2 - APP - Unit 4.1 - Integumentary System Flashcards
Integumentary system - Skin
Main organ of the integumentary system
Aka cutaneous membrane
Sheet-like organ composed of two major layers:
- epidermis
- dermis
Integumentary system - Skin - Epidermis
The thin outermost layer of skin
Integumentary system - Skin - Dermis
The thicker and deeper layer of skin
Integumentary system - Skin - Hypodermis
AKA subcutaneous tissue
Thick layer of loose connective tissue and fat.
Role:
- Supporting the two layer of skin.
- Acts as shock-absorbing pad & helps protect underlying tissues from injury caused by bumps & blows to the body surface
- Fat insulates the body from extreme heat and cold & serves as stored source of energy for the body
Epidermis - Cells
Tightly packed
Arranged in many distinct layers
Epidermis - Stratum germinativum
AKA stratum basale
Cells of the innermost layer / deepest layer of epidermis
Undergo mitosis and reproduce themselves
As they move toward skin surface, new cells increase their ability to provide protection for body tissues that lie below them.
As new cells are being produced in deep layer of epidermis, they move upward through upper layers or “strata” of cells.
Epidermis - Mitosis
A cell makes a complete copy of itself
Epidermis - Keratin
A tough & waterproof protein
Produced by keratinocytes that protect cells in the outer layer of skin.
Replaces cytoplasm as new cells are approaching the surface
Epidermis - Keratinocytes
Cells producing keratin
Epidermis - Melanin
- Dark brown pigment substance giving color to skin
- Produced by melanocytes
- Amount of melanin in skin: mostly genetic information inherited from parents.
- Darker skin: higher concentration of melanin
Epidermis - Melanocytes
Specialized cells producing melanin
Contained in deep layer of epidermis
Epidermis - Stratum corneum
Tough outer layer of epidermis.
Serves as primary barrier between body & environment
Dry dead cells filled with keratin are continually pushed to surface of epidermis (“flaking off” onto surrounding environment)
Dermis
Deeper of the two primary skin layers
Much thicker than epidermis
Composed largely of connective tissue
Cells scattered far appart, separated by 3 types of fibers:
- collagen
- reticulum
- elastin
Appendages of the skin
Hair & nails
Appendages of the skin - Nails
Composed of hard keratinized cells forming continuous sheets
Develop from crescent shaped white area at the base of the nail (=lunula)
Appendages of the skin - Lunula
Crescent shaped white area at the base of the nail
Appendages of the skin - Hair
Composed of hard keratinized cells forming long endless fibres
Each hair develops from a tube-like depression that extends through epidermis and into skin dermal layer
Appendages of the skin - Arrector pili muscles
Associated with hair follicles
Smooth & involuntary muscles attached to the base of a hair shaft
Erect hair shaft when contracting in reaction to cold or emotional stimuli : “goose bumps”
Appendages of the skin - Types of glands
- Sudoriferous - Sweat gland
- Sebaceous - Oil glands
Appendages of the skin - Types of glands - Sudoriferous
Sweat gland
Most numerous
2 groups:
- Eccrine
- Apocrine
Appendages of the skin - Types of glands - Sudoriferous - Eccrine sweat glands
By far the more numerous, important & widespread sweat glands in the body
Quite small
Distributed over the total body surface
Produce a transparent , watery liquid (=perspiration or sweat)
Appendages of the skin - Types of glands - Sudoriferous - Sweat
= transpiration
Transparent , watery liquid produced by sudoriferous eccrine sweat glands
Assists in the elimination of wastes and the maintenance of body temperature
Appendages of the skin - Types of glands - Sudoriferous - Aprocrine sweat glands
Found primarily in: - skin of the armpit - pigmented skin areas around the genitals Larger than eccrine glands Secret thicker, milky secretion
Enlarge and begin to function at puberty.
Appendages of the skin - Types of glands - Sebaceous
Oil glands
Associated with hair follicles
Secrete oil (=sebum) = a lipid substance that lubricate skin and protect it from drying out.
Appendages of the skin - Types of glands - Other skin glands
- Cerominous glands
- Mammary glands
Appendages of the skin - Types of glands - Other skin glands - Cerominous glands
Found within the skin of the ear canal Produce cerumen (=ear wax)
Appendages of the skin - Types of glands - Other skin glands - Mammary glands
Found within the breast tissue
Produce milk
Appendages of the skin - Receptors
In the dermal layer of the skin
Make body act as a sense organ, relaying messages to brain concerning sensations
Appendages of the skin - Receptors - Type of receptors
- Pacinian corpuscles
- Meissner’s corpuscles
- Ruffini’s end organs
- Merkel’s disks
- Free nerve endings (nociceptors)
- Krause’s end bulbs
Appendages of the skin - Receptors - Pacinian corpuscles
Deep receptors
Detecting pressure on the skin surface
Appendages of the skin - Receptors - Meissner’s corpuscles
Located close to the surface of the glabrous (smooth, hairless) skin
Detect sensation of light touch
Appendages of the skin - Glabrous skin
Smooth & hairless skin
Appendages of the skin - Receptors - Ruffini’s end organs
Touch and pressure receptors
In deeper area of hairy portion of skin and in joints
Appendages of the skin - Receptors - Merkel’s disks
Mechanoreceptors In the glabrous skin Discriminative touch (=fine touch - allows to sense and localize touch)
Appendages of the skin - Receptors - Free nerve endings
Nociceptors
Respond to pain
Appendages of the skin - Receptors - Krause’s end bulbs
Detect:
- sensation of touch
- low frequency vibration
- cold
Disorders of the Skin - Massaging
Localized condition:
- Therapeutic massage not contraindicated
- Avoid affected area
Localized touch can irritate skin disorders
Massage contraindicated :
- if skin inflamed
- if contagious condition
- if condition transmissible through contact
- Malignancy - unless supervised by appropriate medical personnel
Disorders of the Skin - Bacterial Infections
- Acne
- Boils (= furuncles)
- Carbuncles
- Cellulitis (= erysipelas)
- Impetigo
Disorders of the Skin - Bacterial Infections - Acne
Chronic inflammatory skin disorder
Bacterial infection of sebaceous (oil) glands
Usually related to hormonal changes & overeactive sebaceous glands during adolescence
Common acne = Acne simplex or acne vulgaris
- Usually on the back, chest & shoulders
- Raised inflamed pustules on the skin, sometimes white or black tips
- May be accompanied by black heads
More advance cases: cysts (red, swollen lumps beneath skin surface).
Disorders of the Skin - Bacterial Infections - Boils
= Furuncles
Caused by bacteria entering the skin through hair follicles
Subcutaneous abscess that fills with pus
Can be painful if neglected
Should be treated by physician
Disorders of the Skin - Bacterial Infections - Carbuncles
Masses of connected boils/furuncles
Avoid massage on area
Refer client to a doctor
Disorders of the Skin - Bacterial Infections - Cellulitis
Erysipelas
Sudden spreading infection of dermal and subcutaneous tissues
Red hot tender area of skin, often at site of bacterial entry
Most frequently caused by:
- group A beta-hemolytic streptococci
- Straphylococcus aureus
Associated with malaise, anorexia, fever & chills
Untreated: can be life threatening
Disorders of the Skin - Bacterial Infections - Impetigo
= school sores (because affecting children & quite contagious)
Skin infection caused by bacteria
Microorganisms responsible: (and/or)
- streptococcus pyogenes
- straphylococcus aureus
Most often on exposed area such as hands and face
Presents with:
- pustules
- crusted oozing patches which grow larger day by day
Disorders of the Skin - Benign Tumors & Growths - Tumor
Abnormal growth of swollen tissue
Can be located in any part of the body
- Benign - mild character. Not likely to recur after removal, not harmful (moles, skin tags, sebaceous cysts).
Harmless unless they change color or shape (if so get checked by doctor) - Malignant - more serious, recur after removal. Removed by surgery, X-ray or chemical treatments
Disorders of the Skin - Benign Tumors & Growths - Tumor - Angiomas
Begnin tumors - not dangerous or contagious
Small dilated blood vessels
Location: anywhere on the body
Includes: spider angiomas, cherry angiomas & senile angiomas
Unknown cause
Disorders of the Skin - Benign Tumors & Growths - Tumor - Lipomas
Begnin tumors
Formed by mature fat cells
Appears as a soft, movable, subcutaneous nodule
Location: typically trunk, forearms or neck
Disorders of the Skin - Benign Tumors & Growths - Tumor - Moles
Common armless skin lesions
Can be flat or protruding
Vary in color from pink flesh tone to dark brown or dark
Nimber of moles depends on genetic factors 1 sun exposure
Begin to grow in infancy - new one can appear at any age, sometimes in crops
May darken with sun exposure or pregnancy
During adulthood: lose pigmentation
In old age: may disappear
Disorders of the Skin - Benign Tumors & Growths - Tumor - Seborrheic keratoses
= Cell papillomas, senile carts or brown warts
Harmless common skin growths. Superficial. Rarely malignant
First appear during adult life, become more numerous with time.
Inherited tendance to develop a large number
Appear on both covered and uncovered body parts, not caused by sunlight, can follow irritating skin condition, including dermatitis & sun burn
Slightly raised, light brown spots, gradually thicken and get rough warty surface. Slowly darken and may turn black (harmless color changes)
Disorders of the Skin - Benign Tumors & Growths - Tumor - Steatomas
= Sebaceous cysts
Subcutaneous tumors of the sebaceous glands (containing sebum)
Small growth on scalp, neck or back
Disorders of the Skin - Fingal Infections
- Candida
- Dermatophytosis
Disorders of the Skin - Fingal Infections - Candida
Group of yeasts commonly affecting the skin
Candidal infection = Candidiasis, candidosis or moniliasis
Need living host for survival
Normal inhabitant of human digestive tract, from early infancy, not causing disease.
If host’s defenses lower: can cause infection of mucosa (mouth lining, anus, genitals), the skin & rarely deep-seated infection
Disorders of the Skin - Fingal Infections - Dermatophytosis
Superficial fungal infection
Common and very contagious
= jock itch, ringworm or athlete’s foot
Caused by dermatphytes (fungal organisms) living off keratin protein from dead top skin layer (stratum corneum, nils, hair)
Usually treated sith topical cream unless extensives or involving hair or nails, the requiring oral fungicides for months
Disorders of the Skin - Fingal Infections - Dermatophytosis - Variations
- Tinea capilis - head ringworm - skalp
- Tinea corporis - body ringworm - trunk skin
- Tinea manus - hand ringworm - hands skin
- Tinea peids - athletes foot - feet skin
- Tinea barbae - bearded area of the face
- Tinea unguium - nails
Disorders of the Skin - Skin cancer & tumors - Massage therapist role
- No diagnosis on bump, lesion; ulceration or discoloration
- Inform client if noticing changes in appearance or behavior of an existing blemish or a new one
- Advise for medical consultation
Disorders of the Skin - Skin cancer - 3 types
- Basal cell carcinoma
- Squamous cell carcinoma
- Malignant melanoma
Disorders of the Skin - Skin cancer - Basal cell carcinoma
Least malignant & most common
- Begins with a small raised nodule developing a crusty plaque with slightly elevated, whitish border
or - Flat sore that does not heal properly. May develop a crust, shed that crust & form another.
Most common on light skinned people over 40 who had excess sun exposure
Develops slowly
Successfully treated with minor surgery or local application of freezing
Disorders of the Skin - Skin cancer - Squamous cell carcinoma
More serious than basal cell carcinoma:
- can metastasize (spread) into deep tissues & lymph system
- spread more quickly
Scaly, red papules
Sore or lesion that repeatedly crusts over but doesn’t heal
Blood vessels are not visible
Can occur anywhere on the skin, but more common: lips, ears, hands & sun-exposed areas where skin repeatedly repaired irritated tissues.
Successfully treated by freezing the lesions or local surgical removal
Disorders of the Skin - Skin cancer - Malignant melanoma
Most serious & least common
Dark (brown, black or discolored) patches on the skin
Early diagnosis is essential: can metastasize quickly & can be fatal
Often arises from existing mole
Appear on any body part
Disorders of the Skin - Skin cancer - Malignant melanoma - A-B-C-D-E warning
A - Asymmetry of any pigmented lesion
B - Borders that are irregular, notched or indistinct
C - Color that is widely variable (black, brown, red, blue or white)
D - Diameter larger than a pencil eraser
E - Elevation or partial elevation from the skin level
Disorders of the Skin - Miscellaneous Skin Disorders
- Alopecia
- Burns
- Dermatitis
- Papules
- Pustules
- Psoriasis
- Rosacea
- Scleroderma
- Ulcers
- Urticaria (=hives)
- Vitiligo
Disorders of the Skin - Miscellaneous Skin Disorders - Alopecia
Round patches of hair loss appearing suddenly
Affects any hear bearing area - scalp most common
Occur at any age - sometimes after stressful event
Not contagious
Cause: immune reaction targeting individual hair follicles
Treatment: topical or intralesional medications
Regrowth can occur spontaneously
Disorders of the Skin - Miscellaneous Skin Disorders - Burns
Cells destroyed or inflammed by heat, chemicals, radiation or electricity
Severity determined by: - how deep, - how much surface - body parts affected 6 degrees of severity
Losing more than 15% of skin function put person at risk of: infection, shock & circulatory collapse
Burn to face and neck are more serious as resulting inflammation can impair breathing passages
Disorders of the Skin - Miscellaneous Skin Disorders - Burns - 1st Degree Burn
Relatively mild irritation of superficial epidermis
Signs: Quite painful, redness but no blistering
Expl: diaper rash & sunburn without blistering
Disorders of the Skin - Miscellaneous Skin Disorders - Burns - 2nd Degree Burn
Involves all layers of epidermis & possibly some of the dermis.
Can comes from excessive sun exposure, steam under pressure or toxic chemicals
Usually no permanent damage on hair shafts & glands of the skin
Permanent scarring may occur
Signs: Redness, blisters, edema & lot of pain
Expl: Sunburn with blistering
Disorders of the Skin - Miscellaneous Skin Disorders - Burns - 3rd Degree Burn
Go right down to bottom of dermis or beyond
Destroy hair shafts, sebaceous glands, erector pilae muscles, sweat glands & nerve ending
Less painful than 2nd degree burn (as nerve ending damaged)
Very serious due to possibility of infection, fluid loss & shock
Tend to contract rapidly, forming a very confining web scar tissue
Signs: whiteness and/or charring, leathery texture of the skin
Disorders of the Skin - Miscellaneous Skin Disorders - Dermatitis
“Acute” (rapidly evolving red rash, which may blister and swollen) and/or “chronic”
2 basic types of dermatitis:
- atopic dermatitis
- contact dermatitis
Disorders of the Skin - Miscellaneous Skin Disorders - Dermatitis - Atopic dermatitis
= eczema
Non contagious skin rash
Usually brought by hypersensitivity in the skin
Disorders of the Skin - Miscellaneous Skin Disorders - Dermatitis - Contact dermatitis
Results from contact with something that causes the skin to form an allergic inflammatory reaction
Disorders of the Skin - Miscellaneous Skin Disorders - Dermatitis - Seborriheic dermatitis
Common, harmless, scaling rash
Sometimes hitch
Not contagious or related to diet
On the scalp: dandruff
May occur on: eyebrows, eyelids edges, ears, skin near the nose & skin-folds of armpits & groin
Sometimes: round, scaling patches on the middle of the chest or on the back
Cause: proliferation of a normal skin inhabitant, a yeast called Pityrosporum ovale
Patient with Seborriheic dermatitis: reduced residence to the yeast due to: stress, fatigue, change of season & reduced general health
Disorders of the Skin - Miscellaneous Skin Disorders - Papules
Small elevation in the skin
Containing fluid
May develop pus
Disorders of the Skin - Miscellaneous Skin Disorders - Pustules
Elevation of the skin with an inflamed base
Containing pus
Disorders of the Skin - Miscellaneous Skin Disorders - Psoriasis
Red plaques covered by silvery-white scales
Usually found on elbows, knees, lower back & scalp
Can involve groin, armpits, genital area, beneath the breast where it tends to be less scaly & have a glazed appearance.
Infrequently affects face
Does not cause scarring, rarely results in hair loss
Common, affects 2% of the adults
Cause: unknown. Abnormal immune reaction against some skin component ?
Result: skin grows 7 times quicker and thicker than normal
Disorders of the Skin - Miscellaneous Skin Disorders - Rosacea
Facial rash. Red spots & pustules are dome shaped (not pointed & no blackheads, whiteheads, deep cysts or lumps). Sometime swollen & hot skin
Occurs in middle-aged men and women. Mainly 30s & 40s, with fair skin, blue eyes & of Celtic origin
Possible cause: overgrowth of a mite that resides on the skin
Affects cheeks, nose & fore head. Rarely trunk and upper limbs
Disorders of the Skin - Miscellaneous Skin Disorders - Scleroderma
Autoimmune disorder of connective tissues
Localized skin scarring characterized by violet colored rash (early) and ivory colored hard depression (later)
Associated loss of hair follicles and sweat glands
Disease culminates in hardening all the soft tissue leading to digestive, cardiovascular & respiratory failure.
In Europe, lesions associated with lyme disease-like infection.
No effective treatment
Disorders of the Skin - Miscellaneous Skin Disorders - Ulcers
Round, open sores of the skin or mucous membranes resulting from tissue damage that accompanies inflammation, infection or malignancy
Disorders of the Skin - Miscellaneous Skin Disorders - Ulcers - Decubitus ulcer
Open sore developing primarily over bony areas of the body of those immobile, bedridden or in a wheelchair
Continous pressure on the skin overlying bony areas diminishes or stops circulation and tissue dies
Disorders of the Skin - Miscellaneous Skin Disorders - Ulcers - Neurotrophic Ulcer
Develop at pressure point areas on the feet when pain sensation is diminished or absent, as in diabetic neuropathy.
Disorders of the Skin - Miscellaneous Skin Disorders - Urticaria
= hives
Group of disorders with wheals (itchy swollen lesions) occur in the skin
Wheals can be millimeters or several centimeters in diameters. White or red. Surrounded by a red flare and frequently itchy.
Each wheal may last a few minutes/several hours and change shape (round, form rings, map-like-pattern or giant patches).
Surface wheals may be accompanied by deeper swelling of eyelids, lips, hands & elsewhere (=angioedema)
Angioedema may occur without urticarial wheals.
Wheals & swelling cause: release of chemicals, particularly histamine, into tissues, causing blood vessels to leak, allowing fluid to accumulate in the skin.
Medicine as antibiotics or food (fish, eggs, nuts or chocolate, even in tiny amount, are responsible)
Disorders of the Skin - Miscellaneous Skin Disorders - Vitiligo
Loss of skin pigmentation in irregular patches
Usually affects exposed area of the skin in person under 30 with family history of the disease
Disorders of the Skin - Parasitic Skin Infections - Lice/Pediculosis
Insects sucking blood from various body parts.
Having lice = pediculosis
Lice salive is irritating causing itching & accompanying complication of infection.
Very contagious and very mobile insects.
Massage contraindicated for infected individuals.
Disorders of the Skin - Parasitic Skin Infections - Lice - Types of Pediculosis
- Pediculosis capitis
- Pediculosis corporis
- Pediculosis pubis
Disorders of the Skin - Parasitic Skin Infections - Lice - Pediculosis capitis
Lice that primarily resides within the scalp
Disorders of the Skin - Parasitic Skin Infections - Lice
- Pediculosis corporis
Lice that primarily resides within the skin of the trunk
Disorders of the Skin - Parasitic Skin Infections - Lice - Pediculosis pubis
Lice that primarily resides within the skin of pubic region.
A breed apart from the 2 other types: look like crabs.
“Crabs” can live in groin, armpit and body hair.
Disorders of the Skin - Parasitic Skin Infections - Scabies
Severely itchy skin condition.
Rash with tiny lumps, blisters & “burrows”
Caused by a mite that burrows in the surface of the skin. Too small to be seen with naked eye, so visual inspection is not sufficient.
Location: between fingers, around wrists, around armpit folds, buttocks, on the penis, feet insteps or back of heels.
Rarely on the face and head.
Acquired by skin-to-skin contact with infected person.
Itchy nodules on penis, buttocks and around armpits are very suggestive of scabies.
Can have scabies for 12 weeks before starting to itch or rash (contagious without symptoms).
Disorders of the Skin - Viral infections - Herpes simplex
Recurrent viral infection
Highly contagious - Lie dormant in its carrier unless stress or depressed immune system creates an outbreak
Acute phase: tingling or burning sensation followed by outbreak of an oozing blister or blisters that scab over after a few days.
Outbreak may last 2-3 weeks between first sign and healing of blisters.
Disorders of the Skin - Viral infections - Herpes strains
Type I
Herpes Simplex II (= genital Herpes)
Herpes Whitlow
All:
- very contagious in acute phase
- local contraindication for massage
- virulent virus. Can exist outside of its host
- linen mut be isolated and washed in hot water with a cup of bleach added to wash. Sanitize face rest .
- Practitioner with active fever blisters must take precaution - potentially refraining practicing during acute phase - hand washing + not touching area during sub acute phase.
Disorders of the Skin - Viral infections - Herpes strains - Type I
Affects the face, around and sometimes inside the mouth
Cold sore or fever blisters
Disorders of the Skin - Viral infections - Herpes strains - Herpes Simplex II
= genital Herpes
Outbreaks on genitals, buttocks or inner thigh
Disorders of the Skin - Viral infections - Herpes strains - Herpes Whitlow
Rarer variety
Outbreaks around the fingers nail beds
Transmitted from site of outbreak via skin-to-skin contact.
Disorders of the Skin - Viral infections - Warts
Cause: papilloma virus
Types: Common, plantar and venereal
Contagious: avoid touching them & wash hands after any contacts
Disorders of the Skin - Viral infections - Common Warts
Raised, rough surface
Generally on hands
Disorders of the Skin - Viral infections - Plantar Warts
Generally on the soles of the feet
Grow inward
Often painful and hard to remove
Disorders of the Skin - Viral infections - Venereal Warts
Found on and around genital
