PHYSIOTHERAPY IN SKIN CONDITIONS

Skin Introduction

The skin is the outer covering of the body. It is the largest organ of the body. The integumentary system i.e. the skin and its appendages (hair, scale, nail) has functional relationship with many other body systems. The health of the integumentary system is dependent on the normal functions of the arterial, venous and lymphatic capillaries (dermal circulation).

The epidermis is avascular and water resistant. It provides protection from infection, abrasion and chemicals and assists with heat regulation, retention and dissipation.

The dermis is 20-30 times thicker than epidermis. It contains blood vessels and lymphatic; hair follicles; sweat glands, and sebaceous glands; nerves and nerve endings; and collagen, elastin, and ground substance that provide structure, strength, flexibility and elasticity.

The subcutaneous layer is not a part of the integument but is important in stabilizing skin over skeletal muscles and organs. It consists of loose connective tissues and fat cells and provide insulation and protection to underlying structures.

In case of skin conditions, which may be result of injury or disease of some or all the components of the integument are impaired, resulting in sequelae such as oedema, decreased lubrication, sensory loss or loss of elasticity and tensile strength.

Functions of the skin

• protection from external injury
• covering the organs
• used in fluid balance excretory function
• sensory function
• comtrols temparature
• absorption
• metabolizes vitamine D
• gateway for drug delivery
• cosmetic function

Skin Conditions

Acne Valgaris - 

 It is common chronic skin disease involving blockage and/or inflammation of hair follicles.

                                                             

 Types of acne

• open comonade
• close commonade
• papules
• cyst
• scars

Treatment

1. Comedolytics
2. Chemptherapy

Alopecia - 

It is a type of hair loss that occurs when the immune system mistakenly attaks hair follicles.

                                                         

Types 

• Alopecial Areata - local patches
• Alopecia Totalis - whole scalp
• Alopecia Universalis - scalp and body

Treatment

1. Topical Steroids 
2. PUVA therapy

Psoriasis

It is a papulo-sqamous disorder of skin.It is characterised by eryhemato-squamous lesions, vary in size from pinpoint to large plaques.May be localised or generalised with pustular eruption.It may affect the joints/nails.It may cause psoriatic arthritis. Mostally psoritic plaque appeares as as a silvery centre which is surrounded by the reddened border.

                                                       

Types

• Plaque 
• Guttate
• Inverse
• Pustular
• Erythrodermic

Treatment

1. Steroid Creams 
2. Vitamine D3 Creams
3. Ultaviolate Lights
4. Immune system suppressing medication like methotrexate

Leucoderma/Vitiligo - 

This are white patches of the skin in which skin looses their pigment.It is autoimmune disorder.

                                                     

Types 

• Segmental 

• Non segmental

1. Generalised vitiligo - most common type. Wide and randomly distributed areas of depigmentaton.
2.  Universal vitiligo - most of the body is depigmented.
3.  Focal vitiligo - most common in children. few scatterd macules in one area.
4.  Acrofacial vitilio - appearson fingers and periorificial area.
5.  Mucosal vitiligo - only mucous membranes are getting depigmented.

Treatment

1. Immune suppressing medications including glucocorticoids and calcineurine inhibitors - first line tretment
2. Steroids
3. Phototherapy - ultraviolet B(NBUVB) or PUVA
4. Councelling
5. Skin camouflage

Hyperhidrosis

It is a condition which is characterised by abnormal increase in sweating.

Types

• Primary/Focal hyperhidrosis
• Secondary/Generalised hyperhidrosis
• Palmopanter hyperhidrosis
• Gustatory hyperhidrosis

Leprosy

Leprosy disease is a chronic granulomatous disease.It is one of the most serious, disabling disease which attacks nerve and skin. Leprosy which is also called Hansens Disease.

Types

• Tuberculoid Leprosy(TL)
• Borderline Tuberculoid(BT)
• Borderline Borderline(BB)
• Borderline Lepromatous(BL)
• Lepromatous Leprosy(LL)

According to the type and difference in resistance the skin sign changes. In tuberculoid, cases have good resistance. Borderline cases have only fair resistance and lepromatous cases have little or no resistance. Damage to hand and feet can occur in all three types, if the mycobacterium leprae damages nerve trunk.

Treatment

1. Combinatin of antibiotics like dapsone, rifampin, and clofazimine. Because the bacteria are difficult to eradicate, antibiotics must be continued for a long time. Depending on the severity of the infection and the doctor's judgment, treatment continues from 6 months to many years. 
2. Active Exercise for muscle strenghening
3. Heat therapy

Common PT Assessment

• Inspection under good light 
• Skin temperature 
• General appearance of skin
• Skin texture , moisture and dryness
• Color and size of the lesion
• Cyanosis
• Check the pulses

Common Physiotherapy treatmrent for all

• UVR Therapy
• Joint and muscle integrity
• Increase joint mobility
• Care of bony prominances
• Don't expose to extreme heat
• Lubricate the skin
• Exercise to improve circulation 
• Maintain hygiene