Thursday, December 22, 2011

12-14-11 Wednesday

PHYS/PATH

Fungal Infection
superficial fungal infection
mycosis, dermatophytosis, ringworm (no worms)
legions = tinea which means fungal infect

etiology: dermatophytes live dead skin cells, transmitted skin-skin

Signs and symptoms
tinea corporis is body ringworm
common and contagious
small, round, red, scaly, patch on trunk/extremities
scratch spreads

tinea capitis is head ringworm
itchy flaking looks like dandruff

tinea pedis is athlets foot
often b/w toes 3rd &4th digit
very common
burns, itches, oozing blisters
may spread to hands (tinea manus)

tinea cruris is jock itch
upper thigh to butt
can be internal

Tx: topical, oral, also treat shoes, gloves ect.
Prevent: avoid contact
M. local contra


Herpes Simplex virus

HSV-1 : mouth above waist
HSV-2 : genitals below waist
demographics 20-25% have type 2, 60-80% have type 1

etiology
oral, respiratory, mucous secretion
primary vs. recurrent herpes
virus never expelled
waits for trigger: sun, stress, pms, wedding pict. . .
communicability: virus is stable outside host

S&S
pain/tingle before out break
blister on red base
after scab, lesion less infect
2wks-1month
types: oral-cold sore; genital-genitals, thigh, butt, low back

complications
secondary bact. infect
increase risk of HIV
accelerates progress of HIV and AIDS
complicates vaginal births

Tx
antiviral suppress
no cure
isolate towels and bedding . . .
no sexual contact with lesions
keep healthy immune system

M. local contra



Impetigo: skin infect with staph or strep - face and head

S&S: imetigo contagissa
bullous impetigo
ecthyana?

Tx: antibiotic cream

Prevention: treat chapped skin, clean and cover
don't touch

M. systemic contra



Lice and Mites
Mites: sarcoptes scabiei
burrow under skin
cause lesions called scabies
poop/waste are irritant
spread skin to skin, clothes. lives days off host

S&S: trails left in skin, itch

Tx: pesticidal soap, wash clothes and stuff

M. systemic


lice: wingless insect
lives in head hair and sucks blood from scalp
saliva irritating
lay eggs called nits

S&S nits, base of hair
itch, mvmt on scalp

Tx: pesticidal shampoo

M. systemic

body lice: pediculus humanus humanus, closely related to head lice
Pubic lice: crabs, coarse body hair


Warts: benign growth; varieties of HPV, invades keratinocytes

etiology: HPV 100+ variants
common wars through skin contact
require repeated exposure, grows slowly

types: plantar, palmar plantar, cystic, butchers
plane or flat
molluscum contagissum- not HPV
genital, several varieties, can lead ot cervical cancer

Tx: benign neglect gone in 2yrs.
topical acid
liquid nitro
electrosurgery
garlic
duct tape
self fulfilling prophecy

M. local


Acne Rosacea: idiopathic chronic skin cond.

etiology: not sell understood, comes and goes, triggers can be sunlight...
S&S: 4 stages
facial flushing
vascular rosacea
Inflammatory rosacea- papales
rhinophyma

complications: damage cornea, self esteem, public perception

Tx: topical, oral, plastic surgery
M, local (face)

Acne Vulgaris: small bacterial infect. of face, neck, upper back
Demographics: teens 85%, 5% after 45yrs old

etiology: factor 1-testosterone
factor 2-bacteria
3-stress
4-liver congestion
5-hormonal imbalance

S&S: local pain
pimples
cyst
open comedones-black heads
closed comedones- white heads

Tx: avoid touch face, wash, meds, stuff for scars
M: local, consider water based instead of oil


Dermatitis/Eczema: skin inflammation by convention; not infectious
contact dermatitis: externally applied irritant or allergen
eczema: immune dyst. hypersensitive, expressed in skin
10-20% infants, 15 million U.S. adults

etiology: type I: reaction- hay fever, asthma
typeIV:

causes of eczema: fatty acid deficient, elevated immunoglobulin
trigger detergents
contact derm: allergens

S&S: atopic dermatitis

*nummular eczema
itchy, small circular lesions on legs and buttocks
looks like ringworm


S&S: contact derm: acute inflam at area of contact

stasis derm: bed sores- infected

compl. itch, scratch, 2nd infect

Tx: self care, avoid trigger
meds, topical and antihistamines

M. depends- local to systemic


Hives: urticaria- itch, swell, stress, allergy
acute hives
cholinergiz hive- hundred tiney wheels
physical hives: mechanic trigger
chronic: 6+ wks, idiopathic (don't heal)

S&S: red, itch,
Tx: antihist. topical
M. local- hypoallergenic lub.


*Psoriasis: chronic skin condition with acute episodes, pile up of excess skin
6-7 million, mostly whites

etiology: overactive T cells and chem

S&S: most common, raised pink, red patches with silvery scales
mild itchy
knees, elbows, scalp
can be wide spread
under nails (pitted)
[silver scales, pitted nails, on extensors (elbows)]

complicants: sever cracking- infect. psoriatic arthritis

Tx. topical
photo therapy
oral
no permanent sol.
vit D

M. avoid lesions, not contagious, not spread through M.


Skin Cancer: uncontrolled replication of cells, some local others metastasize
1 in 5 get skin cancer
1 million case/yr
110k are melanoma
mortality risk rising
common in people who:
sunburn
south or high altitude
immune suppressed
have had skin cancer
moles/atypical
toxic

etiology: *precancer lesion known as Actinic Keratosis*

S&S: some don't heal, brown red scaly lesions, squamous cell

Tx: liquid nitrogen, meds

M. local, make sure referred

**Basal Cell Carcinoma: most common type of skin cancer 75-90%
slow growing,

S&S: some don't heal, comes and goes same place
nodular BCC
pigmented
superficial
micronodule
morph_________

Tx: excision

M: local


Squamous Cell Carcinoma
affects beratinocytes
long sun exposure
doesn't heal/comes and goes

Tx: liquid nitrogen
shaved off in layers

M. depends on Tx


**Maligment melanoma
may develop in non sun areas
leading cause of skin cancer death
72% of skin cancer death
S&S starts with preexisting mole
A-asymmetrical
B-boarder
C-color
D-diameter
E-elevated

Tx: surgery, radiation
prevention: limit sun exposure, cover up, sunglasses
M. depends on Tx


Burns: injury destroys protein in skin
etiology: depends on depth and area
1st degree: epidermis, no blistering
2nd degree: edema, pain, inflammation, blistering, can scar
3rd degree: through dermis, destroys layers, whiteness, charring, leathering texture

Tx: 1-2nd: lotion, antibiotic cream, cold
3rd: cleansing, skin graft

M: local in acute, work w/in pain tolerance


Decubitus Ulcer: bed sores, pressure, no mobility
etiology: squeeze capilaries to death

S&S: change in skin temp., red, pain, itch,
Tx. topical
M. good prevention, local when compromised


Scar Tissue: new tissue to repair damage

etiology: after injury, inflammation, scabs- let fall off
S&S: hypertrophic-bulges
keloid, over flows area
Tx: cosmetic
M: post acute stages, watch for areas of numbness

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