Integumentary LO

he outermost layer of the skin that is thin and avascular, where melanin and keratin are formed

Epidermis

The middle layer that is vascular and contains collagen and elastic fibers. Also contains the sebaceous glands, sweat glands, hair follicles, and end of cutaneous nerves

Dermis

The deepest layer composed of adipose tissue and contains larger blood vessels and nerves. Provides insulation and mechanical integrity

Subcutaneous (adipose) tissues

Hair, nails, and glands (sebaceous and sweat) are considered _______ of the skin

appendages

what are some important things to consider when trying to differentiate different skin etiologies

Timing/progression, exposures, associated symptoms, medical history

when inspecting the skin look for what characteristic

color, moisture, temp, texture, turgor

Yellow coloration from increased bilirubin, often visible in the eyes (scleral icterus).

Jaundice

Yellow-orange color from diet (carrots/squash), visible on palms and soles.

Carotenemia

Bluish color indicating decreased oxygen or blood flow. Can be peripheral (acrocyanosis) or central (perioral).

Cyanosis

Measures skin elasticity. Elicited by pinching the skin over the dorsum of the hand; it should return quickly to its normal shape Measures skin elasticity. Elicited by pinching the skin over the dorsum of the hand; it should return quickly to its normal shape

Turgor

flat lesion less than 1 cm

macule

flat lesion greater than 1 cm

patch

raised lesion less than 1 cm

papule

raised lesion greater than 1 cm

plaque

round, elevated lesion that is less than 1 cm

nodule

a fluid filled lesion less than 1 cm

vesicle

a fluid filled lesion greater than 1 cm

bulla

a pus filled lesion

pustule

small, round, non-blanching red spots

petechia

arger, irregular, non-blanching purple lesions

Purpura

local dermal edema that is elevated and irregularly shaped

Wheal

dilated superficial blood vessels

telangiectasis

name some configurations of lesions

annular, target, linear, serpiginous, confluent, clustered

name some different skin textures

smooth, scaly, keratotic, or verrucous

The most common type. Arises in sun-exposed areas (head/neck). Findings: Pearly, translucent nodules with telangiectasias and a "rolled edge" appearance.

BCC

The second most common. Findings: Often a crusted, hyperkeratotic lesion with a rough, scaly, or ulcerated appearance.

SCC

The least common but most lethal. Can occur in sun-exposed and non-exposed areas.

Melanoma

short, fine, unpigmented hair

vellus

Thick, coarse, pigmented hair

Terminal

Sudden onset of localized, round hair loss

alopecia areata

Excess terminal hair growth in androgen-dependent areas in women; often an indicator of endocrine disorders.

Hirsutism

Fungal infection causing round patches of loss with scaling and a "black dot" appearance.

Tinea capitis

hair pull test, grasp hair with fingers and pull firmly. this is checking for

hair shedding

tug test, two hands and gently tug a group of hair, this is checking for

hair fragility

Bulbous enlargement of the nail bed with a change in the angle between the fold and plate.
Significance: Malignancy (especially lung), cardiovascular disease, or chronic lung/GI disease.

clubbing

Punctate depressions associated with psoriasis, eczema, and alopecia areata.

pitting

Transverse depressions from temporary growth disruption due to systemic illness or trauma.

beaus lines

Painless separation of the nail plate from the bed. Can be local (trauma) or systemic (psoriasis, thyroid disease).

onycholysis

Fungal infection resulting in thickened, discolored nails with debris.

onychomycosis

Brown-black longitudinal streak. Common in darkly pigmented skin, but if it is adult-onset, single-digit, or >3mm, it may indicate melanoma.

Melanonychia

Superficial infection of the nail fold (proximal or lateral). Findings: Painful, erythematous swelling filled with purulent material.

Paronychia

a list of possible conditions that could be causing the patient's symptoms. It involves weighing the probability of one disease over another based on history and physical exam findings to distinguish between conditions with similar signs.

differential diagnosis