Integumentary System Notes

Integumentary System Roots and Terms

Chapter Objectives

  • Identify roots/word parts associated with the integumentary system (3.1).
  • Translate subjective terms related to the integumentary system (3.2).
  • Translate objective terms related to the integumentary system (3.3).
  • Translate assessment terms related to the integumentary system (3.4).
  • Translate plan terms related to the integumentary system (3.5).
  • Use abbreviations associated with the integumentary system (3.6).
  • Distinguish integumentary system terms in electronic health records (3.7).

Introduction and Overview of Dermatology

  • Skin serves a protective and surveillance function, similar to the walls of ancient cities.
  • Skin is the first line of defense against germs and irritants.
  • Skin serves as the body's first point of contact with its surroundings.
  • Skin is the largest organ in the body.

3.1 Word Parts of the Integumentary System

Word Parts Associated with Anatomy
  • The integumentary system (skin) is complex, with many structures each having a specific function.
  • The outermost layer of skin is the epidermis, made of squamous cells (scaly appearance).
  • Under the epidermis is the dermis, a thicker layer with fewer cells and more fibers, providing strength and flexibility. Contains hair follicles, nerves, and glands.
  • Hair follicles (roots: pi/o/tricho) anchor hair to the skin and provide nourishment.
  • Nerves in the dermis detect fine pressure, deep pressure, temperature, and pain, making skin the largest sensory organ.
  • Skin has two types of glands that release fluid:
    • Sweat glands (hidro) release sweat to rid the body of waste and cool the body.
    • Sebaceous glands (sebaceo) secrete oil as a natural moisturizer for skin and hair.
  • Nails (onycho/unguo) are specialized tissue made of keratin, protecting fingers and toes and providing a base for movement.
Roots, Examples, and Notes
  • Fat
    • ROOTS: adipo, lipo, steato
    • EXAMPLES: adipocyte, lipoma, steatosis
    • NOTES: Avoid adipogenic foods.
  • Skin
    • ROOTS: cutaneo, dermo, dermato
    • EXAMPLES: subcutaneous, epidermal, dermatology
    • NOTES: Perioral dermatitis means around (peri) the mouth (oral) skin (dermat) inflammation (itis).
  • Hair
    • ROOTS: pilo, tricho
    • EXAMPLES: piloid, atrichosis
    • NOTES: Caterpillar comes from Latin words "catta" (cat) and "pila" (hair), meaning hairy cat. Schizotrichia is split ends.
  • Sweat
    • ROOT: hidro
    • EXAMPLES: hyperhidrosis, hypohidrosis
    • NOTES: Hypohidrosis (lack of sweat) can indicate a problem. Dogs pant instead of sweat to cool their bodies.
  • Scale
    • ROOT: squamo
    • EXAMPLE: squamous layer
    • NOTES: Desquamation refers to peeling skin after a sunburn or removing scales from a fish.
  • Nail
    • ROOTS: onycho, unguo
    • EXAMPLES: onychalgia, subungual
    • NOTES: Exungulate means to trim nails. Onychoclasis means a broken nail.
  • Oil
    • ROOTS: sebo, sebaceo
    • EXAMPLES: sebolith, pilosebaceous
    • NOTES: Cerumen (ear wax) is sebum produced in the ears.
Word Parts Associated with Pathology - Change
  • Skin abnormalities: Unusual skin texture and unusual skin color.
  • Skin texture problems:
    • Hardness/horniness (kerato-)
    • Dryness (xero-)
  • Abnormal skin color prefixes:
    • Whiteness (leuko-)
    • Redness (erythro-)
    • Yellowness (xantho-)
    • Blackness (melano-)
Roots, Examples, and Notes
  • Hidden
    • ROOT: crypto
    • EXAMPLE: onychocryptosis
    • NOTES: Onychocryptosis is an ingrown toenail. Crypt can refer to a hidden room or vault, often for corpses.
  • Hard, Horny
    • ROOT: kerato
    • EXAMPLES: keratosis, keratoderma
    • NOTES: Rhinoceros has a horn on its nose. Triceratops had three horns on its head.
  • Dry
    • ROOT: xero
    • EXAMPLE: xeroderma
    • NOTES: Xeriscaping is landscaping that uses plants that require little water.
Word Parts Associated with Pathology - Skin Conditions Involving Color
  • Changes in skin color are important in diagnosing skin conditions.
  • Roots refer to changes in skin color i.e xantho, erythro, leuko, melano.
Roots, Examples, and Notes
  • Yellow
    • ROOT: xantho
    • EXAMPLE: xanthoderma
    • NOTES: Axanthopsia is the inability to see the color yellow.
  • Red
    • ROOT: erythro
    • EXAMPLE: erythroderma
    • NOTES: Erythroderma is redness of the skin. The Red Sea was originally called the Erythraen Sea. Eritrea gets its name from this.
  • White
    • ROOTS: leuko, albo
    • EXAMPLES: leukoderma, albinism
    • NOTES: Leukotrichia is white hair. Albinism is a complete lack of skin pigment. An albatross is a white sea bird.
  • Black
    • ROOT: melano
    • EXAMPLE: melanoma
    • NOTES: Ancient Greeks believed the body was filled with four humors: bile (chole), black bile (melan chole), phlegm (phlegma), and blood (sanguis). Melancholy comes from the belief that sadness or depression is caused by too much black bile.
  • Differing levels of melanin determine skin color
  • Dark skin has heavy melanin deposits in the basal layer.
  • Light skin has little visible melanin in the basal layer.

3.2 Patient History, Problems, Complaints

  • Common reasons for seeking medical care related to skin:
    • New rash, which may be painful (dermatalgia/dermatodynia) or itchy (pruritus).
    • Rash appearance: hives (urticaria) or oily secretion (seborrhea).
    • Dryness (xerosis) or wetness (macerate).
    • Excessive sweating (hyperhidrosis) or lack of sweating (anhidrosis).
    • Change in skin color: loss of pigment (depigmentation) or darkening (hypermelanosis); or lack of pigment (albinism).
    • Hair problems: hair loss (alopecia) or too much hair (hypertrichosis).
Dermatological Terms
  • abrasion (ab/rasion): scraping away of skin
  • albinism (albin/ism): lack of pigment in skin causing patient to look white
  • albino (albino): a person afflicted with albinism
  • alopecia (AL-oh-PEE-shah): baldness
  • anhidrosis (an/hidr/osis): lack of sweating
  • comedo (KOM-eh-doh): hair follicle plugged with sebum (blackhead, whitehead)
  • cyanhidrosis (cyan/hidr/osis): blue sweat
  • depigmentation (de/pigment/ation): loss of pigmentation
  • dermatalgia (dermat/algia): skin pain
  • dermatodynia (dermato/dynia): skin pain
  • dermatolysis (dermat/olysis): loose skin
  • erythema (ER-rh-THEE-mah): redness
  • erythroderma (erythro/derma): red skin
  • hemathidrosis (hemat/hidr/osis): sweating blood
  • hidropoiesis (hidro/poiesis): the formation of sweat
  • hyperhidrosis (hyper/hidr/osis): excessive sweating
  • hyperkeratosis (hyper/kerat/osis): excessive growth of horny skin
  • hypermelanosis (hyper/melan/osis): excessive melanin in the skin
  • hyperpigmentation (hyper/pigment/ation): excessive pigment in the skin
  • hypohidrosis (hypo/hidr/osis): diminished sweating
  • hypomelanosis (hypo/melan/osis): diminished melanin in the skin
  • hypopigmentation (hypo/pigment/ation): diminished pigment in the skin
  • leukoderma (leuko/derma): white skin
  • macerate: to soften the skin
  • onychophagia (onycho/phagia): eating or biting the nails
  • pruritus: an itch
  • rhytid/ermia (rhytid/ermia): wrinkled skin
  • sebopoiesis (sebo/poiesis): formation of oil (sebum)
  • seborrhea (sebo/rrhea): discharge of oil (sebum)
  • trichomegaly (tricho/megaly): abnormally thick hair
  • urticaria: swollen, raised, itchy areas of the skin
  • xanthoderma (xantho/derma): yellow skin
  • xeroderma (xero/derma): dry skin
  • xerosis (xer/osis): condition of dryness

3.3 Objective: Observation and Discovery

  • Specific language is used to describe rashes based on location, size, color, texture, and filling.
  • Location:
    • Localized: Limited to a specific area.
    • Generalized: All over the body.
    • Centrifugal: Starts from the middle and works outward.
    • Centripetal: Spreads from the outside inward.
  • Size:
    • Papules: Small bumps (under 1 cm).
    • Nodules: Larger bumps (over 1 cm).
    • Plaques: Large and flat, like a plateau.
  • Contents:
    • Vesicles: Small bumps (less than 1 cm) filled with clear fluid.
    • Pustules: Bumps filled with pus.
    • Bulla: Larger vesicle (blister).
    • Abscesses: Larger pustules.
    • Macules: Small, flat spots (freckles).
    • Patches: Larger macules.
  • Blood Vessel Findings:
    • Cherry angioma: Mass caused by too many blood vessels.
    • Telangiectasia: Heavy concentration of blood vessels that is flat but still visible.
    • Petechiae: Small bruises under the skin.
    • Ecchymosis: Larger bruises.
  • Burns: Injury to skin cells caused by heat, radiation, chemicals, electricity, or friction.
    • Impaired skin functions: regulate heat, regulate hydration, and ability to fight infection.
    • Severity depends on body area affected and depth of burn.
    • First-degree: Affects only the epidermis (e.g., sunburn).
    • Second-degree: Involves the dermis.
    • Third-degree: Injures the subcutaneous layer.
    • Fourth-degree: Involves underlying tissues (bone, muscle, fascia).
  • Diagnostic Procedures:
    • Culture and sensitivity: Skin cultured for bacteria, virus, or fungus.
    • Skin biopsy: Removal of skin for examination under a microscope.
      • Can involve removal of the entire lesion (excisional).
      • Shave biopsy: Slice of the blade.
      • Punch biopsy: Device similar to paper hole punch.
Primary Lesions
  • Flat, Nonpalpable
    • macule, macula (freckle): small, flat, discolored area
    • patch (vitiligo): larger, flat, discolored area
  • Elevated, Palpable, Solid Mass
    • papule: a small solid mass
    • plaque: a solid mass on the surface of the skin
    • nodule: a solid mass that extends deeper into the skin
    • tumor: a larger solid mass
  • Elevated, Fluid-Filled
    • vesicle: a smaller blister
    • bulla: larger vesicle
    • pustule: a pus-filled blister
    • abscess: a localized collection of pus in the body
Secondary Lesions
  • Loss of Skin Surface
    • erosion: loss of skin
    • ulcer: a sore
    • excoriation: a scratch
    • fissure: a crack in the skin
    • scale: skin flaking off
  • Material on Skin Surface
    • crust: a dried substance (i.e., blood, pus) on the skin
Vascular Lesions
  • vascular lesion: wounds related to blood vessels
  • cherry angioma: a small blood vessel tumor
  • telangiectasia (spider angioma): the overexpansion of the end of a blood vessel
  • petechiae: a small bruise
  • ecchymosis: a larger bruise
  • cicatrix (plural: cicatrices): a scar
  • keloid: overgrowth of scar tissue
Epidermal Tumors
  • epidermal tumors: tumors on the skin
  • nevus: mole
  • dysplastic nevus: a mole with bad changes/formations (often precancerous)
  • verruca: wart
Diagnostic Procedures
  • culture and sensitivity (C&S): growing microorganisms in isolation to determine drug sensitivity
  • biopsy (Bx): removal of tissue for examination
  • excisional biopsy: removal of an entire lesion for examination
  • incisional biopsy: removal of a portion of a lesion for examination
  • dermatoscope: instrument used to look at the skin
  • dermatoscopy: procedure for looking at the skin
Pathology
  • adipocele: a hernia filled with fatty tissue
  • dermatofibroma: a fibrous skin tumor
  • erythrocyanosis: a red and/or blue discoloration of the skin
  • keratogenic: causing horny tissue development
  • keratosis: horny tissue condition
  • necrosis: tissue death
  • onychia: a nail condition
  • onychocryptosis: an ingrown nail
  • onycholysis: the loss of a nail
  • onychomalacia: abnormal softening of a nail
  • onychopathy: nail disease
  • pachyderma: tough skin
  • paronychia: a condition of the tissue around a nail
  • steatoma: a fatty tumor
  • xanthoma: a yellow tumor

3.4 Diagnosis and Pathology

  • Skin problems are generally infections, inflammations, tumors, or changes in skin.
  • Bacterial infections:
    • Impetigo (small yellow crust).
    • Cellulitis (invades deeper layers).
    • Hidradenitis (sweat glands).
    • Acne (sebaceous glands), common in puberty.
  • Fungal infections:
    • Mycosis (skin).
    • Onychomycosis (nails), requires long treatment.
  • Inflammation without infection:
    • Dermatitis (general term).
    • Actinic dermatitis (sun exposure).
    • Seborrheic dermatitis (scaly red rash, common in infants and older adults).
    • Atopic dermatitis (sensitive skin, associated with allergies and asthma).
    • Ichthyosis (thick and scaly skin)
  • Tumors: Related to ultraviolet (UV) exposure.
    • Basal cell carcinoma: Most common skin cancer, round, flesh-colored, pearly nodule.
    • Melanoma: Cancer of pigment-producing cells, responsible for most deaths, brown in color.
    • Squamous cell carcinoma: Begins as a small papule, leads to ulcer.
    • Actinic keratosis: Precancerous condition associated with sun exposure.
  • Decubitus ulcer: Large erosion of skin, often in bedridden individuals.
General Skin Changes
  • decubitus ulcer (de/cubitus ulcer): bed sore
  • dermatosis (dermat/osis): skin condition
  • dermopathy (dermo/pathy): skin disease
  • atopic dermatitis (a/top/ic dermat/itis): chronic dry inflammatory disease characterized by itching
  • hypertrichosis (hyper/trich/osis): excessive growth of hair
  • ichthyosis (ichthy/osis): condition in the skin that is dry and scaly resembling fish scales
  • postpartum alopecia (post/partum alopecia): baldness experienced by women after a pregnancy
  • psoriasis (psor/iasis): skin condition characterized by patches of itchy, red, scaly skin
  • sclerodermatitis (sclero/dermat/itis): inflammation of the skin accompanied by thickening and hardening
  • scleronychia (scler/onych/ia): thickening and hardening of the nails
  • xanthosis (xanth/osis): yellowing of the skin
Oncology
  • actinic keratosis (actin/ic kerat/osis): horny skin condition caused by sun exposure
  • basal cell carcinoma (basal cell cardin/oma): cancerous tumor of basal skin cells
  • hidradenoma (hidr/aden/oma): tumor of the sweat gland
  • malignant cutaneous neoplasm (malignant cutane/ous neo/plasm): a harmful new formation of skin tissue (a.k.a. skin cancer)
  • malignant melanoma (malignant melan/oma): a harmful tumor of melanin cells
  • squamous cell carcinoma (squam/ous cell carcin/oma): cancerous tumor of squamous skin cells
Infections
  • acne vulgaris (acne vulgaris): inflammation of the skin follicles
  • dermatomycosis (dermat/o/myc/osis): a fungal skin condition
  • hidradenitis (hidr/aden/itis): inflammation of the sweat glands
  • impetigo: a highly contagious bacterial infection of the skin
  • mycodermatitis (myco/dermal/itis): inflammation of the skin caused by fungus
  • mycosis (myc/osis): a fungal condition
  • onychodystrophy (onycho/dys/trophy): poor nourishment (and development) of the nail
  • onychomycosis (onycho/myc/osis): a fungal condition of the nail
  • tinea: a fungal condition often called "ringworm"
  • trichomycosis (tricho/myc/osis): a fungal condition of the hair
Inflammations
  • actinic dermatitis (actin/ic dermat/itis): inflammation of the skin caused by sun exposure
  • dermatitis (dermat/itis): inflammation of the skin
  • seborrheic dermatitis (sebo/rrhe/ic dermat/itis): inflammation of the skin caused by the discharge of oil (sebum)
  • steatitis (steat/itis): inflammation of fat tissue
Burns
  • first-degree burn: burn affecting only the epidermis or superficial layer of the skin
  • second-degree burn: deeper burn affecting both the epidermis and dermis
  • third-degree burn: deep burn affecting the epidermis, dermis, and subcutaneous layer
  • fourth-degree burn: affecting not just all layers of the skin but also underlying tissues

3.5 Treatments and Therapies

  • General Dermatology Treatment Strategy:
    • If it's wet, dry it.
    • If it's dry, wet it.
    • If nothing else works, use steroids.
  • Medicine Categories:
    • Anti-infection or cleansing (antibiotics, antiseptics).
    • Anti-immune (steroids or related).
    • Anti-itch or allergy (antihistamines).
  • Procedures Employed:
    • Chemicals (chemosurgery and chemotherapy).
    • Vacuums (liposuction).
    • Cold (cryosurgery).
    • Lasers (dermabrasion).
    • Electricity (electrosurgery, electrodesiccation).
  • Mohs Micrographic Surgery:
    • Removes thin layers of tissue, examines them for cancer, continues until cancer is no longer detected.
    • Originally used chemicals to "fix" the tissue (chemosurgery); now, micrography is used to "map" skin for cancer.
  • Other procedures: incision and drainage; onychectomy; skin grafting (autograft, homograft, heterograft); injections (hypodermic needle).
Pharmacology
  • anesthetic (an/esthetic): a drug that temporarily blocks sensation
  • antibiotic (anti/biotic): a drug that destroys or opposes growth of microorganisms
  • antihistamine (anti/histamine): a drug that opposes the effects of histamine
  • antipruritic (anti/prurit/ic): a drug that prevents or relieves itching
  • antiseptic (anti/septic): a drug that prevents sepsis by killing microorganisms
General Terms
  • epidermal (epi/derm/al): pertaining to the skin
  • hypodermic (hypo/derm/ic): pertaining to beneath the skin
  • intradermal (intra/derm/al): pertaining to inside the skin
  • percutaneous (per/cutane/ous): pertaining to through the skin
  • subcutaneous (sub/cutane/ous): pertaining to beneath the skin
  • topical (topic/al): applied directly to the skin
  • transdermal (trans/derm/al): pertaining to through the skin
Procedures
  • chemosurgery (chemo/surgery): removal of tissue destroyed using chemicals
  • chemotherapy (chemo/therapy): treatment using chemicals
  • cryosurgery (cryo/surgery): destruction of tissue through freezing
  • dermabrasion (derm/ab/rasion): rubbing or scraping away the outer surface of skin
  • electrocauterization (electro/cauteriz/ation): using electricity to destroy tissue by burning it
  • electrodesiccation (electro/desicc/ation): using electricity to destroy tissue by drying it
  • incision and drainage (I&D): to cut into a wound to allow trapped infected liquid to drain
  • lipectomy (lip/ectomy): removal of fatty tissue
  • liposuction (lipo/suction): removal of fatty tissue using a vacuum
  • onychectomy (onych/ectomy): removal of a nail
  • onychotomy (onycho/tomy): incision into a nail
  • rhytidoplasty (rhytido/plasty): reconstruction of wrinkled skin
  • skin grafting
  • autograft (auto/graft): skin transplant taken from a different place on the patient's body
  • homograft (homo/graft): skin transplant taken from another member of the patient's species
  • heterograft (hetero/graft): skin transplant taken from a species other than the patient's
  • xenograft (xeno/graft): skin transplant taken from a species other than the patient's

3.7 Electronic Health Records

  • Example Clinical Note:
    • Patient with a history of atopic dermatitis developed a new rash consisting of vesicles overlying areas of xerosis.
    • Initially diagnosed with impetigo and treated with topical antibiotics, then oral antibiotics without improvement.
    • Reports mild pain and pruritus, denies fever.
    • Physical exam showed erythematous, xerotic patches, red crusts and vesicles, scattered excoriations and erosions. Mild scalp alopecia.
    • Lab tests confirmed eczema herpeticum.
    • Treated with oral antiviral medicine with follow up in 2 weeks.