◄UNIT 4:MEDICAL PATHOLOGIES OF ORAL AND OESOPHAGUSTopic 9►

UNIT 5: MEDICAL PATHOLOGIES OF THE SKIN

  • UNIT 5: MEDICAL PATHOLOGIES OF THE SKIN

    5.1. Key unit Competence
    Take appropriate decision on different common medical pathologies of the skin

    5.2. Prerequisite (knowledge, skills, attitudes, and values) 
    To achieve the above competence the associate nurse student needs to have learnt 
    the following subjects:
    • Human body anatomy and physiology: Anatomy of integumentary system is 
       human body’s outer layer, it consists skin, hair, nails and gland. The skin 
       protects human body from infection and injuries that could get from the 
       external environment.
    • Fundamental of Nursing: Vital signs taking and parameters measurements, 
       drugs administration, History taking, Complete health assessment from head 
       to toes trough interview and Physical assessment regarding cardiovascular 
       system.
    • Pharmacology: Some topical and oral drugs for skin condition include: 
        antibacterials,antiinflamatory,corticosteroids,antibiotics,antifungal,antiviral 
         drugs

    5.3. Cross-cutting issues to be addressed
    5.3.1. Gender education
    Emphasize to learners that anybody irrespective of their gender can present and 
    report during group activities.
    During interactive lecturing, make sure that the response of both boys and girls are 
    equally considered.
    Ensure that boys and girls participate equally in all activities such as group work 
    presentations.

     5.3.2. Environment and sustainability
    They also get skills and attitudes that will enable them in their everyday life to address 
    the environment and climate change issues and to have a sustainable livelihood. 
    Help the learners to know maximum skills and attitudes on the environmental 
    sustainability and to be responsible in caring for the skills laboratory where they 

    perform their practice even at health facilities.

    5.4. Guidance on the introductory activity
    This introductory activity helps you to engage learners in introduction of medical 
    pathologies of integumentary system and invite the learners to follow the next 

    lessons.

    Teacher`s activity:
    • Ask learners to observe the schematic representation of skin diseases and 
    answer the given questions.
    • Engage learners in working individually on the activity.
    • Ask any three learners to give their answers

     The expected answers:
    1) The organs and layers of the integumentary include the epidermis(Nails, hair, 
         gland), dermis (It contains sweat and oil glands and hair follicles.),Hypodermis 
         (It’s the fatty layer of skin that helps insulate the body)
    2) The integumentary system is responsible of protective barrier against 
         mechanical, thermal and physical injury and hazardous substances. 
         Prevents loss of moisture. Reduces harmful effects of UV radiation. Acts as 
        a sensory organ (touch, detects temperature)
    3) The different skin conditions due various microorganism such as bacteria, 
         fungi, virus and some allergy agent. 
    4) The most common genetic skin diseases(albinism) and atopic dermatitis 
        (eczema) 
    5) Treatment of Skin conditions such as antihistamines; medicated creams and 
         ointments; antibiotics; vitamin or steroid injections; laser therapy; targeted 

         prescription medications.


        

         

        a) Prerequisites
    This is the first lesson of the fifth unit of medical pathologies of integumentary 
    system. In this lesson, you will be dealing with the common medical skin conditions, 
    which are dermatitis, skin infection, and genetic diseases. The first thing to do before 
    starting teaching is to remind learners that they have learnt about structure of skin 
    and skin function, health assessment of integumentary system from fundamentals 
    of nursing. The teacher will let students discuss the questions as indicated in 
    introductory activity and from the case study from learning activity 5.1 so that they 
    can prepare themselves for this lesson.

    b) Learning objectives: 
    • List the common medical skin conditions of integumentary system: erythema, 
       eczema, albinism, vitiligo, psoriasis, furuncle and acne.
    • Describe causes, risk factors and pathophysiology of skin diseases

    c) Teaching resources
    The teacher could avail the model of skin structure. In addition, the teacher should 
    present to the students the library textbooks on diseases, which affect the human 
    skin, and indicates the pages. All students must have their student’s books. There 
    is need of black board and chalks or flipcharts and markers.

    d) Learning activities 
    Teacher ‘activities and methodology
    • Ask learners to do individually activity 5.0 in their student book and answer 
    the questions number 1, 2 and learning activity 5.1
    • Provide the necessary materials.
    • Move around in silence to monitor if they are having some problems
    • Remember to assist those who are weak but without giving them the 
       knowledge.
    • Invite any five students to provide their answers 
    • Ask other students to follow carefully the answers provided by students
    • Note on the blackboard the main student`s ideas.
    • Tick the correct responses and correct those ones, which are incorrect and try 
       again to complete those, which are incomplete.
    • Harmonize and conclude on the learned knowledge and still engage student 

       in making that conclusion

    The expected answers from Questions of introductory activity5.0
    1. Probably the patients are complaining of rashes, itchiness, skin changes 
        and damage of body image.
    2. The different medical conditions could be Vitiligo, eczema, psoriasis, 
         acne etc.

    The expected answers from Questions of learning activity 5.1
    1. The abnormal signs and symptoms that patient was presenting are: 
        Physical examination revealed multiple rounded purplish nodules located bilaterally 
        on the extensor surface of the lower extremities, and red bumps on the soles, palms, 
        arms, face and legs that grow into circles that may look like targets, itchiness.

    2. The medical problem of this patient could be:
         Skin conditions like eczema, scabies, and pityriasis versicolor.

    3. The following investigations have been ordered to guide the confirmation of the 
        medical problem:
       Laboratory investigations revealed an elevated C-reactive protein – CRP (119.82 
        mg/l, normal 5.0 mg/l) and erythrocyte sedimentation rate – ESR (74 mm/h; normal 
        0–10 mm/h). Urine and blood culture results were negative. Throat swab revealed 
        growth of normal flora. The diagnostic test for Yersinia was negative. His chest 
        X-ray revealed bihilar lymphadenopathy.

    4. The management of this case include:
        Further evaluation with high-resolution chest computed tomography confirmed 
        the lymphadenopathy and demonstrated thickened bronchial walls of both lungs 
       and nodular lesions, which suggested an alveolar sarcoidosis. The foot ultrasound 
       showed a small amount of fluid in the right ankle joint and effusion in all sheaths of the 
       flexor, extensor digitorum and the big toe tibial and peroneal tendons. Sonography 
       also showed massive bilateral swelling of the subcutaneous tissue up to 1/2 shank.

    5. If not treated, the consequences will be:
        Altered body image, generalized infection, anxiety and depression.

    The expected answers from Questions of self-assessment 5.1
    1) Definition of Erythema
    Erythema is redness of the skin or mucous membranes, caused by hyperemia 
    (increased blood flow) in superficial capillaries.It occurs with any skin injury, 
    infection, or inflammation. Examples of erythema not associated with pathology 

    include nervous blushes.

    2) The Types of Erythema are:
    There are various types of erythema, of which erythema multiforme is the most 
    common. Each type of erythema has a different cause, and therefore needs different 
    treatments. Some forms of erythema include:
    • Erythema multiforme (EM), which occurs due to an allergic reaction to 
       medications or infection
    • Erythema nodosum (EN), which is characterized by nodular eruptions on the 
       lower legs 
    • Erythema Ab Igne, which is caused by continued exposure to heat
    • Erythema chronicum migrans, which is noted in in the early stages of Lyme 
      disease
    • Erythema induratum, which is associated with tuberculosis
    • Erythema infectiosum (also called the Fifth disease), which is commonly 
       caused during childhood
    • Erythema marginatum, which is characterized by pink rings on the limbs
    • Erythema toxicum (ET), which affects neonates
    • Erythema gyratum repens, which is a component of a paraneoplastic process
    • Palmar erythema, which is characterized by reddening on the palms of hands
    • Erythema annulare centrifugum, presents with erythema (redness) in a ring 
      (annulare) form that spreads from a center (centrifugam). This condition was 
       first described by Darier in 1916.
    • Erythema nodosum (EN), which is characterized by nodular eruptions on the 
    lower legs. Specific symptoms include weight loss, uneasiness, low-grade 
    fever, cough and pain in joint (arthralgia) with or without arthritis.
    There are two serious forms of erythema multiforme – Stevens Johnson syndrome 
    (SJS) and Toxic epidermal necrolysis (TENS)

    3) The Causes of Erythema are:
      The causes of erythema vary in different conditions. Common causes include an 
       allergic reaction to:
    • Medications such as penicillin, antibiotics, sulfonamides, barbiturates and 
       phenytoin
    • Infections such as herpes simplex virus (HSV), or mycoplasma. 
      Other causes of erythema include exposure to:
    • Heat
    • Radiation
    • Insect bites

    • Hormonal problems

    4) The Symptoms of Erythema are the following:
    The symptoms associated with erythema vary from one type to another. The most 
    common symptoms of erythema multiforme include: Itchy skin, Joint pain, Vision 
    problems with dry and itchy eyes, Mouth sores, Fatigue, Photosensitivity (sensitivity 
    to light or sun), Flu-like symptoms in severe cases, Fever.
    The skin sores or lesions may be raised, discolored and have a central sore 
    surrounded by pale red rings that look like a bulls-eye, earning them the name 
    Target lesions. Some lesions are liquid-filled blisters while others look like hives. 
    They can appear on face, lips, legs, feet, hands, arms or palms.

    5) The diagnosis of Erythema
    Different types of erythema manifest differently, and the diagnosis may depend 
    on the physical appearance of the skin. Doctors normally recognize erythema 
    multiforme just by examining the skin. The doctor may also ask a series of questions 
    such as a history of recent infections and medications to pinpoint out the cause. In 
    some cases, a skin biopsy may be done.

    6) Treatment plan of Erythema
    Supportive care for erythema includes:
    • Cool compresses on the affected areas
    • Pain killers( Paracetamol ) or antihistamines(Polaramine), for itching
    • Steroid(hydrocortisone, dexamethasone)) or IV medications in severe cases
    • Soothing creams for itchy or sore skin
    These medications and supportive care do not shorten the duration of the condition, 
    but provide comfort to the patient. 
    Erythema is treated depending on the severity and type of erythema.
    • For mild rashes: These may be treated with only moisturizers and topical 
    corticosteroid creams to reduce itching and burning of the skin.
    A Burrow’s compress, which has antibacterial and antifungal properties, is an 
    effective way to treated erythema.
    For severe rashes: These can be life threatening and must be treated as soon as 
    possible. Patients with severe rashes may need to stay in a burns unit. Severe pain 
    due to blisters and nodules may require pain medications such as acetaminophen, 
    hydrocodone or others as recommended by your doctor. The blisters can be 
    infected and leak large amounts of pus, which needs to be monitored and treated. 
    Intravenous immunoglobulins such as immunoglobulin G (IgG) may be needed. 
    Antivirals may be administered if the cause of the erythema is suspected to be 
    herpex simplex virus (HSV). Other specialists may be consulted if different organs 
    such as the eyes are affected. Photomodulation therapy, which is a red light therapy 

    for the skin is another effective way to treat severe cases.

    For recurrent rashes: Recurrent rashes due to HSV infection may require a daily 
    dose of the anti-viral medication acyclovir orally to suppress the virus for several 
    months.

    Lesson 2: Description of albinism and vitiligo 

    a) Prerequisites
    This is the second lesson of the fifth unit of medical pathologies of integumentary 
    system. In this lesson, you will be dealing with the common medical skin conditions, 
    which are albinism and vitiligo. The first thing to do before starting teaching is to 
    remind learners that they have learnt about structure of skin and skin function, health 
    assessment of integumentary system from fundamentals of nursing. In addition, the 
    teacher will remind the learners what they have learnt on erythema. The teacher 
    will let students discuss the questions from the case studies from learning activity 
    5.2 and 5.3 so that they can prepare themselves for this lesson.

    b) Learning objectives: 
    • Define the term of albinism and Vitiligo
    • Identify the causes of albinism and Vitiligo
    • Explain the different signs and symptoms of albinism and Vitiligo
    • Explain pathophysiology of albinism and Vitiligo
    • Describe the different types of albinism and Vitiligo.
    • Describe different medical diagnosis of albinism and Vitiligo
    • Describe different treatment of albinism and Vitiligo

    c) Teaching resources
    The teacher could avail the model of skin structure. In addition, the teacher should 
    present to the students the library textbooks on diseases, which affect the human 
    skin, and indicates the pages. All students must have their student’s books. There 
    is need of black board and chalks or flipcharts and markers.

    d) Learning activities 
    Teacher ‘activities and methodology
    • Ask learners to do individually activity 5.2 and 5.3 in their student book and 
    answer the questions number from the learning activities 5.2 and 5.3
    • Provide the necessary materials.
    • Move around in silence to monitor if they are having some problems
    • Remember to assist those who are weak but without giving them the 
    knowledge.
    • Invite any five students to provide their answers 
    • Ask other students to follow carefully the answers provided by students
    • Note on the blackboard the main student`s ideas.
    • Tick the correct responses and correct those ones, which are incorrect and try 
       again to complete those, which are incomplete.
    • Harmonize and conclude on the learned knowledge and still engage student 
       in making that conclusion.

    ♦ Expected answers to Learning Activity 5.2 
    1) The abnormal signs and symptoms that patient was presenting 
    are: 
    • Freckles
    • Moles, with or without pigment — moles without pigment are generally pink colored
    • Large freckle-like spots (lentigines)
    • Sunburn and the inability to tan

    2) The medical problem of this patient could be:
    Skin diseases like vitiligo, hypopigmentation, albinism

    3) The investigations that have been ordered to guide the confirmation 
    of the medical problem: None
    Physical examination is helpful to diagnose the eczema

    4) The management of this case:
    Albinism is a lifelong genetic condition with no cure. Therefore, treatment focuses 
    on minimizing the symptoms and watching for skin changes.
    People with albinism must receive appropriate eye care, including: 
    • prescription glasses
    • dark glasses to protect the eyes from the sun
    • regular eye exams
    Surgery on the optical muscles can sometimes minimize the “shaking” that occurs 
    in nystagmus. Procedures to minimize strabismus can make it less noticeable, but 
    surgery does not improve the vision. The level of success in reducing symptoms 
    varies among individuals.
    People should watch their skin carefully for any changes and use sunscreen for 

    protection.

    5) If not treated, the consequences are:
    If the albinism is not treated, the patient will present eye problems, poor eyesight – 
    either short-sightedness or long-sightedness, and low vision (sight loss that cannot 
    be corrected)

    astigmatism – where the cornea (clear layer at the front of the eye) is not perfectly 
    curved or the lens is an abnormal shape, causing blurred vision, photophobia – 
    where the eyes are sensitive to light, nystagmus – where the eyes move involuntarily 

    from side to side, causing reduced vision.

       

          

             6) Treatment plan of albinism
    There is no cure for albinism. You must manage the condition by being vigilant 
    about sun protection. You can protect your skin, hair and eyes by:
    • Staying out of the sun.
    • Wearing sunglasses.
    • Covering up with sun-protective clothing.
    • Wearing hats.
    • Applying sunscreen regularly.
    If you have crossed eyes (strabismus), a surgeon may be able to correct the issue 
    with surgery.

    ♦ Expected answers to Learning Activity 5.3
    1. The abnormal signs and symptoms that pictures present are:
    2. Discoloration of skin, hypopigmentation, white patches
    3. The medical problem of this patient could be Vitiligo or albinism.
    4. The investigations that have been ordered to guide the confirmation of the 
    medical problem
    Skin disease as vitiligo is diagnosed by physical examination according to health 
    experience of working with patient suffering the vitiligo.
    A skin biopsy involves removing a small portion of the affected skin tissue to check 
    whether there are pigment cells (melanocytes) in the skin. The skin sample will be 
    evaluated under a microscope in the lab. If it shows that there are no pigment cells 
    present, a diagnosis of vitiligo will likely be confirmed.

    1) The management of this case
    There is no cure for vitiligo. The goal of medical treatment is to create a uniform skin 
    tone by either restoring color (repigmentation) or eliminating the remaining color 
    (depigmentation). Common treatments include camouflage therapy, repigmentation 
    therapy, light therapy and surgery. Counseling may also be recommended.

    2) If not treated, the consequences will be the following:
    Vitiligo does not pose a serious threat to one’s health, but it can result in physical 
    complications, such as eye issues, hearing problems, and sunburn. People with 
    vitiligo also tend to be more likely to have another autoimmune disease (like thyroid 

    disorders and some types of anemia)

      

        

         6) Treatment plan of vitiligo
    There is no cure for vitiligo. The goal of medical treatment is to create a uniform skin 
    tone by either restoring color (repigmentation) or eliminating the remaining color 
    (depigmentation). Common treatments include camouflage therapy, repigmentation 
    therapy, light therapy and surgery. Counseling may also be recommended.

    Camouflage therapy:
    • Using sunscreen with an SPF of 30 or higher. Also, the sunscreen should 
    shield ultraviolet B light and ultraviolet A light (UVB and UVA). Use of 
    sunscreens minimizes tanning, thereby limiting the contrast between affected 
    and normal skin.
    • Makeups help camouflage depigmented areas. One well-known brand is 
    Dermablend®.
    • Hair dyes if vitiligo affects the hair.
    • Depigmentation therapy with the drug monobenzone can be used if the 
    disease is extensive. This medication is applied to pigmented patches of skin 
    and will turn them white to match the areas of vitiligo.

    Repigmentation therapy:
    • Corticosteroids can be taken orally (as a pill) or topically (as a cream put on 
    the skin). Results may take up to 3 months. The doctor will monitor the patient 
    for any side effects, which can include skin thinning or striae (stretch marks) 
    if used for a prolonged period.
    • Topical vitamin D analogs.
    • Topical immunomodulators such as calcineurin inhibitors.

    Light therapy:
    • Narrow band ultraviolet B (NB-UVB) requires two to three treatment sessions 
    per week for several months.
    • Excimer lasers emits a wavelength of ultraviolet light close to that of narrow 
    band UVB. This is better for patients who do not have widespread or large 
    lesions since it is delivered to small, targeted areas.
    • Combining oral psoralen and UVA (PUVA) is used to treat large areas of skin 
    with vitiligo. This treatment is said to be very effective for people with vitiligo 
    in the areas of the head, neck, trunk, upper arms and legs. 

    Surgery:
    • Autologous (from the patient) skin grafts: Skin is taken from one part of
      the patient and used to cover another part. Possible complications include 
       scarring, infection or a failure to repigment. This might also be called mini 
        grafting.
    • Micropigmentation: A type of tattooing that is usually applied to the lips of 
       people affected by vitiligo.

    Counseling:
    • Vitiligo can cause psychological distress and has the ability to affect a person’s 
    outlook and social interactions. If this happens, your caregiver may suggest 
    that you find a counselor or attend a support group.

    Lesson 3: Description of Eczema and Psoriasis

    a) Prerequisites
    This is the third lesson of the fifth unit of medical pathologies of integumentary 
    system. In this lesson, you will be dealing with the common medical skin conditions, 
    which are Eczema and Psoriasis . The first thing to do before starting teaching is 
    to remind learners that they have learnt about structure of skin and skin function, 
    health assessment of integumentary system from fundamentals of nursing. In 
    addition, the teacher will remind the learners what they have learnt on erythema, 
    albinism and vitiligo. The teacher will let students discuss the questions from the 
    case studies from learning activity 5.4 and 5.5 so that they can prepare themselves 
    for this lesson.

    b) Learning objectives: 
    • Define the term of psoriasis and eczema
    • Identify the causes of psoriasis and eczema 
    • Explain the different signs and symptoms of psoriasis and eczema 
    • Explain pathophysiology of psoriasis and eczema 
    • Describe the different types of psoriasis and eczema 
    • Describe different medical diagnosis of psoriasis and eczema
    • Describe different treatment of psoriasis and eczema 

    c) Teaching resources
    The teacher could avail the model of skin structure. In addition, the teacher should 
    present to the students the library textbooks on diseases, which affect the human 
    skin, and indicates the pages. All students must have their student’s books. There 

    is need of black board and chalks or flipcharts and markers.

    d) Learning activities 
    Teacher ‘activities and methodology
    • Ask learners to do individually activity 5.4 and 5.5 in their student book and 
    answer the questions number from the learning activities 5.4 and 5.5
    • Provide the necessary materials.
    • Move around in silence to monitor if they are having some problems
    • Remember to assist those who are weak but without giving them the 
    knowledge.
    • Invite any five students to provide their answers 
    • Ask other students to follow carefully the answers provided by students
    • Note on the blackboard the main student`s ideas.
    • Tick the correct responses and correct those ones, which are incorrect and try 
       again to complete those, which are incomplete.
    • Harmonize and conclude on the learned knowledge and still engage student 
        in making that conclusion.
    ♦ Expected Answers from questions of Learning Activity 5.4
    1. The abnormal signs and symptoms that patient was presenting 
          Plaques of red skin often covered with silver-colored scales. These plaques may 
          be itchy and painful, and they sometimes crack and bleed. In severe cases, the 
          plaques will grow and merge, covering large areas.
          Disorders of the fingernails and toenails, including discoloration and pitting of the 
          nails. The nails may also crumble or detach from the nail bed.
    2. Basing on those signs and symptoms, The medical problem could be Psoriasis, 
         eczema or Pityriasis vesicolor
    3. The investigations that have been ordered to guide the confirmation of the 
         medical problem: None
       Investigation is based by physical examination done by experienced health care 
          providers
    4. The management of this case include:
    • Steroid creams
    • Moisturizers for dry skin
    • Coal tar (a common treatment for scalp psoriasis available in lotions, creams, 
       foams, shampoos, and bath solutions)
    • Vitamin D-based cream or ointment (a strong kind ordered by your doctor. 
       Vitamin D in foods and pills has no effect.)
    • Retinoid creams
    5. If not treated, the consequences will be the following:
    The short-term symptoms of psoriasis may include: thick, discolored skin patches 
    with a covering of silvery scales, dry and cracked skin that may bleed or itch, 
    thick, ridged, and pitted nails, psoriatic arthritis (PsA),

    Expected Answers from questions of Self-assessment 5.4

    1) Definition of psoriasis
    Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times faster 
    than normal. This makes the skin build up into bumpy red patches covered with 
    white scales.

    2) Types of psoriasis
    • Psoriatic arthritis
    • Pustular psoriasis
    • Guttate psoriasis
    • Inverse psoriasis
    • Erythrodermic psoriasis

    3) The Causes of psoriasis are not known
    Things that can trigger an outbreak of psoriasis include:
    • Cuts, scrapes, or surgery
    • Emotional stress
    • Strep infections
    • Medications, including blood pressure medications, anti-malarial drugs, 
        lithium and other mood stabilizers, antibiotics, and NSAIDs.

    4) Signs and Symptoms of psoriasis are the following:
    Plaques of red skin often covered with silver-colored scales. These plaques may 
    be itchy and painful, and they sometimes crack and bleed. In severe cases, the 
    plaques will grow and merge, covering large areas.
    Disorders of the fingernails and toenails, including discoloration and pitting of the 
    nails. The nails may also crumble or detach from the nail bed.

    Plaques of scales or crust on the scalp Arthritis

    5) Diagnosis of psoriasis
    Physical exam. It is usually easy for the doctor to diagnose psoriasis, especially if 
    the patient has some plaques on areas such as on the Scalp, Ears, Elbows, Knees, 
    Belly button, and Nails. The health care provider performs full physical exam and 
    ask if people in the family have psoriasis.
    Lab tests. The doctor might do a biopsy -- remove a small piece of skin and test it 
    to make sure you do not have a skin infection. There is no other test to confirm or 
    rule out psoriasis.
    6) Treatment of psoriasis
    • Steroid creams
    • Moisturizers for dry skin
    • Coal tar (a common treatment for scalp psoriasis available in lotions, creams, 
    foams, shampoos, and bath solutions)
    • Vitamin D-based cream or ointment (a strong kind ordered by your doctor. 
    Vitamin D in foods and pills has no effect.)
    • Retinoid creams
    Treatments for moderate to severe psoriasis include:
    • Light therapy
    • Biologic treatments .These work by blocking the part of the body’s immune 
    system that is overactive in psoriasis. Biologic medications such as 
    adalimumab.
    • An enzyme inhibitor

    ♦ Expected Answers from questions of Learning Activity 5.5
    1) The abnormal signs that above picture present
         Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, 
         upper chest, eyelids, inside the bend of the elbows and knees, and in infants, the 
        face and scalp. Small, raised bumps, which may leak fluid and crust over when scratched.
    2) Based the signs that picture have, it should be eczema, psoriasis, pityriasis
    3) The investigations that have been ordered to guide the confirmation of the 
          medical problem
          Investigation is based by physical examination done by experienced health care 
          providers
    4) The management of this case include:
       Use a humidifier if dry air makes your skin dry
    Moisturize your skin using a cream or ointment. Lotions do not work as well.
    Use skin products that contain ceramide. These moisturizers replace some 
    of the “glue” (the barrier) missing from your skin.
    Apply cortisone creams and ointments. Cortisone is an over-the-counter steroid 
    found in hydrocortisone (Cortisone 10®) and hydrocortisone acetate (Cort-Aid®). 

    They may help control the itching and redness

    ♦ Expected Answers to Self-assessment 5.5
    1) Definition of eczema
    Eczema (eg-zuh-MUH) is an inflammatory skin condition that causes itchiness, 
    dry skin, rashes, scaly patches, blisters and skin infections. Itchy skin is the most 
    common symptom of eczema. There are seven different types of eczema: atopic 
    dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic 

    dermatitis and stasis dermatitis.

    2) Types of eczema
    There are several types of eczema:
    • Besides atopic dermatitis
    • Allergic contact dermatitis: This is a skin reaction that occurs following contact 
      with a substance or allergen that the immune system recognizes as foreign.
    • Dyshidrotic eczema: This refers to irritation of the skin on the palms of the 
        hands and soles of the feet. It is characterized by blisters.
    • Neurodermatitis: This leads to scaly patches of skin on the head, forearms, 
       wrists, and lower legs. It occurs due to a localized itch, such as from an insect 
       bite.
    • Discoid eczema: Also known as nummular eczema, this type presents as 
      circular patches of irritated skin that can be crusted, scaly, and itchy.
    • Stasis dermatitis: This refers to skin irritation of the lower leg. It is usually 
       related to circulatory problems.

    3) The Causes of eczema
    Researchers do not know the definitive cause of eczema, but many health 
    professionals believe that it develops from a combination of genetic and 
    environmental factors.
    Children are more likely to develop eczema if a parent has it or another atopic 

    condition. If both parents have an atopic condition, the risk is even higher.

    The following environmental factors may also bring out the symptoms of eczema:
    • Irritants: These include soaps, detergents, shampoos, disinfectants, juices 
    from fresh fruits, meats, and vegetables.
    • Allergens: Dust mites, pets, pollens, and mold can all lead to eczema. This is 
    known as allergic eczema.
    • Microbes: These include bacteria such as Staphylococcus aureus, viruses, 
    and certain fungi.
    • Hot and cold temperatures: Very hot and very cold weather, high and low 
    humidity, and perspiration from exercise can bring out eczema.
    • Foods: Dairy products, eggs, nuts and seeds, soy products, and wheat can 
    cause eczema flares.
    • Stress: This is not a direct cause of eczema, but it can make the symptoms 
        worse.
    • Hormones: Females may experience increased eczema symptoms when 
       their hormone levels are changing, such as during pregnancy and at certain 
        points in the menstrual cycle.

    4) The Symptoms of eczema
    The following atopic dermatitis symptoms are common in adults:
    • rashes that are more scaly than those occurring in children
    • rashes that commonly appear in the creases of the elbows or knees or the 
    nape of the neck
    • rashes that cover much of the body
    • very dry skin on the affected areas
    • rashes that are permanently itchy
    • skin infections

    5) The diagnosis of eczema
    The healthcare provider may recommend patch testing on the skin. In this test, 
    small amounts of different substances are applied to the skin and then covered. 
    The healthcare provider looks at the skin during visits over the next few days to look 
    for signs of a reaction. Patch testing can help diagnose specific types of allergies 
    causing your dermatitis

    6) Treatment plan of eczema
    The goal is to reduce itching and discomfort and prevent infection and additional 
    flare-ups.
    Consider these treatment tips: 
    • Use a humidifier if dry air makes your skin dry. 
    • See a psychiatrist for medication and a therapist for counseling if you are 
      experiencing symptoms of poor mental/emotional health. 
    • Moisturize your skin using a cream or ointment. Lotions do not work as well. 
      Apply several times a day, including after you bathe or shower. Use lukewarm 
      water in the tub or shower instead of hot. 
    • Use mild soaps and other products that are free of perfumes, dyes and 
       alcohol. Look for products labeled “fragrance free,” “hypoallergenic” and “for 
       sensitive skin.” 
    • Use skin products that contain ceramide. These moisturizers replace some of 
       the “glue” (the barrier) missing from your skin. 
    • Apply cortisone creams and ointments. Cortisone is an over-the-counter 
       steroid found in hydrocortisone (Cortisone 10®) and hydrocortisone acetate 
      (Cort-Aid®). They may help control the itching and redness. 
    • Take over-the-counter antihistamines for severe itching. 
    • Take prescription medications. Your healthcare provider may prescribe 
       steroid creams, pills and/or shots. Long-term risks include side effects like 
       high blood pressure, weight gain and thinning of the skin. There are newer 
       medications, called topical immunomodulators (TIMs) that show progress in 
       treating patients who do not respond to other treatments. They change the 
       body’s immune response to allergens and have fewer side effects. 
    • Phototherapy: The ultraviolet light waves found in sunlight have been shown 
       to help certain skin disorders, including eczema. Phototherapy uses ultraviolet 
        light, usually ultraviolet B (UVB), from special lamps.

    Lesson 5: Description of furuncle and acne

    a) Prerequisites
    This is the fifth lesson of the unit 5 of medical pathologies of integumentary system. 
    In this lesson, you will be dealing with the common medical skin conditions, which 
    are furuncle and acne. The first thing to do before starting teaching is to remind 
    learners that they have learnt about structure of skin and skin function, health 
    assessment of integumentary system from fundamentals of nursing. In addition, 
    the teacher will remind the learners what they have learnt on erythema, albinism, 
    vitiligo, psoriasis, and eczema. The teacher will let students discuss the questions 
    from the case studies from learning activity 5.6 and 5.7 so that they can prepare 
    themselves for this lesson.

    b) Learning objectives: 
    • Define the term of furuncle and acne
    • Identify the causes of furuncle and acne 
    • Explain the different signs and symptoms of furuncle and acne 
    • Explain pathophysiology of furuncle and acne 
    • Describe the different types of furuncle and acne 
    • Describe different medical diagnosis of furuncle and acne 
    • Describe different treatment of furuncle and acne 

    c) Teaching resources
    The teacher could avail the model of skin structure. In addition, the teacher should 
    present to the students the library textbooks on diseases, which affect the human 
    skin, and indicates the pages. All students must have their student’s books. There 
    is need of black board and chalks or flipcharts and markers.

    d) Learning activities 
    Teacher ‘activities and methodology
    • Ask learners to do individually activity 5.6 and 5.7 in their student book and 
       answer the questions number from the learning activities 5.6 and 5.7
    • Provide the necessary materials.
    • Move around in silence to monitor if they are having some problems
    • Remember to assist those who are weak but without giving them the 
       knowledge.
    • Invite any five students to provide their answers 
    • Ask other students to follow carefully the answers provided by students
    • Note on the blackboard the main student`s ideas.
    • Tick the correct responses and correct those ones, which are incorrect and try 
       again to complete those, which are incomplete.
    • Harmonize and conclude on the learned knowledge and still engage student 

       in making that conclusion.

        

           

              Self-assessment 5.6
    1) Definition of furuncle
    A boil (or furuncle) is a pus-filled bump that develops in your skin. Carbuncles are 
    clusters of several boils. Boils usually begin as red bumps, which quickly increase 
    in size and fill with pus. Boils are usually caused by the bacteria Staphylococcus 
    aureus (staph infection)
    Furuncles (boils) are skin abscesses caused by staphylococcal infection, which 
    involve a hair follicle and surrounding tissue. Carbuncles are clusters of furuncles 
    connected subcutaneously, causing deeper suppuration and scarring. They are 
    smaller and more superficial than subcutaneous abscesses.

    2) Types of furuncle are :
    • Carbuncle.
    • Hidradenitis suppurativa (seen in the armpit or groin)
    • Pilonidal cyst (area on the back where the buttocks merge)
    • Cystic acne.
    • Sty (stye)

    3) The Causes of furuncle are:
    Bacteria typically cause a furuncle, the most common being Staphylococcus aureus 
    — which is why furuncles can also be called staph infections. S. aureus normally 
    resides on some areas of the skin.
    S. aureus can cause an infection in situations where there are breaks in the skin, 
    such as a cut or a scratch. Once the bacteria invade, the immune system tries to 
    fight the microorganisms. The boil is actually the result of your white blood cells 
    working to eliminate the bacteria

    4) The Symptoms of furuncle are the following:
    Furuncles develop rapidly as pink or red bumps. They are often painful. The 
    surrounding skin is typically red, inflamed and tender.
    The lesions often appear on the neck, breast, face, buttocks, or thighs. They occur
    in places prone to hair, sweat, and friction, and they tend to start in a hair follicle
    The bump fills with pus within a few days, and it grows. The bigger it gets, the more 
    painful it becomes.

    5) The diagnosis of furuncle
    The health care provider will likely be able to diagnose a boil or carbuncle simply 
    by looking at it. A sample of the pus may be sent to the lab for testing. This may 
    be useful if you have recurring infections or an infection that has not responded to 
    standard treatment.

    6) Treatment plan of furuncle include:
    Antibiotics should only be used if recommended by a medical professional. The 
    best medicine for furuncle are clindamycin (Cleocin, Benzaclin, Veltin), doxycycline 
    (Doryx, Oracea, Vibramycin), erythromycin (Erygel, Eryped), gentamicin (Gentak), 
    levofloxacin (Levaquin), mupirocin (Centany), sulfamethoxazole/trimethoprim 
    (Bactrim, Septra), tetracycline. The health care provider prescribe the painkiller 
    such paracetamol, etc.

    ♦ Expected answers to Learning Activity 5.7 
    1. The medical skin conditions that above pictures present are acne, abcess ,
         and     furuncle
    2. The causes of the above skin conditions are Some microorganism such as 
         bacteria, virus, fungiuman body and hormonal change in 
    3. The treatment of the above skin condition
          Prescribe the antibiotics, anti inflammatory, and pain killer
    4. If they are not treated , it can be complicated into the abscess, damage body 

         image of adolescent.

               

    6) Treatment plan of acne
    The most common topical prescription medications for acne are:
    • Retinoids and retinoid-like drugs. Drugs that contain retinoic acids or tretinoin 
       are often useful for moderate acne. ... 
    • Antibiotics. These work by killing excess skin bacteria and reducing redness 
       and inflammation. ... 
    • Azelaic acid and salicylic acid. ... 

    • Dapsone.

    1.5. SUMMARY OF THE UNIT
    Skin diseases are conditions that affect your skin. These diseases may cause 
    rashes, inflammation, itchiness or other skin changes. Some skin conditions 
    may be genetic, while lifestyle factors may cause others. Skin disease treatment 
    may include medications, creams or ointments, or lifestyle changes. Common 
    skin conditions include acne, contact dermatitis, benign tumors, cancers, atopic 

    dermatitis (also called eczema), and psoriasis.

    END UNIT 5 ASSESSMENT OF MEDICAL PATHOLOGIES OF THE SKIN 

    (TO BE HIGHLIHTTED)

                    

                  

            ADDITIONAL INFORMATION 

             1. Scabies

         

           Source: World Health Organisation (2022),scabies retreived from https://www.
           who.int/news-room/fact-sheets/detail/scabies

    Scabies is a skin infestation caused by a mite known as the Sarcoptes scabiei. 
    Untreated, these microscopic mites can live on your skin for months. They reproduce 
    on the surface of your skin and then burrow into it to lay eggs. This causes an itchy, 
    red rash to form on your skin.

    Signs and Symptoms
    After the initial exposure to scabies, it can take 2 to 5 weeks Trusted Source for 
    symptoms to appear. 
    The hallmark symptoms of scabies include a rash and intense itching that gets 
    worse at night.
    Common sites for scabies in older children and adults include the:
    • wrist
    • elbow
    • armpit
    • nipple
    • penis
    • waist
    • buttocks
    • area between the fingers
    Scabies in babies and toddlers, and sometimes the very elderly or 
    immunocompromised, can show up on the:
    • head
    • face
    • neck
    • hands
    • soles of the feet

    The rash itself can consist of: 
    • tiny bites
    • hives
    • bumps under the skin
    • pimple-like bumps
    The burrow tracks of the mite can sometimes be seen on the skin. They may appear 
    as tiny raised or discolored lines.

    Types of scabies
    There is only one type of mite that causes a scabies infestation in humans. This 
    mite is called Sarcoptes scabiei. However, these mites can cause several types of 
    infestations.

    Typical scabies
    This infestation is the most common. It causes an itchy rash on the hands, wrists, 
    and other common spots. However, it does not infest your scalp or face.

    Nodular scabies
    This type of scabies may develop as itchy, raised bumps or lumps, especially 
    around your genitals, armpits, or groin.

    Scabies diagnosis
    The health care provider is able to diagnose scabies simply by performing a physical 
    exam and inspecting your affected area of skin. In some cases, your doctor may 
    want to confirm the diagnosis by removing a mite from your skin with a needle.
    If a mite cannot easily be found, your doctor will scrape off a small section of skin to 
    obtain a tissue sample. This sample will then be examined under a microscope to 
    confirm the presence of scabies mites or their eggs.
    A scabies ink test (or Burrow Ink Test) can help spot burrowed paths in your skin 
    created by the mites. To do this test, your doctor can drop ink from a fountain pen 
    onto an area of the skin that appears to be infested. They then wipe away the ink.
    Any ink that fell into the burrowed tunnels will remain and be obvious to the naked 
    eye. That is a good indication you have an infestation.

    Scabies treatment
    Products used to treat scabies are called scabicides because they kill scabies mites; 
    some also kill mite eggs. Scabicides used to treat human scabies are available only 
    with a doctor’s prescription.
    Scabicide lotion or cream should be applied to all areas of the body from the neck 
    down to the feet and toes.
    Scabies treatment includes administration of a scabicidal agent (eg, permethrin, 
    lindane, or ivermectin), as well as an appropriate antimicrobial agent if a secondary 
    infection has developed.
    The two most widely used treatments for scabies are permethrin cream and 
    malathion lotion (brand name Derbac M). Both medications contain insecticides 
    that kill the scabies mite. Permethrin 5% cream is usually recommended as the first 
    treatment. Malathion 0.5% lotion is used if permethrin is ineffective.

    Medications for scabies itch
    There are additional medications to help relieve some of the bothersome symptoms 
    associated with scabies. These medications include:
    • antihistamines, such as diphenhydramine (Benadryl or pramoxine lotion to 
       help control the itching
    • antibiotics to kill any infections that develop as a result of constantly scratching 
         your skin
    • steroid creams to relieve swelling and itching
     Pityriasis versicolor

      Carefully observe the picture below and answer the following questions:

         

        

          Source: Wikipedia (2022),tinea verscolor,retrieved from https://en.wikipedia.org/

             wiki/Tinea_versicolor

    Pityriasis versicolor is a rash caused by a yeast-like germ. It is not harmful or passed 
    on through touching (contagious). Treatment can clear the rash. Some people who 
    are prone to this condition need regular treatment to prevent the rash from coming 
    back (recurring).

    Signs and Symptoms
    Discolored patches of skin are the most noticeable symptom of tinea versicolor, and 
    these patches usually show up on the arms, chest, neck, or back. These patches 
    may be:
    • lighter (more common) or darker than the surrounding skin
    • pink, red, tan, or brown
    • dry, itchy, and scaly
    • more prominent with tanning
    • prone to disappear in cooler, less humid weather
    Tinea versicolor that develops in people with dark skin may result in the loss of skin 
    color, known as hypopigmentation. For some people, the skin may darken instead 
    of lighten. This condition is known as hyperpigmentation.

    Pathophysiology of Tinea versicolor (Ptyriasis versicolor)
    Pityriasis versicolor (Tinea versicolor) is a superficial chronic fungal infection 
    caused by Pityrisporum species which are normal “inhabitants” of the cutaneous 
    flora. The morphologic changes from yeast to mycelial hypha form are important in 
    the development of clinical lesions.

    Pityriasis versicolor is a superficial fungal infection of the stratum corneum, due 
    to dimorphic yeasts of the genus Malassezia, leading to hypo- or hyperpigmented 
    macular lesions on seborrheic areas of the trunk.

    Eruption is most common in the summer months in adolescents. Often has a 
    relapsing nature requiring frequent treatment or prophylaxis.

    Primarily a clinical diagnosis that is confirmed by a KOH preparation demonstrating 
    fungal elements with a characteristic spaghetti-and-meatballs appearance indicating 
    the presence of both yeast and short hyphae.

    Easily treated with either topical medications, including zinc pyrithione shampoo, 
    selenium sulfide shampoo, or azole-class topical antifungal creams. More extensive 
    disease may require systemic therapy with antifungal drugs.

    After successful treatment, remind patients that it may take up to 6 weeks before 
    their normal skin pigmentation returns.

    Causes of Ptyriasis Versicolor ( Tenea Versicolor)
    The fungus that causes tinea versicolor can be found on healthy skin. It only starts 
    causing problems when the fungus overgrows. A number of factors may trigger this 
    growth, including:
    • Hot, humid weather
    • Oily skin
    • Hormonal changes
    • Weakened immune system

    Medical Diagnosis
    The health care provider can diagnose tinea versicolor by physical exam (inspection). 
    If there’s any doubt, he or she may take skin scrapings from the infected area and 
    view them under a microscope.

    Treatment
    If tinea versicolor is severe or doesn’t respond to over-the-counter antifungal 
    medicine, you may need a prescription-strength medication. Some of these 
    medications are topical preparations that you rub on your skin. Others are drugs 
    that you swallow. Examples include:
    • Ketoconazole (Ketoconazole, Nizoral, others) cream, gel or shampoo
    • Ciclopirox (Loprox, Penlac) cream, gel or shampoo
    • Fluconazole (Diflucan) tablets or oral solution
    • Itraconazole (Onmel, Sporanox) tablets, capsules or oral solution

    • Selenium sulfide (Selsun) 2.5 percent lotion or shampoo

      5.8. REMEDIAL ACTIVITIES

      Question one: Fulfill the following table

        

             QUESTION TWO: MULTIPLE CHOICE QUESTIONS: Circle the most one correct 

              answer

             Bottom of Form

    1) Which of the following pathogens can cause skin infections?
    a. Fungi 
    b. Bacteria
    c. Virus

    d. All of above

    Answer: d

    2) Topical skin infection can spread to internal organs.
    a. True

    b. False

     Answer: a 

    3) Which of the following can make you susceptible for a skin 
        infection?
    a. Burn injury
    b. Poor injury
    c. Skin disease

    d. All of above

    Answer: d
    5) Which of the following drugs is commonly recommended as 
    topical cream for skin infections?
    a. Fusidic acid
    b. Cefaclor
    c. Ampicillin

     Answer: a
    4) Which of the following is the most common micro-organism 
    responsible for causing skin infections?
    a. Mycobacterium tuberculae
    b. Staphylococcus aureus
    c. Plasmodium

    Answer: b
    4) Bacterial skin infection may occur due to alternation of normal 
    skin flora    .
    a. True
    b. False

     Answer: a
    3) Which of the following symptoms indicate a possible skin 
    infection?
    a. Erythema /warmth
    b. Pain /tenderness
    c. Swelling 
    d. All of above

     Answer: d
    5.9 CONSOLIDATION ACTIVITIES
    Question 1 
    What is the most common causative agent of erythema multiforme (EM)?
    a. Penicillin and sulphonamides
    b. Systemic lupus erythema
    c. HSV infection
    d. Malignancy

    Answer: c
    HSV is the most common etiologic agent of EM, which presents as a targetoid 
    rash and bullae. All the other options are also associated with the disorder, but less 
    commonly.

     Question 2 How does impetigo present?
    a. Golden honey coloured crust over an erythematous base
    b. Salmon coloured plaque with silvery scale
    c. Comedones , pustules and nodules
    d. Flesh coloured papule with a rough surface

     Answer: a
    Impetigo is a superficial skin infection caused by Staph aureus or Strep pyogenes. 
    It frequently affects children. It is treated with penicillin and topical preparations e.g. 
    mupirocin. 

    Question 3
    What is the infective agent implicated in acne?
    a. Staphylococcus aureus
    b. Streptococcus pyogenes
    c. Staphylococcus epidermidis
    d. Propionibacterium acnes

    Answer: d
    Propionibacterium acnes infection produces lipases resulting in inflammation and 

    breakdown of sebum, leading to pustule formation. 

        5.10 EXTENDED ACTIVITIES

        Question one: Fulfill the following table

     

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    ◄UNIT 4:MEDICAL PATHOLOGIES OF ORAL AND OESOPHAGUSTopic 9►