What is the major function of the skin?
to keep the body in homeostasis
What else does the skin do?
provides boundaries for body fluid, protects underlying tissue from microorganisms, harmful substances and radiation, modulates body temp, and synthesises vitamin D
The skin makes up ___ of body weight?
What are the 3 layers of the skin?
epidermis, dermis and subcutaneous tissue
What are all considered appendages of the skin?
hair, nails, and sebaceous and sweat glands
What do nails do?
protect distal ends of fingers/toes
What are the sebaceous glands?
present all surfaces except palms/soles, produce a fatty substance secreted onto skin surface through hair follicles
What are the 2 types of sweat glands?
eccrine glands and apocrine glands
What do the eccrine glands do?
widely distributed, open directly onto skin surface, help control body temp
What do the apocrine glands do?
found in axilla and groin, stimulated by emotional stress
What are some common or concerning symptoms in the health hx about the skin/hair/nails?
hair loss, rash, moles
What are some things to ask the patient concerning skin/hair/nails?
have you noticed any changes in your skin or your hair? have you noticed any moles that have changed size, shape, color, or sensation? Have you noticed any new moles?
What do you need to educate patients on regarding the skin/hair/nails?
early detection of suspicious moles, protective measures for skin care, hazards of excessive sun exposure
What is the most common cancers in the US?
Where is skin cancer most prevalent?
hands neck and head
What is basal cell carcinoma?
comprises 80% of skin cancers, shiny and translucent, they grow slowly and rarely metastasize
What is squamous cell carcinoma?
comprises 16% of skin cancers, crusted, scaly, and ulcerated, can metastisize
What is melanoma?
comprises 4% of skin cancers, rapidly increasing in frequency they spread rapidly
HARMM Risk factors for Melanoma?
history of previous melanoma, over 50, no reg. derm appts, changing moles, male gender
What are some additon risk factors for melanoma?
greater than 50 common moles, greater than 1-4 atypical or unusual moles, red or light hair, actinic lentiguines(liver spots), amcular brown or tan spots usually on sun exposed areas, heavy sun exposure(especially sever childhood sunburns), light eye or skin color(especially freckles/burns easily), family hx of melanoma
ABCDE screening moles for possible melanoma?
A for asymmetry, B for irregular borders, especially ragged, notched or blurred, C for variation in color, especially blue or black, D for diameter greater than 6mm or different from other moles, especially changing itching or bleeding, E for elevation or enlargement
How do you do an examination of the skin/hair/nails?
make sure the pt wears a gown(drap appropriately to facilitate close inspect of hair, anterior and posterior surfaces of body, palms, soles and webspaces) Inspect entire skin surface in good light
What should you note when inspecting and palpating the skin?
color, moisture, temp, texture, mobility and turgor, lesions
What is important to notice about the color of the skin?
pts often notice change in color before physician, look for increased pigmentation, loss of pigmentation, look for redness, pallor, cyanosis, and yellowing
Where is the red color of oxyhemoglobin best assessed at?
fingertips, lips and mucous membranse(in dark skined people palms and soles)
Where is central cyanosis best assessed at?
lips,oral mucosa, and tounge
Where is jaundice best assessed at?
When assessing the moisture of skin what are u assessing?
dryness, sweating, oiliness
How do you assess the temperature of skin?
use back of fingertips, indentify warmth or coolness of skin
What are you assessing w/ texture of skin?
roughness or smoothness of skin
How do you assess the mobility and turgor of skin?
lift fold of skin, note ease with which it lfts up(mobility) and speed with which it returns to place(turgor)
What is a macule?
flat, very circumsized areas of a different color
What is a papule?
eleveated small less than 5mm solid
What is a nodule?
elvated, larger, solid
What is a plaque?
elevated, flat tops, greater than 5mm
What is a vesicle?
fluid filled lesion-raised, less than 5mm
What is a bulla?
fluid filled lesion-raised, greater than 5mm commonly referred to as blisters
What is a pustule?
raised descrete area filled w/ puss, same as vessicle or bulla but w/ puss
What is scale?
dry patchlike areas
What is lichenification?
thick rough skin w/ very prominent skin markings
What is excoriation?
result of excessive scratching, looks like its been scraped- traumatic breakdown of epidermis tends to be linear
What is hyperkeratosis?
hyperplasia of stratum corneum
What is parakeratosis?
normal, retained nuclei in stratum corneum resulting in keratinization
What is acanthosis?
epidermal hyperplasia involving the stratum spinosum
What is dyskeratosis?
abnormal keratinization that occurs prematurely below stratum granulosum
What is acantholysis?
loss of intracellular connections resulting in lack of keratinocyte cohesion
What is papillomatosis?
hyperplasia of papillary dermis w/ elongation or widening of dermal papillae
what is lentiginous?
linear pattern of melanocyte proliferation in epidermal basal cell layer
What is spongiosis?
intracellular edema of epidermis
What is a wheal?
a somewhat irregular relatively transient superficial area of localized skin edema
What is a cyst?
nodule filled w/ expressible material either liquid or semisolid
What is a patch?
flat spot, 1cm or larger
What is a burrow?
a minute slightly raised tunnel in the epidermis commonly found on the finger webs and on the sides of the fingers. Looks like short linear or curved gray line and may end in a tiny vessicle. Skin lesions include small papules pustules lichenified areas and excoriations w/ a magnifying lens look for the burrow of the mite that causes scabes
What is crust?
the dried residue of skin exudates such as pus or blood
What are keloids?
hypertrophic scarring that extends beyond the borders of the initiating injury
What is excoriation?
linear or punctate erosions caused by scratching
What is a fissure?
a linear crack in the skin often resulting from excessive distress(ex-athletes foot)
What is an ulcer?
a deeper loss of epidermis and dermis may bleed and scar
what should you note if you find a lesion?
characteristics, anatomic location and distribution, patterns and shapes, type of lesion, color, whenever you see a skin lesion look it up in a well illustrated textbook of derm, to arrive at a derm diagnosis consider all factors
How do you examine hair?
inspect and palpate, note quanity, distribution and texture
How do you examine nails?
inspect and palpate fingernails/toenails, note color and shape, note lesions, longitudinal bads of pigment may be a normal finding in people w/ darker skin
How do you evaluate the bedbound patient?
people confined to bed are particularly susceptible to skin damage and ulceration- pressure sores result when sustained compression obliterates arteriolar and capilarry blood flow to the skin, assess these pts by carefully inspecting the skin that overlies the sacrum, buttocks, greater trochanters knees and hells, roll pt to one side to see sacrum and buttocks