Download Chapter 13 Integumentary Function

Chapter 13
Integumentary
Function
Integumentary System
• Functions
– Protects the body from pathogen
invasions
– Regulates temperature
– Senses environmental changes
– Maintains water balance
• Includes: skin, nails, hair, mucous
membranes, and glands
Skin
• Layers
– Hypodermis – inner
– Dermis – middle
– Epidermis – outer
• Keratin – protein that strengthens
• Melanin – pigment that protects
Glands
• Sebaceous glands – produce sebum
to moisturize and protect the skin
• Sweat glands
– Eccrine glands – secrete through skin
pores in response to the sympathetic
nervous system
– Apocrine glands – open into hair follicles
in the axillae, scalp, face, and external
genitalia
Understanding Integumentary
Conditions
• Alterations primarily result in Impaired Skin
Integrity
• Alterations may also result in:
– Risk for Infection
Vascular Birthmarks
• Consist of blood vessels that have not
formed correctly
• Macular stains
– Also called salmon patches, angel kisses, and
stork bites
– Most common type
– Faint red marks often occurring on the forehead,
eyelids, posterior neck, nose, upper lip, or
posterior head
– Most fade on their own by 2 years of age,
although they may last into adulthood
Vascular Birthmarks
• Hemangiomas
–
–
–
–
–
–
–
–
Also referred to as a strawberry
Bright red patch of extra blood vessels in the skin
May be superficial or deep
Deep hemangiomas may be bluish because they involve deeper
blood vessels
Grow during the first year of life and then usually recede
Some may leave scars as they regress; these scars can be
corrected by minor plastic surgery
Usually on the head or neck, but can be anywhere
Most are benign, but can cause complications if they interferes with
sight, feeding, breathing, or other bodily functions
Vascular Birthmarks
• Port-wine stains
– Discolorations that look like wine was spilled on
the skin
– Most often occur on the face, neck, arms, and
legs
– Can be any size, but they grow only as the child
grows
– Tend to darken and thicken over
– Will not resolve spontaneously
– Those occurring near the eye should be
assessed for possible complications
Pigmented Birthmarks
• Cluster of pigment cells
• Can be many different colors, from tan to
brown, gray to black, or even blue
• Café au lait spots
– Very common
– Color of coffee with milk
– Can be anywhere on the body and sometimes
increase in number with age
– One spot alone is not usually a concern, but
several spots larger than a quarter can be
neurofibromatosis
Pigmented Birthmarks
• Mongolian spots
– Flat, bluish-gray patches
– Often found on the lower back or buttocks
– Most common on those with darker
complexions (e.g., Asian, American Indian,
African, Hispanic, and Southern European
descent)
– Usually fade, often completely, by school age
without treatment
Pigmented Birthmarks
• Mole
– Also called congenital nevi or hairy nevi
– Brown nevi
– Can be tan, brown, or black; flat or raised;
and may have hair growth
– All should be monitored for cancerous
changes
Birthmarks
• Diagnosis: physical examination
• Treatment:
–
–
–
–
–
–
–
–
Varies depending on the type
Some do not require treatment
Larger hemangiomas often are treated with steroids
Lasers are the treatment of choice for port-wine
stains
Moles are surgically removed
Café au lait spots can be removed with laser
treatment but often return
Opaque makeup
Support and coping strategies
Albinism
• Recessive condition that results in little or no
melanin production
• Melanin – pigment that provides color and
protection while playing a role in the
development of certain optic nerves
• Melanin deficits cause a lack of pigment in
the skin, hair, and iris
• All forms cause problems with eye
development and function
Albinism Types
• Type 1 albinism—caused by defects that
affect melanin production
• Type 2 albinism—caused by a defect in the P
gene; have slight coloring at birth
Albinism Forms
• Oculocutaneous albinism
– Have white or pink hair, skin, and iris color, as
well as vision problems
• Ocular albinism type 1
– Affects only the eyes
– Skin and eye colors are usually normal; however,
an eye exam will reveal no coloring of the retina
in one or both irises
Albinism Forms
• Hermansky-Pudlak syndrome
– Can occur with a bleeding disorder as well as with lung
and bowel diseases
– Other complex diseases may lead to localized color loss
• Chédiak-Higashi syndrome
– Lack of coloring all over the skin, but not complete
• Tuberous sclerosis
– Small areas without skin coloring
• Waardenburg’s syndrome
– Often a lock of hair that grows on the forehead is
affected, or no coloring in one or both irises
Albinism Manifestations
• Skin changes
– Color ranges from
white to nearly the
same as relatives
• Hair changes
– Color can range from
very white to brown
– People of African or
Asian descent may
have hair color that is
yellow, reddish, or
brown
• Eye changes
– Color ranges from light
blue to brown
– Irises is semi-translucent,
causing some eyes to
appear red
• Vision changes
– Nystagmus
– Strabismus
– Extreme nearsightedness
or farsightedness
– Photophobia
– Astigmatism
– Functional blindness
Albinism
• Diagnosis: history, physical examination
(including a thorough ophthalmology exam),
and genetic testing
Albinism
• Treatment:
– No cure
– Using sunscreen
– Wearing protective clothing
– Limiting time outdoors
– Wearing sunglasses
– Wearing glasses
– Eye muscle surgery
– Coping strategies and support
– Educational strategies (e.g., sitting at the front
of the classroom, using large-print and highcontrast colors)
Vitiligo
• Rare condition characterized by small patchy areas of
hypopigmentation
• Occurs when the cells that produce melanin die or no
longer form melanin, causing slowly enlarging white
patches of irregular shapes on the skin
• Affects all races but may be more noticeable in those
with dark skin tones
• The exact cause is unknown, but causes may include
autoimmune conditions, genetic influences, sunburn,
and emotional stress
• Also associated with pernicious anemia, hypothroidism,
and Addison’s disease
Vitiligo
• May affect any area, but usually develops on
sun-exposed areas first
• Can start at any age, but often first appears
between 10 and 30 years of age
• Appears in one of three patterns
– Focal – depigmentation is limited to one or a few
areas of the body
– Segmental – loss of skin color occurs on only one
side of the body
– Generalized – pigment loss is widespread across
many parts of the body, often symmetrically
Vitiligo
• Pathogenesis varies and difficult to predict
– Patches may stop forming without treatment
– Usually pigment loss spreads and can eventually
involves most of the skin’s surface
• Other manifestations: depigmentation of hair,
mucous membranes, and retina
• Diagnosis: history, physical examination, skin
biopsy, serum autoantibody level, serum
thyroid hormone level, and serum B12 level
Vitiligo Treatment
• No cure
• The goal is to stop or slow the progression
and attempt to return some pigment
• Light therapy
• Pharmacotherapy:
–
–
–
–
–
Oral synthetic melanizing agent
Topical corticosteroid agents
Topical immunosuppressants
Topical repigmenting agents
Oral or topical photochemotherapy
Vitiligo Treatment
• Skin graft
• Autologous melancyte transplant (still experimental)
• Permanent depigmentation of the remaining skin (a
last resort reserved for extreme cases)
• Sun safeguards
• Coping strategies and support, which may include:
– Makeup or skin dyes
– Tattooing (most effective around the lips)
Changes Associated With Aging
• Decreased sensations of pain, vibration, cold,
heat, pressure, and touch
– Increase the risk of injury including falls, decubitus
ulcers, burns, and hypothermia
• Decreased elasticity, integrity, and moisture
– Environmental factors, genetic makeup, and nutrition
contribute to these changes
– Blue-eyed, fair-skinned people show more of these
changes
• Appears thin, pale, and translucent
– Epidermis thins even though the number of cell layers
remains unchanged
– Melanocyte numbers decreases but increase in size
Changes Associated With Aging
• Large pigmented spots (lentigos) may appear in
sun-exposed areas
• Changes in the connective tissue reduce the
skin’s strength and elasticity
• Dermis blood vessels become fragile, leading to
bruising, cherry angiomas, and other similar
conditions
• Sebaceous glands produce less sebum
– Men experience a minimal decrease, usually after the
age of 80
– Women gradually produce less sebum beginning after
menopause
– Difficult to maintain skin moisture
Changes Associated With Aging
• The subcutaneous fat layer thins
– Increases risk of skin injury and reduces the ability to
maintain body temperature
– Changes the actions of some medications
• Sweat glands produce less sweat
– Contributes to the difficulty in controlling body
temperature
• Repairs itself more slowly
– Wound healing may be up to four times longer
– Contributes to decubitus ulcer formation and infections
– The presence of chronic diseases along with other
changes with aging (e.g., impaired immunity and
circulatory changes) further delays healing
Changes Associated With Aging
• Skin tags
– Benign, soft brown or flesh-colored masses
– Usually occurs on the neck
– Most are painless, but can become inflamed in
the presence of constant friction
– More common in persons who are obese or
have diabetes mellitus
– Can be removed with surgery, cryotherapy, and
cautery
Contact Dermatitis
• Acute inflammatory reaction triggered by direct exposure
to an irritant or allergen-producing substance
• Not contagious or life threatening
• Irritant contact dermatitis
– Causes: chemicals, acids, and soaps
– Does not involve the immune system, just the inflammatory
response
– Produces a reaction similar to a burn
– Manifestations: erythema, edema, pain, pruritus, and vesicles
• Allergic contact dermatitis
– Causes: metals, chemicals, cosmetics, and plants
– Sensitization occurs on the first exposure, and subsequent
exposures produce a type IV cell-mediated hypersensitivity
– Manifestations appearing 24–48 hours after exposure
– Manifestations: pruritus, erythema, edema, and small vesicles
Contact Dermatitis
• Varies in severity depending on the
substance, area affected, exposure extent,
and individual sensitivity
• Usually resolves in 2-4 weeks
• Diagnosis: history, physical examination, and
allergy testing
• Treatment: identify and remove the causative
agent, wet compresses, anti-inflammatory
creams (e.g., corticosteroid agents), and
systemic anti-inflammatory agents
Atopic Eczema
•
•
•
•
Chronic inflammatory condition triggered by an allergen
Has an inherited tendency
May be accompanied by asthma and allergic rhinitis
Most common in infants and usually resolves by early
adulthood
• Characterized by remissions and exacerbations
• The exact cause is unknown, but may result from an
immune system malfunction
• Complications: secondary bacterial skin infections,
neurodermatitis (permanent scarring and discoloration
from chronic scratching), and eye problems (e.g.,
conjunctivitis)
Atopic Eczema
• May affect any area, but it typically appears
on the arms and behind the knees
• Manifestations
–
–
–
–
–
Red to brownish-gray colored skin patches
Pruritus, which may be severe, especially at night
Vesicles
Thickened (lichenified), cracked, or scaly skin
Irritated, sensitive skin from scratching
• Diagnosis: history, physical examination,
allergy testing, and skin biopsy (to rule out
other causes)
Atopic Eczema Treatment
• Avoiding factors that can worsen:
–
–
–
–
–
–
–
–
–
–
–
Long, hot baths or showers
Dry skin
Stress
Sweating
Rapid changes in temperature
Low humidity
Solvents, cleaners, soaps, or detergents
Wool or synthetic fabrics or clothing
Dust or sand
Cigarette smoke
Certain foods (e.g., eggs, milk, fish, soy, and wheat)
• Avoiding scratching
• Moisturizing the skin by applying ointments 2–3 times daily
Atopic Eczema Treatment
• Using a humidifier
• Strategies when washing or bathing:
– Keep water contact brief and use little soap
– Do not excessively scrub or dry the skin
– Apply lubricating creams, lotions, or ointment on the
skin after while it is damp to trap moisture in the skin
• Pharmacology
–
–
–
–
–
Antihistamine agents (may be topical or oral)
Corticosteroid agents (may be topical or oral)
Immunomodulators (may be topical or oral)
Antibiotics (may be topical or oral if infection is present)
Allergen desensitizing injections
• Receiving phototherapy
Urticaria
• Raised erythematous skin lesions (welts)
• Result of a type I hypersensitivity reaction often
triggered by food (e.g., shellfish and nuts) and
medicine (e.g., antibiotics)
• May also be a result of emotional stress,
excessive perspiration, diseases (e.g.,
autoimmune conditions and leukemia), and
infections (e.g., mononucleosis)
• Caused by histamine release initiated by these
substances or conditions
Urticaria
• Usually short-lived and harmless
• Can impair breathing if around the face and
progress to anaphylaxis and shock
• Diffuse welts may grow large, spread, and fuse
together
• Manifestations: welts that blanch and pruritus
• Diagnosis: history, physical examination, and
allergy testing
• Treatment: avoid hot baths or showers, avoid
further irritation, antihistamines, epinephrine,
corticosteriods, and maintain respiratory status
Psoriasis
• Common chronic inflammatory condition that affects skin
cell life cycle
• Cellular proliferation is significantly increased, causing
cells to build up too rapidly on the skin’s surface
• Normally takes weeks, but occurs over 3–4 days with
psoriasis
• Buildup leads to thickening of the dermis and epidermis
because dead cells cannot shed fast enough
• The exact cause is unknown, but it is thought to be a
result of an autoimmune process in which T lymphocytes
mistake normal skin cells as foreign
Psoriasis
• Has a family tendency
• Onset is most frequently between 15 and 35 years
of ages, and may be sudden or gradual
• Usually experience remissions and exacerbations
• Factors that trigger an exacerbation or worsens:
bacteria or viral infections in any location, dry air or
dry skin, skin injuries, certain medicines (e.g.,
antimalaria agents, beta blockers, and lithium),
stress, too little or too much sunlight, and excessive
alcohol consumption
Psoriasis
• Severity varies
• May also have arthritis
• May be severe in persons who have a
weakened immune system
• Begin as a small, red papule
• Papules most often occur on the elbows,
knees, and trunk, but they can appear
anywhere
Psoriasis
• Papules develop into one of the following lesions:
– Erythrodermic—intense erythema and that covers a large
area
– Guttate—small, pink-red spots
– Inverse—erythema and irritation that occurs in the
armpits, groin, and in skin folds
– Plaque—thick, red patches covered by flaky, silver-white
scales (the most common type)
– Pustular—white blisters surrounded by red, irritated skin
• Other manifestations: genital lesions in males, joint
pain or aching, nail changes (e.g., thickening,
yellow-brown spots, pits on the nail surface, and
separation of the nail from the base), and dandruff
Psoriasis
• Diagnosis: history, physical examination,
skin biopsy, and other tests to rule out
other conditions that mimic psoriasis (e.g.,
seborrheic dermatitis and tinea corporis)
Psoriasis Treatment
• No cure
• Requires a multiprong approach
• Topical treatments: corticosteroid agents, vitamin D analogues,
anthralin (Dritho-Scalp), retinoids, calcineurin inhibitors, salicylic acid,
coal tar, and moisturizers
• Phototherapy: sunlight, broadband ultraviolet B (UVB) phototherapy,
narrowband UVB phototherapy, photochemotherapy (psoralen plus
ultraviolet A), and excimer laser
• Systemic pharmacotherapy: retinoids, methotrexate, cyclosporine,
hydroxyurea, and immunomodulator drugs
• Stress management
• Avoiding triggers
Bacterial Infections
• Can be caused by any of the normal flora
bacteria
• Varies from mild to life threatening
• Staphylococcus and Streptococcus genera
are common culprits
• Folliculitis
– Involving the hair follicles
– Characterized by tender, swollen areas that
form around hair follicles, often on the neck,
breasts, buttocks, and face
Bacterial Infections
• Furuncles
– Begins in the hair follicles and then spreads into
the surrounding dermis
– Most commonly occur on the face, neck, axillae,
groin, buttocks, and back
– Starts as a firm, red, painful nodule that
develops into a large, painful mass, which
frequently drains large amounts of purulent
exudate
– Carbuncles refer to clusters of furuncles
Bacterial Infections
• Impetigo
– Common and highly contagious
– Can occur without an apparent skin break, but
typically arises from a break in the skin
– Lesions usually begin as small vesicles that
enlarge and rupture, forming the characteristic
honey-colored crust
– Can spread throughout the body through selftransfer of the exudate
– Typically caused by a staphylococcal infection,
which produce a toxin that attacks collagen and
promotes spread
– Other manifestations: pruritus and
lymphadenopathy
Bacterial Infections
• Cellulitis
– Occurs deep in the dermis and subcutaneous
tissue
– Usually results from a direct invasion through a
break in the skin, especially those breaks where
contamination is likely, or spreads from an existing
skin infection
– Appears as a swollen, warm, tender area of
erythema
– Systemic manifestations: indicators of
infection(e.g., fever, leukocytosis, malaise, and
arthralgia)
– Complications: necrotizing fasciitis, septicemia, and
septic shock
Bacterial Infections
• Necrotizing fasciitis
– Rare, serious infection, but rates are rising
– Can aggressively destroy skin, fat, muscle, and other tissue
– Typically results from a highly virulent strain of gram-positive, group
A, beta-hemolytic Streptococcus that invade through a minor cut or
scrape
– The bacterium release harmful toxins that directly destroy the tissue,
disrupt blood flow, and break down the tissue
– The first sign may be a small, reddish, painful area that quickly
changes to a painful bronze- or purple-colored patch
– The center of the lesion may become black and necrotic
– Exudate is often present
– The wound may grow in less than an hour
– Systemic manifestations: fever, tachycardia, hypotension, and
confusion
– Complications: gangrene and shock
Bacterial Infections
• Diagnosis: history, physical examination,
and cultures
• Treatment: organism specific antibiotics,
wound care, adequate hydration, surgical
debridement, drainage, antipyretic agents,
and analgesic agents
Viral Infections
• Herpes simplex type 1
– Typically affecting the lips, mouth, and face
– Usually begins in childhood
– Can involve the eyes, leading to conjunctivitis
– Can result in meningoencephalitis
– Transmitted by contact with infected saliva
– The primary infection may be asymptomatic
– After the primary infection, the virus remains dormant in the sensory nerve
ganglion to the trigeminal nerve until it is reactivated
– Reactivation may be a result of an infection, stress, or sun exposure
– When reactivated, causes painful blisters or ulcerations that are preceded
by a burning or tingling sensation
– The lesions resolve spontaneously within 3 weeks, but healing can be
accelerated with oral or topical antiviral agents
Viral Infections
• Herpes zoster
– Caused by the varicella-zoster virus
– Appears in adulthood years after a primary infection of varicella in
childhood
– The virus lies dormant on a cranial nerve or a spinal nerve
dermatome until it is activated years later
– The virus affects this nerve only, giving the condition its typical
unilateral manifestations.
– Manifestations: pain, paresthesia, a red or silvery vesicular rash that
develops in a line over the area innervated by the affected nerve
(one side of the head or torso), extremely sensitive skin, and pruritis
– The rash may persist for weeks to months
– Complications: neuralgia and blindness
– Treatment: antivirals, antidepressants, and anticonvulsants
Viral Infections
• Verrucae
– Warts caused by a number of the human
papillomaviruses
– Can develop at any age and often resolve
spontaneously
– Transmitted through direct skin contact between
people or within the same person
– The human papillomavirus replicates in the skin
cells, causing irregular thickening
– Varying color, shape, and texture
– Treatment: laser treatments, cryotherapy with liquid
nitrogen, electroclautry, and topical medications
(e.g., keralytic, cytotoxic, and antiviral agents)
– May return after treatment
Parasitic Infections
• Tinea
– Causes several types of superficial fungal
infections
– These fungi typically grow in warm, moist places
(e.g., showers)
– Typically manifests as a circular, erythematous
rash accompanied by pruritus and burning
– Tinea capitis – involving the scalp
• Common in school-aged children
• Hair loss at the site is common
Parasitic Infections
• Tinea
– Tinea corporis – involving the body
– Tinea pedis – involving the feet, especially the
toes
– Tinea unguium – involving the nails, typically the
toenails
• Begins at the tip of one or two nails and then usually
spreads to other nails
• Turns nails white and then brown, causing them to
thicken and crack
– Treatment: topical and systemic antifungal
agents
Parasitic Infections
• Scabies
– Result of a mite infestation
– Male mites fertilize the females and then die
– Female mites burrow into the epidermis, laying eggs over a
period of several weeks through tracks
– After laying the eggs, the female mites die
– Larvae hatch from the eggs and then migrate to the skin’s
surface
– Larvae burrow in search of nutrients and mature to repeat the
cycle
– Burrowing appears as small, light brown streaks on the skin
– Burrowing and fecal matter left by the mites triggers the
inflammatory process, leading to erythema and pruritus
– Mites can only survive for short periods without a host, so
transmission usually results from close contact
– Treatment: topical treatments
Parasitic Infections
• Pediculosis
– Lice infestation – small, brown, insects that feed off human blood
and cannot survive long without host
– Pediculus humanus corpus – body louse
– Pediculus pubic – pubic louse
– Pedicuus humanus capitis – head louse
– Females lay nits on the hair shaft close to the scalp
– Nits appear as small white, iridescent shells on the hair
– After hatching, the lice bite and suck the blood
– Bite site develops a highly pruritic macule or papule
– Easy transmitted through close contact
– Treatment: several topical treatments
Parasitic Infections
• Diagnosis: microscopic examination of
skin scrapings processed with potassium
hydroxide
• Many feed off the dead skin cells of the
host and may use the host as a breeding
ground
Burns
• Injury that can result from a thermal or a nonthermal source
• Sources: dry heat (e.g., fire), wet heat (e.g., steam or hot
liquids), radiation, friction, heated objects, natural or artificial
UV light, electricity, and chemicals (e.g., acids, alkaline, and
paint thinner)
• Triggers inflammatory reaction and results in tissue
destruction
• First-degree burns – affect only the epidermis and cause
pain, erythema, and edema
• Second-degree burns – affect the epidermis and dermis and
cause pain, erythema, edema, and blistering
• Third-degree burns – extend into deeper tissues and cause
white or blackened, charred skin that may be numb
Burns
• Complication: local infection (particularly
Staphylococcus infection), sepsis,
hypovolemia, shock, hypothermia,
respiratory problems, scarring, and
contractures
• Diagnosis: history, physical examination
(including determining the total body
surface area affected), chest X-ray,
endoscopy, complete blood count, and
blood chemistry
Burn Treatment
• Strategies for minor burns
– Remove the source of the burn
– If the skin is unbroken, run cool water over the area of the burn or
soak it in a cool water bath (not icy)
– Keep the area submerged for at least 5 minutes
– After flushing or soaking, cover the burn with a dry, sterile bandage
or clean dressing
– Protect the burn from pressure and friction
– Analgesics
– Nonsteroidal anti-inflammatory drugs
– Apply moisturizing lotion once the skin has cooled
– If a second-degree burn covers an area more than 2–3 inches in
diameter, or if it is located on the hands, feet, face, groin, buttocks, or
a major joint, treat the burn as a major burn
Burn Treatment
• Strategies for major burns
– Remove the source of the burn
– If someone is on fire, have the person to stop, drop, and roll. Wrap
the person in thick material to smother the flames e.g., (a wool or
cotton coat, rug, or blanket). Douse the person with water.
– Do not remove burned clothing that is stuck to the skin. The
clothing may be soaked and then removed, and surgical removal
may be necessary in severe cases.
– Ensure the person is breathing. Initiate rescue breathing and
cardiopulmonary resuscitation if necessary. Continue to monitor
respiratory status because it can become impaired as edema
worsens.
– Maintain respiratory status (e.g., endotracheal intubation with
mechanical ventilation, oxygen therapy)
– Cover the burn area with a dry sterile bandage or clean cloth. Do
not apply any ointments. Avoid rupturing blisters.
Burn Treatment
• Strategies for major burns
– If fingers or toes are involved, separate them with dry,
sterile, nonadhesive dressings.
– Elevate the affected body part
– Protect the burn area from pressure and friction
– Prevent shock by place the individual in Trendelenburg
position and cover the person with a coat or blanket.
However, do not place the person in this position if a
head, neck, back, or leg injury is suspected or if it
makes the person uncomfortable.
– Monitor vital signs for signs of shock
– Administer intravenous fluids (usually colloids or
crystalloids) using specific formulas
Burn Treatment
• Strategies for major burns
– Administer oral, intravenous, or topical analgesics,
sedatives, or antibiotics
– Implement reverse isolation
– Meticulous wound care
– Protective dressings
– Skin grafting
– Surgery to close the wound, remove the dead tissue, or
treat related complications (e.g., scarring and
contractures)
– Physical therapy
– Increase dietary intake of protein and carbohydrates
Acne Vulgaris
• Commonly affects adolescents, but it can occur at
any age
• Pores become clogged with oil, debris, or bacteria
• Can become inflamed and develop a pustule,
nodule, or cyst
• May present as whitehead or blackhead
• Rupturing can spread the material inside to the
surrounding area and cause an inflammatory
reaction
• Commonly appears on the face and shoulders, but
it may also occur on the trunk, arms, legs, and
buttocks
Acne Vulgaris
• Complications: scarring
• Risk factors: family history, hormonal
changes, using oily cosmetic and hair
products, certain medications (e.g.,
corticosteroids, testosterone, estrogen, and
phenytoin), and high levels of humidity and
sweating
• Diagnosis: history and physical examination
Acne Vulgaris Treatment
• Clean with a mild, nondrying soap once
or twice a day, including after
exercising; however, avoid excessive or
repeated skin washing
• Shampoo hair daily, especially if it is oily
• Comb or pull hair back to keep the hair
away from the face, but avoid tight
headbands
Acne Vulgaris Treatment
• Avoid squeezing, scratching, picking, or rubbing
areas
• Avoid touching affected areas
• Avoid oily cosmetics or creams; use waterbased or noncomedogenic formulas
• Over-the-counter or prescription acne products
containing benzoyl peroxide, sulfur, resorcinol,
or salicylic acid
• Oral or topical antibiotics (e.g., erythromycin)
Acne Vulgaris Treatment
•
•
•
•
•
•
•
•
•
•
•
Oral or topical antibiotics (e.g., erythromycin)
Retinoic acid cream or gel (e.g., Retin-A)
Oral isotretinoin (Accutane)
Oral contraceptives
Alternative therapies including tea tree oil, zinc, guggul, and
brewer’s yeast
Photodynamic therapy
Chemical skin peels
Microdermabrasion
Dermabrasion
Soft-tissue fillers (e.g., collagen, and fat)
Limit sun exposure
Rosacea
• Chronic, progressive inflammatory condition that typically
affects the face
• Prevalent in persons who are fair skinned, bruise easily,
and women
• May present as erythema, telangiectasia, swelling, or
acnelike eruptions
• Other manifestations: rhinophyma, a burning or stinging
sensation, and red, watery eyes
• Usually experience remissions and exacerbations
• Exacerbation triggers: sun exposure, sweating, stress,
spicy food, alcohol, hot beverages, wind, hot baths, and
cold weather
• Diagnosis: history and physical examination
Rosacea Treatment
•
•
•
•
•
•
•
•
•
•
•
•
•
No cure
Avoid triggers
Avoid excessive scrubbing when cleaning
Avoid sun exposure and use sunscreen
Avoid prolonged physical exertion in hot weather
Stress management
Limit spicy foods, alcohol, and hot beverages
Topical or oral antibiotics
Retinoic acid cream or gel (e.g., Retin-A)
Oral isotretinoin (Accutane)
Laser surgery
Surgical reduction of enlarged nose tissue
Green- or yellow-tinted prefoundation creams and
powders
Skin Cancer
• Abnormal growth of skin cells
• Most frequently occurring cancer in US
• Most prevalent in males, Caucasians, those
with fair complexion, and those with a family
history
• UV exposure, natural or artificial, is the most
significant risk factor
• Most skin cancers occur on areas that have
the most sun exposure
Skin Cancer
• Basal cell carcinoma
– Most common
– Develops from abnormal growth of the cells in the lowest layer of
the epidermis
– Rarely metasticize
• Squamous cell carcinoma
– Involves changes in the squamous cells, found in the middle layer
of the epidermis
• Melanoma
– Develops in the melanocytes
– Least common type but the most serious
– Often metastasize to other areas
Skin Cancer
• Vary widely in appearance
• Can be small, shiny, waxy, scaly, rough, firm, red,
crusty, bleeding, and so on
• Any suspicious skin lesion should be examined
• Suspicious features:
–
–
–
–
–
–
Asymmetry
Borders irregularity
Color variations
Diameter larger than 6 mm in size
Any skin growth that bleeds or will not heal
Any skin growth that changes in appearance over time
Skin Cancer
•
•
•
•
Early detection is crucial to positive outcomes
Diagnosis: history, physical examination, and biopsy
Prevention: limiting or avoiding exposure to UV light
Treatment: cryosurgery, excisional surgery, laser
therapy, Mohs’ surgery (the skin growth is removed
layer by layer, examining each layer under the
microscope, until no abnormal cells remain),
curettage and electrodessication (involves scraping
layers of cancer cells away using a circular blade
[currette] and then using an electric needle to
destroy any remaining cancer cells), radiation
therapy, and chemotherapy