Skin, Hair, & Nails Flashcards
3 layers of skin
epidermis, dermis, subcutaneous
4 Pigments of skin
melanin, carotene, oxyhemoglobin, deoxyhemoglobin
Anagen phase
(growing phase)
lasts 2-5 years
85-90% of scalp hair is in anagen
this % decreases with age & male pattern baldness
Catagen phase
short transitional phase lasting a few days
Telogen phase
(resting phase)
approx 3 months
Hair is shed in the telogen stage or when a new hair pushes it out during the next anagen.
Vellus Hair
short and fine
Terminal Hair
coarser, thicker, pigmented
2 layers of nail plate
Outermost layer: formed by proximal nail matrix
Innermost layer: formed by distal nail matrix, which can be seen as the lunula or white crescent of the proximal nail plate
Alopecia universalis
permanent total hair loss
Alopecia totalis
permanent hair loss of eyebrows and up
Alopecia areata
Round shaped areas of hair loss; usually stress-related
Erythema
Red hue, increased blood flow, “slapped cheeks” (cellulitis, rosacea)
Violaceous
Purpling of the skin
senile purpura, kaposi’s sarcoma, benign vascular collection (venous lake), dermatomyositis (heliotrope=purple eyelids)
Pallor
Pale appearance
anemia, arterial insufficiency, arterial occlusion
Peripheral Cyanosis
Blue color of hands, nails, feet
severe heart disease, venous obstruction, anxiety, cold room
Central Cyanosis
Blue color of lips, oral mucosa, tongue
advanced lung disease, COPD, congenital heart disease, hemoglobinopathies
Jaundice
Yellowing of skin (sclera affected)
liver disease, hemolysis of RBCs
Carotonemia
Yellowing of skin (sclera not affected)
diet high in yellow vegetables
Hyperpigmentation
Darkening of skin
tan, melasma, post-inflammatory change
Depigmentation
absence of any pigment
vitiligo, albinoism
Pigment cells destroyed, hairs will be white
Hypopigmentation
skin lighter than normal
post-inflammatory, like after eczema inflammation becomes controlled; will return with time;
Warm/Hot skin indicative of
Inflammation, fever
Cool/Cold skin indicative of
Decreased perfusion, cold exam room
Moist skin indicative of
Anxiety, hyperthyroidism, ↑ oil production
Dry skin indicative of
Hypothyroidism, xerosis
Most common cutaneous symptom
Pruritis
Pruritis: definition and indications
Itching
May be a symptom of skin disease (dry skin, eczema, contact dermatitis, parasitic) or systemic illness (anemia, thyroid disorder, liver/kidney dz, lymphoma)
Things to look for in a mole to diagnose melanoma
ABCDE: Asymmetry, Border irregularity, Color (blue/black mixed with white/red), Diameter (>6mm), Evolution
Name the Primary Lesions
Macule, Patch, Papule, Nodule, Plaque, Wheal, Vessicle, Bulla, pustule, cyst
Macule
FLAT, nonpalpable lesions with change in color
Patch
FLAT, nonpalpable lesions with change in color >1 cm (vitiligo) 1°
Papule
RAISED, palpable, solid lesions (no fluid)
Nodule
RAISED, palpable, solid lesions (no fluid) >5mm (lipoma) 1°
Plaque
RAISED, palpable, solid lesions (no fluid) Elevated area of confluent papules (psoriasis) 1°
Wheal
RAISED, palpable, solid lesions (no fluid) Raised, edematous, evanescent (come and go) plaque (hive) 1°
Vesicle
Papule that contains yellowy serous fluid;
Bulla
Larger variant of a vesicle; >5mm (large blister) 1°
Pustule
Papule that contains white purulent material (acne) 1°
Cyst
Nodule that contains purulent or semisolid material (acne) 1°
What is a primary lesion?
Initial presenting lesion that has NOT been altered by trauma, manipulation, scratching or natural regression over time
What is a secondary lesion?
Created by scratching, scrubbing, infection or natural regression of lesion with time (scale).
TELANGIECTASIA
Small dilated blood vessel (rosacea); will blanch 1°
Petechiae
Reddish purple discoloration caused by extravasation of blood;
Purpura
Reddish purple discoloration caused by extravasation of blood; >5mm (bruise) 1°
Comedo
Follicular collection of sebum & keratin (whitehead/blackhead) 1°
Burrow
Linear tunnel of epidermis produced by a parasite (scabies) 1°
Abscess
Circumscribed collection of pus associated with infection 1°
Furuncle
Acute, deep seated, hot, tender nodule or abscess (inflamed hair follicle) 1°
Carbuncle
Deeper infection comprised of interconnecting abscesses (multiple furuncles) 1°
Name the secondary lesions
Crust, Erosion, Ulcer, Fissure, Excoriation, Scar, Scale
Crust
Dried residue of serum, pus or blood (scab) 2°
Erosion
Loss of superficial epidermis, heals without scarring (popped blister) 2°
Ulcer
Deeper loss of epidermis & dermis (bed sore) 2°
Fissure
Vertical crack or split in the epidermis & dermis (after primary lesion, like with athlete’s foot between toes) 2°
Excoriation
Linear erosion induced by scratching (pickers!) 2°
Scar
Collection of new fibrous connective tissue (keloid) 2°
Scale
Thick stratum corneum or flaking of skin (dandruff)
Overproduction of oil in the scalp can cause overgrowth of yeast in the skin. This causes inflammation, which causes skin to peel. 2°
Linear
Pattern of lesions in a linear fashion
Annular
Pattern of lesions: round area with central clearing
Arcuate
Pattern of lesions: arc like
Gyrate
Pattern of lesions: like a worm crawling around AKA serpiginous
Reticular
Pattern of lesions: lacy patches
Confluent
Pattern of lesions: everything is colliding everywhere
Generalized
Pattern of lesions: head to toe
Dermatomal
Pattern of lesions: along one dermatome/nerve root. Unilateral. Can see in midline and off to one side.
Ex: shingles and HSV (If bilateral, rule these out)
Grouped
Pattern of lesions: just like it sounds. Grouped together lesions. Grouped vesicles are almost always some type of herpes virus
Pitting
Change affecting nails: Small pinpoint depressions; psoriasis
Splitting
Change affecting nails: Frequent hand washing, trauma, artificial nails, etc.
Dystrophy
Change affecting nails: Resulting from inflammation of skin overlying matrix or invasion of fungus (subungal debris)
Thickening
Change affecting nails: Psoriasis, onychomycosis (fungus)
Separation of nail bed
Change affecting nails: Trauma
Detachment of cuticle
Change affecting nails: Allows moisture & bacteria to invade in a normally sealed off environment, causing soft tissue swelling around the nail (paronychia)
Ridging of nails
Change affecting nails: Severe illness, trauma, or fever may cause temporary arrest of nail growth, resulting in horizontal grooving (Beau’s lines); longitudinal grooving (lichen planus).
Discoloration
Change affecting nails:
Trauma (bruising/hematoma)
Blue nails (drugs like minocycline or anti-malarials)
Green nails (pseudomonas bacteria)
Gray linear streak: deposition of lead
Splinter hemorrhages: reddish-black linear streaks of nail (trauma, endocarditis)
