ADVANCE PHARMACOLOGY

SKIN DISORDERS
THE SKIN
 SKIN DISORDERS

A. BACTERIAL INFECTIONS
D. ALLERGIC, THERMAL AND
B. FUNGAL INFECTIONS CHEMICAL SKIN REACTIONS

C. VIRAL INFECTIONS E. INFESTATION AND BITES

BACTERIAL INFECTION
BACTERIAL INFECTIONS
• Bacteria are single celled micro-organisms
— Spherical, doublets, and spirochetes
 
• Staphylococcus
— Gram positive bacteria that appears in clumps in skin and upper respiratory
tract
 
• Streptococcus
— Chain bacteria often associated with systemic disease and skin infections
 
• Bacillus
— Spore forming, aerobic, and occasionally mobile
— Can cause systemic damage
BACTERIAL INFECTIONS
• * Impetigo Contagiosa
Etiology
* Caused by A-beta-hemolytic
streptococci, S aureus or
combination of these bacteria

* Spread through close contact

 
* Impetigo Contagiosa

• Signs and Symptoms

* Mild itching and soreness followed by eruption of small
vesicles and pustules that rupture and crust
* Generally develops in body folds that are subject to
friction
 
 
• — Management
* Cleansing and topical antibacterial agents
* Systemic antibiotics
BACTERIAL INFECTIONS
• Furunculosis (Boils)
Etiology
• Infection of hair follicle that results in
pustule formation
• Generally the result of a staphy. Infection
 
• *Usually, the cause is bacteria such as
staphylococci that are present on the
skin.
BACTERIAL INFECTIONS
• Furunculosis (Boils)
• — Signs and Symptoms
* Pustule that becomes reddened and enlarged as well as hard from internal
pressure
* Pain and tenderness increase with pressure
* Most will mature and rupture
 

— Management
* Care involves protection from additional irritation
* Referral to physician for antibiotics
» Keep athlete from contact with other team members
while boil is draining
BACTERIAL INFECTIONS
• Carbuncle
• A carbuncle is a skin infection that
often
involves a group of hair follicles. The
infected material forms a lump, which
occurs deep in the skin and may
contain
pus.
* most commonly Staphylococcus
aureus, or
Streptococcus pyogenes,
BACTERIAL INFECTIONS
•
Carbuncle

• Etiology
• +» Similar in terms of early stage development as furuncles
— Signs and Symptoms
* Larger and deeper than furuncle and has several openings in the skin
* May produce fever and elevation of WBC count
» Starts hard and red and over a few days emerges into a
lesion that discharges yellowish pus
 

— Management
* Surgical drainage combined with the administration of
antibiotics
* Warm compress is applied to promote circulation
BACTERIAL INFECTIONS
• Folliculitis
• Etiology
* [Inflammation of hair follicle
* Caused by non- infectious or
infectious agents
* Moist warm environment and
mechanical occlusion contribute to
condition
* Psuedofolliculitis
(PFB)
BACTERIAL INFECTIONS
• Folliculitis
• Signs and Symptoms
* Redness around follicle that is followed by development of papule or pustule at
the hair follicle
* Followed by development of crust that sloughs off with the hair
* Deeper infection may cause scarring and alopecia in that area
 

— Management
* Management is much like impetigo
* Moist heat is used to increase circulation
 
* Antibiotics can also be used depending on the condition
BACTERIAL INFECTIONS
• Hidradenitis Suppurativa
a chronic suppurative inflammatory disease of
the apocrine sweat glands
Etiology
-Primary inflammation event of the hair follicle
resulting in Secondary blockage of the apocrine
gland
Post-pubescent individuals are more likely to
exhibit HS.
-Plugged apocrine (sweat) gland or hair follicle
-Excessive sweating
-Androgen dysfunction
-Genetic disorders that alter cell structure
-Patients with more advanced cases may find
BACTERIAL INFECTIONS
• Hidradenitis Suppurativa
• Signs and Symptoms
* Begins as small papule that can develop into deep
dermal inflammation

— Management
* Avoid use of antiperspirants, deodorants and shaving
creams
* Use medicated soaps and systemic antibiotics
BACTERIAL INFECTIONS
• Acne Vulgaris
• Etiology
• * Inflammatory disease of
the hair follicle and the
sebaceous glands
• * Sex hormones may
contribute
BACTERIAL INFECTIONS
• Acne Vulgaris
• Signs and Symptoms
* Present with whiteheads, blackheads, flesh or red
colored papules, pustules or cysts
* If chronic and deep = may scar
* Psychological impact
 
— Management
* Topical and systemic agents used to treat acne
* Mild soaps are recommended
BACTERIAL INFECTIONS
• Paronychia and Onychia
Paronychia is an infection of
the surrounding tissue where
the nail meets the skin.
Onychia is an infection of the
nail itself, which causes
inflammation of the nail and
swelling of the surrounding
tissue. 
BACTERIAL INFECTIONS
• Paronychia and Onychia
• Etiology
* Caused by staph, strep and or fungal organisms that accompany
contamination of open wounds or hangnails
* Damage to cuticle puts finger at risk
 
— Sign and Symptoms
* Rapid onset; painful with bright red swelling of proximal and lateral fold of nail
* Accumulation of purulent material w/in nail fold
 
— Management
* Soak finger or toe in hot solution of Epsom salt 3 times daily
* Topical antibiotics, systemic antibiotics if severe
* May require pus removal through skin incision
BACTERIAL INFECTIONS
• Cellulitis
-Connective tissue, dermis and
subcutaneous tissues
-acute spreading
-pain, erythema,
-edema, and warmth
 
History trauma or surgery causing a
lesion in the skin
may have no discernible dermal injury
develops over a period of several days
BACTERIAL INFECTIONS
• Cellulitis Etiology:
Signs & Symptoms
Microorganism normal
The affected area
— group A streptococci &
» Warmth
Staphylococcus aureus
Infants
* Erythema
— group B streptococci
 
Immunocompromised
» Edema
— Pneumococcus gram-negative
* Tenderness
rods or fungi
 
Wounds
The proximal to the area
— Aeromonas hydrophila, gram-
* Ascending lymphangitis
negative rod
* lymphadenopathy
BACTERIAL INFECTIONS
• Cellulitis

• High Risk Factors Management:

-Obesity Antibiotics:
-Diabetes * penicillinase-resistant
synthetic penicillin
-Poor hygiene condition
* first-generation
-Intravenous drugs cephalosporin
-Immunodeficiency * clindamycin
* metronidazole
BACTERIAL INFECTIONS
• Erysipelas
caused by group A beta-hemolytic
streptococci Involving dermis and
lymphatics more superficial
subcutaneous infection than cellulitis
-characterized by intense erythema,
induration, and a sharply demarcated
border,
-70-80% in lower extremities
-5-20% in face
BACTERIAL INFECTIONS
• Erysipelas
Etiology:
Microorganism
Abrupt onset of illness (Painful rash) * Group A streptococci (the
Initial fever and chills (1-2 days later) most)
Muscle and joint pain * Group G, C, B streptococci
Nausea (less)
Headache * Staphylococci (rarely)
Systemic infectious manifestations
Skin discomfort
BACTERIAL INFECTIONS
• Erysipelas
• Signs & Symptoms
Management:
*Fever
* Dermatologic signs Painful, erythematous, and Antibiotics (as soon as
edematous rash possible)
* Sharply-raised border with abrupt demarcation from
healthy adjacent skin
* Penicillin
* Lymphangitis * Erythromycin
* Erythema (irregular extensions) * Cephalexin
* Desquamation
* Vesicles
Symptomatic treatment
* Lymphadenopathy * Antipyretic
Sharply-raised border with abrupt demarcation from * Analgesics
healthy adjacent skin rash
«Painful
Hydration (oral intake if
*Erythematous possible)
Edematous Cold compresses
BACTERIAL INFECTIONS
• Lymphadenitis
The infection of lymph
nodes (glands) usually
associated with the site of
the underlying infection,
tumor, inflammation
common result of a
cellulitis or other bacteria
infection
BACTERIAL INFECTIONS
• Lymphadenitis
Signs & Symptoms
• swollen, tender, hard nodes
• smooth or irregular to touch
• or soft and "rubbery" (fluctuant) if an abscess
has formed

• the skin over a node may be reddened and hot

BACTERIAL INFECTIONS
• Lymphangitis
-Infection of lymph vessels/channels
-Commonly results from cellulitis or
abscess in the skin or soft tissues
A progressing infection raising spread
of bacteria to the bloodstream
— life-threatening infections
Be confused with a clot in a vein
(thrombophlebitis)
BACTERIAL INFECTIONS
• Lymphangitis

• Signs & Symptoms

red streaks
— from infected area to the armpit or groin
 
throbbing pain
— along the affected area

lymph nodes
fever and chills
malaise.loss of appetite, headache, muscle aches
BACTERIAL INFECTIONS
• Lymphadenitis and
Lymphangitis
Diagnosis: Management:
* Physical examination Treatment should begin
* Biopsy (LN) promptly
* Blood culture
 
 
Lymphadenitis and lymphangitis may
» Specific antibiotics
spread within * Surgical drainage
   
hours, spreading to the bloodstream * Hot moist compresses
may be fatal.
BACTERIAL INFECTIONS
• Necrotizing Fasciitis
• It is a progressive,
rapidly spreading,
• inflammatory infection
located in the deep
• fascia with 2ry necrosis
of the subcutaneous
• tissue.
BACTERIAL INFECTIONS
•Necrotizing Fasciitis
Risk Factors
 
Causative Agents
* Immunocompression illnesses  
 e.g.: DM, Cancer, alcoholism, vascular It is a mixed microbial flora:
insufficiency, organ transplant, HIV or  
neutropenia. -microaerophilic
  streptococci.
* Trauma or foreign bodies in surgical  
wound. -staphylococci.
 
-anerobic gram
* |diopathic as scrotal or penile  
necrotizing fasciitis.
BACTERIAL INFECTIONS
• Necrotizing Fasciitis
Management
 
-Gentamycine combined with
-If streptococci are the identified major clindamycine or
pathogens, the chloramphenicol has been
D.0.C is Penicillin-G with clindamycin as an reported as a
alternative. standard coverage.
 
 
-To ensure adequate treatment, we have to
cover aerobic & anaerobic bacteria.
-Ampicilline may be added to
the basic regimen
-The anaerobic coverage can be provided by to treat enterococci if
Metronidazole or 3" generation cephalosporin's. suspected by gram
stain.
FUNGAL INFECTIONS
 FUNGAL INFECTIONS

Group of organisms that include yeast and

molds which are usually not pathogenic
 
Grow best in unsanitary conditions with
warmth, moisture and darkness
 
Infections generally occur in keratinized
tissue found in hair, nails and stratum
Corneum
Dermatophytes (Ringworm fungi)
 
— Cause of most skin, nail and hair fungal
infections
 FUNGAL INFECTIONS

• Tinea of the Scalp (tinea

capitis)

Signs and Symptoms

 
* Ringworm of the scalp begins as a small papule that
spreads peripherally
 
* Appears as small grayish scales resulting in
scattered balding
 
* Easily spread through close physical contact
FUNGAL INFECTIONS

• Tinea of the Scalp (tinea capitis)

Management
 
* Topical creams and shampoos are ineffective in
treating fungus in hair shaft
 
* Systemic antifungal agents are replacing older
agents due to increased resistance 
* Some topical agents are used in conjunction
FUNGAL INFECTIONS

• Tinea of the Body (tinea

corporis)

Signs and Symptoms

* Commonly involve extremities and trunk
 
* Itchy red-brown scaling annular plaque that
expands peripherally
 
— Management
* Topical antifungal cream
 
FUNGAL INFECTIONS

• Tinea of the Nail (tinea

unguium/onchomycosis)
Fungal infection of the nail -- found
commonly in those engaged in
water sports or who have chronic
athlete’ s foot
* Nail becomes thick, brittle and
separated from its bed
 
FUNGAL INFECTIONS

• Tinea of the Nail (tinea unguium/onchomycosis)

• Management
« Some topical antifungal agents have proved useful
* Systemic medications are most effective
+ Surgical removal of nail may be necessary if
extremely
infected
 
FUNGAL INFECTIONS

• Tinea of the Groin

(tinea cruris)
— Etiology
* Symmetric red-brown scaling
plaque with snake-like border
 
— Signs and Symptoms
* Mild to moderate itching
FUNGAL INFECTIONS

• Tinea of the Groin (tinea cruris)

— Management
* Treat until cured
* Will respond to many of the non-prescription
medications
* Medications that mask symptoms should be avoided
+ Failure to respond to normal management may
suggest a non-fungal problem (such as bacteria) and
should be referred to a physician
* May require additional topical medications and oral
prescriptions
FUNGAL INFECTIONS

• Athlete’ s Foot (tinea pedis)

— Etiology
* Most common form of superficial
fungal infection
* Tricophyton species are most
common cause of athlete’ s foot
* Webs of toes may become
infected by a combination of yeast
and dermatophytes
FUNGAL INFECTIONS

• Athlete’ s Foot (tinea pedis)

— Signs and Symptoms
» Extreme itching on soles of feet, between and on top of
toes
* Appears as dry scaling patch or inflammatory scaling red
papules forming larger plaques
* May develop secondary infection from itching and
bacteria
 
— Management
* Topical antifungal agents and good foot hygiene
FUNGAL INFECTIONS

• Candidiasis (Moniliasis)
— Etiology
* Yeast-like fungus that can
produce skin, mucous
membrane and internal
infections
* Ideal environment includes
hot humid weather, tight
clothing, and poor hygiene
FUNGAL INFECTIONS

• Candidiasis (Moniliasis)
— Signs and Symptom
* Infections w/in body folds
* Presents as beefy red patches and possible satellite
pustules
* White, macerated border may surround the red area;
deep painful fissures may develop at skin creases
 
— Management
* Maintain dry area
* Use antifungal agents to clear infection
FUNGAL INFECTIONS

• Tinea Versicolor
— Etiology
* Caused by a yeast
* Appears commonly in
areas in which
sebaceous glands
actively secrete body oils
FUNGAL INFECTIONS

• Tinea Versicolor
— Signs and Symptoms
* Fungus produces multiple, small, circular macules that are pink, brown,
or white
* Commonly occur on chest, abdomen, and neck
* Do not tan when exposed to sun and usually are asymptomatic
 
— Management
* Straightforward treatment - recurrences are common
* Use selenium shampoo (Selsun) and topical econazole nitrate (or
something similar)
VIRAL INFECTIONS
VIRAL INFECTIONS
VIRAL INFECTIONS
VIRAL INFECTIONS
VIRAL INFECTIONS
VIRAL INFECTIONS

Ultramicroscopic organisms that require host

cells to complete their life cycle
— May stimulate cell chemically to produce
more virus until host cell dies
— Lies within bud-like structure that does not
damage cell or virus, w/out causing infection
* A number of skin infections are caused by
viruses
VIRAL INFECTIONS

• Herpes Simplex Labialis,

Gladiatorum, and Herpes Zoster
— Etiology
* Highly contagious and is usually
transmitted directly through a lesion
in the skin or mucous membrane
* Resides in sensory nerve
neurilemmal sheath following initial
outbreak
* Recurrent attacks stimulated by
sunlight, emotional disturbances,
VIRAL INFECTIONS

• Herpes Simplex Labialis, Gladiatorum, and Herpes

Zoster
• — Signs and Symptoms
* Early indication = tingling or hypersensitivity in an infected area 24 hours
prior to appearance of lesions
* Local swelling followed by outbreak of vesicles
+ Athlete may feel ill w/ headache, sore throat, swollen
lymph glands and pain in area of lesions
* Vesicles generally rupture in 1-3 days spilling serous
material
* Heal in generally 10-14 days
* If an athlete has an outbreak they should be
disqualified from competition due to contagious nature of condition
VIRAL INFECTIONS

• Herpes Simplex Labialis, Gladiatorum,

and Herpes Zoster
— Management 
* Herpes simplex lesions are self limiting -
reduce pain and promote early healing
* Use of antiviral drugs can reduce
recurrence and shorten course of
outbreak
VIRAL INFECTIONS

• Verruca Virus and Warts

• * Varied of forms exist
• — verruca plana (flat wart),
verruca plantaris (plantarwart),
and condyloma acuminatum
(venereal wart)
• * Different types of human
papilloma virus have been
identified
• — Uses epidermal layer of skin to
reproduce and growth
• * Wart enters through lesion in
skin
VIRAL INFECTIONS

• Verruca Virus and

Warts
a. Common Wart
— Signs and Symptoms
* Small, round, elevated lesion rough dry surfaces
* Painful if pressure is applied
* May be subject to secondary infection
 
— Management
* If vulnerable, they should be protected until treated by a
physician
* Use of electrocautery, topical salicylic acid or liquid
nitrogen are common means of managing this condition
VIRAL INFECTIONS

• Verruca Virus and Warts

b. Plantar Warts
— Etiology
* Spread through papilloma virus
— Signs and Symptoms
* Located on sole of foot, on or adjacent
to areas of
abnormal weight bearing
* Areas of excessive epidermal thickening
* Discomfort, point tenderness
* Hemorrhagic puncta (black seeds)
VIRAL INFECTIONS

• Verruca Virus and Warts

b. Plantar Warts
— Management
* While in competition, protect and prevent spreading
* Pair away callus and apply keratolytic
* Following season, wart can be removed by freezing
it or
by electrodessication (maintain protection until
removal)
VIRAL INFECTIONS

• Molluscum
Contagiosum
— Etiology
* Poxvirus infection which
is more contagious than
warts (especially during
direct body contact)
VIRAL INFECTIONS

• Molluscum Contagiosum
— Signs and Symptoms
* Small, flesh or red colored, smooth-domed
papuleswith central umbilication
 
— Management
* Physician referral is necessary
* Cleansing and destructive procedure (counterirritant
such as cantharidin, surgical removal or cryosurgery)
ALLERGIC, THERMAL
AND CHEMICAL SKIN
REACTIONS
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

Allergies are immunologically mediate responses to molecules in

dyes and proteins against which the body’ s immune system is
sensitized
• Allergens may be food, drugs, clothing, dusts, pollens, plants,
animals, heat, cold, or light
 
• The skin will reflect an allergy in many ways such as reddening
and swelling of the tissue, uticaria or hives, burning or itching
 
• ATC’ s must recognize gross signs of allergic responses and be
prepared to remove allergens and treat topically or
systemically with antipruritic agents
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Contact Dermatitis (allergic and

irritant)
• — Etiology
* Plants are the most common
cause (poison ivy, poison oak,
sumac,ragweed, primrose)
* Topical medications
* Chemicals found in fragrances and
preservatives of soaps, detergents
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Contact Dermatitis (allergic and irritant)

— Signs and Symptoms
* Onset may range from 1 day to 1 week
* Redness, swelling, formation of vesicles that ooze fluid and
form crust, constant itching
* May change from redness and blistering to erythematous
scaling, lichenified papules and plaques
 
— Management
* Avoid allergen
* Tap water compresses or soaks, topical corticosteroids
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Milaria (Prickly Heat)

— Etiology
* Continued exposure to
heat and moisture
causing retention of
perspiration by sweat
glands
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Milaria (Prickly Heat)

— Signs and Symptoms
* Itching and burning vesicles and pustules
* Occurs most often on arms, trunks, and bending
areas of the body
— Management
* Avoidance of overheating, frequent bathing with
non-irritating soap, wearing loose-fitting clothing
and use of antipruritic lotions
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Chilblains
(pernio)
— Etiology
* Caused by
excessive exposure
to cold
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Chilblains (pernio)
— Signs and Symptoms
* Tissue does not freeze but reacts with edema,
reddening and possibly blistering along with a
sensation of burning and itching after exposure to cold
 
— Management
* Exercise and gradual warming of the part
* Massage and application of heat are contraindicated
* Some systemic drugs can be used in severe cases
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Sunburns
• — Etiology
+ Inflammatory response to
injury caused by ultraviolet
solar radiation
* Must be cautious of physical
characteristics, chemicals, food
and drugs that make individuals
more susceptible
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Sunburns
— Signs and Symptoms
* Varies from erythema to severe blistering
* May experience shock if severe enough
* Can cause malfunctioning of organs w/in the skin
* Will appear 2-8 hours following exposure,
withsymptoms becoming most severe at 12 hours
* S&S will dissipate w/in 72-96 hours
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Sunburns
— Management
* Can be prevented through the use of sunscreen (sun
protection factor or SPF)
— Filters ultraviolet light
— Water/sweat resistant sunscreen is recommended
* Treat a burn according to the degree of inflammation
* Cool water, aloe based solutions
* More severe burns may require bathing in a bath of
cornstarch or vinegar
* Severe burns require physician assistance
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Psoriasis
— Etiology
» Exact cause is unknown --
genetic factors may play arole
in condition
* Infection, smoking, some
drugs and possible hormonal
factors may cause an
outbreak
ALLERGIC, THERMAL AND CHEMICAL SKIN REACTIONS

• Psoriasis
— Signs and Symptoms
* Lesion begins as reddish papules that progress to plaques
* Lesions progress to yellowish white scaly condition that tends to
be located on the elbows, knees, trunk, genitalia, and umbilicus
 
— Management
* Teaching patient self management
* Glucocorticoids and kerolytic agents can be used in
conjunction with each other
* Long term oral medications may be necessary
* Counseling may be necessary for psychological
aspects of condition
INFESTATION AND BITES
INFESTATION AND BITES

Infestation is the state of being invaded

or overrun by pests or parasites. It can
also refer to the actual organisms living
on or within a host.
A bite is when an insect (like a mosquito,
flea, or bedbug) uses its mouth to break
a person's skin, usually so it can feed.
INFESTATION AND BITES

• Scabies
— Etiology
* Caused by mites
which cause extreme
nocturnal itching
(tunnels and lays eggs)
INFESTATION AND BITES

• Scabies
— Signs and Symptoms
* Appear as dark lines between fingers and toes, body flexures, nipples
and genitalia
* Excoriations, pustules and papules caused by itching tends to hide
true cause
» Skin develops hypersensitivity to the mite
 
— Management
* Permethrin 5% is treatment of choice
* Washing of bedding and clothes is necessary
* Topical corticosteroids may be necessary to treat itching
INFESTATION AND BITES

• Lice (Pediculosis)
— Etiology
* Manifestation by the
louse (louse of head,
pubic region and body)
INFESTATION AND BITES

• Lice (Pediculosis)
— Signs and Symptoms
» Bites cause itching dermatitis through subsequent scratching
-- promotes pustule and excoriations to develop
— Management
* Cure is rapid with use of any number of agents
* Good hygiene is paramount
* To prevent re-infestation all clothing and bedding
should be washed in hot soapy water or discarded