Diagnosing and Treating Skin Wounds

The concept of skin infection, diagnosis, and treatment of those diseases should be very clear in the mind of any medical practitioner. Many of the skin related conditions can be ignored as most of them come in mild form. This article will expose some of the skin diseases and discuss one of them in details.

Diagnosis of skin infections is a significant step in dealing with such conditions. Some skin conditions present noticeable symptoms while others remain undiscoverable under the skin, causing discomfort to the patient. Before exploring deep into the matter, let me clear up the confusion that many people have about distinguishing an infection from colonization. Colonization is the presence of disease-causing organism (bacteria) on the skin surface to the extent that they don’t cause diseases to an individual pustular (Olendorf & Jeryan, 2012). Infection, on the other hand, is the invasion of the organism’s body tissue by disease-causing organisms or as a result of interaction between pathogens and immune system of the body. The two terms give an insight in what is just about to be discussed.

Cold sores, hair loss, blisters, chafing, sunburn, ingrown hair, rashes, itching just to list a few, characterize skin diseases. Cold sores are painful infections which are viral in nature. Its causative agent is herpes simplex virus. Rashes show an abnormal change in skin color or texture caused by skin inflammation. Many circumstances can lead to skin inflammation that is not within the scope of this article. Various skin infections symbolize the presence of a disease or disorder in the body. Some result from individuals who are allergic. Allergy is a common disease that shows that a person’s antigen is compatible with some environmental conditions or some foods, and it manifests itself on the skin.

When a causative agent of any skin infection is not apparent, then the patient is subjected to diagnostic tests. Such tests include patch testing, Biopsy, scrapings, examination by wood light, Tzanck testing and Diascopy.  All of the above-listed techniques involves elaborate processes done in a well-equipped medical laboratory. The situation might be slightly different for the aging people. In some cases, they need not pass through diagnostic tests. The medic needs just to understand how the structure and function of the skin changes with age. Many skin infections become prevalent with age.

The main aim of diagnosis is to help in identification of the right infection for treatment. Skin is the only organ that gets affected with the most number of diseases.  The most common skin infections include skin cancer, lupus, rubeola, acne, hemangioma of skin, psoriasis, hives, warts, cellulitis, etc. From the long list, only one of the skin infections will be discussed in details. The Steven Johnson’s Syndrome

Description of Steven Johnson’s Syndrome

It is an immune-complex-mediated hypersensitive complex involving skin and the mucous membranes. Its classification depends on body surface area (BSA) detachment. A minor form of Steven Johnson’s syndrome has less than 10% BSA, overlapping Steven Johnson’s syndrome has a detachment of 10-30% and toxic epidermal necrolysis has more than 30% of the BSA.

Signs and Symptoms of Steven Johnson’s syndrome

The most dominant indication of Steven Johnson’s syndrome includes a cough productive of a thick, purulent sputum, headache, malaise, and arthralgia. Some patients may complain of rashes with burning sensation which appear symmetrically on the face and the upper side of the torso.

Signs of mucosal involvement may feature some or all of the following: erythema, edema, sloughing, blistering, ulceration and necrosis.

Advanced examination such as slip-lamp may reveal the following signs: trichiasis, distichiasis, Meibomian gland dysfunction and blepharitis, all of which occur on the eyelids. Other signs may also be discoverable around conjunctiva and cornea region.

Diagnosis of Steven Johnson’s syndrome

Patients suffering from Steven Johnson’s syndrome are very distinguishable, and the unique signs and symptoms are discoverable through Histopathologic examinations and Ocular examination.

Histopathologic examination reveals the following:

  • Apostosis of keratinocytes
  • Dermal infiltrate which is superficial and perivascular in many cases.
  • Changes in the epidermal-dermal junction which ranges from vacuolar to subepidermal
  • Predomination of CD4+ T lymphocytes in the dermis and CD8+ T lymphocytes in the epidermis.

The ocular examination can show conjunctival biopsies from patients having the active ocular disease, and immunohistology of the conjunctiva will hold many HLA-DR-positive cells in the substantia propia, epithelium, and vessel walls.

Treatment and prevention of Steven Johnson’s syndrome

Patients suffering from Steven Johnson’s syndrome undergo symptomatic treatment which is similar to therapy application to patients with extensive burns. Particular attention to the respiratory tract, hemodynamic stability, fluid status, pain control, and wound care should be given to the patients during the treatment session.

Treatment involves a well-predefined procedure carried out by the medics. It begins by eliminating any suspected causative agents to prevent secondary infection. Oral lesions which may appear in some patients are handled with mouthwashes. Mouthwashes are nothing but just a typical anesthesia. Saline or Burow solution are preferably administered on areas of denuded skin. Finally, dressing of tetanus prophylaxis follows.

In cases of acute ocular manifestations, application of topical steroids, mechanical symblepharon lysis, or antibiotics are the most appropriate medication. The medication entails the following:

  • Grafting of mucous/amniotic membranes
  • Removal of plaque from the lid margins
  • Transplantation of limbal stem cell
  • Removal of conjuctivalized or keratinized ocular surface by superficial keratectomy.

Long-term lubrication may be sufficient in treating mild chronic superficial keratopathy.

References

Olendorf, D. & Jeryan, C. (2012). The Gale Encyclopedia of Medicine. Farmington Hills, MI. Emerald Group Publishing Limited.

Beauregard S, Gilchrest BA. (1987). A survey of skin problems and skin care regimens in elderly. Arch Dermatol.  123: 1638-1643

Elizabeth, H. (2017). Diagnostic Tests for Skin Disorders. Merck Manuals. Retrieved from

http://www.merckmanuals.com/professional/dermatologic-disorders/approach-to-the-dermatologic-patient/diagnostic-tests-for-skin-disorders

Katherine, B. (2005). Common Skin Disorders. Health Line. Retrieved from http://www.healthline.com/health/skin-disorders

Foster, S. (2016). Stevens-Johnson Syndrome. Medscape. Retrieved from http://emedicine.medscape.com/article/1197450-overview

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