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UNIT 3
PATHOLOGY OF THE EPIDERMIS
PATHOLOGY
The basic general appearance and condition of the skin is clinically important because it
may provide clues to body conditions and dysfunctions. Pale skin may indicate
shock. Red, flushed very warm skin may indicate fever and infection.
A rash may indicate allergies or local infections. Even chewed fingernails may be a clue
to emotional problems. For diagnosis, treatment, and management of skin disorders,
the medical services of a specialist may be warranted.
One branch of medicine is Dermatology, which is concerned with skin disease and the
relationship of cutaneous lesions to systemic disease. The doctor who practices
diagnosis and treatment of the skin is known as a Dermatologist.
SKIN LESIONS
Lesions are areas of pathologically altered tissue caused by disease, injury, or a wound
due to external factors or internal disease. Evaluation of skin lesions, injuries, or
changes to tissue helps establish the diagnosis of skin disorders.
Lesions are described as primary or secondary. The primary skin lesions are the
initial reaction to pathologically altered tissue and may be flat or elevated. Secondary
skin lesions are the changes that take place in the primary lesion due to
infection, scratching, trauma, or various stages of a disease. Lesions
are often described by their appearance, color, location and size as measured in
centimeters.
BURNS
Burns are tissue injuries that are created by contact with thermal, chemical, or
radioactive agents. Even though burns can mostly occur on the skin, they can also
involve the respiratory and digestive tract linings. You must realize that burns that have
a local effect (local tissue destruction) are not as important as those that have a systemic
effect. Systemic effects are life threatening and those side effects can include
dehydration, shock, and infection. Burns are always classified as first-, second-, or
third-degree. The extent of injury and degree of severity determine a burn’s
classification.
FIRST-DEGREE BURN
With a first-degree burn the epidermis is damaged. Symptoms are restricted to local effects,
like skin redness (erythema). The burn site does not blister and heals with no scar formation.
Examples are sunburn or scalding with hot water.
SECOND-DEGREE BURN
Second-degree burns are deep burns that damage both the epidermis and the dermis.
They are characterized by the formation of fluid-filled blisters (vesicles or bullae),
caused by the deeper penetration of heat. Second-degree burns are more painful, and
recovery is usually slow but complete, with no scarring.
THIRD-DEGREE BURNS
In third-degree burns, both the epidermis and the dermis are destroyed and some of the
underlying connective tissue is damaged, leaving the skin waxy and charred with
insensitivity to the touch. Due to the major destruction, ulcerating wounds develop and the
body attempts to heal itself by creating more scar tissue.
Diagram 3.1 –Types of Burns
TYPES OF BURNS
First-degree burn
Epidermis
A first-degree burn, such as a sunburn,
damages the top layer of skin called the
epidermis. This type of superficial burn
usually turns the skin red and causes some
pain that can be treated with cold-water
dressings.
Second-degree burn
Epidermis
Second-degree burns cause blisters
damaging both the epidermis and parts of
the dermis.
Dermis
Third-degree burn
Epidermis
Dermis
Subcutaneous
Damaging all layers of skin, third-degree
burns are usually received in fires.
Diagram 3.2- The 4 Actual Degrees of Burns
4 Actual Degrees of Burns
1st Degree
Top layer of skin is
affected, such as with
a sunburn.
Medical attention not
required
2nd Degree
Affects top 2 layers of
skin. Skin is irritated
and blistery. Some
moisture and oozing
with severe pain.
3rd Degree
All three layers of skin
are affected. Very little
pain, as the nerves are
destroyed. Skin is
leathery and dry.
Emergency Medical
attention required
4th Degree
All skin is burned, as well
as the muscle and bone.
Moderate pain at first,
sever pain as the nerves
grow back.
Keep in mind that skin grafts, also known as dermoplasty, are often used to assist
in recovery. In some situations, especially extreme emergencies, a method for
estimating the extent of burn damage is to apply the Rule of the Nines. This method is
done by calculating the body surface that is involved in burns by assigning values of 9% or
18% of surface areas to specific regions. Accurate estimation of damaged surface
areas is important for treatment with I.V. fluid, which replaces the fluids lost from tissue
damage and destruction.
ONCOLOGY
Neoplasm is an abnormal growth of new tissue that can be benign or malignant. Benign
neoplasm is a non-cancerous growth composed of the same type of cells as the tissue
in which they are growing. They harm the individual only as much as they place
pressure on surrounding structures. Keep in mind that if the benign neoplasm remains
small and places no pressure on adjacent structures, it is most likely not going to be
removed. On the other hand, when it gets to be extremely large, causes pain, or places
pressure on other organs or structures, its removal is necessary.
The diagnosis of a malignant neoplasm is composed of cancerous cells that do not
necessarily resemble the tissue in which they are growing. The cells show altered
function, altered appearance, and uncontrolled growth, and the malignant tumor invades
the surrounding tissue. Ultimately, malignant cells break loose from the primary tumor,
enter blood and lymph vessels, and travel to remote regions of the body to form
secondary tumor sites, a process called metastasis. The ability to invade surrounding
tissues and spread to remote regions of the body is a distinguishing feature of malignancy.
If left untreated, malignant neoplasm are usually progressive and generally lethal.
When it comes to cancer, especially of the epidermis (skin), we need to be cautious at
all times. Eliminating long periods of time in the sun is one of the most important ways
to begin with protecting our bodies from becoming victims of cancer. One of the biggest
ways to protect our skin from being ridden with cancer is to frequently examine
moles for the following:
1. Asymmetry
2. Irregular borders
3. Uneven color
4. Large diameter
Once you have completed the reading you can move on to the
assignments for this lesson.