Chapter 56: Managing Dermatologic Disorders

Managing Dermatologic Disorders , “Management of Patients with Dermatologic Disorders,” comprehensively details the nursing and medical care for a wide range of skin issues, focusing on wound healing, inflammatory conditions, infections, blistering diseases, and both benign and malignant skin tumors. Effective skin management starts with preventative strategies, emphasizing the use of pH-balanced, non-alkaline soaps and moisturizing agents like emollients and humectants. Wound care utilizes a structure built around five fundamental rules, guiding the selection, categorization, and evolution of diverse dressing types—including passive, interactive (like hydrocolloids and hydrogels), and active dressings. Techniques for débridement, such as autolytic and enzymatic methods, are explored alongside topical and systemic pharmacologic interventions, including corticosteroids, which require careful application due to local side effects like skin thinning, and systemic absorption risks. A major focus is placed on pressure injury prevention and treatment, detailing risk factors like friction, shear, and malnutrition, and utilizing staging guidelines (Stage 1 through 4, Deep Tissue, and Unstageable) to determine the appropriate intervention, such as repositioning, specialized pressure redistribution surfaces, and nutritional support (protein and Vitamin C are critical). The chapter covers common dermatoses, including pruritus (itching), which can signal systemic disease and is managed by avoiding irritants and using antihistamines; secretory disorders like hidradenitis suppurativa and seborrheic dermatitis (dandruff); and acne vulgaris, managed through hygiene, topical retinoids or benzoyl peroxide, and systemic agents like isotretinoin, requiring strict monitoring for teratogenicity. Infectious dermatoses span bacterial pyodermas (impetigo, furuncles), viral infections like herpes zoster (shingles), and parasitic infestations (pediculosis and scabies), all requiring specific antimicrobial treatments and meticulous hygiene to prevent spread. Noninfectious inflammatory disorders include irritant contact dermatitis, notably seen in healthcare workers using protective equipment (PPE), and psoriasis, a chronic autoimmune condition resulting in silvery plaques, managed with light therapy (PUVA) and systemic biologic agents. Severe conditions like the blistering diseases (pemphigus vulgaris, bullous pemphigoid) and the life-threatening drug reactions Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome necessitate specialized burn center care focusing on fluid balance, infection prevention, and pain management. Finally, malignant skin tumors—Basal Cell Carcinoma (most common), Squamous Cell Carcinoma (more invasive), and Melanoma (most aggressive, diagnosed via ABCDEs)—are discussed, with surgical methods like Mohs micrographic surgery emphasized, along with advanced treatments like targeted therapy and checkpoint inhibitors for metastatic disease, underscoring the vital importance of sun safety and regular self-assessment.