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Mennonite College of Nursing At Illinois State University Family Nurse Practitioner III 475 Skin Problems Statistics About 4 percent of all physician visits are made to dermatologists (approximately 25 million per year) 58% females 32% between ages of 25 and 44, 16% between ages 15 and 24 This has changed…in 1975-76, patients under 25 years of age accounted for 40% of the visits 91% of visits were made by white patients Visit rate was highest for patients 65 years of age and older (17 visits per 100 persons) Major expected sources of payment were “self-payment” (37%) and “Blue Cross/Blue Shield” (16%) Reasons for visits Acne/pimples (16.6%) Skin rash (11.8%) Skin lesion (6.7%) Warts (6.0%) Discoloration or pigmentation (5.5%) Other symptoms referable to skin (4.6%) Moles (4.2%) Hair/scalp (3.3%) Cancer (2.6%) Psoriasis (2.4%) Eczema and dermatitis (1.8%) When medications prescribed, most common were dermatologics (such as steroids) (55.5%) and antimicrobial agents (16.5%) Length of visits 1-5 minutes (17.1%) 6-10 minutes (37.6%) 11-15 minutes (26.5%) 16-30 minutes (15.6%) 31-60 minutes (2.5%) More than 60 minutes (0.1%) Primary and Secondary Skin Lesions Primary Skin Lesions Definition/Term/ Size/Description Example Flat, nonpalpable changes in skin color with circumscribed borders: Macule 1 cm Freckle, petechiae, flat moles (nevi) Patch 1 cm Vitiligo Palpable elevated solid masses: Papule 0.5 cm Elevated nevi, warts Plaque 0.5 cm (flat, elevated; may be formed by clustering of papules, feels like “thick” skin) Psoriasis, actinic keratosis Nodule 0.5-2 cm (has circumscribed border; extends deeper into the dermis layer than a papule) Lipoma Tumor 1-2 cm (may not have well- defined borders) Large lipoma, carcinoma Wheal Irregular, transient, superficial area of edema Insect bite, urticaria (hives) Circumscribed elevated area containing fluid: Vesicle 0.5 cm (filled with serous fluid) Herpes simplex, herpes zoster (s