Viral Skin Infection: Herpes Zoster, Herpes Simplex, Fungal Infection, Dermatitis Contact, Skin Neoplasm, Ulceration KusmanIbrahim,

Ph.D DEPARTEMENT OF CLINICAL NURSING FACULTY OF NURSING UNIVERSITAS PADJADJARAN logounpad

VIRAL SKIN INFECTION Herpes Zoster(Shingles) .HZ is a common, predominantly dermal, and neurologic disorder caused by the varicella-zoster virus (VZV), a virus morphologically and antigenicallyidentical to the virus causing varicella(chickenpox) .The disease is characterized by a painful vesicular eruption along the area of distribution of the sensory nerves from one or more posterior ganglia. It is assumed that herpes zoster represents a reactivation of latent varicellavirus infection and reflects lowered immunity

VIRAL SKIN INFECTION Incidence and Mortality/Morbidity .About 10% of adults get shingles during their lifetimes, usually after age 50 years. There is an increased frequency of herpes zoster infections among patients with weakened immune systems and cancers, especially leukemiasand lymphomas (Odom et al., 2000) .Internationally, the incidence of zoster has not been well studied, but probably it is in the same range of 2-3 cases per 1000 persons per year .Zoster is rarely, if ever, fatal, although in individuals who are severely debilitated, zoster may be considered a contributing factor to death.

VIRAL SKIN INFECTION Incidence and Mortality/Morbidity .Morbidity usually is confined to pain within the affected dermatome, which can be severe and can persist well beyond the duration of active disease (postherpeticneuralgia [PHN]). Eye involvement (zoster ophthalmicus) can cause temporarily or permanently decreased visual acuity or blindness. .Almost 50% of individuals who live beyond age 80 years can expect to develop zoster. Zoster is rare in children and young adults, with the exception of younger patients with AIDS, lymphoma, other malignancies, and other immune deficiencies, and patients who are recipients of bone marrow and kidney transplants

VIRAL SKIN INFECTION Clinical Manifestation .The eruption is usually accompanied or preceded by pain, which may radiate over the entire region supplied by the affected nerves. .The pain may be burning, lancinating(ie, tearing or sharply cutting), stabbing, or aching. .Itching and tenderness may occur over the area .Malaise and gastrointestinal disturbances precede the eruption who are recipients of bone marrow and kidney transplants

VIRAL SKIN INFECTION Clinical Manifestation .The patches of grouped vesicles appear on the red and swollen skin. .The early vesicles, which contain serum, later may become purulent, rupture, and form crusts. The inflammation is usually unilateral, involving the thoracic, cervical, or cranial nerves in a bandlikeconfiguration. .The blisters are usually confined to a narrow region of the face or trunk (Fig. 56-2). .The clinical course varies from 1 to 3 weeks. If an ophthalmic nerve is involved, the patient may have eye pain. Inflammation and a rash on the trunk may cause pain with the slightest touch. The healing time varies from 7 to 26 days.

VIRAL SKIN INFECTION Medical Management .The goals of herpes zoster management are to relieve the pain and to reduce or avoid complications, which include infection, scarring, and postherpeticneuralgia and eye complications. .Analgesics .Corticosteroids .Antiviral agents such as acyclovir (Zovirax), valacyclovir(Valtrex), or famcicl ovir(Famvir) are administered within 24 hours of the initial .Ophthalmic herpes zoster .ophthalmic emergency, refer to an ophthalmologist immediately to prevent the possible sequelaeof keratitis, uveitis, ulceration, and blindness

VIRAL SKIN INFECTION Nursing Management .The nurse assesses the patient s discomfort and response to medication and collaborates with the physician to make necessary adjustments to the treatment regimen. .The patient is taught how to apply wet dressings or medication to the lesions and to follow proper hand hygiene techniques to avoid spreading the virus .Diversionary activities and relaxation techniques are encouraged to ensure restful sleep and to alleviate discomfort. .Help with dressing changes and food preparation for patients who cannot care for themselves or prepare nourishing meals.

Typical zoster in the vicinity of right popliteal... Suspected zoster of the hand. Typical zoster in the vicinity of right popliteal fossa in a vertebral nerve L4 distribution Suspected zoster of the hand Herpes zoster ophthalmicus(HZO)

VIRAL SKIN INFECTION Herpes Simplex .Two types of the causative virus, which are identified by viral typing. .Type 1 (orolabial) occurs on the mouth and type 2 in the genital area .About 85% of adults worldwide are seropositivefor .herpes type 1. The prevalence of type 2 is lower; type 2 usually appears at the onset of sexual activity. .Herpes simplex is classified as a true primary (the initial exposure to the virus), a nonprimaryinitial episode (the initial episode of type 1 or type 2 in a person previously infected with the other type), recurrent episodes (subsequent episodes of the same viral type)

VIRAL SKIN INFECTION Orolabial Herpes .= fever blisters or cold sores, consists of erythematousbased clusters of grouped vesicles on the lips. .Tingling or burning with pain may precede the appearance of the vesicles by up to 24 hours. .Sunlight exposure or increased stress, may cause recurrent episodes. .The onset is often accompanied by high fever, regional lymphadenopathy, and generalized malaise. .Another complication of orolabialherpes is the development of erythemamultiforme, an acute inflammation of the skin and mucous membranes with characteristic lesions that .have the appearance of targets.

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VIRAL SKIN INFECTION Genital Herpes .Manifests with a broad spectrum of clinical signs. Minor infections may produce no symptoms at all; severe primary infections with type 1 can cause systemic flulike illness. .Lesions appear as grouped vesicles on an erythematousbase initially involving t he vagina, rectum, or penis. .New lesions can continue to appear for 7 to 14 days. .Fever and flulike symptoms are common. Typical recurrences begin with a prodromeof burning, tingling, or itching about 24 hours before the vesicles appear. As the vesicles rupture, erosions and ulcerations begin to appear. Severe infections can cause extensive erosions of the vaginal or anal canal

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VIRAL SKIN INFECTION Diagnostics .Viral cultures and rapid assays .In all cases, it is imperative to obtain enough viral cells for testing, and careful collection methods are therefore important. All crusts should be gently removed or vesicles gently unroofed. A sterile cotton swab premoistenedin viral culture preservative is used to swab the base of the vesicle to obtain a specimen for analysis

VIRAL SKIN INFECTION Complication .Eczema herpeticum .The same type of spread of herpes can occur in severe seborrhea, scabies, and other chronic skin conditions. .Herpes Whitlow is an infection of the pulp of a fingertip with herpes type 1 or 2. .Most cases of neonatal infection with herpes occur during delivery by contact of the infant with the mother s active ulcerations. .Rarely, in mothers who have primary infections during pregnancy, intrauterine neonatal infections occur. Fetal anomalies include skin lesions, microcephaly, encephalitis, and intracerebralcalcifications.

VIRAL SKIN INFECTION Medical and Nursing Management .Use a sunscreen liberally on the lips and face .Topical treatment with drying agents may accelerate healing. .Acyclovir .Treatment of genital herpes depends on the severity, the frequency, and the psychological impact of recurrences and on the infectious status of the sexual partner .Patients who have more than six recurrences per year may .benefit from suppressive therapy. Use of acyclovir, alacyclovir, or famciclovirsuppresses 85% of recurrences, and 20% of patients are free of recurrences during suppressive therapy

FUNGAL (MYCOTIC) INFECTIONS Tinea .= ringworm because of its characteristic appearance of ring or rounded tunnel under the skin. .Tineainfections affect the head, body, groin, feet, and nails .Tineapedis(ie, athlete s foot) is the most common fungal infection. It is especially prevalent in those who use communal showers or swimming pools .Tineacorporis(ie, ringworm of the body), the typical ringed lesion appears on the face, neck, trunk, and extremities .Tineacapitis: ringworm of the scalp is a contagious fungal infection of the hair shafts and a common cause of hair loss in children

FUNGAL (MYCOTIC) INFECTIONS Tinea .Tineacruris(ie, jock itch) is ringworm infection of the groin, which may extend to the inner thighs and buttock area. It occurs most frequently in young joggers, obese people, and those who wear tight underclothing. The incidence of tineacrurisis increased amo ng people with diabetes .Tineaunguium(ie, ringworm of the nails) is a chronic fungal infection of the toenails or, less commonly, the fingernails. It is usually caused by Trichophytonspecies (T. rubrum, T. mentagrophytes) or Candida albicans. It is usually associated with long-standing fungal infection of the feet. The nails become thickened, friable (ie, easily crumbled), and lusterless. In time, debris accumulates under the free edge of the nail. Ultimately, the nail plate separate

FUNGAL (MYCOTIC) INFECTIONS Management .During the acute, vesicular phase, soaks of Burow ssolution or potassium permanganate solutions are used to remove the crusts, scales, and debris and to reduce the inflammation. .Topical antifungal agents (eg, miconazole, clotrimazole) are applied to the infected areas. Topical therapy is continued for several weeks because of the high rate of recurrence .Oral antifungal agents are used only in extensive cases. Side effects of oral antifungal agents include hotosensitivity, skin rashes, headache, and nausea .Personal and enviromentalhygiene

Tineacorporis(ringworm) of the face http://t0.gstatic.com/images?q=tbn:ANd9GcQEFG15vbbDbFrVVzalTUMmFQo39pSOKRNFGkfNe m65yVFM0Dk&t=1&usg=__4wvgbivrjnxXTmH8EFuXb-WLs5c= Tineapedis http://t0.gstatic.com/images?q=tbn:ANd9GcRtNH0ByuX9nLCLJUzJ_aub9bTIvLeK1ifTEH0lt wpEwAvZ9lw&t=1&usg=__IetxTeOqNDmArkCFL1T7VdAiE68= http://t2.gstatic.com/images?q=tbn:ANd9GcQ6BK8TC-RXnIEYUUCXBJtVDVtTA5OP5dVqMApX5 -wqKmo4NYs&t=1&h=155&w=240&usg=__85DCtp0qrIwFq1tzY8M_L0GDyZg= Tineaunguium

DERMATITIS KONTAK Peradangan pd kulit, merupakan reaksi imunologis yaitu hipersensitifitas tipe lambat akibat kontak dengan bahan yang merangsang respon imun pd kulitPenyebab: Zat iritan (mekanik, kimia, biologis, asam, alkali) Alergen (tumbuhan, kosmetik, nikel, dll) Tanda dan Gejala: Erytema, edema lokal, vesikel, kulit mengeras, bersisik, gatalTerapi: Basah .kompres PK 1 : 10.000 Kering .steroid topikal Antibiotik, antihistamin, kortikosteroid

contact allergic dermatitis contact dermatitis Contact dermatitis due to cosmetic sensitivity (left) and plants (right)

contact dermatitis contact dermatitis Hand dermatitis from sticking plaster (left) and shoes (right).

Intervensi keperawatan .Bantu klien dalam melakukan perawatan luka .kompres, ganti balutan,terapi topikal .Beri penjelasan tentang terapi oral/topikal tsb untuk mengurangi rasa gatal, ikuti sesuai program pengobatanPendidikan Kesehatan: .Hindari kulit terlalu kering (tdk menggunakan sabun yang keras/deterjen, berendam dlm air, menggunakan krem steroid langsung setelah mandi) .Menggunakan sarung tangan ketika menyentuh benda iritas atau allergen .Hindari kain wool, nylon, bulu binatang .untuk kulit yg sensitif .Hindari pengobatan sendiri yg bisa memperburuk keadaan .Bantu klien dalam memecahkan masalah, berikan kesempatan klien untuk mengekspresikan perasaannya

TUMOR KULIT (SKIN NEOPLASM) KISTASuatu nodul yg berisi cairan atau material semisolit, berbatas tegas, tubuh dan menempel pada jaringan dibawahnya, sebagian kista terletak pd epidermal, tumbuh spontan dan asymptomatik, lokasi pertumbuhan bisa dimana saja (seluruh tubuh) .kepala & badan, terapi; excisi (jarang) KELOIDPertumbuhan yg berlebihan dari scar (jaringan sikatrik) akibat penumpukan kollagen dan jaringan yg masih hidup setelah trauma. terapi; kombinasi pembedahan + injeksi steroid atau dosis rendah radiotherapi NEVUSSel-sel pigmen yg membentuk neoplasma jinak, dpt kongenital atau didapat (usia 1-35 th). nevus normal berbentuk teratur, batas tegas, warna seragam. 50% nevus bisa berubah melanoma maligna

KANKER KULIT (SKIN CANCER) PENYEBAB: Faktor instrinsik .dari sel Faktor extrinsik .pengaruh lingkungan thd sel (sinar matahari dg pj gel 290-320 nm, radiasi sinar x, gamma, kimia arsen, hidrokarbon, trauma jar. baru yg sering teriritasi)

KARSINOMA SEL BASAL PREDISPOSISI: -PAPARAN SINAR MATAHARI YG BERLEBIHAN -SINAR RONTGEN/RADIOAKTIF -JARINGAN PARUT -BAHAN-BAHAN KIMIA -PERADANGAN KRONIS -KELAINAN GENETIK -IMUNOSUPRESIF TANDA: PAPUL/NODUL SEPERTI LILIN, BAGIAN TENGAH CEKUNG ATAU TIMBUL ULKUS (ULKUS RODENS) BERBATAS TEGAS, DASAR IRREGULER, MERUSAK SUBKUTIS, FASCIA, OTOT DAN TULANG, JARANG DAN TDK BERMETASTASE TERAPI; EXCISI TOTAL, KRIOSURGERY, ELEKTRODESICCATION, ELEKTROCOAGULASI Example of Basal Cell Carcinoma mssvbcc2 massivbcc

KARSINOMA SEL SKUAMOSA TERJADI PD KULIT/MUKOSA BEREPITEL GEPENG, DAPAT BERMETASTASE KE KGB DAN ORGAN LAIN PENYEBAB; IRITASI KRONIS SINAR MATAHARI, BAHAN-BAHAN KIMIA, SINAR X, GAMMA, JAR.PARUT KRONIS TANDA; ULKUS LAMA TDK SEMBUH, MAKIN MELUAS, PERABUAN KERAS, MUDAH BERDARAH, MENONJOL DIATAS PERM. KULIT, PERM. TDK RATA, SEPERTI KEMBANG KOL. TERAPI; PEMBEDAHAN + KEMOTERAPI (SITOSTATIKA) Example of Squamous Cell Carcinoma

MELANOMA MALIGNAPALING BERBAHAYA .CEPAT BERMETASTASE DAN FATAL, DAPAT TIMBUL BEGITU SAJA PD KULIT NORMAL ATAU TAHI LALAT YG MENGALAMI DEGENERASI & KEGANASANATANDA: BERCAK ATAU BINTIL HITAM YG CEPAT MEMBESAR, WARNA MENJADI LEBIH HITAN DAN TDK MERATA, TIMBUL ULKUS YG MUDAH BERDARAH, METASTASE CEPATTERAPI; -PEMBEDAHAN DG EKSISI LUAS (PEMERIKSAAN HISTOPATOLOGIK) -KEMOTERAPI. PROGNOSA BURUK sm_mel_abcd sm_mel_nod sm_nmel_acrll

Ulcerations .Superficial loss of surface tissue as a result of death of the cells. .A simple ulcer, such as the kind found in a small, superficial, partial-thickness burn, tends to heal by granulation (ie, new tissue granules) if kept clean and protected from injury. If it is exposed to the air, the serum that escapes will dry and form a scab, under which the epithelial cells will grow and cover the surface completely. Certain diseases cause characteristic ulcers; tuberculousulcers and syphilitic ulcers

Ulcerations .Ulcers related to problems with arterial circulation are seen in patients with peripheral vascular disease, arteriosclerosis, treatment of the ulcers is concurrent with treatment of the arterial disease .Nursing management includes the use of the dressings .If nursing interventions are instituted early in the progression of an ulcer, the condition can often be effectively improved. .Surgical amputation of an affected limb is a last resort. .Pressure ulcers involve breakdown of the skin due to prolonged pressure and insufficient blood supply, usually at bony prominence

http://t0.gstatic.com/images?q=tbn:ANd9GcQIN4HLaR4VC5P4UrLg1ekSgiMRlANvm59AYqCGG 5PQy_zHNaw&t=1&usg=__ow61n3W_-NVcFA3l9ErXuOwzJgY= http://t1.gstatic.com/images?q=tbn:ANd9GcTOo-I4R74UbaeqnURNw4qREPU9Zp5Ivfonne3q5 NkJ01OKROY&t=1&usg=__SahbIEzVD3z73U4ARDa3yUM9EdU= Ulceration