Skin, Hair, and Nail
CHAPTER 12
Hair, Sebaceous Glands, Sweat Glands and Nails
Hair
◦ Threads of keratin—hair shaft and bulb matrix
◦ Types of hair—vellus and terminal
◦ Follicle—cyclical with active and resting phases
Sebaceous glands
◦ Sebum—secreted lipid substance through hair follicles
◦ Lubricate skin and form emulsion
Sweat glands
◦ Eccrine produce sweat.
◦ Apocrine produce milky secretion and open into hair follicles.
Nails
◦ Hard plates of keratin on dorsal edges of fingers and toes
Skin
Largest organ system in the body, guard the body from environmental stressors
and influences
Epidermis
 Thin layer of cells that forms a protective barrier.
Dermis
 Inner supportive layer of connective tissue/collagen
Subcutaneous Layer
 Fatty adipose tissue
Function of the Skin
Protection
Prevents penetration
Perception
Temperature regulation
Identification
Communication
Wound repair
Absorption and Excretion
Production of vitamin D
Developmental Competence: Infants,
Children, and Adolescents
Newborn infants
◦ Lanugo: fine downy hair of newborn infant
◦ Vernix caseosa: thick, cheesy substance
◦ Sebum: holding water in the skin producing milia
Children
◦ Epidermis thickens, darkens, and becomes lubricated.
◦ Hair growth accelerates.
Adolescents
◦ Secretions from apocrine sweat glands increase.
◦ Subcutaneous fat deposits increase.
◦ Secondary sex characteristics
Developmental Competence:
The Aging Adult
Elasticity
◦ Loses elasticity; skinfolds and sags
Sweat and sebaceous glands
◦ Decrease in number and function, leaving skin dry
Senile purpura
◦ Discoloration due to increasing capillary fragility
Skin breakdown due to multiple factors
◦ Cell replacement is slower and wound healing is delayed.
Hair matrix
◦ Functioning melanocytes decrease, leading to gray fine hair
Culture and Genetics
Genetic attributes of dark-skinned individuals afford protection against skin cancer
due to melanin.
◦ Increased likelihood of skin cancer in whites than in black and Hispanic populations
◦ Succession of genetic mutations leading to increased chromosome sensitivity to sun
damage
Most important environmental risk factor for skin cancer is exposure to ultraviolet
(UV) radiation both from sun and indoor tanning sources.
Increased risk for melanoma r/t increased number of sunburns during one’s lifetime.
Certain skin presentations are associated with different ethnic groups.
Subjective Data
Past History – any predisposition to allergies, psoriasis, eczema
HPI
 Characteristic, Onset, Location, Duration, Severity, Pattern, Associating Factors
Medication
Family Hx
Occupational hazard
Objective Data: Inspect and Palpate the Skin
Inspect and palpate the overall condition of the skin
 Color – Pallor, Erythema, Cyanosis, Jaundice
 Temperature – Skin should be warm and equal bilaterally (Hypothermia, Hyperthermia)
 Moisture – Diaphoresis/Dehydration
 Thickness
 Edema – four point grading scale
 Mobility and turgor
 Vascularity or bruising
 Lesions – Color, Elevation, Shape, Size, Location, Exudate
Objective Data: Inspect and Palpate the Skin
Developmental Competence: Infant Skin Presentations
Skin color—general pigmentation
◦ Mongolian spot
◦ Café-au-lait spot
Physiologic jaundice
Moisture, texture, thickness, mobility and turgor
Vascularity or bruising—nevus simplex
Hair and nails—lanugo and presence of cyanosis in newborn
Developmental Competence:
Life-Cycle Presentations
Adolescent
◦ Acne
◦ Open and closed comedones
Pregnancy
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Striae
Linea nigra
Chloasma
Vascular spiders
Aging
◦ Skin color and presentations
◦ Senile lentigines
◦ Keratoses
◦ Moisture
◦ Xerosis
◦ Texture
◦ Skin tags
◦ Thickness
◦ Thin parchment
◦ Decreased mobility and turgor
◦ Decreased hair growth, nail growth, and brittle nails
Objective Data: Inspect and Palpate Hair
Color
 Due to melanin production
Texture
 Characteristics range from fine to thick to curly to straight and may be affected by use of hair
care products
Distribution
 Tanner staging identifies gender patterns of hair distribution
Lesions
 Identification by looking at scalp and dividing hair into sections
Objective Data: Inspect and Palpate Nail
Shape and contour
 Profile sign: view index finger at its profile and note angle of nail base; it should be about 160
degrees
Consistency
Color
Capillary refill
 Depress nail edge to blanch and then release, noting return of color; indicates status of
peripheral circulation
 Color return is normally instant
 Sluggish color return takes longer than 1 or 2 seconds
Profile Sign: Clubbing
Examination of the Nails
Edges:
Contour:
Consistency:
Color:
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Lesions
Moles and suspicious pigmented lesions are assessed using the ABCDE mnemonic
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A: asymmetry
B: border
C: color
D: diameter
E: elevation and enlargement
F: funny looking/ different from others
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
Malignant Melanoma - ABCDE
Lesions
Primary lesions are lesions that occur on a
Secondary lesions results from a change in the
previously unaltered skin.
primary lesion
 Macule, Papule, Patch, Plaque,
 Crust and Scale (skin surface debris)
 Nodule, Wheals, Tumors, Urticaria (hives)
 Fissure, Erosion, Excoriation
 Vesicles, Cysts, Bullas ,Pustule
 Ulcer
 Scar
 Lichenification
 Keloid
Primary Lesions
Primary Lesion
Cyst
Pustule
Secondary Lesions
Crust
Scale
Fissure
Lesion Shapes and Configuration
Annular
Confluent
Grouped
Discrete
Linear
Vascular Lesions
Petechiae
Purpura
Decubitus Ulcer
Results from unrelieved pressure, poor nutrition and decrease mobility
Staging Criteria:
 Stage 1 – Nonblanchable erythema of intact skin.
 Stage 2 – Partial thickness tissue loss of both epidermis and dermis. Shallow like abrasion
 Stage 3 – Full thickness tissue loss involving the subcutaneous tissue. Will not see muscle, bone or
tendon
 Stage 4 – Full thickness with loss involving the muscle or bone
Unstageable ulcer – When eschar or slough covers the obscure the wound bed and ulcer cannot
be assessed
BRADEN SCALE
Decubitus Ulcer
Decubitus Ulcer
Bruises Assessment
1. Red-blue or purple within 24 hour after trauma
2. Blue to Purple
3. Blue – green
4. Yellow
5. Brown about 10 to 14 days after trauma