Assessment of the skin, hair, and nails

two layers of skin

epidermis and dermis

what is below the dermis

subcutaneous layer

what layer of the epidermis forms new skin cells

stratum basale or basal cell layer

what is the major ingredient of new skin cells

keratin

what is dispersed in the stratum basal

melanocytes

what do melanocytes give rise to

melanin

what does melanin do

gives brown tones to the skin and hair

where do new cells migrate up and flatten to from the basal layer

stratum corneum/ horny cell layer

what is in the stratum corneum

dead keratinized cells that are interwoven

is the epidermis vascular or avascular

avascular

what three things determine skin color

brown pigment melanin, yellow-orange carotene, red-purple tones of blood in vascular bed

what makes up the dermis

collagen

what is collagen

tough, fibrous protein that enables the skin to resist tearing

what three things does the subq tissue do

stores fat for energy, provides insulation for temp control, and aids in protection by its soft cushioning effect

what are hairs made of

keratin

where is the shaft of the hair

visible projecting part

where is the root of the hair

below the surface embedded in the follicle

what type of muscle are around the hair follicle

arrector pilli

what do arrector pilli do

contract and elevate the hair so it resembles “goose flesh” when the skin is exposed to cold or in emotional states

what are vellus hair

fine and faint → covers most of the body (except the palms and soles, the dorsa of the distal parts of the fingers, the umbilicus, glans penis, and inside the labia)

what are terminal hair

darker and thicker hair → grows on scalp and eye brows, axillae, pubic area, and face and chest in males

what do sebaceous glands produce

sebum

where is sebum secreted

hair follicles

what does sebum do

lubricates the skin and hair and forms an emulsion with water that retards water loss from the skin

eccrine glands

coiled tubes that open directly on the skin surface and produces sweat

apocrine glands

produce thick, milky secretion and open into hair follicles

what happens to the function of apocrine glands in aging adult

decreases

what do normal nails look like

nail surface is slightly curved/flat, posterior/lateral nail folds are smooth and rounded. nail edges are smooth, rounded, and clean

ten functions of the skin

protection, prevents penetration, perception, fluid balance, temperature regulation, identification, communication, wound repair, absorption and excretion, production of vitamin D

when do hair follicles develop in the fetus

3 months gestation

what develops by midgestation in infants

lanugo

what is lanugo

fine, downy hair of the newborn infants

what replaces lanugo after the first few months after birth

fine vellus hair

what is present on the skin of infants at birth

vernix caseosa

what is vernix caseosa

thick, cheesy substance made up of sebum and shed epithelial cells

what does an infant’s skin look like

smooth, thin, elastic, and more permeable than those of the adult

what happens as child grows

epidermis thickens, toughens, and darkens, skin becomes better lubricated. hair growth accelerates

when do sebaceous glands become more active

puberty

what does the normal skin look like in aging adults

loses its elasticity, parchment skin, lax, dry, and wrinkled

senile purpura

dark red discolored areas

what happens in the hair matrix of the aging adult

number of functioning melanocytes decreases

what does the balding in males look like

W-shaped balding in the frontal areas

what is another function of melanin that has to do with the sun

protects the skin against UV rays

keloids

raised scars that form at a wound site and grow beyond the normal boundaries of the wound

what does hypopigmentation and hyperpigmentation appear as

light/dark spots after acne has been resolved

two other words for pseudofolliculitis

razor bumps and ingrown hairs

how do pseudofolliculitis form

occur when shaving too close with an electric or straight razor

melasma

patchy tan-to-brown discoloration of the face

12 things to ask for subjective data with skin

hx of skin disease, change in pigmentation, change in mole, excessive dryness or moisture, prutitus, excessive bruising, rash/lesion, meds, hair loss, change in nails, environmental/occupational hazards, patient-centered care

seborrhea

oily

xerosis

dry

pruritus

itchy

alopecia

significant hair loss

hirsutism

shaggy or excessive hair

when does physiologic jaundice happen after birth

day 3 or 4

when does pathologic jaundice happen after birth

day 1

what are two things to keep in mind when preparing for a skin assessment

force yourself to attend to skin characteristics and know the person’s normal skin coloring

what does normal skin look like in adults

even and consistent with genetic background

vitiligio

absence of melanin pigment in patchy areas of of white or light skin on the face, neck, hands, feet, and body folds and around orifices

what population are more severely affected by vitiligo

dark-skinned people

another word for freckle

ephelides

ephelides

small, flat macules of brown melanin pigment that occur on sun-exposed skin

another word for mole

nevus

nevus

clump of melanocytes, tan-to-brown color, flat or raised

what do acquired nevus look like

symmetry, 6 mm or less, smooth borders, and single uniform pigmentation

junctional nevus

macular only and occurs in children/adolescents

compound nevus

macular and papular in young adults

A in ABCDEF

asymmetry (both halves of the lesion look different)

B in ABCDEF

border irregularity (notching, scalloping, ragged edges, poorly defined margins)

C in ABCDEF

color variation (areas of brown, tan, black, blue, red, white, or combo)

D in ABCDEF

diameter greater than 6 mm

E in ABCDEF

elevation or evolution (sudden appearance or recent change of a mole)

F in ABCDEF

funny looking (suspicious lesion stands out as looking different compared with its neighboring nevi)

pallor

tones from hemoglobin in blood so skin takes on color of collagen → white

erythema

intense redness of the skin from hyperemia

cyanosis

blueness from decreased perfusion → best seen in lips, nose, cheeks, ears, and oral mucous membranes and in artifical light

jaundice

yellowish skin color that means there are high levels of bilirubin in the blood

where can jaundice be seen

hard and soft palate in the mouth and sclera, eyes appear yellow

hypothermia

generalized coolness

hyperthermia

increased metabolic rate, heat

diaphoresis

profuse perspiration

what does dehydration look like

mucous membranes are dry, lips look parched and cracked

what does skin look like in hyperthyroidism

skin feels smoother and softer

what does skin look like in hypothyroidism

skin feels rough, dry, and flaky

anasarca

generalized edema over the whole body

skin mobility

ease of skin to rise

skin turgor

ability of skin to return to place promptly when returned

scleroderma

“hard skin”, associated with decreased mobility

cherry (senile) angiomas

small (1 to 5 mm), smooth, slightly raised bright red dots that appear on the trunk in all adults over 30 years, normally increase in size and number with aging

cherry (senile) angiomas

6 things to note when a lesion is present

color, elevation, pattern/shape, size in cm, location/distribution of body, any exudate

primary lesion

lesion develops on previously unaltered skin

secondary lesion

lesion changes over time or changes becaise of scratching or infection

dermatoscope

blocks skin surface reflections to inspect for early detection of melanoma, scabies, wart vs foreign body, and fungal lesions

Wood’s light

UV light through special glass to detect fluorescing lesions,

what will a fungal infection look like with a Wood’s light

blue-green fluorescence

what order does hair grow in males during puberty

pubic area → axillae → facial area

genital area hair pattern in females

inverted triangle

genital area hair pattern in males

upright triangle with pubic hair extending up to umbilicus

Profile sign

view the index finger at its profile and note the angle of the nail base, should be about 160 degrees