1. Medical Terminology A Word-Building Approach
Jane Rice, RN, CMA-C
Chapter 5 Integumentary System

2. Multimedia Directory
Slide 26 Acne Video Slide 31 Skin Cancer Video Slide 34 Wound Cultures Video Slide 68 Wound Repair Animation Slide 69 Wound Care Video Slide 75 TB Testing Video Slide 85 Decubitus Ulcer Video Slide 90 Eczema Video

3. Anatomy and Physiology Overview
The integumentary system is composed of the skin and its accessory structures: hair, nails, sebaceous glands, and sweat glands.

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5. Functions of the Skin
External covering of the body; it is the largest organ in the body and is well supplied with blood vessels and nerves.
The four main functions of the skin:
Protection
Regulation
Sensation
Secretion

6. protection PROTECTS AGAINST BACTERIA
PROTECTS AGAINST INJURY OF DELICATE CELSS BENEATH EPIDERMIS.
INHIBITS EXCESSIVVE LOSS OF WATER AND ELECTROLYTES, AND PROVIDES A RESERVIOR FOR STORING FOOD AND WATER.
GUARDS AGAINST EXCESSIVE EXPOSURE TO THE SUN
PRODUCES BODY’S SUPPLY OF VITAMIN D.

7. Regulation
Blood vessels dilate to increase blood flow to the surface. Loose heat through Radiation.
Sweat glands are secreting more sweat for cooling through Evaporation.
When need to conserve heat, vessels constrict allowing more heat carrying blood to circulate to the muscles and organs.

8. sensation
Pain
Touch
Heat
Cold
Presure

9. Secretion
Sudoriferous Gland (sweat gland)- millions of glands in the body.
Perspiration is largely water and small amount of salt and other compounds.
When left to accumulate, causes body odor, especially where it is trapped among hairs
Sebaceous Gland (oil glands)-
Sebum-oily secretion that acts to protect the body from dehydration and possible absorption of harmful substances.

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Figure 5.1 The integument: the epidermis, dermis, subcutaneous tissue, and its appendages.

11. Layers of the Skin
The two layers of the skin are the epidermis and the dermis.

12. Layers of the Skin Epidermis Stratum Corneum
The outermost, horny layer, consisting of dead cells filled with a protein substance called keratin. It forms the protective covering of the body that varies in thickness.

13. Layers of the Skin Epidermis Stratum Lucidum
A translucent layer lying directly beneath the stratum corneum.
Is not seen in thin skin and is also composed of dead or dying cells.

14. Layers of the Skin Epidermis Stratum Granulosum
Consists of several layers of living cells that are in the process of becoming a part of the previously mentioned strata.

15. Layers of the Skin Epidermis Stratum Germinativum
The innermost layer is composed of several layers of living cells capable of mitosis or cell division. It is also called the mucosum or malpighii and is responsible for regeneration of the epidermis.

16. Layers of the Skin Dermis
Composed of connective tissue containing lymphatics, nerves and nerve endings, blood vessels, sebaceous and sweat glands, elastic fibers, and hair follicles.
Attached to underlying structures by subcutaneous tissue that supports, nourishes, insulates, and cushions the skin.
Also called the corium or true skin.

17. Layers of the Skin Dermis Upper or Papillary Layer
Arranged into parallel rows of microscopic structures called papillae. (produces ridges that are one’s fingerprints or footprints).

18. Layers of the Skin Dermis Lower or Reticular Layer
Composed of white fibrous tissue that supports the blood vessels.

19. Accessory Structures of the Skin
Hair
A thin, threadlike structure formed by a group of cells that develop within a hair follicle or socket.
Each hair is composed of a shaft, which is the visible portion, and a root, which is embedded within the follicle.

20. Accessory Structures of the Skin
Hair
At the base of the follicle is the:
Hair papilla
Pilomotor muscle

21. Accessory Structures of the Skin
Nails
Horny cell structures of the epidermis that are composed of hard keratin.
Nail growth may vary with age, disease, and hormone deficiency.
The crescent-shaped white area of a nail is known as the lunula.

22. Accessory Structures of the Skin
Nails
A nail consists of three parts:
Body
Root
Matrix or nailbed

23. Figure 5.2 The fingernail, an appendage of the integument.
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Figure 5.2 The fingernail, an appendage of the integument.

24. Accessory Structures of the Skin
Sebaceous glands
The oil-secreting glands of the skin.
The tiny ducts open into the hair follicle, and their secretion lubricates the hair and the skin.
Sebum secretion, which is controlled by the endocrine system, varies with age, puberty, and pregnancy.

25. Accessory Structures of the Skin
Sweat (sudoriferous) glands
The approximately 2 million sweat glands are coiled and tubular in structure.
They are distributed over the entire surface of the body with the exception of the margin of the lips, glans penis, and the inner surface of the prepuce.
The sweat glands secrete sweat or perspiration, which:
Helps to cool the body by evaporation.
Rids the body of waste through the pores of the skin.

26. Life Span Considerations: The Child
In the fetus, the skin is transparent and blood vessels are clearly visible.
Vernix caseosa (a cheeselike substance) covers the fetus until birth.
At approximately weeks, lanugo hair develops, and at weeks, the skin is reddish and wrinkled.

28. Life Span Considerations: The Child
Newborns are more sensitive to heat and cold because of a lack of subcutaneous fat.
Skin conditions can be acute or chronic, local, systemic, or congenital.
The hair of a child will vary in texture, quality, and distribution. It can become dry and brittle due to improper nutrition and lose color due to severe illness.

29. Life Span Considerations: The Child
Age-associated disorders of the skin may include:
Milia
White pinhead-size pimples that appear on the face and sometimes the trunk of a newborn.
Acne
Also known as pimples, is an inflammatory condition of sebaceous glands and hair follicles.

30. Figure 5.3 Acne. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.3 Acne. (Courtesy of Jason L. Smith, M.D.)

31. Life Span Considerations: The Older Adult
The skin becomes looser (due to dermal papilla growing less dense).
Collagen and elastic fibers of the upper dermis decrease, skin loses its elastic tone, and skin wrinkles more easily.
The hair of older adults becomes somewhat gray, with scalp hair thinning, and becomes dry and brittle in both men and women.

32. Life Span Considerations: The Older Adult
Older women have an increase in facial hair, and men have an increased growth of the hair of the nares, eyebrows, or helix of the ears.
The nails flatten and become discolored, dry, and brittle.

33. Life Span Considerations: The Older Adult
Skin conditions common to older adults include:
Xerosis
Dryness
Pruritus
Itching
Premalignant/malignant skin lesions
Carcinomas frequently appear on the nose, eyelid, or cheek.
Basal cell carcinoma (BCC) accounts for 80% of skin cancers in the older adult.

34. Figure 5.4 Basal cell carcinoma. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.4 Basal cell carcinoma. (Courtesy of Jason L. Smith, M.D.)

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36. Click here to view a video on the topic of wound cultures.
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37. Figure 5.5 Photodermatitis. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.5 Photodermatitis. (Courtesy of Jason L. Smith, M.D.)

38. Figure 5.6 Alopecia areata. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.6 Alopecia areata. (Courtesy of Jason L. Smith, M.D.)

39. Figure 5.7 Male pattern alopecia. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.7 Male pattern alopecia. (Courtesy of Jason L. Smith, M.D.)

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Figure 5.8 Brown recluse spider bites. (Courtesy of Jason L. Smith, M.D.)

41. Figure 5.9 Tick bite. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.9 Tick bite. (Courtesy of Jason L. Smith, M.D.)

42. Figure 5.10 Flea bites. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.10 Flea bites. (Courtesy of Jason L. Smith, M.D.)

43. Figure 5.11 Bulla. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.11 Bulla. (Courtesy of Jason L. Smith, M.D.)

44. Figure 5.12 Burn, second degree. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.12 Burn, second degree. (Courtesy of Jason L. Smith, M.D.)

45. Figure 5.13 Candidiasis. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.13 Candidiasis. (Courtesy of Jason L. Smith, M.D.)

46. Figure 5.14 Carbuncles. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.14 Carbuncles. (Courtesy of Jason L. Smith, M.D.)

47. Figure 5.15 Cellulitis. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.15 Cellulitis. (Courtesy of Jason L. Smith, M.D.)

48. Figure 5.16 Wound dehiscence, back. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.16 Wound dehiscence, back. (Courtesy of Jason L. Smith, M.D.)

49. Figure 5.17 Dermatitis, poison ivy. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.17 Dermatitis, poison ivy. (Courtesy of Jason L. Smith, M.D.)

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Figure 5.18 Erythema infectiosum (Fifth disease). (Courtesy of Jason L. Smith, M.D.)

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Figure 5.19 Staphylococcal folliculitis. (Courtesy of Jason L. Smith, M.D.)

52. Figure 5.20 Herpes labialis. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.20 Herpes labialis. (Courtesy of Jason L. Smith, M.D.)

53. Figure 5.21 Urticaria (hives). (Courtesy of Jason L. Smith, M.D.)
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Figure 5.21 Urticaria (hives). (Courtesy of Jason L. Smith, M.D.)

54. Figure 5.22 Impetigo. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.22 Impetigo. (Courtesy of Jason L. Smith, M.D.)

55. Figure 5.23 Keloid. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.23 Keloid. (Courtesy of Jason L. Smith, M.D.)

56. Figure 5.24 Miliaria. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.24 Miliaria. (Courtesy of Jason L. Smith, M.D.)

57. Figure 5.25 Nevus (mole). (Courtesy of Jason L. Smith, M.D.)
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Figure 5.25 Nevus (mole). (Courtesy of Jason L. Smith, M.D.)

58. Figure 5.26 Onychomycosis. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.26 Onychomycosis. (Courtesy of Jason L. Smith, M.D.)

59. Figure 5.27 Pediculosis capitis. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.27 Pediculosis capitis. (Courtesy of Jason L. Smith, M.D.)

60. Figure 5.28 Purpura. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.28 Purpura. (Courtesy of Jason L. Smith, M.D.)

61. Figure 5.29 Roseola. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.29 Roseola. (Courtesy of Jason L. Smith, M.D.)

62. Figure 5.30 Scabies. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.30 Scabies. (Courtesy of Jason L. Smith, M.D.)

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Figure 5.31 Photoaging solar elastosis; senile keratosis. (Courtesy of Jason L. Smith, M.D.)

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Figure 5.32 Squamous cell carcinoma. (Courtesy of Jason L. Smith, M.D.)

65. Figure 5.33 Striae. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.33 Striae. (Courtesy of Jason L. Smith, M.D.)

66. Figure 5.34 Tinea corporis. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.34 Tinea corporis. (Courtesy of Jason L. Smith, M.D.)

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Figure 5.35 Leg ulcer radiation site. (Courtesy of Jason L. Smith, M.D.)

68. Figure 5.36 Varicella (chickenpox). (Courtesy of Jason L. Smith, M.D.)
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Figure 5.36 Varicella (chickenpox). (Courtesy of Jason L. Smith, M.D.)

69. Figure 5.37 Planar wart. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.37 Planar wart. (Courtesy of Jason L. Smith, M.D.)

70. Wound Repair Animation
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71. Click here to view a video on the topic of wound care.
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72. Drug Highlights Emollients Keratolytics Local anesthetic agents
Substances that are oily in nature.
Keratolytics
Promote loosening of the horny (keratin) layers of the skin.
Local anesthetic agents
Inhibit the conduction of nerve impulses from sensory nerves and thereby reduce pain and discomfort.
Antipruritic agents
Prevent or relieve itching.

73. Drug Highlights Antihistamine agents Antibiotic agents
Act to prevent the action of histamine.
Antibiotic agents
Destroy or stop the growth of microorganisms.
Antifungal agents
Destroy or inhibit the growth of fungi and yeast.
Antiviral agents
Agents that combat specific viral diseases.

74. Drug Highlights Anti-inflammatory agents
Relieve the swelling, tenderness, redness, and pain of inflammation.
Consist of:
Topical corticosteroids.
Treat dermatitis and psoriasis.
Oral corticosteroids
Used when symptoms are severe.
Treats contact dermatitis, such as poison ivy.

75. Drug Highlights Antiseptic agents Other Drugs
Prevent or inhibit the growth of pathogens.
Other Drugs
Retin-A (tretinoin)
Used to treat acne vulgaris.
Rogaine (minoxidil)
Used to stimulate hair growth.
Botulinum Toxin Type A (Botox Cosmetic)
Approved by the FDA to temporarily improve the appearance of moderate to severe frown lines between the eyebrows.

76. Diagnostic and Lab Tests
Tuberculosis Skin Test
Test performed to identify the presence of the Tubercle bacilli.
The tine, Heaf, or Mantoux test may be used.

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78. Diagnostic and Lab Tests
Scratch (epicutaneous) or prick Test
Test involves the placement of a suspected allergen in the uppermost layers of the epidermis, usually on the skin of the forearm or back.
Redness or swelling at the scratch site within 10 minutes indicates allergy to the substance, rendering a positive test result.
If no reaction occurs, the test result is negative.
Sweat Test (chloride)
Test performed on sweat to determine the level of chloride concentration on the skin. In cystic fibrosis there is an increase in skin chloride.

79. Diagnostic and Lab Tests
Tzanck Test
Microscopic examination of a small piece of tissue that has been surgically scraped from a pustule to identify type of viral infection.
Wound Culture
Test done on wound exudates to determine the presence of microorganisms.
Biopsy (skin)
Small piece of living tissue from any skin lesion that exhibits signs or characteristics of malignancy is examined microscopically to establish a diagnosis.

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81. Decubitus Ulcer
An area of skin and tissue that becomes injured or broken down.
The word decubitus, which means lying down, indicates the cause of pressure ulcers.
When a person sits or lies in a position too long, without shifting his or her weight, the constant pressure causes a decrease of blood supply to the area.
Without blood, the tissue dies and infection may occur, leading to systemic problems.

82. Decubitus Ulcer The ulcers are staged as follows: Stage I Stage II
Stage III
Stage IV

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Figure 5.38 Pressure ulcer staging. (Courtesy of Sandra Quigley, Children’s Hospital, Boston, MA)

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Figure 5.38 (continued) Pressure ulcer staging. (Courtesy of Sandra Quigley, Children’s Hospital, Boston, MA)

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Figure 5.38 (continued) Pressure ulcer staging. (Courtesy of Sandra Quigley, Children’s Hospital, Boston, MA)

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Figure 5.38 (continued) Pressure ulcer staging. (Courtesy of Sandra Quigley, Children’s Hospital, Boston, MA)

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88. Eczema
A chronic skin disorder characterized by scaly and itching rashes.
It is most common in infants, and usually a chronic condition in adults.
Is also called atopic or contact dermatitis.

89. Eczema Medical treatment is stage dependent: Weepy lesions
Treated with moisturizers, mild soap, or wet dressings.
Dry scaly lesions
Treated with mild anti-itch lotions or low-potency topical corticosteroids.

90. Eczema Medical treatment is stage dependent:
Chronic dry, thickened lesions
Treated with ointments or creams that contain tar compounds, medium to very high potency corticosteroids, and ingredients that lubricate and soften the skin.
Severe cases
Systemic corticosteroids to reduce inflammation.

91. Eczema
The latest eczema treatment is a new class of nonsteroidal skin medications called topical immunomodulators (TIMS).

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93. Psoriasis
Common skin condition characterized by frequent episodes of redness, itching, and thick, dry scales on the skin.
Commonly begins in individuals between the ages of 15 and 35.
Thought to be an inherited, autoimmune disease.

94. Psoriasis
The disease presents with a buildup of dead skin cells and the formation of thick scales within a few days versus the normal one-month period of time that it takes new skin cells to move up from lower layers to the surface.

95. Psoriasis
Treatment varies with the extent and severity of the disorder:
Severe or resistant cases can require hospitalization.
Mild cases treated with topical medications.
Other treatments include nonpharmacologic and phototherapy.

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Figure 5.39 Psoriasis, lower extremities. (Courtesy of Jason L. Smith, M.D.)

97. Skin Cancer
Disease in which malignant cells are found in the epidermis.
Three types of skin cells include squamous cells (flat, scaly cells on the surface), basal cells (round cells), and melanocytes (give skin its color).
Basal cell and squamous cell cancers
Melanoma

98. Skin Cancer
The ABCDs of melanoma describe the changes that occur in moles and include:
Asymmetry
Border
Color
Diameter

99. Figure 5.40 Melanoma, forearm. (Courtesy of Jason L. Smith, M.D.)
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Figure 5.40 Melanoma, forearm. (Courtesy of Jason L. Smith, M.D.)

100. Skin Signs
Objective evidence of an illness or disorder, which can be seen, measured, or felt.
May be described as lesions that are circumscribed areas of pathologically altered tissue.

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Figure 5.41 Skin signs are objective evidence of an illness or disorder. They can be seen, measured, or felt.

102. Burns First-Degree (superficial)
When only the outer layer of the skin is burned. The skin is red with some degree of swelling and pain
Cool the burn with running water or cold compresses to reduce swelling by conducting heat away from the skin.
DO NOT USE ICE
Cover the burn with clean gauze to keep air off the burned skin, reduce pain, and protect blistered skin.

103. Burns Second-Degree (partial thickness)
The second layer of skin is burned. Blisters develop and the skin takes on an intensely reddened, splotchy appearance that presents with severe pain and swelling.
CALL 911 for emergency assistance if necessary:
Remove the victim from contact with smoldering materials or exposure to smoke and heat, however DO NOT REMOVE BURNT CLOTHING.

104. Burns Second-Degree (partial thickness)
Don’t immerse severe large burns in cold water because this could cause the victim to go into shock.
Check for signs of circulation and if indicated, start cardiopulmonary resuscitation (CPR).
Cover the area of the burn with cool, moist, sterile bandages, clean, moist cloth or moist towels.

105. Burns Third-Degree (full thickness)
Burns involve all three layers of skin, usually destroying the sweat glands, hair follicles, and nerve endings.
Areas involved are generally charred black or appear dry and white.
Since the nerve endings have been burned, there is usually no pain involved.

106. Burns
The Rule of Nines estimates the extent of burns received by the patient.
It is expressed as a percentage of body surface area.
The body is divided into either sections, multiples, or divisions of 9 percent to accurately estimate the extent of the burns for fluid replacement therapy.

107. Figure 5.42 Characteristics of burns by depth of thermal injury.
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Figure 5.42 Characteristics of burns by depth of thermal injury.

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Figure 5.43 Rule of Nines for burns (all numbers are percent of body surface).

109. Figure 5.44 Poison ivy. (Source: Pearson Education/PH College)
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Figure 5.44 Poison ivy. (Source: Pearson Education/PH College)