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Authors: Claire Jordan Wiggins, Riyad N.H. Seervai, Medical Students, Baylor College of Medicine, Houston, Texas, USA. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. June 2020.
Coma describes prolonged unconsciousness when the patient does not move or respond to a painful stimulus, light, or sound. Causes of coma include head injury, stroke, brain tumour, drugs, alcohol, diabetes, and infection.
Examination of the skin of a comatose patient provides information about the cause of coma and the effects of the coma on the body, including skin colour and temperature, coma blisters, and pressure ulcers.
Colour changes in the skin may reveal a potential cause of the coma.
Colourful skin changes and associated swelling provide important clues for cellulitis, venous stasis, or deep vein thrombosis, for example .
Fluctuations in skin temperature may reflect the depth of a coma.
Traditionally associated with barbiturate overdose, coma blisters present as dusky bullae. They are thought to be caused by hypotension-associated necrosis. Coma blisters appear within 48–72 hours of the onset of coma and typically self-resolve after several weeks. Sweat gland necrosis may be noted on histopathology .
Bedbound hospitalised patients are at risk for pressure ulcers, especially patients who cannot communicate or who lose sensation. Prevention of pressure ulcer includes limiting pressure, friction, and shear, while managing comorbid conditions that may interfere with wound healing, such as diabetes .
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