SKIN DISEASES AND DISORDERS FOR NURSESS

SKIN IS LARGEST ORGANS IN OUR BODY NURSE NEED TO EXAMINE AND UNDERSTANDING ABNORMAL SKIN

1. INTEGUMENTARY

2. HA(MSN) 2

3. INTEGUMENTARY SYSTEM DEFINATIONS Alopecia refers to hair loss from any cause , which can be caused by various factors such as genetics, hormonal imbalances, autoimmune disorders, stress, or underlying medical conditions. There are different types of alopecia, including:1. Alopecia areata: Patchy hair loss on the scalp or body2. Alopecia totalis : Complete hair loss on the scalp3. Alopecia universalis: Complete hair loss on the body4. Alopecia barbae: Hair loss in the beard area5. Alopecia areata monolocularis : Hair loss in one eye areaSymptoms may include:- Hair loss or thinning- Round, smooth patches on the scalp- Redness or inflammation- Brittle or broken hairTreatment options depend on the type and severity of alopecia and may include:1. Medications (e.g., minoxidil, corticosteroids)2. Topical treatments (e.g., creams, ointments)3. Light therapy4. Hair transplantation5. Wigs or hairpiecesIf you're experiencing hair loss, it's essential to consult a healthcare professional for proper diagnosis and treatment guidance.

4. Erythema is a medical term that refers to redness of the skin, often caused by increased blood flow or inflammation. It can be a symptom of various conditions, including:1. Skin infections (e.g., bacterial, viral, fungal)2. Allergic reactions (e.g., hives, eczema)3. Insect bites or stings4. Sunburn or phototoxicity5. Certain medications (e.g., antibiotics, antihypertensives)6. Autoimmune disorders (e.g., lupus, rheumatoid arthritis)7. Skin conditions (e.g., acne, rosacea, psoriasis)Characteristics of erythema may include:- Redness or pinkness- Warmth or heat- Swelling or edema - Pain or tenderness- Itching or pruritusTreatment for erythema depends on the underlying cause and may involve:1. Topical creams or ointments (e.g., hydrocortisone, calamine)2. Oral medications (e.g., antihistamines, antibiotics)3. Cool compresses or wet dressings4. Avoiding triggers or allergens5. Protecting the skin from further irritationIf you're experiencing erythema, it's essential to consult a healthcare professional for proper diagnosis and treatment guidance.

5. Hirsutism is a medical condition characterized by excessive hair growth in women, particularly in areas where men typically grow hair, such as:1. Face (chin, cheeks, upper lip)2. Chest3. Back4. Shoulders5. Abdomen6. ButtocksCauses of hirsutism may include:1. Hormonal imbalance (androgen excess)2. Polycystic ovary syndrome (PCOS)3. Congenital adrenal hyperplasia (CAH)4. Cushing's syndrome5. Medications (e.g., anabolic steroids, testosterone)6. Family history7. Insulin resistanceSymptoms may also include:1. Male pattern baldness2. Deepening voice3. Enlarged clitoris4. Irregular menstrual cycles5. Acne6. Male pattern fat distributionTreatment options for hirsutism may include:1. Hormonal therapies (e.g., birth control pills, anti-androgens)2. Medications to regulate menstrual cycles3. Hair removal methods (e.g., waxing, electrolysis, laser)4. Anti-androgen medications5. Lifestyle changes (e.g., weight loss, exercise)If you're experiencing symptoms of hirsutism, consult a healthcare professional for proper diagnosis and treatment guidance.

6. Hyperpigmentation is a condition characterized by the appearance of darker skin patches or spots, due to an excess of melanin , the skin's pigment. It can be caused by:1. Sun exposure (UV radiation)2. Hormonal changes (e.g., pregnancy, birth control pills)3. Inflammation (e.g., acne, injuries)4. Skin conditions (e.g., eczema, psoriasis)5. Genetics6. Aging7. Certain medications (e.g., antibiotics, antihistamines)Types of hyperpigmentation:1. Melasma: Patchy, hormonal-induced hyperpigmentation2. Post-inflammatory hyperpigmentation (PIH): Dark spots after skin inflammation3. Solar lentigines: Age spots caused by sun exposure4. Cafe-au-lait spots: Light brown birthmarksSymptoms :- Darker skin patches or spots- Uneven skin tone- DiscolorationTreatment options:1. Topical creams (e.g., hydroquinone, retinoids)2. Chemical peels3. Microdermabrasion4. Laser therapy5. Sun protection (SPF 30 or higher)6. Skin brightening treatmentsPrevention :- Use sunscreen daily- Avoid excessive sun exposure- Wear protective clothing- Maintain a consistent skincare routineIf you're concerned about hyperpigmentation, consult a dermatologist for personalized advice and treatment.

7. Hypopigmentation is a condition characterized by the appearance of lighter skin patches or spots, due to a decrease or absence of melanin, the skin's pigment . It can be caused by:1. Skin injuries (e.g., burns, cuts)2. Infections (e.g., vitiligo, leprosy)3. Autoimmune disorders (e.g., vitiligo, alopecia areata)4. Genetic conditions (e.g., albinism, piebaldism )5. Skin conditions (e.g., eczema, psoriasis)6. Certain medications (e.g., corticosteroids)7. AgingTypes of hypopigmentation:1. Vitiligo: Patchy loss of skin pigment2. Albinism: Congenital absence of melanin3. Piebaldism : Congenital white patches4. Post-inflammatory hypopigmentation (PIH): Light spots after skin inflammationSymptoms :- Lighter skin patches or spots- Uneven skin tone- DiscolorationTreatment options:1. Topical creams (e.g., corticosteroids, immunomodulators)2. Light therapy (e.g., PUVA, narrowband UVB)3. Skin grafting4. Camouflage makeup5. Sun protection (SPF 30 or higher)Note: In some cases, hypopigmentation may be permanent, and treatment may focus on managing symptoms and improving appearance.If you're concerned about hypopigmentation, consult a dermatologist for personalized advice and treatment.

8. Keratin is a type of protein that is found in the skin, hair, nails, and internal organs of humans and animals. It is a key component of the outer layer of skin, hair, and nails, and plays a crucial role in their strength, rigidity, and elasticity .Functions of keratin:1. Provides strength and structure to skin, hair, and nails2. Helps to regulate skin moisture and hydration3. Protects skin from environmental stressors and damage4. Gives hair its texture, shine, and manageability5. Helps to grow and strengthen nailsTypes of keratin:1. Alpha-keratin: Found in skin, hair, and nails2. Beta-keratin: Found in skin and internal organs3. Gamma-keratin: Found in hair and nailsBenefits of keratin:1. Improves skin elasticity and firmness2. Enhances hair growth and strength3. Strengthens nails4. Reduces frizz and improves hair manageability5. Protects skin from damage and environmental stressorsKeratin can be obtained through:1. Diet: Consuming keratin-rich foods like gelatin, meat, and fish2. Supplements: Taking keratin supplements or vitamins3. Topical products: Using keratin-based creams, serums, and shampoosNote : Keratin is not a cure-all, and individual results may vary. Consult a healthcare professional o

9. Keratinocytes are the primary cell type of the epidermis, the outermost layer of the skin. They play a crucial role in maintaining the skin's barrier function, regulating water loss, and protecting against external factors like UV radiation, pathogens, and mechanical stress .Functions of keratinocytes:1. Produce keratin: Synthesize keratin proteins to maintain skin strength and rigidity.2. Form tight junctions: Create a tight barrier to prevent water loss and entry of harmful substances.3. Regulate water loss: Control water evaporation to maintain skin hydration.4. Respond to UV radiation: Activate pathways to protect against UV-induced damage.5. Initiate immune responses: Recognize and respond to pathogens, triggering immune reactions.6. Differentiate and proliferate: Undergo controlled cell division to maintain skin homeostasis.Characteristics of keratinocytes:1. Polygonal shape2. Ability to differentiate into various skin cell types3. Expression of specific markers (e.g., cytokeratins , involucrin )4. Ability to form desmosomes (cell-cell adhesion structures)Dysfunction or abnormalities in keratinocytes can lead to various skin conditions, including:1. Skin cancers (e.g., squamous cell carcinoma)2. Psoriasis3. Eczema (atopic dermatitis)4. Ichthyosis (dry, scaly skin)5. Wound healing disordersResearch on keratinocytes continues to advance our understanding of skin biology and disease, leading to new treatments and therapies for various skin conditions.

10. Langerhans cells are a type of immune cell found in the epidermis, the outermost layer of the skin. They play a crucial role in the skin's immune system, acting as sentinels to detect and respond to pathogens, allergens, and other foreign substances. Functions of Langerhans cells:1. Antigen presentation: Process and present antigens to T-cells, activating an immune response.2. Surveillance: Continuously monitor the skin environment for potential threats.3. Phagocytosis: Engulf and digest foreign particles, bacteria, and dead cells.4. Cytokine production: Release chemical signals to recruit other immune cells and coordinate responses.5. T-cell activation: Interact with T-cells to stimulate an immune response.Characteristics of Langerhans cells:1. Dendritic morphology: Branching, tree-like shape allows for efficient surveillance.2. Expression of specific markers (e.g., CD1a, Langerin)3. Ability to migrate to lymph nodes to present antigens to T-cells4. Role in initiating immune responses, including contact hypersensitivity and toleranceDysfunction or abnormalities in Langerhans cells have been implicated in various skin conditions, including:1. Contact dermatitis2. Psoriasis3. Atopic dermatitis (eczema)4. Skin cancers (e.g., Langerhans cell histiocytosis)5. Immune disorders (e.g., HIV, autoimmune diseases)Research on Langerhans cells continues to advance our understanding of skin immunology and disease, leading to new treatments and therapies for various skin conditions.

11. Melanin is a group of biological pigments responsible for skin, hair, and eye color in humans and animals. It's produced by cells called melanocytes through a process called melanogenesis. Types of melanin:1. Eumelanin: Brown-black pigment responsible for skin and hair color2. Pheomelanin: Red-yellow pigment found in red hair and freckles3. Neuromelanin: Found in the brain and nervous systemFunctions of melanin:1. Skin and hair pigmentation2. Protection against UV radiation3. Antioxidant properties4. Immune system regulation5. Involvement in auditory and visual functionsMelanin production is influenced by:1. Genetics2. UV exposure3. Hormonal changes4. Age5. Environmental factorsAbnormalities in melanin production or distribution can lead to:1. Albinism (reduced melanin production)2. Vitiligo (patchy melanin loss)3. Melasma (hyperpigmentation)4. Skin cancer (abnormal melanocyte growth)Interesting facts:1. Melanin is responsible for the black color of tattoos.2. Melanin can act as a natural sunscreen, protecting against UV damage.3. Some animals change their melanin production to adapt to their environment (e.g., chameleons).Overall, melanin plays a vital role in protecting our skin and eyes from the sun, and its unique properties make it an fascinating area of study!

12. Melanocytes are specialized cells responsible for producing melanin, the pigment that gives color to our skin, hair, and eyes. They are found in the epidermis (outer layer of skin), hair follicles, and eyes .Functions of melanocytes:1. Melanin production: Synthesize and distribute melanin to surrounding cells.2. Pigmentation: Determine skin, hair, and eye color.3. UV protection: Produce melanin to protect against UV radiation damage.4. Antioxidant properties: Melanin has antioxidant properties to neutralize free radicals.Characteristics of melanocytes:1. Dendritic shape: Branching extensions to distribute melanin.2. Expression of specific markers (e.g., tyrosinase, TRP-1).3. Ability to migrate and proliferate in response to UV exposure.4. Regulation by hormones (e.g., melanocyte-stimulating hormone, MSH).Dysfunction or abnormalities in melanocytes can lead to:1. Pigmentation disorders (e.g., vitiligo, albinism, melasma).2. Skin cancer (e.g., melanoma, the most aggressive form).3. Hair graying or whitening.4. Eye disorders (e.g., ocular albinism, Waardenburg syndrome).Research on melanocytes continues to advance our understanding of skin biology, pigmentation, and related disorders, leading to new treatments and therapies.

13. Merkel cells are specialized epithelial cells found in the skin, particularly in the epidermis (outer layer). They play a crucial role in sensory perception, touch, and pressure sensation.Functions of Merkel cells:1. Mechanoreception: Detect mechanical stimuli, such as pressure, vibration, and stretch.2. Touch sensation: Contribute to the sensation of light touch, texture, and shape.3. Neurotransmission: Release neurotransmitters to transmit signals to nerve fibers.4. Epidermal maintenance: Help maintain the integrity of the epidermis.Characteristics of Merkel cells:1. Small, rounded shape2. Expression of specific markers (e.g., CK20, neurofilament proteins)3. Innervated by sensory nerve fibers4. Found in hairless skin areas (e.g., fingertips, lips, genitalia)Abnormalities in Merkel cells have been implicated in:1. Merkel cell carcinoma (a rare, aggressive skin cancer)2. Neurological disorders (e.g., neuropathies, sensory processing disorders)3. Skin conditions (e.g., psoriasis, eczema)Research on Merkel cells continues to advance our understanding of sensory perception, skin biology, and related disorders, leading to new treatments and therapies.Interesting fact: Merkel cells are named after German anatomist Friedrich Merkel, who first described them in 1875.

14. Petechiae (singular: petechia) are small, pinpoint-sized spots or patches of bleeding that appear on the skin or mucous membranes. They are caused by tiny blood vessels (capillaries) that rupture, releasing a small amount of blood into the surrounding tissue. Causes of petechiae:1. Trauma or injury2. Infections (e.g., sepsis, meningitis)3. Bleeding disorders (e.g., platelet disorders, clotting factor deficiencies)4. Vasculitis (inflammation of blood vessels)5. Medications (e.g., anticoagulants, aspirin)6. Cancer (e.g., leukemia, lymphoma)7. Autoimmune disorders (e.g., ITP, SLE)Appearance of petechiae:1. Small, flat, or slightly raised spots2. Red, purple, or brown in color3. Typically 1-5 mm in diameter4. Often appear in clusters or patchesLocations where petechiae may appear:1. Skin (anywhere, but often on arms, legs, torso)2. Mucous membranes (e.g., mouth, nose, eyes)3. Internal organs (e.g., kidneys, lungs)If you notice petechiae, it's essential to consult a healthcare professional to determine the underlying cause and appropriate treatment.

15. Rete ridges , also known as rete pegs, are small, finger-like projections of the epidermis (outer layer of skin) that extend into the dermis (inner layer of skin). They play a crucial role in:1. Skin anchoring: Rete ridges help anchor the epidermis to the dermis, providing stability and preventing separation.2. Nutrient exchange: They facilitate the exchange of nutrients, waste, and gases between the epidermis and dermis.3. Skin elasticity: Rete ridges contribute to skin elasticity by allowing the epidermis to stretch and retract.Characteristics of rete ridges:1. Small, finger-like projections (typically 0.1-0.5 mm long)2. Found at the dermal-epidermal junction (DEJ)3. More prominent in thicker skin areas (e.g., palms, soles)4. Less prominent in thinner skin areas (e.g., eyelids, lips)Abnormalities in rete ridges have been implicated in:1. Skin conditions (e.g., psoriasis, eczema, dermatitis)2. Aging (reduced rete ridge depth and density)3. Skin cancer (e.g., squamous cell carcinoma)Research on rete ridges continues to advance our understanding of skin biology, aging, and related disorders, leading to new treatments and therapies.

16. Sebaceous glands are small, oil-producing glands found in the skin, particularly in the face, scalp, and torso. They play a crucial role in:1. Sebum production: Sebaceous glands produce sebum, an oily substance that helps to: - Moisturize and protect the skin - Keep hair healthy and shiny - Regulate skin pH2. Skin barrier function: Sebum helps to maintain the skin's natural barrier against water loss and external factors.Structure of sebaceous glands:1. Small, sac-like structure2. Composed of sebocytes (sebum-producing cells)3. Connected to a hair follicle (except in palms and soles)Functions of sebaceous glands:1. Sebum production and secretion2. Regulation of skin pH and moisture levels3. Contribution to skin's natural barrier functionAbnormalities in sebaceous glands can lead to:1. Acne (excessive sebum production, clogged pores)2. Seborrheic dermatitis (inflammation, flaking skin)3. Sebaceous hyperplasia (enlarged sebaceous glands)4. Sebaceous carcinoma (rare, aggressive skin cancer)Interesting fact: Sebaceous glands are most active during puberty, which is why acne is more common during adolescence.

17. Sebum is a thick, oily substance produced by sebaceous glands in the skin. It plays a crucial role in:1. Moisturizing and protecting the skin2. Keeping hair healthy and shiny3. Regulating skin pH4. Maintaining the skin's natural barrier functionComposition of sebum:1. Triglycerides (40-60%)2. Wax esters (20-30%)3. Squalene (10-20%)4. Cholesterol and other sterols (5-10%)Functions of sebum:1. Emollience: Softens and smooths the skin2. Occlusion: Helps retain moisture in the skin3. Antimicrobial: Inhibits growth of certain microorganisms4. Anti-inflammatory: Reduces inflammation and irritationAbnormalities in sebum production or composition can lead to:1. Acne (excessive sebum production, clogged pores)2. Dry skin (insufficient sebum production)3. Seborrheic dermatitis (inflammation, flaking skin)4. Skin conditions like eczema, psoriasis, and rosaceaInteresting fact: Sebum production varies with age, sex, and hormonal changes. For example, sebum production increases during puberty and decreases with age.

18. Telangiectasias are small, dilated blood vessels that appear as:1. Fine, red or purple lines or threads2. Web-like patterns3. Small, round or oval spotsThey are caused by:1. Weakening of blood vessel walls2. Increased pressure or fragility3. Genetic predisposition4. Environmental factors (e.g., sun exposure, radiation)5. Certain medical conditions (e.g., rosacea, scleroderma)Types of telangiectasias:1. Spider telangiectasias (central artery with branching vessels)2. Arterial telangiectasias (thicker, more pulsatile vessels)3. Venous telangiectasias (thinner, more serpiginous vessels)4. Capillary telangiectasias (small, round or oval spots)Treatment options:1. Laser therapy2. Electrocautery3. Sclerotherapy4. Camouflage makeup5. Avoiding triggers (e.g., sun, cold, stress)Telangiectasias can be associated with various conditions, including:1. Rosacea2. Scleroderma3. Psoriasis4. Liver disease5. Carcinoid syndromeIf you notice telangiectasias, consult a healthcare professional for proper evaluation and treatment.

19. Vitiligo is a chronic skin condition characterized by:1. White or pale patches on the skin (due to loss of pigment-producing cells) 2. Destruction of melanocytes (cells responsible for skin pigmentation)3. Potential for hair whitening or grayingTypes of vitiligo:1. Segmental vitiligo (localized, unilateral)2. Non-segmental vitiligo (widespread, bilateral)3. Acrofacial vitiligo (affects face, hands, and feet)4. Universal vitiligo (extensive, widespread depigmentation)Causes and triggers:1. Autoimmune response (immune system attacks melanocytes)2. Genetic predisposition3. Hormonal changes4. Stress5. Sunburn or skin traumaSymptoms:1. White or pale patches on skin2. Premature graying of hair3. Eyelash or eyebrow loss4. Increased risk of skin cancerTreatment options:1. Topical corticosteroids2. Light therapy (UVB, PUVA)3. Immunomodulators4. Surgical grafting5. Camouflage makeupEmotional and psychological support is essential for managing vitiligo, as it can impact self-esteem and quality of life.Research continues to explore new treatments and understand the underlying mechanisms of vitiligo.

20. Wood's light, also known as ultraviolet (UV) light or black light, is a specialized light source used to examine the skin. It emits a specific wavelength of UV light (365nm) that helps diagnose and visualize various skin conditions .When exposed to Wood's light, certain skin conditions or features may become more apparent, such as:1. Fungal infections (e.g., ringworm, tinea versicolor)2. Bacterial infections (e.g., erythrasma)3. Pigmentation disorders (e.g., vitiligo, melasma)4. Scars or skin damage5. Porphyria (a group of rare genetic disorders)Wood's light can also help:1. Detect skin conditions that are not visible to the naked eye2. Confirm diagnoses3. Monitor treatment progress4. Identify underlying skin issuesSome common observations under Wood's light include:1. Fluorescence (glowing) of certain skin areas2. Enhanced visibility of skin lesions or pigmentation3. Changes in skin texture or appearanceWood's light is a valuable tool in dermatology, helping healthcare professionals diagnose and manage various skin conditions.

21. HA(MSN) 42

22. HA(MSN) 43

23. Factors influencing skin integrity Immoblity is the major factor leading to pressure sore development . The pt who is confined to bed & unable to change position is at greatest risk . Trauma most likely occur over the prominent areas weight bearing areas HA(MSN) 66

24. Prolonged pressure impairs blood flow to tissue & resulfs in ischemia & inferction The extent of pressure necessary to cause tisue damage depnds on the tolerance of the pt's skin & supporting stuctures . HA(MSN) 67

25. Tolerance to pressurs trauma is influenced by the following factors: Duration of pressure Magnitude of pressure Body position Friction Impaired moblity Malnutrition Dehydration HA(MSN) 68

26. COMMON DERMATOLOGIC TERMS Lichenification: distinictive thickening of skin Crust: dried exudate of body fliuds Erusion : epithelial deficiet Ulcer: epithelial deficiet (disruption of deep skin integrity) Atrophy: an acquired loss of substance Scar: change in the skin secondery to trauma or inflammation HA(MSN) 69

27. Lichenification is a skin condition characterized by the thickening of the outer layer of skin (epidermis) and the formation of visible lines or patterns on the skin's surface. It's often a result of chronic skin irritation, inflammation, or scratching, leading to skin thickening and hyperpigmentation .Causes of lichenification include:1. Eczema (atopic dermatitis)2. Psoriasis3. Contact dermatitis4. Skin allergies5. Insect bites or stings6. Chronic scratching or rubbingSymptoms of lichenification:1. Thickened skin2. Visible lines or patterns on the skin (lichenoid pattern)3. Hyperpigmentation (darkening of the skin)4. Skin dryness or scaling5. Itching or pruritusTreatment options for lichenification:1. Topical corticosteroids to reduce inflammation2. Moisturizers to hydrate the skin3. Topical immunomodulators to reduce immune system response4. Oral antihistamines to relieve itching5. Phototherapy (light therapy) in severe casesPrevention methods:1. Avoiding skin irritants2. Keeping the skin moisturized3. Avoiding excessive scratching or rubbing4. Wearing gentle, breathable clothing5. Managing underlying skin conditionsIf you're experiencing symptoms of lichenification , consult a healthcare professional or dermatologist for proper diagnosis and treatment. They can help you develop a personalized plan to manage the condition and prevent further skin damage. HA(MSN) 72

28. HA(MSN) 73

29. Description of skin lesion ( primary lession ) I . circumscribed , flat , nonpalpable changes in skin color Macule = small upto 1 cm, eg. petechia Patch = larger than 1 cm , eg vitilligo HA(MSN) 74

30. Description of skin lesion... II. Palpable elevated solid masses Papule: up to 0.5cm eg. elevated nevus Plaque: elevated surface > 0.5 cm Nodule: deeper & firmer than papule => 0.5 -1-2cm eg tumor Wheal: irregular, superficial area of localized skin edema HA(MSN) 75

31. Description of skin lesion... III. Superficial elevation of skin formed by free fluid in a cavity in the skin layer. Vesicle: up to 0.5 cm => filled c serous fluid,eg herps simplex Bulla: > 0.5 cm, Filled of serous fluid , eg 2nd degree burn ( blister) Pustule: filled pus, eg impetiao, acne HA(MSN) 76

32. Secondery lesion IV. Loss of skin surface Erusion => loss of superficial epidermis Ulcer => deep loss of skin surface => May bleed & scar, eg. sphilic chancre Fissure => linear creak in the skin eg. Athlet's foot HA(MSN) 77

33. A fissure is a deep crack or groove in the skin, often caused by:1. Dry skin (xerosis)2. Skin conditions like eczema, psoriasis, or dermatitis3. Infections like athlete's foot or fungal infections4. Trauma or injury to the skin5. Poor skin care or hygiene6. Nutritional deficiencies (e.g., vitamin B7 deficiency)Common areas for skin fissures:1. Heels2. Hands (especially fingers and fingertips)3. Feet (especially toes and toe webs)4. Lips5. Nasolabial folds (lines between nose and mouth)Symptoms:1. Deep cracks or grooves in the skin2. Pain or tenderness3. Bleeding or discharge4. Itching or burning sensations5. Swelling or rednessTreatment:1. Moisturizers or emollients to hydrate the skin2. Topical antibiotics or antifungals for infections3. Steroid creams for inflammation4. Protecting the affected area with bandages or dressings5. Wearing gloves or socks to protect hands and feet6. Avoiding harsh soaps or cleansers7. Staying hydrated and maintaining a balanced dietIf you experience:- Increased pain or bleeding- Pus or discharge- Fever- No improvement with self- careConsult a healthcare professional for proper diagnosis and treatment. HA(MSN) 78

34. HA(MSN) 79

35. Secondery lesion.... On skin surface: curst = dried residue of serum ,pus or blood, eg Impetigo Scale = a thin flake of exfoliative epiderms eg.dandruff, Dry skin, Psoriasis HA(MSN) 80

36. Crusted skin , also known as crusty skin or skin crusting, refers to a condition where the skin develops a thick, hardened crust or scab, often du e to:1. Infections (bacterial, fungal, or viral)2. Insect bites or stings3. Burns or scalds4. Skin allergies or irritations5. Eczema or atopic dermatitis6. Psoriasis7. Skin injuries or traumaCharacteristics of crusted skin:1. Thick, hardened crust or scab2. Redness and inflammation3. Itching, burning, or stinging sensations4. Swelling or edema5. Discharge or pus (in cases of infection)Treatment for crusted skin depends on the underlying cause but may include:1. Topical antibiotics or antifungals2. Steroid creams or ointments3. Moisturizers or emollients4. Cool compresses or wet dressings5. Protecting the affected area from further irritationIt's essential to consult a healthcare professional for proper diagnosis and treatment, especially if you experience:- Increased redness or swelling- Pus or discharge- Fever- Difficulty moving the affected area- No improvement with self- careRemember , crusted skin can be a sign of an underlying condition that needs medical attention. HA(MSN) 81

37. HA(MSN) 82

38. Vascular skin lesions a lesion that originated from a blood vessel Petechia / Purpura Ecchymosis venous star   HA(MSN) 83

39. Skin lesion configuration Linear - in line Annular and arciform –circular or arcing Zosteriform - linear along a nerve route. Grouped -clustered lesion Discrete -separate and distinict Confluent - lesions that run together or join Generalized - widespread eruption Localized - lesions on distinct area HA(MSN) 84

40. Assessing the skin Assessment includes a thorough - history taking , -inspection and -palpation of the skin. HA(MSN) 85

41. HA(MSN) 86

42. HA(MSN) 87

43. Herpes vircilla virus HA(MSN) 88

44. Tinea pedis HA(MSN) 89

45. acne HA(MSN) 90

46. Adverse effect of topical corticosteroids HA(MSN) 91

47. psoriasis HA(MSN) 92

48. Assessing the general appearance of the skin The general appearance of the skin is assessed by observing (Inspection) color, skin lesions, and vascularity . On palpation skin turgor and mobility, possible edema, temperature, moisture, dryness, oiliness, tenderness, and skin texture (rough and smooth). HA(MSN) 93

49. Color change: can be hyperpigmentation , hypopigmentation or depigmentation 1. Redness - fever, alcohol intake, local inflammation due to increased blood flow to the skin. 2. Bluish color (cyanosis) - decreased oxygen supply due to chronic heart and lung disease, exposure to cold , and anxiety HA(MSN) 94

50. Cont’ed … 3. Yellowish color (jaundice) - increased serum bilirubin concentration due to liver disease or red blood cell haemolysis - Uremia- renal failure 4. Brown-tan - Addison’s disease: cortisol deficiency stimulates increased melanin production - Birth mark, chloasma of pregnancy (face patches), and sun exposure 5. Pale : Albunism - total absence of pigment melanin Vitiligo - destruction of the melanocytes in circumscribed areas of the skin   HA(MSN) 95

51. Benign skin condition- vitilligo HA(MSN) 96

52. HA(MSN) 97

53. HA(MSN) 98

54. HA(MSN) 99

55. HA(MSN) 100

56. Diagnostics test Skin biopsy : removal of a piece of skin by shave, punch, or excision technique for a microscopic study of the skin to determine the histology of cells to rule out malignancy and to establish an exact diagnosis. Patch testing : performed to identify substances to which the patient has developed an allergy. Potassium hydroxide test (KOH) : helps to identify fungal skin infection   HA(MSN) 101

57. Diagnostics test… Gram stain and culture with sensitivity test : helps to identify the organism responsible for an underlying infection with the effective drug identification Slit Skin Smear (SSS) : to identify the causative agent of leprosy (mycobacterium leprea ) HA(MSN) 102

58. Disorder of the skin I . Inflammatory and allargic skin disorders Acne Psoriasis Atopic dermatitis (eczema) Contact dermatitis II. Bacterial infections Impetigo Boil (furuncle) Carbancle Cellulitis HA(MSN) 103

59. Disorder of the skin… III. fungal infections Candidiasis Tinea captis Tinea corporis Tinea pedis (atlet's foot) HA(MSN) 104

60. candidiasis, also known as candida or yeast infection, is a fungal infection caused by Candida albicans. It can affect various parts of the body, including:1. Genital area (vaginal yeast infection or penile yeast infection)2. Mouth (thrush)3. Skin (cutaneous candidiasis)4. Esophagus (esophageal candidiasis)5. Bloodstream (invasive candidiasis)Symptoms:- Genital area: - Itching, burning, or redness - Thick, white discharge - Painful urination or intercourse- Mouth: - White patches or lesions - Redness, soreness, or bleeding - Difficulty swallowing- Skin: - Redness, itching, or burning - Crusty or oozing patches - Skin folds or creases- Esophagus: - Difficulty swallowing - Chest pain or discomfort - Hoarseness- Bloodstream: - Fever - Chills - Confusion or disorientationTreatment options:- Antifungal medications (clotrimazole, fluconazole, or nystatin)- Topical creams or suppositories- Oral tablets or capsules- Intravenous medication (for severe cases)Prevention:- Practice good hygiene- Wear breathable clothing- Avoid tight-fitting clothing- Keep skin dry- Avoid sharing personal items- Maintain a healthy dietIf you suspect you have candidiasis, consult a healthcare professional for proper diagnosis and treatment. HA(MSN) 105

61. HA(MSN) 106

62. Tinea capitis, also known as ringworm of the scalp, is a fungal infection that affects the hair and scalp. It's most common in children, but can occur in adults as wel l.Causes :- Fungal infection (usually Trichophyton or Microsporum species)- Direct contact with an infected person or contaminated objects- Sharing personal items like hair accessories, towels, or pillowsSymptoms :- Round, scaly patches on the scalp- Hair loss or brittle hair- Redness, itching, or burning sensations- Swollen lymph nodes- Crusty or oozing patchesTreatment :- Topical antifungal creams or shampoos (e.g., selenium sulfide or ketoconazole)- Oral antifungal medications (e.g., griseofulvin or terbinafine)- Combining topical and oral treatments for severe casesPrevention :- Practice good hygiene- Avoid sharing personal items- Keep hair and scalp clean and dry- Avoid close contact with infected individuals- Regularly wash and disinfect hair accessories and toolsComplications :- Kerion: a severe, inflammatory reaction- Folliculitis: bacterial infection of the hair follicles- Scarring alopecia: permanent hair lossConsult a healthcare professional for proper diagnosis and treatment. They may perform a scalp examination, take a hair sample, or use a Wood's lamp to diagnose tinea capitis. HA(MSN) 107

63. HA(MSN) 108

64. Tinea pedis , also known as athlete's foot, is a fungal infection that affects the skin on the feet, particularly between the toes. It's a common condition that can be caused by:- Fungal infection (usually Trichophyton, Epidermophyton, or Microsporum species)- Warm, moist environments- Poor foot hygiene- Sharing personal items like towels or socks- Walking barefoot in public areasSymptoms :- Itching, burning, or stinging sensations- Redness, cracking, or scaling on the skin- Blisters or ulcers- Dry, flaky skin- Foul odorTreatment :- Topical antifungal creams, powders, or sprays (e.g., clotrimazole, terbinafine, or miconazole)- Oral antifungal medications (e.g., terbinafine or itraconazole) for severe cases- Keeping feet clean and dry- Changing socks regularly- Wearing well-ventilated shoesPrevention :- Practice good foot hygiene- Dry feet thoroughly, especially between toes- Wear clean socks and change them regularly- Use antifungal powders or sprays on feet and in shoes- Avoid sharing personal items- Wear sandals or shoes in public areasComplications :- Cellulitis: bacterial infection of the skin and underlying tissues- Foot ulcers- Fungal nail infections (onychomycosis)Consult a healthcare professional if you experience:- Increased redness or swelling- Pus or discharge- Fever- No improvement with self- careRemember , tinea pedis can be contagious, so take steps to prevent its spread. HA(MSN) 109

65. HA(MSN) 110

66. Disorder of the skin… IV. Viral infections Herpes simplex (cold - sore) Herpes zoster (shingles) Warts v.Parasitic infections - pediculosis -scabies HA(MSN) 111

67. Herpes simplex is a viral infection caused by the herpes simplex virus (HSV). It's a common and highly contagious infection that affects millions of people worldwide .There are two main types of HSV:1. HSV-1 (Herpes Simplex Virus Type 1): Primarily causes oral herpes, leading to cold sores or fever blisters on the mouth, lips, and face.2. HSV-2 (Herpes Simplex Virus Type 2): Primarily causes genital herpes, leading to blisters and sores in the genital area.Symptoms of herpes simplex include:- Painful blisters or sores- Itching, burning, or tingling sensations- Flu-like symptoms (fever, headache, fatigue)- Swollen lymph nodesHerpes simplex is spread through:- Skin-to-skin contact with an infected person- Sexual contact (genital herpes)- Sharing personal items (utensils, towels, lip balm)There is no cure for herpes simplex, but antiviral medications can help manage symptoms and reduce outbreaks. Treatment options include:- Acyclovir (Zovirax)- Valacyclovir (Valtrex)- Famciclovir ( Famvir )Prevention methods include:- Practicing safe sex (using condoms)- Avoiding close contact with infected individuals- Keeping the affected area clean and dry- Avoiding sharing personal itemsIf you think you have herpes simplex, it's essential to consult a healthcare professional for proper diagnosis and treatment. They can provide guidance on managing symptoms and preventing future outbreaks. HA(MSN) 112

68. HA(MSN) 113

69. Herpes zoster , also known as shingles, is a viral infection caused by the varicella-zoster virus, which is the same virus that causes chickenpox. It occurs when the virus reactivates in the body, often due to:- Weakened immune system- Aging (most common in people over 50)- Stress- Certain medical conditions (e.g., cancer, HIV/AIDS)- Medications that suppress the immune systemSymptoms :- Painful rash or blisters on one side of the body- Burning, itching, or tingling sensations- Fever- Headache- Fatigue- Swollen lymph nodesTreatment :- Antiviral medications (e.g., acyclovir, valacyclovir, or famciclovir) to reduce severity and duration- Pain relief medications (e.g., acetaminophen or ibuprofen)- Topical creams or patches for pain relief- Rest and relaxationPrevention :- Vaccination (Zostavax or Shingrix) to reduce risk and severity- Practicing good hygiene- Avoiding close contact with individuals who have shinglesComplications :- Postherpetic neuralgia (PHN): persistent pain after the rash heals- Eye problems (e.g., uveitis, keratitis)- Bacterial infections- Hearing loss- Encephalitis (rare)Consult a healthcare professional if you experience:- Severe pain- Difficulty swallowing- Fever over 101.5°F (38.6°C)- Eye symptoms- No improvement with treatmentNote : Shingles can be contagious to people who have not had chickenpox or the chickenpox vaccine. HA(MSN) 114

70. HA(MSN) 115

71. Warts are small, usually painless growths on the skin that are caused by the human papillomavirus (HPV). They can appear anywhere on the body, but are most commonly found on the hands, feet, and genitals .There are several types of warts, including:1. Common warts (verruca vulgaris): These are the most common type and appear as rough, dome-shaped growths on the hands, fingers, and feet.2. Plantar warts (verruca plantaris): These appear on the soles of the feet and can be painful.3. Flat warts (verruca plana): These are small, flat growths that appear on the face, hands, and legs.4. Genital warts (condyloma acuminatum): These appear on the genitals and are sexually transmitted.Warts are contagious and can be spread through:- Direct contact with an infected person- Indirect contact with contaminated surfaces or objects- Sharing personal care itemsTreatment options for warts include:- Salicylic acid creams or gels- Cryotherapy (freezing)- Cantharidin (a blistering agent)- Surgical removal- ImmunotherapyIt's important to note that warts can take time to resolve on their own, and treatment may take several attempts to be effective. If you have persistent or painful warts, it's best to consult a healthcare professional for proper diagnosis and treatment. HA(MSN) 116

72. Warts HA(MSN) 117

73. Inflammatory and allergic condition A. Eczema/Dermatitis - It is a chronic pruritic inflammatory disorder affecting the epidermis, and dermis commencing in infancy, often persisting throughout child hood but eventually remitting and some times recurring in adult life. They are a non-infectious inflammation of the skin and it can be acute, sub-acute or chronic. HA(MSN) 118

74. HA(MSN) 119

75. Con’ted …. Causes The exact cause is unknown Imbalance of the immune system with an increase in the immunoglobulin “E” activity and deficient of cell mediated delayed hypersensitivity. Can be exacerbated by infection, bites, pollen, wool, silk, fur, ointments, detergents, perfume, certain foods, temperature extremes, humidity, sweating and stress HA(MSN) 120

76. Hypersensitivity reactions HA(MSN) 121

77. Sign and symptom An acute stage eczema shows redness, swelling, papules, blisters, oozing and crusts . In the sub-acute stage the skin is still red but becomes drier and scalier and may show pigment change. In the chronic stage -lichenification, -excoriation, -scaling and cracks are seen 122

78. Types of eczema Atopic eczema - is a chronic relapsing skin disorder that usually begins in infancy a nd is characterized principally by dry skin and pruritis , consequent rubbing and scratching lead to lichenification This patient has a genetic predisposition for hypersensitivity reactions such as asthma, allergic rhinitis, and chronic urticaria . The eczema comes and goes The eczema triggered by dryness of the skin, infections, heat, sweating, contact with allergens or irritants and emotional stress. HA(MSN) 123

79. Atopic eczema… Mostly affected sites are elbow and knee folds, wrists, ankles, face, and neck; in some cases it can be generalized HA(MSN) 124

80. Atopic dermatitis HA(MSN) 125

81. Atopic dermatitis HA(MSN) 126

82. Seborrhoic eczema - is a very common chronic dermatitis characterized by redness and scaling that occurs in regions where the sebaceous glands are most active, such as: Scalp, border of forehead/scalp Behind ears, above and in between eyebrows In nasolabial folds, Sternum In between the shoulder blades, in axillae Groin , Perianal area HA(MSN) 127

83. Seborrhoic eczema… Under the breast , umbilicus and in body folds Pts often complains of oily skin The eczema comes and goes In HIV patients, the eczema can become very widespread and easily super infected   HA(MSN) 128

84. Infective eczema which occurs as a response to an oozing skin infection . Common sites are the foot, and ankle region Causative organisms are usually staphylococci/ streptococci Vaseline use aggravates this condition HA(MSN) 129

85. Contact eczema : is caused by contact of the skin with an irritant or an allergen . Vaseline commonly causes: Vaseline dermatitis . Common causes of irritant contact eczema on hands, arms and legs are excessive use of H 2 O, soap (especially if not washed off properly) detergents, chemicals, sunlight, jewellery , dyes, bleaches, perfume, nail polish/remover, etc HA(MSN) 130

86. Contact dermatitis HA(MSN) 131

87. Sign and symptom of eczema/ dermatitis (general) Itching Redness, dry skin, lichenification, excoriation, scaling skin Papules, blisters, oozing and crusts Color change HA(MSN) 132

88. Management (general) Stop the use of irritants (contact eczema) Mild topical steroid such as hydrocortisone 1% cream twice daily until lesions clear. In severe itching use antihistamines E.g.: promethazine 25mg at night, chlorphenaramine 4mg at day time/night HA(MSN) 133

89. Mgt cont… In bacterial super infection use KMNO 4 solution, Betadine solution, antibiotics Explain to the Patient, and Parents that not serious and will disappear in time. Keep finger nails short and covered at night Use non greasy or non moisturizers ( seborrhoic eczema) HA(MSN) 134

90. Mgt cont… An imidazole cream twice daily/ ketaconazole 200 mg/d 1-3 weeks ( seborrhoic eczema) The vicious circle of itch – scratch – lichenification – itch needs to be broken , (atopic eczema)- conscious effort to stop scratching In photo allergies – sun protection by wide rim sun hat, long sleeves, high collar, sunglasses, stay indoor, sunscreen, umbrella, etc Keep the site clean HA(MSN) 135

91. Acne - Is a common disorder of the sebaceous gland associated with excess production of sebum and blockage of the duct resulting in a variety of inflammatory manifestations. Common in puberty and usually regresses in early adult hood Patient complain of oiliness of the skin. - Occurs on the face, upper trunk and shoulders - Appears to be multiple inflammatory papules, pustules and nodules HA(MSN) 136

92. Acne… It can be very mild to be very severe: - they blend together to form large inflammatory areas with cysts and scar formation. Cause -genetic, hormone and bacteria play a role HA(MSN) 137

93. HA(MSN) 138

94. Cont.. Sign and symptom Red nodules, cyst , red papules, scars, pustules, keloids There may be mild soreness, pain or itching Inflammatory papules, pustules, pores acne cyst, scarring Diagnosis Clinical Cyst formation, slow resolution, scarring Common at puberty and common of all skin conditions HA(MSN) 139

95. Management Stop the use of vaseline , oil, ointment, greasy cosmetics which further blocks sebaceous ducts. Benzoyl per oxide 5-10% gel or tretinoin 0.01-0.1% cream or gel apply at night. Salicylic acid 1-10% in alcoholic solution for removal of excess sebum . For pustular /inflammatory lesions use topical clindamycin 1% solution, erythromycin 2% lotion HA(MSN) 140

96. Management … In severe cases use systemic long term antibiotics like doxycycline 100mg twice daily until substantial improvement followed by 100mg once daily until acceptable. Surgical treatment – extraction of comedones , incision and drainage of large fluctuant, nodulocystic lesions HA(MSN) 141

97. Psoriasis Is a chronic recurrent , hereditary , non infectious disease of the skin caused by abnormally fast turn over of the epidermis The turn over may be up to 40 times than normal and as a result the epidermis is not able to develop normally, therefore it doesn’t allow formation of the normal protective layer of the skin. HA(MSN) 142

98. Psoriasis… Skin become red, inflamed, and the scales are thicker than normal It produces a so called candle-wax phenomenon , when you scratch such a patch it becomes silvery white. Sites can be extensor areas of extremities especially elbow, knees, buttocks, shoulder and scalp HA(MSN) 143

99. HA(MSN) 144

100. Generalized psoriasis HA(MSN) 145

101. HA(MSN) 146

102. Cure is there but it reoccurs Occurs at any age but 10-35 years is common mostly. Periods of emotional stress and anxiety aggravate the condition. Sign and symptom . May itch severely in body folds covered with silvery scales Finger and toenails may show pitting and thickening Associated arthritis HA(MSN) 147

103. Management Explain to the Pt the recurrent nature of the disease. Salicylic acid 2-10% ointment twice daily to reduce scaling Moisturizers (Vaseline, paraffin oil, or cream) Treat any super infection with KMNO 4 , or antibiotics if necessary Psoriatic arthritis NSAIDS E.g.: Ibuprofen, Indomethacin , and ASA Methotrexates as a last option in sever cases. HA(MSN) 148

104. Infection of the skin 1. Cellulitis Is a diffuse, acute streptococcal or staphylococcal infection of the skin and subcutaneous tissue Cause Caused by bacteria’s like streptococcus/staphylococcus aureus Results from break in skin Infection rapidly spread through lymphatic system Sign and symptom Tender, red, hot , indurated and swollen area that is well demarcated Possible fluctuant abscess or purulent drainage Fever, chills, and malaise HA(MSN) 149

105. HA(MSN) 150 Features : Red Swollen Warm to touch No areas of pus Painful Tender

106. HA(MSN) 151

107. HA(MSN) 152

108. HA(MSN) 153

109. HA(MSN) 154

110. HA(MSN) 155 The result of “skin popping” - Multiple injection site abscesses

111. HA(MSN) 156 Cellulitis with abscess If rapid spreading beyond this line occurs, this may be necrotizing , and requires surgery

112. HA(MSN) 157 Necrotizing fasciitis

113. HA(MSN) 158

114. HA(MSN) 159

115. Management Oral antibiotics Parentral /systemic antibiotics for hands, face, or lymphatic spread Surgical drainage and debridement HA(MSN) 160

116. 2. Furunclosis Is an acute painful infection of perifollicular abscess (boils) Is an acute, localized, deep seated, red, hot, very tender, inflammatory perifollicular abscess . Common microorganism : staphylococcus aureus Most common on persons who are carriers of staphylococcus, contact with oils or grease, diabetes, poor habits of personal hygiene, immunosuppression , alcoholism, obese, malnutrited , etc HA(MSN) 161

117. Furunclosis … The lesion begins in the opening of hair follicle or sebaceous gland Sites can be back of the neck, face, buttocks, thighs, perineum, breasts, axilla , nose, genitallia , etc HA(MSN) 162

118. HA(MSN) 163

119. Sign and symptom Hard nodule initially then fluctuant abscess with centrally yellow pustule, then ruptures in to an ulcer. It can be isolated single lesion or few multiple lesion Hotness and pain at the site. Diagnosis Gram stain of the pus Culture and sensitivity test of blood/pus HA(MSN) 164

120. Cont.. Treatment Warm compresses - Warn patient not to squeeze or incise the lesion Incision and drainage when it is fluctuance . Systemic antibiotics ( cloxacillin , erythromycin ) Rest especially for genital areas. For the sever pain codien , morphine HA(MSN) 165

121. 3. Carbuncles (multiple furuncles) - Is an aggregation of interconnected furuncles that drain through multiple openings in the skin . Exposure to grease and oil increase the risk. Occurs mostly where the skin is thick Microorganism mostly: staph. aureus Sign and symptom Sites are back of the neck, shoulder, buttock, outer aspect of the thigh and over the hip joints . HA(MSN) 166

122. Carbuncles …. Develop slowly than furuncle They can reach the size of an egg/small orange. Fever, chills, extreme pain, malaise. Because of the large size of the lesion and its delayed drainage the patient is much sicker HA(MSN) 167

123. HA(MSN) 168

124. Cont… Diagnosis Gramstain of the pus Culture of pus/blood Leucocytosis (12,000-20,000 mm 3 ) normal 4,000-10,000mm 3 Treatment The same as furuncle, plus Avoid friction and irritation from tight clothing.   HA(MSN) 169

125. 4. Folliculitis Is inflammation of the hair follicle Sign and symptom Single or multiple papules or pustules Commonly seen in the beard area of men and women’s legs from shaving Management Warm compress to relieve pain Clean with antibacterial soap Topical antibiotic ointment Systemic antibiotics for recurrent cases HA(MSN) 170

126. HA(MSN) 171

127. 5. Impetigo Is an acute, contagious, rapidly spreading cutaneous infection and is a very common bacterial infection of the superficial skin Causative agents are stap . aureus or a B- hemolytic streptococcus or both Sign and Symptom Superficial pustules or blisters which becomes oozing with yellow crusts Contagious Blisters break easily and form golden crusts Diagnosis - Clinical - Culture and sensitivity HA(MSN) 172

128. HA(MSN) 173

129. HA(MSN) 174

130. Management KMNO 4 bath or wet dressing-in mild forms Prevent spreading by not sharing towels and ointment, change clothes, towels and sheets frequently. In sever forms give cloxacillin 250-500mg QID daily for 7-10 days in adults, and 50-100mg/kg/24 hours divided in to 4 doses for children. Erythromycin 250-500mg 4 times daily for 7-10 days in adults, and 25-50mg/kg/24hrs divided in to 4 doses for children Cut finger nails short to minimize damage to lesion and to prevent autoinoculation from scratching HA(MSN) 175

131. Fungal skin disorder 1. Dermatophytoses (Mycoses) Is a fungal infection of the skin, hair and nails Types a. Tinea pedis (Athlete’s foot) Is itchy, whitish scaling lesions and inflammation of the superficial skin of the feet and interdigital spaces of the toes Common between the 4 th and 5 th toe . Often seen in people wearing rubber boots/shoes HA(MSN) 176

132. HA(MSN) 177

133. Cont.. Management Keep the space in between the toes dry wear cotton socks Avoid shoe that are too tight/hot changing socks daily prevents reinfection . Imidazole cream/ whitfield’s ointment twice daily until symptoms disappear for a total of 4 weeks Treat secondary bacterial infection if present HA(MSN) 178

134. b. Tinea corporis (Tinea circinata) A fungal infection that affects the trunk, legs, arms/neck, excluding the beard area, feet, hands and groin Is fungal infection of the skin most common on the exposed surfaces of the body. Sites are face, arms and shoulders . Intensive itching is there Frequent causes of tinea corporis is the prescence of an infected pet in the home HA(MSN) 179

135. Cont.. Management Imidazole cream/ whitfield’s ointment twice daily for a minimum of 4 weeks Multiple, widespread lesions may be treated systematically Griseofulvin 500mg once daily for 2-6wks (10-15mg/kg) Ketaconazole 200mg once/twice daily When there is sever itching antihistamines /mild steroids can be added HA(MSN) 180

136. HA(MSN) 181

137. c. Tinea capitis (ring worm) Is a contagious fungal disease of the scalp and hair shaft Sign and symptom One or more round patches with scaling Hair loss ( temporarly ), alopecia Lymphnodes in the neck swell and the patient may have fever and headache Diagnosis Clinical Microscopy of affected hairs and skin(KOH) HA(MSN) 182

138. HA(MSN) 183

139. Cont.. Management Greseofulvin 500mg once daily for 8-12 weeks. (10-15mg/kg for children) Add whitfield’s ointment/ miconazole twice daily topically for 4 weeks In case of bacterial super infection antiseptics and /antibiotics are needed HA(MSN) 184

140. d. Tinea unguium - Is a chronic fungal and some times mixed yeast infection of the toe/finger nails Is commonly occurs in people who frequently wet the hands such as domestic workers, cleaners, kitchen and laundry staff Sign and Symptom Nail become t hickened , friable (easily crumbled), lusterless Accumulation of debris under the free edge of the nail The nail may be destroyed HA(MSN) 185

141. HA(MSN) 186

142. Cont.. Management Griseofulvin 500gm once daily until the affected nails have grown out completely (year/longer) even though it recurred. If there is no improvement by griseofulvin in 2-4 months  mixed yeast infection - use ketaconazole 200mg/d until symptoms clear. ( Itraconazole 200mg/d x 3 months, or Itraconazole 200mg bid x 1week per month during 3 months) Keep the site dry HA(MSN) 187

143. e. Tinea versicolor ( pityriasis versicolor ) Is a common chronic superficial fungal infection which is caused by the unicellular yeast pityrosporum ovale or orbiculare which is normally present on the trunk as a commensal . Often there is cosmetic complaints HA(MSN) 188

144. HA(MSN) 189

145. Cont.. Sign and Symptom Appears commonly when there is warm and humid air, pregnancy, and serious underlying disease Hypopigmented macule on the trunk Disturbance of the pigment of the skin ( versicolor ) Recurrences are common especially after in adequate treatment or re-infection. Diagnose Clinical Microscopy HA(MSN) 190

146. Cont… Management Scrubbing the skin with a brush takes away a lot of the infected scales. Imidazole cream twice daily on affected areas for 4 weeks. Add selenium sulphide suspension / ketaconazole 2% shampoo twice weekly. Selsun shampoo to affected areas overnights as a lotion or to affected areas and the scalp for 10 minutes daily for 2-4 weeks. HA(MSN) 191

147. f. Tinea cruris (Jack itch) A fungal infection of the groin, pubic region and thighs Sign and symptom Scaling at the periphery A patch that may spread to buttocks Starts from groin and advancing down to inner thigh Itching and irritation Diagnosis Clinical,KOH Management Treat with topical antifungal or systemic antifungal for sever cases Reduction of moisture in groin Wash contaminated under wear in hot water HA(MSN) 192

148. g. Tinea barbae Is a fungal infection involving the beard Affects males only More common in farmers Sign and symptom Pruritis Tenderness and pain Pustular folliculitis around the hair follicle Involved hairs are loose and easily removed Management: Systemic antifungal HA(MSN) 193

149. HA(MSN) 194

150. h. Candidiasis / moniliasis / Candida albicans is a resident of the mucus membranes , it becomes pathogenic under favourable host condition these are: When host immunity is decreased, such as HIV, cancer, steroid use, cytotoxic drugs, radiotherapy, chronic disease, pregnancy and contraceptive pill use Warm and moisture (groins, under breasts, b/n toes) Use of broad spectrum antibiotics which kills resident non pathogenic bacteria HA(MSN) 195

151. HA(MSN) 196

152. HA(MSN) 197

153. Sign and Symptom On the oral ( oral candidiasis /thrush )- white cheesy adherent plaque that can be painful When oral lesions extend to the throat and esophagus they can cause anorexia, nausea, dysphasia, and vomiting On the vulvovagina ( candidia vulvovaginitis )-vaginal irritation, soreness and a thick creamy discharge HA(MSN) 198

154. Management Keep lesions of the skin dry Paint mucosal /smaller wet lesions with Gentian violet daily Nystatin cream , oral suspension twice daily for skin/ oral / miconazol oral gel 4 x /d x 1week Imidazole pessaries nightly for 2 weeks for vaginal candldiasis Imidazole cream twice daily for skin infections Ketaconazole 200mg twice daily for 1-2weeks for oesophageal candidiasis Itraconazole 100mg/d x 2weeks Fluconazole 50-200mg /d x 1-2weeks HA(MSN) 199

155. Parasitic skin disorder a. Scabies Is an infection of the skin caused by a parasite called mite sarcoptes scabiei , a mite which lays its eggs in burrow in the stratum and induces an intensively itchy allergic response Sign and Symptom Small blisters and papules Sever itching , when warm particularly at night Scratch marks and very common secondary infection with pustules Common sites are between fingers, sides of the hands, sides of the wrists, buttocks HA(MSN) 200

156. HA(MSN) 201

157. Cont… Management Treat all close contacts of the patient and family Benzyl benzoate 25% emulsion for adult, dilute with one part water (1:1) for children, dilute with 3 parts water (1:3) for infants. Apply for 3 consecutive nights. Wash off each morning. Sulphur 5-20% ointment twice daily for 1-2 Weeks HA(MSN) 202

158. b. Pediculosis Is an infestation with a louse which may be found in the: Scalp- Pediculosis capitis Body- Pediculosis corporis Hair bearing region- Pediculosis pubis ( phthiriasis ) Sign and symptom Itching (excoriation) The presence of lice and nits Over crowding, poor personal hygiene, prolonged wearing of the same cloth HA(MSN) 203

159. HA(MSN) 204

160. Cont.. Management Improve personal hygiene Improve living condition Change clothing Treat secondary bacterial infection if present HA(MSN) 205

161. F. Viral skin disorder It is an acute contagious short lived (7-12 days) infection of the skin or mucus membrane caused by virus Types: a. Herpes simplex Is an infection which is caused by herpes simplex virus that causes vesicular eruption (cold sore or fever blister) on lip (herpes labialis ), and on genitalia (herpes genitalia ) HA(MSN) 206

162. Cold sores HA(MSN) 207

163. HA(MSN) 208

164. Cont…. Sign and Symptom Few days of burning sensation at the site initially and tingling sensation Then a group of blisters appear which quickly break down to form superficial ulcer Highly contagious when the lesions are visible Diagnose Clinical smear HA(MSN) 209

165. Cont… Management Primary infection-since they are painful: Analgesia Lips: Zinc oxide ointment to soothe and protect from sun light Zinc oxide ointment plus castor oil Antiseptic mouth wash : Chlorhexidine 3-4 times daily HA(MSN) 210

166. Cont…. TTC skin ointment 3 times daily for secondary bacterial infection Genital: KmNo4 ( Betadine ) sitz bath 3 times a day TTC ointment application 3 times a day Zinc oxide and castor oil to soothe For severe infections or infections in immunocompromised patients Acyclovir 200-400 mg five times daily for 5-10 days either topically or systematically Recurrence can be triggered by: - Exposure to sun light (herpes labialis ) -Oral sex, fever, stress, etc HA(MSN) 211

167. b. Herpes zoster (shingles) Is an acute unilateral and segmental inflammation of the dorsal root ganglia of a nerve by a latent varicella zoster infection in the partially immune host. Sign and symptom A localized vesicles in cluster form on one side of the body/unilateral/ Itching, tenderness and severe pain on the site **The thoracic, cervical and ophthalmic nerves are frequently affected HA(MSN) 212

168. b. Herpes zoster… After 1-2 weeks crusts begin to fall off with residual scaring Over 10% of patients develop a persistent burning sensation Much more common in HIV patients, old patients, and malignancy cases HA(MSN) 213

169. HA(MSN) 214

170. Management Analgesia with NSAIDs Antibiotics for secondary infections If the eye is involved immediately refer to ophthalmologist For immunocompromised patients Acyclovir 800mg 5 times daily for 1 week Amitryptline 75mg at night Night/ Carbamazepine 600-800mg/day HA(MSN) 215

171. c. Verrucae /Warts/ Are common benign skin tumors caused by infection with the Human Papilloma Virus . Types: 1. Plantar warts - warts on the sole of the foot 2. Plane (flat/Juvenile) warts - warts on the face of children 3. Genital warts/ condylomata acuminate/ - warts that appear on genital organs 4. Molluscum contagiosum - a wart which appear on small children which has typical characteristics of central dimple and dome shaped papules HA(MSN) 216

172. HA(MSN) 217

173. Sublingeal warts HA(MSN) 218

174. Sign and symptom Found at any age but most common in children and teenagers They can spread by contact The infected person immune system clears the warts with in 2 years in 2/3 cases Management Freeze with liquid nitrogen- Molluscum contagiosum Salicylic acid 50% twice daily followed by scraping the warts – Plantar warts Salicylic acid 2-5% ointement twice daily for 4-8 weeks –Plane warts Silver nitrate pencil touch- daily - Plane warts Podophyllin 10-25% solution apply weekly by using match sticks and wash off after 4-6 hours- Genital warts Threat partners - Genital warts HA(MSN) 219

175. G. Skin cancer Cancer is a disease of the cell in which the normal mechanism of control of growth and proliferation are disturbed. The malignant cell is able to invade the surrounding tissue and regional lymph nodes. Metastasis is the secondary growth of the primary cancer in another organ. Skin assessment-20-39 age-every 3 years > 40 age-annually HA(MSN) 220

176. Plastic surgery (Cosmetic surgery) Are a type of reconstructive surgery performed to reconstruct or to alter congenital or acquired defects or to restore or improve the body’s appearance HA(MSN) 221

177. Purpose of plastic surgery To repair defect (reconstruction) To restore function (restoration) To replace lost part For better appearance To install prosthetic implants For complete change of identity HA(MSN) 222

178. Possible complications of plastic surgery Pigment change- chemical peeling Infection-surgery Milia - chemical peeling Scarring- surgery Atrophy- surgery Sensitivity change- chemical peeling Long term (4 to 5 months) erythema or pruritis - chemical peeling Hematoma- surgery HA(MSN) 223

179. Skin graft Is the technique in which a section of skin is detached from its own blood supply from the donor site and transferred as free tissue to a distant (recipient) Purpose To enhance wound healing To repair defects To cover wounds in which insufficient skin is available To improve appearance HA(MSN) 224

180. Sources of skin graft can be: Autograft - use of tissue from self Allograft - use of tissue from the same species Xenograft - use of tissue from different species Isograft - use of tissue from genetically identical persons HA(MSN) 225

181. Pathophysiology of burn Tissue destruction results from: - coagulation - protein denaturation , or -ionization of cellular contents. Disruption of the skin can lead to: - increased fluid loss, -infection, hypothermia, scarring, -compromised immunity, and -changes in function, appearance, and body image. The depth of the injury depends on: - the temperature of the burning agent and -the duration of contact with the agent. HA(MSN) 230

182. Assessment of burn injury depends on: 1. cause and temperature of the burning agent. 2. location 3. duration of contact with the agent HA(MSN) 231

183. Classification of burn Burn injuries are described according to: - the depth of the injury, -extent of body surface area injured, -location and age . . A. By depth 1. First degree burn (superficial burn) epidermis is involved Redness and pain on the area Healing takes place rapidly within a week. HA(MSN) 232

184. HA(MSN) 234

185. HA(MSN) 235

186. CONT… 2. Second degree burn (partial thickness burn ) epidermis and part of the dermis Blister formation, pain, moist, and swelling. Hair follicles and sebaceous glands may be partly destroyed . Superimposed infection can interfere with healing Small burns (1-2% BSA) of this type can be treated through self care HA(MSN) 239

187. HA(MSN) 240

188. Deep partial thickness HA(MSN) 241

189. HA(MSN) 242

190. Cont’d.. infection by gram + ve bacteria (staphylococcus, streptococcus) occurs during the first day. After the third day, gram – ve bacteria (mainly pseudomonas) predominate and can convert a second degree burn to third degree. Topical therapy with silver sulfadiazines , silver nitrate or antibiotics is essential HA(MSN) 243

191. 3. Third degree burn (full thickness burn) The skin, with all of its epithelial structures, hair follicle, sebaceous gland and subcutaneous tissue destroyed. Dry, pale white, leathery, or charred, broken skin with fat exposed is seen. Symptoms of shock and haematuria can be present. Scarring and loss of function is inevitable. Needs skin graft for healing HA(MSN) 247

192. HA(MSN) 249

193. HA(MSN) 250

194. Fourth degree burn (as char burn) May damage bones, tendons, muscles, blood vessels and peripheral nerves. Necrosis of muscles and bones can happen. *The following factors are considered in determining the depth of burn : How the injury occurred Causative agent Temperature of the burning agent Duration of contact with the agent Thickness of the skin   HA(MSN) 253

195. extravasations HA(MSN) 254

196. RXs 1. Superficial burn treatment Skin is intact so there is a low chance of infection. Topical “exudates” as physical protection can be used. Dressings or films that are self adhesive, water proof and semi-permeable. Skin protectants Cold compresses, external anesthetics, topical corticosteroids and oral pain relievers. HA(MSN) 260

197. 2. Superficial partial thickness burn Unbroken skin  Do not disturb blisters!!! They are protective of the skin below the blister. If broken/ debrided : May become infected so cleanse 1-2x’s/day to remove dead skin. Do not pull on skin! Cleanse with bland soaps or surfactants and water 1-2xs/day First aid antiseptics or antibiotics sufficient Dressing and skin protectant should be used HA(MSN) 261

198. B. By extent TBSA -Rule of nine , - Palm method. 1. Estimate of body surface area using rule of nine It assigns percentages in multiples of nine to major body surfaces It is the most common, simple, and quick method HA(MSN) 262

199. Adult Infant (child ) Head 9% 18% Abdomen and Thorax - Front 18% 18% - Back 18% 18% Genitalia 1% - Hands - Right 9% 9% - Left 9% 9% Leg -Right 18% 14% -Left 18% 14% Total 100% 100% HA(MSN) 263

200. HA(MSN) 264

201. HA(MSN) 265

202. 2. Estimate of body surface area using the Lund and Browder method Is the more precise method of estimating the extent of burn , because it recognizes the various anatomic parts, especially the head and legs Head ----------------------- 7% Neck ----------------------- 2% Anterior trunk ---------- 13% Posterior trunk --------- 13% Right buttock ------------ 2 ½ % Left buttock -------------- 2 ½ % HA(MSN) 266

203. Genitalia ------------------ 1% Right upper arm --------- 4% Left upper arm ----------- 4% Right lower arm ---------- 3% Left lower arm ------------ 3% Right hand ----------------- 2 ½ % Left hand ------------------- 2 ½% Right thigh ---------------- 9 ½% Left thigh ------------------ 9 ½% Right leg ------------------- 7% Left leg --------------------- 7% Right foot ----------------- 3 ½% Left foot ------------------- 3 ½% 100% HA(MSN) 267

204. 3. Palm method Used in patients with scattered burns The size of the patient’s palm is approximately 1% of TBSA   In general an adult who suffered burns of 25% and an infant (child) of 15% wherever the location requires Hospitalization HA(MSN) 268

205. C. By location Burns of the -face, -neck and -circumferential burns of the chest may inhibit respiration Burns of the hands, feet, joints, and eyes are of concern because they make self care impossible Hands and feet are difficult to manage medically because of superficial vascular and nerve supply systems HA(MSN) 269

206. Cont… The ears and nose , composed mainly of cartilage, are susceptible to infection because of poor blood supply to the cartilage Burns of the buttock or genitalia are susceptible to infection circumferential burns of the extremities can cause circulatory compromise distal to the burn with subsequent neurologic impairment of the affected extremity HA(MSN) 270

207. D. By age an infant is less able to cope with burn injuries because of: - an immature immune system and - generally poor host defense mechanisms, The older adult heals more slowly and has more difficulty with rehabilitation than a child or younger adult Infection of the burn wound and pneumonia are common complications in the older patient   HA(MSN) 271

208. Fluid type and fluid replacement formulas for burn patients Fluids can be: Colloids are whole blood, plasma, plasma expanders, and dextran , etc Crystalloid (Electrolytes) are sodium chloride, ringers lactate, etc   Fluid replacement formulas are: Consensus formula Evans formula Brooke Army formula Parkland/Baxter formula   HA(MSN) 272

209. 1. Consensus formula (In the first 24 hours ) - the most commonly used method 2-4ml X kg X % TBSA burned for 24 hours E.g.: mr.A , 38 years old factory worker, 60kg body weight, sustained a burn injury with a 30% body surface burn came to surgical emergency OPD where you are working. How are you going to calculate the fluid to be replaced for mr.A ? Using the Consensus formula 2ml X 60kg X 30%= 3600ml/24 hours HA(MSN) 273

210. Plan of fluid administration Half of the calculated fluid in the above case 1800ml should be given over the first 8 hours and the remaining half that is 1800ml over the next 16 hours. For example   Our casualty has a burn to his legs approximating 18% of body surface:  18 He weighs approximately 100 Kilograms:  100 Therefore 100 x 4 = 400,  400 x 18 = 7200 7200 CCs of fluid are needed. HA(MSN) 274

211. cont’d Standard IV drip sets for Prehospital cases are usually called Macrodrip sets ...they deliver 1ml Q 10 drop, 1ML= 1CC In order to deliver 3600 CCs of fluid in eight hours we would set the drip rate at 75 drops per minute, or 7.5 CCs per minute. 7.5 CCs x 480 minutes (8 hours) = 3600 CCs or 3.6 Litres (1000 CCs per Litre ) HA(MSN) 275

212. 2. Evans formula Colloids- 1ml X Kg X % TBSA burned Electrolyte(normal saline)- 1ml X Kg X % TBSA burned Plan of fluid administration Day 1: Half to be given in first 8 hours; remaining half over the next 16 hours Day 2: Half of previous day’s colloids and electrolytes HA(MSN) 276

213. 3. Brooke Army formula Colloids 0.5 ml X Kg X % TBSA burned Electrolyte(Ringer’s lactate)- 1.5 ml X Kg X % TBSA burned Plan of fluid administration Day 1: Half to be given in first 8 hours; remaining half over the next 16 hours Day 2: Half of colloids; half of electrolytes HA(MSN) 277

214. 4. Porkland /Baxter formula Ringer’s lactate- 4 ml X Kg X % TBSA burned Plan of fluid administration Day 1: Half to be given in first 8 hours; remaining half over the next 16 hours Day 2: Varies. Colloid is added HA(MSN) 278

215. Systemic effects of burn Metabolic - client is in a hypermetabolic stage Endocrine increased catecholamines , ADH, aldosterone , and cortisol increase metabolism O2 and calorie needs are increased the body is under stress response  catabolism increases calorie requirements may be double or triple the usual amount needed HA(MSN) 279

216. Respiratory Major cause of morbidity/ mortality inhalation injury r/t contact to steam, toxic fumes, or smoke may be r/t treatment  large amount of fluid volume infused may cause edema increase in alveolar capillary permeability constriction of chest r/t circumferential burn injury can occur from edema from irritants which cause edema and blockage of trachea HA(MSN) 280

217. Respiratory… decreased movement of the normal cilia in the trachea may allow foreign bacteria and particles to enter into the lungs lining of the trachea may slough off and become lodged in the bronchus damage to the alveoli and the capillary membrane may lead to infection and respiratory failure HA(MSN) 281

218. Cardiac cardiac output is the most effected by the loss of fluid early the rate increases to compensate for the loss of volume cardiac output remains decreased in spite of the increase rate may be decreased for 36 hrs when fluid is replaced goes back to normal function HA(MSN) 282

219. GASTROINTESTIONAL Effects occur due to the shift of blood volume to vital organs Epinephrine and NE inhibit gastric motility and decrease blood flow to the GI tract Decreased periostalis occurs H+ ion production increases Develop ulcers (Curling’s ulcer within 24 hours) Use H2 blockers HA(MSN) 283

220. Immune response Widespread impairment of the immune system Skin is barrier to invading organisms Changes in the WBC’s occur, Susceptibility to infection increases HA(MSN) 284

221. Renal response Blood flow to the kidneys is decreased and renal ischemia occurs Unless flow is improved renal failure occurs With full thickness electrical burns myoglobin and hemoglobin are released in the blood and can occlude the renal tubles  With adequate diuretics and fluid the problem can be corrected HA(MSN) 285

222. Renal function may be altered as a result of decreased blood volume . Destruction of RBC at the injury site results in free haemoglobin in the urine. If muscle damage occurs, myoglobin is released from the muscle cells and excreted by the kidney. If there is in adequate blood flow through the kidneys, the hemoglobin and myoglobin occlude the renal tubules resulting in acute tubular necrosis and renal failure. HA(MSN) 286

223. Etiologies of burn Many causes  cause affects the outcome Dry hea t-open flame  house fire and explosionsŸ Moist heat =scald  older adults most common=spills and splatters Contact burns  hot metal/tar/grease (industrial, home and restaurants) usually deep because liquid is extremely hot Chemical injury -occurs in home and industry (drain cleaner, acids used in industry or chemicals in industry ) **Severity depends on the length of contact and amount of tissue exposed HA(MSN) 287

224. Management of the patient with a burn injury Burn care must be planned according to the burn depth, local response, the extent of the injury, and the presence of a systematic response. Burn care then proceeds through 3 phases HA(MSN) 288

225. Emergent/ resuscitative phase Duration is from onset of injury to completion of fluid resuscitation. The priorities are  ABC of first aid Prevention of shock Prevention of respiratory distress Detection and treatment of concomitant injuries Wound assessment and initial care HA(MSN) 289

226. Emergent/ resuscitative phase… The goal of fluid replacement therapy should be out put totals of 30 to 50ml/ hour, in addition systolic blood pressure exceeding 100 mmHg and pulse rate less than 110/minute. Oral resuscitation can be successful in adults with less than 20% TBSA and children with less than 10% to 15 % TBSA HA(MSN) 290

227. 2. Acute/ intermediate phase Duration is from the beginning of diuresis to near completion of wound closure. The priorities are- wound care and closure Prevention and treatment of complications, including infection. Nutritional support HA(MSN) 291

228. 3. Rehabilitation phase Duration is from major wound closure to return to individual’s optimal level of physical and psychosocial adjustment. The priorities are- Prevention of scars and contractures. Physical, occupational and vocational rehabilitation Functional and cosmetic reconstruction . Psycho-social counseling HA(MSN) 292

229. Nursing management by using the nursing process 1. Assessment Vital signs- especially respiration rate and pulse Respiratory functions Monitor fluid intake and out put Urine out put hourly Maximum requirements of fluid replacement Body weight History of allergy HA(MSN) 293

230. Tetanus immunization Past medical and surgical problems Current illness and use of medication Patient with facial burns- eye examination Depth of the wound Time of injury Burn occurrence in closed space Related trauma Level of consciousness Excessive fluid volume loss HA(MSN) 294

231. 2. Nursing diagnosis 3. Outcome identification 4. Planning 5. Implementation 6. Evaluation Complication of Burn/Most severe ones are: Air way obstruction Hypovolemic shock Secondary infection Contracture   HA(MSN) 295

232. Wound I. Based on cleanness Clean wound - has a discharge that may be fresh blood/ serum. Septic wound - has discharge like pus, exudates, and dead tissues. II. Based on opening 1. Closed wound - involves injury to the underlying tissues with out a break to the skin or mucus membrane 2. Open wound - is a break in the skin or mucus membrane HA(MSN) 296

233. Cont’d III. Based on tissue damage 1. Abrasion/Graze/wound The outer layer/superficial layer of the protective skin is scrapped off 2. Incised wound/cut/ When body tissue is cut by a sharp edged material 3. Lacerated wound It is an irregular tearing of soft tissue 4. Puncture/stab/wound 5. Avulsion wound 6. Contusion wound/bruise/ wound A closed wound that results in tissue damage and ruptured blood vessels If internal organs are contused serious effect may result       HA(MSN) 297

234. Types of wound healing 1 . Primary intention The wound is clean and no tissue loss The wound closes rapidly because there are no gaps in the tissue Edges can be approximated with suture/staples (clip)/ wound closure strips Risk of infection is low Fine scar will remain E.g.: surgical incision 2. Secondary intention Loss of tissue Irregular edge, large wound with blood clot Edge can not be approximated Greater risk of infection Longer healing time Granulation tissue f ills in wound Visible scar formation E.g.: wounds from trauma, ulceration and infection HA(MSN) 298

235. Cont’d… 3 . Tertiary intention Large area of tissue loss Contaminated wound Delayed closure even with suture that breaks down and re-sutured latter Results in deeper and wider scar E.g.: primary wound which was infected HA(MSN) 299

236. Phases of wound healing Inflammatory phase Occurs immediately after an injury and lasts 4-6 days Small blood vessels become more permeable Presence of edema Pain and tenderness occurs Phagocytosis occurs The client shows elevated temperature, leukocytosis and generalized malaise HA(MSN) 300

237. 2. Proliferative or granulation phase Begins between 1 and 4 days after the injury and ends 14-21 days later Rapid growth of epithelial cells Rebuilding of vascular capillary network and collagen tissue Collagen fibers fill in the gap and form the scar Wound scar tissue is very fragile and susceptible to re-injury The color is red because of increased blood flow HA(MSN) 301

238. cont’d… 3. Maturation or wound remodeling phase Wound contraction begins between 14-21 days, after the injury and lasts up to 2 years Scar shrinks and become flat Less red as the capillary regress HA(MSN) 302

239. Factors that delay wound healing Age Nutrition - adequate nutrition that includes essential amino acids, vitamin A, C, and zinc is essential for normal wound repairs Infection - Hormonal influences - the therapeutic administration of adrenal corticosteroids can make: Impairs phagocytosis Inhibit fibroblast proliferation and function Depresses the formation of granulation tissue Inhibit wound contraction Mask presence of infection by impairing normal inflammatory response Blood supply - Poor blood flow may occur as result of swelling, arterial and venous pathology HA(MSN) 303

240. Wound separation Presence of foreign bodies - Smoking - vasoconstriction caused by smoking, decreases blood supply to the wound, the carbon in smoke binds with hemoglobin and further diminishes oxygenation Obesity - the bulk and weight of adipose tissue causes poor vascularity Fluid and electrolyte balance - Immuno -suppression - Radiation therapy - the blood supply in irradiated tissue is decreased HA(MSN) 304

241. Handling of tissue - rough handling causes injury and delayed healing Edema - reduces blood supply by exerting pressure on blood vessels Medications -Anti-inflammatory - decrease epithelization and wound contraction -Corticosteroids - may mask presence of infection by impairing normal inflammatory response -Anticoagulants - may cause hemorrhage Patient over activity - prevents approximation of wound edges HA(MSN) 305

242. Cont’d Wound stressors - like vomiting, coughing heavily, and straining produces tension on wounds and destroys granulation tissue that prevents apposition of wound edges Poor general health - alters cellular function Duration of surgical procedure - the longer the time the higher the delay of wound healing Drainage accumulation - accumulation of drainages favors bacterial growth Bleeding (hemorrhage) - bleeding sites becomes a growth media for microorganisms HA(MSN) 306

243. Complications of wound healing Hypertrophic scar and keloids - due to excess production of collagen tissue Contracture- shortening of muscle or scar tissue Delviscence Separation and disruption of previously joined wound edge It can be due to infection, inflammation, weak granulation tissue. Evisceration- excess growth of tissue protrudes above the surface of the healing wound. Adhesions- binding two surfaces or structures that normally are separate HA(MSN) 307

244. Cont’d… Major organ dysfunction- Herination - the surface layer remains intact but the deep layers separate permitting the underlying muscles/organs bulge Fistula- draining tunnel may form between two organs Sinus tract- an abscess may form in deeper tissues and form a tunnel to the out side of the body Hematoma - collections of blood or serum in wound ( seroma ) Infection - Hemorrhage - HA(MSN) 308

245. Thanks but still to go!!!!!! HA(MSN) 309