NUR 611 – WK 1
Disorders of the Integumentary System
TASK:
Discuss each of the conditions under the following headings:-
F) Psoriasis & Acne Vulgaris:
1. Definition:-
PSORIASIS – T-cell (T lymphocyte) mediated chronic skin disease marked by epidermal
proliferation. Causing lesions of erythematous papules and plaques covered with silvery
scales (with lesions that vary widely in severity and distribution). Involves recurring
remissions and exacerbations. Unpredictable exacerbations and remissions that are usually
controllable with therapy. Flares commonly related to specific environmental factors (such
as trauma and sunlight) and systemic factors (such as infection, drugs, smoking, and
alcohol). Several different forms, with plaque psoriasis (also called discoid psoriasis) the
most common.
ACNE VULGARIS – an inflammatory disease of the pilosebaceous follicle. Comedonal,
papulo-pustular, nodulocystic(scarring)
2. Risk Factors:
PSORIASIS- Local trauma or irritation, Cold exposure, Infection (such as streptococcal
pharyngitis), Human immunodeficiency virus (HIV) infection, Withdrawal of steroid
treatment, Medications, such as lithium carbonate, angiotensin-converting enzyme
inhibitors, beta-adrenergic blockers, tetracycline, nonsteroidal anti-inflammatory drugs,
amiodarone hydrochloride, morphine sulfate, procaine, potassium iodide, salicylates,
sulfonamides, and penicillin, Alcohol use, Smoking, Stress, Genetic influence.
ACNE VULGARIS – hormonal abnormalities, psycohological stress, high humidity,
friction, picking, exposure to oils, meds, diet, face washing.
3. Pathophysiology:
, PSORIASIS- Although not completely understood, an antigen (environmental or internal)
triggers cytokine production and cell proliferation. Innate immune cells stimulate activation
of the myeloid dendritic cells in the skin, which in turn produce cytokines that attract,
activate, and differentiate T cells. T cells produce cytokines that stimulate keratinocytes to
proliferate and produce proinflammatory antimicrobial peptides and cytokines. These
cytokines continue the cycle via a positive feedback loop. Psoriatic skin cells have a
shortened maturation time as they migrate from the basal membrane to the surface or
stratum corneum. (The normal life cycle of skin cells is 28 days; with psoriasis, turnover
increases to every 4 days.) As a result, the stratum corneum develops thick, scaly plaques
(the cardinal manifestation of psoriasis).
ACNE VULGARIS – Increased sebum production by androgens. Abnormal desquamation
of follicular epithelium. Keratinous material becomes more dense and blocks secretion of
sebum. Leads to the development of the comedo (is a plugged follicular orifice.)
Propionibacterium acnes proliferation and colonization. Inflammation ensues and causes
rupture of the comedone (are small, flesh-colored, white, or dark bumps that give skin a
rough texture.) into the dermis resulting in the formation of pustules or cysts.
4. Assessment/ Clinical Manifestations/ Signs & Symptoms:
PSORIASIS – History Assessment: Family history of psoriasis. History of risk factors.
Pruritus and burning. Arthritic symptoms such as morning joint stiffness. Remissions and
exacerbations; worse in the winter and improved in the summer. Physical Assessment:
Erythematous, well-demarcated papules and plaques covered with silver scales, typically
appearing on the scalp, chest, elbows, knees, back, and buttocks in a symmetrical
distribution. In mild psoriasis: plaques scattered over a small skin area. In moderate
psoriasis: plaques more numerous and larger (up to several centimeters in diameter). In
severe psoriasis: plaques covering at least one-half of the body. Friable or adherent scales
Fine bleeding points or Auspitz sign after attempts to remove scales. Thin, erythematous
Disorders of the Integumentary System
TASK:
Discuss each of the conditions under the following headings:-
F) Psoriasis & Acne Vulgaris:
1. Definition:-
PSORIASIS – T-cell (T lymphocyte) mediated chronic skin disease marked by epidermal
proliferation. Causing lesions of erythematous papules and plaques covered with silvery
scales (with lesions that vary widely in severity and distribution). Involves recurring
remissions and exacerbations. Unpredictable exacerbations and remissions that are usually
controllable with therapy. Flares commonly related to specific environmental factors (such
as trauma and sunlight) and systemic factors (such as infection, drugs, smoking, and
alcohol). Several different forms, with plaque psoriasis (also called discoid psoriasis) the
most common.
ACNE VULGARIS – an inflammatory disease of the pilosebaceous follicle. Comedonal,
papulo-pustular, nodulocystic(scarring)
2. Risk Factors:
PSORIASIS- Local trauma or irritation, Cold exposure, Infection (such as streptococcal
pharyngitis), Human immunodeficiency virus (HIV) infection, Withdrawal of steroid
treatment, Medications, such as lithium carbonate, angiotensin-converting enzyme
inhibitors, beta-adrenergic blockers, tetracycline, nonsteroidal anti-inflammatory drugs,
amiodarone hydrochloride, morphine sulfate, procaine, potassium iodide, salicylates,
sulfonamides, and penicillin, Alcohol use, Smoking, Stress, Genetic influence.
ACNE VULGARIS – hormonal abnormalities, psycohological stress, high humidity,
friction, picking, exposure to oils, meds, diet, face washing.
3. Pathophysiology:
, PSORIASIS- Although not completely understood, an antigen (environmental or internal)
triggers cytokine production and cell proliferation. Innate immune cells stimulate activation
of the myeloid dendritic cells in the skin, which in turn produce cytokines that attract,
activate, and differentiate T cells. T cells produce cytokines that stimulate keratinocytes to
proliferate and produce proinflammatory antimicrobial peptides and cytokines. These
cytokines continue the cycle via a positive feedback loop. Psoriatic skin cells have a
shortened maturation time as they migrate from the basal membrane to the surface or
stratum corneum. (The normal life cycle of skin cells is 28 days; with psoriasis, turnover
increases to every 4 days.) As a result, the stratum corneum develops thick, scaly plaques
(the cardinal manifestation of psoriasis).
ACNE VULGARIS – Increased sebum production by androgens. Abnormal desquamation
of follicular epithelium. Keratinous material becomes more dense and blocks secretion of
sebum. Leads to the development of the comedo (is a plugged follicular orifice.)
Propionibacterium acnes proliferation and colonization. Inflammation ensues and causes
rupture of the comedone (are small, flesh-colored, white, or dark bumps that give skin a
rough texture.) into the dermis resulting in the formation of pustules or cysts.
4. Assessment/ Clinical Manifestations/ Signs & Symptoms:
PSORIASIS – History Assessment: Family history of psoriasis. History of risk factors.
Pruritus and burning. Arthritic symptoms such as morning joint stiffness. Remissions and
exacerbations; worse in the winter and improved in the summer. Physical Assessment:
Erythematous, well-demarcated papules and plaques covered with silver scales, typically
appearing on the scalp, chest, elbows, knees, back, and buttocks in a symmetrical
distribution. In mild psoriasis: plaques scattered over a small skin area. In moderate
psoriasis: plaques more numerous and larger (up to several centimeters in diameter). In
severe psoriasis: plaques covering at least one-half of the body. Friable or adherent scales
Fine bleeding points or Auspitz sign after attempts to remove scales. Thin, erythematous
