Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2952_Библиотеки_им_академика_М_И_Перельмана
.pdf
Integumentary System Diseases and Disorders 427
Complementary and Alternative Therapy
Chamomile for Skin ^^hamomile is the common name for some plants in the Asteraceae family. It was
used in ancient times by Egyptians, Romans, and Greeks. The plant produces a
<-
o
nlH
ons
daisy-like flower. There are several types, but the two that have been used in health
care are German chamomile and Roman chamomile. German chamomile is used more
commonly in the United States for a variety of health conditions such as skin disorders,
mouth ulcers, upset stomach, insomnia, and anxiety. The flowers are used to brew a
tea, but it is also found in extracts, caplets, and in a topical form. It has been used for
sleep disorders, indigestion, and diarrhea. The topical form is used for wounds, rashes,
and herpes simplex. Although it has been studied in animals, it has not been widely
researched for its potential effects on humans. Some studies have shown its therapeutic
effect on a few skin disorders and for mouth ulcers caused by chemotherapy or radi
ation. Side effects are rare but can include nausea, dizziness, and allergic reactions.
Chamomile may also interact with other medications such as cyclosporine so caution is
recommended when using it.
Source: NIH: National Center for Complementary and Integrative Health (NCCIH) (2021)
Benign Tumors
Benign tumors of the skin are relatively common. They tend
to be familial and often are more common in older adults.
Seborrheic Keratosis
■ Description. Seborrheic keratosis (SEB-oh-REE-ic
KERR-ah-TOH-sis) is a benign overgrowth of epithelial
cells. It is one of the most common types of benign skin
growth in older adults. This keratosis is synonymous
with senile keratosis and does increase with age, but has
also been found to appear on individuals as young as 15.
Most people as they age will have at least one of these
lesions (Figure 18-27).
■ Etiology. The cause is unknown, although it does
appear to be age-related.
■ Symptoms. The lesions usually appear as a tan,
brown, or black growth with a well-defined border. The
surface of the lesion is covered with a warty scale that
is soft on the trunk but harsh, dry, and rough on the
hands, arms, and face. These lesions are rather loose and
appear to be tacked onto the skin.
■ Diagnosis. This condition is easily diagnosed by
physical examination of the lesion. Seborrheic keratosis
does not become cancerous, but can appear that way at
times. If this is the case, a skin biopsy might be ordered.
■ Treatment. They are often easily scraped off by curet
tage, the treatment of choice. These skin growths are
Figure 18-27 Seborrheic keratosis.
normally painless and require no treatment. They are
often removed for cosmetic reasons.
■ Prevention. There is no prevention for this condition.
Keloid
■ Description. A keloid (KEE-loid) is a raised, firm,
irregularly shaped mass of scar tissue that develops
428 Chapter 18
Therapy
for Scars
Complementary and Alternative Therapy
H
ere are some home care treatments to reduce the development of scars after receiv
ing a skin wound.
■
■
■
■
■
■
■
■
Aloe vera—cools and hydrates the area
Vitamin E—may improve wound healing; hydrates the area
Honey—has antibiotic and anti-inflammatory properties
Moisturizers—moisturizing the area is very important
Apple cider vinegar—has some antibacterial effects
Petroleum jelly—moisturizes the area
Coconut oil—hydrates the area
Other products to reduce the appearance of scars can be found in pharmacies and in
the beauty products aisles of stores.
Scars take a while to heal, but the above tips might help reduce the appearance of
scars. They fade a little but not completely after a year or more. There is some evidence
that most of these remedies will not noticeably heal or reduce scaring, but other studies
have shown some improvement in the scar appearance using alternative treatments.
Source: Frothingham (2019)
following trauma or surgical incision. (See Chapter 4,
“Inflammation and Infection,” for more information.)
■ Etiology. Keloids are an overgrowth of collagen
during connective tissue repair; they are more common
in Blacks (Figure 18-28).
■ Symptoms. Keloids can be unsightly but are generally
considered harmless.
■ Diagnosis. Diagnosis is easy and consists of a physical
examination of the keloid.
I Figure 18-28 Keloid.
■ Treatment. Surgical removal of keloids is usually
not effective because it often results in the formation
of another keloid. Radiation, injecting the lesion with
steroids, and cryotherapy might be helpful in reducing
the size of a keloid.
■ Prevention. There are no known preventive measures.
Hemangioma
■ Description. Hemangioma (heh-MAN-jee-OH-mah;
hem = blood, angio = vessel, oma = tumor) is the most
common childhood tumor. In most cases, hemangi
omas will disappear over time, with as many as 50%
disappearing by age 5 and the majority disappearing
by puberty. Most hemangiomas appear on the face and
neck and affect females more often than males. They are
also more likely to appear in twin births. Hemangiomas
are congenital and do not grow on adults.
■ Etiology. The cause of hemangioma is unknown.
■ Symptoms. Hemangiomas are made up of small
blood vessels forming a reddish or purplish birthmark.
Sometimes they present as a flat red or pink area. Com
mon types of hemangioma include port wine stain,
strawberry, and cherry hemangioma (Figure 18-29).
■ Port wine stain A dark red to purple birthmark,
usually appearing on the face.
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Integumentary System Diseases and Disorders 429
(A) (B) (C)
Figure 18-29 Hemangiomas. (A) Port wine hemangioma. (B) Strawberry hemangioma. (C) Cherry hemangioma.
■ Strawberry hemangioma A strawberry red, rough,
protruding lesion, commonly appearing on the face,
neck, or trunk.
■ Cherry hemangioma A small, red, dome-shaped
lesion.
■ Diagnosis. Diagnosis is easy and consists of a physical
examination of the hemangioma.
■ Treatment. Treatment is usually not necessary
because most hemangiomas will disappear with time.
Surgical removal of lesions on the face is common for
cosmetic reasons.
■ Prevention. There are no preventive measures.
Premalignant and Malignant Tumors
Skin cancer is the most common type of cancer in
humans and, in most cases, is due to exposure to the
sun. Skin cancers generally occur in multiples and
appear on the face, arms, and hands of middle-aged
and older individuals. The most common skin cancer
is basal cell carcinoma, but the most deadly is malignant
melanoma. Diagnosis is made on the basis of clinical
examination and positively confirmed by biopsy. Pre
vention for all forms of skin cancer consists of avoiding
overexposure to the sun and lifelong use of sunscreen
with a high sun protection factor (SPF).
Actinic Keratosis
■ Description. Actinic keratosis (ack-TIN-ick KERR-
ah-TOH-sis; actinic = sun-related) is a premalignant
skin condition more common in those with fair com
plexions, sunbathers, and individuals who have occu
pations in the sun, such as fishermen, farmers, and
construction workers (Figure 18-30).
■ Etiology. Actinic keratosis, also known as solar
keratosis, is caused by excessive exposure to UV rays,
Figure 18-30 Actinic keratosis.
typically from the sun. These actinic lesions are
slow-growing, usually taking years to develop, and often
appear first in older adults.
■ Symptoms. Actinic keratosis is characterized by the
growth of multiple wart-like lesions on sun-exposed
areas of the body such as the face, backs of the hands,
forearms, ears, and legs.
■ Diagnosis. Diagnosis is made on the basis of clinical
examination of the lesions.
■ Treatment. Left untreated, about 2% to 5% of actinic ker
atoses develop into a serious form of skin cancer called squa
mous cell carcinoma. Treatment is with topical medication
such as Retin-A® or removal by curettage or cryotherapy.
■ Prevention. Reducing sun exposure reduces or elim
inates this condition.
Basal Cell Carcinoma
■ Description. Basal cell carcinoma is the most common
type of skin cancer. It is most common in fair-skinned,
430 Chapter 18
(A) (B) (C)
Figure 18-31 Basal cell carcinoma: (A) ear; (B) nose;
(C) near eye.
blonde, and blue- or gray-eyed individuals. Basal cell car
cinoma is a slow-growing, locally invading tumor that does
not metastasize. This is not to say that if left untreated it
is not dangerous. Tumors near the eyes and mouth can
invade these spaces and cause much concern. Tumors on
the nose, lip, and ear can lead to the loss of these tissues.
■ Etiology. As with most cancers, the cause of basal cell
carcinoma is unclear but does seem to be the result of a
mixture of genetic and environmental factors. The most
common identified environmental factor is excessive
exposure to the sun.
■ Symptoms. The appearance of this tumor varies,
appearing as a raised nodule with a depressed or dented
center; a smooth, shiny bump that is pink to pearly
white in color; or a nonhealing lesion that bleeds easily
(Figure 18-31).
■ Diagnosis. Diagnosis is confirmed by biopsy.
■ Treatment. Treatment of basal cell carcinoma is sur
gical removal.
■ Prevention. Basal cell carcinomas that are related to
sun exposure can be prevented by avoiding the strong
midday sun, using sunscreen year-round, and covering
up with protective clothing if exposure is necessary.
Squamous Cell Carcinoma
■ Description. Squamous cell carcinoma is less com
mon than basal cell carcinoma, but it tends to grow
more rapidly and become metastatic.
■ Etiology. This tumor, like basal cell carcinoma, tends
to occur on the sun-exposed skin of those with fair
complexion. It most commonly appears on people over
age 50. As a general rule, basal cell carcinoma occurs on
the face above the lip line, and squamous cell carcinoma
occurs below the lip line. This tumor is often preceded
by another skin lesion such as actinic keratosis, chronic
ulcers, sinus tracts, or scars.
Figure 18-32 Squamous cell carcinoma.
■ Symptoms. Squamous cell carcinoma can appear as a
firm, red nodule with crusts or a slightly elevated plaque
(Figure 18-32). The nodule is usually located on the
face, arm, neck, or hands but can appear in other areas.
A sore that does not heal or bleeds easily might be a
symptom of this cancer.
■ Diagnosis. Diagnosis is confirmed by skin biopsy.
■ Treatment. Squamous cell skin cancer has a high
rate of cure if caught early. Treatment depends on loca
tion and size of the tumor and if there is metastasis.
Wide surgical excision with radiation treatments and
follow-up for at least five years for signs of recurrence
is often the recommended treatment.
■ Prevention. Reducing sun exposure, examining the
skin frequently for suspicious growths or changes in
existing skin lesions, and seeking immediate treatment
for these are preventive measures.
Malignant Melanoma
■ Description. Malignant melanoma (melan = black,
oma = tumor) is the most serious type of skin cancer. It
occurs more commonly in men and is responsible for
the majority of skin cancer deaths.
■ Etiology. Malignant melanoma is due to an uncon
trolled growth of pigment, or skin-coloring cells, called
melanocytes. Growth of this tumor is caused by genetic
and environmental factors, primarily sun exposure.
Malignant melanoma rarely occurs before the age of 20
and can be related to a severe childhood sunburn.
■ Symptoms. This tumor is usually tan, brown, or
dark brown in color (Figure 18-33). Often, it arises
in a mole and causes a change in size and color of the
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Integumentary System Diseases and Disorders 431
Figure 18-33 Malignant melanoma.
mole. Malignant melanoma metastasizes quickly and is
highly malignant. It spreads into the lymph nodes and
can metastasize to all organs of the body.
■ Treatment. Treatment depends on the degree of spread
and might include wide surgical excision, radiation,
and chemotherapy. Prognosis depends on the degree of
spread when discovered, but approximately 20% of those
diagnosed with this tumor die from effects of metastasis.
■ Prevention. Preventive measures include reducing
sun exposure, examining the skin frequently for suspi
cious growths or changes in existing skin lesions, and
seeking immediate treatment.
Kaposi’s Sarcoma
■ Description. Prior to the discovery of AIDS, Kaposi’s
sarcoma (KAP-oh-seez sar-KOH-mah) was relatively
rare. The development of this neoplasm has increased
in conjunction with the increase in the AIDS-affected
population.
■ Etiology. The relationship between Kaposi’s sarcoma
and AIDS is not fully understood. Usually, this tumor
is not highly malignant except in the case of AIDS, in
which it tends to be widespread and is often the cause
of death in affected individuals.
■ Symptoms. This sarcoma is a malignant vascular skin
tumor characterized by bluish-red cutaneous patches
that grow under the skin, most often on the face and
legs. About one-third of the time, they show up in the
lining of the nose, mouth, and throat and can lead to
pain and difficulty with eating and swallowing. The
patches are usually composed of blood and cancer cells
and often cause no symptoms. Tumors developing on
the toes, feet, and legs often increase in number and size
and spread upward. If the cancer spreads to the digestive
tract or lungs, bleeding can result (Figure 18-34).
■ Diagnosis. Diagnosis is made on the basis of a phys
ical examination of the skin revealing painless, flat,
bluish-red lesions that do not itch or drain. A skin
biopsy is definitive.
■ Treatment. The most important advancement in
treating Kaposi’s sarcoma has been the development
of drugs to control HIV infection and AIDS. Specific
Kaposi’s treatments include liquid nitrogen, chemother
apy, and radiation. As with AIDS, there is no cure for
Kaposi’s.
Healthy Highlight
Sunburn Prevention E air-skinned persons and those working in the sun—sailors, farmers, ranchers, road
crew workers, and construction personnel—are at the greatest risk for development
of sunburn and, ultimately, skin cancer. Preventive measures against sunburn include:
Avoiding sun exposure between the hours of 10:00 a.m. and 3:00 p.m., when the sun’s
rays are the strongest.
Using sunscreen with SPF of 30 or higher on all exposed skin.
Wearing a large, brimmed hat to reduce sun exposure to the face, ears, and head.
Avoiding tanning beds.
■
■
■
■
432 Chapter 18
Figure 18-34 Kaposi’s sarcoma. (A) Kaposi’s sarcoma — skin. (B) Kaposi’s sarcoma — mouth.
Courtesy of Mark L. Kuss
■ Prevention. Because most cases of Kaposi’s are related
to HIV infection, taking preventive measures to avoid
HIV infection will usually prevent Kaposi’s.
Abnormal Pigmented Lesions
The epidermis of normal skin contains melanocytes
that produce melanin, the coloring pigment of skin.
Skin color varies from light to dark, depending on the
number of melanocytes present, and protects the skin
from burning. This explains why individuals with a
fair or pale complexion burn more easily than indi
viduals with a darker complexion. An individual’s
skin can contain several variations of abnormal lesions
associated with pigment. These abnormal, pigmented
lesions include ephelis, lentigo, nevus, albinism, vitil
igo, and melasma. These conditions can be unsightly
but are usually harmless and easily diagnosed by a
physician. Moles can cause increased concern if they
undergo a change in size and shape, possible indi
cators of cancer. Lesions can be biopsied if cancer is
suspected. A brief description of abnormal pigmented
lesions follows:
■ Ephelis Commonly called a freckle and is indic
ative of skin damage due to sunburn. The mela
nocytes in a freckle area are hyperreactive to
sunlight, causing the darkened lesion. Freckles
commonly occur in children and tend to fade in
adults.
■ Lentigo A small brown spot occurring on the
face, neck, and back of the hands of older adults.
Commonly called liver spots, these lesions are not
due to aging but to years of overexposure to the sun.
■ Nevus Commonly called a mole. Nevi can be brown,
black, or pink-colored and are often due to a collec
tion of melanocytes, which can appear on any area of
the body, vary in size and shape, and occur singly or
in multiples. Suspicious or unsightly nevi are often
removed surgically.
■ Albinism A hereditary disorder characterized by a
decrease or total absence of pigment in the skin, hair,
and eyes. Individuals affected with albinism have pale
skin, white hair, and pale blue or pink eyes. These
individuals suffer from extreme sunburn if adequate
protection is not provided.
■ Vitiligo (VIT-ih-LYE-go) Characterized by destruc
tion of melanocytes in small or large patches of skin
(Figure 18-35). This condition can be due to an
immune disorder.
■ Melasma Characterized by dark patches of skin on
the face, especially the cheeks (Figure 18-36) and
common in pregnant females and those taking birth
control pills. It is commonly called the mask of preg
nancy. Melasma usually disappears after delivery or
discontinuation of birth control pills.
Diseases of the Nails
Nails act as coverings for the toes and fingers and can
be considered extensions of the skin. Diseases of the
nail can cause abnormal shape, thickening, and color
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Integumentary System Diseases and Disorders 433
I Figure 18-35 Vitiligo.
Figure 18-36 Melasma.
changes. Fungal and bacterial infections are the most
common cause of nail disease.
Bacterial infection of the nails is paronychia (PAR-
oh-NICK-ee-ah), an infection of the skin around the
nail. This condition is commonly seen in individuals
whose hands are in water for long periods of time, such
as dishwashers, for example. This infection can cause
the nail to lift away from the bed, causing acute pain.
Antibiotics are usually an effective treatment.
Fungal infections frequently affect the feet, are
often chronic in nature, and commonly cause perma
nent nail deformity. Tinea pedis (athlete’s foot) is a
common cause of fungal nail infections of the feet. Fun
gal infections, as discussed previously in this chapter,
are difficult to treat, and recurrence is common.
Diseases of the Hair
Hair color, texture, and distribution are genetically
determined and influenced by hormones.
Hirsutism
■ Description. Hirsutism (HER-soot-izm; Latin, mean
ing shaggy) is excessive growth of hair. Men typically
have facial and chest hair due to stimulation by male sex
hormones. Hair growth in these areas in females is quite
distressing, however, and is usually caused by hormone
abnormalities due to such disorders as adrenal tumors,
ovarian tumors, and polycystic ovaries.
Alopecia
■ Description. Alopecia (AL-oh-PEE-shee-ah;
Greek, meaning fox mange, which causes hair loss)
is partial or complete hair loss, usually from the head
(Figure 18-37A).
■ Etiology. Alopecia can be caused by a number of
factors, including aging, heredity, thyroid disease, iron
deficiency, chemotherapy, radiation, and dermatitis.
Alopecia can occur suddenly or over a period of time
and can be temporary or permanent.
■ Treatment. Treatment of alopecia varies according
to cause and usually restores hair growth. One of the
most common causes of sudden, temporary alopecia is
related to chemotherapy and radiation treatment. Hair
growth normally returns when treatments are stopped.
Male Pattern Baldness
■ Description. Male pattern baldness is a common
cause of hair loss in men and is an inherited trait passed
to males by their mothers. The mother does not have
this type of hair loss because it is influenced by male sex
hormones, but the pattern can easily be recognized in
the mother’s brothers or the affected individual’s mater
nal uncles.
■ Symptoms. Male pattern baldness often begins
around age 30 with a receding front hairline and
loss of hair on the top and back portion of the head
434 Chapter 18
(A)
(B)
Figure 18-37 (A) Alopecia. (B) Male
-patterned baldness.
(Figure 18-37B). In some men, these areas of alopecia
eventually meet, leaving hair on only the sides of the
head. Alopecia in females is usually due to a hormonal
or nutritional disorder.
■ Treatment. In the case of male pattern baldness, hair
growth can be restored to some degree by certain special
medications. These medications are quite expensive, and loss
of hair returns if treatment is discontinued. Other options
include use of a wig, toupee, and hair transplantation.
which might be the result of mechanical, thermal, or
electrical injury, or radiation or pressure injury, and
insect or spider bites.
Mechanical Skin Injury
Skin is exposed to mechanical trauma in a variety of
ways. Mechanical trauma can be due to blunt or sharp
objects and range from mild and insignificant to major
and life-threatening. Types of mechanical skin injury
include the following.
Abrasion
■ Description. A common mechanical trauma is caused
by scraping away the skin surface. Abrasions are also
called friction burns or rug burns.
■ Symptoms. An abrasion is red, raw, and painful, but
bleeding is usually minimal. A skinned knee is a typical
example of an abrasion.
■ Treatment. Treatment generally consists of cleaning
the area with soap and water, removing any embed
ded particles such as grass or rock, applying antibiotic
ointment, and covering the area with a light sterile
dressing.
Blunt Trauma
■ Description. Blunt trauma can be caused when an
individual is struck by a heavy item (such as a hammer
or club) or is thrown against an object or a surface that
does not yield (such as a steering wheel or a wall). Falls
also can cause blunt trauma.
■ Symptoms. Blunt trauma often causes a large bruise
called a contusion (kon-TOO-zhun), an accumulation
of blood from injured or disrupted blood vessels in the
tissue that does not break the skin (Figure 18-38).
Consider This...
A human naturally loses 40 to 100 strands
of hair a day.
Trauma
The skin is the outermost organ of the human body and
the body’s first line of defense. The position of the skin
exposes it to high risk for receiving frequent trauma,
Figure 18-38 Bruise of the finger due to blunt trauma.
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Integumentary System Diseases and Disorders 435
Figure 18-39 Avulsion of finger.
Avulsion
■ Description. Avulsion occurs when a portion
of skin or appendage is pulled or torn away. Avul
sion injuries usually occur when tissue is caught
up in some type of machinery (Figure 18-39). If an
appendage is completely torn away, it is termed an
amputation.
Crush Trauma
■ Description. Crush trauma occurs when tissue is
caught between two hard surfaces. Crush injuries com
monly involve fingers, hands, feet, and toes, such as
when hands and fingers are caught in doors or between
objects or when heavy items are dropped on the fingers,
hands, feet, and toes.
Puncture Injury
■ Description. Puncture injury occurs when a sharp
object such as a knife, nail, or splinter of glass or metal
is forced into the tissue. Bleeding is usually minimal.
A feared complication of puncture injury is tetanus
because puncture injuries set up an anaerobic condition
favorable to tetanus bacteria.
Laceration
■ Description. A laceration is a cut in the skin caused
by a sharp object such as a knife, razor, glass, or metal.
The edges of the laceration can be smooth, making
repair easy, or the edges can be jagged, leading to a more
difficult repair. A laceration with smooth, even edges is
commonly called an incision.
Thermal Skin Injury
Thermal skin injury can be due to excessive heat
or cold or to short- or long-term exposure to vary
ing temperatures. Skin injury can range from mild
to severe. Untreated severe skin injuries can become
life-threatening.
Hyperthermia
■ Description. Hyperthermia (hyper = excessive, ther-
mia = temperature) occurs when the body is overheated
from excessive exposure to the sun or a hot environ
ment or to excessive exercise in a hot environment.
There are two types of hyperthermia: heat exhaustion
and heat stroke. The cause and treatment of these types
of hyperthermia vary considerably.
Heat Exhaustion
■ Description. Heat exhaustion is sometimes called heat
prostration; it commonly occurs from excessive exercise
or activity in a warm environment.
■ Symptoms. The individual has profuse perspiration
and loss of salt and water, leading to dehydration. The
skin is cool and moist. The individual might feel weak
and nauseated and might have muscle cramps. Body
temperature is usually normal.
■ Treatment. The affected individual should lie quietly
in a cool place. Fluid and salt replacement can include
drinking tomato juice or other high-sodium drinks
along with water. In extreme cases, the affected indi
vidual should be transported to the hospital.
Heatstroke
■ Description. Heatstroke is more serious than heat
exhaustion. It occurs when the body’s temperature
regulating mechanisms are no longer able to cope with
the excessive exposure to heat.
■ Symptoms. The body’s core temperature rises above
105°F, and the skin is red and hot. The skin is dry with
a noted absence of perspiration. The affected individ
ual might feel nauseated and weak and can become
mentally confused. In extreme cases, the confusion
can progress to loss of consciousness with convulsions.
Without rapid and effective treatment, brain damage
and death can result.
■ Treatment. Treatment is aimed at immediate and
aggressive cooling of the body by removing clothing and
pouring cool water over the body or placing the body
436 Chapter 1 8
in a cool tub or pool. The affected individual should be
immediately transported to a hospital.
Burns
■ Description. Burns can be caused by fire, steam, expo
sure to hot liquids or items, chemicals, and electricity.
The degree of tissue injury is related to the intensity of
the heat and duration of exposure. Burns are classified
by depth of skin injury and include first-, second-, and
third-degree burns.
■ Etiology. The main complications of burns are fluid
loss and infection. Open tissue affected by second- and
third-degree burns can leak pints to quarts of serous
fluid per day, leading to dehydration and shock. Pseudo
monas, the bacterium often causing infection, is noted
for its ability to spread to the blood, leading to septice
mia and death.
■ Treatment. Treatment of burns depends on the
degree and type of burn. Generally, treatment will
include cooling the tissue with cool water to prevent
further burning. Pain is treated with analgesics ranging
from over-the-counter products to narcotic analgesics,
depending on the severity of pain. Antibiotics are given
orally and intravenously to prevent or treat infection.
Antibiotic ointments also can be applied directly to the
burned area.
Surgical debridement might be needed to remove
charred and necrotic tissue. In some cases, this can be
accomplished by whirlpool treatments. Surgery is often
necessary to graft skin, remove excessive scar tissue,
and reshape deformities. Surgical treatment might be
necessary multiple times over a period of months or
years to obtain the desired results.
First-Degree Burns
■ Description. First-degree burns are fairly common
and are characterized by pain, skin redness, and swell
ing. First-degree burns involve only the epidermis and
are often the result of sunburn (Figure 18-40). Healing
generally occurs within a week, followed by peeling of
the damaged epidermis.
Second-Degree Burns
■ Description. Second-degree burns are also called
partial-thickness burns; they involve the epidermis
and dermis and are characterized by extreme pain,
redness, blisters, and open wounds (Figure 18-41).
Second-degree burns usually heal in 2 to 3 weeks. If the
Courtesy of Mark L. Kuss
Figure 18-40 First-degree burn.
Figure 18-41 Second-degree burn.
burned area becomes infected, a second-degree burn
can progress into a third-degree wound.
Third-Degree Burns
■ Description. Third-degree burns are also called
full-thickness burns; they involve the epidermis and
entire dermis, exposing layers of fat, muscle, and
bone. Tissue burned to the third degree is painless
because the nerves in the dermis have been destroyed
(Figure 18-42). This is not to say that individuals with
third-degree burns do not have pain; there is extreme
pain, but the pain is due to a layering of degrees of burn,
with first- and second-degree areas surrounding the
third-degree areas.
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Соседние файлы в папке Библиотека им академика М.И. Перельмана