3.A. Dermatoses from Physical Factors [Heat Injuries]

Question 1

Thermal burns

Answer 1

Injury of varying intensity may be caused by the action of EXCESSIVE HEAT on the skin

Question 2

First-degree burns

Answer 2

An active congestion of the superficial blood vessels, causing erythema that may be followed by epidermal desquamation (peeling)

Question 3

The most common example of a first-degree burn

Answer 3

Sunburn

Question 4

Is 1st degree burn painful?

Answer 4

YES. The pain and increased surface heat may be severe, and some constitutional reaction can occur if the involved area is large.

Question 5

Types of Second-degree burn and affected layer

Answer 5

1. Superficial (beneath outer layer of epidermis) 2.Deep (Reticular dermis)

Question 6

Pathology of Superficial 2nd degree burn

Answer 6

Transudation of serum from the capillaries, which causes edema of the superficial tissues. Vesicle and blebs: NO SCAR

Question 7

Pathology of Deep 2nd degree burn

Answer 7

Injury to the reticular dermis compromises blood flow and destroys appendages. SCAR >1 month healing.

Question 8

Span of injury in Third-degree burns

Answer 8

Loss of the full thickness of the dermis. + Some of the subcutaneous tissues.

Question 9

Type of wound in 3rd degree burn

Answer 9

ULCERATING WOUND: Skin appendages are destroyed, there is no epithelium available for regeneration of the skin.

Question 10

Span of injury in Fourth-degree burns

Answer 10

Entire Skin + Subcutaneous fat + Underlying tendons

Question 11

Which burns require grafting for closure?

Answer 11

3rd and 4th degree burns

Question 12

What location of the skin is burn more severe?

Answer 12

Vascular areas.

Question 13

Poor prognosis of burn in:

Answer 13

1. Large area of involvement ( > 2/3) 2.Women 3. Infants 4. Toddlers

Question 14

Where does Delayed Postburn Blistering occur?

Answer 14

1. Partial-thickness wound 2. Skin graft donor sites Most common on the lower extremities. Self-limited.

Question 15

What type of carcinoma may arise from burn scars?

Answer 15

Squamous cell carcinoma

Question 16

What is the immediate first-aid for minor thermal burns?

Answer 16

Cold applications

Question 17

Which burn lesion forms a natural barrier against contamination by microbes and should not be opened?

Answer 17

Vesicle and Blebs of 2nd degree burns

Question 18

When can fluid may be evacuated under strictly aseptic conditions by puncturing the wall with a sterile needle in a bleb?

Answer 18

When they become tense and unduly painful.

Question 19

What should you do on wounds that won’t reepithelialize in 3 weeks?

Answer 19

Excision of full-thickness and deep dermal wounds after stabilizing hemodynamic status.

Question 20

Advantages of full-thickness and deep dermal wound excision.

Answer 20

1. Reduces wound infections 2. Shortens hospital stays 3. Improves survival Together with grafting, 4. May mitigate contractures and functional impairment.

Question 21

Management for the most superficial thermal wounds?

Answer 21

Greasy gauze

Question 22

Management for intermediate thermal wounds?

Answer 22

Silver-containing dressings

Question 23

Key components of Crtical care of burns:

Answer 23

1. Fluid resuscitation 2. Treatment of inhalational injury and hypercatabolism 3. Monitoring and early prevention of sepsis 4. Pain control 5.Environmental control 6. Nutritional support

Question 24

Intensive care management for burn patients is recommended for:

Answer 24

1. Partial-thickness wound (>10%) 2. Burn on face, hands, feet, genitalia, perineum, or joints 3. Secondary to electrical, chemical or inhalational injury. 4. Patients with special needs 5. Full-thickness burn

Question 25

2 types of electrical burns

Answer 25

1. Contact 2. Flash exposure

Question 26

Which type of electrical burn usually has a larger surface area?

Answer 26

Flash burn

Question 27

Where does low-voltage electrical burn happen?

Answer 27

At home

Question 28

Where does high-voltage electrical burn happen?

Answer 28

Workplace

Question 29

Should surgical intervention be delayed in electrical burns?

Answer 29

NO. Early surgical intervention is helpful in improving circulation and repairing vital tissues to limit loss of the extremity.

Question 30

What is the most lethal type of lightning strike?

Answer 30

Direct lightning strike with entrance and exit.

Question 31

Enumerate indirect lightning strikes:

Answer 31

Linear burns: sweat is present Feathery/ Arborescent pattern: pathognomonic Punctate burns: multiple, deep and circular Thermal burns from ignited clothing or heated metal: phone, ipod

Question 32

Agents excellent for removal of hot tar from burns:

Answer 32

1. Polyy-oxy-ethylene sorbitan in Bacitracin Zinc-Neomycin-Polymixin B (Neosporin) 2. Vitamin E ointment (Webber) 3. Sunflower oil

Question 33

Eruption caused by retention of sweat due to occlusion of eccrine sweat ducts.

Answer 33

Miliaria

Question 34

What type of climate is conducive for Miliaria?

Answer 34

Hot and humid climates

Question 35

Which microorganism induces miliaria in the experimental setting?

Answer 35

Staphylococcus epidermidis

Question 36

What does S.epidermidis produce that obstructs delivery of sweat to the skin surface?

Answer 36

an extracellular polysaccharide (EPS)

Question 37

Pathology of Miliaria

Answer 37

Obstruction of eccrine sweat duct \>\>Increased pressure in the duct \>\>\>\>Rupture of sweat gland/duct at different levels \>\>\>\>\>\>Escape of sweat to adjacent tissue \>\>\>\>\>\>\>\>\>MILIARIA

Question 38

Types of Miliaria:

Answer 38

1. Miliaria crystallina (Sudamina) 2. Miliaria rubra (Prickly heat) 3. Miliaria pustulosa 4. Miliaria profunda

Question 39

Type of Miliaria characterized by: Small, clear, superficial vesicles with no inflammatory reaction

Answer 39

Miliaria crystallina

Question 40

Other term for Miliaria crystallina

Answer 40

Sudamina

Question 41

People prone to Sudamina

Answer 41

Bedridden patients with fever

Question 42

Symptoms and duration of Sudamina

Answer 42

Asymptomatic and short-lived (easily ruptures) Self-limited.

Question 43

Drugs that induce Sudamina

Answer 43

1. Isotretinoin 2. Bethanecol 3. Doxorubicin

Question 44

Type of Miliaria characterized by: Discrete, extremely pruritic, erythematous papulovesicles.

Answer 44

Miliaria rubra

Question 45

Other term for Miliaria rubra

Answer 45

Prickly Heat

Question 46

Symptoms associated with Miliaria rubra:

Answer 46

Prickling, burning, or tingling

Question 47

Most common sites of Prickly heat

Answer 47

1. Antecubital fossa 2. Popliteal fossae 3. Trunk 4. Inframammary areas 5. Abdomen (waistline) 6. Inguinal regions

Question 48

Site of injury in Miliaria rubra where spongiosis is produced.

Answer 48

Prickle cell layer | (Stratum Spinosum)

Question 49

Type of Miliaria characterized by: Distinct, superficial pustules that are independent of the hair follicle.

Answer 49

Milaria pustulosa

Question 50

What causes the injury, destruction and blocking of the sweat ducts in Miliaria pustulosa?

Answer 50

Precedent dermatitis

Question 51

Examples of precedent dermatitis causing Miliaria pustulosa:

Answer 51

1. Contact dermatitis 2. Lichen simplex chronicus 3. Intertrigo

Question 52

Site of pruritic pustules in Miliaria pustulosa:

Answer 52

1. Intertriginous areas 2. Flexure surfaces 3. Scrotum 4. Back of bedridden patients

Question 53

Recurrent Miliaria pustulosa

Answer 53

Type I Pseudohyporaldosteronism

Question 54

Crisis that will induce Miliaria pustulosa and rubra

Answer 54

Salt-losing crises

Question 55

Type of Miliaria: Nonpruritic, flesh-colored, deep-seated, whitish papules.

Answer 55

Miliaria profunda

Question 56

Distribution of Miliaria profunda

Answer 56

Trunk and Extremities.

Question 57

Onset of Miliaria profunda

Answer 57

1 hour after overheating

Question 58

Non-functional sweat glands in Miliaria profunda

Answer 58

ALL. Except for sites with compensatory hyperhidrosis.

Question 59

Sites of Compensatory Hyperhidrosis in Miliaria profunda

Answer 59

1. Face 2. Axillae 3. Hands 4. Feet

Question 60

Type of Miliaria that usually follows a sever Miliaria rubra

Answer 60

Miliaria profunda

Question 61

Results from occlusion of sweat ducts and pores so severe that it impairs ability to work in a hot environment

Answer 61

Postmiliarial hypohidrosis

Question 62

Symptoms of Postmiliarial hypohidrosis

Answer 62

* Decreasing efficiency * Irritability * Anorexia * Drowsiness * Vertigo * Headache * May wander in a daze.

Question 63

Percentage of decrease in sweating ability in Postmiliarial hypohidrosis

Answer 63

50%

Question 64

Duration of Postmiliarial hypohidrosis

Answer 64

3 weeks

Question 65

Rare form of Miliaria with long-lasting poral-occlusion

Answer 65

Tropical anhidrotic asthenia

Question 66

Most efficient treatment for Miliaria

Answer 66

Place patient in cool environment

Question 67

MOA of Anhydrous Lanolin for treatment of Miliaria

Answer 67

Resolves the occlusion of pores and May help to restore normal sweat secretions

Question 68

MOA of **Hydrophilic ointment** in treating Miliaria

Answer 68

Dissolve keratinous plugs and Facilitates the normal flow of sweat.

Question 69

Treatment for mild cases of Miliaria

Answer 69

Dusting powders (Cornstarch or Talcum baby powder)

Question 70

Adjuncts to Miliaria treatment

Answer 70

Soothing and cooling baths (Colloidal oatmeal or Cornstarch)

Question 71

A persistent erythema caused by long exposure to excessive heat without production of a burn.

Answer 71

**Erythema ab igne**

Question 72

What produces **mottling** in Erythema ab igne?

Answer 72

Local hemostasis

Question 73

Evolution of lesion in Erythema ab igne

Answer 73

*[Heat exposure]* Mottling --\> Reticulated erythema (multiple colors) *[Removal of heat]* Reticulated erythema --\> Affection disappears gradually --\>Permanent pigmentation (sometimes)

Question 74

Histopathology of Erythema ab igne

Answer 74

**Increased of elastic tissue in the Dermis** \*Interface dermatitis and epithelial atypia may be noted

Question 75

Condition with similar histopath findings as Erythema ab igne.

Answer 75

Actinic elastosis

Question 77

Situations conducive for Erythema Ab igne

Answer 77

Warming legs in front of open fireplaces, space heaters,or car heaters Electric heating pad application on the lower back Upper thighs with laptop computers Posterior thighs from heated car seats.

Question 78

Occupational risk for Erythema ab igne

Answer 78

Cooks, silversmiths, etc

Question 79

Rare sequelae of epithelial atypia in Erythema ab igne

Answer 79

Bowen’s disease and Squamous cell carcinoma

Question 80

Treatment for Erythema ab igne

Answer 80

1. 5-fluorouracil (5-FU) 2. Imiquimod 3. or Photodynamic therapy

Question 81

Treatment for pigmentation left in Erythema ab igne

Answer 81

Emollients with 1. α-hydroxy acids or a cream 2. Fluocinolone acetonide 0.01% 3. Hydroquinone 4% 4. Tretinoin 0.05% 5. Q-switched Nd:YAG Laser

Question 83

Nd:YAG

Answer 83

* *N**eodymium-**d**oped * *Y**ttrium **A**luminum **G**arnet