> Burns A burn is an injury to the skin caused by heat, chemicals, electricity, or radiation. Burns can be described by how deep the burn is and by the area of skin burned. • First-degree burn (superficial burn) is a burn to the epidermis only. There is redness but no vesicles (blisters). An example is sunburn. • Second-degree burn (partial-thickness burn) involves the epidermis and upper portion of the dermis. The skin is red. There are vesicles (blisters). • Third-degree burn (full-thickness burn) involves the epidermis and all of the dermis. The subcutaneous tissue may be damaged. • Fourth-degree burn involves the epidermis, dermis, subcutaneous tissue, and muscle  TREATMENT: 1. Stop Burning Immediately. 2. Remove Constrictive Clothing Immediately. Take off jewelry, belts, and tight clothing. Burns can swell quickly. For First-Degree Burns (Affecting Top Layer of Skin) 1. Cool Burn Hold burned skin under cool (not cold) running water or immerse in cool water until the pain subsides. Use compresses if running water isn't available. 2. Protect Burn Cover with a sterile, non-adhesive bandage or clean cloth. Do not apply butter, oil, lotions, or creams (especially if they contain fragrance). Apply a petroleum-based ointment two to three times per day. 3. Treat Pain Give over-the-counter pain relievers such as acetaminophen (Panadol, Tylenol), ibuprofen (Advil, Motrin, Nuprin), or naproxen (Aleve, Naprosyn). |
Bruises
A bruise is a discoloration to the skin from a ruptured blood vessel. The skin is not broken and blood accumulates in the tissue spaces. A bruise, is also known as a contusion (kon-TOO-zhun). Bruises can take on different looks each with a different name. These are listed below:
• Ecchymosis (ek-ih-MOH-sis) (plural ecchymoses) is a large, irregular area of purplish discoloration.  Treatment: Icing the area several times a day for 30 minutes. Keep the area elevated and resting may help to reduce bruising. Applying an elastic bandage for compression and taking a pain reliever such as paracetamol or ibuprofen may also help. Consult a doctor if you feel severe pain or developing a lump on top of the bruise.
• Hematoma is a mass or collection of blood causing a swelling under the skin. Hematomas are often named after their location. For example, subungual hematoma.
Treatment: Hematomas of the skin and soft tissues are often treated with rest, ice, compression, elevation (RICE). Some health care professionals may advocate heat as another treatment alternative. The pain of a hematoma is usually due to the inflammation surrounding the blood and may be treated with over-the-counter pain medications. The choice of medication depends upon the underlying health of the patient. For those patients who are taking anticoagulation medications, ibuprofen is relatively contraindicated (not recommended) because of the risk of gastrointestinal bleeding. Patients with liver disease should not take over-the-counter acetaminophen. When in doubt, it is wise to ask the health care professional or pharmacist for a recommendation.
Treatment for hematomas involving other organs in the body depends upon what organ system is involved. In these cases, treatment will be tailored to the specific situation.
• Petechiae (peh-TEE-kee-ee) are tiny purple, red, or brown spots on the skin. They usually appear on your arms, legs, stomach, and buttocks. You might also find them inside your mouth or on your eyelids. These pinpoint spots can be a sign of many different conditions — some minor, others serious. They can also appear as a reaction to certain medications.
Though petechiae look like a rash, they’re actually caused by bleeding under the skin. One way to tell the difference is by pressing on the spots. Petechiae won’t turn white when you press on them. A rash will turn pale.
Treatment:
Before recommending a treatment, your doctor will identify what’s causing your petechiae and other symptoms. Your doctor may prescribe any of these medicines to treat the cause of the spots: > Rest • Purpura (PER-per-ah) is a broad term that includes a number of conditions characterized by bleeding into the skin such as ecchymoses and petechiae. Purpura means purple, the color of the bruise.
 Treatment: Patient will need treatment if purpura doesn't go away on its own. Treatments include medications and sometimes a splenectomy, or surgery to remove the spleen. You may also be asked to stop taking medications that impair platelet function, such as aspirin, blood thinners, and ibuprofen. |
Cutaneous Lesions (LEE-zhunz) A skin lesion is any abnormality caused by disease or injury (trauma). Any deviation from the normal appearance of the skin can be called a lesion. Distinguishing the various kinds of skin lesions are important since they characterize specific diseases.
• Cicatrix (sick-ah-TRICKS) is normal scar tissue resulting from the normal healing of a wound.
. Cyst (SIST) is a small closed sac of the cavity filled with fluid or semifluid. Ex: ovarian cyst
• Fissure is a crack-like sore. Often seen on the heels and between the toes when the skin is very dry. • Macule (MACK-yool) is a discolored, unelevated area of skin. Ex: birthmarks
. Papule (PAP-yool) is a solid, elevated area of skin. Example: acne
• Pustule (PUS-tyool) is a small, elevated area of skin that contains pus. Example: acne, abscess
• Vesicle is an elevated area of skin containing clear fluid. Example: blister (Figure 6-8F). A blister larger than 0.5 cm is called a bulla (BOO-lah).
• Wheal (WHEEL) is a raised, circular area of skin usually pale in the center, surrounded by redness, Example mosquito bite and hives are also known as urticaria) (yoo-tih-KEHR-ce-ah). Treatment: Sebaceous cysts often don't need treatment. A doctor can remove a cyst if it's painful or infected or if the appearance is a concern. |
Exanthem Exanthem (eg-ZAN-thum) is a diffuse rash can have causes that aren't due to underlying disease. Examples include heat rash, insect bites, sunburn, or medication side effects. Treatment: Taking paracetamol may help to reduce fever and discomfort. Drinking fluids and getting plenty of rest may also help. |
Infections Bacterial Infection . Furuncle (FYO0-run-kul) are also known as boils. They are large, tender swollen areas around hair follicles or sebaceous glands. A cluster of boils is called a carbuncle (KAR-bun-kul). Boils are caused by a staphylococcus infection.
• Cellulitis (sell-yoo-LYE-tis) is an inflammation of the connective tissue underlying the epidermis caused by staphylococcus or streptococcus.
• Impetigo (im-peh-TYE-gob) is a superficial but highly contagious skin Infection that usually affects infants and children. Characteristic red sores appear on the face
• Necrotizing fascitis (NEK-roh-tye-ring fah-SIGH-tis) is a severe infection caused by streptococcus bacteria causing inflammation of the fascia and resulting in tissue death. If left untreated, the infected body tissue becomes necrotic. Can be fatal. Also known as flesh-eating disease.
Treatment: Bacterial infections are often treated with topical antibiotics applied directly to the skin or with oral antibiotics. If the strain of bacteria is resistant to treatment, treating the infection may require intravenous antibiotics administered in the hospital.
Fungal Infections
• Candidiasis (kan-dih-DYE-ah-sis) is a yeast infection occurring on the skin and mucous membranes. Also known as moniliasis (mon-ih-LYE-eh-sis). If the fungus appears in the oral cavity, the condition is called thrush. The mucous membrane of the vagina can also be affected, resulting in an inflamed vagina - Tinea (TIN-ee-ah) is a fungal infection that can grow on skin, hair, and nails.
Treatment: Fungal infections are typically treated with antifungal drugs, usually with antifungal drugs that are applied directly to the affected area (called topical drugs). Topical drugs may include creams, gels, lotions, solutions, or shampoos. Antifungal drugs may also be taken by mouth.
Viral Infection
• Verrucae (veh-ROO-see) are small, hard skin lesions caused by the human papillomavirus. Verrucae is commonly known as warts. Treatment: Some types of viral skin infections may improve on their own within days or weeks, viral infections are often treated with topical antibiotics applied directly to the skin or with oral antibiotics. |
Psoriasis (sor-EYE-ah-sis)
Psoriasis is a chronic inflammation of the skin (Figure 6-9). The skin appears erythema tous (red), with silvery scales. Symptoms include xeroderma and pruritus (pro0-EYE- tus). Pruritus means itchy. Psoriasis is not infectious.  Treatment: Psoriasis treatments aim to stop skin cells from growing so quickly and to remove scales. Options include Corticosteroids, Retinoids, creams and ointments (topical therapy), light therapy (phototherapy), and oral or injected medication. |
Tumors, Neoplasms
An abnormal growth of tissue cells. Tumors can be benign or malignant. Benign tumors are noncancerous, usually harmless, and do not spread from one location to another. Malignant tumors are cancerous and harmful and usually spread or metastasize (meh- TAS-tah-size). Common benign and malignant tumors are listed below. Treatment involves removal of the tumor by surgery, laser, radiation, and/or chemotherapy.
Benign Tumors
• Papilloma (pap-ih-LOL-mah) a benign nipple-like growth projecting from epithelial tissue. Example: a wart.
Treatment: Whether a papilloma lump or lesion needs treatment depends on its location and whether it is causing problems there. A papilloma is often harmless and does not require treatment. A doctor will likely not even discover internal papillomas unless they encounter the wart while investigating another issue. When a papilloma does need treatment, it is by destruction or removal using cauterization or excision or laser surgery, or cryothrapy.
• Lipoma (lih-POH-mah) is a benign tumor of fatty tissue.
Treatment: Treatment generally isn't necessary, but if the lipoma is bothersome, painful or growing, surgical removal may be required.
Malignant Tumors
• Carcinoma (kar-sih-NOH-mah) is a malignant tumor of epithelial cells. Two types are basal (BAY-sal) cell and squamous (SKWAY-mus) cell carcinomas
• Basal cell carcinoma is a malignant tumor of the epidermis. Unlike other malignant skin cancers, it rarely spreads to other locations
• Squamous cell carcinoma is also a malignant tumor of the epidermis. It has a tendency to spread to other organs
• Melanoma (mel-ah-NOl-mah) is a malignant tumor arising from the melanocytes in the epidermis
• Sarcoma (sar-KOH-mah) is a malignant tumor arising from connective tissues of the skin. One example is Kaposi sarcoma, a type of skin cancer that is a typical complication of AIDS.  Treatment: Basal cell carcinoma, squamous cell carcinoma, and some type of melanomas are most commonly treated by Mohs (MOHZ) surgery. This type of surgery removes cancerous tissues in layers. This limits the loss of normal tissue and provides the highest cure rate. Other treatments include surgery, chemotherapy, and radiation therapy. |
