o Lyons us L Dermatology for the ey AdvanceD Practice nurse the for Dermatology Dermatology Faye Lyons, DNP, RN, FNP-C & Lisa ousley, DNP, RN, FNP-C Unique decision trees promote accurate diagnosis and treatment of 60 common skin conditions for the his is the first primary care dermatology reference written by and for nurses. It focuses on approximately 60 skin conditions that are commonly seen in primary care settings and Tprovides unique decision trees to assist in accurate diagnosis. Organized for quick access, the AdvanceD book presents conditions alphabetically and includes evidence-based treatment and management strategies along with full-color photos taken during actual office visits. Dermatologic diagnostics cover skin assessment, specimen collection procedures, and use of mechanical devices, along with relevant evidence-based topical, systemic, and surgical treatment options. Ad Practice nurse The resource provides an overview of dermatology basics including skin anatomy and physi- ology and skin terminology. Illustrations, graphs, and skin terminology help to accurately document descriptions of rashes, lesions, and diseases during diagnostic evaluations. The book also defines vance risk factors in relation to skin conditions and diseases and delineates conditions common to specif- ic populations. A broad range of management strategies is presented along with alerts for when expert follow-up is indicated. To promote rapid identification of skin conditions, each is presented in a consistent format that includes overview, epidemiology, pathology/histology, clinical presen- D tation, differential diagnosis, treatment/management, special considerations and appropriate Practice referrals, and patient education. The Clinical Pearls feature captures the authors’ expertise. Addi- tional photos are available from the website as a digital image bank. Key Features: • Focuses on approximately 60 common dermatological conditions with high-quality, full-color photos n • Presents four unique decision trees to foster accurate diagnosis and clinical decision making urse • Delivers evidence-based protocols for diagnosis, treatment, and management • Uses a consistent format to promote quick access to information • Written by advanced-degree nurse practitioners with nurses’ informational needs in mind ISBN 978-0-8261-3643-5 Faye Lyons & Lisa ousLey 11 W. 42nd Street New York, NY 10036-8002 www.springerpub.com 9 780826 136435 Dermatology for the Advanced Practice Nurse Faye Lyons, DNP, RN, FNP-C, is a doctor of nursing practice–prepared family nurse practitioner who has been practicing in family medicine, internal medicine, derma- tology, and aesthetic dermatology since 1999. Prior to becoming an NP, Dr. Lyons was a member of the armed services (U.S. Air Force), and an RN in medical, cardiac, and surgical intensive care units and dialysis units. Her experience in dermatology includes working in two large dermatology practices during her NP career and serv- ing rural areas with dermatological services while working in internal medicine. Her responsibilities included skin examinations, biopsies, surgical excisions, and cosmetic procedures that included Botox, cosmetic fillers, and laser therapies. Dr. Lyons is cre- dentialed in dermatology nursing by the Dermatology Nursing Association. Her pub- lications include an award-winning poster presentation on dermatology decision trees at the 2012 Virginia Nurse Practioner Association meeting, dermatological chapters in an upcoming geriatric textbook titled Healthy Aging: Principles and Clinical Practice for Clinicians and in Solving a Skin Rash in Primary Care: Use of a Diagnostic Decision Tree in the journal Advance for NPs and PAs. Lisa Ousley, DNP, RN, FNP-C, is a doctor of nursing practice–prepared family nurse practitioner who has been a primary care provider since 1999. Within primary care, Dr. Ousley has assessed, treated, and referred thousands of skin conditions. Dr. Ousley has been taking photos of skin conditions for many years and has a collection of over 1,000 photos, many of which are used in this book. Dr. Ousley is the director of Eastern Tennessee State University (ETSU) Student/University Health Services. This clinical opportunity supports health promotion and clinical management of acute and episodic illness for a culturally diverse university population. Dr. Ousley’s past primary care experiences include Hillsville and Galax Family Care, outpatient hospital-based clinics in Virginia, and she has worked as a hospitalist service provider at Twin County Regional Hospital and in a clinic targeting the public-housing population in Johnson City, Tennessee. Since 2009, Dr. Ousley has been an online graduate instructor at the University of Phoenix, teaching graduate nursing theory. Dermatology for the Advanced Practice Nurse Faye Lyons, DNP, RN, FNP-C Lisa Ousley, DNP, RN, FNP-C Copyright © 2015 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Margaret Zuccarini Composition: diacriTech ISBN: 978-0-8261-3643-5 e-book ISBN: 978-0-8261-3644-2 Digital image bank ISBN: 978-0-8261-2825-6 A digital image bank can be accessed at www.springerpub.com/lyons-image-bank 14 15 16 17 / 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base continues to expand. Therefore, as new information becomes available, changes in procedures become necessary. We recommend that the reader always consult current research and specific institutional policies before performing any clinical procedure. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Lyons, Faye, author. Dermatology for the advanced practice nurse / authors, Faye Lyons, Lisa Ousley. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8261-3643-5—ISBN 978-0-8261-3644-2 (e-Book) I. Ousley, Lisa Ellen, author. II. Title. [DNLM: 1. Skin Diseases—nursing. 2. Nursing Diagnosis—methods. 3. Primary Nursing—methods. 4. Skin Care—nursing. WY 154.5] RL125 616.5’0231—dc23 2014008527 Special discounts on bulk quantities of our books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. If you are interested in a custom book, including chapters from more than one of our titles, we can provide that service as well. For details, please contact: Special Sales Department, Springer Publishing Company, LLC 11 West 42nd Street, 15th Floor, New York, NY 10036-8002 Phone: 877-687-7476 or 212-431-4370; Fax: 212-941-7842 E-mail: [email protected] Printed in the United States of America by Bang Printing. Contents Preface ix Acknowledgments xi Share Dermatology for the Advanced Practice Nurse Part I. Overview of Dermatology 1. Education: Nurses and Primary Care Providers 3 Epidemiology and Statistics of Skin Disorders 4 Annual Economic Burden 5 Quality-of-Life Implications 5 Evidence-Based Practice and Decision Trees 6 Conceptual Framework for Assessing, Diagnosing, and Treating Skin Rashes 6 Decision Trees and Differential Diagnoses 8 2. Basics of Dermatology 15 Skin Anatomy and Physiology 15 Skin Terminology 19 Vascular Lesions 21 Diagnostic Evaluations 21 Distribution, Type, Characteristics, and Pattern of Lesions 22 Special Distribution Category: Patterns of Intentional or Unintentional Injury 22 3. Special Considerations for Populations, Culture, and Comorbid ­Conditions 27 Infants and Children 27 The Elderly 27 Ethnicity 28 Cultural Practices 28 Puberty 29 Pregnancy 29 VI ■ CONTENTS Part II. Clinical Management of Dermatology Conditions 4. Skin Assessment 35 History 35 Skin Assessment (Physical) 35 Social History 36 Family History 36 Dermatologic Signs 36 Differential Diagnosis 37 5. Diagnostics 39 Collecting Specimens 39 Mycology: Microscopic Examination of Scale (Potassium Hydroxide) 40 Use of Mechanical Devices 41 6. Treatment Approaches 43 Topical Treatment 43 Systemic Evaluation and Treatment 45 Surgical Treatment 46 Other Treatments 46 7. Clinical Management 51 Routine Skin Care 51 Preventive Care 52 Skin Self-Examination 52 Protection From the Sun 53 Moisturizer 54 Nutritional Counseling 55 Appropriate Referrals 56 Genetic Counseling Referrals 58 Part III. Common Dermatologic Conditions Abrasions and Skin Tears 61 Acne 65 Alopecia 71 Aphthous Stomatitis 79 Bruise and