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Disease of skin -Lec RVU.pptx


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Disease of skin -Lec RVU.pptx

  2. 2. Subtopics • Anatomy and physiology overview • Bacterial infections • Viral infections • Secretary disorders • Inflammatory and allergic skin disorders • Burn 2 2/8/2023 By Amir A
  3. 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 3 2/8/2023 By Amir A
  4. 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 2/8/2023 By Amir A 4
  5. 5. 5 2/8/2023 By Amir A
  6. 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.” 2/8/2023 By Amir A 6
  7. 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 2/8/2023 By Amir A 7
  8. 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 2/8/2023 By Amir A 8
  9. 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 2/8/2023 By Amir A 9
  10. 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 2/8/2023 By Amir A 10
  11. 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 2/8/2023 By Amir A 11
  12. 12. 12 2/8/2023 By Amir A
  13. 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. 13 2/8/2023 By Amir A
  14. 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 14 2/8/2023 By Amir A
  15. 15. Assessing the skin • Assessment includes a thorough: - history taking, -inspection and -palpation of the skin 15 2/8/2023 By Amir A
  16. 16. 16 2/8/2023 By Amir A
  17. 17. 17 2/8/2023 By Amir A
  18. 18. Herpes vircilla virus 18 2/8/2023 By Amir A
  19. 19. Veruca vulgaris 19 2/8/2023 By Amir A
  20. 20. Tinea pedis 20 2/8/2023 By Amir A
  21. 21. 21 2/8/2023 By Amir A
  22. 22. scabies 22 2/8/2023 By Amir A
  23. 23. acne 23 2/8/2023 By Amir A
  24. 24. acne 24 2/8/2023 By Amir A
  25. 25. 25 Pediculosis 2/8/2023 By Amir A
  26. 26. Adverse effect of topical corticosteriods 26 2/8/2023 By Amir A
  27. 27. psoriasis 27 2/8/2023 By Amir A
  28. 28. 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? 28 2/8/2023 By Amir A
  29. 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? 29 2/8/2023 By Amir A
  30. 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? 30 2/8/2023 By Amir A
  31. 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 2/8/2023 By Amir A 31
  32. 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 32 2/8/2023 By Amir A
  33. 33. Benign skin condition-vitiligo 33 2/8/2023 By Amir A
  34. 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 34 2/8/2023 By Amir A
  35. 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) 35 2/8/2023 By Amir A
  36. 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 10 2/8/2023 By Amir A 36
  37. 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 2/8/2023
  38. 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 2/8/2023 By Amir A 38
  39. 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 2/8/2023 By Amir A 39
  40. 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 2/8/2023 By Amir A 40
  41. 41. Cont…. 3. Vascular skin lesions- a lesion that originated from a blood vessel • Petechia/Purpura • Ecchymosis • Telangiectasia (venous star) 41 2/8/2023 By Amir A
  42. 42. PETECHIAE / PURPURA 2/8/2023 By Amir A 42
  43. 43. 43 2/8/2023 By Amir A
  44. 44. 44 2/8/2023 By Amir A
  45. 45. A . Inflammatory and allergic skin disorders Acne vulgaries 2/8/2023 By Amir A 45
  46. 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 46 2/8/2023 By Amir A
  47. 47. • 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 47 2/8/2023 By Amir A
  48. 48. 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 2/8/2023 By Amir A 48
  49. 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 49 2/8/2023 By Amir A
  50. 50. 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 50 2/8/2023 By Amir A
  51. 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 51 2/8/2023 By Amir A
  52. 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 2/8/2023 By Amir A
  53. 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) 53 2/8/2023 By Amir A
  54. 54. 54 2/8/2023 By Amir A
  55. 55. Generalized psoriasis 55 2/8/2023 By Amir A
  56. 56.  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 56 2/8/2023 By Amir A
  57. 57. 2/8/2023 By Amir A 57
  58. 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 2/8/2023 By Amir A
  59. 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 59 2/8/2023 By Amir A
  60. 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 60 2/8/2023 By Amir A
  61. 61. 61 Features: Red Swollen Warm to touch No areas of pus Painful Tender 2/8/2023 By Amir A
  62. 62. 62 2/8/2023 By Amir A
  63. 63. 63 2/8/2023 By Amir A
  64. 64. 64 2/8/2023 By Amir A
  65. 65. 65 2/8/2023 By Amir A
  66. 66. 66 The result of “skin popping” - Multiple injection site abscesses 2/8/2023 By Amir A
  67. 67. 67 Cellulitis with abscess If rapid spreading beyond this line occurs, this may be necrotizing fasciitis, and requires surgery 2/8/2023 By Amir A
  68. 68. 68 Necrotizing fasciitis 2/8/2023 By Amir A
  69. 69. 69 2/8/2023 By Amir A
  70. 70. 70 2/8/2023 By Amir A
  71. 71. Management • Oral antibiotics cloxacillin, erythromycin Amoxacillin Doxycycline ,,,,, • Parentral/systemic antibiotics for hands, face, or lymphatic spread • Surgical drainage and debridement 71 2/8/2023 By Amir A
  72. 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/ 72 2/8/2023 By Amir A
  73. 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 73 2/8/2023 By Amir A
  74. 74. 74 2/8/2023 By Amir A
  75. 75. 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????? 75 2/8/2023 By Amir A
  76. 76. 2/8/2023 By Amir A 76
  77. 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 77 2/8/2023 By Amir A
  78. 78. 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 78 2/8/2023 By Amir A
  79. 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 79 2/8/2023 By Amir A
  80. 80. 2/8/2023 By Amir A 80
  81. 81. 81 2/8/2023 By Amir A
  82. 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. 82 2/8/2023 By Amir A
  83. 83. 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 83 2/8/2023 By Amir A
  84. 84. 84 2/8/2023 By Amir A
  85. 85. Management • Warm compress to relieve pain • Clean with antibacterial soap • Topical antibiotic ointment • Systemic antibiotics for recurrent cases 85 2/8/2023 By Amir A
  86. 86. 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 86 2/8/2023 By Amir A
  87. 87. 2/8/2023 By Amir A 87
  88. 88. 88 2/8/2023 By Amir A
  89. 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 89 2/8/2023 By Amir A
  90. 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 90 2/8/2023 By Amir A
  91. 91. Impetigo pictures 91 2/8/2023 By Amir A
  92. 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. 92 2/8/2023 By Amir A
  93. 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 93 2/8/2023 By Amir A
  94. 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 94 2/8/2023 By Amir A
  95. 95. 95 2/8/2023 By Amir A
  96. 96. • 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 2/8/2023 By Amir A 96
  97. 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 97 2/8/2023 By Amir A
  98. 98. 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 98 2/8/2023 By Amir A
  99. 99. 2/8/2023 By Amir A 99
  100. 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 100 2/8/2023 By Amir A
  101. 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) 101 2/8/2023 By Amir A
  102. 102. 2/8/2023 By Amir A 102
  103. 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 103 2/8/2023 By Amir A
  104. 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 104 2/8/2023 By Amir A
  105. 105. 105 2/8/2023 By Amir A
  106. 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 106 2/8/2023 By Amir A
  107. 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 107 2/8/2023 By Amir A
  108. 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 108 2/8/2023 By Amir A
  109. 109. 109 2/8/2023 By Amir A
  110. 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 110 2/8/2023 By Amir A
  111. 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. 111 2/8/2023 By Amir A
  112. 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 112 2/8/2023 By Amir A
  113. 113. Tinea Cruris 2/8/2023 By Amir A 113
  114. 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 114 2/8/2023 By Amir A
  115. 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 2/8/2023 By Amir A
  116. 116. 116 2/8/2023 By Amir A
  117. 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 2/8/2023 By Amir A
  118. 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 118 2/8/2023 By Amir A
  119. 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 2/8/2023 By Amir A
  120. 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 2/8/2023 By Amir A
  121. 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 121 2/8/2023 By Amir A
  122. 122. 122 2/8/2023 By Amir A
  123. 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 2/8/2023 By Amir A
  124. 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 124 2/8/2023 By Amir A
  125. 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 125 2/8/2023 By Amir A
  126. 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 2/8/2023 By Amir A
  127. 127. 127 2/8/2023 By Amir A
  128. 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 128 2/8/2023 By Amir A
  129. 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 129 2/8/2023 By Amir A
  130. 130. 130 2/8/2023 By Amir A
  131. 131. Cont.. Management • Improve personal hygiene • Improve living condition • Change clothing • Treat secondary bacterial infection if present 131 2/8/2023 By Amir A
  132. 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. 133. Cold sores 133 2/8/2023 By Amir A
  134. 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 134 2/8/2023 By Amir A
  135. 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 2/8/2023 By Amir A
  136. 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 136 2/8/2023 By Amir A
  137. 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 137 2/8/2023 By Amir A
  138. 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 2/8/2023 By Amir A
  139. 139. 139 2/8/2023 By Amir A
  140. 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 140 2/8/2023 By Amir A
  141. 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. 141 2/8/2023 By Amir A
  142. 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 142 2/8/2023 By Amir A
  143. 143. • Warts of the sales of foot • Constant pressure and friction causes in ward growth than out ward growth Plantar or wart (varucae plantaris) 2/8/2023 By Amir A 143
  144. 144. • Occur frequently on face , back and back of hands • Very small (1-3 mm) slightly raised • Resistant to therapy Plane (flat / juvenile) warts 2/8/2023 By Amir A 144
  145. 145. • multiple raised hyperkeratotic lesion • commonly found on the hands common wart 2/8/2023 By Amir A 145
  146. 146. 146 Planar wart Vs tinea pedis 2/8/2023 By Amir A
  147. 147. 147 genital warts 2/8/2023 By Amir A
  148. 148. 2/8/2023 By Amir A 148
  149. 149. Perineal wart 2/8/2023 By Amir A 149
  150. 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 150 2/8/2023 By Amir A
  151. 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 2/8/2023 By Amir A 151
  152. 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 152 2/8/2023 By Amir A
  153. 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 2/8/2023 By Amir A 153
  154. 154. 2/8/2023 By Amir A 154
  155. 155. • Induction of inflammatory reactions • Puncturing the lesion individually and applying iodine • liquid nitrogen or Co2 can also be used RX of molluscum contagiosum 2/8/2023 By Amir A 155
  156. 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 2/8/2023 By Amir A
  157. 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 2/8/2023 157
  158. 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. 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. 2/8/2023 SL 2016 159
  160. 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. 2/8/2023 SL 2016 161
  161. 161. 2nd Degree Burn 162
  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. 2/8/2023 SL 2016 163
  163. 163. Depth of Burn
  164. 164. 166
  165. 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. 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. 167. 169
  168. 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. 169. Management of Patients With Burn Injury 171
  170. 170. MANAGEMENT Burn management include: • Emergency aids • General treatments • Management of burn wound 2/8/2023 By Amir A 172
  171. 171. 1. Emergency aids Remove heat source Remove restrictive objects Assess airway, breathing , and Circulation Avoid re-damage Lessen contamination Control pain 2/8/2023 By Amir A 173
  172. 172. 2. General treatments 1.Correct burn shock 2.Prevention and treatment of systemic infection 3.Nutritional support 4.Pain management 2/8/2023 By Amir A 174
  173. 173. Complications of burn Scar and contracture Shock Sepsis Pulmonary complications and respiratory failure Acute renal failure Stress ulcer Heart failure Cerebral edema 2/8/2023 SL 2016 175
  174. 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 2/8/2023 By Amir A
  175. 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 2/8/2023 By Amir A
  176. 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 178 2/8/2023 By Amir A
  177. 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 2/8/2023 By Amir A
  178. 178. 12. Breast- can be  Enlarged: augmentation mammolplasty Reduced: reduction mammoplasty Reconstructed: reconstructive mammoplasty 180 2/8/2023 By Amir A
  179. 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 2/8/2023 By Amir A
  180. 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 2/8/2023 By Amir A
  181. 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 2/8/2023 By Amir A
  182. 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 2/8/2023 By Amir A
  183. 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 2/8/2023 By Amir A
  184. 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 2/8/2023 By Amir A
  185. 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 2/8/2023 By Amir A
  186. 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 2/8/2023 By Amir A
  187. 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 189 2/8/2023 By Amir A
  188. 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 190 2/8/2023 By Amir A