Integumentary System Flashcards
Macule
- flat, circumscribed area that is a change in the color of skin
- less than 1 cm diameter
- -ex. freckles, mole, measles
Patch
- flat, nonpalpable irregular-shaped macule
- larger than 1 cm diameter
- -ex. port-wine stains, cafe au lait spots
Papule
- elevated, firm circumscribed area
- less than 1 cm
-ex. wart, elevated mole
PLaque
- elevated, firm rough lesion with flat top
- greater than 1 cm
Wheal
- elevated, irregular-shaped area of cutaneous edema
- solid transient,
- variable diameter
ex. insect bites, allergic reactions
Nodule
elevated, firm circumscribed lesion
- deeper in dermis thatn papule
- 1-2 cm
-ex. lipoma
vesicle
elevated, circumscribed superficial (not into dermis)
- filled with serous fluid
- less than 1 cm
-ex. chicken pox
Bulla
- vesicle greater than 1 cm in diameter
- ex. blister
Erosion
- loss of part of epidermis
- depressed, moist, glistening
- can follow rupture of vesicle or bulla
Pustule
- elevated superficial lesion
- similar to vesicle
- filled with purulent fluid
-ex. acne
Cyst
- elevated, circumscribed, encapsulated lesion
- in dermis or subQ
- filled with liquid or semisolid material
ex. sebaceous cyst
Scale
- heaped up, karatinized cells
- flaky skin, irregular
- thick/thin, dry/oily, variation in size
-(ex. eczema)
Lichenification
- rough, thickened epidermis
- secondary to persistent rubbing, itching or skin irritation
- involves flexor surface of extremity
-Ex. chronic dermatitis
Plaque
patch of raised cells (scale)
- usually silvery in appearance
- ex. psoriasis
Telangiectasia
Fine, irregular red lines produced by capillary dilation
-ex. rosacea, spider veins
Excoriation
- loss of epidermis
- linear, hollowed-out
- crusted area
-ex. abrasion/scratch
Fissure
- linear crack/break from epidermis to dermis
- moist or dry
- ex. athlete’s foot
Scar
-thin/thick fibrous tissue that replaces normal skin following injury or laceration to dermis
Keloid
- irregular-shaped, elevated, progressively enlarging scar
- grows beyond boundries of wound
- cause by excessive collagen formation
Tumor
- elevated, solid lesion
- may be clearly demarcated
- deeper in dermis
- greater than 2 cm
Types of Skin Cancer
-basal cell carcinoma (doesn’t go deeper or metastasize, spread wider)
-squamous cell carcinoma (spreads deeper)
-malignant melanoma (spreads)
kaposi sarcoma
Prognosis of melanoma based on:
- depth of lesion
- >0.76 mm=prognosis is worse
Benign Characteristics
- <6 mm
- uniform color
- distinct borders
- symmetric
- seldom bleed/ulcerate
- soft to firm consistency
- slow rate of growth/change
Malignant Characteristics
- > 6mm
- multiple shades, varied pigmentation
- irregular, blurred borders
- asymmetric
- often bleed/ulcerate
- firm to hard consistency
- slow/rapid growth or change
Basal Cell Carcinoma
- contained in epidermis
- does not invade blood or lymph vessels
- grows out not deeper
- face, head, ears, neck, back of hands
Squamous Cell Carcinoma
- precursed by actinic keratosis
- can present as flat red area, indurated plaque/nodule
- can metastasize
- face, head, ears, neck, back of hands
ABCDE
- Asymmetrical
- Borders irregularly, poorly circumscribed
- Color variation, black/blue/multiple
- Diameter >6mm
- Evolving/Elevation, changing
Risk Factors skin cancer (HARMM)
- History of skin cancer
- Age >50
- Regular dermatologist absent
- Mole changing
- Male gender
Pruritis
- itching
- local/general
- primary skin condition or systemic condition
Mechanisms of Pruritis
5
1-histamine release 2-wheal formation 3-activation of nerve fibers 4-activation of lymphocytes 5-pain
Management
- antihistamines
- tranquilizers
- skin emollients
- increasing environmental humidity
- topical steroids
Eczema/dermatitis
- inflammatory disorder of skin caused by endog/exogenous agents
- erythema, vesicles, scales and pruritis
Atopic Dermatitis
- most common eczma
- chronic skin disorder with scaly itching rashes
- have family history of allergic conditions like asthma/hay fever
Eczema Most common in:
- infants
- usually clear by age 36
Sx of Atopic Dermatitis
- skin redness, inflammation around blisters
- rash
- kids under 2: cheeks, elbows, knees
- more/less pigment than other skin
- inner elbows, behind knees common
- spread to neck, hands, feet, eyelids, behind knees
- raw areas, ear discharge, bleeding
Atopic Dermatitis Intervention
-avoid agg factors
-topical anti inflammatory meds
-lubrication
-antibiotics for infections
-cold compress for acute irritation
-wet dressings
-
Eczema Prognosis/Complications
- chronic, avoid irritants
- not contagious
- 2* bacterial infections of skin
- permanent scar formation
Papulosquamous disorders
- characterized papules, scales, plaques, erythema
- psoriasis, acne vulgaris, systemic lupus erythematosis
- pityriasis rosea, lichen planus, acne rosacea, lupus erythematosus
Psoriasis
- chronic, relapsing, proliferative skin disorder of unknown cause
- agg by mechanical injury, chemical injury, virus infections, prescription drug use, psych stress, drinking, smoking, pregnancy, emotional stress
- flare-ups in winter with lack of sunlight
Psoriasis Pathophys
- skin turnover decreased from 26-30 days to 3-4 days
- increased T cell lymphocytes
- may be autoimmune disorder
Psoriasis Common on:
-scalp, chest, nails, elbows, knees, groin, skin folds, lower back, buttocks
Psoriasis Msk Complaints
- itching
- may develop into psoriatic arthritis
Psoriatic Arthritis Locations
-fingers, toes, SIJ
Post-Rest Gel
- stiffness in mornings
- time it takes to feel good in morning
- RA 2-3 hours
- Psoriatic Arthritis 30 min-2 hours
Psoriasis Treatment
- topical preps
- UV light (sunlight)
- Anti-metabolic meds (slow cell proliferation)
- immunosuppressants
- most are progressive
Lupus Erythematosus Hallmark Sign
butterfly rash
malar rash
SSc
- Systemic Sclerosis
- chronic disease that results in differing degrees of skin thickening
Polymyositis/Dermatomyositis
- inflammatory myopathy from autoimmune reaction causing muscle breakdown
- inflam and deterioration of muscle & skin
DM/PM
Dermatomyositis/Polymyositis
DM/PM S/Sx
- joint swelling
- raynaud’s phenomenon
- abnormal cardiopulm exam
- weakness in Mm
- skin reddening
- heliotrope rash
- high CPK levels
- gottron’s sign
Heliotrope rash
-red discoloration of eyelids in dermatomyositis, usually associated with periorbital edema
Elevated CPK due to
- muscle break down
- can cause kidney failure
DM/PM Diagnostic tests
- CPK levels
- electromyogram
- myscle biopsy
- positive ANA titer
Gottron’s Sign
- pink patches/papules on knuckles
- in dermatomyositis
DM/PM Management
- immunosuppressants
- immunolomodulating agents
- bed rest
- positioning
- diet
- prevent contractures
- avoid sun
Calcinosis
- deposition of calcium deposits in soft tissue
- in DM/PM
- Treatment: surgery, calcium channel blockers
Vesiculobullous Disorders
characterized by blister or vesicle formation
-(pemphigus, erythema multiform, infections)
Pemphigus
-Autoimmune blistering disease
erythema multiform
-reaction to drugs or microorganism leading to inflammation of skin and mucous membranes
Infections causing Vesiculobullous Disorders
- folliculitis
- cellulitis
- impetigo
Folliculitis
-bacterial infection of hair follicle
Cellulitis
- infection of dermis and subq tissue
- usually bacterial
- thin water exudate spreads thru interstitial spaces
- treat with antibiotics
Impetigo
- superficial lesion caused by staphylococcus or streptococcus
- most common bacterial skin infection in infants and young children
- erythematous vesicles, straw colored fluid, honey crust
Viral Infections
-herpes simplex
Wart
- benign lesion by virus
- named by location and appearance
- TYPES: plantar warts, flat warts, filiform, digital warts, mosaic, genital
Wart: S/Sx
- small, hard, flat, raised skin lesion/bump
- lighter/darker than other skin
wart treatment
- go away spontaneously w/n 2 years
- freeze/cut off
Fungal infections
- tinea (based on location)
- candidiasis (yeast like infection
Tinea Corporis
- ring worm
- transmission thru contact
Tinea Pedis
- athlete’s foot
- erythema, skin peeling, pruritis
- strong odor
- point of entry for bacterai
Signs and Symptoms of Skin Disorders
- pruritis
- urticaria
- rash
- blisters
- xeroderma (dry skin)
- unusual spots, moles, nodules, cysts
- edema/swelling
- change in appearance of nails
- changes in pigmentation, turgor, texture
Skin with aging
- vascular changes (thermoregulation/wound healing)
- loss of collagen (skin integrity)
- decreased wound healing
