Assessment: Skin, Hair, Nails Flashcards
What is the name of a lesion that is circular, begins int he center and spreads to the periphery
(e.g. tinea corporis or ringworm, tinea versicolor, pityriasis rosea)
Annular
What is the name of a lesion where the lesions run together (e.g. urticaria [hives])
Confluent
What is the name of a lesion that is distinct and individual, remains separate (e.g. acrochordon or skin tags, acne)
Discrete
What is the name of a lesion that is twisted, coiled spiral, snakelike?
Gyrate
What is the configuration of a lesion that is clustered (e.g. vesicles of contact dermatitis)?
Grouped
What is the shape of a lesion that is a streak, line, stripe, or scratch?
Linear
What is the configuration of a lesion that is made of concentric rings of color (e.g. as we would see with Lyme’s disease, erythema multiforme)
Target
What is the configuration of a lesion that is linear in arrangement along a unilateral nerve route (e.g. herpes zoster).
Zosteriform
What is the configuration of a lesion that is made up of annular (circular) lesions that grow together (e.g. lichen planus, psoriasis).
Polycyclic
Describe a “macule” lesion
Soley a color change, flat and circumscribed,
Describe a “patch” lesion
Macules that are > 1 cm. Examples: Mongolian spot, vitiligo, cafe au lait spot, chloasma, measles rash.
Describe a “nodule” lesion
Solid, elevated, hard or soft, larger than 1 cm. May extend deeper into dermis than papule. Examples: Xanthoma, fibroma, intradermal nevi
Describe a “tumor” lesion
Larger than a few centimeters in diameter, firm or soft, deeper into dermis; may be benign or malignant, although “tumor” implies “cancer” to most people. Examples: lipoma, hemangioma
Describe a “papule” lesion
Something you can “feel” (i.e. solid, elevated, circumscribed,
Describe a “plaque” lesion
Papules coalesce to form surface elevation wider than 1 cm. A plateau-like, disk-shaped lesion. Examples: psoriasis, lichen planus.
Describe a “wheal” lesion
Superficial, raised, transient, and erythematous; slightly irregular shape due to edema. Examples: Mosquito bite, allergic reaction, dermographism
Describe an “urticaria” (hives) lesion
Wheals coalesce to form extensive reaction, intensely pruritic
Describe a “vesicle” lesion
Elevated cavity containing free fluid, up to 1 cm; a “blister”. Clear serum flows if wall is ruptured. Examples: herpes simplex, early varicella (chickenpox), herpes zoster (shingles), contact dermatitis.
Describe a “bulla” lesion
Larger than 1 cm diameter; usually single chambered (unilocular); superficial in epidermis; it is thin walled, so it ruptures easily. Examples: friction blister, pemphigus, burns, contact dermatis
Describe a “cyst” lesion
An encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin. Examples: sebaceous cyst, wen.
Describe a “pustule” lesion
Turbid fluid (pus) in the cavity. Circumscribed and elevated. Examples: impetigo, acne
Describe a “crust” lesion
The thickened, dried-out exudate left when vesicles/pustules burst or dry up. Color can be red-brown, honey, or yellow, depending on the fluid’s ingredients (blood, serum, pus). Examples: Impetigo (dry, honey-colored), weeping eczematous dermatitis, scab after abrasion
Describe a “scale” lesion
Compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells. Examples: after scarlet fever or drug reaction (laminated sheets), psoriasis (silver, mica-like), seborrheic dermatitis (yellow, greasy), eczema, ichthyosis (large, adherent, laminated), dry skin.
Describe a “fissure” break in the skin
Linear crack with abrupt edges, extends into dermis, dry or moist. Examples: cheilosis - at corners of mouth due to excess moisture; athlete’s foot.
Describe an “erosion” break in the skin
Scooped out but shallow depression. Superficial; epidermis lost; moist but no bleeding; heals without scar because erosion does not extend into dermis.
Describe an “ulcer” break in the skin
Deeper depression extending into dermis, irregular shape; may bleed; leaves scar when heals. Examples: Stasis ulcer, pressure sore, chancre
Describe an “excoriation” break in the skin
Self-inflicted; Superficial; sometimes crusted; scratches from intense itching. Examples: insect bites, scabies, dermatitis, varicella
Describe a “scar”
After a skin lesion is repaired, normal tissue is lost and replaced with connective tissue (collagen). This is a permanent fibrotic change. Examples: healed area of surgery or injury, acne
Describe an “atrophic scar”
The resulting skin level is depressed with loss of tissue; a thinning of the epidermis. Example: striae
Describe a “lichenfication” lesion
Prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (or lichen)
Describe a “keloid” lesion
A hypertrophic scar. The resulting skin level is elevated by excess scar tissue, which is invasive beyond the site of original injury. May increase long after healing occurs. Looks smooth, rubbery, and has a higher incidence among Blacks.
What are risk factors for pressure ulcers?
Impaired mobility; thin fragile skin from aging; decreased sensory perception (unable to respond to pain); impaired level of consciousness; moisture; incontinence; shearing (being pulled down or across the bed); poor nutrition; infection
What does a “stage I pressure ulcer” look like?
Intact skin appear red but unbroken. Localized redness in lightly pigmented skin will blanch (turns light with fingertip pressure). Dark skin appears darker but does not blanch.
What does a “stage II pressure ulcer” look like?
Partial-thickness skin erosion with loss of epidermis or also the dermis. Superficial ulcer looks shallow like an abrasion or open blister with a red-pink wound bed.
What does a “stage III pressure ulcer” look like?
Full-thickness pressure ulcer extending into the subcutaneous tissue and resembling a crater. May see subcutaneous fat but not muscle, bone, or tendon.
What does a “stage IV pressure ulcer” look like?
Full-thickness pressure ulcer involves all skin layers and extends into supporting tissue. Exposes muscle, tendon, or bone, and may show slough (stringy matter attached to wound bed) or eschar (black or brown necrotic tissue).
What is a lack of color in an area of skin called?
Hypopigmentation
What is an increase in color in an area of skin called?
Hyperpigmentation
What changes in moles should we question?
Changes in color, size, shape, sudden tenderness, bleeding, itching.
What does “seborrhea” mean?
oily
What are some observations we can make when assessing a rash or lesion?
When did you first notice it?
Where did it start?
Where did it spread?
Color?
Raised or flat? Any crust, odor? Does it feel tender, warm?
How long have you had it?
Anyone at home/work with similar rash? Have you been camping, acquired a new pet, tried a new food/drug? Does the rash come with stress?
What home care have you tried for it? Do any make it better/worse?
Any itching, fever?
Has the lesion affected your ability to function?
What is “alopecia”?
A significant loss of hair
What is “hirsutism”?
Shaggy or excessive hair
True or False: Acne is caused by factors such as poor diet, oily complexion, or contagion?
False. The cause is still unknown.
What is “vitiligo”?
The complete absence of melanin pigment in patchy areas of white or light skin. Can occur in all races.
What are “danger signs”, or abnormal characteristics of lesions (think ABCDE)?
A = Asymmetry B = Border irregularity C = Color variation (areas of brown, tan, black, blue, red, white, or combination D = Diameter (>6 mm) E = Elevation or Enlargement
What areas of skin may be best to assess on dark skinned individuals?
Under the tongue, buccal mucosa, palpebral conjunctiva, nail beds, and sclera
How can we assess for dehydration?
Inspect mucous membranes; Test skin fold for turgor
What are the grades of edema?
1+ Mild pitting, slight indentation, no perceptible swelling of the leg
2+ Moderate pitting, indentation subsides rapidly
3+ Deep pitting, indentation remains for a short time, leg looks swollen
4+ Very deep pitting, indentation lasts a long time, leg is very swollen
What is generalized edema of the whole body?
Anasarca
What is a normal angle of the nail bed?
160 degrees
What does early clubbing of a nail look like?
Nail straightens to 180 degrees
In a newborn, what is “erythema toxicum”?
A common rash that appears in the first 3-4 days of life. Consists of tiny red macules and papules on the cheeks, trunk, chest, back, and buttocks. No treatment needed.
How would anemia look in Light vs. Dark skin
Light: Generalized pallor
Dark: Brown skin is yellow-brown, dull; Black skin appears ashen gray, dull (check conjunctivae, mucous membranes
How would local arterial insufficiency look in Light vs. Dark skin
Light: Marked localized pallor (e.g. lower extremities, especially when elevated)
Dark: Ashen gray, dull; cool to palpatation
