Skin Flashcards

1
Q

Give a definition for ‘skin’ including its functions (4)

A

The skin is a self-repairing barrier.

It permits terrestrial life by preventing the entering of microorganisms and chemicals whilst regulating heat and water loss from the body.

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2
Q

What is the integumentary system?

A

The organ system that protects the body from various kinds of damage, such as loss of water or abrasion from outside.

The system comprises the skin and its appendages (including hair, scales, feathers, hooves, sweat glands and nails).

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3
Q

Where would the stratum corneum mostly be located on the body? What is its function?

A

On load bearing areas of the body e.g. the palms of your hands and soles of your feet

It provides mechanical support and a rigid barrier (so when you stop on something, it does not go straight into the body)

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4
Q

What is transdermal delivery? Give 4 advantages of transdermal delivery

A

Transdermal delivery is defined as getting across the skin for systemic action

Advantages include:
1. large surface area so potentially numerous sites

  1. Good patient compliance (e.g. it’s discrete)
  2. Easy cessation of therapy in problematic cases
  3. Avoidance of first pass hepatic metabolism (and therefore no systemic side-effects)
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5
Q

What’s the most common way in which drugs permeate through the skin? (2)

A

Through the follicles and sweat ducts (shunt route)

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6
Q

What are appendages in terms of drug delivery and skin?

A

The appendages are essentially shunt routes (short-cuts) through which molecules can pass across the stratum corneum barrier

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7
Q

Name 3 appendages found that originate in the dermis

A
  1. Hair follicles and associated sebaceous glands
  2. Eccrine (sweat) glands
  3. Apocrine (specialised e.g. milk - nipples) glands
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8
Q

What are the 2 micro routes for permeation via the stratum corneum?

A
  1. transcellular (across the cell)

2. intercellular (between lipids)

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9
Q

Name 3 potential routes through intact skin

A
  1. Shunts (holes)
  2. Intercellular (between lipids)
  3. Transcellular (across the cell)
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10
Q

Out of shunts, intercellular and transcellular, which one is the major route through intact skin to reach the systemic circulation?

A

Intercellular route (between lipids)

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11
Q

Define permeant

A

the molecule moving into or through the skin

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12
Q

What does Flick’s Law of Diffusion assume?

A

The law assumes that diffusion is through an isotropic (meaning same properties in all dimensions) material (aka skin).

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13
Q

What is a Franz cell used for?

A

A Franz diffusion cell is used to measure the delivery of a drug through skin

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14
Q

What is the main drive for drug delivery?

A

Thermodynamic activity

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15
Q

What are key characteristics in selecting a good molecule candidate for skin? Hint MW, LogP, Aqueous solubility

A
  1. MW 300-500
  2. LogP 1 - 3.5
  3. Aqueous solubility > 100 mg/ml
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16
Q

Give the rationale for topical delivery (4)

A
  1. low oral bioavailability
  2. Short half-life
  3. Potential to induce insulin resistance at high doses in diabetic patients
  4. long-term treatment
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17
Q

What is basal cell carcinoma (rodent ulcer)?

A

Basal cell carcinoma is a type of skin cancer.

It’s the least malignant and most common form of skin cancer.

It’s common in later life. Lesions are often on sun-exposed areas of the face.

Lesions appear shiny, dome-shaped nodules that later develop during central ulcer with pearly, beaded edge

It’s relatively slow-growing and metastasis seldom occurs before detection

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18
Q

What’s the treatment for basal cell carcinoma (rodent ulcer)?

A

Treatment:

  • full cure by surgical excision
  • radiotherapy useful in large superficial forms
  • cryo-therapy can be used for superficial forms
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19
Q

What is squamous cell carcinoma?

A

Squamous cell carcinoma arises from keratinocytes of stratified squamous epithelium.

lesions are scaly red papules that can ulcerate and bleed

found on head (scalp, ears, lower lips) and hands

grows rapidly and metastases if not removed

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20
Q

What is malignant melanoma?

A

It is the most dangerous of all skin cancers.

Exposure to UV radiation is a major cause

It’s common on head, face, hands, back (men) and lower left (women).

It’s highly metastatic and resistant to chemotherapy

it occurs spontaneously in melanocytes and can begin wherever there is a pigment

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21
Q

What advice would you to people in regards to the dangers of sunbathing?

A
  • avoid sun exposure during hours 11am-3pm
  • wear a sun hat
  • apply high protection sunscreen e.g. SPF30 and re-apply at regular intervals
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22
Q

What is the USA criteria for recognising melanoma?

A

ABCD(E)

A: Asymmetry - one half doesn’t match the appearance of the other half
B: Border irregularity - the edges are ragged, notched, or blurred
C. Colour - the colour (pigmentation) is not uniform. Shades of tan, brown and black are present. Dashes of red, white and blue add to a mottled appearance
D: Diameter - the size of the mole is great than 1/4 inch (6mm).
E: Elevation - any growth of a mole should be evaluated

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23
Q

Describe the 7-point checklist for melanoma (UK criteria)

A

Major criteria:

  • change in size
  • change in shape
  • change in colour
Minor criteria:
- diameter > 6mm
- inflammation
- oozing/bleeding
mild itch or altered sensation
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24
Q

What type of infection is candidiasis?

A

Candidiasis are fungal infections (meaning thrush)

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25
Q

Where on the body does tinea capitis occur? At what age is it usually seen in and how is it spread?

A

the scalp. Usually seen in children and is spread by close-contact (especially in schools and households)

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26
Q

Where on the body does tinea corporis occur? Name some of its symptoms

A

the body (truck and/or limbs).

Symptoms include isolated erythematous and scaly lesions or clusters of round or oval red patches

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27
Q

Where on the body does tinea cruris occur? Where is it more common in? What are some of the symptoms?

A

Groin.

It’s common in warmer climates and involves itching in the groin thigh skin folds or anus. it’s red, raised, scaly patches that may blister and ooze.

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28
Q

Where on the body does tinea pedis occur?

A

feet (also known as athletes foot). It appears in toe clefts

It presents as red, scaly eruption that itches.

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29
Q

What is tinea?

A

Tinea is used to describe skin mycoses. It’s sometimes called ‘ringworm’

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30
Q

What is onchomycosis?

A

It’s a nail infection

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31
Q

What is the treatment for localised ringworms?

A

Imidazoles (e.g. clotrimazole, miconazole) or terbinafine

Apply 3 times daily for 1-2 weeks

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32
Q

What is the treatment for Athletes foot?

A

Terbinafine 1% cream or spray

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33
Q

What’s the treatment for widespread tinea infections?

A

Adults: Oral antifungal -Terbinafine (250mg OD) or Itraconazole (100mg OD) for 1-2 months

Children: Griseofulvin

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34
Q

What is the role of NMF (natural moisturising factors)? (5)

A
  • flexibility
  • cohesion
  • hydration
  • plays as a buffer (as pH increases, NMF decreases)
  • integrity
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35
Q

What happens when there is a loss of filaggrin?

A

A loss of filaggrin results in:

  • corneocyte deformation (meaning flattening of the surface skin cells)
  • a reduction in NMF
  • an increase in skin pH which encourages serine protease activity (the enzymes which digests lipid-processing enzymes and desmosomes in addition to promoting skin inflammation)
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36
Q

What are the symptoms of atopic eczema (dermatitis)? (4)

A
  1. Dry
  2. Scaly
  3. Erythematous
  4. Itchy rash (particularly noticeable on face, scalp, neck inside elbows and behind knees)

N.B. If often resides in childhood but can continue into adulthood

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37
Q

What are the 3 possible triggers for eczema (Dermatitis)?

A
  1. Internal inflammation
  2. Eternally applied chemicals e.g. soaps
  3. Environment e.g. humidity
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38
Q

How does irritant contact eczema usually occur?

A

It results from damage to skin from topically applied liquids or chemicals in absence of an allergic mechanism

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39
Q

How does allergic contact eczema occur?

A

Patients are allergic to a specific allergen. Whenever skin comes into contact with that allergen, then a eczematous rash occurs e.g. from nickel (jewellery, studs), leather, dyes, plans etc.

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40
Q

What are the available treatments for eczema (dermatitis)? (3)

A
  1. Emollients e.g. aqueous cream, emulsifying agents (to maintain hydration of SC and reduce water evaporation) - also helps avoid dryness and cracking of the skin
  2. Topical steroids e.g. 1% hydrocortisone to reduce inflammation and itchiness
  3. Sedating oral antihistamines e.g. chlorphenamine (Piriton) at night

N.B. Avoid soaps, wool fabrics and synthetic materials (as it irritates the skin)

41
Q

Define seborrheic eczema (4)

A
  • It’s a common, harmless scaling rash, affecting the scalp, face and other areas (eyebrows, ears, folds of underarms and groin).
  • it’s non-contagious
  • may be aggravated by illness, physiological stress, fatigue, change of season, reduced general health
  • may predispose to psoriasis
42
Q

What advice would you give to someone with seborrhoeic eczema? (3)

A
  1. Reduce exposure to allergen e.g. houe dust mite, moulds, grass pollens, etc.
  2. keep cool - wear loose cotton clothing avoid wool and dusty conditions, wear gloves when handling chemicals, solvents, detergents etc.
  3. Use soap-free cleansers
43
Q

What’s the treatment for someone with seborrhoeic eczema on their scalp?

A

Medicated shampoos containing:

  • ketoconazole
  • selenium disulphide
  • zinc pyrthione
  • coal tar
  • salicylic acid

to be used 2x week for at least a month

44
Q

What’s the treatment for someone with seborrhoeic eczema on their face, ears, chest and back?

A

Ketoconazole cream OD for 2-4 weeks

Hydrocortisone cream can also be used - applied up to BD for 1-2 weeks

45
Q

Define systemic lupus erythematosus

A
  • mainly affects women between 35-45 years old

symptoms include:

  • ‘butterfly’ rash on cheeks and nose
  • fatigue
  • rapid hair loss
  • non-specific join pains

often exacerbated by sunlight/other stresses that increases skin circulation

46
Q

Define psoriasis

A

It’s a chronic, scaling disease associated with skin redness or inflammation. It appears raised, rough and reddened areas with fine silvery scales.

47
Q

Name the 5 common causes of psoriasis

A
  1. infection
  2. trauma
  3. emotional stress/ anxiety
  4. cimate factors
  5. certain drugs
48
Q

Describe plaque psoriasis

A

it’s the most common form. It manifests itself in form of scattered, raised, scaly patches, often on elbows, knee and scalp. Lesions can become itchy and sore

49
Q

Describe guttate (teardrop shaped) psoriasis

A

This consists of numerous, small discrete patches scattered all over the body

50
Q

Describe flexural (inverse) psoriasis

A

This affects areas of skin-to-skin contact e.g. armpits, buttocks. It tends to occur in later life

51
Q

Describe generalised pustular psoriasis

A

This is an acute, severe eruption of superficial pustules with reddening of the skin and high fever.

Pustules don’t contain bacteria and it is not caused by infection. It can occur follwing the use of large quantities of strong steroid creams or steroid tablets to treat psoriasis.

52
Q

Describe pustular psoriasis

A

This is a chronic, localised form on the hands and feet. It occurs in the middle age usually

53
Q

Describe psoriatic arthritis

A

this is an inflammatory joint disease. It usually affects the small joints of hands and feet. The skin changes before the onset of joint pain

54
Q

Name some of the treatments available for the control of psoriasis

A

N.B. Treatment is more for the control, not cure

  1. Emollients for hydrating skin
  2. Topical corticosteroids
  3. Calcipotriol (Dovonex) - a synthetic vitamine D3 analogue
    Applied 1-2 Daily for palpable lesions (once lesions have flattened, treatment can be stopped)
  4. coal tar (contains anti-inflammatory and anti-scaling)
  5. Salicyclic acid
  6. Dithranol to induce remission
  7. Retinoids (topically for mild-moderate plaque psoriasis)
55
Q

Name some of the phototherapy treatments available for the cure of psoriasis (2)

A

Phototherapy treatments includes:

  1. UVB light for chronic stable psoriasis and guttate psoriasis
  2. PUVA therapy
56
Q

When should systemic treatments for psoriasis be used?

Name some of the systemic treatments available for the cure of psoriasis (3)

A

Systemic treatments are used for severe, unstable or complicated forms of psoriasis.

  1. Acitretin
  2. Cyclosporin
  3. Methotrexate (in conjunction with folic acid)
57
Q

Define acne vulgaris

A

They include acne, pimples, zits

They’re skin conditions characterised by the formation of:

  • comedones (blackheads and whiteheads)
  • papules (pinheads), skin elevation no fluid 5-10 mm diameter
  • nodules (like papules but bigger than 5-10mm)
  • cysts (cavity usually containing fluid)
  • it can be inflammatory or non-inflammatory
58
Q

How do acne vulgaris arise?

A

When hair follicles become obstructed with sebum/dead keratinocytes. They then become infected with normal skin anaerobe leading to inflammation

59
Q

What’s the most common trigger for acne vulgaris? Name other triggers

A

Puberty is the most common trigger.

Others include:

  • hormonal changes in pregnancy/menstrual cycle
  • occlusive cosmetics, cleansing agents and clothing
  • stress
  • certain drugs e.g. oral contraceptives, corticosteroids
60
Q

Name and describe the 3 levels of severity of acne

A
  1. Mild < 20 comedones or<15 inflammatory lesions or < 30 total lesions
  2. Moderate 20-100 comedones, or 15-50 inflammatory lesions, or 30-125 total lesions
  3. Severe > 5 cysts or total comedone count is > 100, or total inflammatory count is > 50, or >125 total lesions
61
Q

What is the main aim for the treatment of acne?

A

To reduce sebum production, comedone infection, inflammation and infection

62
Q

What’s the treatment for mild acne vulgaris?

A
  • Benzoyl peroxide - usually started low and then increase dose if necessary (possible skin irritation but it subsides)
  • Benzoyl peroxide with clindamycin
  • Azelaic acid
  • topical retinoids e.g. tretinoin/ adapalene (however can be irritant)
  • topical antobacterials e.g. clindamycin, erthromycin (but tends to be ineffective if used alone)

N.B Mild to moderate is treated usually topically. Also, topical corticosteroids should not be used

63
Q

What’s the treatment for moderate acne?

A

Antibiotics

  • tetracycline (1st choice_
  • minocycline
  • doxycycline
  • erythromycin
64
Q

What’s the treatment for severe acne?

A

Isotretinoin (most effective but has serious side effects)

65
Q

What is rosacea?

A

It’s an inflammatory skin disease affecting the middle third of the face

pimples can occur in affected areas also. There’s no blackheads or whiteheads

N.B. Not to be confused with acne. In acne, if you have cysts/nodules, there will be black/whiteheads

66
Q

What are some of the symptoms of rosacea?

A
  1. persistant redness over areas of face and nose that normally blush (forehead, chin, lower half of nose)
  2. dilation of blood vessels under skin appearing as thread veins

if left untreated, it can affect eyes (gritty sensation, conjunctivitis), ears and nose that swells and grows

67
Q

Name the possible causes of rosacea (5)

A
  1. people who blush easily
  2. emotional factors e.g. fear, stress, embarrassment
  3. flare-ups can be caused by changes in weather
  4. Helicobacter pylori and certain medications e.g. vasodilators and corticosteroids
  5. certain foods/ beverages e.g. alcohol, tea, sicy foods, hot soups
68
Q

What are the treatments for rosacea?

A
  1. Topical metronidazole
  2. topical azelaic acid
  3. oral antibiotics (1st line being tetracycline)
  4. Isotretinoin (accutane)

N.B. Skin treatments for acne e.g. benzoyl peroxide can make rocasea worse

69
Q

What advice would you give patients with rosacea?

A
  1. Wear sunscreen with SPF > 30 to protect the face from the sun
  2. Protect your face in the winter e.g. scarf
  3. avoid irritating facial skin by rubbing or touching it too much
  4. avoid facial products that contain alcohol or other skin irritants
  5. when using moisturiser with a topical medication, apply the skin moisturiser after the medication has dried
  6. use products that are labelled ‘non-comedogenic’
  7. avoid alcohol
70
Q

What are scabies? How are they transmitted?

A

Scabies are a human parasite that lives in burrowed tunnels in the stratum corneum. They’re tiny black papules (the mite) that are often visible in one end

They’r transmitted through person-to-person physical contact. So in crowded areas e.g. schools

71
Q

Name the different forms of scabies and give a brief description of each (6)

A
  1. Classic scabies - erythematous papules first appear in finger web spaces, wrists, elbows, axillary folds, waistline. Face remain unaffected in adults
  2. Crusted (Norwegian) scabies - due to impaired immune system
  3. Nodular scabies - more common in infants/young children. May be due to hypersensitivity to retained organisms
  4. Bullous scabies - occurs in children and also in elderly
  5. Scalp scabies - occurs in infants and immuno-compromised patients. Can mimic seborrhoeic eczema
  6. Scabies incognito - widespread atypical form resulting from application of topical corticosteroids.
72
Q

What’s the treatment for scabies?

A

1st line treatment: topical scabicides - Permethrin. You apply it to the entire body from the neck down and wash it off after 8-14 hours. Repeat this treatment after 7 days.

N.B. For infants and young children, permethrin should be applied to the head and neck, avoiding periorbital and perioral regions. Special attention should be given to fingernails, toenails, and umbilicus.

Lindane is not recommended in children under 2 years old or in patients with a seizure disorder because of potential neurotoxicity.

Precipitated sulphur 6-10% in petrolatum is applied for 24 hours for 3 consecutive days. It’s safe and effective.

Ivermectin is indicated for patients who do not respond to topical treatment, are unable to adhere to topical regimes, or are immunocompromised with Norwegian scabies.

Pruritus can be treated with corticosteroid ointments and/or oral antihistamines

73
Q

Describe lice (pediculosis)

A

They infest the scalp, the body, the pubis and the eyelashes.

There are 3 kinds and they are all different in terms of morphology and clinical features e.g. head/pubic lice live on the body, whereas body lice live in clothing

74
Q

What are the available treatments for headlice and how do you use it?

A
  1. Mechanical removal (wet combing) - avoids irritation by chemicals
  2. Dimetocone (4%) apply to dry hair and scalp, allow to dry naturally, wash off after 8 hours. Repeat after 7 days
  3. Malathion (0.5%) apply to dry hair and scalp, allow to dry naturally, wash off after 12 hours. Unpleasant odor.
  4. Primethrin (active, but not recommended for head lice)
75
Q

What’s the treatment of body lice?

A

There’s no topical treatments since body lice are found in clothing!

76
Q

What’s the treatment for pubic lice and how do you use it?

A
  1. Malathoin - apply 0.5% aqueous preparation over the whole body. Dry naturally and wash off after 12 hours. Repeat this application after 7 days
  2. Permethrin - apply 5% cream over the whole body, dry naturally, leave 12 hours or overnight then wash off. Repeat after 7 days
77
Q

Define boils

A

Boils are also called furuncles and carbuncles. They’re tender nodules caused by staphylococcal infection, often due to an infection of the hair follicle

A carbuncle is a cluster of furuncles connected subcutaneously, causing scarring. It can be accompanied by fever

Furuncles are common on the neck, face, breasts and buttocks

It can affect healthy people but more common in obese people

78
Q

Define impetigo an ecthyma

A

This is a superficial skin infection with crusting caused by Streptococci or Staphylococci, or both. Ecthyma is an ulcerative form of impetigo. There’s no predisposing lesion identified in most patients but can follow any break the skin.

Ecthyma is characterised by small, purulent, shallow, punched-out ulcers with thick, brown-black crusts and surrounding erythema.

Impetigo and ecthyma can cause mild pain or discomfort. Pruritus is common and scratching can spread the infection

79
Q

What are risk factors that can increase the chances of developing impetigo and ecthyma? (3)

A
  • Moist environment
  • Poor hygiene
  • Chronic nasal carriage of staphylococci
80
Q

What’s the treatment of impetigo and ecthyma? (3)

A
  • Fusidic acid is used to treat localised diseased (2% 3-4 times daily)
  • Mupirocin can be used topically is it’s MRSA (2% TDS for 10 days)
  • Flucloxacillin or clarithromycin (oral antibiotics) is used if it’s extensive
81
Q

Define photosensitivity

A

It’s a reaction of skin to sunlight. The individual can get redness, rash and urticaria within minutes of exposure to sunlight. In extreme cases, it can lead to dizziness, wheezing and other systemic problems

82
Q

Describe the different types of burns available (4)

A
  • Thermal burns are from any external heat source e.g. flames, liquids, solid objects, gases etc.
  • Radiation burns commonly result from prolonged exposure to solar UV radiation (sunburn). It can be from other sources e.g. tanning beds, X-rays, non-solar radiation
  • Chemical burns occur from strong acids or alkalis e.g. cement, phenols, cresols. Skin/deeper tissue necrosis due to agents may progress over hours
  • Electrical burns can result from electrical generation of heat. Skin/deeper tissue damage may result despite minimal apparent cutaneous injury
83
Q

Why are burns bad?

A

Burns cause protein denaturation and coagulation necrosis. Platelets aggregate, vessels constrict around coagulated burned tissue. Get inflammation around damaged zone and can get bacterial infection through damaged epidermal layer. Leads to oedema and external fluid leakage. Heat loss can be significant because thermoregulation of damaged dermis is impaired and fluid leakage increases evaporative heat loss.

84
Q

What the classifications of burns and give a brief definition of each (2)

A

First degree is the most common type of burn. Burns are red, blanch markedly with light pressure, are painful and tender. Limited to epidermis

Second degree (partial thickness) - involve part of dermis. Sub-divided into superficial and deep.

Superficial 2nd degree burns involve upper half of dermis; heal within 2-3 wks. Rarely scar in this period unless become infected. Skin is red/white, blanch with pressure. Intense pain and tender. Vesicles develop within 24 hr. In contrasts, deep 2nd degree burns involve bottom half of dermis, take >3 wk to heal and scarring is common. May be white, red or mottled. Do not blanch and less painful/tender than more superficial burns. Vesicles may develop. Burns tend to be very dry.

Third degree (full thickness) burns extend through the entire dermis and into the underlying fat

85
Q

What are the steps for the treatment of burns

A
  • First priorities are same as for any injured patient (airway, breathing, circulation)
  • Remove clothing that covers burn
  • Flush chemicals (except powders that are brushed off first) with water
  • Burns caused by acids, alkalis etc should be flushed with copious amounts of water for at least 20 mins
  • Small burns can be immersed early in cold water until pain subsides (although this will not limit depth of injury)
  • IV fluids given to patients who are in shock or with burns >15% BSA
  • Hypothermia/pain treated appropriately
  • After cleaning wound, cover burn with topical antibacterial salve (e.g. 1% silver sulphadiazine) and sterile dressing. Prophylactic antibiotics not given
  • Depending on severity, patient might need to be hospitalized
  • Dressings are changed daily. Burned cleaned completely with water. Apply a new layer of antibacterial salve and re-apply the clean dressing
  • Surgery (grafting) is indicated for all 3rd degree burns and for burns that do not heal within 3 weeks (most deep 2nd degree burns)
86
Q

Give the different types wounds (6)

A
  • Abrasion; graze. Superficial, epidermis scraped off
  • Laceration; irregular tear
  • Avulsion; removal of all skin layers by abrasion (bottom right)
  • Incision; regular slice with clean sharp object (e.g. knife, bottom left)
  • Puncture; e.g. Nail or needle

Amputation; cut off!

87
Q

What are the 4 different wound classifications

A
  1. Necrotic: dead (ischaemic) tissue, usually black and covered with dead epidermis
  2. Sloughy: often yellow due to accumulation of cellular debris, serum excudate, bacteria
  3. Granulating: typically deep pink or red with a high vascularized granular appearance
  4. Epithelializing: cells migrating from wound edges to start the process of re-epithelialisation, see a pink wound bed
88
Q

What are the 4 steps in wound healing?

A
  1. Haemostasis
  2. Inflammation
  3. Proliferation
    a. Granulation
    b. Epithelialisation
    c. Collagen production
    d. Wound contraction
  4. Maturation/ remodelling
89
Q

Define haemostasis

A

When an injury occurs, vasoconstriction takes place and then platelet aggregation happens. A haemostatic plug/clot seals the damaged vessel.

90
Q

Define inflammation

A

This is characterized by redness, heat , pain and swelling. It typically lasts 4-5 days. It initiates the healing process by stabilising the wound through platelet activity (thus stopping bleeding and triggers the immune response).

Within 24 hours of the initial injury, neutrophils, monocytes and macrophages are on the scene to control bacterial growth and remove dead tissue. It’s characteristic red color and warmth is caused by the capillary blood system increasing circulation & laying foundation for epithelial growth.

91
Q

Define granulation

A

This is the formation of new capillaries that generate and feed new tissue - angiogenesis. Fibrous connective tissue replaces the fibrin clot and grows from the base of the wound.

92
Q

Define epithliazation

A

This involves the formation of an epithelial layer that seals and protects the wound form bacteria and fluid loss. It’s essential to have a moist environment to foster growth of this layer. It’s initially a very fragile layer that can be easily destroyed with aggressive wound irritation or cleansing of the involved area.

93
Q

define collagen synthesis

A

This creates a support matrix for the new tissue and provides a new tissue its’ strength. This stage is the actual rebuilding of the skin barrier. It’s influenced by the overall patient condition (age, nutrition etc.) and by the condition of the wound bed.

94
Q

Describe maturation

A

This is the final stage of wound healing. It begins around day 21 and may continue for up to 2 years. Maturation begins when collagen synthesis and degradation equalize.

In this stage, disorganized collagen fibers are rearranged, cross-linked and aligned along ‘tension lines.’ This is termed re-modelling. As the activity at the wound site reduces, the scar loses its red appearance as blood vessels that are no longer needed are removed by apoptosis.

95
Q

Name the 3 types of wound healing

A

Primary healing: also called healing by first intention, or primary wound closure

Secondary healing: healing by secondary intention or secondary wound closure

Delayed primary healing: sometimes called healing by third intent or tertiary intention

96
Q

Define primary wound closure and include its advantages

A

This is when wound edges are brought together so that they are adjacent to each other. Most surgical wounds heal by primary intention. Wound closure is performed with stitches, staples or adhesive tape.

Advantages include:
- Minimises scarring
Lowers infection risk

97
Q

Define secondary wound closure and include its advantages

A

This is where the wound is allowed to granulate. Granulation results in a broader scar than primary intent. Healing can be slowed due to drainage from the infection. The wound care must be performed daily to encourage wound debris removal to allow for granulation tissue formation.

Advantages include:
- Allows removal of foreign bodies
Prevents haematoma development (collection of blood outside of blood vessels that would be trapped when wound closed immediately by, for example, stitches)

98
Q

Define delayed primary wound closure

A

This is where the wound is purposely left open. The wound is initially cleaned, debrided (remove dead, damaged or infected tissue) and observed. By the 4th day, phagocytosis of contaminated tissues is well underway, and epithelisation, collagen deposition, and maturation are occurring. Usually, the wound is closed surgically after 4-5 days.

But if ‘cleansing’ of the wound is incomplete, chronic inflammation can then occur. This results in significant scarring.

99
Q

Describe what hypertronic scars are

A

This is due to the over-production of collagen during the healing causing scars to be raised and above the skin surface. It’s typically a red, raised lump on the skin.