Skin,Hair,Nails
Terms
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- Skin Hair and Nails are considered the _____ system
- Integumentary System
- Three layers of skin
-
Epidermis-thin/tough
Dermis-conctv tiss or collagen
Subcut layer: adipose tissue - Hair is:
- threads of keratin; fine vellus and thicker terminal
- Nails are:
- hard plates of keratin
- Benign Pigmented areas: Freckles
- small flat macules of brown melanin pigment that occur on sun exposed areas
- Benign Pigmented areas: Mole
- (nevus) melanocytes, tan to brown color, flat or raised. Symmetrical small, smooth, even pigment
- Benign Pigmented areas: Mole-Junctional Nevus
- macular only occuring in children and adolescent
- Benign Pigmented areas: Mole-compound Nevi
- macular and papular found in adolescents
- Benign Pigmented areas: Birthmarks
- may be tan to brown in color
- Danger signs of pigmented lesions
-
A-asymmetry
B-border irregular
C-color varia: brwn,blue,red
D-diameter > 6mm
E-elevation and enlargement - Widespread color change: Pallor
- White
- Widespread color change: Erythema
- Red (fever or localized inflammation)
- Widespread color change: cyanosis
- Blue (poor perfusion)
- Widespread color change: Jaundice
- Yellow (bilirubin in blood deposited in eyes and skin)
- If dark skinned, check for color changes in:
- tongue,buccal mucosa,palpebral conjuctiva
- Vitiligo
- White patches
- ecchymosis
-
1: red/blue - 24 hrs
2: blue to purple
3: blue to green
4: yellow
5: brown and disappearing - Palpation Components
-
Temp: use dorsa of hands
Moisture: dry
Texture: smooth and firm
Thickness - Thin shiny skin occurs with:
- arterial insufficiency
- Diaphoresis
- profuse persperation
- If complaint is dehydration, check the ____
- mucous membranes
- 1+ Edema
- mild pitting, slight indentation, no obvious swelling
- 2+ Edema
- moderate pitting, indentation subsides rapidly
- 3+ Edema
- deep pitting, indentation remains for short time, leg looks swollen
- 4+ Edema
- very deep pitting, indent. lasts long time, leg is very swollen
- Annular Lesions
- circular beginning in center and spreading outward (i.e. tinea corporis)
- Confluent Lesions
- Lesions run together e.e. urticaria (hives)
- Discrete Lesions
- lesions remain separate
- Linear Lesions
- scratch, streak, stripe (poison ivy)
- Zosteriform Lesions
- Linear arrangement along nerve route (herpes zoster)
- Primary Skin lesions
- Result from specific cause, devel on prev unaltered skin (macule,papule,nodule,wheal, vescicle,pustule)
- Secondary Skin lesions
- Result from a change in a primary lesion over time, an evolution chnge (crust,scale, fissue,erosion,ulcer,exoriation,scar, lecchenification, keloid)
- List the diseases for which you can be jaundiced
- hepatitis, cirrhosis, sickle-cell disease, transfusion reaction, and hemolytic disease of the newborn
- The skin feels____ if you have hyperthyroidism
- smoother, softer, like velvet
- The skin feels ____ if you have hypothyroidism
- rough,dry,flaky
- If you have edema, hair follicles look
- prominent-"pig skin" orange peel look
- Cherry angiomas
- small, smooth, slightly raised bright red dots on trunk and are benign
- Lesions with blue-green fluorescence indicates:
- fungal infection (i.e. ringworm)
- grouped lesions
- clusters, i.e. vesicles of contact dermatitis
- gyrate lesion
- twiste, coiled, snakelike
- target lesion
- iris, resembles iris of eye, concentric rings of color in the lesions (i.e. erythema multiforme)
- linear lesion
- scratch, streak, line, strip
- polycyclic lesion
- annular lesions grow together, lechen planus, psoriasis
- macule
- soley a color change, flat and circumscribed, of less than >1cm (freckles, flat nevi, pertechiae, measles, scarlet fever
- patch
- macules that are larger than 1 cm (mongolian spot, vitiligo, measles, rash)
- papule
- something you can feel (solid, elevated, less 1cm dia, due to superficial thickening in the epider. mole, lichen planus, molluscum, wart
- plaque
- papules coalesce to form surface elevation wider than 1 cm. psoriasis, lichen planus
- nodule
- solid, elevated, hard or soft, larger than 1cm. may extend deeper into surface than papule: xanthoma, fibroma, intradermal nevi
- tumor
- larger than a few cm in diam, firm or soft, deeper into dermis; may be benign
- wheal
- superficial, raised, transient and red, with swelling: mosquito bite, allergic reaction, dermographism
- urticaria
- hives
- vesicle
- elev. cavity containing free fluid, up to 1 cm. clear serum flows if wall is ruptured: herpes, chicken pox, shingles,
- bulla
- >1cm usually single chambered, thin walled, friction blister, burns
- cyst
- encapsulated fluid filled cavity in dermis or subq layer, tensley elevat skin; sebaceous cyst, wen
- pustule
- turbid fluid (pus): impetigo, acne
- crust
- scab
- scale
- flakes (laminated sheets, silver, micalike, yellow, greasy, large adherent
- fissure
- linear crack with abrupt edges, dry or moist, (at corners of mouth
- erosion
- scooped out but shallow depression, heals with scar
- ulcer
- deeper depression extending into dermis, irregular shape, may bleed, stasis ulcer, pressure sore
- scar
- normal tissue replaced woth connective tissue
- lichenification
- prolonged intense scratching eventually thickens the skin and produces tightly packed sets of papules, looks like surface of moss
- excoriation
- self inflicted abrasion from scratching
- atrophic scar
- loss of tissue from injury
- keloid
- hypertrophic scar, elevated skin level; prevalent in blacks
- hemoangioma
- benign proliferation of blood vessels in the dermis
- port-wine stain
- large, flat macular patch cov ering the scalp, face or along cranial nerve--does not fade
- strawberry mark: immature hemoangioma
- raised bright red with well defined borders; does not blanch with pressure, ususally disappears by 5-7y/o.
- cavernous hemangioma
- spongy mass of blood vessels, enlarging during first 10-15 months
- telangiectases
- vascular dilatation; permanently enlarged and dilated blood vessels that are visible on the skin surface
- spider/star angioma
- capillary radiations with a pressure point that will blanch it's legs
- venous lake
- blue-purple dilatation of venules and capillaries in a star shape, linear. pressure causes them to empty or disappear
- Purpuric lesions
- blood flowing out of breaks in the vessels, rbc's and blood pigments are deposited in the tissues
- petechiae
- tiny punctate hemorrhages, discrete, dark red or purplle and will NOT blanch; bacterial infections show in mucous membranes
- purpura
- extensive patch of petechiae and ecchymoses, flat macular hemorrhage. seen in thrombocytopenia, scurvy, old needle trauma
- basal cell carcinoma
- usually starts with skin-colored papule with a translucent top and overlying teangiecta; looks like large open pore with central yellowing
- squamous cell carcinoma
- erythematous scaly patch with sharp margins, 1 cm or more. develops central ulcer and surrounding erythema; less common than basal cell and grows rapidly
- malignant melanoma
- arise from preexisting nevi, usually brown, may have scaling, flaking, oozing texture, soles feet and nails of blacks
- epidemic kaposi's sarcoma: Patch stage
- faint pink on temple and beard area, could be mistaken for bruis
- epidemic kaposi's sarcoma: advanced disease
- disseminated lesions involving skin, visceral organs, violet colored tumors over nose and face
- epidemic kaposi's sarcoma: plaque stage
- raised papules or thickened plaques; oval shaped and vary in color, red to brown
- smallpox
- viral infex, flu-like symptoms, malaise, fever, HA, vomitting, then a maculopapular rash appears, first in mouth face, arms trunk; no tx, 30-40% mortality rate
- anthrax
- bascillus anthracis, red, raised pruritic papule, round ulcer w/ vescles falls off, painless (within few weeks)
- alopecia
- balding due to aging, illness, drugs, endocrine disorders, trauma, dermatitis, heredity
- hirsutism
- excess body hair in females forming a male hair distrib due to endocrine or metaboloci dysf.
- folliculits
- superficial infex of hair follicle, pustules, whiteheads
- furuncle (boil)
- acute localized infex of hair follicle, bacterial (staph a), swollen hard pus filled
- abscesses
- traumatic introduc of bacteria into skin (deeper than faruncles)
- clubbing
- rounded nails
- onycholysis
- loosening of nail plate with separation from bed; candida, pseudonom infx, hyperthyroidism
- subungual hematoma
- bruise under nail
- beau's lines
- transverse depression of lunula; affects all nails, assoc with coronary occlusion, hypercalcemia and skin disease
- paronychia
- inflammation of paronychium; may produce rippling of nails
- Conditions of skin in aging adult
-
senile lentigines (liver spots);
seborrheic keratosis, dark greasy and look stuck on ;
actinic keratosis, red tan scaly plaques, become raised - Conditions of Hair in aging adult
- postmenopausal women: facial hair
- Condition of Nails
- brittle, thickend yellow