Chapter 31: Integumentary Dysfunction: Skin Disorders & Burns

Integumentary Dysfunction: Skin Disorders & Burns details the physiology of wound healing, categorizing the process into inflammation, fibroplasia, and scar maturation, while contrasting healing by primary, secondary, and tertiary intention. A significant portion of the text focuses on general therapeutic management, emphasizing the superiority of moist wound healing over traditional dry dressings and the importance of nutritional factors like protein and vitamins A, C, and zinc in tissue repair. The discussion progresses to a wide array of skin infections, including bacterial conditions like impetigo contagiosa, cellulitis, and methicillin-resistant Staphylococcus aureus (MRSA); viral infections such as verruca (warts), herpes simplex, and varicella-zoster; and fungal dermatophytoses like tinea capitis and candidiasis. The text also covers systemic mycotic infections and hypersensitivity reactions, including contact dermatitis caused by plants like poison ivy (urushiol sensitivity) and severe drug reactions such as Stevens-Johnson syndrome. Furthermore, the chapter analyzes environmental injuries and infestations, detailing the management of arthropod bites, Lyme disease, scabies, and pediculosis capitis (head lice), emphasizing education on prevention and treatment compliance. Specific age-related dermatoses are explored in depth, including diaper dermatitis, seborrheic dermatitis, and atopic dermatitis (eczema), with a focus on hydration and pruritus control. Adolescent skin care is addressed through a detailed look at acne vulgaris, covering pathophysiology, topical agents, systemic antibiotics, and the careful monitoring required for isotretinoin therapy. The chapter concludes with a critical section on thermal injuries, categorizing burns by depth (superficial, partial-thickness, and full-thickness) and severity based on total body surface area (TBSA). It outlines the systemic responses to major burns, such as hypovolemic shock and anemia, and delineates the acute, management, and rehabilitative phases of burn care. This includes emergency airway maintenance, fluid resuscitation protocols, nutritional support for hypermetabolic states, and wound management techniques ranging from hydrotherapy and debridement to the use of allografts, xenografts, and synthetic skin substitutes.