LESSON 4

SKIN AND SOFT TISSUE CONDITIONS

Traumatic injuries, infections

OBJECTIVES

By the end of this lesson, you should be able to:1.Indentify tissues involved in skin and soft tissue

conditions2.Classify skin and soft tissue conditions3.Describe traumatic conditions of the skin and their

management4.Describe the clinical presentation and management

of different types of infective disorders of the skin

INTRODUTION

• Skin and soft tissue conditions are conditions that affect the integumentary and fascial systems of the body as well as the underlying soft tissue.

• They are therefore conditions involving epithelial and connective tissues

• The structures involved include: -– Skin and its derivatives– Superficial fascia – deep fasciae– muscles

CLASSIFICATION

They can be classified depending on: -1.Anatomical structures the involved2.Underlying pathophysiological process

Classification depending on underlying Pathophysiological process

1. Traumatic injuries2. Infections3. Inflammatory conditions4. Neoplastic conditions5. Others

Skin and soft tissue infectionsEtiology• Viruses, bacteria, and fungi generally cause skin and soft tissue

infections by entering the body at a spot where a cut, scrape, bite, or other wound has broken the skin;

• some infections are even the result of bacteria that normally live on the body.

• These infections can affect the layers of the skin or deeper tissues, such as muscle and connective tissue (the interlacing framework of tissue that forms ligaments, tendons, and other supporting structures of the body), and they may bring about symptoms in other parts of the body.

Many infections like varicella (chicken pox) and measles (rubeola) affect the skin, but these infections involve the whole body and do not primarily arise within the skin or soft tissues.

SKIN LESIONS

• Skin is the largest organ in the body – 15% of Bwt, 10000 to 18000cm2

• Functions – protection, immunological, Vit D synthesis, sensory, thermoregulation, excretion, psychological expression

• Aging process – drying, wrinkles, effect by UV light• Affected by drug reactions and other

hypersensitivity conditions (allergies)• Exposed to trauma and infections

Infections of the skin

1.Staphylococcal infections – Due to staph aureus, present with acute inflammation with supuration, most settle without intervention or with, use of antiseptics, if severe can lead to lymphagitis, cellulitis and abscesses. Pus swab for c/s to diagnose, treat with appropriate antibiotics and painkillers

Boils (furuncle)

• Infection of sebaceous or pilosebaceous unit with folliculitis which is usually preceded with suppuration and central necrosis.

• A blind boil heals without suppuration. • Usually occur on the head, neck and face. • Related to overwork, debility, stress or diabetes.• Furunculosis of the external auditory meatus is

very painful due to attachment of the skin to the cartilage

Style (hordeolum) – infection of eyelash follicle usually by staph aureus. May suppurate. Removal of the eyelash may allow the pus to escape

Carbuncle – infective gangrene of the subcutaneous tissue cased by coalescing of furuncle and tension of the skin inflammatory process and suppuration. Often occurs at the nape of the neck.

Impetigo

• Often an infection by staph aureus, occassionally by beta haemolytic streptococcus pyogenes

• Intradermal infection first forming a bullous which then ruptures and forms a crust.

• Appears as a dirty looking crusted, it is contagious in children and can cause epidemics in crowded houses

• Sycosis Barbae – infection of beard. Presents with erythma on background. It is initiated by shaving

• Toxic epidermal necrolysis (Scalding skin syndrome - SSS) – Caused by strep pyogenes, usually in infants, clinically mimics boiling water burns, rare but life threatening

• Erysipelas – superficial sharply marginate lesions, red oedematous area, red streaks of lymphagitis, patients feel ill and feverish

• Cellulitis – deeper infection involving subcutaneous tissue. On observation has got no sharpness. Treat vigorously with parenteral antibiotics, elevate the limb

• Acne valgaris – caused by propionibacterium acnes, papulo-pastule and cystic lesion on the face (mainly the cheeks). Disease of the sebaceous gland in adolescents

• Erythrasma – Patches of erythma, usually affecting the axillary and groin, may be mistaken for tenia infection

Fungal infections of the skin

• Tenia capitis – Large patchy areas with crusted and scaling. Has areas showing hair loss

• Tenia Barbae – Multiple folliculo-pastules with scaling. Infection occurs in adult males

• Tenia corporis – Raised plaques of tenia corporis which often became lichenified

• Tenia unguim – sub ungual hyperkelatosis with destruction of nail plate and lingitudinal striations of nails and white spots.

• Tenia cruris – Multiple circinate lesions with erythmatous active borders and central clearing

• Tinea Pedis – characteristic macerations scaling and peeling of the webs of the toes. Usually takes a chronic cause.

• Candidal intertrigo – maceration and whitish and erythematous finger web infection. Burning sensation and itchy. Common in housewives and kitchen employees.

• Valvovaginitis – Due to candida albicans• Tenia versicolor – Multiple irregular

hyperpigmented lesions on the skin. Usually on the neck and trunk

Viral infections

• Herpes zoster• Herpes libialis• Herpes genitalis• Varicella – Chicken Pox• Measles

Conclusion

Classification of skin and soft tissue injuries

Presentations of specific conditionsInfections of the skinDiagnosis of infections of the skinManagement of infections of the skin

04/19/23