700 - Sys Path > Lecture 2 > Flashcards

Lecture 2 Flashcards

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1
Q

Psoriasis

Definition

A
  • Chronic, non-contagious, inflammatory autoimmune disease of hyper-proliferation
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2
Q

Psoriasis

Etiology

Type of disease, may be r/t, contributing factors

A
  • Auto-immune, but idiopathic in acquisition
  • May be r/t genetics (inheritance is possible)
  • Smoking, obesity and alcohol use have been linked to psoriasis
  • Infections (both bacterial and viral) have been linked to worsening psoriasis
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3
Q

Psoriasis

Epidemiology

age, ethnicity

A
  • More common in certain age ranges, but can occur at any age
  • More common in Caucasians vs other ethnicities
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4
Q

Psoriasis

Signs and Symptoms

plaques covered w/, auspitz sign, koebner phenomenon, MC affected areas

A
  • Erythematous papules and plaques covered with silvery scales
  • Extremely pruritic
  • Scraping of plaques often causes punctate bleeding (Auspitz’s sign)
  • Development of new psoriasis at sites of skin trauma (Koebner phenomenon)
  • MC affected areas: scalp, extensor surfaces of elbow and knee, back, chest,
    groin, and armpit
  • Different classifications present in different ways. Plaque psoriasis is most common
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5
Q

Psoriasis - Common Comorbidities

  • Psoriatic arthritis

affects what, characterized by, DDx from

A
  • An extensive form of psoriasis that affects joints
  • ~5-30% of patients with psoriasis develop psoriatic arthritis
  • Characterized by stiffness, pain, swelling and tenderness of the joints and their
    surrounding ligaments and tendons
  • DDx from RA
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6
Q

Psoriasis Common Comorbidities

Nail bed involvement

A
  • 1/3 of those affected by psoriasis also have nail involvement
  • Pitting, discolouration, and nail separation
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7
Q

Psoriasis

Diagnosis

A
  • Clinical examination
  • Skin biopsy can be helpful for challenging cases
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8
Q

Psoriasis

Treatment

A
  • Topical corticosteroids
  • OTC ointments and creams to keep areas moist
  • Controlled UV light and sunbathing
  • Avoid overexposure d/t risk of skin CA
  • Antihistamines for pruritus
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9
Q

Psoriasis

Massage and Psoriasis

A
  • LOCAL CONTRAINDICATION if there is the presence of broken skin at lesions
  • If there is no presence of open skin, LIGHT massage may be performed over areas with the consent of patient
  • Non Contagious
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10
Q

Rosacea

Definition

A
  • Chronic, progressive, erythematic skin condition causing facial redness
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11
Q

Rosacea

Etiology

A
  • Idiopathic
  • May be r/t genetics and/or overactive immune system
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12
Q

Rosacea

Epidemiology

mc age/gender

A
  • MC age: 30-50
  • More common in females and those with fair complexion
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13
Q

Rosacea

Signs and Symptoms

A
  • Persistent facial erythema, dryness, warmth, swelling
  • Tiny pustules may appear, resembling acne
  • Telangiectasia and thickened skin can develop
  • Potential for rhinophyma
  • Erythematous, bulbous, nose caused by sebaceous gland hypertrophy
  • MC affected area: face, particularly the middle one-third (nose, cheeks, chin)
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14
Q

Rosacea

Signs and Symptoms

A
  • In general, S&S tend to go through flare up/remission phases
  • There are known triggers for flare ups (listed later)
  • Some people only ever present with some of the symptoms listed above
  • In others, the disease is more progressive (flushing -> rhinophyma)
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15
Q

Rosacea

Treatment

A
  • No cure
  • Avoid triggers
  • Direct sunlight
  • Strenuous exercise
  • Extreme temperatures
  • Spicy foods, hot beverages, alcohol
  • Topical antibiotics for inflammatory phase
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16
Q

Rosacea

Prognosis

more likely to suffer from, also linked with

A
  • More likely to suffer from migraines
  • Rosacea also linked with IBD, celiac disease, SIBO/IBS
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17
Q

Rosacea

Massage and Acne Rosacea

A
  • Depends on the severity of the disease
  • Inquire about sensitivity over affected areas
  • Non Contagious, but AVOID areas containing PUSTULES
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18
Q

Hidradenitis Suppurativa

Definition

A
  • Chronic, scarring, acne-like inflammatory
    process
  • MC in axillae, groin, and around the nipples and
    anus
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19
Q

Hidradenitis Suppurativa

Etiology

Develops when what becomes blocked, could be connected to

A
  • Idiopathic: develops when hair follicles become
    blocked, but why this blockage occurs isn’t known
  • Could be connected to hormones, genetic predisposition, cigarette smoking or excess weight
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20
Q

Hidradenitis Suppurativa

Symptoms

A
  • Small, swollen, painful nodules under the skin
  • Pain followed by sudden, random draining of pus
  • In chronic cases: cord-like fibrotic bands form d/t inflamed nodules adhering together
  • Painful and produce foul odor
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21
Q

Hidradenitis Suppurativa

Treatment and Prognosis

A
  • Drug therapy not usually beneficial, but may be Rx topical antibiotics and steroids
  • Warm compress to drain
  • Laser hair removal for prophylaxis
  • Surgical excision may be necessary
  • Often leads to significant scarring
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22
Q

Hidradenitis Suppurativa

Massage and Hidradenitis Suppurativa

A
  • Not Contagious but any pustules would be a LOCAL CONTRAINDICATION
  • Inquire about sensitivity over affected areas
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23
Q

Erythema Multiforme

Definition

def, what type hypersensitivity, triggers

A
  • Erythema multiforme is an inflammatory reaction, characterized by target shaped skin lesions
  • Oral mucosa is sometimes involved
  • Considered type IV hypersensitivity reaction (more on this in later classes)
  • Triggers = drugs and infections
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24
Q

Erythema Multiforme

Etiology

A
  • MC trigger = herpes simplex virus (~50% of cases)
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# Erythema Multiforme Signs and Symptoms
* Mildly itchy, symmetrically distributed patches of red, raised skin with target-like lesions, blistering, and mucous membrane involvement * Blisters can ooze blood * Systemic sx = fatigue, joint pain, and fever
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# Erythema Multiforme Treatment
* Self-limiting condition that lasts 2-4 weeks * No intervention required * Sometimes antivirals given if HSV is the cause
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# Massage and Erythema Multiforme
* Not contagious but is a LOCAL CONTRAINDICATION * Allow for full healing of lesions before direct treatment
28
# Stevens-Johnson Syndrome (SJS) Definition | def, class hypersensitivity, also involves
* A life-threatening type IV hypersensitivity reaction where necrosis causes the dermis to separate from the epidermis * Also involves mucous membranes
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# Stevens-Johnson Syndrome (SJS) Etiology
* Medications (sulfa drugs are MC), infections
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# Stevens-Johnson Syndrome (SJS) Symptoms
* Severe blistering * Pain with closing mouth/eating (leads to drooling) * Dysphagia d/t pain * Painful swelling of eyes w/ sealing of eyelids d/t pus * Dysuria w/ genital involvement * Systemic sx: fever, fatigue, sore throat
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# Stevens-Johnson Syndrome (SJS) Treatment
* Aimed at supportive care: analgesics, IV fluids, NG tube or parenteral nutrition
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# Stevens-Johnson Syndrome Massage and Stevens-Johnson Syndrome
* CONTRAINDICATION * Wait until patient has recovered fully * Not contagious
33
# Urticaria Definition | def, associated with, hypersensitivity type, papules mediated by
* Inflammatory skin disorder usually associated with allergic reactions * Type I hypersensitivity * Transient, edematous papules mediated by histamine
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# Urticaria Etiology
* Allergen triggers immunologic response * Medications, insect bites, foods, idiopathic
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# Urticaria Signs and Symptoms | wheals, flares, angioedema
* Itching followed by wheal and flare response * Wheals: small, smooth, slightly elevated lesions * Usually only last a few hours * Flares: redness that shortly follows the wheal * If it affects deeper tissues, causes edema with warm, red, painful skin called angioedema * Angioedema of the mouth and throat can be life threatening
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# Urticaria Treatment
* Oral antihistamines to reduce itching and swelling * Topical corticosteroids * Monitor for lesions around mouth * Hives in the throat can be life-threatening * Difficulty breathing and/or swallowing * EpiPen for anaphylaxis
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Massage and Urticaria (Hives) | Acute, chronic
* In acute/allergic urticaria, massage is CONTRAINDICATED and should be postponed * In chronic urticaria, massage is a LOCAL CONTRAINDICATION
38
# Drug Eruptions and Reactions | 7 types (3 covered in class)
* Erythema Multiforme * Stevens-Johnson Syndrome * Urticaria * Fixed Drug Reaction * Purpuric Eruptions * Acneiform Eruptions * Toxic Epidermal Necrolysis (more severe form of SJS)
39
# Decubitus Ulcers (Bed Sores/Pressure Sore) Definition
* Breakdown of skin integrity d/t lack of blood flow and irritation from prolonged pressure * Tissue necrosis can occur in as little as 12 hours * MC affected areas: sacrum, greater troctrochanter, heels * Areas of skin over a bony prominence
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# Decubitus Ulcers (Bed Sores/Pressure Sores) Etiology
* Prolonged pressure on the skin resulting in reduced blood flow * Bed/wheelchair bound, cast/splint * Paralysis, coma, diabetes
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# Decubitus Ulcers (Bed Sores/Pressure Sores) * Stage I ## Footnote Categorized by four stages (Stage I – Stage IV) where different signs and symptoms appear:
* Non-blanchable erythema of intact skin * No ulcer at this stage
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# Decubitus Ulcers (Bed Sores/Pressure Sores) * Stage II
* Partial thickness skin loss with exposed dermis * Erythema, edema, and blistering * No visualization of adipose or muscle layers
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# Decubitus Ulcers (Bed Sores/Pressure Sores) * Stage III
* Full thickness skin loss * Deeper layers of skin and adipose tissue exposed; not muscle or bone * Undermining and tunneling may occur
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# Decubitus Ulcers (Bed Sores/Pressure Sores) * Stage IV
* Full thickness skin and tissue loss * Destruction of tissue with visualization of muscle or bone
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# Decubitus Ulcers (Bed Sores/Pressure Sores) Treatment
* Stage I and Stage II ulcers are treated by repositioning the client * Stage III and Stage IV will need medical treatment from a wound care specialist * Antibiotics may be given to prevent infection
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Massage and Decubitus Ulcers
* LOCAL CONTRAINDICATION * If the ulcer shows signs of infection, odour or discharge, treatment should be postponed and the client should be referred to MD for treatment
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Dermatitides
* Dermatitides is the plural of dermatitis
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Definition of dermatitis
* Superficial inflammation of the skin * Common presentation: pruritus, redness, edema, oozing, crusting, and scaling * May be acute, subacute, or chronic
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Types of dermatitis
* Atopic dermatitis (eczema), contact dermatitis, phototoxic and photoallergic dermatitis, stasis dermatitis, seborrheic dermatitis, perioral dermatitis
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# Atopic Dermatitis (Eczema) Definition | how common inflammatory skin condition, type of inflammation
* Most common inflammatory skin condition * Immune-mediated inflammation of the epidermis and dermis
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# Atopic Dermatitis (Eczema) Etiology | genetics (spec. overprod. of?), m/l also have, contributing factors
* Genetics (inherited tendency to over-produce IgE - atopy) * Between 75-80% of affected individuals have Hx of asthma and/or allergic rhinitis * Food allergies, environmental allergies, emotional stress, humidity, irritation of skin by clothing, bacterial infection
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# Atopic Dermatitis (Eczema) Signs and Symptoms
* Chronic, itchy inflammation of the upper layers of skin * Leads to dry, scaly, leathery, or crusty skin * Skin may be lighter or darker than surrounding areas * Possible to crack, ooze fluid, and bleed * Potential for “itch-scratch-rash” cycle * Scratching induces itchiness
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# Atopic Dermatitis (Eczema) Treatment
* Treating eczema can be tricky * hard to identify triggers need to be discovered and removed before any improvement can be seen * OTC moisturizers * Topical corticosteroids
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Massage and Atopic Dermatitis (Eczema)
* Non Contagious * LOCAL CONTRAINDICATION if the skin is broken * Proceed with caution and with client permission if skin is intact * Affected areas should never be treated with vigorous pressure
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# Primary Irritant Contact Dermatitis Definition
* Inflammation of the skin d/t contact with an irritant
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# Primary Irritant Contact Dermatitis Cause
* Any irritating substance * Cleaning products such as chlorine bleach * Laundry detergents or soaps/shampoos * Dyes * Fertilizers * Fiberglass * Latex * Certain metals in jewelry
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# Primary Irritant Contact Dermatitis Signs and Symptoms
* Itchy or painful rash of erythematic, scaling or blistering lesions with demarcated borders * MC affected area: hands
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# Primary Irritant Contact Dermatitis Treatment
* Resolves a few days after irritant is removed * Antihistamines and corticosteroids can help to ease pruritus and inflammation
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Massage and Irritant Contact Dermatitis
* Non Contagious * LOCAL CONTRAINDICATION
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# Allergic Contact Dermatitis (ACD) Definition | hypersensitivity type, first exposure causes, immunity builds with
* Type IV delayed, cell-mediated hypersensitivity reaction causing rash at site of contact * First exposure creates Ab-Ag complexes without rash * Immunity builds and subsequent exposures create pruritus and dermatitis 4-24 hours after exposure
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# Allergic Contact Dermatitis (ACD) Etiology
* Cosmetics, metal compounds, plants, drugs, skin creams, chemicals in clothing
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# Allergic Contact Dermatitis (ACD) Symptoms
* Symptoms include intense pruritus (itching), and pain is usually the result of excoriation (scratching) or infection * Vesicles may form and ooze
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# Allergic Contact Dermatitis (ACD) Treatment
* Avoid offending allergen * Oral and/or topical antihistamines * Topical corticosteroids to relieve itching and pain
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Massage and Allergic Contact Dermatitis
Non Contagious * LOCAL CONTRAINDICATION
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# Phototoxic Dermatitis Definition
* Cutaneous reaction within minutes to hours following sun exposure * Light-absorbing free radicals and inflammatory mediators are activated by over-exposure to sunlight * An increase in energy damages skin
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# Phototoxic Dermatitis Etiology
* Over 100 topical and oral substances are known to cause reaction * Topical substances (perfumes, sunscreens, aftershave, oils, coal tar) * Ingested substances (tri and tetracyclic antibiotics)
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# Phototoxic Dermatitis Signs and Symptoms
* Painful, swollen, erythematic lesions * Burn like characteristics * Will only affect sun exposed skin * Highly variable reactions
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Massage and Phototoxic Dermatitis
* Non Contagious * LOCAL CONTRAINDICATION
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# Photoallergic Dermatitis Definition | type of immune response, appears when, caused by
* Type IV cell-mediated immune response 1-3 days after sun exposure * Light absorption causes structural changes in a drug or substance, allowing it to bind to tissue protein and function as an antigen
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# Photoallergic Dermatitis Etiology
* Topical medications or photosensitizing agents (aftershave, sunscreens, sulfonamides)
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# Photoallergic Dermatitis Signs and Symptoms
* Erythematic vesicles and pruritus * Prior exposure to the sun is required * Reaction may affect non-sun exposed areas of the skin
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Massage and Photoallergic Dermatitis
* Non Contagious * LOCAL CONTRAINDICATION
73
# Stasis Dermatitis Definition
* “Stasis” or blood/fluid pooling and inflammation of the lower legs due to chronic venous insufficiency
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# Stasis Dermatitis Etiology
Chronic venous insufficiency * Risk factors: * History of deep vein thrombosis (most important) * Varicose veins or a family history of varicose veins * Obesity * Pregnancy * Not getting enough physical activity * Smoking and tobacco use
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# Stasis Dermatitis Signs and Symptoms | physical signs, MC area, complication
* Chronic, bilateral redness, warmth, swelling, and scaling of lower legs * Dark brown hyperpigmentation from increased blood * MC affected area: ankles * Complication: venous ulcers may form
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Massage and Stasis Dermatitis
* Non Contagious * LOCAL CONTRAINDICATION * Do not work over venous ulcers * Have to be cautious about blood clots (DO NOT WANT TO MASSAGE)
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# Neurodermatitis Definition ## Footnote * Aka Localized Scratch Dermatitis or Lichen Simplex Chronicus
* Chronic, itchy inflammation that leads to thickening of the epidermis * Linked to psychogenic factors (anxiety, depression, etc.)
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# Neurodermatitis Etiology ## Footnote * Aka Localized Scratch Dermatitis or Lichen Simplex Chronicus
* Unknown; psychological factors are a possible cause * Anxiety and nonspecific emotional stress
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# Neurodermatitis Epidemiology
* More common in ages 20-50 and among Asians and Native Americans
80
# Neurodermatitis Signs and Symptoms
* Itchy, dry, scaling rash with dark, thickened patches * Repeated skin scratching and/or rubbing, causing further itching and then further scratching and/or rubbing, creating a vicious circle (itch–scratch cycle) * MC affected areas: arms, legs, neck, anus, and vagina
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# Neurodermatitis Treatment
* Treat the cause of the itching (possible psychological factors) * Pt education re: effects of scratching * Topical corticosteroids * Antihistamines
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Massage and Neurodermatitis
* Non Contagious * LOCAL CONTRAINDICATION
83
# Seborrheic Dermatitis Definition
* Chronic, inflammatory disease of skin rich with sebaceous glands * “Cradle cap”
84
# Seborrheic Dermatitis Cause
* No known cause, but has been associated with the normal yeast Malassezia furfur (can also cause tinea versicolor) * Linked to weakened immune system and possibly genetics * Also linked to stress, cold & dry climate, and diet * Higher incidence and intensity w/ Parkinson’s and HIV patients
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# Seborrheic Dermatitis Signs and Symptoms
* Pruritus, extensive dandruff, and yellow, greasy-appearing flakes * MC affected areas: face, hairline, and scalp
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# Seborrheic Dermatitis Treatment
* Anti-inflammatory shampoos * Antifungal topicals
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Massage and Seborrheic Dermatitis
* Inquire about history * Inquire about sensitivity of affected areas and adjust pressure accordingly * Use thin, water-based lubricants rather than oil-based
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# Perioral Dermatitis Definition | dermititis surrounding what, can be mistaken for
* Dermatitis that is found surrounding the mouth * Can be mistaken for acne or acne rosacea
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# Perioral Dermatitis Etiology
* Idiopathic * Many factors have been suggested, but one of the most common is topical steroid use
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# Perioral Dermatitis Signs and Symptoms
* Often limited to the area immediately surrounding the mouth, but can spread toward the eyes * Acne-like papules and pustules, scaling, and erythema
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# Perioral Dermatitis Treatment
* Removal of possible triggers * Antibiotic creams * Anti-inflammatory creams
92
# Melanocytic Nevi (Moles) How to know if a mole is concerning?
* Atypical or dysplastic nevi may indicate melanoma * The ABCDEs of moles * A = asymmetry * B = borders * C = colour * D = diameter * E = evolving
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# Malignant Melanoma main cause, rapid growth, detect early, if not detected
* Main cause is UV light exposure * Extremely dangerous * Has a variety of presentations * Cancerous melanocytes grow rapidly and metastasize through lymphatic system * If detected early and removed surgically, the 5-year survival rate is 99 percent * If not detected until after metastasis, the 5-year survival rate drops to 14%
94
# Basal Cell Carcinoma (BCC) M/c form, originates where and how, appearance, survival rate
* Most common form of skin cancer * Originates in stratum basale due to mutations caused by overexposure to UV radiation * Appears as a transparent or pearly white nodule * Although there are a variety of appearances * Virtually no metastasis and most people survive * ~100% 5-year survival rate
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Basosquamous Carcinoma (BSC) | Rareness, Appears how, caused by
* Rare, aggressive cancer * Appears to be a BCC that has undergone mutation and differentiation as if it were a squamous cell * Caused by overexposure to UV radiation
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# Sebaceous Neoplasm
* Group of tumours involving sebaceous glands * Usually benign, but can be malignant * Can often be mistaken for other tumours such as BCC or BSC
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# Cutaneous Papilloma (aka Skin Tag) Commonality, found where on body, possibly linked with
* Extremely common, benign skin growth typically found in areas where skin rubs together * Base of the neck, flexor surfaces or limbs, etc * Possibly associated with human papilloma virus (HPV)
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Massage and Skin Neoplasms
* All LOCAL CONTRAINDICATIONS * Follow guidelines for working with clients who have cancer * Observe client’s skin for other suspicious lesions and encourage patient to be evaluated by doctor if anything new is noticed.
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# Ichthyosis Definition
* Group of over 30 diseases with similar presentations including red, itchy skin
100
# Ichthyosis Etiology
* Genetic mutation or inheritance
101
# Ichthyosis Signs and Symptoms
* Vary, depending on the exact type of ichthyosis * Common: redness, pruritus, flaky skin, leathery skin, skin that forms large, hard plates
102
# Ichthyosis Treatment
* Dependant on type of ichthyosis * Typically involve creams to hydrate the skin
103
Massage and Icthyosis
* Non contagious * No contraindications * Skin may be sensitive, so make sure to check in with the patient
700 - Sys Path
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