Physical Assessment of Tinea Versicolor (an-an)

EMILIO AGUINALDO COLLEGE SCHOOL OF MEDTECH In Partial Fulfillment of the Requirements of Health Care 1 Entitled PHYSICAL ASSESSMENT OF TINEA VERSICOLOR (AN-AN) Submitted to: Maria Eliza Mangaliman, PTRP Submitted by: Diego, Mary Rose A. Mendoza, Frances Gracelle Q. Domingo, Rodalyn U. Trinidad, Kaye Erika D. Trinidad, Denesse Joy G. Date of Submission: October 01, 2010 I. ANATOMY AND PHYSIOLOGY OF THE SKIN The skin, or integument, and its accessory structures (hair, glands, and nails) constitute the integumentary system.

Included in this system are the millions of sensory receptors of the skin and its extensive vascular network. The skin is a dynamic interface between the body and the external environment. It protects the body from the environment even as it allows for communication with the environment. The skin is an organ, since it consists of several kinds of tissues that are structurally arranged to function together. It is the largest organ of the body, covering over 7,600 sq cm (3000 sq in) in the average adult, and accounts for approximately 7% of a person’s body weight. The skin is of variable thickness, averaging 1. mm. It is thickest on the parts of the body exposed to wear and abrasion, such as the soles of the feet and the palms of the hand. In these areas, it is about 6mm thick. It is thinnest on the eyelids, external genitalia, and tympanic membrane (eardrum), where it is approximately 0. 5mm thick. Even its appearance and texture varies from the rough, callous skin covering the elbows and knuckles to the soft, sensitive areas of the eyelids, nipples, and genitalia. Major functions of the integumentary system include: 1. Protection. The skin provides protection against abrasion and ultraviolet light.

It also provides the entry of microorganisms and dehydration by reducing water loss from the body. 2. Sensation. The integumentary system has sensory receptors that can detect heat, cold, touch, pressure and pain. 3. Vitamin D production. When exposed to ultraviolet light, the skin produces a molecule that can be transformed into vitamin D. 4. Temperature regulation. Body temperature is regulated by controlling blood flow through the skin and the activity of sweat glands. 5. Excretion. Small amounts of waste products are lost through the skin and in gland secretions. 6. Hydroregulation.

Human skin is virtually waterproof, protecting the body from desiccation (dehydration) on dry land, and even from water absorption when immersed in water. 7. Cutaneous absorption. Some gases, such as oxygen and carbon dioxide, may pass through the skin and enter the blood. Small amounts of UV light are absorbed readily. Certain chemicals can easily enter. 8. Communication. Contraction of the facial muscles produces facial expressions that convey an array of emotions. HYPODERMIS The skin rests on the hypodermis, which attaches it to underlying bone and muscle and supplies it with blood vessels and nerves.

The hypodermis, which is not part of the skin, is sometimes called subcutaneous tissue. The hypodermis is loose connective tissue that contains about half the body’s stored fat, although the amount and location vary with age, sex and diet. LAYERS OF THE SKIN DERMIS The dense collagenous connective tissue that makes up the dermis contains fibroblasts, fat cells, and macrophages. Nerves, hair follicles, smooth muscles, glands and lymphatic vessels extend into the dermis. Collagen and fibers are responsible for the structural strength of the dermis. The dermis is composed of two layers: 1.

Stratum papillarosum is in contact with the epidermis. Numerous projections called papillae extend from the upper portion of the dermis into the epidermis. Papillae form the base for friction ridges on the fingers and toes. 2. Stratum reticularosum the deeper and thicker layer of the dermis. Fibers within this layer are denser and regularly arranged to form a tough, flexible meshwork. The repair of a strained dermal area leaves a white streak called a stretch mark, or linea albicans. EPIDERMIS The epidermis is the superficial protective layer of the skin.

It is composed of stratified squamous epithelium that varies in thickness. All but the deepest layers are composed of dead cells. Either four or five layers may be present, depending on where the epidermis is located. The names and characteristics of the epidermal layers are as follows: 1. Stratum basale consists of a single layer of cells in contact with the dermis. Four types of cells compose this layer: keratinocytes, melanocytes, tactile cells, and nonpigmented granular dendrocytes. 2. Stratum spinosum, or the spiny layer, contains several stratified layers of cells.

The spiny appearance of this layer is due to the spinelike extensions that arise from the keratinocytes when tissue is fixed for microscopic examination. The stratum basale and stratum spinosum are collectively called the stratum germinativum. 3. Stratum granulosum consists of only three or four flattened rows of cells. These cells contain granules that are filled with keratohyalin, a chemical precursor to keratin. 4. Stratum lucidum or the clear layer. The nuclei, organelles, and cell membranes are no longer visible in the cells, and so histologically this layer appears clear.

It exists only in the lips and in the thickened skin of the soles and palms. 5. Stratum corneum, or the hornlike layer, is composed of 25 to 30 layers of flattened, scale-like cells. This surface layer is cornified; it is the layer that actually protects the skin. Cornification, brought about by keratinization, is the drying and flattening of the stratum corneum and is an important protective adaptation of the skin. II. Definition and Description of Tinea Versicolor a. Causes Tinea Versicolor or Pityriasis Versicolor is a skin disease caused by fungal infections.

Fungous diseases may attack various parts of the body, but attack the skin more often. Fungi, a more complex form of vegetable organisms than bacteria, multiply by means of spores. This classifies them midway between bacteria and seed plants. Fungous skin diseases seldom cause fever or pus unless complicated by bacterial infection. Pitysporum orbiculare and Pitysporum ovale are two types of yeast which are found in the normal flora of the skin. These are found in the stratum corneum of the epidermis and in hair follicles and have a high affinity for subaceous glands.

Certain factors can convert these yeasts into its pathogenic form, Malassezia furfur, which is the factor that causes rashes in Tinea Versicolor. This yeast is a colonizer of all humans, which accounts for the high 2-year recurrence rate after treatment and initial cure. b. Manifestations Tinea Versicolor manifests itself as small, rounded, velvety, flat spots, yellow or brownish-yellow in color, usually appearing on the chest, shoulders, armpits, proximal extremities and abdomen. These pale macules will not tan and are hyperpigmented. The patient has an odd speckled appearance.

The spots are covered with small dry scales which are not always visible. They may grow in size until they are an inch (2. 5 cm) or more in diameter. When they are numerous, they may grow together and form large, irregular patches. Lesions are asymptomatic, but few patients note itching. The lesions are velvety, tan pink, whitich or brown maculesand initially do not look scaly. But scales may be readily obtained by scraping the area. Tinea Versicolor does not affect the general health and is only slightly contagious. III. Patient’s General Information A. Patient’s Profile

Name: Patient JGE Age: 5 years old Gender: Male Date of Birth: July 02, 2005 Place of Birth: Philippine General Hospital, Ermita Manila Address: 1683-G UN Avenue, Paco, Manila Religion: Roman Catholic Civil Status: Child B. Family History: MATERNALPATERNAL GrandmotherGrandfatherGrandmotherGrandfather Alive and wellAlive and wellAlive and wellDeceased MotherFather 35 years old 34 years old Alive and well Alive and well Brother ABrother BJGEBrother C 8 years old7 years old5 years oldMother 4 months pregnant Well childWell child C. Biographic Data

Their primary source of medical care is the local health center (Canonigo Health Center). When the Health Center cannot handle the case, the Mother takes her children to PGH. D. Social Data JGE lives with his family: mother, father, and 2 brothers. The Mother only stays at home and the father is a driver. They live in an eskinita beside the Nissan Center at UN Avenue. JGE is now in Kinder and is studying at the Lucban Elementary School in Manila. E. Lifestyle JGE sleeps at 10pm every night and wakes up at 7. 30pm then goes to school at 11. 30am. After school, the Mother allows his kids to go outside and play ith the neighbors. JGE eats breakfast, lunch and dinner at home where his Mother cooks the food. F. Psychological Data The patient reacts well with others. JGE is a happy and well child. He responds well when spoken to and is very polite. He is very playful and interactive. IV. History of Patient’s General Health Status JGE has never been confined in a hospital. When he gets sick, the Mother takes him to the local Health Center (Canonigo Health Center) or to PGH when the Health Center cannot handle the case. JGE has already had measles, chicken pox, mumps and has recently had sore eyes.

He has no allergies and has already received measles vaccination, BCG vaccinitaion, complete DPT vaccinations and complete Hepatitis B vaccinations. JGE’s case of Tinea Versicolor (An-an) started only in May of this year after coming home from vacationing in their province, Cebu. Mother has stated that after a month, she noticed that the affected area has gotten bigger. She has also stated that when she touches the affected area to scratch it, JGE occasionally complains that it hurts. V. General Physical Assessment Date of Assessment: September 29, 2010 Vital Signs: Temperature: 38. 0 C PR: 62 beats/min

RR: 18 cycles/min Skin: (+) normal skin pigmentation (-) edema, skin lesions, injury Head:fine and thin, slightly oily hair (-) lice, flaking (-) bleeding, lesions Eyes:normal vision Ears:patient responds when being called (-) discharges Nose:(+) nasal secretions (-) epistaxis Oral cavity:normal teeth, gums, tongue Respiratory:18cycles/min Symmetrical chest expansion Cardiovascular: (-) visible veins Gastrointestinal: normal bowel movement Urinary:yellow colored urine (-) bleeding Muscular:normal muscle tone (+) muscle movement Bones:(-) edema, injury, swelling Neurologic:alert and awake

Good communication skills VI. HEALTH CARE PROCESS Assessing Diagnosis Planning Implementation Evaluation Presence of pale, light brown spots on the upper arm of the right arm, about an inch in diameter. Occasional tenderness and itching, when mother touches affected area, patient complains, ‘Wag, Ma. Masakit pa’ Velvety light brown macules on the superficial layer of the skin with mild itching indicates presence of Tinea Versicolor (An-an). Topical treatments include selenium sulfide lotion, sulfur-salicylic acid, rubbing alcohol, Tinver lotion and Ketaconazole. Ketaconazole results in 90% short term cure.

It could be taken orally or used in cream form. Without maintenance, recurrences will occur in over 80% of “cured” cases over the subsequent 2years. Local antifungal treatment, Nizoral Jansenn (Ketaconazole) is recommended. In tablet form, 1-2 tablets daily, 200mg, taken for 10 days. Medication must not be stopped until full course of the treatment. Nizoral cream could also be used. Cream is to be applied everyday until the affected area is gone. Clean area to be treated first before applying medication and wash hands. Mother will be buying Nizoral cream to treat the an-an.

The group will visit Patient JGE again after a week to determine effectiveness of the treatment. INFORMED CONSENT September 30, 2010 I, Estrella Empesto, am allowing the students of Health Care 1 Ctrl No. 598 of Emilio Aguinaldo College, Manila to conduct a study on my son, John Lester Estrella, for their Patient Care Plan Study on Tinea Versicolor (An-an) in partial fulfillment of their requirements on the said subject. ___________________________ Estrella Empesto Mother VII. Bibliography and Appendices 1. Tierney, L. M. , McPhee, S. J. , Papadakis, M. A. (Eds. ). (1998).

CURRENT Medical Diagnosis & Treatment 1998. USA: Prentice Hall International, Inc. 2. Arrojo, M. T. A. (2007). MIMS Philippines PIMS Philippines Index of Medical Specialties. (11th ed. ) Singapore: CMPMedica Asia PTE Ltd. 3. Shyrock, H. (1990). Modern Medical Guide. Washington DC: Review and Herald Publishing Association 4. Van de Graaf, K. M. (1998). Human Anatomy (5th ed. ) USA: WCB/McGraw-Hill 5. Seeley, R. R. , Stephens, T. D. , Tate, P. (2008). Essentials of Anatomy and Physiology (6th ed. ) Singapore: McGraw-Hill 6. http://faculty. stcc. edu/AandP/AP/imagesAP1/skin/skin. jpg

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