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

Kusman Ibrahim, Ph.D
DEPARTEMENT OF CLINICAL NURSING FACULTY OF NURSING UNIVERSITAS PADJADJARAN

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 antigenically identical 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 varicella virus 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 leukemias and 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.

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

stabbing. or aching. which may radiate over the entire region supplied by the affected nerves. tearing or sharply cutting).  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 eruption is usually accompanied or preceded by pain. lancinating (ie.  The pain may be burning.

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

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

 Help with dressing changes and food preparation for patients who cannot care for themselves or prepare nourishing meals. .  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.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.

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

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

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

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

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

VIRAL SKIN INFECTION Complication  Eczema herpeticum  The same type of spread of herpes can occur in severe seborrhea. scabies. and other chronic skin conditions. Fetal anomalies include skin lesions. in mothers who have primary infections during pregnancy. intrauterine neonatal infections occur. . microcephaly. encephalitis.  Rarely.  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. and intracerebral calcifications.

VIRAL SKIN INFECTION Medical and Nursing Management  Use a sunscreen liberally on the lips and face  Topical treatment with drying agents may accelerate healing. and 20% of patients are free of recurrences during suppressive therapy . alacyclovir. or famciclovir suppresses 85% of recurrences. 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.  Acyclovir  Treatment of genital herpes depends on the severity. the frequency. Use of acyclovir.

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

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

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FUNGAL (MYCOTIC) INFECTIONS Management  During the acute. soaks of Burow’s solution or potassium permanganate solutions are used to remove the crusts. 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.  Topical antifungal agents (eg. headache. miconazole. skin rashes. scales. vesicular phase. and nausea  Personal and enviromental hygiene . and debris and to reduce the inflammation.

Tinea corporis (ringworm) of the face Tinea pedis Tinea unguium .

kosmetik. dll) Tanda dan Gejala: • Erytema.DERMATITIS KONTAK • Peradangan pd kulit. merupakan reaksi imunologis yaitu hipersensitifitas tipe lambat akibat kontak dengan bahan yang merangsang respon imun pd kulit Penyebab: • Zat iritan (mekanik. biologis. edema lokal. nikel. antihistamin. gatal Terapi: • Basah  kompres PK 1 : 10. kulit mengeras. vesikel. kimia. bersisik.000 • Kering  steroid topikal • Antibiotik. asam. kortikosteroid . alkali) • Alergen (tumbuhan.

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

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

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

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

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

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

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

PROGNOSA BURUK . WARNA MENJADI LEBIH HITAN DAN TDK MERATA. .KEMOTERAPI. METASTASE CEPAT TERAPI. DAPAT TIMBUL BEGITU SAJA PD KULIT NORMAL ATAU TAHI LALAT YG MENGALAMI DEGENERASI & KEGANASANA TANDA: BERCAK ATAU BINTIL HITAM YG CEPAT MEMBESAR.MELANOMA MALIGNA PALING BERBAHAYA  CEPAT BERMETASTASE DAN FATAL.PEMBEDAHAN DG EKSISI LUAS (PEMERIKSAAN HISTOPATOLOGIK) . TIMBUL ULKUS YG MUDAH BERDARAH.

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

usually at bony prominence . Surgical amputation of an affected limb is a last resort. arteriosclerosis. the condition can often be effectively improved.Ulcerations      Ulcers related to problems with arterial circulation are seen in patients with peripheral vascular disease. Pressure ulcers involve breakdown of the skin due to prolonged pressure and insufficient blood supply. 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.

Ulceration .