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Cafe au Lait spot large round or oval patch of light brown pigmentation, which is usually present at birth Lanugo the fine downy hair of the newborn infant Milia tiny white papules on the cheeks and forehead and across the nose and chin caused by sebum that occludes the follicles, occurs in infants will resolve on its own Mongolian Spot common variation of hyperpigmentation in Black, Asian, American Indian, and Hispanic newborns; a blue-black to purple macular area at the sacrum or buttock but sometimes on the abdomen, thighs, shoulders, or arms; due to deep dermal melanocytes; gradually fades by the first year Physiologic Jaundice a yellowing of the skin, sclera and mucous membranes; develops after 3-4 days of life because of increased numbers of red blood cells that hemolyze after birth; occurs in half of all newborns Storkbite (Salmon Patch) flat, irregularly shaped red or pink patch found on the forehead, eyelid, or upper lip but is most common at the back of the neck; present at birth, fades during th first year Acne caused by an increase in sebaceous gland activity that causes increased oiliness Comedones open:blackheads closed: whiteheads Striae jagged linear "strech marks" of silver to pink color that appear during pregnancy during the second trimester on the abdomen, breasts and thighs; occur in half of all pregnancies; fad after birth but don't disappear Vascular Spiders occur in 2/3 of pregnancies in white women and less often in blacks; lesions have tiny red centers with radiating branches and occur on face, neck, upper chest, and arms Acrochordons "skin tags" overgrowths of normal skin that form a stakls and are polyp-like; occur frequently on eyelids, cheeks and neck, and axillae and trunk Cherry (senile) Angiomas small, smooth, slightly raised bright red dots that commonly appear on the trunk in all adults older than 30 years; increase in size and number with age Seborrheic Keratosis lesions that are raised, thickened areas of pigmentation that look crusted, scaly and warty; this type looks dark, greasy and "stuck on;" develop mostly on the trunk but also on face and hands Senile Lentigines "liver spots," small, flat, brown macules; clusters of melanocytes that appear after extensice sun exposure; appear on the forearems and dorsa of hands Diaphoresis excessive sweating Cyanosis bluish mottled color that signifies decreased perfusion; the tissues do not have oxygenated blood Erythema intense redness of the skin from excess blood (hyperemia) in the dialted superficial capillaries; expected with fever, local inflammation or with emotional reaction Edema fluid accumulating in the intercelluar space Freckles (ephelides) small, flat macules of brown melanin pigment that occur on sun-exposed skin Herpes Zoster "shingles" small grouped vesicles emerge along route of cutaneous sensory nerve, then pustules, then crusts; cause by varicella zoster virus; reactivation of the dormant virus of chickenpox; acute appearance, unilaters; pain is often severe and long lasting in aging adults Hyperthermia generalized occurs with an increased metabolic rate such as in fever or after heavy exercise; localized after trauma, infection or sunburn Hypothermia generalized coolnes may be induced for surgery or high fever; localized is expected with an immoblized extremity Pressure Ulcer (decubitus ulcer) appear on the skin over a bony prominence when circulation is impaired Malignant Melanoma half of these lesions arise from preexisting nevi; usually brown; ofetn irregular or notched borders; may have scaling, flaking, oozing texture; common on trunk and back in men and women, on legs in women, on the palms, sole and nails in Blacks Mole (nevus) a proliferation of melanocytes, tan to brown, flat or raised; acquired nevi are characterized by symmetry, small size (<6mm), smooth borders, and single uniform pigmentation Junctional Nevus macular only and occurs in children and adolescents; progress to compound Compound Nevus macular and paular Pallor when the red-pink tones from the oxygenated hemoglobin in the blood are lost, the skin takes on the color of the connective tissue underneath which is mostly white; dark skinned people, underlying red tones give skin its luster Jaundice yellowish skin color that indicated rising amounts of bilirubin in the blood; first noted in the soft palate of mouth and in sclera Pruritus itching Psoriasis scaly, erthematous patch, with silvery scales on top; usualy on scalp, outside of elbows and knees, low back, and anogenital area Mobility skin's ease of rising Turgor skin's ability to return to place promptly when released (<1 sec) Vitiligo acquired condition; complete absence of melanin pigment in patchy areas of white ot light skin on the face, neck, hands, feet, body fold, and around orifices Annular Lesion circular, begins in center and spreads to periphery (ringworm) Confluent Lesion lesions run together as in hives Discrete Lesion individual lesions that remain separate (skin tags, acne) Grouped Lesion clusters of lesions (vesicles of contact dermatitis) Gyrate Lesion twisted, coiled, spiral, snakelike Linear Lesion scratch, streak, line or stripe Polycyclic Lesion annular lesions grow together (psoriasis) Target Lesion or iris, resemble iris of eye, concentric rings of color in lesions Zosteriform Lesion linear arrangement along a unilateral nerver route Macule solely a color change, flat and circumscribed, of less than 1 cm (freckle) Patch macules that are larger than 1 cm (cafe au lait) Papule something you can feel caused by superficial thickening of the epidermis (elevated mole, wart) Plaque papules coalesce to form surface elevtion wider than 1 cm, a plateau-like disk-shaped lesion (psoriasis) Nodule solid, elevated, hard or soft, larger than 1 cm, may extend deeper into the dermis than papule Tumor larger than a few cm in diameter, firm or soft, deeper into dermis; may be benign or malignant Wheal superficial, raised, transient and erythematous, slightly irregular shape due to edema (mosquito bite) Urticaria "hives" wheals coalesce to form extensice reaction, intensely pruritic Vesicle "blister" elevated cavity containing free fluid, up to 1 cm Bulla larger than 1 cm in diameter, usually single chambered (unilocular); superficial in epidermis; thin walled, ruptures easily (friction blister, burns) Cyst encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevatinf skin Pustule turbid fluid (pus) in the cavity; circumscribed and elevated (acne) Crust thickened, dried-out exudate left when vesicles/pusules burst to dry up; color can be red-brown, honey, or yellow depening on fluid's ingredients (scab after abrasion) Scale compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells (eczema) Fissure linear crack with abrupt edges, extend into dermis, dry or moist (athlete's foot) Erosion scooped out but shallow depression; superficial; epidermis lost; moist but not bleeding; heals without scar because erosion does not extend into dermis Ulcer deeper depression extending into dermis, irregular shape; may bleed; leaves scar when heals (pressure sore, chancre) Excoriation self-inflicted abrasion; suferficial; sometimes scratches from intense itching (insect bites, varicella) Scar after a skin lesion is repaired, normal tissue is lost and replaced with connective tissue (collagen); this is permanent fibrotic change Atrophic Scar the resulting skin level is depressed with loss of tissue; a thinning of the epidermis Lichenification prolonged; intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss Keloid a hypertrophic scar; resulting skin level is elevated by excess scar tissue, which is invasive beyond the site of original injury; may increase long after healing; looks smooth, rubbery, and "clawlike" and has a higher incidence among blacks Pattern Injury bruise or wound whose shape suggest the instument or weapon that caused it (belt buckle) Hematoma bruise you can feel; elevates the skin and is seen as swelling Contusion "bruise" mechanical injury results in hemorrhage into tissues; skin is intact Ecchymosis a purplish patch resulting from extravastion of blood into the skin; >3 mm in diameter Capillary Refill depress the nail edge to blanch and then release, noting the return of color; normally is instant; indicates status of peripheral circulation Clubbing occurs with congenital cyanotic heart diseases; in early, the angle straightens out to 180 degress and the nail bas feels spongy to palpation; the nail becomes convex as the digit grows Profile Sign angle of the nail base at a profile; should be about 160 degrees Alopecia hair loss Fine Vellus the hair that coats the body Hirsutism excess body hair; in females, this forms a male pattern on the face and chest and indicates endocrine abnormalities How is an infant's skin different from an adult's? The newborn's skin is similar in structure to the adult's, but many of its functions are not fully developed. The newborn's skin is thin, smooth, and elastic and is relatively more permeable than that of the adult, so the infant is a greater risk for fluid loss. How is an elder's skin different from an adult's? The epidermis's outer layer thins and flattens. This allows chemicals easier access into the body. Wrinkling occurs because the underlying dermis thins and flattens. A loss of elastin, collagen, and subcutaneous fat occurs as well as a reduction in muscle tone. The loss of collagen increases the risk for shearing, tearing injuries. Where do you assess for skin mobility and turgor in adults? pinch up a large fold of skin on the anterior chest under the clavicle Where do you assess for skin mobility and turgor in infants? over the abdomen Describe the 4 stages of a pressure ulcer (decubitus ulcer). Stage I: Intact skin appears red but unbroken. Localized redness in lightly pugmented skin will blanch. Dark skin appears darker but does not blanch. Stage II: Partial-thickness erosion with loss of epidermis or also dermis. Superficial ulcer looks shallow like an abrasion or open blister with a red-pink wound bed. Stage III: Full-thickness pressure ulcer extending into the subcutaneous tissue and resembling a crater. May see subcutaneous fat but not muscle, bone or tendon. StageIV: Full-thickness pressure ulcer involves all skin layer adn extend into supporting tissue. Exposes muscle, tendon or bone, and may show slough (stringy matter attached to wound bed) or escar (black or brown necrotic tissue). Port-wine Stain (Nevus Flammeus) a large, flat, macular patch covering the scalp or face, frequently along the distribution of cranial nerve V; color is dark red, bluish, or purplish; marking consists of mature capillaries; presents at birth, does not fade Strawberry Mark (Immature Hemangioma) a raised bright red area with well-defined borders about 2-3 cm in diameter; does not blanch with pressure; consists of immature capillaries; present at birth or develops in the first few months, diappears by 5-7 years Spider or Star Angioma a fiery red, star-shaped marking with a solid circular center; capillary radiation exten from the central arterial body; with pressure, not a pulsating body and blanching of extended legs; develop on face, neck, or chesy; may be associated with pregnancy, chronic liver disease, or estrogen therapy or may be normal Venous Lake a blue-purple dialtion of venules and capillaries in a shar-shaped, linear, or flaring pattern; pressure csuse them to empty or disappear; located on legs near varicose veins and also on face, lips, ears and chest Petechiae tiny punctate hemorrhages, 1-3 mm, round and discrete, dark red, purple, or brown in color; caused by bleeding from superficial capillaries; will not blanch; may indicated abnormal clotting factors; in dark skin, are best visualized in areas of lighter melanization; cannot be seen on very dark skin; most of the disease that cause bleeding and microembolism formation are characterized by petechiae in mucous membranes as well on skin Purpura confluent and extensive patch of petechiae and ecchymoses, >3mm flat, red to purple, macular hemmorrhage; seen in generalized disorders such as thrombocytopenia and scurvy; also occurs in old age How often should skin self-examinations be performed? once a month Explain the use of the ABCDE rule in regards to skin cancer. A: asymmetry (not regularly round or oval, two halves of the lesion do not look the same B: border irregularity (notching, scalloping, ragged edges, poor defined margins) C: color variation (areas of brown, tan, black, blue, red, white or combo) D: diameter greater than 6mm E: elevation or enlargement Android Obesity greater proportion of fat in the upper body (apple shaped) Gynoid Obesity greater proportion of fat in hips and thighs (pear shaped) Anthropometric Measures evaluate growth, development and body composition (height, weight, etc.) Body Mass Index BMI, practical marker of optimal weight for height and an indicator of obesity or undernutrition BMI= weight (kg)/ height (meters squared) <18.5 Underweight 18.5-24.9 Normal 25-29.9 Overweight 30-39.9 Obesity 40+ Extreme Obesity Waist-to-Hip Ratio assesses body fat distribution as an idicator of health risk waist circumference/ hip circumference Men: <1.0 Women: <0.8 (android obesity if greater) Cachectic Appearance accompanies chronic wasting disease such as cancer, dehydration, and starvation; features include sunken eyes, hollow cheeks and exhausted, defeated expression Overnutrition caused by consumption of nutrients (especially calories, sodium and fat) in excess of body needs Undernutrition occurs when nutritional reserves are depleted and/or when nutrient intake is inadequate to meet needs or added metabolic demands Hemoblobin The hemoglobin (Hb) determination is used to detect iron deficiency anemia Men: 14-18 g/dL Women: 12-16 g/dL Hematocrit Hematocrit (HCT), a measure of cell volume, also indicates iron status Men: 37%-49% Women: 36%-46% Cholesterol total cholesterol evaluates fat metabolism and the risk for CV disease Normal: 120-200 mg/dL Triglycerides serum triglycerides (TGs) or blood fats are used to screen for hyperlipidemia and the risk for coronary artery disease 0-19: 10-100 mg/dL 20-65: <150 mg/dL Serum Albumin common measurement of visceral protein status Normal: 3.5-5.5 g/dL C-reactive Protein (CRP) a plasma protein marker of inflammatory status produced by the liver, used to monitor metabolic stress Normal: <0.1 mg/dL Low-density Lipoprotein Cholesterol (LDL-C)"bad" cholesterol, major carrier of cholesterol in the blood and is closely related with increased risk for atherosclerosis and coronary heart disease Children: <110 mg/dL Adults: <130 mg/dL High-density Lipoprotein Cholesterol "good" cholesterol, incersely related to corornary heart risk Men: 35-65mg/dL Women: 35-80 mg/dL What are some of the new "My Plate" recommendations? reduce portion size; make at least half of each meal fruit and vegetables; make at least half of grains whole; switch to fat free milk; less salt; water instead of sugary beverages