The skin is the largest organ of the body that protects us from heat, cold, injury and infection. It has multiple layers including an upper layer with dead skin cells and a lower layer with blood vessels, sweat and oil glands. The skin helps regulate body temperature through sweating and provides sensory functions through nerve endings. Some common skin conditions include rashes, boils, allergies, eczema, fungal infections and diseases like leprosy. Rashes can occur with or without fever and be caused by illnesses, medicines or fungi/insects. Proper treatment and hygiene is important for skin health.

1. 20-1
SKIN

2. 20-2
SKIN
The whole body is covered with skin. It may be very thin as on the eyelids and on the penis, but
very thick as the scalp on the head. It has lots of hair on the head, but none on the palms and soles.
Women have softer and fairer skin compared to men whose skin is more hairy, rough and darker.
Layers of the Skin Skin has layers
Lower layer: Just above
the bones and muscles,
hair the lower layer of skin has
Upper layer the blood vessels that
oil keep it alive. It also has the
glands nerves that help us in
knowing what we are
touching and at whether
blood
it is hot or cold.
vessels
Lower layer
It also has the sweat and
root of the oil glands that secrete
hair the sweat and the oil that
we can all experience or
fat know about, especially
cells when it gets hot.
Upper layer: The upper layer has the has the cells of the What our skin does?
skin in many layers. The lowest layer has the new cells and The skin protects us from:
the uppermost layer have old and dead cells. This layer is o Heat
pierced by hair, blood, sweat and nerve tubes. o Cold
o Injury
There are different types of nerve organs in the skin for heat, o Infection
for cold, for fine touch, for pain, for coarse touch and for
pressure. These structures are what make the touch sensa- It also helps make Vitamin D
tion so important for us. The number of each type of nerve that helps to put Calcium
organ for each task determines which part is more sensitive in our bones.
to the sensation.
Skin help us keep away infections Our skin also keeps us cool
The skin has many oil glands that secrete some Do you know how earthen pots keep the wa-
oil. This oil actually keeps the skin supple and ter cool? The pores in the wall of the pot al-
soft and helps avoid infections. Too much low a bit of water to come out that gets
of soap applied every now and then can take evaporated to cause cooling. In the same
away this softness. This can lead to the skin way, the skin helps us to remain cool by giv-
cracking. You too must have noticed how the ing out sweat from sweat glands. These
skin on the heels and on the back of hands often evaporate to cool us down. If that did not
cracks during winters. These cracks allow germs happen, every time we had a fever or we
to enter the body, which is otherwise protected exercised, our temperature would have
by the skin. reached boiling point!

3. 20-3
Germs wait to enter our skin
When there is a break on the top layer of our
skin, germs that normally stay on our skin, en-
ter it. Germs like bacteria create boils while vi-
ruses can cause the blisters of chicken pox and
the rash of measles. Fungus can cause the Dhobi
itch on the groins. The ‘ringworm’ is nothing
but a fungus of the skin that enjoys to stay in
skin that remains wet with sweat most of the
time. Fungus of the skin takes a long time to
germs enter through our skin
cure. As cells move out from below to the top
if there is a break in it
and are shed off – a permanent cure of skin fun-
gus also takes three months.
Dead cells make up our top skin
The cells keep moving slowly outwards as they grow in age. Newer cells join them from below as the
old ones eventually become dead and form the outermost layer of the skin. It takes about three months
for cells from below to be pushed up, die and shed off.
The brown ‘dirt’ that you often see on the collars and cuffs of men are actually the dead cells shed off
Knowledge You Can Use
Our skin colour What are goose pimples?
Staying out in the sun The skin has
can tan the skin into a small muscles
darker colour. But the that can make
colour of the skin as we the hair on the
are born is determined skin stand up
by our heredity. Com- when the person
pared to an average Eu- feels cold or
ropean, Indians have a when very ex-
darker skin. Even cited. In other
among Indians the aver- animals with
age North Indian more more hair or fur,
fair coloured than the it is part of the body’s response because erect
average South Indian. hair traps more air. This insulates the body
People of the Mongoloid from cold.
race as in the Northeast
have a yellowish tinge to their skin. Some other muscles attached to the skin - as
in the face — help us to express ourselves.
However, there is nothing hard and fixed about it. A per- These muscles are attached to the bones be-
son of any heredity if exposed to the sun too often tends low and it is these that make people read from
to get dark while another staying indoors all the time our face whether we are happy or sad.
tends to get fair. One should know that the basic colour
of th skin cannot be changed by any cosmetic, cream or
medicine as advertised.
Avoiding sunburn Why are burns difficult to heal?
Fair skinned people may also get sunburns if exposed to Deep burns are difficult to heal because even
the sun too long. Some creams when applied to the skin, the blood vessels get burnt, spoiling the re-
reduce the effect of the sun on the skin and prevent too pair process. But deep burns have lesser pain
much of tan and sun burn also. than burns on the outer skin because the
nerves also get burnt and pain signals can-
not go to the brain !

4. 20-4
Know the Answers
Skin
1. Please mark if “right” or “wrong”:
a. The skin helps the body to keep cool.
b. Deep burns hurt more than burns on top skin.
c. The skin prevents germs from entering the body as
long as it is intact (not broken).
d. Fair people are more healthy than dark people.
e. Cleaning the skin with soap helps in keeping the skin healthy.
2. Fill in the Blanks:
a. The skin helps us to :
1._________________________________________
2. ________________________________________
3. ________________________________________
4. ________________________________________
5. ________________________________________
b. The skin helps in producing ___________________ that makes the bones stronger.

5. 20-5
Skin Diseases
In this chapter, you will learn: Page Number
1. Rashes
a. Rashes with fever 20-6
1. Scarlet fever with sore throat
2. Rose rash with typhoid
3. Measles
4. Chicken Pox
b. Rashes without fever
1.Rashes with medicines 20-7
2.Rashes with severe itching 20-7
3.Rashes due to fungus 20-8
4. Rashes of insect bites 20-8
2. Boils & Abscesses 20-9
3. Skin Allergy 20-9
4. Eczema 20-10
5. White Patches 20-10
6. Cracked Soles 20-10
7. Leprosy 20-10

6. 20-6 20-6
1. Rashes
We get many kinds of rashes which are tiny red bumps on the skin.
Some bumps are large enough to be felt by the hand when we rub the
skin but others we can see but cannot feel with our hands.
Rashes can be grouped into:
a. Rashes with fever
b. Rashes without fever.
a. Rashes with fever body rash
If there is fever along with the rash, think of mainly four diseases:
1. Scarlet fever with sore throat 3. Rose rash with typhoid
A scarlet (bright red) rash can be felt when the The rose colour rash seen at the end of the first
hand is rubbed only against it and is seen all over week of Typhoid is seen on the abdomen usually
the neck, chest, elbows and armpits. The rash turns and blanches on pressure. It disappears after a few
white when pressed. With Scarlet Fever comes days by itself. Treatment of typhoid is what is
sore throat and if sore throat is treated, the scarlet more important. (Check Phase I Manual “Fevers”for
fever will also be taken care of. treating Typhoid)
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
2. Measles 4. Chicken Pox
Measles is one of the most important diseases of A rash can also be due to chicken pox. It starts off
childhood that can kill. It is caused by a virus that with a high fever followed by a rash on the face
gets into the body through breathing. The rash which soon spreads to the trunk and chest. Then,
starts from the forehead and neck and spreads all within a day or two of the fever, the rash turns to
over the body after four to six days of fever. The blisters with fluid inside .
eyes look red and there may be a cough as well.
How Chicken Pox spreads?
What happens in Measles? The chicken pox virus enter the body when we
Measles decreases the breathe in the droplets from sneezing or cough-
body’s capacity to ing of a person with chicken pox. It can also spread
fight other illnesses, from the scabs (dried part) of the blisters of chicken
such as pneumonia, pox or when we come in contact with the fluid
diarrhoea etc. These from the blisters of chicken pox.
diseases can kill a
child and they may Chicken Pox is seen much more in young children
not even come immediately with Measles. Ten times and it is rare in adults. However, the same chicken
more children of an age group die within one year of pox virus can cause Zoster or Shingles in older
getting measles than those who do not get measles. Then, people, especially those who have a low immu-
it is seen that the mental capacity of a child may also be nity. Patients with Zoster get severe pain in one
lessened by a long illness like Measles. So, it is very part of the body – usually the chest, but also face
important to protect a child against Measles. and thighs. The pain is followed 4-6 days later by
blisters with fluid. Since the virus is same, chil-
dren can get Chicken Pox from adults with Zoster
Give children Measles vaccine and even adults can get Zoster from children with
Vaccines are available for measles. This should chicken pox.
be given to all children around nine months of
age after they lose their natural immunity. If there What to do in Chicken Pox?
is a Measles epidemic, even children who have Chicken pox usually gets well on its own within 10
taken measles vaccine will get the disease. But they days. All that one needs to do is to be alert to the possi-
will not die do as the measles will not be so se- bility of pneumonia. And if pneumonia sets in, quick
vere. The disease of Measles also gives life long treatment must be started (for treating pneumonia see
immunity. Apart from the vaccine given at nine I Phase Manual on “Diseases of Breathing System”).
months of life, Vitamin A also protects from mea- With Chicken Pox, some may get swelling of the brain,
sles. Many governments gives Vitamin A to every but this is rare. To avoid getting chicken pox, it is wise
child below five just before the onset of the mea- to keep away from patients until the skin of that person
sles season around March to May. has healed and the scabs have fallen off.
Note: Many medicines that are taken to reduce fever or to kill germs may also create a rash.
Paracetamol, Aspirin, Cotrimoxazole, Amoxycillin, etc. may give a person a rash on the skin.

7. 20-7
b. Rashes without fever
Common rashes that are seen are:
1.Rashes with medicines 3. Rashes due to fungus
2.Rashes with severe itching 4. Rashes of insect bites
1. Rashes with medicines
It is a rash that has come after taking What to do:
a particular medicine. If the person If some other medicine
is taking too many medicines at the can be taken for the same
same time, it may not be easy to purpose, stop the one
make out which medicine is the causing the rash and give
cause of the rash. But if the rash gets the alternative.
worse every time a new dose is taken
it confirms an allergy to the medi- To reduce the rash – often with some
cine. swelling and lots of itching –
CHLORPHENIRAMINE may be given.
Probably every medicine can cause a skin rash in some If the medicine is important to be given
person or the other. But medicines with Sulpha (as in and has only a few doses left, for exam-
Cotrimoxazole and Sulfadiazine), other germ killers, (as ple Chloroquine in three doses for ma-
Penicillin, Amoxycillin and Chloroquine ) and simple laria, the medicine may be continued
pain killers (like Aspirin and Paracetamol) are com- along with CHLORPHENIRAMINE.
mon culprits for rashes.
2. Rashes with severe itching
Scabies is the most important and most common skin illness
seen in India’s villages. Scabies is caused by a small insect that
grows and lays eggs inside the skin. It makes us itch very badly
especially when our body gets warm in the sun or under a blan- In Scabies, small
ket in winters. itchy bumps appear
all over the body.
What to do in Scabies?
Parts of Body affected by Scabies
After a good scrub bath, dry the body
between completely and apply BHC ( or BB)
the fingers lotion lightly on the entire body be-
on the forearms low the neck.
Leave the application for a day or two
elbows
and then wash it off.
armpit folds Repeat after one week to kill newer
germs that may have hatched from
belt area (waist) the insects’ eggs in the skin.
If one person has scabies, all the fam-
on the scrotum ily members must be treated at the
or penis (of boys) same time.
CHLORPHENIRAMINE may reduce
itching.
If boils with pus can be seen at the
scratch sites, DOXYCYLCINE or
Too much itching and COTRIMOXAZOLE may be given.
scratching may cause boils. To prevent scabies, take regular baths
and do not get close to another per-
son having the disease.

8. 20-8
3. Rashes because of fungus
We can get fungus of the skin. In summers sweat collects at some sites and fungus seeds (called
spores) that may get to the skin through dust or using each other’s clothes, may give rise to fungus
of the skin.
Types of skin fungus
Ring Worms : The commonest variety of skin fungus is the ring worms. The rash appears
as tiny bumps on the skin in a circle. It can be seen as small rings that continue to
grow or spread and may itch. It is commonly found on the groins next to the thigh,
on the neck or the body. The ringworm tends to heal from the centre of the circle
while the circle of bumps keeps increasing in size. The skin in
the area gets dark especially if the person feels very itchy and
scratches on the site.
On Body: On the chest, the fungus often appears as lots of small patches
of white – lighter colour than the normal skin around – that are not
raised and usually do not itch.
On Feet: Fungus between the toes of the feet is commonly seen
amongst army and police personnel who have to keep their feet inside shoes for long
periods of time. Also seen amongst people who have to walk for long distances in
floodwaters, or those housewives whose feet do not get to dry at all, such fungus tends
the skin of the feet to peel off and the heels to crack.
On Nails : Fungus of the nails can be seen along with fungus of the fingers and toes. The
nails get deformed and may also crack. The skin around the nail is swollen up although it
may not pain.
What to do?
Keep the area dry.
Wipe carefully after taking a bath and if possible sprinkle powder on the affected part.
Apply MICONAZOLE cream twice a day.
To remove the fungus totally, the above measures need to be continued for at least one
month.
CHLORPHENIRAMINE may be used for decreasing the itching.
If the problem is very old, the skin has thickened and become very dark,
BETAMETHASONE may also be used.
To keep away from fungus, do not use others’ clothes and linen and do not wear
damp clothes.
4. Rashes of insect bites
The person bitten can make out What to do in rashes of insects?
rashes that are because of insect In case of a sudden swelling due to a wasp bite, apply-
bites. Usually, small bumpy rashes ing vinegar helps reduce the swelling and
happen in places where the insect pain. Baking soda – Bicarb soda – reduces
was unable to enter a belt area or that of a Bee sting ( B for Bee and V for V(W)
the tight edge of a blouse. The area asp!). For most others,
could also pain along with some CHLORPHENIRAMINE by mouth and
swelling. some coconut oil locally will help.

9. 20-9
2. Boils and abscesses
A boil, or abscess, is an infection that forms a sac of pus under the
skin. Boils and abscesses are very common in the summers, mainly
among children. They are caused when different bacteria enter the
skin when we scratch with our nails or injure the skin. Sometimes
the bacteria staying in our nose or mouth may also spread to other
places when we scratch without washing our hands after eating or
after picking our noses. Boils on the skin
are common
Abscess means a big and deep boil. It is better to wait and drain any
pus found lurking inside an abscess to avoid it from occuring again.
Taking care of boils & abscesses
1. Put hot compresses on the boils several times a day.
2. Let the boil burst open by itself. Allow the pus to drain but do not
press or squeeze the boil.
3. If the boil does not burst open even after a few days of hot com-
presses, it may have to be cut open or punctured by a boiled needle. If
possible, advise the person to go to a doctor.
What to do in boils?
Clean the boils with warm water. If possible, put some Neem leaves or the Neem bark in the
water before heating. Turmeric paste with oil may also be used.
• Give DOXYCYCLINE or COTRIMOXAZOLE for seven days. If the boils have burst,
a capsule of Doxycycline may be punctured or opened and the powder applied locally
after cleaning the area.
• For those who get boils very often, GENTAMICIN / CIPROFLOXACIN drops may be put
in the nose thrice a day for seven days along with the above treatment.
3. Skin allergy
We get allergy of the skin because our skin What to do in skin allergy?
reacts with some things it comes in contact Stop the contact with the
with. Creams that we use, lipsticks, hair thing causing allergy. Give
dyes, wearing rubber gloves or chappals CHLORPHENIRAMINE
could cause allergy. Certain skin types also by mouth and apply
develop allergies to plants, flowers or BETAMETHASONE cream to the
metal coated ring or watch. The skin may spot. The skin allergy may decrease.
get a rash at the site of contact and the skin At times, the allergy may continue
may get thick and itch. and lead to Eczema.

10. 20-10
4. Eczema 5. White patches
Eczema is a common skin Many people’s skin
problem. The skin becomes develops white
thick, dark and may ooze patches. Some of
out some watery sub- these are due to
stance. At times due to a fungus infection. In
long term allergy, or due to others, the person
skin infection like Scabies red patches has had burns or
that has not healed, Eczema with blisters skin injuries at the
needs lots of careful han- same spots earlier.
dling. But in most, we do not know the cause.
Avoiding contact with the allergic item or There are some medicines that are available
treating the underlying infection is impor- that may be eaten or applied before sitting in
tant. The area may be cleaned and the sun, but they require close monitoring by
softened by applying warm salt a doctor, so please refer them.
water. BETAMETHASONE
cream may also be applied.
6. Cracked Feet
Cracks on the soles of the Treatment for Cracked feet
feet are very common. It • Footwear should be worn as far as
is usually seen in people possible.
who work barefoot or • Socks could be worn to prevent dust
wear very poor footwear. and dirt getting to it and to keep the
It is usually more in dry feet moist.
and dusty weather. • In painful and acute conditions, the
feet can be immersed in warm water
The cracks sometimes get quite big and for 15 minutes and then some oil
could be painful and could even bleed at (such as coconut or any edible oil)
times. or cream could be applied to it.
This is best
done in the night before sleeping.
7. Leprosy
Any patch on the skin that is lighter than the skin can be leprosy. Ask the person to close
her eyes and say “one” whenever she can feel the touch of a wisp of cotton when you touch
the light area and the area around it randomly. If you find that the person cannot feel the
touch of cotton on the light patches compared to the surrounding areas, such a person
may have leprosy. Please refer to the PHC for free treatment at the earliest. Leprosy is
caused by bacteria and can be completely treated these days.

11. 20-11
Know the Answers
Skin Diseases
a. Please mark whether “right” or “wrong” :
1. Measles is seen as a rash on the face appearing one
day after the fever.
2. Chicken Pox rash is seen along with sore throat.
3. Typhoid fever and its treatment can both cause a skin rash.
4. Measles vaccine can be given to the mother to avoid
the disease in the child.
5. Scabies leads to lots of itching and cn be treated with a BHC
(Gammaxene) lotion.
6. Fungus infections of skin needs long treatment.
b. Please fill in the blanks:
1. Eczema of skin ahs the following signs:
a. ________________________________
b. ________________________________
c. ________________________________
2. The itching and swelling of rashes can be lessened by giving
Tablet __________________ by mouth.
3. We can know leprosy from Ringworm and other skin patches by _________________.
4. Craked feet is caused by _______________, and _______________________.
5. Fungus of feet needs the following treatment:
a. _________________________________
b. _________________________________
c. _________________________________
6. Ringworm is commonly seen in the body at the following sites:
a. _________________________________
b. _________________________________
c. _________________________________

12. 20-12
My Notes