Common benign conditions of the skin
Psoriasis
Autoimmune chronic dermatitis that involves excessively rapid turnover of epidermal cells. Family predisposition. Usually develops before age 40. Clinical manifestation: Sharply demarcated silvery scaling plaques on reddish colored skin commonly on the scalp, elbows, knees, palms, soles, and fingernails. Itching, burning, pain. Localized or general, intermittent or continuous. Symptoms vary in intensity from mild to severe. TX: Goal to reduce inflammation and suppress rapid turnover of epidermal cells. NO CURE but control is possible. Topical treatments: corticosteroids for chronic plaques. Systemic treatments: natural or artificial UVB, PUVA (UVA with topical or systemic photosensitizer (psoralen). Antimetabolite (methotrexate), retinoid (acitretin), immunosuppressant (cyclosporine), biologic therapy (adalimumab [Humira], and others (see p. 439).
Lipoma
Benign tumor of adipose tissue, often encapsulated, most common in 40 - 60 yr olds. Rubbery, compressible, round mass of adipose tissue. Single or multiple. Variable in size, poss. extremely large. Most common on trunk, back of neck, and forearms. TX: Usually no treatment, biopsy to differentiate from liposarcoma, excision usual treatment (when indicated).
Seborrheic Keratoses
Benign, familial, exact etiology unknown. Usually occur after age 40, increase in number with age. Clinical manifest: Irregularly round or oval, often verrucous papules of plagues. Well-defined shape, appearance of being stuck on. Increase in pigmentation with time. Usually multiple and possibly itchy. TX: Removal by curettage or cryosurgery for cosmetic reasons or to eliminate source of irritation. Biopsy if unable to distinguish from melanoma.
Acrochordons (skin tags)
Common after midlife. Small, skin-colored, soft, pedunculated papules. May become irritated. TX: No treatment medically necessary. Surgical removal when needed. Usually just snipping without anesthesia.
Reference
Dirksen, S. R. (2014). Nursing management: Integumentary problems. In S. Lewis, S. Dirksen, M. Heitkemper, L. Bucher, & M. Harding (Eds.), Medical-surgical nursing: Assessing and management of clinical problems (9th ed., Vol. 1) (pp. 427-449). St. Louis, Missouri: Elsevier.
Nevi (moles)
Grouping of normal cells derived from melanocyte-like precursor cells. Hyperpigmented areas that vary in form and color. Flat, slightly elevated, dome-shaped, verrucoid, polypoid, sessile, or papillomatous. Preservation of normal skin markings. Hair growth possible. TX: No treatment necessary except for cosmetic reasons. SKIN BIOPSY for SUSPICIOUS NEVI
Lentigo
Increased number of normal melanocytes in basal layer of epidermis r/t sun exposure and aging. Also called "liver spots" or "age spots." Hyperpigmented brown to black macule or patch (flat lesion) on sun-exposed areas. TX: Evaluate carefully for progression. Treatment only for cosmetic purposes: liquid nitrogen, laser resurfacing. May recur. Biopsy when suspicious of melanoma.
Acne Vulgaris
Inflammatory disorder of the sebaceous glands. More common in teenagers but possible development and persistence in adulthood. Flare can occur with corticosteroids and androgen-dominant birth control pills and before menses. Clinical manifestations: Noninflammatory lesions, including open comedones (blackheads) and closed comedones (whiteheads). Inflammatory lesions, including papules and pustules, Most common on face, neck, and upper back. TX: Mechanical removal of multiple lesions with comedo extractor. Topical benzoyl peroxide or other antimicrobials. Veltin gel (clindamycin and tretinoin). Topical retinoids, systemic antibiotics. Aim of treatment is to minimize scarring. Spontaneous remission possible. Often improves with exposure to sun. Use of isotretinoin (Accutane) for severe nodulocystic acne to possibly provide lasting remission (see Drug alert on p. 438). Pregnancy tests, monitoring of liver function, cholesterol, triglycerides, and for depression are essential.
