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MODULE 5:
Integumentary System
PART 6 OF 7
Repeatedly noted: minor wounds slow to heal, especially during flares; one biopsy site took weeks. Attributed to “age” and “maybe diabetes” (HbA1c normal).
Slide 1 Transcript
PATIENT CHART
STINA
Grad student · recurrent fevers, pain & swelling since childhood
THIS PART
Ages 3-35
PRESENTING WITH
Variable skinThe body’s largest organ, providing protection and regulation. conditions
ACTION TAKEN
Dermatological evaluation
DIAGNOSIS
Sweet Syndrome
CHART CLUES
COLLECTED AS YOU GO
Post-Streptococcal Guttate Psoriasis
Concurrent Eczema + Sterile Pustulosis
Sweet Syndrome — Acute Febrile Neutrophilic Dermatosis
Inflammatory Cutaneous Vasculopathy
Two Opposite-Looking Dermatoses
?
?
Put your money down: Her labs are normal — so why won’t her wounds close?
A nurse joked that Stina healed ‘in dog years’ — a nick or biopsy site would sit open for weeks, always worst during flares — and with a normal HbA1c she was told it was just age. Two quick fact-checks on how wounds heal; then the ask: is her slow healing about age or sugar — or about the same inflammation driving her rashes?
Pick the answer you believe now. We’ll come back to it later!
Healing in Dog Years
A nurse once joked that Stina healed “in dog years,” and the joke stuck because it was true. A shaving nick, a scraped shin, the site of that one skin biopsy — during a flare they would sit open, red, and angry for weeks longer than they should. Her HbA1c came back normal, so diabetes was ruled out, and “you’re just getting older” became the closing line. But she had been healing slowly since her twenties, and it was always worst exactly when her inflammation was loudest — a correlation nobody wrote down.
The Wound-Healing Orchestra
Three overlapping phases, precisely timed — each must hand off to the next.
Slide 2 Transcript
Cash out the clip
Single Choice: What is true of the phases of wound healing?
Phase 1 — Inflammatory (Days 0–3)
Stop the bleeding, then clear the debris — and it is supposed to be brief.
Slide 3 Transcript
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Drag the Words: Drop the events of the inflammatory phase into place.
Four Phases, Each Handing Off
Wound healing runs in four ordered phases, and each must hand off cleanly to the next: hemostasis stops the bleeding, inflammation clears debris and microbes, proliferation rebuilds tissue, and remodeling matures the new collagenA structural protein in the dermis that provides strength and elasticity. into a strong scar. The inflammatory phase is meant to be brief — a quick cleanup crew that then stands down so the builders can move in. Once it quiets, fibroblasts take over as the workhorses of the proliferation phase, laying down the fresh collagen that closes and strengthens the wound. The whole system depends on that timely “all-clear” signal telling inflammation to stop and construction to start.
Phase 2 — Proliferative (Days 4–21)
Rebuild the tissue and resurface the wound — the fibroblast’s collagen phase.
Slide 4 Transcript
Cash out the clip
Fill in the Blanks: Fill in what the proliferative phase The phase when the endometrium rebuilds after menstruation. builds, and which cell leads it.
Phase 3 — Remodeling (Day 21 – 2 yrs)
Strengthen the collagen and mature the scar.
Slide 5 Transcript
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Mark the Words: Mark what happens during remodeling.
A Repair Crew Stuck Waiting for the All-Clear
In Stina, that all-clear never quite comes. Chronically high IL-1β and IL-6 hold the process in the inflammatory phase and suppress fibroblast activity, so the wound sits waiting for a “build now” signal that keeps getting postponed. The very cytokines that drive her rashes are the ones stalling her repair — the same fire, sabotaging the fire department. Her slow healing was never about age or hidden sugar; it was a repair crew standing around a half-cleared site, waiting for an all-clear that her own inflammation refuses to give.
Chronic Wounds & the Whole Sequence
When healing stalls — and the three phases in review.
Slide 6 Transcript
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Multiple Choice: Why does a wound become chronic when the inflammatory phase won’t end?
FINDING!
Impaired Wound Healing During Flares
Concrete, repeatedly charted sign: minor wounds heal slowly, especially during flares — one biopsy site took weeks — with a normal HbA1c ruling out diabetes, and ‘age’ offered as the closing line. Healing runs in ordered phases (hemostasis, inflammation, proliferation, remodeling), and the inflammatory phase is meant to be brief. In Stina, chronically high IL-1β and IL-6 jam the process in that inflammatory phase and suppress fibroblasts, so the wound never gets the ‘build now’ signal on time. Chart entry: flare-associated impaired healing from a stalled inflammatory phase — not age, not sugar.
Confirm or refute your bet: Her labs are normal — so why won’t her wounds close?
Having walked the ordered phases — hemostasis, inflammation, proliferation, remodeling — return to the bet. The inflammatory phase is meant to be brief, but chronically high IL-1β and IL-6 jam the process there and suppress fibroblasts, so the wound never gets the ‘build now’ signal on time.
Slide 7 Transcript
NEXT PART
Six skin stories — psoriasis, eczema, a fever rash, mottled legs, a contradictory belt, stalled wounds — and six separate diagnoses. Step back, line them up, and a single sentence ties them together. That sentence is Chart Clue #5.
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← Familial Mediterranean Fever — case home
All pages for Module 5 — The Integumentary System
5.0 Module Overview
5.1 The Rash Nobody Noticed
5.2 The Barrier Breaking Down
5.3 The Fever Rash
5.4 Red Feet & Mottled Shins
5.5 The Epidermal Conveyor Belt
5.6 Wounds That Won’t Heal
5.7 Inside the Skin’s Inflammation
5.8 Conclusion and Assessment
5.9 The evidence behind Stina’s skin
All Modules
- Anatomical Language, Membranes & Homeostasis
- Just Enough Chemistry
- The Cell & Its Transport
- Making Cells & Proteins
- The Integumentary System
- The Skeletal System
- The Muscular System
- Nervous Tissue & the Senses
- The Spinal Cord
- The Brain & the Blood–Brain Barrier
- The Autonomic Nervous System
- Special Senses (in developmentThe process of growth and differentiation.)
- The Endocrine System
- Blood
- The Heart
- Blood Vessels
- The Digestive System
- The Respiratory System
- The Urinary System
- Fluids, Electrolytes & Acid–Base Balance
- The Reproductive System
- The Immune System
List of terms
- skin
- collagen
- proliferative phase
- development