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Wound Classification
Wound Classification Presented by Dr. Karen Zulkowski, D.N.S., RN Montana State University Welcome! Thank you for joining this webinar about how to assess and measure a wound. 2 A Little About Myself… • Associate professor at Montana State University • Executive editor of the Journal of the World Council of Enterstomal Therapists (JWCET) and WCET International Ostomy Guidelines (2014) • Editorial board member of Ostomy Wound Management and Advances in Skin and Wound Care • Legal consultant • Former NPUAP board member 3 Today We Will Talk About • How to assess a wound • How to measure a wound Please make a note of your questions. Your Quality Improvement (QI) Specialists will follow up with you after this webinar to address them. 4 Assessing and Measuring Wounds • You completed a skin assessment and found a wound. • Now you need to determine what type of wound you found. • If it is a pressure ulcer, you need to determine the stage. 5 Assessing and Measuring Wounds This is important because— • Each type of wound has a different etiology. • Treatment may be very different. However— • Not all wounds are clear cut. • The cause may be multifactoral. 6 Types of Wounds • Vascular (arterial, venous, and mixed) • Neuropathic (diabetic) • Moisture-associated dermatitis • Skin tear • Pressure ulcer 7 Mixed Etiologies Many wounds have mixed etiologies. • There may be both venous and arterial insufficiency. • There may be diabetes and pressure characteristics. 8 Moisture-Associated Skin Damage • Also called perineal dermatitis, diaper rash, incontinence-associated dermatitis (often confused with pressure ulcers) • An inflammation of the skin in the perineal area, on and between the buttocks, into the skin folds, and down the inner thighs • Scaling of the skin with papule and vesicle formation: – These may open, with “weeping” of the skin, which exacerbates skin damage. -
Pressure Ulcer Staging Cards and Skin Inspection Opportunities.Indd
Pressure Ulcer Staging Pressure Ulcer Staging Suspected Deep Tissue Injury (sDTI): Purple or maroon localized area of discolored Suspected Deep Tissue Injury (sDTI): Purple or maroon localized area of discolored intact skin or blood-fi lled blister due to damage of underlying soft tissue from pressure intact skin or blood-fi lled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, fi rm, mushy, boggy, and/or shear. The area may be preceded by tissue that is painful, fi rm, mushy, boggy, warmer or cooler as compared to adjacent tissue. warmer or cooler as compared to adjacent tissue. Stage 1: Intact skin with non- Stage 1: Intact skin with non- blanchable redness of a localized blanchable redness of a localized area usually over a bony prominence. area usually over a bony prominence. Darkly pigmented skin may not have Darkly pigmented skin may not have visible blanching; its color may differ visible blanching; its color may differ from surrounding area. from surrounding area. Stage 2: Partial thickness loss of Stage 2: Partial thickness loss of dermis presenting as a shallow open dermis presenting as a shallow open ulcer with a red pink wound bed, ulcer with a red pink wound bed, without slough. May also present as without slough. May also present as an intact or open/ruptured serum- an intact or open/ruptured serum- fi lled blister. fi lled blister. Stage 3: Full thickness tissue loss. Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible but Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. -
Pressure Ulcers By: Esther Hattler BS,RN,WCC
Pressure Ulcers By: Esther Hattler BS,RN,WCC Staging Objectives The attendee will be able to list the 6 stages of pressure ulcers. Stage I Definition Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching. Its color may differ from surrounding area. Description Stage I The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk). Pictures stage I Stage II Definition Partial thickness loss of dermis presenting as a shallow open ulcer with a red/pink wound bed, WITHOUT slough. May also present as an intact or open ruptured serum filled blister. Description stage II Presents as a shiny or dry shallow ulcer WITHOUT slough or bruising. The stage II should NOT be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation. Pictures stage II Stage II Stage III Definition Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Description stage III The depth of a a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. -
UC Davis Dermatology Online Journal
UC Davis Dermatology Online Journal Title Penicillamine-associated cutis laxa and milia en plaque - case report and review of cutaneous changes associated with penicillamine Permalink https://escholarship.org/uc/item/47p4d8zv Journal Dermatology Online Journal, 22(5) Authors Vajdi, Tina Lee, Wiggin Wu Paravar, Taraneh Publication Date 2016 DOI 10.5070/D3225030951 License https://creativecommons.org/licenses/by-nc-nd/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Volume 22 Number 5 May 2016 Photo Vignette Penicillamine-associated cutis laxa and milia en plaque - case report and review of cutaneous changes associated with penicillamine Tina Vajdi1, Wiggin Wu Lee2, Taraneh Paravar2 Dermatology Online Journal 22 (5): 12 1University of California, San Diego School of Medicine 2Department of Dermatology, University of California, San Diego Correspondence: Taraneh Paravar, MD Assistant Clinical Professor Department of Dermatology University of California, San Diego 8899 University Center Lane, Suite 350 San Diego, California 92122, USA Tel. (858) 657-8322 E-mail: [email protected] Abstract Penicillamine-induced skin changes are rare and include: hypersensitivity reactions, autoimmune reactions, and cutaneous elastoses. We report a case of a 73-year-old man with cystinuria taking penicillamine for over 50 years who presented with penicillamine-induced cutis laxa and milia en plaque. A brief review of penicillamine induced skin changes, specifically cutis laxa and milia en plaque, is presented. Key Words: penicillamine, elastic tissue, cystinuria, cutis laxa, milia en plaque Introduction Penicillamine is a chelating agent commonly used to treat cystinuria and Wilson disease. Cystinuria is a genetic disorder in which patients lack the cysteine amino acid transporter. -
What's Inside: Become a Member Today!
Texas Bluebonnet Chapter Newsletter Winter/Spring 2014 President’s Welcome Message Dear Partners in the fight against Scleroderma, It is hard to believe we are already looking at March! Time has gone by so quickly and we are in full swing of activity. Our Board for the Texas Chapter has some wonderful ideas and we have started to implement several of them. Over the next several months our Board Members will be visiting all of our Support Groups and we are looking forward to meeting all of you. Follow us on Face Book and our Website. Jasminne and Jacob are working to get our social media current and running smoothly. Fundraisers are already in the works with several walks, patient educations, dinners, rummage sales and disc golf tournaments. These are just a glimpse of some of the things we have coming this year. Stay tuned we have a lot more in store! - Audrey What's Inside: Become A Member Today! 1- Meet Your Board of Directors 2- Scleroderma Stories The Scleroderma Foundation TX Bluebonnet 3- The Doctor Is In-Finger Ulcers Chapter needs you! 5- Chapter News & Events Are you a member already? Do you receive the 7- Scleroderma Spotlight: Johns Scleroderma Voice? Do you need to renew Hopkins Study your annual membership? Not sure? Please go to our chapter page and sign up to become a member of the TX chapter today. Get Connected! Your membership keeps you up to date on chapter news and events and helps raise TX Chapter FB Page awareness and provide funds for research. -
Oral Manifestations of Systemic and Cutaneous Lupus Erythematosus in a Venezuelan Population
J Oral Pathol Med (2007) 36: 524–7 ª 2007 The Authors. Journal compilation ª Blackwell Munksgaard Æ All rights reserved doi: 10.1111/j.1600-0714.2007.00569.x www.blackwellmunksgaard.com/jopm Oral manifestations of systemic and cutaneous lupus erythematosus in a Venezuelan population Jeaneth Lo´pez-Labady1, Mariana Villarroel-Dorrego2, Nieves Gonza´lez3, Ricardo Pe´rez3, Magdalena Mata de Henning1 1Dental School; 2Oral Medicine; 3Medical School, Universidad Central de Venezuela Caracas, Venezuela BACKGROUND: The aim of this study was to charac- and ⁄ or arthritis to renal failure or intense nervous, terize oral lesions in patients with systemic and cutane- cardiac and haematological disturbances (1). ous lupus erythematosus (LE) in a Venezuelan group. The basic manifestations of LE occur in the connect- METHODS: Ninety patients with LE were studied. Oral ive tissue and blood vessels, but depending on the biopsies were taken from patients who showed oral mu- anatomical location and course of the disease, LE has cosal involvement. Tissue samples were investigated with been classified as systemic LE (SLE) or cutaneous LE histology and direct immunofluorescence techniques for (CLE). Cutaneous lupus erythematosus includes variety the presence of immunoglobulins G, M, A and comple- of LE-specific skin lesions that are subdivided into three ment factor C3. categories: chronic CLE (CCLE), subacute CLE (SCLE) RESULTS: In 90 patients with LE, 10 patients showed oral and acute CLE (ACLE) based on clinical morphology lesions related to the disease. Sixteen lesions were and histopathologic examination (2–4). investigated. Oral ulcerations accompanied by white Patients with SLE frequently show cutaneous mani- irradiating striae occurred in five patients, erythema was festations during the course of the disease. -
Anetoderma Secondary to Mid-Dermal Elastolysis
Anetoderma Secondary to Mid-dermal Elastolysis Gabriela A. Maloney, BS,* Jane James, MD, PhD,** Michael Welsch, MD,** Marylee Braniecki, MD** *Midwestern University, Downers Grove, IL **Pathology Department, University of Illinois Hospital & Health Sciences System, Chicago, IL Abstract Anetoderma usually presents as circumscribed, 1 cm to 2 cm patches and plaques of flaccid skin secondary to loss of dermal elastic tissue. Lesions often occur in the neck, upper extremities, chest, and back. On histopathology, one sees complete loss of dermal elastin involving the papillary and reticular dermis, with infiltration of plasma cells and histiocytes. A 40-year-old female with no significant medical history presented with multiple round, 1 cm to 2 cm lesions scattered on her upper back and chest. Skin biopsy demonstrated elastic-fiber loss localized to the mid-dermis along with a lymphohistiocytic infiltrate with elastophagocytosis and active inflammatory phase in the papillary and mid-reticular dermis. The histopathological findings were consistent with mid-dermal elastolysis with advancing inflammation, and the clinical features were consistent with anetoderma. The microscopic examination revealed an active inflammatory phase of mid-dermal elastolysis, supporting the postulated theory that MDE may be part of a continuous spectrum with anetoderma. Case Report by lax, wrinkled skin with underlying palpable biopsy and elastic-fiber staining demonstrated A 40-year-old female with no significant medical depression (Figure 1). They were often preceded elastic-fiber loss in the mid-dermis along with history presented with multiple round, 1 cm to by two to six months of local erythema and had a lymphohistiocytic infiltrate with evidence 2 cm lesions scattered throughout the upper increased in number over the past two years. -
Dermatose Degenerativa Induzida Por D-Penicilamina Em Paciente Com Doença De Wilson
Revista SPDV 76(2) 2018; D-Penicillamine induced degenerative dermopathy; Rui Pedro Santos, Joana Gomes, Celeste Brito. Caso Clínico Dermatose Degenerativa Induzida por D-penicilamina em Paciente com Doença de Wilson Rui Pedro Santos1, Joana Gomes2, Celeste Brito2 1Interno de Dermatovenereologia/Resident, Dermatovenereology, Hospital de Braga, Braga, Portugal 2Especialista de Dermatovenereologia/Specialist of Dermatovenereology, Hospital de Braga, Braga, Portugal RESUMO – As dermatoses degenerativas induzidas por D-penicilamina incluem, entre outras, a elastose perfurante serpiginosa e o pseudo-pseudoxantoma elástico. A elastose perfurante serpiginosa é uma doença perfurante rara caracterizada pela elimi- nação transepidérmica de fibras elásticas anormais. Esta condição pode ser idiopática, reativa ou induzida por D-penicilamina, habitualmente utilizada para o tratamento da doença de Wilson, cistinúria, artrite reumatóide ou esclerose sistémica. Manifesta- ções cutâneas semelhantes a pseudoxantoma elástico mas sem história familiar e mutações do gene ABCC6 foram identificadas como sendo uma dermatose induzida por D-penicilamina e designada de pseudo-pseudoxantoma elástico. Descreve-se o caso de uma mulher de 17 anos tratada por vários anos com D-penicilamina para doença de Wilson, com pápulas assintomáticas, algumas cor de pele e hiperqueratósicas e outras macias e amareladas, na região cervical e face. A histopatolo- gia mostrou a eliminação transepidérmica de fibras elásticas espessadas, em forma de dentes de serra. Estes achados sugeriram uma dermopatia induzida por D-penicilamina e os autores consideraram o diagnóstico de elastose perfurante serpiginosa e pseudo-pseudoxantoma elástico no mesmo paciente. O fármaco foi alterado para acetato de zinco sem lesões novas, mas com manutenção das lesões existentes no seguimento a 1 ano. -
Healed Corneal Ulcer with Keloid Formation
Saudi Journal of Ophthalmology (2012) 26, 245–248 Case Report Healed corneal ulcer with keloid formation ⇑ Hind M. Alkatan, MD a, ; Khalid M. Al-Arfaj, MD c; Mohammed Hantera, MD d; Soliman Al-Kharashi, MD b Abstract We are reporting a 34-year-old Arabic white female patient who presented with a white mass covering her left cornea following multiple ocular surgeries and healed corneal ulcer. The lesion obscured further view of the iris, pupil and lens. The patient under- went penetrating keratoplasty and the histopathologic study of the left corneal button showed epithelial hyperplasia, absent Bow- man’s layer and subepithelial fibrovascular proliferation. The histopathologic appearance was suggestive of a corneal keloid which was supported by further ultrastructural study. The corneal graft remained clear 6 months after surgery and the patient was sat- isfied with the visual outcome. Penetrating keratoplasty may be an effective surgical option for corneal keloids in young adult patients. Keywords: Corneal mass, Histopathology, Keloid, Penetrating keratoplasty Ó 2012 Saudi Ophthalmological Society, King Saud University. All rights reserved. doi:10.1016/j.sjopt.2011.10.005 Introduction segment has been often unsuccessful.7 In extreme cases, the eyes were eventually enucleated due to spontaneous corneal Keloids and hypertrophic scars are fibrous tissue out- perforation or buphthalmos.8 We describe a case of corneal growths that result from a deviation from normal wound- keloid after healed corneal ulcer which was successfully man- healing process and were first described in 1865.1 Clinically, aged by penetrating keratoplasty. The clinical, histopatho- corneal keloids appear as gray–white elevated masses dif- logic, and ultrastructural findings are all presented. -
Oral Ulcers in Juvenile-Onset Systemic Lupus Erythematosus: a Review of the Literature
Am J Clin Dermatol DOI 10.1007/s40257-017-0286-9 REVIEW ARTICLE Oral Ulcers in Juvenile-Onset Systemic Lupus Erythematosus: A Review of the Literature 1 3 2 Pongsawat Rodsaward • Titipong Prueksrisakul • Tawatchai Deekajorndech • 4 5,6 1 Steven W. Edwards • Michael W. Beresford • Direkrit Chiewchengchol Ó The Author(s) 2017. This article is an open access publication Abstract Oral ulcers are the most common mucosal sign in juvenile-onset systemic lupus erythematosus (JSLE). Key Points The ulcers are one of the key clinical features; however, the terminology of oral ulcers, especially in JSLE patients, is Oral ulcers are one of the key clinical features in often vague and ill-defined. In fact, there are several clin- juvenile-onset systemic lupus erythematosus (JSLE) ical manifestations of oral ulcers in JSLE, and some lesions patients; however, the terminology remains unclear. occur when the disease is active, indicating that early management of the disease should be started. Oral ulcers There are several oral ulcers in JSLE patients that are classified as lupus erythematosus (LE) specific, where sometimes go unnoticed, and some ulcers indicate the lesional biopsy shows a unique pattern of mucosal that treatment should be started promptly. change in LE, and LE nonspecific, where the ulcers and Lesional biopsy is required when other oral diseases their histopathological findings can be found in other oral cannot be excluded, such as oral lichen planus and diseases. Here, the clinical manifestations, diagnosis and oral lichenoid contact lesions. management of oral ulcers in JSLE patients are reviewed. 1 Introduction & Direkrit Chiewchengchol Juvenile-onset systemic lupus erythematosus (JSLE) is one [email protected] of the most common autoimmune diseases in children and has a clinical course ranging from mild, gradual onset to 1 Center of Excellence in Immunology and Immune-mediated Disease, Faculty of Medicine, Chulalongkorn University, rapid, progressive multi-organ failure [1]. -
5 Allergic Diseases (And Differential Diagnoses)
Chapter 5 5 Allergic Diseases (and Differential Diagnoses) 5.1 Diseases with Possible IgE Involve- tions (combination of type I and type IVb reac- ment (“Immediate-Type Allergies”) tions). Atopic eczema will be discussed in a separate section (see Sect. 5.5.3). There are many allergic diseases manifesting in The maximal manifestation of IgE-mediated different organs and on the basis of different immediate-type allergic reaction is anaphylax- pathomechanisms (see Sect. 1.3). The most is. In the development of clinical symptoms, common allergies develop via IgE antibodies different organs may be involved and symp- and manifest within minutes to hours after al- toms of well-known allergic diseases of skin lergen contact (“immediate-type reactions”). and mucous membranes [also called “shock Not infrequently, there are biphasic (dual) re- fragments” (Karl Hansen)] may occur accord- action patterns when after a strong immediate ing to the severity (see Sect. 5.1.4). reactioninthecourseof6–12harenewedhy- persensitivity reaction (late-phase reaction, LPR) occurs which is triggered by IgE, but am- 5.1.1 Allergic Rhinitis plified by recruitment of additional cells and 5.1.1.1 Introduction mediators.TheseLPRshavetobedistin- guished from classic delayed-type hypersensi- Apart from being an aesthetic organ, the nose tivity (DTH) reactions (type IV reactions) (see has several very interesting functions (Ta- Sect. 5.5). ble 5.1). It is true that people can live without What may be confusing for the inexperi- breathing through the nose, but disturbance of enced physician is familiar to the allergist: The this function can lead to disease. Here we are same symptoms of immediate-type reactions interested mostly in defense functions against are observed without immune phenomena particles and irritants (physical or chemical) (skin tests or IgE antibodies) being detectable. -
Elastosis Perforans Serpiginosa: a D-Penicillamine Induced Dermatoses in a Patient with Wilson’S Disease
Article / Clinical Case Report Elastosis Perforans Serpiginosa: a D-penicillamine induced dermatoses in a patient with Wilson’s disease Swagatika Samala , Mukund Sablea How to cite: Samal S, Sable M. Elastosis Perforans Serpiginosa: a D-penicillamine induced dermatoses in a patient with Wilson’s disease. Autops Case Rep [Internet]. 2020 Apr-Jun;10(2):e2020167. https://doi.org/10.4322/acr.2020.167 ABSTRACT Long term use of D-penicillamine for Wilson’s disease can be associated with many adverse reactions and systemic side effects. We report the case of a 28-year-old male patient diagnosed with Wilson’s disease presenting with a serpiginous raised violaceous skin lesion in the anterior aspect of the neck over the last six months and two small papules with central umbilication during the last month. Histopathological examination of skin lesions demonstrated transepidermal perforating channel, and the Verhoeff’s-van Gieson stain showed marked increase number of irregular serrated elastic fibers suggesting the diagnosis of D- penicillamine induced elastosis perforans serpiginosa. Keywords Skin Diseases; Biopsy; Elastic tissue. INTRODUCTION CASE REPORT D-penicillamine (DPA) therapy is the mainstay A 28-year-male diagnosed with WD on oral DPA of chelation therapy for patients of Wilson’s therapy (250 mg thrice daily) for the last 18 years disease (WD). Various systemic adverse effects, presented with serpiginous raised violaceous skin including many dermatological manifestations, lesions in the anterior aspect of neck over the last may be observed with prolonged use of this drug. six months and two small papules with central The dermatological side effects of DPA can be of three umbilication for one month (Figure 1).