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Ji-Whan Park - Integumentary Physical Therapy

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Ji-Whan Park Integumentary Physical Therapy

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This book is a practical guide to safe and effective physical therapy methods that can be applied in patients with diverse skin ailments, including scars, decubitus ulcers, burns, frostbite, photosensitivity disorders, inflammatory skin disease, skin cancers, obesity-related conditions, psoriasis, herpes zoster, tineapedis, and vitiligo. For each condition, physical therapy interventions therapeutic exercises, manual physical therapies, and therapeutic modalities employed in rehabilitation are described in detail. In addition, information is provided on symptoms and complications, examination and evaluation, medical interventions, and prevention and management methods. In the case of obesity-related skin problems, management is discussed from the point of view of Eastern as well as Western medicine. The text is complemented by more than 300 color photographs and illustrations. Integumentary Physical Therapy will help the reader to obtain optimal therapeutic results when treating patients with skin ailments. It will be of value for both practicing physical therapists and students in physical therapy.

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Ji-Whan Park - Integumentary Physical Therapy
Integumentary Physical Therapy
Ji-Whan Park
Integumentary Physical Therapy

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Springer-Verlag Berlin Heidelberg 2016
Ji-Whan Park and Dae-In Jung (eds.) Integumentary Physical Therapy 10.1007/978-3-662-47380-1_1
1. An Outline of the Integumentary System
Keon Cheol Lee 1 and Dae-In Jung 2
(1)
Department of Physical Therapy, Kyungnam College of Information and Technology, Busan, South Korea
(2)
Department of Physical Therapy, Gwangju Health University, Gwangju, South Korea
Keon Cheol Lee Professor
Email:
ICD10 Code
  • A18.4 Tuberculosis of Skin and Subcutaneous Tissue
  • I73.9 Peripheral Vascular Disease, Unspecified
  • L29 Pruritus
  • L30.2 Cutaneous Autosensitization
  • L50.9 Urticaria, Unspecified
  • L53.9 Erythematous Condition, Unspecified
  • L68.0 Hirsutism
  • L68.3 Polytrichia
  • L83 Acanthosis Nigricans
  • L85.0 Acquired Ichthyosis
  • O01.9 Hydatidiform Mole, Unspecified
  • R23.2 Flushing
  • R23.8 Other Unspecified Skin Changes
  • A18.4
Learning Outcomes
After completing this chapter, you should be able to describe the following:
  • The skin types
  • The skin damages and the recovery processes
  • Skin aging
  • Histopathology of the skin
  • Assessment of the skin
Key Terms
  • Dermis
  • Epidermis
  • Skin test
  • Subcutaneous
  • Skin type
  • Skin property
  • Skin interpretation
  • Skin assessment
1.1 Structure of Integumentary System
1.1.1 Anatomy of the Integumentary System
As the largest organ of the human body, the skin surrounds the body and comprises 16% of a persons total body weight. The skin protects the body from the external environmental stimuli and also has a metabolic function. The skin forms the functional boundary between the external environment and the internal environment of the body, participating in the maintenance of homeostasis. Oral cavity, nasal cavity, orbital cavity, anal cavity, and vaginal cavity are body cavities that open to the exterior of the body, and the skin forms a mucosal surface barrier by contacting with the mucous membranes that line such cavities. The thickness of the skin varies from 0.5 to 6 mm. In the trunk, the skin of dorsal surface and limbs is thicker than that of the ventral surface, and in the neck, the dorsal surface is thicker than the ventral surface. The skin is composed of the epidermis and the dermis, which are structurally distinguishable. The epidermis consists of tough stratified squamous epithelium, and the dermis is composed of dense connective tissue (Chung ).
1.1.1.1 Epidermis
The epidermis protects internal organs from dangerous chemicals and harmful microorganisms, regulates body fluid volume and body temperature, and eliminates body wastes. The epidermis consists of tough stratified squamous epithelium and does not contain blood vessels (Fig. ).
Fig 11 Epidermis Stratum Corneum The stratum corneum is flat and does not - photo 1
Fig. 1.1
Epidermis
Stratum Corneum
The stratum corneum is flat and does not contain nuclei. It is composed of thick keratinized layers of dead squamous epithelial cells and accounts for up to 75% of the epidermal thickness. Cells of the stratum corneum are so tightly bonded to each other that water evaporation is prevented and the skin is kept hydrated.
Stratum Lucidum
The stratum lucidum (Latin for clear layer) is a thin, translucent layer that presents only in thick skin such as the lips, the palm of the hand, and the sole of the feet. It lacks nuclei and organelles but contains distinct desmosomes and a semifluid substance called eleidin, which explains the histologically translucent character of the stratum lucidum.
Stratum Granulosum
The stratum granulosum is composed of three to four layers of flattened cells and contains irregular granules of keratohyalin.
Stratum Spinosum
The stratum spinosum consists of several layers of polygonal cells. It contains large oval nuclei and the cells undergo occasional mitosis. Spiny projections on the surface of the cells are connected to the projections of the adjacent cells and form intercellular bridges. Lymph fluid passes through the intercellular bridges and has a part in providing nourishment and immunity to the skin.
Stratum Basale
The stratum basale (basal layer) is composed of a single layer of columnar epithelial cells placed on the surface of the dermis, and its basal surface has a role to fix the epidermis to the dermis. Cells populating the stratum basale include keratinocytes, melanocytes, tactile cells (Merkel cells), and nonpigmented granular dendrocytes (Langerhans cells).
1.1.1.2 Dermis
The dermis is composed of two layers. The upper layer, stratum papillarosum, lies below the epidermis and consists of loose connective tissue. It accounts for 1/5 of the dermis. The deep thicker layer of the dermis is called stratum reticularosum (reticular layer). It is located beneath the stratum papillarosum and consists of dense irregular connective tissues containing cross-linked collagen and elastin fibers. Nerves are widely distributed in the dermis. Blood vessels provide nourishment to the stratum basale of the epidermis and have an important role in regulating body temperature and blood pressure (Fig. ).
Fig 12 Cross-section of the skin and subcutaneous tissue 1113 - photo 2
Fig. 1.2
Cross-section of the skin and subcutaneous tissue
1.1.1.3 Subcutaneous Tissue
The subcutaneous tissue consists of loose connective tissue, blood vessels, and adipose cells. It attaches the skin loosely to the underlying organs and muscles, so that the skin can slide over them. The adipose cells serve as a buffer between the bones and the tissues. Because blood vessels and nerves course through the subcutaneous tissue and are surrounded by the connective tissue fibers, they can withstand the pulling force applied to them.
1.1.1.4 Skin Appendages
The appendages of the skin include hairs, nails, sweat glands, sebaceous glands, mammary glands, and ceruminous glands. They are developed from the embryonic epidermis. While hairs and nails have very restricted functions, integumentary glands play a highly important role in body protection and homeostasis maintenance.
Hair
Hair is a thin and flexible filament produced by hair follicle. It consists of keratinized dead cells and contributes to maintaining body temperature and perceiving touch sensation.
Fingernails and Toenails
The fingernails and toenails are firm plates formed in the stratum corneum of the epidermis and consist of highly compressed and keratinized dead cells. While the growth rate of nails varies depending on individuals health and nutrition, fingernails grow at an average rate of 1 mm a week, and toenails grow slower than fingernails. Fingernails are almost transparent and colorless, but it appears slightly pink due to the capillaries running underneath. Nails protect sensitive fingertips and toes on which nerves are concentrated, and they help fingers accurate movement.
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