elective integumentary

8/4/2019 Elective Integumentary

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Intertrigo


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is an erythermatous

skin eruption with

inflammation in the skin

folds under the breasts,

the groin, the transverse

abdominal folds, and

the axilla


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the mainsymptom isintense pruritus.

Intertrigo ismore commonin obese elderlypersons who donot maintain anappropriate

level ofcleanliness.


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Risk factors for

intertrigo include

the following. Adductor

spasticity of the

lower

extremities,

making perineal

hygiene difficult

to achieve, leaves

a chronically

moistenvironment

ideal for the

growth of fungal

organisms.


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Incontinence

providing both a

chemical irritant to

the skin an a

chronically moist

environment that

supports the

growth of fungi.


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Low energy or

motivation

leading to

inadequate drying

under breast or in

the perineal area

during baths.


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Staff or familymembers withinadequatetraining or

motivation toadequately drypatients underbreasts or inthe perineum


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Inflammation is

due to a

combination of

friction and

moisture.

Bacterial

or Candida

infection of

the,compro

mised tissue

is common


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cutaneous fungal

infections has focused

primarily on the feet

in adults and thediaper area in infants.


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The most appropriate care.

keeping affected areas clean and dry andseparating adjacent


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Folds should be washed with tepid water and

dried thoroughly.


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Soft gauze may be used to separate adjacent

surfaces.


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Undergarments and positioning have a role in

treatment and prevention of fungal infections.


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For breast candidiasis, a well fitting cotton

brassiere will help absorb moisture andreduce chatting.


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In perineal candidiasis, an adductor block

pillow may improve air circulation to theaffected area, reducing moisture

accumulation.


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Appropriate treatment of the rash with

antifungal agents and good hygiene often

reduce the discomforts and anxiety associated

with rashes. However, itching sometimes

persist as a major source of discomfort.


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Oral therapy usually is reserved for

chronic or extensive skin involvement and for

patients


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The condition may be

localized, especially on the

dorsal forearms, lateral

tibial areas, and posteriorneck, or it may be

generalized over the entire

body. When the condition is

localized, the constant

scratching and rubbing of aparticular area produces

lichenificationa thickening

of the skin


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This leads to chronic inflammation and itching

which in term produce further scratching and

rubbinga self perpetrating cycle.

When dressing vulgar lichen simplexchronicus. Recommended patch test to assest

sensitization that may contribute to the

symptoms.


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TREATMENT

The condition is treated with steroids creams and anti

histamines for the itch. Even if the condition improves itwill recur unless.

Scratching is controlled bedtime oral antihistamines areprescribed to prevent nighttime scratching. The dosageshould be urinated, starting with a low dose, until

satisfactory results are achieved. The patient is encouraged to keep the fingernails very

short. The application of a dressing such Duo Derm mayprotect the plaque from scratching. Mittens may be neededfor confused older adults. For localized lesions, a tape thatis impregnated with a topical steroids


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Lichen Sclerosis

is charaterzed bywhite plaques ofkeratin aroundthe vulva withpurple areas

where keratin isreduced. Tissues fuse so

that introitalstenosissometimes

occurs. Chronicscratchingcauses the skinto thicken(lichenification).


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Pruritus Ani This dermatitis, which

affects the perianalarea, is caused byirritation from heat,swelling hemorrhoidsor fissures

Rubbing and

scratching leads tothickening of perinealskin

Complicated by bowelor urinaryincontinence

Treated with bathand mild steroid cream


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Drug Eruptions

Any drug can cause an adverse

cutaneous reaction, called a drug

eruption.

Drugs are the most common cause of

allergic reactions in older persons, and

the most frequent drug side effects

are skin eruptions.

Not only are older adults at greaterrisks for skin reactions to drug, they

also are at greater risk for major

morbidity and for mortality than

younger persons

The morbilliform or exanthematous

(maculopapular) eruption is the most

common form of drug eruption.

Main treatment withdrawal of drug.

elective integumentary

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