1. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 Chapter 9 Skin Anatomy and Conditions

2. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 Objectives  List major components of skin anatomy.  List four types of noninfectious skin conditions and their treatments.  List four types of infectious skin conditions and their treatments.

3. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 Objectives (Continued)  Determine the right strength of sunscreen necessary to protect skin from ultraviolet rays.  Define the various forms of acne.  Describe psoriasis and the types of medications used to treat this skin condition.

4. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 Skin Anatomy  Skin: the integumentary system is the largest organ in the body  Includes skin, hair, subcutaneous tissues  One of the most abused organs in the body  Protects the body, regulates temperature, is a sensor or stimuli

5. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 Skin Anatomy (Continued)  Keratin: top layer of skin; for protection  Epidermis and dermis: layers beneath keratin  Below dermis: subcutaneous layer of fat  Epidermis: no blood flow of its own

6. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 Skin Anatomy (Continued)  Dermis: much thicker; holds nerves, blood vessels, and other connective tissue  Skin: can absorb moisture and medications  Diabetics: inject insulin subcutaneously  Intradermal route: between dermal layer  Intramuscular: into the muscle layer

7. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 Anatomy of the Skin Epidermis Dermis Hypodermis Adipose Tissue

8. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 Conditions Affecting the Skin  For a list of common dosage forms and types of conditions they treat, see Table 9-14  For popular antibiotic ointments and creams, see Table 9-15

9. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 Skin Disorders and Medications  Proper diagnosis: physical assessment, family history, drug history, lab tests, possible biopsy  Two very common skin conditions: sunburn and acne

10. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 Miscellaneous Skin Conditions  Two categories:  Noninfectious inflammatory conditions  Infectious inflammatory conditions  See physician for persistent symptoms

11. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 Topical Antibiotics  Used to treat abrasions, small cuts, and scrapes  Clean wound properly  See the list of agents for treating such wounds on the next slide

12. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 Antibiotic Products ProductTrade NamesDosage Forms BacitracinBacitracinOint NeomycinNeomycinOint MyciguentCream Polymyxin B, neomycin, bacitracinNeosporinOint, cream Oint, Ointment.

13. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Skin Protection Factor Guide  SPF agents: topical form; prevent sunburn  UVA rays and UVB rays: two main wavelengths of rays that cause concern  UV rays cause premature aging, changes in the DNA, erythema, and blistering

14. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Sunscreen Skin Protectant Factor  Overexposure to the sun can cause mutations in DNA  Cancer can occur and discoloration of prematurely aged skin  Melanin: chemical for skin color

15. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 Sunscreen Skin Protectant Factor (Continued)  Two types of protectants:  Sunscreens: protect from UVA and UVB rays  Sunblocks: reflect UV rays  SPF factor important  Choose coverage based on skin types

16. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 Skin Protectant Factor Guide for Application of Sunscreen Skin CharacteristicsSuggested Skin TypeAfter 10 Min Sun Exposure Minimum Coverage IBurns easily/rarely tans20 to 30 SPF IIBurns easily/tans minimally12 to 20 SPF IIIBurns moderately/tans gradually8 to 12 SPF IVBurns minimally/tans well4 to 8 SPF VRarely burns/always tans2 to 4 SPF VINever burns/deeply pigmentedNone SPF, Skin protectant factor.

17. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 Acne Development and Treatment  Acne affects teenagers and adults  Caused by hormonal changes and genetics  Hormones enlarge the glands of the skin

18. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 Acne Development and Treatment (Continued)  Two productive glands:  Sweat: regulate temperature  Sebaceous: produce skin oil or sebum  Increased sebum traps bacteria  Keep skin clean and free from bacteria

19. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Acne Development and Treatment (Continued)  Acne classified into two groups:  Noninflammatory: treatment is mild medication (keratolytics)  Inflammatory: benzoyl peroxide most common OTC product recommended

20. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Acne Development and Treatment (Continued)  Antibiotics used: tetracycline, erythromycin, clindamycin  Topical agents: retinoic acid, isotretinoin (Accutane), and tretinoin (Retin A)

21. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 Hives/Inflammation  Common noninfectious conditions include: urticaria (hives), eczema (red skin rash), psoriasis (plaques, scaly skin), seborrheic dermatitis (rash), and atopic dermatitis (rash)  Topical agents: used for hives and skin rashes causing inflammation from severe itching  Psoriasis: consult a doctor

22. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22 Infectious Inflammatory Skin Conditions  Warts: viral, contagious, caused by papovavirus(Treatment: see Table 9-19)  Genital warts: see doctor  Tinea infections: caused by fungus; treat with powdered antibiotics (Treatment: see Table 9-20)  Canker sores: inside cheek of mouth; small topical ulcers (See Table 9-21)

23. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23  Lice: Children come home from school with head lice; high risk for catching without body contact; whole family should be treated  Herpes—two different types:  Herpes simplex (causes sores)  Herpes zoster- Shingles (causes lesions) Treated with antiviral medications Treated with antiviral medications Infectious Inflammatory Skin Conditions (Continued)

24. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 24  Impetigo: contagious condition caused by streptococcal organisms; infection contagious  Treatment: antibiotics and Burrow’s solution  See Figure 9-6 Infectious Inflammatory Skin Conditions (Continued)

25. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 25 Serious Skin Conditions  Require a visit to the hospital or doctor  Include skin melanomas, psoriasis, burns  Malignant melanoma: cancerous skin growth; treatment: removal, skin graft  See Figure 9-7

26. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 26  Ulcers: external ulcers caused by bed sores and affect elderly; may harbor MRSA— highly contagious  Treatment: antibiotics  Can be caused by STDs  See Figure 9-8 Serious Skin Conditions (Continued)

27. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 27 Psoriasis  Genetic skin condition; cannot be cured; lasts a lifetime  Not contagious but looks bad when inflamed  Most affected areas: joints, limbs, neck, scalp  Potent drugs used: corticosteroids (require physician’s prescription)  Sunlight treatments

28. Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 28Burns  Range from first degree (least severe) to third degree (most severe)  Medications include silver sulfadiazine (Silvadene) cream