Skin Conditions

Skin Conditions
Aging changes
Thinner skin Cell replacement decreased by 50% Loss of subcutaneous fat Reduced blood supply Loss of elasticity Less moisture

Skin Conditions

Skin Conditions
Aging changes result in
Easily torn and blistered skin Slower wound healing Reduced thermoregulation Decreased absorption of topicals Decreased sense of pressure and touch
Increased risk for injury

Decreased inflammatory response Easier bruising

Skin Conditions
Aging Changes Management
Avoid temperature extremes
Lower water heater setting

Avoid wind/sun exposure Confine soap use to underarm, genital area Rinse well Apply moisturizing lotion to damp skin Avoid products with alcohol

Skin Conditions
Dry Skin (xerosis)
Not a NANDA diagnosis Affects 59% to 85% older adults Due to lack of water
Skin doesnt hold it in Not due to lack of skin oils

Skin Conditions
Dry Skin Management
Control humidity Use occlusive emollients
Greasier is better!

Decrease total body bathing

Not everywhere every day

Tepid water, rinse well Rub in direction of hair follicles in sweeping motion Dont apply directly from container

Skin Conditions
Dry Skin Management
Use mild, superfatted, non-irritating soaps
Dove Basis Tone Caress Neutrogena

Skin Conditions
Dry Skin Management
Use oil based emollients or containing urea or ammonium lactate
Vaseline (if can tolerate feeling) Lanolin Mineral oil Vegetable or olive oil Keri Nivea Aquaphor Eucerin Vanicream Cetaphil Moisturel

Skin Conditions- Atypical

Pressure ulcers Herpes Zoster Benign lesions Pre-malignant lesions Malignant lesions

Skin Conditions- Atypical

Pressure ulcers Pop Quiz
Contributing factors are: a)P________ b)S________ c)F________ d)M________ e)N________

Skin Conditions- Atypical

Pressure ulcers Staging

Skin Conditions- Atypical

Pressure ulcers Staging

Skin Conditions- Atypical

Pressure ulcers Staging

Skin Conditions- Atypical

Pressure ulcers Staging

Skin Conditions- Atypical

Pressure ulcers Staging

Skin Conditions- Atypical

Pressure ulcers Staging
What stage is this ulcer?

Skin Conditions- Atypical

Pressure ulcers: Management
Assess accurately
Length, width, depth Color(s) Presence of exudate Closed or open wound edges

Skin Conditions- Atypical

Pressure ulcers: Management
Wound edges
OPEN

Closed

Skin Conditions- Atypical

Pressure ulcers: Management
General Principles
Relieve pressure Address contributing factors Provide moisture Absorb drainage Control infection/cleaning Remove non-viable tissue Protect surrounding tissue

Skin Conditions- Atypical

Herpes Zoster
Reactivation of varicella-zoster virus Painful, pruritic Follows dermatomes Vesicles form, then dry and crust Vesicles clear in 2-3 weeks Pain may last up to 6 months-years Need to see doctor within 1-3 days for antiviral medication If near eyes=emergency, high risk blindness & death

Skin Conditions- Atypical

Herpes Zoster

Skin Conditions- Atypical

Herpes Zoster-Management
Lesions may remain open to air
Light gauze cover if desired

Caregivers/visitors should be those who have had chicken pox or vaccine

Airborne particles

Shingles are NOT contagious

Skin Conditions- Atypical

Benign lesions
Seborrheic keratoses Skin/Cutaneous tags Angiomas Senile Lentigines Senile Purpura Moles (nevi)

Skin Conditions- Atypical

Seborrheic keratoses
Wart-like waxy scaly growths Face, chest, shoulders, back Have a stuck on appearance

Skin Conditions- Atypical

Seborrheic keratoses

Skin Conditions- Atypical

Skin/Cutaneous tags
Small protrusions < inch on a narrow stalk Usually flesh colored or darker Neck, upper body

Skin Conditions- Atypical

Skin/Cutaneous tags

Skin Conditions- Atypical

Angiomas
Bright red spots, flat or slightly raised Pinhead size to quarter inch diameter Trunk, arms, legs Formed by clumps of dilated capillaries

Skin Conditions- Atypical

Angiomas

Skin Conditions- Atypical

Senile Lentigines
AKA liver spots, age spots Back of hands, face Yellow, tan, brown Round, oval, irregular shape Flat (macular) Up to an inch in diameter Clearly defined border Caused by exposure to sunlight
No relationship to liver

Skin Conditions- Atypical

Senile Lentigines

Skin Conditions- Atypical

Senile Purpura
Dark purple irregularly shaped patches Small hemorrhages in sun damaged skin Face, back of hands, forearms Fade in few weeks

Skin Conditions- Atypical

Senile Purpura

Skin Conditions- Atypical

Moles (nevi)
Pigmented growths Flesh colored, black, or brown Usually small, sharp outlines, present since early adulthood Almost universal
Most adults have 10 40, average 25

Skin Conditions- Atypical

Moles (nevi)

Skin Conditions- Atypical

Pre-malignant lesions
Actinic/solar/senile keratosis Dysplastic nevi

Skin Conditions- Atypical

Actinic/solar/senile keratosis
Macular, ill-defined, scaly, sandpaper-like patches on sun exposed areas Reddish papule, freckles, weather beaten 5 to 15 % progress to squamous cell CA

Skin Conditions- Atypical

Actinic/solar/senile keratosis

Skin Conditions- Atypical

Dysplastic nevi
Larger than usual moles Macular and/or papular Irregular or ill-defined Variegated in color Upper back in men, legs in women Increased risk for melanoma

Skin Conditions- Atypical

Dysplastic nevi

Skin Conditions- Atypical

Malignant lesions - Incidence
Most common cancer overall Incidence increases with age
Physiologic changes in skin Accumulation of damage sun exposure

Skin Conditions- Atypical

Malignant lesions Risk Factors
Sun exposure especially sun burns early in life
Slip, slop, slap (shirt, sunscreen, hat)

Fair skin, blond/red hair with blue/green eyes Outdoor occupation/hobbies Personal or family hx of melanoma Presence of pre-malignant lesions Poor tanning, freckles, large # moles Immunosuppression

Skin Conditions- Atypical

Malignant lesions Types
Basal cell carcinoma Squamous cell carcinoma Malignant melanoma

Skin Conditions- Atypical

Basal cell carcinoma
Most common skin malignancy Affects sun-exposed areas Shiny, translucent, waxy, dome-shaped papule
May occur with telangectasias

Head, neck, backs of hands, forearms Tends to ulcerate (sore that wont heal) Metastasis rare 90% cure rate treated early

Skin Conditions- Atypical

Basal cell carcinoma

Skin Conditions- Atypical

Squamous cell carcinoma
Rough, scaly plaque, nodule or ulcer
Firm with rolled border

Pink, tan, or brown Affects sun-exposed skin

Scalp, lower lip, ears

Occurs at sites of chronic inflammation, ulceration, radiation, chemical injury or burns Some simulate warts, have cutaneous horns Can arise from actinic keratosis

Skin Conditions- Atypical

Squamous cell carcinoma

Skin Conditions- Atypical

Squamous cell carcinoma
May be symptomatic
Pain, itching stinging

Slow growing, rarely metastasizes Survival rates 47% to 96% with early detection and treatment
Declines to 36% if metastasizes

Skin Conditions- Atypical

Malignant melanoma
Least common
Accounts for less than 5% of all cancers Responsible for 75% of all skin cancer deaths

Occurs anywhere
Often found in covered areas

Skin Conditions- Atypical

Malignant melanoma

Skin Conditions- Atypical

Malignant melanoma
Metastasizes aggressively
Thinner lesions have better prognosis

ABCD (now add E) rule governs need for biopsy E = Evolving lesion
Changes in size, shape, color, surface (bleeding), & symptoms (itchy, tender)

Skin Conditions- Atypical

A = asymmetry

Skin Conditions- Atypical

B = border (irregular)

Skin Conditions- Atypical

C = Color
Variegated (more than one color)

Skin Conditions- Atypical

D = Diameter
More than 6mm