Diseases and Disorders of the Integumentary System

Conditions

• Some external or superficial conditions can give the doctor clues as to what is wrong with the patient • These are based on color of the condition

Cyanosis

• Certain disease can cause the skin to take on a bluish color – Methomeglobenemia, from nitrates in the water – Tetrology of Fallot (congenital heart condition) – Reduce pulmonary function, reducing oxygen availability to the body

Lyme’s Disease

Erythema

Fifth’s Disease • Redness of the skin due to – Rash Sulfa drug allergic reaction – Redness due to • heat • Photosensitivity • Ultraviolet radiation • Medications • Birth control pills • Ulcerative colitis, Crohn’s Disease • Fifth’s Disease • Laptop on your lap for extended period of time!

Bronzing of Skin

• 19 known diseases can cause skin bronzing, which looks like a suntan • Increased pigmentation on the elbows, knees, heels, and palms due to hyperpigmentation in those areas • Can also be caused by Addison’s Disease, Chronic Kidney Disease, Adrenal Hyperplasia, biliary cirrhosis, and many diseases

Pallor

• Lack of coloration to the skin (loss of “pinkness”) • Usually due to lack of oxygen to the body because of shock, stress, illness, migraine, Vitamin D deficiency, frostbite, hypoglycemia, and much more • Mucous membranes appear very pale

Jaundice or Cholestasis

Yellow coloration of eyes, skin, and mucus membranes Usually due to excess bilirubin in the blood from excessive erythrocyte breakdown liver overloaded or damaged bilirubin cannot be processed for use by gall bladder and digestive system

Bronzing

• Bronze color similar to a tan, but with a metallic sheen; can be in form of hyperpigmentation spots • Causes: Addison’s Disease & Cushing’s Disease; overproduction of cortisol from adrenal glands

Bruises

• Cause: broken capillaries under the skin due to intense pressure • Colors range from deep blue-black, purple and red to yellowish-green

Genetic Disorders

Oculocutaneous Albinism

• Cause: loss of genetic information for melanin production in hair, eyes and skin • Human albinos have very light blue eyes, not pink!

• Inherited trait – must inherit genes from both parents.

Porphyria

• Cause: inheritance of genes that cause body to lack a certain enzyme or acquired in life • Red blisters, breakdown of skin, photosensitivity, itching, swelling, fine, lanugo-like hair growing on forehead and body • Believed to have given rise to myth of lycanthropy or were wolves

Hypertrichosis or “Werewolf Disease”

• Abnormal growth of terminal hair • Congenital or acquired Stephen Bibowski, known as Lionel the Lion-Maned Man

Harlequin ichthyosis

• Congenital skin disorder caused by thickening of the keratin in the epidermis • Skin contains massive, diamond-shaped scales as skin cracks • Allows bacterial infections to occur • associated with a mutation in the gene for the protein

ABCA12

Rosacea

• Cause is unknown; not believed to be genetic • Chronic inflammation and dilation of capillaries and blood vessels under the skin • Exacerbated by heat, food, alcohol, caffeine, hot spices • Skin may thicken in these areas, making skin bumpy, especially on cheeks and nose (nose growth called Rhinophyma) • Some areas more sensitive and may develop pustules • Begins in teen years, gets worse as age • Can also occur in the eyes!

Mongolian Spot

• Common in persons of Latino, Asian, East Indian and African heritage; 10% of Caucausians • Caused by excess melanocytes in affected area; form just before or just after birth; areas have a wavy edge • May fade with age

Port Wine Stain or Hemangioma

• Cause:congenital feature at birth of excess caused by enlarged capillaries under the skin • Can be treated with laser therapy

Microbial Diseases

Virus, Bacterial, or Fungal

Boils and Carbuncles

• Cause: infection of hair follicles with

Staphylococcus aureus bacteria

• Enter through a scratch, cut, or break in skin • Bacteria encounter white blood cells and are killed; forms pus in a painful nodule under the skin that rises up • Boils and carbuncles can either be lanced or can be “expressed” (squeezed) if a white “head” appears

Cold Sores, Fever Blisters

• Cause: Herpes Simplex 1 virus • Virus hibernates in the trigeminal nerves of the face which ennervates the nose, eye, lips and cheek • In active condition forms the “cold sore” on the lip • Person is HIGHLY contageous!

• In immune-compromised patients, cold sores can spread to nose and eyes

Syphilis

• • • STD caused by

Treponema pallidum

• Highly contageous • • Transmitted congenitally to fetus

Primary

– active form; appearance of painless chancre on genitals

Secondary

– skin rash, sore throat, fever, swollen lymph glands, headaches, weight loss, patchy hair loss

Tertiary

– affects nervous system, can cause insanity

Genital Herpes

• Cause: Herpes Simplex 2 virus • Contagious when developing sores or with open sores • Forms on the genitalia and anus • Person will experience “prodromal symptoms” of tingling, itching or burning before lesions appear – VERY contageous at this point • Use of Acyclovir or Valtrex, both which can control outbreaks • Use of condom during sex is recommended between outbreaks

Impetigo

• Caused by ivy, sunburn

Streptococcus

Group A bacteria or

Staphylococcus aureus

• Bacteria usually infect area already compromised by poison • Scratching affected area with dirty fingers • Occurs predominately in summer • Occurs predominately in pre-school or school aged children

Psoriasis

• Caused by rapid cell turnover of the cutaneous epidermis due to an immune system overload to the skin • Occurs more often in adults • Family history or none

Measles or Rubiola

• Caused by a paramyxovirus • Inhaled • Highly contageous • Asymptomatic incubation period of 9-12 days!

• Fever for three days accompanied by cough, conjunctivitis and coryza (head cold symptoms), along with Koplik’s Spots (measles of the throat)

Cause not Certain

Vitiligo

Caused by loss of pigmentation in spots all over the body when melanocytes stop producing melanin in those areas due to a. Immune system destroying the melanocytes b. Hyperthyroidism c. Very severe sunburn killing off melanocytes d. Family history

Thrush

• Fungus genitals bacteria

Candidas albicans

• Normally found in mouth, throat, intestinal tract, and • Kept in balance by body’s • Gets “out of control” in immunosuppressed patients and babies, as well as women who have a bacteria imbalance • White patches in mouth • “Cottage cheese” in vagina • Emits 70 different toxins into the body if gets into bloodstream

Skin Cancer

Squamous Cell Carcinoma

• • • • • • • • • • Non melanoma cancer Normal skin or skin that has been inflamed Earliest form called Bowen’s Disease Bump with scaly skin, crusting, redness More frequent in light-skinned, blue or green eyes, blonde or red haired hair individuals Long term sun exposure; frequent sunburns Also many x-rays or chemical exposure Removed by excision, curettage, burning, freezing John’s Surgery – removing layer by layer until no more cancer cells Easiest to treat

Basal Cell Carcinoma

• Non-melanoma cancer • Slow, painless cancer that originates in the stratum basale layer of the epidermis • skin bump or growth that is: – Pearly or waxy – White or light pink – Flesh-colored or brown • In some cases the skin may be just slightly raised or even flat.

Other Symptoms

• You may have: • A skin sore that bleeds easily • A sore that does not heal • Oozing or crusting spots in a sore • Appearance of a scar-like sore without having injured the area • Irregular blood vessels in or around the spot • A sore with a depressed (sunken) area in the middle

Prevention and Treatment

• Prevention - same as for squamous cell carcinoma • Treatment – same as for squamous cell carcinoma