PRS Journal Club Episodes : Plastic and Reconstructive Surgery

Daily Dose: Dealing With Skin Tears

In our Daily Dose, a viewer tells us they seem to be having a lot of skin tears now that they're older. Dr. Lacy Anderson explains what they could do at home to help the tears heal.

Monday, November 27th 2023, 11:24 am

By: News 9

In our Daily Dose, a viewer tells us they seem to be having a lot of skin tears now that they're older.

Dr. Lacy Anderson explains what they could do at home to help the tears heal.

"As we get older, we lose collagen in our skin and it can even get paper thin as we age! Small trauma to the skin, like carrying plastic grocery sacks on your forearms can cause bruising and skin tears. Suturing the skin usually doesn't work because the skin is so fragile the sutures won't hold. The best thing to do is to clean the skin by rinsing with clean water and get some non-adherent bandages from the pharmacy.

These bandages won't stick to the wound as it's healing. You'll want to apply some topical antibiotic ointment to the bandages before you apply them. This helps prevent infection and it also helps keep the bandage from sticking to the wound as it heals. Then you can wrap the non-adherent bandage with an ACE bandage over the outside to help hold the other bandage in place. You don't want to use tape or bandages that stick to the skin because they can actually tear the skin when you try to remove them.

You'll need to change this dressing once daily and check for infection. If the wound has a foul odor or you see any pus draining from the wound or redness spreading from the wound, be sure to see your doctor because you may need oral antibiotics.

Good luck and stay healthy!"

What Is Impetigo?

Impetigo is a common bacterial skin infection that spreads easily. It causes itchy sores or blisters to form on exposed skin, commonly around the nose or mouth. Impetigo is seen most often in babies and young kids, but you can get it at any age. The condition happens more often in the summer. Antibiotic treatment can help get rid of it. 

If your child gets red sores, especially around the nose and mouth, they could have impetigo. It's a skin infection caused by a bacteria, and it spreads easily. It's most common in babies and young children, but adults can get it too. (Photo credit: Zay Nyi Nyi/Dreamstime)

Impetigo looks different based on the type you get and the color of your skin. But there are three main types, including: 

Non-bullous impetigo. This is the most common type. It causes tiny blisters to form around the nose and mouth that itch but usually aren't that painful. These blisters eventually break open and ooze pus and fluid, leaving behind crusty yellow or golden scabs on your skin. This dry crust becomes a mark on the skin that fades over time without leaving a scar. Fever and swollen glands can develop in more serious cases.

Bullous impetigo. You'll get large fluid-filled blisters with this kind. They appear from the neck to the waist, but can also show on the arms and legs. The blisters spread quickly and burst after several days, leaving a crust that goes away without scarring. The area around the blisters may cause pain and itchiness. High temperatures and swollen glands are more common with this type of impetigo.

Ecthyma. If impetigo goes untreated, it can develop into this form. Ecthyma is more serious because it goes deeper into the skin. It causes sores that are painful and filled with liquid or pus that lead to ulcers. Crust and redness develop around the sore. With this form, scars can develop, because the sores are set in the skin.

For all of the types of impetigo, you should avoid touching or scratching the affected areas. The infection can spread to other parts of your body or to other people.

You're most likely to get an impetigo infection around your nose and mouth or somewhere else on your face, but impetigo sores can appear anywhere on your skin on the body. Children tend to get them on their face. Sometimes they show up in the middle of your body (between your belly and neck) or on your arms or legs.

Depending on your skin tone, impetigo may look different, but symptoms may include:  

Impetigo rash. The infected areas range from dime to quarter size. They start as tiny clusters of blisters that break open and reveal moist, red, raw skin that may look like other kinds of rashes at first. But after a few days, you'll get a grainy, golden crust that gradually spreads at the edges.

Impetigo diaper rash happens when babies or young kids get an infection in moist spots under or around their diaper area.

An impetigo rash may look red on lighter skin tones. The sores may be harder to notice right away on brown or darker skin, but they might be purple or grayish in color.

Impetigo blisters. Before you develop a crusty yellow or golden scab, you may get itchy sores that hurt and burst and leak fluid or pus for a few days. The blisters caused by bullous impetigo tend to be larger and stay longer than the kind from non-bullous impetigo. 

The most common cause of impetigo is bacteria called Staphylococcus aureus. Another bacteria source is group A streptococcus. You get impetigo when your immune system doesn't fight off an infection from certain bacteria.

These bacteria lurk everywhere. The most common way for your child to get impetigo is when they have contact with someone who has the infection, such as from playing contact sports like wrestling. It's especially easy to pick it up if your kid has an open wound or a fresh scratch.

In addition to being able to get impetigo from your skin's contact with bacteria, there are certain things that increase the chances you'll get an infection, including:  

Younger age. It shows up most often in kids ages 2 to 5. Experts think that's because a child's immune system hasn't fully developed yet. 

Living in a certain climate. Impetigo is more common when it's warm and humid outside. 

Open wounds. Germs can get inside your skin easier when it's already broken.

Other skin problems. People who have skin problems, fungal infections, or other skin conditions – like scabies, atopic dermatitis, eczema, body lice, or insect bites , – may have a harder time guarding against impetigo. 

Crowded spaces. Germs spread easier in places where people are in close contact with one another, such as schools or day care centers. If you share clothes, bedding, towels, or other objects with someone with the infection, you can catch impetigo.

Health conditions or medical treatment that weaken your immune system can also raise your risk of impetigo, including: 

Cancer treatment (chemotherapy)

Diabetes

Liver damage

HIV or AIDS infection

Kidney problems

Drug use through a vein in your arm

Treatment with dialysis

IV (intravenous) drug use

If you're already at a higher risk of impetigo, you may be more likely to get an infection if you don't wash your hands, body, or face very often. 

Children are also at risk of re-infection, as they may scratch and open their scabbing.

If impetigo goes untreated, there's a greater risk of complications.

Impetigo rarely causes serious or long-lasting health issues, but complications do happen. These problems are more likely to pop up if your impetigo is severe and goes untreated, but most impetigo complications clear up with antibiotics. 

Impetigo complications may include: 

Cellulitis. This is when the infection goes deeper into your skin. The area may get red, warm, swollen, or painful. You may also get other signs of infection, including fever, chills, or generally feeling unwell. Untreated cellulitis can be fatal. 

Guttate psoriasis. This is a non-infectious skin condition that can show up after a bacterial infection. You may get red, scaly patches on your arms, chest, legs, or scalp. It may go away without treatment in a few weeks, but tell your doctor about it. Creams may help.  

Scarring. Impetigo blisters and rashes typically don't damage your skin permanently. Scars are more likely to develop from ecthyma or intense scratching, so try not to touch your sores even if they're really itchy. 

Post-streptococcal glomerulonephritis. Rarely, impetigo can infect the tiny blood vessels in your kidneys. This can be fatal. Get medical help right away if you notice symptoms such as dark or bloody urine; swelling of your belly, face, eyes, feet, or ankles; or if you pee a lot less. 

Septicemia. This is a bacterial infection in your blood. It can be life-threatening and needs fast antibiotic treatment. Go to the hospital if you or a loved one has impetigo with symptoms such as diarrhea, a high fever, fast breathing, dizziness, or throwing up.

Staphylococcal scalded skin syndrome. One of the bacteria that causes impetigo can send out a kind of poison that causes your skin to blister. It may hurt, turn red, or start to peel off. You'll need treatment right away with antibiotics through a vein in your arm.   

Scarlet fever. See your doctor if you notice a faint, pink rash across your body. This bacterial infection usually isn't serious, but you could spread it to others if you don't take antibiotics to clear it up.  

To diagnose impetigo, your doctor will ask about your symptoms and check for sores and blisters on your face and other areas of your body. Lab tests usually aren't needed. 

Some bacteria are resistant to certain antibiotics. You're more likely to need extra lab work if your infection doesn't get better with the first treatment you try. The doctor may take a sample of liquid from one of the sores to see which antibiotic might work the best. 

If you get impetigo a lot, the doctor may swab the inside of your nose and send the sample to a lab. They're checking to see if you have bacteria in your nostrils causing repeat infections. 

These infections usually aren't serious and may go away on their own within a few weeks, but doctors usually recommend antibiotic treatment for impetigo. 

There's no guaranteed way to get rid of impetigo overnight, but antibiotics can help your skin heal faster (usually within 7 to 10 days) and lessen the chances you'll spread the bacteria to someone else. 

Antibiotics to treat impetigo include: 

Impetigo cream. If you have only a few sores, your doctor may suggest you put over-the-counter or prescription antibiotic ointment or cream directly on your skin. They'll let you know exactly how to use this topical treatment and for how long.  

To use antibiotic cream or ointment for impetigo, here are some things your doctor might suggest: 

Wash the affected area with soap and water to clear away crusted skin. 

Apply the antibiotic cream three or four times a day for 5 to 7 days.

Wash your hands before and after you touch your skin.

Cover the infected area loosely with a bandage, if possible. 

If your symptoms don't start to improve within a few days, tell your doctor. They may need to switch you to a different kind of antibiotic or another type of medicine. 

Impetigo antibiotics by mouth. You may need to take antibiotic pills or liquid for 7 to 10 days if your impetigo is serious or covers a big area. Your doctor may switch you to oral antibiotics if skin cream or ointments don't help. 

Use impetigo antibiotics for as many days as your doctor tells you to, even if your skin gets better before you run out of medicine. Your infection is more likely to come back if you stop treatment early. 

Check in with your doctor or dermatologist if you suspect impetigo. They can take a look at your skin to figure out what's going on and find the best way to treat your blisters and sores. 

Tell the doctor if you or your child gets a fever along with skin problems. And let them know if the infection gets worse or if impetigo is not healing with antibiotics within a week of starting treatment.

If you keep getting impetigo rashes or bullous impetigo, your doctor may run some tests to see why your skin can't fight off the bacteria.

You may not be able to avoid exposure to the bacteria that cause impetigo, but you can lessen the chances of spreading the infection to other people or other parts of your body.

How to stop impetigo from spreading. Talk to your doctor about how to care for your skin, and use antibiotics or other impetigo treatment exactly as prescribed. 

You should also: 

Clean your sores with soap and water.

Wash your hands often. 

Keep the sores covered with a bandage until they heal, if possible. 

Wash or disinfect toys touched by someone with impetigo. 

Use hot water to wash sheets, towels, clothing, or bedding used by someone with impetigo. 

Follow up with your doctor if your sores don't get better with treatment. 

Until your infection clears up or your doctor gives you the OK, here are some things to remember: 

Don't touch or scratch your sores (or let other people touch your infected skin). 

Don't have close contact with other people, especially babies or young kids. 

Don't go to work, school, sports practice, day care centers, or to the gym.

Don't share unwashed clothes, linens, or towels.  

Options To Get Rid Of Skin Moles

Medically reviewed by Brendan Camp, MD

Getting rid of moles on your face and body may be done for health or cosmetic reasons. Moles can be removed in several ways with little pain and a low risk of scarring.

No matter the reason for removing a mole, working with a dermatologist or plastic surgeon can improve your outcomes. It also ensures that your mole is reviewed for signs of skin cancer.

Mole removal treatments are typically done in a medical office or clinic. Local anesthetic is used to reduce pain. Aftercare typically involves keeping the wound site covered for the first 24 to 48 hours.

This article describes the ways to get rid of moles. It also explains why you should always consult a healthcare provider to have this done.

bluecinema / Getty Images

How to Get Rid of Facial Moles

Based on your condition, the depth of the mole, and your risk of scarring, facial moles are removed using one of the following techniques:

Shave excision: Shave excision is used for moles that rise above your skin. A small blade is used to remove the outermost layers of your skin. Stitches usually aren't needed. Bleeding is stopped with cautery (a current of heat) to seal the blood vessels or treatment with a special ointment.

Scissor excision: Scissor excision removes skin lesions that sit above your skin. The mole is grabbed with small forceps and pulled up so small curved scissors can cut around and under the mole. A curette (a scraping tool) removes any remaining sections. Bleeding is stopped with cautery or a special ointment.

Punch excision: A punch excision uses a tiny, round tool, similar to a cookie cutter. The tool makes a rounded puncture to remove an area deeper than a shave biopsy. Stitches are typically used to close the area.

Cryotherapy: Cryotherapy treats moles on the surface of your skin. This technique involves spraying or swabbing liquid nitrogen on the mole. The liquid nitrogen freezes the mole off, often leaving a blister. It can cause scarring and/or discoloration.

Excisional and incisional removal: An excisional or incisional removal using a surgical knife is used for a mole that has grown into deeper layers of tissue, An excisional removal takes the entire mole while an incisional removal only takes a portion of the mole. Stitches are used to close the site.

Mohs Surgery

If you have skin cancer on your face, you may benefit from Mohs surgery. This precise technique treats skin cancer in sensitive areas like your face. It removes only the skin with the cancer cells and keeps as much healthy skin as possible.

During this precise surgery, the visible skin cancer and a thin layer of the surrounding skin are removed. The removed skin is examined under a microscope for cancer cells. The process of removing a thin layer of skin and examining it under a microscope continues until there is no trace of cancer cells.

What Is a Mole?

A mole, or nevus, is a common type of skin spot that is often a different color from the surrounding area. It is made of clusters of melanocytes, the pigment-producing cells responsible for skin color. A mole can be present at birth or develop later in life.

A mole can be a birthmark (a skin marking present at birth), though not all birthmarks appear as moles. Birthmarks can also include cafe-au-lait spots (flat, pigmented spots) and Mongolian spots (bluish or bruised-looking spots).

A beauty mark often refers to a mole or birthmark that is considered attractive.

Mole Removal on Other Body Parts

Mole removal on other parts of your body typically can involve the same techniques as those used on your face, which include the following:

Moles on your trunk and other areas where a scar isn't easily seen can also be removed by a procedure called curettage and electrodesiccation. This involves scraping out the mole followed by treatment with electrodesiccation, a high-frequency electrical current).

These medical procedures are the safest ways to have any mole removed. Having one of these treatments performed by a dermatologist or plastic surgeon generally ensures the following:

Complete removal of the mole to reduce the chance of recurrence

Lowest risk of scarring or infection

Insurance coverage for moles removed for medical reasons

Examination of the mole for signs of skin cancer

Having your mole checked for signs of skin cancer can help identify this serious disease at its earliest stages,,,,,,, when it is most curable. Moles that are shaved or excised are sent to a laboratory for microscopic evaluation by a pathologist.

Dangers of Home Remedies to Remove Moles

The Food and Drug Administration (FDA) warns that there are no FDA-approved prescription or over-the-counter drugs for treating moles or skin tags. Using these products or purported home remedies can result in an infection requiring antibiotic treatment, scarring, and delayed diagnosis of skin cancer.

See a healthcare provider to assess and possibly remove a mole that is concerning you to ensure the best outcome.

When Don't You Need to Remove a Mole?

Most moles are benign (noncancerous) and do not have to be removed. A mole that does not bleed or change in size, shape, or color has a lower risk of being malignant. If a mole shows no signs of skin cancer or does not bother you, it is likely harmless to leave it in place.

However, moles that remain in place should not be ignored. An annual skin exam with a dermatologist can help identify moles that require monitoring or testing for skin cancer. Between skin exams, keep track of changes in any existing moles or the appearance of new ones.

Not all signs of skin cancer look the same on everyone. Notify your healthcare provider if you find any of the ABCDE warning signs of skin cancer:

Asymmetrical: An irregular shape that has two different sides when a line is drawn down the center

Border: An irregular or jagged border

Color: An irregular color

Diameter: A mole or spot larger than the size of a pea or about 6 millimeters (mm) or one-fourth of an inch

Evolving: An evolving (changing) mole or spot over a few weeks or months

Learn More: How Can You Tell If It's a Mole or Skin Cancer?

How to Remove Hair in Moles

A hairy mole occurs when a mole contains hair follicles and the hair pushes through the darker pigmentation. The presence of hair on a mole does not always indicate the health of the mole since the hair is growing from the hair follicle, not your mole.

Hairy moles are often regarded as unsightly. If you choose to leave your mole in place, you can safely use most types of hair removal treatments.

While the FDA advises that you avoid waxing skin with moles, you can use other ways to remove hair in moles without harming the mole:

Tweezing

Trimming with a nose or ear hair trimmer

Shaving for flat moles flush against your skin

Chemical hair removal products

While these products can safely remove hair from a mole, some treatments may irritate the surrounding skin, which can be more sensitive. The result could cause discomfort or scabbing, making the mole harder to examine for signs of skin cancer.

Learn More: When Should You Get Rid of a Mole?

Summary

While most moles do not have to be removed, there are several reasons to do so. You may want to be rid of moles that rub against your clothing, bleed, or look unsightly. Moles that have signs of skin cancer should also be taken off and examined by a healthcare provider.

A dermatologist or plastic surgeon can help you determine whether getting rid of a mole is advised. They can also provide the treatment needed to remove a mole with the lowest risks of problems and scarring.

Read the original article on Verywell Health.

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