Integumentary System

CHAPTER 5

Integumentary System

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.


• Skin

– Also called integument or cutaneous membrane

– Epidermis

– Dermis

– Subcutaneous layer



• Accessory structures

– Hair

– Nails

– Glands


Layers and Structures of the Skin


Structure of the Nail


Question

True or False: The epidermal layer contains most of the skin's vital structures.


Question

The half-moon we see at the base of our fingernails is called the _______.

a. cuticle b. lunula c. nail bed d. edge


Skin Lesions

• Abrasion

– Scraping or rubbing away of skin or mucous membrane as a result of friction to the area

• Example: carpet burn

• Abscess

– Localized collection of pus in any body part that results from invasion of pus-forming bacteria

• Example: pustule = small abscess


Skin Lesions

• Blister

– Small, thin-walled lesion containing clear fluid

– Also known as a vesicle

• Bulla

– Large blister


Skin Lesions

• Carbuncle

– Circumscribed inflammation of skin and deeper tissues; contains pus

• Comedo

– Typical lesion of acne vulgaris

• Example: whitehead = closed comedo

• Example: blackhead = open comedo


Skin Lesions

• Cyst

– Closed sac or pouch in or within the skin; contains fluid, semifluid, or solid material

• Example: hydrocele = fluid-filled cyst

• Example: sebaceous cyst = solid-filled cyst


Skin Lesions

• Fissure

– Crack-like sore or groove in the skin or mucous membrane

• Example: anal fissure

• Fistula

– Abnormal passageway between two tubular organs, or from an organ to the body surface

• Example: rectovaginal fistula


Skin Lesions

• Hives

– Circumscribed, slightly elevated lesions on skin; paler in center than surrounding edges

– Also called wheals

• Example: mosquito bite

• Laceration

– Tear in skin; torn, jagged wound


Skin Lesions

• Macule

– Small, flat discoloration of the skin; neither raised nor depressed

• Example: bruises, freckles

• Nodule

– Small, circumscribed swelling protruding above the skin


Skin Lesions

• Papule

– Small, solid, circumscribed elevation on the skin

• Example: pimple, wart, elevated mole

• Polyp

– Small, stalk-like growth, protruding upward or outward from membrane surface

• Example: nasal polyp


Skin Lesions

• Pustule

– Small elevation of skin filled with pus

• Example: small abscess on the skin

• Scales

– Thin flakes of hardened epithelium that are shed from the epidermis


Skin Lesions

• Ulcer

– Circumscribed, open sore or lesion of skin, accompanied by inflammation

• Example: decubitus ulcer

• Vesicle

– Small, thin-walled lesion containing clear fluid

• Example: blister


Skin Lesions

• Wheal

– Circumscribed, slightly elevated lesion of the skin

– Paler in center than surrounding edges

• Example: hives


Question

Notice that sometimes 2 different terms are used to describe the same thing. For instance, if a physician says a patient has hives, this patient also has: a. comedos b. papules c. cysts d. wheals


Question

A patient has a rash consisting of both macules and papules. What would be the combined adjective form?

a. maculepapular b. papulemacular c. papulomacular d. maculopapular e. c and d


Acne Vulgaris

• Pronounced

– (

ACK -nee vulGAY -ris)

• Defined

– Common inflammatory disorder seen on face, chest, back, and neck

– Appears as papules, pustules, and comedos


Albinism

• Pronounced

– (

AL -bin-izm)

• Defined

– Condition characterized by absence of pigment in the skin, hair, and eyes


Burns

• Defined

– Tissue injury produced by flame, heat, chemicals, radiation, electricity, or gases

– Extent of damage determined by:

• Mode and duration of exposure

• Thermal intensity or temperature

• Anatomic site of the burn


Burns

• First-degree (superficial) burns

– Example: sunburn

• Second-degree (partial-thickness) burns

– Example: flash contact with hot objects

• Third-degree (full-thickness) burns

– Example: deep burns from a fire


Callus

• Pronounced

– (

CAL -us)

• Defined

– Common, usually painless thickening of the epidermis at sites of external pressure or friction, such as weightbearing areas of the feet and on the palmar surface of the hands

– Also known as a callosity


Question

True or False: The higher the degree rating, the deeper the burn.


Carcinoma, Basal Cell

• Pronounced

– ( car -sihNOH -mah BAY -sal sell)

• Defined

– A malignant epithelial cell tumor

– Begins as a slightly elevated nodule with a depression or ulceration in the center



• Defined

– As the depression enlarges, the tissue breaks down, crusts, and bleeds

– Most common malignant tumor of epithelial tissue; occurs most often on skin exposed to the sun



• Image courtesy of Robert A. Silverman,

M.D., Pediatric Dermatology, Georgetown

University


Carcinoma, Squamous Cell

• Pronounced

– ( car -sihNOH -mah SKWAY -mus sell )

• Defined

– Malignancy of the squamous, or scale-like, cells of the epithelial tissue

– Much faster growing than basal cell carcinoma

– Greater potential for metastasis if not treated


Carcinoma, Squamous Cell

• Frequent sites on sun-exposed areas

– Top of nose

– Forehead

– Margin of external ear

– Back of hands

– Lower lip


Question

True or False: Basal cell carcinoma does not originate in the epithelial layer.


Dermatitis

• Pronounced

– (der-mah-

TYE -tis)

• Defined

– Inflammation of skin, seen in several different forms

– Acute or chronic

– Contact or seborrheic


Eczema

• Pronounced

– (

EK -zeh-mah)

• Defined

– Acute or chronic inflammatory skin condition characterized by erythema, papules, vesicles, pustules, scales, crusts, scabs, and itching


Exanthematous Viral Diseases

• Pronounced

– ( eks -anTHEM -ah-tus VYE -ral dihZEEZ -ez)

• Defined

– Skin eruption or rash accompanied by inflammation, having specific diagnostic features of an infectious viral disease


Exanthematous Viral Diseases

• Examples

– Rubella = German measles = 3-day measles

– Roseola infantum

– Rubeola = red measles = 7- to 10-day measles

– Erythema infectiosum = fifth disease


Gangrene

• Pronounced

– (

GANG -green)

• Defined

– Tissue death due to loss of adequate blood supply, invasion of bacteria; subsequent decay with foul odor


Herpes Zoster

• Pronounced

– (

HER -peez ZOS -ter)

• Defined

– Acute viral infection, characterized by painful, vesicular eruptions on the skin that follow along nerve pathways of underlying spinal or cranial nerves

– Highest incidence in adults over 50


Herpes Zoster

Image courtesy of Robert A. Silverman,

M.D., Pediatric Dermatology,

Georgetown University


Impetigo

• Pronounced

– (im-peh-

TYE -goh)

• Defined

– Contagious superficial skin infection characterized by serous vesicles and pustules filled with millions of staphylococcus or streptococcus bacteria

• Usually forming on the face


Question

This viral infection is derived from a childhood disease, and then it most commonly flares up after age 50 along nerve pathways: a. eczema b. rubeola c. Herpes zoster d. impetigo


Kaposi’s Sarcoma

• Pronounced

– (

KAP -oh-seez sarKOH -ma)

• Defined

– Rare malignant lesions beginning as soft purple-brown nodules or plaques on the feet

– Gradually spreads throughout skin

– Increased incidence in men with AIDS


Keloid

• Pronounced

– (

KEE -loyd)

• Defined

– Enlarged, irregularly shaped, elevated scar that forms due to the presence of large amounts of collagen during formation of a scar


Keratosis

• Pronounced

– (kair-ah-

TOH -sis)

• Defined

– Skin condition in which there is a thickening and overgrowth of the cornified epithelium


Seborrheic Keratosis

• Pronounced

– (seb-oh-

REE -ik kair-ahTOH -sis)

• Defined

– Brown or waxy yellow, wart-like lesions that are loosely attached to the skin

– Also known as senile warts


Actinic Keratosis

• Pronounced

– (ak-

TIN -ic kair-ahTOH -sis)

• Defined

– Premalignant, gray or red-to-brown, hardened lesion caused by excessive exposure to sunlight

– Also known as solar keratosis


Leukoplakia

• Pronounced

– (loo-koh-

PLAY -kee-ah)

• Defined

– White, hard, thickened patches firmly attached to the mucous membrane

• In mouth, vulva, or penis


Question

True or False: Keratosis literally means condition of a horny-like growth in the upper layer of skin, like a wart or callus.


Malignant Melanoma

• Pronounced

– (mah-

LIG -nant mel-ahNOH -mah)

• Defined

– Malignant skin tumor originating from melanocytes in preexisting nevi, freckles, or skin with pigment

– Darkly pigmented tumor with irregular surfaces and borders; variable colors


ABCDs of Malignant Melanomas

•

A symmetry

•

B orders

•

C olor

•

D iameter


Nevus

• Pronounced

– (

NEV -us)

• Defined

– Visual accumulation of melanocytes, creating a flat or raised rounded macule or papule with definite borders

– Commonly known as a mole


Question

Based on the definition of melanoma, what is the actual meaning of melan-?

a. dark pigment b. light pigment c. blue pigment d. white pigment


Onychocryptosis

• Pronounced

– ( on -ih-koh-kripTOH -sis)

• Defined

– Ingrown nail

• Most commonly involves the large toe


Onychomycosis

• Pronounced

– ( on -ih-koh-myKOH -sis)

• Defined

– Fungal infection of the nails


Pediculosis

• Pronounced

– (peedik -youLOH -sis)

• Defined

– Highly contagious parasitic infestation caused by bloodsucking lice


Pediculosis

• Pediculosis capitis

– Head

• Pediculosis corporis

– Body


Pediculosis

• Pediculosis palpebrarum

– Eyelashes and eyelids

• Pediculosis pubis

– Pubic hair


Pemphigus

• Pronounced

– (

PEM -fih-gus)

• Defined

– Rare, incurable disorder manifested by blisters in the mouth and on the skin

– Spreads to involve large areas of the body


Pilonidal Cyst

• Pronounced

– ( pye -lohNYE -dal SIST )

• Defined

– Closed sac located in the sacrococcygeal area of the back

– Sometimes noted at birth as a dimple


Psoriasis

• Pronounced

– (soh-

RYE -ah-sis)

• Defined

– Common, noninfectious, chronic skin disorder manifested by silvery-white scales over round, raised, reddened plaques producing itching

– Pruritus


Psoriasis

• Image courtesy of Robert A. Silverman,

M.D., Pediatric Dermatology, Georgetown

University


Question

True or False: Pilus means hair and nidus means nest; therefore, a pilonidal cyst probably literally means a fluid “nest” containing hair.


Rosacea

• Pronounced

– (roh-

ZAY -she-ah)

• Defined

– Chronic inflammatory skin disease that mainly affects the skin of the middle third of the face

– Characterized by persistent redness over areas of the face, nose, and cheeks


Scabies

• Pronounced

– (

SKAY -beez)

• Defined

– Highly contagious parasitic infestation caused by the

“human itch mite”

– Resulting in a rash, pruritus, and a feeling in the skin of

“something crawling”


Scleroderma

• Pronounced

– ( sklair -ohDER -mah)

• Defined

– Gradual thickening of the dermis and swelling of the hands and feet to a state in which the skin is anchored to the underlying tissue


Systemic Lupus Erythematosus

• Pronounced

– (sis-

TEM -ic LOO -pus air -ih-them-ahTOH -sus)

• Defined

– Chronic, multisystem inflammatory disease characterized by lesions of the nervous system and skin, renal problems, and vasculitis

– Characteristic “butterfly rash” is often seen on nose and face


Tinea

• Pronounced

– (

TIN -ee-ah)

• Defined

– Chronic fungal infection of the skin

– Characterized by scaling, itching, and sometimes painful lesions


• Tinea capitis

– Scalp

• Tinea corporis

– Body

Tinea


• Tinea cruris

– Groin

• Tinea pedis

– Foot

Tinea


Verruca

• Pronounced

– (ver-

ROO -kah)

• Defined

– Benign, circumscribed, elevated skin lesion that results from hypertrophy of the epidermis

– Commonly known as a wart


Verruca

• Verruca vulgaris

– Common wart on face, elbow, fingers, or hands

• Plantar warts

– Singly or in clusters on the sole of the foot


Verruca

• Venereal warts

– Transmitted by sexual contact

• Seborrheic warts

– Seen in the elderly on the face, neck, chest, or upper back


Question

When people say they can feel their skin crawl, perhaps they have this condition where a tiny bug is the culprit?

a. verruca vulgaris b. dermatitis c. scabies d. rosacea


Diagnostic Techniques, Treatments, and Procedures

• Allergy testing

– Various procedures used to identify specific allergens in an individual by exposing the person to a very small quantity of the allergen

• ImmunoCAP Allergy Blood Test more advanced, convenient, and reliable

• Cautery

– Heat or caustic substances that burn and scar the skin


Diagnostic Techniques, Treatments,

• Cryosurgery and Procedures

– Noninvasive treatment that uses subfreezing temperature to freeze and destroy tissue

• Curettage and electrodesiccation

– Scraping away of abnormal tissue, followed by destroying the tumor base with a low-voltage electrode



• Debridement and Procedures

– Removal of debris, foreign objects, and damaged or necrotic tissue from a wound in order to prevent infection and promote healing

• Dermabrasion

– Removal of the epidermis and a portion of the dermis with sandpaper or brushes in order to eliminate superficial scars of unwanted tattoos



• Dermatoplasty

– Skin transplantation to a body surface damaged by injury or disease

• Electrodesiccation

– Technique using an electrical spark to burn and destroy tissue

– Also known as fulguration



• Electrosurgery

– Removal or destruction of tissue with an electrical current

• Escharotomy

– Incision made into the necrotic tissue resulting from a severe burn



• Liposuction and Procedures

– Aspiration of fat through a suction cannula or curette to alter the body contours

• Skin biopsy

– Removal of a small piece of tissue from skin lesions for examination under a microscope to confirm or establish a diagnosis



• Skin graft

– Process of placing tissue on a recipient site, taken from a donor site, in order to provide the protective mechanisms of skin to an area unable to regenerate skin

• Wood’s lamp

– Ultraviolet light that is used to examine the scalp and skin for the purpose of observing fungal spores


Question

True or False: A person with third-degree burns would benefit from a dermatoplasty.


Integumentary System

Integumentary System

Integumentary System

Integumentary System

Layers and Structures of the Skin

Structure of the Nail

Question

Question

Skin Lesions

Skin Lesions

Skin Lesions

Skin Lesions

Skin Lesions

Skin Lesions

Skin Lesions

Skin Lesions

Skin Lesions

Skin Lesions

Skin Lesions

Question

Question

Acne Vulgaris

Albinism

Burns

Burns

Callus

Question

Carcinoma, Basal Cell

Carcinoma, Basal Cell

Carcinoma, Basal Cell

Carcinoma, Squamous Cell

Carcinoma, Squamous Cell

Question

Dermatitis

Eczema

Exanthematous Viral Diseases

Exanthematous Viral Diseases

Gangrene

Herpes Zoster

Herpes Zoster

Impetigo

Question

Kaposi’s Sarcoma

Keloid

Keratosis

Seborrheic Keratosis

Actinic Keratosis

Leukoplakia

Question

Malignant Melanoma

ABCDs of Malignant Melanomas

Nevus

Question

Onychocryptosis

Onychomycosis

Pediculosis

Pediculosis

Pediculosis

Pemphigus

Pilonidal Cyst

Psoriasis

Psoriasis

Question

Rosacea

Scabies

Scleroderma

Systemic Lupus Erythematosus

Tinea

Tinea

Tinea

Verruca

Verruca

Verruca

Question

Question

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