Date post: | 02-Nov-2014 |
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Skin Disorders in Sleep Patients
Anatomy
Derma is the ancient Greek word for skin
Skin is made up of two main layers no thicker than 1-2 mm Epidermis Dermis
Some refer to the Hypodermis as the third layer of skin. Hypo (under) Dermis (skin)
Skin
Epidermis The epidermis is approximately .2 mm in
thickness.
Nonvascular layer of skin
Five layers
Stratum Corneum (top) Made up of Keratin, which is a protein
formed from what is left of the dead skin cells.
Stratum Basale (bottom) Melanocytes, which are the cells that
produce melanin. Melanin = Pigmentation
Note: Melanoma is a type of skin cancer that originates in the melanocytes. The production of melanin is what gives the melanoma a brownish sometimes black color.
Dermis (Mesodermal Layer)
Blood vessels, capillaries Nerves Hair follicles Sebaceous glands (produce oil) Sweat glands - average person has 2-4
million sweat glands; many are located in the hands, feet armpits and face.
Hyperhidrosis
Disorder involving excessive sweating
Likely to sweat 4-5 times more than the average person
Non-life threatening
Greater risk for fungal infections
Hypodermis – subcutaneous layer
Fat cells
Connective tissues
Larger veins and arteries
Larger nerves
Fun Facts
Skin is the largest organ of the body Shield that helps protect the body
against bacteria, chemicals, harmful rays from the sun and other potentially harmful organisms.
One of the most vulnerable organs of the body
Skin helps regulate body temperature by releasing moisture (sweat)
Questions to ask yourself:
What type of skin cleanser would be best for this patient?
How much pressure should I use while prepping this patient’s skin?
Do I need to relocate any electrodes? Should I be using tape? Or should I
use gauze?
Aging and the Skin
Skin becomes more delicate More prone to skin disorders due to
decreased elasticity and thickness of the skin
Increased dryness and roughness
Several reasons for this, include:
Exposure to UV rays Smoking or other toxin exposure Previous skin disorders
Head Lice - Pediculosis
Different from body lice and pubic lice
Highly contagious Nuisance, not hazardous to one’s
health Lice do NOT jump from head to head
Lifecycle of Head Louse
Louse and Nits under a microscope
Skin irritation from Lice infestation
The skin can become itchy due to the bites from the head nymph.
Lice Infestation
Nits are commonly mistaken as dandruff and vice versa. The easiest way to tell the difference is that dandruff moves and nits stick to the hair shaft.
Patient Information on Lice Use OTC shampoos that rid the hair of lice
After shampooing check head everyday for the next two weeks.
Prescription shampoo is sometimes necessary
Buy sprays with lice killing agent to spray pillows and carpets
Vacuum carpets every other day for two weeks. (Do Not forget to vacuum the car)
Dermatitis
Common signs and symptoms, include:
Redness Swelling Itching Skin lesions
Several Types of Dermatitis Contact dermatitis – a rash resulting from an irritant or allergy-producing substance.Ex.: Poison ivy
Seborrheic dermatitis- scalp condition that often causes dandruff
Atopic dermatitis- commonly known as eczema, it is a chronic itchy rash that comes and goes.
Other types of Dermatitis: Stasis dermatitis, Neurodermatitis, Perioral dermatitis
Dandruff (Seborrheic Dermatitis)
Excessive flaking of dead skin cells due to rapid skin cell turnover
Eczema (Atopic Dermatitis)A rash that is red, patchy, scaly and itchy.
Often times blisters and oozing can develop.
The exact cause of Eczema is unknown.
Genetic predisposition Several forms of eczema Topical ointments and medications can
help with the itching and appearance Can lead to bacterial infection Stress can often times aggravate the
condition
Hives (Urticaria)Raised skin with welt like appearance.
Can be itchy.
Develops from stress Develops from an allergic reaction
- Side effect of medication
Poison Ivy or Oak – classified as a contact dermatitis Plant that many
people have an allergy to, in which
they develop an itchy red
rash or blisters. Any drainage
from therash or blisters can be contagious.
BurnsA burn occurs when the skin becomes
damaged due to exposure from: Radiation
- Sunlight
- Sound waves
- Ionizing radiation
- X-rays
Chemicals Electricity Wind
Radiation Burn/Dermatitis
The most common burn is a sunburn caused by UV rays.
Radiation therapy used in combination with Chemotherapy can also cause severe burns
Bacterial InfectionsThere are several types of bacteria.
Listed below are a few examples: Staphylococcus
MRSA (Methicillin-Resistant Staphylococcus Aureus) is a strain of staphylococcus.
Streptococcus
Hemophyllus Influenza HIB vaccine helps to protect against this
bacteria
Staphylococcus
Bacteria can be present without causing an infection
Commonly found on the skin and in the nose
Infections can affect tissues, bone, bloodstream and can be the cause of pneumonia
Different Strains = Level of Severity
MRSA (Methicillin- Resistant Staphylococcus Aureus)
Since the bacteria does not respond well to many antibiotics (Methicillin, Penicillin, Amoxicillin), infections can become serious.
Mild infections can be treated with certain antibiotics and good hygiene.
Progression of the infection into the bloodstream or bone can be potentially life-threatening.
Topical antibiotics, oral antibiotics and intravenous antibiotics are all options used to treat MRSA infections.
Note: MRSA is contagious when a person has an active infection or if somebody is a “carrier” of the bacteria.
MRSA Infection
CDC Recommendations to avoid MRSA Wash hands with soap and warm
water. Alcohol based sanitizers can be just as good.
If one has an abrasion, make sure to clean and cover the wound until it has healed.
Avoid contact with other’s wounds or bandages
Avoid sharing towels and razors
Streptococcus
Common infections, include: Strep throat Scarlett fever Cellulitis
Different Strains = Level of Severity
Cellulitis
Bacterial infection that spreads through the dermal and subcutaneous tissues.
Skin is visibly warm, red, swollen and tender
Sensitivity to pressure Hard to culture, unless pus like
substance or other drainage is available
Common infection areas, include: Legs Around the eyes (Periorbital
Cellulitis) Cheeks
Treatment options, include: Oral antibiotics Injection antibiotics Intravenous antibiotics
Cellulitis
Peri-orbital Cellulitis
Neuropathy
An abnormality of the nervous system. There is a problem with the communication between the brain and the body. Any part of the nerve cell (cell body, axon, or dendrites) can be damaged. The most common place for the damage to occur is in the axon. There are several types of neuropathy, including: Diabetic, Alcoholic, and Chemotherapy Induced Peripheral Neuropathy (CIPN).
The three nerve types affected are:
Sensory Nerves- controls the sense of touch, pain, temperature, numbness, etc.
Motor Nerves-control of voluntary movements
Autonomic Nerves - control involuntary functions such as breathing, digestion, blood pressure, etc.
If sensory nerves become damaged, the result could be loss of pain sensation replaced with numbness. Numbness of the extremities could cause minor wounds to become infected by bacteria, leading to Ulcers.
Neuropathic Ulcer
Diabetic patients are prone to skin disorders due to sensory neuropathy and micro-vascular disease. This is why extra caution should be taken when cleansing the skin with a light abrasive solution.
Fungal Infections
Fungi or fungus is a microscopic organism that can be found on the skin. Fungus does not always cause problems; however, problems occur when it grows out of control, in turn, creating a fungal infection.
Fungus grows in moist areas Some people are genetically prone to
fungal infections Contagious. Can easily be transferred
from one section of skin to another or from person to person.
Itchy Medications and anti-fungal ointments can
be used to get rid of an infection
Fungal infections can occur on the skin and/or nails. There are several names for fungal infections depending on the infected area.
Body Ringworm (Tinea Corporis) Athlete’s Foot (Tinea Pedis)- Most
common Jock Itch (tinea Cruris) Scalp Ringworm (Tinea Capitis) Nail Ringworm Beard Ringworm
Tinea Corporis (Ringworm)
Tinea Capitis- Scalp Ringworm
Scalp ringworm can cause hair loss in the infected area.
Extremely hard to rid the scalp of the fungus
Nail Ringworm
Nail thickening Yellow Malformation Nail loss
Note: Important to disinfect oximeters or use disposable oximeters
Sebaceous Gland Disorders
Sebaceous glands are located alongside the hair follicles. They produce oils. The most common Sebaceous gland disorders are acne and Rosacea. Some people report discomfort from sebaceous gland disorders.
Blackheads
Also known as an open comedo. Blackheads are formed at the surface of the skin. Oils (Sebum) and keratin cells are what clog the pore. The black coloring is due to the exposure to the air.
Whiteheads and Cystic AcneWhiteheads are closed comedos. Whiteheads
develop when oils that are clogging the pore are trapped below the skins surface.
Cystic Acne is the most severe form of acne due to its ability to cause scarring. The pressure from dead skin cells builds up causing leakage of bacteria found in the duct to inflame the dermis. If that bacteria cannot drain completely bumps and nodules appear causing cystic acne.
Rosacea Early Symptoms Progression of
Disease
Rosacea is a poorly understood disease affecting the face. The cause of Rosacea is unknown. There is no cure; however, symptoms can be controlled with medications.
Commonly reported symptoms, include: burning, stinging, and itching.
Other symptoms of Rosacea, include:
Redness on the cheeks, nose, chin and forehead
Small visible blood vessels Bumps or pimples Watery or irritated eyes
Varicella (Chickenpox)
Rash and flulike symptoms caused by the herpes zoster virus that typically affect children, but can be seen in adults as well. Chickenpox is extremely contagious from two days before the rash appears until the sores have scabbed over.
Shingles
Shingles is another disorder caused by the herpes zoster virus. Up to 20% of people that have had chickenpox or the varicella vaccine are at risk for getting shingles later in life.
The herpes virus lies dormant in the nerves located alongside the spinal cord. A weakened immune system or stress can cause the virus to reactivate. Many times only one nerve is effected, so the shingles rash appears on one side, in one area.
•Tingling, itchy blisters and rash•Treatment includes steroids, pain medication and anti-viral medications•Vaccines for people older than 60 years to help prevent a shingles occurrence.
Shingles is not contagious to those who have had chickenpox.
Shingles is only contagious to those who have not had chickenpox.
Note: The person can NOT get shingles, but can contract chickenpox.
Shingles is only contagious before the blisters have crusted over.
Important for the infected area to be covered
Autoimmune Disorders
Autoimmune means the body’s immune system wants to attack itself. The immune system creates antibodies to protect against outside bacteria, viruses and antigens, but these antibodies, for reasons not fully understood, can sometimes attack the body leaving it vulnerable to infections.
LupusAccording to www.lupus.org, approximately
1.5 million Americans and 5 million people worldwide are believed to be living with Lupus. Lupus can be an acute or chronic inflammatory disease of bodily tissues, which effect various parts of the body, including: the skin, heart, lungs, kidneys, liver, joints, nervous system, blood, etc. The cause of Lupus is unknown. Although, there is not a cure for Lupus, medications can help alleviate or reduce the severity that the disease has on the body. Lupus is a disease known for its flare-ups.
There are different forms of Lupus. The two most commonly discussed types are:
SLE (Systemic Lupus Erythematosus) Cutaneous Lupus Erythematosus
Others include: Drug-induced Lupus Erythematosus Neonatal Lupus
SLE (Systemic Lupus Erythematosus) SLE is the most notable form of Lupus,
effecting internal organs Can be fatal, although more recent
medical advances suggest that 80-90% of people with SLE will live a normal life span
Most common reason for fatalities are due to infection or kidney failure
Cutaneous Lupus Erythematosus
Cutaneous Lupus, also referred to as Discoid Lupus, effects the skin. The most common rash resulting from cutaneous lupus is the discoid rash. The rash appears red, raised and often times scaly. The disc like lesions that develop are where the name Discoid Lupus originated.
The malar rash or butterfly rash is another example of cutaneous lupus. The malar rash develops on the cheeks, nose, and eyelids. Approximately 10% of people with Cutaneous Lupus will develop SLE (Lupus Foundation of America, 2008).
Many times the areas of the body exposed to sunlight or fluorescent lights are affected more so than areas that are covered (Lupus Foundation of America, 2008).
Psoriasis
Psoriasis is a chronic skin condition originating in the stratum corneum and other layers of the epidermis. It is characterized by inflamed, itchy, red, scaly areas that often develop on the scalp, elbows, knees, and lower back. Psoriasis affects between 5-7 million people in the U.S. (http://www.healthline.com, Psoriasis, 10/07)
Skin Cancer
There are different types of skin cancer. All originate in the five layers of the epidermis. Some include:
Basal Cell Carcinoma Squamous Cell Carcinoma Melanoma Kaposi’s Sarcoma Paget’s Disease Cutaneous T-Cell Lymphoma
Basal Cell Carcinoma
Most common form of skin cancer accounting for approximately 80% of all cases. Originates in the basal cells located at the bottom of the epidermis. Commonly found on the face, neck, scalp, shoulders, and back.
Melanoma
Melanoma is known as the deadliest form of skin cancer, due to it’s ability to metastasize. Begins in the melanocytes.
Many of these disorders present in similar ways.
Be familiar with some of the more common skin disorders if mentioned in a patients chart
Be able to recognize what some of the skin disorders look like.
Know when to use alternative methods for cleansing the skin and electrode placement.
Ensure patients are comfortable COMMUNICATION
Helpful Websites
www.cdc.gov www.cancer.gov www.healthline.com www.lupus.org www.nlm.nih.gov www.rosacea.org www.webmd.com http://www.mayoclinic.com http://www.merck.com
Questions,Concerns,Feedback
Should you have any questions or feedback regarding this presentation please feel free to contact our program director, Jennifer Brickner-York, at [email protected].
Thank You.