pallor. Sever pain, swelling, redness and blistering seen once client in warm environment. necrosis and gangrene may develop

Rewarm affected area rapidly and continuously with warm water bath until skin flushing occurs. avoid slow thawing.

Hypothermia

Occurs when 2 skin surfaces rub.  Most common cause: urinary incontinence.

Friction+heat+moisture = redness, maceration, itching/burning.

Dry area and aerate.  Talc powder.  No cornstarch.  Low-potency topical steroids

Intertrigo

yellow-white or gray-white lesion in mouth-elevated with roughened or leathery surface with clearly defined borders.

Tx:  Close monitoring  Precancerous

Leukoplakia

Cause unknown.  (No evidence to certain foods affect acne)  Exacerbations may occur with menstrual cycle. heat, humidity, increased perspiration, increase acne.

Comedones, pustules, papules, and nodules.

Suppress inflammation. Antimicrobial, Topical antibiotics, Comedolytic agents, Hormone therapy

Acne Vulgaris

Acne Rosacea

Stage 1:  Facial redness similar to normal flushing persistent. facial skin dry. may c/o skin burning/tightness.

Stage2:  Redness permanent. Sm. red solid papules & pustules may develop.  Skin pores noticeably larger.

Stage3:Edema & hyperplasia of affected facial areas. 

TX:  Topical ointments. topical antimicrobial. rarely topical steroids

Psoriasis

Cause unknown. Possibly stress, trauma, infection and changes in climate.   Koebner's phenonmenon development of psoriatic lesions at site of injury.

Anxiety and stress often precede flare-ups

Fleeting skin elevation irregularly shaped because of edema

Urticaria/Hives (wheals)

Varies. Irreg. shaped flat sl. red macule or papule w/ indistinct border & and overlying scale.

Caused by sun exposure

Senile keratosis

Actinic keratosis

Appears as target appearance w/ irregular borders.

Supportive Care. NO steroids, no silvadene.

Caused by meds like: Tegretol, Dilantin, Fansidar, Bactrim, septra

Cellulitis

Skin redness or inflammation that increases in size as the infection spreads

Skin sore or rash (macule)

Comes on suddenly

Grows quickly in the first 24 hours

Usually has sharp borders

Tight, glossy, "stretched" appearance of the skinWarmth over the area of redness

Folliculitis

The infection usually appears as small, white-headed pimples around one or more hair follicles

Localized response to minor burn

Pink to red. minor edema.  Continued pain can be eased by cooling.

systemic response to a burn

       --> Vascular permeability increases  --> 

inc. hematocrit -->  inc. viscocity --> 

inc peripheral resistance --> lower cardiac output -->

Lower IV (intravenous) pressure -->  EDEMA

                       is an emergency condition in which severe blood and
fluid loss makes the heart unable to pump enough blood to the body

Hypovolemic Shock