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Integumentary System Diseases and Disorders 407
Healthy Highlight
Collagen for
Healthy Skin
C
ollagen is a protein found in connective tissue in animal bodies. It is the main
component of connective tissue and makes up about 25+ percent of the total pro
tein content. It is found in tendons, ligaments, and the skin. There about 16 types of
collagen but four are considered the main types and each has a significant role in the
body. Collagen is important for healthy hair, skin, nails, and joints. Collagen can be
incorporated into the diet in several ways such as increasing intake of chicken, pork
skin, and bone broth, getting plenty of vitamin C, or by taking supplements. Collagen
supplements have been shown to improve the skin’s texture and to prevent some wrin
kles. Collagen supplements come in many forms and are usually sold in pharmacies,
health food stores, and grocery stores. There are also some behaviors that might dam
age collagen such as eating too many refined carbohydrates, getting excessive exposure
to sunlight, and smoking.
Sources: Elliott (2020) and Jennings (2020)
and around the umbilicus, anus, and genital areas.
These glands are inactive until puberty and initiate
their function with hormonal changes at that time.
Their secretions are odorless, but bacteria that accu
mulate in these areas cause the smell referred to as
body odor. Both the sebaceous glands and the apo
crine glands secrete through the hair follicles. The
eccrine sweat glands are found throughout the body
surfaces and secrete through the skin pores to help
the body regulate heat. Some electrolytes are also lost
through these sweat glands.
The hair follicles are found in the dermal layer and
extend through the epidermis. They grow in cycles,
which vary with the individual, with an average growth
of about 1 cm per month. Hair loss occurs continually
but is not usually obvious until a large amount is lost
and not replaced. Testosterone, the male hormone,
influences hair growth, especially at puberty when hair
begins to appear in the axillae and groin. It also trig
gers the male’s baldness later in life. Generally, soft, tiny
hairs cover most of the body, and terminal hairs (stiffer,
longer, and often darker) are found on the scalp, axillae,
groin, eyebrows, and eyelashes of both sexes and the
face and trunk of males.
The nails are composed of keratin (epidermal cells
in a tight web). Fingernails grow more rapidly than
toenails, but they are composed of the same material.
The thickness and growth rate of the nail vary with the
individual. Health status, nutrition, and other factors
can influence nail strength and growth.
Common Signs and Symptoms
Common signs and symptoms of integumentary dis
eases include:
■ Skin lesion (LEE-zhun). A lesion is a very broad
term meaning any discontinuity or abnormality of
tissue. Lesions can be hard, soft, flat, raised, large,
small, reddened, crusted, fluid-filled, or pus-filled,
to name only a few characteristics (Figure 18-2).
■ Pain.
■ Pruritus (proo-RYE-tus) or itching.
■ Edema (swelling).
■ Erythema (ER-ih-THEE-mah) or skin redness.
■ Inflammation.
Consider This...
Every half square inch of skin has approxi
mately 10 hairs, 15 sebaceous glands, 100
sweat glands, and 32 feet of blood vessels.
Diagnostic Tests
There are numerous skin diseases; several have very
characteristic lesions, leading to an easy diagnosis.
However, many exhibit the same or similar types of
(A) Papule (B) Plaque (C) Macule
(D) Patch (E) Scale (F) Crust
(G) Wheal (H) Cyst (I) Pustule (J) Vesicle
(K) Bulla (L) Ulcer (M) Fissure
Courtesy of Mark L. Kuss
Figure 18-2 Skin lesions.
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Integumentary System Diseases and Disorders 409
lesions and symptoms, making diagnosis difficult.
Biopsy might be used in diagnosing nodules and
chronic lesions. Dermascopy is used to better visualize
lesions. Culture and sensitivity are effective in deter
mining the presence of bacterial infections. Blood tests
are helpful, especially if there is concern about a sys
temic infection or metabolic disorder. Diagnosis and
identification of fungal and parasitic infections can be
determined by using cultures and microscopic smear
examinations. Patch tests are often done to diagnose
allergies by applying allergens to the skin and observing
for reactions.
Consider This...
Humans shed and regrow outer skin about
once a month — approximately 1,000 new
skins in a lifetime.
Common Diseases of the
Integumentary System
The numerous diseases and disorders of the integumen
tary system often make diagnosis of skin disorders quite
difficult because several diseases can be characterized
by the same type or similar types of lesions. Common
diseases include infections; metabolic, hypersensitivity,
and idiopathic disorders; and tumors and can be cate
gorized according to cause.
Infectious Diseases
Skin infections are quite common and usually con
tagious, so care must be taken to prevent spread
from one area of the body to another and from one
person to another. Most infections are not serious
unless systemic involvement occurs. Infections of
the skin can be caused by viruses, bacteria, fungi,
and parasites.
Viral Diseases
Viral skin diseases can be acute or chronic. Acute viral
diseases commonly affect children and usually resolve
spontaneously, but many viral infections become
lifelong with periods of remission and exacerbation
(flaring up).
Herpes
■ Description. Herpes is a large family of viruses,
including:
1. Cold sores and fever blisters (herpes simplex 1
or HSV-1).
2. Genital herpes (herpes simplex 2, HSV-2, or
herpes genitalis).
3. Chicken pox (herpes varicella).
4. Shingles (herpes zoster).
5. Other, rarer herpes are ocular herpes, herpes
simplex encephalitis, and neonatal herpes sim
plex. These cases can lead to blindness and high
levels of morbidity and mortality, respectively.
Herpes simplex is very common and often appears
on the mouth, nose, buttocks, and genitals. The herpes
simplex viruses (HSV-1 and HSV-2) appear identical
under a microscope, cause the same type of lesions,
and, clinically, cannot be separated. Both can infect the
mouth or genitals. Usually, HSV-1 appears above the
waist and HSV-2 appears below the waist.
■ Herpes simplex type 1 Commonly called fever
blisters and cold sores because febrile conditions and
the common cold often bring about an exacerbation.
The vesicles commonly appear around the lips and
nose (Figure 18-3). Lesions appearing around the
lips can be further identified as herpes labialis (labia =
lip), and those occurring in conjunction with a fever
can be further identified as herpes febrilis.
■ Herpes genitalis (herpes simplex type 2) Commonly
called genital herpes. This is a highly contagious dis
ease and is spread by direct contact. Genital herpes
Figure 18-3 Herpes simplex virus 1.
410 Chapter 18
Pharmacology
Common Drugs for Integumentary Disorders
■ ■ ■ Bill ^^1 f
Highlight
Category Examples of Medications
Antibiotics
Drugs used to treat skin
infections
Clindamycin, demeclocycline, erythromycin,
mupirocin, tetracycline, or upirocin
Antifungals
Drugs used to treat fungus
infections
Clotrimazole, econazole, itraconazole,
ketoconazole, or terbinafine
Antihistamines
Drugs used to reduce the
symptoms from allergies and
contact dermatitis
Carbinoxamine, desloratadine, diphenhydramine,
fexofenadine, levocabastine, or loratadine
Anti-inflammatories
Drugs used to reduce
inflammation
Alclometasone, anthralin, beclomethasone,
diflucortolone, or hydrocortisone
Antivirals
Drugs used for herpes and
shingles
Acyclovir, famciclovir, or valacyclovir
Enzyme inhibitors
Drugs used for atopic
dermatitis
Aprimilast
Immunosuppressants
Drugs used to treat severe
cases of psoriasis and eczema
Azathioprine or methotrexate
Retinoids
Drugs used to treat skin
disorders like acne or psoriasis
Acitretin, isotretinoin, or tazarotene
Biologies
Drugs used to treat psoriasis Adalimumab, etanercept, infliximab, ixekizumab,
risankizumab, secukinumab, tildrakizumab, or
ustekinumab
Anesthetics
Drugs used to decrease pain
in/on the skin
Lidocaine or procaine
Parasiticides
Drugs used to treat mites or
lice
Lindane, malathion liquid, or permethrin
Others
Topical drugs or drugs mixed
in shampoos for seborrheic
dermatitis or psoriasis
Calcitriol ointment, coal tar 0.5%-5%, or anthralin
micronized topica
Drugs for hair loss treatment Minoxidil (different preparation for men and
for women)
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Integumentary System Diseases and Disorders 411
can be a sexually transmitted disease, but transmis
sion is not limited to sexual contact. Autoinoculation
with the hands is also possible by touching the lips
and then the genitals and vice versa. Herpes genitalis
is discussed in detail in Chapter 17, “Reproductive
System Diseases and Disorders.”
■ Herpes varicella Commonly called chicken pox.
This is an acute, highly contagious childhood dis
ease. Varicella is discussed in detail in Chapter 20,
“Childhood Diseases and Disorders.”
■ Herpes zoster Commonly called shingles. The virus
that causes chicken pox in children causes zoster in
adults. It is characterized by painful lesions that follow
the course of a spinal nerve. Zostavax® is the vaccine
for shingles, but it is recommended only for adults over
age 60. More detailed information can be found in
Chapter 15, “Nervous System Diseases and Disorders.”
■ Symptoms. Herpes is characterized by inflammation
of the skin and clusters of fluid-filled vesicles (VES-
ih-kuls). The infection is painful, embarrassing, and
often recurrent.
■ Diagnosis. Diagnosis is made by observation of vesi
cles, positive viral culture, and blood testing for herpes
antibodies.
■ Treatment. The virus is treatable but remains in the
affected individual’s body for life. Some type of balance
between the host and the virus exists, with periods of
viral remission and exacerbation. The virus exacerbates,
or flares up, often during times of decreased immunity
as occurs with stress. Valacyclovir, acyclovir, and fam
ciclovir are approved to treat herpes genitalis but are
also used for oral herpes. Penciclovir cream can also be
prescribed for oral herpes.
■ Prevention. Prevention of simplex viruses includes
avoiding skin-to-skin contact with anyone showing
signs of infection. Use of a condom helps prevent her
pes genitalis. Vaccination in children and those over
60 helps prevent varicella and zoster, respectively. In
general, maintaining a healthy immune system by mak
ing healthy lifestyle choices helps reduce risk.
Verrucae (Warts)
■ Description. Verrucae, or warts, a chronic skin con
dition, usually occur in multiples that can differ in size,
shape, and appearance. They can appear at any age, but
more commonly affect children. The most common
types are as follows:
Figure 18-4 Verrucae (warts).
■ Common warts Predominantly appear on the
hands and fingers of children (Figure 18-4).
These lesions are contagious and are spread by
scratching and direct contact. Although unsightly,
they are usually painless and harmless and often
disappear spontaneously. Common warts occur
ring in adults should be called to the attention of a
physician to ensure that they are not skin cancers.
■ Plantar warts Appear on the sole of the foot. This
wart usually grows inward, is smooth on the sole of
the foot, and feels like a hard lump. Plantar warts con
tain small, clotted blood vessels that appear like dark
splinters inside the wart and give it a cauliflower-like
appearance (Figure 18-5). This wart commonly
causes pain with walking; thus, surgical removal is
often the treatment of choice.
■ Genital warts A sexually transmitted disease. They
are highly contagious and often need to be removed
surgically. More detailed information can be found
in Chapter 17.
■ Etiology. A verruca is caused by the papillomavirus
affecting the keratin cells of the skin, causing cellular
hypertrophy.
■ Symptoms. The only symptom is a painless, often
rough-surfaced skin lesion appearing on any surface of
the body, but primarily on the fingers and hands.
412 Chapter 18
Figure 18-5 Plantar warts.
■ Treatment. Treatment depends on the location of the
verruca. Warts on the fingers and hands are commonly
treated topically with over-the-counter medications.
The best topical medications are those containing sal
icylic acid such as Trans-Ver-Sal, Sal-Acid Plaster, or
Sal-Plant Gel. Genital and plantar warts are commonly
removed surgically. Verrucae are often resistant to treat
ment, and recurrence is frequent.
■ Prevention. The best prevention is to avoid skin-
to-skin contact with those infected with verruca.
Measles
Measles is a highly contagious childhood disease that
causes a characteristic maculopapular skin rash. For
more information on measles, see Chapter 20.
Bacterial Diseases
Bacterial skin infections are often highly contagious and
affect individuals who are immunosuppressed or who
practice poor personal hygiene. These skin infections
Consider This...
5
The skin has its own ecosystem of micro
organisms, including yeast and bacteria
that cannot be removed by any type of
cleaning.
are generally caused by normal flora bacteria and are
treated effectively with antibiotics.
Impetigo
■ Description. Impetigo is a highly contagious skin dis
ease. It is one of the most common skin infections of
children and usually affects the face and hands.
■ Etiology. Impetigo is caused by Streptococcus and
Staphylococcus bacteria.
■ Symptoms. Impetigo is characterized by the appear
ance of vesicles and pustules (PUS-tyouls; small pus-
filled lesions) that rupture, producing a yellow crust over
the lesions (Figure 18-6). Impetigo occurs more readily
in those with poor hygiene, anemia, and malnutrition.
■ Diagnosis. Diagnosis is confirmed by symptoms and
a positive bacterial culture of the infected lesion.
■ Treatment. Treatment includes washing and drying
the affected area several times a day and applying anti
biotic ointment. More serious conditions might also
require oral antibiotics.
■ Prevention. Prevention is aimed at good personal
hygiene, including frequent handwashing. Those with
anemia and malnutrition need treatment to cure those
conditions also.
Folliculitis
■ Description. Folliculitis is inflammation and infection
of the hair follicle and can occur anywhere on the skin.
■ Etiology. Folliculitis usually starts when hair follicles
are damaged by shaving or friction from clothing. The
Figure 18-6 Impetigo.
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Integumentary System Diseases and Disorders 413
damaged hair follicle then becomes infected with Staph
ylococcus bacteria.
■ Symptoms. Common symptoms include rash, itch
ing, and the formation of pimples or small pustules
surrounding the hair (Figure 18-7) that can also open,
drain, and crust over. This condition commonly occurs
in young men and affects the neck, groin, thighs, but
tocks, beard, and scalp.
■ Diagnosis. Diagnosis is based on physical examina
tion of pustules and condition of the skin. Cultures can
reveal bacterial or fungal infection.
■ Treatment. Warm, moist compresses help ease the
pain and promote drainage of the pustules. Daily cleans
ing of the area with an antiseptic cleanser and applica
tion of antibiotic or antifungal creams for several weeks
usually cure the condition. Severe or chronic cases
might need additional treatment with oral antibiotics.
■ Prevention. Preventive measures include reducing
friction from clothing, keeping skin clean and dry,
avoiding bathing with dirty or contaminated wash
cloths, and avoiding shaving the area until the infection
is healed.
Abscess, Furuncle, Carbuncle
■ Description. There are some differences in these
lesions. An abscess is a localized collection of pus
occurring in any tissue of the body, including the skin.
Abscesses commonly occur around sites of trauma,
embedded foreign material such as splinters, and hair
follicles (Figure 18-8).
A small abscess occurring in the tissues of the skin
is a furuncle, commonly called a boil. Furuncles gener
ally occur around a hair follicle and can develop during
an acute case of folliculitis. Boils can develop in any
hairy area of the body, with common sites including the
skin of the neck, back, and buttocks.
Carbuncles are larger abscesses and involve sev
eral interconnected furuncles. These lesions arise in a
cluster of hair follicles and have multiple drainage sites.
Needless to say, carbuncles are much larger than furun
cles and are less common.
■ Etiology. These lesions are commonly caused by the
pyogenic, normal flora bacteria, Staphylococcus. Pre
disposing factors for these lesions include a lowered
immunity due to the presence of other diseases and
poor personal hygiene.
■ Symptoms. Abscess, furuncle, and carbuncle are all
characterized by inflammation, infection, and the for
mation of a capsule to wall off and prevent the spread of
infection. All of these encapsulated lesions are extremely
painful, usually develop a soft spot or come to a head,
and need to be opened or surgically drained.
■ Diagnosis. Diagnosis is based on history and physical
examination of the lesion.
■ Treatment. Warm, moist compresses usually relieve
pain and promote spontaneous drainage. If sponta
neous opening and drainage do not occur, surgical
Figure 18-7 Folliculitis.
Figure 18-8 Abscess.
414 Chapter 18
opening and drainage might be necessary. Antibacte
rial or antifungal medications are usually prescribed to
treat infection.
■ Prevention. Nothing can prevent these lesions,
although using antibacterial soaps can help reduce bac
terial count on the skin and thus aid in prevention.
Consider This...
It is estimated that there are approximately
50 million individual bacteria on the sur
face of 1 square inch of skin.
Cellulitis
■ Description. Cellulitis is a diffuse, or spreading,
inflammation of the skin and subcutaneous tissue
(Figure 18-9). It commonly appears on the lower legs
but can affect any part of the body.
■ Etiology. Cellulitis is a bacterial infection commonly
caused by Streptococcus and Staphylococcus. These bac
teria are common bacteria of the skin (normal flora).
Cellulitis often appears in open areas of the skin and can
be the extension of a wound, ulcer, insect bite, blister,
burn, or other skin infection.
■ Symptoms. Cellulitis is characterized by pain, red
ness, swelling, warmth, and tenderness of the involved
skin. Other symptoms might include headaches, fever,
or chills. In advancing cases, red streaks can develop and
travel from the affected area.
■ Diagnosis. Medical history and physical examination
of the involved area are helpful in diagnosis. If the leg
is involved, an ultrasound can be performed to rule out
deep vein thrombosis.
■ Treatment. Cellulitis is generally treated successfully
with oral antibiotics. Analgesics for pain and resting the
affected limb or affected area also can be part of the
treatment plan. In extreme cases, intravenous antibiot
ics might be needed. Any cellulitis involving the face can
be dangerous because this has the potential of spread
ing into the sinuses of the skull. If pain becomes severe,
necrotizing fasciitis might have developed, which will
require emergency surgical treatment.
■ Prevention. Good handwashing, proper cleansing,
and care of open areas of the skin lower the risk of cel
lulitis. Deep, dirty, and open wounds need prompt med
ical treatment to prevent cellulitis.
Erysipelas
■ Description. Erysipelas is an acute infection of the
dermis that extends into underlying fat tissue. It can
affect the face, especially in children and older adults,
but also affects the arms and legs (Figure 18-10).
■ Etiology. Most cases are due to Streptococcus, specif
ically group A Streptococcus. These bacteria can come
from the skin or from the affected individual’s throat
or nasal passages and can enter the skin through any
open area such as surgical incisions, ulcers, and minor
trauma.
■ Symptoms. Symptoms include fatigue, chills, fever,
headaches, and vomiting. The infected skin develops a
red, warm, hard, and painful rash showing a consistency
Figure 18-9 Cellulitis. Figure 18-10 Erysipelas.
Courtesy of Mark L. Kuss
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Integumentary System Diseases and Disorders 415
similar to an orange peel. Swelling develops rapidly and
exhibits sharply demarcated, raised edges.
■ Diagnosis. A physical examination of the classic
orange-peel rash and affected skin assists in diagnosis.
Tests can determine that this skin condition is not her
pes zoster or contact dermatitis.
■ Treatment. Antibiotics given orally or intravenously
usually resolve the condition, but it often takes weeks for
the skin to return to normal. In some cases, bacteria can
infect the blood, leading to endocarditis and osteomyelitis.
■ Prevention. Prevention includes maintaining healthy
skin, avoiding injuries to the skin, and promptly and
completely treating streptococcal infections, including
strep throat.
Lyme Disease
■ Description. Lyme disease was first discovered in
1975 in the town of Lyme, Connecticut, for which it
is named. It is more prevalent in the northeast and has
become the most common tick-borne disease in the
United States.
■ Etiology. Lyme disease is caused by the Borrelia burg
dorferi bacterium and is transmitted to humans by the
bite of an infected deer or blacklegged tick.
■ Symptoms. The bacteria can affect any organ, causing
a variety of symptoms and possibly delaying diagno
sis. Symptoms can include flu-like symptoms, arthritis,
malaise, chills, and fever. A characteristic bull’s-eye skin
rash is a common sign (Figure 18-11). The bull’s eye is
a reddened circle with a lighter center and can appear
days to weeks after the infected bite.
■ Diagnosis. Lyme disease is diagnosed by a history
confirming possible exposure to infected ticks and a
physical examination revealing positive symptoms.
Positive blood testing for antibodies confirms the diagnosis.
■ Treatment. Most cases can be treated successfully
with a few weeks of antibiotics. If left untreated, the
disease can cause arthritis and various neurologic and
cardiovascular complications.
■ Prevention. Prevention of Lyme disease is aimed at
preventing tick bites by using insect repellent; wearing
long-sleeved shirts, long pants, and socks; and tuck
ing the pants into the socks and boots when hiking or
camping in grassy or wooded areas. Showering and
inspecting the skin immediately after outside activities
can also help prevent bites.
Methicillin-Resistant Staphylococcus Aureus
■ Description. Methicillin-resistant Staphylococcus
aureus (MRSA) is a strain of bacteria that is resistant to
the antibiotics commonly used to treat staphylococcal
infections (Figure 18-12). This infection usually affects
the elderly and those with other disease conditions and
occurs in hospitals, nursing homes, and other health care
settings and is known as health care-associated MRSA.
More recently, MRSA is appearing in healthy people who
might share personal items, such as athletes and students.
These individuals are often in a community of people. In
this case, MRSA is responsible for skin, tissue, and lung
infections and is called community-associated MRSA.
Figure 18-11 Lyme disease — bull’s eye rash.
Figure 18-12 Staphylococcus aureus.
416 Chapter 1 8
Historically, MRSA has been a public health scare
and superbug for about 10 years. In 2005, the Centers for
Disease Control and Prevention (CDC) expressed con
cern that the number of MRSA deaths was increasing to
the point that the number of MRSA deaths was higher
than the number of deaths caused nationwide by acquired
immunodeficiency syndrome (AIDS). In 2007, the CDC
estimated that the number of MRSA infections in hospi
tals had doubled in only six years. These reports suggest
a nationwide epidemic of MRSA. In 2011, encouraging
results from the CDC showed that invasive (life-threaten
ing) MRSA infections in health care settings had declined
approximately 54% in the six years from 2005 through
2011. Declines in MRSA infections slowed from 2013 to
2016 when no significant change was noted (CDC, 2019).
■ Etiology. S. aureus is commonly found on the skin
of individuals, is usually harmless, and does not cause
illness. This presence of bacteria without illness is called
being colonized. Individuals who are colonized with
MRSA can easily pass these bacteria to others.
MRSA represents a group of bacteria that have
developed a resistance to antibiotics, which is a natural
survival method of bacteria. However, humans have
helped build this resistance by excessive and unnec
essary use of antibiotics. Many individuals insist on
taking antibiotics for viral conditions such as flu and
the common cold, even though it has been proven that
these viruses are not affected by antibiotics. This over
use helps strengthen bacteria and build their resistance.
Even when antibiotics are used properly, they do
not always kill every kind of bacterium. Those that sur
vive become resistant to that antibiotic and many oth
ers. Because bacteria reproduce rapidly, they can build
family resistance faster than new antibiotics can be
developed. Staphylococcaceae is one of the families of
bacteria that have built such a resistance that currently
only a few drugs are effective to kill them.
Prescription medications are not the only sources
of antibiotics that help build resistance. Antibiotics are
often used in livestock. These antibiotics not only end
up in meat products but eventually end up in ground
water supply from feedlot runoff.
■ Symptoms. Symptoms of MRSA, like other staph
bacteria, often start with small red bumps that resemble
pimples or boils. These can quickly cause deep abscesses
or become blood-borne. As a blood-borne infec
tion, staph bacteria can invade all organs of the body,
including bones, heart, and lungs. Symptoms of sepsis
include a rash over most of the body along with fever,
chills, headaches, joint pain, and shortness of breath.
Sepsis with MRSA can be life-threatening, and infection
requires immediate medical attention.
■ Diagnosis. Diagnosis is determined by culture and
drug sensitivity testing of wound and nasal secretions
for MRSA.
■ Treatment. Some cases of MRSA do not need treat
ment with antibiotics. Cleaning the area and washing
with antibacterial soap may be effective. Oral antibiotics
may be effective for mild to moderate cases of MRSA.
Severe cases often need treatment with an expensive
medication, vancomycin, or a combination of medica
tions which must be given intravenously.
Even though these medications are currently
effective, there are signs that some MRSA bacteria are
building resistance to several medications, including
clindamycin and vancomycin.
■ Prevention. Avoiding those with active infection is
helpful along with maintaining a healthy lifestyle to
keep natural immunity levels high. Other activities
include frequent handwashing and carrying hand sani
tizer for use when handwashing is not possible. Do not
share personal items such as towels, clothing, combs,
and eating utensils. Keep any open wounds covered and
protected. Do not share or overuse antibiotics.
Prevention in health care facilities requires com
plete sanitation of all surface areas, fabrics, linens, and
equipment in patient areas. Alcohol has been proven to
be an effective sanitizer against MRSA. Therefore, many
health care facilities have installed alcohol-based skin
sanitizers in patient rooms, hallways, and utility rooms.
Current best practices to prevent MRSA infection in
health care settings include frequent handwashing by
all staff, testing all patients upon admission for coloni
zation with MRSA, placing all patients in isolation until
culture results are reported as negative, and thorough
cleansing regimens of patient rooms and common clin
ical areas.
Fungal Diseases
Fungal infections are very common and usually affect
the nails and hair. Pathogenic fungi are called dermato
phytes, which often cause the skin to itch and crack, leav
ing it open to bacterial infections. Fungal infections are
difficult to eradicate and can cause lifelong symptoms.
Tinea (Ringworm)
■ Description. Tinea is a term used to identify any of
a number of highly contagious fungal infections of the
skin. They typically affect warm, moist areas of the
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