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8/4/2019 Elective Integumentary
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Intertrigo
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is an erythermatous
skin eruption with
inflammation in the skin
folds under the breasts,
the groin, the transverse
abdominal folds, and
the axilla
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the mainsymptom isintense pruritus.
Intertrigo ismore commonin obese elderlypersons who donot maintain anappropriate
level ofcleanliness.
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Risk factors for
intertrigo include
the following. Adductor
spasticity of the
lower
extremities,
making perineal
hygiene difficult
to achieve, leaves
a chronically
moistenvironment
ideal for the
growth of fungal
organisms.
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Incontinence
providing both a
chemical irritant to
the skin an a
chronically moist
environment that
supports the
growth of fungi.
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Low energy or
motivation
leading to
inadequate drying
under breast or in
the perineal area
during baths.
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Staff or familymembers withinadequatetraining or
motivation toadequately drypatients underbreasts or inthe perineum
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Inflammation is
due to a
combination of
friction and
moisture.
Bacterial
or Candida
infection of
the,compro
mised tissue
is common
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cutaneous fungal
infections has focused
primarily on the feet
in adults and thediaper area in infants.
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The most appropriate care.
keeping affected areas clean and dry andseparating adjacent
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Folds should be washed with tepid water and
dried thoroughly.
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Soft gauze may be used to separate adjacent
surfaces.
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Undergarments and positioning have a role in
treatment and prevention of fungal infections.
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For breast candidiasis, a well fitting cotton
brassiere will help absorb moisture andreduce chatting.
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In perineal candidiasis, an adductor block
pillow may improve air circulation to theaffected area, reducing moisture
accumulation.
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Appropriate treatment of the rash with
antifungal agents and good hygiene often
reduce the discomforts and anxiety associated
with rashes. However, itching sometimes
persist as a major source of discomfort.
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Oral therapy usually is reserved for
chronic or extensive skin involvement and for
patients
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The condition may be
localized, especially on the
dorsal forearms, lateral
tibial areas, and posteriorneck, or it may be
generalized over the entire
body. When the condition is
localized, the constant
scratching and rubbing of aparticular area produces
lichenificationa thickening
of the skin
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This leads to chronic inflammation and itching
which in term produce further scratching and
rubbinga self perpetrating cycle.
When dressing vulgar lichen simplexchronicus. Recommended patch test to assest
sensitization that may contribute to the
symptoms.
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TREATMENT
The condition is treated with steroids creams and anti
histamines for the itch. Even if the condition improves itwill recur unless.
Scratching is controlled bedtime oral antihistamines areprescribed to prevent nighttime scratching. The dosageshould be urinated, starting with a low dose, until
satisfactory results are achieved. The patient is encouraged to keep the fingernails very
short. The application of a dressing such Duo Derm mayprotect the plaque from scratching. Mittens may be neededfor confused older adults. For localized lesions, a tape thatis impregnated with a topical steroids
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Lichen Sclerosis
is charaterzed bywhite plaques ofkeratin aroundthe vulva withpurple areas
where keratin isreduced. Tissues fuse so
that introitalstenosissometimes
occurs. Chronicscratchingcauses the skinto thicken(lichenification).
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Pruritus Ani This dermatitis, which
affects the perianalarea, is caused byirritation from heat,swelling hemorrhoidsor fissures
Rubbing and
scratching leads tothickening of perinealskin
Complicated by bowelor urinaryincontinence
Treated with bathand mild steroid cream
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Drug Eruptions
Any drug can cause an adverse
cutaneous reaction, called a drug
eruption.
Drugs are the most common cause of
allergic reactions in older persons, and
the most frequent drug side effects
are skin eruptions.
Not only are older adults at greaterrisks for skin reactions to drug, they
also are at greater risk for major
morbidity and for mortality than
younger persons
The morbilliform or exanthematous
(maculopapular) eruption is the most
common form of drug eruption.
Main treatment withdrawal of drug.