Integumentary System Health Assessment

annular

circular ring-like arrangement

confluent

joining or running together

discrete

separate lesions

grouped

clustered together

gyrate

rings or convolutions

polycyclic

formed from circles

macule

<1 cm, flat, nonpalpable, circumscribed, discolored

patch

>1 cm, flat, nonpalpable, irregular shape, discolored

papule

<1 cm, raised, palpable, firm

nodule

>1 cm, raised, solid

plaque

large flatter elevation of skin, can be formed by papules coalescing

vesicle

<1 cm, circumscribed elevation of epidermis containing clear fluid

bulla

>1 cm, circumscribed elevation of the epidermis containing clear fluid

pustule

small circumscribed elevation of the epidermis filled with purulent fluid

wheal (hives/urticaria)

raised lesion consisting of dermal edema

scale

irregular formation of exfoliated, keratinized cells, irregular shape and size

crust

dried serum, blood or exudate, slightly elevated

lichenification

thickened epidermis with accentuated skin lines caused by rubbing

scar

thin or thick fibrous tissue, following dermal injury (burn)

fissure

linear break in skin through epidermis and dermis

excoritation

hollowed-out area of all or portion of epidermis with depressed appearance (eczema)

erosion

localized loss of epidermis, heals without scarring (herpes)

ulcer

loss of epidermis and dermis, variations in size (decubitus)

atrophy

depression resulting from loss of epidermis and/or dermis (striae)

burrow

narrow, elevated channel produced by a parasite (scabies)

telangiectasia

superficial dilated blood vessel (rosacea)

petechiae

<1 cm circumscribed deposit of blood, deep red or reddish purple, variable shape that fades over time, non-blanchable

purpura

>1 cm circumscribed deposit of blood, deep red or reddish purple, variable shape, fades over time, non-blanchable

ecchymosis

>3 mm variable size, larger than petechiae, purple or purplish blue, fading to green, yellow and brown with time. Non-blanchable

spider angioma

central body sometimes raised, surrounded by erythema and radiating legs, most common on the face and chest. Seen in pregnancy and liver disease

spider vein

varying size and shape, bluish color; most common on the legs near veins and anterior chest

cherry angioma

1-3mm, bright or ruby red, may turn purple with age. Common on trunk and extremities

list the primary lesions

macule, patch, papule, nodule, plaque, pustule, vesicle, bulla, wheal

list the secondary lesions

scale, crust, lichenification, scar, fissure, excoriation, erosion, ulcer, atrophy

what are the vascular skin lesion

spider angioma, spider vein, cherry angioma

define epidermis

outermost, avascular layer of the skin composed of 4-5 layers

define dermis

composed of a thin upper layer, the papillary dermis, and a thicker lower layer, the reticular dermis

what is the subcutaneous layer

layer of connective tissue and fat that binds the dermis to underlying tissue

what provides the first line of defense for the body

the skin

what is the hair shaft composed of

dead protein

what are the two types of sweat glands

eccrine glands and apocrine glands

what do the eccrine glands do

regulate body temp through water secretion and evaporation

what controls the eccrine sweat glands

hypothalamus

What do apocrine glands do?

release clear and odorless secretions under cholinergic and hormonal control

Where are apocrine glands found?

places that have hair- scalp, axillary, groin

list the functions of the skin

prevent fluid loss

provide a barrier to invading organisms

relaying sensations

regulate body temp

synthesize vitamin D

excrete sweat, urea, and lactic acid

what are the primary papulosquamous disorders

pityriasis rosea, lichen planus, seborrheic keratosis

what are the secondary papulosquamous disorders

seborrhea, psoriasis

wha do papulosquamous disorders consist of

papules or plaques with scales

what is the first sign of a pityriasis rosea rash

herald patch (usually on the trunk)

the distribution of pityriasis rosea follows what type of arrangement

christmas tree

what papulosquamous disorder is shown in this picture

Pityriasis rosea (herald patch)

this rash is periodic, lacy, with purple papules or plaques that is common during winter months. It occurs when the immune system attacks the cells of the skin

lichen planus

what rash is shown

lichen planus

what is seborrheic keratosis

an asymptomatic flat, light tan lesion that can become raised with increased pigment and karotic surface

describe psoriasis

plaques present in the epidermis, scales shed easily, common on the knees, elbows, and buttocks

what is seborrheic dematitis

Dry or oily scales common on the head. flakes easily

what is vitiligo

macular, flat. Progressive loss of pigmentation

what is tinea versicolor (pityriasis versicolor)

scaly patches of hyper or hypopigmented skin, accompanied by itching

what is xanthoma

flesh to yellow-colored asymptomatic plaques around eyes/eyelids or extensor surfaces of knees and elbows

xanthoma is indicative of abnormal ____ _____

lipid metabolism

what are café au lait spots

tan to brown asymptomatic macular lesions that vary in appearance and size from increased melanin

what is café au lait spots associated with

developmental and congenital conditions- neurofibromatosis

what is acanthosis nigricans

hyperpigmented area usually in the axillae, neck and groin areas. Macular lesions with velvety texture

what is acanthosis nigricans associated with

insulin resistance (evaluate for diabetes)

what is the most common symptom associated with dermatitis

pruritus

people with atopic dermatitis (eczema) have a hx of ____ or chronic ____

asthma/allergies

describe the presentation of atopic dermatitis

recurrent, itchy rash and erythematous scaly patches and flax

on flexor surfaces of extremities, neck, and face

what labs are elevated in pts with atopic dermatitis

eosinophil or serum IGE

varicose veins results in this

stasis dermatitis

this rash has a red base with satellite pastels when left in contact with feces or urine

diaper dermatitis

this is known as cradle cap

seborrheic dermatitis

list the physical exam findings of seborrheic dermatitis

greasy scales, macules, papules, and patches

list the vesiculobullous disorders

impetigo, herpes simplex, varicella, herpes zoster, erythema multiforme, dyshidrosis

describe the presentation of impetigo

erythematous papules that have honey-colored crust. Highly contagious, caused by staph

describe presentation of herpes simplex

cluster of multiple vesicles - painful erosion of the vesicle with ulcer formation

what is the hallmark of varicella

lesions present and in all stages simultaneously

list the stages of varicella

red papule --> vesicle --> pustule --> ulceration --> crusted lesion

what two disorders are caused by the varicella zoster virus

herpes zoster (shingles)

varicella (chicken pox)

what is the hallmark for shingles

presents along a dermatome and is usually unilateral

herpes zoster

viral disease affecting the peripheral nerves, characterized by painful blisters that spread over the skin following the affected nerves, usually unilateral; also known as shingles

describe the presentation of erythema multiforme minor

flat, reddened macules and/or plaques. Lesions may have a target appearance or the bull's-shaped lesions with 3 zones of color

what can the erythema multiforme minor lesions progress to

vesicles or bulla

what causes erythema multiforme minor

herpes virus

what causes erythema multiforme major

infection like herpes virus or mycoplasma

or response to medicine

what lab changes might you see in a patient with erythema multiforme

decreased WBC and RBC

Increased sed rate, BUN and creatinine

what is dyshidrosis

vesicular disorder that typically affects the hands and feet

what is dyshidrosis associated with

excessive moisture or sweating of the hands/feet

small vesicles that itch and burn which crust over

list the inflammatory disorders

acne vulgaris, rosacea, cellulitis, boil/abscess, folliculitis

what are the 4 components of rosacea

facial flushing, papules or pustules, rhinophyma, dry eyes

how can rosacea be differentiated from acne

no comdeones present

what usually causes boils or abscesses

staphylococcal infections of hair follicles or sebaceous glands

what typically causes cellulitis

staph or strep infections

what is folliculitis

inflammation of hair follicles, typically associated with staph

list the types of hyperplasia disorders

verruca (warts), corns & calluses, molluscum, skin tag, epidermal inclusion cyst

what is the difference between a corn and a callus

callus is thick skin with indistinct borders, painless

corn has distinct borders and is painful

true/false: molluscum is contagious

true

describe molluscum

white or flesh-colored firm dome-shaped papule with a small dimple center

describe epidermal inclusion cysts

lesions with a cheesy discharge and a foul odor

nodular and firm

subcutaneous lesions and tender

what is tinea pedis

fungal infection on the soles of the feet and webs of the toes. scaly rash with maceration