Most people take their skin for granted, but skin is a lot more than just a bag to put your body in. It has a life of its own, so to speak. It has its own chores--or functions--and it serves to put you on notice about what is happening inside.

In fact, skin is the largest organ of the human body. A typical adult has about 17 square feet of skin! Despite being so thin, your skin manages to protect the inside of your body, providing a barrier to invasion by unwanted or dangerous elements like bacteria. Because it plays this important protective role, any injury to the skin--a bruise, cut, abrasion, or burn--must be taken seriously.

The minor cuts and skin abrasions that are common in childcare usually require only appropriate first aid. The skin has an absolutely amazing ability to heal itself very quickly.

Abrasions that are deep enough to damage the skin and draw blood should be washed well with warm running water. Soap also may be used to assist in removing dirt. A simple bandage should then be applied. Minimal abrasions require no bandage. While often quite painful, abrasions are rarely serious.

More serious cuts and abrasions may require additional action. The most urgent concern with deeper cuts is to stop the bleeding. Place a sterile gauze pad over the cut, and apply direct pressure for several minutes until the bleeding stops. Once the bleeding stops, wash the cut with large amounts of running water. Warm soapy water may be used if the cut appears to be dirty, but generally plain tap water does very well. Place a sterile dressing over the wound.

If a cut does not stop bleeding within about five minutes, medical advice should be sought immediately. Also, if the wound is long or deep, or if the edges gape and will not come together with direct pressure, medical treatment may be necessary.

Puncture wounds are probably the most readily infected type of skin injury because there is usually relatively little bleeding and bleeding helps cleanse a wound. It also is difficult to irrigate puncture wounds satisfactorily.

The classic, and mildest, type of puncture wound is a splinter. Do not attempt to remove the splinter with a needle or other invasive tool. This can be painful and can introduce more germs into the wound. Use clean tweezers and carefully extract the splinter from the same path through which it entered. If the splinter is not projecting and cannot be removed easily, then medical attention should be sought.

A more serious puncture wound might be from an object such as a stick or knife. If the puncturing object is still in the wound, do not try to remove it; call for emergency medical assistance.

Various types of injuries from heat, chemicals, and pressure can cause blisters. In blisters, the top layers of skin are elevated by the presence of a fluid produced by the body to protect the delicate tissue beneath. Generally speaking, intact blisters contain sterile fluid and should not be broken. There is a risk of introducing of infection through the opening into the blister. A collapsed blister can also be quite painful. Cover blisters, unbroken or broken, with gauze pads.

Infection of the skin by any cause is a serious health threat. The “four cardinal signs of infection” are redness, swelling, warmth, and pain. The redness and warmth are partially from the swollen capillaries of the skin and partially from swelling and pain from the increased body fluids fighting infection. A skin injury should steadily improve in the days after it was suffered. If it does not improve, or if you notice any or all of the signs of infection, then parents should seek medical treatment for the child.

Impetigo, a highly contagious infection of the skin, may cause a scab or blister (often filled with pus). Be sure that the infected area is well covered with a generous bandage (preferably with antibiotic ointment if authorized). Impetigo requires antibiotic treatment, and medical treatment should be sought.

The skin shows evidence of injury to the tissue beneath it by producing a purplish bruise. Bruises (contusions) occur when blood has escaped from damaged capillaries into surrounding tissue. Superficial bruises are obvious because they appear soon after the injury, marking the skin, with obvious discoloration. However, deeper bruises may not become apparent until the blood in the tissues has spread toward the skin’s surface, a process that may take several days. For example, when a child has been hit in the forehead, a “goose egg” may appear immediately; but discoloration may not appear until a few days later as the blood migrates downward.

Bruises usually go through color changes as they age, from reddish purple to brownish purple to yellow. The age of a bruise can only be approximately guessed by the color of the skin. It is important to be aware of the presence of bruises and to record them on the child’s record. Certain patterns of bruises are very suggestive of violence, perhaps even child abuse.

All stings and bites can be painful, although they rarely cause serious harm. In all cases, the parent should be notified as soon as possible.

When honeybees sting, the barbs in their stingers act like fish hooks. When the bee flies off, the venom sac is pulled from the bee’s body and may be left on the skin. If this is the case, scrape the venom sac off with the edge of a plastic knife or a plastic spoon. Do not press or squeeze the sac in the process, as it will discharge more venom into the child. Other related insects--wasps, hornets, and yellow jackets--do not leave their stingers embedded.

For all sting injuries, apply a cold compress to relieve discomfort. Watch for the rare but significant signs of a dangerous allergic reaction to insect stings or bites, such as fainting or trouble breathing. Call 911 immediately if this occurs. An itchy rash--hives--and/or nausea also may occur. In either case, call your medical advisor or health consultant.

Spider bites can produce local pain and swelling. Apply cold compresses. Be especially alert for a steadily growing area of brown or yellow discoloration in the skin around the bite. Only a fraction of spiders are poisonous, but their bites can cause serious tissue damage and the spreading discoloration is the first and most recognizable sign. Call your health consultant; if possible, describe the appearance of the spider.

Ticks attached to the skin need to be removed promptly. Grasp the tick with tweezers and slowly pull. Wash the area thoroughly with soap and water.

Animal and human bites require flushing with a lot of warm soapy water if the skin is broken. Remember the increased danger of infection in puncture-type bite wounds--medical advice is recommended.

Donald Palmer, MD
Alabama Chapter, American Academy of Pediatrics

Healthy Life Self Care, healthcenter.ucdavis.edu/selfcare/skin.htm

Florida International University, www.fiu.edu/~health/clinicalservices/selfcare_guide/skin_injuries.htm

San Diego Children’s Hospital, www.chsd.org/1722.cfm