2Objectives: After completing this unit each student should be able to: Compare the composition and function of the epidermis with those of the dermisDescribe the functions of the skin.Describe normal hair, nails, sebaceous glands, and sudoriferous glands and their primary functions.
3Objectives:Give examples of the appropriate health history questions for assessment of the skin, hair, and nails.Describe how to assess thee client’s skin by inspection and palpation.Differentiate between normal and abnormal skin conditions.Describe the characteristics of common skin lesions using appropriate terminology.
4Objectives: Identify life-threatening drug induced skin eruptions. Describe the general dermatologic preparations and their indications.Discuss ectoparasitic diseases and the use of topical ectoparasiticidal drugs in their treatment.
6Considered to be both:(a) Membrane – covers the body(b) Organ – contains several types of tissueLargest organ in body - covering (c) 3,000 square inchesAbout (d) 15% total body weight
7Tissue: 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 tissueBlood vesselsLymph vesselsNervesInvoluntary muscleSweat and oil glandsHair follicles
8Tissue: Made of: Connects the skin to underlying muscles (h) Subcutaneous layer (hypodermis) – the innermost layerMade of:Elastic and fibrous connective tissueAdipose (fatty) tissueConnects the skin to underlying muscles
9Fingerprints?The top layer of the dermis has ridges which form lines or striations on the skin which give us our unique fingerprints
10Major Organs/Structures SkinSweat and oil glandsNailsHair
11Two Main Types of Glands (i) Sudoriferous (sweat) glandsSweat eliminated by these glands contains water, salts, and some body wastesSweat is odorless until it interacts with bacteria on the skinPerspiration (sweating) removes excess water from the body and cools the body
12Two Main Types of Glands (j) Sebaceous (oil) glandsUsually open onto hair folliclesProduce sebum (oil) which keeps skin and hair from becoming dry and brittleSlightly acidic nature helps prevent infectionOil glands plugged with dirt and oil result in blackheads or pimples.
13HairConsists of a root (which grows in a hollow tube called a (k) follicle)A (l) hair shaftHelps protect the bodyCovers all body surfaces except the palms of the hands and the soles of the foot
14(m) Alopecia (baldness) Genetically inheritedMales (and some females)Permanent loss of hair of the scalp
15Nails Protect the fingers and toes from injury Made of (n) dead, keratinized epithelial cellsFormed in the nail bedIf lost, nails will regrow if the nail bed is not damaged
17when blood vessels (s) constrict (get smaller) – heat is retained (o) 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 regulationwhen blood vessels in the skin (r) dilate (get larger) – excess heat can escapewhen blood vessels (s) constrict (get smaller) – heat is retained
18(t) 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
20Basic skin color is inherited (y)Melanin – brownish-black pigment produced in the epidermisEveryone has the same number of (z) melanocytes but genes determine the amount of melanin producedFreckles are small concentrated areas of melanin(aa)Albino – absence of color pigments in the skinSkin has pinkish tintHair is pale yellow or whiteEyes lack pigment; are red; very sensitive to light
51Skin cancer – most common type of cancer 3 types:Squamous cell carcinoma – affects the thin cells of the epitheliumspreads quicklyMelanoma – develops in the melanocytesMost dangerous type of skin cancerBasal cell carcinoma – cancer of the basal cells in the epidermisslow growing
52Acne – inflammation of the sebaceous glands Athlete’s foot – contagious fungal infection that usually affects the feet
53Eczema – noncontagious, inflammatory skin disorder caused by allergens or irritants
54Psoriasis – 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
55Impetigo – 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.
56Tinea – general name for many different types of mycoses (fungal infections); signs include erythema, scaling, and crusting.
57Warts – 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.
58Boils – 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.FuruncleCarbuncle
59Scabies – 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
60Uticaria – (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.
61Scleroderma – 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.
62Decubitus 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.
63Stage 1Nonblanchable erythema of the intact skin; discoloration of skin, warmth, or hardness may also be indicators.
64Stage 2Partial thickness skin loss involving epidermis and or dermis; the ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.
65Stage 3Full-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.
66Stage 4Full-thickness skin loss with extensive destruction; tissue necrosis; or damage to muscle, bone, or supporting structures.
68Burns – 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.
69Classification 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.
70First Degree Burnscauses 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,
71Second Degree BurnInvolves 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.
72Third Degree BurnCharacterized by 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
73Fourth Degree BurnCharacterized by 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;
74Inhalation BurnCaused by directly breathing in hot air/flame source; usually occur in the upper airways (trachea, esophagus, and mucous membranes)
75Nail Infection: Onychomycosis Caused by yeast or fungus; most common form of nail infection; fungus grows on the growing portion of the nail and spreads proximallyOnychomycosis - Wikipedia, the free encyclopedia
76Nail Ridging:Fingernail Ridging: What Does It Indicate?
77Nail ClubbingClubbing of the Nails: eMedicine Dermatology
78OnycholysisOnycholysis 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
85Capillary RefillThe 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
87Skin Observe overall appearance Note any body odor Note disturbances in pigmentationNote skin color (Be aware that skin color varies from person to person depending on race and ethnic origin)Note skin lesions
88Skin 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).
89Skin Lesion Assessment Configuration – arrangement of lesions in relation to each other;
90Skin TurgorAssess 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 immediatelyThis technique also assesses skin mobility, which may be diminished in connective tissue disorders.
91Case 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.
92Ms. 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.
93Ms. 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.
94Ms. 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.
95Part IUsing the information provided, write a SOAPIE note documenting this patients condition.
96Part II Answer the following questions: What is a probable diagnosis for the patient’s condition?Review the Objective Data, what is the name for the fungal infection Ms. Roman suffers from?What is the correct name for the linear scratch marks noted on the patients skin?
97Part IIWhat could be some possible causes of the Ms. Roman’s nails having the striations. What is another name for the striations?What is this patient at risk for as a result of her current signs and symptoms?
98Part III Answer the following questions: What effects do each of the following conditions have on the skin?-Anemia-Decreased oxygenation-Fever-Liver Disease
99Part IIIWhat 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
132Dr. Norman OrentreichInstructions: 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?