Ji-Whan Park Dae-In Jung Editors Integumentary Physical Therapy 123
Integumentary Physical Therapy
Ji-Whan Park Dae-In Jung Editors Integumentary Physical Therapy
Editors Ji-Whan Park Daejeon Health Sciences College Daejeon South Korea Dae-In Jung Gwangju Health University Gwangju South Korea ISBN 978-3-662-47379-5 ISBN 978-3-662-47380-1 (ebook) DOI 10.1007/978-3-662-47380-1 Library of Congress Control Number: 2016943112 Springer-Verlag Berlin Heidelberg 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer-Verlag GmbH Berlin Heidelberg
Preface There was a stonemason whose job was cutting and shaping stones. He worked hard, streaming with sweat under the blazing sun. After the stone was shaped, he inscribed the stone with the phrase integumentary PT. Such a beautiful stone! We would like to inscribe our names on people s hearts. How can we do that? asked the people who had been watching the stonemason working. That s not difficult at all. You can do it as long as you get down on your knees and stay up all night working, he answered. How many times have the physical therapy professors in South Korea got down on their knees and stayed up? Since its origin in 1949, Korean physical therapy has been developing for the last 66 years with academic and technical supports from the world academics of physical therapy. However, there has been little contribution of Korean physical therapy to world physical therapy. Therefore, those professors, who believed that they must return the supports from the world physical therapy, considered the way to return what they have been benefited from the world physical therapy. This book is a practical guide to safe and effective physical therapy methods that can be applied to patients with diverse skin ailments, including scars, decubitus ulcers, burns, frostbite, photosensitivity disorders, inflammatory skin diseases, skin cancers, obesity-related conditions, psoriasis, herpes zoster, tinea pedis, 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. Knowledge of integumentary physical therapy will help the therapist to obtain optimal therapeutic results when treating patients with skin ailments. It will be of value for both practicing physical therapists and students of physical therapy. We thank the staff of Springer for sparing no efforts in publishing this book. v
vi Preface Especially, we express our sincere thanks to Prof. Keon Cheol, Prof. Lee, and the authors from many universities who worked relentlessly. Hopefully, this book will contribute to the advancement of world physical therapy. Daejeon, South Korea Gwangju, South Korea February 2015 Ji Whan Park, PhD, RPT Daein Jung, PhD, RPT
Contents 1 An Outline of the Integumentary System.................... 1 Keon Cheol Lee and Dae-In Jung 2 Wounds............................................... 43 Eun Young Kim 3 Decubitus Ulcer........................................ 61 Ji Whan Park 4 Burn................................................. 85 Han Shin Jeong 5 Frostbite............................................. 105 Keun-Jo Kim 6 Photosensitivity Disorders.............................. 121 Wonan Kwon 7 Inflammatory Skin Disease............................. 139 Myung-chul Kim 8 Skin Cancer.......................................... 165 DongYeop Lee 9 Obesity.............................................. 193 Eun Jeong Kim 10 Other Skin Diseases (Psoriasis, Herpes Zoster, Dermatophytosis, Vitiligo).............................. 217 Nam Jeong Cho Index.................................................... 239 vii
An Outline of the Integumentary System 1 Keon Cheol Lee and Dae-In Jung ICD 10 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 K.C. Lee (*) Professor, Department of Physical Therapy, Kyungnam College of Information and Technology, Busan, South Korea e-mail: rptgeon@lycos.co.kr D.-I. Jung Professor, Department of Physical Therapy, Gwangju Health University, Gwangju, South Korea Springer-Verlag Berlin Heidelberg 2016 J.-W. Park, D.-I. Jung (eds.), Integumentary Physical Therapy, DOI 10.1007/978-3-662-47380-1_1 1
2 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 person s 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 K.C. Lee and D.-I. Jung squamous epithelium, and the dermis is composed of dense connective tissue (Chung 2011 ). 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. 1.1 ). 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 Stratum corneum Stratum lucidum Stratum granulosum Stratum spinosum Stratum basale Fig. 1.1 Epidermis