Chapter 5: The Integumentary System Flashcards
What is the integumentary system?
The skin along with its accessory organs (hair, nails, glands); skin is the largest organ in the body.
Accessory organs of the integumentary system:
Hair, nails, glands.
Androgen
Genetic term for agent (usually testosterone or androsterone) that stimulates the development of male characteristics.
Ductule
Very small duct
Homeostasis
State of equilibrium of the internal environment of the body despite changes in the external environment.
Synthsize
Forming a complex substance by the union of simpler compounds or elements.
Functions of the skin:
Protects underlying structures from injury.
Provides sensory info to the brain.
Protects the body from UV rays.
Regulates body temperature.
Prevents dehydration.
Acts as a reservoir for food and water.
Synthesizes Vitamin D when exposed to sunlight.
Epidermis
Outermost layer of the skin that’s thickest on the palms and soles. Separated into strata (different layers).
Strata of the epidermis:
Stratum corneum (top), basal layer (bottom); takes ~1 month for cells formed in the basal layer to slough off the stratum corneum.
Stratum corneum
Composed of dead, flat cells that lack blood supply and sensory receptors.
Basal layer
Only layer of the epidermis that contains living cells, where new cells are formed. These move toward the stratum corneum to replace the cells that have been sloughed off.
Keratin
Hardened skin cells with a waterproof characteristic that prevents evaporation of fluids and prevents moisture from entering the body.
Melanocytes
Cells that produce a black pigment called melanin
Melanin
Responsible for different skin colors; dark-skinned people have high melanin production, light skinned people have little-no melanin production. Provides a protective barrier from the Sun’s UV rays; moderate Sun exposure results in suntan, high exposure results in sunburn. Local accumulations of melanin result in freckles/moles.
Albino
An individual that has absence of pigment in the skin, hair and eyes as a result of an inherited inability to produce melanin.
Dermis
Second layer of the skin, also called the corium. Composed of living tissue and contains capillaries, lymphatic vessels, nerve endings, hair follicles, sebaceous (oil) glands, and sudoriferous (sweat) glands.
Subcutaneous layer
Also called the hypodermis, binds the dermis to underlying structures, stores fats, insulates/cushions the body, and regulates temperature. Is composed of connective and adipose tissue interlaced with blood vessels.
2 types of glands in the skin:
Sudoriferous (sweat)
Sebaceous (oil)
Both are exocrine glands because they secrete substances through ducts outside the body rather than into the bloodstream.
Sudoriferous glands
Secrete sweat onto the skin’s surface through pores, most plentiful on the palms, soles, forehead, and axillae. Main function is to cool the body by evaporation, excrete waste products, and moisten surface cells.
Sebaceous glands
Filled with cells, whose centers contain fatty droplets; when these disintegrate they release sebum. The acidic nature of sebum helps destroy harmful organisms on the skin and prevent infection. When the ductules of these glands get blocked, this forms acne. Present everywhere on the body except for the palms of hands/soles of feet.
Androgens
Hormone that regulates the production of sebum; increased during adolescence and decreased with age.
Hair
Found on all body parts except lips, nipples, palms, soles, and part of external genetalia.
Parts of a hair:
Hair shaft
Hair root (contains hair follicle)
Papilla
Hair shaft
visible part of the hair
Hair root
part that’s embedded in the dermis.
Hair follicle
the hair root together with its coverings
Papilla
loop of capillaries enclosed in a covering beneath the hair follicle.
Alopecia
baldness, occurs when the hairs of the scalp aren’t replaced because of death of the papillae.
Nails
Protect the fingertips/toes from injuries and bruises.
Formed in the nail root.
Composed of keratinized, stratified, squamous epithelial cells the produce a tough covering.
Nail root
where the nail begins forming; slides over a section called the nailbed, which is continuous with the epithelium of the skin.
Nail body
appears pink because of underlying vascular tissue
Lunula
Half-moon shaped area at the base of the nail; where nail growth occurs.
adip/o
lip/o
steat/o
fat
adip/o/sis: abnormal condition of fat.
lip/oma: fat tumor
steat/itis: inflammation of fat
cutane/o
dermat/o
derm/o
skin
sub/cutane/ous: pertaining to below the skin.
dermat/o/plasty: surgical repair of the skin.
hypo/derm/ic: pertaining to below the skin.
hidr/o
sudor/o
sweat
hidr/aden/itis: inflammation of a sweat gland.
sudor/esis: condition of sweat.
ichthy/o
dry, scaly
ichthy/osis: abnormal condition of dry, scaly skin.
kerat/o
horny tissue; hard; cornea
kerat/osis: abnormal condition of hardened skin.
melan/o
black
melan/oma: tumor made of black skin cells.
myc/o
fungus
dermat/o/mycosis: abnormal condition of skin fungus.
onych/o
ungu/o
nail
onych/o/malacia: softening of the nail.
ungu/al: pertaining to the nail.
pil/o
trich/o
hair
pil/o/nid/al: pertaining to a hair nest.
trich/o/pathy: disease of the hair.
seb/o
sebum, sebaceous
seb/o/rrhea: discharge of sebum.
squam/o
scale
squam/ous: pertaining to scales
scler/o
hardening
scler/o/derma: skin hardening
xen/o
foreign; strange
xen/o/graft: transplantation of foreign (material)
xer/o
dry
xer/o/derma: dry skin.
-cyte
cell
lip/o/cyte: cell composed of fat.
-derma
skin
py/o/derma: skin pus.
-logist
specialist in the study of
dermat/o/logist: specialist in the study of skin.
-logy
study of
dermat/o/logy: study of the skin.
-therapy
treatment
cry/o/therapy: cold treatment.
an-
without, not
an/hidr/osis: abnormal condition of not sweating.
epi-
above, upon
epi/dermis: upon the skin
homo-
same
homo/graft: transplantation of same (material)
What disease can pale skin indicate?
shock
What disease can red, flushed, warm skin indicate?
fever or infection
What does a rash indicate?
allergies or a local infection
What may chewed fingernails indicate?
emotional issues
Dermatology
The medical specialty concerned with diseases that directly affect the skin, and systemic diseases that manifest their effects on the skin.
Dermatologist
a physician who specializes in the diagnosis and treatment of skin conditions.
Skin lesions
areas of tissue that have been pathologically altered by injury, wound, or infection.
Localized lesions
tissue affected over a definite area.
Systemic lesions
widely spread throughout the body.
Primary lesions
initial reaction to pathologically altered tissue, may be flat or elevated.
Secondary lesions
Changes that take place in the primary lesion as a result of infection, scratching, trauma, or various stages of disease.
Types of flat (primary) lesions
macule
Macule
flat, pigmented, circumscribed area < 1 cm in diameter.
freckle, flat mole, or rash that occurs in rubella.
Elevated (primary) solid lesions
papule
nodule
tumor
wheal
Papule
Solid, elevated lesion < 1 cm in diameter that may be the same color as the skin or pigmented.
Nevus, wart, pimple, ringworm, psoriasis, eczema.
Nodule
Palpable, circumscribed lesion, larger/deeper than a papule (0.6-2 cm in diameter); extends into the dermis.
Intradermal nevus, benign or malignant tumor.
Tumor
Solid, elevated lesion > 2 cm in diameter that extends into the dermal and subcutaneous layers.
Lipoma, steatoma, dermatofibroma, and hemangioma.
Wheal
Elevated, firm, rounded lesion with localized skin edema that varies in size, shape, and color; paler in the center than its surrounding edges; accompanied by itching.
bites, urticaria
Elevated (primary) fluid-filled lesions
vesicle
pustule
bulla
Vesicle
Elevated, circumscribed, fluid-filled lesion < 0.5 cm in diameter.
poison ivy, shingles, chicken pox.
Pustule
small, raised, circumscribed lesion that contains pus; usually < 1 cm in diameter.
acne, furuncle, pustular psoriasis, scabies.
Bulla
A vesicle or blister > 1 cm in diameter.
second-degree burns, severe poison oak, poison ivy.
Depressed (secondary) lesions
Caused by loss of skin surface:
excoriations
fissure
ulcer
Excoriations
Linear scratch marks or traumatized abrasions of the epidermis.
scratches, abrasions, chemical/thermal burns.
Fissure
Small slit or crack-like sore that extends into the dermal layer; could be caused by continuous inflammation and drying.
Ulcer
An open sore or lesion that extends to the dermis and usually heals with scarring.
Pressure sore, basal cell carcinoma.
Burns
Tissue injuries caused by contact with thermal, chemical, electrical, or radioactive agents. Systemic effects may include dehydration, shock, and infection. Extent of injury and degree of severity determine a burn’s classification.
First-degree (superficial) burn
Least serious type of burn; injures only the epidermis. Caused by brief contact with dry/moist heat (thermal), spending too much time in the sun (sunburn), or exposure to chemicals (chemical). Extent of injury includes local erythema and hyperesthesia; no blistering or scarring.
Second-degree (partial-thickness) burn
Deep, damage the epidermis and part of the dermis; caused by contact with flames, hot liquids, or chemicals. Sx mimic those of first-degree burns, but blisters form. May heal with little to no scarring.
Third-degree (full-thickness) burn
Epidermis and dermis are destroyed and some of the underlying connective tissue is damaged. Skin looks waxy and charred and becomes insensitive to touch. Because of extensive damage, ulcerating wounds may develop and the body attempts to heal with scar tissue.
Rule of Nines
Formula for estimating the percentage of body surface area affected by burns. Assigns values of 9% or 18% to the surface area of specific regions of the body. Formula is modified for infants/kids because of their proportionally larger head size.
Why’s it important to know the amount of burned surface area on the body?
Determines tx, because the patient will require IV fluids for hydration to replace lost fluids from tissue damage.
Neoplasms
Abnormal growths of new tissue that are classified as either benign or malignant.
Benign neoplasms
non-cancerous growths composed of the same type of cells as the tissue they’re growing upon. Only dangerous if they place pressure on, or interfere with the functioning of, surrounding structures.
Malignant neoplasms (cancer)
Composed of cells that tend to become invasive and spread to remote regions of the body to form secondary tumor sites. Tends to be progressive, and generally fatal, if left untreated. Treatment includes surgery, chemotherapy, radiation,, and immunotherapy.
Metastasis
Process of cancer spreading to remote regions of the body and forming secondary tumor sites.
Immunotherapy (biotherapy)
Stimulates the body’s own immune defenses to fight tumor cells.
Combined-modality treatment
Combination of cancer treatments to provide the most effective result.
Pathologists
Grade and stage tumors to help in the diagnosis and treatment planning, provide possible prognosis, and aid in the compensation of treatment results when different methods are used.
Tumor grading
When cells from the tumor site are evaluated to determine how closely the biopsied tissue resembles normal tissue.
Grade I
Cells from the tumor are differentiated. They have a close resemblance to the tissue of origin and retain some specialized functions.
Grade II
Tumor cells are moderately or poorly differentiated. They have less resemblance to the origin tissue; marked variation of shape and size of tumor cells; greatly increased mitoses.
Grade III
Tumor cells are poorly differentiated. Increased abnormality of appearance, with only remote resemblance to the origin tissue. Marked variation of shape and size of tumor cells; greatly increased mitoses.
Grade IV
Tumor cells very poorly differentiated. Abnormal appearance to the extent that recognition of the tumor’s origin tissue is difficult; extreme variation of size and shape of tumor cells.
TNM
Tumor-Node-Metastasis; most common method used to stage cancers. Classifies tumors by size and degree of spread.
T in TNM stands for…
Size and invasiveness of the primary tumor.
N in TNM stands for…
Area lymph nodes involved.
M in TNM stands for..
Invasiveness (metastasis) of primary tumor.
Basal cell carcinoma
Most common form of skin cancer; is a malignancy of the basal layer of the epidermis or hair follicles. Tumors are locally invasive, but rarely metastasize. Most common malignant tumor affecting white people. Grow slowly and ulcerate as they increase in size; may develop a crust.
What’s the cause of basal cell carcinoma?
Overexposure to sunlight.
Squamous cell carcinoma
Arises from skin that undergoes pathological keratinizing (hardening) of epidermal cells. Invasive with the potential for metastasis. At-risk population includes white males over 60 and people who spend a lot of time in the Sun’s UV rays.
2 types of squamous cell carcinoma:
In situ and invasive
In situ squamous cell carcinoma
confined to the original site
Invasive squamous cell carcinoma
Penetrates the surrounding tissue
Malignant melanoma
Malignant growth of melanocytes. Highly metastatic with a higher mortality rate than squamous or basal cell carcinomas; most lethal skin cancer. Those with fair complexions have the greatest risk of developing this, along with severe exposure to sunlight and severe sunburns in childhood. Diagnosed by biopsy and histological examination.
Abscess
Localized collection of pus at the site of an infection (characteristically a staph infection)
Acne (acne vulgaris)
Inflammatory disease of the sebaceous glands and hair follicles of the skin with characteristic lesions that include blackheads (comedos), inflammatory papules, pustules, nodules, and cysts that are usually associated with seborrhea.
Bowen Disease
Very early form of skin cancer that’s easily curable and characterized by a red, scaly patch on the skin. Also called squamous cell carcinoma in situ.
Cellulitis
Diffuse, acute infection of the skin and subcutaneous tissue. Characterized by a light, glossy appearance of the skin, localized heat, erythema, pain, and swelling, occasionally with fever, malaise, and chills.
Chloasma
Pigmentary skin discoloration, usually occurs in yellow/brown patches or spots.
Comedo
Typical small skin lesion of acne vulgaris caused by accumulation of bacteria, keratin, and dried sebum plugging an excretory ductule of the skin. Closed version is called a whitehead; consists of a papule from which the contents aren’t easily expressed.
Decubitus ulcer
Also known as a bed sore, this is an inflammation, sore, or skin deterioration caused by prolonged pressure from lying in one position that prevents blood flow to tissues, usually in elderly, bed-ridden persons. Most commonly found on skin overlying bony projections.
Ecchymosis
Skin discoloration that consists of a large, irregularly formed hemorrhagic area with colors changing from bluish-black to yellowish-green. Commonly called a bruise.
Eczema
Chronic inflammatory skin condition characterized by erythema, papules, vesicles, pustules, scales, crust, and scabs and accompanied by intense pruritis. Also called atopic dermatitis. Most commonly occurs in infancy and childhood, decreases with adolescence and adulthood. Tends to occur in patients with a history of allergies.
Erythema
Redness of the skin caused by swelling of the capillaries (i.e., sunburn, mild blushing)
Eschar
Dead matter that’s sloughed off from the surface of the skin, especially after a burn. Commonly crusted or scabbed.
Impetigo
Bacterial skin infection characterized by isolated pustules that become crusted and rupture.
Keratosis
Thickened area of the epidermis or any growth on the skin (such as a callus or wart).
Lentigo
Small brown macules, especially on the face and arms, brought on by Sun exposure, usually in older people. Benign, pigmented lesions of the skin that require no treatment unless cosmetic repair is desired.
Pallor
Unnatural paleness or absence of color in the skin.
Pediculosis
Infestation of lice, transmitted by personal contact or common use of brushes, combs, or headgear.
Petechia
Minute, pinpoint hemorrhage under the skin; smaller version of ecchymosis.
Pruritis
Intense itching
Psoriasis
Chronic skin disease characterized by itchy red patches covered by thick, silvery, dry scales and caused by excessive development of the basal layer of the epidermis. New lesions tend to appear at sites of trauma.
Purpura
Any of several bleeding disorders characterized by hemorrhage into the tissue, particularly beneath the skin or mucous membranes, producing ecchymosis/petechiae. Total course of the disease is 2-3 weeks.
Scabies
Contagious skin disease transmitted by the itch mite, commonly through sexual contact. Manifests as papules, vesicles, and pustules, and burrows that cause intense itching; commonly results in secondary infections.
Tinea
Fungal skin infection, commonly called ringworm, whose name indicates the affected part of the body.
Urticaria
Allergic reaction of the skin characterized by the eruption of pale, red, elevated patches called wheals or hives.
Verruca
Epidermal growth caused by a virus; also known as warts that can regrow after removal if the virus remains in the skin. Can be removed by cryosurgery, electrocautery, or acids.
Vitiligo
Localized loss of skin pigmentation characterized by milk-white patches.
Allergy skin test
Any test which a suspected allergen or sensitizer is applied to, or injected in, the skin to determine the patient’s sensitivity to it.
Intradermal allergy skin test
Skin test that identifies suspected allergens by subcutaneously injecting small amounts of extracts of the suspected allergens and observing the skin for a subsequent reaction.
Patch allergy skin test
Skin test that identifies allergic contact dermatitis by applying a suspected allergen to a patch, which is then taped to the skin (usually the forearm), and observing the area 24 hours later for a response.
Scratch allergy skin test
Skin test that identifies suspected allergens by placing a small quantity of the suspected allergen on a lightly scratched area of the skin; also called a puncture test or prick test.
Culture & Sensitivity (C&S)
Lab test to determine the presence of pathogens in patients with suspected wound infections and identify the appropriate drug therapy to which the organism responds (sensitivity)
Biopsy (Bx, bx)
Representative tissue sample is removed from a body site for microscopic examination to establish/confirm a diagnosis.
Frozen section (FS)
Ultrathin slice of tissue from a frozen specimen for immediate pathological examination.
Needle (procedure)
Removal of a small tissue sample for examination using a hollow needle, usually attached to a syrigne.
Punch (procedure)
Removal of a small core tissue using a hollow punch.
Shave (procedure)
Removal of an elevated lesion using a surgical blade.
Mohs procedure
Procedure that involves progressive removal and examination of layers of cancer-containing skin until only cancer-free tissue remains. Also called micrographic surgery.
Skin graft
Transplantation of healthy tissue to an injured site. Can be human, animal, or artificial skin to provide either a temporary or permanent covering over a wound or burn.
Allograft
Transplantation of healthy tissue from one person to another person; also called a homograft. Skin donor is usually a cadaver. This type is usually temporary to protect a patient against infection and fluid loss. Frozen and stored in a skin bank until needed.
Autograft
Transplantation of tissue from one site to another site in the same individual.
Synthetic skin graft
Transplantation of artificial skin produced from collagen fibers arranged in a lattice pattern.
Xenograft
Transplantation (dermis only) from a foreign donor (usually a pig) and transferred to a human; also called a heterograft.
Chemical Peel
Chemical removal of the outer layers of skin to treat acne scarring and general keratoses; also called chemabrasions.
Cryosurgery
Use of subfreezing temp (commonly liquid Nitrogen) to destroy or eliminate abnormal tissue, such as tumors, warts, and unwanted, cancerous, or infected tissue.
Debridement
Removal of necrotized tissue from a wound by surgical excision, enzymes, or chemical agents. Used to promote healing and prevent infection.
Dermabrasion
Rubbing (abrasion) using wire brushes or sandpaper to mechanically scrape away (abrade) the epidermis. Commonly removes acne, scars, and tattoos.
Fulguration
Tissue destruction by means of high-frequency electric current; also called electrodessication. Helps remove tumors and lesions in and on the body.
Photodynamic Therapy (PDT)
Procedure in which cells selectively treated with a photosensitizer are exposed to light which produces a reaction that destroys the cells. Used to treat cancer, actinic keratosis, and macular degeneration.
Antiacne agents
Reduce acne by either decreasing bacteria in the hair follicles or disrupting the stickiness of follicular skin cells to decrease micromedones. PanOxyl, commonly known as Tretinoin or Retin-A.
Antifungals
Alter the cell wall of fungi, or disrupt its enzyme activity, which results in cell death. Helps when topical meds aren’t effective in treating fungal infections of the skin. Itraconazole, oral only, commonly known as Sporanox. Terbinafine, oral or topical, commonly known as Lamisil. Fluconazole, oral or IV, commonly known as Diflucan.
Antihistamines
Inhibit allergic reactions caused by the release of histamine; knon as antipruritics. Diphenhydramine, commonly known as Benadryl, and Hydroxyzine, commonly known as Vistaril or Atarax.
Antiparasitics
Kill insect parasites, used to treat scabies and pediculosis (lice). Lindane, known as Kwell or Thon, and Permethrin known as Nix.
Antiseptics
Topically applied agent that inhibits the growth of bacteria to prevent infection. Ethyl or isopropyl alcohol, hydrogen peroxide, or Povidone-iodine, commonly known as Betadine.
Corticosteroids
Decrease inflammation and itching by suppressing the immune system’s response to tissue damage. Can be oral or topical. Hydrocortisone, commonly known as Ceticort or Cortaid, and Triamcinolone, commonly known as Azmacort or Kenalog.
Keratolytics
Destroy and soften the outer layer of skin so it’s sloughed off or shed. Stronger ones remove warts, milder ones promote shedding of scales/crusts, and weak ones irritate skin and act as a tonic to speed the healing process. Salicylic acid, commonly known as Sebasorb or Psoriasin. Urea, commonly known as Kerafoam or Keralac.
Protectives
Cover, cool, dry, or soothe inflamed skin. Creates a long-lasting film to allow the healing process to occur. Cetaphil and other moisturizing lotions, or ointments such as Vaseline.
Topical anesthetics
Block sensation of pain by numbing skin layers and mucous membranes, which provides temporary symptomatic relief. Lidocaine, or Xylocaine. Procaine, or Novocain.
Bx, bx
biopsy
BCC
Basal cell carcinoma
C&S
Culture & sensitivity
CA
cancer, chronological age, cardiac arrest.
FS
Frozen section.
I&D
incision and drainage
ID
intradermal
IMP
impression (synonymous with diagnosis)
IV
intravenous
TNM
Tumor-node-metastasis
ung
ointment
XP, XDP
xeroderma pigmentosum
