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

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.

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

Structure of Skin

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

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

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

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.

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

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

Annular or Circular Confluent

Discrete Grouped

Gyrate Linear

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

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

Primary skin lesions Macule Papule

Primary skin lesions Nodule Wheal

Secondary skin lesions Fissure Ulcer

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)

Lesions caused by trauma or abuse: Pattern injury

Lesions caused by trauma or abuse: Hematoma Ecchymosis

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

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

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

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

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

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)

Structure of Nails

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.

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

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 .

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

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.

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 .

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

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

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.

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.

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

ANDROGENETIC ALOPECIA                                                                 Male hair loss pattern

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.