Post on 15-Jan-2016
Assessing the IntegumentarySystem
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Mrs. Mahdia Samaha Kony
Composition of the integumentary system•Skin•Hair•Nails•Is the largest organ of the body and the
easiest of all systems to assess
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Mrs. Mahdia Samaha Kony
Anatomy and Physiology Review
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Mrs. Mahdia Samaha Kony
Epidermis■ Covers, protects, and waterproofs.■ Contains four main layers: • Stratum corneum: Keratinized layer. Prevents
loss or entry of water; protects against pathogens and chemicals.
• Stratum lucidum: Found only on palms of hands and soles of feet; protects against UV sunrays to prevent sunburn.
1.Stratum granulosum2.Stratum germinativum. The innermost layer of
epidermis, is the only layer that undergoes cell division & contains melanin & keratin-forming cells.
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Mrs. Mahdia Samaha Kony
Epidermis• The epidermis, hair, nail, dental enamel, & horny tissues
are composed of keratin. • It is replaced every 3-4 weeks.• Skin colorSkin color depends on:1.The amount of melaninamount of melanin & carotene" yellow pigmentcarotene" yellow pigment"
contained in the skin 2.2.The volume of bloodThe volume of blood containing hemoglobin3.The oxygen-binding pigment that circulates in the dermis.
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Mrs. Mahdia Samaha Kony
Dermis■ Contains collagen, reticular, and elastic fibers.■ Adds strength and elasticity to skin. Contains
papillary layer, reticular layer, sweat glands, sebaceous glands, cholesterol, and arterioles.
Papillary Layer: Contains capillaries that supply the stratum germinativum; also contains nerve endings, touch receptors, and fingerprint pattern; double layer on hands and feet.
Reticular Layer: Contains connective tissue with collagen and elastic fibers, blood and lymphatic vessels, nerves, free nerve endings, fat cells, sebaceous glands and hair roots, deep pressure receptors, and smooth muscle fibers.
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Mrs. Mahdia Samaha Kony
DermisSweat Glands (Sudoriferous):Most numerous on
palms of hands and soles of feet. Two types are eccrine and apocrine glands.
Eccrine Glands: Respond to external temperature and psychological stress.
Found over most of body but most numerous on palms of hands and soles of feet; secrete sweat, which helps regulate body temperature and, to a lesser degree, excretes wastes such as urea.
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Mrs. Mahdia Samaha Kony
Dermis•Apocrine or Odoriferous Glands:■ Found in axilla and genital area.■ Respond to stress; secrete pheromones, a
substance with a barely perceptible odor; when apocrine secretions react with bacteria, body odor results.
■ Ceruminous glands are a type of apocrine gland found in the external ear canal.
•They secrete cerumen, which prevents drying of the ear drum and traps foreign substances.
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Mrs. Mahdia Samaha Kony
•Sebaceous Glands: Produce sebum, which lubricates and protects skin and hair.
•Cholesterol: Converts to vitamin D when exposed to UV lights.
•Arterioles: Dilate when hot to increase heat loss and constrict when cold to conserve heat.
•Constrict in response to stressful situations to shunt blood to vital organs.
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Mrs. Mahdia Samaha Kony
Hypodermis/Subcutaneous
•Connective Tissue: Connects skin to muscles; contains white blood cells.
•Adipose Tissue: Contains stored energy, cushions bony prominences, provides insulation.
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Mrs. Mahdia Samaha Kony
The HairThe hair is also made up of keratinized
cells.1. Vellus, which is short, pale,and fine hair, is
located over all of the body. 2. Terminal hairs, which are dark and
coarse, are found on the scalp, brows, and, after puberty, on the legs, axillae, and perineum.
• Hair provides protection by covering thescalp and filtering dust and debris away from the nose, ears, and eyes.
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Mrs. Mahdia Samaha Kony
The Nails• Nails are made up of hard, keratinized
cells and grow from a nail root under the cuticle.
• The nail bed, or epithelial layer of skin: vascular supply gives the nail a pink color
• The lunula, the proximal part of the nail. The nailbed’s .
• The purpose of the nails is to protect the distal portions of the digits and aid in picking up objects
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Mrs. Mahdia Samaha Kony
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Mrs. Mahdia Samaha Kony
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Mrs. Mahdia Samaha Kony
Relationship of the Integumentary System to Other Systems•ENDOCRINE•Thyroid affects growth and texture of
skin, hair and nails.•Hormones stimulate sebaceous glands.•Sex hormones affect hair growth and
distribution, fat and subcutaneous tissue distribution and activity of apocrine sweat glands.
•Adrenal hormones affect dermal blood supply and mobilize lipids from adipocytes.
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Mrs. Mahdia Samaha Kony
Relationship of the Integumentary System to Other Systems•URINARY•Kidneys remove waste and maintain
normal pH.•Skin helps eliminate water and waste.•Skin prevents excess fluid loss.•DIGESTIVE•Skin synthesizes vitamin D for calcium
and phosphorous absorption.•Supplies nutrients while skin stores lipids.
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Mrs. Mahdia Samaha Kony
Relationship of the Integumentary System to Other Systems• CARDIOVASCULAR• Mast cell stimulation produces localized changes in
blood flow and capillary permeability.• CV system provides nutrients and removes wastes.• Delivers hormones and lymphocytes.• Provides heat for skin temperature.• SKELETAL• Skin synthesizes vitamin D needed for calcium and
phosphorus absorption.• Skeletal system provides a framework for skin.
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Mrs. Mahdia Samaha Kony
Relationship of the Integumentary System to Other Systems• LYMPHATIC/IMMUNE• Skin is first line of defense.• Langerhan cells and macrophages resist infection.• Mast cells trigger inflammatory responses.• Lymphatic system protects skin by sending more
macrophages and lymphocytes when needed.• RESPIRATORY• Provides oxygen to and removes carbon dioxide
from integumentary system.• Color of skin and nails can reflect changes in
respiratory system.
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Mrs. Mahdia Samaha Kony
Relationship of the Integumentary System to Other Systems• MUSCULAR• Skin synthesizes vitamin D needed for calcium
absorption for muscle contraction.• Gives shape to and supports skin.• Contraction of facial muscles allows
communication through expressions.• NEUROLOGICAL• Sensory receptors in dermis to touch, temperature,
pressure, vibration and pain.• Provides communication with external
environment.• Controls blood flow and sweating through
thermoregulation.
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Mrs. Mahdia Samaha Kony
Symptom Analysis04/21/23
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Mrs. Mahdia Samaha Kony
Change in Mole or Lesion
•Skin cancer is the most common type of cancer, and changes in a mole (nevus) or skin lesion can often evoke fear in the patient.
Types of skin cancer: •Basal cell •Squamous cell carcinomas, which affect
the epidermal keratinocytes•Melanoma which affects the melanocytes
of the basal layer of the epidermis.•Sun exposure is a risk factor in all types
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Mrs. Mahdia Samaha Kony
Nonhealing Sore or Chronic Ulceration• A nonhealing wound or chronic irritation is
often associated with an underlying disease. • The most common types of nonhealing wounds
or chronic skin ulcerations are caused by vascular disease or pressure or by diabetes.
Pruritus : is severe itching. • May be localized or generalized • Caused by a dermatologic problem or
underlying systemic problem.• Pruritus is often accompanied by a rash.
Itching, when not associated with a rash, may be indicative of significant systemic disease or simply dry skin.
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Mrs. Mahdia Samaha Kony
Causes of pruritis
•External stimuli, such as:• heat• dryness•Inflammation•Vasodilatation
•Psychological factors, such as depression, can influence the perception of itching, which explains the varied responses to it
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Mrs. Mahdia Samaha Kony
Rashes
•Like itching, may be localized or generalized, acute or chronic,
•Caused by an obvious dermatologic problem or an underlying systemic problem.
Seasonal Skin Disorders•Seasonal skin problems include those
caused by temperature fluctuations, air humidity, and exposure to contaminants.
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Mrs. Mahdia Samaha Kony
Seasonal Skin Disorders
•Spring: Chickenpox, Acne flare-ups•Summer: Contact dermatitis, Tinea,
Candida, Impetigo, Insect bites•Fall: Senile pruritus/winter itch,
Pityriasis rosea, Urticaria, Acne flare-ups•Winter: Contact dermatitis of hands,
Senile pruritus/winter itch, Psoriasis, Eczema
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Mrs. Mahdia Samaha Kony
Hair Changes• Hair loss (alopecia) is probably the most
distressing change in hair that can occur because of its cosmetic effect.
• Alopecia not only refers to scalp hair but also to body hair. Scalp hair grows about 0.25mm/d, and about 70- 100 strands of hair are lost per day.
• Hair loss can occur for many reasons.Alopecia classification: • Alopecia scaring (resulting from injury such as burns,
radiation, or traction with irreversible damage to the hair follicles)
• Nonscarring (resulting from hormonal changes, medications, infectious diseases, or thyroid disease, in which the follicles remain intact with a potential to reverse the process).
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Mrs. Mahdia Samaha Kony
Nail Changes
•Changes in the nails also often reflect an underlying systemic problem
•Changes in color and texture are frequent complaints.
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Mrs. Mahdia Samaha Kony
Assessing Lesions
•Primary lesion is one that appears in response to some change in the internal or external environment of the skin and is not altered by trauma.
•Secondary lesions result from changes in primary lesions. They either add to or take away from an existing primary lesion.
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Mrs. Mahdia Samaha Kony
Pressure Ulcers
•Pressure ulcers are a type of secondary lesion caused by unrelieved pressure.
•Assessment begins with identifying those at risk for pressure ulcer development and developing a plan to prevent pressure ulcer formation.
•If a pressure ulcer develops, assessment focuses on staging pressure ulcers and developing and evaluating pressure ulcer treatment plans.
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Mrs. Mahdia Samaha Kony
Clinical Description of LesionsSize: Major determinant of correct category for
primary lesions.• Pigmented lesions are typically 0.5 cm. If larger,
consider potential for malignancy.• Depth of pressure ulcers is major determinant of
assigned gradShape■ Macules, wheals, and vesicles are circumscribed.■ Fissures are linear.■ Irregular borders are associated with melanoma.
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Mrs. Mahdia Samaha Kony
Clinical Description of Lesions
ColorVariegated-colored lesions may signal melanoma.■ Pustules are usually yellow-white.■ New scars are red and raised; old scars, white
or silver.■ Petechiae are red.■ Purpura are red to purplish.■ Vitiligo is whiteTexture ■ Macules are smooth.■ Warts are rough.■ Psoriasis is scaly.
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Mrs. Mahdia Samaha Kony
Clinical Description of Lesions
Surface Relationship■ Flat (nonpalpable): Macules, patches,
purpura, ecchymoses, spider angioma, venous spider.
■ Raised (palpable) solid: Papules, plaques, nodules, tumors, wheals, scale, crust.
■ Raised (palpable) cystic: Vesicles, pustules, bullae, cysts.
■ Depressed: Atrophy, erosion, ulcer, fissures.■ Pedunculated: Skin tags, cutaneous horn
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Mrs. Mahdia Samaha Kony
Exudate■ Clear or pale, straw-yellow exudate: Serous
oozing/weeping from noninfected lesion.■ Thicker, purulent discharge: Infected lesion.■ Clear serous exudates: Vesicles, as seen with
herpes simplex; or bullae, larger thanvesicles, as seen with second-degree burns.■ Yellow pus exudates: Pustules, as seen with
impetigo or acne.• Tenderness or Pain associated with a lesion
depends on the underlying cause. May be associated with bullae from a burn or ecchymoses (bruise).
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Mrs. Mahdia Samaha Kony
Clinical Description of LesionsPetechiae or Purpura■ Extravasations of blood into skin.■ Caused by steroids, vasculitis, systemic
diseases.■ Does not blanch.
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Mrs. Mahdia Samaha Kony
Vascular LesionsEcchymosis■ Extravasation of blood
into skin layer.■ Caused by trauma/injury.■ Does not blanch.
Petechiae or Purpura■ Extravasations of blood into skin.■ Caused by steroids, vasculitis, systemic diseases.■ Does not blanch.
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Mrs. Mahdia Samaha Kony
Vascular LesionsVenous Star■ Blue color.■ Irregular-shaped, linear,
spider.■ Does not blanch.■ Caused by increased
pressure onsuperficial veins.
Telangiectasia■ Red color.■ Very fine and irregular
vessels.■ Blanches.■ Seen with dilation of
capillaries.
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Mrs. Mahdia Samaha Kony
Vascular LesionsSpider Angioma■ Red color, type of
telangiectasis.■ Looks like a spider, with
central body and fine radiating legs.
■ Blanches; seen in liver disease,
vitamin B deficiencies, idiopathic
origin.
Capillary Hemangioma■ Red color.■ Irregular-shaped macula
patch.
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Mrs. Mahdia Samaha Kony
Primary Lesions• Flat, Nonpalpable• Macule:< 1 cm• Patch: >1 cm
Vitiligo
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Mrs. Mahdia Samaha Kony
Primary Lesions• Palpable, Raised, but
Superficial• Papule: <1 cm
• Kaposi’s sarcoma• Psoriasis
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Mrs. Mahdia Samaha Kony
Primary LesionsRaised, Superficial,
TemporaryExamples:■ Allergic reaction■ Hives (urticaria)■ Insect bite
Palpable, Solid WithDepth Into DermisExamples:■ Bartholin’s cyst■ Erythema nodosum■ Lipoma Nodule:<2 cm If fluid filled and
encapsulated, called a cyst• Cyst• ■ Tumor: >2 cm
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Mrs. Mahdia Samaha Kony
Primary LesionsVesicle (serous):<1 cm• Palpable, Fluid FilledExamples:■ Blister■ Contact dermatitis■ Herpes simplex
Bulla (serous):> 1 cmExamples:■ Blister■ Burn■ Contact dermatitis
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Mrs. Mahdia Samaha Kony
Primary Lesions• Pustule(pus filled)Examples:■ Acne vulgaris■ Impetigo
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Mrs. Mahdia Samaha Kony
Secondary Lesions
Lichenification: Thickening and Scaling With Increased Skin Markings
Examples:■ Contact dermatitis■ Eczema■ Lipoma■ Psoriasis
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Mrs. Mahdia Samaha Kony
Secondary Lesions• Scales: Shedding, Dead
SkinCells; Scales Can Be Either
Dry or Oily, Adherent or Loose,
Variable in ColorExamples:■ Psoriasis
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Mrs. Mahdia Samaha Kony
Secondary Lesions• Crust: Dried ExudatesExamples:■ Dried herpes simplex■ Impetigo
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Mrs. Mahdia Samaha Kony
Secondary Lesions• Scar: Replacement
Connective Tissue Formations
Examples:■ Surgical site■ Trauma site
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Mrs. Mahdia Samaha Kony
Secondary Lesions• Keloid: Hypertrophic
scarring because of excess collagen formation; raised and irregular
Examples:■ Surgical site■ Tattoo
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Mrs. Mahdia Samaha Kony
Secondary Lesions: Secondary lesions that take away• Excoriation:
Abrasion or other loss that Does not extend beyond the superficial epidermis
Examples:■ Atopic dermatitis■ scratch marks■ Insect bite■ Scabies■ Vascular rupture site
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Mrs. Mahdia Samaha Kony
Secondary lesions that take away• Erosion: Loss of
superficial epidermisExamples:■ Abrasion■ Candidiasis erosion■ Fragile skin■ Impetigo
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Mrs. Mahdia Samaha Kony
Secondary lesions that take away
Fissure: Linear breaks in the skin with well-defined borders, may extend to the Dermis
Examples:■ Athlete’s foot■ Cheilitis■ Hand dermatitis (chapped
hands)■ Syphilis
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Mrs. Mahdia Samaha Kony
Secondary lesions that take away• Ulcer: Irregularly
shaped loss extending to or through the dermis; may be Necrotic
Examples:■ Pressure ulcer
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Mrs. Mahdia Samaha Kony
Secondary lesions that take away• Atrophy: Thinning of
skin with transparent appearance and loss of markings
Examples: ■ Aging■ Arterial insufficiency■ Topical
corticosteroids
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Mrs. Mahdia Samaha Kony
Common Abnormalities04/21/23
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Mrs. Mahdia Samaha Kony
Acne Vulgaris■ Caused by sebaceous gland overactivity with
plugging of hair follicles and retention of sebum,resulting in comedones, papules, and pustules.
Onset is typically at puberty, but acne may last into advanced age.
Greater incidence in males.■ Aggravated by:1.Emotional distress2.Greasy topical applications (cosmetics) 3.Medications (oral contraceptives, lithium,
phenobarbital).
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Mrs. Mahdia Samaha Kony
ASSESSMENT FINDINGS■ Pimples present as
papules or pustules.■ Cysts may develop and
leave extensive scarring.■ Most common on face,
back, and shoulders.■ Bacillus is cause.■ Lesions may be sore and
painful.
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Mrs. Mahdia Samaha Kony
Basal Cell Carcinoma■ An epidermoid cancer, one of the most common
malignant skin diseases, but rarely metastatic.■ Typically has pearly, flesh-colored or transparent
“rolled” border.■ Central area develops telangiectasia and may
ulcerate.■ Variations can present with nodular, sclerotic,
and/or pigmented appearance.■ Usually occurs on sun-exposed surfaces, especially
the face.
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Mrs. Mahdia Samaha Kony
Contact Dermatitis■ Localized skin irritation, inflammation, and
pruritus from contact with an irritating substance.
1.Additive effect of multiple irritants (soaps, detergents, or chemicals)
2.Allergy to a specific agent (topical to a specific agent, topical medication, plant oils, or metals).
3.Secondary infections may occur at the site.
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Mrs. Mahdia Samaha Kony
ASSESSMENT FINDINGS■ Edema may occur, with development of vesicles
and bullae.■ Vesicles or bullae may rupture, causing
crusting.■ Edema may be very significant, particularly
when face or genitalia are involved.■ Person may have history of previous reaction to
agent and recent exposure.
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Mrs. Mahdia Samaha Kony
Eczema/Atopic Dermatitis
Signs and symptoms:RednessPruritusScratching Skin lesions in a person with a
predisposition to skin irritations
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Mrs. Mahdia Samaha Kony
ASSESSMENT FINDINGS■ Red to red-brown, slightly scaly lesions.■ Skin markings common.■ Exudative■ As sites resolve, skin pigmentation is often
permanently altered.■ Common sites include: Face and NeckUpper trunkWrists and HandsFlexor surfaces (folds) of knees and elbows.
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ASSESSMENT FINDINGS
■ Person also often has asthma or allergic rhinitis; family history is often positive for asthma, rhinitis, eczema, or other allergy problems.
■ Itching can be quite severe.■ Sites may develop secondary infection.■ May be triggered by changes in
temperature, emotional stress, or food allergies.
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Mrs. Mahdia Samaha Kony
Herpes Simplex
■ A common, contagious disease caused by the herpes simplex virus type 1.
More prevalent in women than in men.
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Mrs. Mahdia Samaha Kony
ASSESSMENT FINDINGS■ Recurrent clusters of small vesicles on
erythematous base.■ Sites burn and sting; neuralgia often occurs.■ Typically found on perineal and genital areas.■ May initially follow a minor infection.■ Later recurrences may be triggered by
trauma, stress, or sun exposure.■ Often associated with lymphadenopathy of
regional nodes.
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Mrs. Mahdia Samaha Kony
Herpes Zoster
■ Also called shingles; an acute, infectious disease caused by the varicella zoster virus.
Postzoster neuralgia discomfort can last formonths. Ocular involvement can lead to blindness.
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■ Pain along a nerve dermatome is often the first symptom.
■ Discomfort followed in 2 to 4 days by erythematous area that develops papules or plaques followed by painful grouped vesicles unilaterally along the dermatome.
■ Vesicles or bullae rupture with crusting.■ Most common sites are face and trunk.■ Most common in people over age 60 and those with
impaired immunity.
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Mrs. Mahdia Samaha Kony
Psoriasis
■ A common dermatitis that has genetic causes and may begin at any age.
■ Silvery scales on bright red papules.■ Scales generally thick; area beneath bleeds if
scale isremoved.■ Usually occurs on extensor surfaces of knees,
elbows, and scalp.■ Can occur elsewhere, including between
buttocks.
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Mrs. Mahdia Samaha Kony
Psoriasis
■ Nails may develop a stippled, “pitted” appearance and separations.
■ Itching may be mild or severe.■ A genetic predisposition is suggested by
family history.■ May occur with arthritis.
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Mrs. Mahdia Samaha Kony
Tinea
Tinea Capitis■ A fungal infection of the scalp.■ Scaling, itching.■ Dry, brittle hair.
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Mrs. Mahdia Samaha Kony
Tinea Corporis
■ Ringworm, a fungal skin disease occurring anywhere on the body.
■ Ring-shaped erythematous lesions on body.
■ Central clearing.■ Advancing border with small vesicles.■ Pruritic.■ Most often on exposed surfaces.
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Mrs. Mahdia Samaha Kony
Tinea Cruris
■ Jock itch, a fungal skin disease occurring in the genital and anal areas in males.
■ reddened areas.■ Central clearing.■ Severe pruritus.■ Intertriginous area in groin.■ When it occurs on scalp, proper term is
tinea capitis.
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Tinea Pedis■ Athlete’s foot, a fungal skin disease occurring in
the foot. Tinea manum occurs on the palms.■ Exfoliating, fissuring, macerated area of
erythema.■ Sites itch, burn, and/or sting.■ Tinea manum occurs in interdigital folds of
fingers or on palms.■ Tinea pedis occurs in interdigital folds between
toes or on soles of feet.
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Mrs. Mahdia Samaha Kony
Vitiligo
■ Characterized by white patches of skin surrounded by areas of normal pigmentation. Progresses slowly and is more common in dark-skinned people.
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■ Irregular areas of depigmentation.■ May have hyperpigmented border.■ Flat, nonraised, with smooth surface.■ Most common sites are face, hands, and feet.■ Probably autoimmune cause; also associated
with various endocrine disorders.
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