7/31/2012 FacultyFaculty Jacqueline Giddens, RN, MSN, WOCN, CWCCN Obesity: Clinical Nurse Consultant Skin Problems and Care Alabama Department of Public Health Satellite Conference and Live Webcast Wednesday, May 23, 2012 2:00 – 4:00 p.m. Central Time Produced by the Alabama Department of Public Health Video Communications and Distance Learning Division BariatricsBariatrics Skin is an ORGAN • Bariatrics /bar·i·at·rics/ (-e-ă triks) a • Did you know the skin is an organ? field of medicine encompassing the – Largest organ study of overweight and its causes, – Heaviest organ prevention, and treatment • 15% of body weight Skin Is an ORGAN Skin Changes – In a 150 pound person, the skin • Acanthosis Nigricans weighs about 12 pounds and can – Dark patches cover 18 square feet • Skin tags – These numbers increase with the obese patient • Stretch marks • Stasis dermatitis • Varicose veins 1 7/31/2012 Acanthosis Nigricans Acanthosis Nigricans • Presentation – Velvety, light-brown-to-black markings that occur in areas includingg,p,g, the neck, armpits, groin, and under the breasts • Treatment – Weight loss – Insulin control Acanthosis Nigricans Skin TagsSkin Tags • Presentation – Growths that stick out and may be connected to the skin with a narrow stock • The extra weight causes friction between the affected areas of skin Skin TagsSkin Tags Stretch Marks • Treatment • Presentation – Laser or surgical removal – Indented streaks that appear in the skin called striate, pink, reddish, or purplish • Treatment – Laser therapy – Creams 2 7/31/2012 Skin TagsSkin Tags Stretch Marks Stasis Dermatitis Stasis Dermatitis • Presentation – Skin irritation of the legs – Darkening or redness of skin at the – Thickening of skin at the ankles or ankles or legs legs – Itching – Open sores, ulcers – Leg pains – Skin lesion – Skin appears thin, tissue-like Stasis Dermatitis Stasis Dermatitis • Treatment – Open wounds – Disease management • Topical antibiotics • Compression for Venous Stasis • Anti-fungals Disease • Antimicrobial dressings • Prevention of trauma to areas 3 7/31/2012 Stasis Dermatitis Stasis Dermatitis Varicose Veins Varicose Veins • Presentation • Treatment – Swollen, enlarged veins that are – Compression stockings raised above the skin's surface – Laser • Usually on the inside of the legs – Surgery and backs of the calves Varicose Veins Varicose Veins 4 7/31/2012 Skin Infections CandiasisCandiasis • Candidiasis Albicans • Presentation • Cellulitis – Itchy, red, or purple patch on the • Folliculitis skin with lesions • Erythrasma – FlFungal, yeast • Tinea Cruris CandiasisCandiasis CandiasisCandiasis • Treatment – Topical antifungal • Over the counter or prescription – Oral antifungals – IV antifungals CandiasisCandiasis CellulitisCellulitis • Presentation – Cased by bacteria – Pain, tenderness, redness, warmth, weepy – Chills, shaking, muscle aches and sweating 5 7/31/2012 CellulitisCellulitis CellulitisCellulitis • Treatment – Good hygiene – Oral or IV antibiotics – Wound care, if indicated CellulitisCellulitis FolliculitisFolliculitis • Presentation – Small to medium sized whiteheads around one or more of the hair follicles – Redness around hair follicles – Usually in patches FolliculitisFolliculitis FolliculitisFolliculitis • Treatment – Good hygiene – Oral or IV antibiotics – Topical antibiotics to support the oral or IV antibiotics 6 7/31/2012 FolliculitisFolliculitis Erythrasma • Presentation – Raised, reddish brown, scaly, patches – Itches – Caused by bacterial infection – Appears between skin folds, groin, armpits, and knees – Spreads if untreated Erythrasma Erythrasma • Treatment – Oral or IV antibiotics – Keep area dry • Erythromycin or Azithromycin – Wash with antibacterial soap and – Photo-therapy with specialized rillinse well lig hts – Topical antifungals, antibiotics, moisture barriers Erythrasma Erythrasma 7 7/31/2012 Erythrasma Tinea Cruris • Presentation – “Jock Itch” – Red, patchy rash – Found in groin areas – Fungal skin infection Tinea Cruris Tinea Cruris (Jock Itch) • Treatment – Topical antifungal – Oral antifungal if needed – Keep skin clean and dry Skin Care Basics: Lymphedema Obese Patient • Presentation • Good personal hygiene – Fatigue • Prevention of friction – Heavy, swollen limb • Control moisture and perspiration – Localized fluid accumulation • Daily skin checks for breakdown or – Skin discoloration changes – Deformity • Prompt treatment of any open areas or rashes • Elephantiasis 8 7/31/2012 Lymphedema Lymphedema and Dermatitis • Treatment – Chronic (no cure) – Weight loss – Specialized • Exercise • Compression • Massage Lymphedema Lymphedema Resources • http://www.amylhwilliams.com/ • http://www.obesityaction.org/ • http://skinipedia.org/skin-and- obit/idhtlbesity/index.html • http://www.skinsight.com/adult/stasi sDermatitis.htm • http://www.dermnet.com/ 9.