Chapter Four Integumentary System

Chapter Four Integumentary System
The skin, hair, nails, along with the sweat and sebaceous glands are all parts of the integumentary system. And there are lots of combining forms, prefixes, and suffixes to learn for this system. Mastering Healthcare Terminology/Chapter 4

Quote “Genius is one percent inspiration and ninety-nine
percent perspiration” –Thomas Edison Are you sweating yet?

Functions and Specialties
First line of defense Temperature regulation Sensation Synthesis of vitamin D Elimination of waste Specialties Dermatology Specialtist Dermatologist Discuss the “first line of defense” and what can happen when the skin is broken (healthy, unbroken skin is an initial defense against pathogenic “invasion”). Ask the class to describe how the skin regulates temperature (shivering, sweating). The sensation perceived by the skin is the sense of touch. Receptors in the skin allow an individual to know when he or she is in contact with the environment. We will discuss terms that relate to an excessive sensation of touch (hyperesthesia) and a lack of sensation of feeling (anesthesia). Vitamin D, a substance important to normal development of teeth and bones, is synthesized by the skin. Dermatology is the study of the skin. Dermat/o = skin + -logy = study of the skin. A dermatologist is one who specializes in the study of the skin. Dermat/o = skin + -logist = one who specializes in the study of the skin. Mastering Healthcare Terminology/Chapter 4

Skin (derm/o, dermat/o, cutane/o, cut/o)
Let’s start with the combining forms for the skin: derm/o, dermat/o, and cutane/o. Do you recognize any of these combining forms? Diagram of the skin Mastering Healthcare Terminology/Chapter 4

Layers of the Skin Layers (strata) Epidermis Dermis/corium
Hypodermis/ subcutaneous layer The skin is arranged in layers. The top layer is the epidermis (epi- meaning above, or upon, derm/o for skin, and –is for structure). Hence the epidermis is the top layer of the skin. The dermis (also called the corium) is the true layer of the skin; it holds the blood vessels, oil and sweat glands, and nerves for sensation. Underneath is the layer called the hypodermis (hypo- under or beneath, derm/o again for skin, and –is for structure). The other name is the subcutaneous tissue. Note that sub- means under or below, cutane/o means skin, and -ous means pertaining to. So the two names both refer to the structure under the skin. This tissue is filled with fat (adip/o). How do the prefixes used in naming the layers of the skin help you to remember the order of the layers of skin?

Epidermis Composition of the epidermis Keratinocytes Melanocytes
Stratified squamous (squam/o) epithelium Basal (bas/o) layer: stratum germinativum Stratum corneum (corne/o) Keratinocytes Keratin Melanocytes Melanin The epidermis is composed of mostly avascular (a- = without + vascul/o = vessel + -ar = pertaining to) tissue meaning that it has a very limited blood supply. It covers the body, is arranged in layers, and these layers have a scaly appearance. The medical name for this structure is the stratified squamous epithelium (squam/o means scaly). Did you remember that epithelium is one of the four types of tissue? Once the cells are formed, they are pushed upward toward the outermost layer, the stratum corneum (corne/o means hard, horny). As they are pushed toward the surface, they are filled with a hard protein material, keratin (kerat/o also means hard, horny), and are then referred to as keratinocytes. The addition of keratin to the cells gives them a protective waterproof property. The deepest layer of the epidermis is the basal layer, also referred to as the stratum germinativum. This is the site of continual new growth for skin cells along with the production of the substance, melanin, that gives skin its color. Pigmentation is governed by the melanocytes (melan/o = black + -cyte = cell) that produce a dark pigment called melanin. In the presence of sunlight, the melanocytes increase their production of melanin, providing a form of protection against ultraviolet light. Mastering Healthcare Terminology/Chapter 4

Dermis Composed of vascular connective tissue Structures
Blood and lymphatic vessels Nerves Hair follicles (follicul/o) Sebaceous (sebac/o) and sudoriferous glands (sudor/i) Remind students that the synonym for the dermis is the corium. While the epidermis is the covering, the dermis is the tissue that is being covered. Vascular in nature, and composed of connective tissue, the dermis is also the site of the nerves, hair follicles, touch receptors, and sweat and sebaceous glands. Mastering Healthcare Terminology/Chapter 4

Hypodermis/Subcutaneous Tissue
Adipose tissue (adip/o) This structure is composed of mainly adipose (adip/o = fat) tissue, which serves to insulate and cushion the body. Mastering Healthcare Terminology/Chapter 4

Clicker Question The hair follicles are located in the: Answer:
A. dermis B. epidermis C. subcutaneous tissue Answer: A. dermis Dermis Also called the corium

Glands Sudoriferous glands (hidraden/o) Sebaceous glands Pores
Perspiration (hidr/o) Locations: Apocrine, Eccrine Apocrine- axilla, groin Eccrine- all over body Sebaceous glands Sebum (seb/o) The sudoriferous glands (sudor/i = sweat + -ferous = pertaining to carrying), also called the sweat glands, are instrumental in the regulation of body temperature. Note that the combining form for the sweat glands is hidraden/o, a composite of hidr/o for sweat and aden/o for gland. You may see the term “sudor” used to mean sweat, but it is used rarely. Perspiration is a much more common term, and it occurs through tiny openings in the skin called pores. These pores are present on the soles of the feet, the palms of the hands, the axillae (axill/o = armpit), the upper lip, and the forehead. Sebaceous glands secrete an oily substance termed “sebum,” which serves to lubricate the hair and the skin. Note that the combining form is not tricky, it’s simply seb/o. . Enlarged pores Mastering Healthcare Terminology/Chapter 4

Hair and Nails Hair (trich/o, pil/o) Nails (onych/o, ungu/o)
Hair Follicle Hair (trich/o, pil/o) Follicles (follicul/o) Shaft Papilla (papill/o) Nails (onych/o, ungu/o) Nail body Nail root Nail bed Lunula (looks like a white moon!) Eponychium (cuticle) The combining forms for the hair are trich/o (pronounced as in “trick or treat”) and pil/o. The root of each strand of hair is in the dermis, and along with its covering, is referred to as the hair follicle (combining form follicul/o). The part of the hair that you can see is called the shaft, and underneath the shaft is the nipple-shaped structure called the papilla. You’ll find that the combining form for the papilla (papill/o) is used throughout terminology (in the terms for the eye and, obviously, in the female reproductive system, too). The cells on the top of the papilla are responsible for the formation of hair. When these cells die, for whatever reason, hair loss occurs. The nails have two combining forms: onych/o and ungu/o. They cover the dorsal surface of the distal ends (remember that dorsal pertains to the back and that distal means “far”) of the fingers and toes. The visible surface is the nail body (also called the nail plate), with the nail root being just under the skin at the base of the nail. The nail bed is the highly vascular (blood filled) tissue under the nail body and the small, moonlike area at the base is called the lunula, meaning a tiny moon. The cuticle (or eponychium) is the skin “upon” the nail and the paronychium is the small fold of skin that is at the sides of the nail (literally “near” the nail). The nail Mastering Healthcare Terminology/Chapter 4

Did You Know? Did you know that as the ability to see smaller and smaller body structures became possible, early anatomists named them according to what they resembled that was already named. For example, the nipple was the first structure called a papilla. Later, the term papilla was also used to name the projecting capillaries at the bottom of a hair shaft, the conical-shaped entrance to the optic nerve, and the taste buds on the tongue. Be Careful! Do not confuse papill/o, meaning papilla or “nipple,” with papul/o, meaning pimple.

Clicker Question Which layer of the skin is largely avascular? Answer:
A. epidermis B. dermis Subcutaneous Answer: A. epidermis The epidermis This is the top layer with a very minimal blood supply, but several layers of its own. Mastering Healthcare Terminology/Chapter 4

Terms Related to Skin Lesions
Definition of lesion Any visible, localized abnormality of the skin Primary Ones that initially occur as the result of trauma or disease Secondary Those that have evolved from their primary form A lesion is any visible, localized abnormality of the skin. Primary skin lesions are the ones that initially occur as the result of trauma or disease. Secondary lesions are those that have evolved from their primary form. Mastering Healthcare Terminology/Chapter 4

Terms Related to Primary Lesions
Nod/-ules Palpable, solid lesion less than 2cm Cysts Nodule filled with a semisolid material Tumors Nodule more than 2cm Hemat/-omas Collection of extravasated blood trapped in the tissues palpable to the examiner Nodules are palpable solid lesions. For example, a lipoma. Cysts are nodules that are filled with a semisolid material, like a keratinous cyst (also called a sebaceous cyst). Tumors are nodules that are larger than 2 cm (slightly less than an inch). The term “tumor” can be used to explain any mass or swelling, including neoplasms. Hematomas are collections of extravasated (leaked) blood that are trapped in the tissues and can be felt by the examiner. Mastering Healthcare Terminology/Chapter 4

Terms Related to Primary Lesions (cont’d)
Petechia Tiny ecchymosis within the dermal layer (found around eyes after vomiting) Ec-chym/-osis Hemorrhage or leaking of blood into the subcutaneous tissue Purpur/-a Massive hemorrhage into the tissues under the skin An ecchymosis is a hemorrhage or extravasation of blood into the subcutaneous tissue. It is nonpalpable, but generally darkens the skin. You may recognize it by its common name, a bruise. A petechia is a tiny ecchymosis in the dermal layer. Purpura is a massive hemorrhage into the tissues under the skin. All of these terms are forms of extravasation, which means the process of a substance (blood or lymph) leaking outside of a vessel into surrounding tissues. Ecchymosis From Moll: Rheumatology, ed 3, Churchill-Livingstone Mastering Healthcare Terminology/Chapter 4

Macules Flat blemish or discoloration less than 1cm (freckles) Papules Raised solid skin lesion less than 1cm (pimple) Wheals Circumscribed, elevated papule caused by localized edema (bug bite) A macule is a flat, nonpalpable blemish or discoloration that is less than 1 cm. Examples include freckles, port wine stains, or even tattoos. A patch is a large, flat, nonpalpable macule that is larger than 1 cm. Again, this could be a larger port wine stain or tattoo. A papule is a raised solid skin lesion that is less than 1 cm. A pimple is an example. A plaque is a raised plateau-like papule larger than 1 cm. Psoriatic plaques or seborrheic keratoses are examples. A wheal is a circumscribed, elevated papule that is caused by localized edema. Examples are bug bites. Urticaria, or hives, are wheals that are caused by an allergic reaction. Mastering Healthcare Terminology/Chapter 4

Vesicles/bullae Circumscribed, eleveated lesion containing fluid and smaller than 1/2cm (bug bite) Pustules Superficial, elevated lesion containing pus (acne) Tel/angi/-ectasia Permanent dilation of groups of superficial capillaries and venules A vesicle is a circumscribed elevated lesion that is filled with fluid and smaller than ½ cm. If it’s larger than ½ cm, it is termed a bulla. In English, we refer to these as blisters. A pustule is like a vesicle, but it a raised lesion that is filled with pus as the result of an infection. Finally, telangiectasia is a condition of dilated superficial venules and capillaries (tel/e = distant + angi/o = vessel + -ectasia = dilation). Mastering Healthcare Terminology/Chapter 4

Terms Related to Secondary Lesions
A-troph/-y Paper thin wasted skin (seen in elderly) Cicatrix A scar (from a bug bite or similar) Keloid A scar that is an overgrowth of tissue at the site of an injury Eschar Dried serum, blood, and/or pus Fissure Cracklike lesion of the skin Ulcer Circumscribed craterlike lesion of the skin or mucous membrane resulting tissue death, that can accompany an inflammatory, infectious , or malignant process Keloid From Habif: Clinical dermatology, ed 4, Mosby If skin is atrophied, it is characterized as being paper thin, wasted skin. An example is the thinning skin of the elderly or stretch marks that result from rapid weight gain. The specific term for stretch marks is striae. Don’t confuse that with the term for the layers of the epidermis, the strata. A cicatrix is a scar, while a keloid is an overgrowth of tissue at the site of an injury. Eschar is dried serum, blood, and/or pus that can occur at the site of an injury or a burn. A fissure is a crack-like lesion of the skin. An ulcer is a circumscribed crater-like lesion of the skin or a mucous membrane. It’s important to note that ulcers can occur on the outer surface of the body as well on the inside. Mastering Healthcare Terminology/Chapter 4

Clicker Question The term for a blister is a/an: Answer: A. cyst
B. papule C. pustule Vesicle Answer: D. Vesicle Vesicle a larger vesicle is a bulla

Terms Related to Dermatitis and Bacterial Infections
A-top/-ic dermat/-itis Cellul/-itis Contact dermat/-itis Eczema Follicul/-itis Cellulitis of upper leg From Black and Hawks: Medical-surgical nursing, ed 7, Mosby Atopic dermatitis is a chronic, pruritic superficial inflammation of the skin that usually occurs in families that have a history of allergic disorders. Cellulitis is a bacterial inflammation that is diffuse, spreading, and occurs within solid tissues. Contact dermatitis is an inflammation of the skin that occurs as an irritated or allergic response . Eczema is a superficial inflammation of the skin characterized by vesicles, lesions that “weep,” and pruritus. Eczema is also referred to as dermatitis. Folliculitis is an inflammation of the hair follicles (follicul/o=follicle). These inflammations can be superficial or deep, acute or chronic. Mastering Healthcare Terminology/Chapter 4

Terms Related to Dermatitis and Bacterial Infections (cont’d)
Furuncle Carbuncle (two furuncles connected by tunnel) Impetigo Pil/onid/-al cyst Seb/orrheic dermat/-itis Cradle cap Pruritus Note that these are still terms related to dermatitis and bacterial infections. A furuncle is a localized superficial staph infection that starts in a gland or hair follicle and is characterized by pain, redness, and swelling. If two or more furuncles are connected by subcutaneous pockets, they are called carbuncles. Impetigo is a superficial vesiculopustular skin infection that is usually seen in children. It can be highly contagious. Pilonidal cysts are located in the sacral region of the back and are hairs that grow in a cyst. Seborrheic dermatitis is an inflammatory scaly disease of the face and scalp. In children it is commonly called cradle cap. Note the spelling of pruritus, meaning itching; it is often misspelled. Furuncle From Seidel: Mosby’s guide to physical examination, ed 6, Mosby Mastering Healthcare Terminology/Chapter 4

Terms Related to Yeast and Fungal Infections
Candidiasis (also moniliasis) Dermat/omyc/osis Tinea Capit/is Corpor/is Crur/is Ped/is candidiasis From the CDC Candidiasis is a yeast infection that is also called moniliasis. Another term for fungal infections of the skin is dermatomycosis. Dermat/o = skin, myc/o = fungus, and –osis = abnormal condition. Naming the fungal infections by the specific body is accomplished by using the term tinea for fungus and a second term indicating the area of the body. Tinea capitis is a fungal infection of the head (capit/o = head), tinea corporis of the body (corpor/o = body), tinea cruris (crur/o = leg) of the groin (commonly called “jock itch”), and tinea pedis of the foot (ped/o = foot) (known as athlete’s foot). Show how decoding can help students remember where the fungus appears in the fungal diseases. Mastering Healthcare Terminology/Chapter 4

Terms Related to Parasitic Infestations
Pedicul/osis Scabies Pediculosis is an infestation with lice, while scabies is an infestation with mites. Infestation with scabies causes an itchy (pruritic) papular rash. Note that these two are parasitic infestations and that the common names are lice and mites. Lice in the hair From Callen: Color Atlas of dermatology, ed 3, Saunders Mastering Healthcare Terminology/Chapter 4

Clicker Question A combining form for fungus is: Answer: A. onych/o
B. myc/o C. sudor/i my/o Answer: B. myc/o Myc/o is a combining form for fungus. Onych/o = nail, sudor/i = sweat, and my/o = muscle Mastering Healthcare Terminology/Chapter 4

Terms Related to Disorders of the Hair Follicles and Sebaceous Glands
Acne vulgar/-is Comedones Alopecia Hyper-trich/-osis (hirsutism) Kerat/-in-ous cyst Milia (clogged oil glands) Acne vulgaris (vulgaris means common, not nasty!) is an inflammatory disease of the sebaceous glands. The lesions are papules, pustules, inflamed nodules, and comedones (sing. comedo). A comedo is a plug of sebum that partially blocks a pore. Open comedones are blackheads, while closed comedones are whiteheads. Alopecia is the term for hair loss or baldness. Hair loss occurs for a number of reasons including aging, disease, or genetic factors. Alopecia comes from the Greek term alopekia, meaning fox mange. Mange is an animal disease in which the hair comes out in clumps. Hypertrichosis is an abnormal condition of excessive hairiness. Hyper-= excessive + trich/o = hair + -osis = abnormal condition. A synonym is hirsutism. A keratinous cyst is a benign cavity filled with epithelium that has become hardened (keratinized), sebum, and epithelial debris. A synonym for keratinous cyst is a sebaceous cyst. Milia is a condition of tiny keratinous cysts that are on the surface of the skin. They are the result of clogged sebaceous ducts. Alopecia From Hill: Skin disorders, Mosby Mastering Healthcare Terminology/Chapter 4

Terms Related to Viral Infections
Exanthemat/-ous diseases (maculopapular rash) Herpes simplex virus (HSV) HSV-1 (cold sores) HSV-2 (genital) Herpes zoster Verruca (warts) Herpes zoster From Callen et al: Color atlas of dermatology, ed 2, Saunders Exanthematous diseases are those that are characterized by a rash (exanthem). Measles, mumps, fifth disease, rubeola, and chicken pox are examples of exanthematous diseases. Herpes simplex virus 1 These viral infections cause clusters of small vesicles on raised inflammatory sites on the skin or mucosa. HSV-1 causes fever blisters/cold sores/herpetic stomatitis (they’re all synonyms for each other) and keratitis, an inflammation of the cornea. Point out that the cornea is the hard outer covering of the eye. It uses the same combining forms (corne/o and kerat/o) as the combining forms used to describe hard, horny conditions of the skin.. Remember that stomat/o means mouth, not stomach. HSV-2 is more commonly known as genital herpes. Herpes zoster is an acute painful rash caused by a reactivation of the latent varicella-zoster virus (the one that causes chicken pox). This disorder is more commonly referred to as shingles. Verruca is a medical term for a wart. These are caused by a virus and can appear on the skin in various locations on the body. For example, plantar warts appear on the sole of the foot (the plantar surface). Note the plural form of the term verruca (verrucae). Mastering Healthcare Terminology/Chapter 4

Terms Related to Scaling Papular Diseases
Psoriasis Psoriasis is a common chronic skin disorder characterized by circumscribed salmon red patches covered by thick, dry, silvery scales. Note its unusual spelling and pronunciation. Psoriasis From Bork: Skin disease in clinical practice, ed 2, Saunders Mastering Healthcare Terminology/Chapter 4

Terms Related to Cornification and Pressure Injuries
Callus Corn/clavus Decubitus ulcer/ pressure sore/ bedsore/ pressure ulcer Ichthy/-osis Xeroderma Stage 4 decubitus ulcer From Elkin et al: Nursing interventions and clinical skills, ed 3, Mosby Cornification means a process of becoming hard or horny (corne/o means hard, horny). A callus is a thickening of the stratum corneum (remember that top layer of the epidermis?) that occurs wherever there are areas of pressure or friction. A corn (also called a clavus) is a mass of horny, condensed epithelial tissue that is over a bony prominence. It occurs as the result of pressure or friction. A decubitus ulcer is an inflammation, sore, or erosion of the skin over a bony prominence. These occur most often in debilitated patients who are immobilized. These ulcers are graded by stages of severity with the highest grade being a 6: one that is so deep that it has eroded tissue down to the bone. Note that other names for a decubitus ulcer is a pressure sore or pressure ulcer. You may have seen them referred to as bedsores. The term decubitus comes from a Latin noun meaning a lying down and the adjective, related to the elbow. Romans rested on their elbows when reclining. One assumes they eventually suffered pressure sores on their elbows from this constant position. Ichthyosis is extremely dry skin. It is named by the combining form ichthy/o meaning fish because of the scaly appearance of the skin. A milder form of dry skin is xeroderma. Xer/o = dry. Mastering Healthcare Terminology/Chapter 4

Terms Related to Pigmentation Disorders
Albin/-ism Dyschromia Hyperchromia Hypochromia Vitiligo Albinism is a condition of a lack of pigmentation in the skin. Albin/o is a combining form for white. Discuss why individuals with albinism need special protection for their eyes as well as their skin. (melanin is a form of protection for the skin as well as the iris of the eyes) Dyschromia (dys-=abnormal, chrom/o= color + -ia = condition) is an abnormal condition of pigmentation of the skin. If an individual has less than normal pigmentation, it is referred to as hypochromia. If there is more than normal pigmentation, it is referred to as hyperchromia. Vitiligo is a condition of patches of skin that lack pigment as a result of an acquired disorder of unknown origin. Vitiligo From Lewis: Medical-surgical nursing, ed 7, Mosby Mastering Healthcare Terminology/Chapter 4

Terms Related to Disorders of Sweating
Anhidrosis Hidradenitis Hyperhidrosis Miliaria The first term is an abnormal condition of no sweating. An- = no, not, without + hidr/o = sweat + -osis = abnormal condition. Why is this bad? (sweating is a mechanism to help control body termperature) Hidradenitis is an inflammation of the sweat glands. Hidraden/o is a compound combining form built from hidr/o for sweat and aden/o meaning gland. The suffix –itis means an inflammation. Hyperhidrosis is an abnormal condition of excessive sweating. Hyper- means excessive and again, hidr/o = sweat and –osis = abnormal condition. Miliaria is a condition of occluded (blocked) sweat ducts. Discuss the Be Careful! for milia and miliaria. Discuss the difference between the combining forms hydr/o and hidr/o. Mastering Healthcare Terminology/Chapter 4

Terms Related to Disorders of the Nails
Onychia Onychocryptosis Onycholysis Onychomalacia Onychomycosis Paronychia Onychia is an inflammation of the nail. It is also called onychitis. Onychocryptosis is an abnormal condition of an ingrown (crypt- means hidden) nail. Onycholysis is a loosening or separation of the nail plate from the nail bed. Onychomalacia is a softening of the nail. The suffix –malacia means a softening. Onychomycosis is an abnormal condition of fungus of the nails. Myc/o means fungus. Paronychia is an inflammation of the skin surrounding the nail. This can happen when an individual, for example, chews his or her cuticles and they become inflamed. Onychomycosis From Conlan and Snydman: Mosby’s color atlas and text of infectious diseases, 2000, Mosby Mastering Healthcare Terminology/Chapter 4

Clicker Question The term that means an abnormal condition of fungus in the nails is: A. hyperhidrosis B. onychomycosis C. trichomycosis D. onychocryptosis Onychomycosis Onych/o = nail and myc/o = fungus

Burns Degrees of burns Eschar First/superfical thickness Second
Superficial partial thickness Deep partial thickness Third/full thickness Fourth/deep full thickness Eschar Burns are injuries that can be caused by heat, radiation, chemicals, or electricity. The severity is measured in degrees and in thicknesses. If degrees are used, they are first-degree burns, which damage the epidermis only. First-degree burns are characterized by erythema (redness), tenderness, and hyperesthesia (hyper- = excessive + esthesi/o = feeling + -ia condition), which is a heightened sensitivity to touch. Another name for a first-degree burn is a superficial burn. Second-degree burns involve the epidermis and dermis, with erythema, vesicles, and the likelihood of scar formation. These are also called partial thickness burns. If the burn damages the top part of the dermis called the papillary layer, it is a superficial partial thickness burn. If the entire dermis is damaged (meaning that the reticular layer is included), it is referred to as a deep partial thickness burn. Third-degree burns are those that damage the epidermis, dermis, and subcutaneous layer. Because the nerve endings in the dermis are destroyed, this type of burn does not cause pain. This is also called a full thickness burn. Although not a common category, fourth-degree burns are those that destroy the epidermis, dermis, subcutaneous layer, along with the muscle and/or bone underneath. This is also called a deep full thickness burn. Eschar is the dried serum and blood that covers a burn. Mastering Healthcare Terminology/Chapter 4

Burns: Rule of Nines The rule of nines is used to describe the percentage of the body that is affected by a burn by dividing the body into multiples of 9. As you can see, on the ventral surface of the body, 4.5% is allowed for the head and neck, 4.5 % for each arm (9% total for the front of the arms), 18% for the front of the torso, 1% for the groin area, and 9% for each leg (18% total for the front of the legs). That gives us 50.5% for the front of the body. On the dorsal surface of the body, we again have 4.5% for the head and neck, 4.5% for the back of each arm (9%) total, 18% for the back of the torso, and 9% for the back of each leg (18% total for the legs). If the total back of the body is 49.5%, the total for the body is 100%. Mastering Healthcare Terminology/Chapter 4

Burns 2nd degree burn 1st degree burn 3rd degree burn

Clicker Question The epidermis only is damaged in which type of burn?
A. superficial partial thickness B. deep partial thickness C. superficial thickness D. full thickness Superficial thickness Also called a first-degree burn

Terms Related to Benign Skin Growths
Angioma Hemangioma Dermatofibroma Lipoma An angioma is a tumor of a vessel (angi/o = vessel + -oma = tumor). A hemangioma is a tumor of a blood (hemat/o) vessel. A dermatofibroma is a fibrous tumor of the skin. These lesions are firm, round, and usually appear on the extremities. A lipoma is a fatty (lip/o) tumor. It is soft, movable, and located in the subcutaneous tissue. Hemangioma From Habif: Clinical dermatology, ed 4, 2008, Mosby Mastering Healthcare Terminology/Chapter 4

Terms Related to Benign Skin Tumors (cont’d)
Dysplastic nevus Nevus Dysplastic ABCDE Seborrheic keratosis Skin tags/acrochordons A nevus is a birthmark or a mole. By themselves, these are not a problem. If they are dysplastic, however, it means that they have an abnormal (dys-) formation (-plastic). They can progress to become malignant and the ABCDE rule is used to monitor changes that indicate a need for further evaluation. A= asymmetry (abnormal uneven shape), B= borders (irregular), C= color (any change in color), D= diameter (greater than 6 mm), and E = elevation (any increase). Seborrheic keratosis is a benign, pigmented, warty lesion. Note that it is caused by an abnormal flow (-rrheic) of sebum (seb/o) and is abnormally (-osis) hard or horny (kerat/o). An actinic keratosis is a hardened skin lesion that is caused by exposure to the sun. Finally, skin tags are soft, pedunculated (literally meaning that they have a little “foot”) lesions that are an outgrowth of the epidermis and dermal tissue. These occur most often in multiples on the neck, eyelids, armpits, and groin. A synonym for skin tags is acrochordons. Dysplastic nevus From Goldman et al: Cecil textbook medicine, ed 23, Saunders Mastering Healthcare Terminology/Chapter 4

Terms Related to Malignant Neoplasms
Basal cell carcinoma (BCC) Squamous cell carcinoma (SCC) Malignant melanoma Kaposi sarcoma (KS) (common is pt with AIDS) Basal cell carcinomas are the most common form of skin cancer. They originate in the lowest layer of the epidermis and usually occur on the face and other areas that are chronically exposed to the skin. Basal cell carcinomas rarely metastasize. Squamous cell carcinomas are the second most common skin cancers. These arise from squamous cells instead of basal cells, although like a BCC, they are also the result of sun exposure. Malignant melanoma is the result of mutated melanocytes. It is the leading cause of death for skin cancer. Kaposi sarcoma is a rare form of skin cancer that occurs most often in patients with deficient immune systems. The nodules, usually red/blue/brown/or purple, usually occur on the extremities. Squamous cell carcinoma From Damjanov: Pathology for the health professions, ed 3, Saunders Mastering Healthcare Terminology/Chapter 4

Clicker Question A fatty tumor is a/n: A. dermatofibroma
B. dysplastic nevus C. acrochordon D. lipoma Lipoma Lip/o = fat. This is a fatty tumor. Mastering Healthcare Terminology/Chapter 4

Age Matters Pediatrics Geriatrics Impetigo Acne Seborrheic dermatitis
Cellulitis Pediculosis Burns Geriatrics Corns Calluses Pressure sores Eczema Actinic keratosis Cellulitis Fungal infections Neoplasms Review the disorders/diseases for the age-related matters of children and the elderly. Ask the students why they think these diseases appear for each age group. Mastering Healthcare Terminology/Chapter 4

Terms Related to Biopsies (Bx)
Excisional biopsy Exfoliation Incisional biopsy Needle aspiration Punch biopsy Youtube link: Each of these biopsies involves examinations of living tissue (bi/o = life, living + -opsy= viewing). An excisional biopsy is is one in which the entire tumor is removed along with its borders as a means of diagnosis and treatment. Exfoliation is a scraping or shaving of samples of friable (easily crushed) lesions for examination. An incisional biopsy is a cutting of a wedge of tissue from a lesion followed by a suturing closed of the site. A needle aspiration biopsy is an aspiration of fluid from lesions for culture and examination. A punch biopsy is the insertion of a tubular punch through the skin to the subcutaneous tissue to extract a core of tissue for examination. Punch biopsy Mastering Healthcare Terminology/Chapter 4

Terms Related to Laboratory Tests
Bacterial analyses Fungal tests Sweat tests Tuberculosis (TB) skin tests Sweat test From Mosby's medical dictionary, ed 6, Mosby Bacterial analyses are cultures and serology of fluid removed from lesions to determine the type of bacteria. Fungal tests are scrapings of lesions such as tinea to determine the type of fungus. A sweat test is done to test for abnormally high levels of sodium and chloride that are characteristic of patients who have cystic fibrosis. An intradermal (intra- = within) test for tuberculosis is the Mantoux test. It uses purified protein derivative (PPD) to test for active or dormant tuberculosis. Mastering Healthcare Terminology/Chapter 4

Terms Related to Laboratory Tests (cont’d)
Tzanck test (hsv cells) Viral culture Wood’s light examination Wound and abscess cultures The Tzanck test is used to test for herpes zoster and herpes simplex. Viral cultures are samples of vesicular fluid to help identify the type of virus in a lesion. Wood’s light examination is a method of detecting tinea or pseudomonas in burns. Wound and abscess cultures are samplings that identify pathogens in diabetic or decubitus ulcers, postoperative wounds, or abscesses. Wood’s light examination From Wilson: Health assessment for nursing practice, ed 3, Mosby Mastering Healthcare Terminology/Chapter 4

Clicker Question Which type of examination technique is used to determine if a patient has either herpes simplex or herpes zoster? A. viral culture B. wound and abscess culture C. Tzanck test D. Wood’s light examination C. Tzanck test Mastering Healthcare Terminology/Chapter 4

Terms Related to Grafting Techniques
Skin grafting (SG) Dermatome Graft sources Autograft Allograft Xenograft Types of grafts Flap Split-thickness skin graft (STSG) Full-thickness skin graft Patients who need new skin may be candidates for skin grafting. A dermatome is an instrument to cut thin sheets of skin to be used for donor skin (dermat/o = skin + -tome = instrument to cut). Sources of skin can be an autograft (NOT an autograph!), which is skin that is taken from yourself (auto- = self). Skin for the face could be taken from an area that is not so visible, for example, the buttocks. An allograft is skin that is taken from a donor of the same species (all/o = other) and a xenograft (xen/o = foreign) is a temporary skin graft that is taken from another species. A synonym for an allograft is a homograft and a synonym for a xenograft is a heterograft (heter/o means different). Believe it or not, a xenograft can be from a pig! A flap is another term for a skin graft. These can be split-thickness, meaning that they are from the epidermis and part of the dermis. A full-thickness skin graft is from the entire epidermis and dermis. Autograft From Black and Hawks: Medical-surgical nursing, ed 7, Saunders Mastering Healthcare Terminology/Chapter 4

Terms Related to Other Therapies
Laser therapy Occlusive therapy Psoralen plus ultraviolet A (PUVA) therapy Laser therapy is used to repair or destroy tissue, such as port wine stains, tattoos, or psoriatic lesions. Occlusive therapy is the use of a dressing that closes off (occlus/o = closing) an area of the skin to increase the effectiveness of the absorption and the effectiveness of a medication. Psoralen plus ultraviolet A therapy is the use of ultraviolet light on psoriatic lesions. Mastering Healthcare Terminology/Chapter 4

Terms Related to Tissue Removal
Cauterization Cryosurgery Curettage Debridement Youtube link: Cauterization is the burning of tissues in order to destroy them. Cauter/i = burn. Cryosurgery is the use of extreme cold (cry/o = extreme cold) to destroy lesions. Curettage is the scraping of material from the wall of a cavity to obtain tissue for microscopic examination. The instrument used is a called a curette. Debridement is the first step in wound treatment; it is the process of removing dirt, foreign bodies, damaged tissue, and cellular debris from a wound or burn in order to prevent infection and promote healing. Curettage From HabifL Clinical dermatology, ed 4, Mosby Mastering Healthcare Terminology/Chapter 4

Decubitus Ulcers Inflammation, ulcer, or sore in the skin over a bony prominence. Most often seen in ages, debilitated, cachectic, or immobilized patients; pressure ulcers or sores are graded by stages of stages

Terms Related to Tissue Removal (cont’d)
Escharotomy Incision and drainage (I&D) Mohs surgery Shaving/paring Escharotomy From Monahan et al: Phipp’s medical-surgical nursing, ed 8, Mosby An escharotomy is an incision to cut (and remove) eschar, the scab that forms over a burn; it is done to prevent edema that can cause a lack of blood flow (ischemia) to the underlying tissue. Incision and drainage (I&D) is the cutting open and the removal of the contents of a cyst, wound, or other lesion. Don’t confuse this with ID, meaning intradermal (pertaining to within the skin). Mohs surgery is the repeated removal and microscopic examination of layers of a tumor until no cancerous cells are present. Shaving/paring is the slicing of thin sheets of tissue to remove lesions. Mastering Healthcare Terminology/Chapter 4

Terms Related to Cosmetic Procedures
Blepharoplasty Chemical peel Dermabrasion Dermatoplasty Dermabrasion From Fewkes et al: Illustrated atlas of cutaneous atlas, Churchill-Livingstone If you need your eyelids “done” you would have a blepharoplasty. Blephar/o = eyelid + -plasty = surgical repair. A chemical peel is the use of a mild acid to produce a superficial burn. This procedure is used to remove wrinkles and fine lines from the face. Dermabrasion (-abrasion = scraping of) is a surgical procedure to resurface the skin. It is used to remove acne scars, moles (nevi), wrinkles, and tattoos. Dermatoplasty, although literally the surgical repair of the skin, is the transplant of living skin to correct the effects of injury, operation, or disease. Mastering Healthcare Terminology/Chapter 4

Terms Related to Cosmetic Procedures (cont’d)
Lipectomy Liposuction Rhytidectomy Liposuction A lipectomy is the removal (-ectomy) of fat (lip/o). Liposuction is a technique for removing excess adipose tissue with a suction pump device. A rhytidectomy (rhytid/o = wrinkle) is a surgical procedure to remove wrinkles. This is commonly known as a facelift. Mastering Healthcare Terminology/Chapter 4

Clicker Question What is the destruction of tissue by burning?
A. cauterization B. cryosurgery C. débridement D. Mohs surgery Cauterization Cauter/i = burning Mastering Healthcare Terminology/Chapter 4

Pharmacology, Routes of Administration
Hypodermic (H) Intradermal (ID) Subcutaneous Topical Transdermal therapeutic system (TTS) ID injection Because the skin is the initial protective barrier, in order to administer medications, they will either need to be on, in, under, or through the skin. Hypodermic means pertaining to under (hypo-) the skin. Subcutaneous also means pertaining to under (sub-) the skin. Intradermal means pertaining to within (intra-) the skin. Topical is a type of drug that is applied directly onto the skin. It could be a cream, gel, lotion, or ointment. A transdermal therapeutic system delivers medication through (trans-) the skin by the use of a patch that allows for a specified time release of a medication. From Ignatavicius: Medical-surgical nursing, ed 5, Saunders Subcutaneous injection Mastering Healthcare Terminology/Chapter 4

Pharmacology Anesthetics Antibacterials Antifungals Antihistamines
Antiinflammatories Anesthetic agents are drugs to reduce pain and discomfort; they can be given topically on an affected area. Example include lidocaine and Solarcaine. Antibacterials are drugs that prevent and treat bacterial growth. Examples are bacitracin, Silvadene, erythromycin, and tetracycline. Antifungals are drugs that attack fungi. Examples are Lotromin, Nystat, and Spectazole. Antihistamines are drugs that decrease itching by reducing an allergic response. Examples are Benadryl, Chlor-rimetron, Zyrtec, and Claritin. Antiinflammatories are used to reduce inflammation and pain. Examples are Cortizone, Lidex, and Kenalog. Mastering Healthcare Terminology/Chapter 4

Pharmacology (cont’d)
Antipsoriatics Antiseptics Antivirals Emollients Immunomodulators/immunosuppressants Keratolytics Antipsoriatics are agents that specifically treat psoriasis, such as Drithocreme and Dovonex. Antiseptics are topical agents used to prevent infection by destroying microbials. Idone and Peridex are examples. Antivirals are drugs that are designed to decrease the effect of viruses, such as Valtrex and Zovirax. Emollients are topical substances that soften the skin. Lubriderm is a well-known example. Immunomodulators or immunosuppressants are agents that suppress the body’s immune system. Elidel and Protopic are examples of drugs that are used to treat atopic dermatitis and eczema. Keratolytics are topical substances used to break down hardened skin and shed the top layer of dead skin. They are used to treat warts, calluses, corns, acne, and psoriasis. Examples are salicylic acid, Benzac, and Condylox. Mastering Healthcare Terminology/Chapter 4

Pediculicides Protectives Retinoids Scabicides Pediculicides destroy lice. Malthion, lindane, and permethrin are examples. Protectives are topicals with sun protection factors (SPF). Retinoids are drugs that alter the growth of the top layer of the skin and are used to treat acne, wrinkles, and psoriasis. Examples are Retin-A, Accutane, and Tazorac. Scabicides are used to destroy mites and scabies. Examples are lindane, permethrin, and Eurax. Mastering Healthcare Terminology/Chapter 4

Aloe vera Tea tree oil Finally, herbal medicine is used to treat some skin disorders. Aloe vera is used to treat sunburn and stomach ulcers. Tea tree oil is used for its antibacterial, antiviral, and antifungal properties. Aloe plant Mastering Healthcare Terminology/Chapter 4

Clicker Question Which type of medication is used to treat lice?
A. retinoids B. scabicides C. pediculicides D. antivirals C. Pediculicides are used to treat pediculosis, the medical term for an infestation with lice. Mastering Healthcare Terminology/Chapter 4

Sort these terms into their correct categories.
1. clavus 2. paronychia 3. melanin 4. xenograft 5. needle aspiration Categories __ A + P __ Pathology __ Diagnostic Procedures __ Therapeutic Interventions A+P--melanin Pathology --paronychia, clavus Dx--needle aspiration Tx--xenograft

Parting Thought “Pleasure in the job puts perfection in the work.”
–Aristotle May you all have the opportunity to pursue the work you love! Mastering Healthcare Terminology/Chapter 4

Chapter Four Integumentary System

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Chapter Four Integumentary System

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