Chapter 5 of 5 - Integumentary System Course

Skin Conditions & Wound Healing

When the integumentary system is damaged or diseased, the consequences range from cosmetic concerns to life-threatening emergencies. Understanding skin pathology and wound repair is essential for biology and clinical medicine.

Burns - Classification by Depth

ClassificationDepthAppearanceHealing
Superficial (1st degree)Epidermis onlyRed, painful, no blisters3-5 days, no scarring
Partial thickness (2nd degree)Epidermis + upper dermisRed, blisters, very painful2-3 weeks, possible scarring
Full thickness (3rd degree)Epidermis + entire dermisWhite/brown, leathery, painlessRequires grafting, scarring
4th degreeThrough to muscle/boneCharred, blackAmputation may be needed

The Rule of Nines is used to estimate the total body surface area (TBSA) affected by burns in adults: head = 9%, each arm = 9%, anterior trunk = 18%, posterior trunk = 18%, each leg = 18%, perineum = 1%.

Quick Check

Why are full-thickness (3rd degree) burns painless despite being the most severe?

Skin Cancer

Skin cancer is the most common form of cancer worldwide. UV radiation damages DNA in skin cells, particularly affecting tumor suppressor genes like p53.

Basal Cell Carcinoma

  • Most common (~80%)
  • From stratum basale cells
  • Rarely metastasizes
  • Pearly, waxy nodule
  • Excellent prognosis

Squamous Cell Carcinoma

  • Second most common
  • From keratinocytes
  • Can metastasize if untreated
  • Scaly, red patch or sore
  • Good prognosis if caught early

Melanoma

  • Least common but most deadly
  • From melanocytes
  • Highly metastatic
  • ABCDE rule for identification
  • Requires early detection

The ABCDE Rule for Melanoma

  • Asymmetry - one half does not match the other
  • Border - irregular, ragged, or blurred edges
  • Color - uneven color (brown, black, red, white, or blue)
  • Diameter - larger than 6 mm (size of a pencil eraser)
  • Evolving - changing in size, shape, or color over time

Fill in the Blank

The most dangerous type of skin cancer is________, which originates from melanocytes and has a high potential to metastasize to other organs.

Other Common Skin Conditions

ConditionKey Features
Acne vulgarisBlocked sebaceous glands, bacterial infection (Cutibacterium acnes), hormonal influence
Eczema (dermatitis)Chronic inflammation, itchy, dry, red patches; linked to immune dysfunction
PsoriasisAutoimmune - rapid keratinocyte turnover (3-4 days vs normal 25-45); silvery plaques
VitiligoLoss of melanocytes causing white patches; autoimmune etiology
Athlete's foot (tinea pedis)Fungal infection of the skin between toes; warm, moist conditions

The Four Stages of Wound Healing

1. Hemostasis (seconds to minutes)

Blood clotting - platelets form a plug, fibrin mesh seals the wound

2. Inflammation (hours to days)

Neutrophils and macrophages clear debris, pathogens, and dead cells

3. Proliferation (days to weeks)

Granulation tissue forms, angiogenesis, fibroblasts lay down collagen, re-epithelialization

4. Remodeling (weeks to years)

Collagen cross-linking and reorganization; scar matures (reaches ~80% original strength)

Wounds can heal by primary intention (clean edges brought together, e.g., surgical incision - minimal scarring) or secondary intention (edges too far apart, wound fills in from the bottom with granulation tissue - more scarring). Healed skin typically recovers about 80% of its original tensile strength.

Quick Check

During which stage of wound healing do fibroblasts lay down new collagen and new blood vessels form (angiogenesis)?

Fill in the Blank

During hemostasis, platelets aggregate at the wound site and a________mesh forms to seal the wound and prevent further blood loss.

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