Skin Anatomy and Functions

Epidermis
- Outermost layer, responsible for the skin's barrier function. Composed of four layers, with the stratum corneum being the outermost layer.
- Contains melanocytes (pigmentation), Langerhans cells (immune response), and Merkel cells (sensation)
Dermis
- Deeper layer, containing nerves, muscle tissue, connective tissue, hair follicles, sweat glands, sebaceous glands, and lymphatic vessels.
- Contains fibroblasts (collagen production), mast cells (allergies), and macrophages (phagocytosis)
Subcutaneous Tissue
- Adipose tissue layer that sits below the dermis, separating the skin from underlying structures

Newborn
- Thin skin with a loosely attached epidermis
- Eccrine sweat glands function, apocrine glands are small and non-functional
- Melanin is scarce, resulting in lighter skin color
Adolescents
- Thick skin with tightly connected epidermis and dermis
- Sweat glands function fully, with boys producing more sweat than girls after puberty
- Apocrine sweat glands mature at puberty
- Melanin reaches adult levels, contributing to skin color

Papules: Small, hard skin protrusions that disappear without a trace
Nodules: Protrusions of 1-2 cm in diameter, settling in the subcutaneous tissue
Vesicles: Round, fluid-filled protrusions in the epidermis smaller than 1 cm (e.g., chickenpox)
Bullae: Vesicles larger than 1 cm
Fistula: Similar to a vesicle, but filled with pus
Macules: Non-palpable rashes smaller than 1 cm, raised from the skin (e.g., measles)
Cysts: Palpable, deep-seated protrusions surrounded by a thick wall, containing liquid or semi-solid substance
Fissures: Smooth slits from the epidermis to the dermis
Erosion: Loss of part or all of the epidermis, preceding an ulcer
Ulcers: Damage to both the epidermis and dermis, involving tissue loss

Impetigo
- Superficial, highly contagious infection common in children. Most frequent in areas like the face, mouth, hands, neck, and extremities.
- Caused by streptococci and staphylococci.
- Symptoms: Vesicles or pustules, itching, regional lymphadenopathy.
- Treatment: Removal of crusts, topical antibiotics, oral antibiotics (if necessary).
Folliculitis
- Inflammation of the hair follicle, seen on any hair-bearing area. Characterized by painful swelling around the hair, possibly with a pus-filled vesicle at the center.
- Commonly caused by Staphylococcus aureus.
- Treatment: Keep the area clean, use loose cotton clothing.
Cellulitis
- Infection of the dermis and subcutaneous fat, leading to redness, swelling, tenderness, and plaques with unclear boundaries.
- Often caused by Staphylococcus aureus and Streptococcus pneumoniae.
- Treatment: IV antibiotics, warm compresses.

Warts (Verruca)
- Caused by human papillomavirus, most common on hands and feet but can appear anywhere.
- Treatment: Keratolytic agents, cryotherapy, acidic solutions, surgical methods in some cases.
Molluscum Contagiosum
- Viral inflammation of the skin caused by the smallpox virus.
- Transmission through direct contact or contaminated surfaces.
- Lesions usually disappear spontaneously within 6-9 months.
- Treatment: Local antiviral drugs.

Tinea Capitis
- Fungal infection affecting the scalp, particularly common in children, leading to hair loss (alopecia).
- Transmission through person-to-person or animal-to-human contact.
- Symptoms: Alopecia, itching.
Tinea Corporis
- Fungal infection occurring on the body, typically transmitted through contact with infected animals.
- Symptoms: Round, pale red plaques on the skin.
Tinea Pedis
- Fungal infection affecting the feet, particularly the plantar surface, toes, and between the toes.
- Symptoms: Macerations, fissures, vesicles, plaques, itching.

Pediculosis (Lice)
- Caused by Pediculosis capitis (head lice), Pediculosis corporis (body lice), and Pediculosis pubis (pubic lice), all feeding on human blood. Common in children aged 3-12 years.
- Symptoms: Intense itching.
- Treatment: Special shampoos and creams, oral antihistamines for itching, combing with a fine-toothed comb after treatment.
Scabies
- Highly contagious infestation caused by the Sarcoptes scabei parasite.
- Transmission through skin-to-skin contact, prominent in household environments.
- Symptoms: Intense itching, especially at night.
- Treatment: Topical medications (e.g., permethrin cream) for the entire body.

Risk Factors:
- Reduced mobility (e.g., bedridden, wheelchair-bound)
- External pressure from casts, splints, or rubbing against medical equipment
Nursing Interventions:
- Prevent & detect pressure ulcers early
- Protect from infection
- Provide appropriate wound care
- Address pain & itching
- Educate family about home care
- Regular skin assessment (visual inspection & palpation) for color changes, wounds, temperature, and other signs of injury
Nursing Diagnoses:
- Impaired skin integrity (due to environmental agents or immune deficiencies)
- Risk of impaired skin integrity (mechanical trauma, bodily secretions, infection)
- Risk of infection
- Acute pain
- Disturbance in body image

Burn Severity:
- First-degree (superficial): Epidermis only. Pain, erythema, no scarring.
- Second-degree (partial thickness): Epidermis and part of the dermis. Redness, wetness, bullae, severe pain.
- Third-degree (full thickness): Involves epidermis, dermis, and subcutaneous tissue. No pain, white or charred appearance. Scarring is likely.
Determining Severity:
- Lund and Browder card is used to calculate the burn surface area in different age groups
- Depth of the burn is also a crucial factor in assessing severity.