Chapter 45

Disorders of the Skin

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Skin Infections
Superficial fungal infections Ringworm, athletes foot

Attack the keratinized (dead) cells

Inflammatory reaction to toxins causes most signs and symptoms Deep fungal infections Candidiasis, sporotrichosis Attack living tissue

May attack other organs

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Bacterial Skin Infections

Impetigo May lead to poststreptococcal hypersensitivity reactions These can cause glomerulonephritis

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Viral Skin Infections

Verrucae (warts) Benign neoplasms (papillomas) Herpes simplex (cold sores) Herpes zoster (shingles) Herpes invades dorsal root ganglia Caused when chickenpox herpesvirus is reactivated Travels out nerve to skin and causes a new inflammation

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Mrs. K Is Worried About Her Complexion

She says she always had good skin, but now her face itches and burns on the right side, and there are red lumps on one side of her forehead

What are the possible causes?

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Acne
Disorder of sebaceous glands Related to:

Hormonal stimulation of sebaceous glands

Increased number of sebaceous cells Increased sebum production

Inflammatory response to bacteria in sebum

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Allergic and Hypersensitivity Dermatoses

Type I allergies
Atopic eczema Urticaria (hives)

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Mast cell

Mechanism of Type I Hypersensitivity

Sensitized Mast cell

IgE attaches to mast cell

Allergen attaches to IgE Mast cell degranulates

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Type I Allergies Are Mediated by IgE

What cells must be involved in this process? On the first exposure to the allergen?

On repeated exposure?
When the allergen binds to IgE? What inflammatory mediators are involved? How?

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In Autoimmune Urticaria, the Client Creates Anti-IgE Antibodies

How would this cause hives? How would a deficiency in complement inhibitor cause hives? Why would antihistamines help? Why would corticosteroids help?

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Drug-Induced Skin Eruptions

Erythema multiforme Occurs after herpes simplex; self-limiting Stevens-Johnson syndrome Skin detaches from body surface; <10% of body affected Toxic epidermal necrolysis >30% of epidermis detaches 30%35% mortality rate
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Papulosquamous Dermatoses
Psoriasis Pityriasis rosea Lichen planus

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Psoriasis

Activated T cells growth factors

attract neutrophils and monocytes

enter the papules create inflammation

keratinocytes and blood vessels grow create papules

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Burns
First-degree: outer layers of epidermis Second-degree: epidermis and dermis Partial-thickness: only part of dermis Full-thickness: entire dermis Third-degree full-thickness

Extends into subcutaneous tissue

May damage muscle, bone, blood vessels
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Mr. D Was Boiling Corn

The pot tipped over on him He has painful, bright pink, blistering burns over most of his left arm and chest

How would you categorize this burn?

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Mr. D's Burns Are Pink

But the rest of his body looks pale, and he has a rapid heart rate His pulses are weak Bowel sounds are absent Respiration is rapid

What has caused these signs?

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Complications of Burns
Burn shock Respiratory system dysfunction Hypermetabolic response Renal insufficiency

Gastric ulceration
Sepsis Constriction of areas under circumferential burns Systemic infection
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A Woman Was Severely Burned

She has been in the hospital for 8 days Why would she be developing:

Increased urine production?

Weight loss? Increased temperature? GI bleeding?

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Pressure Sores
External pressure Friction Shear bends blood vessels

obstructs blood flow

ischemia to skin

damages dermis/ epidermis interface

tissue damage
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Ultraviolet radiation

melanin oxidized TAN more melanin produced - delayed tanning

hits melanocytes some UV reaches lower skin layers

immune cells damaged

inflammatory mediators released

DNA damage

sunburn
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UV Damage to DNA

Two thymines next to one another become linked: thymine dimers

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Sun Exposure Increases the Risk of Skin Cancer

Cumulative sun exposure increases risk of: Basal cell carcinoma Squamous cell carcinoma Severe sun exposure with blistering increases risk of: Malignant melanoma

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Malignant Melanoma
Cancers arising from melanocytes Asymmetry Border irregularity Color variegation Diameter > 0.6 cm Evolving change over time

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Types of Melanomas
70% are superficial spreading
Raised edges; grow horizontally and vertically Ulcerate and bleed 15%30% are nodular

Dome-shaped, blue-black
4%10% are lentigo maligna Slow growing, flat

2%4% acral lentiginous

On palms, soles, nail beds, mucous membranes
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Skin Conditions of Infancy

Birthmarks Diaper dermatitis Prickly heat Cradle cap Infectious disease rashes Roseola (herpesvirus) Rubeola (measles) Rubella (German measles) Varicella (chickenpox)
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Skin Disorders of the Elderly

Actinic (solar) damage

Keratoses: premalignant lesions

Lentigines: liver spots Vascular lesions Angiomas Telangiectases Venous lakes
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