Category Archives: ___e) Skin

Sunburn: Protection & Treatment

(Survival manual/6. Medical/e) Skin/Sunburn protection & treatment)

See also:

 Protective Clothing
Sunlight is strongest when it is directly above the sky.  This is why health professionals advise that a person must avoid the sun between ten o’clock in the morning to four o’clock in the afternoon.  A marathon conducted at exactly twelve noon not only plays havoc on the skin, but also causes heat stroke and dehydration.

If going out in the sun is unavoidable during such hours, a person should wear protective clothing.  Protective clothing can reduce the skin’s exposure to sunlight.  Long pants protect the legs.  Long-sleeved shirts protect the arms.  And broad-brimmed hats can protect the face, especially the eyes.  Umbrellas are also effective tools in reducing sun exposure.

Seven Tips for Treating a Sunburn at Home
A sunburn is an actual burn of your skin from the ultraviolet (UV) light from the sun or other UV light sources (ie tanning beds). A sunburn can occur from as little as 15 minutes of midday sun exposure in a very light-skinned person.
The first signs of a sunburn may not appear for a few hours after the UV exposure. Sunburns may often appear “worse” the day after being at the beach, as it can take 24 hours or longer for the full effect of the UV damage to your skin to appear.
Sunburned skin is red and tender skin that is warm to the touch. Severe sunburned skin may result in the formation of blisters. Almost all sunburned skin will result in skin peeling on the burned areas several days after the sunburn.

It is always best to PREVENT sunburns, but when the sunburn occurs use these seven tips for comfort and healing:

  1. Take anti-inflammatory medications such as ibuprophen (Advil, Motrin), naproxen (Aleve) or aspirin. Do NOT give aspirin to children. These help decrease the inflammation and reduce the amount of redness and pain. The pain from a sunburn is usually worst between 6 and 48 hours after sun exposure.
  2. If your skin is not blistering, moisturizing cream may be applied to relieve discomfort. Store the moisturizing cream in the refrigerator between applications as the coolness will aid in comfort to your skin.
  3. Apply cool compresses to the burned skin. Cold wash clothes work well.
  4. Avoid hot showers or bathes. Take a luke warm bath instead. If there is no blistering of the skin, consider adding Aveeno Collodial Oatmeal to the bath water. It will aid in anti-inflammatory relief and act as a moisturizer for your skin.
  5. Avoid any additional sun or UV light exposure while your sunburn is healing. Clothing is better than protection while healing – long sleeves, hats, etc.
  6. Avoid products that contain benzocaine and lidocaine. They may actually create more itching and inflammation by causing an allergic contact dermatitis.
  7. If your sunburned skin develops blisters, resist the urge to pop them. The blister cover is actually protecting your raw skin underneath.

Sunburn Protection
Most organizations recommend using sunscreen with an SPF between 15 and 50 (SPF ratings higher than 50 have not been proven to be more effective than SPF 50). A sunscreen with an SPF of 15 protects against about 93 percent of UVB rays, and one with an SPF of 30 protects against 97 percent of rays, according to the Mayo Clinic. No SPF can block 100% of UV rays.

Because some UV radiation still gets through the sunscreen and into your skin, the SPF number refers to roughly how long it will take for a person’s skin to turn red. Sunscreen with an SPF of 15 will prevent your skin from getting red for approximately 15 times longer than usual (so if you start to burn in 10 minutes, sunscreen with SPF 15 will prevent burning for about 150 minutes, or 2.5 hours), according to the American Academy of Dermatology.

The UV (Ultraviolet) Index
The UV Index scale used in the United States conforms with international guidelines for UVI reporting established by the World Health Organization. What follows is a description of each UV Index level and tips to help you avoid harmful exposure to UV radiation.
** You can sign up for the free, daily  EPA (Environmental Protection Agency’s UV Index alert e-mail for your zip code, at:

 2 or less: Low
A UV Index reading of 2 or less means low danger from the sun’s UV rays for the average person:
•  Wear sunglasses on bright days. In winter, reflection off snow can nearly double UV strength.
•  If you burn easily, cover up and use sunscreen.

Look Out Below:
Snow and water can reflect the sun’s rays. Skiers and swimmers should take special care. Wear sunglasses or goggles, and apply sunscreen with an SPF of at least 15. Remember to protect areas that could be exposed to UV rays by the sun’s reflection, including under the chin and nose.

3 – 5: Moderate
A UV Index reading of 3 to 5 means moderate risk of harm from unprotected sun exposure.
•  Take precautions, such as covering up, if you will be outside.
•  Stay in shade near midday when the sun is strongest.

Me and My Shadow: An easy way to tell how much UV exposure you are getting is to look for your shadow: If your shadow is taller than you are (in the early morning and late afternoon), your UV exposure is likely to be low. If your shadow is shorter than you are (around midday), you are being exposed to high levels of UV radiation. Seek shade and protect your skin and eyes.

6 – 7: High
A UV Index reading of 6 to 7 means high risk of harm from unprotected sun exposure. Apply a sunscreen with a SPF of at least 15. Wear a wide-brim hat and sunglasses to protect your eyes.
•  Protection against sunburn is needed.
•  Reduce time in the sun between 10 a.m. and 4 p.m.
•  Cover up, wear a hat and sunglasses, and use sunscreen.

Made in the Shades: Wearing sunglasses protects the lids of your eyes as well as the lens.

8 – 10: Very High
A UV Index reading of 8 to 10 means very high risk of harm from unprotected sun exposure. Minimize sun exposure during midday hours, from 10 a.m. to 4 p.m. Protect yourself by liberally applying a sunscreen with an SPF of at least 15. Wear protective clothing and sunglasses to protect the eyes.
•  Take extra precautions. Unprotected skin will be damaged and can burn quickly.
•  Minimize sun exposure between 10 a.m. and 4 p.m; seek shade, cover up, wear a hat and sunglasses, and use sunscreen.

Stay in the Game: Be careful during routine outdoor activities such as gardening or playing sports. Remember that UV exposure is especially strong if you are working or playing between the peak hours of 10 a.m. and 4 p.m. Don’t forget that spectators, as well as participants, need to wear sunscreen and eye protection to avoid too much sun.

11+: Extreme
A UV Index reading of 11 or higher means extreme risk of harm from unprotected sun exposure. Try to avoid sun exposure during midday hours, from 10 a.m. to 4 p.m. Apply sunscreen with an SPF of at least 15 liberally every 2 hours.
•  Take all precautions. Unprotected skin can burn in minutes. Beachgoers should know that white sand and other bright surfaces reflect UV and will increase UV exposure.
•  Try to avoid sun exposure between 10 a.m. and 4 p.m.
•  Seek shade, cover up, wear a hat and sunglasses, and use sunscreen.

Beat the Heat: It is possible to go outside when the UV Index is 11 or higher. Make sure you always seek shade, wear a hat, cover up, wear 99-100% UV-blocking sunglasses, and use sunscreen. Or you can opt to stay indoors and take the opportunity to relax with a good book rather than risk dangerous levels of sun exposure

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Suture techniques

(Survival manual/6. Medical/e) Skin/Suture techniques

 A.   Introduction
Pasted from <>
As a method for closing cutaneous wounds, the technique of suturing is thousands of years old. Although suture materials and aspects of the technique have changed, the goals remain the same: closing dead space, supporting and strengthening wounds until healing increases their tensile strength, approximating skin edges for an aesthetically pleasing and functional result, and minimizing the risks of bleeding and infection.

Proper suturing technique is needed to ensure good results in dermatologic surgery. The postoperative appearance of a beautifully designed closure or flap can be compromised if an incorrect suture technique is chosen or if the execution is poor. Conversely, meticulous suturing technique cannot fully compensate for improper surgical technique. Poor incision placement with respect to relaxed skin tension lines, excessive removal of tissue, or inadequate undermining may limit the surgeon’s options in wound closure and suture placement. Gentle handling of the tissue is also important to optimize wound healing.

The choice of suture technique depends on the type and anatomic location of the wound, the thickness of the skin, the degree of tension, and the desired cosmetic result. The proper placement of sutures enhances the precise approximation of the wound edges, which helps minimize and redistribute skin tension. Wound eversion is essential to maximize the likelihood of good epidermal approximation. Eversion is desirable to minimize the risk of scar depression secondary to tissue contraction during healing. Usually, inversion is not desirable, and it probably does not decrease the risk of hypertrophic scarring in an individual with a propensity for hypertrophic scars. The elimination of dead space, the restoration of natural anatomic contours, and the minimization of suture marks are also important to optimize the cosmetic and functional results.

In this article, the suture techniques used in cutaneous surgery are reviewed. The techniques of suture placement for each type of stitch are described, the rationale for choosing one suture technique over another are reviewed, and the advantages and disadvantages of each suture technique are discussed. Frequently, more than one suture technique is needed for optimal closure of a wound. After reading this article, the reader should have an understanding of how and why particular sutures are chosen and an appreciation of the basic methods of placing each type of suture.1,2

B.  Basic suturing principles
Many varieties of suture material and needles are available to the cutaneous surgeon. The choice of sutures and needles is determined by the location of the lesion, the thickness of the skin in that location, and the amount of tension exerted on the wound. Regardless of the specific suture and needle chosen, the basic techniques of needle holding, needle driving, and knot placement remain the same.

1.  Needle construction
•  The needle has 3 sections. The point is the sharpest portion and is used to penetrate the tissue. The body represents the mid portion of the needle. The swage is the thickest portion of the needle and the portion to which the suture material is attached.
•  In cutaneous surgery, 2 main types of needles are used: cutting and reverse cutting. Both needles have a triangular body. A cutting needle has a sharp edge on the inner curve of the needle that is directed toward the wound edge. A reverse cutting needle has a sharp edge on the outer curve of the needle that is directed away from the wound edge, which reduces the risk of the suture pulling through the tissue. For this reason, the reverse cutting needle is used more often than the cutting needle in cutaneous surgery.

2.  Suture placement
•  A needle holder is used to grasp the needle at the distal portion of the body, one half to three quarters of the distance from the tip of the needle, depending on the surgeon’s preference. The needle holder is tightened by squeezing it until the first ratchet catches. The needle holder should not be tightened excessively because damage to both the needle and the needle holder may result. The needle is held vertically and longitudinally perpendicular to the needle holder.

[Left: The needle holder is held through the loops between the thumb and the fourth finger, and the index finger rests on the fulcrum of the instrument.]

•  Incorrect placement of the needle in the needle holder may result in a bent needle, difficult penetration of the skin, and/or an undesirable angle of entry into the tissue. The needle holder is held by placing the thumb and the fourth finger into the loops and by placing the index finger on the fulcrum of the needle holder to provide stability (see first image below). Alternatively, the needle holder may be held in the palm to increase dexterity (see second image below).

•  The tissue must be stabilized to allow suture placement. Depending on the surgeon’s preference, toothed or untoothed forceps or skin hooks may be used to gently grasp the tissue. Excessive trauma to the tissue being sutured should be avoided to reduce the possibility of tissue strangulation and necrosis. Forceps are necessary for grasping the needle as it exits the tissue after a pass. Prior to removing the needle holder, grasping and stabilizing the needle is important. This maneuver decreases the risk of losing the needle in the dermis or subcutaneous fat, and it is especially important if small needles are used in areas such as the back, where large needle bites are necessary for proper tissue approximation.
[Above: Using forceps to stabilize the tissue while the suture is placed.]

•  The needle should always penetrate the skin at a 90° angle, which minimizes the size of the entry wound and promotes eversion of the skin edges. The needle should be inserted 1-3 mm from the wound edge, depending on skin thickness. The depth and angle of the suture depends on the particular suturing technique. In general, the 2 sides of the suture should become mirror images, and the needle should also exit the skin perpendicular to the skin surface.

3.  Knot tying
•  Once the suture is satisfactorily placed, it must be secured with a knot. The instrument tie is used most commonly in cutaneous surgery. The square knot is traditionally used. First, the tip of the needle holder is rotated clockwise around the long end of the suture material for 2 complete turns. The tip of the needle holder is used to grasp the short end of the suture. The short end of the suture is pulled through the loops of the long end by crossing the hands, such that the 2 ends of the suture material are situated on opposite sides of the suture line. The needle holder is rotated counterclockwise once around the long end of the suture. The short end is grasped with the needle holder tip, and the short end is pulled through the loop again.

•  The suture should be tightened sufficiently to approximate the wound edges without constricting the tissue. Sometimes, leaving a small loop of suture after the second throw is helpful. This reserve loop allows the stitch to expand slightly and is helpful in preventing the strangulation of tissue because the tension exerted on the suture increases with increased wound edema. Depending on the surgeon’s preference, 1-2 additional throws may be added.

•  Properly squaring successive ties is important. That is, each tie must be laid down perfectly parallel to the previous tie. This procedure is important in preventing the creation of a granny knot, which tends to slip and is inherently weaker than a properly squared knot. When the desired number of throws is completed, the suture material may be cut (if interrupted stitches are used), or the next suture may be placed (see image below).

 4.  Placement
Sutures are placed by mounting a needle with attached suture into a needle holder. The needle point is pressed into the flesh, advanced along the trajectory of the needle’s curve until it emerges, and pulled through. The trailing thread is then tied into a knot, usually a square knot or surgeon’s knot. Sutures should bring together the wound edges, but should not cause indenting or blanching of the skin, since the blood supply may be impeded and thus increase infection and scarring. Sutured skin should roll slightly outward from the wound (eversion), and the depth and width of the sutured flesh should be roughly equal. Placement varies based on the location, but the distance between each suture generally should be equal to the distance from the suture to the wound edge.

Many different techniques exist. The most common is the simple interrupted stitch; it is indeed the simplest to perform and is called “interrupted” because the suture thread is cut between each individual stitch. The vertical and horizontal mattress stitch are also interrupted but are more complex and specialized for everting the skin and distributing tension. The running or continuous stitch is quicker but risks failing if the suture is cut in just one place; the continuous locking stitch is in some ways a more secure version. The chest drain stitch and corner stitch are variations of the horizontal mattress. Other stitches include the Figure 8 stitch and subcuticular stitch.

 5.  Removal
•  While some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short term device to allow healing of a trauma or wound.
•  “Different parts of the body heal at different speed. Common time to remove stitches will vary: facial wounds 3–5 days; scalp wound 7–10 days; limbs 10–14 days; joints 14 days; trunk of the body 7–10 days.
•  “Not all stitches must be removed. If a small area remains unhealed, notify the health care practitioner. Then if ordered, remove sutures from the healed area only.”


C.  Tissue adhesives
Pasted from <>
In recent years, topical cyanoacrylate adhesives (“liquid stitches”), a.k.a super glue, have been used in combination with, or as an alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing substances/tissue, after which it cures (polymerizes) and forms a flexible film that bonds to the underlying surface. The tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact. Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage.

Cyanoacrylate is the generic name for cyanoacrylate based fast-acting glues such as methyl-2-cyanoacrylate, ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy Glue) and n-butyl-cyanoacrylate. Skin glues like Indermil and Histoacryl were the first medical grade tissue adhesives to be used, and these are composed of n-butyl cyanoacrylate. These worked well but had the disadvantage of having to be stored in the refrigerator, were exothermic so they stung the patient, and the bond was brittle. Nowadays, the longer chain polymer, 2-octyl cyanoacrylate, is the preferred medical grade glue. It is available under various trade names, such as LiquiBand, SurgiSeal, FloraSeal, and Dermabond. These have the advantages of being more flexible, making a stronger bond, and being easier to use. The longer side chain types, for example octyl and butyl forms, also reduce tissue reaction.


 D.  Adventure Medical Kits Suture/Syringe Kit, ~$64.99
Product Features
•  Also used for injecting medications or anesthetics
•  And for starting or delivering IV’s
VA hospital quality field surgical kit for closing wounds

 Suture/Syringe Kit:
Suture/Syringe Supplies, 1 – Angiocatheter, 18G x11/4, 1 – Bandage, Conforming Gauze, Sterile, 3, 1 – Catheter, 18 Gauge, Plastic Tip, 1 – Gloves, Surgical Sterile, Size7.5 (pair), 1 – Gloves, Surgical Sterile, Size8 (pair), 1 – IV Start Kit, Sterile, 1 – Mayo Heger Needle Holder, 5, 1 – Packaging, Suture/Syringe Medic, 1 – Povidone Iodine Solution, 3/4 oz, 1 – Scalpel, Sterile, Disposable, with #11 Blade, 1 – Scissors, Stainless Steel, 5, 1 – Suture, Nylon, 3-0, 1 – Suture, Nylon, 5-0, 1 – Syringe, Irrigation, 20 cc with18 Gauge Tip, 1 – Syringe, Luer Lok, Sterile, 5 ml, 1 – Tape, 1/2 x10 Yards, Box/24, 1 – Thumb Tissue Forceps, Mouse-Tooth, 4.5, 1 – Towel Drape, Sterile, 1 – Wound Closure Strips, 1/4 x4, Pkg./10, 2 – Dressing, Gauze, Sterile, 4 x4, Pkg./2, 2 – Dressing, Non-Adherent, Sterile, 3 x4, 2 – Needle, Disposable, Sterile, 18G x11/2, 2 – Needle, Disposable, Sterile, 21G x11/2, 2 – Needle, Disposable, Sterile, 25G x5/8, 2 – Syringe, Luer Lok, Sterile, 3 ml, 2 – Tincture of Benzoin Topical Skin Adhesive, Swab, 2 – Trauma Pad, 5 x9, 4 – Triple Antibiotic Ointment, Net Wt. 0.9 g, , 5 – After Cuts & Scrapes Anesthetic/Antiseptic Wipe,

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Cut, scrape & wound

(Survival manual/6. Medical/e) Skin)
From< >

How to treat Minor Cuts
1.  Stop the bleeding
2.  Clean the wound

3.  Home care for scrapes and cuts
4. Options for closing wounds
5.  Prevent infection
6.  Promote healing
7.  Identifying secondary infection
8.  Typical (Secondary) skin infections

1.  Stop the bleeding
The first priority is to stop the wound bleeding. Follow these simple steps:
•  Try to calm and reassure the injured person.
•  Apply firm pressure directly to the wound, ideally using a clean cloth or towel. You can also use a finger if nothing else is available.
•  If the blood seeps through the cloth or towel, add more pressure.
•  Remove pressure when the bleeding stops, usually in five to ten minutes.

 When to seek medical help
You may need to seek medical help to stop the bleeding. You should seek immediate medical attention if:
•  The bleeding does not stop in ten minutes. [I’ve had this happen a couple of times, the cut needed stitching.]
•  You see bright red and spurting blood (this means that an artery has been severed).

 2.  Clean the wound
It’s very important to carefully clean a wound. Proper cleaning removes any foreign material, reduces the risk of secondary infection and minimizes any potential scarring.
To clean the wound:
•  Rinse the wound with clear water. Running tap water can be used.
•  Remove any foreign material in the wound (such as dirt, gravel or glass) by using tweezers if necessary.
•  Ideally, clean the wound with a sterile gauze.
•  Avoid using cotton wool.
•  If the bleeding restarts, apply firm pressure.
•  Most first aid kits include sterile or antiseptic wipes which can be used to clean the wound.

 When to seek medical help
If you are unable to remove all foreign objects, you should seek medical help in thoroughly cleaning the wound.

 3.  Home care for scrapes and cuts
Most scrapes and cuts can be cared for at home.
Scrapes often cover large areas, but they are superficial. When caring for a scrape, make sure to remove any embedded grit or dirt.
Small cuts can be cared for at home if the edges of the cut are close together. Make sure to remove any foreign material from the cut, stop the bleeding and cover the cut with a bandage or dressing.

When to seek medical help
You may need to seek medical attention for a cut or scrape. Call your doctor if:
•  The wound needs sutures. A wound needs sutures if it is deep, if fat protrudes from it, if the wound is over half an inch long or if it is a gaping wound.
•  You are unable to remove dirt, debris or dead tissue.
•  You can’t stop the bleeding.
•  The wound is a puncture.
•  The wound occurs on the face, eyelids, lips, or neck.
•  The edges of the wound are badly torn
•  A tetanus shot is required.
•  You are uncomfortable or unable to deal with the situation.

 4.  Options for closing wounds
There are many ways to close wounds, and the best option will depend on the type and severity of the wound itself.
•  Skinstrips are tape-like strips that hold the skin together. These are appropriate for small cuts that occur on parts of the body where there is very little tension or movement that could pull the wound apart (e.g. torso, thigh).
•  For deeper cuts, sutures (or stitches) are used to sew the edges of the cut together. They are very useful for closing wounds that have occurred on parts of the body where there is a lot of movement (e.g. hands).
•  Steri-strips or butterfly strips are used to close wounds on the face in those instances where stitches may leave a scar. Steri-strips are thin and sticky, and usually fall off after a few days.
•  Skin glue is a special adhesive that sticks together the edges of the wound and seals the skin for protection. Skin glue is not as effective on areas where there is a significant amount of skin movement.

5.  Prevent infection
Once you have stopped the bleeding and cleaned the wound, you will want to prevent infections from developing. The most effective strategy is to apply a topical antibiotic to the wound and cover it with a dressing.

You can help prevent infection by:
•  Applying a topical antibiotic, such as Neobiotic ointment to the wound. Topical antibiotics should be applied with each dressing change, or two to three times a day if the wound is left uncovered.
•  Cover the wound to keep it moist and to protect the topical antibiotic.
Studies show that applying a topical antibiotic can promote healing in 8 days, as opposed to 13 days for wounds left untreated. The use of mercurochrome and tincture of iodine was not as effective. These products resulted in healing over 13 and 15 days respectively. 

6.  Promote healing
You can promote healing and minimize the potential for scarring by covering the wound. Scientific studies show that keeping an injured area moist:
•  promotes the growth of new tissue,
•  lessens the potential for infection,
•  minimizes scarring, and
•  lessens the chance of further injury to the cut or scrape.
Many different sizes and types of wound dressings are available. Dressings should be changed daily or when they become wet or dirty.

Although covering a wound is generally the best choice, there are times when it’s appropriate to leave a wound uncovered. A scrape on a knee or elbow, for example, can often be left to heal uncovered after cleaning and applying a topical antibiotic.

 7.  Identifying secondary infection
You should examine the wound carefully to ensure that secondary infection has not developed. Signs of infection generally emerge a few days after the injury and include:
•  red, swollen or warm skin surrounding the wound
•  discharge and pus from the cut or scrape
•  a red line moving up the limb from the wound
•  fever.
If you suspect secondary infection, seek medical help.

 Staph infections are the most common Bacterial Skin Infections, and can lead to impetigo (see below) elsewhere on the skin. Prescription and over-the-counter topical antibiotics have been shown to be as effective at treating localized infections as oral antibiotics – and they have fewer side effects.

Strep infections are often indicated by a red line (lymphangitis) leading from the wound. Strep infections can also produce cellulitis (see below), which is a tender swollen redness on the skin. Oral antibiotics provide an effective treatment.

8. Typical (Secondary) skin infections
See also, (Survival manual/6. Medical/c)Disease/streptococcal infections)

Cellulitis is an infection that involves the outer layers of the skin. It is commonly caused by bacteria known as beta-hemolytic streptococcus or Staphylococcus aureus. You may experience pain, swelling, tenderness, warmth, and redness in the infected area. If you have a severe case of cellulitis, you may experience fever, tiredness, and a lowering of blood pressure. If left untreated, pus may form and cells may die in the infected skin area. Cellulitis can involve any part of the body but most often affects the leg. It typically results from an injury to the skin, such as scratches or animal bites—these allow bacteria to enter the body and cause an infection. An additional cause of cellulitis is skin breakdown around the anal area, typically seen in children. This can lead to redness, swelling, and painful bowel movements.

Oral antibiotics are used to treat mild cellulitis; more severe cases must be treated with intravenous antibiotics in a hospital. Antibiotics that may be used include cephalosporins, dicloxacillin, clindamycin, or vancomycin. Swelling can be lessened by elevating the affected area, such as the legs or arms. To stop cellulitis from occurring again, it is important to keep applying lotion to the skin and to maintain good skin cleanliness.

Impetigo is a contagious skin infection commonly caused by Staphylococcus aureus. Although this infection may occur in adults, it is most often seen in children aged 2 to 5 years and is usually spread through direct contact with another person who has the infection. You may experience tenderness, itching, sores, or blisters that can rupture and form honey-colored crusts. It can affect different parts of the body such as the face, arms, or legs. It also can affect moist parts of the body, such as the armpits, neck folds, and diaper areas.

Impetigo can be treated with a topical ointment or oral antibiotic. Mupirocin is a typical ointment that may be prescribed by your doctor. Oral antibiotics such as penicillins or cephalosporins are used for more severe infections. To prevent the spread of the infection to other parts of the body, avoid scratching the blisters or sores. Because impetigo is commonly seen in children, it may be helpful to cut the fingernails and cover the affected areas of the body with bandages or gauze. It also is important to prevent the spread of infection to other individuals in close contact by not sharing things such as blankets, linens, toys, or clothing.

Folliculitis is a general term used to describe an infection of the hair follicles commonly caused by Staphylococcus aureus, resulting in red pimples. You may experience redness, tenderness, or swelling of the affected area. It also can spread to the deeper parts of the hair follicles and pus can form, also known as furuncles or boils. Carbuncles is a term used to describe a group of infected hair follicles. Folliculitis, furuncles, and carbuncles can be seen on any part of the body with hair, such as the face, scalp, thighs, underarms, and groin area. This includes areas that are bearded or shaved.

Mild folliculitis can be treated with topical antibiotics, such as erythromycin, clindamycin, or mupirocin. More severe infections, such as carbuncles and larger furuncles, may require a surgical cut and drainage of the affected area. After drainage, it is important to clean the area with antibacterial soap; then you should apply the antibiotic ointment to the affected area of the skin. If needed, your doctor may prescribe oral antibiotics such as cephalosporins or dicloxacillin. Keep in mind that your doctor may recommend monthly treatments with mupirocin ointment if you have folliculitis that occurs repeatedly.

General Management of Skin Infections
With antibiotic treatment, signs and symptoms of skin infections begin to improve after approximately 2 to 3 days. If your skin infection does not improve or gets worse (especially if you develop a fever or the infection spreads), notify your doctor right away. If you are prescribed topical or oral antibiotics, be sure to finish the full course of antibiotics unless otherwise directed. Keep in mind that the length of treatment will differ depending on the type and severity of the infection. Lastly, as is true among all skin infections, you should keep the affected area or wound clean with good skin hygiene.

For further information on Cuts and Scrapes see:
Mayo Clinic:  <>, and
WebMD:  <>

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Poison Ivy, Oak & Sumac

(Survival manual/6. Medical/e) Skin/Poison Ivy, Oak and Sumac)

Poison Ivy, Oak, and Sumac Overview
 More than half the people in the United States are sensitive to poison ivy, poison oak, and poison sumac. If you are sensitive, you can develop an itchy, blistering rash by coming into contact with these plants.

Whether you are working or just enjoying the outdoors, look out for these plants:
•  Poison ivy is generally found east of the Rocky Mountains, growing as vines or shrubs. The leaves can have either smooth or notched edges and are often clustered in groups of three.
•  Poison oak is more commonly found west of the Rockies, usually as a small bush but sometimes as a climbing vine. Its leaves are smooth-edged and cluster in groups of three, five, or seven.
•  Poison sumac is most often found in wet areas of the Southeast. The leaves are generally smooth and oval-shaped, with seven to 13 growing on each stem.
•  The appearance of each of these plants can vary considerably from region to region, and with the seasons. Even dead plants in underbrush can transmit the toxic oil to your skin.

Poison Ivy mnemonic:
Leaves of three, let it be, berries white, take flight! (Poison Ivy develops white berries, Poison Sumac develops small white flowerets.)

Distribution maps: Poison Ivy                        Poison Oak                                        Poison Sumac

[Poison ivy, above (L>R)
(L) Poison ivy as a woodland  ground cover. (C) Climbing Poison   Ivy- a climbing vine. (R) Poison Ivy–as a   small free-standing shrub – vivid red fall colors.]

[Poison oak, above (L>R)
(L) Poison Oak as a woodland floor. cover.  Poison oak may grow as a small one-stick plant, as a bush, or   in a vine-like form up the side of a true oak or other tree. (C) Poison oak, is not   actually an oak, but its leaves look somewhat like an oak leaf. (R) Poison oak – fall colors.]

[Poison sumac, above (L>R)
(L) Poison Sumac-limb. (C) Poison Sumac   is a shrub or small tree, up to 20 feet in height, with 7-13 leaflets per pinnateleaf. (R) Poison Sumac-fall   colors.]

[Above: Rash from Poison Ivy/Oak/Sumac is an allergic reaction caused by contact with the   oil, urushiol, found in the leaves. The three poisonous plants are all basically the same, they cause the same dermatitis  rash, itch, are  treated the same and take 1-3 weeks to go   away.  Urushiols are among the world’s most potent external toxins. The amount of urushiol it takes to cause a reaction is  measured in nanograms (one billionth of a gram.) It’s estimated that it would take only one ounce of urushiol to cause a rash on everyone on the earth!]

Causes of Poison Ivy, Oak, and Sumac Rash
The rash caused by poison ivy, oak, and sumac is an allergic skin reaction to an oil, called urushiol, which is in the plant. This oil is found in all parts of the plant, including the leaves, stems, roots, and berries.

Exposure to the oil occurs through any of the following:
•  Touching any part of the plants.
•  Touching clothing or other objects that have contacted the plants.
•  Touching pets or other animals that have contacted the plants.
•  Exposure to the smoke of burning plants.

Symptoms of Poison Ivy, Oak, and Sumac Rash
•  Exposure to poison ivy, oak, or sumac causes an itching rash that usually appears within 24-72 hours.
•  The rash usually starts as small red bumps, and later develops blisters of variable size. The rash may crust or ooze.
•  The rash may be found anywhere on the body that has contacted the oil from the plant. It can have any shape or pattern, but is often in straight lines or streaks across the skin.
•  Different skin areas can break out at different times, making it seem as if the rash is spreading.
•  Contrary to popular belief, leakage of blister fluid does not spread the rash. It is spread only by additional exposure to the oil, which often lingers on hands, clothing and shoes (which are often overlooked as carriers), or tools.
•  When to Seek Medical Care

See your health care provider if you have the following conditions:
•  Large areas of rash causing significant discomfort
•  Rash on your mouth, genitals, or around your eyes
•  An area of the rash that becomes infected or drains pus
•  A great deal of swelling
•  People who are highly sensitive to these plants can get a severe reaction, called anaphylaxis.
•  If you have swelling of the face and throat or difficulty breathing, feel dizzy or faint, or lose consciousness, you may be having an anaphylactic reaction.
•  If you have any of these symptoms, go immediately to a hospital emergency department.
•  Do not attempt to drive yourself; if no one is available to drive you immediately, call 911 for emergency medical treatment.

Treatment of Poison Ivy, Oak, and Sumac Rash
Usually self-care at home is all that is needed for a reaction to these plants.

 Self-Care at Home: Treating Poison Ivy Exposures
If you are exposed, you should quickly (within 10 minutes):
•  first, cleanse exposed areas with rubbing alcohol.
•  next, wash the exposed areas with water only (no soap yet, since soap can move the urushiol, which is the oil from the poison ivy that triggers the rash, around your body and actually make the reaction worse).
•  now, take a shower with soap and warm water.
•  lastly, put gloves on and wipe everything you had with you, including shoes, tools, and your clothes, with rubbing alcohol and water.
•  If you can remove the oil within 10 minutes, you are unlikely to develop the rash.

Symptoms from a mild rash can sometimes be relieved by the following:
•  Cool compresses with water or milk
•  Calamine – A nonprescription lotion
•  Aveeno oatmeal bath – A product you put in the bath to relieve itching
• Oral antihistamines such as diphenhydramine (Benadryl) – Caution: these medications may make you too drowsy to drive a car or operate machinery safely
•  Nonprescription corticosteroid (for example, hydrocortisone) creams usually do not help.
•  Do not attempt to treat severe reactions or to “wait it out” at home. Go immediately to the nearest emergency department or call an ambulance.
__Take an antihistamine (one to two tablets or capsules of diphenhydramine [Benadryl]) if you can swallow without difficulty.
__If you are wheezing or having difficulty breathing, use an inhaled bronchodilator such as albuterol (Proventil) or epinephrine (Primatene Mist) if one is available. These inhaled medications dilate the airway.
__If you are feeling light headed or faint, lie down and raise your legs higher than your head to help blood flow to your brain.
__If at all possible, you or your companion should be prepared to tell medical personnel what medications you take and your allergy history.

•  Topical corticosteroid creams (prescription strength) – These reduce the immune response and relieve inflammatory symptoms.
•  Oral corticosteroid medication (such as prednisone) – These have effects similar to those of the creams but are needed for a more severe or widespread reaction. A course of steroids can run from three days to as long as four weeks.
•  Oral antihistamines – For itching. The main advantage of the prescription antihistamines is that they do not make you sleepy, allowing you to carry on your normal activities.
•  Antibiotics – These are needed only if the skin becomes infected after the initial rash.

•  Avoid these plants. Learn what they look like in your area. Be aware that their appearance can vary with the seasons.
•  Do not burn the plants. Burning can release the allergens into the air.
•  Wear proper clothing to protect your skin, such as gloves, long sleeves, and long pants.
•  Bathe pets that may have the oil on their fur. Use soapy water. Do not forget to wear protective clothing while doing this.
•  Wash any clothing that might contain the plant oil. Unwashed clothes can retain the oil and cause a rash in anyone who wears or handles them.
•  Before you go out in a potentially infested area, you can apply nonprescription products such as Ivy Block or Stokoguard, which act as a barrier to the oils.
•  Remember that the oil can be transferred from people, pets, or objects. Thoroughly wash anything that may carry the oil.

•  The rash and itching usually get better gradually and go away completely in two to three weeks. Treatment should be continued at least this long because the rash can come back if medicines are stopped too soon. You may have temporary darkening of your skin when the rash disappears.
•  Surrounding redness, pain, and pus can indicate a skin infection, which your doctor can treat with antibiotics. This is more likely to happen if the rash is scratched so much that the skin is broken.
•  You almost certainly will have another reaction if you come in contact with these plants again after a first reaction.

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