skin hair nails hape Flashcards
what does pallor indicate?
anemia
cyanosis
a blue color, can indicate decreased oxygen in the blood or decreased blood flow in response to a cold environment.
jaundice
or yellowing of the skin, results from increased bilirubin.
what does the cuticle do?
protects the space between the fold and the plate from external moisture.
what is the angle between the proximal nail fold and nail plate?
less than 180 degrees
pilosebaceous glands
produce a fatty substance secreted onto the skin surface through the hair follicles. These glands are present on all skin surfaces except the palms and soles.
eccrine sweat glands
widely distributed, open directly onto the skin surface, and help to control body temperature by their sweat production
apocrine sweat glands
found chiefly in the axillary and genital regions and usually open into hair follicles. Bacterial decomposition of apocrine sweat is responsible for adult body odor.
common or concerning symptoms of the integumentary system
Lesions
Rashes and itching (pruritus)
Hair loss and nail changes
what kind of lesions should you look for on a pt skin?
Look for lesions suggesting melanoma, basal cell carcinoma (BCC), or squamous cell carcinoma (SCC) throughout the skin examination regardless of the patient’s skin color. Detecting skin cancer at an early stage can increase the likelihood of successful treatment
what are causes of generalized itching without apparent rash?
dry skin; pregnancy; uremia; jaundice; lymphomas and leukemia; drug reactions; and, less commonly, polycythemia vera and thyroid disease
what should you encourage pt to use to replace lost moisture barrier?
moisturizers
what are the most common causes of difffuse hair thinning?
male and female pattern baldness
what do hair breaks along the shaft suggest?
damage from hair care or tinea capitis
what is hair shedding at the roots common of?
telogen effluvium and alopecia areata
what are good descriptions to describe skin lesions and rashes?
number, size, color, shape, texture, primary lesion, location, and configuration.
what is a primary skin lesion?
those that develop as a direct result of, and therefore are most characteristic of, the disease process
examples of macules
Examples include freckles, flat moles, and port-wine stains and the rashes of rickettsial infections, rubella, and measles.3
examples of papules
Examples include nevi, warts, lichen planus, insect bites, seborrheic keratoses, actinic keratoses, some lesions of acne, and skin cancers
examples of plaques
Lesions of psoriasis and granuloma annulare commonly form plaques.3
examples of nodules
cysts, lipomas, and fibromas
what are pustules common in?
common in bacterial infections and folliculitis
what are vesicles characteristic of?
herpes infections, acute allergic contact dermatitis, and some autoimmune blistering disorders such as dermatitis herpetiformis
classic autoimmune bullous diseases
pemphigus vulgaris and bullous pemphigoid
what are wheals?
common manifestation of hypersensitivity to drugs; stings or bites; autoimmunity; and, less commonly, physical stimuli including temperature, pressure, and sunlight
what areas does psoriasis frequently effect?
scalp, extensor surfaces of the elbows and knees, umbilicus, and the gluteal cleft.
where does lichen planus frequently arise?
wrists, forearms, genitals, and lower legs.
characteristics of vitiligo
may be patchy and isolated or may group around the distal extremities and face, particularly around the eyes and mouth.
Discoid lupus erythematosus
characteristic lesions on sun-exposed skin of the face, especially the forehead, nose, and the ear.
Hidradenitis suppurativa
involves skin containing a high density of apocrine glands, including the axillae, groin, and under the breasts.
examples of configuration of skin lesions
herpes zoster with unilateral and dermatomal vesicles; herpes simplex, with grouped vesicles or pustules on an erythematous base; tinea pedis with annular lesions; and poison ivy allergic contact dermatitis with linear lesions.
examples of textures of lesions
Scaling can be greasy, like seborrheic dermatitis or seborrheic keratoses, dry and fine like tinea pedis, or hard and keratotic like actinic keratoses or SCC.
blanchable lesions
erythematous and suggest inflammation
nonblanching lesions
petechiae, purpura, and vascular structures (cherry angiomas, vascular malformations) are not erythematous, but rather bright red, purple, or violaceous. They are nonblanching because blood has extravasated out from the capillaries into the surrounding tissues.
what is the dermoscope used for?
With adequate clinician training, use of dermoscopy improves the sensitivity and specificity of differentiating melanomas from benign lesions
what is the first requirement for the skin examination?
Ask the patient to change into a gown with the opening in the back and clothes removed except for underwear
parts of the full skin exam when patient is seated
Inspect the hair and scalp (distribution, texture, and quantity).
Inspect the head and neck, including forehead, eyebrows, eyelids, eyelashes, conjunctivae, sclerae, nose, ears, cheeks, lips, oral cavity, chin, and beard. Inspect the upper back.
Inspect the shoulders, arms, and hands including palpation of fingernails.
Inspect the chest and abdomen.
Inspect the anterior thighs and legs.
Inspect the feet and toes including soles, interdigital areas, and toenails.
parts of the full skin exam where pt is standing
Inspect the lower back.
Inspect the posterior thighs and legs.
Inspect the breasts, axillae, and genitalia including axillary and pubic hair.
what can you do to be less likely to miss part of the skin exam?
perform it in the same order everytime
alopecia
can be diffuse, patchy, or total. Male and female pattern hair loss are normal with aging. Focal patches may be lost suddenly in alopecia areata.6 Refer scarring alopecia to a dermatologist.
what is associated with sparse hair and what is associated with fine, silky hair
hypothyroidism for sparse hair and fine silky hair for hyperthyroidism
what is the best way to learn to distinguish normal skin lesions from abnormal lesions and potential skin cancers
Instead of documenting what is not present on the skin, document what is present
what are possible internal causes of diffuse nonscarring hair shedding in young women
anemia, hypo or hyper thyroidism
what do fever, chills, and pain suggest in the bed bound patient?
underlying osteomyelitis
revised pressure injury staging system
*Stage 1: Intact skin with a localized area of nonblanchable erythema, which may appear differently in darkly pigmented skin.
*Stage 2: Partial-thickness loss of skin with exposed dermis
*Stage 3: Full-thickness skin loss, in which adipose (fat) is visible in the ulcer and granulation tissue and rolled wound edges, is often present.
*Stage 4: Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer.
*Unstageable: Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.
*Deep tissue pressure injury: Persistent nonblanchable deep red, maroon, or purple discoloration.
important topics for health promotion and counseling
Skin cancer prevention
Skin cancer screening including melanoma
risk factors for melanoma
-Personal or family history of previous melanoma
- ≥50 common moles
-Atypical or large moles, especially if dysplastic
-Red or light hair
-Solar lentigines (acquired brown macules on sun-exposed areas)
-Freckles (inherited brown macules)
-Ultraviolet radiation from heavy sun exposure, sunlamps, or tanning booths
-Light eye or skin color, especially skin that freckles or burns easily
-Severe blistering sunburns in childhood
-Immunosuppression from human immunodeficiency virus (HIV) or from chemotherapy
-Personal history of nonmelanoma skin cancer
what is the best way to prevent against skin cancer?
avoid UV radiation exposure by limiting time in the sun, avoiding midday sun, using sunscreen, and wearing sun-protective clothing with long sleeves and hats with wide brims. Advise patients to avoid indoor tanning, especially children, teens, and young adults.
signs of chronic sun damage
numerous solar lentigines on the shoulders and upper back, many melanocytic nevi, solar elastosis (yellow, thickened skin with bumps, wrinkles, or furrowing), cutis rhomboidalis nuchae (leathery thickened skin on the posterior neck), and actinic purpura
how much does the use of indoor tanning beds (especially before age 35) increase your risk of melanoma?
75%
how many melanomas arise de novo from isolated melanocytes rather than pre-existing nevi
at least half
what is the most sensitive aspect of the ABCDE method?
E, evolution or change
blue or black color within a larger pigmented lesion is especially concerning for melanoma except for….?
homogenous blue color in a blue nevus
Approximately half of melanomas are initially detected by…..
patients or their partners
burrows
Small linear or serpiginous pathways in the epidermis created by the scabies mite
what is the most common skin cancer in the world?
BCC
‘ugly duckling’
the nevus that looks different from the patient’s other nevi. A patient may make many atypical nevi with surrounding macular components and central papular components, but they all look the same. Find the patient’s signature nevus, then search for the ugly duckling that looks different from the patient’s typical “signature” nevi.
tinea captitis
There are round scaling patches of alopecia, mostly seen in children. There may be “black dots” of broken hairs and comma or corkscrew hairs on dermoscopy. Usually caused by Trichophyton tonsurans from humans, and less commonly, Microsporum canis from dogs or cats. Boggy plaques are called kerions.
monilethrix
a rare inherited disorder characterized by sparse, dry, and/or brittle hair that often breaks before reaching more than a few inches in length
clubbing of the fingers
a bulbous swelling of the soft tissue at the nail base, with loss of the normal angle between the nail and the proximal nail fold. The angle increases to 180 degrees or more, and the nail bed feels spongy or floating.
habit tic deformity
There is depression of the central nail with a “Christmas tree” appearance from small horizontal depressions, resulting from repetitive trauma from rubbing the index finger over the thumb or vice versa.
mealnonychia
ncreased pigmentation in the nail matrix, leading to a streak as the nail grows out
onycholysis
painless separation of the whitened opaque nail plate from the pinker translucent nail bed
Local causes include trauma from excess manicuring, psoriasis, fungal infection, and allergic reactions to nail cosmetics. Systemic causes include diabetes, anemia, photosensitive drug reactions, hyperthyroidism, peripheral ischemia, bronchiectasis, and syphilis.
terry nails
Seen in liver disease, usually cirrhosis, heart failure, and diabetes
beau lines (transverse linear depression)
Transverse depressions of the nail plates, usually bilateral, resulting from temporary disruption of proximal nail growth from systemic illness. Timing of the illness may be estimated by measuring the distance from the line to the nail bed
Seen in severe illness, trauma, and cold exposure if Raynaud disease is present.
how fast do nails grow?
1 mm every 6 to 10 days
pitting of the nails
Usually associated with psoriasis but also seen in reactive arthritis, sarcoidosis, alopecia areata, and localized atopic or chemical dermatitis.
addison disease
Hyperpigmentation of oral mucosa as well as sun- exposed skin, sites of trauma, and creases of palms and soles
chagas disease
Unilateral conjunctivitis and lid edema associated with preauricular lymphadenopathy
CREST syndrome
Calcinosis, Raynaud phenomenon, sclerodactyly, matted telangiectasias of face and hands (palms)
secondary lesions associated with acne
pitting and scars
solar elastosis
Yellowish white macules or papules in sun-exposed skin, especially on the forehead
Cutis Rhomboidalis Nuchae
Deep wrinkles on the posterior neck that “crisscross”
