Rodney Castro
Nursing 1100 (Lab)
September 23, 2010
Jarvis, Physical examination and health assessment 2009
Chapter 12: pg 242 – 268
Skin Abnormalities
Adolescents
 Increase in sebaceous gland activity creates increased oiliness and acne
 Acne lesions usually appear on face, back, chest, and shoulders
 May appear in children (7-8 years old)
 Peaks at 14-16 (girls) and 16-19 (boys)
Pregnant Female
 Striae are stretch marks (silver/pink colour), appears in second trimester on abdomen, breast,
thighs, which fades after deliver but not disappears
 Linea nigra is a brownish black line down the midline of abdomen
 Chloasma is an irregular brown patch of hyperpigmentation on the face, which occurs with
pregnancy or ingesting contraceptive pills
 Vascular spiders have tiny red centers radiating branches and occur on neck face and chest
Aging adult (skin colour and pigmentation)
 Senile lentinges (liver spots) are small flat brown macules that appear on forearms, and dorsa of
hand. They are clusters of melanocytes that appear after extensive sun exposure
 Keratoses are thickened areas of pigmentation that look crusty and scaly, which develop on face
and hands, unexposed/sun-exposed areas
Moisture
 Dry skin is common in the aging person because of decline in size, number, and output of sweat
glands and sebaceous glands
Texture
 Common variations occurring in aging adults are acrochordons which are overgrowths of normal
skin that form a stalk and are polyplike (eyelids, cheeks, and neck)
Thickness
 With aging, skiin looks as thin as parchment and the subcutaneous fat diminishes
 Thin skin is in the dorsa of hands, forearms, lower legs, and dorsa of feet
 Skin is thicker over abdomen and chest
Mobillity and Turgor
 Turgor is decreased (less elasticity)
Hair
 Hair growth decreases with aging
 After menopause, woman develop hairs on upper chin
 In men, hairs develop in ears, nose, and eyebrows
Nails
 Nail growth decreases, and local injuries in nail matrix may produce longitudinal ridges

Toenails are thickened and may grow misshapen
Table 12 – 2: Detecting Colour Changes in Light and Dark Skin
*refer to pg 248
~The following all have diagrams in 250-268~
Common shapes and configurations of lesions
Annular
 Begins in the center and spreads to periphery
Confluent
 Lesions run together
Discrete
 Distinct, individual lesions that remain separate
Grouped
 Clusters of lesions
Gyrate
 Twisted, coiled spiral, snakelike
Target
 Or iris, resembles iris of eye, concentric rings of colour in the lesions
Linear
 A scratch, streak, line, or stripe
Polycyclic
 Annular lesions grow together
Zosteriform
 Linear arrangement along a nerve route
Primary skin lesions
Macule
 Solely a colour change, flat and circumscribed, of less that 1 cm (eg: freckles, measles)
Papule
 Something you can feel caused by superficial thickening in epidermis (eg: mole, wart)
Patch
 Macules larger than 1cm (eg: vitiligo, Mongolian spot)
Plaque
 Papules coalesce to form surface elevation wider than 1 cm (eg: lichen planus)
Nodule
 Solid, elevated, larger than 1 cm, extends into dermis (eg: fibroma, xanthoma)
Wheal
 Superficial, raised, transient; irregular shape due to edema (eg: mosquito bite, allergic reaction)
Tumour
 Larger than few cm in diameter, firm or soft, deeper in dermis (eg: lipoma, hemangioma
Vesicle
 Elevated cavity containing free fluid, clear serum flows if ruptured (eg: herpes, shingles)
Hives
 Wheals coalesce to form extensive reaction, intensely pruritic
Bulla
 Single chambered, superficial in epidermis, ruptures easily (eg: friction blister, burns)
Cyst
 Fluid filled cavity in dermis or subcutaneous layer (eg: sebaceous cyst, wen)
Pustule
 Pus in the cavity (eg: acne, impetigo)
Secondary skin lesions
Debris on skin surface
Crust

Scale

Thickened dried out exudates left when vesicles burst or dry up, coloured red-brown, honey, or
yellow (eg: impetigo, scab after abrasion)
Compact desiccated flakes of skin, dry or greasy from shedding of dead excess keratin cells (eg:
seborrheic dermatitis, dry skin
Break in continuity of surface
Fissure
 linear crack with abrupt edges, extends into dermis, dry or moist (eg: athletes foot, cheilosis)
Erosion
 scooped –out but shallow depression. Superficial; epidermis lost; moist but no bleeding, heals
without scar because erosion does not extend into dermis
Ulcer
 Deeper depression extending into dermis, irregular shape; may bleed; leaves scar when heals
(eg: stasis ulcer, pressure sore)
Excoriation
 Self-inflicted abrasion; superficial; sometimes crusted; scratches from intense itching (eg: insect
bites, scabies)
Scar
 After a skin lesion is repaired, normal tissue is lost and replaced with connective tissue
(collagen) (eg: acne, healed area of surgery or injury)
Atrophic scar
 Resulting skin level depressed with loss of tissue, thinning of epidermis (eg: striae)
Lichenification
 Prolonged intense scratching eventually thickens the skin and produces tightly packed sets of
papules; looks like surface of moss
Keloid
 Hypertrophic scar, skin level is elevated by excess scar tissue, looks smooth rubbery
Lesions caused by trauma or abuse
Pattern injury

Is a bruise or wound whose shape suggests the instrument or weapon caused it (eg: bite mark,
pinch mark, belt buckle etc)
Hematoma
 Is a bruise you can feel, elevates the skin and is seen as swelling
Contusion (bruise)
 large patch of capillary bleeding into tissues
 a bruise usually occurs from trauma; also from bleeding disorders and liver dysfunction
Vascular Lesions
Hemangiomas
Port-wine stain
 a large macular patch covering scalp or face, along distribution of cranial nerve V. Colour is dark
red, bluish or purpleish and intensifies when crying
 present at birth and usually doesn’t fade
strawberry mark (immature hemangioma)
 raised right area 2-3 cm in diameter
 consists of immature capillaries, present at birth, disappears ages 5-7
Cavernous hemangioma (mature)
 reddish blue, irregular shape, spongy mass of blood vessels
Telangiectases
Spider or star angioma
 fiery red star shape marking with solid center
 capillary radiations extend from the central arterial body
 develops on face, neck, or chest
venous lake
 blue-purple dilatation of venules and capillaries in a star-shaped linear pattern
 pressure causes them to empty or disappear
 located in face lips, ears, and chest
Purpuric Lesions
Petechiae
 punctuate haemorrhages 1-3mm, round, dark, purple or brown
 caused by bleeding from superficial capillaries,
 may indicate abnormal clotting factors
purpura
 confluent and extensive patch of petechiae and ecchymoses, red to purple,
 Seen in generalized disorders such as scurvy
Common skin lesions in children
Impetigo
 Moist, thin-roofed vesicles with thin erythematous base
 Contagious bacterial skin infection
 Common in children and infantrs
Diaper dermatitis
 Red. Moist maculopopular patch with poorly defined borders in diaper area
 Inflammatory disease caused by skin irritation from ammoinia, heat, moisture, occlusive diapers
Intertrigo
 Scalding red, moist patches, loose scales
 In genital area
 Aggravated by urine, feces, heat, and moisture
Atopic dermatitis
 Erythematous papules and vesicles, with weeping, oozing, and crusts
 Occurs on scalp, forehead, cheeks, forearms, and wrists
Measles
 Red-purple maculopopular blotchy rash appears on 3rd or 4th day of illness
 Rash appears first behind ears, and spreads over face, then neck, trunk, legs
German measles
 Pink papular rash first appears on face then spreads
 Distinguished from measles by presence of neck lymphadenopathy and absnce of kopliks spots
Chicken pox
 Small tight vesicles first appears on trunk, then to face, arms and legs.
 Vesicles erupt in succeeding crops overseveral days then become pustules then crusts
Common skin lesions
Primary contact dermatitis
 Local inflammatory reaction to an irritant in the environment or an allergy
 Erythema shows first, followed by swelling, wheals, scars
Allergic drug reactions
 Erythematous and symmetrical rash
 Some drugs prude urticarial rash or vesicles
Tinea corporis (ring worms of body)
 Scales on chest, abdomen, back of arms forming multiple circular lesions
Tinea pedis (ringworms of foot)
 Fungul infection appears as small vesicles between toes, sides of feet soles
 Commonly found in warm moist feet (eg: after exercising in gym)
Psoriasis
 Scaly erythematous patch, with silvery scales
 Located on scalp, outside of elbows and knees, low back, and anogenital area
Tinea verisocolor
 Fine, scaling, round patches caused by superficial fungal infection
 Located on neck, trunk, upper arms, common in healthy young adults
Labial herpes simplex (cold sore)
 Has a prodrome of skin tingling and sensitivity
 Lesions erupt with tight vesicles, then pustules, then acute gingiovostomatitis with ulcers
 Located in upper lip, and mouth and tongue
Herpes zoster (shingles)


Small grouped vesicles emerge along route of cutaneous senseory nerve, then pustules, then
crusts
Common on trunk, common more on adults older than 50
Erythema migrans of lyme disease
 Caused by spirochete bacterium carried by black or dark brown deer tick
 First stage has a red macular rash
 Rash radiates from the site of the tick bite with some central clearing and is usually located in
axilla, or behind knee
 Rash fades in 4 weeks
Malignant skin lesions
Basal cell
 Usually starts as skin-coloured papulae, with a translucent top
 One of the most common forms of skin cancer
Squamous cell carcinoma
 Erythematous scaly patch with sharp margins
 Usually on hands or head, areas exposed to solar radiation
Malignant
 Brown, black, purple, tan coloured
 Arises from pre-existing nevi
 Common locations are on trunk, back in men and woman, legs on women
Skin lesions associated with acquired immune deficiency syndrome
Epidemic kaposi’s sarcoma: patch stage
 An aggressive form of kaposi’s sarcoma is one of the diseases that characterizes AIDS
Epidemic kaposi’s sarcoma: plaque stage
 Evolving lesions develop into raised papules or thickened plaques
Epidemic Kaposi’s sarcoma: advanced disease
 Advanced – stage, widely disseminated lesions involving skin, mucous membranes and visceral
organs
Infectious disease as a biological weapon
Anthrax
 Cutaneous anthrax is caused by bacillus anthracis when it comes in contact with a pre-existing
lesion or broken skin
 After 3 days, a red raised pruritic papulae appears followed by a round ulcer surrounding
vesicles a few days later
 A tough black scab forms in a few weeks, which loosens and falls off in another few weeks
Small pox
 Is a viral infection with no known treatment
 Disease is spread by direct contact or inhalation of respiratory droplets

During incubation period 10-12 days, infected person will develop flu-like symptom
(fever,headache,vomiting)
Abrnomal conditions of hair
Seborrheic dermatitis (cradle cap)
 Thick, yellow to white, greasy, adherent scales iwth mild erythema on scalp and forehead
 Common in early infancy
Tinea Capitis (scalp ringworm)
 Rounded patchy hair loss on scalp, leaving broken-off hairs
 Caused by fungul infection; l
 Seen in children and farmers, highly contagious
Toxic alopecia
 Patchy asymmetric balding
 Regrowth occurs after illness or discontinuation of toxin
Alopecia areata
 Sudden appearance of sharply circumscribed round or oval balding patch
 When limited to a few patches, person usually has complete regrowth
Traumatic alopecia: traction alopecia
 Linear or oval patch of hair loss along hairline; caused by trauma from hair rollers, tight braiding
etc
Trichotillomania
 Traumatic self-induced hair loss usually the result of compulsive twisting or plucking
Pediculosis capitis (head lice)
 Causes intense itching of scalp
 Common among school age children
Folliculitis
 Superficial infection with hair follicles
 Usually on arms, legs, face, and buttocks
Hirsutism
 Excess body hair in females forming male sexual pattern (face, chest, upper lip etc)
 Caused by endocrine or metabolic dysfunction
Furuncle and abscess
 Red, swollen hard, tender, pus-filled, lesion caused by acute localized bacterial infection
Abnormal conditions of the nail
Koilonchia
 Thin depressed nails with lateral edges tilted up, forming concave shape
Paronchia
 Red swollen tender inflammation of nail folds
 Often a fungal infection
Beau’s line
 Transverse furrow or groove, a depression across the nail that exends down to the nail bed
Splinter haemorrhages
 Red-brown linear streaks with subacute bacterial endocarditis
Late clubbing
 Proximal edge of nail elevates; angle is greater than 180 degrees
 Seen with chronic obstructive pulmonary diseases
Onycholysis
 Slow persistent fungal infection of fingernails and more often toenails
 Fungus causes change in colour
Pitting
 Sharply defined pitting and crumbling of the nails with distal detachment often occurs with
psoriasis
Habit-tic dystrophy
 Depression down middle of nail caused by continuous picking of cuticle