NR 293 Skin and Skin Disorders
Student Name
Chamberlain University
NR-293: Pharmacology for Nursing Practice
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Date
Signs, Symptoms, and Causes of Skin Disorders
Introduction
Skin disorders comprise a diverse spectrum of conditions that may arise from microbial infections, immune system malfunctions, genetic predispositions, or environmental exposures. Prompt identification of these disorders through their clinical signs and symptoms is essential for accurate diagnosis and appropriate therapeutic intervention. This section examines several common dermatological conditions—including impetigo, psoriasis, herpes simplex virus type 1 (HSV-1), nevi, varicella (chickenpox), zoster (shingles), pemphigus, urticaria, candidiasis, tinea capitis, and skin cancers—detailing their etiology and typical presentations.
Common Dermatological Conditions
Impetigo
Impetigo is a superficial bacterial skin infection that is especially prevalent in children but may also occur in adults with compromised skin integrity. Caused primarily by Staphylococcus aureus—and less frequently by Streptococcus pyogenes—this highly contagious condition is characterized by erythematous sores that rapidly evolve into honey-colored crusts. The lesions often appear on the face, particularly around the mouth and nose, and may spread through direct skin contact or via contaminated objects.
Psoriasis
Psoriasis is a chronic, immune-mediated skin disorder in which overactive T-cells stimulate excessive production of keratinocytes, resulting in thickened, scaly plaques. These plaques often display a silvery-white appearance and are commonly found on the scalp, elbows, knees, and lower back. While non-infectious, the disease can significantly impact quality of life due to itching, burning sensations, and cosmetic concerns. Genetics, stress, and environmental triggers may contribute to its onset or exacerbation.
Herpes Simplex Virus Type 1 (HSV-1)
HSV-1 is a viral pathogen that predominantly causes oral herpes, manifesting as painful vesicles or “cold sores” around the lips and mouth. Transmission occurs through direct contact with infected saliva, mucosal surfaces, or contaminated objects. Early symptoms may include localized tingling, burning, or itching before the formation of fluid-filled blisters that eventually crust over.
Nevi
Nevi, more commonly referred to as moles or birthmarks, are localized accumulations of melanocytes. While typically benign, changes in color, size, or symmetry can indicate malignant transformation into melanoma. Risk factors for atypical nevi include excessive ultraviolet (UV) exposure, genetic predisposition, and immune suppression.
Varicella (Chickenpox)
Varicella, caused by the varicella-zoster virus (VZV), is a highly contagious disease that primarily affects children but can also occur in unvaccinated adults. It is distinguished by an itchy, vesicular rash that progresses through macular, papular, vesicular, and crusting stages. Accompanying symptoms often include fever, malaise, and loss of appetite.
Zoster (Shingles)
Shingles is the reactivation of dormant VZV in sensory nerve ganglia, typically occurring decades after a primary varicella infection. The condition produces a unilateral, dermatomal rash with painful vesicles, often located on the trunk or face. Severe cases may lead to postherpetic neuralgia, characterized by prolonged nerve pain after rash resolution.
NR 293 Skin and Skin Disorders
Pemphigus
Pemphigus represents a rare autoimmune blistering disorder in which autoantibodies target desmogleins—proteins critical for cell adhesion in the epidermis. This immune attack results in fragile blisters on the skin and mucous membranes, particularly within the mouth and genital regions. Without appropriate treatment, pemphigus can cause extensive skin loss and secondary infections.
Urticaria (Chronic Hives)
Chronic urticaria is characterized by recurrent outbreaks of intensely pruritic, erythematous welts. It often arises from type I hypersensitivity reactions to allergens, medications, or other triggers. In some cases, no definitive cause is identified (idiopathic urticaria). Severe reactions may be accompanied by angioedema affecting the lips, eyelids, or throat.
Secondary Infections
Secondary skin infections occur when primary lesions become colonized by opportunistic pathogens. For example, scratching an eczema lesion can introduce S. aureus, leading to impetiginization, or fungal overgrowth may follow antibiotic use due to disruption of normal microbial flora.
Candidiasis
Cutaneous or mucosal candidiasis is caused by Candida albicans, a yeast that thrives in moist environments such as skin folds or mucous membranes. It presents with erythema, maceration, intense itching, and sometimes a thick, white exudate. Immunocompromised individuals and those with prolonged antibiotic use are at higher risk.
Tinea Capitis
Tinea capitis is a dermatophyte fungal infection affecting the scalp and hair shafts, caused by species such as Trichophyton or Microsporum. It manifests as scaly patches, alopecia, inflammation, and itching. Transmission may occur via contaminated combs, hats, or contact with infected pets.
Skin Cancers
Skin cancers range from benign lesions, such as seborrheic keratoses, to premalignant conditions like actinic keratoses, which can progress to squamous cell carcinoma. Basal cell carcinoma and melanoma represent more serious forms, often linked to prolonged UV exposure, genetic factors, and immune suppression.
NR 293 Skin and Skin Disorders – Summary Table
| Disorder | Signs and Symptoms | Causes |
|---|---|---|
| Impetigo | Erythematous sores evolving into honey-colored crusts, mainly on the face | Staphylococcus aureus or Streptococcus pyogenes |
| Psoriasis | Silvery plaques, itching, burning, dry skin patches | Autoimmune T-cell activation; accelerated keratinocyte turnover |
| Herpes Simplex Virus (HSV-1) | Tingling, burning, fluid-filled blisters near lips | Direct contact with infected saliva or mucosa |
| Nevi | Pigmented moles or spots; potential malignant transformation | Genetic predisposition, UV exposure |
| Varicella | Itchy, blister-like rash, fever, malaise | Varicella-zoster virus |
| Zoster | Painful, dermatomal vesicular rash | Reactivation of varicella-zoster virus |
| Pemphigus | Fragile blisters, skin shedding, mucosal involvement | Autoimmune attack on desmoglein proteins |
| Urticaria | Intensely itchy, raised welts, possible angioedema | Hypersensitivity to allergens or idiopathic |
| Candidiasis | Red, itchy rash with possible white discharge | Candida albicans overgrowth |
| Tinea Capitis | Scaly patches, hair loss, itching | Dermatophyte fungal infection from contact or fomites |
| Skin Cancers | Pigmented, scaly patches; nodular lesions | UV exposure, genetic mutations |
Conclusion
The wide variety of dermatological disorders underscores the importance of clinical awareness and timely management. While conditions such as impetigo, varicella, and tinea capitis are often treatable with antimicrobial therapies, autoimmune diseases like psoriasis and pemphigus require targeted immunomodulatory approaches. Vigilance in monitoring lesions such as nevi and actinic keratoses is critical to preventing malignant transformation. A thorough understanding of these conditions supports effective patient education, early intervention, and improved treatment outcomes.
References
Centers for Disease Control and Prevention. (n.d.). Infectious skin diseases. https://www.cdc.gov
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (n.d.). Skin diseases. https://www.niams.nih.gov
NR 293 Skin and Skin Disorders
Smith, J., & Brown, R. (2020). Dermatological conditions: A guide for clinicians. Clinical Press.