Chapter 13 - Skin, Hair, and Nails Flashcards
Skin covers _____ m² of surface area on the average adult.
1.86
What is the role of the skin?
-protection
-temperature regulation
-sensory perception
-identification
-communication
-wound repair
-absorption and excretion
What is the outer layer of the skin called?
epidermis
What is the inner supportive layer of the skin called?
dermis
What is the 3rd deepest layer of the skin? What kind of tissue is it?
subcutaneous layer, adipose tissue
Which of the 3 skin layers is the thinnest?
epidermis
What is the role of the inner basal cell layer of the epidermis?
formation of new skin cells
What is the main ingredient of skin cells?
keratin - a fibrous protein
What is the role of melanin in the epidermis?
pigmentation
What impacts changes in hair and skin colour? A) amount of melanin B) amount of melanocytes
A
Above the basal layer is the _______ layer where new cells move up and flatten
horny cell layer
What makes up the horny cell layer?
dead keratinized cells
What does desquamated mean?
skin cells are being shed
The epidermis is completely replaced every ___ weeks
4
The epidermis is avascular meaning…
it does not have a blood supply
Where do blood vessels supply the skin?
dermis
What 3 things comprise skin colour?
- melanin (brown)
- carotene (yellow-orange)
- vascular bed (red-purple)
What is the dermis made of?
-connective tissue - mainly collagen
-elastic tissue
-nerves
-sensory receptors
-blood vessels
-lymphatic vessels
What is the role of collagen?
it is a tough protein that helps resist tearing
Appendages such as hair follicles, sebaceous glands, and sweat glands originate in the ______
dermis
What is the role of the subcutaneous layer?
-stores fat for energy
-insulation
-cushions
The visible part of hair is called the _______
shaft
What part of hair is embedded in the follicle?
root
Where are new hair cells produced at the root?
bulb matrix
What is the muscle around the hair follicle that elevates the hair in response to cold or emotion?
arrector pili muscle
What is vellus hair?
fine hair that covers most of the body
What is terminal hair?
thicker hair that grows on scalp, eyebrows, axillae, pubic area, face & chest (males)
Where are the hairless parts on the body?
-palms
-soles
-dorsa of distal parts of fingers
-umbilicus
-glans penis
-inside labia
What do sebaceous glands produce?
sebum
What does sebum do?
oil and lubricate skin, delays water loss
Where are sebaceous glands not found?
-palms
-soles
Where are sebaceous glands most abundant?
-scalp
-forehead
-face
-chin
What are eccrine sweat glands?
coiled tubules that open DIRECTLY onto skin surface and produce sweat
At what age do mature sweat glands appear?
2 months
What are apocrine glands?
sweat glands that produce a thick MILKY secretion and open into HAIR follicles
Where are apocrine glands located?
-axillae
-anogenital area
-nipples
-navel
When do apocrine glands activate?
puberty
When do apocrine glands secrete?
emotional and sexual stimulation
When do eccrine glands secrete?
temp. regulation
What produces body odour?
bacteria + apocrine sweat
Apocrine gland functioning ____________ in older adults
decreases
What are hair and nails made of?
keratin
What makes nails pink?
underlying vascularized epithelial cells
What is the lanula?
white, opaque, semi-lunar area at proximal end of nail
What is the nail matrix?
area where new keratinized cells are formed
What does the cuticle do?
cover and protect nail matrix
What vitamin does the skin produce?
D
Vitamin D is made by UV light converting ____________
cholesterol
Hair follicles develop at ___ months gestation
3
What is lanugo?
fine hair on newborn infants
What kind of hair is lanugo replaced by?
vellus hair
What is vernix caseosa?
thick, cheesy substance made of sebum and dead skin cells present at birth
Newborn skin is _______ permeable than adult skin
more
Why are infants at greater risk for fluid loss?
their skin is more permeable
What is the cause of milia and cradle cap in some babes?
sebum on skin in first few weeks of life
What is different about temperature regulation in babies?
-eccrine glands don’t sweat in response to heat
-skin can’t contract and shiver to protect against cold
How does skin and hair change during puberty?
-epidermis thickens, toughens, darkens
-skin is better lubricated
-accelerated hair growth
-increased apocrine gland secretion
-more active sebaceous glands
-subcutaneous fat deposits increase
-coarse pubic and axillary hair develops
How does the skin change during pregnancy?
increased pigmentation in areolae, nipples, vulva, midline of abdomen, face
Linea Nigra
midline of abdomen darkens during pregnancy
Cholasma
hyperpigmentation during pregnancy
What are striae gravidarum?
stretch marks on abdomen, breasts, thighs
During pregnancy sweat and sebaceous glands _______ secretion
increase
What are fat deposits used for during pregnancy?
maternal reserves for nursing baby
What happens to aging skin?
-elasticity lost
-folds
-sags
-thins
-dries
Loss of ________ increases risk for shearing and tearing injuries
collagen
Why are older adults at greatest risk for heat stroke?
sweat glands decreased response to heat
What are senile purpura?
dark red discoloured areas produced by minor trauma in older adults
The incidence of melanoma is ____x higher among individual with lighter skin
20
What is alcohol flush syndrome?
genetic condition characterized by redness, flushing, splotchy neck when alcohol is ingested
Alcohol flush syndrome occurs in 90% of individuals of ___________ decent and 50% of individuals of _________ decent
Indigenous, Asian
Pruritus
itching
What risk to tattoos pose?
Hepatitis C exposure
Hyperpigmentation
increase in colour
Hypopigmentation
loss of pigmentation
Pallor
paleness
Jaundice
yellowing usually caused by liver complications
Cyanosis
blue colour usually of oxygen depletion
Seborrhea
oily
Xerosis
dry
What is something to consider with multiple cuts or bruises?
abuse, frequent falls causes by neurological or cardiovascular origin, alcoholism or substance abuse
What are some medications that can cause an allergic skin reaction?
-aspirin
-antibiotics
-barbiturates
-some tonics
What are some meds that can increase sun sensitivity and produce a burn response?
-sulphonamides
-thiazide diuretics
-oral hypoglycaemic agents
-tetracycline
What are some medications that can cause hyperpigmentation?
-antimalarials
-antineoplastic agents
-hormones
-metals
-tetracycline
Alopecia
significant hair loss
Hirsutism
growth of male-pattern hair in women after puberty
Who is at most risk for developing skin cancer from prolonged UV exposure?
-have history of skin cancer
-younger than 18
-fair skinned
-have freckles or moles
-family history of skin cancer
-using medications that increase sensitivity to UV rays
-have a weakened immune system
-have a CDKN2A gene mutation
Use sunscreen with an SPF of ___ or higher and apply 20 mins before exposure and every __ to __ hours
30; 2-3hrs
Why are tanning beds more dangerous than the sun?
2-3x more UVA light exposure which is a known melanoma risk
Borrelia burgdorferi is the bacteria that causes ___________
Lyme disease
When is “tick season”?
late spring and summer
How can you accustom the patient to your touch at the start of the physical examination?
assess their hands and fingernails
Ephelides
freckles
Is it skin cancer? ABCDE
A - asymmetry
B - borders (defines or rugged)
C - colour
D - diameter (>1cm)
E - elevation (flat or raised)
Nevus
mole
Erythema
redness
Local Pallor
blood flow restriction, edema
Central Pallor
shock or anemia
Local Cyanosis
cold or anxiety
Central Cyanosis
cardiopulmonary condition
Local Jaundic
-sclera
-hard palate
-mucus membranes
Central Jaundice
liver issue
Carotenemia
jaundice in babies from eating orange foods
How does pallor appear in dark-skinned people?
-absence of underlying red tones
-loss of lustre
-lips
-nail beds
-ashen gray
What is the preffered site of assessing pallor in dark-skinned people?
palpebral conjunctiva and nail beds
Local Erythema
fever, local inflammation, blushing
How do you observe cyanosis in dark-skinned patients?
other signs such as changes in LOC or signs of respiratory distress
What does jaundice indicate?
rising amount of bilirubin in blood
Diaphoresis
profuse perspiration
What part of your hand do you use to assess temperature?
dorsal surface
How do you check for edema?
imprint your thumbs firmly against the ankle malleolus or tibia, if your pressure leaves a dent then edema is present
Grade 1 Edema
mild pitting, slight indentation, no perceptible swelling of the leg
Grade 2 Edema
moderate pitting, indentation subsides rapidly
Grade 3 Edema
deep pitting, indentation remains for a short time, swelling of the leg
Grade 4 Edema
very deep pitting, lasts a long time
How do you assess skin mobility and turgor?
grasp skin between thumb and index finger or under clavicle and the skin returns to place
What are cherry angiomas?
small (1-5mm), smooth, slightly raised bright red spots
Who commonly has cherry angiomas?
adults >30yoa
Are cherry angiomas concerning?
no
Ecchymosis
bruising
What tool is used for wound prevention?
Braden Scale
Seborrhea
dandruff
Nails should curve at about _____ degrees from cuticle to nail bed
160
What is clubbing?
in turning of nails, a sign of COPD due to decreased O2
What is a mongolian spot?
hyperpigmentation, macular area on buttocks in newborns of Indigenous, African, East Indian, or Hispanic descent
What is a cafe au lait spot?
large patch of light brown pigmentation
What is erythema toxicum?
rash that appear in first 3-4 day of life, of tiny red macules, cause unknown no Tx needed
Acrocyanosis
-bluish colour around the lips, on hands, fingernails, feet, and toenails
-lasts a few hours
-disappears with warming
Cutis marmorata
transient (short-term) mottling (blotchy red marbling) in response to cool room temperatures
Physiological jaundice (newborns)
-occurs in 50% of newborns
-due to increased hemolysis creating bilirubin
Carotenemia doesn’t yellow the ________ or mucous membranes
sclera
What causes carotenemia?
ingestion of a large amount of foods containing carotene
What are milia?
white papules on face caused by sebum that resolve in a few weeks
Where do you test mobility and turgor in an infant?
over the abdomen
What is a storkbite?
a flat irregular shaped red or pink patch found on forehead, eyelid, upper lip, or back of neck that is present at birth and usually fades in the first year
dark-skinned newborns have _______ lanugo than light-skinned newborns
more
What are striae?
jagged linear “stretch marks” on pregnant women that occur in half of pregnancies
Vascular spiders
occur in 2/3 of pregnancies
Senile lentigines
small, flat, brown macules that appear on older adults usually after sun exposure and are not malignant or requiring treatment
What are keratoses?
raised, thickened lesions of pigmentation that look scaly and warty and are uncommon to be cancerous
Actinic Keratosis
less common, scaly plaques that become raised and rough and are premalignant
Acrochordons
skin tags
Sebaceous hyperplasia
raised yellow papules with a central depression common in older men
Skin tenting
skin turgor decreased and so it stands by itself
What are the components of the Braden scale?
-sensory perception
-moisture
-activity
-mobility
-nutrition
-friction and shear
How does CO posioning appear in light-skin people?
bright cherry red in face and upper torso
How does CO poisoning appear in dark-skin people?
cherry red in nail bed, lips, and oral mucosa
Where is jaundice in dark-skinned people most noted?
hard and soft palate, palms
What are annular lesions?
circular lesions that begin in centre and spread to periphery
What is an example of annular lesions?
tinea corporis (ringworm)
What are confluent lesions?
lesions that merge together
What is an example of confluent lesions?
urticaria (hives)
What are discrete lesions?
distinct, individual lesions that remain separate
What is an example of a discrete lesion?
molluscum
What are grouped lesions?
clusters of lesions
What is an example of grouped lesions?
vesicles of contact dermatitis
What are gyrate lesions?
twisted, coiled, spiral, snakelike lesions
What is another name for target lesions?
iris lesions
What are target lesions?
concentric rings of colour in the lesions
What is an example of target lesions?
erythema multiforme
What are linear lesions?
a scratch, streak, line, or stripe
What are polycyclic lesions?
annular lesions that grow together
What is an example of polycyclic lesions?
-lichen planus
-psoriasis
What are zosteriform lesions?
linear arrangement along a nerve route
What is an example of zosteriform lesions?
herpes zoster
Macule, patch, nodule, tumour, vesicle, bulla, papules, plaque, wheal, urticaria, cyst, and pustule are all ____________ lesions
primary
What is a macule lesion?
-a colour change
-flat and circumscribed
-<1cm diameter
What are some examples of macules?
freckles, flat nevi, petechiae, measles
Papule
What is a patch lesion?
macules >1cm diameter
What are some examples of patch lesions?
vitiligo, cafe au lait
Plaque
What is a nodule lesion?
a solid, elevated, hard or soft, >1cm diammeter
What are some examples of nodules?
xanthoma, fibroma
Wheal
What is a tumour lesion?
-larger than a few cm
-firm or soft
-can be malignant or benign
Urticaria
What is a vesicle lesion?
-aka blister
-contains free fluid
-elevated
What is an example of a vesicle lesion?
-herpes simplex
-early varicella
Cyst
What is a bulla lesions?
-single chambered
-superficial in epidermis
->1cm diameter
-thin walled
What is a bulla example?
friction blister, burn
What is a pustule lesion?
-cavity filled with pus
-circumscribed
-elevated
What is an example of a pustule?
acne
Crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, lichenification, and keloid are all ______________ lesions
secondary
Look over pictures of other lesions
