Professional Documents
Culture Documents
Ada Chua
Camille Roxas
Bamby Dio
Mervin Guevarra
Lianah Gutierrez
Edgar Sarmiento
Lyca Leviste
Jerika Abejo
Shahrukh Khan
Sydney Hoper
Mechanical barrier
Barrier against radiation
Immunologic barrier
Sensory modulation
Thermoregulation
-Sweat glands
-Blood vessels
Epidermis
-
Keratinocytes
The main cell type
They originate from the less well differentiated
basal cells in the basal layer
They provide a protective mechanical barrier
Melanocytes
-Neuroectodermal in origin
-Melanin - pigment produced by melanocytes
-Barrier against radiation
-Dendritic process - transfer melanin pigment to neighboring
keratinocytes via melanosomes
Melanin production
Transfer to keratinocyte Degradation of melanosomes
Langerhans cells
-
Basement Membrane:
-Anchors the epidermis and the dermis together
-Reservoir of growth factor
-Tissue organization
-Support for monolayer of cells during tissue development
-Semi-permeable selective barrier
Papillary Dermis:
-Thin arrangement of collagen fibers
-Functions:
Supplies nutrient to select layer in the epidermis
Regulates temperature
Both functions are accomplished by
extensive vascular network
Reticular Dermis:
-
Functions:
Gives strength and elasticity
Houses important structures such as glands,
nerves and hair follicles
Collagen:
-70% dry weight of the dermis
-Tropocollagen - collagen precursor
-Responsible for the tensile strength of the skin
-Types of collagen:
Type I - predominant type in adults
Type III - predominant type in fetal dermis
Elastic fibers
-They are branching protein that can be stretched
twice their resting length
-Allow the skin to regain its original shape after
distortion
Fibroblast
-Responsible for production and maintenance of
protein matrix
Ground Substance:
-
Glycosaminoglycans
Secreted by fibroblast
Cutaneous Receptors:
Pacinian Corpuscles
-Found in the palm of the hands and soles of the feet
-They are involve in the sensation of pressure
Ruffini's Endings
-Found in the subcutaneous tissue of fingers
-They modulate sensitivity to warm temperature
Meisner's Corpuscles
-Found in the hands, feet, skin of lips
-They are involved in tactile sensation
Autonomic Fibers
-They synapse to sweat glands and receptors in the vascular
system
Eccrine Glands
Secretes aqueous secretion
Highest concentration on the palm
and soles, axilla and forehead
Sweat
Produced by sympathetic stimulation mediated by
acetylcholine
It is hypotonic but becomes isotonic with increased sweat
production
Sodium
-Less than in the plasma
Potassium
-Same as the plasma
Thermoregulation
-For every ml of water evaporated from the surface of the skin, 0.58
Kcal are removed from the body
-Insensible (evaporation) - skin, respiratory
Approximately 500 - 700 ml/day No electrolytes are lost Insensitive to
atropine
-Sensible
Up to 3 liters/hr Inhibited by atropine
Pilosebaceous Unit:
-
Hair Follicle
Definition:
Inflammation of the hair follicle,
usually
secondary to Staphylococcus
Definition:
A folliculitis that progresses to form a
nodule that eventually becomes
fluctuant
Definition:
Deep seated infections with
multiple cutaneous draining sinuses
Common sites
Risk Factors:
Diabetes mellitus
Malnutrition
Obesity
Alcoholism
Renal failure
Steroid use
AIDS
Type 1
Type 2
Type 3
Extracutaneous manifestation:
Upper airway
Eye
Mucosa of genitalia
Lungs
Spleen
Treatment
Correction of underlying disorder
Systemic steroids Calcineurin inhibitors
Cyclosporine
Etarnercept Infliximab
Aggressive wound care and skin grafting
Exacerbating factors
Poor hygiene
Smoking
Alcohol consumption
Bacterial infection
Treatment
Topical or systemic antibiotic
Ablation of hair follicles
Radiotx RFA
CO2 laser ablation
Before
After
Before Shaving
After Shaving
Pre-op
excision
Markings
2 weeks post op
8 wks post op
4 wks post op
10 wks post op
Treatment:
-For Acute Pilonidal Abscess
I and D
-For Chronic Sinus Tract
Local excision and closure Fistulotomy
and marsupialization Cleft shaving,
personal hygiene
Management
Early withdrawal of the drugs
Supportive
Temporary skin coverage
Management
IVIG (w/ anti FAS antibodies)
Plasmapharesis
Cyclosporine
Cyclophophamide
Anti tnf-a
Human papillomavirus
Human immunodeficiency virus
Histology
Hyperkeratosis
Acanthosis
Papillomatosis
Koilocytes
Common wart
Fingers and toes
Rough, gray-brown surface
HPV 1, 2, AND 4
Plantar warts
Soles and palms
Resemble a common callus
HPV 1-4
Flat warts
Face, legs, and hands
Slightly raised and flat
HPV 3 AND 10
First line
Topical salicylic acid/silver nitrate
Second line
Cryotherapy
Recalcitrant
Electrodessication,cryoablation H2 antagonist,Zinc Sulfate
Venereal warts
One of the most common STD
Vulva, anus and penis
HPV types 6 and 11
Buschke-Lwenstein tumor
Multiple and large growths
HIV
Debilitated patients
Age
Illness
Immobilization due to injuries
Paraplegics
Pressures as high 300 mmHg
ischial tuberosities
Bedridden individuals
Sacral pressure build to 150 mmHg
at the
Multidisciplinary
Wound care
Host issues
Nutritional, metabolic and circulatory status
Pressure Ulcer
Prolonged excessive pressure (>30 or
60 mmHg) for 1 hour
Histological identifiable venous
thrombosis, muscle degeneration,
and tissue necrosis
Muscular tissues are affected most
Common locations:
Ischial tuberosity (28%)
Trochanter (19%)
Sacrum (17%)
Heel (9%)
Treatment:
Relief of Pressure
Air flotation mattress, gel cushioned seats
Debridement of all necrotic tissues and
irrigation
Optimization of nutrition
Shallow ulcers may be allowed to close by
secondary intention, but deeper wounds
with involvement of the underlying bone
require surgical dbridement and coverage
Degloving injury
Skin and subcutaneous tissue are separated
from musculo-fascial layer
Treatment
Clean
Debridement
Place back the degloved skin
Antibiotic
Gram +
Staphylococcus aureus or Streptococcus
viridans
Eikenella corrodens, Haemophilus
influenzae, and beta-lactamase-producing
bacteria
Treatment: 1st Gen Cephalosporin in
combination with penicillin or Ampicillin in
combination with clavulanic acid
Pasteurella multocida,
Staphylococcus species, alphahemolytic streptococci, E.corrodens,
Actinomyces, and Fusobacterium.
Treatment:
Should not be closed primarily.
Selected facial wounds may be closed
primarily after very thorough cleansing;
Initiation of antibiotic therapy.
should be approached via drainage,
copious irrigation, dbridement of
necrotic material, antibiotic therapy,
extremity immobilization, and
elevation.
Acid Exposure:
Coagulative Injury
-Initial Treatment
Copius skin irrigation with saline or water for 30 minutes
-Hydrofluoric Acid
Continue to injure tissues until neutralized by calcium
May cause cardiac arrhythmia
Treatment:
-Quaternary ammonium compounds
-Calcium carbonate/ topical/ IV / intrarterial
Alkali
Liquefaction Injury:
-Saponification of fat
Facilitates tissue penetration and increases tissue
damage Produces longer and more sustained
injury
-Treatment:
Continuous water irrigation for at least 2 hours
Mild
Emollient and oral analgesic 2nd degree
burns
Debridement and silvadene
Severe injury ( muscles, vessels, bones)
Liposuction and saline infusion
IV Fluid Extravasation:
Considered a chemical burn
Dorsum of the hands
-Most common site
Injury is produced by:
-Chemical toxicity
-Osmotic toxicity
-Pressure effect of a closed environment
Mechanism:
-Direct cellular injury to the blood vessels
-Microvascular thrombosis
-Decrease tensile strength Treatment:
-Rapid rewarming
-Elevation and splinting
-Daily hydrotherapy
-Serial debridement
Hypertrophic Scars:
-Thick red raised scar that do not outgrow their original
border
Keloids:
-They are much bulkier, their nodularity and firmness
extend beyond the wounds
-Common among dark skinned individual
HYPERTROPHIC SCARS
Usually develop within 6 weeks of trauma
Risk increases if epithelialization takes longer than 21 days
Rarely elevated more than 4mm
They usually occur across areas of tension and flexor surface
at right angle to the joints or skin creases
KELOIDS
Tend to occur 3 months to a year after the initial insult
They don't extend into underlying subcutaneous tissues
Areas of the body with higher incidence of keloid formation
Earlobe
Deltoids Parasternal
Upper back regions
Keratinocytes
Express human leukocyte antigen 2 Intercellular adhesion molecule-1
Keloids
Higher deposition of Immunoglobulin G and IgM
Antinuclear antibody against fibroblast
HTS
Higher T lymphocyte and Langerhan cells
Larger number of mast cells in both HTS and keloids
Treatment:
1.
2.
3.
4.
Intradermal injection of
triamcinolone
Mechanical pressure or
radiation
Topical application of silicone
sheets
Excision of keloids E hypertropic
scar