Notes: Integumentary System
Pathology, TCCD Massage Program
Chapter 2
Function and Construction of the Skin
Skin Functions
To keep insides from falling out
Also
Protection from potential invasion, ultraviolet radiation
Homeostasis manages fluid loss, temperature regulation
Sensory envelope
Absorption, excretion (only in special circumstances)
Skin Construction
Varies in thickness
Three basic layers, layers within them
Rules for Massage
Any break or compromise in the skin is a potential portal of entry for infection
Skin lesion vocabulary
Lacerations
Incisions
Excoriations
Fissures
Papules
Vesicles
Pustules
Punctures
Avulsions
Abrasions
Ulcers
Contagious Skin Disorders
Herpes simplex
Cellulitis
Fungal infections
Noncontagious Inflammatory Skin Disorders
Acne vulgaris
Acne rosacea
Neoplastic Skin Disorders
Psoriasis
Impetigo
Lice and mites
Warts
Dermatitis, eczema
Hives
Skin cancer
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Notes: Integumentary System
Pathology, TCCD Massage Program
Skin Injuries
Burns
Decubitus ulcers
Definition
Local staphylococcal infections
Also called furuncles
Scar tissue
Etiology what happens?
Staph A infection at sebaceous glands, hair shafts, or site of injury
Staph A is aggressive, resistant, adaptable
MRSA, methicillin-resistant Staphylococcus aureus
Most common at axilla, groin ( hidradenitis suppurativa )
At buttocks: pilonidal cysts
Signs and Symptoms
Large, obvious, painful infection
Usually one at a time, or in small cluster (Fig. 2.2, 2.3)
Over a larger area: folliculitis (Fig. 2.4)
Starts as hard red/pink bung
Develops center of pus
May rupture
May penetrate deep layers of skin, leave permanent scar
Treatment
Antibiotic ointment, hot compresses
Lance, drain boil
Oral antibiotics tend to be too slow
Don’t squeeze or pop!
Extremely painful
May allow bacteria to get into deeper tissues, bloodstream
Prevention
Observe hygienic practices
Don’t share personal items (razors, towels)
Keep open lesions covered
Massage
At very least locally contraindicated
With signs of systemic infection, systemically contraindicated
Isolate, treat sheets
Definition
Streptococcal infection of skin
Strep A also causes strep throat, impetigo, toxic shock syndrome, necrotizing fasciitis…
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Notes: Integumentary System
Pathology, TCCD Massage Program
Etiology
Strep gain access through a portal of entry
(not always obvious where)
Toxins are corrosive to healthy cells
Signs and Symptoms
May be preceded by obvious skin infection
Tender, red, swollen area (Fig 2.5)
Red streaks toward lymph nodes (lymphangitis)
On face: rash across the nose
Erysipelas (subtype of cellulitis): sharply defined margin of involved skin
Fever, chills, malaise
May complicate to blood poisoning
Treatment
Aggressive, maybe IV, antibiotics
Massage
Systemically contraindicated until all signs and symptoms are over
Definition
Superficial fungal infection:
Mycosis, dermatophytosis, ringworm (no worms)
Lesions = tinea
Etiology: what happens?
Dermatophytes live on dead skin cells
Transmitted skin–skin; animal–skin; surface–skin
Massage sheets, locker room floors, hair brushes…
4–14 days before lesions appear (communicable in meantime)
Types of fungus:
Trichophyton
Epidermophyton
Microsporum
Common, contagious
Small, round, red, scaly patch on trunk, extremities
Scratching spreads to new areas
Increases in size, heals in the middle (Fig 2.7)
Looks like nummular eczema (which isn’t contagious)
=
Itchy, flaking, looks like dandruff
May lead to permanent hair loss (Fig. 2.8)
=
Often starts between the third and fourth digits (Fig 2.9)
Very common
Burns, itches, has oozing blisters (possible portals of entry for infection)
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Notes: Integumentary System
Pathology, TCCD Massage Program
Moccasin distribution: dry flaky lesions elsewhere on the foot
Athlete’s foot may spread to hands: tinea manus, unguium
=
Anywhere from upper thigh to buttocks (Fig 2.10)
May be related to candida: an internal infection (less contagious)
Other varieties of tinea tinea barbae tinea versicolor
Treatment
Topical application of fungicide
Can be stubborn infection
Oral medication for infections under nails
Also treat shoes, gloves, etc.
Prevention
Avoid contact
Wear shoes in public locker rooms, showers
Massage treatments: avoid lesions on clients
Take good care of personal health
Massage
Locally contraindicated
Small, treated, covered lesions can be avoided during a regular session
Be careful with athlete’s foot:
Open lesions
Spreading from one foot to another
Definition
HSV-1: associated with mouth, above waist
HSV-2: associated with genitals, below waist
Distinction less important than it used to be
Demographics
20–25% U.S. adults and teens have HSV-2, women > men
60–80% U.S. adults have HSV-1
Etiology: what happens?
Oral, respiratory, mucous secretions
Primary versus recurrent herpes
Virus never expelled: goes into dormancy in nerve root
Waits for trigger:
Excessive sunlight, stress, menstrual period, wedding pictures
Communicability
Virus is stable outside a host
Virus can shed during prodrome stage (no symptoms present)
Most U.S. adults have been exposed; circulate antibodies against a new infection
Signs and Symptoms
Pain/tingling a few days before outbreak (prodromic stage)
Blisters on a red base (Fig. 2.11)
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Notes: Integumentary System
Pathology, TCCD Massage Program
After they scab, lesions are less infectious
Outbreak lasts 2–3 weeks
Types of herpes
Oral herpes: cold sores, fever blisters
Usually on or around the mouth
Genital herpes: on genitals, thighs, buttocks, low back
May occur with decreasing frequency with age
Herpes Whitlow: on nail beds of the hands; associated with children who suck their thumbs or dental hygienists (Fig. 2.13)
Herpes gladiatorum: trunk and extremity of wrestlers, athletes with skin-to-skin contact
Herpetic sycosis: multiple lesions in beard area: repeated shaving while lesion is active
Eczema herpeticum: associated with atopic dermatitis
Complications
Secondary bacterial infection
Greater risk of communicating HIV
Accelerates the progression of HIV to AIDS.
Vaginally delivered newborns of mothers with active genital herpes may develop blindness, pneumonia, brain damage
Treatment
Antiviral drugs suppress viral activity, shorten duration of an infection
Isolate towels, bedding, and clothing
Avoid sexual contact while lesions are present
Keep as healthy as possible between
Massage
Acute herpes locally contraindicates massage
Encourage clients to reschedule during prodrome
Isolate, treat linens if exposure is suspected
Avoid working with client’s hands
Definition
Skin infection with staphylococcus or streptococcus
Mostly in children; adults can also have it
Usually begins somewhere on face or head
Signs and Symptoms
Three presentations:
Impetigo contagiosa :
Infection with Streptococcus pyogenes
Red sores with small blisters
Yellow-brown crust (Fig 2.14)
Bullous impetigo:
Infection with Staphylococcus aureus
Large, painless blisters on the trunk, arms, and legs
Usually in infants
Fever, diarrhea, and general weakness
Ecthyma
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Notes: Integumentary System
Pathology, TCCD Massage Program
Related to chronic skin inflammation, poor circulation
Painful, pus-filled blisters on legs and feet, malaise, swollen lymph nodes
Can leave permanent scars
Treatment
Antibiotic cream
Oral antibiotics
Can have serious complications; treated aggressively
Prevention
Treat chapped skin, sores; clean and cover lesions
Don’t touch lesions and spread bacteria
Isolate bedding, towels
Massage?
Systemically contraindicated until all signs of infection are over
Mites (on dogs known as mange, contagious from canines to humans)
Definition
Sarcoptes scabiei (Fig 2.15)
Burrow under skin
Cause lesions called scabies
Wastes are irritating
Norwegian scabies is different parasite: relatively rare; usually found in immunocompromised people or overcrowded conditions
How do they spread?
Skin-to-skin contact
Indirectly through clothing, linens
Mites live hours to days off a host
Signs and Symptoms
Trails left in skin
Especially in hands and skin folds (Fig 2.16)
Unrelenting itch
Diagnosis
Skin tests
Treatment
Can resemble noncontagious conditions
Pesticidal soap (toxic—avoid overtreatment)
Wash, isolate linens, towels, clothing
Massage
Systemically contraindicated until infestation is over
Symptoms may be delayed by weeks: still contagious during this time
Definition
Pediculus humanus capitis: wingless insects (Fig 2.17)
Live in head hair, suck blood from scalp
Saliva is irritating
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Lay eggs: nits
How do they spread?
Direct human contact is most efficient
Move slowly when off a host
May infest hats, helmets, car seats, upholstery
Signs and Symptoms
Nits (Fig 2.18)
At base of hair, usually on back of head
Nits adhere strongly to hair: grow out with hair
Itchiness
Sensation of movement on scalp
Treatment
Pesticidal shampoo
Some lice have developed resistance
Other smothering techniques
Modified hair dryer
Washing bedding, towels, clothing
Isolate hats, hairbrushes, combs, etc.
Cover furniture, other soft items 2 weeks
Massage
Contraindicated until infestation is over
Definition
Pediculus humanus humanus
Closely related to head lice; different living, feeding patterns
Don’t live on host: stay in clothing
How are they spread?
Shared unwashed clothing
Signs and Symptoms
Itchy rash that gets progressively worse
Treatment
Good hygiene
Definition
Pthirus pubis : crabs (Fig 2.19)
Live in any coarse body hair (Fig 2.20)
How are they spread?
Sexual contact, clothing, sheets
Signs and Symptoms
Visible animals, itching
Treatment
Pesticidal soap
Isolate sheets, towels, clothing
Massage
Contraindicated until infestation is resolved
Notes: Integumentary System
Pathology, TCCD Massage Program
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Notes: Integumentary System
Pathology, TCCD Massage Program
Definition
Benign growths caused by varieties of human papillomavirus (HPV)
Invade keratinocytes
Demographics
Verruca vulgaris : common warts
Mostly young children, teenagers
7–12% overall population
20% of teens
Etiology
HPV = 100 + pathogens
Common warts spread through skin contact
Requires repeated exposures, grows slowly
Signs and Symptoms
Hard, cauliflower-shaped growths (Fig. 2.21)
On bottom of feet: plantar warts
Types of warts:
Deep palmar–plantar warts, also called myrmecia
Soles of feet (Fig 2.22), sometimes around fingernails
Rarely becomes malignant: verrucous carcinoma
Cystic warts
Sole of foot, smooth and soft, filled with cheesy substance
Theories: blocked sweat glands? Encysting original viral infection?
Butcher’s warts
Associated with meat handling; different type of HPV from common warts
Plane or flat warts
Small, brown, smooth
A few or hundreds
Hands, face, shins
Molluscum contagiosum
Not HPV
Common children’s malady; in adults may be sexually transmitted disease (STD)
Genital warts
STD from several varieties of HPV
Most come and go without symptoms; some may become cancerous
Cervical cancer
Vulvar cancer
Treatment
Benign neglect; usually resolve within 2 years
Topical salicylic acid
Liquid nitrogen
Electrosurgery
Blister beetle juice
Other remedies
Garlic
Duct tape
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Notes: Integumentary System
Pathology, TCCD Massage Program
Massage
Self-fulfilling prophecy: suggestibility
Local contraindication
Watch for bleeding, shedding in area
Definition
Idiopathic, chronic skin condition
Fair-skinned people 30–60 years old
Mostly on face: nose and cheeks, conjunctiva, eyes, eyelids
Etiology
Not well understood
May be inherited
Comes and goes, then may become permanent
Triggers for flares
Sunlight, wind, cold temperature, hot liquids, alcohol, spicy food, menopause, steroids, stress
Signs and Symptoms
Four main stages
Facial flushing: hot or stinging, not usually itchy
Vascular rosacea: telangiectasia, inflammation and irritation of eyes, eyelids
Inflammatory rosacea: papules, pustules
Rhinophyma: thickened, bumpy, distorted, reddened skin; more frequent in men than women
Complications
Can damage the cornea: rosacea keratitis
Can damage self esteem, public perception
Anxiety disorders, depression
Assumption of alcoholism
Treatment
Palliative: topical, oral antibiotics (don’t resolve redness)
Dermabrasion
Plastic surgery for advanced rhinophyma
Avoid triggers
Massage
Face is probably locally contraindicated
Inflammatory, sensitive to lubricants
Elsewhere is fine
Definition
Small bacterial infections
Face, neck, upper back
Demographics
Especially common in teenagers: related to boost in testosterone secretion
85% of U.S. population has acne at some point
After age 45, about 5% of men and women have acne
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Notes: Integumentary System
Pathology, TCCD Massage Program
Etiology
Several factors
Factor 1: Testosterone production
Stimulates sebaceous gland activity and keratinocytes in hair shafts
Factor 2: Bacterial activity
Usually Propionibacterium acnes : produces enzymes that increase inflammation
Factor 3: Stress
Changes endocrine balance, slows immune cell activity
Factor 4: Liver congestion
In adults: liver neutralizes hormones; congestion can impede this function
Factor 5: Hormonal imbalance
Menstrual cycle, birth control pills
Signs and Symptoms
Locally painful; not systemic (Fig 2.24)
Rare form: acne fulminans with fever, joint pain, malaise
Types of lesions
Pimples : infections trapped below skin: raised, red, painful bumps or papules
Cysts: infections trapped deep in dermis or superficial fascia
Open comedones : blackheads, trapped sebum oxidizes, turns dark
Closed comedones : whiteheads, pustules; superficial infections covered with epithelium
Treatment
Avoid touching face
Gentle cleansing
Medications:
Topical, oral antibiotics
Steroidal anti-inflammatories
Retinoins
For acne scars:
Massage
Laser surgery, dermabrasion, filling pockmarks
Locally contraindicated
Consider water-based lotion instead of oil
Definition
Skin inflammation
By convention: not infectious
Contact dermatitis: externally applied irritant or allergen
Eczema: immune dysfunction, hypersensitivity expressed in skin
Demographics: who gets it?
Eczema: 10–20% of infants; 15 million adults in United States
Etiology
Two types of hypersensitivity reactions in skin:
Type I reaction
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Notes: Integumentary System
Pathology, TCCD Massage Program
Type IV delayed reaction
Eczema : Type I reactions; systemic immune system (IS) response to nonthreatening stimuli
High crossover with hay fever, asthma in patients and families
Allergic contact dermatitis : Type IV reaction; symptoms develop 12–48 hours after exposure
Causes of eczema
Contributing factors include
Fatty acid deficiency
Stratum corneum breaks down
T-cell imbalance and dysfunction
Some T cells are deficient; others are overabundant
Proinflammatory interleukin-4
Elevated immunoglobulin-E :
Allergy-related antibodies cause excess release of histamine
Triggers:
Rough textures, detergents, harsh chemicals, extreme temperatures, excessive sweating
Causes of contact dermatitis
Irritation (contact irritant dermatitis)
Harsh detergents, etc.
Allergen (contact allergic dermatitis)
Nickel, adhesive, perfumes, latex
Signs and Symptoms of eczema
Atopic dermatitis:
Most common
Red, dry, flaky, at knees, elbows, ankles, hands (Fig. 2.25)
Lichenification
Seborrheic eczema:
Yellow, oily patches in skin folds on nose, scalp
Dyshidrosis:
Itchy fluid-filled blisters on hands and feet (Fig. 2.26)
Risk for secondary infection
Nummular eczema:
Itchy small circular lesions on legs and buttocks (Fig. 2.27)
Looks like ringworm
Signs and symptoms of contact dermatitis
Acute: signs of inflammation at area of contact (Fig. 2.28)
Other forms of dermatitis
Stasis dermatitis
Usually on lower legs, feet: poor circulation
Red, purple skin
Neurodermatitis
Complications
Minor injury creates excessive inflammatory response
Itch-scratch cycle
Secondary infection
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Notes: Integumentary System
Pathology, TCCD Massage Program
Treatment
Self-care
Isolate, avoid triggers
Use moisturizer, emollient
Supplement essential fatty acids for skin health
Medication
Topical immunomodulators
Antihistamines
Corticosteroids (have risks)
Massage
Depends on
Cause
Severity
Condition of skin
Definition
Also called urticaria
Intense heat, swelling, itching on skin
Etiology
Stress, allergy, other stimuli
Diffuse, unfocused allergic reaction
Histamine release in superficial fascia: dilation, permeability, edema
Triggers vary
Types of hives
Acute hives :
Short-lived
Triggered by allergy, infection, other
Cholinergic hives :
Hundreds of tiny wheals
Associated with rapid changes in temperature
Can be very severe
Physical hives :
In response to mechanical trigger (scrape, pressure)
Dermographia
Chronic hives :
Rare: lesions last six or more weeks
Idiopathic or related to autoimmune disease, liver dysfunction, viral infection
Signs and Symptoms
Redness, itching, heat
Wheals may join in large patches (Fig. 2.29)
Treatment
Antihistamines
Topical/oral steroidal anti-inflammatories
Angioedema is emergency; see allergic reactions
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Notes: Integumentary System
Pathology, TCCD Massage Program
Massage
Locally contraindicated
Use hypoallergenic lubricant
Definition
Chronic skin condition with acute episodes:
Pile-up of excess skin cells
Demographics
6 million to 7 million in United States, mostly whites
15,000 diagnoses/year
Wide range of severity
Only 20% say their psoriasis is moderate to severe
Etiology
Still be studied:
Overactive T cells and chemical signals
Trigger inflammation, cell proliferation
Signs and Symptoms
Plaque psoriasis :
Most common
Raised pink, red patches with silvery scale (Fig. 2.30)
Mildly itchy
Usually on knees, elbows, can be on scalp, trunk, palms, soles
Can be widespread (Fig. 2.31)
Under nails can cause onycholysis
Guttate psoriasis :
Triggered by respiratory infection
Looks like plaque in small circular regions
Pustular psoriasis :
Small noninfectious pustules
Triggered by some medications, topical irritants, UV radiation, pregnancy
Appears on palms and soles
Inverse psoriasis :
At skin folds: skin is red and shiny
Vulnerable to secondary infection with yeast or fungus
Erythrodermic psoriasis :
Triggered by sunburn, steroidal anti-inflammatory use or stoppage
Large hot, painful rash
Can cause fluid loss, medical emergency
Complications
Can cause severe cracking leading to infection, fluid loss, shock
Psoriatic arthritis:
Treatment
10–30% of patients; goes in flare and remission
Topical medications:
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Notes: Integumentary System
Pathology, TCCD Massage Program
Coal tar, vitamin D ointment, steroid cream, salicylic acid, Epsom salt baths
Phototherapy:
Limited exposure to sun for vitamin D production
May be used with drugs
Oral medications:
Steroids, retinoids, cytotoxic drug, psoralen
TNF (tumor necrosis factor) blockers: block inflammatory process
No permanent solutions yet
Massage
Avoid lesions, compromised skin
Not contagious, spread by massage; may benefit with stress management
Definition
Uncontrolled replication of skin cells
Demographics
Some stay local; others metastasize
1:5 people in United will have some kind of skin cancer
1 million dx/year
890,000 not melanoma
110,000 melanoma
11,000 deaths/year
7,900 malignant melanoma
2,800 not melanoma
Mortality rate rising (longer lifespans, more elderly people at risk)
Most common in people who
Had multiple sunburns in childhood
Live in the South or at high altitude
Are immunosuppressed
Have already had some form of skin cancer
Have multiple or atypical moles
Have history of toxic exposures
Definition
Also called solar keratosis
Some call it cancer; others call it precancerous for squamous cell carcinoma
Actinic cheilitis (on lips)
Leukoplakia (tongue, cheek)
Bowen disease (in situ SCC)
Signs and Symptoms
(A sore that doesn’t heal or that comes and goes in the same place)
Brown, red scaly lesions
Usually on face or hands
5–20% of lesions may turn to squamous cell carcinoma
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Notes: Integumentary System
Pathology, TCCD Massage Program
Treatment
Liquid nitrogen
Injected with medication
Topical ointment
Excision if necessary
Massage actinic keratosis lesions should be removed
Undiagnosed lesions contraindicate massage
Definition
Most common type of skin cancer: 75–90% all cases
Slow-growing, nonmetastasizing tumor in stratum basale
Untreated tumors corrode into healthy tissue
Main risk factor: long-term, low-grade sun exposure, other radiation, arsenic, genetic disease
Signs and Symptoms
(A sore that doesn’t heal or that comes and goes in the same place)
Nodular :
Most common form, usually on head, neck, back
Small, hard lump
Pearly border, ulcerated center
May come and go
Pigmented :
Looks like nodular basal cell carcinoma, but darker
Superficial :
Looks like eczema, psoriasis
Appears on trunk in pink, reddish patches
Micronodular :
Can be aggressive; multiple small well-defined yellowish-white lesions
Morpheaform or infiltrating:
Looks like scar tissue; can be aggressive while showing only a small mark on surface
Treatment
Excision, liquid nitrogen, radiation
Recurs, raises risk of malignant melanoma; be vigilant!
Massage
Locally contraindicated
Doesn’t metastasize, so elsewhere massage is fine
Definition
Affect keratinocytes in the middle layers of the epidermis
200,000–300,000 diagnoses/year
Usually on head, face, mouth
Can be in mucous membranes
Related to long-term sun exposure, chronic skin inflammation
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Notes: Integumentary System
Pathology, TCCD Massage Program
Decubitus ulcers, boils, draining sores
Immune suppression raises risk: especially transplant recipients
Can metastasize
Signs and Symptoms
A sore that doesn’t heal, or comes and goes in the same place
Some begin as actinic keratosis
May appear more aggressive than actinic keratosis, basal cell carcinoma (Fig 2.37, 2.38)
Treatment
Liquid nitrogen
Shaved off in layers
May need skin grafts, radiation
Massage
Can be aggressive form of cancer; guidelines are determined by treatment options
Definition
Replication of melanocytes
Most in skin; also in gastrointestinal and reproductive tracts and eye
Associated with history of sunburns
May develop in areas not exposed to sun
Demographics
Leading cause of death by skin cancer
72% of skin cancer deaths
Incidence is rising 5–9% per year
Most common in elderly white men
Signs and Symptoms
Often, not always, starts as preexisting mole
A : A symmetrical
B : B order
C : C olor
D : D iameter
E : E levated
Four main types:
Superficial spreading melanoma (Fig 2.40)
Lentigo melanoma (Fig 2.41)
Acral lentiginous melanoma (Fig 2.42)
Nodular melanoma (Fig 2.43)
Treatment
Surgical excision, radiation, perfusion chemotherapy
Prognosis
Depends on depth of lesion, stage
Prevention
Cover up
Hats should cover ears, neck
Use sunscreen with a minimum of SPF 15
UV-absorbing sunglasses
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Notes: Integumentary System
Pathology, TCCD Massage Program
Massage
Depends on stage, treatment options
Definition
Injury that destroys proteins in skin cells:
Etiology
Dry heat, wet heat, electricity, radiation, corrosive chemicals
Severity depends on depth and surface area
>15% loss of skin function → infection, shock, circulatory collapse
Neck, face burns can block breathing passages
1st degree burn:
Epidermis only
Mild irritation, can be painful
Redness, no blistering (mild sunburn)
2nd degree burn:
Involves epidermis and dermis
Instant symptoms: edema, pain, redness, blisters
May leave scar
3rd degree burn:
Goes through the dermis
Destroys hair shafts, sebaceous glands, sweat glands, nerve endings (can be less painful)
Whiteness, charring, leathery texture
Contract rapidly, forming tight scar tissue
Signs and Symptoms
Listed above
Treatment
First and second degree: lotion, antibiotic cream
Third degree: cleansing, debridement, skin grafts, plastic surgery
Massage
Locally contraindicated while acute
Mild sunburn may be all right
Work within pain tolerance in post acute stages to improve skin health and mobility, reduce pain
Definition
Also called bedsores, pressure sores, trophic ulcers
Inadequate blood flow to skin
Usually over bony areas in contact with surface
Demographics
Mostly elderly, underweight, male, nonambulatory, incontinent
Can happen with any immobility
Etiology
Squeezed capillaries → skin cell death
Damage below surface of skin; may not be visible early
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Notes: Integumentary System
Pathology, TCCD Massage Program
Can go to bone (Fig. 2.47)
Secondary infection can be life threatening
Signs and Symptoms
Change in skin temperature
Localized reddening, pain, itching
Reversible at this point
Later: purple, necrosis
Don’t go through normal healing process: no nutrition available
Treatment
Topical antibiotics and dressings
Debridement, plastic surgery
Dressings treated with hydrocolloids
Limit risk of infection, chronic inflammation and squamous cell carcinoma
Massage
Good preventive measure; contraindicated when skin is compromised
Definition
Development of new tissue to repair from damage
Skin injuries for this discussion
Etiology
After an injury:
Inflammatory process
Scab forms
Underneath basal cells migrate across wound in a sheet
Cells to add to sheet; new strata are added
Superficial cells are keratinized; scab falls off
Can happen within 24 hours, depending on size, depth of wound
Deeper than dermis, or with inflammation/foreign material:
Fibroblasts fill in with granulation tissue
Signs and Symptoms
Hypertrophic scar: bulges at boundaries of original injury
Keloid scar: overflows injury with permanent mass of collagen
Treatment
Cosmetic treatments to reduce appearance:
Injection with collagen
Dermabrasion
Chemical peels
Punch grafts
Laser resurfacing
Hypertrophic scar: injected with cortisone
Keloids: liquid nitrogen, cortisone, silicone gel packs, pressure bandages
With extensive skin damage: skin grafts to reduce contractions
Massage
Appropriate in post-acute stages
May improve quality of new scar tissue
Watch for areas of numbness
Page 18 of 18