Chapter 9: Hair, Skin, Nails Flashcards
Bulla
fluid-filled sac or lesion that appears when fluid is trapped under a thin layer of the skin
- blister
- vesicle like > 1 cm in diameter
Clubbing
condition affective the fingers and toes in which proliferation of distal tissues, especially the nail beds, results in thickening and widening of the extremities of the digits; the nails are abnormally curved and shiny
- when angle of the nail beds is >180 degrees
Confluent
skin lesions that become merged, forming a patch;
- lesions that are not discrete, or distinct one from the other
Cyanosis
bluish discolorations of the skin, mucous membranes, tongue, lips, or nail beds
- due to an increased concentration of reduced hemoglobin in the circulation
Ecchymosis
subcutaneous extravasation of blood within the tissues, which results in discoloration of the skin from the blood in the tissues
- aka bruising
Erythema
a common but nonspecific sign of skin irritation, injury, or inflammation caused by dilation of superficial blood vessels in the skin
- a reddening of the tissue
Jaundice
condition that causes the skin and whites of the eyes to turn yellow
Keloid
excess growth of scar tissue where the skin has healed
Leukonychia
abnormal nail matrix keratinization causing nail plate parakeratosis; also known as white nails
Linear
abnormal lesions that form in a line
Macule
small, flat, nonpalpable skin color change, less than 1 cm with a circumscribed border
- like a freckle or port-wine stain
Nevi
congenital, raised, pigmented growth, e.g, a mole
- uniform color
- typically less then 5 mm in diameter
- 10-40 usually above waist or on sun-exposed areas
- clearly defined border
Nodule
a primary skin lesion that is solid, elevated, hard/soft
- greater than 1 cm in diameter
Pallor
loss of the pinkish tones of the skin due to the lack of blood flow to the surface of the skin
Papule
palpable skin lesions less than 1 cm in diameter
Patch
greater then 1 cm, may have irregular border
Petechiae
tiny, purple spots on the skin
- blood vessels that have popped
Plaque
papules that join to form surface elevation wider than 1 cm
Pustule
vesicle-like filled with purulent fluid
- aka a pimple
Rash
area of irritated or swollen skin; often itchy, red, painful, irritated
Scar
area of fibrous tissue that replaces normal skin after an injury
Striae
asymmetric, raised, red linear streaks (striae rubrae) that tend to flatten and lighten over time
- commonly called stretch marks
Turgor
skin elasticity; the ability of skin to change shape and return to normal
Vesicle
small, fluid-filled sacs that can appear on your skin; fluid may be clear, white, yellow, or mixed with blood
-<1 cm in diameter
- blisters
Zosteriform
distribution of cutaneous lesions that follow a nerve; a unilateral girdle-like distribution
- can be caused by shingles or herpes
What is vitiligo ?
development of unpigmented patch(s)
- hypopigmentation
- most common in dark skinned individuals
- thought to be auto-immune disorder (melanocytes are destroyed)
- not born with but you develop it over time
What is Albinism ?
genetic absence of melanocytes
- hypopigmentation
What is Melasma ?
darkening of the color across the nose and the cheeks, and the upper lip
- hyperpigmentation
- more common in women
- usually on face
- associated with hormonal changes
- worsened with exposure to sunlight
- aka chloasma “mask of pregnancy”; tends to fade a few months after delivery
- harmless
What is Hemosiderin Staining ?
staining of the legs caused by chronic venous insufficiency
- hyperpigmentation
- blood pools under the skin
- poor venous return from legs with back-up of fluid and red blood cells from capillaries into interstitial tissues
- Risk factors: advanced age, obesity, previous blood clots, injuries, or surgery to legs
What is Urticaria/Hives/Wheals ?
a skin rash caused by allergy to food, medication, or environmental irritant
- usually acute
- itchy and raised skin
- can be treated with antihistamines (benadryl)
- can be hard to see in darker skin
What do we use to compare normal moles to possible melanomas ?
A: asymmetry (not round or oval)
B: border (poorly defined or irregular)
C: color (uneven, variegated)
D: diameter (greater than 6 mm)
E: evolving (changing, getting bigger, darker, etc)
F: feeling (itching, burning, tingling, etc)
What is important about melanomas on darker skin ?
- less common on darker skin (increased melanocytes help protect against sun)
- melanoma often diagnosed later in darker skin
- black people are more likely to die from melanoma than white people
What is Basal Cell Carcinoma (BCC) ?
- most common skin cancer
- affects light-skinned individuals between 40-80
- locally invasive, can grow quite large but rarely metastasizes (does not spread)
- most common in males then females
- grows slowly
- nodular pigmented lesions with depressed center and rolled borders and/or central ulceration in areas of sun or UV light exposure
What is Squamous Cell Carcinoma (SCC) ?
- 2nd most common skin cancer
- invasive cancer of head, neck from sun or UV light exposure
- most common if >50 with blue eyes, and childhood freckling
- men more affected
- can be more aggressive than BCC
- lesion is soft, mobile and slightly elevated with surrounding redness
What is Congenital Dermal Melanocytosis ?
irregular/oval patch on sacrum and buttocks, bluish/greenish or bruised looking
- common in asians and african darker skinned children
- usually disappears by age 1-2 yrs
- link with inherited disorders of metabolism
What is Cafe Au-Lait Spots ?
large round/oval patch
- flat, pigmented birthmark
- light brown in color (coffee with milk)
- occasionally associated with neurofibromatosis (tumor growth in nervous system)
- usually present at birth but can develop in first few years of life
What is Nevus Simplex ?
small, red or pink spot seen on back of neck (nape), forehead, eyelids
-aka “stork bite”
- can be caused by telangiectasis (permanent dilation of small blood vessels)
- can also be caused by flat capillary hemangioma (abnormal growth of blood vessels)
- usually disappears by 5 yrs
- vascular
What are some abnormal birthmarks ?
- Nevus Flammeus
- Infantile (Strawberry) Hemangioma
- Cavernous Hemangioma
What is Nevus Flammeus ?
large macule usually on the face along the 5th cranial nerve
- aka port-wine stain
- does not disappear (often start pinkish and become red/purple)
- bluish/purple capillary areas
- caused by a mutation of a specific gene
- treatment: laser (not always effective)
What is Strawberry (Infantile) Hemangioma ?
a slightly raised skin growth
- red (in pale babies) with sharp demarcation line
- may be 2-3 cm diameter as they grow
- usually disappear by age 5
- may require laser treatment
What is Cavernous Hemangioma ?
mass that forms from collection of malformed reddish or bluish blood vessels
- may continue to grow until 10-15 months of age
- should be assessed frequently but often shrink and go away
- could affect eyesight or breathing
- treatment: surgery, depends on location, symptoms, Hx (history) of bleeding from lesion
What is Diaphoresis ?
excess moisture; abnormal in absence of strenuous activity
- causes are hyperthermia, extreme anxiety, shock, hyperthyroidism
What is Alopecia Areata ?
chronic inflammatory disease of hair follicles
- multiple round patches of hair loss
- unknown cause: believe autoimmune disorder, metabolic disease and stressful events
- poorly developed shaft breaks and grows back in 3-4 months (some may suffer total scalp hair loss)
What are melanomas ?
- most serious form of skin cancer
- responsible for majority of skin cancer related deaths
- typically arise from nevi
- ABCDEF assessment
- lesion may have flaking, scaling, be brown, tan, brown, pink or purple with mixed pigmentation
What is Onychomycosis ?
fungal infection of nail plate caused by tinea unguium
- occurs in up to 18% of population in given areas
- nail plate turns yellow or white as debris accumulates
- nail eventually separates from nail bed and nail plate splits and crumbles
What is Paronychia ?
acute or chronic infection of cuticle
- usually caused by staph or strep but candida may also be causative organism
- rapid onset of very painful inflammation at base of nail abscess may form
- frequent exposure to moisture is risk factor
- inflammation develops slowly usually starting at nail base and works along side of nails
What are Ecchymosis ?
bruises; discoloration of skin caused by blood seeping into tissue as result of trauma
- 1-2 days: purple to deep black
- 3-6 days: green to brown
- 6-15 days: tan to yellow (fading)
- look for patterns such as loop pattern (cord hitting)
What are signs of abuse in older adult skin ?
- bruising
- lacerations
- fractures inconsistent with functional ability
- pressure ulcers
- dehydration
- poor hygiene
What does a stage 1 ulcer look like ?
intact non-blanchable (doesn’t change color with pressure) redness
-no slough
What does a stage 2 ulcer look like ?
partial-thickness shallow open ulcer with pink wound bed
- no slough (layer on skin that covers wound and must be removed for healing to begin) or bruising
- may also appear as bulla (blister)
What does a stage 3 ulcer look like ?
full-thickness skin loss
- subcutaneous fat may be visible
- no bone, tendon or muscles exposed
- slough may be present
- wound may have undermining and tunneling
- depth depends on location r/t varied anatomic skin depths
What does a stage 4 ulcer look like ?
full thickness
- bone, tendon or muscle are exposed
- slough or eschar (dead tissue) may be present in wound bed
- undermining and tunneling often present
- depth depends on location
What are examples of hypopigmentation ?
- vitiligo
- albinism
What are examples of hyperpigmentation ?
- melasma
- hemosiderin staining
What is the significance of hot/warm skin ?
- hyperthyroidism
- localization= inflammation, infection, traumatic injury, or thermal injury
What is the significance of cold/cool skin ?
- localization= poor peripheral perfusion
- shock or hypothermia
What can cause excessive skin thickness ?
diabetes
- can cause abnormal collagen resulting from hyperglycemia
What can cause decreased skin thickness ?
- hyperthyroidism
- arterial insufficiency and aging
What can cause dull, coarse and brittle hair ?
- nutritional deficiencies
- hypothyroidism
- exposure to chemicals
What can cause alopecia ?
- autoimmune disorders
- anemic conditions
- nutritional deficiencies
- radiation or antineoplastic treatments
What is Hirsutism ?
hair growth in women with an increase in hair on face, body, and pubic area
- caused by an increase in male hormones
What is a deep tissue injury ?
type or pressure ulcer that damages the underlying tissue, skin, fat and muscle tissue
- restrict blood flow causes non-blanching
How would cyanosis look like in a pale and dark skinned individual ?
Pale: grayish-blue tone
- seen in nail beds, earlobes, lips, mucous membranes, and feet
Dark: ashen-grey tone
- best seen in conjunctiva of eyes, oral mucous membranes
Where are the best places to see jaundice in dark-skinned individuals ?
- sclera, palms of hands and soles of feet
How does pallor look like in dark-skinned individuals ?
- appears lighter then normal
- light-skinned AA: yellowish-brown skin
- dark-skinned AA: appear ashen
How does petechiae appear in dark-skinned individuals ?
- hard to see
- best seen in buccal mucous of mouth, or sclera of eye
- may look like blackish spots instead of reddish or purple
How do rashes appear on dark-skinned individuals ?
- not easily seen but can be felt with light palpation
What is Milia ?
small papules on checks, nose, chin and forehead
- usually disappears by 3rd week of life
- common primary lesion in newborn/infants
What is Erythemia Toxicum ?
common rash in newborns/infants
- erythematous macules, papules and pustules
- lasts a few days, gone within 2 weeks and will go away on its own
What is lanugo ?
silky body hair found on premature babies
- commonly on scalp, ears, shoulders, and back
What is the most serious form of skin cancer ?
melanoma
What is Congenital Dermal Melanocytosis ?
irregular/oval patch on sacrum and buttocks
- caused by increased melanocytes
- bluish/greenish, or bruised looking
- aka mongolian spot
- usually disappear by age 1-2
- common in asian and AA dark skinned kids
- linked with inherited disorders of metabolism
