sun induced skin disorders, wound care Flashcards
UVA
involved in premature aging, skin cancer; responsible for photosensitivity reaction
UVB
‘sunburn radiation’ primary inducer of skin cancer; synthesis of vitamin D3; also contributes to wrinkles and premature aging
basal cell carcinoma
most common type; often aggressive/invasive disorder of epidermis and dermis; rarely metastasizes
squamous cell carcinoma
2nd most common; found in epithelial keratinocytes; grows slowly
melanoma
not most common but most deadly; most come from normal skin (30% from moles)
self examination for melanoma
asymmetry, border (irregular or poorly defined), color, diameter (larger than 6 mm)
minimal erythema dose (MED)
minimum UVR dose that produces clearly emarginated erythema in the irradiated site, given as a single exposure
SPF
ratio of time to burn compared to unprotected skin
SPF derived by
dividing MED on protected skin by MED on unprotected
SPF 2-14
- only protect against UVB
- must be labeled as broad spectrum if pass UVA testing
- must contain warning about skin cancer and aging
- can only claim to help prevent sunburn
SPF 15 and higher
- can be labeled as broad spectrum if they pass the UVA and UVB testing
- can claim to reduce risk of skin cancer and early skin aging
FDA prohibits certain terminology for sunsreen
sunblock, waterproof, sweatproof, or all day protection
labeling rules for water resistance
must put number of minutes that product has been tested to be water resistant in
sunscreen moa (chemical)
- absorbs UVR
- must be applied 15-30 min before sun exposure
- should not be applied to infants < 6 months
sunscreen moa (physical)
- scatters/reflects UVR
- protects against all wavelengths
- applied right before sun exposure
- preferred
amount of sunscreen on
- face and neck
- arms and shoulders
- torso
- legs and tops of feet
1) 1/2 tsp
2) 1/2 tsp for both side of body
3) 1/2 tsp each for front and back side
4) 1 tsp to each side
reapply sunscreen…
after swimming, sweating, toweling, and every two hours
exclusions for self treatment of minor burns and sunburn
- burn to BSA of 2% or more
- burns involving ears, eyes, face, hands, feet, or perineum
- chemical burns
- electrical or inhalation burns
- persons of advanced ages
- patients with diabetes or multiple medical disorders
- immunocompromised
non pharm treatment of sunburn and minor burn
- can be used in treatment of stage 1 and 2 to relieve pain, prevent contamination, and promote healing
- get out of sun or remove source of heat immediately
- wash area with cool water for at leas 10 minutes immediately after
- cool tap water 3-6 times daily for 15-30 minutes
pharm treatment of sunburn and minor burns
- topical skin protectants
- systemic analgesics
- topical anesthetics
- aloe products
topical skin protectants
allantoin, cocoa butter, white petrolatum, petrolatum, shark liver oil
stage I wound depth
reddened, unbroken skin
stage II wound depth
blister or partial thickness skin loss involving epidermis and part of dermis
stage III wound depth
full-thickness skin loss; damage may be down to subq tissue; refer
stage IV wound depth
stage III with underlying muscle, tendon, an bone involvement; refer
self treatment exclusions for minor wound
- wounds containing foreign matter after irrigation
- chronic wounds
- wound from bite
- wounds with infection
- wounds involving face, mucous membrane or genitalia
- deep, acute wound
- patients w diabetes
initial treatment for wounds
- wound irrigants
- antiseptics
antiseptic examples
- hydrogen peroxide
- ethyl alcohol
- isopropyl alcohol
- iodine
- betadine
- camphorated phenol
- chlorhexidine gluconate
hydrogen peroxide
- little benefit over soapy water
- do not use in abscesses and wounds should be dried before dressings are applied
- enzymatic release of oxygen
ethyl alcohol
- good bactericidal activity
- may cause tissue irritation and skin dehydration
- apply bandage after dried
isopropyl alcohol
- stronger bactericidal activity than ethyl
- may have cytotoxic effects on open skin
- flammable
iodine
- broad antimicrobial spectrum
- do not apply bandage
- will stain skin, irritate tissue, and may cause allergic reactions
betadine
- rapid bactericidal activity
- not irritating
- absorbed systemically when on open wounds
camphorated phenol
- high concentrations of phenol
- apply to dry skin only
- do not apply bandage
first aid antibiotics
apply up to three times daily; especially beneficial if wound contains debris or foreign matter; prevent infection
examples of first aid antibiotics
bacitracin, Neomycin, polymyxin B sulfate
bacitracin
inhibits cell-wall synthesis in gram-positive organisms; minimal absorption with topical administration;
neomycin
inhibit protein synthesis in gram-negative organisms and some staphylococcal species; highest risk of sensitivity
polymyxin b sulfate
alters cell wall permeability of gram-negative organisms
Neosporin
bacitracin, polymyxin b, neomycin
Neosporin + pain relief
polymyxin B, neomycin, pramoxine
polysporin
polymyxin B, bacitracin
antimicrobial dressing
decrease bacterial load within wound bed
nonadherent dressing
do not stick to wounds, pose little risk in removing newly formed tissue
primary dressing
placed directly on wound surface, can absorb oozing and provide protection and support for wound during healing
secondary dressing
placed over primary dressings, provide additional absorption, protection and compression
