ASSESSMENT OF THE SKIN, HAIR, AND NAILS Flashcards by Hanz Myko C. DIDULO

is a physical barrier that protects the underlying tissues and
structures from microorganism, physical trauma, ultraviolet
radiation and dehydration.

SKIN

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SKIN
composed of three layers:

o Epidermis
o Dermis
o Subcutaneous Tissue

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EPIDERMIS
* the outer layer of skin.
* 4 distinct layers

stratum corneum
stratum lucidum
stratum granulosum
stratum germativum (stratum basale)

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outermost layer; consists of dead, keratinized
cells that render the skin waterproof; replaced
every 3 to 4 weeks

stratum corneum

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only layer that undergoes cell division;
contains melanin and keratinocyte (keratin-
forming cells)

stratum germativum (stratum basale)

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the inner layer of the skin.

DERMIS

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is a well-vascularized, connective tissue layer containing
collagen and elastic fibers, nerve endings, and lymph
vessels. It is also the origin of sebaceous glands, sweat
glands, and hair follicles

DERMIS

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secrete an oily substance called sebum that
lubricates hair and skin and reduces water
loss through the skin.

Sebaceous Glands

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are located over the entire
skin surface and secrete an odorless,
colorless fluid, the evaporation of which is vital
to the regulation of body temperature.

Sweat Glands
* Eccrine glands

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are concentrated in the
axillae, perineum, and areolae of the breast
and are usually open through a hair follicle.

Sweat Glands
Apocrine glands

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beneath the dermis , a loose connective tissue
containing fat cells, blood vessels, nerves, and the
remaining portions of sweat glands and hair follicles.

SUBCUTANEOUS TISSUE

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(particularly scalp and eyebrows) is
longer, generally darker, and coarser than vellus
hair.

Terminal Hair

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consists of layers of keratinized cells, found over much of
the body except for the lips, nipples, soles of the feet, palms
of the hands, labia minora, and penis.

HAIR

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HAIR
Structures

o Follicle
o Bulb
o Shaft
o Root

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located on the distal phalanges of fingers and toes, are
hard, transparent plates of keratinized epidermal cells that
grow from the cuticle

NAILS

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o layer of clear skin located along the bottom edge of
your finger or toe.

Cuticle

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is short, pale, fine, and
present over much of the body.

Vellus hair (peach fuzz)

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o extends over the entire nailbed and has a pink tinge
as a result of the rich blood supply underneath.

Nail Body

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o a paler, crescent shaped area.

Lunula

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(loss of color) is seen in arterial insufficiency,
decreased blood supply, and anemia. Pallid tones vary from
pale to ashen without underlying pink.

Pallor

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may cause white skin to appear blue-tinged,
especially in the perioral, nail bed, and conjunctival areas.
Dark skin may appear blue, dull, and lifeless in the same
areas.Cyanosis

Cyanosis

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results from a cardiopulmonary problem,
whereas peripheral cyanosis may be a local problem
resulting from vasoconstriction.

Central cyanosis

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in light- and dark-skinned people is characterized
by yellow skin tones, from pale to pumpkin, particularly in
the sclera, oral mucosa, palms, and soles.

Jaundice

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is roughening and darkening of skin
in localized areas, especially the posterior neck.

Acanthosis nigricans

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is a generalized loss of pigmentation.

Albinism

(skin redness and warmth) is seen in inflammation, allergic reactions, or trauma.

Erythema

flat, small macules of pigment that appear following sun exposure

Freckles –

raised papule with a depressed center.

Cutaneous tag,

(stretch marks)

Striae

– flat or raised tan/brownish marking up to 6 mm wide

Mole (nevus) –

small raised spots (1–5 mm wide) typically seen with aging

Cherry angiomas,

warty or crusty pigmented lesion * Scar

Seborrheic keratosis –

Granulation Tissue

* Healthy granulation tissue has a moist, red and granular appearance. * Treatment aim of granulation tissue is to maintain a moist wound healing environment and protect from infection and trauma

Epithelial Tissue

* Epithelial tissue has a pearly pink appearance. * Epithelia spread across the wound surface from the wound edge or islets from within the wound bed in superficial wounds. * Treatment aim for epithelial tissue is to provide protection and a moist wound healing environment.

Over-granulation Tissue

* Granulation tissue has become proud of the surrounding wound bed. * Over-granulation can delay wound healing * Treatment aim for over- granulation is to apply local pressure, remove occlusive dressings and consider corticosteroid or antimicrobial application.

Un-healthy granulation Tissue

* Granulation tissue which appears dark red or pale in colour or dull and dehydrated * Indication that the wound is poorly perfused or infected * Treatment aim for un-healthy granulation tissue is to reassess the patient holistically and treat the underlying cause of poor wound perfusion or wound infection.

Slough Tissue

* Slough tissue is typically white/yellow in colour. * Slough is devitalised tissue which may delay wound healing and increase the risk of infection. * Treatment aim for slough is to debride, if clinically appropriate following a holistic assessment of the patient and wound.

Necrotic Tissue

* Necrosis Can Be Black, Grey Or Tan In Colour. It Can Also Be Wet Or Dry. * Necrosis Is Cause By Ischemia And Cellular Death. * Necrosis May Delay Wound Healing And Increase The Risk Of Infection. * Treatment Aim For Necrosis Is To Debride, If Clinically Appropriate Following A Holistic Assessment Of The Patient And Wound.

PRESSURE ULCER STAGE * Intact skin with nonblanchable redness of a localized area usually over a bony prominence. * Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. * The area may be painful, firm, soft, warmer, or cooler as compared to adjacent tissue.

STAGE I

PRESSURE ULCER STAGE * Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. * May also present as an intact or open/ruptured, serum-filled blister. * Presents as a shiny or dry shallow ulcer without slough or bruising; bruising indicates suspected deep tissue injury.

STAGE II

PRESSURE ULCER STAGE Full-thickness tissue loss. * Subcutaneous fat may be visible * but bone, tendon, or muscle is not exposed. * Slough may be present but does not obscure the depth of tissue loss. * May include undermining and tunneling. * The depth of a stage

STAGE III

PRESSURE ULCER STAGE Full-thickness tissue loss with exposed bone, tendon, or muscle. * Slough or eschar may be present on some parts of the wound bed. * Often includes undermining and tunneling. The depth varies by anatomic location Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon, or joint capsule), making osteomyelitis possible. * Exposed bone/tendon is visible or directly palpable.

STAGE IIII

PRESSURE ULCER STAGE Full-thickness tissue loss in which the base of the ulcer is * covered by slough (yellow, tan, gray, green, or brown) and/ * or eschar (tan, brown, or black) in the wound bed. * The true depth, and therefore stage, cannot be * determined until enough slough and/or eschar is removed to expose the base of the wound * Stable (dry, adherent, intact without erythema * or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.

UNSTAGEABLE

Small, flat, nonpalpable skin color change (skin color may be brown, white, tan, purple, red).

Macule and Patch

are less than 1 cm with a circumscribed border

* Macules

are greater than 1 cm and may have an irregular border.

Patches

Elevated, solid, palpable mass

Nodule, Tumor

0.5–2 cm; circumscribed

* Nodule:

1–2 cm; does not always have sharp border

Tumor:

Examples include freckles, flat moles, petechiae, rubella (pictured below), vitiligo, port wine stains, and ecchymosis.

Macule and Patch

Examples keloid (pictured below), lipoma, squamous cell carcinoma, poorly absorbed injection, and dermatofibroma.

Nodule:

Examples include larger lipoma and carcinoma.

of tumors

Circumscribed elevated, palpable mass containing serous fluid.

Vesicle and Bulla

Bullas are___ than 0.5 cm

greater

Vesicles are____ than 0.5 cm

less

Examples include herpes simplex/zoster, varicella, poison ivy, and second-degree burn

of vesicles

Examples include pemphigus, contact dermatitis, large burn blisters, poison ivy, and bullous impetigo.

of bulla

Elevated mass with transient borders that is often irregular

Wheal

Caused by movement of serous fluid into the dermis; it does not contain free fluid in a cavity (e.g., vesicle).

Wheal

Examples include urticaria (hives, pictured below) and insect bites

Wheal

Pus-filled vesicle or bulla.

Pustule

Examples include acne, impetigo, furuncles, and carbuncles.

Pustule

Encapsulated fluid-filled or semisolid mass that is located in the subcutaneous tissue or dermis.

Cyst

Cyst Examples include

sebaceous cyst and epidermoid cyst

Loss of superficial epidermis that does not extend to the dermis.

Erosion

It is a depressed, moist area. Examples include rupture vesicle, scratch mark, and aphthous ulcer (aphthous stomatitis, commonly called a canker sore,

Erosion

Skin loss extending past epidermis, with necrotic tissue loss.

Ulcer

Skin mark left after healing of wound or lesion that represents replacement by connective tissue of the injured tissue.

Scar (Cicatrix)

Linear crack in the skin that may extend to the dermis and may be painful.

FISSURE

Examples include chapped lips or hands and athlete’s foot.

Fissure

Round red or purple macule that is 1–2 mm in size. It is secondary to blood extravasation and associated with bleeding tendencies or emboli to skin.

Petechia

Round or irregular macular lesion that is larger than petechial lesion.

Ecchymosis

A localized collection of blood creating an elevated ecchymosis.

Hematoma

Papular and round, red or purple lesion found on the trunk or extremities.

Cherry Angioma

Red arteriole lesion with a central body with radiating branches. * It is usually noted on the face, neck, arms, and trunk.

Spider angioma

ABCDE:

o A for asymmetrical o B for borders that are irregular (uneven or notched) o C for color variations o D for diameter exceeding 1/8 to 1/4 of an inch o E for elevated, not flat.

Straight line, as in a scratch or streak.

Linear configuration

Linear configuration An example is

dermatographism.

Circular lesions

Annular Clustered configuration

Clustered configuration An example is

herpes simplex

* Individual and distinct lesions

Discrete configuration

Discrete configuration * An example is

multiple nevi

* Coin-shaped lesions

Nummular configuration

Nummular configuration An example is

nummular eczema

* Smaller lesions run together to form larger lesion.

Confluent configuration

Confluent configuration An example is

tinea versicolor

COMMON NAIL DISORDERS Parallel ridges running lengthwise. * May be seen in the elderly and some young people with no known etiology.

Longitudinal ridging

COMMON NAIL DISORDERS Nails that are half white on the upper proximal half and pink on the distal half. * May be seen in chronic renal disease.

Half-and-Half Nails

COMMON NAIL DISORDERS Seen with psoriasis.

Pitting

COMMON NAIL DISORDERS Spoon-shaped nails that may be seen with trauma to cuticles or nail folds or in iron deficiency anemia, endocrine or cardiac disease).

Koilonychia

COMMON NAIL DISORDERS Yellow nails grow slow and are curved. * May be seen in AIDS and respiratory syndromes.

Yellow Nail Syndrome

COMMON NAIL DISORDERS * Local infection in nails

Paronychia

Elevated, palpable, solid mass.

Papule and Plaque

Examples of include elevated nevi, warts, and lichen planus.

papules

Examples of include psoriasis (psoriasis vulgaris pictured below) and actinic keratosis.

plaques

Bluish or red lesion with varying shape (spider-like or linear) found on the legs and anterior chest.

Telangiectasis (Venous Star)