Integumentary system Objectives Introduction of the Integumentary system

Integumentary system

Objectives Introduction of the Integumentary system. Anatomy and physiology of the skin. Causes of the skin disorders. Common disorders with their signs and symptoms. Diagnostic findings. Nursing Diagnosis Management References

Definitions Disease- an abnormal condition of the body or the mind that causes dysfunction or discomfort. Disorder- a functional abnormality, or disturbance. Condition- a state of being, in health, a disease, such as a heart condition.

Prevalence The prevalence of skin disease in India is 10 to 12 percent of the total population with Eczema and Psoriasis being the major contributors. Due to pollution, ultraviolet light, and global warming, photosensitive skin disorders like pigment darkening, sunburn, skin cancers, and infectious diseases are increasing at a faster pace. A one percent reduction in ozone leads to a two to four percent increase in the incidence of tumors.

According to Ankit Goyal, Program Manager, Healthcare Practice, Frost & Sullivan, "The ecosystem for skin care treatment is witnessing a great change in demand patterns. Gone are the days, when skin care was limited to treatment of common skin diseases. The emergence of cosmetic and anti-aging treatments has changed the face of the skin care industry. The number of these cosmetic procedures is expected reach 18 to 20 lakh by 2015 in India.

In 2013, with prevalence rate of 10 percent, the population affected across India from skin disease is estimated at nearly 15. 1 crore. It is estimated that at a CAGR of 12 percent about 18. 8 crore people is likely to suffer from skin disease by 2015". At present, there about 6, 000 dermatologists catering to a population of over 121 crore. This means that for every 100, 000 people, only 0. 49 dermatologists are available in India as compared to 3. 2 in many states of the US. "

Structure and Function Integumentary system is composed of the skin and accessory structures Copyright 2003 by Mosby, Inc. All rights reserved.

Skin The largest organ of the body Varies in thickness from 1/50 inch (0. 5 mm) in the eyelids to 1/4 inch (6. 3 mm) in the soles of the feet Changes in the skin often indicate the presence of other body system disorders including anemia, respiratory disorders, liver disorders, cancer, and shock Copyright 2003 by Mosby, Inc. All rights reserved.

Skin Structures Copyright 2003 by Mosby, Inc. All rights reserved.

Layers of Skin Epidermis ◦ Outermost layer of the skin that is composed of a surface of dead cells with an underlying layer of living cells Dermis ◦ Called the “true” skin; the dermis contains the blood vessels and nerves Copyright 2003 by Mosby, Inc. All rights reserved.

Hair and Hair Follicles Skin has hair in all areas except the soles of the feet and palms of the hands Hair serves to block foreign particles from entering the body through structures such as the nose and eyes The visible portion is called the shaft The hair follicle is the root with its covering Copyright 2003 by Mosby, Inc. All rights reserved.

Glands Three types of glands in the skin ◦ Sebaceous glands (oil) ◦ Sudoriferous glands (sweat) ◦ Ceruminous glands Function is to help regulate the body temperature and excrete body wastes Copyright 2003 by Mosby, Inc. All rights reserved.

Functions of the SKIN ◦ ◦ ◦ Protects the other body systems from injury and infection Sensation Fluid Balance Temperature regulation Vitamin Production (D)

CAUSES Bacterial infection Viral infection Fungal infection Skin to skin contact Cosmetics

“Disorders, Conditions, and Diseases”

Psoriasis is a long-lasting autoimmune disease characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly. They may vary in severity from small and localized to complete body coverage. Psoriasis is estimated to affect 2– 4% of the population of the western world Causes: Genetic Life style Microbes eg. Candida albicans Hiv Medications eg. beta blockers, , NSAIDS

Clinical menifestations: Psoriatic arthritis eg. Hips, knees, spine (spondylitis), and sacroiliac joint Nail changes Pustular psoriasis appears as raised bumps filled with noninfectious pus. Other skin lesion Diagnosis: Skin biopsy or scraping may be performed to rule out other disorders and to confirm the diagnosis. Management: Topical agents eg. mineral oil, petroleum jelly, calcipotriol Phototherapy Systemic agents Surgery: removal of the tonsils may benefit people with chronic plaque psoriasis, guttate psoriasis, and palmoplantar pustulosis

Acne vulgaris Acne vulgaris (or simply acne) is a long-term skin disease that occurs when hair follicles become clogged with dead skin cells andoil from the skin. Acne vulgaris is a common skin disease that affects 85 -100% of people at some time during their lives. Acne is characterized by areas of blackheads, whiteheads, pimples, and greasy skin, and may result in scarring. The resulting appearance can lead to anxiety, reduced self-esteem and, in extreme cases, depression or thoughts of suicide Causes: Genetic Harmonal Infectious Diet Smoking Psychosocial

Signs And symptoms Typical features of acne include seborrhea (increased oil secretion), microcomedones, papules, pustules, nodules (large papules), and in many cases scarring. The appearance of acne varies with skin color. It may result in psychological and social problems. Management: Diet Medications eg. Benzoyl peroxide, retinoids, antibiotics

Eczema Dermatitis, also known as eczema, is inflammation of the skin. It is characterized by itchy, erythematous, vesicular, weeping, and crusting patches. The term eczema is also commonly used to describe atopic dermatitis also known as atopic eczema. Causes: Are unclear Signs and symptoms: Dermatitis symptoms include itching, stinging and a burning sensation. Papules and vesicles are commonly present. The small red bumps experienced in this type of dermatitis are usually about 1 cm in size, red in color and may be found symmetrically grouped or distributed on the upper or lower back, buttocks, elbows, knees, neck, shoulders, and scalp.

Diagnosis: History and physical examination. skin biopsy may be useful Management: There is no known cure for eczema, with treatment aiming to control symptoms by reducing inflammation and relieving itching. Moisturizers Medications eg. Carticosteroids Light therapy

Contact Dermatitis The word "dermatitis" means inflammation of the skin. It results from exposure to allergens (allergic contact dermatitis) or irritants (irritant contact dermatitis). Phototoxic dermatitis occurs when the allergen or irritant is activated by sunlight. Causes: ◦ Irritant contact dermatitis ◦ Allergic ◦ Photoxic Signs and symptoms: Red rash, blisters, Itchy, burning skin

Diagnosis: patch tests one of various methods commonly known as allergy testing. Management: Self care Medications eg-histamine, corticosteroids

Tinea Pedis- Athletes’ Foot Athlete's foot (also known as ringworm of the foot, tinea pedum, and moccasin foot) is a common and contagious skin disease that causes itching, scaling, flaking, and sometimes blistering of the affected areas. Its medical name is tinea pedis, a member of the group of diseases or conditions known as tinea, most of which are dermatophytoses (fungal infections of the skin, hair, or nails). Causes: It can caused by fungi Trichophyton rubrum or T. mentagrophytes, but may also be caused by Epidermophyton floccosum. Transmission : (direct or indirect)

Diagnosis: Athlete's foot can usually be diagnosed by visual inspection of the skin and by identifying less obvious symptoms such as itching of the affected area. If the diagnosis is uncertain, direct microscopy of a potassium hydroxide preparation of a skin scraping (known as a KOH test) can confirm the diagnosis of athlete's foot and help rule out other possible causes, such as candidiasis, pitted keratolysis, erythrasma, contact dermatitis, eczema, or psoriasis. A Wood's lamp (black light), although useful in diagnosing fungal infections of the scalp. Treatment: Topical eg. miconazole nitrate, clotrimazole, tolnaftate Oral eg. Terbinafine, Fluconazole or itraconazole

Urticaria (from the Latin urtica, "nettle" from urere, "to burn"), commonly referred to as hives, is a kind of skin rash notable for pale red, raised, itchy bumps. Hives may cause a burning or stinging sensation. Causes: Drug induced: Due to codeine, dextroamphetamine, aspirin, ibuprofen, penicillin, Infection or environmental agent Food Excersice Management: The mainstay of therapy for both acute and chronic urticaria is patient education, avoiding triggers, and antihistamines.

Impetigo is a contagious bacterial skin infection most common among preschool children. People who play close contact sports, such as wrestling are also susceptible, regardless of age. It is also known as school sores. Causes: It is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes The infection is spread by direct contact with lesions or with nasal carriers. The incubation period is 1– 3 days after exposure to. Streptococcus and 4– 10 days for Staphylococcus.

Diagnosis: Impetigo is usually diagnosed based on its appearance. It generally appears as honey-colored scabs formed from dried serum, and is often found on the arms, legs, or face. Treatment: The disease was treated with an application of the antiseptic gentian violet. Today, topical or oral antibiotics are usually prescribed. Mild cases may be treated with bactericidal ointment, such as mupirocin. Severe cases require oral antibiotics, such as dicloxacillin, flucloxacillin, or erythromycin. Alternatively, amoxicillin combined with clavulanate potassium, cephalosporins (first-generation) and many others may also be used as an antibiotic treatment.

Carbuncles A skin abscess, a collection of pus that forms inside the body. It is usually caused by bacterial infection, most commonly with Staphylococcus aureus or Streptococcus pyogenes, which can turn lethal. Causes: The initial cause of a carbuncle can often not be determined. Triggers that make carbuncle infections more likely include rashes such as folliculitis; friction from clothing or shaving; having hair pulled out, such as sites where clothing or furniture grab at hairs; generally poor hygiene; poor nutrition; or weakening of immunity. Poor nutrition may be an important factor – for example, persons with diabetes and immune system diseases are more likely to develop infections

Signs and symptoms: The carbuncle may be the size of a pea or as large as a golf ball. It may be red and irritated, and might hurt when touched. It may also grow very fast and have a white or yellow center. It may crust or spread to other skin areas. Sometimes other symptoms may occur, such as fatigue, fever and a general discomfort or sick feeling. Itching may occur before the carbuncle develops. Treatment: Antibiotics is useful.

Ringworm is not, as its name suggests, caused by a worm. Characterized by round lesions (rings) and early belief that the infection was caused by a parasite (worm), the term ringworm was born. Causes: Fungi thrive in moist, warm areas, such as locker rooms, tanning beds, swimming pools, and skin folds. Symptoms: Red, scaly, itchy or raised patches Patches may be redder on outside edges or resembles a ring Patches that begins to ooze or develop blister Bald patches may develop, when the scalp is affected On nail it may be thicker discolored or begin to crac

Treatment Antifungal treatments include topical agents such as miconazole, terbinafine, clotrimazole, ketoconazole, or tolnaftate applied twice daily until symptoms resolve — usually within one or two weeks. Topical treatments should then be continued for a further 7 days after resolution of visible symptoms to prevent recurrence. In severe cases or scalp ringworm, systemic treatment with oral medications may be given.

Warts A wart is a small, rough growth resembling a cauliflower or a solid blister. caused by human papillomavirus(HPV) infection. Causes: Warts are caused by the human papilloma virus (HPV). There about 130 known types of human papilloma viruses. Common warts – HPV types 2 and 4 (most common); also types 1, 3, 26, 29, and 57 and others. It typically occurs on humans' hands or feet but often in other locations

References Text book of medical surgical Nursing Brunner & Siddarth’s 11 th edition Walter Kluwer Publication Page no. 1922 -2039 Lewis’s Medical Surgical Nursing assessment and management of clinical problems, Elesvier publication Page No. 446 -504 Textbook of Anatomy Ross and willson www. haspi. org www. wikipedia/wiki/integumentrysysyem https: //en. wikipedia. org/wiki/psoriasis https: //en. wikipedia. org/wiki/Gangrene

https: //en. wikipedia. org/wiki/Acne https: //en. wikipedia. org/wiki/Dermatitis https: //en. wikipedia. org/wiki/Atheletefoot http: //www. biospectrumindia. com/biospecindia/ne ws/214117/around-19 -crore-indians-suffer-skindiseases-2015 -frostsullivan#sthash. lqi 1 s. Mv. C. dpuf