1.
INTEGUMENTARY SYSTEM
DISORDERS
BY AMIR A
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2/8/2023 By Amir A

2.
Subtopics
• Anatomy and physiology overview
• Bacterial infections
• Viral infections
• Secretary disorders
• Inflammatory and allergic skin disorders
• Burn
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3.
Anatomy of the skin
• The skin consists of 3 layers:
–Epidermis- non vascular outermost layer,
continuously dividing cells
–Dermis- takes the largest portion of the skin and
provides strength and structure.
. It consists of glands (sebaceous, sweat), hair
follicle, blood vessels, and nerve endings
–Subcutaneous tissue (hypodermis)- the inner
most layer.
. contains major vascular networks, fat, nerves,
and lymphatics
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4.
Epidermis
• is an outermost layer
• It ranges in thickness from about 0.1 mm on the
eyelids to about 1 mm on the palms of the hands
and soles of the feet
• This external layer is almost completely replaced
every 3 to 4 weeks
• Keratin is the principal hardening ingredient of
the hair and nails
• Melanocytes are the special cells of the epidermis
that are primarily involved in producing the
pigment melanin, which colors the skin and hair
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5.
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6.
Dermis
• The dermis makes up the largest portion of
the skin, providing strength and structure
• made up of blood and lymph vessels, nerves,
sweat and sebaceous glands, and hair roots
• The dermis is often referred to as the “true
skin.”
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7.
Subcutaneous Tissue
• or hypodermis, is the innermost layer of the skin
• It is primarily adipose tissue, which provides a
cushion between the skin layers, muscles, and
bones
• It promotes skin mobility, molds body contours,
and insulates the body.
• The subcutaneous tissues and amount of fat
deposited are important factors in body
temperature regulation
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8.
Hair
• Grows over most of body except lips, palms &
soles
• The rate of growth varies; beard growth is the
most rapid, followed by hair on the scalp,
axillae, thighs, and eyebrows
• Color is inherited & depends on amount of
melanin
• Protects and warms the head
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9.
Nails
• a hard, transparent plate of keratin, called the
nail, overlies the skin
• Composed of keratinized and horny layer
• Color ranges from pink to yellow or brown
depending on skin color
• Protects ends of fingers and toes
• Growth is faster in fingernails than toenails
and tends to slow with aging
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10.
Glands of the Skin
sebaceous glands
are associated with hair follicles, empty
sebum (ie, oily secretion) onto the space
between the hair follicle and the hair shaft
Found every where on the dermis except on
palmar and plantar surface
Secretion stimulated by sex hormones
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11.
Glands of the Skin
Sweat glands
Only the glans penis, the margins of the lips,
the external ear, and the nail bed are devoid
of sweat glands
Eccrine sweat glands(True sweat: 99% water,
some salts, traces of waste Open through
pores
Apocrine sweat glands(Axillary, anal and
genital areas only ,Ducts open into hair follices
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12.
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13.
Function of the skin
• Protection- protection of underlying structures
from invasion by bacteria, noxious chemicals and
foreign matter.
• Sensory perception- transmits pain, touch,
pressure, temperature, itching, etc
• Fluid balance (excretion)- absorption of fluids
and evaporation of excess.
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14.
Function….
• Temperature regulation- produced heat released
through skin by radiation, conduction, and
convection
• Vitamin synthesis- skin exposed to ultra violet light
can convert substances necessary for synthesizing
vitamin D3 (cholecalciferol).
• Aesthetic- provides beautiness and appearance
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15.
Assessing the skin
• Assessment includes a thorough:
- history taking,
-inspection and
-palpation of the skin
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16.
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17.
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18.
Herpes vircilla virus
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Veruca vulgaris
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20.
Tinea pedis
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21.
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22.
scabies
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23.
acne
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24.
acne
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25.
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Pediculosis
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26.
Adverse effect of topical corticosteriods
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27.
psoriasis
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On patient history ask the following
• When did you first notice this skin problem
(duration)?
• Are there any other symptoms?
• What site was first affected?
• What did the rash or lesion look like when it first
appeared?
• Where and how fast did it spread?
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29.
Cont’d….
• Do you have itching, burning, tingling, or crawling
sensations?
• Is there any loss of sensation?
• Is the problem worse at a particular time or season?
• How do you think it started?
• Do you have a history of hay fever, asthma, eczema
or allergies?
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30.
cont..
- Who in your family has skin problems or
rashes?
- Did the eruptions appear after certain
foods/drinks? Which food and drinks?
- What medications are you taking?
- What topical medications have you put on
the lesion including over the counter
medications?
- What skin products or cosmetics do you
use?
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31.
Color change: can be hyperpigmentation,
hypopigmentation or depigmentation
1. Redness- fever, alcohol intake, local
inflammation due to increased blood flow to
the skin.
2. Bluish color (cyanosis) - decreased oxygen
supply due to chronic heart and lung disease,
exposure to cold, and anxiety
HA(MSN) 26
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32.
Color change…
Yellowish color (jaundice) - increased serum
bilirubin concentration due to liver disease or red
blood cell haemolysis/Carotenemia
- Uremia- renal failure
Pale: Albunism- total absence of pigment melanin
Vitiligo- destruction of the melanocytes in
circumscribed areas of the skin
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33.
Benign skin condition-vitiligo
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34.
Diagnostics test
• Skin biopsy: removal of a piece of skin by shave,
punch, or excision technique for a microscopic study
of the skin to determine the histology of cells to rule
out malignancy and to establish an exact diagnosis.
• Patch testing: performed to identify substances to
which the patient has developed an allergy.
• Potassium hydroxide test (KOH): helps to identify
fungal skin infection
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35.
Dx…
• Tzanck smear: a test used to examine cells from
blistering skin conditions
• Gram stain and culture with sensitivity test: helps
to identify the organism responsible for an
underlying infection with the effective drug
identification
• Slit Skin Smear (SSS): to identify the causative
agent of leprosy (mycobacterium leprea)
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36.
Description of skin lesion
(1.primary lesion)
I. circumscribed , flat , nonpalpable changes in
skin color
• Macule = small upto 1 cm, eg. petechia
• Patch = larger than 1 cm , eg vitilligo
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37.
Description of skin lesion...
II. Palpable elevated solid masses
– Papule: up to 0.5cm eg. elevated nevus
– Plaque: elevated surface > 0.5 cm
– Nodule: deeper & firmer than papule
=> 0.5 -1-2cm eg tumor
– Wheal: irregular, superficial area of localized
skin edema
HA(MS 11
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38.
Description of skin lesion...
III. Superficial elevation of skin formed by free
fluid in a cavity in the skin layer.
• Vesicle: up to 0.5 cm
=> filled c serous fluid,eg herps simplex
• Bulla: > 0.5 cm, Filled of serous fluid, eg 2nd
degree burn ( blister)
• Pustule: filled pus, eg impetiao, acne
HA(MSN) 12
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39.
2.Secondery lesion
IV. Loss of skin surface
• Erusion => loss of superficial epidermis
• Ulcer => deep loss of skin surface
=> May bleed & scar, eg. sphilic chancre
• Fissure => linear creak in the skin
eg.A thlet's foot
HA(MSN) 13
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40.
Secondery lesion....
On skin surface:
• curst = dried residue of serum ,pus or blood,
eg Impetigo
• Scale = a thin flake of exfoliative epiderms
eg.dandruff, Dry skin, Psoriasis
HA(MSN) 14
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41.
Cont….
3. Vascular skin lesions- a lesion that originated from
a blood vessel
• Petechia/Purpura
• Ecchymosis
• Telangiectasia (venous star)
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42.
PETECHIAE / PURPURA
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43.
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44.
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45.
A . Inflammatory and allergic skin
disorders
Acne vulgaries
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46.
Acne
- Is a common disorder of the sebaceous gland
associated with excess production of sebum and
blockage of the pilosebaceous duct resulting in a
variety of inflammatory manifestations.
• Common in puberty and usually regresses in early
adult hood
• Associated with the peak function of endocrine
glands
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• Patient complain of oiliness of the skin.
- Occurs on the face, upper trunk and shoulders
- Appears to be multiple inflammatory papules,
pustules and nodules
• It can be very mild to be very severe: - they blend
together to form large inflammatory areas with cysts
and scar formation.
Cause-genetic, hormone and bacteria play a role
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Pathophysiology
1. During child hood the sebaceous glands are small and
non functioning
2. Androgen during adolescent and young adult secrets
sebum (natural oil) in large amount
3. Obstruction to outflow at peliosebaceous canal
4. Inflammation arising as result of leakage into the
surrounding
5. Appearance of comedowns
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49.
Cont..
Sign and symptom
– Red nodules, cyst , red papules, scars, pustules,
keloids
• There may be mild soreness, pain or itching
• Inflammatory papules, pustules, pores acne cyst,
scarring
• Comedones (swellen part) and Milia (surrounding tissue)
Diagnosis
– Clinical
• Open and closed comedones
• Cyst formation, slow resolution, scarring
• Common at puberty and common of all skin conditions
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Management
• Stop the use of vaseline, oil, ointment, greasy
cosmetics which further blocks sebaceous ducts.
• Benzoyl per oxide 5-10% gel or tretinoin 0.01-
0.1% cream or gel apply at night.
• Salicylic acid 1-10% in alcoholic solution for
removal of excess sebum.
• For pustular/inflammatory lesions use topical
clindamycin 1% solution, erythromycin 2% lotion
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51.
Mgt…
• In severe cases use systemic long term antibiotics
like doxycycline 100mg twice daily until
substantial improvement followed by 100mg once
daily until acceptable.
• Surgical treatment – extraction of comedones
(swellen part), incision and drainage of large
fluctuant, nodulocystic lesions
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52.
Psoriasis
• Is a chronic recurrent, hereditary, non infectious
disease of the skin caused by abnormally fast turn
over of the epidermis
• The turn over may be up to 40 times than normal
and as a result the epidermis is not able to develop
normally, therefore it doesn’t allow formation of the
normal protective layer of the skin.
• Skin become red, inflamed, and the scales are
thicker than normal
• It produces a so called candle-wax phenomenon,
when you scratch such a patch it becomes silvery
white. 52
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53.
Psoriasis…
• Sites: extensor areas of extremities especially elbow,
knees, buttocks, shoulder and scalp
• Cure is there but it reoccurs
• Occurs at any age but 10-35 years is common
mostly.
• Periods of emotional stress and anxiety aggravate
the condition.
• Triggering factors can be trauma, infection, seasonal
and hormonal changes (Immune system)
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54.
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Generalized psoriasis
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 Sign and symptom
• May itch severely in body folds covered with silvery
scales
• Finger and toenails may show pitting and thickening
• Associated arthritis
• Lesions are not moist
• Lesions are symmetry Bilateral
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58.
Management
• Explain to the Patient the recurrent nature of the
disease
• Salicylic acid 2-10% ointment twice daily to reduce
scaling
• Moisturizers (Vaseline, paraffin oil, or cream)
• In body folds sulphur added to a mild steroid cream
is often effective :- to shade the flakes
• Treat any super infection with KMNO4 , betadine or
antibiotics if necessary
• Psoriatic arthritis NSAIDS
E.g.: Ibuprofen, Indomethacin, and ASA
• Methotrexates as a last option in sever cases 58
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59.
B. Bacterial skin disorder
1. Cellulitis
• Is a diffuse, acute streptococcal or staphylococcal
infection of the skin and subcutaneous tissue
Cause
• Caused by bacteria’s like
streptococcus/staphylococcus aureus
• Results from break in skin
• Infection rapidly spread through lymphatic system
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60.
Sign and symptom
• Tender, red, hot, indurated and swollen area that
is well demarcated
• Possible fluctuant abscess or purulent drainage
• Fever, chills, and malaise
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61.
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Features:
Red
Swollen
Warm to touch
No areas of pus
Painful
Tender
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The result of “skin popping” -
Multiple injection site abscesses
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67.
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Cellulitis with abscess
If rapid spreading beyond this line occurs, this may be
necrotizing fasciitis, and requires surgery
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Necrotizing fasciitis
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Management
• Oral antibiotics
cloxacillin,
erythromycin
Amoxacillin
Doxycycline
,,,,,
• Parentral/systemic antibiotics for hands, face, or
lymphatic spread
• Surgical drainage and debridement
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72.
2. Furunclosis
• Is an acute painful infection of perifollicular
abscess (boils)
• Is an acute, localized, deep seated, red, hot, very
tender, inflammatory perifollicular abscess.
• Common microorganism: staphylococcus aureus
• It occurs at all age
• Multiple and recurrent infection of Boils /
furuncle/
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73.
Cont’d…
• Most common on persons who are carriers of
staphylococcus, contact with oils or grease, diabetes,
poor habits of personal hygiene,
immunosuppression, alcoholism, obese, malnutrited,
etc
• The lesion begins in the opening of hair follicle or
sebaceous gland
• Sites can be back of the neck, face, buttocks, thighs,
perineum, breasts, axilla, nose, genitallia, etc
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Sign and symptom
• Hard nodule initially then fluctuant abscess with
centrally yellow pustule, then ruptures in to an ulcer.
• It can be isolated single lesion or few multiple lesion
• Hotness and pain at the site.
Diagnosis
• Gram stain of the pus why???
• Culture and sensitivity test of blood/pus?????
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77.
Cont…
Treatment
• Warm compresses -
• Warn patient not to squeeze or incise the lesion
• Incision and drainage when it is fluctuance.
• Systemic antibiotics (cloxacillin, erythromycin)
• Rest especially for genital areas.
• For the sever pain codien, morphine
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3. Carbuncles
(multiple furuncles, or conglomerate of furuncles)
- Is an aggregation of interconnected furuncles that
drain through multiple openings in the skin.
• Exposure to grease and oil increase the risk.
• Occurs mostly where the skin is thick
• Microorganism mostly involved is staphylococcus
aureus
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79.
Sign and symptom
• Sites:
 back of the neck
 shoulder
 buttock
 outer aspect of the thigh and over the hip joints.
• Develop slowly than furuncle
• They can reach the size of an egg/small orange.
• Fever, chills, extreme pain, malaise.
• Because of the large size of the lesion and its delayed
drainage the patient is much sicker
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82.
Cont…
Diagnosis
• Gramstain of the pus
• Culture of pus/blood
• CBC
Leucocytosis (12,000-20,000 mm3) normal 4,000-
10,000mm3
Treatment
• The same as furuncle, plus
• Avoid friction and irritation from tight clothing.
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d. Folliculitis
• Is inflammation of the hair follicle
Sign and symptom
– Single or multiple papules or pustules
– Commonly seen in the beard area of men and women’s
legs from shaving
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85.
Management
• Warm compress to relieve pain
• Clean with antibacterial soap
• Topical antibiotic ointment
• Systemic antibiotics for recurrent cases
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e. Impetigo
• Is an acute, contagious, rapidly spreading cutaneous
infection
• Is a very common bacterial infection of the
superficial skin
• Causative agents are staphylococcus aureus or a B-
hemolytic streptococcus or both
Common site
• Exposed areas of the body like face ,hands ,neck
and extremities
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89.
 Sign and Symptom
• Superficial pustules or blisters which becomes
oozing with yellow crusts
• Contagious
• Blisters break easily and form golden crusts
Diagnosis
-Clinical
- Culture and sensitivity
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90.
Characteristics
• contagious
• Although impetigo affects all age it particularly
common in children living poor hygienic
condition
• It appear secondary to pediculosis capitis, scabies
, harpers simplex, insect bite or eczema
• Poor hygiene and malnutrition predispose adult
to infection
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91.
Impetigo pictures
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92.
Management
• KMNO4 bath or wet dressing-in mild forms
• Prevent spreading by not sharing towels and
ointment, change clothes, towels and sheets
frequently.
• In sever forms give cloxacillin 250-500mg QID
daily for 7-10 days in adults, and 50-100mg/kg/24
hours divided in to 4 doses for children.
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93.
Mgt…
• Erythromycin 250-500mg 4 times daily for 7-10
days in adults, and 25-50mg/kg/24hrs divided in to
4 doses for children
• Cut finger nails short to minimize damage to lesion
and to prevent autoinoculation from scratching
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94.
D. Fungal skin disorder
1. Dermatophytoses (Mycoses)
• Is a fungal infection of the skin, hair and nails
Types
a). Tinea pedis (Athlete’s foot)
• Is itchy, whitish scaling lesions and inflammation of
the superficial skin of the feet and interdigital spaces
of the toes
• Common between the 4th and 5th toe.
• Often seen in people wearing rubber boots/shoes
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• Usually appear b/n toe webs
• Pruritus, inflamed vesicles
• Scaly, dusky and red rash (chronic )
• Lymphanitis and cellulites
• showers and swimming pools
C/M tinea pedis
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97.
Cont..
Management
• Keep the space in between the toes dry
• wear cotton socks
• Avoid shoe that are too tight/hot
• changing socks daily prevents reinfection.
• Imidazole cream/ whitfield’s ointment twice daily
until symptoms disappear for a total of 4 weeks
• Treat secondary bacterial infection if present
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b. Tinea corporis (Tinea circinata)
• A fungal infection that affects the trunk, legs,
arms/neck, excluding the beard area, feet, hands and
groin
– Is fungal infection of the skin most common on the
exposed surfaces of the body.
– Sites are face, arms and shoulders.
– Intensive itching
• Frequent causes of tinea corporis is the presence of
an infected pet in the home
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100.
Cont..
Management
• Imidazole cream/whitfield’s ointment twice daily
for a minimum of 4 weeks
• Multiple, widespread lesions may be treated
systematically
• Griseofulvin 500mg once daily for 2-6wks (10-
15mg/kg)
• Ketaconazole 200mg once/twice daily
• When there is sever itching antihistamines /mild
steroids can be added
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101.
c. Tinea capitis (ring worm)
• Is a contagious fungal disease of the scalp and hair
shaft , eyebrows, eyelashes
Sign and symptom
• One or more round patches with scaling
• Hair loss (temporarily), alopecia
• Lymphnodes in the neck swell and the patient may
have fever and headache
Diagnosis
– Clinical
– Microscopy of affected hairs and skin(KOH)
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103.
Cont…
Management
• Greseofulvin 500mg once daily for 8-12 weeks.
(10-15mg/kg for children)
• Add whitfield’s ointment/miconazole twice daily
topically for 4 weeks
• In case of bacterial super infection antiseptics and
/antibiotics are needed
• Shampooing with antifungal solution
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104.
d. Tinea unguium
- Is a chronic fungal and some times mixed yeast
infection of the toe/finger nails
** Is commonly occurs in people who frequently wet
the hands such as domestic workers, cleaners,
kitchen and laundary staff
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105.
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106.
Sign and Symptom
• Nail become thickened, friable (easily crumbled),
lusterless
• Accumulation of debris under the free edge of the
nail
• The nail may be destroyed
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107.
Cont..
Management
• Griseofulvin 500gm once daily until the affected
nails have grown out completely (year/longer) even
though it recurres.
• If there is no improvement by griseofulvin in 2-4
months there may be mixed yeast infection
- use ketaconazole 200mg/d until symptoms clear.
(Itraconazole 200mg/d x 3 months, or Itraconazole
200mg bid x 1week per month during 3 months)
• Keep the site dry
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108.
e. Tinea versicolor (pityriasis versicolor)
• Is a common chronic superficial fungal infection
which is caused by the unicellular yeast
pityrosporum ovale or orbiculare which is normally
present on the trunk as a commensal.
• Often there is cosmetic complaints
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109.
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110.
Cont..
Sign and Symptom
• Appears commonly when there is warm and humid
air, pregnancy, and serious underlying disease
• Hypopigmented macule on the trunk
• Disturbance of the pigment of the skin (versicolor)
• Recurrences are common especially after in
adequate treatment or re-infection.
Diagnose
– Clinical
– Microscopy
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111.
Cont…
Management
• Scrubbing the skin with a brush takes away a lot of
the infected scales.
• Imidazole cream twice daily on affected areas for 4
weeks
• Add selenium sulphide suspension /ketaconazole
2% shampoo twice weekly.
• Selsun shampoo to affected areas overnights as a
lotion or to affected areas and the scalp for 10
minutes daily for 2-4 weeks.
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112.
f. Tinea cruris (Jack itch)
• A fungal infection of the groin, pubic region and
thighs
• Occur more frequently in obese person and those
who wear tight underclothing
Sign and symptom
• Scaling at the periphery
• A patch that may spread to buttocks
• Starts from groin and advancing down to inner thigh
• Itching and irritation
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113.
Tinea Cruris
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114.
Diagnosis
• Clinical
• KOH
Management
• Treat with topical antifungal or systemic antifungal
for sever cases
• Reduction of moisture in groin
• Wash contaminated under wear in hot water
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115.
g. Tinea barbae
• Is a fungal infection involving the beard and
moustache areas
• Affects males only
• More common in farmers
Sign and symptom
• Pruritis
• Tenderness and pain
• Pustular folliculitis around the hair follicle
• Involved hairs are loose and easily removed
Management
• Systemic antifungal
115
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116.
116
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117.
h. Tinea facialis
• Is superficial fungal infection of non beard area of
the face characterized by a well circumscribed
erythematous patch
• More common in children
• Exposure to animals is considered to be a
predisposing factor
Management
• Topical and systemic antifungal
117
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118.
i. Tinea manuum
• Is a chronic dermatophytosis of the hand(s)
• Most commonly on dominant hand
• It often unilateral
• Associated with tinea ungium, tinea pedis, and
tinea cruiris
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119.
Sign and symptom
• Pruritis
• Pain if secondary bacterial infection occurs
Management
• Eradicate tinea ungium, tinea pedis, and tinea cruris
• Topical antifungals
- miconazole twice daily topically for 4 weeks
119
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120.
j. Candidiasis /moniliasis/
• Candida albicans is a resident of the mucus
membranes, it becomes pathogenic under
favourable host condition these are:
-When host immunity is decreased, such as HIV,
cancer, steroid use, cytotoxic drugs, radiotherapy,
chronic disease, pregnancy and contraceptive pill
use
120
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121.
Candidiasis /moniliasis/….
-Warm and moisture (babies-nappy area, groins, under
breasts, between toes)
-Use of broad spectrum antibiotics which kills
resident non pathogenic bacteria
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122.
122
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123.
Cont…
Sign and Symptom
• On the oral (oral candidiasis/thrush)- white cheesy
adherent plaque that can be painful
• When oral lesions extend to the throat and esophagus
they can cause anorexia, nausea, dysphagia, and
vomiting
• Infection of the mouth/ lip corners can occur
• On the vulvovagina (candidia vulvovaginitis)-vaginal
irritation, soreness and a thick creamy discharge
• On glans penis (balantitis/balanoposthitis)- red lesions
covered by white plaques, presence of pruritis and
burning
123
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124.
Cont….
Management
• Treat large oozing lesions with KMNO4 solution
dressing/ bath x 10 minutes twice daily
• Keep lesions of the skin dry
• Paint mucosal /smaller wet lesions with Gentian
violet daily
• Nystatin cream, oral suspension twice daily for skin/
oral / miconazol oral gel 4 x /d x 1week
• Imidazole pessaries nightly for 2 weeks for vaginal
candldiasis
• Imidazole cream twice daily for skin infections
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125.
Mgt…
• Ketaconazole 200mg twice daily for 1-2weeks for
oesophageal candidiasis
• Itraconazole 100mg/d x 2weeks
• Fluconazole 50-200mg /d x 1-2weeks
• Gresofulvin is not an effective treatment for
candidia infections
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126.
E. Parasitic skin disorder
a). Scabies
• Is an infection of the skin caused by a parasite called
mite sarcoptes scabiei
 a mite which lays its eggs in burrow in the stratum corneum
and induces an intensively itchy allergic response
Sign and Symptom
• Small blisters and papules
• Sever itching, when warm particularly at night
• Scratch marks and very common secondary infection
with pustules
• Common sites are between fingers, sides of the hands,
sides of the wrists, buttocks 126
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127.
127
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128.
Cont…
Management
• Treat all close contacts of the patient and family
• Benzyl benzoate 25% emulsion for adult, dilute
with one part water (1:1) for children, dilute with 3
parts water (1:3) for infants
– Apply for 3 consecutive nights.
– Wash off each morning.
• Sulphur 5-20% ointment twice daily for 1-2 Weeks
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129.
b. Pediculosis
• Is an infestation with a louse which may be found in
the:
• Scalp- Pediculosis capitis
• Body- Pediculosis corporis
• Hair bearing region- Pediculosis pubis (phthiriasis)
Sign and symptom
• Itching (excoriation)
• The presence of lice and nits
• Over crowding, poor personal hygiene, prolonged
wearing of the same cloth
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130.
130
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131.
Cont..
Management
• Improve personal hygiene
• Improve living condition
• Change clothing
• Treat secondary bacterial infection if present
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132.
F. Viral skin disorder
• It is an acute contagious short lived (7-12 days)
infection of the skin or mucus membrane caused by
virus
Types:
a. Herpes simplex
• Is an infection which is caused by herpes simplex
virus that causes vesicular eruption (cold sore or
fever blister) on lip (herpes labialis), and on
genitalia (herpes genitalia)
132

133.
Cold sores
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134.
Cont….
Sign and Symptom
- Few days of burning sensation at the site initially
and tingling sensation
- Then a group of blisters appear which quickly break
down to form superficial ulcer
- Highly contagious when the lesions are visible
Diagnose
• Clinical
• smear
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135.
Cont…
Management
• Primary infection-since they are painful: Analgesia
• Lips: Zinc oxide ointment to soothe and protect
from sun light
• Zinc oxide ointment plus castor oil
• Antiseptic mouth wash: Chlorhexidine 3-4 times
daily
135
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136.
Cont….
• TTC skin ointment 3 times daily for secondary
bacterial infection
• Genital: KMNo4 (Betadine) sitz bath 3 times a day
• TTC ointment application 3 times a day
• Zinc oxide and castor oil to soothe
• For severe infections or infections in
immunocompromised patients Acyclovir 200-400
mg five times daily for 5-10 days either topically or
systematically
• Recurrence can be triggered by:
- Exposure to sun light (herpes labialis)
-Oral sex, fever, stress, etc
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137.
b. Herpes zoster (shingles)
• Is an acute unilateral and segmental inflammation of
the dorsal root ganglia of a nerve by a latent
varicella zoster infection in the partially immune
host.
Sign and symptom
• A localized vesicles in cluster form on one side of
the body/unilateral/
• Itching, tenderness and severe pain on the site
**.The thoracic, cervical and ophthalmic nerves are
frequently affected
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138.
Herpes zoster (shingles)…
• After 1-2 weeks crusts begin to fall off with residual
scaring
• Over 10% of patients develop a persistent burning
sensation or pain in the area. (few months many
years) posthereptic neuralgia
• Much more common in HIV patients, old patients,
and malignancy cases
138
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139.
139
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140.
Cont….
Management
• Analgesia with NSAIDs
• Antibiotics for secondary infections
• If the eye is involved immediately refer to
ophthalmologist
• For immunocompromised patients Acyclovir
800mg 5 times daily for 1 week
• Amitryptline 75mg at night
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141.
c. Verrucae /Warts/
• Are common benign skin tumors caused by infection
with the Human Papilloma Virus.
• There are many types of HPV which causes different
types of skin lesions.
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142.
Verrucae /Warts/….
Types:
1. Plantar warts- warts on the sole of the foot
2. Plane (flat/Juvenile) warts- warts on the face of
children
3. Common wart (Varrucae vulgaris)
4. Genital warts/condylomata acuminate/- warts that
appear on genital organs
5. Molluscum contagiosum- a wart which appear on
small children which has typical characteristics of
central dimple and dome shaped papules
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143.
• Warts of the sales of foot
• Constant pressure and friction causes in ward
growth than out ward growth
Plantar or wart (varucae plantaris)
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144.
• Occur frequently on face , back and back of
hands
• Very small (1-3 mm) slightly raised
• Resistant to therapy
Plane (flat / juvenile) warts
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145.
• multiple raised hyperkeratotic lesion
• commonly found on the hands
common wart
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146.
146
Planar wart Vs tinea pedis
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147.
147
genital warts
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148.
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149.
Perineal wart
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150.
Cont….
Sign and symptom
• Found at any age but most common in children and
teenagers
• They can spread by contact
• The infected person immune system clears the warts
with in 2 years in 2/3 cases
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151.
• common warts resolve spontaneously but placebo
treatment for the 1st 3-4 months
• Salicylic acid paint
• Glutaraldehyde
• Curettage
• Formalin soaks for plantar wart
• Surgical
• Liquid nitrogen
Treatment of warts
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152.
Cont’d…
Management
• Salicylic acid 50% twice daily followed by scraping
the warts –Plantar warts
• Salicylic acid 2-5% ointement twice daily for 4-8
weeks –Plane warts
• Silver nitrate pencil touch- daily – Plane warts
• Podophyllin 10-25% solution apply weekly by
using match sticks and wash off after 4-6 hours-
Genital warts
• Threat partners - Genital warts
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153.
• An infections Cutaneous lesion caused by a pox
virus
• Common cause of dermatological out pt referral
in under five
• Is a warts of small children in areas of warmth,
moisture and friction such as the armpits and the
groins, and on the face
C/m-
• Elevated smooth reddish papules with small
central punctum
Molluscum contagiosum
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154.
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155.
• Induction of inflammatory reactions
• Puncturing the lesion individually and
applying iodine
• liquid nitrogen or Co2 can also be used
RX of molluscum contagiosum
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156.
Burn injury
156
An injury of the body result from the transfer of
heat energy from heat source to the body.
It may vary in depth, size and severity
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157.
Types
• Thermal: exposure to flame or a hot object
• Chemical: exposure to acid, alkali or organic
substances
• Electrical: result from the conversion of electrical
energy into heat.
• Extent of injury depends on the type of current, the
pathway of flow, local tissue resistance, and duration
of contact
• Radiation
result from radiant energy being transferred to the
body resulting in production of cellular toxins
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158.
TYPES OF BURN
Burn can be classified in to three based on
depth or layers of tissue involved.
1. superficial partial thickness ( 1st degree burn)
2. deep partial thickness (2nd degree burn)
3. Full thickness (3rd degree burn)
158

159.
A person may suffer one or more depths of burn in
single incidents.
1. Superficial partial thickness (First degree) burn:
 It involves only the outermost layer of skin, the
epidermis and possibly a portion of dermis.
 Results from exposure to the sunlight, contact
with hot object or scalding by hot water.
Sign and symptom: redness, mild swelling, pain
tenderness, Tingling and Hyperesthesia.
Wound Appearance: Reddened; dry; minimal or
no edema; Possible blisters
 Complete recovery within a week; no scarring.
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160.
2. Deep partial thickness (second degree) burn:
– Destroy the epidermis and dermis.
– Result from a very deep sun burn, contact
with hot liquid, and flash burns from
kerosene and other products
– Sign and symptom: very painful,
Hyperesthesia, Sensitive to cold air.
– Wound appearance: Blistered, mottled red
base; broken epidermis; Edema.
– Recovery in 2 to 4 weeks; Some scarring and
depigmentation; contractures; Infection may
convert it to full thickness.
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161.
2nd Degree Burn
162

162.
3. Full thickness (third degree) burn:
– Epidermis, entire dermis, and sometimes
subcutaneous tissue; may involve connective
tissue, muscle, and bone are affected.
– Sign and symptom: Pain sensation is usually
lost (nerve endings destroyed) which may
mislead about the severity of the injury.
– Wound appearance: Dry; pale white, Broken
skin with fat exposed; Edema
– Healing is very slow, if at all, and may require
skin grafting. Scarring and loss of contour and
function; contractures, Loss of digits or
extremity possible.
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163.
Depth of Burn

164.
166

165.
Extent of Body Surface Area Injured
• Various methods are used to estimate the
TBSA affected by burns
• among them are the rule of nines,, and the
palm method.
167

166.
RULE OF NINES
• An estimation of the TBSA involved in a burn is
simplified by using the rule of nines
• The rule of nines is a quick way to calculate the
extent of burns.
• The system assigns percentages in multiples of nine
to major body surfaces.
168

167.
169

168.
PALM METHOD
• In patients with scattered burns, a method to estimate the
percentage of burn is the palm method.
• The size of the patient’s palm is approximately 1% of TBSA.
170

169.
Management of Patients With Burn Injury
171

170.
MANAGEMENT
Burn management include:
• Emergency aids
• General treatments
• Management of burn wound
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171.
1. Emergency aids
Remove heat source
Remove restrictive objects
Assess airway, breathing , and Circulation
Avoid re-damage
Lessen contamination
Control pain
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172.
2. General treatments
1.Correct burn shock
2.Prevention and treatment of systemic
infection
3.Nutritional support
4.Pain management
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173.
Complications of burn
Scar and contracture
Shock
Sepsis
Pulmonary complications and
respiratory failure
Acute renal failure
Stress ulcer
Heart failure
Cerebral edema
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174.
Plastic surgery (Cosmetic surgery)
• Are a type of reconstructive surgery performed to
reconstruct or to alter congenital or acquired
defects or to restore or improve the body’s
appearance
176
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175.
Types of procedures
1. Rhytidectomy (face lift) - done through various
techniques and incisions to alleviate skin fold and
wrinkles to improve the appearance of the aging
face.
2. Blepharoplasty- removal of excess skin or fat from
the upper and lower eye lids
3. Dermabrasion (skin planning) - uses a special
instrument to abrade the skin and remove the
epidermis and superficial dermis to improve the
appearance.
177
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176.
4. Body contouring (liposuction) - reduces localized
deposits of fat.
5. Chemical face peeling- a technique that involves
applying a chemical mixture to the face for
superficial destruction of the epidermis and upper
layer of dermis to treat fine wrinkles and pigment
problems
6. Otoplasty- deformity of the external ear repair
7. Rhinoplasty- reshaping of the nose
8. Mentoplasty- altering the shape and size of the
chin
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177.
Cont…
9. Soft tissue augmentation- fat transplantation
may be done by mini-liposuction and injection of
the patient’s own tissue
10. Hair replacement- hair follicles can be
transplanted from the posterior aspect of the scalp to
bald areas
11. Abdominoplasty- includes excision of excess
abdominal wall skin and adipose tissue and
tightening abdominal musculature
179
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178.
12. Breast- can be
 Enlarged: augmentation mammolplasty
Reduced: reduction mammoplasty
Reconstructed: reconstructive mammoplasty
180
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179.
Cont…
13. Scar revision- the scar can be excised; wound
edges realigned and resutured or close
them with anticipation of a better cosmetic result
14. Tissue expanders- it is a new trend in plastic
surgery done by increasing the surface area of the
skin by applying enlarging mass under the skin.
When the expansion is obtained as desired the
expander is removed
181
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180.
Purpose of plastic surgery
–To repair defect (reconstruction)
–To restore function (restoration)
–To replace lost part
– For better appearance
–To install prosthetic implants
– For complete change of identity
182
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181.
• Nurse’s responsibility (precautions)
– Make sure that the patient understands the procedure and
has discussed the risks and benefits of the procedure.
– Ensure consent form is signed
– Protection of pressure points during prolonged
procedures
– Get ready sterile dye (methylene blue) for outline
– Expose both sides for comparison
– Avoid using fenestrated towel instead use towel clips
– Prepare local anesthesia and syringe with 26-30 gauge
needle
– Prepare No 15 and 11 surgical blade
– Prepare an electro-surgical unit (to cut and coagulate
parts)
183
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182.
Cont…
–Use small and fine instruments
–Get ready graft sites (Bone, cartilage, and skin)
–Suture size ranges from 2.0-7.0 and 8.0-11.0 for
micro surgery
–Prepare wound closure strips
–Get ready with fine gauzes impregnated with
petrolatum/ oil emulsion
–Pressure dressings to prevent contracture and
allow graft contact and to prevent fluid formation
in tissues
–Establish good communication understanding and
empathy with the patient and his family members
184
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183.
Possible complications of plastic
surgery
• Pigment change- chemical peeling
• Infection-surgery
• Milia- chemical peeling
• Scarring- surgery
• Atrophy- surgery
• Sensitivity change- chemical peeling
• Long term (4 to 5 months) erythema or pruritis-
chemical peeling
• Hematoma- surgery
185
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184.
Skin graft
• Is the technique in which a section of skin is
detached from its own blood supply from the donor
site and transferred as free tissue to a distant
(recipient)
Purpose
• To enhance wound healing
• To repair defects
• To cover areas denuded of skin
• To cover wounds in which insufficient skin is
available
• To improve appearance 186
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185.
Cont….
Sources of skin graft can be:
• Autograft- use of tissue from self
• Allograft- use of tissue from the same species
• Xenograft- use of tissue from different species
• Isograft- use of tissue from genetically identical
persons
• Engineered- graft sources from combined
biological and synthetic materials
• Synthetic graft- substance from non-biological
source
187
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186.
Cont…
Types of skin graft
• Split thickness graft- the epidermis and half of the
dermis are removed
• Full thickness graft- the epidermis, dermis and
sometimes subcutaneous fat are removed
– Inhibit wound contraction better than do split thickness
– Preferred on the face, neck, hands, elbows, axilla, knees
and feet
• Composite graft- includes epidermis, dermis, fat
and other structures such as bone, cartilage, nerve or
tendon
188
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187.
Cont….
Nurse’s responsibility
• Get consent form signed after the understanding of
the procedure
• Immobilization of the recipient site as much as
possible
• Inspect for signs of infections
• Donor and recipient site should be prepared and
draped concurrently
• Prepare appropriate instruments (sterile) for the
procedure
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188.
Nsg resp cont…
• Keep the grafts in saline
• Apply sterile, moist saline gauze dressings to keep
the skin moist until revascularization occurs
• Prepare plaster of Paris cast (POP)- sometimes used
for immobilization especially on extremities
• Both the recipient and donor site should be free from
infection
• If a graft is placed on a lower extremity, the part is
kept elevated, because the new capillary connections
are fragile and excess venous pressure may cause
rupture
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