Skin Disorders
Introduction
·
The skin is the largest organ of the human body,
covering approximately 1.5–2 m² in adults and accounting for 16–18% of body
weight.
·
It serves as the first line of defense against
environmental hazards, pathogens, mechanical injury, and dehydration.
·
Key functions of the skin include:
·
Protection
– against microorganisms, UV radiation, physical and chemical injuries.
·
Thermoregulation
– via sweating and vasodilation/vasoconstriction.
·
Sensation
– through receptors for touch, pain, temperature, and pressure.
·
Metabolic functions
– vitamin D synthesis.
·
Excretion
– of salts, water, and small amounts of waste.
Definition
Burns are tissue injuries caused by heat,
chemicals, electricity, radiation, or friction, resulting in varying
degrees of skin and sometimes deeper tissue damage..
Causes
- Thermal
– flames, hot liquids, steam, hot objects.
- Chemical
– acids, alkalis, industrial chemicals.
- Electrical
– high-voltage or low-voltage current injuries.
- Radiation
– sunburn, radiotherapy exposure.
- Friction
– skin abrasion due to rubbing.
Classification
- By
depth of injury
- First-degree
(Superficial burns):
- Affects
only epidermis.
- Symptoms:
redness (erythema), mild pain, no blistering.
- Example:
sunburn.
- Second-degree
(Partial-thickness burns):
- Involves
epidermis and part of dermis.
- Symptoms:
blistering, severe pain, swelling, wet appearance.
- Healing:
2–3 weeks with minimal scarring.
- Third-degree
(Full-thickness burns):
- Destroys
epidermis, dermis, sometimes extends to subcutaneous tissue, muscle,
bone.
- Symptoms:
leathery skin, painless (due to nerve damage), white/charred appearance.
- Healing
requires grafting.
- By
extent of body surface area
- Rule
of Nines (adults): estimates total body
surface area (TBSA) burned.
- Lund
and Browder chart: more accurate for children.
- By
severity
- Minor,
moderate, or major depending on depth, % TBSA, location (face, hands,
perineum, joints), and associated complications (inhalation injury,
shock).
Pathophysiology
- Immediate
skin barrier disruption → fluid and electrolyte loss → hypovolemia and
shock.
- Inflammatory
response → edema, tissue necrosis.
- Increased
risk of infection due to exposure of underlying tissues.
- Severe
burns → systemic effects: hypermetabolism, immune suppression, multi-organ
dysfunction.
Complications
- Shock
and hypovolemia.
- Sepsis
and wound infection.
- Contractures
and scarring.
- Respiratory
complications (smoke inhalation).
- Electrolyte
imbalance, renal failure.
Management
- First
aid
- Stop
burning process, remove heat source.
- Cool
with running water (not ice).
- Cover
with sterile cloth to prevent infection.
- Avoid
breaking blisters.
- Hospital
management
- Airway,
Breathing, Circulation (ABC) assessment.
- Fluid
resuscitation (Parkland formula).
- Pain
management.
- Wound
care: cleaning, debridement, dressings.
- Antibiotics
to prevent infection.
- Nutritional
support (high protein, calories, vitamins).
- Surgical
management: skin grafting, escharotomy if needed.
- Rehabilitation
- Physiotherapy
to prevent contractures.
- Psychological
support for disfigurement and trauma.
- Scar
management (pressure garments, silicone sheets).
Definition
A lesion is an abnormal change in the
structure or appearance of skin tissue, which may be congenital,
infectious, inflammatory, neoplastic, or traumatic.
Classification
- Primary
Skin Lesions (develop as initial manifestation of
disease):
- Macule:
flat, non-palpable, discolored spot (e.g., freckles, measles).
- Papule:
raised, solid lesion <1 cm (e.g., warts, lichen planus).
- Nodule:
firm, larger than papule, deeper involvement (e.g., lipoma).
- Plaque:
raised, flat-topped lesion >1 cm (e.g., psoriasis).
- Vesicle:
small fluid-filled blister (e.g., chickenpox, herpes simplex).
- Bulla:
large fluid-filled blister (e.g., burns, bullous pemphigoid).
- Pustule:
pus-filled lesion (e.g., acne, impetigo).
- Wheal:
transient, edematous, irregular elevation (e.g., urticaria).
- Secondary
Skin Lesions (evolve from primary lesions or
result from external trauma):
- Crust:
dried serum, blood, pus (e.g., impetigo).
- Scale:
flaky shedding of keratinized cells (e.g., dandruff, eczema).
- Erosion:
shallow loss of epidermis (e.g., ruptured vesicle).
- Ulcer:
deeper loss of skin (e.g., pressure sores).
- Fissure:
linear crack in skin (e.g., athlete’s foot).
- Scar:
fibrous tissue replacing damaged skin.
- Atrophy:
thinning of skin.
- Lichenification:
thickened, leathery skin due to scratching.
Causes
- Infectious:
bacterial (impetigo, cellulitis), viral (herpes, warts), fungal (ringworm,
candidiasis).
- Inflammatory:
eczema, psoriasis, dermatitis.
- Autoimmune:
lupus erythematosus, pemphigus vulgaris.
- Neoplastic:
basal cell carcinoma, squamous cell carcinoma, melanoma.
- Traumatic:
cuts, burns, insect bites.
Diagnosis
- Clinical
examination.
- Skin
biopsy, dermoscopy.
- Microbiological
tests (KOH mount, cultures).
- Blood
tests for autoimmune markers.
Management
- General
care: maintain hygiene, avoid irritants, use
emollients.
- Medications:
- Antibiotics
for bacterial infections.
- Antifungals
for fungal lesions.
- Antivirals
for viral lesions.
- Corticosteroids
(topical/systemic) for inflammation.
- Immunosuppressants
in autoimmune conditions.
- Surgical:
excision of tumors, cryotherapy, laser therapy.
- Preventive
measures: sun protection, early detection of
suspicious moles, good personal hygiene.
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