Download Human Diseases - Delmar

Chapter 18
Integumentary System Diseases and
Disorders
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Anatomy and Physiology
• Skin
– Largest organ of body
– First line of protection for body against invading organisms
– Provides sense of touch, heat, cold, and pain
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Anatomy and Physiology
• Skin
– Helps stabilize temperature, fluid, and electrolyte balance
– Three layers:
• Epidermis
• Dermis
• Subcutaneous
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Animation
Click Here to Play Skin Animation
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Common Signs and Symptoms
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Skin lesions
Pain
Pruritus
Edema
Erythema
Inflammation
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Diagnostic Tests
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Biopsy
Culture and sensitivity
Blood tests
Microscopic smear examinations
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Infectious Diseases: Viral
• Herpes
– Large family of viruses
– Symptoms:
• Inflammation of skin
• Clusters or fluid-filled vesicles
– Periods of remission and exacerbation
– No cure
• Remains in affected individual’s body for life
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Viral
• Herpes
– Common types:
• Herpes simplex 1
– Fever blisters
– Cold sores
• Herpes simplex 2/Herpes genitalis
– Genital herpes
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Viral
• Herpes
– Common types:
• Herpes varicella
– Chickenpox
• Herpes zoster
– Shingles
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Herpes Simplex Virus 1
Photo courtesy Robert A. Silverman, MD,
Pediatric Dermatology, Georgetown University
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Viral
• Verrucae
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Also known as warts
Chronic condition
Occur in multiples and differ in size, shape, and appearance
Often resistant to treatment
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Infectious Diseases: Viral
• Verrucae
– Common types:
• Appearance on hands and fingers of children
• Appearance on sole of foot
– Plantar warts
• Sexually transmitted
– Genital warts
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Verrucae
Photo courtesy Mark L. Kuss
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Bacterial
• Impetigo
– Streptococcus and staphylococcus
– Affects face and hands of children
– Symptoms:
• Vesicles
• Pustules that rupture
– Producing yellow crust over lesions
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Bacterial
• Impetigo
– Treatment:
• Cleansing
• Antibiotic ointment
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Bacterial
• Folliculitis
– Inflammation and infection of hair follicle
– Common cause:
• Staphylococcus
– Symptoms:
• Small pustules surrounding hair
– Treatment:
• Antibiotics
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Folliculitis
Photo courtesy Robert A. Silverman, MD,
Pediatric Dermatology, Georgetown University
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Bacterial
• Abscess, furuncle, and carbuncle
– Inflammation, infection, and formation of capsule prevent
spread of infection
– Treatment:
• Antibiotics
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Bacterial
• Cellulitis
– Diffuse or spreading inflammation of skin and
subcutaneous tissue
– Causes:
• Streptococcus
• Staphylococcus
– Treatment:
• Antibiotics
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Bacterial
• Cellulitis
– Prevention:
• Good handwashing
• Cleansing of open areas on skin
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Bacterial
• Erysipelas
– Acute infection of dermis extending to fat tissue
– Causes:
• Most commonly Group A streptococcus
– Treatment:
• Oral or IV antibiotics
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Bacterial
• Lyme disease
– Multisystem infections transmitted to humans through bite
of infected deer tick
– Symptoms:
• Flu-like symptoms
• Arthritis
• Malaise
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Bacterial
• Lyme disease
– Symptoms:
• Chills
• Fever
• Bull’s eye skin rash
– Symptomatic treatment:
• Antibiotics
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Bacterial
• Methicillin-resistant staphylococcus aureus
(MRSA)
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Both hospital- and community-acquired
Diagnosed by culture and drug sensitivity testing
Resistant to antibiotics commonly used
Treatment:
• Vancomycin
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Fungal
• Tinea
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Also known as ringworm
Infects warm, moist areas of body
Feeds on perspiration and dead skin
Symptoms:
• Itching, cracking, and weeping of skin
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Fungal
• Tinea
– Treatment:
• Keep affected area clean and dry
• Use antifungal agents
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Fungal
• Tinea
– Types:
• Tinea corporis
– Affects smooth skin on arms, legs, and body
• Tinea pedis
– Athlete’s foot
• Tinea cruris
– Jock itch
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Fungal
• Tinea
– Types:
• Tinea unguium
– Affects fingernails or toenails
• Tinea capitis
– Affects scalp
• Tinea barbae
– Affects bearded areas
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Tinea Pedis
Photo courtesy Centers for Disease
Control and Prevention
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Tinea Unguium
Photo courtesy Mark L. Kuss
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Fungal
• Candidiasis
– Fungal infection
– Cause:
• Candida
– Symptoms:
• Red, itchy skin with blisters and pustules
– Treatment:
• Antifungal medications
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Parasitic
• Pediculosis
– Infestation with lice
– Treatment:
• Bathing and shampooing with medicated shampoo
– E.g., Kwell
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Parasitic
• Pediculosis
– Types:
• Head
• Body
• Pubic
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Infectious Diseases: Parasitic
• Scabies
– Caused by tiny mite
– Also known as seven-year itch
– Symptoms:
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Slightly elevated, grayish-white lines
Intense itching
Vesicles
Pustules
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infectious Diseases: Parasitic
• Scabies
– Treatment:
• Lindane cream to entire body
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Scabies
Photo courtesy Robert A. Silverman, MD,
Pediatric Dermatology, Georgetown University
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Metabolic Diseases
• Acne vulgaris
– Inflammation of sebaceous glands and hair follicles
– Symptoms:
• Comedones
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Metabolic Diseases
• Acne vulgaris
– Treatment:
• Cleansing
• Over-the-counter (OTC) treatments
• In severe cases, antibiotics, steroids, and Retin-A preparations
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Metabolic Diseases
• Seborrheic dermatitis
– Affects sebaceous glands
– Also known as cradle cap in infants
– Also known as dandruff when affecting scalp
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Metabolic Diseases
• Seborrheic dermatitis
– Symptoms:
• Reddened, itchy areas
• Scales
– Treatment:
• Wash and dry
• Steroid creams
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Seborrheic Dermatitis
Photo courtesy Centers for Disease
Control and Prevention
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Metabolic Diseases
• Sebaceous cyst
– Sebaceous gland becomes blocked and sebum collects
under skin
– Special type:
• Pilonidal cyst
– Treatment:
• Incising and draining
• Surgical removal
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hypersensitivity or Immune Diseases
• Eczema
– Inflammation of skin
– Symptoms:
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Itching
Redness
Vesicles
Pustules
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hypersensitivity or Immune Diseases
• Eczema
– Symptoms:
• Scales
• Crusting
– Treatment:
• Topical cortisone
• Antihistamines
• Sedatives
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Eczema
Photo courtesy Centers for Disease
Control and Prevention
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hypersensitivity or Immune Diseases
• Urticaria
– Also known as hives or nettle rash
– Vascular reaction of skin
– Causes:
• Irritants
– Treatment:
• Antihistamines
• Avoidance of allergen
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hypersensitivity or Immune Diseases
• Contact dermatitis
– Acute or chronic allergic reaction of skin
– Causes:
• Cosmetics
• Laundry products
• Jewelry
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hypersensitivity or Immune Diseases
• Contact dermatitis
– Symptoms:
• Pain
• Small red localized lesions to vesicular lesions
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hypersensitivity or Immune Diseases
• Scleroderma
– Hardening, thickening, and shrinking of connective tissues
• Including skin
– Autoimmune reaction
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Idiopathic Diseases
• Psoriasis
– Chronic skin disease
– Symptoms:
• Red, raised lesions with distinct borders and silvery scales
– Treatment:
• Coal tar medications
• Ultraviolet light
• Steroids
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Psoriasis
Photo courtesy Robert A. Silverman, MD,
Pediatric Dermatology, Georgetown University
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Idiopathic Diseases
• Rosacea
– Chronic skin condition
– Symptoms:
• Redness of forehead, nose, cheeks, and chin
– Treatment:
• Avoid triggers
– E.g., sun exposure
– No cure
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Benign Tumors
• Seborrheic keratosis
– Benign overgrowth of epithelial cells
– Symptoms:
• Tan or brown growths
• Warty scale appearance
– Treatment:
• Curettage
– Scraping off
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Benign Tumors
• Keloid
– Raised, firm, irregular-shaped scar tissue following trauma
or surgery
– Treatment:
• Surgical removal
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Benign Tumors
• Hemangioma
– Congenital benign tumor of small blood vessels that form
purplish birthmark
– Common types:
• Port wine stain
• Strawberry hemangioma
• Cherry hemangioma
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Premalignant and Malignant Tumors
• Actinic keratosis
– Premalignant condition
– Common in fair-skinned individuals
– Symptoms:
• Wart-like lesions on sun-exposed areas
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Premalignant and Malignant Tumors
• Actinic keratosis
– Treatment:
• Topical medication
– E.g., Retin-A
• Curettage
• Cryotherapy
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Premalignant and Malignant Tumors
• Basal cell carcinoma
– Most common type of skin cancer
– Slow-growing, locally invading tumor that does not
metastasize
– Treatment:
• Surgical removal
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Basal Cell Carcinoma
Photo courtesy Mark L. Kuss
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Premalignant and Malignant Tumors
• Squamous cell carcinoma
– Tends to occur in sun-exposed areas
– Symptoms:
• Firm red nodule with crusts or slightly elevated plaque
– Treatment:
• Wide surgical excision
• Radiation
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Squamous Cell Carcinoma
Photo courtesy Robert A. Silverman, MD,
Pediatric Dermatology, Georgetown University
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Premalignant and Malignant Tumors
• Malignant melanoma
– Most serious type of skin cancer
– Symptoms:
• Change in size and color of mole
– Rarely occurs before age 20
– May be related to severe sunburn as child
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Malignant Melanoma
Photo courtesy Mark L. Kuss
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Premalignant and Malignant Tumors
• Malignant melanoma
– Treatment depends on degree of spread:
• Wide surgical excision
• Radiation
• Chemotherapy
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Premalignant and Malignant Tumors
• Kaposi’s sarcoma
– Malignant vascular skin tumor
– Bluish-red cutaneous nodules
– Treatment:
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Treat AIDS
Liquid nitrogen
Radiation
Chemotherapy
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Abnormal Pigmented Lesions
• Types:
– Ephelis
• Freckle
– Lentigo
• Liver spot
– Nevus
• Mole
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Abnormal Pigmented Lesions
• Types:
– Albinism
• Decrease or total absence of pigment in skin, hair, and eyes
– Melasma
• Dark patches of skin on face
– Especially cheeks
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Abnormal Pigmented Lesions
• Types:
– Vitiligo
• Destruction of melanocytes in small or large patches of skin
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Diseases of the Nails
• Abnormal shape, thickness, and color
• Causes:
– Most commonly fungal and bacterial infections
• Treatment:
– Bacterial infections treated with antibiotics
– Fungal infections treated with antifungal medications
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Diseases of the Hair
• Hirsutism
– Excessive growth of hair
• Alopecia
– Partial or complete hair loss
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Mechanical Skin Injury
• Abrasion
– Scraping away skin surface
• Blunt trauma
– Contusion by item
• E.g., hammer, club
– Thrown into item
• E.g., steering wheel, wall
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Mechanical Skin Injury
• Avulsion
– Skin or appendage pulled or torn
• Crush trauma
– Tissue caught between two hard surfaces
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Mechanical Skin Injury
• Puncture injury
– Sharp object forced into tissue
• Laceration
– Cut in skin caused by sharp object
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Thermal Skin Injury
• Hyperthermia
– Body overheated due to excessive exposure to sun or heat
– Types:
• Heat exhaustion
• Heat stroke
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Thermal Skin Injury
• Burns
– First degree:
• Pain, redness, and swelling
– Second degree:
• Pain, redness, swelling, blisters, and open wounds
– Third degree:
• Charred and broken skin tissue
• Painless
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Thermal Skin Injury
• Cold injuries
– Not as severe or life-threatening as heat or burn injuries
– Low body temperature
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Thermal Skin Injury
• Cold injuries
– Symptoms:
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Extreme shivering
Mental confusion
Blue or cyanotic extremities
Weak pulse
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Thermal Skin Injury
• Cold injuries
– Treatment:
• Remove wet clothing
• Warm body with warm blankets
• Drink warm liquids
– Frostbite
• Freezing of tissue
– Usually on face, fingers, toes, and ears
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Electrical Injury
• Causes:
– Unprotected or inadequately insulated electrical wiring
– Contact with lightning
• Damage has point of entry and exit
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Radiation Injury
• Ionizing radiation
– E.g., x-rays
• Causes:
– Exposure to sunlight
– Tanning beds
– Damage to skin
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Pressure Injury
• Decubitus ulcer
– Also known as bedsore or pressure sore
– Affects bony areas of body
• E.g., heels, sacrum, elbows
– Treatment:
• Frequent turning and repositioning
• Massaging of affected area to improve circulation
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Pressure Injury
• Corns and calluses
– Protective hyperplasias of tissue
– Corns
• Often painful
• Most common on feet from ill-fitting shoe
• Can be surgically removed
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Pressure Injury
• Corns and calluses
– Calluses
• Not usually painful
• Most common on hands
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Insect/Spider Bites
• May cause swelling and itching at site
• Venom or poison may cause allergic reaction
• Range from mild to severe
– Requires calling 911 for immediate assistance
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Insect Bites/Stings
• May be from mosquitoes, flies, fleas, wasps,
hornets, yellow jackets, and ants
• Symptoms:
– Swelling
– Itching
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Insect Bites/Stings
• Usually mild reaction that disappears in hours
or one day
• Sever allergic reaction may require immediate
intervention
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Spider Bites
• Black widow
– Most common poisonous spider
• Brown recluse spider
– Very dangerous
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Spider Bites
• Treatment:
– Ice
– Analgesics
– Prompt medical care
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Rare Diseases
• Elephantiasis
– Hypertrophy of skin and subcutaneous tissue
• Inflammation of lymphatic system results in
fluid accumulation
• Causes:
– Parasitic worm
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Effects of Aging
• Thinning of epidermal layer
– Retains less water
• Xerosis
• Decreased function of sweat and sebaceous
glands
• Loss of elasticity
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Effects of Aging
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Thickening of nails
Thickening and increased brittleness of hair
Loss and graying of hair
Skin lesions
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.