1. Chapter 10
Skin, Hair, and Nails

2. Competencies
Describe the anatomy and physiology of the integumentary system.
Explain the process of describing and classifying skin lesions.
Identify common skin lesions and discuss possible etiologies.
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3. Competencies
Identify pathophysiological changes to hair and nails and discuss possible etiologies.
State the warning signs of carcinoma in pigmented lesions.
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4. Competencies
Describe methods used to examine integumentary changes in both light- and dark-skinned patients.

5. Integumentary System
Covers approximately 20 square feet on the average adult
Thickness varies from 0.2 mm to 1.5 mm
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6. Integumentary System Layers Epidermis Dermis
Hypodermis (subcutaneous tissue)

7. Glands of the Skin Sebaceous Sweat Sebum-producing glands
Found everywhere in dermis except for the palmar and plantar surfaces
Sweat
Apocrine glands
Eccrine glands

8. Hair
Distributed over the entire body surface except palmar and plantar surfaces, lips, nipples, and glans penis
Vellus
Terminal hair
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9. Hair Hair shaft is composed of the cuticle, cortex, and medulla
Melanocytes

10. Nails Matrix Nail plate Nail root Nail bed Periungual tissues Lunula
Examine color of nail bed

11. Functions of the Skin Serves as a protective barrier
Temperature regulation
Sensory organ—pain, touch, pressure, temperature
Serves as an organ of excretion

12. Functions of Hair and Nails
Warmth
Protection
Sensation
Nails
Protection to distal surface of digits

13. Melanoma Risk Factors Ultraviolet light exposure
Family history of skin cancer
Severe sunburns as a teenager or child
Fair-skinned people with light-colored eyes and hair
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14. Melanoma Risk Factors > 50 moles Dysplastic nevi
Age > 65 years old

15. Basal and Squamous Cell Cancer Risk Factors
Ultraviolet light exposure
Fair-skinned people with light-colored hair and eyes
Chemical exposure
Radiation therapy
Personal history of skin cancer
Smoking

16. Skin Care Habits Ask the patient questions to determine use of
skin care products
hair removal products
home remedies to treat skin irritations
a tanning bed
sun protection
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17. Skin Care Habits Ask the patient questions to determine
frequency of bathing or showering
previous reaction to jewelry (metal)

18. Hair Care Habits Ask the patient questions to determine use of
hair care products
chemicals on hair
wig or hairpiece
hair dryer, heated curlers, or curling iron
Ask if patient has experienced changes to hair (color, texture, or loss)

19. Nail Care Habits Ask the patient questions to determine
type of nail care practiced, including manicures or pedicures
nail biting
nail splitting or discoloration

20. General Examination of Integumentary System
Well-lit room
Good visualization
Explain examination process to patient
Provide warmth and privacy
Cephalocaudal examination

21. Equipment Magnifying glass Good lighting, natural light preferred
Penlight
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22. Equipment
Clean gloves
Microscope slide
Small centimeter ruler

23. Inspection of the Skin Cephalocaudal approach
Anterior and lateral aspects of skin
Dorsal and palmar surfaces of skin
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24. Inspection of the Skin Color Cyanosis Jaundice Carotenemia Pallor
Redness
Dependent rubor
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25. Inspection of the Skin Bleeding Ecchymosis
Assess mucous membranes, previous venipuncture sites, or lesions
Petechiae
Purpura
Ecchymosis
May be sign of physical abuse
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26. Inspection of the Skin Vascularity Spider angioma Venous star
Cherry angioma
Strawberry hemangioma
Nevus flammeus
Necrosis
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27. Inspection of the Skin Lesions Document anatomic location
Assess arrangement or grouping: localized, regionalized, or generalized
Note if any exudate present
Note the morphology

28. Mnemonic for Evaluating Lesion
A (asymmetrical)
B (borders)
C (color)
D (diameter)
E (elevation)

29. Types of Lesions
Nonpalpable
Macule
Patch
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30. Types of Lesions
Palpable
Papule
Plaque
Nodule
Tumor
Wheal
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31. Types of Lesions Fluid-filled cavity Vesicle Bullae Pustule Cyst
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32. Types of Lesions Above the skin surface Scales Lichenification Crust
Atrophy
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33. Types of Lesions Below the skin surface Erosion Fissure Ulcer Scar
Keloid
Excoriation

34. Wound Evaluation
Location
Color
Drainage
Odor
Size
Depth
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35. Wound Evaluation
Measure the borders
Draw a picture to depict wound

36. Stages of Pressure Ulcers
Skin is reddened but intact
Stage 2
Epidermal and dermal layers are injured
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37. Stages of Pressure Ulcers
Subcutaneous tissues are injured
Stage 4
Muscle and perhaps bone are injured

38. Identifying Burns First-degree Epidermis is injured or destroyed
Skin is red, dry, painful
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39. Identifying Burns Second-degree
Epidermis and upper layers of dermis are destroyed
Skin is red, blistery, painful
Also called partial-thickness burn
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40. Identifying Burns Third-degree
Epidermis and dermis are destroyed, subcutaneous tissue is injured
Hair follicles, sweat glands, and nerve endings are destroyed
Skin is white, red, black, tan, or brown
Also called full-thickness burn
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41. Identifying Burns Fourth-degree Epidermis, dermis are destroyed
Subcutaneous tissue, muscle, and bone may be injured
Hair follicles, sweat glands, and nerve endings are destroyed
Skin is white, red, black, tan, or brown

42. Palpation of the Skin Moisture Temperature Xerosis Diaphoresis
Hypothermia
Hyperthermia
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43. Palpation of the Skin Tenderness Should be nontender
Tenderness can be localized or generalized
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44. Palpation of the Skin Texture Turgor Smooth Rough
Decrease may be associated with dehydration
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45. Palpation of the Skin Edema
Note the presence of fluid accumulation in the intercellular spaces
Assess dependent areas
Use 4-point scale to rate severity
Assess symmetry

46. Types of Edema Pitting Nonpitting Angioedema Dependent Inflammatory
Noninflammatory
Lymphedema

47. Inspection of Hair Color Distribution Scalp lesions Palpate texture
Alopecia
Hirsutism
Scalp lesions
Palpate texture

48. Inspection of Nails Color Shape and configuration Palpate texture
Nail angles
Palpate texture