L9 Skin Flashcards
Skin functions
Protection
Sensation
Thermoregulation
Immune System
Endocrine System/Metabolism
Somatosensory receptors
Merkel’s disk
Meissner’s Corpsule
Ruffini Ending
Pacinian Corpuscle
Skin layers
Epidermis
Dermis
Subcutaneous Tissue
Epidermis
outermost layer that provides 1st barrier of protection
avascular
Keratinocytes and Nonkeratinocytes
Keratinocytes
primary cells of epidermis, synthesize keratine
Non-kertinocytes
Melanocytes
Langerhans’ cells
Mechanoreceptors
Melanocytes
synthesize melanin and pigment responsible for skin color
protects against UV
Langerhans’ cells
involved in immune response as antigen-presenting cells
Mechanoreceptors
Merkel, Meissner, Ruffini
Layers of Epidermis
Stratum…
Corneum
Lucidum
Granulosum
Spinosum
(Langerhan’s, Melanocytes, Merkel)
Basale
(Come, let’s get sun-burnt)
Dermis
provides thermoregulation and supports vascular network to supply nutrients to avascular epidermis
2 regions: papillary, reticular
contains many cells, vascular, nerve
Papillary layer of Dermis
thin, loose connective tissue just under epidermis
free nerve endings
Reticular Layer
thicker, irregular tissue beneath papillary layer, provides strength and elasticity
What does the dermis contain?
fibroblasts, macrophages, mast cells, lymphatic vessels, blood vessels, nerves, eccrine/apocrine units
Epidermal appendages
sweat glands
hair follicles
nails
sebaceous glands
Eccrine glands
directly to surface of skin, thermoregulation
Apocrine
joins at hair follicle
does not produce sweat continuously, but at times of stress
Hypodermis role
- largest store of energy
- provides insulation from thermal stress of cold environment
- largest endocrine organ in body
- significant effects on immune system
Effects of aging on epidermis
becomes thinner
decreased number of melanocytes
fewer langerhan’s cells
decreased vitamin d synthesis
Epidermis becomes thinner
more hyper-reactive to skin irritants
increased risk of skin tearing
Decreased # of melanocytes in epidermis
loss of photoprotection
increased risk of cancer
Fewer Langerhans’ cells in epidermis
decreased immune response
increased risk of skin cancer
Decreased Vitamin D Synthesis in epidermis
increased risk of osteoporosis
Dermis and Aging
- Decreased dermal thickness and degeneration of elastin fibers
- Changes in epidermal appendages
Decreased dermal thickness and degeneration of elastin fibers in dermis
- slower wound healing
- increased susceptibility to shear force trauma
- Altered thermoregulation
- Less scar tissue
Changes in epidermal appendages in dermis
- decreased number of altered structure of sweat glands
- Impaired sensation, increased pain threshold
Skin disorders that are contagious
impetigo
chickenpox
superficial fungal skin infections (tinea)
warts
scabies
lice
Macule
circumscribed flat discoloration
may be brown, blue, red or hypopigmented
freckle
cafe au lait spots (birthmarks)
Pustule
circumscribed collection of leukocytes and free fluid that varies in size
acne
folliculitis
Vesicle
circumscribed collection of free fluid
less than .5 cm in diameter
example is a herpetic lesions from chickenpox
Bulla
circumscribed collection of free fluid that is greater than .5 cm in diameter
lupus erythematosus
Wheal
firm edematous plaque resulting from infiltrations of dermis with fluid. Transient, may last only a few hours
hives
insect bites
Papule
elevated solid lesion, color varies, papules may become confluent (grown together) and form plaques
melanoma, warts, moles, skin tags
Scale
excess dead epidermal cells produced by abnormal keratinization and shedding
eczema, psoriasis, lupus
Crust
collection of dried serum and cellular debris
scab, impetigo, tinea capitis
When should a PT document skin lesions?
any time you note a lesion during eval or tx
any time a pt or client reports S/S of skin lesions
possibly medical referral would be needed
How should a PT document a skin lesion?
Location
Characteristics
Exudate
Location of skin lesion
generalized or localized
region of body
unilateral/bilateral
pattern
Characteristics documentation
Size and shape
color and temp
tenderness, pain, pruritic
texture
mobility
elevated or depressed
Exudate documentation
color
odor
amount
consistency
Atopic dermatitis
chronic inflammatory skin disease
Begins in infancy, red, oozing rash
skin becomes dry, thickened
common on face and flexor surfaces
S/S: xerosis and pruritus
not contagious
Xerosis
abnormal dryness
Pruritus
intense itching
Treatment of atopic dermatitis
no cure, often resolves spontaneously
therapy is aimed to break inflammatory cycle–> personal hygiene and topical medications
Eczema
flexing folds
has acute, subacute, chronic stages
common in older people
may be caused by venous insufficiency, allergens
Reminders for Eczema/dermatitis
- Provide education
- Avoid using topical agents containing alcohol
- Provide resources
Rosacea
inflammatory skin condition that causes redness of face
often cyclic, with flare-ups lasting weeks-months
Usually impacts those with lighter skin, women, adults
Clinical Presentation of Rosacea
- red areas on face
- small red bumps or pustules on nose, cheeks, forehead, chin
- Visible blood vessels on nose and cheeks
- Tendency to flush or blush easily
- Burning or gritty sensation in eyes
Rhinophyma
rare form of rosacea, severe cases
hypertrophy of sebaceous glands in nose
more common in men
Pathogenesis of Rosacea
unknown cause
likely genetic and environmental factors
alcohol consumption does NOT cause rosacea, can worsen it
worsened by any condition that increases blood flow to skin surface
Treatment of Rosacea
Rarely clears up on its own, tends to worsen over time if left untreated
dermatologist can be helpful, PTs can be helpful in referring
self-care (minimize sun, alcohol) can be beneficial
Psoriasis
Chronic, hereditary inflammatory disorder that affects skin and nails
marked by itchy patches of thick red skin covered with silvery scales
cycles, most cases, the disease eventually returns
Psoriasis epidemiology
More common in females, onset is 29 years
most common in white people
Pathogenesis of psoriasis
develops when ordinary life cycle of skin cells accelerates
skin cells usually in 26-28 days, with psoriasis in 3-4 days
NOT contagious, lots of different triggers that can possibly cause it
Psoriasis Treatment
no cure, treatment is meant to slow cell turnover with fewest possible adverse effects
Topical creams
Phototherapy
PT role in Psoriasis
Meditation and stress reduction techniques can reduce healing time
proper application education of topical creams –> rub down, only lesions, gloves to reduce infection
Benign skin tumors
seborrheic keratosis
nevi/moles
lipomas
Premalignant skin lesions
actinic keratosis
bowen’s disease
Malignant Skin lesions
basal cell and squamous cell cancer
melanoma
Seborrheic keratosis
waxy yellow, light to dark brown or black papules
usually appear as though they are stuck on
very common, increasingly common in older age groups
medically insignificant
Moles/Nevi
clusters of pigmented cells
normal: uniform in color with distinct borders
dysplastic: ABCDEs/irregular
Lipomas
fatty tumors
within dermal subcutaneous layers
soft/fairly mobile, feel doughy
they are benign. Will be removed if cosmetically upsetting, symptomatic, size > 5 cm
Actinic Keratosis
most common on sun-exposed surfaces of fair-skinned people
brown or dark-pink rough scaly plaques with well-defined margins
Tx: surgical excision, topical meds
can result in carcinoma
Bowen’s disease
persistent, brown to reddish brown scaly plaque with well-defined margins
can occur anywhere on skin on mucous membranes
Tx: surgical excision and topical meds
Skin cancer
abnormal growth of skin cells
Basal cell, squamous cell, melanoma
most common in women <40 yrs of age
develops primarily on areas of sun-exposed skin
Basal cell carcinoma
90% of all cases of skin cancer
Usually appears as either pearly or waxy bump with rolled edges, small blood vessels on surface, slowly increase in size
Lesions commonly bleed, rarely metastasize, but 10% recur
Treatment options of Basal Cell Carcinoma
depends on size, location, depth of lesion
Cyrosurgery
Curettage
Chemotherapy
Surgical Excision
Moh’s surgery
Squamous cell carcinoma
less distinctive in apperance
occurs 60 year of age, men more than women
usually in sun damaged skin, hard horny crust
Risk of metastatic spread with SCC
Lesion on unexposed skin
Lesion >1-2 cm in diameter
Lesion on nose, lip, ear
Treatment of SCC
biopsy and histologic exam
Tx: depends on size, location, depth
Prognosis: tx has excellent cure rates
Melanoma
malignant neoplasm orginating from melanocytes
comprises smallest % of all skin cancers, greatest # of deaths
occurs most commonly on upper back and legs
most common cancer in women 25-29
Pathogenesis of Melanoma
Exact cause is unclear
thought to be caused by intensity rather than duration of sun exposure
UVA
longer wavelength, damage melanocytes can impact subcutaneous
responsible for DNA damage and premature AGING of skin
UVB
partially into dermis, can increase cancer growth
causes DNA damage to cells, responsible for SUNBURN
UVC
never actively hits humans, absorbed by environment
UV radiation
wavelength of sunlight in range too short for human eye to see
commercial tanning lamps and tanning beds produce high doses of UV radiation
Skin Cancer Risk factors
- fair skin
- sunburn history
- sunny, high-altitude or equatorial climates
- mole
Fair skin
less melanin = less protection from damaging UV radiation
Sunburn History
> 3 blistering sunburns 20 year of age
> 3 year of outdoor summer work hx
Sunny, high altitude or equatorial climates
more common in AZ than in MN
Altitude: 8-10% increase in UVB radiation for every 1000 ft of gain
Mole risk factors
having 1 dysplastic mole doubles risk of melanoma
having > 50 ordinary moles increases risk
Other skin cancer risk factors
- family or personal hx of cancer
- precancerous skin lesions
- increased age
- weakened immune system
- hazard exposure
- fragile skin
ABCDEs
helpful in diagnosis of melanoma
Asymmetry
Border
Color
Diameter
Evolving
Ugly Ducking sign
a mole that is obviously different than others in a given individual
Diagnosis of Melanoma
first sign may be a change in an existing mole
scaliness, itching, change in texture, oozing, bleeding
can only be dx with a biopsy
Treatment of melanoma
w/out evidence of spread: surgical excision
regional spread: surgery and radiation
Prognosis of melanoma
99% curable, if detected early
determines on thickness/depth
ones that are deeper are at higher risk
Distant metastases have a lower survival rate
Melanoma screening
monthly self-exams
skin screening exam every 3 years for those with not a ton of RF
Sid the seagull ◡̈
Slip
Slop
Slap
Seek
Slide
Skin cancer prevention
- Avoid peak sunlight hours
- Wear broad spectrum sunscreen year round
- Sunscreen should be 15 SPF, on all exposed skin
- Apply 30 min before sun exposure, 30 min after you are in the sun
- Wear protective clothing
- Avoid tanning beds
- Be aware of sun-sensitizing meds
Photoprotective clothing
Lightweight fabrics either treated with a UV inhibitor or woven to eliminate penetration of UV rays
SPF vs UPF
SPF = measures the time it takes UV rays to cause the skin to redden
UPF = measures amount of UV radiation that penetrates a fabric and reaches the skin
