SKIN ,HAIR ,& NAILS

STRUCTURE & FUNCTION

 SKIN: Has three layers
 Epidermis: divided in two layers:

*outer layer dead keratinized cells

* Inner cellular layer where both melanin & keratin
formed
 Dermis: contain connective tissue , sweat
gland ,& hair follicles ,blood vessels.
 Subcutaneous tissue or fat contain carotene
FUCTION OF THE SKIN:

 Protection
 prevents penetration
 perception
 temperature regulation
 communication
 wound repair
 production of vitamin D
HAIR
 Have two types :
1- Vellus hair:short,fine ,unpigmented
(covers most of the body )
2- Terminal hair: coarser ,thicker ,usually
pigmented (eye brows)
 SUBJECTIVE DATA
 Previous Hx of skin disease
(allergic ,eczema)
 Change in pigmentation
 Change in mole ( size or color
,shape appearance of tenderness
,bleeding )
 Excessive dryness or moisture
*-How was this treated?
- Any known allergies to drugs,
plants ,animals ?
*- A generalized color or change ?
*- Any “sores” that do not heal?
*-Any excess dryness ?Is this
seasonal or constant?
 Pruritus *-Any skin itching ?
-Does it awaken you from sleep?
*-Where in the body ?
 Excessive bruising -How do this happen ?
*-Onset. when did you first notice it?
 Rash or lesion -Location. where did it start?
-Duration. how long have you had it?
-Setting. any one at home or work
with similar rash?
 *-A gradual or sudden onset?
symmetrical?
 Hair loss
-Any unusual hair growth?
*-What medication do you
take?
 Medication -Recent change?
-How long on medication?
*-Any change in nails :shape,
color?
 Change in nails -Do you bite or chew nails?
 Environmental or *-Any hazards –related
occupational hazards problem with your
occupation?
-How about hobbies?
-Recently been bitten by
insect ,bee ?
 Self-care behavior *-what do you do to care
for your skin, hair ,&
nails ?
-Do you perform a skin
self examination?
OBJECTIVE DATA
 Equipment needed:
-strong direct lightening
-ruler
-penlight
-gloves
 Color: general pigmentation, normally it is consistent with genetic
-common (benign) pigmentation:
.freckles: occurs on sun –exposed skin
.mole : proliferation of melanocytes brown color flat or raised
.birth mark
**Abnormal characteristics of pigmented lesion are summarized in ABCDE:
Asymmetry of pigmented lesion
Border irregularity
Color variation
Diameter greater than 6mm
Elevation &Enlargement
 Color change:
-pallor :when red – pink tones from the oxygenated
hemoglobin in blood are lost ,skin take color of the
connective tissue (collagen).
can be observed in mucous membrane , lips ,& nail beds .
-Erythema: intense redness of the skin due to excesses
blood in the dilated superficial .
-Cyanosis : a bluish mottled color that significant decreased
perfusion
-Jaundice : yellow color indicating rising amount of
bilirubin in blood
 Temperature use dorsa of your hand –hypothermia –
hyperthermia
 Moisture :perspiration normally in face ,hands , & axilla
.-dehydration – diaphoresis
 Texture: normally skin feels smooth &firms
 Thickness: epidermis uniformly thin over most of the body.
a callus is overgrowth of epidermis & is an adaptation to
excessive pressure from the friction of work &weight
 Edema: is fluid accumulating in the intercellular
space (thumb pressure firmly against ankle
malleolus or tibia )pitting edema:
+1 mild pitting
+2 moderate pitting
+3 deep pitting
+4 very deep pitting
 Mobility & turgor :skin’s ease of
arising & turgor is its ability to
return to place when released
 Bruising :- cherry: red ,smooth
,raised ,&small
 Lesions: color ,elevation ,shape ,size
,location ,odors.
 Abnormal Findings
Primary and Secondary Skin Lesions
Primary skin lesions
Secondary skin lesions
─ Macule ─ Urticaria (hives) ─ Crust ─ Excoriation
─ Vesicle ─ Scar
─ Papule ─ Cyst ─ Scale ─ Atrophic scar
─ Bulla ─ Lichenification
─ Patch ─ Fissure
─ Pustule ─ Keloid
─ Plaque ─ Erosion
─ Nodule ─ Ulcer
─ Wheal
─ Tumor
Slide 12-19
Ulcer

Slide 12-20
Fissure

Slide 12-21
Scale

Slide 12-22
Pustule

Slide 12-23
Cyst

Slide 12-24
Vesicle

Slide 12-25
Wheal

Slide 12-26
Nodule

Slide 12-27
Papule

Slide 12-28
Macule

Slide 12-29
Scar

Slide 12-30
 INSPECT & PALPATE THE HAIR

 Color : come from melanin production

 Texture : scalp may be fine or thick

 Distribution :

1- Vellus hair : short ,fine ,unpigmented (covers most of the body )

2- Terminal hair: coarser ,thicker ,usually pigmented (eye brows)
*Lesions : separate the hair in to section &lift it observing the scalp
 INSPECT & PALPATE THE NAILS

 Shape & contour :normally slightly curved or flat &

posterior & lateral nail folds are smooth & rounded .angle
between nail base & nail is normal about 160 degree
 Consistency : surface is smooth & regular
 Color : pink nail bed underneath . -capillary refill
The lesions in the illustration
are best described as?
A. Grouped
B. Zosteriform
C. Polycyclic
D. Linear

Slide 12-35