Integumentary System (skin)

Question 1

State 5 functions of the skin

Answer 1

B-SPEC

1. Body temp regulation
2. Synthesis of Vit D
3. Protection
4. Excretion and absorption
5. Cutaneous sensations

Question 2

What is the integumentary system composed of?

Answer 2

1. Skin
2. Hair
3. Nails

Question 3

What are the 2 main layer of skin and what tissue type do they contain?

Answer 3

Epidermis (epithelial tissue)

Dermis (connective tissue)

Question 4

What are the 4 main types of cell in the Epidermis (upper layer) and what are their functions?

Answer 4

1. Keratinocytes (protection) 90%
2. Melanocytes (pigment) 8%
3. Langerhans cells (immune)
4. Merkel cells (touch)

Question 5

What changes occur in the skin with increasing age?

Answer 5

1. acne at puberty due to hormone changes
2. wrinkles as collagen and elastin stiffen and reduce
3. Langerhan cells less effective so immunity weakened
4. Sebaceous glands shrink so skin is drier, more susceptible to infection
5. sweat production reduces to elderly more vulnerable to heat
6. Less melanocytes - grey hair
7. some melanocytes increase - age spots
8. walls of skin blood vessels thicken so less nutrients and oxygen
9. subcutaneous fat is lost
10. skins heals slower
11. hair and nail growth slower and more brittle

Question 6

1. What is Acne Rosacea?

2. What can trigger it?

Answer 6

1. Chronic skin condition seen in mostly fair skinned people between 30-60yrs. Affects skin on face, mostly nose and cheeks
2. can be inherited and/or may involve an overreaction to normally occurring skin bacteria. Main triggers are:
   - exposure to sunlight, wind and cold
   - drinking hot liquids or alcohol
   - eating spicy food
   - menopause
   - steroidal anti inflammatory use on face
   - emotional stress

Question 7

List 6 factors associated with development of Acne Vulgaris

Answer 7

1. genetic predisposition
2. over-activity of sebaceous glands leading to blocked pores
3. production of hormone androgen (at puberty) leading to more sebum production
4. presence of a bacterium that triggers inflammation
5. environmental factors e.g. some medications

Question 8

Compare and contrast acne and boils

Answer 8

Pattern of appearance
Boils - one lesion at a time of small group
Acne - spread over large areas, often face and back

Virulence
Boils - aggressive bacteria attack healthy tissue
Acne - less aggressive bacteria, take advantage of hospitable sites on body

Symptoms
Boils - extremely painful
Acne - mildly painful

Communicability
Boils - more easily
Acne - only with prolonged contact

Special precautions
Boils - local contraindication. May be full contra. if signs of general infection present
Acne - local contraindication.

Question 9

What is dermatitis?

Answer 9

Umbrella term meaning skin inflammation that is not infectious

Question 10

1. What is eczema?

2, What causes it?

Answer 10

1. It is a hypersensitivity reaction where white blood cells inappropriately respond to non dangerous stimuli, releasing molecules like histamine which create an inflammatory response.
2. • genetic predisposition
   • weakened skin
   • imbalances in types of white blood cells resulting in too much inflammatory chemicals
   • flares may be triggered by local irritation e.g. rough textures, detergents, extreme temps or excessive sweating

Question 11

1. What is contact dermatitis?

2. What is the difference between irritant contact and allergic contact dermatitis?

Answer 11

1. Skin inflammation caused by externally applied irritant or allergen
2. Irritant - would affect anyone and triggers include prolonged working in water, harsh cleaners, acids, alkalis, continued friction.

Allergic - affects only people with allergies to the triggers. Can include: nickel, preservatives in lotions, bandage adhesives, some perfumes, latex. It tends to develop several hrs after exposure.

Question 12

1. What is Psoriasis?

2. What are the signs and symptoms?

Answer 12

1. Chronic skin disease where cells which normally replace every 28-32 days are replaced every 3-4days. Instead of sloughing off they accumulate into itchy, scaly plaques, usually on the trunk, elbows and knees. Its an autoimmune disease.
2. • red circular-ish lesions often with a silvery scale on top
   • lesions usually on trunk, elbows, knees and scalp
   • well defined edges
   • runs in cycles of flare and remission
   • sometimes associated with rheumatoid conditions

Question 13

What are common triggers for Psoriasis?

Answer 13

• emotional stress
• bacterial and viral infections
• reactions to medication
• weather, esp dry, cold winter air
• skin injuries
• smoking
• hormonal fluctuations

Question 14

1. What is Herpes Simplex?

2. What are the signs and symptoms?

Answer 14

1. Its a viral infection resulting in painful blisters on a red base
2. • obvious blisters
   • 2 or so days of itching, tingling or pain
   • blisters usually curst over and disappear within 2 wks

Type 1 - oral herpes
Type 2 - genital herpes (may also be associated with fever, MAPS, swelling in inguinal lymph node and difficult of painful urination)

Question 15

1. What is Herpes Zoster?
2. What are the signs and symptoms?
3. What might trigger an attack?

Answer 15

1. Infection of the NS by the virus Varicella Zoster.
   - virus targets dendrites at ends of sensory neurones
   - first infection results in chickenpox then virus remains dormant in body.
   - resurges as shingles in adult when persons immunity is reduced
2. Painful, itchy blisters
   Chickenpox - all over body
   Shingles - line along dermatome (area of skin supplied by a spinal nerve) i.e. along a diagonal line across the trunk, buttocks and upper leg.
   - The pain may continue long after the blisters have disappeared. The blisters can affect the eye and it is nearly always unilateral.
3. Triggers may include: stress, old age, impaired immunity because of other diseases.

Question 16

Describe two common presentations of Athlete’s foot (Tinea pedis)

Answer 16

1. burning and itching, often between 3rd and 4th digits. Weeping blisters, cracking peeling skin, possibility of secondary infection.
2. dry, scaly, itchy lesions on the heel and sole of the foot - ‘moccasin distribution’.

Question 17

What are warts and verrucae?

Answer 17

Warts are small, benign growths caused by varieties of the human papillomavirus (HPV) that invade keratinocytes in the skin and some mucus membranes.

Common warts (verucca vulgaris) usually appear on the hands, knees and elbows

Plantar warts (myrmecia) grow on the soles of the feet.

Question 18

1. What is a burn?
2. List 3 things, other than heat, that can cause burns.
3. What bodily functions might be compromised by a severe burn?

Answer 18

1. Damage to the skin that kills cells
2. Electricity, chemicals, radiation
3. • regulation of temperature
   • control of fluid loss
   • protection from microbial invasion
   • provision of sensory information

Question 19

1. What are varicose veins?

2. Why do they occur?

Answer 19

1. Swollen & enlarged veins, usually blue or dark purple. May be lumpy, bulging or twisted in appearance. Mostly occur in legs.
2. When valves inside veins stop working properly the blood pools in the vein causing expansion and distortion.

Question 20

1. What are piles?

2. What are the risk factors for piles?

Answer 20

1. swellings containing enlarged, swollen blood vessels in or around the rectum and anus
2. Overweight, pregnancy, 50yrs+

Question 21

Compare and contrast leg ulcers and bedsores

Answer 21

What are they?
Leg ulcer - chronic wound in leg/feet, takes 6wks to heal
Bedsore - breakdown of skin and underlying tissue by pressure

Symptoms
Leg ulcer - pain, itching, swelling
Bedsore - 4 grades. 1: skin discoloured but not broken, 4: severe skin damage and surrounding tissues begin to die.

Causes
Leg ulcer - typically high blood pressure in leg
Bedsore - pressure from a hard surface, pressure from involuntary muscle movements (e.g. spasms), moisture can break down epidermis.

At risk
leg ulcer - people with restricted movements, obese, varicose veins
Bedsore - mobility problems, poor nutrition, existing health conditions, 70yrs+, incontinence, serious mental health condition.

Question 22

How do scars form?

Answer 22

Body produces extra collagen to heal a wound. Collagen builds up and continues for 3 months plus.
New collagen continues to form and blood supply increases, causing the scar to be raised, lumpy and red.
Some collagen then breaks down at site of wound, blood supply decreases and scar gradually becomes smoother, softer and paler.