Integumentary System Disorders

Introduction

Skin tissue is mainly affected by aging. Aging affects every organ system in the body, but skin changes are the most obvious. As you grow older, the skin loses its elasticity and becomes rough and dry, resulting in wrinkles. Skin can be damaged by sun exposure for long time periods. There are many cosmetic products available to help protect the skin. It's important to apply an appropriate amount of sunscreen frequently if your skin is exposed to the sun. Common disorders of the skin include infections, lesions, pressure ulcers, inflammatory diseases, burns, and acne. Infections can be caused by bacteria, viruses, fungi, and parasites. Allergic reactions can affect the skin and include symptoms such as inflammation, itching, and hives. Injuries and wounds can also traumatize the skin. 

 

Skin Infection

Skin infections can be caused by various microorganisms, including bacteria, fungi, viruses, and parasites. An infection can be local, with symptoms of inflammation, pus, blisters, and pain. If untreated, an infection can spread to internal organs and cause systemic infection if it reaches the bloodstream. Signs and symptoms of severe infections include fever, dehydration, and increased white blood cells (WBCs) in the blood. Severe infection might require intravenous antibiotics and prolonged hospitalization.

• Bacterial infections are caused by bacteria. Staphylococcus is a common bacterium that causes skin infections. Treatment includes topical, oral, or intravenous antibiotics. Severe infections may require drainage of the infected wound and hospitalization. The following are common antibiotics used to treat bacterial infections.                                                                                                                                                                                1) Azithromycin (Zithromax)                                                                                                                                                                                                            2) Bacitracin (Bacitracin)                                                                                                                                                                                                                    3) Bacitracin/Neomycin/Polymyxin B (Neosporin, Triple Antibiotic)                                                                                                                                            4) Cephalexin (Keflex)                                                                                                                                                                                                                          5) Ciprofloxacin (Cipro)                                                                                                                                                                                                                        6) Mupirocin (Bactroban)                                                                                                                                                                                                                    7) Vancomycin (Vancocin) 
• Fungal infections are caused by fungi. Athlete's foot is a common fungal infection. Skin surfaces that are exposed to sweat, such as abdominal folds, feet, and armpits, are at higher risk of acquiring fungal infections. Fungal infections are treated with antifungal medications. The following are some common antifungal medications:                                                                                                                                                                   1) Nystatin (Nystop)                                                                                                                                                                                                                             2) Fluconazole (Diflucan)                                                                                                                                                                                                                     3) Miconazole (Lotrimin)                                                                                                                                                                                                                     4) Terbinafine (Lamisil)                                                                                                                                                                                                                         5) Amphotericin B (Ambisome)
• Viral infections are caused by viruses. Chicken pox, shingles, and genital warts are common viral infections. Viral infections are highly contagious and sometimes require isolation. Genital warts may spread through sexual contact. Viral infections are difficult to treat, and sometimes patients are provided supportive care until the infection runs its course. Viral infections are treated with antiviral medications. The following are some common antiviral medications:                                                                                                                                                                       1) Acyclovir (Zovirax)                                                                                                                                                                                                                             2) Valacyclovir (Valtrex)                                                                                                                                                                                                                       3) Famciclovir (Famvir)                                                                                                                                                                                                                         4) Ganciclovir (Cytovene)                                                                                                                                                                                                                     5) Cidofovir (Vistide)
• Parasitic infections are caused by parasites. Pediculosis and scabies are common parasitic infections. The following are some common medications to treat parasitic infections:                                                                                                                                                                                         1) Lindane (Kwell)                                                                                                                                                                                                                                 2) Permethrin (Elimite)                                                                                                                                                                                                                         3) Crotamiton (Eurax)

 

Skin Lesions

Infections, allergic reactions, and trauma to your skin can cause skin lesions. The Primary Skin Lesions table lists commonly used terms related to the appearance of primary skin lesions. 

Primary Skin Lesions

Abrasion | The scraping away of epidermal tissue

Contusion | Injured skin that's intact and not broken

Cyst | A hollow cavity filled with liquid secretions

Excoriation | The superficial loss of tissue due to trauma, chemicals, or burns

Laceration | Broken skin layers or torn flesh

Macules | Non-palpable discolored spots or patches

Papules | Small, solid, circumscribed (rounded), raised areas. Examples include warts, moles, and pimples.

Polyp | A small growth protruding from a mucous membrane

Pustules | Small, elevated, circumscribed, pus-containing lesions 

Vesicles | Blister-like elevations containing serious fluid. Examples include lesions due to dermatitis, burns, chicken pox, and scabies.

Wheals | Localized areas of edema on the body surface. Examples include urticaria, or hives from an allergic reaction.

 

Secondary skin lesions result from the healing process. As a primary skin lesion heals, scabs or crusts form over the affected area. These secondary lesions are composed of dry pus, lymph, or blood and may vary in color and thickness. Select each tab to learn about the terms related to the appearance of the secondary skin lesions.

Cicatrix is a scar from a wound that has healed.

Hypertrophied is a firm, raised, and thickened condition of a scar.

Keloid is a progressively enlarging, irregularly shaped scar tissue due to excessive collagen formation in the corium during tissue repair.

 

Skin lesions are usually treated with topical corticosteroids, antibiotics, and antiseptics, depending on the type of skin lesion. The following is a list of common corticosteroids that are available to treat various skin disorders:

• Betamethasone (Diprolene, Valisone)
• Clobetasol (Temovate)
• Desonide (Desowen)
• Desoximetasone (Topicort)
• Fluocinolone (Capex)
• Hydrocortisone (Cortef)
• Triamcinolone (Kenalog)

 

Pressure Ulcers

An ulcer is an open sore or lesion caused by trauma, intense heat or cold, pressure, or bacterial infection. An ulcer is a depression of the epidermis. It can progress to the erosion of the skin layers. Pressure ulcers (or decubitus ulcers) are specifically caused by direct pressure due to prolonged immobility. When someone is sitting or laying down for long periods, ulcers may occur at the points that bear the most pressure, such as the heels, tailbone (coccyx), elbows, and the back of the head. Patients that are immobile due to stroke, coma, or other serious diseases are at the greatest risk for developing pressure ulcers. Once an ulcer has formed, it doesn't heal unless aggressive measures are taken to relieve the pressure. The ulcers may require surgery to remove dead or infected tissue.

 

Pressure ulcer treatment includes keeping the affected area clean and dry. Antibiotics, steroids, and pain reliever medications are sometimes used to provide symptomatic relief, decrease the inflammation, and treat infection if present. Pressure ulcers are classified into four stages based on severity. 

Stage 1: Stage I ulcers have reddened skin, but the skin isn't broken.

Stage 2: Stage II ulcers can have broken or unbroken blisters that are reddened and/or irritated. 

Stage 3: Stage III ulcers have skin breakage through all layers.

Stage 4: Stage IV ulcers go through all layers of skin and can affect muscles, tendons, and even bone.

 

Inflammatory Skin Disorders

Dermatitis is a general term referring to any inflammation of the skin. Dermatitis isn't always caused by infections. Eczema and psoriasis are the most common inflammatory skin conditions. Eczema, also known as atopic dermatitis, is a common inflammatory disorder in which skin patches become rough and swollen with blisters. Eczema is more prevalent in children but may persist into adulthood in some cases. Common symptoms of eczema include itching, dryness, redness, and swelling. In most cases, the cause of eczema is unknown but can be triggered by conditions such as allergies and asthma.

Eczema may also be triggered by humidity, infection, or stress. Eczema may be prevented by avoiding or minimizing exposure to the allergens, keeping the skin clean and moisturized, and drinking plenty of fluids to stay hydrated. Treatment of eczema includes topical corticosteroids, antihistamines, and immunosuppressant agents.

 

       Drug Class: Topical Corticosteroids

 

Generic Name                                   Brand Name

Hydrocortisone                                   Cortef

Triamcinolone                                     Kenalog

Clobetasol                                           Temovate

Desoximetasone                                Topicort

 

         Drug Class: Oral Antihistamines

 

Generic Name                                  Brand Name

Diphenhydramine                             Benadryl

Cetirizine                                             Zyrtec 

Fexofenadine                                     Allegra

Loratadine                                          Claritin 

 

                Drug Class: Topical Antibiotics

 

Generic Name                                            Brand Name   

Mupirocin                                                     Bactroban                                  

Sulfacetamide                                              Klaron

Bacitracin/Neomycin/Polymyxin B           Neosporin, Triple Antibiotic

 

  Drug Class: Topical Immunosuppressants

 

Generic Name                                   Brand Name

Tacrolimus                                           Protopic

Pimecrolimus                                      Elidel

 

 

Psoriasis is a chronic skin disorder that results from overproduction of the skin cells. It's characterized by plaque formation on the skin surface due to the accumulation of the rapidly growing skin cells. The plaque may appear red, dry, and covered with silvery scales. Elbows, wrists, and knees are some of the most commonly affected areas. Psoriasis can occur at any age but is most common between the ages of 15 and 30. Mild psoriasis is treated with topical corticosteroids, vitamin D derivatives, and retinoids. Severe forms of psoriasis generally require oral and injectable immunosuppressant medications. The medications commonly used to treat psoriasis are listed below by drug class.

   Drug Class: Vitamin D Derivatives

 

Generic Name                      Brand Name

Calcipotriene                          Dovonex

 

Drug Class: Retinoid

 

Generic Name                    Brand Name

Tretinoin                               Retin-A

 

 Drug Class: Systemic Immunosuppressants

 

Generic Name                  Brand Name

Methotrexate                     Trexall

Cyclosporine                      Neoral, Sandimmune

 

      Drug Class: Other Drugs

 

Generic Name             Brand Name

Efalizumab                     Raptiva

Etanercept                     Enbrel

Adalimumab                 Humira

 

 

Burns

Burns are common, but they can cause serious problems that affect the skin. Burns occur from overexposure to heat, chemicals, electricity, or radiation. Burns are classified according to their severity. The classification is made by determining the number of tissue layers involved.

1) First-Degree Burn. 

A first-degree burn is a minor burn. Although there may be some redness and discomfort, blistering usually doesn't occur and little tissue is destroyed. First-degree burns are labeled as superficial burns. If blisters do form, the upper layers of the epidermis may peel within one to three days. Healing usually takes about a week.

2) Second-Degree Burn.

A second-degree burn causes injury to the top layers of the dermis. Second-degree burns are labeled as partial-thickness burns. Although these burns damage sweat glands, hair follicles, and sebaceous glands, the dermis isn't completely destroyed. A second-degree burn is characterized by blisters, severe pain, generalized swelling, and fluid loss and usually results in scarring. Healing takes about two weeks.

3) Third-Degree Burn.

Third-degree burns are the most severe and generally cause no pain at first because of the damage to the nerve endings. In this type of burn, the epidermis and dermis have been completely destroyed, and the damage extends below the dermis into the subcutaneous layer. Third-degree burns are labeled as full-thickness burns, wherein the damage goes into the fat, muscle, and bone. Someone with third-degree burns has a high risk of infection from loss of the protective skin layers and may experience a loss of bodily fluids. Third-degree burns usually require skin grafting—a type of surgery in which the burned skin is removed and replaced with skin from another location. However, the larger the surface area affected by the burn, the greater the risk of complications or death.

4) Treatment Options for Burns.

A first-degree burn usually requires no treatment and heals on its own. A second-degree burn may require topical antibiotics such as silver sulfadiazine (Silvadene) or pain relievers. Severe burns require hospitalization, skin grafting, hydration, and intravenous antibiotics.

 

Acne

Acne is a common skin disorder among adolescents and young adults. There are multiple factors that cause acne, such as abnormal epithelial cell growth in puberty, increased production of sebum (oil) by sebaceous glands, infections, and inflammations. There are also many options to prevent and treat acne, including antibacterial washes, creams, and gels. Retinoic agents are also used for the treatment of severe acne. Other agents used to treat acne include keratolytics, corticosteroids, and anti-inflammatory agents.

The acne medications commonly used to treat acne are listed in each tab by drug class.

     Drug Class: Topical Antibiotics

 

Generic Name                   Brand Name

Benzoyl Peroxide               Benzac, Clearasil

Clindamycin                       Cleocin, Clindagel, Clindamax

Erythromycin                     Erygel, Akne-Mycin

Sulfacetamide                   Klaron, Ovace

 

    Drug Class: Retinoic Acid

 

Generic Name              Brand Name

Isotretinoin                     Accutane 

Tretinoin                          Retin-A

Tazarotene                      Tazorac

 

  Drug Class: Keratolytic Agents

 

Generic Name             Brand Name

Salicylic acid                   Multiple brand names

 

 

Key Points

• Skin infections are caused by bacteria, viruses, fungi, and parasites.
• An allergic reaction can cause symptoms of rash, itching, and hives on the surface of the skin and is commonly treated with antihistamines and corticosteroids.
• Eczema is more common in children and can be triggered by various environmental factors.
• A combination of steroids, antibiotics, antihistamines, and immunosuppressant drugs are available to treat eczema.
• Third-degree burns are the most severe and require emergency treatment and hospitalization.