skin and nails

skin function

• protection

• sensation

• thermoregulation

• Vit D synthesis

• excretion

• absorption

skin as a protector

barrier against pathogens, chemicals and physical trauma

skin used for sensation

contains nerve endings for temp, touch, pain and pressure

skin as a thermoregulator

maintains body temp via sweat glands and blood flow

skin as a Vit D synthesizer

initiates production when exposed to UV light

skin in terms of excretion

removes waste through sweat

skin as an absorber

can absorb certain drugs and substances

what is skin turgor

• the elasticity of the skin

• indicator for hydration

how to assess turgor

• pinch skin on hand and watch it go back to normal

• should be back within 3 seconds

what does poor turgor look like

skin is tented → suggests dehydration or age related loss of elasticity

melanoma signs and symptoms

• new or existing mole

• irregular borders

• varied colors

• asymmetry

• skin may itch, bleed or develop crust

who’s at high risk for melanoma

• fair skin

• excessive sun exposure

• family history

• lots of moles

ABCDE rule

• A - asymmetry

• B - border

• C - color

• D - diameter

• E - elevation/enlargement

skin conditions

• cellulitis

• eczematous dermatitis

• folliculitis

• furuncle (boil)

• herpes zoster

• psoriasis

• rosacea

• tinea

eczema

• most common inflammatory skin disorder

• irritant contact → come into contact with irritant

• allergic contact → allergic to something

• atopic dermatitis → eczema related to congenital inflammatory process in body

folliculitis

inflammation and infection of hair follicle + surrounding dermis

furuncle (boil)

deep seated infection of sebaceous gland

cellulitis

acute infection of skin + subcutaneous tissue → usually localized

tinea (dermatophytosis)

group of noncandidal fungal infections

psoriasis

• chronic and recurrent disease

• hard, dry layers of skin

rosacea

• chronic inflammatory skin disorder

• skin looks pink

herpes zoster

• varicella zoster viral infection

• comes from dormant chicken pox

lesion types

• bulla

• cyst

• fissure

• macule

• nodule

• papule

• plaque

• pustule

• ulcer

• vesicle

• wheal

bulla

fluid filled vesicle (blister)

cyst

• elevated

• filled with fluid/semisolid fluid

macule

• flat - maybe brown, red, white or tan

• under 1cm

• freckle

nodule

• elevated, firm

• bigger than 5mm in diameter

• can involve all skin layers

papule

• elevated bump, from excess oil and skin clogging a pore

• under 1 cm

• wart

plaque

• elevated, flat topped, firm, rough patch

• over 1 cm

• psoriasis

pustule

• pull filled, elevated and filled with pus (similar to vesicle)

• acne

vesicle

• fluid filled blister, elevated, superficial

• under 1 cm

• herpes simplex (cluster of fluid filled blisters)

ucler

loss of epidermis/dermis

wheal

• elevated, irregularly shaped area of cutaneous edema

• can be solid, transient and changeable

• red, pink, white (hives)

nail clubbing

when nail base is over 180 degrees and has a spongy nail bed

cause of nail clubbing

• chronic hypoxia

• seen in lung cancer, COPD, CF, CAD

nail conditions

• beau’s lines

• clubbing

• ingrown nails

• koilonychia

• nail avulsion

• onycholysis

• paronychia

• subungal hematoma

beau’s lines

horizontal grooves caused by stress, illness or trauma

ingrown nails

nail grows into dermis

koionychia (spoon nails)

• concave shape (going in)

• linked to iron deficiency anemia

nail avulsion

part of all nail bed torn away from nail bed

onycholysis

• separating of nail from nail bed

• caused by trauma or fungal infection

onychomycosis

• yellow thick nails

• from fungal infection

paronychia

• inflammation of nail fold

• bacterial or fungal

subungual hematoma

trauma to nail plate, bad enough, to cause bleeding and pain

capillary refill assessment

• press down on nail bed until it blanches

• release and observe color return

• normal = under 2 sec

• delayed = over 2 sec → poor perfusion or shock

hair conditions

• alopecia areata - sudden coin shapes hair loss

• scarring alopecia - scar replaces hair follicles

• traction alopecia - hair loss from tight hairstyles

• hirsutism - excess body hair in a male pattern