Skin, Hair, and Nails Flashcards
Skin Functions
(4)
- Provide boundaries for body fluid
- Protect underlying tissue from microorganisms, harmful substances, and radiation
- Modulate body temp
- Synthesize vitamin D
Skin Structure
(% BW, 3 components, 4 appendages)
Largest organ of the body, at 16% of total BW
Components:
Layers
- Epidermis
- Dermis
- Subcutaneous tissue
*Appendages *
- Hair
- Nails
- Sebaceous glands
- Sweat glands
Hair
(describe 2 types)
- Vellus hair – short, fine, less pigmentation
- Terminal hair – coarser, pigmented (scalp/eyebrows)
Nail Function
Protect distal ends of fingers/toes
Sebaceous Glands
(locations, function)
Location: all skin surfaces except palms/soles
Function: produce fatty substance secreted into skin surface thru hair follicles
Sweat Glands
(list and describe 2)
- Eccrine glands – widely distributed, open directly onto skin surface, help control body temperature
- Apocrine glands – found in axilla and groin, stimulated by emotional stress
Common Concerning Hair/Nail/Skin Symptoms
(3, and how to ask abou them in a health hx)
Symptoms:
- Hair loss
- Rash
- Moles
Ask the patient:
“Have you noticed any changes in your skin or your hair?”
“Have you noticed any moles that have changed size, shape, color, or sensation?”
“Have you noticed any new moles?”
Pt Education for Healthy Skin
(3 points)
- Early detection of suspicious moles
- Protective measures for skin care
- Hazards of excessive sun exposure
Prevalence, Skin Cancer
Most common cancers in the U.S., c most cases presenting on
- Hands
- Neck
- Head
Skin Cancers
(3 types, % of cancers, description)
- Basal cell carcinoma
- Comprises 80% of skin cancers
- Shiny and translucent, they grow slowly and rarely metastasize
- Squamous cell carcinoma
- Comprises 16% of skin cancers
- Crusted, scaly, and ulcerated, they can metastasize
- Melanoma
- Comprises 4% of skin cancers
- Rapidly increasing in frequency, they spread rapidly
Melanoma Risk Factors
(7)
- ≥50 common moles
- ≥1-4 atypical or unusual moles (especially if dysplastic)
- Red or light hair
- Actinic lentigines, macular brown or tan spots (usually on sun exposed areas)
- Heavy sun exposure (especially severe childhood sunburns)
- Light eye or skin color (especially freckles/burns easily)
- Family history of melanoma
Melanoma Screening Tool
ABCDE of Melanoma:
A for asymmetry
B for irregular borders, especially ragged, notched, or blurred
C for variation or change in color, especially blue or black
D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding
E for elevation or enlargement
Logistics of a Quality Skin Exam
(2)
- Make sure pt wears a gown, and drape appropriately
- Use good light, preferably natural light, to prevent color distortion
Notable Skin Characteristics on Inspection/Palpation
(6)
- Color
- Moisture
- Temperature
- Texture
- Mobility and turgor
- Lesions
Skin Color Examination Points
(1 tool, 4 colors and where to find them)
Tool: use your pts, they will often notice skin color changes before the examiner
Location Specifics:
- Pigmentation concentration - global
- Redness (from oxyhemoglobin) - fingertips, lips, mucus mem, and palms/soles for darker skinned people
- Central cyanosis - lips oral mucosa, tongue
- Jaundice - sclera
Skin Moisture Variations
(3)
- Dryness
- Sweating
- Oiliness
Skin Temperature Evaluation Technique
Use back of fingertips
Skin Mobility/Turger Eval
(2 steps)
- Lift fold of skin
- Note ease with which it lifts up (mobility) and speed with which it returns to place (turgor)
Notable Skin Lesion Characteristics
(6)
- Location
- Distribution
- Pattern
- Shape
- Category (macule, papule, nevus, vesicle)
- Color
Skin Lesion Identification
(2 guidlines)
- Whenever you see a skin lesion, look it up in a well-illustrated textbook of dermatology
- To arrive at a dermatologic diagnosis, consider the type of lesions, location, and distribution, along with the patient’s history and physical
Hair Evaluation
(2 techniques, 3 observations)
Techniques:
- inspect
- palpate
Points to look for:
- quality
- distribution
- texture
Nail Observations
- Color
- Shape
- Lesions
longitudinal bands of pigment may be normal finding in people c darker skin
Hair/Skin/Nail Eval of a Bedbound Patient
(3 guidlines)
- People confined to bed are particularly susceptible to skin damage and ulceration, so take note to do frequent and thorough skin checks
- Pressure sores result when sustained compression obliterates arteriolar and capillary blood flow to the skin
- Assess these patients by carefully inspecting the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels
- Roll patient onto one side to see sacrum and buttocks
Skin/Hair/Nail Documentation
Initially you may use sentences to describe findings;
later you will use phrases
Examples:
“Color good. Skin warm and moist. Nails without clubbing or cyanosis. No suspicious nevi. No rash, petechiae, or ecchymoses.”
“Marked facial pallor, with circumoral cyanosis. Palms cold and moist. Cyanosis in nailbeds of fingers and toes. One raised blue-black nevus, 1x2 cm, with irregular border on right forearm. No rash.”
