Sun Induced Skin Disorders, Minor Burns, Sunburns, Wounds

First Degree Burn

-Superficial burns through only the epidermis: red, pain

-cover and protect

Seconds Degree Burn

-epidermis and upper region of dermis: blisters

- cover, protect, hydrate, absorb

Third Degree Burns

-burns that destroy the entire thickness of the skin: discoloration (white/black)

-refer

Burns to treat OTC

<2% BSA, superficial/superficial partial thickness, not involving eyes, ears, face, genitalia, not chemical/electrical, healthy, check tetanus status

Cool Water Soaks

initially x10-20 minutes and multiple times daily PRN

Analgesic for Pain

NSAID (recommended, decreased inflammation) or acetaminophen, topical as alt.

Skin Protectant Ointment

-avoid rupturing blisters

-decrease pain, prevent drying, provide lubrication

-use as often as needed

-Vaseline, coco butter, aloe

-not in open wound

Dressing

-want nonadherent, hypoallergenic dressing

-avoid pulling off loose skin

-keep wound moist but remove exudate

-change only when dirty or not intact

-scarring closely related to type used: increase with leaving open to air or using gauze

Minimize Scarring

-promote proper moist healing

-silicone is gold standard

-sheets/gel

-prevents scars and improves the appearance of existing scars through occlusion and subsequent hydration of scar tissue

Wound Assessment

-Type: abrasions (superficial), punctures (sharp object), lacerations (deeper into dermis, referral?)

depth: refer when deeper than dermis

-location: refer when on face/genitalia

-contamination: wash with warm soapy water

Self Care Tx Approach for Wounds

-irrigation

-skin protectants

-antibiotic if debris left in wound

-antiseptics as alt.

-analgesic for pain if needed

-dressing

-puncture wounds; update tetanus vaccine if needed

-contact PCP if not improving in 7 days

Topical Antibiotics

-indicated as prophylaxis if wound contains debris

-not needed for clean wounds

-apply 1-3 times daily, prior to dressing

-Bacitracin and Polymyxin B sulfate preferred

-Neomycin has higher risk of hypersensitivity

Topical Antiseptics

-avoid peroxide and alcohol products: dehydrate, cause pain and cell death

-iodine 2% solution: temporarily stains skin, bandaging discouraged, if area too large can cause systemic effects

Topical Anesthetics

-inhibit transmission of pain signals from pain receptors

-Benzocaine, Lidocaine

-Caines: cross reactivity, hypersensitivity

-relief is short lived (15-45 min), not recommended

-do not apply more than 3-4 times daily

Potato Peel

-provides a moist would healing environment

-desiccation of wound prevented

-optimal epithelial regeneration can occur

Honey

-absorbs exudates

-inhibits bacterial proliferation

-promote moist healing

Cabbage Leaves

-anti-inflammatory

-softens and dissolves dead tissue

-loosens secretions

-cooling

Exclusions for Self Tx of Wounds/Burns

-cuts longer than 1/2 inch

-a cut that continues to bleed after applying pressure for 10 min

-chemical, electrical, or inhalation burns

-animal/human bite

-deep partial thickness, full thickness

-non accidental injury

-infection

-circumferential burns

-preexisting medical disorder that complicates management, prolonging recovery (diabetes, immunocompromised)

-wound containing foreign matter after irrigation

-chronic wound

-face, hands, feet, major joints, genitals

-burns larger than 3 inches in diameter

-skin injury that does not show signs of healing in 7 days

UV Index

rates the amount of skin damaging UVR that reaches the earth's surface at any given time based on an individuals geographic location

Tan

protective mechanism: UVR stimulates melanocytes to increase and/or oxidize more melanin

Sunburn

-UVR penetrates epidermis causing inflammatory reaction with peripheral vasodilation

-intensity of erythema peaks at 12-24 hrs

Risk Factors for UVR Induced Problems

fair skin, history of one or more serious sunburn, blonde or red hair, light eyes, history of freckling, family history of melanoma, current use of immunosuppressive drug or photosensitizing, excessive lifetime exposure to UVR

Photosensitivity

-presents similarly to contact dermatitis

-pruritus with erythematous papules, vesicles, bullae and or urticaria

-drugs: antibiotics, sulfas, spironolactone, hydrochlorothiazide

Photodermatoses

-heterogenous group of skin disorder that are induced or exacerbated by radiation of varying wavelengths

- onset or exacerbation of signs and symptoms at exposure to UVR

Melanoma ABCs

Asymmetry.

Border irregular.

Color variation/change

Diameter >6mmm

Elevation/evolving.

SPF

-sun protection factor

-as the SPF increases the agents effectiveness increases

-common misconception that the SPF of a product is related to the time of UVR exposure

-2 most common reasons get sunburn: not enough, don't reapply

Chemical sunscreens

-absorb and block UVR transmission to epidermis

-must absorb > 85% of UVB

Physical Sunscreen

-reflect and scatter UVR

-zinc oxide and titanium dioxide

-use on small, prominently exposed areas

Broad Spectrum Products

protect against UVA and UVB

Water Resistant Products

must say for 40 or 80 min on label to reapply when swimming/sweating

Amount of Sunscreen

-about 1 ounce per application

-face and neck: 1/2 teaspoon

-arms/shoulders: 1/2 teaspoon each

-torso: 1/2 teaspoon front and back

-legs and tops of feet: 1 teaspoon each

Appropriate Sunscreen Use

-1st application 15 min before UVR exposure

-at least every 2hrs

-water resistant every 40 or 80 min if swimming/sweating

-after towel dry, reapply

-don't forget lips

Sunscreen Product Choice

-UVB protection: decrease sunburn

-broad spectrum: decrease sunburn, cancer, photoaging

-SPF 15+: all patients

-SPF 30+: if burn easily

Patient Counseling: Sunscreen

-stop use if rash occurs

-keep out of eyes

-keep sunscreen out of direct sun

-children under 6 months: ask doctor, keep in shade, protective clothing

Exclusion of Sunburn Self TX

-large areas of blistering

-fever

-extreme pain

-headache/confusion

-lightheadedness/vision change

-sings of infection