Chapt 13: Hair, Skin, Nails

Question 1

What is the epidermis? What layers is it made up of?

Answer 1

Cells are bound tightly together into sheets that form a rugged protective barrier.

Basal Cell Layer: forms new skin cells. Their major ingredient is the tough, fibrous protein keratin. The melanocytes interspersed along this layer produce the pigment melanin, which gives brown tones to the skin and hair.

Horny Cell Layer. This consists of dead keratinized cells that are interwoven and closely packed. The cells are constantly being shed, or desquamated, and are replaced with new cells from below.

The epidermis is completely replaced every 4 weeks.

Question 2

What is the dermis?

Answer 2

the inner supportive layer consisting mostly of connective tissue, or collagen.

Question 3

What is the subcutaneous layer?

Answer 3

adipose tissue, which is lobules of fat cells.

Question 4

What is vellus hair?

Answer 4

Fine, faint hair that covers most of the body (except the palms and soles, the dorsa of the distal parts of the fingers, the umbilicus, the glans penis, and inside the labia).

Question 5

What is terminal hair?

Answer 5

darker, thicker hair that grows on the scalp and eyebrows and, after puberty, on the axillae, the pubic area, and the face and chest in the male.

Question 6

What is sebum?

Answer 6

protective lipid substance which is secreted through the hair follicles. Sebum oils and lubricates the skin and hair and forms an emulsion with water that retards water loss from the skin.

Question 7

What are eccrine glands?

Answer 7

coiled tubules that open directly onto the skin surface and produce a dilute saline solution called sweat.

Question 8

What are apocrine glands?

Answer 8

glands produce a thick, milky secretion and open into the hair follicles. They are located mainly in the axillae, anogenital area, nipples, and navel and are vestigial in humans.

They become active during puberty, and secretion occurs with emotional and sexual stimulation.

Question 9

What are nails?

Answer 9

hard plates of keratin on the dorsal edges of the fingers and toes.

Question 10

Name 3 functions of the skin.

Answer 10

Protection.
Prevents penetration. (Acts as a barrier).
Perception.
Temperature regulation.
Identification.
Communication.
Wound repair.
Absorption and excretion.
Vitamin D production.

Question 11

What is lanugo?

Answer 11

fine downy hair of the newborn infant.

Question 12

What is vernix caseosa?

Answer 12

thick, cheesy substance made up of sebum and shed epithelial cells.

Question 13

What are keloids?

Answer 13

scars that form at the site of a wound and grow beyond the normal boundaries of the wound

Question 14

What is Pseudofolliculitis?

Answer 14

also known as “razor bumps” or “ingrown hairs,” is caused by shaving too closely with an electric or straight razor.

Question 15

What is Melasma?

Answer 15

“mask of pregnancy,” is a patchy tan-to–dark brown discoloration of the face.

Question 16

What is Pruritus?

Answer 16

Skin itching

Question 17

What medications can affect the skin?

Answer 17

Drugs, especially antibiotics, may cause allergic skin eruption. Drugs may increase
sunlight sensitivity and give burn response: sulfonamides, thiazide diuretics, oral
hypoglycemic agents, tetracycline. Drugs can cause hyperpigmentation: antimalarials,
anticancer agents, hormones, metals, and tetracycline.

Question 18

What is Alopecia?

Answer 18

Hair loss

Question 19

What is Hirsutism?

Answer 19

shaggy or excessive hair.

Question 20

What are freckles?

Answer 20

Small, flat macules of brown melanin pigment that occur on sun-exposed skin

Question 21

What is a mole?

Answer 21

A clump of melanocytes, tan-to-brown color, flat or raised. Acquired nevi have symmetry, small size (6 mm or less), smooth borders, and single uniform pigmentation.

Question 22

What is pallor?

Answer 22

When the red-pink tones from the oxygenated hemoglobin in the blood are lost, the skin takes on the color of connective tissue (collagen), which is mostly white.

Question 23

What is erythema?

Answer 23

Intense redness of the skin is from excess blood (hyperemia) in the dilated superficial capillaries. This sign is expected with fever, local inflammation, or emotional reactions such as blushing in vascular flush areas (cheeks, neck, and upper chest).

Question 24

What is cyanosis?

Answer 24

This is a bluish mottled color from decreased perfusion; the tissues have high levels of deoxygenated blood. This is best seen in the lips, nose, cheeks, ears, and oral mucous membranes and in artificial fluorescent light.

Question 25

What is jaundice?

Answer 25

yellowish skin color indicates rising amounts of bilirubin in the blood.

Question 26

How do we assess temperature?

Answer 26

Palpate the skin; it should be warm, and the temperature should be equal bilaterally; warmth suggests normal circulatory status.

Question 27

What is hypothermia?

Answer 27

Generalized coolness may be induced such as in hypothermia used for surgery or high fever. Localized coolness is expected with an immobilized extremity, as when a limb is in a cast or with an intravenous infusion.

Question 28

What is hyperthermia?

Answer 28

Generalized hyperthermia occurs with an increased metabolic rate such as in fever or after heavy exercise. A localized area feels hyperthermic with trauma, infection, or sunburn.

Question 29

What is diaphoresis?

Answer 29

profuse perspiration, accompanies an increased metabolic rate such as occurs in heavy activity or fever.

Question 30

Where can we look for dehydration?

Answer 30

oral mucous membranes. Normally there is none, and the mucous membranes look smooth and moist.

Question 31

What is edema? How is it evaluated?

Answer 31

fluid accumulating in the interstitial spaces; it is not present normally.

To check for edema, imprint your thumbs firmly for 3 to 4 seconds against the ankle malleolus or the tibia. Normally the skin surface stays smooth. If your pressure leaves a dent in the skin, “pitting” edema is present.

Question 32

What is mobility vs turgor? What does it reflect?

Answer 32

Mobility is the ease of skin to rise, and turgor is its ability to return to place promptly when released.

This reflects the elasticity of the skin.

Question 33

What are Cherry (senile) angiomas?

Answer 33

small (1 to 5 mm), smooth, slightly raised bright red dots that commonly appear on the trunk in all adults older than 30 years.

Question 34

What is a Macule?

Answer 34

Solely a color change, flat and circumscribed, of less than 1 cm. Examples: freckles, flat nevi,
hypopigmentation, petechiae, measles, scarlet fever.

Question 35

What is a Papule?

Answer 35

Something you can feel (i.e., solid, elevated, circumscribed, less than 1 cm diameter) caused by superficial thickening in epidermis. Examples: elevated nevus (mole), lichen planus, molluscum, wart (verruca).

Question 36

What is a patch?

Answer 36

Macules that are larger than 1 cm. Examples: mongolian spot, vitiligo, café au lait spot,
chloasma, measles rash.

Question 37

What is a plaque?

Answer 37

Papules coalesce to form surface elevation wider than 1 cm. A plateau-like, disk-shaped lesion. Examples: psoriasis, lichen planus.

Question 38

What is a nodule?

Answer 38

Solid, elevated, hard or soft, larger than 1 cm. May extend deeper into dermis than papule.
Examples: xanthoma, fibroma, intradermal nevi.

Question 39

What is a wheal?

Answer 39

Superficial, raised, transient, and erythematous; slightly irregular shape from edema (fluid held diffusely in the tissues). Examples: mosquito bite, allergic reaction, dermographism.

Question 40

What is a vesicle?

Answer 40

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.

Question 41

What is a bulla?

Answer 41

Larger than 1 cm diameter; usually single chambered (unilocular); superficial in epidermis; thin-walled and ruptures easily. Examples: friction blister, pemphigus, burns, contact dermatitis.

Question 42

What is a cyst?

Answer 42

Encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin.
Examples: sebaceous cyst, wen.

Question 43

What is a pustule?

Answer 43

Turbid fluid (pus) in the cavity. Circumscribed and elevated. Examples: impetigo, acne.

Question 44

What is a tumor?

Answer 44

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.

Question 45

What is a crust?

Answer 45

The thickened, dried-out exudate left when vesicles/pustules burst or dry up. Color
can be red-brown, honey, or yellow, depending on fluid ingredients (blood, serum,
pus). Examples: impetigo (dry, honey-colored), weeping eczematous dermatitis,
scab after abrasion.

Question 46

What is a scale?

Answer 46

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, micalike), seborrheic dermatitis (yellow, greasy

Question 47

What is a fissure?

Answer 47

Linear crack with abrupt edges; extends into dermis; dry or moist. Examples: cheilosis—at corners of mouth caused by excess moisture; athlete’s foot.

Question 48

What is an erosion?

Answer 48

Scooped out but shallow depression. Superficial; epidermis lost; moist but no bleeding; heals without scar because erosion does not extend into dermis.

Question 49

What is an ulcer?

Answer 49

Deeper depression extending into dermis, irregular shape; may bleed; leaves scar
when heals. Examples: stasis ulcer, pressure injury, chancre.

Question 50

What is excoriation?

Answer 50

Self-inflicted abrasion; superficial; sometimes crusted; scratches from intense itching. Examples: insect bites, scabies, dermatitis, varicella.

Question 51

What is a scar?

Answer 51

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.

Question 52

What is an atrophic scar?

Answer 52

The resulting skin level is depressed with loss of tissue; a thinning of the epidermis. Example: striae.

Question 53

What are pressure injuries?

Answer 53

appear on the skin over a bony prominence when circulation is impaired, e.g., when confined to bed or immobilized. Immobilization impedes delivery of blood carrying oxygen and nutrients to the skin, and it impedes venous drainage carrying metabolic wastes away from the skin. This results in ischemia and cell death.