Overview of
Integumentary
Disorders
Disorders of the Nails Disorders
 Clubbing – abnormal curving / increased angle at the
nail bed (often related to O2 deficiency)
 Koilonychia– “spoon nail” = malformation of the nail in
which the outer surface is concaved or scooped out
(often indicates iron deficiency anemia)
 Onychia/Onychitis (onych = fingernail) = inflammation
of the matrix of the nail
 Onychocryptosis (onych = mail, crypt = hidden, osis =
abnormal condition)
NDisorders of the Nails
Continuedil Diseases and Disorders
 Onychomycosis = fungal infection of the nail
(myc= fungus)
 Onychophagia = nail biting (phagia = eating)
 Paronychia – infection of the skin fold at the
margins of a nail (par = along side)
 Subungual hematoma – collection of blood
under a nail
HaiDisorders of the Hairr Diseases
and Disorders
 Hirsutism = excessive hairiness (hirsut = hairy)
 Abnormal Hair Loss
 Alopecia = partial or complete loss of hair (alopec =
baldness)
 alopecia areatea = autoimmune disorder; well defined
bald areas
 alopecia capitis totalis
 alopecia universalis
 Female pattern baldness – hair thins in front and sides
 Male pattern baldness- Horseshoe shape area of hair
remains in the back and temples
Disorders of the Skin
 Acne vulgaris
– Caused by increased secretion of oil related
to increased hormones during puberty
 Albinism
– Inherited disorder in which melanin is not
produced
 Athlete’s foot
– Contagious fungal infection of the foot
Acne Vulgaris
 Description: Self-limiting inflammatory process of the hair
follicle and pilosebaceous glands
 Cause/Incidence: Etiology unknown; predominately during
adolescence
 Manifestations:


Inflammatory acne - pimples, pustule, nodules, and
cysts
Non-inflammatory: open and closed comedones
(blackheads or whiteheads)
 Treatment:
 Drying agents - e.g., Benzoyl peroxide/Retin-A
 Topical antibiotic (clindamycin, erytromycin)
 Systemic antibiotic/Accutane
Disorders of the Integumentary
System (continued)
 Cellulitis
– Bacterial infection of the dermis and subcutaneous
layer of the skin
 Chloasma
– Patchy discoloration of the face
 Cleft lip or cleft palate
– Upper lip has a cleft where the nasal palate doesn’t
meet properly
 Contact dermatitis
– Allergic reaction that may occur after initial contact
or as an acquired response
Cellulitis
 Description: A deep locally diffuse infection of the
skin with systemic manifestations and life-threatening
potential
 Cause/Incidence:




Usually involves face or an extremity.
History of trauma, impetigo, recent otitis media, or
sinusitis
In children less than 3 years, facial cellulitis frequently
is caused by Haemophilus influenza type b.
Cellulitis of extremities is more often associated with S.
aureus and Group a Streptococci.
Cellulitis: Manifestations:




Most children look and
feel ill, often febrile
Pitting edema over
affected area
Classic signs of
inflammation, redness,
swelling, heat and
tenderness/pain
Leucocytosis
Cellulitis
 Management/Treatment:



Systemic antibiotics
Immobilization of affected area
Incision and Drainage with culture
 Nursing Considerations:


warm compresses, elevation
Non-occlusive dressing if skin rear or rupture
Disorders of the Skin (continued)
 Decubitus ulcers
– Sores or areas of inflammation that occur
over bony prominences of the body
 Eczema
– Group of disorders caused by allergic or
irritant reactions
Atopic Dermatitis (Eczema)
 Description-
An inflammatory dermatitis that refers to a
descriptive category of dermatologic disorders. Eczema is
characterized histologically by epidermal changes of intracellular
edema, spongiosis, or vesiculation.
 Cause/Incidence:
Often inherited. Inhaled allergens or
food allergens are thought to induce mast-cell responses.
ECZEMA: MANIFESTATIONS





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Usually symmetrical,
scaly, erythematous
patches or plaques with
possible exudate and
crusting
Pruritus
Unaffected skin dry and
rough.
Chronically, relapsing
course
Immediate skin test
reactivity.
Elevated serum IgE
Atopic Dermatitis (Eczema)
 Management/Treatment
 Burow
solution (aluminum acetate)
compresses.
 Topical Steroids
 Antihistamines to control itching
 Oral antibiotics is widespread breakdown or
infection
 Moderate amount of bathing followed by
application of a lubricating lotion
 Humidified heat in the winter.
Disorders of the Skin (continued)
 Fungal skin infections
– Skin infections that live on dead outer surface or
epidermis
 Furuncle
– Boil, or bacterial infection of a hair follicle
 Impetigo
– Very contagious bacterial skin infection that occurs
most often in children
 Kaposi’s sarcoma
– Form of cancer that originates in blood vessels and
spreads to skin
Impetigo
 Description:
Contagious bacterial skin infection
 Cause/Incidence:
Staphylococcus, streptococcus or a
combination of both. Incubation period is 7-10 days.
 Types:


Impetigo contagiosa (nonbullous)
Bullous Impetigo
Impetigo
 Manifestations:
Small papule that becomes vesicular,
pustular and then forms a honey-colored crust. Usually no
systemic manifestation.
Impetigo
 Management/Treatment



Topical bactericidal ointment.
If no response to topical ointment in 72 hours:
give systemic antibiotics
Good hand washing. Limit person to person
contact.
 Nursing Considerations

Measures to prevent the spread
Disorders of the Integumentary
System (continued)
 Lupus
– Benign dermatitis or chronic systemic disorder
 Psoriasis
– Chronic skin disorder in which too many epidermal
cells are produced. (lesions of psoriasis are plaques –
solid raised area of skin > 0.5 cm in diameter)
 Rashes
– May result from viral infection, especially in children
Disorders of the Integumentary
System (continued)
 Scleroderma
– Rare autoimmune disorder that affects blood
vessels and connective tissues of the skin
 Streptococcus
– Non-motile bacteria that affect many parts of the
body
Carcinoma
Cancerous Tumor
Basal Cell Carcinoma
 Most common
 Least malignant
 Slow growing
 Papules that erode in the center
 Pearly edge
 99% cure rate with early excision
Squamous Cell Carcinoma
 In keratinocytes of stratum spinosum
 Scaly red papule (rounded elevation)
 Rapid growth
 Meets lymph
 Good cure rate if caught early followed by
radiation treatment
Malignant Melanoma




Cancer of melanocytes
Most dangerous, death 1:4 cases
Accounts for 5% of skin cancers
Nevus mole becomes dark, spreads
unevenly, bleeds some
 Metastatic
 Cause: overexposure to UV radiation (sun or
tanning bed)
American Cancer Society ABCD
Rule for Skin Cancer
 A – Asymmetry
 B – Border Irregularity
 C – Colors Different
 D – Diameter (larger than 6 mm –pencil
eraser)
Kaposi’s Sarcoma
 Purple papules spread to lymph nodes and
other organs
 Opportunistic disease of AIDS
Disorders of the Skin (continued)
 Vitiligo
– Condition in which a loss of melanocytes results in whitish
areas of skin bordered by normally pigmented areas
 Warts (Verrucae)
– Papule caused by human papillomavirus
Burns
 Description: injury to skin and possibly
subcutaneous tissue, caused by chemical,
thermal, radiation or electrical causes
 Cause/Incidence: May be accidental or nonaccidental; second leading cause of injury
child < 14
Types of Burns
 Superficial (first degree) – no blisters,
superficial damage to the epidermis (e.g., sun
burned)
 Partial Thickness (second degree) – blisters,
superficial damage to the epidermis
 Full Thickness (third degree) – damage to the
epidermis, corium, and subcutaneous layers
Rule of Nines
Burns: Management
 Skin Care: Promote healing/Prevent infection
 Pain Management
 Fluid Replacement
 High calorie, high carb, high protein diet
 Active/Passive ROM if possible
 Emotional Support
Overview of
Communicable
Disease/Rashes
Scarlet Fever: Manifestations
 Sore throat, chills, fever,
headache (occ. vomiting)
 Erythematous papular rash
on trunk and extremities
(feels like sandpaper)
 Strawberry “white” or “red”
tongue
 Circumoral pallor with
erythema of lips, soles and
palms
Scarlet Fever: Management
 Management/Treatment:

Antibiotics
 Nursing Considerations:
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Bed rest during febrile stage
Analgesics/Antipyretic
Fluids
Prevention of complications and control of
spread of disease
Communicable Diseases:
Scabies
 Description: Contagious skin condition caused by
human mite - Sarcoptes scabiei
 Incidence/Pathophysiology: Transmitted by
close personal contact, Female mite burrow into
outer layer of the epidermis to lay eggs, larvae hatch
in several days and move toward the skin surface,
Mite secretions, ova and feces are highly irritating so
itching begins about 1 mo after infestation
Scabies: Manifestations
 Intense pruritis, esp at rest/
bedtime
 Infants/young child may be
irritable, sleep
fitfully
 Lesions are linear, grayish burrows 1 to 10 cm long
ending in a pinpoint vesicle, papule, or nodules
 Skin excoriation from scratching
Scabies: Management
 Management/Treatment:
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

Scabicida medications crotamiton (Eurax),
permethrin 5% (Elimite), or lindane (Kwell,
Scavene)
Oral antihistamines, soothing creams, lotions
to reduce itching
Antibiotic is secondary infection
 Nursing Considerations:


Pt/family education
Prevent spread: Treat all family/close
contacts, wash clothes/linens
Communicable Diseases:
Varicella
 Description: A viral disease characterized
by a pruritic vesicular rash that appears in
crops
 Cause/Incidence: Varicella-zoster virus,
transmitted by direct contact with vesicular
fluid; Incubation period 14 to 21 days:
Contagious day before rash appears to 1
week after first lesion crusted. Immunity from
vaccination or disease
Varicella: Manifestations
 Prodromal: mild fever
and malaise for 24 hrs
 Acute: Rash that
progresses from macule
to vesicle to crusts;
eruptions last 5 days
and lesions of all types
are present at once
Varicella: Management
 Management/Treatment:
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
Varicella immunoglobulin for
immunocompromised pt within 72 to 96 hrs
Antipruritic lotions
 Nursing Considerations:
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Avoid Aspirin (assoc with Reyes)
Prevent spread of infection
Mitten hands if necessary
Prevention: Vaccine
Communicable Diseases:
Rubeola (“Red” Measles)
 Description:

Highly contagious, acute viral infection
characterized by fever, cough, coryza,
conjunctivitis, maculopapular skin rash and
Koplik’s spots
 Cause/Incidence: Viral etiology; 7 to 14 day
incubation, Communicable several days before rash
appears to 5 days after rash; Immunity = vaccination
or disease
Rubeola: Manifestations
 Prodomal: fever,
lethargy, cough, coryza,
photophobia, Koplik’s
spots on buccal mucosa
 Acute: red, flat rash
(lasting about a wk)
begins behind ears,
spreads to face, trunk,
and extremities
Rubeola: Management
 Management/Treatment:

Symptomatic
 Nursing Considerations:

Monitor for complications - bacterial superinfections, pneumonia, otitis media,
encephalitis
Communicable Diseases:
Rubella (German Measles)
 Description:
 Mild disease characterized by
erythematous maculopapular discrete
rash; postauricular and suboccipital
lymphandenopathy
 Cause/Incidence:RNA virus classified as
rubivirus, transmitted by direct contact with
nasopharyngeal secretions. Incubation - 14 to
21 days; Communicable 1 wk before and 5
days after onset of rash. Immunity=disease or
vaccination
Rubella (German Measles):
Continued
 Manifestations:

Prodromal: low grade fever, headache, sore throat
and cough

Acute: Flat rash begins on face and spreads to
body; lasts 3 days
 Management/Treatment:



Antipyretics/symptomatic
Complications: rare
Prevent spread of infection
Communicable Diseases:
Mumps (Parotitis)
 Description: Viral, communicable disease
characterized by swelling of the parotid
glands
 Cause/Incidence: Mumps virus;
Transmission: droplet or direct contact;
Incubation 14 to 21 days; Communicability:1
week before parotoid swelling until 1 week
after swelling begins
 Immunity: from disease or vaccination
Mumps: Manifestations
 Prodromal: fever,
headache, earache that
worsens with chewing
 Acute: Swelling of
parotid glands
Mumps: Management
 Management/Treatment:


antipyretics
fluids and soft diet
 Nursing Considerations:
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
Monitor for complications: Orchitis,
encephalitis, deafness
Prevent spread
Prevention: vaccination
Communicable Diseases: Roseola
(exanthema subitum)
 Description:

mild, viral disease
 Cause/Incidence:


caused by herpes virus type 6 (HHV-6)
common 6 mos to 2 yrs
Roseola: Continued
 Manifestations:
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
Starts with high fever > 103 and irritability lasting 23 days
Followed by rosy pink rash develops - first on trunk
then to neck, face, & extremities
 Cause/Incidence:
 Control fever (febrile seizures common)
 Fluids
Fifth Disease - erythema infectiosum
 Description: A communicable disease of
childhood that causes a rash
 Cause/Incidence: Etiology unknown;
possibly spread thru resp tract; most
contagious 1 week before rash appears.
Once rash appears no longer contagious
 Risk to developing fetus and to immunosuppressed children
 Treatment: supportive
 Complications rare: self-limiting arthritis or
arthragia, encephalitis, or myocarditis
Fifth Disease: Manifestations
 Red rash on face that
looks like “slapped
cheeks”
 Lacy pink rash on the
backs of the arms and
legs, torso, and buttock
Stevens-Johnson Syndrome
 Description: an acute cutaneous disorder, severe
form of erythema multiforme
 Cause/Incidence: Possible hypersensitivity to
certain drugs; secondary to resp infection
 Management:



Identification and elimination of underlying
cause (Antibiotic if necessary)
Prevention of secondary infection
Pain relief
Stevens-Johnson Syndrome:
Manifestations
 Fever, malaise, cough, sore
throat, diarrhea, vomiting,
chest pain, myalgia
 Bulla with a grayish-white
membrane on the mucous
membranes of the lips, eyes,
oral/nasal mucosa, genitalia,
and rectum
 Extensive skin lesions
Fungal Infections
 Descriptions: Superficial infections that live on the
skin and not “in” the skin.
 Cause/Incidence:


Fungi grow best in warm, moist places
Causative fungi are usually opportunistic and
not usually pathogenic unless they enter a
compromised host
Fungal Infections: Tinea Pedis
 Description: - fungal infection of the foot
(Althelete’s foot )
 Cause/Incidence: Most common fungal infection.
Caused by species of the genera Microsporum and
Trichophyton. Transmitted by direct contact with skin
containing fungi, and fungi in damp areas
Tinea Pedis: Continued
 Manifestations: Interdigital lesions (fissures);
Vesicles/erosions on instep, Pruritus, Diffuse scaling
 Management:
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
Miconazole, clortrimazole, or haloprogin
Burrow solution compresses
 Nursing Considerations:



Teach foot hygiene
Observe for secondary infection
Prevent transmission
Fungal Infections: Ringworm (Tinea
Capitis or Tinea Corporis)
 Description:
A fungal infection of the scalp or body
 Cause/Incidence:
Microsporum and Trichophyton;
transmitted by direct contact
 Management:




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Oral grisofulvin
Selenium Sulfate shampoo to reduce fungi on hair
Topical antifungal agents - e.g.,Miconazole
Antihistamine for itching
Prevention of secondary infection
Education regarding transmission
Ringworm: Manifestations
 One or more irregular,
erythematous, slightly
raised, scaly patches
 Lesions tend to spread
but central clearing
occurs resulting in “ring”
 Pruritus
Fungal Infections: Candida
 Description: A yeast infection that occurs in the
mouth, esp in infants
 Cause/Incidence: may be acquired in newborns
from maternal vaginal infection or transmitted by poor
hygiene
 Manifestations: Oral thrush = white plaques on
the mucous membrane; Diaper Dermatitis- char by
“beefy” red erythematous areas with surrounding
papules and pustules
 Management: Nystatin; no isolation required