Integumentary System
HST III
2009-2010
Objectives:
After completing this unit each student should
be able to:
• Compare the composition and function of
the epidermis with those of the dermis
• Describe the functions of the skin.
• Describe normal hair, nails, sebaceous
glands, and sudoriferous glands and their
primary functions.
Objectives:
4. Give examples of the appropriate health
history questions for assessment of the
skin, hair, and nails.
5. Describe how to assess thee client’s skin by
inspection and palpation.
6. Differentiate between normal and
abnormal skin conditions.
7. Describe the characteristics of common skin
lesions using appropriate terminology.
Objectives:
8. Identify life-threatening drug induced skin
eruptions.
9. Describe the general dermatologic
preparations and their indications.
10. Discuss ectoparasitic diseases and the use
of topical ectoparasiticidal drugs in their
treatment.
Anatomy
and
Physiology
Considered to be both:
• (a) Membrane – covers the
body
• (b) Organ – contains several
types of tissue
– Largest organ in body covering (c) 3,000 square
inches
– About (d) 15% total body
weight
Tissue:
• 3 layers of tissue
1. (e) Epidermis – outermost layer of skin
• (f) NO blood vessels or nerve cells (avascular)
2. (g) Dermis – corium or “true skin”
• Includes:
–Elastic connective tissue
–Blood vessels
–Lymph vessels
–Nerves
–Involuntary muscle
–Sweat and oil glands
–Hair follicles
Tissue:
Subcutaneous layer (hypodermis) – the
innermost layer
3.
(h)
•
Made of:
•
•
•
Elastic and fibrous connective tissue
Adipose (fatty) tissue
Connects the skin to underlying muscles
Fingerprints?
• The top layer of the
dermis has ridges
which form lines or
striations on the skin
which give us our
unique fingerprints
Major Organs/Structures
•
•
•
•
Skin
Sweat and oil glands
Nails
Hair
Two Main Types of Glands
Sudoriferous (sweat)
glands
1.
(i)
•
•
•
Sweat eliminated by these
glands contains water, salts,
and some body wastes
Sweat is odorless until it
interacts with bacteria on the
skin
Perspiration (sweating)
removes excess water from
the body and cools the body
Two Main Types of Glands
2.
(j)
•
•
•
•
Sebaceous (oil) glands
Usually open onto hair
follicles
Produce sebum (oil) which
keeps skin and hair from
becoming dry and brittle
Slightly acidic nature helps
prevent infection
Oil glands plugged with dirt
and oil result in blackheads
or pimples.
Hair
• Consists of a root
(which grows in a
hollow tube called a (k)
follicle)
• A (l) hair shaft
– Helps protect the body
– Covers all body surfaces
except the palms of the
hands and the soles of
the foot
(m)
Alopecia (baldness)
• Genetically inherited
• Males (and some females)
• Permanent loss of hair of the scalp
•
•
•
•
Nails
Protect the fingers and toes from injury
Made of (n) dead, keratinized epithelial cells
Formed in the nail bed
If lost, nails will regrow if the nail bed is not
damaged
Functions
of
Skin
Protection –barrier against UV rays and
infection, and helps prevent dehydration
(p) Sensory perception – nerves help the body
respond to pain, pressure, temperature, and
touch sensations
(q) Body temperature regulation
1. (o)
2.
3.
• when blood vessels in the skin (r) dilate (get
larger) – excess heat can escape
• when blood vessels (s) constrict (get smaller) –
heat is retained
4.
5.
6.
7.
Storage – tissue temporarily stores fat,
glucose, water, vitamins, and salts; adipose
(fatty) tissue is a source of energy
(u) Absorption – certain substances are
absorbed through the skin, such as medicine
and nicotine patches; medication patches are
(v) transdermal
(w) Excretion – eliminates salt, waste, excess
water and heat through perspiration
(x) Production – skin helps produce vitamin D
using UV rays
(t)
Skin
Pigmentation
• Basic skin color is inherited
– (y)Melanin – brownish-black pigment produced in the epidermis
• Everyone has the same number of (z) melanocytes but genes determine
the amount of melanin produced
• Freckles are small concentrated areas of melanin
– (aa)Albino – absence of color pigments in the skin
• Skin has pinkish tint
• Hair is pale yellow or white
• Eyes lack pigment; are red; very sensitive to light
Abnormal
Pigmentation:
• (bb)Erythema –
reddish color that can
be caused by burns or
a congestion of blood
in the vessels
• (cc)Jaundice – yellow
discoloration;
indicates bile in the
blood resulting from
liver and gallbladder
disease; also seen in
diseases that involve
destruction of RBC
• (dd)Cyanosis –
bluish
discoloration
caused by
insufficient
oxygen; associated
with heart, lung,
and circulatory
diseases or
disorders
• (ee)Chronic
poisoning – may
cause gray or
brown skin
discoloration
Primary Skin
Lesions:
Appear on previously healthy
skin in response to disease or
external irritation.
• Macules – flat
spots on the skin,
such as freckles
• Papules – firm,
raised areas such as
pimples and the
eruptions seen in
some stages of
chickenpox and
syphilis; up to 0.5cm
in diameter
• Vesicles – blisters, or
fluid-filled sacs, such
as those seen in
chickenpox
• Pustules – pusfilled sacs such as
those seen in
acne, or pimples
• Bulla – fluid filled
lesion greater
than 2cm in
diameter; caused
by severe poison
oak or ivy
dermatitis
• Comedo –
plugged
pilosebaceous
duct, formed from
sebum and
keratin; blackhead
(open comedo);
whitehead (closed
comedo)
• Cyst – Semi-solid or
fluid-filled
encapsulated mass
extending deep into
the dermis; example
is lacrimal cyst
• Nodule – Firm,
raised lesion;
extending into
dermal layer;
deeper than a
papule, 0.5 – 2cm
in diameter;
example
intradermal nevus
• Patch – Flat,
pigmented,
circumscribed area
greater than 1cm
in diameter
• Plaque –
Circumscribed, solid,
elevated lesion
greater than 1cm in
diameter; elevation
above skin surface
occupies larger
surface area in
comparison with
height
• Wheals – itchy,
elevated areas
with an irregular
shape; hives and
insect bites are
examples
• Tumor – Elevated,
solid lesion larger
than 2cm in
diameter,
extending into
dermal and
subcutaneous
layers
Secondary Skin
Lesions:
Result from changes in the
primary lesion, usually related
to the disease process.
• Crusts – areas of
dried pus and
blood, commonly
called scabs
• Ulcer – a deep loss
of skin surface that
may extend into the
dermis; may cause
periodic bleeding
and the formation of
scars
• Atrophy –
Thinning of skin
surface at site of
disorder; aging
skin
• Erosion – Circumscribed lesion
involving loss of superficial
epidermis; rug burn, abrasion
• Excoriation – Linear scratched or
abraded areas, often self-induced; for
example, abraded (scratched) acne
lesions, eczema
• Fissure – Linear cracking of the skin,
extending into the dermal layer; for
example hand dermatitis (chapped skin)
• Keloid – Thick, red, or dark firm scar
formed by hyperplasia of fibrous tissue;
more frequent in African Americans and
Asians.
• Lichenification – Thickened, prominent
skin markings caused by constant
rubbing;
• Scale – Thin, dry
flakes of shedding
skin; for example
psoriasis, dry skin
• Scar – Fibrous
tissue caused by
trauma, deep
inflammation, or
surgical incision;
red and raised
(recent); pink and
flat (6 weeks), or
pale and
depressed (old)
Diseases and
Abnormal
Conditions
• Skin cancer – most
common type of cancer
– 3 types:
• Squamous cell carcinoma
– affects the thin cells of
the epithelium
– spreads quickly
• Melanoma – develops in
the melanocytes
– Most dangerous type of
skin cancer
• Basal cell carcinoma –
cancer of the basal cells in
the epidermis
– slow growing
• Acne – inflammation of
the sebaceous glands
• Athlete’s foot –
contagious fungal
infection that usually
affects the feet
• Eczema –
noncontagious,
inflammatory
skin disorder
caused by
allergens or
irritants
• Psoriasis – chronic,
noncontagious skin disease
with periods of
exacerbations (symptoms
present) and remission
(decrease or disappearance
of symptoms)
• Ringworm – highly
contagious fungal infection
of the skin or scalp
• Impetigo – Highly
contagious condition
resulting from
staphylococcus or
streptococcal
infection, and occurs
most often in young
children; starts as
erythema but soon
develops into
vesicles and
yellowish crusts.
• Tinea – general name
for many different
types of mycoses
(fungal infections);
signs include
erythema, scaling,
and crusting.
• Warts – caused by
papilloma virus; type
of benign neoplasm
of the skin; some
transform and
become malignant;
transmission
generally occurs
through direct
contact with lesions
on the skin of an
infected person.
• Boils – also called
furuncles are most
often local
staphylococci
infections of hair
follicles characterized
by large, inflamed
pustules; A group of
untreated boils may
fuse into even larger
pus filled lesions
called carbuncles.
• Scabies – contagious
skin condition
caused by the itch
mite (Sarcoptes
scabiei); transmitted
by skin to skin
contact; causes
intense itching, and
excoriation occurs as
a result
• Uticaria – (hives);
characterized by raised,
red lesions called wheals
caused by leakage of
fluid from the skin’s
blood vessels; often
associated with severe
itching; hypersensitivity
or allergic reactions,
physical irritants, and
systemic diseases are
common causes.
• Scleroderma – an
autoimmune disease
that affects the blood
vessels and connective
tissue of the skin; comes
from the word sclera
(hard) and derma (skin),
means hard skin; begins
with an area of mild
inflammation that later
develops into a patch of
yellowish, hardened
skin.
• Decubitus ulcer – (pressure sore); the word
decubitus means laying down; these lesions
appear after blood flow to a local area of
skin slows or is obstructed because of
pressure on skin covering body prominences
such as the heel; frequent changes in body
position and soft support cushions help
prevent these lesions from forming. Have
different degrees in severity.
Stage 1
• Nonblanchable
erythema of the
intact skin;
discoloration of skin,
warmth, or hardness
may also be
indicators.
Stage 2
• Partial thickness skin
loss involving
epidermis and or
dermis; the ulcer is
superficial and
presents clinically as
an abrasion, blister,
or shallow crater.
Stage 3
• Full-thickness skin loss
involving damage or
necrosis of
subcutaneous tissue
that may extend down
to, but not through,
underlying fascia;
presents as a deep
crater with or without
undermining of
adjacent tissue.
Stage 4
• Full-thickness skin
loss with extensive
destruction; tissue
necrosis; or damage
to muscle, bone, or
supporting
structures.
• Burns – constitute one of the most serious
and frequent problems that affect the skin.
Typically you think of a burn as an injury
caused by fire or by contact of the skin with a
hot surface; however over exposure to
ultraviolet light or contact of the skin with an
electrical current or a harmful chemical such
as an acid can also cause a burn.
Classification of Burns
• The classification system used to describe the
severity of burns is based on the number of
tissue layers involved; the most severe burns
destroy not only the layers of the skin and
subcutaneous tissue but underlying tissues as
well.
First Degree Burns
• causes minor
discomfort and some
reddening of the skin;
surface layers of thee
epidermis may peel in
1-3 days; no blistering
occurs, and actual
tissue destrucction is
minimal; Example is
typical sunburn,
Second Degree Burn
• Involves the deep
epidermal layers and
always causes injury
to the upper layers of
the dermis; blisters,
severe pain,
generalized swelling,
and fluid loss
characterize this type
of burn, scarring is
common.
• Characterized by Third
complete destruction
of the epidermis and
dermis; tissue death
extends below the
primary skin layers
into the subcutaneous
tissue; often involve
underlying muscle;
insensitive to pain
immediately
afterwards, requires
skin grafts for
treatment
Degree Burn
• Characterized by Fourth Degree Burn
complete destruction
of the epidermis and
dermis; tissue death
extends below the
primary skin layers
into the subcutaneous
tissue; often involve
underlying muscle and
bone; insensitive to
pain immediately
afterwards;
Inhalation Burn
• Caused by directly
breathing in hot
air/flame source;
usually occur in the
upper airways
(trachea, esophagus,
and mucous
membranes)
Nail Infection: Onychomycosis
• Caused by yeast or
fungus; most common
form of nail infection;
fungus grows on the
growing portion of the
nail and spreads
proximally
• Onychomycosis Wikipedia, the free
encyclopedia
Nail Ridging:
• Fingernail Ridging:
What Does It
Indicate?
Nail Clubbing
• Clubbing of the Nails:
eMedicine
Dermatology
Onycholysis
• Onycholysis is a
common nail disorder. It
is the loosening or
separation of a
fingernail or toenail
from its nail bed. It
usually starts at the tip
of the nail and
progresses back.
• Onycholysis: eMedicine
Dermatology
Physical
Assessment
Nails
Assessment Techniques:
• Inspection
• Palpation
Inspection
•
•
•
•
•
•
•
Color
Consistency
Symmetry
Freedom from ridges and cracks
Length
Jagged or bitten edges
Cleanliness
Inspection
• Assess the angle
between the
fingernail and
the nail base,
usually about
160 degrees;
Palpation
• Smoothness
• Temperature
• Capillary Refill
Temperature
• HOT
• COLD
Capillary Refill
• The capillary nail refill test is a quick test
performed on the nail beds to monitor and
the amount of blood flow to tissue.
• Capillary refill time, increased (Professional
Guide to Signs & Symptoms (Fifth Edition)) WrongDiagnosis.com
Skin
Assessment Techniques:
• Inspection
• Palpation
Skin
•
•
•
•
Observe overall appearance
Note any body odor
Note disturbances in pigmentation
Note skin color (Be aware that skin color
varies from person to person depending on
race and ethnic origin)
• Note skin lesions
Skin Lesion Assessment
• Morphology – clinical description of the
lesion; Note size, shape, configuration, color,
elevation or depression, and texture.
• Distribution – Pattern; includes extent of
involvement and characteristic locations.
• Location – related to total skin area; Note
whether the pattern of lesions are local (
small area), regional (one large area), or
general (over entire body).
Skin Lesion Assessment
• Configuration – arrangement of lesions in
relation to each other;
Skin Turgor
• Assess skin elasticity by gently grasping and
pulling up a fold of skin, releasing it, and
observing how quickly it returns to normal
shape.
• Normal skin usually resumes its flat shape
immediately
• This technique also assesses skin mobility,
which may be diminished in connective tissue
disorders.
Case Study:
• Ms. Julie Roman, age
21, is a single
Caucasian female law
student. She has
noted changes in her
skin over the past 4
months.
• Ms. Roman states that she has been under a
lot of stress since she started law school 6
months ago, and noticed some faint redness
and inflammation over her elbows and
knees, with itching about 4 months ago. She
stated that the redness progressed to large
raised patches with scales that now involve
the skin over her arms and back. She states
that the lesions get better intermittently, but
they always come back. Ms. Roman reports
that the itching is an 8/10 and gets worse on
humid days.
• Ms. Roman states that she has tried
numerous lotions and creams, even aloe
vera, but it does not help, and it is
embarrassing because her skin looks dirty
and ugly.
• On assessment Ms. Roman’s skin appears dry,
oral mucosa is pink and moist. Large
erythematous plaques with scales noted over
her knees elbow, and back. Multiple scratch
marks noted; some in a linear pattern with
some thickened skin in areas caused by
rubbing.
• Ms. Roman’s nails are noted to have
striations and their appears to be a fungal
infection to the right index and ring fingers.
Her skin elasticity is noted to be poor, and
her hair is dry and brittle.
Part I
• Using the information provided, write a
SOAPIE note documenting this patients
condition.
Part II
Answer the following questions:
1. What is a probable diagnosis for the
patient’s condition?
2. Review the Objective Data, what is the
name for the fungal infection Ms. Roman
suffers from?
3. What is the correct name for the linear
scratch marks noted on the patients skin?
Part II
4. What could be some possible causes of the
Ms. Roman’s nails having the striations.
What is another name for the striations?
5. What is this patient at risk for as a result of
her current signs and symptoms?
Part III
Answer the following questions:
1. What effects do each of the following
conditions have on the skin?
-Anemia
-Decreased oxygenation
-Fever
-Liver Disease
Part III
2. What harmful effects on the skin, hair, and
nails can the following behaviors produce?
-Taking excessively long showers
-Sunbathing or using a tanning booth
-Exposing unprotected skin to cleaning
solvents
-Long-term braiding or corn-rowing of hair
Pharmacology
General Dermatologic
Preparations
Baths
Oatmeal Bath
• Click on the link below to get information
regarding the use of this preparation.
• Oatmeal Bath
Soaps
Antifungal Soap
• Click on the link below to get information
about Antifungal soap
• What Is Antifungal Soap? | eHow.com
Solutions and Lotions
Calamine Lotion
• Click on the link below to get information
about calamine lotion
• CALAMINE LOTION - TOPICAL side effects,
medical uses, and drug interactions.
Cleansers
Hebiclens
• Click on the link below to get information
about hebiclens cleanser.
• chlorhexidine-1 : Information on Uses,
Dosage & Side Effects on Yahoo! Health.com
Emollients
Panthoderm
• Click on the link below to get information
about this emollient.
• Panthoderm Cream Facts and Comparisons at
Drugs.com
Skin Protectants
Benzoin Compound
• Click on the link below to get information
about this benzoin compound.
• benzoin compound
Wet Dressings & Soaks
Aluminum Acetate Solution
• Click on the link below to get information
about this aluminum acetate topical solution.
• Aluminum Acetate Topical Solution
Rubs and Liniments
Benzocaine
• Click on the link below to get information
about this benzocaine.
• Benzocaine
Topical Anti-Infectives
Antibiotics
• Neomycin Sulfate
• BACITRACIN
Antivirals
• Acyclovir
Antifungals
• Lotrimin
Corticosteroids
• Corticosteroids
• Eczema
• Psoriasis
Keratolytics
•
•
•
•
•
Keratolytic Medications
Keratin dissolvers
Salicylic acid
Warts
Plaque
Acne Products
•
•
•
•
Benzoyl-peroxide
Clindamycin
Erythromycin
Tetracycline
Burn Products
• Silver-sulfadiazine
Topical Ectoparasite
Drugs
• Kwell Drug Information,
Professional
Medical Terminology
Instructions:
• Look through the power point and identify
the key terms that are important for you to
know.
• Write them down in your notebook.
Medical Abbreviations
•
•
•
•
•
•
•
•
•
•
dil – dilute
dist – distilled
dr – dram
DC – discontinue
DX – diagnosis
elix. – elixer
et – and
ext. – external
F – fahrenheit
fl - fluid
VIP of the Week
Dr. Norman Orentreich
Instructions: Research this person and write
the following in your notebook.
• Who is he? Describe him as a person.
• What significance did he have to medicine,
science, or health care?
• How can you utilize his contribution in your
profession?
• How did his contribution affect the world?