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