Skin, Hair, and Nails

The epidermis (does or does not) contain any blood vessels?

Does NOT

If someone gets a 3rd degree burn, will there be any pain?

No

Within the Epidermis what are the layers?

Outer horney layer (dead keratinized cells)

Inner cellular level (keratin and melanin producers)

The dermis (does or does not) contain blood vessels?

DOES

The dermis contains the following

blood vessels. CT, sebaceous glands, and some hair follicles

The subcutaneous tissue contains

fat sweat glands and hair follicles

Sebaceous glands produce _________. What is its function?

Sebum

protective fatty substance located everywhere except palms and soles

What are the two types of hair?

Vellus (short fine and unpigmented)

Terminal (coarser and thicker)

During exam, what will you be looking for in the skin?

Color, Vascularity, moisture, temperature, texture, mobility and turgor

How will you assess skin temp?

Back of the hand

When observing lesions what needs to be documented?

The anatomical location

The arrangement (cluster, linear etc)

The type of lesion

Color

When inspecting the fingernails and toenails what are you looking for?

color, shape, and any lesions

When inspecting the mucus membranes what should you look for?

Color (pallor or cyanosis or jaundice)

Moisture

Lesions

EX: mouth, nose, eyelids

When examining the head what do you consider

Hair- quality, distribution, pattern of loss?, nits/lice

Scalp- look for lumps, scaliness, part hair in several areas

Skull- contour or deformities, lumps or tenderness

Face- expression, structure, droop

Skin- color, pigment, texture, hair distribution, and any lesions

Primary lesions may

arise from previously normal skin

Secondary lesions are

resulting from changes in the primary lesion

What are the two flat nonpalpable primary lesions?

Macules and Patches

A macule is

a change in normal skin color without elevation or depression and less than 1 cm

EX: freckle

Identify the macule

How large is a macule

less than 1 cm

Identify the patch

What is a patch?

Greater than 1 cm of discoloration

EX: vitiligo, cafe au lait

How large are patches?

Greater than 1 cm

Primary lesions: Palpable elevated solid masses

Papule

Plaques

Nodule

Tumor

Wheals

In order of smallest to largest

What is a papule?

Smaller than 1 cm

solid raised

EX: nevus, acne, warts and measles

Identify the wheal

Identify the tumor

Identify the plaques

Identify the papule

How big are papules? Example? Are they raised?

smaller than 1 cm

Acne or warts

YES

What are plaques?

Elevated greater than 1 cm

Psoriasis

How big are plaques? Are they elevated?

Yes, greater than 1 cm

When you hear plaque, what condition should you think of?

Psoriasis

What is a nodule?

1-2cm deeper and firmer than a papule or plaque

When you hear nodule what condition should you think of ? How does it present?

Erythema nodosum

Pretibial lumps

What is a tumor?

A spontaneous new growth greater than 2 cm w no physo function

A wheal is a

superficial area of localized skin edema

Can be from mosquito bite or urticaria

Types of free fluid between skin layers

Vesicle

Bulla

Pustule

A vesicle is described as

Circumscribed, elevated, and up to .5 cm

EX: herpes simpex, impetigo, chicken pox, and scabies

How large are vesicles

up to .5 cm

Identify the vesicle

A bulla is a

fluid containing lesion that is greater than .5 cm

often from burns

Identify the bulla

Identify the pustule

A pustule is considered

a conical lesion usually containing a hair in the center with purulent exudate

oftentimes from acne or pustular psoriasis

What are three types of secondary lesions associated with loss of skin surface?

Erosion

Ulcer

Fissure

The loss of superficial epidermis is known as

erosion/excortiation

Does not bleed

An ulcer is a

deeper loss of skin surface, may bleed and scar

Can be caused by heat cold traume syphilis carcinoma or stasis ulcer

A fissure is a _____________ often caused by

linear crack or deep groove caused by eczema

Types of material on the skin surface include

Crust and scale

Crust on the skin surface is oftentimes

Dried residue of serum pus or blood

Eczema impetigo and tinea

Identify the crust

Scale is considered

thin flake of epidermis

seborrhea psoriasis tinea and pityriasis rosea

Identify scale

Lichinifcation is characterized by

the thickening and toughening of skin caused by eczema and other chronic skin conditions

Atrophy is

the thinning of the skin and loss of normal skin furrows

Excoriation is the

abrasion or scratch mark of epidermis

Scar is

replacement of destroyed tissue by fibrous CT

A comedo is

a blocked sebaceous gland (blackhead)

Telangiectasia is

dilated small blood vessels

Sclerosis is

the hardening of the skin

What is a keloid?

Elevated enlarging scar beyond boundaries of the wound

What is cyanosis?

Bluish discoloration of the mucus membranes and skin commonly associated with reduced or deoxygenated hemoglobin

Where is cyanosis best seen?

tongue, lips, earlobes, fingers and toes

Cyanosis results when the right to left shunt is greater than

25%

Central cyanosis occurs when there is

low arterial oxygen concentration

Poor oxygenation to the lungs

Rt to left shunt

Peripheral cyanosis occurs as a result of

sluggish circulation with increased extraction of oxygen by the tissues

From vasoconstriction and diminished peripheral blood flow

Seen with cold exposure, HF and peripheral vascular disease

Jaundice is otherwise known as

icterus

What is the cause of jaundice

yellow color of the skin and sclera caused by deposition of bilirubin

Where does jaundice appear?

Commonly in the sclera, lips, hard palate, undersurface of tongue and skin

What are the three types of jaundice?

Hemolytic

Obstructive

Hepatocellular

Hemolytic jaundice occurs when there

is a massive lysis of RBCs

Obstructive Jaundice occurs when

there is an obstruction of the bile ducts

Hepatocellular jaundice occurs when

there is damage to the liver cells and prevents uptake and conjugation of bilirubin

How can you tell the difference between carotenemia and jaundice?

The sclera remains white in carotenemia

Why does carotenemia occur?

Diets high in carrots and other yellow veggies and fruits

What is pallor, why does it happen?

Paleness or lack of color of the skin

Seen w anemia or deoxygenated blood

Where is pallor best seen ?

Where the epidermis is the thinnest such as fingernails, lips, and mucus membranes

What is skin elasticity?

The ease with which skin moves

What is turgor?

The speed with which the skin returns into place. It is dependent on the interstitial volume of skin and underlying tissue

What are some changes in melanin?

Vitiligo

Cafe au lait spot

Tinea versicolor

What are cafe au lait spots?

Uniformly pigmented macule or patch

Most are .5—> 1.5cm

If an individual has 6 or more spots larger than 1.5cm (cafe au lait) what might this suggest?

Neurofibromatosis

What is vitiligo

Depigmented macules on the face, hands, feet and may coalesce into extensive areas that lack pigment

What is tinea versicolor

superficial fungal infection that causes hypopigmented macules on the trunk and upper extremeties and is easier to see on dark people or after tanning

A spider angioma is characterized by:

a bright red pulsatile lesion w central arteriole and slender projections

When an individual has a significant amount of spider angiomas, what might this suggest?

Hepatic cirrhosis

How can you differentiate between spider angiomas and spider veins?

Spider angiomas will “blanch” or disappear if you press on the central arteriole

The spider vein will not disappear

A cherry angioma is a

bright red macule or papule 1-3mm in size, no significance

Petechia is a

deep red or purple fading over time, smaller than .5 cm

Purpura is a

petechia that is larger than .5cm

Ecchymosis

blood outside vessels aka bruise

Atopic dermatitis is

the pruritic inflammation of the epidermis, “the itch that rashes”

Poorly defined eyrthematous patches, papules and plaques

Lichinification from repeated scratching

Where is atopic dermatitis usually found

neck, face, upper trunk, elbows and knees )crevices)

What is an important factor when diagnosing atopic dermatitis?

2/3 of cases have family or personal Hx of allergies

What is essential for a atopic dermatitis diagnosis?

Pruritis

What to avoid with atopic dermatitis

Hot showers, drying soaps and anything that may dry out the skin and potential allergens

What works best for treatment of atopic derm?

corticosteroids (specifically ointment >lotion)

What is seborrheic dermatitis?

Dandruff

Characterized by redness and scaling where sebaceous glands are most active, zink tar or selenium shampoos

May or may not be itchy

Face scalp eyelids chest and body folds may be oily with dry yellowish scales

What kind of pathogen is candida?

Opportunistic

Can be typically cultured from mouth feces and vagina