Unit 2 Pathophysiology - Chapter 47 Structure, function, and d/o of integument Flashcards
Skin has how many layers?
Three: dermis, epidermis, and subcutaneous layer
Keratinocytes
Keratin (forms superficial layer of epidermis)
Underlying epidermis contains:
* basal and spinous layer w/
* melanocytes - creates pigment via melanin
* Langerhans cells - cutaneous immune system
* Merkel cells - sensitivity for touch, hormonal functions
Dermis
Consist of:
* connective tissue
* hair follicles
* sweat glands
* sebaceous glands
* blood vessels, nerves, and lymphatic vessels
Subcutaneous layer
Contains:
* macrophages
* fibroblasts (produce and maintain the ECM of connective tissue)
* fat cells
* nerves, fine muscles, blood vessels, lymphatics and hair follicle roots
dermal appendages
nails, hair, sebaceous glands, eccrine (most of body, sweats and evaporates) and apocrine (mainly hair follicles, same concept)
Papillary capillaries
provide major blood supply to skin, arising from deeper arterial plexuses
sympathetic nervous system regulates skin blood flow
Arteriorvenous anastomoses
l/t papillary capillaries => help with heat loss and heat conservation
Single Large vein and artery together
Older skin
thinner + drier w/ less collagen; fewer capillary loops and fewer changes in pigmentation
Gray and thinner hair
Lack of melanocytes and hair follicles
Skin integrity of OA
- more permeable
- decreased sweating
- loss of thermal regulation
- less protection
Pressure injuries
D/t continuous pressure and shearing forces occluding capillary blood flow l/t ischemia and necrosis
- greatest risks bony prominences: greater trochanter, sacrum, ischia, and heels.
Keloid
scars that extend beyond injury border and develop d/t abnormal fibroblast activity + excess collagen formation
Hypertrophic scars
elevated erythematous (abnormal redness) fibrious lesions that do not ext beyond injury border
Pruitus
Itch mediators, peripheral unmyelinated polymodal C nerve fibers, and central processes contribute to itching
Allergic contact dermatitis
form of delayed hypersensitivity develops with changes in skin barrier fx and exposure to allergns - microorganisms, metals, chemical, or poison ivy
Irritant contact dermatitis
inflammatory response to prolonged exposure to chemicals, acids or soaps
atopic dermatitis or atopic eczema
atopic (sensitivity to allergens); family history of allergies, hay fever, elevated IgE levels, and increased histamine sensitivity; common in children
Stasis dermatitis
occurs on legs; d/t venous stasis and edema
Seborrheic dermatitis
scaly, yellowish, inflammatory plaques of the scalp, eyebrows, eyelids, ear canals, chest, axillae, back; associated with Malassezia yeasts, immunosuppression, and epidermal hyperproliferation.
Papulosquamous disorders
papules, scales, plaques, and erythema
Psoriasis
chronic autoimmune T-cell mediated inflammatory skin disease; thickened epidermis and dermis w/ scaly, erythmatous pruitic plaques
Forms
* plaque (scaly, red, can impact nails)
* inverse (skin folds => groin, armpits => smooth and shiny red patches
* guttate (torso and limbs [younger folks] tear drop shapes]
* pustular (palms and soles blotchy red pustules)
* erthrodermic
Can accompany w/ disease:
* arthritis
* nail disease
* CV disease
Pityriasis rosea
self-limiting disease w/ herpes type viruses present w/ oval lesions w/ scales around edges (herald patch) at skin lines of the trunk
Lichen planus
papular violet-colored autoimmune inflammatory lesion involving T cells and inflammatory cytokinesd/t severe pruitus and involve both skin and mucuos membrane lesions
Acne vulgaris
nose; inflammation of pilosebaceous follicles with hypertrophy (increased growth) of sebaceous glands + telangiestasia (small, widened blood vessels on the skin)
Hidradenitis suppurativa
chronic inflammatory recurring scarring disease of pilosebaceous follicular ducts at skin w/ folds, hair follicles, and aprocrine (Sweat) glands and is r/t immune and environmental factors
Acne rosacea
inflammation w/ erythema, edema, papules, pustules, and telangiectasia that develops on middle 1/3 of face with hypertrophy + inflammation of sebaceous glands d/t infection or immune mediated inflammation
Cutaneous lupus erythematosus
inflammatory autoimmune disease affecting only skin; inflammatory lesions usually in sun-exposed area w/ butterfly distribution over nose + cheeks
Pemphigus
chronic autoimmune blistering disease begins in mouth or scalp and spreads to other parts of body => fatal outcomes
- pemphigus vulgaris (most common)
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Bullous pephigold
benign autoimmune blistering disease that resolves rapidly
Erythema multiforme minor
acute inflammation of skin w/o involvement of mucous membrane; target-like with alternating rings of edema + inflammation d/t HSV (herpes simplex) or other infections; rarely drug reactions
SJS, stevens-johnson syndrome and toxic epidermal necrolysis (TEN)
There is a SJS/TEN overlap syndrome are the same disease with progressive blistering d/t keratinocyte cell death via bullous epidermal detachmen, mucositis (when your mouth or gut is sore and inflamed. It’s a common side effect of chemotherapy and radiotherapy), and organ involvement d/t cytotoxic t-cell drug reaction
Folliculitis
bacterial infection of hair follicle
Furuncle
infection of the hair follicle that extends to the surrounding tissue
Carbuncle
collection of infected hair follicles that forms a draining abcess
Cellulitis
diffuse infection - dermis + subq
d/t staphylococcus, CA-MRSA or group B streptococci
Erysipelas
superficial streptococcal infection of skin (face, ears, lower legs)
Impetigo
bullous or ulcerative form d/t staphylococcus or streptococcus (common in children)
contagious skin infection that causes red sores on the face.
HSV-1
cold sores can infect cornea, mouth and labia
HSV-2
genital lesions and spread by sexual contact
Herpes zoster and varicella (chickenpox)
Same herpesvirus, herpes zoster manifesting years after intial infection
Warts or verrucae
benign, rough, elevated lesions d/t papillomavirus; venereal warts (condylomata acuminata) spread via sexual contact
Tinea skin infections
Fungal infections; anywhere on body and classified by location (capitis - scalp, pedis - feet, corporis - body, crusis - groin, unguium - nails)
Candidiasis
yeastlike fungal infection - C. albicans [skin, mucous membranes, GI tract]
Cutaneous vasculitis
immune-mediated inflammation of small skin blood vessels w/ purpura, ishcemia, and necrosis resulting from disruption of vessel wall
A purpura rash occurs when small blood vessels burst, causing blood to pool under the skin.
Utricarial lesions
type I hypersensitivity responses; wheals (raised itchy pruitic patch), welts, or hives
scleroderma
immune-mediated schlerosis (hardening) of skin localized to skin to systemic and affect bone, bone, and other organs that invovle T helper cells, cytokines, and autoantibodies
seborrheic keratosis
older adults; usually sun damaged skin; squamous cells that make elevated, smooth or warty lesions of different sizes
keratocanthoma
Hair follices on sun areas; dome-shaped, crusty lesion filled with keratin resolves in 3-4 months
Keratin is protein can be a hair plug
actinic (solar) keratosis
pigmented scaly lesion on sun exposed person w/ fair skin; may become malignant in form of squamous cell carcinoma
Nevi
melanocytes form; pigmented or fleshy pink; single or groups => transition to malignant melanoma
Basal cell carcinoma
common skin cancer and occurs on sun-exposed areas with different subtypes and morphologic presentations
Squamous cell carcinoma
tumor of epidermis with uncontrolled growth of kerantinocytes associated w/ sun exposure and localized or invasive
cutnaeous melanoma
maligant tumor arising from melanocytes; if not excised early, metastasis occurs through lymph nodes d/t chronic sun exposure or melanocytic nevi
KS
endothelial cell vascular malignancy r/t immunodeficiency states and herpesvirus 8
cutaneous lymphomas
cutaneous T-cell and B-cell lymphomas that present in the skin but may develop disease in extracutaenous sites
frostbite
cheeks + digits, direct injury to cell and impaired circulation
Androcentric alopecia
irreversible baldness in central scalp and recession of temporofrontal hairline that occus in both men and women
Female pattern alopecia
thinning of central hair of scalp for women 20-30 and d/t high levels of serum adrenal androgen dehydropiandrosterone sulfate
Alopecia areata
patchy loss of hair d/t autoimmune process and stress triggers or metabolic diseases; reversible
Hirsutism
male pattern of hair growth in women; normal or d/t androgenic hormone secretions
Paronychia
inflammation of cuticle d/t staphylococci or streptococci
Onychomycosis
fungal infection of nail plate
