INTEGUMENTARY SYSTEMINTEGUMENTARY SYSTEM

GENERAL OVERVIEWDESCRIPTION OF SKIN LESIONS

PRIMARY LESIONSMacula - flat, circumscribed discoloration of skin; may have any size or shape

• Papule - solid, elevated lesion less than 1 cm wide

•Nodule - raised, solid lesion larger than 1 cm wide.

•Vesicle - circumscribed elevated lesion less than 1 cm, containing fluid.

•Bulla - a vesicle or blister larger than 1 cm wide.

Pustule - circumscribed raised lesion that contains pus; may form as a result of purulent changes in a vesicle.

•Wheal - elevation of the skin that lasts less than 24 hours, caused by edema of the dermis; may be surrounded by erythema or blanching.

•Plaque - solid, elevated lesion on the skin or mucous membrane, larger than 1 cm in diameter; psoriasis is commonly manifested as plaques on the skin; leukoplakia is an example of plaques on mucous membranes.

•Cyst - soft or firm mass in the skin, filled with semisolid or with liquid material contained in a sac.

Secondary Lesions• Secondary lesions involve changes

that take place in primary lesions that modify them.

•Scale - heaped-up, horny layer of dead epidermis; may develop as a result of inflammatory changes.

•Crust - covering formed by the drying of serum, blood, or pus on the skin.

•Excoriation - linear scratch marks or traumatized areas of skin.

•Fissure - cracks in the skin, usually from marked drying and long-standing inflammation.

•Ulcer - lesion formed by local destruction of the epidermis and by part or all of the underlying dermis.

•Lichenification - thickening of skin accompanied by accentuation of skin markings.

Scar - new formation of connective tissue that replaces the loss of substance in the dermis as a result of injury or disease.

•Atrophy - diminution in size or in loss of skin cells that causes thinning of the skin.

Configuration: A) Linear - in a line.

B) Arciform - in the form of an arc, curved.   1. Arcuate: having an outline of a curved line or arc.  2. Annular: ring-shaped  3. Serpentine: having an outline like a serpent, coiled.  4. Polycyclic: having two or more rings.  5. Targetoid:  resembling a target, rings within rings.

C) Circular - having an outline of a full circle without central clearing. (Guttate - like a gutt or drop. Nummular or discoid - having the shape and size of a coin or a disc.)

Shape and Configuration• Circinate - circular• Confluent - lesions run together or join• Discrete - lesions remain separate• Generalized - widespread eruption• Grouped - clustering of lesions• Herpetiform - grouped vesicles

• Iris - ring or a series of concentric circles• Multiform - more than one kind of skin

lesion• Polymorphous - occurring in several or

many forms• Reticulated - lacelike network• Serpiginous - snakelike or creeping

eruption

• Telangiectasia - tiny, superficial, dilated cutaneous vessel; can be seen as a red thread or line

• Zosteriform or dermatomal - bandlike distribution, limited to one or more dermatomes of skin

History and Assessment

• C-haracter• L-ocation• I-ntensity• T-ime• A-asso. factors• A-ggravating factors

ASSESSMENT HISTORY

• Characteristics of Rash• When did the rash first occur? Was the

onset sudden or gradual?• What site was first affected? Describe

the spread and its severity.• What was the initial color and

configuration of the rash? Has it changed?

• Is there associated itching, burning, tingling, pain, or numbness?

• Has it been constant or intermittent?

DIAGNOSTIC TESTS LABORATORY TESTS

Microscopy• Sample taken by scraping, swabbing,

or aspirating a lesion is transferred to a glass slide for observation or staining.– Direct visualization of scrapings mixed

with mineral oil to detect scabies, mites, or lice nits that cling to hair.

– Gram stain may be performed to tentatively identify bacteria in certain skin infections.

Culture• Drainage from lesions may be cultured

on specific media to detect causative organism and sensitivity to antimicrobial therapy

• Usually takes 24 to 48 hours for results; fungal cultures may take 4 to 5 weeks.

Patch Testing• Patch testing is an office procedure done

in dermatology to determine if patients are allergic to contact materials.

• Materials are applied in patches to the skin and checked for reaction 48 hours after application and possibly again later.

• Erythema, swelling, papules, and vesicles indicate an allergic contact dermatitis rather than an irritant contact dermatitis or no reaction.

GENERAL PROCEDURES AND TREATMENT MODALITIES

BATHS AND WET DRESSINGS• A therapeutic bath is used to apply

medication to the entire skin surface and is useful in treating widespread eruptions and general pruritus.

• Baths soothe, soften, and reduce inflammation, and relieve itching and dryness.

• Wet dressings and soaks are damp compresses that contain water, normal saline solution, aluminum acetate solution, or magnesium sulfate solution.

• They may be sterile or clean, or warm or cool, depending on the skin condition and the area to which they are applied.

THERAPEUTIC BATHS• Indications• Vesicular disorders, eczema, atopic

dermatitis• Acute inflammatory conditions.• Erosions and exudative, crusted

surfaces.

OPEN WET DRESSINGSIndications• Bacterial infections that require

drainage.• Inflammatory and pruritic

conditions.• Oozing and crusting conditions.

DRESSINGS FOR SKIN CONDITIONSOcclusive Dressing• An occlusive dressing is formed by an

airtight plastic or vinyl film applied over medicated areas of skin (usually with corticosteroids) to enhance absorption of medication and to promote moisture retention.

Indications• Skin conditions with thick scaling, such

as psoriasis (on feet) and lichen simplex chronicus

SKIN BIOPSY• Removal of a piece of skin by shave,

punch, or excision technique to detect malignancy or other characteristics of skin disorders.

Types of biopsy.1. Excisional Biopsy-  In this procedure the

entire lump or tumour is excised and a margin of normal tissue is present around the lesion together with subcutaneous fat.

2. Incisional Biopsy-  A portion of the lump is removed surgically.  This is most commonly used for tumours of the skin. A.  Shave Biopsy :   In this procedure the surface portion is sliced off with a blade.B. Curette method:  In this procedure the surface of the lesion is scrapped off.These methods are done to remove small growth and to confirm its nature.C. Punch Biopsy:  This procedure is done to sample skin rashes and small masses. A small cylinder of skin is removed. 

WOUND COVERAGE: GRAFTS AND FLAPS

• Wound coverage, using grafts and flaps, is a type of reconstructive (plastic) surgery performed to improve the skin's appearance and function.

Skin graft• A section of skin tissue is separated

from its blood supply and transferred as free tissue to a distant (recipient) site; it must obtain nourishment from capillaries at the recipient site.

• In dermatology, skin grafting is used to repair defects that result from excision of skin tumors and to cover areas of denuded skin.

• Definitions.– Autografts - grafts done with tissue

transplanted from the patient's own skin.– Allografts - involve the transplant of tissue

from one individual of the same species; these grafts are also called allogenic or homografts.

– Xenograft or heterograft - involve the transfer of tissue from another species.

• Classification by thickness.– Split thickness (thin, intermediate, or

thick) - graft that is cut at varying thicknesses and is used to cover large wounds because its total potential donor area is virtually unlimited.

– Full thickness - graft consists of epidermis and all of the dermis without the underlying fat; used to cover wounds that are too large to close primarily. They are used frequently to cover facial defects because they provide a better contour match and less postoperative contracture.

Skin Flaps• A flap is a segment of tissue that has

been left attached at one end (called a base or pedicle); the other end has been moved to a recipient area. It is dependent for its survival on functioning arterial and venous blood supplies and on lymphatic drainage in its pedicle or base.

• Flaps offer the best aesthetic solution because a flap retains the color, texture, and thickness match of the donor area.

AESTHETIC PROCEDURES• Aesthetic procedures (cosmetic

surgery) consist of reconstructive (plastic) surgery performed to reconstruct or to alter congenital or acquired defects or to restore or improve the body's appearance.

Types of Procedures• Rhytidectomy• Done through various techniques and

incisions to alleviate skin folds and wrinkles to improve the appearance of the aging face (face lift).

• The correction can last as long as 10 years, but results vary with each individual. Skin relaxes with time, and the muscles may also relax, but seldom does the face revert to its preoperative condition.

Rhytidectomy

Blepharoplasty• Removes loose skin, muscle and excess

fat from upper or lower eyelids. It will not remove lines at the lateral corners of the eyes.

• The procedure is generally done by either scalpel under local or general anesthetic or by carbon dioxide laser

Dermabrasion, Chemical Peel, and Laser Resurfacing

• Patients with weathered skin, fine wrinkles (especially at the corner of the eyes and along the vermilion border), or acne pitting and scarring may benefit from these procedures.

Laser Resurfacing• Dressings, such as Flexan, Vigilon,

or Biobrane, may be applied to the affected areas immediately and left in place for 24 to 48 hours

• Alternately, the open technique involves using petroleum jelly and daily face washes with tepid water.

Liposuction• Also called body contouring, liposuction

reduces localized deposits of fat not amenable to weight loss, with a cannula aided by suction or fitted to a syringe.

• May be done on the face, neck, breasts, abdomen, flanks, hips, buttocks, and extremities.

ScabiesScabies

Scabies definition • Scabies is a disease of the skin caused by a mite. {Sarcoptes

scabiei}

The parasite is very tiny almost impossible to see without a microscope.

• It lives inside the layer of the skin.

• This mite lays their eggs under the skin and feeds on blood.

Population Population

Who gets scabies?Who gets scabies? • Anyone can have a scabies infestation.Anyone can have a scabies infestation.

• Scabies can affect people of any age, gender or Scabies can affect people of any age, gender or race and social levels. But it occurs mostly in race and social levels. But it occurs mostly in children and young adults. children and young adults.

• Even people who keep themselves very clean Even people who keep themselves very clean can get scabies.can get scabies.

  • If a person has had a scabies infestation before, If a person has had a scabies infestation before, it can get reinfested again if they are exposed to it can get reinfested again if they are exposed to the mites.the mites.

How the Scabies Disease is How the Scabies Disease is transmitted?transmitted?

• Scabies mites are highly contagious and Scabies mites are highly contagious and are spread or transmitted by close skin are spread or transmitted by close skin contact with someone who has scabies. contact with someone who has scabies. Also Infestation is easily spread to sexual Also Infestation is easily spread to sexual partners and household members. partners and household members.

• Scabies can also be spread by sharing Scabies can also be spread by sharing towels, bed sheets, and other personal towels, bed sheets, and other personal belongings.belongings.

Symptoms and Diagnosis

• It causes a severe itchy skin.

• Itching usually get worse at night and while bathing.

• Visible symptoms include rash and bumps between the fingers wrists, elbows or knees and buttocks also on the head, neck, palms, and foot soles. with the appearance scaly or crusty skin.

• Diagnosis - based on the symptoms, or sample of the skin by gently scraping on the affected areas of the dry skin.

Exclusion policy for this disease

• Exclude persons with scabies from school or day care until 24 hours after treatment.

Treatment• Treating scabies means killing the mites and

their eggs. Prescription skin creams or lotions will kill the mites and eggs. Medication should be applied as directed by the doctor. Second treatments may be prescribed.

Responsibility of the caregiver to stop the spread of this disease.

• Prevent infections from spreading by reporting the illness.

• Exclude from the facility the child or children that are infected.

• Don’t wait until a break out occurs!

• Report the infection to the child care director

• Clean all of the child's clothes and bedding by washing in very hot water.