Acne, eczema and pemphigus.pptx

1. REGENCY INSTITUTE OF
NURSING,KANPUR
TOPIC- Acne, Eczema and Pemphigus
By- Shreya Yadav
Nursing tutor
Medical surgical
Nursing

2. ACNE
Acne is a common follicular disorder affecting susceptible
hair follicles, most commonly found on the face, neck, and
upper trunk.
INCIDENCE RATE
 Acne is the most commonly encountered skin condition in
adolescents and young adults between ages 12 and 35.
 Both genders are affected equally, although onset is
slightly earlier for girls.

3. ETIOLOGY
 Stress
 Hormonal Changes: Hormonal changes during puberty,
menstruation, pregnancy and menopause too may trigger
breakouts.
 Medications: corticosteroids, testosterone or lithium
 Diet: High sugar
 Excess oil (sebum) production
 Hair follicles clogged by oil and dead skin cells
 Bacteria
 Inflammation
 Cosmetics

4. PATHOPHYSIOLOGY

5. CLINICAL MANIFESTATION
 Whiteheads (closed plugged pores)
 Blackheads (open plugged pores)
 Small red, tender bumps (papules)
 Pimples (pustules), which are papules with pus at their
tips
 Large, solid, painful lumps under the skin (nodules)
 Painful, pus-filled lumps under the skin (cystic lesions)
 Inflammatory pustules, and inflammatory cysts

6. DIAGNOSTIC EVALUATION:
 History collection
 Physical examination
 Biopsy of lesion
 Blood test
MANAGEMENT:
 Medical management:
 Benzoyl Peroxide- reduction of inflammatory lesions and
depress sebum production.
 Benzoyl erythromycin, and benzoyl sulfur
combinations are available over the counter and by
prescription.
 Vitamin A acid (Tretinoin) applied topically is used to
clear the keratin plugs.

7.  Oral antibiotics, such as tetracycline, doxycycline, and
minocycline.
 Hormonal therapy(Estrogen and progestrone).
SURGICAL MANAGEMENT:
 Drainage Of Pustules And Cysts
 Excision Of Sinus Tracts And Cysts
 Cryotherapy
 Dermabrasion For Scars
 Laser Resurfacing Of Scars

8. NURSING MANAGEMENT:
 Patients are instructed to avoid manipulation of pimples
or blackheads.
 Should be warned that discontinuing these medications
can exacerbate acne, lead to more flare-ups(sudden out
burst), and increase the chance of deep scarring.
 Manipulation of the comedones, papules, and pustules
increases the potential for scarring.
 Caution the patient to avoid scrubbing the face.
 Taking prescribed medications, patients are instructed to
wash the face and other affected areas with mild soap
and water twice each day to remove surface oils and
prevent obstruction of the oil glands.

9. ECZEMA
DEFINITION:
Eczema comes from the Greek for ‘boiling’ – a reference to
the tiny vesicles (bubbles) that are often seen in the early
acute stages of the disorder • ‘Dermatitis’ means
inflammation of the skin and is therefore, strictly speaking,
a broader term than eczema.

10. RISK FACTOR
 Genetic
 Exposure to smoke, air pollutants, harsh soaps, fabrics
such as wool, and some skin care products.
 High levels of stress, anxiety or depression.
 Infection
 Touching something you’re allergic to.
 Dry weather
 Certain food(peanuts, dairy, eggs)
 Drugs(corticosteroids, penicillin)

11. CLINICAL MANIFESTATION:
 Dry skin
 Itchy skin
 Skin rash
 Bumps on your skin.
 Thick, leathery patches of skin.
 scaly or crusty skin.
 Swelling

12. DIAGNOSTIC EVALUATION
 History taking :-A physician ask the question focusing
on when the rash appears, where it appears & How often
it does it does so. They also ask about itching, any food
or inhaled allergen, temp. changes etc.
 Blood test such as eosinophilia count & IgE because
eosinophilia count & serum IgE levels are raised.
 Skin biopsy :- A doctor first numbs the skin and then
removes one or more small pieces of skin. A pathologist
then examines the skin sample under a microscope.

13. MANAGEMENT
MEDICAL MANAGEMENT:
 Corticosteroids such as Hydrocortisone, Betamethasone
(Betnovate), Prednisolone.
 Topical immunomodulators like pimecrolimus & tacrolimus
were developed after corticosteroid treatments.
 Antibiotic such as Ceftriaxone should be given.
 Immunosuppressant such as methotrexate should be given.
 Antihistamine.

14. NURSING MANAGEMENT:
 Avoiding contact with known irritants like soaps,
perfumes detergents, jewelry, environmental irritants
etc.
 Bathing in warm,not hot water and using a mild soap.
 wearing loose-fitting clothing (cotton clothing may be
less irritating for many people than wool or synthetic
fibers).
 The use of cool compresses to help control itching.
 Wearing protective gloves for activities that require
frequent submersion of the hands in water.
 Avoiding activities that make you hot and sweaty as
well as abrupt changes in temperature and humidity.

15. PEMPHIGUS
Pemphigus is a blistering autoimmune disease that
affects the skin and mucous membranes

16. RISK FACTOR
 Genetic .
 Gender(Both male and female).
 Age (middle age, rarely affect childhood)
 Associated with autoimmune disorder such as
rheumatoid arthritis, myasthenia gravis.
 Drugs (Penicillin and captopril).

17. TYPES OF PEMPHIGUS
There are mainly three types of Pemphigus:
1. Pemphigus vulgaris- The most common form of the disorder is
pemphigus vulgaris. It occurs when antibodies attack Desmoglein (a
protein that is present in the epidermal layer of skin). Blisters usually
first appear in the mouth. The blisters don’t itch. They can be painful.
Blisters may then appear on the skin and sometimes on the genitals

18.  Pemphigus foliaceus – The least severe of the three
types is Pemphigus foliaceus(PF).
 Desmoglein-1, is the protein that is destroyed by the
autoantibody.
 It doesn’t cause blisters in the mouth. The blisters first
appear on the face and scalp. Blisters then appear on the
chest and back. The blisters are usually itchy and
painless.

19. 3. Paraneoplastic pemphigus
 The least common and most severe type of pemphigus is
paraneoplastic pemphigus (PNP).
 This disorder is a complication of cancer.
 The blisters and sores may appear in the mouth, on the
lips, and on the skin. This type may also cause scars on
the eyelids and eyes. It can also cause lung problems

20. PATHOPHYSIOLOGY:
Due to etiological factor
Antigen and antibody reaction
immune system mistakenly attacks cells in the top layer of
the skin (epidermis) and the mucous membranes.
produce antibodies against desmogleins(proteins that bind
skin cells to one another)
Sign and symptoms occur(skin bullae enlarge, rupture, and
leave large, painful eroded areas that are accompanied
by crusting and oozing)

21. CLINICAL MANIFESTATIONS
 Oral lesion appearing as irregularly shaped erosions that
are painful, bleed easily, and heal slowly.
 The skin bullae enlarge, rupture, and leave large, painful
eroded areas that are accompanied by crusting and oozing.
 A characteristic offensive odour emanates from the bullae
and the exuding serum.
 NIKOLSKY’S SIGN: The Nikolsky sign is dislodgement of
intact superficial epidermis by a shearing force.

23. DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Direct Immunofluorescence: A biopsy sample will be
examined by a technique known as direct
immunofluorescence.
 Blood test

24. MANAGEMENT
 Corticosteroids, usually prednisolone(To control blisters).
 Immunosuppressive drugs: azathioprine,
cyclophosphamide.
 Antibiotic (Tetracycline).

25. NURSING MANAGEMNET
 Oral hygiene is important to keep the oral mucosa clean
and allow the epithelium to regenerate.
 Frequent rinsing of the mouth is prescribed to rid the
mouth of debris and to soothe ulcerated areas.
 The lips are kept moist with lip balm.
 Advice patient to do not scratch the wound.
NURSING DIAGNOSIS:
 Acute pain of skin and oral cavity related to blistering
and erosions
 Impaired skin integrity related to ruptured bullae
 Anxiety and ineffective coping related to the appearance
of the skin and no hope of a cure
 Deficient knowledge about medications and side effect