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Skin Hair and Nails are considered the _____ system
Integumentary System
Three layers of skin
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
B-border irregular
C-color varia: brwn,blue,red
D-diameter > 6mm
E-elevation and enlargement
Widespread color change: Pallor
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
White patches
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
Thin shiny skin occurs with:
arterial insufficiency
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
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
soley a color change, flat and circumscribed, of less than >1cm (freckles, flat nevi, pertechiae, measles, scarlet fever
macules that are larger than 1 cm (mongolian spot, vitiligo, measles, rash)
something you can feel (solid, elevated, less 1cm dia, due to superficial thickening in the epider. mole, lichen planus, molluscum, wart
papules coalesce to form surface elevation wider than 1 cm. psoriasis, lichen planus
solid, elevated, hard or soft, larger than 1cm. may extend deeper into surface than papule: xanthoma, fibroma, intradermal nevi
larger than a few cm in diam, firm or soft, deeper into dermis; may be benign
superficial, raised, transient and red, with swelling: mosquito bite, allergic reaction, dermographism
elev. cavity containing free fluid, up to 1 cm. clear serum flows if wall is ruptured: herpes, chicken pox, shingles,
>1cm usually single chambered, thin walled, friction blister, burns
encapsulated fluid filled cavity in dermis or subq layer, tensley elevat skin; sebaceous cyst, wen
turbid fluid (pus): impetigo, acne
flakes (laminated sheets, silver, micalike, yellow, greasy, large adherent
linear crack with abrupt edges, dry or moist, (at corners of mouth
scooped out but shallow depression, heals with scar
deeper depression extending into dermis, irregular shape, may bleed, stasis ulcer, pressure sore
normal tissue replaced woth connective tissue
prolonged intense scratching eventually thickens the skin and produces tightly packed sets of papules, looks like surface of moss
self inflicted abrasion from scratching
atrophic scar
loss of tissue from injury
hypertrophic scar, elevated skin level; prevalent in blacks
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
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
tiny punctate hemorrhages, discrete, dark red or purplle and will NOT blanch; bacterial infections show in mucous membranes
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
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
bascillus anthracis, red, raised pruritic papule, round ulcer w/ vescles falls off, painless (within few weeks)
balding due to aging, illness, drugs, endocrine disorders, trauma, dermatitis, heredity
excess body hair in females forming a male hair distrib due to endocrine or metaboloci dysf.
superficial infex of hair follicle, pustules, whiteheads
furuncle (boil)
acute localized infex of hair follicle, bacterial (staph a), swollen hard pus filled
traumatic introduc of bacteria into skin (deeper than faruncles)
rounded nails
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
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

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