DERMATOLOGY

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 OBJECTIVES
1. By the end of the module, the learner should
be able to classify and describe common
dermatological conditions
2. Discuss the risk factors, causes and
pathophysiologic basis of the disease process.
3. Describe the presenting signs of symptoms of
the different skin conditions.
4. Understand the potential complications and
consequences of the disease and various
treatment options.
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 Definition
The branch of medicine that deals with the skin
and its diseases.

Skin facts:
• Largest organ.
• An average adult’s skin
– spans about 6m²,
– weighs 4kg, and
– contains more than 17 Km of blood
vessels.
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 Anatomy of the skin
• The skin consists of 3 layers:
– Epidermis- non vascular outermost layer,
contains continuously dividing cells
– Dermis- takes the largest portion of the skin
and provides strength and structure. It
consists of glands (sebaceous, sweat), hair
follicle, blood vessels, and nerve endings
– Subcutaneous tissue (hypodermis)- the
inner most layer. contains major vascular
networks, fat, nerves, and lymphatics
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6
 Function of the skin
• Protection- protection of underlying structures
from invasion by bacteria, noxious chemicals and
foreign matter.
• Sensory perception- transmits pain, touch,
pressure, temperature, itching, etc
• Fluid balance (excretion)- evaporation of
excess fluid.
• Temperature regulation- produced heat released
through skin by radiation, conduction, and
convection
• Vitamin synthesis- skin exposed to ultra violet
light can convert substances necessary for
synthesizing vitamin D3 (cholecalciferol).
• Aesthetic value- provides beauty and appearance
77
 COMMON DERMATOLOGICTERMS
• Lichenification: distinictive thickening and
hardening of skin
• Crust: dried exudate of body fliuds
• Ulcer: disruption of deep skin integrity
• Wheal: irregular, superficial area of localized
skin edema.
• Bulla: > 0.5 cm, Filled of serous fluid, e.g 2nd
degree burn ( blister)
• Atrophy: a decrease in size
• Scar: change in the skin secondary to trumas or
inflammation 88
 Cont..
• Pruritus - An intense itching sensation that can
have various causes (as by allergies, infection)
• Urticaria- An itchy skin eruption characterized by
wheals; usually the result of an allergic response
to insect bites, food or drugs
• Keloid - Raised scar tissue at the site of an injury;
results from excessive tissue repair
• Macule - A patch of skin that is discolored but not
usually elevated
• Papule - A small inflamed elevation of skin that is
nonsuppurative (not containing pus) e.g chicken
pox 9
Lichenification - distinictive thickening
and hardening of skin

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• Macule - A patch of skin that is discolored
but not usually elevated

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Papule - A small inflamed elevation of skin
that is nonsuppurative e.g chicken pox
Nodule – is a large papule.

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Pustule - A small inflamed elevation of skin
containing pus; a blister filled with pus.

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 Assessing the skin
• Assessment includes a thorough
- history taking,
-inspection and
-palpation of the skin.

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 Diagnostic tests
• Skin biopsy: removal of a piece of skin by
shave or excision technique for a
microscopic study
• Patch testing: performed to identify
substances to which the patient has
developed an allergy.
• Potassium hydroxide test (KOH): helps
to identify fungal skin infection
• Culture and sensitivity test 16
16
Classification of skin disorders
I . Inflammatory and allergic skin disorders
– Acne
– Psoriasis
– Atopic dermatitis (eczema)
– Contact dermatitis
II. Bacterial infections
– Impetigo
– Furuncle
– Carbuncle
– Cellulitis
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III. fungal infections
– Candidiasis
– Tinea capitis
– Tinea corporis
– Tinea pedis (athlete's foot)

[Link] infections
– Herpes simplex I (cold - sore)
– Varicella zoster (chicken pox)
– Herpes zoster (shingles)
– Warts
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V. Parasitic skin infections
– Scabies

VI. Others
– Skin cancer
– Wounds

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Inflammatory and allergic
conditions

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 Inflammatory and allergic conditions
1. Eczema/Dermatitis
- Inflammation of the skin; becomes itchy
and may develop blisters
- It is non-infectious and can be acute, sub-
acute or chronic.

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 Con’ted….
• Causes
– The exact cause is unknown
– Imbalance of the immune system with an
increase in the immunoglobulin “E” activity
and deficient of cell mediated delayed
hypersensitivity.
• Can be exacerbated by infection, bites,
pollen, wool, silk, fur, ointments,
detergents, perfume, certain foods,
temperature extremes, humidity,
sweating and stress
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Hypersensitivity reactions

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 Sign and symptom
• An acute stage eczema shows redness,
swelling, papules, blisters, oozing and
crusts.
• In the sub-acute stage the skin is still
red but becomes drier and scalier and
may show pigment change.
• In the chronic stage
-lichenification,
-excoriation (torn skin),
-scaling and cracks are seen 25
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 Types of eczema
i) Atopic eczema

- is a relapsing skin disorder that usually begins

in infancy and is characterized principally by
dry skin and pruritis, consequent rubbing and
scratching lead to lichenification
– The eczema comes and goes
– It is triggered by dryness of the skin,
infections, heat, sweating, contact with
allergens or irritants and emotional stress.
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 Atopic eczema…
• Mostly affected sites are elbow and
knee folds, wrists, ankles, face, and
neck; in some cases it can be
generalized

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Atopic dermatitis

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Atopic dermatitis

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 ii) Seborrhoic eczema
- is a very common chronic dermatitis
characterized by redness and scaling
that occurs in regions where the
sebaceous glands are most active,
such as:
– Behind ears, above and in between
eyebrows
– In between the shoulder blades, in
axillae
– Groin , Perianal area
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iii) Infective eczema
• Occurs as a response to an oozing skin
infection.
• Common sites are the foot, and ankle
region
• Causative organisms are usually
staphylococci/ streptococci
• Vaseline use aggravates this condition

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iv) Contact eczema:
• is caused by contact of the skin with
an irritant or an allergen.
• Common causes of irritant contact eczema
on hands, arms and legs are excessive use
of soap (especially if not washed off
properly) detergents, chemicals, sunlight,
jewellery, dyes, bleaches, perfume etc

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Contact dermatitis

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 Sign and symptom of eczema/
dermatitis

• Itching
• Redness, dry skin, lichenification,
excoriation, scaling skin
• Papules, blisters, oozing and crusts
• Color change

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 Management (general)

• Stop the use of irritants (contact eczema)

• Mild topical steroid such as hydrocortisone
1% cream twice daily until lesions clear.
• In severe itching use antihistamines
E.g: promethazine, chlorpheniramine

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 Mgt cont…
• In bacterial super infection use
antibiotics
• Explain to the Patient that its not serious
and will disappear in time.
• Keep finger nails short and covered at
night.

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 Mgt cont…
• An imidazole cream twice
daily/ketaconazole 200 mg/d 1-3 weeks
(seborrhoic eczema)
• The vicious circle of "itch – scratch –
lichenification – itch" needs to be broken ,
(atopic eczema)- conscious effort to stop
scratching
• In photo allergies – sun protection by wide rim
sun hat, long sleeves, high collar, sunglasses,
stay indoor, sunscreen, umbrella, etc
• Keep the site clean 39
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2. Acne
- Is a common disorder of the sebaceous
gland associated with excess
production of sebum and blockage of
the duct resulting in a variety of
inflammatory manifestations.
• Common in puberty and usually
regresses in early adult hood
• Patient complain of oiliness of the skin.
- Occurs on the face, upper trunk
and shoulders
- Appears to be multiple inflammatory
papules, pustules and nodules 40
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 Acne…

• It can be very mild to be very severe: -

they blend together to form large
inflammatory areas and scar
formation.

Cause-genetic, hormone and bacteria

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 Cont..
Sign and symptom
• Red nodules, cyst , red papules,
scars, pustules, keloids
• There may be mild soreness, pain or
itching

Diagnosis
• Clinical
– Cyst formation, scarring
– Common at puberty and common of
all skin conditions 44
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 Management
• Stop the use of vaseline, oil, ointment,
greasy cosmetics which further blocks
sebaceous ducts.
• Tretinoin 0.01- 0.1% cream or gel
• Salicylic acid 1-10% in alcoholic solution
for removal of excess sebum.
• For pustular/inflammatory lesions use
topical clindamycin 1% solution,
erythromycin 2% lotion

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 Management …
• In severe cases use systemic long term
antibiotics like doxycycline 100mg twice
daily
• Surgical treatment – incision and
drainage of large nodulocystic lesions

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 3. Psoriasis
• Is a chronic, recurrent, hereditary, non
infectious disease of the skin caused by
abnormally fast turn over of the
epidermis
• As a result the epidermis is not able to
develop normally, therefore it doesn’t allow
formation of the normal protective layer of
the skin.

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 Psoriasis…
• Skin becomes red, inflamed, and the
scales are thicker than normal
• when you scratch such a patch it
becomes silvery white.
• Sites can be extensor areas of extremities
especially elbow, knees, buttocks.

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Generalized psoriasis

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• Commonly reccurs
• Occurs at any age but 10-35 years is
commonest.
• Periods of emotional stress and anxiety
aggravate the condition.

Signs and symptoms.

• May itch severely
• covered with silvery scales

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 Management

• Explain to the Pt the recurrent nature of the

disease.
• Salicylic acid 2-10% ointment twice daily
to reduce scaling
• Moisturizers (Vaseline, paraffin oil, or
cream)
• Treat any super infection - antibiotics if
necessary
• Methotrexate as a last option in severe
cases.** 52
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INFECTIONS

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Bacterial Infections

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1. Cellulitis
• Is a diffuse, acute streptococcal or
staphylococcal infection of the skin
and subcutaneous tissue

Cause
• Caused by bacteria like
streptococcus/staphylococcus aureus
• Results from a break in skin (Often
associated with skin trauma)
• Infection rapidly spread through
lymphatic system 55
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 Signs and symptoms
• Pain
• Tenderness,
• redness,
• hotness,
• swollen area (well demarcated)
• Possible abscess or purulent drainage
• Fever,
• chills,
• Malaise

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Cellulitis with abscess

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 Management
• Oral antibiotics
• Parentral/systemic antibiotics
• Surgical drainage and debridement

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• Will progress, if not treated, to a deeper
infection (Necrotizing fasciitis)

• Necrotizing fasciitis (“flesh eating

bacteria”)
• Treated with antibiotics, generally
cephalexin, erythromycin,
dicloxacillin, Augmentin

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Before debridement

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After debridement

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64
 2. Furunculosis
• Is an acute painful infection with a
hard core filled with pus.
• Is an acute, localized, deep seated, red, hot,
very tender, inflammatory perifollicular
abscess.
• Common microorganism:
staphylococcus aureus
• Most common on persons who are carriers
of staphylococcus, diabetes, poor habits of
personal hygiene, immunosuppression,
obese, malnourished etc 65
81
• The lesion begins in the opening of
hair follicle or sebaceous gland
• Sites:
 face,
 buttocks,
 thighs,
 perineum,
 breasts,
 axilla,
 nose,
 genitallia, etc 66
67
 Signs and symptoms
• Hard nodule initially then an abscess with
centrally located yellow pustule, then
ruptures into an ulcer.
• Very tender
• Hotness and pain at the site.
• Redness

Diagnosis
• Gram stain of the pus
• Culture and sensitivity test of blood/pus
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 Cont..
Treatment
• Warm compresses -
• Warn patient not to squeeze or incise
the lesion
• Incision and drainage when it is fluctuant.
• Systemic antibiotics (cloxacillin,
erythromycin)
• Rest especially for genital area furuncles.
• For severe pain: codeine, morphine
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 3. Carbuncles
(multiple furuncles)
- Is an aggregation of interconnected
furuncles that drain through multiple
openings in the skin.
• Exposure to grease and oil increase the
risk.
• Occurs mostly where the skin is thick
• Causative microorganism: staph. Aureus
• Sites are: back of the neck, buttock, outer
aspect of the thigh and over the hip joints.
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 Carbuncles ….
Signs and symptoms
• Fever,
• chills,
• extreme pain,
• malaise.

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 Cont…
Diagnosis
• Gram stain of the pus
• Culture of pus/blood
• Leucocytosis (12,000-20,000 mm3)
normal 4,000-10,000mm3

Treatment
• The same as furuncle, plus
• Avoid friction and irritation from tight
clothing.**
73
 4. Folliculitis
• Is inflammation of the hair follicle
• Generally a staph infection.

Sign and symptom

Symptoms are generally mild and the
course can be self limited.
– Single or multiple papules or pustules
– Commonly seen in the beard area of men
and women’s legs from shaving

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Folliculitis: Special Circumstances

i. Pseudofolliculitis barbae (razor

bumps)

• Tightly curled hairs embed into skin and

irritate it generating raised, reddened
papule or pustule
• Treated by allowing hair to grow out.

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ii. Hot tub Folliculitis

• Caused by Pseudomonas aeruginosa

found in hot tubs that are poorly
cleaned, especially wooden.
• Appears much like common folliculitis 1-
2 days after exposure, lesions become
larger and more varied in size
• Very superficial and self limited
• Treated with oral ciprofloxacin or
Augmentin
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 Management

• Warm compress to relieve pain

• Clean with antibacterial soap
• general skin care,
• support.
• Topical antibiotic ointment
• Systemic antibiotics for recurrent cases

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 5. Impetigo

• Is an acute, very contagious,

rapidly spreading cutaneous
infection.
• Is a very common bacterial
infection of the superficial skin
• Causative agents are staph. aureus or a
Beta-hemolytic streptococcus or both

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Signs and Symptoms

• Superficial pustules
• Contagious
• Blisters break easily and form yellow
crusts

Diagnosis
- Culture and sensitivity

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 Management
• Prevent spreading by not sharing
towels, cloths and ointment.
• In severe forms administer cloxacillin 250-
500mg QID daily for 7-10 days
• Erythromycin 250-500mg 4 times daily
for 7-10 days

• Cut finger nails short to minimize damage

to lesion and to prevent autoinoculation
from scratching
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Fungal skin Infections

84
Common fungal infections

• Tinea Corporis (on the body)

• Tinea Pedis (on the foot)
• Tinea Cruris (in the groin area)
• Tinea Capitis (on the head)
• Tinea unguium (toe & finger nails)
• Tinea barbae
• Candidiasis (moniliasis)
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 1. Dermatophytoses (Mycoses)

• Are fungal infections of the skin, hair and nails

Types
[Link] pedis (Athlete’s foot)
• Is itchy, whitish scaling lesions and
inflammation of the superficial skin of the feet
and interdigital spaces of the toes
• Common between the 4th and 5th toe.
• Often seen in people wearing
rubber shoes / boots
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 Management

• Keep the space in between the toes dry

• wear cotton socks
• Avoid shoes that are too tight
• changing socks daily prevents reinfection.
• Imidazole cream/ whitfield’s ointment twice
daily until symptoms disappear for a total of
4 weeks
• Treat secondary bacterial infection if present

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 b. Tinea corporis
• A fungal infection that affects the trunk,
legs, arms/neck, excluding the beard
area, feet, hands and groin
– Is fungal infection of the skin most
common on the exposed surfaces of
the body.
– There is Intensive itching
– Frequent causes of tinea corporis is
the prescence of an infected pet in
the home
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 Management

• Imidazole cream/whitfield’s ointment twice

daily for aminimum of 4 weeks
• Griseofulvin 500mg once daily for 2-
6wks
• Ketaconazole 200mg once/twice daily
• When there is severe itching
antihistamines /mild steroids can be
added.

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91
c. Tinea capitis (ring worm)
• Is a contagious fungal disease of the
scalp and hair shaft.
Sign and symptom
• One or more round patches with scaling
• Hair loss (temporarily)
• The patient may have fever and
headache
Diagnosis
– Clinical features
– Microscopy of affected hairs and skin
(KOH) 92
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 Management

• Greseofulvin 500mg once daily for 8-12

weeks. (10-15mg/kg for children)
• Add whitfield’s ointment / miconazole
twice daily topically for 4 weeks
• In case of bacterial super infection
antiseptics and/ antibiotics are needed
96
 d. Tinea unguium
- Is a chronic fungal and some times mixed
yeast infection of the toe/finger nails
• It commonly occurs in people who
frequently wet the hands such as
domestic workers, cleaners, kitchen and
laundary staff
Signs and Symptoms
• Nails become thickened, friable (easily
crumbled)
• The nail may be destroyed
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 Cont..

Management

• Griseofulvin 500gm once daily until

the affected nails have grown out
completely
• use ketaconazole 200mg/day until
symptoms clear.
• Itraconazole 200mg/day x 3 months
• Keep the site dry
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e. Tinea cruris (Jack‘s itch)

• A fungal infection of the groin, pubic

region and thighs
Sign and symptom
• A patch that may spread to buttocks
• Starts from groin and advancing down to
inner thigh
• Itching and irritation

Diagnosis
• Clinical features,
• KOH 100
 Management

Treat with topical antifungal or systemic

antifungal for severe cases
Reduction of moisture in groin
Wash contaminated inner wear in hot water

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 f. Tinea barbae
• Is a fungal infection involving the beard
• Affects males only
• More common in farmers*?
Sign and symptom
• Pruritis
• Tenderness and pain
• Pustular folliculitis around the hair follicle
• Involved hairs are loose and easily
removed
Management:Systemic antifungals 102
103
 g. Candidiasis /moniliasis
• Candida albicans causes candidiasis
– Commonly occurs when host immunity is
decreased, such as :
– HIV,
– cancer,
– steroid use,
– cytotoxic drugs,
– radiotherapy,
– chronic disease,
– pregnancy. 104
105
 Signs and Symptoms
• On the oral cavity (oral
candidiasis/thrush)- white cheesy
adherent plaque that can be painful.
• When oral lesions extend to the throat and
esophagus they can cause anorexia,
nausea, dysphagia, and vomiting
• On the vulvovagina (candidia
vulvovaginitis)- vaginal irritation,
soreness and a thick creamy discharge
106
 Management

• Nystatin cream, oral suspension twice

daily for skin/ oral / miconazol oral gel 4
x /day x 1week
• Imidazole pessaries NOCTE for 2
weeks for vaginal candidiasis
• Ketaconazole 200mg twice daily for 1-
2weeks for oesophageal candidiasis
• Itraconazole 100mg/d x 2weeks
• Fluconazole 50-200mg /d x 1-2weeks
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Parasitic skin
infections

108
a. Scabies
• Is an infection of the skin caused by a parasite
called sarcoptes scabiei, a mite which lays
its eggs in burrow in the stratum and induces
an intensively itchy allergic response.
Sign and Symptom
• Small blisters and papules
• Severe itching, when warm particularly at
night
• Scratch marks
• Common sites are between fingers,
sides of the hands, buttocks
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110
111
 Cont…
Management
• Benzyl benzoate 25% emulsion
• Sulphur 5-20% ointment twice daily for
1-2 Weeks

112
Viral skin infections

113
 [Link] simplex

• Is an infection which is caused by herpes

simplex virus that causes vesicular
eruption (cold sore or fever blister) on
lip (herpes labialis), and on genitalia
(herpes genitalia)

114
Cold sores

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116
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 Cont….
Signs and Symptoms
- Few days of burning sensation at the site
initially then tingling sensations
- Then a group of blisters appear which
quickly break down to form superficial ulcers
- Highly contagious when the lesions are
visible

Diagnosis
• Clinical features
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 Cont…
Management

• since they are painful: Analgesia

• Lips: Zinc oxide ointment to soothe
and protect from sun light
• Antiseptic mouth wash: Chlorhexidine
3-4 times daily

119
 Cont….
• For severe infections or infections in
immunocompromised patients :
Acyclovir 200-400 mg five times daily for
5-10 days either topically or systemically
• Recurrence can be triggered by:
- Exposure to sun light (herpes
labialis)
-Oral sex, fever, stress, etc

120
 b. Herpes zoster (shingles)
• Is an acute inflammation of a nerve by a
latent varicella zoster infection in the
partially immune host.

Signs and symptoms

• Localized vesicles in cluster form on one
side of the body/unilateral
• Itching, tenderness and severe pain on
the site
**The thoracic, cervical and ophthalmic
nerves are frequently affected 121
 Herpes zoster…
• After 1-2 weeks crusts begin to fall off with
residual scarring
• Over 10% of patients develop a persistent
burning sensation
• Much more common in HIV patients, old
patients
• In both shingles and chicken pox,
patients are infectious until lesions
crust*** 122
123
 Management

• Analgesia with NSAIDs

• Antibiotics for secondary infections
• If the eye is involved immediately refer to
ophthalmologist
• For immunocompromised patients Acyclovir
800mg 5 times daily for 1 week
• Amitryptline 75mg at night
• Night: Carbamazepine 600-800mg/day
124
 c. Verrucae /Warts
• Are common benign skin tumors caused by
infection with the Human Papilloma Virus.
Types:
[Link] warts- warts on the sole of the foot
[Link] warts- warts on the face of
children
[Link] warts- appear on genital organs
[Link] contagiosum- a wart which
appear on small children. Caused by pox
virus. Generally self limited, made worse by
shaving. 125
126
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 Sign and symptom

• Found at any age but most common in

children and teenagers
• They can spread by contact
• The infected person immune system
clears the warts within 2 years in 2/3
cases

128
 Management

• Freeze with liquid nitrogen- Molluscum

contagiosum
• Salicylic acid 50% twice daily followed by
scraping the warts –Plantar warts
• Silver nitrate pencil touch- daily - juvenile
warts
• Podophyllin 10-25% solution apply
weekly by using match sticks and wash off
after 4-6 hours- Genital warts
• Treat partners - Genital warts
129
d) Chicken Pox (Varicella)
It is a highly contagious, mild viral
disease characterized mainly by a skin
rash.
It mainly affects children under 10
years of age.
An adult person who becomes infected
suffers a severe form of the illness.
Causative organism is the Varicella-
Zoster Virus (VZV).
130
Mode of Transmission

The virus is spread by droplets from

the upper respiratory tract or from
the discharges of ruptured lesions
on the skin.
The incubation period is 14 - 21 days.

131
Clinical Features
It begins with mild fever, sore throat and a
sore palate. The rash vesicles are
superficial and it clears spontaneously
within a week.
Management
Symptomatic treatment
Give the patient calamine lotion to relieve
itching and a local antiseptic.
Prevention and Control
School children should be kept off school if
there is an outbreak among schoolmates
Otherwise, it is a self-limiting disease.
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Surgical interventions

134
 1. Plastic surgery (Cosmetic
surgery)

• A type of reconstructive surgery

performed to:
 reconstruct or to alter congenital
or acquired defects
 to restore or improve the body’s
appearance

135
 Purpose of plastic
surgery

– To repair defect (reconstruction)

– To restore function (restoration)
– To replace lost part
– For better appearance
– To install prosthetic implants
– For complete change of identity

136
Possible complications of plastic
surgery
• Infection
• Scarring

• Long term pruritis

• Hematoma

137
 2. Skin grafting
• Is the technique in which a section of skin
is detached from its own blood supply
from the donor site and transferred as
free tissue to a recipient

Purpose
• To enhance wound healing
• To repair defects
• To cover wounds in which insufficient
skin is available
• To improve appearance 138
 Sources of skin graft can be:

• Autograft- use of tissue from self

• Allograft- use of tissue from the same
species
• Xenograft- use of tissue from different
species
• Isograft- use of tissue from
genetically identical persons
• Synthetic graft- substance from non-
biological source 139
WOUNDS
 Definition

An injury to living tissue; especially an injury

involving a cut or break in the skin

141
 Classification
I. Based on cleanness
• Clean wound- has a discharge that may be
fresh blood/ serum.
• Septic wound- has discharge like pus,
exudates, and dead tissues.
II. Based on openings
• Closed wound- involves injury to the
underlying tissues without a break to the skin
or mucus membrane 14
2

• Open wound- is a break in the skin or mucus

membrane
 III. Based on tissue damage

[Link]
–The outer layer/superficial layer of the
protective skin is scrapped off
[Link]/cut wound
–When body tissue is cut by a sharp edged
material
[Link] wound
• It is an irregular tearing of soft tissue
[Link]/stabwound 143
 Types of wound healing

1. Primary intention

• The wound is clean and no tissue loss

• The wound closes rapidly because there are
no gaps in the tissues
• Risk of infection is low
• Fine scar will remain
E.g.: surgical incision
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4
2. Secondary intention

• Loss of tissue
• Irregular edge, large wound with blood clot
• Greater risk of infection
• Longer healing time
• Granulation tissue fills in wound
• Visible scar formation
E.g.: wounds from trauma and
infection

145
3. Tertiary intention

• Large area of tissue loss

• Contaminated wound
• Delayed wound closure
• Wound may break down and re-sutured
later
• Results in deeper and wider scar

14
6
Phases of woundhealing
1. Inflammatory phase

• Occurs immediately after an injury and lasts

4-6 days
• Small blood vessels become more
permeable
• Presence of edema
• Pain and tenderness occurs
14
• The client shows elevated temperature,
7

and leukocytosis
2. Proliferative or granulation phase
–Begins between 1 and 4 days after the injury
and ends 14-21 days later
–Rapid growth of epithelial cells
–Rebuilding of vascular capillary network
and collagen tissue
–Collagen fibers fill ing the gap and form the
scar
–Wound scar tissue is very fragile and
susceptible to re-injury 14
8

–The color is red because of increased blood

flow
3. Maturation or remodeling phase

• Wound contraction begins between 14-21

days after the injury and lasts up to 2
years
• Scar shrinks and become flat
• Less red as the capillary regresess

14
9
Factors that delay wound healing

• Nutrition- adequate nutrition that includes

essential amino acids, vitamin A, C, and
zinc is essential for normal wound repairs
• Infections
• Age
• Blood supply- Poor blood flow may occur
as result of swelling, arterial and venous
pathology
15
0
• Wound separation
• Presence of foreign bodies
• Smoking- vasoconstriction caused by
smoking, decreases blood supply to the
wound
• Obesity- the bulk and weight of adipose
tissue causes poor vascularity
• Immuno-suppression
• Edema- reduces blood supply by exerting
pressure on blood vessels
• Medications 15
1

-Anticoagulants- may cause hemorrhage

• Wound stressors- like vomiting, coughing
heavily, and straining produces tension on
wounds and destroys granulation tissue that
prevents coming together of wound edges
• Drainage accumulation-
accumulation of drainage material
favors bacterial growth
• Bleeding (hemorrhage)- bleeding sites
becomes a growth media for
microorganisms 15
2
Complications of wound healing
• Hypertrophic scar / keloids- due to
excess production of collagen tissue
• Contracture- shortening of muscle or scar
tissue
• Delviscence - Separation and disruption of
previously joined wound edge. It can be
due to infection, weak granulation tissue.
• Hematoma- collections of blood or serum in
wound
15

• Infection- 3

• Hemorrhage-
Thank you

154