Dermatology and Wound Care
Core concepts
Know the classification and staging of wounds (Wagner, Texas, and NPUAP pressure injury staging) and the principles of wound bed preparation: debridement, moisture balance, infection control, and offloading. Understand the difference between arterial, venous, and neuropathic ulcers by location, appearance, and associated findings. Familiarize yourself with common dermatologic conditions of the foot-tinea pedis, onychomycosis, plantar warts, psoriasis, and contact dermatitis-and their distinguishing features. Know the signs of wound infection (erythema, warmth, purulence, odor, systemic signs) and when to culture versus when to treat empirically.
Traps in questions
A common trap is misidentifying a neuropathic ulcer (plantar, pressure points, callused) as ischemic (distal, painful, punched-out). Another is failing to recognize that a plantar wart disrupts skin lines while a callus does not. Know that systemic antibiotics are not indicated for uninfected ulcers, and that offloading is as important as antibiotics in the diabetic foot.
Rule of thumb
For any diabetic foot ulcer, address pressure (offload), perfusion (assess vascular status), and infection (debride and culture if infected) in that order.
Worked example
A plantar ulcer over the first metatarsal head in a neuropathic patient with a callused rim is a neuropathic ulcer. Treatment is offloading and debridement, not antibiotics unless infection is present.