Integumentary System

Three main layers of tissue make up the skin Epidermis Dermis Hypodermis

Epidermis The Outermost layer of skin Avascular Complete regeneration approximately 35 days

Dermis Also called corium or “true skin”. Contains blood vessels, nerves, involuntary muscle, sweat and oil glands and hair follicles.

Hypodermis (Subcutaneous Fascia) Innermost layer of skin Made of elastic and fibrous connective tissue and adipose tissue Connects skin to underlying muscles

Two main types of glands Sudoriferous Glands Sebaceous Glands

Sudoriferous Glands (Sweat Glands) Coiled tubes. Extend through dermis and open on surface of skin at pores. Sweat eliminated by these glands.

Sebaceous Glands Oil glands. Usually open to hair follicles. Produces sebum which is an oil that keeps skin and hair from becoming dry and brittle.

Hair & Nails Hair Each hair consists of root which grows in hollow tube (follicle) and a hair shaft. Helps protect body.

Hair & Nails Nails Consist of dead epithelial cells packed closely together to form thick, dense surface. Formed in nailbed.

Function of Integumentary System Protection Serves as barrier to sun’s ultraviolet rays and invasion of pathogens (germs). Hold moisture in . Prevents deeper tissues from drying out.

Sensory Perception Nerves in skin help body to respond to pain, pressure, temperature, and touch sensations.

Body Temperature Regulation Blood vessels dilate- excess heat from blood escapes through skin. Blood vessels constrict – heat is retained in body.

Excretion of oil, water, sodium and carbon dioxide. Waste Disposal Excretion of oil, water, sodium and carbon dioxide.  

Vitamin D production.

Pigmentation Melanin Only pigment made in skin. Yellow to reddish-brown to black Absorbs ultraviolet light to tan skin. Gives color to hair, skin, and the iris

Karotene Yellowish-red pigment Can help determine skin color.

Abnormal Skin Colors Jaundice Yellow discoloration of skin. Can indicate bile in blood due to liver or gallbladder disease

Erythema Reddish color of skin. Due to burns or congestion of blood vessels

Cyanosis Bluish discoloration of skin. Caused by insufficient oxygen. Associated with heart, lung, and circulatory diseases or disorders.

Skin Diseases and Disorders Acne – overactive secretion of sebaceous glands. Pimples and blackheads. Teens to early twenties. Rx: Thorough washing, steroid creams, UV light, avoidance of certain foods, chemical face peel.

Eczema Vesicles or reddened skin which burst and weep a crust ( dried pus and blood) Most common inflammatory disorder of the skin Rx: Tranquilizers, antihistamines, wet dressings, starch baths.

Psoriasis Psoriasis – Red thick areas covered with white or silver scales Chronic, noncontagious, inherited skin disease Rx: No Cure Cortisone Ointments Ultraviolet Light Removal of Scales

Contact Dermatitis Redness, itching, blisters, edema Caused by poison ivy, poison oak, cleansing agents, cosmetics, etc. Rx: Wash with soap and water then apply alcohol and antipruritic (relieves itching) lotions.

Impetigo Erythema, vesicles with sticky yellow crusts Very contagious. Infection with staph or strep Rx: Remove crusts and apply antibiotic ointment

Warts Caused by virus. Painless except for plantar warts. Rx: Nitric or sulfuric acid deep into root of wart or freezing with liquid nitrogen.

Scleroderma systemic autoimmune disease of skin, muscles, bones, heart, lungs. Skin becomes hard and tight. Progressive disease. Mainly affects women in child bearing years. Considered an auto immune disease Rx: Ointment, heat, massage, steroids.

Skin Cancer Definition: neoplasms or abnormal growth of cells that originate in the epidermis. More than 800,000 new cases each year in the USA One in five people in the US will develop skin cancer in his/her lifetime. This number jumps to one in three in the Sunbelt states. Three Major Types of Skin Cancer Basal Cell, Squamous Cell, Malignant Melanoma

Skin Cancer Basal Cell Carcinoma Most common type of skin cancer Malignancy begins in cells at the base of the epidermis and most often appears on the nose and face Incidence increases after age 40 Basal cell tumors rarely metastasize but may cause wide-spread destruction of normal tissue if left untreated

Skin Cancer Squamous Cell Carcinoma Slow-growing Arises from the epidermis Most frequently occurs in middle-aged and elderly individuals Typically found on sun-exposed areas of skin May metastasize but is not likely to spread to other body areas.

Skin Cancer Malignant Melanoma Most deadly of all skin cancers Steady increase in incidence of 4% per year over last 20 years Median age of diagnosis is 53 years Sometimes develops from a pigmented Nevus (mole) to become a dark spreading lesion Most likely to metastasize

Skin Cancer Malignant Melanoma

Skin Cancer http://www.skincancer.org/ “ABCD” Rule of Self-Examination of Moles Asymmetry: Lesion halves are not mirror images of each other giving a lopsided appearance Border: Irregular or indistinct borders Color: Unevenly colored, exhibiting a mixture of shades or colors Diameter: By the time lesions exhibit characteristics A, B, and C, it is probably larger than 6mm or ¼ inch

BURNS Burn is an injury that can be caused by fire, heat, chemical agents, radiation and/or electricity Classification of burns: Severity of burn is determined by depth of lesion and percent of body surface burned.

Burns First-degree or superficial Least severe type of burn Involves only top layer of skin, the epidermis Usually heals in 5 to 6 days without permanent scarring Skin is reddened or discolored May have some mild swelling Victim feels pain Three common causes Overexposure to sun or mild sunburn Brief contact with hot objects or steam Exposure of skin to weak acid or alkali

Burns Second-degree or partial-thickness Usually causes injury to top layers of skin and involves both epidermis and dermis Blister or vesicle forms Skin is red or has mottled appearance Swelling occurs along with severe pain Surface of skin appears to be wet Painful burn that may take 3 to 4 weeks to heal Three common causes Excessive exposure to sunlamp or artificial radiation or severe sunburn Contact with hot or boiling liquids Burns from fires

Burns Third-degree or full-thickness Most severe type of burn Involves injury to all layers of skin in addition to underlying tissue Area has a white or charred appearance Can be extremely painful or relatively painless if nerve endings are destroyed Can be life-threatening because of fluid loss, infection, and shock Common causes Exposure to fire or flames Prolonged contact with hot objects Contact with electricity Immersion in hot or boiling liquids  

Burns Methods to Determine Percent of Body Surface Burned “Rule of Palms”: Based on the assumption that palm size of burn victim is about 1% of body surface. Estimating the number of “palms” burned will approximate the percentage of body surface involved.

Burns Methods to Determine Percent of Body Surface Burned “Rule of Nines”: 9% of total skin area covers head and each upper extremity, including front and back surfaces 18%of total skin area covers each of the following: front of trunk back of trunk each lower extremity including front and back surfaces

Burns Methods to Determine Percent of Body Surface Burned Lund-Browder Charts: Permits more accurate estimates of burned surface area in children Makes allowances for large percent of surface are in certain body regions in children such as the head

Burns Medical help for burns Usually not required for first-degree or superficial burns Should be obtained if: More than 15% of adult’s body is burned More than 10% of child’s body is burned Rule of nines is used to calculate the percentage of body surface burned Burns affect face or respiratory tract Victim is having difficulty breathing Burns cover more than one body part Victim has a partial-thickness burn and is under 5 or over 60 years of age Burns result from chemicals, explosions, or electricity

Burns All third-degree or full-thickness burns should receive medical care First aid for superficial and mild partial-thickness burns with closed blisters Cool area by flushing with large amounts of cool water Do not use ice or ice water because it causes body to lose heat Use dry, sterile gauze to blot area dry Apply dry, sterile dressing (nonadhesive or nonstick is best) to prevent infection Elevate affected part if possible to reduce swelling Do not apply oils, grease, butter or other substances unless instructed to do so by physician Do not break or open any blisters as this creates an open wound prone to infection

Burns First aid for severe second-degree and full-thickness or third-degree burns Call for medical help immediately Cover burned area with thick, sterile dressings Elevate Hands or feet if they are burned Do not allow victim to walk if feet or legs are burned Do not attempt to remove particles of clothing from burn Watch for respiratory distress or signs of shock

Burns