skin, hair, nails

From the basal layer the new cells migrate up and flatten into the—— or horny cell layer

outer stratum corneum

The epidermis is completely replaced every

4 weeks

The epidermis doesn’t have

vasculature

This is the tough, fibrous protein that enables the skin to resist tearing - connective tissue

collagen

appendages from the epidermis such as the hair follicles, sebaceous glands, and sweat glands are embedded in the

dermis

Hairs are threads of

keratin

is the expanded area where new cells are produced at a high rate

root of the bulb matrix

around the hair follicle are the ——, which contract and elevate the hair so it resembles “goose flesh” when the skin is exposed to cold or in emotional states

muscular arrestor pili

Two types of hair:

vellus, terminal

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

vellus hair

the darker, thicker hair that grows on the scalp and eyebrows and, after puberty, on the axillae, the pubic area, and the face and chest in the male

terminal hair

oils and lubricates the skin and hair and forms an emulsion with water that retards water loss from the skin (don’t have these glands on palms or soles)

sebum

where is sebum secreted from

sebaceous glands

Two types of sweat glands:

eccrine and apocrine

are coiled tubules that open directly onto the skin surface and produce a dilute saline solution called sweat

eccrine glands

produce a thick, milky secretion and open into the hair follicles. They are located mainly in the axillae, anogenital area, nipples, and navel and are vestigial in humans. They become active during puberty, and secretion occurs with emotional and sexual stimulation

apocrine glands

The nails are hard plates of —- on the dorsal edges of the fingers and toes

keratin

is the white, opaque, semilunar area at the proximal end of the nail. It lies over the nail matrix where new keratinized cells are formed

lunula

The skin is the surface on which ultraviolet (UV) light converts cholesterol into

vitamin D

the fine downy hair of the newborn infant. In the first few months after birth, this is replaced by fine vellus hair, midgestation most of the skin is covered

lanugo

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

vernix caseosa

The newborn’s skin is thin, smooth, and elastic and is relatively more permeable than that of the adult; thus the infant is at greater risk for

fluid loss

do not secrete in response to heat until the first few months of life and then only minimally throughout childhood

eccrine sweat glands

is increased in pregnancy; as a way to dissipate heat, the peripheral vasculature dilates and the sweat and sebaceous glands increase secretion

metabolism

occurs because the underlying dermis thins and flattens

wrinkling

The loss of collagen increases the risk for —- - in aging adults

shearing, tearing injuries

Decreased response of the sweat glands to thermoregulatory demand also puts the aging person at greater risk for

heat stroke

In the aging hair matrix, the number of functioning melanocytes decreases; therefore the hair turns

gray

The UV light damages DNA, causing several oncogene mutations, and also causes mutation of the (TP53)

tumor suppressor gene

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

keloids

(“razor bumps” or “ingrown hairs”) occur when shaving too closely with an electric or straight razor

pseudofolliculitis

the “mask of pregnancy,” is a patchy tan-to-dark brown discoloration of the face

melasma

one of the most highly contagious pathogens known among all groups of people

measles

loss of skin color

hypopigmentation

increase in skin color

hyperpigmentation

Oily in excess

seborrhea

Dry skin

xerosis

skin itching, is the most common skin symptom; occurs with dry skin, aging, drug reactions, allergy, obstructive jaundice, uremia, lice

pruritus

Stress can exacerbate chronic

skin illnesses

Even after a long time on medication, a person may develop

sensitivity

is shaggy or excessive hair, excess body hair in females. This forms a male pattern on the face, chest, and back and indicates an increase in androgen hormones

hirsutism

Scratching with dirty, jagged fingernails produces

excoriations

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

vitiligo

(ephelides)—Small, flat macules of brown melanin pigment that occur on sun-exposed skin 

freckles

(nevus)—A clump of melanocytes, tan-to-brown color, flat or raised. Acquired nevi have symmetry, small size (6 mm or less), smooth borders, and single uniform pigmentation

mole

is macular only and occurs in children and adolescents

junctional nevus

Abnormal characteristics of pigmented lesions: ABCDEF

asymmetry, border irregularity, color variation, diameter greater than 6mm, elevation or evolution, funny looking

as you get older a junctional nevus progresses into a

compound nevus

When the red-pink tones from the oxygenated hemoglobin in the blood are lost, the skin takes on the color of connective tissue (collagen), Ashen gray color in dark skin - or lack of color in red toned areas

pallor

Chronic iron deficiency anemia may show “spoon” nails, with a

concave shape

Intense redness of the skin is from excess blood (hyperemia) in the dilated superficial capillaries. This sign is expected with fever, local inflammation, or emotional reactions such as blushing in vascular flush areas (cheeks, neck, and upper chest)

erythema

This is a bluish mottled color from decreased perfusion; the tissues have high levels of deoxygenated blood, indicates hypoxemia

cyanosis

A yellowish skin color indicates rising amounts of bilirubin in the blood

jaundice

Chronic cigarette smoking causes vasoconstriction, noted in

cool, pale hands

Generalized coolness may be induced such as in —-used for surgery or high fever. Localized coolness is expected with an immobilized extremity, as when a limb is in a cast or with an intravenous infusion

hypothermia

occurs with an increased metabolic rate such as in fever or after heavy exercise. A localized area feels hyperthermic with trauma, infection, or sunburn

generalized hyperthermia

has an increased metabolic rate, causing warm, moist skin

hyperthyroidism

or profuse perspiration, accompanies an increased metabolic rate such as occurs in heavy activity, fever, or during perimenopause in women

diaphoresis

skin feels smoother and softer, like velvet

hyperthyroidism

skin feels rough, dry, and flaky

hypothyroidism

Bilateral edema or edema that is generalized over the whole body, consider a central problem such as heart failure or kidney failure

anasarca

is the ease of skin to rise

motility

is its ability to return to place promptly when released, for skin

turgor

literally “hard skin,” is a chronic connective tissue disorder associated with decreased mobility

scleroderma

are small (1 to 5 mm), smooth, slightly raised bright red dots that commonly appear on the trunk in all adults older than 30 years. They normally increase in size and number with aging and are not significant

cherry (senile) angiomas

When a lesion develops on previously unaltered skin, it is

primary

However, when a lesion changes over time or changes because of scratching or infection, it is

secondary

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

dermatoscope

Use a Wood’s light (i.e., a UV light filtered through a special glass) to detect

fluorescing lesions

Absent or sparse genital hair suggests

endocrine abnormalities

(eggs) of lice, which are oval and adherent to hair shaft and cause intense itching

nits

the angle of the nail base; it should be about

160 degrees

In early clubbing the nail angle straightens out to ——, and the nail base feels spongy to palpation

180 degrees

All people normally may have white hairline linear markings from trauma or picking at the cuticle called

leukonychia

Black newborns initially have lighter-toned skin than their parents because of

immature pigment function

It is a blue-black–to-purple macular area at the sacrum or buttocks but sometimes on the abdomen, thighs, shoulders, or arms. It is caused by deep dermal melanocytes

Mongolian spot

is a large round or oval patch of light brown pigmentation (thus the name coffee with milk), which is usually present at birth, six or more could be neurocutaneous disease

cafe au lait

is a distinct line of red/pale color down the midline or horizontal. One-half of the body turns red and blanches; this is transient with no treatment needed. It may be due to changes in vascular tone

harlequin color change

is a common rash that appears in the first 3 to 4 days of life. Sometimes called the flea bite rash or newborn rash, it consists of tiny punctate red macules and papules on the cheeks, trunk, chest, back, and buttocks. The cause is unknown; no treatment is needed

erythema toxicum

is a bluish color around the lips, hands and fingernails, and feet and toenails. This may last for a few hours and disappear with warming

acrocyanosis

is a transient mottling in the trunk and extremities in response to cooler room temperatures. It forms a reticulated red or blue pattern over the skin. It disappears with warming, Persistence could be accompanied with down syndrome

cutis marmorata

is a normal variation in about half of all newborns. A yellowing of the skin, sclera, and mucous membranes develops after the 3rd or 4th day of life because of the increased numbers of red blood cells that hemolyze after birth

physiologic jaundice

physiologic jaundice after 2 weeks of age may indicate

biliary tract obstruction

also produces a yellow-orange color in light-skinned persons but no yellowing in the sclera or mucous membranes. It comes from ingesting large amounts of foods containing carotene, a vitamin A precursor

carotenemia

is a common variation; you will note tiny white papules on the forehead and eyelids, also on cheeks, nose, and chin, caused by sebum that occludes the opening of the follicles

milia

One common vascular birthmark is a ——(salmon patch and stork bite); it is a flat, irregularly shaped red or pink patch found on the forehead, eyelid, or upper lip but most commonly on the face or back of the neck

nevus simplex

is the most common skin problem of adolescence

acne

are jagged linear “stretch marks” of silver-to-pink color that appear during the 2nd trimester on the abdomen, breasts, and sometimes thighs. They occur in half of all pregnancies

striae

is an irregular brown patch of hyperpigmentation on the face. It may occur with pregnancy or in women taking oral contraceptive pills

chloasma

(“liver spots”) are common, circumscribed clusters of melanocytes due to chronic sun exposure. They are small, flat, brown macules

solar lentigines

are raised, thickened areas of pigmentation that look crusted, scaly, and warty, can be seborrheic and look dark, greasy, and stuck on

keratoses

is the most frequent premalignant skin lesion in White persons and is caused directly by sun/artificial UV radiation exposure, These lesions are red-tan scaly plaques that increase over the years to become raised and roughened

actinic keratosis

“skin tags,” are overgrowths of normal skin that form a stalk and are polyp-like, They occur frequently on eyelids, cheeks and neck, and axillae and trunk - in aging adults 

acrochordons

consists of raised yellow papules with a central depression. They are more common in men, occurring over the forehead, nose, or cheeks. They have a pebbly look

sebaceous hyperplasia

Increased red blood cells, capillary stasis, Ruddy blue in face, oral mucosa, conjunctiva, hands, and feet, Well concealed by pigment in dark skin; check for redness in lips

polycythemia

Bright cherry red in face and upper torso, Cherry-red color in nail beds, lips, and oral mucosa

carbon monoxide poisoning

Decreased blood flow from area, engorged venules, Dusky rubor of dependent extremities; a prelude to necrosis with pressure sore, Easily masked; use palpation for warmth or edema

venous stasis

Renal failure causes retained urochrome pigments in the blood, Orange-green or gray overlying pallor of anemia; may also have ecchymoses and purpura

uremia

Cortisol deficiency stimulates increased melanin production, “eternal tan,” most apparent around nipples, perineum, genitalia, and pressure points

addison’s disease

or circular, begins in center and spreads to periphery (e.g., tinea corporis or ringworm, tinea versicolor, pityriasis rosea), shape of a lesion

annular