The skin is composed of layers of tissue. Appendages of the skin include the hair and glands.

The skin consists of two layers and a sublayer, the hypodermis or subcutaneous tissue:

Hair changes markedly during the stages of development.

The main glands of the skin are:

A drop of 20% KOH is added to skin scrapings to dissolve debris before the scrapings are placed on a slide. When the slide is heated, the skin cells dissolve, leaving fungal elements visible on microscopic examination.

In a shave biopsy, the protruding portion of the growth is excised at skin level and the specimen is sent for microscopic examination.

In a punch biopsy, the skin surrounding the lesion is pulled taut, and the punch is introduced firmly into the lesion. The punch is then rotated to obtain a tissue specimen, or plug. The plug is lifted with forceps or a needle and the surgeon severs as deeply as possible into the fat layer. The wound is then sutured closed.

In an excisional biopsy, a scalpel is used to excise the lesion completely.

After the procedure:

Explain the procedure to the parents and the child. Tell the child what to expect, including discomfort he may experience, and suggest coping strategies such as distraction techniques.

Explain the procedure to the parents and the child and prepare the child for discomfort he may experience. Make sure to prepare the child (and the parents) for the appearance of the treated area after laser surgery because it will probably look much worse than it does before treatment (some laser treatments leave skin raw and oozing). Reassure the child that this is normal and the area will heal quickly.

The area from which the skin is removed is referred to as the donor site. For donor areas in which appearance or joint movement is important, the graft is transplanted intact. In flat areas where appearance is less critical, the graft may be meshed (fenestrated) to cover up to three times its original size. It’s then placed on what’s known as the recipient site.

Skin from the patient’s own healthy skin (autograft) may be used. If an autograft isn’t available, a homograft (cadaver skin) or xenograft (pigskin) may be surgically attached.

The skin graft may be a split-thickness graft (involving the epidermis and superficial dermis) or a full-thickness graft (involving the epidermis and all layers of dermis). To be successful, grafts must have a sufficient blood supply, have contact with the recipient area, be free from infection and mechanical trauma, and have minimal bleeding or fluid accumulation.

After grafting, follow these steps:

Acne is the most prevalent pediatric skin condition especially among adolescents and is typically observed on the face, chest, upper arms and back, and neck, where a large number of sebaceous glands are located. It appears predominantly during middle to late adolescence often paralleling puberty and with a peak incidence at ages 16 to 17 in girls and ages 17 to 18 in boys. It’s a common skin problem in all ethnic populations and affects males more severely than females. Neonatal acne takes approximately 1 month to resolve spontaneously.

Even though acne is self-limiting, the psychosocial impact and significance of acne on the quality of life of adolescents can have a negative effect on their self-esteem.

Continued accumulation of follicular contents results in perforation of the follicular wall; the contents leak into surrounding tissue and cause an inflammatory reaction and the characteristic skin lesions of acne.

Inspection reveals acne lesions, most commonly on the face, neck, shoulders, chest, and upper back. The area around the infected follicle may appear red and swollen. The rupture or leakage of an enlarged plug into the dermis produces inflammation and characteristic acne pustules, papules, or, in severe forms, acne cysts or abscesses. If the patient has previously picked or squeezed the lesions, scars may be visible.