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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.