Skin Flashcards
Functions of Integumentary System
(hair, nails, glands)
- protects underlying structures
- provides sensory information: pain, temp, pressure
- protects from UV rays
- regulate body temperature
- prevents dehydration
- synthesizes vitamin D
Physical Exam of Integumentary System Includes
skin, hair, nails
mucous membranes: mouth, eyes, anus, genitals
Skin Exam Techniques Used
- inspection
- color and uniform appearance
- thickness
- symmetry
- hygiene
- lesions
- odors
- palpation
- moisture (min perspiration or oiliness)
- temperature (cool to warm; symmetrical)
- texture (smooth, soft, even)
- turgor (fullness produced by fluid in skin)
- mobility
Skin Exam Equipment
- pen light
- centimeter ruler
- magnifying glass or dermatoscope
- Wood’s lamp
- gloves
flat or slightly elevated, dark brown mole
junctional nevus - remove
slightly elevated brownish papule w/ indistinct border
compound nevus - remove
dome-shaped, raised, flesh to black colored mole
(can be pedunculated -stalk- or hair baring)
intradermal nevus - not necessary to remove
sharp oval or circular mole with depigmented ring surrounding
halo nevus - biopsy
sometimes present at birth and can cover large area
(hair growth can occur after several years)
hairy nevus - remove
Normal vs Dysplastic Nevi
color: uniform v. mixture of colors
shape: well defined borders v. irregular/notched borders
surface: smooth bump v. scaly/rough
size: <6mm v. >6mm
number: 10-4 v. >100
location: sun-exposed areas v. anywhere
ABC’s of Pigmented Lesions
A- asymmetry of shape
B- border irregular
C- color irregular
D- diameter > 6mm
E- evolving/changing
Risk factors of Melanoma
- Previous hx
- Family hx
- Mole changes
- UV exposure
- Fair skin
- Sun sensitivity
pigmented benign lesions on sun exposed areas of
immature keratinocytes
seborrheic keratosis
causes of skin color changes
- striae (stretch marks)
- freckles
- birthmarks
- melasma/chloasma- facial discoloration, “mask of pregnancy”
- vitiligo- “geographic skin depigmentation”
Skin Color Meanings
- brown: darkening of melanin pigment
- generalized: pituitary, adrenal, liver disease
- localized: nevi, neurofibromatosis
- white: absence of melanin
- generalized: albinism
- localized: vitiligo
- red: increased cutaneous blood flow
- generalized: fever, viral xanthema, urticaria (hives)
- localized: inflammation
- yellow:
- jaundice- liver disease
- increased carotene pigmentation- hypothyroid, veggies
- blue: hypoxia- VC and pulmonary disease
Vascular Discolorations
- Non-blachable
- purpura, petechiae, ecchymosis
- Vasculature
- spider angioma
- venous star
- telangiectasia (spider veins)
- capillary hemangioma (extra vessels in skin)
Causes of Odors
- rotten apples- Clostridium gas gangrene
- mousy- Proteus infection
- grapelike- Pseudomonas
- stale beer- Tuberculous lymphadenopathy
- putrid- anaerobic (scurvy)
- feculent- intestinal obstruction, peritonitis
- mousy/musty- phenylketonuria
Primary vs Secondary Lesion
- primary- initial spontaneous manifestation or pathologic process
- secondary- evolution or trauma to primary lesion
How to Describe Lesions
- characteristics (name or describe)
- exudates
- configuration
- location
- distribution
primary lesion: flat, <0.5cm
macule
primary lesion: flat, >0.5cm
patch
primary lesion: solid, elevated, <0.5cm
papule
primary lesion: solid, elevated, >0.5cm
plaque
white to pink edematous papule or plaque lasting < 24h
wheal
primary lesion: dermal or subcutaneous solid, elevated, >0.5cm
nodule
primary lesion: fluid/blood filled blister <0.5cm
vesicle
primary lesion: fluid/blood filled blister >0.5cm
bulla
primary lesion: cavity filled with pus <0.5cm
pustule
primary lesion: cavity filled with pus or keratin >0.5cm
cyst
secondary lesion: loose or adherent flake
scale
secondary lesion: yellow, brown, black or green deposit of serum, blood or pus
crust
secondary lesion: thickening of epidermis
lichenification
secondary lesion: deep crack in skin
lesion
secondary lesion: localized loss of superficial epidermis
erosion / excoriation
secondary lesion: epidermal defect due to loss of tissue
ulcer
secondary lesion: black, hard, crust of necrosis
eschar
secondary lesion: depression/surface change due to diminution
atrophy
secondary lesion: depressed or elevated connective tissue
scar
Describing Lesion Characteristics
(if not using primary/secondary names)
- size
- shape
- color
- texture
- elevation/depression
- attachment at base:
- peunculated, sessile, verrucous
Describing Exudates
- color
- odor
- amount
- consistency
Describing Lesion Configuration
- annular (ring)
- grouped
- linear
- aciform (needle-shaped)
- diffuse
Describing Lesion Location/Distribution
- localized / generalized
- symmetric / assymetric
- discrete / grouped
- coalescing
- body region
Inflammatory & Infectious Conditions
- acne
- eczematous dermatitis
- folliculitis
- furuncle/carbuncle
- cellulitis
- tinea (fungal) infections
- pityriasis rosea (herald patch, christmas tree)
- psoriasis
- rosacea (rhinophyma)
- herpes simplex
- herpes zoster
- erythema migrans (lyme disease)
- erythema multiforme (target lesions hand, white tongue- immunologic/Steven-Johnson’s syndrome)
- scabies
- bed bugs
Cutaneous Reactions
- drug eruptions (morbiliform rash)
- acanthosis nigricans (thickening on back of neck
Pre-malignant/malignant Lesions
- actinic keratosis (pre)
- basal cell carcinoma- pearly/translucent/shiny nodule
- squamous cell carcinoma- scaly red patch w/ central depression
- malignant melanoma
- kaposi sarcoma
Hair/Scalp PE Techniques
- Inspection
- color, distribution, quantity
- Palpation
- texture, scalp
Nail PE Techniques
- Inspection:
- color, length, configuration, symmetry, cleanliness
Nail color associated conditions
- pigment deposits- normal in dark skin people
- yellow- psoriasis, fungal infections
- diffuse darkening- candida, hyperbilirubinemia
- greenish black- pseudomonas
- single blue or black- melanoma, trauma
- general blue- cyanosis
- splinter hemorrhage- endocarditis, vasculitis
- leukonychia punctate- cuticle manipulation, matrix trauma
Nail plate associated conditions
- ridging (longitudinal lines)- lichen planus
- beau lines- injury, infection, nutrition
- mee’s bands- hodgkins, CHF, carbon monoxide poisoning
- lindsay’s nails- renal disease
- terry’s nails- hepatic failure, cirrhosis
- depressions- syphilis, high fever, PVD, DM
- pitting- psoriasis
- clubbing- CV disorder, cirrhosis, colitis, thyroid, respiratory
- 160 degrees normal, >180 degrees abnormal
- kollonychia (spoon)- Fe deficiency, Plummer-Vinson
infection between nail fold and plate
paronychia
fungal infection of nail
onychomycosis
loosing of nail from bed
onycholysis
