CLASS 6 - SKIN ASSESSMENT Flashcards
How does the stratum corneum (outer layer of the epidermis) change with age?
thins + flattens - allows chemicals easier access into the body
how does the dermis change w age?
thins + flattens, results in wrinkles
how does skin change w age in terms of elastin, collagen, subcut fat and muscle tone? What risks does this introduce for the older adult?
- elastin, collagen, subcut fat + muscle tone is lost
- loss of collagen increases the risk for shearing + tearing injuries
How does the skin change w age in terms of sweat + sebaceous glands? What risks does this pose for the older adult?
- Sweat + sebaceous glands decrease in # and function which results in dry skin
- decreased response of the sweat glands to thermoregulatory demand puts older adults at greater risk for heat stroke.
how the skin change w age in terms of vascularity and fragility? What risks does this pose for the older adult?
Vascularity diminishes + fragility increases. As a result, minor trauma may produce senile purpura (red discoloured areas).
What questions would you ask a patient when collecting subjective data about a patient’s skin?
- previous history of skin disease (allergies, hives, psoriasis, eczema)
- changes in pigmentation
- excessive dryness (xerosis) or moisture (seborrhea)
- pruritis (itching)
- excessive bruising
- rash or lesion
- medications
- hair loss, change in nails
- environmental or occupational hazards
- self-care behaviours
What would you ask a patient about a previous history of skin disease?
Any previous skin disease or problem? How was this treated? Any family history of allergies? Any known allergies? Any birthmarks or tattoos (bc risk for hep C)
What would you ask a patient about changes in pigmentation in their skin?
any change in skin colour or pigmentation?
is the colour change generalized or localized?
What would you ask a patient about changes in moles?
Have you experienced a sudden appearance of tenderness, bleeding, or itching?
Any sores that don’t heal?
What would you ask a patient about excessive bruising?
Any excessive bruising? Where on the body?
How did this happen? How long have you had it?
What would you ask a patient about rashes or lesions?
Onset - when did tou first notice it?
Location - where did it start?
Extent - have you noticed it spreading?
Describe the colour
Is it raised or flat> Any crust or odour? Does it feel tender or warm?
How long have you had it? Does anyone at work or at home have a similar rash? Have you been camping, acquired a new pet, tried a new food, or taken a new medication> Does the rash seem to come w stress?
What home care have you tried (baths, lotions, heat, cold)? Do they help or make it worse?
Associated symptoms - any itching or fever?
What do you think a rash or lesion means?
How has the rash or lesion affected your self care, hygiene, and ability to function at home + at work?
Any new increased stress in your life (stress can exacerbate chronic skin disease?
What questions would you ask a patient about medications?
What medications do you take? Prescription or over the counter? Have you noticed any changes in your skin since you started taking the medication?
What would you ask a patient about environmental or occupational hazards?
how much sun exposure do you get?
have you recently been bitten by an insect like a bee, tick, or mosquito?
any recent exposure to plants or animals in yard work or camping?
What questions would you ask a patient about their self-care behaviours?
What do you do to care for your skin, hair, and nails? What cosmetics, soaps, or chemicals do you use? Do you clip cuticles on nails or use adhesive for false fingernails? Do you use sunscreen? what SPF? Do you perform a skin self-examination?
What questions would you ask a patient about hair loss + changes in nails?
Any recent hair loss? Gradual or sudden onset? Symmetrical? Any unusual hair growth? Any recent change in texture or appearance>
What is alopecia?
What is hirsutism?
alopecia = significant hair loss hirsutism = shaggy or excessive hair
What are 5 potential causes of pallor?
Anemia Shock Local arterial insuffiency Albinism Vitiligo
How do anemia + shock present in light skin? Brown skin? Black skin?
Light skin: Generalized pallor
Brown Skin: appears yellow-brown, dull
Black Skin: appears ashen grey, dull
How does local arterial insufficiency present in light skin? dark skin?
light skin: marked localized pallor such as extremities
Dark skin: Ashen grey, dull, cool to palpation
What is albinism?
total absence of pigment melanin thoughout the integument
What is vitiligo?
Patchy depigmentation from destruction of melanocytes
How does albinism present in light skin + dark skin?
whitish pink
How does vitiligo present in light + dark skin?
Patchy milky white spots, often symmetrical bilaterally
What is cyanosis? What causes it?
Blueish hue to the skin - caused by increased amount of unoxygenated Hgb, signifies decreased perfusion
How does cyanosis present in light skin? Dark skin?
Light skin: blue
dark skin: dark, but dull + lifeless. only sever cyanosis is apparent in dark skin
what causes central cyanosis? How does it present in light skin + dark skin?
Central cyanosis results from chronic heart and lung diseases that cause arterial desaturation
light skin: grey coloration
dark skin: hard to detect
what causes peripheral cyanosis? How does it present in light + dark skin?
Caused by exposure to cold, anxiety
Light skin: dusky nail beds
Dark skin: hard to detect
What is erythema?
How does it present in light + dark skin?
Intense redness of the skin from excess blood (hyperemia) ‘
Light skin: red / bright pink
Dark skin: purple tinge, difficult to see
what is hyperemia?
increased blood flow through engorged arterioles such as inflammation, fever, alcohol intake, blushing
what is polycythemia? How does it present in light + dark skin?
increased numbers of RBCs
light skin: ruddy blue in face, oral mucosa, conjunctiva, hands + feet
dark skin: hard to detect, check for redness in lips
What are 4 potential causes of erythema?
Hyperemia
Polycythemia
Carbon monoxide poisoning
venous stasis
How does carbon monoxide poisoning present in light skin? dark skin?
light skin: bright cherry red in face + upper torso
dark skin: cherry-red colour in nail beds, lips, and oral mucosa
what is venous stasis?
decreased blood flow from an area
how does venous stasis present in light skin? dark skin?
light skin: rubor of dependent extremeties,
dark skin: easily masked, palpate for warmth or edema
what is jaundice?
jaundice is caused by increased serum bilirubin ( > 2 mg / 100 mL) as a result of liver inflammation or hemolytic disease.
how does jaundice present in light skin? dark skin?
light skin: yellow in sclera, hard palate, mucous membranes, and over skin
dark skin: check sclera for yellow tinge near limbus of eye. jaundice is best noticed in junction of hard and soft palate + also palms
what is carotenemia?
increased serum carotene from ingestion of large amts of carotene-rich foods
how does carotenemia present in light skin? dark skin?
light skin: yellow-orange in forehead, palms + soles, and nasolabial folds (smile lines)
dark skin: yellow-orange in palms + soles
what is uremia?
occurs in renal failure - urochrome pigments are retained in the blood
how does uremia present in light skin? dark skin?
light skin: orange-green or grey overlying pallor of anemia, ecchymoses and purpura
dark: easily masked, rely on lab findings
what is purpura?
purple coloured spots from burst blood vessels
what is Brown-Tan?
eternal tan
What is Addison’s disease? How does it present in light skin? dark skin?
Increased melanin production stimulation by cortisol deficiency
light skin: bronzed appearance and eternal tan, most apparent around nipples, perineum, genitalia, and pressure points
dark skin: easily masked, rely on laboratory and clinical findings
what are cafe au lait spots? how do they present in light skin? dark skin?
Caused by increased melanin pigment in basal cell layer
tan to light brown, irregularly shaped oval patches w well-defined borders
dark skin: easily masked, rely on laboratory and clinical findings
what is skin turgor?
Skin turgor refers to the elasticity of your skin. If you pinch the skin, it should go back to normal in a few seconds . Having poor skin turgor means that your skin takes longer to return to its normal position (tenting). This is often a sign of dehydration/
What is skin atrophy?
thinning of the skin, looks v shiny
When palpating the skin for temperature, what could a low temperature indicate?
Decreased perfusion, vasoconstriction, or poor central control
When palpating the skin for temperature, what could a high temperature indicate?
vasodilation, local inflammation, febrile patient
What is edema?
Accumulation of fluid in intracellular spaces?
What is pitting edema?
V/ watery. If pressure leaves an indentation in the skin, pitting edema is present.
What is non-pitting edema?
less watery + more firm, fluid doesn’t move + doesn’t dent in
What is dependent edema?
edema settles in lowest parts of patient’s body - follows gravity
What is lymph edema?
not as free-flowing and watery as dependent edema
Describe 1+, 2+, 3+ and 4+ edema
1+ : mild pitting, slight indentation, no perceptible swelling
2+ : moderate pitting, indentation that subsides rapidly
3+ : deep pitting, indentation remains for a short time, swelling evident
4+ : very deep pitting, indentation lasts a long time, gross swelling + distortion
what is an annular lesion?
circular lesion
what are confluent lesions?
legions that merge + are multi shaped
what are discrete lesions?
distinct + separate
what are grouped lesions?
clusters of lesions
what are gyrated lesions?
twisted, coiled, spiraled, snake-like
what are target lesions?
bullseye
what are linear lesions?
scratch, streak, line or stripe
what are polycyclic lesions?
annular lesions that grow together
what are zosteriform lesions?
linear arrengement along a nerve route
macules, patches, papules, plaques, nodules, tumors, wheals, urticaria (hives), vesicles, bullas, cysts, and pustules are examples of what types of lesions?
Primary
what are macules?
give examples of these types of lesions.
colour change; flat + circumscribed, < 1 cm in diameter
freckles, hypopigmentation, measles, scarlet fever
what are patches? give examples of these types of lesions.
macules > 1 cm in diameter.
mongolian spot, vitiligo, cafe au lait spot, measles rash
what are papules?
give examples of this type of lesion.
solid, elevated, circumscribed, < 1 cm diameter; caused by superficial thickening in the epidermis
elevated nevus (mole), molluscum, wart
what is a plaque? give an example this type of lesion
papules that come together to form surface elevation wider than 1 cm; plateau-like, disk-shaped
psoriasis, lichen planus
what is a nodule? give an example of this type of lesion.
solid, elevated, hard or soft, > 1 cm in diameter; may extend deepr into epidermis than papule
xanthoma, fibroma, intradermal nevi
what is a tumor? give an example of this type of lesion.
larger than a few cm diameter, firm or soft, deeper into dermis, may be benign or malignant
lipoma, hemangioma
what is a wheal?
superficial, raised, transient, and erythematous; slightly irregular shape bc of edema
what are urticaria (hives)?
wheals that coalesce to form extensive reacion; intensely priuretic
what are vesicles?
give examples of this type of lesion
blisters. elevated cavities containing free fluid, up to 1 cm in diameter; clear serum flows if wall is ruptured
herpes simplex, early varicella, herpes zoster, contact dermatitis
what is a bulla? Give examples of this type of lesion
single-chambered (unilocular); superficial in epidermis; > 1 cm diameter; thin-walled and therefore ruptures easily
friction blister, pemphigus, burns, contact dermatitis
what is a cyst? give examples.
encapsulated fluid-filled cavity in dermis or subcutaneous layer; tensely elevates skin
sebaceous cyst, trichilemmal cyst
what is a pustule? give examples of this type of lesion.
cavity filled w pus; circumscribed and elevated
impetigo, acne
crusts, scales, fissures, erosion, ulcers, excoriations, scars, keloids, and lichenification are examples of which types of lesions?
Secondary skin lesions
What is a crust? What causes it? What colours can it be?
Give examples of this type of lesion.
thickened, dried out exudate left when vesicles or pustules burst or dry up.
colour depends on the fluid’s ingredients (blood, serum, pus) - red-brown, honey-like, or yellow
impetigo (dry, honey-coloured), weeping ecxematous dermatitis, scab after abrasion)
What is a scale? What causes it? Give examples of this type of lesion.
Compact, dessicated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells
lesions after scarlet fever or medication rxn, psoriasis, seborrheic dermatitis, eczema, ichthyosis, dry skin.
What is a fissure? Are they dry or moist? Give examples of this type of lesion.
Linear crack w abrupt edges extending into dermis. Can be dry or moist.
Cheilosis at corners of mouth as a result of excess moisture, athlete’s foot
What is erosion? It is dry or moist? Does this type of lesion leave a scar?
Scooped-out but shallow depression; superficial. Moist but no bleeding. Does not leave a scar because it does not extend into dermis
What is an excoriation? What causes it? Give examples of this type of lesion.
Self- inflicted scratch or abrasion. Superficial. Sometimes crusted scratches from intense itching.
Lesions caused by scratching of insect bites, scabies, dermatitis, varicella
what is a scar? give examples of how scars can occur.
Permanent change; CT (collagen) that replaced normal tissue after a skin lesion heals.
healed area of surgery or injury, acne scars
What is an atrophic scar? Give an example of this type of lesion.
Depression of skin level as a result of loss of tissue; a thinning of the epidermis
striae
what is a keloid? among which population are keloids more prevalent?
hypertrophic scar; elevation of the skin level by excess scar tissue which is invasive beyond the site of original injury. may increase long after healing occurs. looks smooth + rubbery, “claw-like”. Has a higher incidence among those of African descent.
What is lichenification? What causes it?
Thickening of the skin w production of tightly packed sets of papules caused by prolonged intense scratching. Looks like lichen or surface of moss.
What are the 2 types of vascular lesions?
Hemangiomas + Purpuric lesions
What are hemangiomas?
Lesions caused by proliferation of blood vessels in the dermis.
What are purpuric lesions?
Caused by blood flowing out of breaks in the vessels.
These lesions are difficult to see in dark-skinned people.
Identify the 6 types of Hemangiomas.
= Port-Wine Stain = Stawberry Mark = Cavernous Hemangioma = Telangiectasis = Spider or star angioma = Venous lake
What is a Port-Wine Stain?
- Large, flat, macular patch covering the scalp or face.
- Frequently along distribution of cranial nerve V
- Dark red, bluish, or purpleish
- intensifies w crying, exertion, or exposure to heat or cold
What is a strawberry mark? Does it require treatment?
Immature hemangioma. Formed from immature capillaries.
Does not necessitate treatment as it disappears by age 5-7
What is a Cavernous Hemangioma?
Mature hemangioma.
Reddish-blue, irregularly shaped, solid, and spongy mass of blood vessels
What is telangiectasis?
Appearance of blood vessels on the skin surface - caused by vasodilation. Vessels are permanently enlarged and dilated.
(some people call these spider veins_
What are spider/star angiomas?
Star-shaped marking w solid circular center.
May be normal or may be associated w pregnancy, chronic liver disease, or estrogen therapy.
What is a venous lake?
Clusters of dilated venules. Pressure causes them to empty / disappear. Located on legs near varicose veins and also on the face, lips, ears, and chest.
What are the 5 types of purpuric lesions?
- Petechiae
- Purpura
- Ecchymosis
- Hematoma
- Contusion / Bruise
What are petechiae? What causes them?
tiny hemorrhages, 1-3 mm, round + discrete
caused by bleeding from superficial capillaries - do not blanche
may indicate abnormal clotting factors
What are purpura?
Extensive patch of confluent petechiae and ecchymoses, > 3 mm flat, red-purple, macular hemorrhage.
What is an ecchymosis?
Purple patch resulting from extravasation of blood into the skin, > 3 mm in diameter
What is a hematoma?
Palpable bruise. Elevates the skin and is seen as swelling.
What is a pattern injury?
*Sign of abuse
bruise or wound whose shape suggests which instrument or weapon caused it (ex - belt buckle, cigarette, pinch marks, bite marks, scalding hot liquid)
ex - inflicted scalding immersion burns usually have a clear border, like a glove or sock, indicating that body part was held under water intentionally
What is a contusion / bruise?
- sign of abuse
large patch of capillary bleeding into tissues; caused by blunt force trauma
What is the ABCDE rule for assessing for malignant skin neoplasms?
Asymmetry Border Irregularity Colour Change / Variation Diameter of 6 mm + Elevated or Evolving in appearance
A patient comes in reporting a skin lesion that will not heal. What might this be a sign of?
This would raise suspicion of malignancy.
