Dermatology Quiz on Dermatitis and Infections

Integumentary System

• The integumentary system is comprised of the skin, hair, and nails.

• Inspection and palpation of skin require assessment of recent rashes or lesions, location of onset, duration, pain or discomfort, pruritus or tingling, burning, recent color changes, sun exposure, family history of skin cancer, and visual inspection for skin lesions.

• Assessment of dark skin must consider that skin color is genetically determined and that melanin increases sun protection and decreases the incidence of skin cancer. Assessment is easier in areas of lighter skin. Assess for pallor in lips and mucous membranes, nailbeds, and conjunctiva. Rashes may require palpation.

• Documentation of chief complaints of skin conditions includes exact location, length, width, general appearance, and type of lesion. Use of the mnemonic PQRST is recommended (Provocative and Palliative factors, Quality and quantity, Region, Severity, Time). Specific assessment of moles uses the mnemonic ABCDE (Asymmetry, Borders, Color, Diameter, Evolving).

• Pressure injuries (stages 1-4) utilize descriptions of the damage to the skin. Non-blanchable erythema is stage 1. Partial thickness skin loss of dermis is stage 2, including abrasion, blister, or shallow crater. Full thickness loss is stage 3, manifesting as a deep crater with/without undermining or tunneling. Stage 4 involves loss of full thickness tissue, with exposed cartilage, bone, tendon, or muscle, and slough/eschar, often with undermining and tunneling; Risk for osteomyelitis. Unstageable includes a wound base covered by slough and/or eschar of the wound bed. Descriptions of deep tissue injury include descriptions of color, pain, and texture compared to surrounding skin.

• Types of Herpes Simplex, including Type 1 (cold sores) and Type 2 (genital herpes) have characteristic symptoms including lesions at the corner of the mouth, on the lips, or nose or genitals. Subjective and objective data is used in diagnosis; subjective data can include fatigue and/or pruritus, and objective data can include edematous and erythematous areas that appear first. Vesicles ulcerate and encrust with dried exudate, resulting in burning pain when rupturing.

• Herpes Zoster is caused by the same virus that causes chickenpox; the virus lies dormant until resistance to infection has lowered. Lesions are found along nerve fibers, and the virus multiplies, producing an erythematous rash of small vesicles along a spinal nerve pathway.

• Cellulitis is an infection of the skin, not contagious but spread by direct contact with an open area; it develops as an edematous and erythematous area of skin that feels hot and tender. Usually caused by strep and staph bacteria.

• Impetigo Contagiosa is caused by staphylococcus aureus or strep, commonly in children. It presents with honey-colored exudate that easily removes; this is spread by touching or close contact.

• Fungal infections, such as tinea capitis, tinea corporis, tinea cruris, and tinea pedis, require diagnosis with antifungal medications. Topical or oral antifungal medications are used.

• Contact dermatitis is caused by a direct reaction to environmental agents. The condition presents with erythema and edema that may lead to vesicles and crusts and secondary excoriation.

• Urticaria (hives) is an allergic reaction that includes wheals that are elevated with white centers and pale red periphery. It manifests quickly and is caused by histamine release and antigen-antibody reactions.

• Angioedema is a form of urticaria that presents with swelling of subcutaneous tissue; it can affect several areas, including eyelids, hands, feet, tongue, larynx, GI tract, genitalia, or lips. Antihistamines, epinephrine, and corticosteroids are used in treatment. Cold packs or compresses can help reduce symptoms.

• Eczema is a chronic inflammatory skin disorder primarily beginning in infancy that may have allergies to specific foods like chocolate, eggs, wheat, and OJ. The disorder is treated by reducing exposure to allergens.

• Acne vulgaris involves papulopustular skin eruptions of the sebaceous glands commonly occurring during adolescence. Diet, stress, heredity, hormones, grease/oil containing cosmetics, and perspiration are contributing factors. Acne develops when oil glands become occluded and presents with edema followed by blackheads; treatments include topical, systemic, or intralesional medications.

• Psoriasis is a chronic inflammatory skin disorder that is hereditary. Skin cells divide too quickly. The disorder presents with red skin patches with silver scales, usually on the scalp, elbows, and trunk. Treatment decreases inflammation and shedding of the outer layer using topical steroids, keratolytic agents, photochemotherapy, methotrexate, vitamin D, and biologics.

• Systemic Lupus Erythematosus (SLE) is an autoimmune disorder with inflammation of almost any body part. The body produces antibodies against its own cells, presenting with various symptoms such as oral ulcers, arthralgias, arthritis, vasculitis, rash, nephritis, pericarditis, synovitis, and butterfly rash. Diagnoses use anti-nuclear antibody, DNA antibody, Anti-Sm antibody, complement, CBC, erythrocyte sedimentation rate, coagulation profile, rheumatoid factor, rapid plasma reagin, skin and renal biopsy, C-reactive protein, and Coomb's test. Medications used include NSAIDs, corticosteroids, antimalarial drugs, and antineoplastic agents.

• Disorders of appendages include alopecia (hair loss), hypertrichosis (excessive hair growth), hypotrichosis (decreased hair growth), and paronychia (nail disorder).

• Burns present with tissue damage from heat, electricity, chemicals, and radiation, evaluated by extent and depth of injury. Classification categorizes these burns into areas. Treatment includes airway management, fluid therapy, urinary output monitoring, pain management, and tetanus immunization.

• Smoke inhalation manifests with damage to respiratory cilia and mucosa. Signs include singed nasal/facial hairs, soot in throat, hoarseness, stridor, sooty sputum, productive cough, and agitation with flaring nostrils.

• Carbon monoxide poisoning results from exposure to CO and will present with headache, nausea, and unsteady gait. Treatment includes 100% oxygen therapy.

• Skin cancers include Basal cell, Squamous cell, and Malignant Melanoma. The latter is the most significant, arising from melanocytes and having more complex presentations with the potential for deeper invasion and metastasis.

• Grafts include autografts, homografts, and heterografts.