Skin Exam and Diseases Flashcards
Physical Attributes of Skin
Heaviest organ at 16% of body weight
Composed of 3 layers = epidermis, dermis, and SubQ
Functions to maintain homeostasis, provides boundaries and protection for body contents, regulates body temperature
Describe the Epidermis
Thin and devoid of blood vessels
Divided into outer horny and inner cell layers
Dependent on dermis for nutrition
Describe the Dermis
Supplied with blood
Contains: connective tissue, sebaceous glands, sweat glands, and hair follicles
Describe the Hypodermis/SubQ
A layer of fat
4 Pigments of skin color
Melanin: brownish, genetic, increased by sun
Carotene: gold/yellow, located in SubQ & heavy keratinized areas of soles and palms
Oxyhemoglobin: a bright red pigment found in arteries and capillaries
Deoxyhemoglobin: dark blue pigment, increase causes cyanosis
Types of Hair
Vellus Hair: short, fine, inconspicuous, unpigmented
Terminal Hair: coarse, thick, more conspicuous, and pigmented (scalp and eyebrows)
Nails
Protect distal end of fingers and toes
Nail plate pink from underlying vasculature
Luna, proximal nail fold, cuticle, and lateral nail fold
Fingernails grow 0.1mm/day while toenails grow slower
Glands
Sebaceous: produce fatty substance secreted on skin through hair follicles. Present on all skin surface except palms and soles of feet
Sweat:
Eccrine Glands: widely distributed and open directly to skin surface to control body temp
Apocrine Glands: found in axillary and genital regions, open to hair follicles, stimulated by stress
ABCs of Mole and Melanoma Screening
A - Asymmetry
B - Border irregularity, ragged, notched, or blurred
C - Change in color or variation, esp. blue or black
D - Diameter > or equal to 6mm, esp. if changing, itching, or bleeding
E - Elevation or enlargement
Skin Exam
Look For:
Color - increase or loss of pigment, redness & pallor
Moisture - dryness, sweating, and oiliness
Temperature - use back of fingers to check for warmth
Texture - roughness or smoothness
Mobility & Turgor - lifting (mobility), shape return (turgor)
Lesions - location, pattern, types, and color
Cafe-Au-Lait Spot
Uniformly pigmented patch with irregular border
Usually 0.5-1.5 cm in diameter
6 or more with diameters > 1.5 cm suggests neurofibromatosis
Neurofibromatosis (NF) refers to a number of inherited conditions that are clinically and genetically distinct and carry a high risk of tumor formation, particularly in the brain.
Vitiligo
Depigmented patches on hands and feet
Brown pigment is normal while pale areas are affected
May be hereditary
Michael Jackson thought to have had this
Raynaud Phenomenon
Excessively reduced blood flow in response to cold or stress with discolouration of fingers, toes, and other areas. May also cause nails to become brittle with longitudinal ridges.
Named after French physician Maurice Raynaud (1834–1881), believed to be the result of vasospasms that decrease blood supply to the respective regions.
Tetralogy of Fallot
A birth defect of the heart consisting of four abnormalities resulting in poorly oxygenated blood pumped to the body. Infants may not show the signs of the cyanosis but may develop episodes of bluish skin from crying or feeding called “Tet spells”.
Jaundice
Yellow skin seen in the sclera and mucous membranes
Caused by high blood bilirubin levels from liver disease and hemolysis of RBCs
Erythema
Red hue of skin from increased blood flow
“slapped cheeks” or “fifth disease”
Psoriasis
Happens when immune system mistakes skin as pathogen sending out faulty signals that speed up skin growth. Silvery scaly lesions on extensor surfaces. Often associated with strokes.
Atopic Eczema
Allergic disease associated with asthma
Dry recurring rashes characterized by redness, edema,
Lupus-Malar Rash
Red or purple and mildly scaly
Butterfly rash over the nose sparing the nasolabial folds of the face
Macular with sharp edges and not itchy. Present in about 46 to 65% of lupus patients
Plaques
Patches of closely grouped papules more than 2/5 inches (1cm) across
Seen in Psoriasis patient
Papules
Solid raised lesion that is less than 1 cm across
Seen in warts, syphilis, psoriasis, seborrheic and actinic keratoses, lichen planus, and skin cancer
Nodules
Solid lesions less than 0.5 cm that has distinct edges and deeply rooted
Described as palpable
Associated with keratinous cysts, lipomas, fibromas, and some types of lymphomas
Cyst
A nodule filled with expressible material like liquid or semisolid
Epidermal Inclusion Cyst or Sebaceous Cyst
Wheal
AKA Hives; Urticaria
Itchy skin swelling that can disappear after erupting
Associated with allergic reactions like drugs or insect bites
Angioedema
Vascular swelling of the deep dermis or subQ or submucosal layer caused by increased permeability of capillaries. Characterized by development of giant wheals. Can be hereditary but most often caused by medication.
Vesicles
Raised lesions less than 5mm across and filled with clear fluid.
Seen in Herpes simplex or chicken pox or shingles
Herpes Simplex
Gross nasty shit on your junk
Bulla
Vesicles more than 5mm across are called bullae or blisters
May be the result of sunburns, insect bites, and chemical irritation.
Erythema Multiforme
Stevens-Johnson Syndrome (SJS)
Toxic Epidermal Necrolysis (TEN)
Two forms of life threatening skin conditions in which cell death causes epidermis to separate from the dermis.
Pustules
Raised lesion filled with pus
Usually the result of an infection, acne, impetigo, or boils (abscesses)
Burrows-Scabies
Small, slightly raised tunnel of the epidermis commonly found on finger webs and sides of fingers.
Appears short 5-15 mm linear or curved lines ending in a tiny vesicle
Scale
Dry, horny build-up of dead skin cells that often flake off the surface of skin
Diseases that promote scales include fungal infections, psoriasis, and seborrheic dermatitis
Crust
Dried collection of blood, serum, or pus.
Also known as a scab
Lichenification
Rough, thick epidermis with exaggerated skin lines
Often characteristic of scratch dermatitis and atopic dermatitis.
Scars
Discolored fibrous tissue that permanently replaces normal skin after destruction of the dermis
Keloid
Hypertrophic scarring that extends beyond the borders of the initial injury.
Erosion
Nonscarring loss of superficial epidermis
Surface is moist but does not bleed
Excoriation
Linear or punctate erosions caused by scratching or picking at a primary lesion (Cat Scratch)
Fissure
A linear crack in the skin, often resulting from excessive dryness like athlete’s foot
Ulcers
A deep loss of epidermis and dermis; may bleed and scar
Stasis ulcer = venous insufficiency
Syphilitic chancre
Stages of pressure ulcers
Stage 1: Skin is not broken but is red or discolored
Stage 2: Epidermis is broken, with shallow open sore
Stage 3: Skin break extends into subQ and fat tissue
Stage 4: Breakdown extends into muscle and possibly bone. Lots of dead tissue and drainage present
Cellulitis
Local or diffuse inflammation of connective tissue with severe inflammation of dermal and subq layers
Caused by normal skin flora or exogenous bacteria.
Occurs when skin has been broken
Common in diabetics and immunocompromised
Spider Angioma
Fiery red, up to 2 cm
Central body surrounded by radiating legs
Found on face, neck, arms, and upper trunk
Associated w/ liver disease, pregnancy, & low vitamin B
Spider Veins
Bluish, variable in size, and resembles a spider
Can be linear, irregular, or cascading
Found on legs near veins or anterior chest
Accompanies increased pressure in the superficial veins, as in varicose veins
Cherry Angiomas
Bright or ruby red 1-3 mm
Round, flat, sometimes raised
Found on trunk or extremities
increase size and numbers with aging
Petechiae/Purpura
Deep red or reddish purple Petechiae (1-3 mm) Purpura larger Rounded, sometimes irregular; flat Distributed variably Suggests blood outside the vessels; may suggest a bleeding disorder or if petechia, emboli to skin; palpable purpura in vasculitis
Ecchymosis
Purple or purplish blue, fades to green, yellow, and
brown with time.
Variable size, larger than petechia > 3mm
Rounded, oval, or irregular; may have central subcutaneous flat nodule (a hematoma)
Variable distribution
Suggests blood outside the vessels; secondary to bruising or trauma, also seen in bleeding disorders.
Splinter Hemorrhages
Small linear subungual hemorrhage which is red when fresh and brown when aged, located at the distal 1/3of the nail bed, classically associated with mitral stenosis
Clubbing
Build-up of tissue in the fingers, causing the end of the fingers to become enlarged and the nails to curve downward.
Results in the fingers appearing bulb-like, or like an upside down spoon.
Seen most commonly with diseases of the heart and lungs that result in less oxygen in the blood.
Skin Tumors: Basal Cell Carcinoma
Grows slowly and seldom metastasizes
Most common in fair-skinned adults over age 40 and usually appears on the face.
Initial translucent nodule w/ depressed center and firm elevated border.
Skin Tumors: Squamous Cell Carcinoma
Usually appears on sun exposed skin of fair-skinned adults > 60 yrs age.
Grows quicker than a BCC, is firmer, and looks redder.
Face and back of hands often affected.
AIDS-Kaposi’s Sarcoma
KS lesions are nodules or blotches that may be red, purple, brown, or black, and are usually papular.
Typically found on skin, but common elsewhere, especially the mouth, GI tract and respiratory tract.
Growth can range from very slow to explosively fast, and associated with significant mortality and morbidity.
1st Degree Burn
1st-degree burn: The least serious burns are those in which only the outer layer of skin is burned, but not all the way through.
2nd Degree Burn
2nd-degree burn: When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned
3rd Degree Burn
3rd-degree burn: Burns involving all layers of skin causing permanent tissue damage. Fat, muscle and bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn.
Necrotizing Fasciitis
Commonly known as flesh-eating disease or flesh-eating bacteria syndrome.
Rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue.
Quickly progressing, having greater risk of developing in the immunocompromised due to conditions like diabetes & cancer.
Treatment: IV antibiotics/Amputation
