Week 3: Skin, Hair and Nails Flashcards
Skin
Body’s largest organ
Three layers of skin
Epidermis, dermis, subcutaneous
Epidermis
Outer layer of the skin
- Thin but tough, cells bound tightly for form protective barrier
- Avascular, nourished from blood vessels in the skin below
Consists of inner Basal Cell Layer (keratin and melanin) and outer Horny Cell Layer (dead skin cells)
Dermis
The middle, supportive layer of the skin
Consists mostly of collagen (connective tissue); resists tearing, elasticity to stretch with movement
Contains:
- Nerves, sensory receptors, blood vessels, lymphatic vessels
- Hair follicles, sebaceous glands, sweat gland
Subcutaneous
Innermost layer of the skin,
Consists of adipose/fatty layer
Function:
- Stores fat for energy and insulation (temp control)
- Aids in protection (cushioning effect)
- Gives skin mobility over structures beneath
Basal Cell Layer
Inner layer of the epidermis, consists of keratin (new cells) and melanin (pigmentation)
Horny Cell Layer
Outer layer of the epidermis, consists of dead skin cells
Sebum
- lipid substance secreted by the sebaceous glands in the hair follicle
- lubricates hair and skin
- prevents water loss
Eccrine glands
Sweat glands right on the skin for thermoregulation
Apocrine glands
vestigial glands secreting milky substances that produces body odour when interacting with bacteria in the axillae and peri areas
Epidermal Appendages (4)
Hair
Sebaceous glands
Sweat glands
Nails
Functions of the skin (10)
- Protection
- Guards the body from microorganisms
- Prevents water loss
- Sensory/perception (pressure, touch)
- Temperature regulation (sweating, heat storage)
- Identification
- Communication (emotions on skin)
- Wound repair
- Absorption and excretion
- Production of vitamin D (by absorbing UV light and converting cholesterol)
Lanugo
fuzzy hair over infant body at birth, lasts a few weeks
Vernix
white substance covering the newborn, protects skin in amniotic fluid
Milia
baby acne (excess sebum, little white dots)
Integumentary considerations for infants
Eccrine glands not fully functional for first few months and subcutaneous layer is insufficient at insulation in newborns, so thermoregulation is really tough for first few months
Integumentary considerations for adolescents (3)
- Increased secretion from apocrine glands (BO)
- Sebaceous glands more active (acne)
- Subcutaneous fat deposits increase (weight gain)
Integumentary considerations for pregnant people (3)
Linea nigra (line down the midline from extra hormones in body)
Cholasma: hyperpigmentation in the face, can remain post-partum
Striae gravidarum: stretch marks
Integumentary considerations for older people (5)
- Decrease elasticity, subcutaneous fat and muscle tones
- Decrease in sweat and sebaceous glands in number and function
- Drier, thinner, more lax skin as a result, and wrinkles
- Decreased melanocytes, hair starts to grey
- Hair distribution changes
Skin Mobility
The ease with which skin can be pulled (decreases with swelling)
Turgor
How quickly the skin returns to its normal position (decreases with age)
Lesion
any unexpected finding in the skin tissue
ABCDE
Danger signs in pigmented lesions
- Asymmetry
- Border irregularity (evenness is good)
- Colour variation(two or more shades is bad)
- Diameter greater than 6mm
- Elevation and evolution
Annular lesion
Circular
Confluent lesion
lesions that look like they are running or growing together (hives)
Discrete lesion
lesions are distinct and remain separate
Grouped lesion
clustered lesions (e.g., contact dermatitis)
Gyrated lesion
twisted or coiled lesions (usually parasitic)
Targeted lesion
bullseye (e.g., lyme disease)
Linear lesion
lesion in a line
Polycyclic lesion
annular lesions that are starting to grow together
Zosteriform lesion
linear, but follow a nerve line (e.g., shingles)
Macule
- Primary skin lesion
- Flat colour change <1cm
E.g., freckles
Patch
- Primary skin lesion
- Flat colour change >1cm
E.g., Mongolian spots
Papule
- Primary skin lesion
- Elevated lesion <1cm
E.g., small mole
Plaque
- Primary skin lesion
- Elevated lesion >1cm
E.g., psoriasis
Nodule
- Primary skin lesion
- Elevated lesion, hard or soft, >1cm, can extend deeper into dermis
Tumor
- Primary skin lesion
- Elevated lesion, hard or soft, >1cm, usually something malignant
Wheal
- Primary skin lesion
- anything that’s raised and red
Urticaria
- Primary skin lesion
- hives (wheals that have joined together)
Vesicle
- Primary skin lesion
- elevated cavity containing free fluid <1cm
E.g., chickepox
Bulla
- Primary skin lesion
- elevated cavity containing free fluid >1cm
E.g. blister
Cyst
- Primary skin lesion
- Encapsulated, extends into subcutaneous layer, tensely elevates the skin
Eg. Sebaceous cyst
Pustule
- Primary skin lesion
- Encapsulated, pus filled-cavity
E.g. acne
Crust
- Secondary skin lesion
- Dried out exudate that’s left when a lesion dries up
E.g., Scab
Scale
- Secondary skin lesion
- Flake of dry skin
Fissure
- Secondary skin lesion
- Crack in the skin; dry or moist
Erosion
- Secondary skin lesion
- Scooped out, shallow depression; moist, not a ton of bleeding
E.g., scrape from falling off a bike
Ulcer
- Secondary skin lesion
- Deeper into the dermis, can bleed
E.g., pressure ulcer
Excoriation
- Secondary skin lesion
- Self-inflicted abrasion from intense itching
E.g., mosquito bite
Scar
A scar…
Atrophic Scar
- Secondary skin lesion
- Caused by thinning of the epidermis, depression in the top skin level
E.g., stretch marks
Lichenification
- Secondary skin lesion
- Caused by prolonged scratching (more than excoriation); can thicken skin
E.g., Elbows, my sacrum
Keloid
- Secondary skin lesion
- Hypertropic scar, excess scar tissue, above the skin, rubbery
E.g., Common in darker skin
Hemangiomas
Vascular Lesion
Caused by benign proliferation of blood vessels in the dermis
E.g., Port wine stains, strawberry marks
Telangiectaces
Vascular Lesion
Vascular dilation; permanently enlarged or dilated blood vessels
E.g., Spider or star angioma Venous lake (common in older people)
Purpuric Lesions
Vascular Lesion
Usually found with widespread systemic infection, e.g., sepsis and meningitis
Two kinds:
Petechiae: smaller/pinpoint
Purpura: larger, pinpricks are growing together
(blood flowing out of tiny breaks in blood vessels)
Secondary Lesion
Lesions that have changed over time (scratching, infection, etc.)
Primary Lesion
Lesions that occur on previously unaltered skin
Components of Objective Assessment of Integument (7)
- Colour
- Temperature
- Moisture
- Texture
- Mobility and Turgor
- Vascularity or bruising
- Lesions
Components of Objective Assessment of Hair (4)
- Colour
- Texture
- Distribution
- Lesions
Components of Objective Assessment of Nails (4)
- Shape and contour
- Consistency (thickness, firmness, attached)
- Colour
- Capillary refill
Blanching
Technique to check if circulation to the area is compromised or not
Edema
Fluid accumulation in the tissues, unexpected finding
Arrector Pili
muscle in the hair follicle that elevates hair upon contraction due to temp or emotion
Vellus hair
fine faint hair on most of body
Terminal hair
darker hair found on head, face, axillae, and pubic areas
Subjective Assessment of the Integument (12)
- Previous history of skin disease
- Change in pigmentation
- Change in a mole
- Excessiv dryness or moisture
- Pruritus (itchiness)
- Excessive bruising
- Rash or lesion
- Medications
- Hair loss
- Change in nails
- Environmental or occupational hazards
- Self-care behaviours
Pruritus
Itchiness