1. Integumentary System: Skin, Hair, and Nails
Present by :Dr.Amira Yahia

2. Introduction
The major function of the skin is to keep the body in homeostasis despite daily assaults from the environment. The skin provides boundaries for body fluids while protecting underlying tissues from microorganisms, harmful substances, and radiation. The skin is the heaviest single organ of the body, accounting for approximately 16% of body weight and covering an area of roughly 1.2 to 2.3 meters squared. It contains three layers: the epidermis, the dermis, and the subcutaneous tissues. Sebaceous glands produce a fatty substance secreted onto the skin surface through the hair follicles. These glands are present on all skin surfaces except the palms and soles.

3. Structure and Function
Skin—three layers
1. Epidermis
Stratum germinativum or basal cell layer
Stratum corneum or horny cell layer
Derivation of skin color
2. Dermis
Connective tissue or collagen
Elastic tissue
3. Subcutaneous layer
Epidermal appendages
1. Hair
2. Sebaceous glands
3. Sweat glands
Eccrine glands
Apocrine glands
4. Nails

4. Structure of Skin

5. Sweat glands are of two types: eccrine and apocrine
Sweat glands are of two types: eccrine and apocrine. The eccrine glands are widely distributed, open directly onto the skin surface, and by their sweat production help to control body temperature.
The apocrine glands are found chiefly in the axillary and genital regions, usually open into hair follicles, and are stimulated by emotional stress. Bacterial decomposition of apocrine sweat is responsible for adult body odor

6. Functions of the Skin Protection from injury
Prevents penetration of microorganisms
Perception for touch, pain, temperature
Body Temperature regulation
Identification of people by skin colour, hair
Emotions are expressed in sign language so Communicate emotional status.
Helps in wound repair
Absorption and excretion of metabolic waste.
Helps in production of vitamin D

7. Subjective Data- Health History Questions
Previous history of skin disease (allergies, hives, psoriasis, or eczema)
Change in mole
Change in pigmentation (size or color)
Excessive dryness or moisture
Pruritus
Excessive bruising
Rash or lesion
Medications
Edition Change: Incidence of melanoma in whites is noted to be 20 times higher than in blacks and 4 times higher than in Hispanics.
Edition Change: Skin conditions that are noted to be specific to black patients are as follows.
Keloids
Pigmentary disorders
Pseudofolliculitis
Melasma

8. Subjective Data— Health history questions (cont.)
Hair loss
Change in nails
Environmental or occupational hazards
Self-care behaviors
Edition change: Those at risk from environmental/occupational hazards now include outdoor sports enthusiasts and coal workers.

9. TECHNIQUE OF EXAMINATION
INSPECTION: Inspect the skin for color, rashes, inflammation, swelling.
PALPATION: Palpate the skin for temperature, moisture, skin turgor

10. Abnormal Findings: Common Shapes and Configurations of Lesions
Annular or circular
Confluent
Discrete
Grouped
Gyrate
Target or iris
Linear
Polycyclic
Zosteriform

11. Annular or Circular
Confluent

12. Discrete
Grouped

13. Gyrate
Linear

14. Abnormal Findings
Causes of generalized itching include dry skin, aging, pregnancy, uremia, jaundice, lymphomas and leukemia, drug reaction, and lice

15. Abnormal Findings Primary and Secondary Skin Lesions
Primary skin lesions
Secondary skin lesions
Macule
Papule
Patch
Plaque
Nodule
Wheal
Tumor
Urticaria (hives)
Vesicle
Cyst
Bulla
Pustule
Crust
Scale
Fissure
Erosion
Ulcer
Excoriation
Scar
Atrophic scar
Lichenification
Keloid

16. Primary skin lesions
Macule
Papule

17. Primary skin lesions
Nodule
Wheal

18. Secondary skin lesions
Fissure
Ulcer

19. Abnormal Findings Vascular Lesions
Hemangiomas
Port-wine stain (nevus flammeus)
Strawberry mark (immature hemangioma)
Cavernous hemangioma (mature)
Telangiectases
Spider or star angioma
Venous lake
Purpuric lesions
Petechiae
Purpura
Lesions caused by trauma or abuse
Pattern injury
Hematoma
Ecchymosis (bruise)

20. Lesions caused by trauma or abuse: Pattern injury

21. Lesions caused by trauma or abuse:
Hematoma
Ecchymosis

22. Abnormal Findings Common Skin Lesions in Children
Diaper dermatitis
Interigo (candidiasis)
Impetigo
Atopic dermatitis (eczema)
Measles (rubeola)
German measles (rubella)
Chickenpox (varicella)

23. Abnormal Findings Common Skin Lesions
Primary contact dermatitis
Allergic drug reaction
Tinea corporis (ringworm of the body)
Tinea pedis (ringworm of the foot)
Psoriasis
Tinea versicolor
Labial herpes simplex (cold sores)
Herpes zoster (shingles)
Erythema migrans of Lyme disease

24. Abnormal Findings Malignant Skin Lesions
Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma

25. Abnormal Findings Skin Lesions Associated with AIDS
Epidemic Kaposi’s sarcoma
Patch stage
Plaque stage
Advanced disease

26. Abnormal Findings Infectious Disease as a Biological Weapon
Anthrax
Smallpox (variola major)

27. Diseases and Related Skin Conditions
Hairy leukoplakia, Kaposi's sarcoma, herpes simplex virus (HSV), mycobacterial skin infections, candidiasis and, bacterial abscesses, psoriasis .
AIDS
Pallor, xerosis, pruritus, hyperpigmentation
Chronic renal disease
diabetic bullae, diabetic dermopathy, granuloma annulare, neuropathic ulcers, peripheral vascular disease
Diabetes
Dry, rough, and pale skin; coarse and brittle hair; myxedema; alopecia (lateral third of the eyebrows to diffuse); skin cool to touch; thin and brittle nails
Hypothyroidism
Jaundice, spider angiomas and other telangiectasias, palmar erythema, Terry's nails, pruritus, purpura, caput medusae
Liver disease
increased pigmentation of areolae, linea nigra, palmar erythema, varicose veins, pyogenic granuloma
Pregnancy (physiologic changes)

28. Structure of Nails

29. Nails
Nails are hard plates of keratin on the dorsal edges of the fingers and toes.
The nail plate is clear, with fine longitudinal ridges.
Nails take their pink colour from the underlying nail bed of highly vascular epithelial cells.
The lunula is the white opaque semi lunar area at the proximal end of nail.
The cuticle works like a gasket to cover and protect the nail matrix.

30. Abnormal Conditions of the Nails
Koilonychia (spoon nails)
Paronychia
Beau’s line
Splinter hemorrhages
Clubbing
Onycholysis
Nail pitting

31. Abnormalities of Nails
One nail abnormality is the spoon shape , in which the nail curves upward from the nail bed .
This condition , called koilonychia , may be seen in clients with iron deficiency anemia .

32. Abnormalities of Nails
Clubbing is condition in which the angle between the nail and the nail bed is 180 degrees or greater .

33. Abnormalities of Nails
Nail texture is normally smooth. Excessively thick nails can appear in elders , in the presence of poor circulation , r in relation to a chronic fungal infection.
Excessively thin nails or the presence of grooves or furrows can reflect prolonged iron deficiency anemia .
Beaus lines are horizontal depression in the nail that can result from injury or severe illness.

34. Abnormalities of Nails
Paronychia is an inflammation of the tissue surrounding a nail . The tissue appear inflamed and swollen , and tenderness is usually present
Symptoms of nail fungus include brittleness , discoloration , thickening , distortion of nail shape , crumbling of the nail and loosening (detaching) of the nail. The tissue surrounding the nails is normally intact epidermis .

35. ONYCHOLYSIS Distal nail bed separated from the nail plate in 2 nails.
The subungual space may be filled with hyperkeratotic debris

36. ONYCHOMYCOSIS
Distal subungual hyperkeratosis and onycholysis involving most of the nail bed of the great toenails; these findings are usually associated with tinea pedis.

37. Hairs
Hair consists of layers of keratinized cells found over much of the body except for the lips, nipples, soles of the feet, palms of the hands, labia minora, and penis.
Hair develops within a sheath of epidermal cells called the hair follicle.
Hair growth occurs at the base of the follicle, where cells in the hair bulb are nourished by dermal blood vessels. The hair shaft is visible above the skin; the hair root is surrounded by the hair follicle .
Attached to the follicle are the erector pili muscles, which contract in response to cold or fright, decreasing skin surface area and causing the hair to stand erect.

38. Hairs There are two general types of hair: vellus and terminal.
Vellus hair is short, pale, and fine and is present over much of the body.
The terminal hair (particularly scalp and eyebrows) is longer, generally darker, and coarser than the vellus hair. Puberty initiates the growth of additional terminal hair in both sexes on the axillae, perineum, and legs.
Hair color varies and is determined by the type and amount of pigment production. The absence of pigment or the inclusion of air spaces within the layers of the hair shaft results in gray or white hair.

39. Abnormal Conditions of Hair
Seborrheic dermatitis (cradle cap)
Tinea capitis (scalp ringworm)
Toxic alopecia
Alopecia areata
Traumatic alopecia, traction alopecia
Trichotillomania
Pediculosis capitis (head lice)
Folliculitis
Hirsutism
Furuncle and abscess

40. ANDROGENETIC ALOPECIA
                                                               
Male hair loss pattern

41. ALOPECIA AREATA
Sharply outlined portion of scalp with complete alopecia without scaling, erythema or scarring.
Short, broken-off hair shafts (exclamation point hair) appear as short stubs emerging from the bald scalp.