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Obesity: Skin Problems and Care
Obesity: Skin Problems and Care
Produced by the Alabama Department of Public HealthVideo Communications and Distance Learning DivisionProduced by the Alabama Department of Public HealthVideo Communications and Distance Learning Division
Satellite Conference and Live WebcastWednesday, May 23, 2012
2:00 – 4:00 p.m. Central Time
Satellite Conference and Live WebcastWednesday, May 23, 2012
2:00 – 4:00 p.m. Central Time
FacultyFaculty
Jacqueline Giddens, RN, MSN, WOCN, CWCCNClinical Nurse Consultant
Alabama Department of Public Health
Jacqueline Giddens, RN, MSN, WOCN, CWCCNClinical Nurse Consultant
Alabama Department of Public Health
BariatricsBariatrics• Bariatrics /bar·i·at·rics/ (-e-ă triks) a
field of medicine encompassing the
study of overweight and its causes,
prevention, and treatment
• Bariatrics /bar·i·at·rics/ (-e-ă triks) a
field of medicine encompassing the
study of overweight and its causes,
prevention, and treatment
Skin is an ORGANSkin is an ORGAN• Did you know the skin is an organ?
– Largest organ
– Heaviest organ
• Did you know the skin is an organ?
– Largest organ
– Heaviest organ
• 15% of body weight• 15% of body weight
Skin Is an ORGANSkin Is an ORGAN– In a 150 pound person, the skin
weighs about 12 pounds and can
cover 18 square feet
– These numbers increase with the
– In a 150 pound person, the skin
weighs about 12 pounds and can
cover 18 square feet
– These numbers increase with the
obese patientobese patient
Skin ChangesSkin Changes
• Acanthosis Nigricans
– Dark patches
• Skin tags
• Acanthosis Nigricans
– Dark patches
• Skin tags
• Stretch marks
• Stasis dermatitis
• Varicose veins
• Stretch marks
• Stasis dermatitis
• Varicose veins
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Acanthosis Nigricans Acanthosis Nigricans • Presentation
– Velvety, light-brown-to-black
markings that occur in areas
including the neck, armpits, groin,
• Presentation
– Velvety, light-brown-to-black
markings that occur in areas
including the neck, armpits, groin, g , p , g ,
and under the breasts
• Treatment
– Weight loss
– Insulin control
g , p , g ,
and under the breasts
• Treatment
– Weight loss
– Insulin control
Acanthosis NigricansAcanthosis Nigricans
Acanthosis NigricansAcanthosis Nigricans Skin TagsSkin Tags
• Presentation
– Growths that stick out and may be
connected to the skin with a
narrow stock
• Presentation
– Growths that stick out and may be
connected to the skin with a
narrow stocknarrow stock
• The extra weight causes friction
between the affected areas of
skin
narrow stock
• The extra weight causes friction
between the affected areas of
skin
Skin TagsSkin Tags
• Treatment
– Laser or surgical removal
• Treatment
– Laser or surgical removal
Stretch Marks Stretch Marks
• Presentation
– Indented streaks that appear in the
skin called striate, pink, reddish, or
purplish
• Presentation
– Indented streaks that appear in the
skin called striate, pink, reddish, or
purplishpurplish
• Treatment
– Laser therapy
– Creams
purplish
• Treatment
– Laser therapy
– Creams
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Skin TagsSkin Tags Stretch MarksStretch Marks
Stasis DermatitisStasis Dermatitis• Presentation
– Darkening or redness of skin at the
ankles or legs
– Itching
• Presentation
– Darkening or redness of skin at the
ankles or legs
– ItchingItching
– Leg pains
– Skin lesion
– Skin appears thin, tissue-like
Itching
– Leg pains
– Skin lesion
– Skin appears thin, tissue-like
Stasis DermatitisStasis Dermatitis– Skin irritation of the legs
– Thickening of skin at the ankles or
legs
– Open sores ulcers
– Skin irritation of the legs
– Thickening of skin at the ankles or
legs
– Open sores ulcersOpen sores, ulcersOpen sores, ulcers
Stasis DermatitisStasis Dermatitis• Treatment
– Disease management
• Compression for Venous Stasis
Di
• Treatment
– Disease management
• Compression for Venous Stasis
DiDisease
• Prevention of trauma to areas
Disease
• Prevention of trauma to areas
Stasis DermatitisStasis Dermatitis– Open wounds
• Topical antibiotics
• Anti-fungals
– Open wounds
• Topical antibiotics
• Anti-fungals
• Antimicrobial dressings• Antimicrobial dressings
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Stasis DermatitisStasis Dermatitis Stasis DermatitisStasis Dermatitis
Varicose Veins Varicose Veins
• Presentation
– Swollen, enlarged veins that are
raised above the skin's surface
• Presentation
– Swollen, enlarged veins that are
raised above the skin's surface
• Usually on the inside of the legs
and backs of the calves
• Usually on the inside of the legs
and backs of the calves
Varicose Veins Varicose Veins
• Treatment
– Compression stockings
– Laser
• Treatment
– Compression stockings
– Laser
– Surgery– Surgery
Varicose VeinsVaricose Veins Varicose VeinsVaricose Veins
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Skin InfectionsSkin Infections• Candidiasis Albicans
• Cellulitis
• Folliculitis
• Candidiasis Albicans
• Cellulitis
• Folliculitis
• Erythrasma
• Tinea Cruris
• Erythrasma
• Tinea Cruris
CandiasisCandiasis• Presentation
– Itchy, red, or purple patch on the
skin with lesions
F l t
• Presentation
– Itchy, red, or purple patch on the
skin with lesions
F l t– Fungal, yeast– Fungal, yeast
CandiasisCandiasis• Treatment
– Topical antifungal
• Over the counter or prescription
• Treatment
– Topical antifungal
• Over the counter or prescription
– Oral antifungals
– IV antifungals
– Oral antifungals
– IV antifungals
CandiasisCandiasis
CandiasisCandiasis CellulitisCellulitis• Presentation
– Cased by bacteria
– Pain, tenderness, redness, warmth,
weepy
• Presentation
– Cased by bacteria
– Pain, tenderness, redness, warmth,
weepyweepy
– Chills, shaking, muscle aches and
sweating
weepy
– Chills, shaking, muscle aches and
sweating
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CellulitisCellulitis
• Treatment
– Good hygiene
– Oral or IV antibiotics
• Treatment
– Good hygiene
– Oral or IV antibiotics
– Wound care, if indicated– Wound care, if indicated
CellulitisCellulitis
CellulitisCellulitis FolliculitisFolliculitis• Presentation
– Small to medium sized whiteheads
around one or more of the hair
follicles
• Presentation
– Small to medium sized whiteheads
around one or more of the hair
folliclesfollicles
– Redness around hair follicles
– Usually in patches
follicles
– Redness around hair follicles
– Usually in patches
FolliculitisFolliculitis• Treatment
– Good hygiene
– Oral or IV antibiotics
• Treatment
– Good hygiene
– Oral or IV antibiotics
– Topical antibiotics to support the
oral or IV antibiotics
– Topical antibiotics to support the
oral or IV antibiotics
FolliculitisFolliculitis
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FolliculitisFolliculitis ErythrasmaErythrasma• Presentation
– Raised, reddish brown, scaly,
patches
– Itches
• Presentation
– Raised, reddish brown, scaly,
patches
– Itches– Itches
– Caused by bacterial infection
– Appears between skin folds, groin,
armpits, and knees
– Spreads if untreated
– Itches
– Caused by bacterial infection
– Appears between skin folds, groin,
armpits, and knees
– Spreads if untreated
ErythrasmaErythrasma• Treatment
– Keep area dry
– Wash with antibacterial soap and
i ll
• Treatment
– Keep area dry
– Wash with antibacterial soap and
i llrinse well
– Topical antifungals, antibiotics,
moisture barriers
rinse well
– Topical antifungals, antibiotics,
moisture barriers
ErythrasmaErythrasma– Oral or IV antibiotics
• Erythromycin or Azithromycin
– Photo-therapy with specialized
li ht
– Oral or IV antibiotics
• Erythromycin or Azithromycin
– Photo-therapy with specialized
li htlightslights
ErythrasmaErythrasma ErythrasmaErythrasma
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ErythrasmaErythrasma Tinea CrurisTinea Cruris• Presentation
– “Jock Itch”
– Red, patchy rash
• Presentation
– “Jock Itch”
– Red, patchy rash
– Found in groin areas
– Fungal skin infection
– Found in groin areas
– Fungal skin infection
Tinea CrurisTinea Cruris
• Treatment
– Topical antifungal
– Oral antifungal if needed
• Treatment
– Topical antifungal
– Oral antifungal if needed
– Keep skin clean and dry– Keep skin clean and dry
Tinea Cruris (Jock Itch)Tinea Cruris (Jock Itch)
Skin Care Basics:Obese Patient
Skin Care Basics:Obese Patient
• Good personal hygiene
• Prevention of friction
• Control moisture and perspiration
• Good personal hygiene
• Prevention of friction
• Control moisture and perspiration• Control moisture and perspiration
• Daily skin checks for breakdown or
changes
• Prompt treatment of any open areas
or rashes
• Control moisture and perspiration
• Daily skin checks for breakdown or
changes
• Prompt treatment of any open areas
or rashes
LymphedemaLymphedema
• Presentation
– Fatigue
– Heavy, swollen limb
• Presentation
– Fatigue
– Heavy, swollen limb
– Localized fluid accumulation
– Skin discoloration
– Deformity
• Elephantiasis
– Localized fluid accumulation
– Skin discoloration
– Deformity
• Elephantiasis
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LymphedemaLymphedema
• Treatment
– Chronic (no cure)
– Weight loss
• Treatment
– Chronic (no cure)
– Weight loss
– Specialized
• Exercise
• Compression
• Massage
– Specialized
• Exercise
• Compression
• Massage
Lymphedema and DermatitisLymphedema and Dermatitis
LymphedemaLymphedema LymphedemaLymphedema
ResourcesResources• http://www.amylhwilliams.com/
• http://www.obesityaction.org/
• http://skinipedia.org/skin-and-
b it /i d ht l
• http://www.amylhwilliams.com/
• http://www.obesityaction.org/
• http://skinipedia.org/skin-and-
b it /i d ht lobesity/index.html
• http://www.skinsight.com/adult/stasi
sDermatitis.htm
• http://www.dermnet.com/
obesity/index.html
• http://www.skinsight.com/adult/stasi
sDermatitis.htm
• http://www.dermnet.com/