ASSESSMENT OF THE SKIN, HAIR, AND NAILS Flashcards
is a physical barrier that protects the underlying tissues and
structures from microorganism, physical trauma, ultraviolet
radiation and dehydration.
SKIN
SKIN
composed of three layers:
o Epidermis
o Dermis
o Subcutaneous Tissue
EPIDERMIS
* the outer layer of skin.
* 4 distinct layers
stratum corneum
stratum lucidum
stratum granulosum
stratum germativum (stratum basale)
outermost layer; consists of dead, keratinized
cells that render the skin waterproof; replaced
every 3 to 4 weeks
stratum corneum
only layer that undergoes cell division;
contains melanin and keratinocyte (keratin-
forming cells)
stratum germativum (stratum basale)
the inner layer of the skin.
DERMIS
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
secrete an oily substance called sebum that
lubricates hair and skin and reduces water
loss through the skin.
Sebaceous Glands
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
are concentrated in the
axillae, perineum, and areolae of the breast
and are usually open through a hair follicle.
Sweat Glands
Apocrine glands
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
(particularly scalp and eyebrows) is
longer, generally darker, and coarser than vellus
hair.
Terminal Hair
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
HAIR
Structures
o Follicle
o Bulb
o Shaft
o Root
located on the distal phalanges of fingers and toes, are
hard, transparent plates of keratinized epidermal cells that
grow from the cuticle
NAILS
o layer of clear skin located along the bottom edge of
your finger or toe.
- Cuticle
is short, pale, fine, and
present over much of the body.
Vellus hair (peach fuzz)
o extends over the entire nailbed and has a pink tinge
as a result of the rich blood supply underneath.
- Nail Body
o a paler, crescent shaped area.
- Lunula
(loss of color) is seen in arterial insufficiency,
decreased blood supply, and anemia. Pallid tones vary from
pale to ashen without underlying pink.
Pallor
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
results from a cardiopulmonary problem,
whereas peripheral cyanosis may be a local problem
resulting from vasoconstriction.
Central cyanosis
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
is roughening and darkening of skin
in localized areas, especially the posterior neck.
Acanthosis nigricans
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)
