Lecture Integumentary Presentation 09

Chapter 12
Skin, Hair, and Nails
Ella Yu (VL)
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 12
 Structure and Function

 Subjective Data—Health History Questions
 Objective Data—The Physical Exam
 Abnormal Findings
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Slide 12-1
Chapter 12
Structure and Function

 Skin – three layers
1. Epidermis
– Stratum germinativum or basal cell layer
• Fibrous protein keratine
• Melanocytes (same amount)- melanin (varies)
– Stratum corneum or horny cell layer
• Dead keratinized cells
Chapter 12

2. Dermis
– Connective tissue or collagen
– Elastic tissue
– Nerves, sensory receptors, blood vessel, lymphatic
– Appendages from the dermis
Chapter 12

1. Subcutaneous layer
– Adipose tissue
– Lobules of fat cells
– Stores fat for the energy
– Provides insulation foe temperature control
– Protection- soft cushioning effect
– mobility
 Epidermal appendages
1. Hair
– Threads of keratine
– Hair shaft (visible projecting part)
– Hair root (embedded in the follicles
– Bulb matrix (cell production)
– Arrector pili muscle- goose skin
– 2 types: vellus and terminal

 Epidermal appendages
1. Sebaceous glands
– Sebum
– Lubricate skin and hair
– Retards water loss from the skin
2. Sweat glands
– Eccrine glands
– Apocrine glands
3. Nails
– Hard plates of keratine
– Nail matrix

Chapter 12
Function of the Skin

 Protection
 Prevents penetration
 Perception
 Temperature regulation
 Identification
 Communication
 Wound repair
 Absorption and excretion
 Production of vitamin D
Chapter 12
Subjective Data—
Health History Questions
 Previous history of skin  Pruritus
disease (allergies, hives,  Excessive bruising
psoriasis, or eczema)
 Rash or lesion
 Change in mole  Medications
 Change in pigmentation  Hair loss
(size or color)
 Change in nails
 Excessive dryness or
moisture  Environmental or
occupational hazards
– Seborrhea  Self-care behaviors
– xerosis
Chapter 12
Objective Data—
The Physical Exam
 Preparation
– External variables that influence skin color
 Equipment needed
– Strong direct lighting
– Small centimeter ruler
– Penlight
– Gloves
– For special procedures
• Wood’s light
• Magnifying glass
• Materials for laboratory tests: potassium hydroxide (KOH),
glass slide
Chapter 12
Objective Data—
The Physical Exam, cont.
Skin—Inspect and Palpate
 Color
– General pigmentation
• Vitiligo
• Freckles, mole, birthmark
• Abnormal: ABCDE
– Widespread color change
• Pallor- anemia
• Erythema- carbon monoxide poisoning, hyperemia
• Cyanosis- increased amount of unoxygenated hemoglobin
• Jaundice- increase serum bilirubin
Chapter 12
Objective Data—
Promoting Health and Self-Care
 Teach skin self-examination, using the ABCDE rule
A—asymmetry
B—border
C—color
D—diameter
E—elevation and enlargement
Chapter 12
Objective Data—
Skin—Inspect and Palpate, cont.
 Temperature
– Hypothermia: general/ localized
– Hyperthermia
 Moisture
– Diaphoresis- profuse perspiration
– Dehydration
Chapter 12
Objective Data—
 Texture (smooth and firm)
 Thickness (callus)
 Edema (fluid accumulating in the intracellular space)
– 1+ , 2+, 3+, 4+
 Mobility and turgor
– (anterior chest under clavicle)
– Elasticity of skin
– Mobility- ease of rising (oedema)
– Turgor- ability to return to place promptly when release (dehydation)
 Vascularity or bruising (abuse- different stage of healing)
– Cherry angioma
– tattoo
Chapter 12
Objective Data—
 Lesions
– Primary or secondary
– Color
– Elevation
– Pattern or shape
– Size
– Location and distribution on body
– Exudate
Chapter 12
Objective Data—
Skin—Inspect and Palpate,
cont.
 Lesions
– Wood’s light detects
fluorescing lesions
• Lesions with blue-green
fluorescence indicate
fungal infection, such as
tinea capitis (scalp
ringworm)
– Potassium Hydroxide (KOH)
preparation helps dignose
superficial fungal infection
as it can dissolve nonfungal
skin debris
Chapter 12
Objective Data—
Hair—Inspect and Palpate
 Color
 Texture
 Distribution
 Lesions
– Seborrhoea
– Nits of lice
Chapter 12
Objective Data—
Nails—Inspect and Palpate
 Shape and contour
– Profile sign
 Consistency
 Color
– Capillary refill
Chapter 12
Objective Data—
Promoting Health and Self-Care
 Teach skin self-examination, using the ABCDE rule
A—asymmetry
B—border
C—color
D—diameter
E—elevation and enlargement
Chapter 12
Abnormal Findings
Common Shapes and
Configurations of Lesions
 Annular or circular
 Confluent
 Discrete
 Grouped
 Gyrate
 Target or iris
 Linear
 Polycyclic
 Zosteriform
Gyrate Grouped
Linear
Zosteriform
Chapter 12
Abnormal Findings
Primary and Secondary Skin Lesions
Primary skin lesions Secondary skin lesions
– Macule – Urticaria (hives) – Crust – Excoriation

– Papule – Vesicle – Scale – Scar
– Patch – Cyst – Fissure – Atrophic scar
– Plaque – Bulla – Erosion – Lichenification
– Nodule – Pustule – Ulcer – Keloid
– Wheal
– Tumor
Primary Skin lesion
 A lesion develops on previously unaltered skin

Macule Papule Nodule
Flat and circumscribed Solid, elevated
Less than 1 cm
Solid, elevated
Less than 1 cm Larger than 1 cm
Extend to dermis

Wheal
-superficail, Pustule
-Erythematous - pus
--mosquito bite - acne
Vesicle
-Up to 1 cm
-Clear serum
Crust -Chicken pox
Cyst
-Dry on abrasion -Herpes simplex
- Fluid filled in dermis/
Scab following Subcutaneous layer
abrasion
Secondary skin lesion
 A lesion change over time or changes because of a
factor such as scratching or infection

Scale Excoriation
-psoriasis -superficial, sometimes crusted
-self inflicted abrasion
-Scratches from intense itching
-insect bits, scabies
Fissure
-linear crack Ulcer
-extend to dermis -deeper depression to dermis
-Athelet’s foot -Pressure sore
Chapter 12
Scar Atrophic scar
Lichenification
Keloid
-intense scratching Slide 12-14
-excsess scar tissue
Chapter 12
Abnormal Findings
Vascular Lesions
 Hemangiomas
– Port-wine stain (nevus
flammeus)
– Strawberry mark
(immature
hemangioma)
– Cavernous
hemangioma (mature)
Chapter 12
Abnormal Findings
Vascular Lesions
 Telangiectases
– Spider or star angioma
– Venous lake
Chapter 12
Abnormal Findings
Vascular Lesions
 Purpuric lesions
– Petechiae
– Purpura
 Lesions due to trauma or abuse
– Pattern injury
– Hematoma
– Ecchymosis (bruise)
Chapter 12
Abnormal Findings
Vascular Lesions
 Lesions due to trauma or
abuse
– Pattern injury
– Hematoma
– Ecchymosis (bruise)
Chapter 12
Abnormal Findings
Common Skin Lesions in Children
 Diaper dermatitis
 Interigo (candidiasis)
 Impetigo
 Atopic dermatitis (eczema)
 Measles (rubeola)
 German measles (rubella)
 Chickenpox (varicella)
Chicken pox
Psoriasis

Chapter 12
Abnormal Findings
Common Skin Lesions
 Primary contact dermatitis
 Allergic drug reaction
 Tinea corporis (ringworm of the body)
 Tinea pedis (ringworm of the foot)
 Psoriasis
 Tinea versicolor
 Labial herpes simplex (cold sores)
 Herpes zoster (shingles)
 Erythema migrans of Lyme disease
Chapter 12
Abnormal Findings
Malignant Skin Lesions
 Basal cell carcinoma

 Squamous cell carcinoma
 Malignant melanoma
Squamous cell carcinoma Malignant Melanoma

Chapter 12
Abnormal Findings
Skin Lesions Associated with AIDS
 Epidemic Kaposi’s sarcoma

– Patch stage
– Plaque stage
– Advanced disease
Chapter 12
Abnormal Findings
Infectious Disease
as a Biological Weapon
 Anthrax
 Smallpox (variola major)
Chapter 12
Abnormal Findings
Abnormal Conditions of Hair
 Seborrheic dermatitis (cradle cap)
 Tinea capitis (scalp ringworm)
 Toxic alopecia
 Alopecia areata
 Traumatic alopecia, traction alopecia
 Trichotillomania
 Pediculosis capitis (head lice)
 Folliculitis
 Hirsutism
 Furuncle and abscess
Chapter 12
Abnormal Findings
Abnormal Conditions of the Nails
 Koilonychia (spoon
nails)
 Paronychia
 Beau’s line
 Splinter hemorrhages
 Late clubbing
 Onycholysis
 Habit-tic dystrophy
 Pitting
Chapter 12
Abnormal Findings
Abnormal Conditions of the Nails

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Chapter 12

Skin, Hair, and Nails

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

 Structure and Function

Structure and Function

Structure and Function

Structure and Function

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Function of the Skin

Primary skin lesions Secondary skin lesions

– Macule – Urticaria (hives) – Crust – Excoriation

 A lesion develops on previously unaltered skin

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Scar Atrophic scar

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

 Basal cell carcinoma

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

 Epidemic Kaposi’s sarcoma

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