Skin Disorders and Lesions: A Nursing Guide

• Skin disorders encompass a wide range of conditions affecting the integumentary system, requiring specialized nursing care.

Functions of the Skin

• The skin protects against microorganisms, UV radiation, and physical trauma.
• Body temperature is maintained through sweat glands and blood vessel dilation/constriction.
• Nerve endings in the skin detect touch, pain, temperature, and pressure.
• When exposed to sunlight, the skin produces vitamin D, which is essential for calcium absorption.
• Small amounts of waste products are excreted through sweat.

Common Skin Lesions

• Macule: A flat, distinct, colored area of skin less than 1 cm wide.
• Papule: A raised, solid skin lesion less than 1 cm in diameter.
• Vesicle: A small, fluid-filled blister less than 1 cm in diameter.
• Pustule: A pus-filled elevation of the skin.
• Nodule: A solid, raised clump of skin cells larger than 1 cm in diameter.
• Wheal: A raised, itchy area of skin that is characteristic of hives.
• Ulcer: An open sore or lesion of the skin.

Inflammatory Skin Conditions

• Dermatitis: A general term for skin inflammation, often causing itching, redness, and rash.
• Eczema (Atopic Dermatitis): A chronic inflammatory condition causing dry, itchy skin, often with periods of flare-ups and remission.
• Nursing care focuses on managing itching, preventing infection, and educating patients on proper skin care for eczema.
• Emollients are used to moisturize the skin in eczema cases, and topical corticosteroids may be prescribed to reduce inflammation.
• Psoriasis: A chronic autoimmune disease causing raised, red, scaly plaques on the skin.
• Treatment options for psoriasis include topical corticosteroids, phototherapy, and systemic medications.
• Nursing care involves educating patients about their condition, promoting adherence to treatment, and providing emotional support for psoriasis.
• Urticaria (Hives): Characterized by raised, itchy wheals on the skin, often caused by allergic reactions.
• Antihistamines are commonly used to relieve itching from hives.
• Severe cases of hives may require epinephrine or corticosteroids.

Bacterial Skin Infections

• Cellulitis: A bacterial infection of the skin and subcutaneous tissues, causing redness, swelling, and pain.
• Treatment for cellulitis involves antibiotics, and nursing care includes wound care and monitoring for complications.
• Impetigo: A highly contagious bacterial infection, usually caused by Staphylococcus aureus or Streptococcus pyogenes, characterized by honey-colored crusts.
• Impetigo is treated with topical or oral antibiotics, and it's important to emphasize good hygiene practices to prevent spread.
• Folliculitis: Inflammation of hair follicles, often caused by bacterial or fungal infections.
• Treatment for folliculitis may include topical antibiotics or antifungals.

Viral Skin Infections

• Herpes Simplex Virus (HSV): Causes cold sores (HSV-1) and genital herpes (HSV-2).
• Antiviral medications can reduce the frequency and severity of HSV outbreaks.
• Nursing care includes educating patients on transmission prevention and pain management for HSV.
• Herpes Zoster (Shingles): Reactivation of the varicella-zoster virus, causing a painful rash along a nerve pathway.
• Antiviral medications and pain management are essential for shingles.
• Vaccination is available to prevent shingles.
• Warts (Verrucae): Caused by human papillomavirus (HPV).
• Treatment options for warts include cryotherapy, salicylic acid, and surgical removal.

Fungal Skin Infections

• Tinea (Ringworm): A fungal infection affecting the skin, hair, or nails.
• Antifungal medications are used for ringworm treatment.
• Candidiasis: A yeast infection caused by Candida albicans, often affecting the skin, mouth, or vagina.
• Antifungal creams or oral medications are prescribed for candidiasis.

Parasitic Skin Infestations

• Pediculosis (Lice): Infestation of the skin with lice, causing intense itching.
• Pediculosis is treated with medicated shampoos and lotions, and thorough cleaning of clothing and bedding is necessary.
• Scabies: Infestation of the skin with mites, causing intense itching, especially at night.
• Scabies is treated with scabicides applied to the entire body, and all household members should be treated simultaneously.

Skin Cancer

• Basal Cell Carcinoma: The most common type of skin cancer, typically slow-growing and rarely metastasizes.
• Squamous Cell Carcinoma: Arises from keratinocytes and has a higher risk of metastasis than basal cell carcinoma.
• Melanoma: The most dangerous type of skin cancer, arising from melanocytes, and has a high potential for metastasis.
• Risk factors for melanoma include UV radiation exposure, fair skin, and family history.
• Prevention strategies include sun protection measures, such as sunscreen, protective clothing, and avoiding peak sun hours.
• Early detection through regular skin self-exams and professional skin exams is crucial for melanoma.
• Treatment options vary depending on the stage and type of skin cancer, including surgical excision, radiation therapy, chemotherapy, and targeted therapies.

Nursing Assessment

• History: Gather information about the patient's skin problems, including onset, duration, symptoms, and previous treatments.
• Physical Examination: Inspect the skin for lesions, rashes, color changes, and other abnormalities. Palpate the skin for temperature, texture, and moisture.
• Diagnostic Tests: Skin biopsies, cultures, and allergy testing may be performed to aid in diagnosis.

Nursing Interventions

• Skin Care:
  • Keep the skin clean and dry.
  • Use gentle cleansers and moisturizers.
  • Avoid harsh chemicals and irritants.
• Wound Care:
  • Assess wounds for signs of infection.
  • Clean and dress wounds as ordered.
  • Promote wound healing through proper nutrition and hydration.
• Medication Administration:
  • Administer topical and systemic medications as prescribed.
  • Educate patients on medication side effects and proper usage.
• Patient Education:
  • Teach patients about their skin condition, treatment options, and preventive measures.
  • Emphasize the importance of sun protection and regular skin self-exams.

Impaired Skin Integrity

• Contributing Factors: Pressure, friction, shear, moisture, malnutrition, immobility, decreased sensation, and impaired circulation.
• Prevention Strategies:
  • Reposition patients frequently to relieve pressure.
  • Use pressure-reducing devices, such as specialty mattresses and cushions.
  • Keep the skin clean and dry.
  • Provide adequate nutrition and hydration.
• Treatment:
  • Pressure injuries are staged to classify the depth of tissue damage.
  • Treatment varies depending on the stage and may include wound cleansing, debridement, dressings, and negative pressure wound therapy.
  • Monitor for signs of infection and complications.

Pruritus (Itching)

• Causes: Skin conditions, allergic reactions, systemic diseases, and medications.
• Management:
  • Identify and eliminate the underlying cause.
  • Use emollients to moisturize the skin.
  • Administer antihistamines to relieve itching.
  • Apply cool compresses to soothe the skin.
  • Advise patients to avoid scratching.

Sun Safety

• Limit sun exposure, especially during peak hours (10 AM to 4 PM).
• Use sunscreen with an SPF of 30 or higher.
• Wear protective clothing, such as hats and long sleeves.
• Avoid tanning beds and sunlamps.
• Perform regular skin self-exams to detect suspicious lesions.