Integumentary system: Skin lesions

Skin lesions can include any abnormal area of the skin, so there are several terms to describe them. Let’s start with macules, which are flat lesions with a clear border up to 1 centimeter in diameter; patches are similar to a macule but are larger than 1 centimeter.

Papules are raised bumps that are up to 1 centimeter in diameter, while plaques are like papules but larger than 1 centimeter.

A smooth papule or plaque that is transient, meaning that it comes and goes, is called a wheal. Pustules are blisters filled with pus.

Vesicles are clear blisters filled with fluid that are up to 1 centimeter in diameter, while bullae are fluid-filled blisters larger than 1 centimeter.

Scales are accumulations of thickened skin on the surface, which become dry and flaky and sometimes peel off. Crusts are dry exudates, which is the liquid that leaks out of blood vessels, containing cells, sebum, pus, or blood.

Now, lesions can appear in groups and form a rash, which includes any skin eruption. Rashes that are limited to one area are called localized, while rashes that occur all over the body are called systemic.

In addition, there are four categories based on how they look: maculopapular, vesicular, petechial or purpuric, and desquamating rashes.

As the name suggests, a maculopapular rash has both macules and papules. A vesicular rash has vesicles.

Petechial and purpuric rashes both have flat red-brown spots that represent bleeding into the skin. If the spots are smaller than 2 mm in diameter, it’s a petechial rash; if the spots are larger than 2 mm, it’s a purpuric rash.

Finally, there are desquamating rashes, which cause peeling of the skin, like after a sunburn. Now, rashes can have many different causes, and specific care depends on which rash a client has.

Rashes may be caused by systemic infections in which the skin itself isn’t infected but develops a rash as a sign of an infection occurring somewhere inside the body.

As an example, clients with shingles, which is caused by varicella zoster virus, have a painful vesicular rash that usually forms a red, belt-like strip on the body.

Rashes can also be caused by direct skin contact with a trigger substance, causing a localized pruritic rash, called contact dermatitis.

Triggers can include poison ivy; metals, like nickel; cosmetics; soaps and cleansers; bleach; and latex. Another type of rash is atopic dermatitis, or eczema, which results from an allergy and is characterized by dryness, itching, and redness.

Atopic dermatitis can worsen in the presence of allergens, like cigarette smoke, mold, and dust mites, as well as changes in the weather and even emotional stress.Moving on: A wound is an injury to the skin and, sometimes, its underlying tissue.

Wounds can be classified as intentional or unintentional. Intentional wounds are planned and carefully made by a healthcare professional for therapeutic purposes and interventions, such as surgical incisions or when placing medical devices, IV lines, or other tubes.

On the other hand, unintentional wounds are unplanned and are typically the result of trauma from violence or accidents or from a car crash or a fall.

Now, unintentional wounds can be further classified as closed or open. A bruise or contusion is a good example of a closed wound.

It’s caused by trauma to the body where the skin over the damaged area remains intact. On the other hand, if there is a break in the skin, the wound is open.

There are different types of open wounds. Abrasions are the most superficial ones in which there’s a wearing or rubbing away of the skin due to friction.

Abrasions rarely bleed. An excoriation is similar to an abrasion but usually a bit deeper, caused by the scraping away of the skin and its underlying tissue.

For this reason, excoriations tend to bleed. Finally, a fissure is a long and narrow crack in the skin that’s often caused by extreme dryness and can present with pain and bleeding.

Lacerations are deep cuts with torn tissue and jagged edges.A skin ulcer is an unhealed sore or open wound that can appear when the tissue dies and sheds.

The skin surrounding an ulcer can be red, swollen, and tender. Some ulcers may even reach subcutaneous fat or deeper tissues.

Now, skin ulcers can have many causes and types, and this is important to determine in order to give proper care. A common type of skin ulcer is the venous stasis ulcer; these are caused by poor blood flow through the veins in the legs, which deprives the overlying skin and tissue of oxygen and nutrients, causing it to die.

Venous stasis ulcers may be associated with signs and symptoms like pain, leg edema, varicose veins, and brown discoloration.

Another type of painful ulcers are pressure ulcers, also known as bedsores or decubitus ulcers. Pressure ulcers usually appear in clients who aren’t moving about, like those on chronic bedrest or consistently in a wheelchair.

These clients are lying in bed or sitting for a long period of time, leading to constant pressure on the skin. The blood vessels can become compressed, which reduces blood flow to the area.

That’s why pressure ulcers mostly appear over bony prominences, which are parts of the body with the thinnest subcutaneous tissue between the bone and the skin.Next up: Neuropathic ulcers occur when individuals have damage to peripheral nerves involved in sensation.

The most common cause is diabetes mellitus. Neuropathic ulcers usually appear over pressure points, but they are painless, so they often go unnoticed until they’re pretty advanced.

Other less common causes of leg ulcers include infection; rare diseases, like pyoderma gangrenosum; various types of skin cancer; or certain medications Last but not least: Burns are injuries caused by direct contact of the skin with something really hot, like fire, hot water, or steam, or even a hot object.

But they can also be caused by extreme cold; electricity; some chemicals, like strong acids; or excessive exposure to sunlight.

Now, the number of skin layers affected determines the severity and burn degree. So, first degree burns, also called superficial burns, only affect the epidermis: the outermost layer of the skin.

As a result, the affected area becomes red, dry, and painful. These areas also tend to blanch, turning white as blood flow is restricted with compression, and typically heal without scarring.

Classic examples include sunburns and household accidents, like touching a hot iron. Second degree burns, also called partial thickness burns, affect the epidermis and part of the dermis: the layer under the epidermis that contains most of the nerves and blood vessels.

The affected area can be red, dry or wet, as if weeping; have blisters; and are even more painful than first degree burns.

However, second degree burns still blanch. Healing is usually without scarring.

Second degree burns have a higher risk of infection than first degree burns. Finally, in third degree burns, also called full thickness burns, the entire epidermis, dermis, and subcutaneous tissue are affected.

These can appear waxy white to leathery gray or black and dry. In addition, third degree burns present damage to nerve endings and blood vessels, so they’re typically painless, don’t blanch, have the highest risk of infection, and healing always results in scar tissue replacing the normal tissue in the wound because the surrounding tissue is destroyed.

All right, so as a nursing assistant, there are a few things you should report to the nurse right away. Make sure you keep an eye out for any new skin lesions and observe already existing ones for any changes that might indicate a problem with healing.

Make sure you let the nurse know if you notice any changes in the appearance and size of the lesion as well as changes in the surrounding skin.You should also report if a client complains of increased pain or develops any complications, like bleeding, infection, and fever.

Make sure to document the date and time of your observations.All right, as a quick recap… Skin lesions include any abnormal area of the skin, so there are several terms to describe them.

Macules are flat, well circumscribed lesions up to 1 centimeter, while patches are larger than 1 centimeter. Papules are raised bumps up to 1 centimeter, while plaques are larger than 1 centimeter.

A wheal is a transient smooth papule or plaque. Pustules are blisters filled with pus.Vesicles are blisters filled with fluid that are up to 1 centimeter, while bullae are larger than 1 centimeter.

Now, lesions can appear in groups and form a rash. Localized rashes are limited to one area, while systemic rashes occur all over the body.

A wound is an injury to the skin and its underlying tissue. Wounds can be intentional, like in medical and surgical procedures, and unintentional, like in trauma.

A skin ulcer is an unhealed sore or open wound that can appear when the tissue dies and sheds. Finally, burns can be caused by direct contact of the skin with something really hot or cold, electricity, some chemicals, or excessive exposure to sunlight.

Burns can be classified into first, second, or third degree burns based on the depth of skin damage. Now, as a nursing assistant, you must let the nurse know if any new skin lesions appear and keep an eye on already existing ones for any changes in the appearance and size, increased pain, bleeding, and infections.

Remember to report and document these observations. existing ones for any changes in the appearance and size, increased pain, bleeding, and infections remember to report and document these observations.