4-2

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4-2. SKIN DISEASES PERTAINING TO COMMON DERMATOSES

a. Eczema.

(1) Definition/characteristics. Eczema is the general name for a group of noncontagious inflammatory skin diseases. These diseases have a tendency toward erythema (redness of the skin), swelling edema (presence of abnormally large amounts of fluid in the intercellular tissue spaces), vesiculation (small bladder or sac containing fluid), oozing, weeping, and crusting with itching. Eczematous dermatoses are those skin diseases where changes seen in eczema are apparent. Nummular eczema are round, coin-shaped lesions. These lesions are most commonly found on extremities near or on surfaces where muscles extend joints, shoulders, and buttocks. The cause of nummular eczema is not known. It is proven that winter, bathing, and soaps aggravate this skin condition. Hand eczema has the characteristics of scaling, crusting, and fissuring (grooving). The dorsa (back) of the hands is a common location. A common cause of hand eczema is prolonged contact with soaps and detergents. Ear eczema (otitis externa) is usually found on the external auditory canal, and seborrheic dermatitis (dry, moist, or greasy scaling) is normally found in the same area.

 

(2) Treatment. To treat eczema, you should apply cold, wet compresses and antipruritic medications (agents that relieve itching, burning, and pain). Air dry the area and use bland dusting powders. Apply topical antibiotics for secondary infections. If neomycin is used, be aware that the patient may become sensitive to the drug (experience excessive skin reactions) and use of the drug may need to be discontinued. Another medication that can be applied topically is a steroid cream (with hydrocortisone one percent). Refer all cases that are chronic or acute and unresponsive to conservative topical therapy to a medical doctor. Treat all underlying diseases, if present.

b. Contact Dermatitis.

(1) Definition/characteristics. Contact dermatitis is an acute or chronic inflammation often sharply marked. This abnormality is produced by substances coming into contact with the skin. People most susceptible are blondes, redheads, and light-skinned individuals. Contact dermatitis is a toxic, allergic, photoallergic (reaction- increased-by-light) condition, and may or may not be limited to the point of contact. Contact dermatitis can be caused by touching these common items: plants (poison ivy, oak, sumac), chemicals, cosmetics, fabrics, and such household items as detergents, waxes, and polish. The effects of touching any of these substances may be immediate or delayed according to how sensitive a person is to the particular substance. The skin area that the offending substance has touched will be itching and red and will have burning blisters. In later stages, oozing or crusty areas are common.

 

(2) Treatment. No treatment is effective unless the offending agent is removed. Use cool soaks. Apply bland compresses and a drying corticosteroid medication during the period when skin lesions are acute. Be careful not to use hydrocortisone medication for a long period; this drug can cause disabling conditions.

c. Psoriasis.

(1) Definition/characteristics. Psoriasis is a common skin disease caused by gene combination. Skin lesions are discrete- pink or dull-red. Patches of thick skin with a red base

and white-silvery scales or flakes are present. Psoriasis usually occurs at the elbows, knees, scalp, back, or penis. The condition is worse if the area is exposed to sunshine too long; however, a small amount of sunlight is helpful.

 

(2) Treatment. There is no known cure for psoriasis, but the following treatment can be administered to provide temporary relief. Apply hydrocortisone cream (one to two percent) four times daily. Mild sunlight and a warm climate have a favorable effect, but humidity makes the condition worse. Kenalog^® spray and vitamin E are also helpful.

d. Acne.

(1) Definition/characteristics. Acne is a chronic inflammatory disease of the sebaceous glands and hair follicles. It is caused by excessive oils due to hormone stimulations, bacteria, and family history. Commonly affected areas are the face, back, and chest. Skin lesions are multiple spreading pimples, cysts, and painful nodules. In many cases, pus develops.

 

(2) Treatment. There are pros and cons about a number of foods contributing to acne. Since acne is usually chronic for a number of years (ranging from 1 to 15), certain foods may be eliminated from the diet. Eliminate one or two foods for not less than three weeks and notice whether the skin condition has improved. Generally, chocolate, nuts, and carbonated cola beverages should be eliminated from the diet. Additionally, give the patient vitamin A for a 3-month period with a 1-month interruption to avoid hypervitaminosis (an excess of the vitamin). Also, apply drying lotions such as white lotion or commercially prepared lotions containing sulfur and resorcinol. DO NOT USE greasy ointments. In some cases, applying a corticosteroid lotion is valuable. Tetracycline is the most beneficial antibiotic, but it must be monitored carefully. Taking oral contraceptives are said to help some young women with acne.

e. Pityriasis Rosea.

(1) Definition/characteristics. This is a skin disease that is characterized by granular scales. The disease is noncontagious and is seen most frequently in young adults. The number of cases of this skin disease is highest during spring and fall in temperate climates. The skin lesions are red, oval, scaly patches on the neck and elbow. Spontaneous remission of the disease usually occurs in six weeks, but the skin eruptions may last two months or more.

 

(2) Treatment. Obtaining a suntan helps the patient's appearance but does not help the disease. Cool baths and application of oatmeal and caladryl lotion help reduce itching.

f. Sebaceous Cysts.

(1) Definition/characteristics. Sebaceous cysts are round, globular, cutaneous (skin) or subcutaneous (under the skin) tumors. These tumors rise from the sebaceous glands, usually on the face, neck, scalp, back, and genitalia. The cysts are caused when a gland closes off. When the gland closes, small, hard nodules (cysts) form at the hair follicles.

 

(2) Treatment. There is usually no treatment unless the cysts are large, annoying, or infected. In such cases, follow this procedure: Remove the cyst surgically including the epithelial wall so that the cyst will not reform. Administer antibiotics to treat the infection.

g. Seborrheic Dermatitis.

(1) Definition/characteristics. Seborrheic dermatitis is an acute or chronic papulosquamous dermatitis (scaly dandruff) with or without redness of the skin. It usually affects the scalp, face, the area of the sternum, interscapular (shoulder blade) area, umbilicus, and body folds. Genetic factors as well as climate seem to affect the number of cases of this disease. Stress, hormones, nutrition, and infection cause the disease to become more severe. Seborrheic dermatitis is associated with overactive sebaceous (oil) glands of the skin. This skin condition is usually apparent as dry or oily scaling of the skin or scalp sometimes accompanied by itching. Redness, fissuring, and secondary infection may be present, and the affected area may become acutely inflamed and weeping. Intertriginous dermatitis, lesions in the skin folds, may develop. Typically, lesions are yellowish, greasy scales or flakes that resemble potato chips. This condition tends to be recurring and last throughout the patient's life. Individual outbreaks of the disease may last weeks, months, or years. Seborrheic dermatitis is frequently found closely associated with common acne. Both skin conditions should be treated at the same time.

 

(2) Treatment. The patient should eat a well balanced diet, restricting excess sweets, spices, hot drinks, and alcoholic beverages. Urge him to maintain regular working hours, get adequate sleep and recreation, and observe standards of simple cleanliness. Living in this manner should relieve such factors as infections, overwork, stress, constipation, and dietary abnormalities--all of which cause the disease to worsen. Steroids, creams or lotions, may be applied to the skin lesions.

 

CAUTION: Potent fluorinated corticosteroids used regularly on the face, however, may

produce steroid rosacea (superficial inflammation resembling acne).

Selsun^®, Fostex^®, and Sebulex^® may be used to treat seborrheic dermatitis

of the scalp. Do not overuse Selsun because it can cause baldness. If

seborrheic dermatitis in the skin folds is being treated, apply astringent wet

dressings followed by three percent vioform and one percent hydrocortisone

base.

h. Urticaria (Hives).

(1) Description/characteristics. Urticaria is an acute or chronic inflammatory skin reaction of an allergic origin with eruptions of evanescent (unstable) wheals or hives. Hives are caused by ingesting food or drugs. An acute case lasts less than six weeks. A chronic case lasts longer than six weeks. Common causes of hives include eating shellfish, strawberries, eggs, and chocolate as well as using penicillin medications or serum vaccines.

 

(2) Treatment. Avoid re-exposure to sensitizing drugs or foods and look for the drugs and foods that caused the hives. Eliminate these drugs and foods. Give epinephrine 1:1000 in the dosage 0.3-1.0 ml sc if laryngeal spasm is suspected. Administer antihistamines for prompt and sustained relief of symptoms.

i. Nevi (Mole).

(1) Description/characteristics. A nevi is a congenital, discolored spot which is elevated above the surface of the skin. The cause of these skin lesions is unknown. Nevi are dome-shaped, flat, or elevated papules with brown or black colored flesh. They are often hairy and appear on any part of the body. Nevi usually appear during childhood, usually on the palms, soles, and genitalia. They may be the precursor to malignant melanoma.

 

(2) Treatment. All suspicious lesions of this type should be examined by a dermatologist for surgical removal and biopsy.

j. Keloid.

(1) Description/characteristics. A keloid is a mass of fibrous tissue overgrowth at the site of a burn or skin wound. These growths occur more frequently in Blacks. A keloid is a firm, elevated, whitish or reddish elastic nodule of scar tissue. It is common for keloids to have crab-like projections. Their surface is smooth, glistening, and hairless.

 

(2) Treatment. Keloids are treated by surgical removal, x-rays, and intralesional corticosteroid and hyaluronidase injections.

k. Basal Cell Cancer Lesions.

(1) Description/characteristics. These skin lesions are single or multiple, elevated, waxy nodules with pearly, rooted borders. In the later stages, the lesions may become ulcerous. These lesions are most frequently found on areas of the body which are exposed to the sun: the scalp, face, neck, and ears.

 

(2) Treatment. Basal cell cancer lesions can be treated by removing them surgically or by x-ray therapy. Fair-skinned people can prevent these lesions from forming by wearing sunscreen lotions.

l. Malignant Melanomas.

(1) Description/characteristics. Malignant melanomas are highly malignant tumors of the skin or mucous membranes. These tumors may metastasize (transfer) to any organ of the body. They occur more frequently in women, fair complexioned individuals, and people between the ages of thirty and sixty. Incidence is increased with great ultraviolet light exposure. The lesions are usually brown, pink, black, or purple nodules ("red, white, and blue"). These tumors are sometimes flat.

 

(2) Treatment. Malignant melanomas may be removed surgically or exposed to chemotherapy or immunotherapy.

m. Drug Eruptions.

(1) Description/characteristics. Skin lesions can be caused by drugs. The skin eruptions are usually small, red maculae, papules, vesicles, or wheals. The onset is sudden, and itching may be severe. The lesions are generally widespread and symmetric in distribution. Almost any systemically administered medication may produce a skin eruption: penicillin, antibiotics, salicylates, and barbiturates.

 

(2) Treatment. Follow this treatment for drug eruptions. Find the cause. Which drug caused the skin eruptions? Discontinue the medication. Administer antihistamines; they may be helpful. For severe cases, administer corticosteroid therapy.

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