23/01/2012 09:43:00

CELLULITIS  is a spreading bacterial infection just below the skin surface, it is a generalized infection caused with either ←
Staphylococcus or Streptococcus and involves the deeper connective tissue/inflammation of the soft or connective tissue, in which a thin, watery exudate spreads through the cleavage planes of interstitial and tissue spaces; it may lead to ulceration and abscess. SIGNS /SYMPTOMS >Fever ← >Pain or tenderness in the affected area CAUSATIVE AGENT RISK FACTORS ∗Cracks or breaks in the skin ← MEDICAL MANAGEMENT > penicillins ← NURSING MANAGEMENT >Elevation of the affected area is also important to reduce swelling. Instruct patient to: >Keep skin moist with lotions or ointments to prevent cracking. >cephalexin >cloxacillin >acetamino >Wear shoes that fit well and provide enough room for your feet. >Learn how to trim your nails to avoid harming the skin around them. >Wear appropriate protective equipment when participating in work or sport. >ibuprofen >aspirin Whenever you have a break in the skin: >Clean the break carefully with soap and water. >Apply an antibiotic cream or ointment every day.

∗Staphylococ cus ∗streptococcus bacteria DIAGNOSTIC EXAMS >Blood culture >Complete blood count (CBC) >Culture of any fluid or material inside the affected area

>Skin redness or

∗History of

← cin ← ← ← ← ←


inflammation that gets bigger as the infection spread ← >Skin sore or rash that starts suddenly, and grows quickly in the first 24 hours ← >Tight, glossy, "stretched" appearance of the skin ← ← ← ← ← >Warm skin in the the Signs of infection: >Chills or shaking >Fatigue >General ill feeling area of redness

peripheral vascular disease ←

∗Injury or

trauma with a break in the skin ←

∗Insect bites phen ← ← ← ∗Ulcers from

and stingsites, or human bites ←

certain diseases, including diabetes >Flucloxacillin

pains ← ← ← ←

>Muscle aches and >Warm skin >Sweating Other symptoms that >Hair loss at the site >Joint stiffness

and vascular disease ←

>dicloxacillin monotherapy >phenoxymethylpe nicillin >benzylpenicillin >ampicillin/amoxici llin. >Cover with a bandage and change it every day until a scab forms. >Watch for redness, pain, drainage, or other signs of infection.

∗Use of

corticosteroid medications or medications that suppress the immune system

can occur with this disease: of infection

∗Wound from

← ← ←


caused by swelling of the tissue over the joint ← >Nausea and vomiting

a recent surgery Complications > sepsis > osteomyelitis > lymphangitis > endocarditis >Meningitis >Shock

c oxygen Surgery: >surgical

drainage >plastic surgery

> gangrene

ooze. which speeds healing. which occurs deep in the skin & may contain pus. several family members may develop carbuncles at the same time. >Wash & cover the furuncle w/ antibiotic cream or antiseptic tea tree oil & a bandage to promote healing >Gently soak the area with a warm. NURSING MANAGEMENT >Place warm moist cloth on the carbuncle to drain. but they are most common on the back and the nape of the neck. The infected material forms a lump. made up of several skin boils (furuncles). SIGNS & SYMPTOMS ∗swollen lump or mass under the skin ∗ may be the size of a pea or as large as a golf ∗may be red and irritated & might hurt when you touch it ∗may grow very fast ∗Have a white or yellow center ( contain pus) ∗Weep. The diagnosis is primarily based on what the skin looks like. or crust CAUSATIVE AGENT BACTERIA STAPYLOCOCCUS AUREUS DIAGNOSTIC EXAMS: Doctor will look at the skin. but sometimes the mass is so deep that it cannot drain on its own & may develop anywhere. dermatitis & weakened immune > contact with MEDICAL MANAGEMENT >Antibacterial soaps >Antibiotic therapy w/c can be applied to the skin or taken by mouth >Deep or large lesions may need to be drained by a health care provider. Fluid may drain out of the carbuncle. . pus & dead tissue. A sample of the pus may sent to a lab to determine the bacteria causing the infection & to help the doctor RISK FACTORS >male >Friction from clothing or shaving >Poor personal hygiene >Poor overall health >Persons with diabetes. moist cloth several times each day or warm salt water.CARBUNCLE is a skin infection that often involves a group of hair follicles. The infected mass is filled with fluid. Because the condition is contagious.

contaminated fomites. infected family members. or organs such as the kidneys >Endocarditis >Osteomyelitis >Permanent scarring of the skin >Sepsis >Spread of infection to other areas > Do not re-use or share washcloths or towels -this can cause the infection to spread. skin.determine the ∗Spread to other skin areas ∗Fatigue ∗Fever ∗General discomfort or sick feeling ∗Skin itching before the carbuncle develops appropriate treatment. towels. washcloths. spinal cord. or from other extra-nasal sites > Never squeeze a boil or attempt to cut it open at home because this can spread the infection & make it worse >advise patient to have proper hygiene to prevent the spread of infection & always wash hands after touching a carbuncle Complications >Abscess of the brain. and sheets or other items that contact infected areas should be washed in very hot (preferably boiling) water >Bandages should be changed frequently and thrown away in a bag that can be tightly closed. Clothing. .

firm area in the skin. ∗Deep or large boils may need to be drained with surgery by a health care provider. >malnutrition >use of immunosuppressive drugs. >When the boil finally does burst & drain. . buttocks. but they may be caused by other bacteria or fungi found on the skin's surface. neck. Damage to the hair follicle allows these bacteria to enter deeper into the tissues of the follicle & the tissue underneath. and thighs. SIGNS/SYMPTOMS >tender. ∗Antibiotics taken by mouth or given as a shot may help a more severe infection or if the boil returns. > myiasis caused by the Tumbu fly RISK FACTORS >Damage to the hair follicle >Skin infections > obesity > hematologic disorders >bacterial carriage in the nostrils. which speeds >Antibiotics placed on the healing skin are of little help once a boil has formed. continue to put > gently soak the area with a warm. They are most common on the face. >diabetes mellitus >lymphoproliferative neoplasms. swollen. moist compresses help boils drain. armpit. >Do not squeeze a boil or try to cut it open at home. feel like a waterfilled balloon or cyst & painful > usually pea-sized. may occur in the hair follicles anywhere on the body. >positive family MEDICAL MANAGEMENT >Antibacterial soaps & NURSING MANAGEMENT >Warm. can spread the infection & make it worse.FURUNCLES/BOIL −−a skin infection involving an entire hair follicle and nearby skin tissue. moist cloth several times each day. but may be as large as a golf ball >May develop white or yellow centers (pustules) >May join with another boil or spread to other skin areas >May grow quickly EXAMS & TEST The health care provider CAUSATIVE AGENT >Bacteria Staphylococcus aureus. pinkish-red.

kidneys. or other organs. folliculitis. > sepsis > cellulitis. . >taking antibiotics > have been hospitalized >anemic COMPLICATIONS >scarring & infection or abscess of the skin. such as by placing them in a bag that can be closed tightly before throwing it out. >Careful hygiene & clean draining boils often >wash your hands after touching a boil. or crust >Fatigue >Swollen lymph nodes >General ill-feeling >fever >Itching before the boil develop >Skin redness around the boil can usually diagnose a boil history based on how it looks. towels & sheets or items that contact infected areas in very hot water. ooze.May weep. wet compresses on the area. or impetigo) >bacteremia >wound infections >abscesses >osteomyelitis >endocarditis >pneumonia warm. >Change dressings often and throw them out with the drainage. >Do not re-use or share washcloths or towels & wash clothing. A culture may show staphylococcus or other bacteria. brain. spinal cord.

creating a follicular-based pustule. formation of pus inside the follicle & skin bumps mount. It can occur anywhere on the skin. flucloxacilline & topical antibiotic-steroid preparation like mupirocin and fluticasone combination & fexofenadine for ittching Malassezia: Topical antifungal agents like miconazole and ketoconazole. increase in local temperature. Folliculitis is defined histologically as the presence of inflammatory cells within the wall and ostia of the hair follicle. formation of pustules. SIGNS /SYMPTOMS STAPHYLOCCOCUS AUREUS >redness of the area itching.FOLLICULITIS Folliculitis is inflammation of one or more hair follicles.In refractory cases systemic antifungal drugs like itraconazole. smooth bumps over a particular area (‘chicken skin) . red halo indicates active inflammatory process CAUSATIVE AGENT >Staphylococcus aureus >fungi Malassezia furfur >Pseudomonas aeruginosa >Tinea rubrum >Herpes simplex virus – chicken pox virus >gram-negative RISK FACTORS >Japanese and the Afro-Americans staphylococcus aureus: >Decreased immunity > diabetes mellitus. chronic debilitating diseases like cancer and tuberculosis MEDICAL MANAGEMENT Staphylococcus aureus : ∗systemic antibiotics like amoxicilline. The condition may occur anywhere on the skin with the exception of the palms of the hands and soles of the feet. dicloxacilline. ketoconazole and terbenafine are administered along with topical terbenafine NURSING MANAGEMENT >cleaning the affected area with normal saline and chlorhexidine solution >stopping of shaving until the infection controls >good personal hygiene & close observation of the . cloxacilline.

sore throat. >maintaining proper cleanliness in the swimming pools and Jacuzzis & using suitable medicines . workers in dye factory. ibuprofen or diclofenac. cefixime and cefpodoxime Tufted >Topical steroid affected area >instruct patient to avoid tight fitting clothes. & gastrointestinal disorders. Proteus sp. follicles may arise any part of the body and they are painful Gram-negative >Small red colored pustules present in the cheek. generalized bodyache . coli.MALASSEZIA > skin usually protrude as a whole & color of the affected area becomes pale yellow or white PSEUDOMONAS FOLLICULITIS > fever. shaving with care. electrolysis or laser ablation of the unwanted hair follicles Herpetic folliculitis Systemic antiviral agents like acyclovir along with topical acyclovir Gram-negative Oral antibacterial agents like erythromycin. Fever and body ache can be neutralized with paracetamol. E. chin and neck region Tufted folliculitis >hairs fall off and there is localized baldness due to permanent scarring bacteria (Klebsiella. refinery worker and shepherds > Exposure to certain allergic toiletries preparations and other chemicals >Trauma >Chronic friction >Occlusive clothing >Occlusive chemicals >Excessive sweating >Exposure to water cream. roxithromycin. Pseudomonas folliculitis. >systemic antibiotics like cefixime & cefpodoxime. Serratia &Enterobacter) >Frequent shaving Oil folliculitis >females. fexofenadine for itching Tinea Systemic antifungal agents like itraconazole and terbenafine Razor folliculitis topical antifungal-steroid combination.

ERYSIPELAS − is a superficial bacterial skin infection that characteristically extends into the cutaneous lymphatics referred to as St. indurated. and tenderness & lymphatic involvement manifested by skin streaking and regional lymphadenopathy. Anthony's Fire. and shiny plaque > Local signs of inflammation. roxithromycin & pristinamycin > A first-generation cephalosporin or macrolide(erythromycin or azithromycin) NURSING MANAGEMENT >teach patient to keep skin healthy by avoiding dry skin & preventing cuts & scrapes to reduce the risk >Elevate & rest the affected limb to reduce local swelling & limit inflammation & pain >apply saline wet dressings to ulcerated & necrotic lesions & change every 2-12 hours > close monitoring >educate patient . >Blisters Signs and tests >biopsy of the skin > Bacterial cultures from the portal of entry > MRI and bone scintigraphy are helpful when early osteoarticular involvement is suspected. such as warmth. CAUSATIVE AGENT ∗group A Streptococcus pyogenes RISK FACTORS >A cut in the skin >Problems with drainage through the veins or lymph system >Skin sores (ulcers) > more common in European countries > more common in females but occurring at an earlier age in males because of their more aggressive activities MEDICAL MANAGEMENT Antibiotics : penicillin ∗In severe cases. tense. >. SIGNS/SYMPTOMS >small erythematous patch that progresses to a fiery-red. edema. An acute disease of the skin and subcutaneous tissue caused by a species of hemolytic streptococcus and marked by localized inflammation and fever. antibiotics may need to be given through an IV (intravenous line).

lymphatic drainage problems (eg. and warm skin underneath the sore (lesion) >Skin lesion with a raised border >Sores (erysipelas lesions) on the cheeks and bridge of the nose >tenderness >malaise >Pruritus & burning > common on infants. swollen. and bones. bypass grafting). young children & elderly patients are the most commonly affected groups. especially to high-risk & immunocompromised . after mastectomy. peak incidence on aged 60-80 years. > history of recent trauma or pharyngitis Complications >bacteremia >The infection may spread to the heart valves. >Return of infection >Septic shock > penicillinase-resistant antibiotic(dicloxacillin or nafcillin) for facial erysipelas >Debridement in severe infections with necrosis or gangrene. very red.>Fever. and chills >Painful. shaking. pelvic surgery. joints. regarding local antisepsis & general wound care >encourage to limit activity .

>Methicillinresistant staph aureus (MRSA). to remove crusts and drainage Teach patient how to prevent the spread of infection: >use a clean washcloth and towel each time. or other virus >Do not share towels. There are two types.IMPETIGO A contagious bacterial skin infection characterized by the eruption of superficial pustules & the formation of thick yellow crusts. RISK FACTORS A break in the skin that may occur with: >Animal bites >Human bites >Injury or trauma to the skin >Insect bites >unhealthy living conditions. . leave a reddish raw-looking base (in infants) >Itching blister filled with yellow or honeycolored fluid.oozing and crusting over >Rash may begin as a single spot. Impetigo refers to a very localized bacterial infection of the skin. it may spread to other areas DIAGNOSTIC TEST > culture of the skin or lesion CAUSATIVE FACTORS >Streptococcus (strep) >Staphylococcus (staph) bacteria. bullous and epidemic. commonly on the face. easy to pop and when broken. clothing. and and MEDICAL MANAGEMENT >antibacterial cream >antibiotics taken by mouth. >may follow other skin disorders or a recent upper respiratory infection such as a cold >Skin lesions on the face. but if person scratches. preferably with an antibacterial soap. SIGNS/SYMPTOMS >A single or possibly many blisters filled with pus. razors. >antibacterial soap NURSING MANAGEMENT >instruct patient to wash (do not scrub) the skin several times a day.

or legs. arms. >avoid touching the draining (oozing) lesions PYODERMA .lips. that spread to other areas >Swollen lymph nodes near the infection (lymphadenopathy) Complications >Kidney failure (poststreptococcal glomerulonephritis) (rare) >Many patches of impetigo (in children) >Permanent skin damage and scarring (very rare) >Spread of the infection to other parts of the body (common) other personal care products with other family members. >Good general health & hygiene help to prevent infection. >Wash hands thoroughly after touching the skin lesions. >Thoroughly clean minor cuts & scrapes with mild antibacterial soap & clean water.

either ulcerative colitis or regional enteritis/Crohn disease. >Less common associated diseases include other MEDICAL MANAGEMENT >antibiotics >anti-inflammatory medications >immunosuppressants Topical corticosteroids: >cromolyn sodium 2% solution > nitrogen mustard >5-aminosalicylic acid Topical immune modifiers : >tacrolimus >pimecrolimus >Systemic therapies : >corticosteroids. >mycophenolate >mofetil > azathioprine >dapsone > tacrolimus >cyclophosphamide >chlorambucil >thalidomide >tumor necrosis factoralpha (TNF-alpha) NURSING MANAGEMENT > gentle local wound care and dressings > instruct patient to maintain their range of motion and perform all activities that they are able to tolerate > instruct patient to use correct dose. >cyclosporine. predominantly myelocytic in nature or monoclonal gammopathies (primarily immunoglobulin A [IgA]). & hematologic diseases/disorders. >adults age 40 to 50 > Commonly associated diseases include inflammatory bowel disease.g leukemia or preleukemic states. e.& a polyarthritis that is usually symmetric and may be either seronegative or seropositive. continue until beyond resolution & compliance as to three times a day or once a day of medication >clean pets and proper handwashing >good physical hygiene . >fatigue >pain >aching joints and bones.Pyoderma gangreosum is a type of skin condition that causes painful skin ulcers. SIGNS/ SYMPTOMS >ulcers usually appear on the legs and begin as small red bumps resembling spider bites. >arthralgias >malaise CAUSATIVE AGENT > Staphylococcus Aureus DIAGNOSTIC TEST >CBC count >liver function test >urinalysis >serum & urine protein electrophoresis peripheral smear > bone marrow aspiration >Venereal Disease Research Laboratory (VDRL) test >antineutrophil cytoplasmic antibody test >partial thromboplastin time test >antiphospholipid antibody test >Serum protein electrophoresis >Cultures of the ulcer/erosion RISK FACTORS >severe skin ulcers from s small cuts & scrapes. The bumps progress into large. open sores surrounded by red or purple skin.

including hepatitis & primary biliary cirrhosis.>Chest radiography >Colonoscopy >Angiography or Doppler studies forms of arthritis. myelomas (IgA type predominantly). >Intravenous therapies include pulsed methylprednisolone. infliximab & intravenous immune globulin. inhibitors & nicotine. such as lupus erythematosus & Sjögren syndrome >slight female predominance may exist. >hyperbaric oxygen. osteoarthritis. . & immunologic diseases. or spondyloarthropathy. pulsed cyclophosphamide. such as psoriatic arthritis. hepatic diseases.

It has in different shapes usually red. impetigo and boils are examples. Lesions are rough in texture and usually color pink. Flat moles. The other term is tumor which is associated with lipomas. Lesions are cause by chemical burn.5 cm) across. insect bites or viral infection.PRIMARY SKIN LESIONS Are initial reactions to a problem that alters one of the structural components of the skin Macule The lesion appears circular small and flat spot that is less than in (1 mm to 1 cm) in diameter and with the color not the same as that of nearby skin. Papule A solid elevated skin lesion less than in (1 cm) across. brown.5 to 2 cm. petechiae and freckles are the examples of macule. Pustule A raised vesicle or bulla lesion filled with pus. malignant melanoma and hemangioma are examples. and white. Nodule A solid elevated lesion that has edges and area 0. Lesions are round or oval in shape with thin mass filled with serous blood or clear fluid. it has an irregular in shape. exposure to sunlight. This lesion is associated with psoriasis. and syphilis. burn blister and early chicken pox are examples of vesicle. Wheal . Vesicle A raised lesion that is less than in (0. Macule that is more than in (1 cm) in diameter is called a patch. Bullae are another example of vesicle that is more than in (5 mm) across. red and brown. Herpes simplex. pimples and elevated moles are examples." where hard mass is felt from the tissue surrounding it. and keratinous. acne. The size of the nodule is more than 2 cm in diameter. measles. Physician describes this as "palpable. Acne vulgaris. Infection is the primary cause. actinic keratosis. skin cancer. Warts.

They may or may not have some surface changes – either slight scale or fine wrinkles. red. Epidermoid and sebaceous cyst and chalazion of the eyelid or meibomian gland lipogranuloma are examples. The size is 1 cm or larger. It is often manifestation of certain diseases such scleroderma or rosacea. Crust and Oozing .A red swelling skin itchy lesion and localized edema. insect bites or reaction from drugs. Lesions are rough in texture and color brown. They appear dry and are usually whitish. The size is larger than 1 cm. Rubeola and psoriasis are examples. Cyst Elevated skin lesion and encapsulated filled with fluid. Telanglectasia A dilated small blood vessels in the surface of the skin. or pink. urticaria and mosquito bites are examples. Hives. Lesion is usually cause by an allergic reaction. They are seen most often with papule as and plaques. Scales Such as (exfoliative dermatitis and psoriasis) are visisbly thickened stratum corneum. Patches Such as ( vitiligo or café au lait spots). Plaque A patch of closely grouped papules more than in (1 cm) across. are macules that are larger than 1cm in diameter.

Ulcers Such as (stage 3 pressure ulcers) are deep erosions that extend beneath the epidermis and involve the dermis and sometimes the subcutaneous fat. bullae or pustules. bullae or pustules. Lichenifications Such as (chronic dermatitis) are palpably thickened areas of epidermis with accentuated skin markings.Such as (eczema and late stage impetigo) are composed of dried serum or pus on the surface of the skin. Erosions Such as (vaaricella) are wider than fissures but involve only the epidermis. Fissures Such as (athletes foot) are linear cracks in the epidermis . They are caused by chronic rubbing and scratching. The skin is translucent and paper like. SECONDARY SKIN LESIONS . Atropy Such as ( stretch marks and aged skin) is characterized by thinning of the skin surface with loss of skin markings. Atropy involving the dermal layer results in skin depressions. which often extend into the dermis. They are often associated with vesicles. beneath which include debris may accumulate. Crusts frequently results from broken vesicles.

. (Please bear in mind this definition does not at all mean that the lesion is a neoplasm. or may be caused by external forces such as scratching. TUMOR A tumor is a solid mass of the skin or subcutaneous tissue.) BULLAE Bullae are circumscribed fluid-filled lesions that are greater than 1 cm. These changes occur with progression of an underlying disease or in response to a topical or a systemic therapeutic interventions. The distinction between a primary and secondary lesion is not always clear.g. trauma. TELANGIECTASIA Telangiectasia are the permanent dilatation of superficial blood vessels in the skin and may occur as isolated phenomena or as part of a generalized disorder. it is larger than a nodule. infection. with infestation by the scabitic mite or by cutaneous larva migrans).Are changes in the appearance of the primary lesions. in diameter. THE SECONDARY LESIONS Secondary lesions may evolve from primary lesions. or the healing process. BURROW Burrows are linear lesions produced by infestation of the skin and formation of tunnels (e. . such as ataxia telangiectasia.

It is usually due to chronic rubbing or scratching of an area. Desquamation occurs when there are peeling sheets of scale following acute injury to the skin. One can usually be distinguished from the other by appearance alone. LICHENIFICATION "Lichenification" refers to a thickening of the epidermis seen with exaggeration of normal skin lines. Please remember that crusting is different from scaling.SCALE Scale consists of flakes or plates that represent compacted desquamated layers of stratum corneum. EROSION Erosions are slightly depressed areas of skin in which part or all of the epidermis has been lost. ATROPHY Atrophy is thinning or absence of the epidermis or subcutaneous fat. CRUST Crusting is the result of the drying of plasma or exudate on the skin. The two terms refer to different phenomena and are not interchangeable. FISSURE . EXCORIATION Excoriations are traumatized or abraded skin caused by scratching or rubbing.

the term "petechiae" refers to smaller lesions. In all situations. "Purpura" and "ecchymoses" are terms that refer to larger lesions. ULCERATION Ulcerations occur when there is necrosis of the epidermis and dermis and sometimes of the underlying subcutaneous tissue. KELOIDS Keloids are an exaggerated connective tissue response of injured skin that extend beyond the edges of the original wound. plaque covering an ulcer implying extensive tissue necrosis. If there is any question. ESCHAR An eschar is a hard. SCAR Scars are the permanent fibrotic changes that occur on the skin following damage to the dermis. Don't break the slide or cut the patient. In certain situations purpura may be palpable. petechiae. Scars may have secondary pigment characteristics. Generally. and ecchymoses. PURPURA. purpura. .A fissure is linear cleavage of skin which extends into the dermis. press on the lesions carefully with a glass slide. AND ECCHYMOSES Three terms that refer to bleeding that occurs in the skin are petechiae. usually darkened. infarcts or gangrene. ecchymoses. PETECHIAE. and purpura do not blanch when pressed.


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