Skin, Hair, Nails Flashcards
Two open ended questions about skin
“Have you noticed any changes in your skin? hair? nails?”
“Have you noticed any new sores, lumps, bumps or changes in your skin color?”
Parts to ROS
Skin, hair & nail changes, itching, rashes, sores, lumps, new moles or change in existing moles
Questions Regarding Lesion Timing
- When did it start or 1st noticed?
- Sudden or gradual onset?
- Specify change: size, shape or color
Technique for PE of Skin
- Inspection & palpation
- Good lighting and magnifying lens
- Disrobe pt relative to CC
Part of Physical Evaluation of Skin
- Color (overall): erythema, pallor, yellow, cyanosis
- Moisture: dryness, sweating, oiliness
- Temperature
- Texture
- Mobility & Turgor (rapid or less than 2-3 sec)
Aggravating/Alleviating Factors for Skin Conditions
What did skin come into contact with? Chemical irritants? -Changes in topical exposures (skin lotions, fabric softeners, soaps, wool, lanolin, make-up) -New medications: topical or systemic -Switch brand name to generic
Severity/Character of Skin Conditions
- what did it look like when it first started compared to now? Has it spread, if so pattern? Does it hurt or itch?
- Additional descriptors: scaling, crust, weeping, bleeding, delayed healing, odor
Environmental Triggers of Skin Conditions
when/where does the lesion appear
-sun, home, work, outside, near pets
Erythema
bright red all over
Pallor
Paleness caused by loss of hemoglobin, vasovagle reaction
Central Cyanosis
- lips, tongue, mucous membranes; usually related to COPD, heart problems
Peripheral Cyanosis Causes
- poor perfusion
- blood not returning to heart quickly due to viscosity
- connective tissue disorders
Terminology to Describe Texture of Skin
rough, smooth, dry, scaly
Location of Psoriasis
- extensor surfaces
- elbows, knees, across chest, vulva
Location of Tinea versicolor
fungus with general distribution all over body
Location of Eczema
- flexor surfaces
children: cheeks, around mouth
adults: hairline
Components Physical Evaluation of Lesions
Size (bi-dimensional) Location and Distribution Color Patterns and Shapes Types (Primary and Secondary)
café-au-lait
- uniform tan patch
- one spot not a big concern
- associated with neurofibromatosis
T. versicolor
Pigmented macules on body
heliotrope
purple, violet, lilac
Examples of patterns & shapes of lesions
Linear or dermatomal geographic clustered serpiginous annular arciform targetoid
Linear
straight line
Dermatomal
- straight line following specific nerve pattern
- shingles is most common
Clustered
lesions separate but grouped together
Annular
ring/ round
Arciform
Arc
Targetoid
look like bullseye
Primary Lesions
Flat: macule, patch,
Raised: papule, plaque, nodule/cyst, wheal, burrow
Raised & fluid filled: vesicle, bulla, pustule
Primary Flat Lesions
Macule and Patch
Primary Raised Lesions
Papule, plaque, nodule/cyst, wheal, burrow
Primary Raised & fluid filled Lesions
vesicle, bulla, pustule
Secondary Lesions
Flat: Scale, crust, lichenification, scars/keloids
Depressed: erosion, excoriation, fissure, ulcer
Secondary Flat Lesions
Scale, crust, lichenification, scars/keloids
Secondary Depressed Lesions
erosion, excoriation, fissure, ulcer
Lichenification
skin becomes thick and rough due to chronic scratching or itching; does not happen overnight
Scar vs. Keloid
Scar is superficial and filling in defect
Keloid goes beyond area of original injury and hypertrophies
Stage 1 Pressure Ulcers
- Erythema that fails to blanch
- in people who are bed ridden with limited mobility
Stage 2 Pressure Ulcers
Partial thickness skin loss
Stage 3 Pressure Ulcers
Full thickness skin loss & extends to underlying muscle but does not go through the muscle
Stage 4 Pressure Ulcers
Full thickness skin loss w/ damage to muscle & bone
Type of Lesions
Vascular and Purpuric
Types of Vascular Lesions
Spider angioma, spider vein, cherry angioma
Types of Purpuric Lesions
Petechia/purpura
Ecchymosis
Spider Angioma
- red
- will not blanche
- usually found above waist
- commonly associated with liver disease
Spider Veins
- do not blanche with central pressure, but press on outer edges it may blanche
- associated with lower extremities
- typically people will also have varicose veins
Cherry Angioma
- bright fiery red, but benign
- very tiny
Nevi (moles)
- Congenital or acquired with malignant potential
- Basal cell
- Squamous cell
- Melanoma
Basal Cell CA
Grow slowly, seldom metastasizes
Most common: fair skin, 40+ y/o, common on face
Early: red macule or papule
Late: Depressed center, Firm elevated border, Translucent nodule w/telangiectasia
Squamous Cell CA
- Grows quicker than basal cell
- Face, neck, back, tips of ears, hands
- Most common: fair skinned, 60+ y/o
- Firm, erythematous, Scale, crust
ABCDE’s of Moles
Asymmetry Border Color Diameter Evolution
Causes of Hair Loss
Alopecia
Trichotillomania
Infection
Alopecia
- clearly delineated round or oval patches of hair loss
- various forms of balding
Compulsive pulling out of hair
Trichotillomania
Clubbing
- change in angle of nail due to bulbous swelling of the tissue at the nail base
- seen in long term COPD or heart failure
Paronychia
- superficial infection of cuticles
- cuticles are red, swollen, and tender
Tinea Capitis
- ringworm
- round scaling patches of alopecia
Onycholysis
- painless separation of the whitened opaque nail plate from the pinker translucent nail bed
- from fungal infection; manicuring, trauma, dishwashing detergents, psoriasis
Leukonychia
trauma to the nails causes white spots
Mees’ Lines
-transverse white lines; usually due to repetitive manicuring
Beau’s LInes
- transverse linear depression
- due to systemic illness
Pitting
punctate depressions of nail plate caused by defective layering of superficial nail plate
Geriatric Changes
Capillary fragility (Actinic purpura)
Decreased turgor
Long term sun-exposure
Patient Education
- Skin Cancer types (ABCDE for early recognition)
- Modifiable Risk Factors: sun exposure, blistering sunburns
- Non-modifiable: FHx, fair skin, changing or atypical nevi, hx dysplastic nevi
- Monthly self exam > 50 y/o; Annually/PCP
- Shaving: prevent cross contamination
Non-modifiable risk factors for skin cancer
FHx, fair skin, changing or atypical nevi, hx dysplastic nevi
Modifiable Risk Factors for Skin Cancer
sun exposure, blistering sunburns
