Download infectious disorders of the skin

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. 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. 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 varicellazoster 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