Inflammatory Disorders of the Skin Objectives 1. Describe and discuss, Dermatitis, Acne Vulgaris,...

Inflammatory Inflammatory Disorders of the SkinDisorders of the Skin

Inflammatory Inflammatory Disorders of the SkinDisorders of the Skin

Objectives1. Describe and discuss, Dermatitis, Acne

Vulgaris , Urticaria, Psoriasis, Seborrheic Keratosis. Scleroderma and Systemic Lupus Erythematous as to definition, etiology, pathophysiology, signs and symptoms, diagnosis, medical and nursing management.

2. Apply the nursing process for clients with inflammatory disorders of the skin.

3. Recognize systemic disorders with dermatologic symptoms.

Content

1.Dermatitisa. Etiologyb. Pathophysiologyc. Signs and Symptomsd. Diagnostic findingse. Medical managementf. Nursing management

Content2.Acne Vulgaris

a. Etiologyb. Pathophysiologyc. Signs and Symptomsd. Diagnostic findingse. Medical managementf. Nursing management

Content3. Urticaria


Content4. Psoriasis

a. Etiologyb. Pathophysiologyc. Signs and Symptomsd. Diagnostic findingse. Medical management

Content5. Seborrheic Keratosis


Content6. Scleroderma


Content7. Systemic Lupus Erythematous


Content8. Nursing Process

a. Assessmentb. Nursing Diagnosisc. Planningd. Implementatione. Evaluation

Dermatitis

• A general term used to describe inflammation of the skin.

Description• Most types of dermatitis are characterized by an itchy

pink or red rash.• Contact dermatitis is an allergic reaction to something

that irritates the skin and is manifested by one or more lines of red, swollen, blistered skin that may itch or seep.

• It usually appears within 48 hours after touching or brushing against a substance to which the skin is sensitive.

• The condition is more common in adults than in children.

Dermatitis

Contact dermatitis of the (left) face and (right) wrist

Contact dermatitis• Can occur on any part of the body, but it

usually affects the hands, feet, and groin.• Contact dermatitis usually does not

spread from one person to another, nor does it spread beyond the area exposed to the irritant unless affected skin comes into contact with another part of the body.

Contact dermatitis• However, in the case of some

irritants, such as poison ivy, contact dermatitis can be passed to another person or to another part of the body.

POISON IVY

Atopic Dermatitis

• This form of dermatitis, commonly referred to as eczema, is a chronic condition that causes itchy, inflamed skin.

• Most often, it occurs in the folds of the elbows, backs of the knees or the front of the neck.

• It tends to flare periodically and then subside for a time, even up to several years.

• The exact cause of this skin disorder is unknown, but it may result from a malfunction in the body's immune system.

Atopic Dermatitis

Dermatitis

• Pathophysiology and Etiology– Types: Allergic contact; primary

irritant• Assessment Findings

– Blood vessel dilation; itching; vesiculation

– Skin patch test; visual examination

Dermatitis

• Medical Management – Flushing skin with cool water; topical

lotions; wet dressings; corticosteroids

• Nursing Management– Client teaching: Avoid contact with

soap, topical substances; preserve skin integrity

Acne Vulgaris

Acne of (left) the face and (right) the chest

Acne Vulgaris • Pathophysiology and Etiology

– Overproduction of sebum

• Assessment Findings– Comedones (blackhead); oily scalp– Visual examination

• Medical Management – Gentle facial cleansing; drying agents

containing benzoyl peroxide – Topical and oral drugs and antibiotics – Removal with instruments

Acne• Develops as a result of blockages in follicles.

Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change.

• Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen production .

• The microcomedo may enlarge to form an open comedo (blackhead) or closed comedo (whitehead).

• Increased sebum production provides an environment for the overgrowth of Propionibacterium acnes.

Acne Vulgaris

• Surgical Management– Dermabrasion

• Nursing Management – Client teaching

• Cleanliness: Face and hair• Avoid cosmetics, Manipulation of lesions• Precautions for pregnant women: Risk

associated with systemic oral isotretinoin

Urticaria

• A vascular reaction pattern of the skin marked by the transient appearance of smooth, slightly elevated patches that are more red or more pale than the surrounding skin and are accompanied by severe itching.

• Also called hives.

Non-allergic urticaria

– Mechanisms other than allergen-antibody interactions are known to cause histamine release from mast cells. For instance, a diverse group of signaling substances called neuropeptides have been found to be involved in emotionally induced urticaria.

Urticaria

Urticaria• An acute or chronic condition

characterized by the appearance of itchy weals on the skin.

• The cause may be an allergy to certain foods , drugs, emotional stress, or local skin irritation resulting from contact with certain plants.

• Athletes sometimes develop hives while exercising (exercise-induced urticaria). The hives are small and seem to develop in response to the release of histamines associated with the increase in body temperature produced by exercise.

Urticaria

Treatment & Management

• Most treatment plans for urticaria involve being aware of one's triggers.

• If one's triggers can be identified then outbreaks can often be managed by limiting one's exposure to these situations.

Drug treatment

• Typically in the form of Antihistamines such as diphenhydramine, hydroxyzine, cetirizine and other H1 receptor antagonists. These are taken on a regular basis to protective effect, lessening or halting attacks.

• For some people, H2-receptor antagonists such as cimetidine (Tagamet) and ranitidine (Zantac) can also help control symptoms either protectively or by lessening symptoms when an attack occurs.

• When taken in combination with a H1 antagonist it has been shown to have a synergistic effect which is more effective than either treatment alone.

Psoriasis • Pathophysiology and Etiology

– Likely genetic predisposition– Keratinocytes; plaque

• Assessment Findings – Erythema with silvery scales; lesions– Visual examination; skin biopsy

• Medical Management – Symptomatic treatment – Drug therapy; biologic therapy (immunotherapy - interferon)– Photochemotherapy (fiberoptic probe)

Psoriasis• Named for the Greek word psōra

meaning "itch," psoriasis is a chronic, non-contagious disease characterized by inflamed lesions covered with silvery-white scabs of dead skin.

Psoriasis

Pathophysiology• Normal skin cells mature and replace

dead skin every 28–30 days. • Psoriasis causes skin cells to mature in

less than a week. • Because the body can't shed old skin as

rapidly as new cells are rising to the surface, raised patches of dead skin develop on the arms, back, chest, elbows, legs, nails, folds between the buttocks, and scalp.

• Psoriasis is considered mild if it affects less than 5% of the surface of the body; moderate, if 5–30% of the skin is involved, and severe, if the disease affects more than 30% of the body surface.

Nursing Process:

The Client With Psoriasis

• Assessment– Skin integrity; appearance– Family history of psoriasis– Triggering factors

• Diagnosis, Planning, and Interventions – Impaired skin integrity – Disturbed body image

Nursing Process: The Client With Psoriasis

• Evaluation of Expected Outcomes– Improved integrity and appearance of

skin– Reduced itching; copes effectively

with altered appearance

Seborrheic Keratosis

A superficial, benign, verrucose lesion consisting of proliferating epidermal cells enclosing horn cysts, usually appearing on the face, trunk, or extremities in adulthood.

Seborrheic Keratosis

Sign And Symptoms

• The growths resemble flattened or raised warts, but have no viral origins and may exhibit a variety of colors, from pink or yellow through brown and black.

• Because only the top layers of the epidermis are involved, seborrheic keratoses are often described as having a "pasted-on" appearance.

Etiology• A mutation of a gene coding for a

growth factor receptor (FGFR3), has been associated with seborrheic keratosis.

Treatment• Because the tumors are rarely painful,

treatment is not often necessary. • If a growth becomes excessively itchy,

or if it is irritated by clothing or jewelry, cryosurgery has been found to be highly effective in their removal.

• With resemblance to malignant melanomas, which has sometimes led to a misdiagnosis of the cancerous lesions. If there is any doubt, a skin biopsy will allow a physician to make a correct diagnosis.

Scleroderma

• Scleroderma is a progressive disease that affects the skin and connective tissue (including cartilage, bone, fat, and the tissue that supports the nerves and blood vessels throughout the body).

• There are two major forms of the disorder. Localized scleroderma mainly affects the skin. Systemic scleroderma, which is also called systemic sclerosis, affects the smaller blood vessels and internal organs of the body.

SCLERODERMA

Scleroderma• Is an autoimmune disorder, which

means that the body's immune system turns against itself. In scleroderma, there is an overproduction of abnormal collagen (a type of protein fiber present in connective tissue). This collagen accumulates throughout the body, causing hardening (sclerosis), scarring (fibrosis), and other damage.

Therapy• There is no cure for every patient with

scleroderma, though there is treatment for some of the symptoms, including drugs that soften the skin and reduce inflammation. Some patients may benefit from exposure to heat.

• A range of NSAIDs (nonsteroidal anti-inflammatory drugs) can be used to ease symptoms, such as naproxen. If there is esophageal dysmotility .Care must be taken with NSAIDs as they are gastric irritants, and so a proton pump inhibitor (PPI) such as omeprazole can be given in conjunction.

Treatment• Immunosuppressant drugs, such as

mycophenolate mofetil (Cellcept®) or cyclophosphamide are sometimes used to slow the progress.

• Digital ulcerations and pulmonary hypertension can be helped by prostacyclin (iloprost) infusion. Iloprost increases blood flow by relaxing the arterial wall.

Sytemic Lupus Erythematous

• Lupus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease.

• Autoimmune diseases are illnesses that occur when the body's tissues are attacked by its own immune system.

SLE - NECK

Etiology• The precise reason for the

abnormal autoimmunity that causes lupus is not known.

• Inherited genes, viruses, ultraviolet light, and drugs may all play some role.

What is drug-induced lupus?

• Dozens of medications have been reported to trigger SLE; however, more than 90% of this "drug-induced lupus" occurs as a side effect of one of the following six drugs: hydralazine (used for high blood pressure), quinidine and procainamide (used for abnormal heart rhythm), phenytoin (used for epilepsy), isoniazid ( used for tuberculosis), d-penicillamine (used for rheumatoid arthritis). These drugs are known to stimulate the immune system and cause SLE.

The 11 criteria used for diagnosing

systemic lupus erythematosus are: • Molar (over the cheeks of the face) "butterfly" rash

• Discoid skin rash: patchy redness that can cause scarring

• Photosensitivity: skin rash in reaction to sunlight exposure

• Mucus membrane ulcers: ulcers of the lining of the mouth, nose or throat

• Arthritis: two or more swollen, tender joints of the extremities

• Pleuritis/pericarditis: inflammation of the lining tissue around the Heart or lungs, usually associated with chest pain with breathing

• Kidney abnormalities: abnormal amounts of urine protein or clumps of cellular elements called casts

• Brain irritation: manifested by seizures (convulsions) and/or psychosis

• Blood count abnormalities: low counts of white or red blood cells, or platelets

• Immunologic disorder: abnormal immune tests include anti-DNA or anti-Sm (Smith) antibodies, falsely positive blood test for syphilis, anticardiolipin antibodies, lupus anticoagulant, or positive LE prep test

• Antinuclear antibody: positive ANA antibody testing

Treatment

• There is no permanent cure for SLE. • The goal of treatment is to relieve symptoms

and protect organs by decreasing inflammation and/or the level of autoimmune activity in the body.

• Many patients with mild symptoms may need no treatment or only intermittent courses of anti - inflammatory medications.

• Damage to internal organ(s) may require high doses of corticosteroids in combination with other medications that suppress the body's immune system.

Heat and Cold Applications

Heat Application• Heat – causes vasodilation which

increases blood flow to the area where heat was applied.

• Heat – increases the amount of oxygen, nutrients, and white blood cells delivered to body tissues.

• Heat - also aids in removal of waste products from injured tissues.

Purposes of Heat Application

• Relieves local pain, stiffness or aching, particularly of muscle and joints

• Assists in wound healing• Reduces inflammation• Makes the chilly client more comfortable• Raise the body temperature• Promotes drainage

Nursing Care Guidelines: Heat

Therapy• Heat application should be ordered by MD• Specific body parts such as the eyelids,

neck, and inside the arm are especially sensitive to heat.

• Infants and older people have less heat resistance.

• Client complaints are very important. Listen to the client.

Cold Application • Indirect application of ice or a cold compress is often

the first line of treatment for an acute sports injury. • The low temperature decreases the metabolic rate of

injured tissue and constricts blood vessels. • Since most internal bleeding occurs a few minutes after

an injury, immediate application of ice for about 10 minutes reduces bruising and swelling.

• The low temperature also stops muscle spasms and deadens pain receptors in the injured tissue.

• The pain killing effect of ice is sometimes too effective. A victim who feels no pain may return to activity prematurely and exacerbate the injury.

Approximate Range of Temperatures for Hot & Cold Applications

• Hot 37.7 – 40.5 °C 100-105 °F• Warm 35 - 37.7 °C 95 – 100 °F• Tepid 26.6 – 35 °C 80 – 95 °F• Cool 18.3 – 26.6 °C 65 – 80 °F• Cold 10 - 18.3 °C 50 – 65 °F

» To convert F to C = ( F-32) x 5/9» To convert C to F = (C x9/5) x 32

Inflammatory Disorders of the Skin Objectives 1. Describe and discuss, Dermatitis, Acne Vulgaris,...

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