Dermatologic Pathologies Chapter 4 1 Learning Objectives Lesson

Dermatologic Pathologies Chapter 4 1

Learning Objectives Lesson 4. 1: Physiologic Processes, Infections, and Inflammatory Conditions 1. Discuss anatomy, physiology, and the effects of aging of the integumentary system. 2. Define bacterial, fungal, viral infections and inflammatory skin conditions featured in this chapter and list appropriate massage modifications for each. 2

Integumentary System Overview The skin is the first body structure contacted directly during massage The skin accessories and structures are the hair, nails, and various glands, muscles, and nerves 3

Skin Functions Protection and absorption Sensory reception and temperature regulation Vitamin D production 4

Hair Found on most body surfaces Protects scalp from injury and ultraviolet radiation Touch receptors activated when hairs move 5

Nails The keratin in the nails is derived from the epidermis Nails aid in: Grasping small objects Protecting fingertips Enabling scratching 6

Aging and the Integumentary System Skin begins to lose elasticity Skin becomes rougher, drier, and flakier Skin pigmentation increases Hair color fades; turns gray 7

Dermatologic Pathologies Skin lesions: Variation from normal tissue Primary: Color or texture Secondary: Develop from primary lesions 8

Acne Bacterial infection of hair follicles Most common on face Distressing and disfiguring Affects mainly adolescents (ages 12 to 20) 9

Etiology Sebum overproduction Rapidly shedding cells of follicles Bacterial overgrowth 10

Signs and Symptoms Pustules Papules Comedones Blackheads Whiteheads 11

Treatment Skin cleansers or topical creams Oral antibiotics and contraceptives Light therapy 12

Folliculitis Inflammation of hair follicles Groin Axilla Bearded areas 13

Etiology Staphylococcal bacteria Yeasts Fungi 14

Signs and Symptoms Pustular rash, redness Crust from ruptured pustules Itching and tenderness 15

Treatment Topical cleansers Antiseptic cleaner Oral antibiotics 16

Impetigo Mouth and nose Hands Skin folds 17

Signs and Symptoms Itching/burning vesicles Wet, reddish skin 18

Treatment Eradicate infection, manage symptoms Topical, oral antibiotics Separate contaminated items 19

Boils Occur when infected follicles spread to other areas Face and neck Back and buttocks 20

Signs and Symptoms Red, swollen nodule Develops into an abscess Bursts internally or externally 21

Treatment Warm compresses Lancing Meticulous hygiene 22

Cellulitis Arises from skin wound or boil Lower extremities Erysipelas: Superficial cellulitis 23

Etiology Streptococcus and Staphylococcus bacteria CA-MRSA: Soft tissue infections 24

Signs and Symptoms Localized swelling Abscess formation Tender skin Fever and malaise 25

Massage Considerations Widespread: Massage is postponed Localized: Avoid infected limb If client has cellulitis on limb affected by cancer treatments, ask him or her to seek immediate medical attention, as this may be serious treatment complication MRSA infections are spread by direct contact Ask client to seek immediate medical attention if you notice wound that seems to get worse instead of healing 26

Paronychia Infection of tissue surrounding nail Acute or chronic Causes Staphylococcal bacteria Streptococcal bacteria 27

Signs and Symptoms Red and swollen nail Discolored or deformed nail plate 28

Fungal Skin Infections: Ringworm Transmitted through infected: Skin Animals Occurs in areas of the body with little or no hair 29

Signs and Symptoms Scaling, spreading peripherally with clear center Itch, burn, ooze clear fluid 30

Massage Considerations Location of infection Widespread: Postpone massage until healed Localized: Avoid affected limb Sanitize contaminated items 31

Athlete’s Foot Occurs mainly on soles and between toes Avoid contact with: Affected area Contaminated objects 32

Signs and Symptoms Itching Burning Stinging Skin discoloration 33

Treatment Topical antifungal agents Wash area daily Wear absorbent socks and ventilated shoes 34

Nail Fungus Involves one or more nails Can occur simultaneously with athlete’s foot Generally seen in toenails 35

Signs and Symptoms Nail turns yellow or white Nail becomes elevated Nail will be thick, may crack or crumble 36

Jock Itch Infects groin, but can spread to: Inner thighs Buttocks 37

Signs and Symptoms Itchy, dry, or scaly area; red border Abnormally dark or light skin Unpleasant odor 38

Massage Considerations Ask how widespread infection is Avoid lesions on buttocks and medial thigh 39

Viral Skin Infections Cold sores Chickenpox Shingles Warts 40

Cold Sores and Fever Blisters Slide 1 of 2 Appear most often around mouth Confused with canker sores 41

Cold Sores and Fever Blisters Slide 2 of 2 Contagious Direct contact with contaminated items Recurring lesions 42

Signs and Symptoms Burning sensation Fluid-filled vesicles Reddened area 43

Chickenpox Common in children and young adults Viral infection may recur as shingles later in life Direct or indirect contact Respiratory droplets 44

Signs and Symptoms Headache Appetite loss Fever Rash 45

Treatment Oatmeal baths Antihistamines: Itching Acetaminophen: Fever 46

Shingles Reactivation of chickenpox Lies dormant, but can reappear through dermatome Affects thoracic area 47

Signs and Symptoms Paresthesias Painful blisters Chills, nausea, cramping, diarrhea 48

Treatment Antivirals Antiinflammatories Analgesics Antibiotics 49

Warts Resultant mass of viral-induced cell growth Hands and feet Face and legs 50

Signs and Symptoms Lighter in color than surrounding skin Wart seeds Cause little discomfort Will likely recur 51

Inflammatory Skin Conditions Eczema Contact and seborrheic dermatitis Psoriasis and rosacea Lichen planus 52

Eczema Scalp and face Skin folds of elbows and knees Ankles and feet 53

Signs and Symptoms Dry skin Scaly Leathery Crusty 54

Treatment Moisturizers Topical antibiotics Topical steroids 55

Massage Considerations Level of sensitivity Use highly emollient lubricant 56

Psoriasis Chronic inflammatory condition Accelerated proliferation rate Exacerbation and remission 57

Etiology Reduced immune system response Genetics Environment Keratinocyte-derived medications 58

Signs and Symptoms Red skin covered in white scales Dry, cracked, crusted skin Joint pain 59

Treatment Topical A and D vitamins Phototherapy Tar preparation Antihistamines 60

Massage Considerations Use highly emollient cream Sensitivity of area Hypoallergenic products 61

Contact Dermatitis Irritant Contact with an irritant Allergic Contact with an allergen 62

Signs and Symptoms Rash Redness Swelling Vesicular lesions 63

Treatment Clean thoroughly Apply corticosteroids 64

Seborrheic Dermatitis No known cause Affects the sebaceous glands Amount of secretion Quality of secretion 65

Signs and Symptoms White-yellow scales, reddened skin underneath Mild itching or burning 66

Massage Considerations Sensitivity Adjust pressure as needed Avoid hypersensitive areas 67

Rosacea Progressive condition Facial redness Involves middle third of face May affect forehead and eyes 68

Signs and Symptoms Persistent: Redness Dryness Warmth Swelling 69

Treatment Redness-reducing topical agents Facial cleansers and moisturizers Avoid direct sunlight and hard exercise 70

Pityriasis Rosea Occurs during winter months Unknown cause Common in people ages 10 to 35 years 71

Signs and Symptoms Begins with herald patch Generalized rash follows Rarely affects face 72

Massage Considerations Inquire about sensitivity Avoid: Areas hypersensitive to pressure Secondary lesions 73

Lichen Planus Affects: Wrist and forearms Ankles and legs Trunk 74

Signs and Symptoms Red-violet papules Affected nails may split Lacy, ulcerating patches 75

Scleroderma Sclerosis of the skin Overproduction of collagen Localized or systemic fibrosis 76

Signs and Symptoms Skin appears: Hard Shiny Stretched Red or pale 77

Treatment Depends on signs and symptoms alone Corticosteroids Heartburn, cardiovascular, or respiratory problems 78

Massage Considerations Increase circulation and range of motion Keep client warm Adjust pressure to sensitive areas 79

Hives Associated with allergic reactions Last less than 24 hours Lesions appear anywhere on body 80

Etiology Allergic reaction to: Food Insect bites or stings Medications 81

Signs and Symptoms Wheals: Red welts Red flare: Area of redness Angioedema 82

Massage Considerations Acute: Postpone until healed Chronic: Avoid affected areas 83

Ichthyosis Disruption in skin cell production and removal Thick dry flakes occur 84

Signs and Symptoms Dry, rough, scaly skin Oddly shaped White, dirty gray, or brown 85

Massage Considerations Avoid broken skin Be aware of sensitivity Use highly emollient lotion 86

Epidermal Cyst Filled with keratinous material Located just beneath skin Develop over time 87

Signs and Symptoms Movable balls beneath skin Usually painless Infected area may be red, warm, or tender 88

Treatment Infected: Corticosteroid may be injected Bothersome: May be surgically removed 89

Actinic Keratosis Found in sunlight-exposed areas High risk: Light-complexioned, older individuals Rough, scaly surface; yellow-brown color 90

Treatment and Considerations Lesions removed by: Cryosurgery Phototherapy Massage Avoid broken skin Question area sensitivity 91

Seborrheic Keratosis Benign growth of epidermal cells Lesions are two colors, have an irregular border No known cause, genetic link 92

Signs, Symptoms, and Treatment Lesions go from pink to brown Appears pasted on skin Usually asymptomatic 93

Skin Tag Benign skin growths (skin flaps) Genetics and friction Usually same color as skin 94

Learning Objectives Lesson 4. 2: Lice, Mites, Skin Injuries, and Proliferations 3. Describe lice, mites, skin injuries, other skin disorders, proliferations, and skin pigmentations outlined in this chapter and state appropriate massage modifications for each. 95

Lice and Scabies Cause skin-related diseases Highly contagious 96

Lice Lives on human host Depends on blood for survival Head lice Body lice Pubic lice 97

Treatment Kill lice eggs Dry-clean clothes Vacuum furniture and rugs 98

Scabies Burrowing parasitic mites Webbing between fingers Creases of wrists, elbows, knees 99

Signs and Symptoms Scabies trail Tiny blisters Reddened skin Intense itching 100

Treatment Prescription strength Shampoos Creams Lotions 101

Skin Injuries Bruises, burns, scars Corns, calluses Decubitus ulcers 102

Bruise Types Subcutaneous: Just under skin Intramuscular: In muscle belly Periosteal: Bone bruise 103

Etiology Trauma Sports injury Motor vehicle accident Surgery 104

Signs and Symptoms Discoloration Swelling Tenderness or pain 105

Massage Considerations Locally contraindicated until bruise is greenish-yellow Relieve pain and increase blood flow 106

Burns First degree Second degree Third degree 107

Etiology Heat and cold Radiation and chemical agents Electricity or friction 108

Signs and Symptoms First degree: Tender, red, swollen Second degree: Redness, blisters, pain Third degree: Skin is white or blackened, but numb Damaged nerve endings 109

Treatment Depends on: Size Degree Source 110

Massage Considerations Avoid affected area until healed Scar mobilization permissible when healed 111

Scars Slide 1 of 2 Left after damaged skin heals Collagen production increases Loss of function 112

Scars Slide 2 of 2 Adhesion: Abnormal binding of multiple layers Hypertrophic scars Keloid scars 113

Treatment and Considerations Altering appearance Topical agents Don’t massage area until healed Clean and dry 114

Stretch Marks Tearing or thinning skin Reduces thickness Result of extreme skin stretching from: Weight gain or loss Pregnancy 115

Signs and Symptoms Start as red or pink Eventually fade to white Different texture than other skin 116

Massage Considerations Lighter pressure on affected area Will not reduce scar tissue 117

Corn and Callus Protective mechanism Corns located on top or sides of toe Calluses found on hands or soles of feet 118

Signs and Symptoms Corn: Glossy core surrounded by thick skin Callus: Thick surface surrounded by flaky skin 119

Treatment Relieve pressure: Wear shoes or gloves Lower elevation: Pumice stone or topical agent 120

Decubitus Ulcer Stages I to IV Extend to: Epidermis or subcutaneous layers Dermis, joints, and bones 121

Etiology Local ischemia from pressure Tissue death 122

Signs and Symptoms Stage I: Redness, feels spongy or firm to touch Stage II: Open sore surrounded by purple skin Stage III: Ulcer penetrates all layers of skin Stage IV: Tissue layers, muscle, joint, bone 123

Treatment Stages I and II: Reposition every 15 minutes Bedridden: Reposition every 2 hours Stages III and IV: Irrigation, débridement 124

Massage Considerations Postpone if ulcer is emitting odor Local: Four-inch radius around ulcer if no odor 125

Skin Cancers Basal cell carcinoma Squamous cell carcinoma Malignant melanoma 126

Basal Cell Carcinoma (BCC) Arises from deepest level of epidermis Rarely metastasizes May recur after treatment 127

Signs, Symptoms, and Treatment Pearly white nodule, central depression Could later ulcerate, causing bleeding Cryosurgery, electrodessication, excision 128

Squamous Cell Carcinoma (SCC) Arises from outer epithelial layer of skin Tumors grow in all directions Occasionally arises from scar tissue Rarely metastasizes 129

Treatment Cryosurgery Electrodesiccation Excision Radiation 130

Malignant Melanoma Forms from melanocytes or melanocytic moles Ultraviolet light exposure Begins as single lesion but metastasizes 131

Treatment Surgical excision Metastatic melanomas Immunotherapy Chemotherapy Radiation 132

Recognizing Abnormal Moles ABCDE Asymmetry Border Color Diameter Evolving 133

Massage Considerations (Slide 1 of 2) Address signs, symptoms, side effects of treatment Avoid any affected areas Surgery Avoid lower extremities and incision until healed 134

Massage Considerations (Slide 2 of 2) Immunotherapy Postpone massage if sick, infection carrier Few or no clients in office area during appointment time, reduce infection risk Chemotherapy Dependent on client response Make client warm and comfortable 135

Skin Pigmentations Underproduction or overproduction of melanin Burns and scars change pigment Tattoo is elective pigmentation 136

Birthmarks Dense collection of melanocytes Moles most common Blue spots, café-au-lait spots, hemangiomas 137

Freckles Tan or brown spots, occur on sun-exposed skin Fade in adult life Seen in fair-skinned individuals 138

Melasma Tan-to-brown spots Seen most often in pregnant women or women taking oral contraceptives 139

Age Spots Flat brown-to-black spots on skin of fair-skinned older individuals Also called solar lentigo, senile lentigo, or liver spots 140

Vitiligo Depigmented skin, irregular patches Milky white Grow larger, spread 141

Albinism Partial or total lack of melanin Pale skin White hair Pale blue or pink eyes 142

Questions? 143