1
Q
Skin Lesion
what is it, classifications
A
- A lesion is any variation from normal tissue
- Classified by either primary or secondary
2
Q
Primary Skin Lesions
A
- Changes to the skin in direct response to a disease
3
Q
Secondary Skin Lesions
A
- Develop from primary lesions, from external forces, such as scratching
4
Q
Acne Vulgaris
Definition
Inflammation of, overprod. of, forms what
A
- Obstructive, inflammatory condition of pilosebaceous units
- Overproduction of sebum forming a keratin plug which becomes infected by bacteria
- Forms comedones (pimples)
5
Q
Acne Vulgaris
Epidemiology
M/c in
A
- MC in younger individuals (12-25)
- MC trigger: puberty d/t androgen surge
- Males and females equally affected, males tend to have more severe cases
6
Q
Acne Vulgaris
Etiology
A
- Follicular keratinization blocks follicle
- Increased sebum production by sebaceous glands d/t androgens
- Colonized by anaerobic bacteria, Propionibacterium acnes (normal flora)
- Genetics play a major role
7
Q
Acne Vulgaris
Acne triggers
A
- Hormonal changes: puberty, menstrual periods, pregnancy, birth control pills, or stress
- Greasy or oily cosmetic and hair products
- Certain drugs (such as steroids, testosterone, estrogen)
- Heavy sweating and humidity
- Excessively touching, resting on, or rubbing the skin
- Massage oil
- Jojoba oil is an oil that does not clog pores and may help treat acne
8
Q
Acne Vulgaris
Signs and Symptoms
A
- Comedones, papules, pustules, cysts, and/or nodules
- Often in this progression
- Open comedones (blackheads):
oxidized sebum and melanin makes
black - Closed comedones (whiteheads)
9
Q
Acne Vulgaris
Treatment
A
- Goals are to limit triggers r/t sebum production and hormone regulation
- Over the counter (OTC) and/or prescription (Rx) creams and medications
- Skin cleansers
- Topical or oral Ab used if acne is widespread
- Oral contraceptives control androgen secretion
- Isotretinoin (Vit A derivative) for severe cases (Accutane)
- Possibly link with depression, psychosis, and suicidal thoughts
- May improve in summer d/t anti-inflammatory effects of the sun
10
Q
Acne Vulgaris
Massage and Acne
A
- Avoid affected areas, especially if inflamed
- Avoid use of table warmers or hot packs over affected area
- NOT CONTAGIOUS
11
Q
Infections of Hair Follicles
Folliculitis
A
inflammation of hair follicle
12
Q
Infections of Hair Follicles
Furuncle
A
inflammation of hair follicle that goes
into deeper layers of skin
* Abscess (pus) forms
* Also known as a boil
13
Q
Infections of Hair Follicles
Carbuncle
A
a group of furuncles
14
Q
Infections of Hair Follicles
Definition
A
- Infection of the skin with inflammation of the hair follicle
15
Q
Infections of Hair Follicles
Etiology
A
- MC cause is bacterial (Staphylococcus aureus)
- May also be caused by:
- Viruses or fungi
- Irritation from hair regrowth (folliculitis barbae)
- Occlusion from clothing or topical medications
16
Q
Infections of Hair Follicles
Symptoms
A
- Pustules formed around hair and surrounding area of erythema
- Furuncles and carbuncles will have more pus formation
- Possible pruritus
- Itchy
17
Q
Infections of Hair Follicles
Treatment
A
- Topical cleansers and antibiotics
- Antivirals or antifungals may be used if that is the cause
- Antihistamines to relieve itching
- Furuncles and carbuncles need to drain before healing
- Warm compress can help by bringing pus to the surface
18
Q
Infections of Hair Follicles
Prognosis and complications
A
- Infection damages follicle and hair can easily be pulled out
- Potential for in-grown hairs
- Spread of infection is possible, leading to local tissues becoming involved
19
Q
Folliculitis
Massage and inflammation of hair follicles
A
- Same principles as acne vulgaris
- Avoid affected areas, especially if inflamed
- Avoid use of table warmers or hot packs over affected area
- Most cases are NOT CONTAGIOUS, but some may be CONTAGIOUS
20
Q
Pseudofolliculitis Barbae
Definition
A
- Ingrown beard hairs
- Irritation of skin and hair follicles d/t shaving
- Hair curls into the skin causing inflammation
21
Q
Pseudofolliculitis Barbae
Presentation
A
- Itchy, red papules and/or pustules
- DDx from folliculitis barbae (bacterial)
- Pseudofolliculitis typically more chronic and has firm papules, sterile
- Folliculitis barbae typically more acute, pustules, not sterile
22
Q
Pseudofolliculitis Barbae
Epidemiology
A
- More common in black men
23
Q
Pseudofolliculitis Barbae
Treatment
A
- Warm compress
- Oral/topical Ab if infection occurs
24
Q
Impetigo
Definition
Deeper variant called
A
- Bacterial infection of the superficial layers of skin
- Deeper variant called ecthyma
25
# Impetigo
Epidemiology
* More common in children, can occur at any age
26
# Impetigo
Etiology
* MC causes are streptococcus bacteria and Staphylococcus aureus
* Can be spread by contact with an infected person or by handling contaminated
objects
27
# Impetigo
Signs and Symptoms
* Vesicular or pustular lesions that itch or burn
* Lesions rupture and ooze, releasing exudate which turn into honey-coloured crust
* Possible lymphadenopathy, but fever uncommon
28
# Impetigo
Prevention of spreading is key
* Handwashing
* Keep wounds clean
* Do not share linens or utensils, etc
29
# Impetigo
Treatment and Prognosis
* Topical or oral antibiotics
* Usually heals without any scars
30
# Impetigo
Massage and Impetigo
* LOCAL CONTRAINDICATION
* *HIGHLY CONTAGIOUS*
* Skin lesions must be covered during the massage
* Use caution when massaging hands as client may have touched own lesions
* Use gloves or other barrier
31
# Cellulitis
Definition
* Bacterial infection of the dermis and
subcutaneous tissues
* Often arises from previous skin wound
or boil
32
# Cellulitis
Etiology
* MC causes: Staphylococcus aureus;
group A Streptococcus infection
33
# Cellulitis
Signs and Symptoms
| visual/physical signs, lymphangitis,
* Redness, warmth, tenderness, and swelling in an
area where skin has been damaged
* Left untreated, the area of redness tends to
expand over time
* Red streaks or red lines can occur proximal to the
site (lymphangitis)
* Group A strep can cause blistering in superficial
and deep layers
* Systemic Sx: possible fever, chills,
lymphadenopathy, headache
34
# Cellulitis
Treatment and Prognosis
* Left untreated, cellulitis can be
life-threatening
* Can spread to bloodstream
* Oral antibiotics based on
suspected organism
35
# Cellulitis
Massage and Cellulitis
* LOCAL CONTRAINDICATION
* Not contagious
* If you notice signs and symptoms of cellulitis, REFER THE CLIENT TO
THEIR HEALTHCARE PROVIDER for evaluation
36
# Erysipelas
Definition
* Bacterial infection of upper dermis and superficial
lymphatics
* Superficial form of cellulitis
37
# Erysipelas
Etiology
* MC cause is various Streptococcus species
38
# Erysipelas
Epidemiology
* MC in older and younger individuals
39
# Erysipelas
Signs and Symptoms
* Erythematous lesion of skin w/ sharply
demarcated, raised border
* Orange-peel skin
* Warm, swollen, painful/tender
* Lymphadenopathy and possible
lymphedema
* Systemic Sx: fever, chills, vomiting,
headache, fatigue, and general malaise
40
# Erysipelas
Treatment and Prognosis
* Oral or IV antibiotics based on
severity
* Tx should be prompt to avoid
sepsis, tissue necrosis, or PSGN
(post-streptococcal
glomerulonephritis)
41
# Erysipelas
Massage and Erysipelas
* LOCAL CONTRAINDICATION
* Not contagious
* If you notice signs and symptoms of erysipelas, REFER THE CLIENT TO
THEIR HEALTHCARE PROVIDER for evaluation
42
# Warts
caused by
human papilloma virus (HPV)
43
Common Warts (verrucae vulgaris)
* Firm growths w/ rough surface and sharply
demarcated border
* Round or irregular
* Yellow, brown, or grayish in colour
* < ½ inch
* Usually painless
44
Plantar Warts
* Look similar to common warts
* May be more tender
* “Seeded” lesions that flatten with pressure and
have pinpoint bleeding when trimmed
* Seeded = clotted vessels that appear as small
black dots within the wart
45
Flat Warts
* Groups of smooth, yellow-brown spots; more common
in children
46
Genital Warts (condyloma acuminata)
* Most common viral STI
* Highly contagious
* Soft, fleshy, cauliflower-like growths around the vagina, penis, or rectum
* MC cause of cervical and penile cancers
* Treating external warts does not influence development of cancer
47
# Warts
Treatment
* Most will spontaneously resolve
* OTC treatments are usually successful
* Salicylic acid and/or lactic acid topical solution breakdown
wart
* Oral or topical antiviral medications
* Wart pads or cushions can reduce pressure/discomfort
* If initial treatment fails
* Cryotherapy (liquid nitrogen) and/or laser treatment
* Surgical excision
48
# Warts
Massage and Warts
* While common warts are not highly contagious, there is
still a chance of transmission
* Treat warts as a LOCAL CONTRAINDICATION and
avoid direct contact
* Use gloves or other barrier
49
# Varicella Zoster (Chickenpox)
Definition
| def. and spread how
Highly contagious viral infection
* Spread via
* Respiratory droplets
* Direct contact with lesions
50
# Varicella Zoster (Chickenpox)
Etiology
* Caused by varicella-zoster virus (VZV)
* Contagious 2 days before rash to 6 days after onset of rash
* A chickenpox is available and should be received between 12-15 months
51
# Varicella Zoster (Chickenpox)
Signs and Symptoms
* Clusters of small, raised or flat spots that turn to fluid filled blisters and crust over
* Pruritus
* Prodromal Sx (show up before the diagnostic S&S)
* mild (headache, mild fever) or absent in kids
* fever, malaise, and backpain in adults
52
# Varicella Zoster (Chickenpox)
* Complications
* Pneumonia and encephalitis (rare)
* Pregnancy: pneumonia, rare congenital birth defects
* Can lead to shingles (herpes zoster) later in life
53
# Varicella Zoster (Chickenpox)
Treatment
* Spontaneously resolves
* Oatmeal baths and antihistamines reduce
pruritus
* Antipyretics and antivirals may also be
suggested
* VZV vaccine exists for children as early as 12
months old
54
# Varicella Zoster (Chickenpox)
Massage and Varicella Zoster (Chickenpox)
* Chickenpox is HIGHLY CONTAGIOUS and clients should
be isolated
* Massage is postponed until client has completely
recovered
55
# Herpes Zoster (Shingles)
Definition
* Dermatomal rash caused by reactivation of dormant varicella-zoster virus
* Virus dormant in dorsal root ganglia after initial infection
* Can also present in face
56
# Herpes Zoster (Shingles)
Risk Factors
* Immunosuppression, stress, age
* MC in people > 50, can occur at any age
57
# Herpes Zoster (Shingles)
Etiology
* Reactivation of dormant varicella-zoster virus
* You cannot get shingles from someone with shingles, but if you have never had chickenpox, you
may get chickenpox
* Vaccine available for people >50
58
# Herpes Zoster (Shingles)
Signs and Symptoms
| Prodrome, rash
* Prodrome: dermatomal tenderness (neuralgia) and
paresthesia 3-5 average days before rash
* Rash: red, linear cluster of fluid filled vesicles
* Dermatomal pattern
* Very sensitive: pain with even light touch
* Dry and crust in 7 days and clear in approximately 2-3 weeks
* Pain resolves when vesicles crust over
59
# Herpes Zoster (Shingles)
Signs and Symptoms
* Systemic Sx: malaise, nausea, diarrhea,
fever, difficulty urinating
* Complications:
* post herpetic neuralgia (PHN)
* long term dermatomal pain
* Loss of vision if in eye
* Recurrence is rare, but possible
60
# Herpes Zoster (Shingles)
Treatment
* Spontaneous resolution
* If treatment is needed
* Antivirals
* Anti-inflammatories
* Analgesics
61
# Herpes Zoster (Shingles)
Massage and Herpes Zoster (Shingles)
* How you manage clients with shingles depends on your PMHx
and your vaccination status
* If you have had chickenpox or received the chickenpox
vaccine, and are not pregnant:
* Treat as a LOCAL CONTRAINDICATION as lesions may be painful
* If you have never had chickenpox or been vaccinated, or are
pregnant
* There should be NO CONTACT with shingles patient
62
# Herpes Simplex Virus (HSV)
Definition
* Highly contagious, recurrent viral infection that can either cause oral lesions (cold
sores) or genital lesions depending on the strain
63
# Herpes Simplex Virus (HSV)
Etiology
| hsv 1 and hsv 2
* HSV-1: Oral herpes (cold sores)
* Spread via oral secretions
* MC affected areas: mouth, face, ocular lesions
* HSV-2: Genital herpes
* Spread via genital secretions
* May cause neonatal herpes infections
64
# Herpes Simplex Virus (HSV)
Signs and Symptoms
| primary infection, recurrent infection
* Primary infection:
* lymphadenopathy, fever, malaise, and paresthesia for 24 hours before rash (not always
present)
* Rash: painful vesicles surrounded by reddish rim that turn to pustules, erode, and crust over
* Latent HSV-1 remains in trigeminal ganglia, HSV-2 in dorsal root ganglia
* Recurrent infections:
* 2-24 hours of burning, itching, crawling, tingling in a dermatomal pattern
* Common Triggers: Stress, fever, UV exposure, immunosuppression, menstruation
* Can be active, but asymptomatic
65
# Herpes Simplex Virus (HSV)
Treatment
* No cure
* Keep area clean and dry
* Topical antiviral creams sometimes effective
* Reduce period of symptoms and therefore period of
transmission, but do not cure the disease
* Analgesics may help with pain
66
# Herpes Simplex Virus (HSV)
Massage and Herpes Simplex Virus (HSV)
* Herpes lesions are a LOCAL CONTRAINDICATION
67
# Molluscum Contagiosum (MC)
Definition
* Highly contagious viral infection, common in children
* Spread via contact or indirect contact
* Also called water warts
68
# Molluscum Contagiosum (MC)
Etiology
* Molluscum contagiosum virus (MCV)
69
# Molluscum Contagiosum (MC)
Signs and symptoms
* Small, pink, round, raised lesions with a dimple in the
centre
* Possible pruritus
* Often bleed when scratched
70
# Molluscum Contagiosum (MC)
Treatment
* Spontaneously resolve in 6-9 months
* Can be removed if the lesions are particularly
bothersome. Removal techniques include:
* Cryotherapy
* Surgery
71
# Molluscum Contagiosum (MC)
Massage and Molluscum Contagiosum (MC)
* MCV lesions are a LOCAL CONTRAINDICATION
* MCV is HIGHLY CONTAGIOUS
* Can be spread through indirect contact, so wear
gloves if treating a patient’s hands
72
# Fungal Infections of the Skin
The Basics
* Extremely common
* Fungal pathogens that affect the skin are called dermatophytes
* Occupy dead, topmost layer of skin
* Warm, moist areas where skin surfaces meet is ideal medium
* b/t toes, nails, groin, under the breast, head, feet
73
# Tinea (Ringworm)
Definition
| type of fungi, classified by location
* Common fungal infection caused by a number of
different fungi called dermatophytes
* Classified by the location
* Tinea pedis (foot)
* Tinea unguium (nail)
* Tinea corporis (body)
* Tinea cruris (groin)
* Tinea capitis (head)
* Contagious through direct contact
74
# Tinea (Ringworm)
Common Signs and Symptoms
* Circular rash surrounded by an outer ring
* Produce keratolytic enzyme causing scaling, crumbling nails, breaking hairs
75
# Tinea (Ringworm)
Risk factors
* Immunosuppression
* Hyperhidrosis
* Tight clothing
* Warm environment
76
# Tinea (Ringworm)
Treatment
* Keep area clean and dry
* Antifungal creams are most effective (OTC)
* Powders are less effective
* Topical corticosteroids Rx for pain and pruritus relief
77
# Tinea (Ringworm)
Massage and Tinea (Ringworm)
* All tinea infections are a LOCAL CONRAINDICATION
* The lesions should not be massaged as they can cause more
pain and are CONTAGIOUS
78
# Candidiasis
Definition
Fungal infection of skin and mucous membranes
* MC affected areas: groin, mouth, and b/t digits
79
# Candidiasis
Etiology
* Candida albicans, a vaginal/intestinal yeast and natural flora
80
# Candidiasis
Risk factors
* Immunosuppression, hyperhidrosis, incontinence, excessive corticosteroid
or antibiotic use, being pregnant, obese, diabetic, and/or a child
81
# Candidiasis
Vaginal Candida Infections (yeast infection)
| Signs and Symptoms
* Thick white or yellow vaginal discharge with burning, itching, and redness of the groin
* May cause dysuria or dyspareunia
82
# Candidiasis
Penile Candida Infections
| Signs and Symptoms
* Painful red, scaling lesions with raised, white border on
the underside of the penis
* Common in diabetics and men with infected sexual partners
83
# Candidiasis
Oral Candida Infections (thrush)
| Signs and Symptoms
* Painful, cream-coloured patches that adhere to oral
mucosa
* Bleed when scraped off
* Common in children and immunocompromised
persons
84
# Candidiasis
Diagnosis
* Based on observation of distinctive rash/pasty discharge
85
# Candidiasis
Treatment
* Antifungal creams
* Vaginal suppositories
* Medicated mouthwash
* Keep skin dry to clear and prevent return
86
# Candidiasis
Massage and Candidiasis
* Vaginal and penile candidiasis
* No special considerations exist, continue as normal
* Oral candidiasis
* LOCAL CONTRAINDICATION as you work around neck and face
87
# Tinea Versicolor
Definition
* Fungal infection of skin causing patches of discolouration
88
# Tinea Versicolor
Etiology
* Malassezia globosa, a yeast naturally found on skin
* Less commonly caused by other yeasts
89
# Tinea Versicolor
Risk factors
* Immunosuppression, hyperhidrosis, hot and humid climates, young adults
90
# Tinea Versicolor
Signs and Symptoms
* Hypo- or hyperpigmented patches of skin
* Sometimes the patches may cause scaling
* Patches don’t tan evenly, so sun exposure makes
them more noticeable
* Sometimes called “sun fungus” for this reason
91
# Tinea Versicolor
Diagnosis
* Typically diagnosed by visual symptoms
* Can also use a special dye that glows under UV light
92
# Tinea Versicolor
Treatment
* Topical antifungal cream
* Oral antifungals exist, but there are concerns of organ damage and other
systemic interactions with these medications
* Used only if the topical medications are ineffective
93
# Tinea Versicolor
Massage and Tinea Versicolor
* Lesions are not painful and NOT CONTAGIOUS
* LOCAL CONTRAINDICATION
94
# Scabies
Definition
* Mite infestation of the itch mite Sarcoptes scabiei
* Female mite burrows under top layer of skin and lays eggs
* Young mites hatch in a few days and then burrow deeper
* Highly contagious spreads skin to skin; can live longer than two days w/o host and be
spread on items (fomites)
95
# Scabies
Signs and Symptoms
* Tiny, red pimple-like rash with wavy lines with severe, persistent pruritus
* Worse at night, worse after a bath
* MC affected areas: waistline, axillae, groin, feet, between fingers, creases of elbows,
wrists, and knees
* Rarely above neck
96
# Scabies
Diagnosis
* Based on history of pruritus and observation of rash
97
# Scabies
Treatment
* Topical cream for mites and hydrocortisone cream for pruritus
* Antihistamines for itch
* Wash all bedding and clothes in hot water
* Fumigation not necessary
98
# Scabies
Massage and Scabies
HIGHLY CONTAGIOUS and spread by direct contact, therefore
treatment should be POSTPONED until infestation clear
* Wash all linens in hot water if come in contact
99
# Pediculosis (Lice)
Definition
* Louse: barely visible mites that cannot jump or fly and can infect any
area of the skin
* There are three types of lice:
* Head louse
* Body louse
* Pubic louse
100
# Pediculosis (Lice)
Signs and Symptoms
* Severe pruritus and possible red bumps on skin
* Visible lice in the area of infestation
* Visible egg sacs on shaft of hair near scalp
101
# Pediculosis (Lice)
Head Louse (Pediculus humanus capitis)
* Spread by personal contact and by shared personal items; common in schools
102
# Pediculosis (Lice)
Body Louse (Pediculus humanus corporis)
* Less easily transmitted, usually infect people who have poor hygiene and those living in close quarters
* Largest louse
103
# Pediculosis (Lice)
Pubic Louse (Pthirus pubis)
* Infestation of genital area typically spread by sexual contact
* Wide, short body that resembles a crab
104
# Pediculosis (Lice)
Treatment
* Medicated cream, lotion, or shampoo
* Reapplication after 10 days to kill newly hatched lice
* Daily combing to remove eggs
* Re-infection possible through infected objects
* Fomite control: disinfect personal objects and vacuum
105
# Pediculosis (Lice)
Massage and Pediculosis (Lice)
* HIGHLY CONTAGIOUS and spread by direct contact, therefore treatment
should be POSTPONED until infestation clear
* Wash all linens in hot water if come in contact
700 - Sys Path
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