Dermatologic Disorders and Burns

1
Dermatologic Disorders and Burns

• Physical Disabilities, Rehabilitation and
  Employment (BCE 542)
• Dr. Dunn
• October 8, 2002

2
The Skin as a Body Organ

• Two layers
• Epidermis outer layer of the skin, made of old
  cells that migrate upward from the dermis.
• Dermis inner layer of the skin containing
  structures such as sweat glands and hair
  follicles.
• The skin performs a number of functions
• Protects against infection
• Regulates body heat (insulation and perspiration)
• Allows the body to retain fluids, avoiding
  dehydration.

3
Skin Disorders

• Dermatitis/Contact Dermatitis
• Hives
• Psoriasis
• Herpes Zoster
• Scleroderma

4
Dermatitis, Contact Dermatitis Hives

• Dermatitis is an inflammation of the skin, which
  may arise from a number of causes.
• Contact Dermatitis involves contact of the skin
  with an allergen, causing an allergic reaction.
• Hives--a rash of small raised spots on the skin,
  can result from skin contact or other inducement
  of allergens into the body.
• Treatment usually involves topical ointments and
  occasionally antibiotics, antihistamines, and
  removal of allergens.
• Rehabilitation considerations are usually not
  important, but if a person develops contact
  dermatitis for a substance used in their regular
  occupation, this could necessitate a job change.

5
Psoriasis and Herpes Zoster

• Psoriasis a chronic skin disorder in which
  patches of skin become dry and itchy.
• Herpes Zoster (Shingles) An infection of the
  skin by the chickenpox virus affects particular
  areas of the nervous system, causing eruptions of
  painful red blisters in the areas served by those
  nerves. Can cause scarring, like chickenpox.
• Treatment is largely symptomatic for both
  disorders.
• Rehabilitation concerns are not important.

6
Scleroderma

• A systematic hardening of the skin, caused by
  unknown autoimmune factors
• More common in women than men, usually begins age
  30-60
• Hands swell and lose flexibility and acquire a
  purplish hue gradually becomes painful.
• Other parts of the body may be affected,
  including internal organs.
• There is no cure or treatment for scleroderma.
• Rehabilitation Considerations include the need to
  attend to reduced flexibility in hands and loss
  of dexterity. Disease may affect many other body
  functions and result in additional rehabilitation
  considerations.

7
Burns

• Burns are caused by exposure of the skin to
  temperatures that are incompatible with cell life
  (113 degrees F or above)
• Burns can be caused by hot surfaces, hot liquids,
  electrical current, flames, radiation, or
  corrosive chemicals.
• The severity of burns is determined by two
  factors
• Burn Depth
• Percentage of the Body Burned

8
Burn Depth

• Superficial Burns (1st degree burns)
• Only the upper layer (epidermis) is affected
  skin is reddened. While painful, these burns are
  minor injuries only first aid and logical
  precautions are necessary.
• Partial Thickness Burns (2nd degree burns)
• Involve the epidermis and part of the dermis
• Identifiable through blistering of the skin.
• May cause loss of fluids, require skin grafts if
  extensive.
• Partial Thickness burns can be serious, esp. if
  they cover large areas of the body, and should be
  examined by a physician.

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Burn Depth (continued)

• Full Thickness Burns (3rd Degree Burns)
• Involve all of the epidermis and dermis (skin is
  burned through to the underlying muscle).
• Identifiable through charred areas of skin
  (eschars) that are blackened and totally
  lifeless.
• Always require hospitalization even if over a
  small area because they do not heal
  spontaneously, are very susceptible to infection
  and require skin grafting.

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Notes on electrical burns

• Electrical burns are among the most severe types
  of burns.
• May appear minor on the skin as only the entrance
  and exit point of electrical current, but the
  interior of the body is burned between those two
  points.
• If current is very strong, can cause massive
  damage at the exit point (such as amputation)

11
Size of Burn

• Rule of Nines Each of the following body parts
  represents approximately 9 of the bodys surface
  area
• Front and back of each leg.
• Half of the back (whole back 18)
• Half of the chest and abdomen (whole
  chest/abdomen18).
• Each arm.
• The head and neck.
• Pubic area represents 1 of body surface area.
• Estimate of area burned involves adding the parts
  of the body involved.
• Method is not exact, but it is a reliable
  estimate more sophisticated methods are
  available.

12
Burn Treatment

• Initial Treatment
• Provide intravenous fluids and prevent
  dehydration--individual may need catheters to
  remove increased urine flow
• Caloric intake increased to maintain body
  temperature.
• Administer antibiotics to prevent infection
  burnt skin does not prevent infection and
  provides an excellent culture for germ growth).
• Dead skin must be debrided (scraped awaythis
  hurts).
• Avoid complications other
• Thrombophlebitis from inactivity, esp. if lower
  extremities are involved.
• Urinary tract infections from catheters.

13
Skin Grafting

• Debrided areas must be covered with skin grafts.
• Initially, these may come from pigs (xenographs),
  cadavers, or human donors (homographs), but must
  eventually be replaced with skin harvested from
  the burn victim (autografts).
• If burn area is large, individual may have
  extended period of hospitalization while enough
  skin can be harvested to provide autografts.

14
Preventing Scarring

• After autografts are in place, it is critical to
  prevent scarring (hypertrophic scars) as the
  grafts attach themselves to the body.
• Compression garments (Jobst garments) are used to
  put pressure on the grafts while they heal. This
  minimizes scar tissue.
• Scar tissue that does develop can be addressed
  through plastic surgery, to varying levels of
  effectiveness.
• Scars that do develop usually disappear within 2
  years.

15
Other Burn Complications

• Grafted areas can result in tightened skin,
  reducing range of motion.
• If joints need to be immobilized to allow
  healing, contractures (joint locking or
  stiffness) can result can be avoided with
  certain exercises.
• Ears or noses that are destroyed by burns must be
  reconstructed with plastic surgery.
• Burned eyelids must be sewed shut during healing
  to prevent damage to eye (severe burns to the eye
  surface itself is very rare).
• If scalp is burned severely, hair will not grow
  back. Person will need a hairpiece, wig, or hair
  transplant.

16
Rehabilitation Implications

• Healing period
• Up to two years person may be able to return to
  work before this time has passed if precautions
  are taken
• During healing
• Compression garments must be protected from oils,
  which reduce their elasticity and effectiveness.
• Also, compression garments can affect
  perspiration hot, humid environments should be
  avoided.
• Extremely dry environments should also be
  avoided, as this can worsen the itching that is
  common with burn healing.
• Persons in people oriented or persuasive
  occupations need to weigh early return to work
  against potential career damage if burns or
  garments are particularly disfiguring.

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Rehabilitation Considerations (Cont.)

• Long term issues
• Avoidance of extremes of heat and cold, due to
  loss of body fat and reduced perspiration.
• Reduced skin pigmentation in grafted areas
  necessitates avoiding prolonged exposure to
  sunlight
• Complications can affect other body systems
• Smoke inhalation can affect respiration.
• Thrombophlebitis can develop if lower extremities
  are involved.
• Amputations are common
• Key Point Burns are stable. The restrictions
  present after healing will be permanent, and will
  not progress.