February 2010 Archives

February 26, 2010

Regulation Of Body Temperature

The skin plays an important role in the regulation of body temperature and protecting it from sudden temperature changes. Our body needs to be kept at an optimum operating temperature in order for our cells to perform properly. Temperature affects the rate of chemical reactions inside the body. The average body temperature is 98.6F or 37 degree centigrade. The body temperature is kept constant by physiological adjustments controlled by the hypothalamus which acts as a thermostat. The hypothalamus receives nerve impulses from the heat and cold thermoreceptors in the skin called the peripheral thermoreceptors as well as from central thermoreceptors located in the hypothalamus itself.

Our body uses energy to generate heat through the vital actions of the body. This heat production rises with muscle activity like exercise and shivering. Heat is lost and gained through radiation, conduction and conviction while evaporation contributes only to heat loss which occurs through sweating.

When someone has a fever the body thermostat will be set at a higher level, therefore the person first shivers leading to heat release which will lead to the rise of temperature to the new setting, and when the fever subsides the setting of the thermostat will drop back to normal and the person sweats to dispose the excess heat.

In cold weather the cold receptors on the skin will be stimulated sending signals to the hypothalamus and the higher cortical centers. The hypothalamus is also activated by the change in the blood temperature; the response will be constriction of the blood vessels in the skin preventing too much blood from the entering the skin and keeping it inside the body so that little heat is lost, there will be decreased sweating, contraction of the muscle attached to the hair follicle which is called arrector pili muscle and this will lead to pulling the hair up which traps air close to the skin. Shivering is contraction of skeletal muscles leading to release of heat. The skin also acts as an insulation layer through the adipose tissue of the hypodermis which prevents heat loss.

In hot weather the heat receptors will be stimulated sending signals to the hypothalamus and the higher cortical centers and the response will be dilatation of the blood vessels in the skin leading the blood to run near the surface of the skin and this will allow heat to escape from the blood. There will be increased sweating. For sweat to evaporate it needs heat which is taken from our body and that's why we feel cooler when we sweat.

It's important in hot weather to drink enough fluids to avoid dehydration. It's also important to protect ourselves from excessive sun exposure and use protective measures such as sunscreens and protective clothing. (See sunburn part I, II)

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

February 25, 2010

Vitamin D And The Skin

Vitamin D is one of the fat soluble vitamins; it plays an important role in maintaining the normal blood levels of calcium and phosphate which are needed for normal mineralization of bone, muscle contraction, nerve conduction and proper cellular function of the body, it also plays a role in the immune modulation and evidence suggest that it has an anti-cancer properties.

The skin plays an important role in the formation of vitamin D; vitamin D can also be obtained from certain food, and supplements. When we are exposed to sun, Ultraviolet B radiation (UVB) found in the sunlight will convert cholesterol (7-dehydrocholesterol) found in the skin to Vitamin D3 (Cholecalciferol), Vitamin D3 will be transported to the liver where it will be converted to Calcidiol (25 D3) and this is what is tested when we measure Vitamin D level in the blood, normal level is between 80 - 175 nmol/L. Calcidiol will be carried to the kidney and will be converted there to Calcitiol (1, 25 D3) which is the active form of vitamin D; it will be released to the circulation and will be carried in the plasma to the target organs. Vitamin D toxicity doesn't usually occur if we are exposed for a long period of time to sunlight and this is because once Vitamin D3 concentration produced in the skin reaches equilibrium, further Vitamin D3 produced will be degraded by the same Ultraviolet light that created it.

Sources of Vitamin D: 1- The main source of Vitamin D comes from the exposure of our body to sunlight (see above). 2- Food sources: like oily fish such as salmon and sardines butter, egg yolks, some food can be fortified with Vitamin D like milk and cereals. 3- Vitamin D supplements.

Vitamin D deficiency can happen as a result of inadequate exposure to sunlight, liver or kidney disorders that will interfere with the conversion of Vitamin D into the active form, diseases that limit its absorption from the gastrointestinal track and other causes. Vitamin D deficiency will lead to softening of the bones due to the impairment of mineralization, it will lead to Rickets in growing children and osteomalacia in adults, and it can also lead to osteoporosis in which the bone mineral density is decreased leading to an increased tendency for fracture.

Severe burn injury may be associated with vitamin D deficiency; therefore vitamin D supplement is given to these patients.

Vitamin D overdose usually happens if excessive doses are taken (prescription forms); the symptoms include nausea, vomiting, weakness, loss of appetite, diarrhea and excessive thirst.

Some factors might decrease the ability of skin to synthesize vitamin D and therefore extra vitamin D may be required, these factors are:

  1. Latitude and season: they influence the amount of UV light reaching the skin.
  2. Skin pigmentation: the darker the skin, the more melanin pigment is present and this pigment will absorb UV light leading to a reduce ability of the skin to produce vitamin D.
  3. Aging process: with age the skin gets thinner and this reduces the efficiency of vitamin D synthesis.
  4. The use of sunscreen: although sunscreen reduces skin damage by the sun, widespread use of sunscreens affects the synthesis of vitamin D.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

February 24, 2010

Skin And Infection

One of the important functions of the skin is to protect the body against infection. The skin is the first line of defense against infection. Infection happens when harmful bacteria, viruses, parasites, or fungi enter the body and replicate. The skin protects against infections through the following mechanisms:


  1. It acts like a covering and a barrier that prevent the entrance of harmful organisms.

  2. The continuous shedding of the outermost cells of the skin leading to the shedding of these organisms with them. Some bacteria live on our skin but can't enter the skin as long as it is healthy. An adult sheds more than 40,000 skin cells a minute.

  3. The skin has the ability to secrete compounds that kill or prevent the growth of the harmful organisms. Sweat and oil produced in the dermis combine to form a protective barrier on the surface of the skin, it is called the acid mantle, and it is useful in providing a protective barrier against temperature and wind. The acidity of the acid mantle inhibits the growth of bacteria and fungi that may be present on the surface of the skin and neutralizes foreign chemicals before they can damage the skin

There are certain things that can be done to decrease the risk of or prevent infection like keeping the hands clean by washing them regularly, avoid sharing personal things with others such as towels and razors, taking care of cuts, wounds and scratches by keeping them clean and protected. If the skin around the wound becomes red, warm, swollen, increasingly painful, begins to drain a yellow or greenish fluid, have an odor, reopen of a closed wound, feel feverish; a wound infection may be present and medical care should be sought.

The skin has an amazing ability to heal wounds, the rate of healing varies depending on the severity of the wound, for superficial wounds they may be repaired rapidly by simple migration of skin cells over the defect, for deeper wounds it involves more complicated processes which are blood coagulation, inflammation, re-epithelialization, wound contraction and new tissue synthesis and remodeling.

It's important to take care of our skin and keep it healthy; if it starts getting dry or cracking we should apply moisturizers to keep it soft, also eating a well balanced diet helps insure that the body gets all the vitamins needed to maintain a healthy skin.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

February 23, 2010

The Skin (Part II)

The Dermis:

This is the second layer of the skin under the epidermis, it cushions the body from stress and strain, this layer contains nerve endings, sebaceous glands, sweat glands, hair follicles and blood and lymphatic vessels.
The nerve endings in our dermis tell us how things feel when we touch them; they work with our brain and nervous system so that the brain gets the message about what we are touching. The dermis is also full of tiny blood vessels that keep the skin cells healthy by bringing them oxygen and nutrients they need and by taking away waste. The sebaceous glands secrete sebum which is an oily matter that keeps the skin lubricated and water proof, these glands are present throughout the skin except the hands and feet; they are in greatest abundance on the face and scalp. The sweat glands help in the regulation of body temperature by releasing sweat through pores on the skin. The hair follicle grows hair and attached to it is the sebaceous gland; about 50-100 hairs are shed daily from a normal scalp.

The Hypodermis (subcutaneous tissue):

This layer lies below the dermis and attach the skin to underlying bone and muscle as well as supplying it with blood vessels and nerves. It consists of loose connective tissue and elastin (a protein which play a role in the elasticity of skin). The hypodermis contains 50% of body fat. Fat serves as padding and insulation for the body.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

February 22, 2010

The Skin (Part I)

The skin is the largest organ in the body that has many important functions which include the following:


  1. It protects the body from infection by preventing the invasion of harmful organisms.

  2. It protects the body from dehydration by preventing the loss of excessive fluids.

  3. It participates in the regulation of body temperature and protects the body from abrupt temperature changes.

  4. It protects the body against sun burns.

  5. It protects the internal tissues and organs.

  6. It helps excrete waste materials through perspiration.

  7. It generates vitamin D through the exposure to sun light and stores vitamin D.

  8. It has receptors through which we feel heat, cold, pain, pressure and touch.


The skin is made up of three layers: 1) Epidermis, 2) Dermis, 3) Hypodermis

The Epidermis:

It is the outermost layer of the skin which is the part of the skin that we can see, it is composed of five layers from inside to outside they are, Stratum basale, Stratum spinosum, Stratum granulosum, Stratum lucidum and Stratum corneum. The epidermis is continuously making new cells to replace the old ones, this process starts at the bottom of the epidermis moving toward the top of epidermis, the process takes between two to four weeks, as the newer cells continue to move up, older cells near the top die and rise to the surface of skin. 95% of the cells of the epidermis work to make new skin cells, the other 5% make a substance called melanin. Melanin is a pigment responsible for skin color, the darker the skin is the more melanin there is. Melanin protects us from getting burned by the sun's ultraviolet rays that is why when we go out into the sun these cells make extra melanin to protect us from getting burned and that's why our skin gets tan if we spend a lot of time in the sun. Melanin can't protect the body by itself therefore we wear sunscreens and protective clothing such as a hat to prevent painful sunburns, protecting the skin also can help prevent skin cancer.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

February 19, 2010

Third Degree Burns (Part II)

First aid:

All third degree burns require emergency medical treatment, usually in a burn unit, call 911 or take the person to an emergency room as soon as possible.


  • Smother any flames if the patient is on fire eg, using a blanket, stop drop and roll.

  • Remove jewelry and any clothing if possible.

  • Monitor the victim's vital signs (breathing, pulse, blood pressure).

  • You have to make sure that the person is breathing, if necessary begin CPR.

  • Cover the burned area with a clean sheet.

  • Elevate the burned area to protect it from pressure and friction.

  • Lay the person flat and elevate the feet to prevent shock unless a head, neck, back or leg injury is suspected.


Don't do the following:

  • Don't let the person run if he/she is on fire.

  • Don't remove the burnt clothes if it is stuck to the burn.

  • Don't use ice or water because that will further damage the burned area and might cause frost injury.

  • Don't apply cold compresses or immerse the burn in cold water because this might cause shock.

  • Don't apply household remedy to the burn because this can interfere with healing.

  • Don't allow the burn to be contaminated, don't break blisters if they are present and don't remove dead skin.

  • If there is an airway burn, don't place a pillow under the person's head as this might close the airway when the patient is lying down.


Hospital treatment:

  • Fluid replacement: in third degree burns the body loses a lot of fluid through the burned area, this fluid is lost due the destruction of the skin and the blood vessels and it's important to replace that fluid to restore blood supply to important organs. Fluid replacement is done in the hospital through an IV line calculated according to the percentage of burn and the weight of the person.

  • Infection control: antibiotics are given in the hospital usually intravenously, in addition to topical antibiotics on the burned area.

  • Wound debridement: cleaning and debridement which is the removal of dead skin and tissue from the burned area, it's done in the hospital or a surgical unit.

  • Third degree burns might leave extensive scars as they heal, these are called hypertrophic scars.

  • Because the burned area is deep, some might need skin graft to cover the burned area.

  • Dressing changes and use of creams and ointments.


This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

February 18, 2010

Third Degree Burns (Part I)

A third degree burn is a burn that causes injury to all three layers of the skin (epidermis, dermis and hypodermis). There may also be damage to fat tissue, muscle and bone. It is the most serious type of burn and may result in extensive scarring as well as other injuries and limitations.

Causes:


Clinical features:

  • Black, white, brown or yellow colored skin.

  • Dry and leathery skin.

  • The burned area may not be painful because the nerve endings have been burned and destroyed but the area around the burn may be painful.

  • Swelling.

  • Blister may be present in some areas of the wound.

  • Shock, see clinical features of shock.


This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

February 17, 2010

Second Degree Burns

A second degree burn is caused by injury to the epidermis which is the first layer of the skin and the dermis which is the second layer of the skin.
Causes:

  • Severe sunburns.

  • Contact with hot liquids.

  • Exposure to flames.

  • Contact with chemicals.

  • Clinical features:

  • Blisters.

  • Deep redness.

  • Swelling.

  • Pain, they are the most painful because nerve endings are intact.

  • Peeling of the skin.

  • Shock because of loss of fluid (see clinical features of shock).

  • Burned area may appear wet and shiny or white.


  • Treatment:
    Second degree burns can be treated at home if they are minor. Moderate and critical burns require treatment in a hospital. You need to seek medical treatment immediately if the burn is greater than 2-3 inches in diameter, if it is on the face, hands, feet, or genitals; or if the burn is caused by an electrical source.

    The goal of treatment for second degree burns is to ease the pain and prevent infection.

    1. Remove any jewelry or clothes from the burned area.
    2. Hold the burn under cool running water for 10-15 minutes or apply cold water compresses like a wet towel.
    3. Don't break blisters because it will increase the risk of infection.
    4. You can apply an antibiotic cream or an aloe based cream then cover the burn with a dry sterile gauze pad.
    5. Use pain reducing medications like Tylenol or Motrin.
    6. If the burn is on the arms or legs, keep them raised to reduce swelling.

    Don't do the following things:

    1. Don't use ice or ice water. (may cause more injury).
    2. Don't remove clothing if it is stuck to the burn (it will remove burned tissue with it).
    3. Don't put grease, ointments, petroleum jelly or home remedies, these substances can hold the heat in and make the burn worse.
    4. Don't use bandages with adhesive material (it will stick to the wound).
    5. Don't give aspirin to a child under the age of 18 years.
    • If there is any change or worsening of the burned area you should see your doctor. These include: puss drainage from the burned area, increased redness, excessive swelling, blister filled with greenish or brownish fluid, fever, swollen lymph nodes, numbness or coolness of the skin beyond the burned area.
    • A second degree burn heals between 10 days to 3 weeks, deep second degree burns may take more than 3 weeks to heal.
    This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.
    February 16, 2010

    First Degree Burns (Part II)

    Prevention:
    Burns of all degrees including first degree can be avoided or decreased by following simple measures, burns caused by scalding with hot water can be prevented by careful handling of hot liquids, turning pot handles on the stove out of the reach of children, check the temperature of the bath water before putting the child in the tub, setting the water heater thermostat no higher than 120°F (49°C), install radiator covers, insulate exposed stem pipes, properly placed and working smoke detectors, children must be taught never to play with matches, lighters, gasoline, never allow children to handle fireworks without adult supervision.

    Sunburns may be prevented by the liberal use of a sunscreen with a SPF of 15 and above, use protective coverings like hats, loose clothing, and umbrellas, avoid spending time in the sun between 10 am and 3 pm when the most damaging ultraviolet rays are present.

    According to the consumer product safety commission, in most adults 5 minutes of exposure to 120 degree hot water causes a third degree burn, 30 seconds of exposure to 130 degree hot water causes a third degree burn, 6 seconds of exposure to 140 degree hot water causes a third degree burn and 2 seconds of exposure to 150 degree hot water causes a third degree burn.

    This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

    February 15, 2010

    First Degree Burns (Part I)

    A first degree burn is caused due to injury to the epidermis which is the outer first layer of the skin; it involves minimal tissue damage and is the least serious type of burn.
    Causes:


    1. Spending too much time in the sun (sun burn part I, II).

    2. A brief contact with a dry, moist heat or chemicals.

    3. Friction like rubbing the skin (against a rug).


    Hot water, hot beverages and cigarettes are the most common sources of heat that cause first degree burns; it is called a scald when it is caused by hot water of hot steam.

    Symptoms:


    1. Redness.

    2. Swelling.

    3. Pain and sensitivity to touch, pain usually lasts 48 - 72 hours and then subsides.

    4. Peeling of the skin

    5. They don't usually blister or leave scar.

    6. You must watch for signs of infection, such as increased pain, redness, fever, swelling or oozing. If infection develops, seek medical help.


    Treatment:

    First degree burns are minor burns and can be treated at home, the treatment is as follows:


    1. Remove any clothing or jewelry from the burned region.

    2. Hold the burned skin under cool running water for 5 - 10 minutes. Cold compresses can also be used.

    3. You can soothe the area with aloe-vera cream or burn ointment

    4. Place clean and dry sterile gauze around the burned area; wrap the gauze loosely to avoid putting pressure on burned skin.

    5. Use Tylenol, ibuprofen or aspirin to relieve pain.

    6. Call your doctor.


    Things not to do: don't use ice to cool the burn as it can cause further damage the burned skin, don't use bandages that are adhesive as it might adhere to the burned skin, don't apply oils or butter to the burned area as it interferes with healing and can make the burn worse, never give aspirin to children under the age of 18 because of the risk of Reye's syndrome which is a serious illness affecting mostly the liver and the brain. Ask your doctor about children's pain relievers.
    Minor burns usually heal on their own within a week. They may heal with pigment changes.
    For treatment of chemical burns, see chemical burns part I, II.

    This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

    February 12, 2010

    Keloid Scar

    A keloid scar is a type of scar that results in an overgrowth of tissue at the site of healed skin injury due to aggressive healing process. This type of scar grows and extends beyond the site of injury unlike hypertrophic scar. They occur as a result of the body's continuous production of collagen which is a fibrous protein after the healing of the wound.

    They often appear red or pink in color as compared to the surrounding normal skin. They are firm, rubbery lesions; they may appear shiny or as fibrous nodules. Keloid scars may be accompanied by severe itching, pain and may limit mobility if they are extensive. They may vary in size and some types may increase in size. They may occur anywhere on the body although some areas are more susceptible to form keloid scars such as the deltoid region. They occur more often in darker skinned patients.

    Treatment:

    The treatment of keloid scar varies and the recurrence after treatment is common. Treatment may include:

    1. Steroid injection: this involves injecting steroid into the keloid scar, it may help to reduce the size of the scar and decrease itching and redness that may be associated with these scars. It may be used with other procedures like surgery.
    2. External pressure therapy: eg, compression garments.
    3. Cryotherapy: this involves freezing the keloid scar with a medication.
    4. Surgical therapy: is used if the keloid scar is not responsive to nonsurgical treatment.
    5. Laser surgery: this method involves the use of different lasers depending on the underlying cause of scar. It may be used to smooth the scar, remove abnormal color of a scar, or flatten a scar. This method is often done with other methods like steroid injection.
    • Keloid scars have the tendency to re-occur and multiple treatments may be required.
    • It is important to follow your doctor's instructions, if you have been prescribed compression garments, it is important to wear them for 23 hours a day (taken off only when bathing), as they can minimize scarring. If you were taught any exercises than you have to do them as they will minimize the scarring.

    This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

    February 12, 2010

    Compression Garments

    One of the common complications that a burn patient may experience is a scar depending on the severity of the injury. Scars may lead to physical and emotional distress. One of the methods used to deal with and decrease the incidence of scaring is the use of compression garments.

    Compression garments are used in the treatment of keloid and hypertrophic scars, they work by applying pressure to the affected area which helps flatten and improve the appearance of scar.

    There are different kinds of compression garments like Ace bandage, pre-fabricated garments and custom made garments.

    It is important to wear compression garments in the early stages of the scar (when the scar is fresh and immature) as scars are highly responsive to pressure in their early stages of development. All compression garments should be worn 23 hours a day and should be taken off only during bathing and dressing change, they may have to be worn for up to 2 years after the burn. your doctor will decide when you can stop wearing the garments.

    Taking care of the garments:

    It is important that you take care of the compression garments; if they become loose or damaged then they will no longer perform their intended function.

    • Hand wash the compression garments gently, use mild detergent or mild soap.
    • Rinse the garments, squeeze them gently on a towel than lay them flat or hang them to dry.
    • You should have at least 2 sets of garments so that when one is washed, the other one is worn.
    • Wear socks and shoes over feet garments to avoid wear and tear.
    • If the garment becomes damaged, loose, or the patient is a child who grows (too tight), you have to contact your rehabilitation therapist or compression representative to obtain the appropriate size
    . Don't do the following:
    • DON'T use bleach or strong detergent as this may damage the garments.
    • DON'T dry garments in the sun and DON'T put them in a washer or dryer because this will damage the garments and make them too loose.
    This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.
    February 11, 2010

    Hypertrophic Scar

    A hypertrophic scar is an elevated scar that appears red, thick and raised as a lump on the skin, hypertrophic scars usually feel firm to the touch, and they may be sensitive to changes in temperature or texture. They don't grow beyond the injury site or incision (unlike a keloid scar which grows beyond the original site of the injury). Hypertrophic scars usually start to develop within weeks after the injury and often improve in appearance with time, which may take few years.

    There is no simple cure for hypertrophic scars. Compression garment is one of the methods used in the treatment. Steroid may be used as an injection into the hypertrophied area or as a topical application. Surgery may be used to remove these scars, often in conjunction with the use of steroid injection. Steroid treatment may continue even after the surgery to maximize healing and decrease the chance of recurrence of these scars.

    This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.