Skin Flashcards
Importance of Including Diverse Skin
Color Examples
* Diverse skin tone representation improves diagnosis and outcomes.
* Common conditions (e.g., cyanosis, jaundice) often overlooked on darker skin tones.
* Examples:
o Cyanosis: Check mucous membranes, tongue, lips, or extremities.
o Jaundice: Inspect eyes, palms, or soles.
Lighting in Skin Assessment
- Proper lighting is crucial to detect subtle changes (e.g., bruising, discoloration).
- Comparing symmetrical areas enhances accuracy.
- Common conditions (e.g., hives, rashes) present differently on darker skin tones.
Assessing Specific Skin Conditions
- Edema: Traditional scale (+1 to +4) supplemented with ankle circumference for reliability.
- Skin Turgor:
o Children: Tenting = late dehydration sign.
o Older Adults: Tenting = earlier dehydration indicator.
Biases in Dermatology
- Historical Context: Colonialism and pseudoscience influenced biases.
- Examples:
o Myth: “Black people have thicker, less sensitive skin.”
o Flawed tools: Pulse oximeters overestimate oxygen levels in dark skin.
Impact on Diagnosis and Outcomes
- Underrepresentation leads to misdiagnoses and worse survival rates for conditions like acral lentiginous melanoma.
- Example: Bob Marley died of undiagnosed melanoma common in darker skin tones.
Efforts to Address Disparities
- Resources:
o Brown Skin Matters: Images of conditions on darker skin.
o Mind the Gap Handbook: Focus on diverse skin tone education. - Advocacy for inclusive medical practice and education.
Broader Healthcare Implications
- Biases exist in other fields (e.g., technology, photography).
- Privatization of “skin of color” clinics may exploit patients instead of solving inequities.
Common Conditions on Dark Skin
- Urticaria (Hives):
o Raised, itchy lesions.
o Redness not always visible; compare to unaffected areas. - Dermatitis:
o Grouped, fluid-filled lesions.
o Often darker, not red, on dark skin tones. - Eczema:
o Dry, rough patches, lighter or darker than normal skin tone. - Chickenpox:
o Raised, fluid-filled vesicles. - Measles:
o Flat and raised lesions, darker than surrounding skin. - Herpes Zoster (Shingles):
o Vesicles along dermatomes, inflammation may appear darker or lighter.
Key Practices for Dermatological Assessments
- Use of Palpation:
o Helps identify raised lesions or fluid-filled vesicles. - Health History:
o Critical for identifying causes (e.g., irritant exposure, infection history). - Symmetry Comparison:
o Identifies subtle changes in tone or texture. - Lighting Adjustments:
o Ensures accurate visualization of discoloration.
Call to Action for Medicine
- Decolonize dermatology by:
o Diversifying resources and imagery.
o Educating healthcare providers on biases.
o Reshaping systems to serve all patients equitably.
Functions of the Skin
- Protection
o Shields body from physical, chemical, thermal, and UV damage. - Prevention of Penetration
o Acts as a barrier against microorganisms, water loss, and electrolyte loss. - Perception
o Contains sensory receptors for touch, pain, temperature, and pressure. - Temperature Regulation
o Dissipates heat via sweat glands and retains heat through subcutaneous insulation. - Identification
o Unique facial characteristics, fingerprints, and skin colour aid in personal identification. - Communication
o Displays emotions through facial expressions, posture, blushing, and blanching. - Wound Repair
o Enables cell replacement for healing surface wounds. - Absorption and Excretion
o Excretes metabolic wastes like urea, uric acid, and minerals. - Vitamin D Production
o Converts cholesterol into vitamin D upon UV light exposure.
Aging and Skin
- Changes in Structure
o Thinning epidermis and dermis, reduced elastin, collagen, subcutaneous fat, and muscle tone.
o Increased risk of shearing and tearing injuries. - Sweat and Sebaceous Glands
o Decreased gland function leads to dry skin and higher risk of heat stroke. - Vascular Changes
o Reduced vascularity increases fragility, leading to senile purpura (dark red discolorations). - Sun and Smoking Effects
o Accelerate aging: wrinkling, pigmentation changes, leathery texture. - Risk of Skin Breakdown
o Factors: thinner skin, decreased nutrients, environmental trauma, immobility.
o Slower wound healing due to delayed cell replacement. - Hair and Nails
o Hair: Greying due to fewer melanocytes; thinner, finer texture.
o Nails: Grow slower, lustreless, develop longitudinal ridges. - Psychological Impact
o Aging appearance can lower self-esteem, compounded by societal beauty standards.
Social Determinants of Health
- Pigmentation Differences
o Melanin offers UV protection; darker-skinned individuals have lower melanoma risk.
o Sexual skin areas (nipples, areola, labia majora, scrotum) are darker in individuals of African and Asian descent. - Sweat Gland Adaptations
o Inuit: Sweat less on trunk/extremities but more on the face for temperature regulation. - Alcohol Flush Syndrome
o Affects Indigenous (90%) and Asian (50%) populations. Symptoms: flushing, redness, heat sensation, and rapid intoxication upon alcohol consumption.
Mobility and Turgor:
o Testing: Pinch a large skin fold on the chest under the clavicle.
Mobility: Ease of rising.
Turgor: Skin’s ability to return promptly.
o Decreased Mobility: Due to edema.
o Poor Turgor: Indicates severe dehydration or weight loss; skin may tent or recede slowly.
o Scleroderma: Chronic connective tissue disorder with decreased mobility (hard skin).
- Edema:
o Definition: Fluid accumulation in intercellular spaces.
o Testing: Press thumbs firmly against the ankle or tibia.
1+: Mild pitting, slight indentation.
2+: Moderate pitting, indentation subsides quickly.
3+: Deep pitting, indentation remains briefly.
4+: Very deep pitting, indentation lasts long, gross swelling.
o Types of edema
Unilateral Edema: Local or peripheral cause.
Bilateral or Generalized Edema: Consider central problems like heart or kidney failure.
- Pallor (white)
: Loss of red-pink tones from oxygenated hemoglobin; seen in high-stress states (anxiety, fear), cold, smoking, or edema. In dark-skinned individuals, may appear as ashen-gray.
- Erythema (red)
Increased blood flow to the skin, usually from inflammation, fever, or blushing.
- Cyanosis (blue)
: Indicates a lack of oxygen; appears in areas like lips, nail beds, or under the tongue.
- Jaundice (yellow)
Indicates liver dysfunction, seen in the sclera, under the tongue, or the palms.
Danger Signs for Pigmented Lesions (ABCDE Mnemonic):
- Asymmetry: Irregular shape, two halves don’t match.
- Border irregularity: Notched, ragged, or poorly defined edges.
- Color variation: Multiple colors (brown, tan, black, blue, red, white).
- Diameter: Greater than 6 mm (size of pencil eraser).
- Elevation and Evolution: Changes in height, size, or symptoms (itching, burning, bleeding).
