Details of integumentary system

1. SKIN DISORDERS
BY –
SHUBHRIMA KHAN

2. INTRODUCTION
• Skin is the largest organ of your body. It is a soft outer covering of an animal, in particular
a vertebrate.
• The skin functions in thermoregulation, protection, metabolic functions and sensation.
• Skin is composed of three primary layers:
1. The epidermis, which serves as a barrier to infection
2. The dermis, which serves as a location for the appendages of skin
3. The hypodermis (subcutaneous adipose layer)
• Its function is to protect from infection. Sometimes the skin itself becomes infected.
• Skin infections are caused by a wide variety of germs, and symptoms can vary from mild
to serious. Mild infections may be treatable with over-the-counter medications and home
remedies, whereas other infections may require medical attention

4. TYPES OF SKIN INFECTIONS
• Bacterial skin infections
• Viral skin infections
• Fungal skin infections
• Parasitic skin infections

5. BACTERIAL SKIN INFECTIONS
• Gram positive staphylococcus aureus and beta hemolytic streptococci cause
bacterial infections.
• Primary infection occur if break present in skin present.
• Secondary infection occurs if it followed after already damaged skin or as sign of
systematic infection.
• Predisposing Factors: Moisture, Obesity, Skin disease, Systematic corticosteroids,
Antibiotics, Chronic diseases like diabetes mellitus increase the incidence of
infection.

6. IMPETIGO
• Impetigo is superficial skin infection caused by staphylococci, streptococci or
multiple bacteria,
• It involves exposed areas of body, face, hands, neck and extremities. It is often
called school sores because it most often affects children. It is quite contagious.
• Primary impetigo occurs due to poor hygiene and malnutrition. Secondary
impetigo occurs due to pediculosis capitis (Head lice scabies, herpes simplex,
insect bite or eczema).
CLINICAL MANIFESTATIONS
• Impetigo presents with pustules and round, oozing patches which grow larger day
by day
• There may be clear blisters or golden yellow crusts.

8. CONT..
TREATMENT
• Soak moist or crusted areas: Soak a clean cloth in a mixture of half a cup of white
vinegar in a liter of tepid water. Apply the compress to moist areas for about ten
minutes several times a day. Gently wipe off the crusts.
• Antiseptic or antibiotic ointment: apply it two or three times a day to the affected
areas and surrounding skin.
• Oral antibiotics: Oral antibiotics are recommended if infection is extensive,
proving slow to respond to topical antibiotics, or if impetigo is recurrent. The
preferred antibiotic is penicillin antibiotic. The complete course should be taken,
usually at least 7 days.

9. FOLLICULITIS
• Folliculitis means an inflammation or infection of the hair follicles of the skin. It is a
problem that is not usually serious.
• Tiny pus-filled spots (pustules) develop at the hair where friction, moisture, rubbing
or oil is more.
• Common sites for folliculitis are the beard, arms, legs, armpits.

10. CONT..
CLINICAL MANIFESTATIONS
Superficial folliculitis, which affects the upper part of the hair follicle, may cause:
• Clusters of small red or pus-filled bumps that develop around hair follicles
• Red and inflamed skin
• Itchiness or tenderness
Deep folliculitis starts deeper in the skin surrounding the hair follicle and affects the
entire hair follicle. Signs and symptoms include:
• A large swollen bump or mass
• Pus-filled blisters that break open and crust over
• Pain

11. CONT..
TREATMENT
• Mild folliculitis usually heals on its own in about 2 weeks.
• Warm compresses made with white vinegar solution ease itching & helps healing.
• Medicated shampoo can be used to treat folliculitis on the scalp or beard.
• Antibiotics applied to the skin (mupirocin) or taken by mouth (dicloxacillin).
• Gently wash the infected skin twice a day with antibacterial soap.
• Avoid shaving irritated skin. If must shave, use an electric razor rather than a blade
and apply a soothing aftershave lotion when finished. Also, shave in the direction of
hair growth rather than against it.
• Don't share towels or washcloths

12. FURUNCLE
• Furuncle is another word for "boil." A boil is
a bacterial infection of a hair follicle.
• The infected hair follicle can be on any part
of body. Furuncles mostly occur on body
areas prone to excessive perspiration,
friction and irritation such as back of neck,
thigh, axillae, and perineum or on buttocks.

13. CONT..
CLINICAL MANIFESTATIONS
• Deep, firm, red, raised bump on skin which is 1 – 5 cm in diameter,
• Pain which gets worse as it fills with pus and dead tissue.
• White or yellow centers (pustules)
• Spreading to other skin areas or joining with other boils
• Weeping, oozing, or crusting
• Fatigue
• Fever and general ill-feeling
• Itching before the boil develops
• Skin redness around the boil

14. CONT..
TREATMENT
• Put warm, moist compresses on the boil several times a day to speed draining and
healing.
• Cleanse surrounding skin with antibacterial soap, followed by application of
antibacterial ointment.
• Surgical incision and drainage may be performed.
• Systemic antibiotic therapy is instituted for carbuncles or spreading furuncles.
Analgesia and antipyretics are ordered as necessary.
• Cover mattress and pillows with plastic and wipe daily with a disinfectant.
• Wash all linens, towels, and clothing after each use.
• Strict hand washing is maintained to prevent cross-contamination.

15. CARBUNCLES
• A carbuncle is a red, swollen, and painful cluster of boils that are connected to
each other under the skin. A carbuncle occurs when a group of hair follicles next
to each other become infected. It is like a multiple boil. Furuncles may progress to
carbuncles.
• Carbuncles found on back of neck, upper arm, buttocks and lateral thighs.

16. CONT..
CLINICAL MANIFESTATIONS
• The boils that collect to form carbuncles usually start as red, painful bumps.
• The carbuncle fills with pus and develops white or yellow tips that weep, ooze, or
crust.
• Untreated carbuncles rupture, discharging a creamy white or pink fluid.
• Superficial carbuncles which have multiple openings on the skin's surface are less
likely to leave a deep scar.
• Deep carbuncles are more likely to cause significant scarring.
• Other carbuncle symptoms include chills, fever, fatigue, and a feeling of general
sickness.
• Swelling may occur in nearby tissue and lymph nodes, especially lymph nodes in the
neck, armpit, or groin.

18. CELLULITIS
• Cellulitis is an inflammation of the skin and subcutaneous tissue resulting from a
generalized bacterial infection.
• Cellulitis appears as a swollen, red area of skin that feels hot and tender.
CAUSES AND RISK FACTORS
• Staphylococcus and streptococcus bacteria
• Cracks or peeling skin between the toes
• Weakened immune system
• Injury or trauma with a break in the skin (skin wounds)
• Insect bites, animal bites.
• Ulcers from certain diseases, including diabetes and vascular disease.
• Use of corticosteroid medications or medications that suppress the immune system
• Intravenous drug use
• Obesity
• Wound from a recent surgery

19. CONT..
CLINICAL MANIFESTATIONS
• Pain or tenderness in the affected area
• Skin redness or inflammation (Swelling)
• Warm skin in the area of redness
• Fever with chills
• Malaise
• Headache
• Swollen lymph nodes
• Tight, glossy, stretched appearance of the skin
• Hair loss at the site of infection
• Joint stiffness caused by swelling of the tissue over the joint

20. CONT..
TREATMENT
• Topical/systemic antibiotics are prescribed according to culture and sensitivity test
results.
• Debridement of nonviable tissue is necessary if there is an open wound.
• Systemic antibiotics are indicated if fever and lymphadenopathy are present.
• Warm, moist compresses may be ordered.
• Immobilization and raise the infected area higher than heart to reduce swelling
• Wash wound daily with soap and water
• Moisturizing and lubricating skin regularly helps prevent cracking and peeling.
• Wear appropriate footwear and gloves.
• Regularly check feet for signs of injury.
• In severe cases: Hospitalization required

21. DIAGNOSIS OFALL BACTERIAL INFECTIONS
Lesion drainage and blood culture tested to identify causative organism. Drug
sensitivity also checked.
In case of repeated bacterial infections. Culture is taken from external nares to
determine carriers of bacteria (MRSA).

22. VIRAL SKIN INFECTIONS
• Viral infections are common and can occur anywhere in body.
• They range from the common to the rare, from the mild to the severe and
from localized skin infection to systemic disease.
• The principle site of attack in the skin is the epidermis.

23. ETIOLOGY
• Birth control pills and corticosteroids have immune-suppressive properties.
• Antibiotics also kill normal skin flora of bacteria that serve as resistance
against virus.

24. WARTS
• Warts are small, usually painless growths on the skin. Most of the time
warts are harmless.
• They are caused by a virus called human papillomavirus (HPV).
• Warts found on mucous membrane and genital skin of humans.
• All warts can spread from one part of your body to another. Warts may be
spread from person to person but this is uncommon.

26. CONT..
TYPES
1. Common wart (Verruca vulgaris): most commonly appears on fingers. They
grow above the skin surface and they are usually dome shaped.
2. Planter warts (Verruca plantaris): occur on bottom surface of foot. They grow
inwards as pressure of shoes or walking prevents its outward growth. These
warts extend deeper beneath the skin
3. Flat wart (verruca plana): They are flat lesion present on forehead or dorsum
of the hand
4. Condylomata acuminata or venereal warts: occur in moist areas - Glans of
penis, anal region, on vulva & cervix. They are pink or purple in color and have
cauliflower appearance.

29. CONT..
CLINICAL MANIFESTATIONS
• Most warts are raised with a rough surface. They may be round or oval.
• The spot where wart grows may be lighter or darker than the other skin. Rarely,
warts are black.
• Some warts have smooth or flat surfaces (very rare).
• Some warts may cause pain.

30. CONT..
TREATMENT
1. Chemicals:
• Typical chemicals like salicylic acid, trichloroacetic acid, 5-
• fluorouracil, cantharidin, tretinoin etc. are used.
• Flat warts are often treated with peeling agents such as tretinoin or salicylic
acid. Imiquimod can be used for the treatment of genital warts.
• Chemicals usually require multiple applications over several weeks to months.
• Applied every 12-24 hours and warts disappear within 2-3 days.

31. CONT..
TREATMENT
2. Freezing (Cryotherapy): Freezing is safe. Warts may be frozen with various
commercial freezing probes or with liquid nitrogen sprayed on or applied with a
cotton swab. Cryotherapy is often used for plantar warts, and warts under the
fingernails.
3. Burning and Cutting: These methods are effective but are more painful and
usually leave a scar. A laser or electrical current is used to burn warts off.

33. CONT..
PREVENTION
Avoiding cross-contamination can reduce the risk of spreading warts.
• Don't bite fingernails: Warts occur more often in skin that has been broken.
Nibbling the skin around fingernails opens the door for the virus.
• Groom with care: In order to avoid spreading the virus, don't brush, clip, comb or
shave areas that have warts.
• Don't pick at warts: Picking may spread the virus. Consider covering warts with an
adhesive bandage to discourage picking.
• Keep hands dry: Warts are more difficult to control in a moist environment.

34. HERPES SIMPLEX
Herpes simplex virus infection is a common viral infection Of the skin that tends to
recur repeatedly. It is also called fever blister or cold sore.
There are two types of herpes simplex:
1. Type I virus (HSV-I), which occurs above the waist on lips, face and mouth and
causes a fever blister or cold sore.
2. Type Il virus (HSVII), which occurs below the waist and causes genital herpes.
MODES OF TRANSMISSION
• It is transmitted by direct contact, respiratory droplet, or contact with virus containing
fluid-saliva or cervical secretions in the form of kissing and sexual activity.
• Trauma, sunlight, menses, stress and systematic infection often cause reoccurrence of
infection.

35. CONT..
CLINICAL MANIFESTATIONS
• Burning and tingling sensation at the site for a few hours before eruption.
• Area becomes erythematous and swollen
• Vesicles and pustules erupt in 1 to 2 days
• Lesions can burn, itch, and be painful
• Vesicles become pustules, ulcers and crusting until healing occurs in 10-14 days
• Fever, sore throat are systematic manifestations of initial infection
• The patient is contagious until scabs are formed

36. CONT..
DIAGNOSTIC EVALUATIONS
• Assess the appearance of lesions.
• Tzanck smear identifies herpes virus.
• Vesicle fluid culture differentiate herpes virus from bacterial infections.

37. CONT..
TREATMENT
• There is no complete cure for herpes simplex.
• Topical acyclovir (Zovirax) ointment is the drug of choice for primary lesions, to
suppress the multiplication of vesicles.
• Oral acyclovir may be recommended for severe attacks or immunosuppressed
patients. Lotions, creams, and ointments may be prescribed to accelerate drying and
healing of lesions (e.g., camphor, phenol, alcohol).
• Antibiotics may be indicated for secondary infections.

38. HERPES ZOSTER (SHINGLES)
• Herpes zoster, or shingles, is an acute inflammatory viral infection that produces a
painful vesicular eruption along the distribution of nerves from one or more posterior
ganglia. This eruption follows the course of the cutaneous sensory nerve and is almost
always unilateral.
• It's caused by the varicella-zoster virus, which is the same virus that causes
chickenpox. The rash most often appears as a band of rashes or blisters in one area of
the body.

41. Where does shingles come from?
When you have chickenpox as a child, your body fights off the varicella-zoster virus
and the physical signs of chickenpox fade away, but the virus always remains in your
body. In adulthood, sometimes the virus becomes active again. This time, the varicella-
zoster virus makes its second appearance in the form of shingles.

42. CAUSES AND RISK FACTORS
• Previously suffered from chicken pox
• Most common in the elderly people above 60 years.
• With a weakened immune system (such as people with cancer, HIV, organ transplant
recipients or those receiving chemotherapy).
• Patient injury to the spine or a cranial nerve
• Who are under stress.

43. PATHOPHYSIOLOGY
• Herpes virus reactivate Varicella virus (latent infection present in spinal nerve
root called the dorsal root ganglion)
• When latent infection reactivated — Virus travel by way of peripheral nerves
to skin
• Virus multiples and create blisters

45. STAGES
• First, a few days before the rash appears, there may pain in an area
on the skin. The pain is described as itching, burning, stabbing or
shooting.
• Next, the raised rash appears as a band or a patch, usually on one
side of body. The rash usually appears around waistline or on one
side of face, neck, or on the trunk (chest/abdomen/back), but not
always. It can occur in other areas including arms and legs.
• Within three to four days, the rash develops into red, fluid-filled,
painful, open blisters.
• Usually, these blisters begin to dry out and crust over within about
10 days.
• The scabs clear up about two to three weeks later.
• It can take three to five weeks from the time begin to feel
symptoms until the rash totally disappears.

46. CLINICAL MANIFESTATIONS
Early symptoms of shingles may include:
• Fever.
• Chills.
• Headache.
• Feeling tired.
• Sensitivity to light.
• Stomach upset.
Other signs and symptoms that appear a few days after the early symptoms include:
• An itching, tingling or burning feeling in an area of skin.
• Redness on skin in the affected area.
• Raised rash in a small area of skin.
• Fluid-filled blisters that break open then scab over.
• Mild to severe pain in the area of skin affected.

47. DIAGNOSIS AND TESTS
Distribution or appearance of the rash: The blisters of a shingles rash usually
appear in a band on one side of your body.
Shingles also may be diagnosed in a laboratory using scrapings or a swab of the
fluid from the blisters.

48. TREATMENT
There is no cure for shingles but there are treatments for managing the symptoms.
Treatment is aimed at controlling the outbreak, reducing pain and discomfort, and
preventing complications.
• Antiviral drugs: such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir
(Valtrex), interfere with viral replication.
• Pain management: aspirin, acetaminophen, NSAIDs, opioids are useful during the
acute stage.
• Topical steroids should not be applied if a secondary infection is present because they
suppress the immune system.
• Anti-inflammatory drugs like prednisone may be prescribed if shingles affects the
eyes or other parts of the face.
• Antihistamines are administered to control itching.
• Antibiotics are prescribed for secondary bacterial infections.

49. NURSING MANAGEMENT
Nursing Diagnosis:
1. Acute Pain may be related to presence of localized inflammation and open
lesions, possibly evidenced by verbal reports, distraction behaviors, and
restlessness.
2. Risk for [secondary] Infection: risk factors may include broken/traumatized
tissue, altered immune response, and untreated infection/ treatment failure.
3. Risk for ineffective sexuality pattern: risk factors may include lack of
knowledge, and/or fear of transmitting the disease.

50. CONT..
Nursing interventions
• Monitor location, duration and intensity of pain. Monitor for adverse effects of
pain medications.
• Assess patient's level of discomfort and medicate as prescribed.
• Encourage distraction techniques such as music therapy.
• Teach relaxation techniques, such as deep breathing, progressive muscle
relaxation, and imagery, to help control pain.
• Administer antiviral medication in dosage prescribed (usually high dose).

51. CONT..
• Apply antibacterial ointments (after acute stage) as prescribed, to soften and
separate adherent crusts and prevent secondary infection.
• Teach patient to use proper hand-washing technique, to avoid secondary infection.
• Advice the patient to observe signs of systematic infection i.e. fever, malaise,
headache, increased redness, formation & drainage of pustules.
• Maintain strict isolation.
• Wear gown & gloves if contact has to be established with patient.
• Keep patient’s room cool and avoid heavy clothes and bedding.

52. COMPLICATIONS
• Postherpetic neuralgia: After the shingles rash has disappeared, there might
continue to have nerve pain in that same area, last for months or years and become
quite severe. More than 10% of people who get shingles develop postherpetic
neuralgia. It may be that nerves become more sensitive or that the virus may be
invading and damaging the central nervous system.
• Other complications include:
• Other types of nerve issues like numbness or itching.
• A bacterial infection of the shingles rash.
• Eye and ear inflammation if the rash is near these organs.