Exam 3: Skin, hair, nails Flashcards
Skin is like a
window for viewing changes that take place within the body
Inspect and palpate skin for
Color & presence of lesions Moisture Temperature Texture & thickness Turgor Vascularity Edema Pain response w/ palpation
Chloasma
- Darker pigmentation on forehead, nose, and cheeks “mask of pregnancy”
- Usually fades after birth
Linea Nigra
Darkened line from umbilicus to symphysis pubis
- Darkening of areola
- Usually fades after birth
Normal/benign pregnancy skin variations
Chloasma
Linea nigra
Normal or benign newborn skin markings
Milia
Mongolian spots
Erythema toxicum
Stork bike (nevus simplex)
Milia
Unopened/clogged sebaceous glands that usually appear on nose and cheeks
Mongolian spots
Normal in dark-skinned infants during 1st few years of life
Erthema toxicum
Transient maculopapular rash; may be due to increased eosinophil activity
Stork bite (nervous simplex)
Caused by dilation of small capillaries; regress spontaneously
Sebaceous Glands in elderly
Decrease in size, number, and output
Decreased output of the sweat glands cause
Senile Xerosis
Skin itches
Looks flaky and loose
Senile Xerosis
Age related dry skin
Age related skin changes
Paper-thin, transparent skin Wrinkles Actinic lentigo Cherry hemangiomas Skin tags
Wrinkles
Decrease elastin and subcutaneous tissue
Actinic lentigo: liver spots
Normal with aging
Cluster of melanocytes on dora of hands and forearms
Cherry hemangiomas
Common and arise in middle-ages to older adults
Cherry hemangioma is a
Vascular lesion
Cherry hemangiomas usually located on
the trunk
Cherry (senile) hemangiomas increase in what with age
Increase in size and number
Are Cherry (senile) hemangiomas a concern?
No, they are benign
Skin tags
Overgroths of normal skin that forms a stalk
skin tags are frequently on
eyelids
cheeks and neck
axillae and trunk
Skin tags are more common with
diabetes
Turgor indicates
Elasticity and overall hydration
turgor can be altered by
Water content
Aging
How to check turgor
Pinch skin and release
If skin has normal elasticity and hydration, it will
Immediately return to its original state after pinching
Poor skin turgor is
tenting of the skin with a slow return to the original
Skin/mucous membrane color comes from
melanin carotene oxyhemoglobin deoxyhemoglobin bilirubin
Pallor
Observed most readily in the palms, nail beds, face, and conjunctiva
Pallor is caused by
Lowered Hgb content fight or flight response Medications Cold Shock
Red/erythema increased visibility of
Hgb
red/erythemic skin cause what with hand pressure
Blanches
Red/erythema is often related to
inflammation
is red/erythmea skin the same as burns?
No!
Blue/cyanosis is increased
Geoxyhemoglobin (Hhb=hypoxia/hypoxemia)
Blue/cyanosis often related to
cardio/pulmonary diseases or end of life
Jaundice
Excess bilirubin
Carotenoderma / Carotenemia:
(blood levels 4X normal)
Eyes remain white!
Ephelides (freckles)
Small brown macule on sun exposed skin of fair skinned individuals
Cafe-au-lait
A light brown, oval macule (dark brown on brown or black skin) found anywhere on the body
Loss of pigmentation
Vitiligo
Vitiligo is
Congenital
Autoimmune
Assessment methods for dark skin: Pallor
Use good lighting
Mucous membranes ash-gray color: absence of underlying red tones that give skin a healthy glow
Assessment methods for dark skin: Cyanosis
Lips & tongue are grayish
Palms, soles, conjunctivae, & nail beds have a bluish tinge
Assessment methods for dark skin: Erythema
How to assess for inflammation in a dark-skinned patient?
- Compare palpation with other areas of the body.
- Ask about pain in the area
- Palpate for edema/induration
- Moisten skin to look for redness
Ski lesions are grouped according to
fluid-filled versus solid, diameter, compare scaling versus flat, etc.
Flat lesion
<0.5 cm diameter
Macule
Flat lesion
>0.5 cm diameter
Patch
Elevated. fluid filled with pus, and regular
Pustules
Elevated, fluid filled with serous, <0.5 cm diameter
Vesicle
Elevated, fluid-filled with serous, > 0.5 cm in diameter
Bulla
elevated, edematous, and generally irregular/transiet
Hives !
Hives are
Whelts/ wheals
Annular:
Circular, ring-like, raised, border around normal skin
Circunate
Circular
Circumscribed
Well-define borders
Clustered
Grouped together
Coalesced
Lesions that merged together
Diffuse
Wide-spread/generalized
Linear
Straight line
Universal
All over with no “normal” skin
Ecchymosis
Larger area of bleeding associated with injury
— may be caused by drugs, low platelets, clotting disorders
Purpuric lesions
Less vessels burst without trauma/injury
Purpura & petechiae
Often due to low platelets or clotting disorders causing increased capillary fragility
Purpura & Petechiae are
- Non-blanching (do not fade w/pressure)
- petechiae 1-3mm, flat, pinpoint
- Purpura generally larger than petechiae
Tattooing medical complications are rare, but mainly related to
pigment ingredients, but include viral, bacterial, fungal, and diseases
Piercing medical complications are common:
Metal-induced contact allergic dermatitis, broken teeth, anesthetic risks & infections of all types
Malignant moles are typically
Asymmetrical
Uneven borders
Two or more shades
Larger than 1/4 inch
Skin malignancies
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
Nails protects
Vital ends of fingers and toes
Nail plate
Pink color from vascular nail bed beneath
Nail matrix
Site of growth; protected by cuticle
Lunula
White crescent-shaped area that extends beyond cuticle; the visible portion of the nail matrix
Dystrophic nails may occur with a
Serious systemic illness or local skin disease involving the epidermal keratinocytes
variations in color, texture, & grooming of the nails are influenced by
factors unrelated to disease, such as occupation, personal preferences, or customs
Color of the nail plate depends on
Thickness Transparency Amount of red blood cells Arterial blood flow Pigment deposits
Cgnages in nail color can be caused by
Chemical damage that occurs with some occupations or with long-term use of nail polish
Regardless of skin color, the healthy nail
Blanched (lightens) with pressure
To differentiate between color changes from the underlying vascular supply problems & those resulting from pigment deposition assess capillary refill
Vascular alterations
Pigment alterations
Vascular alterations
Color will change as pressure it applied and returns to the original state when released
Noting the rate of return of color for vascular alterations:
Indicates the status of the peripheral circulation
Pigment alterations
color remains unchanged with or without pressure
Clubbing
Bulbous swelling of soft tissue of terminal phalanx of the digit
Clubbing is associated with
Pulmonary, cardiovascular, infectious, neoplastic, and other disorders
Schamroth
Loss of diamond shape formed when right and left thumbs are opposed in person
– positive sign means abnormal clubbing
Beau Lines
Transverse, band-like depressions in nail
Beau Lines etiology
Damage to matrix
Beau lines can occur after
- Severe, sudden, acute, sometimes febrile illness;
- Severe reactions to drugs/cytotoxic drugs (e.g. chemotherapy, as in top photo)
Onycholysis
- Detachment of nail from its bed at distal &/or lateral attachments
Etiology of onycholysis
idiopathic, mechanical or chemical damage; also associated with psoriasis
Onychomycosis
Invasion of the nail by fungus
-affects up to 14% of population with increasing prevalence among older individuals
Age-related nail changes
- Gradual thickening of the nail plate
- Longitudinal ridges
- Yellowish gray discoloration
what is responsible for forming hairs
Cells of the germinal matrix responsible
Cells of the germinal matrix undergoes repeated
Mitosis, push upward in the follicle, and become keratinized to form a hair
As long as the cells of the germinal matrix remain alive,
hair regenerates even though it is cut, plucked, or otherwise removed
A common type of baldness occurs when two requirements are met:
genes for baldness + male sex hormones (androgens)
When the right combination of these causative factors exist (genes for baldness + male sex hormones)
Androgenic alopecia or
Male pattern baldness inevitably results
Sudden or marked changes in hair characteristics may reflect
an underlying disease process
Intense itching/scratching for hair
Examine the scalp & pubis for lice and nits
Nits
Lice eggs
Inspect scalp for
Scaling, redness, open areas, crusting, tenderness
Dandruff
Collection or patchy or diffuse white/gray scales on the surface of the scalp
Flaking from dandruff causes people to mistakenly think the scalp is
too dry, however, it is excessive oil production
Pediculosis
Infestation with any of several kinds of lice
Types of lice encountered most frequently
Pediculus humanus capitis
Pediculus humanus corporis
Phthirus pubis
Pediculus humanus capitis
Head louse
Pediculus humanus corporis
Body louse
Phthirus pubis
Pubic or crab louse
louse (lice) requires
BLOOD
infestation of louse causes
Pruritus (result of sensitization to louse saliva)
Scratching from lice can result in
secondary bacterial infections
Head lice reside on the
Scalp, lay nits (eggs) on hair
The head louse can be found infesting people from
All socioeconomic groups
Can lice be acquired through contact with pets or other animals?
No!
Hirsutism
Condition of male-pattern hair growth in women
Hirsutism may arise
from excess male hormones called androgens, primarily testosterone
Hair of older individuals looks gray or white due to
decrease in number of functional melanocytes
Although gradual hair loss occurs with aging, sudden asymmetric or patchy hair loss at any age
is of concern
