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For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 16, Dermatologic Drug Reactions and Common Skin Conditions.



  • image The skin is the largest organ of the human body. It performs vital functions such as (a) protecting the body against injury, physical agents, and ultraviolet radiation; (b) regulating body temperature; (c) preventing dehydration, thus helping to maintain fluid balance; (d) acting as a sense organ; and (e) acting as an outpost for immune surveillance. Skin also has a role in vitamin D production and absorption.

  • image Age-related factors affect the epidermis, dermis, and subcutis. Pediatric skin is thinner, which enhances topical drug absorption and potential drug toxicities. Neonates, particularly premature neonates, are especially susceptible due to an incomplete skin barrier. Skin of older adults is drier, thinner, and more friable, which may predispose them to external insults and loss of the skin barrier function.

  • image Examination of a patient’s skin involves assessing skin color (degree of pigmentation, pallor, carotenemia, jaundice), skin temperature (warm, cool, clammy), skin surface characteristics (dryness, seborrhea, turgor, excessive or reduced sweating, texture), and the degree of photoaging.

  • image Signs that a mole (nevus) may be dysplastic include: size >5 mm, irregular shape, variable/different pigmentation, indistinct borders; and they may be totally flat or flat with a central elevation.

  • image Skin hydration is especially important for people with dry skin conditions. This involves an appropriate daily skin care routine and adequate daily fluid intake.

  • image Management of diaper dermatitis includes frequent diaper changes, air drying (removing the diaper for as long as practical), gentle cleansing (preferably with nonsoap cleansers and lukewarm water), and the use of barriers such as zinc oxide 40% ointment. After healing, a barrier such as zinc oxide 10% should be used with each diaper change as prophylaxis.

  • image Due to the many negative effects and skin disorders relating to sun damage, sun protection at all times is critical, and this should be emphasized to patients, whether they are on medications with a photosensitivity potential or not. Sun protection includes sunscreens, sun avoidance, shading, long sleeve clothing, and wide brim hats or hats with a flap that covers the ears and neck. Sunscreens should always be used except in infants <6 months of age.


Patient Care Process

Three Patient Care Process boxes have been included in this chapter to enhance learning as follows:

  1. Patient Care Process 1: Nevi

  2. Patient Care Process 2: Diaper dermatitis

  3. Patient Care Process 3: Sunburn

Patient Care Process for Nevi



  • Patient characteristics (eg, age, sex, pregnancy status)

  • Patient medical history (personal and family) for skin cancer or melanoma

  • Size and shape of skin lesions of concern

  • Recent changes in the appearance of lesions

  • During patient interactions, be alert for presence of moles or other lesions that appear to be suspicious


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