Skin, Hair, and Nails (Chapter 9) Flashcards
What are some functions of the skin? (7)
- Protects the body against microorganism invaders
- Excretes urea, sweat, and lactic acid
- Helps with injury healing via exaggerated cell replacement
- Prevents excessive water loss
- Helps regulate body temperature
- Produces vitamin D
- Helps with sensory perception
Where is the epidermis? What are its layers? What are it’s primary functions?
The epidermis is the outermost layer of the skin. It is composed of the stratum basale, stratum granulosum, stratum corneum. Thicker parts of the skin (soles of the feet and palms of the hands) contain an extra layer for protection known as the stratum lucidum. Mucus membranes lack the stratum corneum layer.
The epidermis primary functions are protection from invading organisms and restriction of water loss.
Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum basale
Stratum corneum is the outer most layer of the epidermis and the skin in general. It’s composed of dead squamous cells packed full of keratin.
Stratum lucidum is an extra layer of protection found on the palms of the hands and soles of the feet.
Stratum granulosum is a middle layer
Stratum basale is the lowest layer and contains stem cells that allow for the regenerative properties of the skin.
How long does it take skin cells to progress through the layers of the epidermis?
28 days
What is the dermis? Where is it? What is its main functions? How does it differ from the epidermis?
The dermis is the middle layer of the skin. It is connective tissue and is highly vascular and contains nerves.
What is the hypodermis? What is it otherwise known as? What is it’s functions?
The hypodermis is also known as the subcutaneous layer. It is comprised of adipose tissue that provides insulation and shock absorption.
What are the appendages of the skin?
- Eccrine sweat glands
- Apocrine sweat glands
- Hair
- Nails
- Sebaceous glands
Eccrine Vs Apocrine sweat glands
Eccrine sweat glands open directly onto the surface of the majority of the skin. Secrete sweat which helps regulate body temperature.
Apocrine sweat glands are sweat glands that are only found in the armpits, nipples, areolae, and anogenital region. They secrete a clear, odorless sweat that is more oily than that of the eccrine sweat glands. It help lubricate movement
What is the function of sebum?
Sebum is a lipid rich substance secreted by the sebaceous glands and acts as a lubricant, moisturizer for the skin
Infant skin:
- What is vernix caseosa?
- What is lanugo?
- Why are infants at risk for hypothermia?
- Eccrine and Apocrine functioning
Vernix caseosa - a mixture of sebum and cornified epidermis that covers the babies body at birth.
Lanugo - fine, silky hair that covers the newborns body. More prominent at the shoulders and back
Infants are at increased risk for hypothermia due to their lack of adipose tissue and inability to shiver to create heat
Eccrine sweat glands begin functioning after 1 month
Apocrine glands do not start working until puberty, which explains the lack of smell from a sweaty child
What changes of the skin are seen with puberty?
- Apocrine glands begin secreting their oily, lipid filled substances which accounts for the new found body odor in this population.
- Hormonal changes, in particular androgen, cause an increase in sebum secretion via the sebaceous glands. This gives adolescents the oily appearance and predisposes them to acne.
- Coarse hair grows in the armpits and pubic region in both males and females. Males begin growing coarse hair on their face.
Nevi
Moles
What skin changes are seen in older adults?
- Dry skin - decrease in sebaceous and sweat gland activity. Epidermis thins which allows increased amounts of moisture to escape.
- Wrinkles - loss of collagen in the dermis and exposure to sun rays cause the epidermis to fold inward.
- Decreased subcutaneous tissue
- Gray hair - decreased melanocytes
- Facial hair in women, baldness
Carotenemia
Common in infants who are eating baby food or whole foods that are high in beta-carotene. Foods that are high in this are sweet potatoes, carrots, squash. This is a harmless condition that is self-limiting once the consumption of the offending food is eliminated.
What are the risk factors for melanoma? (8)
How does a nevi concerning for melanoma appear?
- Sun exposure or tanning beds
- Increased exposure to UV radiation (high altitude living)
- Personal history of melanoma
- Family history of melanoma
- Atypical nevi (mole)
- Large nevi
- Immunosuppression
- Skin type, relative inability to tan
Think of the ABCDEs. Asymmetrical, borders are irregular, not the same color throughout the nevi, larger in diameter than 6mm, and evolving.
What are the risk factors for basal and squamous cell carcinoma?
- Age - 50+ increases risk
- Exposure to sunlight or UV radiation
- Chronic and cumulative - squamous
- Intermittent exposure to sunlight - basal
-Petroleum products - Over exposure to radiation (x-rays)
- Large scars
Compare the color features of a normal nevi (mole) vs an atypical one
Normal - uniformly tan or brown. All moles on one individual seem to look alike
Atypical - mixture of tan, brown, black, red, or pink. The moles on the individual do not resemble each other
Compare the shape features of a normal nevi vs an atypical one
Normal - round or oval with a clearly defined border that separates the nevi from surrounding skin
Atypical - irregular borders that may include notches. May fade into surrounding skin.
Compare the surface features of a normal nevi vs an atypical one
Normal - Begins as flat, smooth spot on skin; becomes raised; smooth bump
Atypical - smooth, slightly scaly, or have a rough irregular appearance
Compare the size features of normal vs atypical nevi
Normal - Usually less than 6mm
Atypical - often larger than 6 mm
Compare the number feature of normal vs atypical nevi
Normal - 40 or less
Atypical - whole bunch
Compare the location features of normal vs atypical nevi
Normal - above the waist on sun exposed surfaces. Scalp, breast, and buttocks rarely have normal moles.
Atypical - occur anyway on the body. Most commonly appear on the back but can also be seen on the scalp, breast, and buttock
Purpura
Red, purple nonblanchable. Similar to bruising but smaller in size and has different causes.
Causes - platelet dysfunction, infections
Petechiae
Red-purple nonblanchable. Tiny dots.
Causes - platelet dysfunction, infection
Ecchymoses
Bruising.
Causes - trauma
Spider angioma
Red central body with radiating spinder-like legs branching off center.
Causes - liver dysfunction, vitamin B deficiency
Venous star
Bluish spider, linear or irregular
Causes - increased venous pressure in superficial veins
Telangiectasia
Fine, irregular red lines (see it on pts noses sometimes)
Causes - dilation of capillaries
What is the ABCDEs of mole VS melanoma?
A - asymmetry - atypical nevi can more likely to lack symmetry
B - border - atypical nevi will lack a clear and well defined border. They may have an irregular, ragged, notched, or blurred border.
C - color - atypical nevi are unevenly colored throughout the nevi. Can include colors such as brown, black, blue, red, and pink.
D - diameter - atypical nevi present as larger, larger than 6mm is a red flag
E - evolving - the nevi is changing size, shape, and/or color
What are macules? How do they appear? What are some examples?
Macules are flat, circumscribed areas that are a break in color from the rest of the skin. Less than 1 cm in diameter. Examples include freckles, flat nevi, petechiae, measles.
What are papules? What are some examples?
Papules are areas of elevated, firm, circumscribed alterations in the skin. Less than 1 cm in diameter. Examples include warts (verruca), elevated nevi, and lichen planus
What are patches? What are some examples?
Patches are flat, nonpalpable, irregularly shaped macule that exceeds 1cm in diameter. Vitiligo, port-wine spots
What are plaques? What are some examples?
Elevated, firm, rough lesion with flat top. Greater than 1 cm. Examples include psoriasis and atopic dermatitis.
What are wheals? What are some examples?
Wheals are elevated, irregular-shaped areas of cutaneous edema. They are solid and change in diameter through the course of their existence. Examples include insect bites (think what a mosquito bite looks like), urticaria, allergic reaction.
What are nodules? What are some examples?
Nodules are elevated, firm, circumscribed lesions. They are located deeper in the dermis than papules. 1-2cm in diameter. Examples include erythema nodosum, and lipomas.
Compare and contract papules and nodules
Papules and nodules both have elevated, firm, circumscribed lesions. Papules tend to be smaller at 1cm or less while nodules can range between 1-2 cm. The biggest difference between the two is that nodules present as a deeper lesion, farther into the dermis while papules are more superficial.
What are masses/tumors? Examples?
Masses/tumors are elevated, solid lesions that are found deep in the dermis and are larger than 2 cm. Examples are neoplasms, benign tumors/masses, and lipomas.
What are vesicles? Examples?
Vesicles are elevated, circumscribed, superficial (not into the dermis) serous fluid filled areas that are less than 1 cm in diameter. Examples are varicella (chickenpox) and herpes zoster (shingles).
What are bulla? Examples?
Bulla are vesicles that are greater than 1 cm. A vesicle is an elevated, circumscribed, superficial, serous filled lesion that is less than 1 cm in diameter.
Examples are blisters, permphigus vulgaris
What are pustules? Examples?
Pustules are elevated, superficial lesions that are similar to vesicles but are filled with purulent fluid instead of serous.
Examples include acne and impetigo.
What are cyst? Examples?
Cyst are elevated, circumscribed, encapsulated lesions that are either found in the dermis or subcutaneous layers of the skin (deep). They are filled with liquid or semisolid material.
Examples include sebaceous cyst and cystic acne.
What is telangiectasia? Examples?
Fine, irregular, red lines produced by capillary dilation. Seen in rosacea and similar conditions.
What is a scale? Examples?
Heaped up, keratinized cells, flaky skin, irregular, thick and dry or oily. Seen with dry skin that is flaking, seborrheic dermatitis (cradle cap is an example).
Lichenification. Examples
Rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation. Seen in contact dermatitis.
Keloid. Example
Keloids are irregularly shaped, elevated, progressively enlarging scars. Grows beyond the border of the wounds. Caused by excessive collagen growth during healing process.
Scar
Thin or thick fibrous tissue that replaces normal skin after injury or laceration to the dermis
Excoriation
Loss of epidermis. Linear, hollowed out. Abrasion or scratch, scabies are examples.
Fissure
Linear crack or break from the epidermis to the dermis. Athletes foot, cracks at the corner of the mouth.
Erosion
Loss of part of the epidermis. Depressed, moist, glistening, Follows rupture of vesicle or bulla.
Ulcer
Loss of epidermis and dermis. Concave, varies in size. Pressure ulcers or stasis ulcers.
Crust
Dried serum, blood, or purulent exudates. Slightly elevated. Rough. Varies in color. Scabs and eczema.
Atrophy
Thinning of the skin surface and loss of skin markings. Translucent and paper-like. Striae (stretch marks) or aged skin.
Shapes of lesions
- Annular
- Zosteriform
- Polycyclic
- Iris/target lesion
- Stellate
- Serpiginous
- Reticulate
- Morbilliform
- Annular - round, active margins with a clear center (tinea corporis)
- Zosteriform - follows a nerve or segment of the body
- Polycyclic - interlocking circles (caused by enlargement of annular lesions)
- Iris/target lesion - pink macules with purple central papules
- Stellate - star shaped
- Serpiginous - snakelike, wavy line track
- Reticulate - netlike or lacy
- Morbilliform - measles-like; maculopapular lesions that become confluent on the face and body
Desquamation
Keratotic
Punctation
Desquamation - peeling or sloughing of the skin
Keratotic - hypertrophic stratum corneum (calluses, warts)
Punctuation - central umbilication or dimpling (basal cell carcinoma)
Anonychia. How does it come about?
Absence of the nail. Congenital condition.
What are two expected changes seen in nail beds with aging? What are some changes in darker skin people that are expected findings? How does this change if the appearance of the darkened band is sudden?
Formation of longitudinal lines and beading. Darker skinned individuals can present with pigmented bands on their fingernails, areas of differing color.
Sudden appearance of darkened bands or darkened areas on the nail bed are worrisome for melanoma.
What is the normal nail base angle? What conditions can alter this angle? What is seen in these conditions and what causes them?
The normal nail base angle is 160 degrees.
Changes in the nail bed angle can be seen with chronic respiratory diseases such as COPD, emphysema. Cardiovascular, cirrhosis, colitis, and thyroid disease can also present with these changes.
This increase in nail bed angle is known as clubbing. Clubbing is considered when the nail bed angle approaches and exceeds 180 degrees.
What are transverse grooving of the nails? What is it known as? Common causes?
Beau lines. This is caused by temporary stunting of the nail growth. Can be caused by many factors such as decreased nutrition, trauma, or illnesses.
What is spoon nail? What is it known as? What causes it?
Spoon nails, also known as koilonychia, is a condition where the nails become slightly concave instead of convex as they would be normally. The nails are thin and brittle and may be slightly discolored. Associated causes are iron deficiency anemia (most commonly), other nutritional deficiencies, chemotherapy.
Abnormality found in one nail bed vs all nail beds
Abnormalities affecting a single nail bed is associated with trauma or damage to the nail bed on that finger. Abnormalities that are affecting multiple nails are more indicative of systemic disease.
Common systemic diseases that affect the nails include syphilis, high fevers, PVD, and uncontrolled DM.
How long does it take a fingernail to grow out? What about toe nails?
Fingernails take about 6 months to completely grow out
Toenails take about 9 months to completely grow out
Dark bands or darkened spots on the nail bed that extend back past the nail bed onto the finger?
Worrisome for melanoma
Broadening or flattening of the nail
Seen with syphilis
Pitting of the nails
Associated most commonly with psoriasis
Paronychia
Infection of the nailbed.
What are some changes that can occur in the skin, nails, and hairs seen in infants?
Infants can be born with a number of skin color differences.
- Acrocyanosis - cyanosis appearing on the hands and feet (expected findings and will resolve spontaneously)
- Cutis marmorata
- Erythema toxicum
- Congenital dermal melanocytosis
- Salmon patches (stork bites)
Cutis Marmorata
Expected or normal finding of the newborn. Transient mottling when the infant is exposed to decreased temperature.
Erythema toxicum
Expected or normal finding of the newborn. Pink papular rash with vesicles superimposed on the thorax, back, buttocks and abdomen. Resolves in a couple days.
Congenital dermal melanocytosis
Expected or normal findings in the newborn. Irregular areas of deep blue pigmentation, usually in the sacral and gluteal regions. More commonly see in non-Caucasians
Salmon patches (AKA)
Stork bites. Flat, deep pink localized areas usually seen on the midforehead, eyelids, upper lip, and back of neck.
Skin changes seen in pregnant populations
Striae gravidarum - stretch marks
Increased pigmentation of the nipples, scars, stretch marks
Palmar erythema
Linear nigera
Stage 1 Pressure injury
Intact skin. Nonblanchable redness of a localized area, typically over a bony prominence.
Stage 2 Pressure injury
Partial thickness loss of dermis presenting as a shallow open ulcer with a red or pink wound bed. No slough.
Stage 3 Pressure injury
Full thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon or muscle are not exposed. Slough may be present but does not obscure depth of tissue loss.
Stage 4 Pressure injury
Full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present but do not obscure the depth of tissue loss. Tunneling may be present.
Unstageable Pressure injury
Full thickness tissue loss in which the base of the wound is obscured by slough.
What is the most common inflammatory disorder of the skin?
Eczematous dermatitis. Includes contact, allergic contact, and atopic dermatitis.
Folliculitis
Inflammation and infection of the hair follicle and surrounding dermis
Furuncle
AKA boil. Deep-seated infection of the pilosebaceous unit
Cellulitis
Diffuse, acute, infection of the skin and subcutaneous tissue
Tinea (dermatophytosis)
Group of noncandidal fungal infections that involve the stratum corneum, nails, and hair
Psoriasis
Chronic and recurrent disease of keratinocyte proliferation
Rosacea
Chronic inflammatory skin disorder
Herpes simplex 1 vs 2
1 - associated with oral infection
2 - associated with genital infection
Kaposi sarcoma
Associated with HIV infection. Neoplasm of the endothelium and epithelial layers of the skin
Patterns of physical abuse in infants and children
- Bruises - normal bruises of childhood occur over bony prominences, suspicious bruises are seen over soft tissue
- Burns - typically stocking and glove appearance where the child’s hands or feet were placed into hot water
- lacerations
- Hair loss
- anogenital warts
Patterns of abuse in older adults
- Neglect
- Bruising
- Scars
- Burns
Describe the appearance of basal cell carcinoma
Small, pearly, or flesh colored bump on the skin.
Describe the appearance of squamous cell carcinoma
Firm, red bump, or scaly red patches. Usually found on sun exposed surfaces.
