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The Skin Homeostatic Imbalances Tattoos • Needle is used to deposit pigment within the dermis • Risks: – One ugly tattoo – Dyes w/cancer causing agents – Hepatitis C • Removal: – Dermabrasion, cryosurgery, caustic chemicals, laser based technology Excessive Sun exposure • Damages skin • Elastic fibers clump -> leathery skin • Chance for herpes (aka cold sore) increases • Alter DNA of skin cells -> skin cancer – inc melanin in black ppl dec chance for skin cancer Decubitus Ulcer • Restriction of normal blood supply to skin • Causes cell death • Occurs often in bedridden patients who are no turned regularly or who are dragged or pulled repeatedly across bed – Blood supply restricted -> blanching – Skin reddens when pressure released – Cracks appear in skin @ compressed – areas Infections and Allergies • Athlete’s Foot – Itchy, red, peeling – between toes – Fungal infection: fungus grows on or in the top layer of the skin – Easily transferred – Can be caught walking near swimming pools and lockers Infections and Allergies • Boils and carbuncles – Boils: inflammation of hair follicles and sebaceous glands – Carbuncles: boils caused by bacterial infection Infections and Allergies • Cold Sores – Small, fluid-filled blisters – Itch and sting – Caused by herpes simplex infection – Virus localizes in cutaneous nerve – Dormant until activated by emotional upset, fever, or UV Infections and Allergies • Contact dermatitis – Itching, redness, swelling of skin, blistering – Caused by exposure of skin to chemicals – i.e. poison ivy Infections and Allergies • Impetigo – Pink, water-filled, raised lesions – Develops yellow crust and ruptures – Caused by staphylococcus infection – Common in elementary children Infections and Allergies • Psoriasis – Reddened epidermal lesion – Dry, silvery scales – May be disfiguring Burns • Tissue damage and cell death caused by intense heat, electricity, UV, or chemicals • Two life-threatening problems: – Body loses supply of fluids containing proteins and electrolytes – Dehydration and electrolyte loss = shutdown of kidneys and circulatory shock • Lost fluids must be replaced immediately! Burns • Rule of nines: – Divides body into 11 area, each accounting for 9% of total body surface (plus 1% for genital) • Infection leading cause of death in burn victims • Burned skin sterile for 24 hours • Patient’s immune system depressed Burns • First degree – Only epidermis damaged – Area red and swollen – Not serious – Heals in two to three days – i.e. sunburn Burns • Second degree – Injury to epidermis and upper dermis – Red, painful, and blisters present – Enough epithelial present for regeneration – No permanent scars result if taken care of • First and second degree burns are called partial-thickness burns Burns • Third degree – Destroys entire thickness of skin – aka full-thickness burn – Burned area is blanched or blackened – Nerve endings destroyed = no pain – Regeneration not painful – Skin grafting • Fourth Degree Burn – a burn that extends deeply into the subcutaneous tissue, completely destroying the skin, subcutaneous tendons, underlying tendons, involving muscle, fascia, or bone 16 Burns • Considered critical if: – 25% has second degree burns – 10% has third degree burns – Third degree burns of face, hands, or feet • Dangerous because burned respiratory passageways • Swells and causes suffocation Skin Cancer • Single most common type of cancer in humans • Most important risk factor is UV radiation Skin Cancer • Basal cell carcinoma – Least malignant – Most common type (usu. On face) – Cells in stratum basale cannot form keratin and no longer honors boundary between epidermis and dermis – Appears shiny, dome-shaped nodules that develop an ulcer – Slow-growing – curable Skin Cancer • Squamous Cell Carcinoma – Lesion appears scaly, reddened papules – Gradually forms ulcer – Usu on scalp, ears, dorsum of hands, lower lip – Grows rapidly and into lymph nodes if not removed – Curable surgically or w/radiation therapy Skin Cancer • Malignant melanoma – Cancer of melanocytes – Accounts for 5% of skin cancers – Usu. Appears as spreading brown to black patch – Grows into lymph and blood vessels – Survival is 50% – Treatment is wide surgical excision with immunotherapy Malignant melanoma • Use ABCD on new moles or pigmented spots to recognize – Asymmetry: two sides of spot do not match – Border irregularity: borders of lesion are not smooth and have indentations – Color: spot contains areas of different colors – Diameter: spot is larger than 6 mm in diameter AGE • Newborn: skin is thin and blood vessels are visible – Skin thickens with age • Adolescence: skin and hair become oily • Adulthood (twenties and thirties): skin reaches optimal appearance – Environmental affects: abrasion, chemicals, wind, sun, and other irritants clog pores with pollutants and bacteria – dermatitis (skin inflammation), pimples, scales occur • Old Age: subcutaneous tissue decreases, skin is drier, skin thins, decreased elasticity • FRECKLES: Concentration of Melanin in a certain area • HAIR: – By 50, # of follicles dec by 1/3 – Bald men have hair in “bald areas” • degenerated follicles develop colorless and tiny hair – Graying: dec in amount of melanin deposited in the hair • emotional crisis, anxiety, protein deficiency, chemotherapy, radiation, excessive vitamin A, fungal diseases, genetics