CHAPTER 5
Integumentary System
Integumentary System
• Skin
– Integument or cutaneous membrane
– Epidermis
– Dermis
– Subcutaneous layer
• Accessory structures
– Hair
– Nails
– Glands
2
Layers and
Structures of the Skin
3
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
4
Skin Lesions
• Bedsore
– Ulcer in skin over a bony prominence
– Also known as pressure ulcer
• Example: decubitus ulcer
• Blister
– Small, thin-walled lesion containing clear fluid
– Also known as a vesicle
5
Skin Lesions
• Bulla
– Large blister
• Carbuncle
– Circumscribed inflammation of skin and
deeper tissues; contains pus
• Comedo
– Typical lesion of acne vulgaris
• Example: whitehead = closed comedo
• Example: blackhead = open comedo
6
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
7
Skin Lesions
• Fissure
– Cracklike 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: recto-vaginal fistula
8
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
9
Skin Lesions
• Macule
– Small flat, discoloration of the skin; neither
raised nor depressed
• Example: bruises, freckles
• Nodule
– Small, circumscribed swelling protruding
above the skin
10
Skin Lesions
• Papule
– Small, solid, circumscribed elevation on the
skin
– Example: pimple, wart, elevated mole
• Polyp
– Small, stalklike growth, protruding upward or
outward from membrane surface
– Example: nasal polyp
11
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
• Ulcer
– Circumscribed, open sore or lesion of skin,
accompanied by inflammation
• Example: decubitus ulcer
12
Skin Lesions
• Vesicle
– Small, thin-walled, lesion containing clear fluid
• Example: blister
• Wheal
– Circumscribed, slightly elevated lesion of the
skin
– Paler in center than surrounding edges
• Example: hives
13
PATHOLOGICAL CONDITIONS
Integumentary System
Acne Vulgaris
• Pronounced
– (ACK-nee-vul-GAY-ris)
• Defined
– Common inflammatory disorder seen on face,
chest, back, and neck
– Appears as papules, pustules, and comedos
15
Albinism
• Pronounced
– (AL-bin-izm)
• Defined
– Condition characterized by absence of
pigment in the skin, hair, and eyes
16
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
17
Burns
• First-degree or superficial burns
– Example: sunburn
• Second-degree or partial-thickness burns
– Example: flash contact with hot objects
• Third-degree or full-thickness burns
– Example: deep burns from a fire
18
Callus
• Pronounced
– (CAL-us)
• Defined
– Common, usually painless thickening of the
epidermis at sites of external pressure or
friction, such as weight-bearing areas of the
feet and on the palmar surface of the hands
• Also known as a callosity
19
Carcinoma, Basal Cell
• Pronounced
– (car-sih-NOH-mah BAY-sal sell)
• Defined
– Most common malignant tumor of epithelial
tissue, occurring most often on areas of skin
that are exposed to the sun
• Presents as a slightly elevated nodule with a
depression or ulceration in the center that becomes
more obvious as the tumor grows
20
Carcinoma, Squamous Cell
• Pronounced
– (car-sih-NOH-mah SKWAY-mus sell )
• Defined
– Malignancy of the squamous, or scalelike,
cells of the epithelial tissue
– Much faster growing than basal cell
carcinoma
– Greater potential for metastasis if not treated
21
Carcinoma, Squamous Cell
• Frequent sites on sun-exposed areas
– Top of nose
– Forehead
– Margin of external ear
– Back of hands
– Lower lip
22
Dermatitis
• Pronounced
– (der-mah-TYE-tis)
• Defined
– Inflammation of skin, seen in several different
forms
– Acute or chronic
– Contact or seborrheic
23
Eczema
• Pronounced
– (EK-zeh-mah)
• Defined
– Acute or chronic inflammatory skin condition
characterized by erythema, papules, vesicles,
pustules, scales, crusts, scabs, and itching
24
Exanthematous Viral Diseases
• Pronounced
– (eks-an-THEM-ah-tus viral diseases)
• Defined
– Skin eruption or rash accompanied by
inflammation, having specific diagnostic
features of an infectious viral disease
25
Exanthematous Viral Diseases
• Examples:
– Rubella = German Measles = 3 day measles
– Roseola Infantum
– Rubeola = Red Measles = 7-10 day measles
– Erythema Infectiosum = Fifth disease
26
Gangrene
• Pronounced
– (GANG-green)
• Defined
– Tissue death due to loss of adequate blood
supply, invasion of bacteria, subsequent
decay with foul odor
27
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
28
Herpes Zoster
Image courtesy of Robert A. Silverman,
M.D., Pediatric Dermatology,
Georgetown University
29
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
30
Kaposi’s Sarcoma
• Pronounced
– (CAP-oh-seez sar-KOH-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
31
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
32
Keratosis
• Pronounced
– (kair-ah-TOH-sis)
• Defined
– Skin condition in which there is a thickening
and overgrowth of the cornified epithelium
33
Seborrheic Keratosis
• Pronounced
– (seb-oh-REE-ik kair-ah-TOH-sis)
• Defined
– Brown or waxy yellow wart-like lesions that
are loosely attached to the skin
– Also known as senile warts
34
Actinic Keratosis
• Pronounced
– (ak-TIN-ic kair-ah-TOH-sis)
• Defined
– Premalignant, gray or red-to-brown, hardened
lesion caused by excessive exposure to
sunlight
– Also known as solar keratosis
35
Leukoplakia
• Pronounced
– (loo-koh-PLAY-kee-ah)
• Defined
– White, hard, thickened patches firmly
attached to the mucous membrane
• In mouth, vulva, or penis
36
Malignant Melanoma
• Pronounced
– (mah-LIG-nant mel-ah-NOH-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
37
ABCDs of
Malignant Melanomas
•
•
•
•
Asymmetry
Borders
Color
Diameter
38
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
39
Onychocryptosis
• Pronounced
– (on-ih-koh-krip-TOH-sis)
• Defined
– Ingrown nail
• Most commonly involves the large toe
40
Onychomycosis
• Pronounced
– (on-ih-koh-my-KOH-sis)
• Defined
– Fungal infection of the nails
41
Pediculosis
• Pronounced
– (pee-dik-you-LOH-sis)
• Defined
– Highly contagious parasitic infestation caused
by blood-sucking lice
42
Pediculosis
• Pediculosis capitis
– Head
• Pediculosis corporis
– Body
• Pediculosis palpebrarum
– Eyelashes and eyelids
• Pediculosis pubis
– Pubic hair
43
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
44
Pilonidal Cyst
• Pronounced
– (pye-loh-NYE-dal SIST)
• Defined
– Closed sac located in the sacrococcygeal
area of the back
– Sometimes noted at birth as a dimple
45
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
46
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 the
areas of the face, nose, and cheeks
47
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”
48
Scleroderma
• Pronounced
– (sklair-ah-DER-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
49
Systemic Lupus Erythematosus
• Pronounced
– (sis-TEM-ic LOO-pus air-ih-them-ah-TOHsis)
• Defined
– Chronic, multi-system, 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
50
Tinea
• Pronounced
– (TIN-ee-ah)
• Defined
– Chronic fungal infection of the skin
– Characterized by scaling, itching, and
sometimes painful lesions
51
Tinea
• Tinea capitis
– Scalp
• Tinea corporis
– Body
• Tinea cruris
– Groin
• Tinea pedis
– Foot
52
Verruca
• Pronounced
– (ver-ROO-kah)
• Defined
– Benign, circumscribed, elevated skin lesion
that results from hypertrophy of the epidermis
– Commonly known as a wart
53
Verruca
• Verruca vulgaris
– Common wart on face, elbow, fingers, or
hands
• Plantar warts
– Singly or in clusters on the sole of the foot
• Venereal warts
– Transmitted by sexual contact
• Seborrheic warts
– Seen in the elderly on the face, neck, chest,
or upper back
54
DIAGNOSTIC
TECHNIQUES, TREATMENTS
AND PROCEDURES
Integumentary System
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
• Cautery
– Heat or caustic substances that burn and scar
the skin
56
Diagnostic Techniques,
Treatments, and Procedures
• Cryosurgery
– 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 lowvoltage electrode
57
Diagnostic Techniques,
Treatments, and Procedures
• Debridement
– 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
58
Diagnostic Techniques,
Treatments, and Procedures
• 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
59
Diagnostic Techniques,
Treatments, and Procedures
• Electrosurgery
– Removal or destruction of tissue with an
electrical current
• Escharotomy
– Incision made into the necrotic tissue resulting
from a severe burn
60
Diagnostic Techniques,
Treatments, and Procedures
• Liposuction
– 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
61
Diagnostic Techniques,
Treatments, and Procedures
• 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
62