1. Nurses SOAR! Training Curricula Series For More Information and Inquiries: nursessoar@georgetown.edu

2. HIV and Skin

3. How to Evaluate Skin  Use a good light source  Inspect the entire body  Oral mucosa  Scalp  Palms of hands and soles of feet  Nails  Use a good light source  Inspect the entire body  Oral mucosa  Scalp  Palms of hands and soles of feet  Nails

4. History taking  2 most important questions:  Where was the first lesion?  What is the distribution?  Scattered  Clustered  Linear  Regional  Localized  2 most important questions:  Where was the first lesion?  What is the distribution?  Scattered  Clustered  Linear  Regional  Localized

5. More questions…  OLDCARTS  Onset  Location  Duration  Characteristics  Aggravating/associated factors  Relieving factors  Time  Severity  OLDCARTS  Onset  Location  Duration  Characteristics  Aggravating/associated factors  Relieving factors  Time  Severity

6. What does it look like? Texture Color Shape Borders Number Temperature Size Texture Color Shape Borders Number Temperature Size

7. Molluscum

8. Molluscum Contagiosum  Pimples with dimples  Commonly found on face, neck, eyelids, genitalia  Can be identified visually  Pimples with dimples  Commonly found on face, neck, eyelids, genitalia  Can be identified visually

9. Molluscum Treatment  Do not scratch!  Molluscum may go away on its own within 2 years  ARV’s may help to treat  Some patients with very weakened immune systems may never clear Molluscum  Do not scratch!  Molluscum may go away on its own within 2 years  ARV’s may help to treat  Some patients with very weakened immune systems may never clear Molluscum

10. Molluscum Prevention  Avoid skin-to skin contact with someone who has molluscum -- WEAR GLOVES!!  If the beard area is affected, minimize shaving facial hair  Avoid skin-to skin contact with someone who has molluscum -- WEAR GLOVES!!  If the beard area is affected, minimize shaving facial hair

11. Kaposi’s Sarcoma  Type of cancer  Tumors of the tissue just below the skin  May involve the skin, mouth, lymph nodes, GI tract, lung, liver, or spleen  Type of cancer  Tumors of the tissue just below the skin  May involve the skin, mouth, lymph nodes, GI tract, lung, liver, or spleen

12. Kaposi’s Sarcoma  Symptoms:  Purple, red or brown lesions  Flat, painless  Non-itching, non-draining  Does not change color with pressure  Painful swelling around legs or groin area  GI bleeding  Swollen lymph nodes, unexplained fever, or weight loss  Coughing, shortness of breath  Difficulty swallowing, breathing, eating  Symptoms:  Purple, red or brown lesions  Flat, painless  Non-itching, non-draining  Does not change color with pressure  Painful swelling around legs or groin area  GI bleeding  Swollen lymph nodes, unexplained fever, or weight loss  Coughing, shortness of breath  Difficulty swallowing, breathing, eating

14. Lymphedema  Accumulation of lymphatic fluid in the interstitial tissues due to damaged lymph nodes or lymph vessels  If left untreated, the fluid may:  Cut off oxygen supply to the tissues  Provide a medium for bacterial growth  Interfere with wound healing  Lymphedema is different from edema caused by venous insufficiency  Accumulation of lymphatic fluid in the interstitial tissues due to damaged lymph nodes or lymph vessels  If left untreated, the fluid may:  Cut off oxygen supply to the tissues  Provide a medium for bacterial growth  Interfere with wound healing  Lymphedema is different from edema caused by venous insufficiency

17. Lymphedema Prevention  NO HEAT!!!  Elevate limbs while resting  Avoid tight clothing  Avoid strenuous activity to affected limb  Protect your skin  NO HEAT!!!  Elevate limbs while resting  Avoid tight clothing  Avoid strenuous activity to affected limb  Protect your skin

18. Lymphedema Treatment and Management  Treat underlying cause of infection  Proper skin care and diet  Lymphatic massage to promote drainage  Bandaging – Tight at the toes, loosening as you move towards the trunk  Compression garments  Exercise – gentle contraction will help pump lymphatic fluid out of the system  Treat underlying cause of infection  Proper skin care and diet  Lymphatic massage to promote drainage  Bandaging – Tight at the toes, loosening as you move towards the trunk  Compression garments  Exercise – gentle contraction will help pump lymphatic fluid out of the system

19. Kaposi’s Sarcoma Treatment and Management  Safe sex practices  HIV prevention will also prevent HIV-related Kaposi’s Sarcoma  Using condoms will help protect from HHV-8, the cause of Kaposi’s Sarcoma  ARV treatment  Starting ARVs for HIV will also treat Kaposi’s Sarcoma  Safe sex practices  HIV prevention will also prevent HIV-related Kaposi’s Sarcoma  Using condoms will help protect from HHV-8, the cause of Kaposi’s Sarcoma  ARV treatment  Starting ARVs for HIV will also treat Kaposi’s Sarcoma

20. Herpes Zoster  Also known as Shingles  Patch-like pattern that stops midline  PAIN is the most common associated symptom  Most commonly found on the side of the ribcage  Patients may also have lymphadenopathy  May take 6-10 days for all lesions to form  Also known as Shingles  Patch-like pattern that stops midline  PAIN is the most common associated symptom  Most commonly found on the side of the ribcage  Patients may also have lymphadenopathy  May take 6-10 days for all lesions to form

23. Zoster Treatment and Management MINIMIZE PAIN  Amitriptyline  Cool soaks for 20 minutes  Moist dressings relieve pain  Place a sterile dressing over lesions to avoid contact with clothing  Antihistamines – Diphenhydramine, Chlorpheniramine MINIMIZE PAIN  Amitriptyline  Cool soaks for 20 minutes  Moist dressings relieve pain  Place a sterile dressing over lesions to avoid contact with clothing  Antihistamines – Diphenhydramine, Chlorpheniramine

24. Tinea  Fungal infections  3 major types  Tinea capitis - involving the head or scalp  Tinea coporis - involving the body  Tinea pedis - involving the feet  Fungal infections  3 major types  Tinea capitis - involving the head or scalp  Tinea coporis - involving the body  Tinea pedis - involving the feet

25. Tinea Capitis

26.  Can cause loss of hair to affected area  Many broken hairs will be seen  Hair pulls out easily  Often circular in shape  Skin may have a dull grey shade  Fine scaling with sharp, well-defined border  May show one or many patches  Can cause loss of hair to affected area  Many broken hairs will be seen  Hair pulls out easily  Often circular in shape  Skin may have a dull grey shade  Fine scaling with sharp, well-defined border  May show one or many patches

27.  Tinea corporis  Tinea corporis

28. Tinea corporis

29.  Small to large scaly, sharply marginated plaques  Raised borders with central clearing  Usually circular shaped  May see one or many  Associated symptom - ITCHING  Small to large scaly, sharply marginated plaques  Raised borders with central clearing  Usually circular shaped  May see one or many  Associated symptom - ITCHING

30. Tinea pedis

31.  May see dry, white scaling on bottom of foot and between toes  May see bloody cracks between toes  Often space between 4th and 5th toes affected  May be unilateral or bilateral  May have blisters  Associated symptom - ITCHING  May see dry, white scaling on bottom of foot and between toes  May see bloody cracks between toes  Often space between 4th and 5th toes affected  May be unilateral or bilateral  May have blisters  Associated symptom - ITCHING

32. Onychomycosis  Fungal infection of the nail bed  Chronic  Unresponsive to antifungal creams  Causes brittle, yellow nails  Fungal infection of the nail bed  Chronic  Unresponsive to antifungal creams  Causes brittle, yellow nails

33. Onychomycosis

35. Identifying Tinea  Often diagnosed by visual exam  Remember to ask about itching  Key questions: Where was the first lesion? What is the distribution?  Often diagnosed by visual exam  Remember to ask about itching  Key questions: Where was the first lesion? What is the distribution?

36. Tinea treatment  Use an antifungal ointment twice a day  Continue using ointment one week AFTER symptoms resolve  Tinea pedis and onychomycosis  Expose the feet to air - go barefoot  Air out shoes between use  If 2 pairs of shoes, alternate use  Change socks twice daily  Use an antifungal ointment twice a day  Continue using ointment one week AFTER symptoms resolve  Tinea pedis and onychomycosis  Expose the feet to air - go barefoot  Air out shoes between use  If 2 pairs of shoes, alternate use  Change socks twice daily

37. Tinea treatment  Tinea pedis, tinea capitis and onchomycosis  Try topical anitfungal agents first  If unresponsive:  Oral antifungal agents such as Griseofulvin  Tinea pedis, tinea capitis and onchomycosis  Try topical anitfungal agents first  If unresponsive:  Oral antifungal agents such as Griseofulvin

38. Tinea treatment  Griseofulvin  4 – 6 weeks of treatment for hair and scalp infections  4 – 8 weeks of treatment for foot infections  3 – 4 months of treatment for fingernail infections  At least 6 months for toenail infections  Griseofulvin  4 – 6 weeks of treatment for hair and scalp infections  4 – 8 weeks of treatment for foot infections  3 – 4 months of treatment for fingernail infections  At least 6 months for toenail infections

39. Candidiasis  Fungus (C. albicans) that can occur  In the mouth  On the genitalia  Under dressings  Under folds of skin  Any warm, moist area  Fungus (C. albicans) that can occur  In the mouth  On the genitalia  Under dressings  Under folds of skin  Any warm, moist area

42. Identifying Candidiasis  Can be identified visually  Often occurs in warm, moist areas such as body folds, genitalia, mouth, under an occlusive dressing  Cottage cheese-like patches that can be removed with gauze  Patches of redness between white patches  May involve esophagus  Can be identified visually  Often occurs in warm, moist areas such as body folds, genitalia, mouth, under an occlusive dressing  Cottage cheese-like patches that can be removed with gauze  Patches of redness between white patches  May involve esophagus

43. Candidiasis Treatment  Prevention:  Good oral care  Throw away toothbrush  Disinfect cups and utensils  Oral antifungal agents:  Nystatin  Prevention:  Good oral care  Throw away toothbrush  Disinfect cups and utensils  Oral antifungal agents:  Nystatin

44. Ngiyabonga ka khulu!! Ngiyabonga ka khulu!!