Skin and subcutaneous tissue

Skin and subcutaneous tissue
Chapter Four Skin and subcutaneous tissue Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Composition and Function of the Skin
Skini- 1st line defense from injury Subcutaneous tissue- fat Hair- Nails Sweat & sebaceous glands Function First line of defense Temperature regulation Sensation Synthesis of vitamin D Elimination of waste Word Parts derm/o, dermat/o, cutane/o = skin sub- = under trich/o, pil/o = hair onych/o, ungu/o = nail hidr/o, sudor/i = sweat seb/o, sebac/o = oil, sebum The skin and subcutaneous tissue, hair, and nails, along with the sweat and sebaceous glands, are all parts of the integumentary system. The term “integument” means a covering. Although the term integumentary is only used as a collective name for the system, there are many combining forms, prefixes, and suffixes to learn for all of the structures to be described. ICD- 10 calls this system “Skin and Subcutaneous Tissue.” 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. Vitamin D, a substance important to normal development of teeth and bones, is synthesized by the skin. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Diagram of the Skin Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Epidermis- outermmost layer Dermis/corium- middle
Layers of the Skin Epidermis- outermmost layer Dermis/corium- middle Hypodermis/subcutaneous layer- fat and connective tissue Word Parts epi- = above derm/o = skin a- = no, not without vascul/o = vessel -ar = pertaining to hypo- = below sub- = below cutane/o = skin adip/o, lip/o = fat 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. It is avascular, meaning that it has no blood supply. 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- meaning nder 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 Melanocytes Word Parts
Stratified squamous epithelium Basal layer: stratum germinativum Stratum spinosum Stratum granulosum Stratum lucidum Stratum corneum Keratinocytes Keratin Melanocytes Melanin Word Parts squam/o = scaly bas/o = basal germ/i = sprout nat/o = birth corne/o = hard, horny kerat/o = hard, horny -cyte = cell -in = substance melan/o = black The epidermis is composed of mostly avascular 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. 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. As they are pushed toward the surface, they are filled with a hard protein material, keratin, 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, which gives skin its color. Pigmentation is governed by the melanocytes 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. From the deepest to the top layer in order are the stratum germinativum, the stratum spinosum, the stratum granulosum, the stratum lucidum, and, finally, the stratum corneum. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Diagram of the Skin Point out the terms discussed on the previous slide. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Composed of vascular connective tissue Structures
Dermis Composed of vascular connective tissue Structures Blood and lymphatic vessels Nerves Hair follicles Sebaceous and sudoriferous glands (oil and sweat) Meissner’s corpuscles- provide sensitivity to light and touch Pacinian corpuscles- sense pressure Word Parts follicul/o = follicle hidraden/o = sweat gland 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 sudoriferous (sweat) and sebaceous (oil) glands. Meissner’s corpuscles provide sensitivity to light touch, while the Pacinian corpuscles sense pressure. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Subcutaneous Tissue Adipose tissue Word Parts sub- = under
cutane/o = skin -ous = pertaining to adip/o = fat -ose = pertaining to, full of Remember that the subcutaneous tissue is under the dermis and is composed of mainly adipose (adip/o = fat) tissue, which serves to insulate and cushion the body. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Review Question The hair follicles are located in the: A. dermis
B. epidermis C. subcutaneous tissue A. Dermis

Glands Sudoriferous glands: eccrine in hands feet and forehead secrete sweat and apocrine in armpits and groin Pores Perspiration Locations Sebaceous glands- oil Sebum- secretion of oil from sebaceous glands Word Parts sudor/i = sweat -ferous = carrying hidr/o = sweat ec- = out, outward -crine = to secrete apo- = separate, away from 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 for the process of sweating, 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. There are two types of sweat glands: the eccrine glands, which are located in the hands, feet, and forehead (their name is derived from their secretion to the outside of the body), and the apocrine glands, which are named for their action of part of the gland being broken off and secreted with the sweat before it is discharged to the surface of the body. The apocrine glands are located in the armpit and groin. Sebaceous glands secrete an oily substance termed “sebum,” which serves to lubricate the hair and the skin. Its acidic nature helps inhibit the growth of bacteria. Note that the combining form is not tricky; it’s simply seb/o. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Follicles- root and strand of each hair in the dermis
Shaft- part of the hair you can see Papilla –part underneath the shaft, that you can’t see Word Parts trich/o, pil/o = hair follicul/o = follicle papill/o = papilla eu- = healthy, normal phe/o = dark 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. Hair is colored by the pigment melanin: eumelanin gives hair a black or brown color, while pheomelanin results in red or blond hair. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Nails Word Parts The nail Nail body Nail root Nail bed Lunula
Eponychium (cuticle) Paronychium- folds Near the sides of nail Word Parts onych/o, ungu/o = nails epi- = above par- = near -um = structure 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. Note that in anatomic position with the palms forward, the nails face the back of the body. 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 Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Primary Lesions Word Parts Nodules- palpable solid lesions
Cysts-semisolid nodule Tumors- modle more than 2 cm Hematomas- collection of blood trapped in tissue Word Parts nod/o = knot -ule = small cyst/o = sac, bladder hemat/o = blood -oma = tumor, mass 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. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Petechia- tiny bruise in dermal layer
Primary Lesions Petechia- tiny bruise in dermal layer Ecchymosis- bruise into the subcu layer Purpura- massive hemorrhage under skin. Word Parts ec- = out chym/o = juice -osis = abnormal condition purpur/o = purple -a = noun ending 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 Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Primary Lesions Word Parts Macules- flat less than 1 cm Patches
Papules- raised solid less than 1cm Plaques Wheals-elevated and localized, such as a bug bite Word Parts macul/o = spot papul/o = pimple, papule 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. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Primary Lesions Word Parts
Vesicles/bullae- elevated and containing fluid and smaller than ½ cm Pustules- elevated and containg pus Telangiectasia- permanent dilation of groups of capillaries and venules. Word Parts vesicul/o = blister or small sac pustul/o = pustule tel/e = far angi/o = vessel -ectasia = dilation 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 = far + angi/o = vessel + -ectasia = dilation). Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Secondary Lesions Word Parts
Atrophy- paper think wasted skin seen in aging and stretch marks Striae (stretch marks) Cicatrix/cicatrices – scar Be Careful! Don’t confuse strata, meaning layers, with striae, meaning stretch marks. Word Parts a- = no, not, without -trophy = process of nourishment eschar/o = scab Cicatrix 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. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Secondary Lesions Word Parts Keloid Fissure
Keloid- type of scar that is an overgrowth Eschar- dried blood or pus, or scab Fissure- cracklike lesion Ulcer- craterlike lesion Word Parts eschar/o = scab Keloid 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. Fissure Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Cellulitis of upper leg
Infections of the Skin and Subcutaneous Tissue (L00-L08) and Bullous Disorders (L10-L14) Cellulitis- acute inflammation within solid tissue Omphalitis- inflammation of the navel Onychia- inflammation of a fingernail Paronychia- infection of the skin beside the nail Pyoderma- a bacterial skin disease containing pus Pilonidal cyst- growth of hair in a cyst Word Parts cellul/o = cell -itis = inflammation omphal/o = umbilicus onych/o = nail -ia = condition par- = near py/o = pus -derma = skin condition pil/o = hair nid/o = nest cyst/o = sac, bladder Cellulitis is a bacterial inflammation that is diffuse, spreading, and occurs within solid tissues. Omphalitis is an inflammation of the navel. Onychia is an inflammation of the nail. It is also called onychitis. 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. Pyoderma is a bacterial purulent (containing pus) skin infection. Pilonidal cysts are located in the sacral region of the back and are hairs that grow in a cyst. Cellulitis of upper leg Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

paronychia pyoderma

Infections of the Skin and Subcutaneous Tissue (L00-L08) and Bullous Disorders (L10-L14)
Abscess- collection of pus anywhere in the body Furuncle – staphylococcal skin infection originating in a gland Carbuncle- two or more furncles connected by subcutateous pockets Impetigo- vesicopustular skin infection in children. carbuncle 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. Impetigo Furuncle Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Dermatitis and Eczema (L20-L30)
Atopic dermatitis- chronic, pruitic, superficial inflammation of the skin associated with allergies Contact dermatitis- irritated or allergic response of the skin that can lead to acute or chronic inflammation. Eczema- inflammation of the skin characteried by vesicles, weeping and pruritus Pruritus- itching Seborrheic dermatitis- scaling disease of the scalp and face Word Parts a- = no, not, without top/o = place, location dermat/o = skin -itis = inflammation prurit/o = itching seb/o = sebum -rrheic = pertaining to discharge Atopic dermatitis is a chronic, pruritic superficial inflammation of the skin that usually occurs in families that have a history of allergic disorders. 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. Pruritus is the medical term for itching. Terms that use pruritus may be described by the area that the itching occurs in: ex. scroti, vulvae. Careful! Note the spelling of pruritus, meaning itching; it is often misspelled. It’s not an inflammation! Seborrheic dermatitis is an inflammatory scaly disease of the face and scalp. In children it is commonly called cradle cap. Contact dermatitis Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Atopic dermatitis exczema Seborrheic dermatitis

urticaria Actinic keratosis Word Parts
Papulosquamous (L40-L45), Urticaria and Erythema (L49-L54), and Radiation Related Disorders of Skin and Subcutaneous Tissue (L55-L59) Psoriasis- chronic skin disorder characteried by salmon red patches cover by thick dry silvery scales Actinic keratosis- skin lesions caused by prolonged sun exposure Urticaria- wheals, or hives Word Parts act/i = rays -in = substance kerat/o = hard, horny -osis = abnormal condition 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. Actinic keratoses are skin lesions that are caused by prolonged sun exposure. Urticaria is a skin condition characterized by wheals. Causes are allergies, stress, insect bites, and/or drugs. Another name is hives. Psoriasis urticaria Actinic keratosis Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Disorders of Skin Appendages (L60-L75)
Acne vulgaris Comedones- plugs of Oil that partially block A pore Alopecia- hair loss 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. Alopecia Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Anhidrosis- little or no sweat production Hidradenitis suppurativa- inflammation of sweat glands Hyperhidrosis- excessive sweating Bromhidrosis- abnormal body odor Hypertrichosis- excessive hair Folliculitis- inflammation of hair follicles Word Parts an- = no, not, without hidr/o = sweat hidraden/o = sweat gland hyper- = excessive brom/o = odor, stench trich/o = hair follicul/o = follicle Anhidrosis 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 temperature.) 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. Suppurativa refers to the presence of pus from a resulting infection. Hyperhidrosis is an abnormal condition of excessive sweating. Hyper- means excessive and, again, hidr/o = sweat and -osis = abnormal condition. Bromhidrosis is a disorder of the apocrine sweat glands, causing an unpleasant body odor. Discuss the difference between the combining forms hydr/o and hidr/o. Folliculitis is an inflammation of the hair follicles (follicul/o = follicle). These inflammations can be superficial or deep, acute or chronic. Hidradenitis suppurativa Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Word Parts Disorders of Skin Appendages (L60-L75) Hypertrichosis- excessive hair Poliosis- localized patch of gray or white hair due to lack of melanin caused by disease Keratinous cyst- benign cavity filled with oil and epithelial debris Milia- tiny keratinous cysts caused by clogged oil ducts Miliaria– vesicles and papules surrounded by redness caused by occlusion of sweat ducts during times of exposure to heat and high humidity hyper- = excessive trich/o = hair -osis = abnormal condition poli/o = gray kerat/o = hard, horny -in = substance -ous = pertaining to Hypertrichosis is an abnormal condition of excessive hairiness. Hyper- = excessive + trich/o = hair + -osis = abnormal condition. A synonym is hirsutism. Poliosis is localized patches of gray or white hair, usually caused by disease. A keratinous cyst is a benign cavity filled with epithelium that has become hardened (keratinized), sebum, and epithelial debris. As discussed earlier, 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. Miliaria is a condition of occluded (blocked) sweat ducts. Discuss the Be Careful! for milia and miliaria. milia miliaria Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Onychocryptosis- hidden or ingrown nail Onycholysis- separation of the nail plate from the bed Onychomalacia- soft nails Onychogryphosis- thick and curved finger or toe nails Onychodystrophy- abdnormally developed finger or toe nails. Word Parts onych/o = nail crypt/o = hidden -lysis = loosening -malacia = softening gryph/o = curved dys- = abnormal -trophy = nourishment, development 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. Onychogryphosis is abnormally curved and thickened finger or toe nails. Onychodystrophy is an abnormally developed finger or toe nail. Onycholysis Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Other Disorders of the Skin and Subcutaneous Tissue (L80- L99)
Callus- thickening of the stratum corneum at locations of external pressure or friction. Corn/clavus- condensed epithelial cells overlaying a bony prominence as the Result of pressure Pressure sore/decubitus ulcer/ bedsore- results from immobilized patients, inflammation, ulcer or sore Ichthyosis- dry skin that has the scaly appearanc e of a fish. 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 are a pressure sore or pressure ulcer. You may have seen them referred to as bedsores. The term decubitus comes from a Latin noun meaning 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. The milder form is xeroderma. Xer/o = dry. Stages 1-4 decubitus ulcers Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Dyschromia- abnormality of skin pigmentation Hyperchromia- increased pigmentation Hypochromia- decreased pigmentation Vitiligo- irregular patches of pigment Leukoderma- loss of pigmentation Word Parts dys- = abnormal chrom/o = color hyper- = excessive hypo- = decreased leuk/o = white -derma = skin 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. Leukoderma is a loss of skin pigmentation (leuk/o = white, -derma = skin). Vitiligo Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Lentigo- age spots Skin tags- soft lesions that are an outgrowth of epidermis and dermal tissue Discoid lupus erythematosus (DLE)- autoimmune skin condition characterized by red, round-shaped lesions Seborrheic keratosis- benign pigmented warty lesion Xerosis cutis- dry skin Word Parts disc/o = disc erythemat/o = red seb/o = sebum -rrheic = pertaining to drainage ketat/o = hard, horny -osis = abnormal condition xer/o = dry cut/o = skin -is = noun ending A lentigo (pl. lentigenes) is darkened macules caused by sun exposure. Otherwise known as “age spots”. 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. Discoid lupus erythematosus (DLE) is an autoimmune skin condition characterized by red, round-shaped lesions. 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). Don’t confuse seborrheic keratosis with an actinic keratosis is a hardened skin lesion that is caused by exposure to the sun. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Viral Infections Characterized by Skin and Mucous Membrane Lesions (B00-B09)
Exanthematous diseases Herpes simplex virus (HSV) HSV-1- cold sores HSV-2- genital herpes Herpes zoster- painful rash, part of chicken pox family Verruca- wart Herpes zoster 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 are viral infections that 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). Verruca Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Candidiasis-yeast infection of skin Dermatomycoses
Tinea Capitis- scalp ringworm Corporis-ringworm Cruris-jock itch Pedis- athlete’s foot Onychomycosis- nail fungus Word Parts dermat/o = skin myc/o = fungus -osis = abnormal condition capit/o = head -is = structure corpor/o = body crur/o = leg ped/o = foot onych/o = nail Onychomycosis 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. Fungal infections are named by the specific body 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. Tinea corporis Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Pediculosis, Acariasis, and Other Infestations (B85-B89)
Pediculosis- lice Scabies- mite infestation Word Parts pedicul/i = lice -osis = abnormal condition 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. Pediculosis Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Burns Degrees of burns First/superficial thickness Second
Superficial partial thickness Deep partial thickness Third/full thickness Fourth/deep full thickness 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, and subcutaneous layer, along with the muscle and/or bone underneath. This is also called a deep full-thickness burn. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Angioma- localized vascular lesion
Benign Skin Growths Angioma- localized vascular lesion Hemangioma Dermatofibroma- fibrous tumor of the skin that is painless, round, firm and usually found on the extremeties Lipoma- fatty tumor that is soft and movable. Word Parts angi/o = vessel -oma = tumor dermat/o = skin fibr/o = fiber lip/o = fat 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 Lipoma Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Benign Skin Growths Dysplastic nevus- mole Dysplastic nevus
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). Dysplastic nevus Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Malignant Neoplasms Basal cell carcinoma (BCC) Kaposi’s sarcoma (KS)
Malignant melanoma Squamous cell carcinoma (SCC) Squamous cell carcinoma 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. Kaposi’s 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. Malignant melanoma is the result of mutated melanocytes. It is the leading cause of death for skin cancer. 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. Squamous cell carcinoma on the ear Malignant melanoma on arm Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Biopsies (Bx) Excisional biopsy- entire tumor removed
Exfoliation-scraping or shaving samples Incisional biopsy-cutting of a wedge of tissue Needle aspiration- withdrawing fluid Punch biopsy- using a punch to extract core Each of these biopsies involves examinations of living tissue (bi/o = life, living + -opsy= viewing). An excisional biopsy 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 Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Laboratory Tests Bacterial analyses Fungal tests Sweat tests
Tuberculosis (TB) skin tests Sweat test 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. Mantoux test Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Laboratory Tests Wood’s light examination
Tzanck test- examining lesions under microscope for herpes and herpes zoster Viral culture- sampling of vesicular fluid for the purpose of identifying a virus Wood’s light examination- identifies skin infections through ultraviolet light such as tinea capitis Wound and abscess cultures-lab samplings that can identify pathogens Wood’s light examination 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. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Grafting Techniques and Other Therapies
Skin grafting (SG) Dermatome Graft sources Autograft Allograft Xenograft Types of grafts Flap Split-thickness skin graft (STSG) Full-thickness skin graft Autograft 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. Epithelial autograft Dermatome Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Grafting Techniques and 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. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Tissue Removal and Other Procedures
Cauterization Cryosurgery Curettage- scraping Débridement- removing debris Curettage 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. Débridement 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. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Escharotomy- surgical incision into dead tissue resulting from severe burn Incision and drainage (I&D)- cutting open and removing contents of a wound or cyst Shaving/paring- slicing thin sheets of tissue to remove lesions Escharotomy 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). Shaving/paring is the slicing of thin sheets of tissue to remove lesions. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Mohs Surgery Mohs surgery is the repeated removal and microscopic examination of layers of a tumor until no cancerous cells are present. Maps of tumor location drawn from frozen section specimens indicate areas of remaining tumor that must be removed. Repeated removal and microscopic examination of layers of a tumor until no cancerous cells are present. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Onychectomy- removal of a nail Onychoplasty- surgical treatment that usually includes removing the nail matrix Onychotomy- cutting the nail to drain subungal hematoma Word Parts onych/o = nail -ectomy = cutting out -plasty = surgically formation -tomy = cutting An onychectomy is a removal of a nail, usually to treat trauma. An onychoplasty is the removal of the nail matrix to treat ingrown toenails. An onychotomy is a cutting of a nail to drain a subungual hematoma. Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Cosmetic Procedures Blepharoplasty- surgical repair of eyelid
Chemical peel- use of acid to produce mild burn to remove wrinkles Dermabrasion-resurface skin Dermatoplasty-transplant of living skin Word Parts blephar/o = eyelid -plasty = surgically forming derm/o = skin -abrasion = scraping Dermabrasion 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. Chemical peel Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Lipectomy- removal of fat tissue
Cosmetic Procedures Lipectomy- removal of fat tissue Liposuction- removing fat with suction pump Rhytidectomy- face lift Word Parts lip/o = fat -ectomy = cutting out rhytid/o = wrinkle 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. Liposuction of the neck Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Pharmacology Anesthetic agents- reduce pain and discomfort
Antibacterials – prevent and treat bacteria Antifungals –prevent and treat fungal infections Antihistamines- reduce allergies Anti-inflammatories- reduce inflammation Antipsoriatics –treat psoriasis Antiseptics – prevent infection by destroying microbials Antivirals- reduce the effect of viruses. Anesthetic agents: reduce pain and discomfort Antibacterials: prevent and treat bacterial growth Antifungals: treat fungal infections Antihistamines: lessen itching by reducing an allergic response Anti-inflammatories: reduce inflammation and pain Antipsoriatics: treat psoriasis Antiseptics: topical agents used to prevent infection by destroying microbials Antivirals: reduce the effect of viruses Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

Pharmacology Emollients – soften skin
Immunomodulators or immunosuppressants- supress immune response Pediculicides –destroy lice Protectives –spf’s that protect skin Retinoids –alter growth of the top layer of skin Scabicides- destroy mites and scabies Emollients: topical substances that soften the skin Immunomodulators or immunosuppressants: agents that suppress the body’s immune system Keratolytics: topical substances used to break down hardened skin and shed the top layer of dead skin Pediculicides: destroy lice Protectives: topicals with sun protection factors (spfs) that protect the skin against ultraviolet a and b in sunlight Retinoids: alter the growth of the top layer of skin and may be used to treat acne, reduce wrinkles, and treat psoriasis Scabicides: destroy mites and scabies Medical Terminology and Anatomy for ICD-10 Coding/Chapter 4

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Skin and subcutaneous tissue

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