Physical Assessment: Skin Exam Flashcards
Skin: Three Layers
Epidermis
Dermis
Subcutaneous Layer
Epidermis: 5 Layers
Stratum Corneum Stratum Luciderm Stratum granulosum Stratum Spinosum Stratum Basale
Dermis: Composition and Function
composition: living cells
Two Functions:
Perspiration
Supply Epidermis with nutrient rich blood
Dermis: Two layers
Papillary
Reticular
Subcutaneous Tissue: Composition and Function
Composition: Fat and loose CT
Function: Stabilizes skin
-insulates, stores energy, shock absorption
Skin: Changes with age
Looses vascularity
Blood vessels become thin
Skin becomes thinner, pale and translucent
Decrease in elasticity
Physical Assessment of skin
Color Temperature Dry/moist Legions? Skin folds (intertriginous)
Lesions: 3 types
Primary
Secondary
Vascular/ Purpuric
Primary Legions: Non palpable (2)
Macule: < 1cm (freckles)
Patch: > 1cm (birthmark)
Primary Legions: Palpable (3)
Papule: < 1cm
Plaque: often a collection of papules, >1cm
Nodule: Marble like, >0.5cm (deep and firm)
Primary Legions: With Fluid (3)
Vesicle: 1cm, serous fluid
Bulla: >1cm, serous fluid
Pustule: inside is pus (infection)
Primary Legions: Wheal
Irregular, superficial area of edema
Secondary Legions: 4 types involving skin loss
Crust: serum/pus/blood dried on skin
Erosion: chicken pox scar
Ulcer: deep, loss of epidermis and dermis, may go to bone
Fissure: Linear crack, only epidermal and dermal layer
Secondary Legions: Vascular vs Purpuric
Purpuric = think purple (bruise)
Vascular = think (think tiny veins)
Purpuric: Outside vessels -petechiae -ecchymosis Vascular: Within vessels -telangiectasia -spider vein -spider angioma -cherry angioma
Petechia
(purpuric) 1-3mm, red/purple. Non-blanching
Ecchymosis
(purpuric) >3mm, purple, non-blanching
Telangiectasia
(vascular) small, dilated blood vessels, blanching, 0.5-1mm: encompasses spider vein and spider angioma
Spider Angioma: size and location
(vascular) <2cm, face, arms and trunk
Spider Vein: Size and location
(vascular) Small to several inches, mostly on legs, chest.
Cherry angioma
(vascular) 1-3mm, trunk and extremities
Lesions: Arrangements (5)
clustered linear (line) annular (in a ring) arciform (in an arc) dermatomal (covering a skin band that corresponds to a nerve root)
Skin Tumors: 6 types
Actinic Keratosis Seborrheic Keratosis Basal Cell Carcinoma Squamous Cell Carcinoma Benign Nevus (Lentigo) Malignant Melanoma
Actinic keratosis
tumor: superficial hyperkeratonic papules, often multiple
1/1000 develop into squamous cell carcinoma
Seborrheic Keratosis
tumor: benign, white-yellow or brown raised papules. Typically multiple.
Basal Cell Carcinoma
tumor: although malignant, almost never metastasizes.
Begins as a macule, often on face
Squamous Cell Carcinoma
REDDER Macule, firm elevated border. Begin small, white legion. Slow growth at first, rapid and spread later on.
Benign Nevus
the common mole
Malignant Melanoma: ABCD
most aggressive and life threatening A: asymmetry B: Irregular borders C: Variation in Color D: Diameter: >6mm
Skin Color: Cafe-Au-Lait Spot
Macule, irregular borders, 0.5-1.5 cm, benign.
Skin Color: Tinea Versicolor
hypo/hyper pigmented area of skin, found on trunk, neck, and upper arms. Pale, reddish, or tan
Skin Color: Vitiligo
Depigmented macules on hands, feet, extensor surfaces. Caused by a loss/lack of melanin
Skin Color: Cyanosis
Bluish color of nail beds, fingers, oral mucosa.
Skin Color: Jaundice
Yellow discoloration, also sclera
Skin Color: Carotenemia
Yellow palms, not jaundice, associated with a diet of yellow vegetables such as carrots, etc. Sclera remains white
Skin Color: Erythema
Red hue, “Slapped cheeks”
Skin Color: Heliotrope
Violaceous patches over the eyelids
Skin Texture: Lichenification
thickening of skin
Skin Texture: Atrophy
Thinning of skin
Skin Texture: Scar
raised regenerative skin growth
Skin Texture: Keloid
excessive growth in healing of a legion
Skin Texture: Excoriation
linear loss of epidermis
Striae
“stretch marks” associated with rapid growth
Legions: Distribution Classification
EXTENT
isolated, localized, regionalized, generalized, universal
Skin Breakdown: 5 forms
Decubitus Ulcer Decubiti Bedsore Pressure Sore Dermal Ulcer
Pressure Ulcer: 4 stages
Stage 1: Unbalanceable, redness
Stage 2: Skin forms blister or sore
Stage 3: Crater, full thickness skin loss
Stage 4: Full thickness, damage to underlying structures (muscle etc.)
Pressure Sores: Three ways
1: sustained compression
2: shearing forces (sliding/transferring)
3: friction and moisture
Hair Loss: Alopecia Areata
hair loss, in round or oval patches. Thought to be autoimmune. NO SCALING
Hair Loss: Trichotillomania
Hair loss from pulling/twisting hair
Hair Loss: Tinea Capitis (ringworm)
Round scaling patches of alopecia. Hairs are broken off close to surface of scalp.
Nails: Paronychia
Infection of the lateral and proximal nail folds. Due to Staphylococcus Aureus or Streptococcus.
Nails: Clubbing
Bulbous swelling. Due to hypoxia or genetics
Nails: Onycholysis
Spontaneous separation of nail at distal margin due to loss of supporting structures. Due to Trauma Psoriasis Fungal infection Onychmyosis
Nails: Terry’s Nails
Nail plate turns white. Due to Liver disease Cirrhosis Heart Failure Diabetes
Nails: Leukonychia
White spots due to trauma
Nails: Mee’s Lines
Transverse white bands, run parallel to lanula Due to: Arsenic poisoning Heart Failure Hodgkin's Disease Chemotherapy CO poisoning Leprosy
Nails: Beau’s Lines
Transverse Depressions Due to: Severe illness trauma Cold exposure (w/ Reynaud's disease)
Nails: Pitting
Depressions Due to: Psoriasis Reiter's syndrome Sarcoidosis Alopecia areata Localized atopic or chemical dermatitis
Nails: Anatomical Components
Lunula, Nail plate, Cuticle, Lateral nail fold, proximal nail fold, Free Edge Nail bed, Nail root, Distal Phalanx Cross section of nail plate.
Nails: Paronychia
infection of nail bed, spreads to entire nail
Nails: Herpetic Whitlow
infection caused by herpes virus, contagious
Asteatosis
Dry skin
Common in geriatrics
Flaky, rough
Skin Exam: Palpation
Temperature/Moisture: hot or cold, wet or dry
Texture: smooth or rough
Turgor: elasticity
Edema: swelling
Inspection and Palpation of Skin Checklist
Location Pattern (Configuration) Size, Shape Mobility Consistency Color Exudate (Drainage)
Legion: Distribution Classification
PATTERN
symmetrical, exposed areas, areas of pressure, intertriginous area, follicular localization, random
Legion: Distribution Classification
CHARACTERISTIC PATTERN
acne,
syphilis,
erythema mulitform,
many more
