Integumentary System The Skin

Introduction Called a membrane because it covers the body Also called organ because it contains several kinds of tissues Most studies call it a system because it has organs and other parts that work together for a particular function

Did you know? On an average adult the skin covers more than 3000 square inches of surface area and accounts for about 15% of total body weight 1 square centimeter of skin contains: 15 sebaceous glands, 1 yard of blood vessels, 700 sweat glands, 3000 sensory cells at the end of nerve fibers, 4 yards of nerves, 25 pressure apparatus for the perception of tactile stimuli, 200 nerve endings to record pain, 2 sensory apparatuses for cold, 12 sensory apparatuses for heat, 3,000,000 cells, and 10 hairs.

Layers of the Skin Epidermis: Outermost layer of skin, made of 5-6 smaller layers; epithelial cells Two main layers: Stratum corneum: outermost layer where cells constantly shed; cells have keratin which makes them waterproof; first line of defense against bacteria; thickest on palms and soles Stratum germinativum: (reproductive layer) provides cells to replace cells in strata corneum Contains no blood vessels or nerve cells (avascular) Contains melanocytes that contain melanin Contains Keratin, a fibrous water repellent protein

Dermis Also call dorium or true skin Has framework of elastic connective tissue Contains blood vessels (vascular), blood and lymph vessels, nerves, involuntary muscle, sweat and oil glands and hair follicles

Top of the Dermis Covered with papillae Fit into ridges on the stratum germinativum of the epidermis Ridges form lines or striations on the skin Pattern of ridges is unique for each individual- pattern is used for finger/footprints, used for identification

Glands of skin Sebaceous glands: Oil glands Usually open onto hair follicle Produce oil called sebum, which keeps hair from becoming dry and brittle, pimples occur when clogged with dirt and oil Antibacterial and antifungal properties due to slight acidity of sebum Arrector pili muscle – smooth muscle attached to follicle; causes “goosebumps”

Glands of skin Sudoriferous glands: Sweat glands Coiled tubes that extend through dermis Open on surface of the skin at an opening called a pore Sweat contains water, salt, and some body wastes Sweat is odorless, body odor occurs when the sweat interacts with bacteria on the skin

Subcutaneous fascia or hypodermis Innermost layer of skin Made of elastic and fibrous connective tissue and adipose (fatty tissue) Connects skin to underlying muscles

Other parts of the skin Hair: consists of a root that grows in a hollow tube called a follicle, and a hair shaft, helps protect the body, covers all body surfaces except for the palms of the hands and soles of the feet Alopecia or baldness: permanent loss of hair on the scalp, genetic condition, usually in men

Nails Protect the fingers and toes from injury Made of dead keratinized epidermal epithelial cells, which are packed closely together to form a thick dense surface Cells formed in nail bed Cells can be replaced if lost if nail bed is not damaged

Functions of the Integumentary System Protection Sensory perception Regulation of body temperature Storage Absorption Excretion Production

Protection: Barrier for sun’s ultraviolet rays Protects against invasion of pathogens or germs Holds moisture in and prevents deeper tissues from drying out

Sensory perception: Nerves present in skin Respond to pain, pressure, temperature (heat and cold), and touch sensations

Regulation of body temperature : Blood vessels in skin help body retain or lose heat Dilate: blood vessels get larger and allow excess heat to escape through the skin Constrict: blood vessels get smaller and retain heat Sudoriferous (sweat) glands also help cool body through evaporation of perspiration

Storage: Skin has tissues for temporary storage of fat, glucose (sugar), water, vitamins, and salts Stores adipose tissue in the subcutaneous fascia, which is a source of energy

Absorption: Certain substances absorbed through skin, but limited Examples: medication for motion sickness (gel), ointments and creams, and heart patches, nicotine patches to stop smoking, pain medicine patches. Transdermal medications are sticky patches placed on the skin

Excretion: Helps body eliminate salt, a minute amount of waste, and excess water Done through perspiration or sweat

Production: Skin helps produce vitamin D Uses ultraviolet rays from the sun to form an initial molecule of vitamin D that matures in the liver

Pigmentation Melanin and Carotene determine skin color Melanin – brownish-black pigment; leads to a black, brown, or yellow skin tint, depending on racial origin; absorbs UV rays to tan the skin; small concentrated areas form freckles Carotene – yellowish-red pigment; helps determine skin color Albino- lack of pigmentation; skin has pinkish tint and hair is pale yellow or white; eyes also lack pigment and are red in color and very sensitive to light

Abnormal colors of the skin can indicate disease Erythema – reddish color of skin; causes can be burns, congestion of blood in the vellels Jaundice – yellow discoloration of the skin; causes can be bile in the blood from liver or gallbladder disease, also associated with diseases that involve the destruction of red blood cells Cyanosis – bluish discoloration of the skin; caused by insufficient oxygen; may be associated with heart lung, circulatory diseases Chronic poisoning may cause a gray or brown skin discoloration

REVIEW Epidermis: Dermis: Hypodermis:

Functions 1. 2. 3. 4. 5. 6. 7.

Skin Eruptions: Ulcers Also known as decubitus ulcers, pressure ulcers, or bed sores. Localized areas of necrosis that develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time

Most common pressure points: Sacrum heels Elbows Nose, ear and genitalia from tubes(catheters)

Any shearing force.. Which is the force that stretches the skin during turning or moving in bed, decreases blood flow.

Guidelines to prevent: Adequate nutrition is important. A diet high in protein with enough calories, vitamins and minerals. Frequently turn and position client to relieve pressure. Turn every 1 to 2 hours. Use specialized beds and mattresses to distribute pressure on dependent body parts

Assessing Damage Pressure ulcer staging systems are based on the depth of the tissue destroyed. If the nurse cannot see the bottom of the sore, staging cannot be done.

Four Stages of Pressure Sores Partial thickness skin loss involving epidermis and/or dermis Ulcer is superficial and presents as a blister, abrasion or shallow crater Stage 1 Nonblanchable erythema of intact skin. May also have warmth, edema, induration or hardness

Stages, cont. Stage 3 Full thickness skin loss involving damage of subcutaneous tissue that may extend to fascia Presents as a deep crater Stage 4 Full thickness skin loss with extensive destruction, damage to muscle, bone, or supporting structures

Pictures of pressure ulcers

More pictures…

Risk Assessment Early identification of at risk patients. High risk/at risk patients include clients with neurological impairment, chronically ill long term care clients, and orthopedic clients.

Treatment Stages 1, 2 and 3 : Local treatment: wound care, saline often used. Occlusive dressings. Use clean technique. Stage 4: May involve surgery

Other skin eruptions: Macules – ex. freckles (ephelides) Papules – ex. Pimples Vesicles- ex. Blisters and Chicken pox Pustules – ex. Pimples, ant bites Crusts- ex. “scabs”, made up of dried pus and blood Wheals- ex. Hives and insect bites Nodules – ex. a cyst / a small solid bump

Medical Terminology – A- Melan/o -cyte Germin/o Sudor/I Seb/o Hypo Derm, dermat/o Lip/o Adip/o Tact/i

Diseases and Abnormal Conditions Acne Vulgaris – inflammation of the sebaceous glands Cause unknown, but usually occurs at adolescence. Hormonal changes and increased secretion of sebum are probably underlying causes Symptoms: papules, pustules, and blackheads Treatment: frequent, thorough washing, avoidance of creams and heavy makeup, antibiotic or vitamin A ointments, oral antibiotics, and/or ultraviolet light treatments

Athlete’s foot- contagious fungal infection that usually affects the feet Symptoms: itching, blisters, and cracks that turn into open sores Treatment: antifungal medication and keeping the area clean and dry Contagious

Athlete’s foot

Skin Cancer- most common type of cancer. There are 3 main types: Basal cell- cancer of basal cells in epidermis of skin. Slow growing and does not usually spread. Lesions can be pink to yellow-white. They are usually smooth with a depressed center and an elevated, irregular-shaped border

Basal cell

Squamous cell- affects thin cells of the epithelium but can spread quickly to other areas of the body. Lesions start as small, firm, red, flat sores that later scale and crust. Sores that don’t heal are frequently squamous cell carcinomas.

Squamous cell

Melanoma- develops in the melanocytes of the epidermis and is the most dangerous type of skin cancer. The lesions can be brown, black, pink, or multicolored. They are usually flat or raised slightly, asymmetric and irregular or notched on the edges.

melanoma

Skin cancer often develops from a mole or nevus that changes in color, shape, size, or texture. Bleeding or itching of a mole can also indicate cancer. Exposure to the sun, prolonged use of tanning beds, irritating chemicals, or radiation are the usual causes of skin cancer. Treatment involves surgical removal of the cancer, radiation, and/or chemotherapy.

Dermatitis- inflammation of the skin Dermatitis- inflammation of the skin. Can be caused by any substance that irritates the skin and is frequently an allergic reaction to detergents, cosmetics, pollen, or certain foods. Ex. Poison ivy, poison oak, poison sumac Symptoms: dry skin, erythema, itching, edema, macular-papular rashes, and scaling Treatment: eliminating the cause, anti-inflammatory ointments, antihistamines, and/or steroids also used

dermatitis

Eczema- noncontagious, inflammatory skin disorder caused by an allergen or irritant. Diet, cosmetics, soaps, medications, and emotional stress can all cause eczema. Symptoms: dryness, erythema, edema, itching, vesicles, crusts, and scaling Treatment: removing the irritant, application of corticosteroids to reduce the inflammatory response

eczema

Impetigo- highly contagious, skin infection usually caused by streptococci or staphylococci organisms Symptoms: erythema, oozing vesicles, pustules, and the formation of a yellow crust Wash lesions with soap and water and keep dry. Treatment: antibiotics (oral and topical)

impetigo

Psoriasis- chronic, noncontagious skin disease with periods of exacerbations and remission. Exact cause unknown, but is an immune disorder. Scientists believe the immune system mistakenly activates a reaction in the skin cells, which speeds up the growth cycle of skin cells. Stress, cold weather, sunlight, pregnancy, and endocrine changes tend to cause an exacerbation of the disease

Symptoms: thick, red areas covered with white or silver scales No cure, but treatment includes: coal/tar or cortisone ointments, ultraviolet light, and/or scale removal

psoriasis

Ringworm- highly contagious fungal infection of the skin or scalp Characteristic symptom- formation of a flat or raised circular area with a clear central area surrounded by an itchy, scaly, or crusty outer ring Treatment: antifungal medicines, both oral and topical, are used

ringworm

Verrucae, or warts- viral infection of the skin Plantar warts usually occur at pressure points on the sole of the foot. A rough, hard, elevated, rounded surface forms on the skin Treatment: some may disappear spontaneously, but others must be removed with electricity, liquid nitrogen, acid, chemicals, or laser

Sebaceous cyst Cyst of a sebaceous (oil) gland that contains yellow, fatty material Commonly found on face, neck, and trunk Benign, can cause problems with become large; can be painful; can become infected Surgically removed, can return if all of “sac” not removed

Boil A boil, also known as a furuncle is a skin abscess, a painful bump that forms under the skin - it is full of puss. A carbuncle is collection of boils that develop under the skin. When bacteria infect hair follicles they can swell up and turn into boils. Cause: bacteria infect hair follicles Treatment: hot packs and lancing

Petechiae pinpoint, round spots that appear on the skin as a result of bleeding under the skin Caused from capillaries bleeding into the skin Usually indicate another problem Possible causes: disruption of blood clotting mechanisms; thrombocytopenia (low platelet count); side effect of some drugs; leukemia; lupus; measles; mononucleosis; rheumatoid arthritis; vitamin K deficiency (infants)

Cellulitis A type of bacterial skin infection; appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly More commonly affects lower legs Can spread to blood and lymph systems, causing systemic life threatening infection

Lupus erythematosus chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs (autoimmune). Inflammation caused by lupus can affect many different body systems, including your joints, skin, kidneys, blood cells, heart and lungs More common in women Some people often have a characteristic butterfly-shaped rash on bridge of nose and cheeks

Pediculosis (lice) tiny, wingless, parasitic insects that feed on your blood. Lice are easily spread through close personal contact and by sharing belongings. Lice can appear on scalp, body, pubic area s/s : itching; tingling feeling; small red bumps; visible lice or eggs

Scabies a condition of very itchy skin caused by tiny mites that burrow into your skin Spread by close contact with someone who has scabies. Scabies can also be spread by sharing towels, bed sheets, and other personal belongings. Direct skin to skin contact Treatment: scabicide drug (Elimite (permethrin)

Keloid raised growth of fibrous scar tissue that forms over an area of trauma to the skin and extends beyond the area of the original injury. more common in young women and African Americans. Scar tissue normally grows in response to a wound, but a keloid is an overgrowth of scar tissue over a healed wound

Chloasma (melasma) brownish pigmentation on the face that develops slowly and fades with time. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes. Usually seen in women; more common in people that tan well or have naturally dark skin Causes: genetic predisposition; pregnancy; contraceptives; sun exposure; unknown

Birthmarks Port wine stain: large, reddish purple discoloration of the face or neck; laser treatment Strawberry hemangioma: soft, raised birthmark; dark, reddish purple growth is a benign tumor of newly formed blood vessels; usually resolve by 7 yoa but can be treated; benign but can be disfiguring

Hives (urticaria) Skin condition characterized by localized swelling accompanied by itching that is associated with an allergic reaction urtic – rash Aria – means connected with Treatment: steroid creams, antihistamines