medical

1. INSTITUTE OF HEALTH SCIENCE
SCHOOL OF NURSING AND MIDWIFERY
DEPARTMENT OF NURSING
PRESENTATION ON ALLERGIC AND INFLAMMATORY SKIN
CONDTIONS, INFECTIOUS OF SKIN: PATHOGENIC (VIRAL,
BACTERIAL, FUNGAL)
BY: ZEWUDE M.(B.SC ,AHN STUDENT)
2/7/2023 By Zewude M 1

2. presentation outline
Objectives
Introduction of integumentary system
Allergic and inflammatory conditins of the skin
Bacterial Infectious of the skin
Viral skin infections
Fungal skin infections
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3. objectives
By the end of this session, the learner will be able to
Define integumentary system
List common integumentary disorder
Describe allergic and inflamatory condition of the
skin
Explain infectious of the skin (bacterial,viral and
fungal)
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4. WHAT IS INTEGUMENTARY SYSTEM?
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5. Integumentary system
 The integumentary system is the largest organ of the body that
forms a physical barrier between the external environment and
the internal environment
 The integumentary system includes :-
Skin
Hair
Nails
Glands (sweat and exocrine glands)
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6. Skin
 The skin is one of the largest organs
 The skin is composed of three layers: epidermis,
dermis, and subcutaneous tissue .
 The epidermis is an outermost layer
 It ranges in thickness from about 0.05 mm on the
eyelids to about 1.5 mm on the of the hands and soles
of the feet.
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7. Skin
The dermis makes up the largest portion of the skin,
the connective tissue between the epidermis and
subcutaneous tissue.
It provides strength and structure in the form of
collagen and elastic fibers.
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8. Skin
The subcutaneous tissue, or hypodermis, is the
innermost layer of the skin.
It promotes skin mobility, molds body contours, and
insulates the body.
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9. Functions of the Skin
Protection
Sensation
Fluid balance
Vitamin production
Immune response function
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10. Integumentary disorder
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11. Inflammatory and allergic conditions
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12. Allergic skin conditions
Allergic skin conditions are caused by allergens.
When an allergen is responsible for triggering an immune
system response, this results in an allergic skin condition.
Some of these allergens are physical agents which evoke an
immune response by way of
contact with the skin and some are food-stuffs ,insect bites,and
drugs taken systemically.
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13. Cont…
Allergic skin conditions include
Urticaria (Hives)
Allergic contact dermatitis,
Atopic dermatitis,
Hand dermatitis,
Photo allergic reactions
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14. Urticaria (Hives)
 Hives are an inflammation of the skin triggered when the
immune system releases histamine.
 This causes small blood vessels to leak, which leads to
swelling in the skin.
 Swelling in deep layers of the skin is called angioedema.
 There are two kinds of urticaria, acute and chronic.
 Acute urticaria occurs at times after eating a particular food or
coming in contact with a particular trigger.
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15. Cont…
It can also be triggered by non-allergic causes such as heat or
exercise,
medications, foods, insect bites or infections
Chronic urticaria is rarely caused by specific triggers and so
allergy tests are usually not helpful.
Chronic urticaria can last for many months or years.
Although they are often uncomfortable and sometimes
painful,
hives are not contagious.
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16. Cont…
Signs and symptoms include:-
Skin reactions, including hives and itching
flushed or pale skin
Low blood pressure (hypotension)
Constriction of the airways and
A swollen tongue or throat, which can cause
wheezing and trouble breathing
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17. Management of hives
Avoid aggravating factors such as avoiding excessive heat, spicy
foods or alcohol.
Aspirin and other NSAIDs should be avoided as they often make
symptoms worse.
Medications like non-drowsy antihistamines are often used to
reduce the severity of the itch
Steroids decrease redness, pain, and swelling.
Epinephrine is used to treat severe allergic reactions such as
anaphylaxis.
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18. Nursing Management
Administer Epinephrine if the patient has anaphylaxis.
Provide oxygen.
Monitor respiration and prepare for intubation.
Educate patients on the avoidance of allergen.
Be ready to perform CPR.
Monitor vital signs.
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20. Inflammatory Skin Conditions
Skin inflammation is a sign of an immune response in the
body.
It includes
Psoriasis.
Seborrheic dermatitis
Eczema
Acne
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21. Psoriasis
 Named from Greek word “Psora meaning itch”.
 Psoriasis is a chronic inflammatory multisystem disorder of
the skin.
 Psoriasis is a common, noncommunicable skin disease, with
no clear cause or cure.
 The negative impact of this condition on people’s lives can be
immense
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22. Psoriasis
• Psoriasis is typically characterized by the appearance of
silvery plaques that most commonly appear on the skin
over the elbows, knees, scalp, lower back, and buttocks.
• Onset may occur at any age
• Psoriasis is characterized by periods of remission and
exacerbation throughout life .
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23. Psoriasis
 Psoriasis is classified as mild, moderate and severe
 Although the primary manifestation of this
noncommunicable disease tends to involve the skin,
 psoriasis may involve the oral cavity, eyes (including
the lids, conjunctivae, and corneas), and joints
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24. Psoriasis
• Pathophysiology
• Current evidence supports an autoimmune basis for
psoriasis.
• Periods of emotional stress and anxiety aggravate the
condition, and trauma ,infections, and seasonal and
hormonal changes may also serve as triggers
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25. Psoriasis
• Pathophysiology
• In this disease, the epidermis becomes infiltrated by
activated T cells and cytokines
• Resulting in both vascular engorgement and proliferation
of keratinocytes.
• Epidermal hyperplasia results.
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26. Psoriasis
Pathophysioligy
• These epidermal cells tend to improperly retain their
nuclei, crippling their ability to release lipids that
encourage cellular adhesion.
• This results in rapid turnover of poorly matured cells
that do not adhere well to each other, resulting in the
classic presentation of plaque like lesions that have a
silvery, scaly, flaky appearance
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27. Psoriasis
Clinical Manifestations
• Psoriasis may range in severity from a cosmetic source of
annoyance to a Physically disabling and disfiguring disorder
• Dry, itchy, raised skin patches (plaques) covered with scales.
• Lesions appear as red, raised patches of skin covered with
silvery scales.
• The scaly patches are formed by the buildup of living and
dead skin.
• The patches are not moist and may be pruritic
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28. Psoriasis
Complications
Psoratic arthritis of multiple joints occurs in up to 42% of people
with psoriasis, most typically after the skin lesions appear (Nicpon,
2017).
• skin color changes (post-inflammatory hypopigmentation or
hyperpigmentation).
• Eye conditions, such as conjunctivitis, blepharitis
• Type 2 diabetes.(A 2018 study on mouse and human skin indicates
that skin inflammation from psoriasis can result in insulin resistance,
which is a risk factor for type 2 diabetes)
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29. Psoriasis
Medical Management
• The goals of management are to slow the rapid turnover
of epidermis,
• to promote resolution of the psoriatic lesions, and to
control the natural cycles of the disease.
• There is no known cure.
• Management of emotional factors should
be addressed as part of the overall treatment of psoriasis.
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30. Psoriasis
Medical Management
• Three types of therapy are commonly indicated:
• topical, corticosteroids
• phototherapy, and
• systemic. Methotrexate, a systemic cytotoxic agent, is
the first-line drug for treating moderate to severe
psoriasis
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31. Psoriasis
Nursing Management
• Give education on factors which can aggravate psoriasis
include stress, infection, trauma and dry skin.
• Smoking and alcohol may trigger or exacerbate it, so
patients should be encouraged to give up or cut back
• Many patients need reassurance that the condition is not
infectious, not a reflection of poor personal hygiene,
and not skin cancer.
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33. INFECTIOUS DERMATOSES
INFECTIOUS OF SKIN: PATHOGENIC (VIRAL,
BACTERIAL, FUNGAL)
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34. Bacterial Infections: Pyodermas
 pyodermas is pus-forming bacterial infections of the skin.
 may be primary or secondary.
 Primary skin infections originate in previously normal-
appearing skin and are usually caused by a single organism.
 Secondary skin infections arise from a preexisting skin
disorder or from disruption of the skin integrity
 In either case, several microorganisms may be implicated
(eg, Staphylococcus aureus, group A streptococci).
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By Zewude M

35. Cont…
 The most common primary bacterial skin infections
are:
Impetigo
Folliculitis.
Folliculitis may lead to
furuncles or boil
carbuncles
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By Zewude M

36. Impetigo
Impetigo is a superficial bacterial infection of the skin caused
by
 Streptococci
Staphylococci
Multiple bacteria
The lesions begin as small red macular (spot), which quickly
become discrete thin walled vesicles that soon rapture and
become covered with loose adherent honey yellow crust.
 The crusts are easily removed and reveal smooth, red moist
surfaces on which new crusts soon develop.
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37. Impetigo
There are two types of impetigo:-
 nonbullous (i.e., impetigo contagiosa) and
 bullous impetigo.
Nonbullous impetigo represents a host response to the
infection, whereas a
 staphylococcal toxin causes bullous impetigo and no
host response is required to manifest clinical illness
2/7/2023 By Zewude M 37

38. Impetigo
Bullous impetigo, a more deep-seated infection of the
skin caused by S. aureus,
 is characterized by the formation of bullae (ie,
large, fluid-filled blisters) from original vesicles.
 The bullae rupture, leaving raw, red areas.
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39. Impetigo
• The exposed areas of the body
face, hands, neck, and extremities are most
frequently involved.
Impetigo is contagious and may spread to other
parts of the patient’s skin or to other
• Members of the family who touch the patient or use
towels or combs that are soiled with the exudate of
the lesions.
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By Zewude M

40. Impetigo
impetigo is seen at all ages
it is particularly common among children living in poor
hygienic conditions.
It often follows
 pediculosis capitis (head lice),
 scabies (itch mites),
 herpes simplex,
 insect bites, poison ivy, or eczema.
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41. Impetigo
Chronic health problems, poor hygiene, and
malnutrition may predispose an adult to impetigo.
Some people have been identified as asymptomatic
carriers
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42. Impetigo
Common signs and symptoms: -
Small lesions which are vesicular or bullous
Red macules followed by thin adherent honey-
yellow crust
Crust are easily removed
Itching and oozing when vesicle is ruptured .
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44. Impetigo
Medical Management
• Systemic antibiotic therapy is the usual treatment.
• It reduces contagious spread, treats deep infection, and
prevents acute glomerulonephritis (ie, kidney infection),
which may occur as an aftermath Of streptococcal skin
diseases.
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By Zewude M

45. Impetigo
Medical management
• In nonbullous impetigo, benzathine penicillin or oral
penicillin may be prescribed.
• Bullous impetigo is treated with a penicillinase-
resistant penicillin (eg, cloxacillin,
• In penicillin-allergic patients, erythromycin is an
effective alternative.
2/7/2023 By Zewude M 45

46. Impetigo
Nursing Management
• Educate how to apply topical antiseptic cream or
antibiotics
• Advise on personal hygiene
• Relief pain by using non steroidal anti inflammatory
drugs (NSAIDS)
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47. Impetigo
Nursing management
• Adminster Systematic antibiotic therapy
• Clean the wound with antiseptic preparation to reduce
bacterial content
• After crusts are removed, topical medication will be
used eg neomycin or tetracycline or mupirocin is
applied
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48. Folliculitis, Furuncles, and
Carbuncles
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49. Folliculitis
• Folliculitis is an inflammatory condition of the cells
within the wall and ostia of the hair follicles.
• Lesions may be superficial or deep.
• Single or multiple papules or pustules appear close to
the hair follicles.
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51. Folliculitis
• Folliculitis commonly affects the beard area of men
who shave, as well as women’s legs, if they shave.
Other areas include the
• axillae, trunk, pubic area and buttocks
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54. Follicullitis
signs and symptoms include:
Clusters of small red bumps or white-headed
pimples that develop around hair follicles
Pus-filled blisters that break open and crust over.
Itchy, burning skin.
Painful, tender skin.
A large swollen bump or mass
2/7/2023 By Zewude M 54

55. Folliculitis
Management
• The only entirely effective treatment is to avoid
shaving.
• Other treatments include using special lotions or
antibiotics.
• If the patient must remove facial hair, a depilatory
cream or electric razor may be used.
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By Zewude M

56. Folliculitis
Management
• Clean the affected skin.
• Gently wash the infected skin twice a day with
antibacterial soap.
• Use a clean washcloth and towel each time and don't
share your tow
• Warm compress
2/7/2023 By Zewude M 56

57. Folliculitis
Management
• Before a treatment plan is devised, it is important to
consider the etiology of the folliculitis, severity, and
distribution of the lesions.
• For uncomplicated superficial folliculitis, use of
antibacterial soaps
• For refractory or deep lesions with a suspected infectious
etiology, empiric treatment with oral antibiotics that
cover gram-positive organisms should be considered.
2/7/2023 By Zewude M 57

58. Folliculitis
• If systemic antibiotics are indicated, coverage should
include S aureus since it is the most common
pathogen.
• Because this organism may be penicillin resistant,
dicloxacillin or a cephalosporin are the initial choices
of therapy
2/7/2023 By Zewude M 58

59. Furuncles
• A furuncle (boil) is an acute inflammation arising deep in one
or more hair follicles and spreading into the surrounding
dermis.
• This inflammation is a deep form of folliculitis.
• Furunculosis refers to multiple or recurrent lesions.
• Furuncles may occur anywhere on the body
• but are more prevalent in areas subjected to irritation, pressure,
friction, and excessive perspiration, such as the back of the
neck, the axillae, and the buttocks.
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60. Furuncles
• A furuncle may start as a small, red, raised, painful
pimple.
• Frequently, the infection progresses and involves the
skin and subcutaneous fatty tissue, causing tenderness,
pain, and surrounding cellulitis.
• The area of redness and induration represents an effort
of the body to keep the infection localized.
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61. Furuncles
• The bacteria (usually staphylococci) produce necrosis
of the invaded tissue.
• The characteristic pointing of a boil follows in a few
days.
• When this occurs, the center becomes yellow or
black, and the boil is said to have “come to a head.”
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63. Furuncles
Clinical presentation
• The lesion develops into a
hard, red, tender nodule which often brusts,
discharging ,pus and frequently a solid core of
necrotic tissue.
• It is rarely accompanied by systemic symptoms, when
the lesions are multiple
2/7/2023 By Zewude M 63

64. Furuncles
Management
• For simple furuncle, the primary treatment is usually
the application of warm, moist packs
• Topical antibiotic cream
• Systemic antibiotic for multiple lesions
• Can be drain if severe
2/7/2023 By Zewude M 64

65. Carbuncles
• A carbuncle is an abscess of the skin and subcutaneous tissue
that represents an extension of a furuncle that has invaded
several follicles and is large and deep seated.
or
• A carbuncle is a red, swollen, and painful cluster of
boils that are connected to each other under the skin
• A carbuncle is palpable and can range in size to be as
small as a pea or as large as a ball
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66. Carbuncle
• It is usually caused by a staphylococcal infection.
• Carbuncles appear most commonly in areas where the skin is
thick and inelastic;
• the back of the neck and the buttocks are common sites.
• Furuncles and carbuncles are more likely to occur in patients with
underlying systemic diseases, such
 as diabetes or hematologic malignancies, and
 in those receiving immunosuppressive therapy for other
diseases.
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69. carbuncle
Clinical manifestation
• start as red, painful bumps.
• The carbuncle fills with pus and develops white or
yellow tips that weep, ooze, or crust.
• Over a period of several days, many untreated carbuncles
rupture, discharging a creamy white or pink fluid.
2/7/2023 By Zewude M 69

70. carbuncle
Clinical manifestation
• Deep carbuncles are more likely to cause significant
scarring.
• Other carbuncle symptoms include
• fever, fatigue, and a feeling of general sickness.
• Swelling may occur in nearby tissue and lymph nodes,
especially lymph nodes in the neck, armpit, or groin.
2/7/2023 By Zewude M 70

71. Carbuncle
Medical management
• In treating carbuncle, it is important not to rupture or destroy the
protective wall of induration that localizes the infection.
• The boil or pimple should never be squeezed.
• Systemic antibiotic therapy, selected by culture and sensitivity
study, is generally indicated.
• Oral dicloxacillin and cephalosporins are first-line medications.
• If MRSA is suspected, antibiotic agents selected may include
clindamycin, trimethoprim–sulfamethoxazole, or minocycline
2/7/2023 By Zewude M 71

72. Carbuncle
Nursing management
• fever reduction, and
• other supportive treatments are indicated for patients who
are acutely ill from infection.
• Warm, moist compresses hasten resolution of the furuncle
or carbuncle
• Adminster antibiotics and antpain
2/7/2023 By Zewude M 72

73. Carbuncle
Nursing management
• The surrounding skin may be cleaned gently with
antibacterial soap, and
• An antibacterial ointment may be applied.
• Soiled dressings are handled according to standard
precautions.
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74. VIRAL SKIN INFECTIONS
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75. Herpes Zoster
• Herpes zoster, also called shingles,
• is an infection caused by the varicella zoster virus
(VZV), which are members of a group of
deoxyribonucleic acid (DNA) viruses.
• The disease is characterized by a painful vesicular
eruption along the area of distribution of the sensory
nerves (i.e., dermatome) from one or more posterior
ganglia.
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76. Herpes Zoster
• After a case of chickenpox, or primary varicella, runs its
course, the VZV responsible for the outbreak lies dormant
inside nerve cells near the brain and spinal cord.
• Later, when these latent viruses are reactivated because of
declining cellular immunity, they travel by way of the
peripheral nerves to the skin,
• where the viruses multiply and create a red rash of small,
fluid-filled blisters.
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77. Cont…
• Herpes zoster develops over the lifetime of about 10%
to 20% of all adults who had chickenpox earlier in life,
usually after 50 years of age.
• The rates of occurrence tend to be the same in both
men and women.
• There is an increased frequency of herpes zoster
infections in patients with weakened immune systems
2/7/2023 By Zewude M 77

78. Herpes Zoster
Clinical manifestations
• In some patients the pain is absent and
• in some patients itching and tenderness may occur over the
area.
• The lesions are grouped vesicles appear on the red and
swollen skin following dermatone.
• The early vesicles contain serum and later, rupture and
form crusts.
• The inflammation is usually unilateral, involving the
thoracic, cervical and cranial nerves.
2/7/2023 By Zewude M 78

79. Clinical manifestation
• The clinical course varies from 1 to 3 weeks.
• If an ophthalmic branch of trigeminal nerve is involved
the patient may have painful eye.
• In eye it causes keratitis, uveitis, ulceration and blindness.
• Herpes zoster in healthy adult is usually localized and
benign, however,
• in immuno suppressed patient, the disease may be severe
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81. Herpes Zoster
Medical Management
• Herpes zoster infection can be arrested if oral antiviral
agents such as
 acyclovir (Zovirax),
 valacyclovir (Valtrex), or
 famciclovir (Famvir) are
given within 24 hours of the initial eruption.
• IV acyclovir may be indicated in patients who are
immunocompromised
2/7/2023 By Zewude M 81

82. Management
The goals of herpes zoster management are
• to relieve the pain and
• to reduce or avoid complications, which include
infection, scarring, and eye complications.
• Analgesic agents
• Systemic corticosteroids
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83. Nursing Management
• The patient and family members are instructed about
the importance of
• taking antiviral agents as prescribed and
• in keeping follow-up appointments with the primary
provider.
• The patient is educated about how to apply dressings or
medication to the lesions and to follow proper hand
hygiene techniques to avoid spreading the virus.
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84. Nursing mng’t
• Diversionary activities and relaxation techniques are
encouraged to ensure restful sleep and to alleviate
discomfort.
• A caregiver may be required to assist with dressings,
particularly if the patient is an older adult and unable
to apply them.
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85. Herpes Simplex
• Herpes simplex is a common skin infection.
• There are two types of the causative virus, which are
identified by viral typing.HSV1 and HSV2
• Herpes simplex type 1 occurs on the skin of the lips,
mouth, gums, or tongue (or on the skin around the
mouth) and
• Type 2 occurs in the genital area, but
both viral types can be found in both locations.
2/7/2023 By Zewude M 85

86. Herpes Virus Type 2 Infection (Herpes
Genitalis)
• Herpes simplex virus 2 (HSV2) is a recurrent, lifelong viral
infection that causes herpetic lesions (blisters) on the external
genitalia and occasionally the vagina and cervix.
• It is a STI but possibly may also be transmitted
• asexually from wet surfaces or by self-transmission (i.e., touching
a cold sore and then touching the genital area).
• The initial infection is usually very painful and blisters may take
2 to 4 weeks to heal, but it can also be asymptomatic.
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87. HSV 2
• Over 87% of infected individuals are unaware of their
infection;
• most HSV transmission occurs from asymptomatic
viral shedding
• Recurrences can be associated with stress, or inadequate
rest or poor nutrition, or any situations that tax the
immune system.
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88. Cont…
• Close human contact by the mouth, oropharynx, mucosal
surface, vagina, or cervix appears necessary to acquire the
infection.
• Other susceptible sites are skin lacerations and conjunctivae.
• When viral replication diminishes, the virus ascends the
peripheral sensory nerves and remains inactive in the nerve
ganglia.
• Another outbreak may occur when the host is subjected to
stress
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89. Pathophysiology of HSV
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90. Clinical Manifestations
• Itching and pain occur as the infected area becomes red and
edematous.
• Infection may begin with macules and papules and progress to
vesicles and ulcers.
• The vesicular state often appears as a blister, which later
coalesces, ulcerates, and encrusts.
• Inguinal lymphadenopathy (enlarged lymph nodes in the groin),
• minor temperature elevation
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91. Clinical Manifestations
• malaise
• headache
• myalgia (aching muscles)
• dysuria (pain on urination) are often noted.
• pain
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92. Medical Management
• Currently, there is no cure for genital herpes infection,
but treatment is aimed at relieving the symptoms.
• Management goals include preventing the spread of
infection
• making patients comfortable, decreasing potential
health risks, and initiating a counseling and education
program.
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93. Medical Management
• Three oral antiviral agents
• acyclovir (Zovirax),
• valacyclovir (Valtrex), and
• famciclovir (Famvir)—can suppress symptoms and
shorten the course of the infection
• Analgesics and a saline compress can provide
additional relief of symptoms
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94. Nursing Management
• Patient education is an essential part of nursing care
of the patient with a herpes infection.
• This includes an adequate explanation about the
infection and how it is transmitted,
• strategies to minimize spread of infection,
• the importance of adherence to the treatment
regimen, and self-care strategies.
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95. Nursing management
• proper hand hygiene, the use of barrier
methods with sexual contact, and adherence to
prescribed medication regimens
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96. Fungal (Mycotic) Skin Infections
• A fungal infection, also called mycosis, is a skin disease caused
by a fungus.
• There are millions of species of fungi.
• They live in the dirt, on plants, on household surfaces, and on
your skin.
• In some cases, they affect only the skin and its appendages (hair
and nails).
• In other cases, internal organs are involved, and the diseases may
be life threatening.
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97. Cont..
• There are varies types of ring worm or tinea and
• they are named according to the site of involvement as:
• Tinea infections affect the feet commonly called athletes foot or
tinea pedis
• Fungal infection of head- tinea capitis.
• Fungal infection of the body including face, neck & extremities -
tinea corporis.
• Fungal infection of groin -Jock itch, or tinea cruris
• Fungal infection of the nail -tinea unqum.
2/7/2023 By Zewude M 97

98. Tinea pedis (Ringworm of the feet:
Athlete’s foot)
Fungal infection of foot is one of the common fungal
infections and it may appear as an acute or chronic
infection to the soles of the feet or the space between the
toes
There are dry scaly types of lesion.
Others are vesicular type of lesion
The third group is macerated lesion between toes,
especially between the third, fourth and, fifth toes.
2/7/2023 By Zewude M 98

99. Cont…
Mode of transmission
 Contact with an infected person i.e. sharing patient shoes and socks,
or in showers or swimming pools .
Clinical manifestation
In acute stage there will be
Itching and burning sensation.
The nail may also be involve with chronic infection
• Lymphangitis & cellulitis may be seen when bacterial super infections
occurs.
2/7/2023 By Zewude M 99

100. Tenia pedis
2/7/2023 By Zewude M 100

101. Medical management
• Topical antifungal (Miconazole, clotrimazole) applied
to the infected area.
• Topical therapy is continued for at least 8 weekes
weeks, because of recurrence.
2/7/2023 By Zewude M 101

102. Nursing mng’t
• Keep the foot clean and dry daily
• tell the patient to use clean socks
• Moisture encourages the growth of fungi, the pt is instructed to keep the
feet as dry as possible
• Pieces of cotton can be placed between the toes at night to absorb
moisture.
• Clean shoes daily or boil soaks.
• Advise the patient to wear light and open foot wear
• Apply dusting powder such as zinc oxide powders for the purpose of
drying
2/7/2023 By Zewude M 102

103. Tinea corporis
 Ringworm of the body (tinea corporis) is a rash caused by a fungal
infection
 They are known to cause an intense inflammatory reaction in humans
because they are not normally adapted to living on human hosts.
Mode of transmission
 Through contact with patient or through contact with object, the patient
has used that.
2/7/2023 By Zewude M 103

104. Cont…
 Clinical manifestation
Typical annular ringed lesion is produced with an
advancing scaly border and central clearing or
scaly patches with well defined margin.
 It is associated with purities.
itchy, circular rash with clearer skin in the middle
2/7/2023 By Zewude M 104

105. Tenia corporis
2/7/2023 By Zewude M 105

106. Medical Management
• Topical antifungal medication may be applied to
small areas of lesion
• Griseofulvin is used in extensive cases but has side
effect include photo sensitivity, skin rashes, headache
& nausea.
• In those patient who have resistance to griseofulvin
give ketoconazole
2/7/2023 By Zewude M 106

107. Nursing intervention
Give education to :-
• use clean towel & wash cloth daily.
• All area and skin folds that retain moist must be
dried thoroughly
• The patient has to wear clean cotton cloth next to the
skin
2/7/2023 By Zewude M 107

108. Tinea capitis (Ringworm of the scalp)
• Ringworm of the scalp is a contagious fungal infection
of the hair shafts and common cause of hair loss
• Mode of transmission
• Making contact with an infected person’s, such as
using of hat, comb and brush of diseased person.
2/7/2023 By Zewude M 108

109. Cont…
Clinical manifestation
• one or several round patches of redness and scaling are present on scalp
• Small pustules or papules may be seen at the edges of such patches.
• As the hair in the affected areas are invaded by the fungi, the fungi
become brittle and often break off at or near the surface of the scalp,
resulting in patchy loss of hair.
• Most cases of tinea capitis heal without scarring, so the hair loss is
temporary.
• It could be complicated by secondary bacterial infection
2/7/2023 By Zewude M 109

110. Medical Management
• Griseofulvin and other anti fungal agents are
administered systemically
• The hair should be shampooed two or three times
weekly with antifungal shampoo.
2/7/2023 By Zewude M 110

111. Nursing intervention
• Patient and family should be advised to set up a
hygienic regimen for home use
• Family member should have a separate comb &
brush
• All infected members of the family & household must
examined and treated.
2/7/2023 By Zewude M 111

112. Tinea cruris (jock itch)
• Tinea cruris is a ringworm infection of the groin,
which may extend to the inner thighs and buttock
area.
• It most frequently occurs in young, obese person and
those who wear tight under clothing
2/7/2023 By Zewude M 112

113. Cont…
Clinical manifestation
• Itching may be severe, or the rash may be asymptomatic
• The lesion consists of erythematous plaque with well
defined margin & cleared center
• Rarely the lesion may have a vesicle formation at the
borders and satellite vesicle lesions are rarely present
could be complicated by secondary Candidal infection.
2/7/2023 By Zewude M 113

114. Tenia capitis
2/7/2023 By Zewude M 114

115. Management
General measure
• Drying powder eg. Miconazole nitrate should be dusted
in to the involved area in a patient with perspiration or
occlusion of skin due to obesity.
• Under wear should be loose – fitting
• Advice to wear light cotton underwear.
• Iron or boil underwear and change daily.
2/7/2023 By Zewude M 115

116. Cont…
• Clean affected area daily and keep it dry.
• Topical medication such as clotrimazole ketoconazol,
miconazole cream will be used for 3 to 4 wks
• Terbenatin cream is curative in over 80% of cases
twice daily for 7 days
• Systematic treatment griseofulvin
2/7/2023 By Zewude M 116

117. 2/7/2023 By Zewude M 117

118. THANK YOU!!
2/7/2023 By Zewude M 118