This month we are discussing the patient with a skin complaint.  In our first post, we reviewed the common lesions that may be seen in the correctional environment.  Patients may also present with secondary lesions – those resulting from infection or manipulation of the skin.  Below find a list of secondary lesions that are commonly occurring in the correctional environment.  

secondary lesions

Scale is heaped-up accumulations of horny epithelium that occur in disorders such as psoriasis, seborrheic dermatitis, and fungal infections. Pityriasis rosea and chronic dermatitis of any type may be scaly.

Crusts (scabs) consist of dried serum, blood, or pus. Crusting can occur in inflammatory or infectious skin diseases (e.g., impetigo).

Ulcers result from loss of the epidermis and at least part of the dermis. Causes include venous stasis dermatitis, physical trauma with or without vascular compromise (e.g., caused by decubitus ulcers or peripheral arterial disease), infections, and vasculitis.

Atrophy is thinning of the skin, which may appear dry and wrinkled. Atrophy may be caused by chronic sun exposure, aging, and some inflammatory and neoplastic skin diseases, including cutaneous T-cell lymphoma and lupus erythematosus. Atrophy also may result from long-term use of potent topical corticosteroids.

Scars are areas of fibrosis that replace normal skin after injury. Some scars become hypertrophic or thickened and raised. Keloids are hypertrophic scars that extend beyond the original wound margin.

Lichenification is increased skin markings and thickening with induration secondary to chronic inflammation caused by irritation such as scratching.

Our next skin post will review the evaluation of a person presenting with a skin complaint, including important subjective information to ascertain, the physical evaluation that should be done, the applicable nursing diagnoses, and the appropriate plan for the person with a skin complaint.  

What is the most unusual, most interesting rash or skin disorder you have encountered in your correctional nursing practice? 

This information is from Skin Assessment for the Correctional Nurse and Skin Assessment II for the Correctional Nurse at The Correctional Nurse Educator.