SKIN

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SKIN

The whole body is covered with skin. It may be very thin as on the eyelids and on the penis, butvery thick as the scalp on the head. It has lots of hair on the head, but none on the palms and soles.Women have softer and fairer skin compared to men whose skin is more hairy, rough and darker.

Skin has layersLower layer: Just abovethe bones and muscles,the lower layer of skin hasthe blood vessels thatkeep it alive. It also has thenerves that help us inknowing what we aretouching and at whetherit is hot or cold.

It also has the sweat andthe oil glands that secretethe sweat and the oil thatwe can all experience orknow about, especiallywhen it gets hot.

What our skin does?The skin protects us from:

o Heato Coldo Injuryo Infection

It also helps make Vitamin Dthat helps to put Calciumin our bones.

Our skin also keeps us coolDo you know how earthen pots keep the wa-ter cool? The pores in the wall of the pot al-low a bit of water to come out that getsevaporated to cause cooling. In the sameway, the skin helps us to remain cool by giv-ing out sweat from sweat glands. Theseevaporate to cool us down. If that did nothappen, every time we had a fever or weexercised, our temperature would havereached boiling point!

Upper layer: The upper layer has the has the cells of theskin in many layers. The lowest layer has the new cells andthe uppermost layer have old and dead cells. This layer ispierced by hair, blood, sweat and nerve tubes.

There are different types of nerve organs in the skin for heat,for cold, for fine touch, for pain, for coarse touch and forpressure. These structures are what make the touch sensa-tion so important for us. The number of each type of nerveorgan for each task determines which part is more sensitiveto the sensation.

Layers of the Skin

hair

oilglands

bloodvessels

root ofhair

fatcells

Lower layer

Upper layer

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Skin help us keep away infectionsThe skin has many oil glands that secrete someoil. This oil actually keeps the skin supple andsoft and helps avoid infections. Too muchof soap applied every now and then can takeaway this softness. This can lead to the skincracking. You too must have noticed how theskin on the heels and on the back of hands oftencracks during winters. These cracks allow germsto enter the body, which is otherwise protectedby the skin.

What are goose pimples?The skin hassmall musclesthat can makethe hair on theskin stand upwhen the personfeels cold orwhen very ex-cited. In otheranimals withmore hair or fur,it is part of the body’s response because erecthair traps more air. This insulates the bodyfrom cold.

Some other muscles attached to the skin - asin the face — help us to express ourselves.These muscles are attached to the bones be-low and it is these that make people read fromour face whether we are happy or sad.

Our skin colourStaying out in the suncan tan the skin into adarker colour. But thecolour of the skin as weare born is determinedby our heredity. Com-pared to an average Eu-ropean, Indians have adarker skin. Evenamong Indians the aver-age North Indian morefair coloured than theaverage South Indian.People of the Mongoloidrace as in the Northeast

have a yellowish tinge to their skin.

However, there is nothing hard and fixed about it. A per-son of any heredity if exposed to the sun too often tendsto get dark while another staying indoors all the timetends to get fair. One should know that the basic colourof th skin cannot be changed by any cosmetic, cream ormedicine as advertised.

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Germs wait to enter our skinWhen there is a break on the top layer of ourskin, germs that normally stay on our skin, en-ter it. Germs like bacteria create boils while vi-ruses can cause the blisters of chicken pox andthe rash of measles. Fungus can cause the Dhobiitch on the groins. The ‘ringworm’ is nothingbut a fungus of the skin that enjoys to stay inskin that remains wet with sweat most of thetime. Fungus of the skin takes a long time tocure. As cells move out from below to the topand are shed off – a permanent cure of skin fun-gus also takes three months.

Dead cells make up our top skinThe cells keep moving slowly outwards as they grow in age. Newer cells join them from below as theold ones eventually become dead and form the outermost layer of the skin. It takes about three monthsfor cells from below to be pushed up, die and shed off.

The brown ‘dirt’ that you often see on the collars and cuffs of men are actually the dead cells shed off

germs enter through our skinif there is a break in it

Avoiding sunburnFair skinned people may also get sunburns if exposed tothe sun too long. Some creams when applied to the skin,reduce the effect of the sun on the skin and prevent toomuch of tan and sun burn also.

Why are burns difficult to heal?Deep burns are difficult to heal because eventhe blood vessels get burnt, spoiling the re-pair process. But deep burns have lesser painthan burns on the outer skin because thenerves also get burnt and pain signals can-not go to the brain !

Knowledge You Can Use

Know the AnswersSkin

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1. Please mark if “right” or “wrong”:

a. The skin helps the body to keep cool.

b. Deep burns hurt more than burns on top skin.

c. The skin prevents germs from entering the body as long as it is intact (not broken).

d. Fair people are more healthy than dark people.

e. Cleaning the skin with soap helps in keeping the skin healthy.

2. Fill in the Blanks:

a. The skin helps us to :

1._________________________________________

2. ________________________________________

3. ________________________________________

4. ________________________________________

5. ________________________________________

b. The skin helps in producing ___________________ that makes the bones stronger.

Skin Diseases

In this chapter, you will learn: Page Number1. Rashes

a. Rashes with fever 20-61. Scarlet fever with sore throat2. Rose rash with typhoid3. Measles4. Chicken Pox

b. Rashes without fever1.Rashes with medicines 20-7 2.Rashes with severe itching 20-73.Rashes due to fungus 20-84. Rashes of insect bites 20-8

2. Boils & Abscesses 20-93. Skin Allergy 20-94. Eczema 20-105. White Patches 20-106. Cracked Soles 20-107. Leprosy 20-10

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1. RashesWe get many kinds of rashes which are tiny red bumps on the skin.Some bumps are large enough to be felt by the hand when we rub theskin but others we can see but cannot feel with our hands.

Rashes can be grouped into:a. Rashes with feverb. Rashes without fever.

a. Rashes with feverIf there is fever along with the rash, think of mainly four diseases:

1. Scarlet fever with sore throatA scarlet (bright red) rash can be felt when thehand is rubbed only against it and is seen all overthe neck, chest, elbows and armpits. The rash turnswhite when pressed. With Scarlet Fever comessore throat and if sore throat is treated, the scarletfever will also be taken care of.

3. Rose rash with typhoidThe rose colour rash seen at the end of the firstweek of Typhoid is seen on the abdomen usuallyand blanches on pressure. It disappears after a fewdays by itself. Treatment of typhoid is what ismore important. (Check Phase I Manual “Fevers”fortreating Typhoid)

2. MeaslesMeasles is one of the most important diseases ofchildhood that can kill. It is caused by a virus thatgets into the body through breathing. The rashstarts from the forehead and neck and spreads allover the body after four to six days of fever. Theeyes look red and there may be a cough as well.

What happens in Measles?Measles decreases thebody’s capacity tofight other illnesses,such as pneumonia,diarrhoea etc. Thesediseases can kill achild and they maynot even come immediately with Measles. Ten timesmore children of an age group die within one year ofgetting measles than those who do not get measles. Then,it is seen that the mental capacity of a child may also belessened by a long illness like Measles. So, it is veryimportant to protect a child against Measles.

Give children Measles vaccineVaccines are available for measles. This shouldbe given to all children around nine months ofage after they lose their natural immunity. If thereis a Measles epidemic, even children who havetaken measles vaccine will get the disease. But theywill not die do as the measles will not be so se-vere. The disease of Measles also gives life longimmunity. Apart from the vaccine given at ninemonths of life, Vitamin A also protects from mea-sles. Many governments gives Vitamin A to everychild below five just before the onset of the mea-sles season around March to May.

4. Chicken PoxA rash can also be due to chicken pox. It starts offwith a high fever followed by a rash on the facewhich soon spreads to the trunk and chest. Then,within a day or two of the fever, the rash turns toblisters with fluid inside .

How Chicken Pox spreads?The chicken pox virus enter the body when webreathe in the droplets from sneezing or cough-ing of a person with chicken pox. It can also spreadfrom the scabs (dried part) of the blisters of chickenpox or when we come in contact with the fluidfrom the blisters of chicken pox.

Chicken Pox is seen much more in young childrenand it is rare in adults. However, the same chickenpox virus can cause Zoster or Shingles in olderpeople, especially those who have a low immu-nity. Patients with Zoster get severe pain in onepart of the body – usually the chest, but also faceand thighs. The pain is followed 4-6 days later byblisters with fluid. Since the virus is same, chil-dren can get Chicken Pox from adults with Zosterand even adults can get Zoster from children withchicken pox.

What to do in Chicken Pox?Chicken pox usually gets well on its own within 10days. All that one needs to do is to be alert to the possi-bility of pneumonia. And if pneumonia sets in, quicktreatment must be started (for treating pneumonia seeI Phase Manual on “Diseases of Breathing System”).With Chicken Pox, some may get swelling of the brain,but this is rare. To avoid getting chicken pox, it is wiseto keep away from patients until the skin of that personhas healed and the scabs have fallen off.

Note: Many medicines that are taken to reduce fever or to kill germs may also create a rash.Paracetamol, Aspirin, Cotrimoxazole, Amoxycillin, etc. may give a person a rash on the skin.

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body rash

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b. Rashes without feverCommon rashes that are seen are:

1.Rashes with medicines 2.Rashes with severe itching

3. Rashes due to fungus4. Rashes of insect bites

It is a rash that has come after takinga particular medicine. If the personis taking too many medicines at thesame time, it may not be easy tomake out which medicine is thecause of the rash. But if the rash getsworse every time a new dose is takenit confirms an allergy to the medi-cine.

Probably every medicine can cause a skin rash in someperson or the other. But medicines with Sulpha (as inCotrimoxazole and Sulfadiazine), other germ killers, (asPenicillin, Amoxycillin and Chloroquine ) and simplepain killers (like Aspirin and Paracetamol) are com-mon culprits for rashes.

What to do:If some other medicinecan be taken for the samepurpose, stop the onecausing the rash and givethe alternative.

To reduce the rash – often with someswelling and lots of itching –CHLORPHENIRAMINE may be given.If the medicine is important to be givenand has only a few doses left, for exam-ple Chloroquine in three doses for ma-laria, the medicine may be continuedalong with CHLORPHENIRAMINE.

1. Rashes with medicines

2. Rashes with severe itchingScabies is the most important and most common skin illnessseen in India’s villages. Scabies is caused by a small insect thatgrows and lays eggs inside the skin. It makes us itch very badlyespecially when our body gets warm in the sun or under a blan-ket in winters.

Too much itching andscratching may cause boils.

on the scrotumor penis (of boys)

betweenthe fingers

on the forearms

armpit folds

belt area (waist)

Parts of Body affected by Scabies

elbows

What to do in Scabies?After a good scrub bath, dry the bodycompletely and apply BHC ( or BB)lotion lightly on the entire body be-low the neck.Leave the application for a day or twoand then wash it off.Repeat after one week to kill newergerms that may have hatched fromthe insects’ eggs in the skin.If one person has scabies, all the fam-ily members must be treated at thesame time.CHLORPHENIRAMINE may reduceitching.If boils with pus can be seen at thescratch sites, DOXYCYLCINE orCOTRIMOXAZOLE may be given.To prevent scabies, take regular bathsand do not get close to another per-son having the disease.

In Scabies, smallitchy bumps appear

all over the body.

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3. Rashes because of fungusWe can get fungus of the skin. In summers sweat collects at some sites and fungus seeds (calledspores) that may get to the skin through dust or using each other’s clothes, may give rise to fungusof the skin.

Types of skin fungus

Ring Worms : The commonest variety of skin fungus is the ring worms. The rash appearsas tiny bumps on the skin in a circle. It can be seen as small rings that continue togrow or spread and may itch. It is commonly found on the groins next to the thigh,on the neck or the body. The ringworm tends to heal from the centre of the circlewhile the circle of bumps keeps increasing in size. The skin inthe area gets dark especially if the person feels very itchy andscratches on the site.

On Body: On the chest, the fungus often appears as lots of small patchesof white – lighter colour than the normal skin around – that are notraised and usually do not itch.

On Feet: Fungus between the toes of the feet is commonly seenamongst army and police personnel who have to keep their feet inside shoes for longperiods of time. Also seen amongst people who have to walk for long distances infloodwaters, or those housewives whose feet do not get to dry at all, such fungus tendsthe skin of the feet to peel off and the heels to crack.

On Nails : Fungus of the nails can be seen along with fungus of the fingers and toes. Thenails get deformed and may also crack. The skin around the nail is swollen up although itmay not pain.

What to do?Keep the area dry.Wipe carefully after taking a bath and if possible sprinkle powder on the affected part.Apply MICONAZOLE cream twice a day.To remove the fungus totally, the above measures need to be continued for at least onemonth.

CHLORPHENIRAMINE may be used for decreasing the itching.If the problem is very old, the skin has thickened and become very dark,BETAMETHASONE may also be used.To keep away from fungus, do not use others’ clothes and linen and do not weardamp clothes.

4. Rashes of insect bites

The person bitten can make outrashes that are because of insectbites. Usually, small bumpy rasheshappen in places where the insectwas unable to enter a belt area orthe tight edge of a blouse. The areacould also pain along with someswelling.

What to do in rashes of insects?In case of a sudden swelling due to a wasp bite, apply-ing vinegar helps reduce the swelling andpain. Baking soda – Bicarb soda – reducesthat of a Bee sting ( B for Bee and V for V(W)asp!). For most others,CHLORPHENIRAMINE by mouth andsome coconut oil locally will help.

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2. Boils and abscesses

A boil, or abscess, is an infection that forms a sac of pus under theskin. Boils and abscesses are very common in the summers, mainlyamong children. They are caused when different bacteria enter theskin when we scratch with our nails or injure the skin. Sometimesthe bacteria staying in our nose or mouth may also spread to otherplaces when we scratch without washing our hands after eating orafter picking our noses.

Abscess means a big and deep boil. It is better to wait and drain anypus found lurking inside an abscess to avoid it from occuring again.

Taking care of boils & abscesses

1. Put hot compresses on the boils several times a day.2. Let the boil burst open by itself. Allow the pus to drain but do notpress or squeeze the boil.3. If the boil does not burst open even after a few days of hot com-presses, it may have to be cut open or punctured by a boiled needle. Ifpossible, advise the person to go to a doctor.

What to do in boils?Clean the boils with warm water. If possible, put some Neem leaves or the Neem bark in thewater before heating. Turmeric paste with oil may also be used.

• Give DOXYCYCLINE or COTRIMOXAZOLE for seven days. If the boils have burst,a capsule of Doxycycline may be punctured or opened and the powder applied locallyafter cleaning the area.

• For those who get boils very often, GENTAMICIN / CIPROFLOXACIN drops may be putin the nose thrice a day for seven days along with the above treatment.

3. Skin allergy

We get allergy of the skin because our skinreacts with some things it comes in contactwith. Creams that we use, lipsticks, hairdyes, wearing rubber gloves or chappalscould cause allergy. Certain skin types alsodevelop allergies to plants, flowers ormetal coated ring or watch. The skin mayget a rash at the site of contact and the skinmay get thick and itch.

What to do in skin allergy?Stop the contact with thething causing allergy. GiveCHLORPHENIRAMINEby mouth and applyBETAMETHASONE cream to thespot. The skin allergy may decrease.At times, the allergy may continueand lead to Eczema.

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Boils on the skinare common

4. Eczema 5. White patchesMany people’s skindevelops whitepatches. Some ofthese are due tofungus infection. Inothers, the personhas had burns orskin injuries at thesame spots earlier.But in most, we do not know the cause.

There are some medicines that are availablethat may be eaten or applied before sitting inthe sun, but they require close monitoring bya doctor, so please refer them.

Eczema is a common skinproblem. The skin becomesthick, dark and may oozeout some watery sub-stance. At times due to along term allergy, or due toskin infection like Scabiesthat has not healed, Eczemaneeds lots of careful han-dling.

Avoiding contact with the allergic item ortreating the underlying infection is impor-

tant. The area may be cleaned andsoftened by applying warm saltwater. BETAMETHASONEcream may also be applied.

red patcheswith blisters

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7. LeprosyAny patch on the skin that is lighter than the skin can be leprosy. Ask the person to closeher eyes and say “one” whenever she can feel the touch of a wisp of cotton when you touchthe light area and the area around it randomly. If you find that the person cannot feel thetouch of cotton on the light patches compared to the surrounding areas, such a personmay have leprosy. Please refer to the PHC for free treatment at the earliest. Leprosy iscaused by bacteria and can be completely treated these days.

6. Cracked Feet

Cracks on the soles of thefeet are very common. Itis usually seen in peoplewho work barefoot orwear very poor footwear.It is usually more in dryand dusty weather.

The cracks sometimes get quite big andcould be painful and could even bleed attimes.

Treatment for Cracked feet

• Footwear should be worn as far aspossible.

• Socks could be worn to prevent dustand dirt getting to it and to keep thefeet moist.

• In painful and acute conditions, thefeet can be immersed in warm waterfor 15 minutes and then some oil

(such as coconut or any edible oil)or cream could be applied to it.This is best

done in the night before sleeping.

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Know the Answers

Skin Diseases

a. Please mark whether “right” or “wrong” :1. Measles is seen as a rash on the face appearing one day after the fever.

2. Chicken Pox rash is seen along with sore throat.

3. Typhoid fever and its treatment can both cause a skin rash.

4. Measles vaccine can be given to the mother to avoid the disease in the child.

5. Scabies leads to lots of itching and cn be treated with a BHC (Gammaxene) lotion.

6. Fungus infections of skin needs long treatment.

b. Please fill in the blanks:1. Eczema of skin ahs the following signs:

a. ________________________________

b. ________________________________

c. ________________________________

2. The itching and swelling of rashes can be lessened by giving Tablet __________________ by mouth.

3. We can know leprosy from Ringworm and other skin patches by _________________.

4. Craked feet is caused by _______________, and _______________________.

5. Fungus of feet needs the following treatment:a. _________________________________

b. _________________________________

c. _________________________________

6. Ringworm is commonly seen in the body at the following sites:

a. _________________________________

b. _________________________________

c. _________________________________

My Notes20-12