Integumentary diseases

• Recommendations for good skin care


  • Avoiding environmental hazards
  • Adequate hygiene (handwashing) and good nutrition (800-2400 mL fluids)
  • Skin self-examination
  • Periodical professional exams for areas difficult to see (Dermatologist)
• Environmental hazard


  Sun exposure
• Types of ultraviolet (UV) rays


  • UVA: Tanning
  • UVB: Sunburn
• Ways sun exposure can damage the body


  • High altitude
  • Snow (reflection) 80% reflective
  • Tanning booths
• Recommended SPF level for sun safety

  92% block of 15 SPF
• Frequency of sunscreen reapplication

  Every 2 hours
• Other environmental hazards


  • Irritants and allergens (ex. jewelry, lotions, detergents)
  • Radiation (ex. x-rays)
  • Sleep
  • Exercise
  • Hygiene (ex. Soaps and perfumes)
  • Nutrition (ex. Vitamins A, D, C, and B complex & proteins)
• Type of hypersensitivity associated with irritants and allergens

  Type IV
• Importance of proteins for nutrition involving environmental hazards


  Protein's function is to repair for body
• Types of nonmelanoma skin cancers


  • Actinic Keratosis
  • Basal Cell Carcinoma
  • Squamous cell carcinoma
  • Dysplastic Nevus
• Actinic keratosis


  • Main Cause: Overexposure to the sun
  • Premalignant skin lesions; can turn malignant, one must monitor
• Basal Cell Carcinoma


  • Most common type of skin cancer
  • Least deadly
• Squamous cell carcinoma


  • More aggressive than basal cell carcinoma
  • Potential to metastasize
  • Commonly found around borders of lips from pipe, cigar, and cigarette smoking
  • Overuse of steroids; Immunosuppression leads to a dramatic increase in the incidence
• Dysplastic Nevus


  • Atypical skin commonly known as moles
  • The majority have irregular borders & more than 5 mm; a Variety of colors
• Physical traits at higher risk of skin cancers


  • Blonde
  • Blue Eyes
  • Fair skin
• Malignant melanoma


  • Aggressive and spread
  • Darker and irregular in shape
• Causes of malignant melanoma


  • Environmental factors (Overexposure to the Sun)
  • Genetics
• Risk factors for malignant melanomas


  • Red or blonde hair
  • Light-colored eyes
  • Fair skin that freckles
  • Chronic Skin exposure
  • Family history
• ABCDE Rule


  • To determine changes in malignant skin site
  • Asymmetry
  • Border irregularity
  • Color change
  • Diameter 6 mm <
  • Evolving in appearance (size, color, shape, texture)
• Procedure to determine if it is malignant or not

  Incisional Biopsy
• Alternatives to an incisional biopsy to track a malignant melanoma


  • MelaFind: magnify and measure
  • Tumor thickness:
  • Breslow measurement: how progressed
  • Clark Level: most frequent
• Clark's levels


  Staging measures the invasion of a melanoma from the dermis to the subcutaneous tissue
• Deepest Clark's level


  Subcutaneous tissue
• Interprofessional care


  Different departments work together for optimal care of the patient (Ex. Surgery, Pharmacy, & PT)
• Factors determining treatment


  • Site of the original tumor
  • Stage of the cancer
  • Patient's age and general health
  • Wide surgical incision
  • Adjuvant therapy
  • Patient's wishes
• Tumor staging evaluation


  Tumor size, nodal, involvement, and metastasis
• Levels of tumor staging

  • 4
• Types of therapy used in interprofessional care


  • Immunotherapy: more than 1 is used (cytokines, PD-1 inhibitors, CTLA-4 inhibitors)
  • Targeted Therapy: BRAF and MEK inhibitors
• Difference between immunotherapy and target therapy


  Targeted therapy is aiming for the tumor site while immunotherapy is trying to destroy the cancer naturally
• Populations at highest risk for skin cancer

  • A 32-year-old who uses a tanning booth twice a week
• Skin infections and infestations


  • Bacterial infections (ex. Staph MRSA)
  • Viral infections (ex. Fever blister, Herpes Zoster)
  • Infestations and insect bites
  • Fungal infections (Golden crusted honey look)
• Herpes Zoster


  The patient had chicken pox and it resurfaced as shingles by reactivation of varicella-zoster
• Populations most common for Herpes zoster


  • Adults over 60
  • Patients with Hodgkin's disease
  • Types of leukemia
  • Lymphomas
  • Immunocompromised (Stress)
• Populations that need to avoid people who have herpes zoster


  • Pregnant Women
  • Immunocompromised
• Complications of herpes zoster


  • Postherpetic neuralgia: pain and nerve following
  • Visual loss: ocular nerves
  • Death may occur in immunocompromised patient
• Location of postherpetic neuralgia


  Ribs and unilateral
• Common signs/symptoms of shingles


  • Burning pain
  • Sensitivity to light
  • Tingling
  • Headache
  • Itching
  • Fatigue
• Herpes simplex (HSV I)


  Viral infection
• Difference between HSV I and HSV II


  • HSV II requires different treatment
  • HSV I: Oral Herpes (cold sores)
  • HSV II: Genital Herpes
• Causes and transmission of HSV


  • Causes: Viral infection orally or sexually
  • Transmission: Droplet (saliva, mucous, sex fluids)