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Chapter 9 Skin Anatomy and Conditions Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 Objectives List major components of skin anatomy. List four types of noninfectious skin conditions and their treatments. List four types of infectious skin conditions and their treatments. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 Objectives (Continued) Determine the right strength of sunscreen necessary to protect skin from ultraviolet rays. Define the various forms of acne. Describe psoriasis and the types of medications used to treat this skin condition. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 Skin Anatomy Skin: the integumentary system is the largest organ in the body Includes skin, hair, subcutaneous tissues One of the most abused organs in the body Protects the body, regulates temperature, is a sensor or stimuli Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 Skin Anatomy (Continued) Keratin: top layer of skin; for protection Epidermis and dermis: layers beneath keratin Below dermis: subcutaneous layer of fat Epidermis: no blood flow of its own Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 Skin Anatomy (Continued) Dermis: much thicker; holds nerves, blood vessels, and other connective tissue Skin: can absorb moisture and medications Diabetics: inject insulin subcutaneously Intradermal route: between dermal layer Intramuscular: into the muscle layer Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 Anatomy of the Skin Epidermis Dermis Adipose Tissue Hypodermis Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 Conditions Affecting the Skin For a list of common dosage forms and types of conditions they treat, see Table 9-14 For popular antibiotic ointments and creams, see Table 9-15 Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 Skin Disorders and Medications Proper diagnosis: physical assessment, family history, drug history, lab tests, possible biopsy Two very common skin conditions: sunburn and acne Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 Miscellaneous Skin Conditions Two categories: Noninfectious inflammatory conditions Infectious inflammatory conditions See physician for persistent symptoms Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 Topical Antibiotics Used to treat abrasions, small cuts, and scrapes Clean wound properly See the list of agents for treating such wounds on the next slide Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 Antibiotic Products Product Bacitracin Neomycin Polymyxin B, neomycin, bacitracin Trade Names Bacitracin Neomycin Myciguent Dosage Forms Oint Oint Cream Neosporin Oint, cream Oint, Ointment. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 Skin Protection Factor Guide SPF agents: topical form; prevent sunburn UVA rays and UVB rays: two main wavelengths of rays that cause concern UV rays cause premature aging, changes in the DNA, erythema, and blistering Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Sunscreen Skin Protectant Factor Overexposure to the sun can cause mutations in DNA Cancer can occur and discoloration of prematurely aged skin Melanin: chemical for skin color Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Sunscreen Skin Protectant Factor (Continued) Two types of protectants: Sunscreens: protect from UVA and UVB rays Sunblocks: reflect UV rays SPF factor important Choose coverage based on skin types Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 Skin Protectant Factor Guide for Application of Sunscreen Skin Type I II III IV V VI Skin Characteristics After 10 Min Sun Exposure Burns easily/rarely tans Burns easily/tans minimally Burns moderately/tans gradually Burns minimally/tans well Rarely burns/always tans Never burns/deeply pigmented Suggested Minimum Coverage 20 to 30 SPF 12 to 20 SPF 8 to 12 SPF 4 to 8 SPF 2 to 4 SPF None SPF, Skin protectant factor. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 Acne Development and Treatment Acne affects teenagers and adults Caused by hormonal changes and genetics Hormones enlarge the glands of the skin Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 Acne Development and Treatment (Continued) Two productive glands: Sweat: regulate temperature Sebaceous: produce skin oil or sebum Increased sebum traps bacteria Keep skin clean and free from bacteria Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 Acne Development and Treatment (Continued) Acne classified into two groups: Noninflammatory: treatment is mild medication (keratolytics) Inflammatory: benzoyl peroxide most common OTC product recommended Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Acne Development and Treatment (Continued) Antibiotics used: tetracycline, erythromycin, clindamycin Topical agents: retinoic acid, isotretinoin (Accutane), and tretinoin (Retin A) Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Hives/Inflammation Common noninfectious conditions include: urticaria (hives), eczema (red skin rash), psoriasis (plaques, scaly skin), seborrheic dermatitis (rash), and atopic dermatitis (rash) Topical agents: used for hives and skin rashes causing inflammation from severe itching Psoriasis: consult a doctor Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 Infectious Inflammatory Skin Conditions Warts: viral, contagious, caused by papovavirus(Treatment: see Table 9-19) Genital warts: see doctor Tinea infections: caused by fungus; treat with powdered antibiotics (Treatment: see Table 9-20) Canker sores: inside cheek of mouth; small topical ulcers (See Table 9-21) Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22 Infectious Inflammatory Skin Conditions (Continued) Lice: Children come home from school with head lice; high risk for catching without body contact; whole family should be treated Herpes—two different types: Herpes simplex (causes sores) Herpes zoster- Shingles (causes lesions) • Treated with antiviral medications Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23 Infectious Inflammatory Skin Conditions (Continued) Impetigo: contagious condition caused by streptococcal organisms; infection contagious Treatment: antibiotics and Burrow’s solution See Figure 9-6 Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 24 Serious Skin Conditions Require a visit to the hospital or doctor Include skin melanomas, psoriasis, burns Malignant melanoma: cancerous skin growth; treatment: removal, skin graft See Figure 9-7 Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 25 Serious Skin Conditions (Continued) Ulcers: external ulcers caused by bed sores and affect elderly; may harbor MRSA— highly contagious Treatment: antibiotics Can be caused by STDs See Figure 9-8 Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 26 Psoriasis Genetic skin condition; cannot be cured; lasts a lifetime Not contagious but looks bad when inflamed Most affected areas: joints, limbs, neck, scalp Potent drugs used: corticosteroids (require physician’s prescription) Sunlight treatments Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 27 Burns Range from first degree (least severe) to third degree (most severe) Medications include silver sulfadiazine (Silvadene) cream Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 28