M12: Integumentary Flashcards
Skin assessment; terminology
Epidermis
- Superficial, outer, defensive layer * Stratum basale * Stratum germinativum
- Stratum spinosum * Stratum corneum
Epidermis (cont.)
- Keratinocytes * Keratin * Melanocytes * Melanin
- Vitiligo: Autoimmune-related loss of melanocytes; depigmentation of patches of skin
- Langerhans cells * Present processed antigen to T cells
- Merkel cells * Function as slowly adapting mechanoreceptors
Skin assessment terminology
DERMIS
- Deeper layer * Collagen, elastin, reticulum, and a gel-like ground substance
- Hair follicles, sebaceous glands, sweat glands, blood vessels, lymphatic vessels, and nerves
- Fibroblasts * Secrete connective tissue matrix and collagen.
- Mast cells * Release histamine. * Macrophages * Are phagocytic immune cells.
- Histiocytes: Are in loose connective tissue; phagocytize pigments and the debris of inflammation.
Skin assessment-Terminology
Subcutaneous layer
- Fat cells or adipocytes and connective tissue * Dermal collagen is continuous with the subcutaneous collagen.
Skin Assessment: terminology
Primary Lesions
- Macule * Flat, circumscribed area that is a change in the color of the skin; measures less than 1 cm in diameter.
- Papule * Elevated, firm, and circumscribed area; measures less than 1 cm in diameter.
- Patch * Flat, nonpalpable, and irregular-shaped macule; measures more than 1 cm in diameter.
- Plaque * Elevated, firm, and rough lesion with a flat top surface greater
than 1 cm in diameter. - Wheal * Elevated, irregular-shaped area of cutaneous edema; is solid and transient; diameter is varied.
- Nodule * Elevated, firm, and circumscribed lesion; is deeper in the dermis than a papule; measures 1–2 cm in diameter.
- Tumor * Elevated, solid lesion; may be clearly demarcated; is deeper in the
dermis; measures greater than 2 cm in diameter. - Vesicle * Elevated, circumscribed, and superficial lesion; does not extend into
the dermis; is filled with serous fluid; measures less than 1 cm in diameter. - Bulla * Vesicle that measures greater than 1 cm in diameter.
- Pustule * Elevated, superficial lesion; is similar to a vesicle but filled with purulent fluid.
- Cyst * Elevated, circumscribed, and encapsulated lesion; is in dermis or
subcutaneous layer and filled with liquid or semisolid material. - Telangiectasia * Irregular red lines; are produced by capillary dilation.
Skin Assessment: terminlogy
Secondary lesions
- Scale * Heaped up, keratinized cells; has flaky skin and an irregular shape; can be thick or thin and dry or oily; varies in size.
- Lichenification * Rough, thickened epidermis; is secondary to persistent rubbing, itching, or skin irritation.
- Keloid * Irregular shaped, elevated, progressively enlarging scar; grows beyond the boundaries of the wound; is caused by excessive collagen formation during healing.
- Scar * Thin-to-thick fibrous tissue; replaces normal skin after an injury or laceration to the dermis.
- Excoriation * Loss of the epidermis; is a linear, hollowed-out, and crusted area.
- Fissure * Linear crack or break from the epidermis to the dermis; may be moist or dry.
- Erosion * Loss of a part of the epidermis; area is depressed, moist, and glistening; follows a rupture of a vesicle or bulla.
- Ulcer * Loss of epidermis and dermis; is concave, and varies in size.
- Atrophy * Thinning of the skin surface; and a loss of skin markings occurs.
Pressure ulcer-p1507
- Is the result of any unrelieved pressure on the skin, causing underlying tissue damage.
- Shearing forces * Friction * Moisture
- Occlude capillary blood flow with resulting ischemia and necrosis
- Decubitus injury: Results when an individual lies or sits in one position for a long time.
- Stage I
- Nonblanchable erythema of intact skin
- Stage II
- Partial-thickness skin loss, involving the epidermis or dermis
- Stage III
- Full-thickness skin loss, involving damage or loss of the subcutaneous tissue
- Stage IV
- Full-thickness skin loss with damage to muscle, bone, or supporting structures
- Deep-tissue pressure injury: Localized in an area of deep red, purple, or maroon discolored intact skin or a blood-filled blister caused by underlying soft tissue damage from pressure and/or shearing
- Unstageable: Full-thickness tissue loss with the base of the ulcer covered by slough or eschar, or both, in the wound bed
- Sacrum, heels, ischia, and greater trochanters: Most common sites
- Predicting ulcers: Braden scale
BCC-p1529
**MC cancer in the world
Surface epithelial tumor, originating from undifferentiated basal or stem cells
C/B: arsenic in food/water, rad therapy, long-term immunosupp.
Pearly or ivory in appearance and slightly elevated; has depressed centers and rolled borders as it grows. as the lesion grows it often ulcerates, develops crusting, and becomes firm to the touch
Mutation in the TP53 and PTCH1 genes; leading to loss of keratinocyte repair functions and apoptosis resistance of dna-damaged cells
Treatment: Surgical excision, radiotherapy, curettage, cryotherapy, photodynamic therapy; topical applications of imiquimod or 5-FU
If un-tx’d: can invade surrounding tissues, can destroy nose, eyelid, or ear. MEts rare d/t no invasion to blood/lymph.
SCC- p 1530
Tumor of the epidermis
2nd MC human cancer
Types: In situ (Bowen disease) and invasive
Mutation of the TP53 gene and other oncogenic signals lesions transform slowly and can be present for 10-50 years before the vertical growth phase begins.
Invasive: can arise from premalignant lesions of the skin and include AK, leukoplakia, scars, radiation-induced keratosis, tar and oil keratosis, and chronic ulcers
R/F: genetic predilection, chronic arsenic exposures, exposure to x-rays and gamma rays, immunosuppression, light colored skin
ETIO-most common cause of lip cancer and move prevalent in older, white men- early diagnosis and surgical resection often curative.
Treatment: Cryotherapy, 5-FU, photodynamic therapy
advanced: Microsurgical excision w/ histopath; radiation, w/ possible immunotherapy and adjuvant chemo.
Malignant melanoma- P 1531
Most serious and most common cause of death from skin cancer
MC in elderly and confused w/ age spots
Cause: Chronic UV radiation-high mutation rate stim’d by UV making gene sequencing difficult
- Protection from UV radiation from the sun and artificial sources (tanning beds), particularly during childhood years of life: Significantly reduces the risk of skin cancer in later years.
lesions transform slowly and can be present for 10-50 years before the vertical growth phase begins.
Malignant (cutaneous) melanoma
- Is a tumor of the skin originating from melanocytes.
- ABCDE rule is used as a guide.
- Asymmetry * Border irregularity * Color variation * Diameter larger than 6 mm * Elevation that includes a raised appearance or rapid enlargement
- Treatment * Surgery * Immunotherapy * Radiation, chemotherapy
Impetigo- p1544
- Common in children 2-5yo
- Superficial lesion of the skin
- Caused by coagulase-positive Staphylococcus or α-hemolytic streptococci
*-two types of impetigo: non bullous or vesicular and more rarely bullous caused only by s. aureus in which blisters enlarge or coalesce to form bullae
*-both forms begin as vesicles that rupture to form a honey-colored crust
*-lesions resolve in 2-3 weeks without scarring
TX: -treatment options include bleach baths, topical antibiotics (mupirocin, fusidic acid, retapamulin, and ozenoxacin
Vitiligo p 1505
Autoimmune-related loss of melanocytes; depigmentation of patches of skin
30% hereditary
present: milky-white patches on the skin.
Onychomycosis-p1535
-chronic infection of the toe or fingernails caused by fungi, dermatophyte, yeast, or nondermatophyte molds or mixed infection
Fungi causing superficial skin lesions: Dermatophytes *MC: tricophyton mentagrophytes, candida
Fungal disorders called mycoses
Mycoses: Termed tinea when caused by dermatophytes
-presentation varies can include discoloration, hyperkeratosis, splitting, and nail plate destruction are common.
-most common pattern is nail plate that turns yellow or white and becomes elevated with accumulation of hyperkeratotic debris within the plate.
- Tinea unguium: Onychomycosis: Nail
TX: difficult b/c topical or systemic meds don’t reach nail bed.
Varicella infection-p 1548
Herpes zoster (shingles) and varicella (chickenpox)
- Cause: Varicella-zoster virus (VZV) spread by closes person-to-person contact and airborne droplets
- Initial infection with varicella, followed years later by herpes zoster
*vesicular lesions occur in the epidermis as infection occurs, inflammatory infiltrate is often present, vesicles eventually rupture followed by crust formation or the development of transient ulcers on mucous membranes - Pain and paresthesia localized to a dermatome, followed by vesicular eruptions along a facial, cervical, or thoracic lumbar dermatome
- No cure
- Antiviral drugs: Administration within the first 72 hours
- Tricyclic antidepressants
Hand/foot/mouth disease-p 1549
Affects infants and young children, Caused by coxsackievirus and enterovirus A71.
- Fever * Vesicular ulcerous lesions in the mouth * Vesicular rashes on hands, feet, buttocks
- Meningitis, encephalitis, acute flaccid paralysis, neuro-respiratory syndrome
Treatment * Supportive care, ds is self-limiting
Measles- p 1546
- Is a ribonucleic acid (RNA) virus.
- Disease is mild in most children.
*Highly contageous
*incubation: 7-12 days - Clinical manifestations * Enlarged cervical and postauricular lymph nodes, low-grade fever, headache, sore throat, runny nose, cough
- Faint pink-to-red maculopapular rash on face, spreading to the trunk and extremities, sparing the palms and soles of the feet
- Vaccination against mumps and measles (rubeola) combined with rubella (German measles) (MMR)
- Treatment * Rest, fluids, and use of a vaporizer
Kolpik spots-what are they and what are they associated with?
characteristic pinpoint white spots surrounded by an erythematous ring develop over the buccal mucosa
Measles
Scabies-p1550
- Contagious disease caused by the itch mite, Sarcoptes scabiei=parasite
- Transmitted by personal contact and infected clothing and linens (esp in overcrowded housing)
- Female mite tunnels into the stratum corneum and deposits eggs (hatch in 48-72hrs)
- Primary lesions: Burrows, papules, and vesicular lesions with severe itching (worse at night)
s/s: appear 3-5 weeks after infestation
*DX: observation of the tunnels and burrows and by microscopic examination of scrapings of the skin to identify the mite, its eggs, or its feces. - Treatment * Scabicide or oral ivermectin (for severe scabies)
- All clothing and linens: Washed and dried in hot cycles or dry cleaned, or kept in sealed bag for 48-72 hrs.
-immunocompromised people at greater risk and scabies can facilitate s.pyogenes and aureus skin coinfections with systemic complications
