1. Unit 4 SKIN and SOFT TISSUES
‘Love the skin you are in’ , a small take off of a song I heard from the 70’s. This unit we will get under our skin.

2. Targeted Learning
1. Recognize word parts and the assembly of medical terms as related to skin and soft tissues.
2. Correctly construct, define, pronounce, and spell medical terms.
3. Link skin and soft-tissue diseases and injury with appropriate diagnostic evaluation, pharmacotherapeutics, surgical, and non-surgical treatments.
4. Relate skin and tissue injuries to documentation using medical terminology.
5. Explore the use of the ICD Index of External Causes with skin injuries.
As usual, we have targeted learning goals

3. Skin Derm/o Dermat/o Cut/i Cutane/o
From tattoos to body piercing to rashes and mosquito bites, we are all pretty familiar with our skin. Of all our organs, it is the one we see in action everyday. It has the two layers, the epidermis and the dermis, together they protect us from heat, cold, UV rays, bugs, rain and many other assorted scrapes and bumps. This man was bitten by a rattle snake 10 hours ago.

4. The Skin Epi/derm/is Derm/is Hypo/derm/is Muscle Nerve endings
Hair follicles
Tiny muscles
The epidermis is the top layer, 30 plus layers of epithelial cells tightly packed, flattened and waxed to create a barrier to scratches and insects and more. The Dermis is the supporting character with blood supply, lymphatics and nerve endings to feel hot, cold, pressure, and the finest touch.
There are sweat glands and oil glands, and a tiny muscle for each hair, arrector pili. The hypodermis is below supporting, cushioning, adding temperature control and providing the anchor to keep the skin in place.

5. Words about Skin Derma/tome Dermat/itis Derm/o/plasty Hypo/derm/ic
Cutane/ous
Cuti/cle
Sub/cutane/ous
Dermoid
Intradermal
Derm or dermat/o are used much more often when describing the skin versus when on the skin –that is cutane/o. We stick hypodermic needles in the skin to draw blood or place an allergy test. We give medications intradermally. A subcutaneous needle goes into the underlying adipose tissue. These are all common words of skin in documentation.

6. Skin colors Eryth/o > red Cyan/o > blue Xanth/o > yellow
Chlor/o > green
Leuk/o > white
Melan/o > black
-cytes > cells
-plakia > patches
-osis > condition of
-emia > blood condition
-penia > too few
-oma > tumor
These color terms are used often to describe skin. “The skin is erythematous with yellow vesicles grouped over the 5th dermatome.” “The AIDS patient has developed a leukoplakia’. ‘Ms. D’s melanoma was found on her temple.’ ‘Little Joey has cyanosis’. Of the six colors, you see Chlor/o and Xanth/o the least often.

7. Primary Skin Lesions Papules Nodules Vesicles Bulla Pustules
Tel/angi/ectasia
The skin lesion seen in this picture would be termed a vesicle, bulla, or blister. It is fluid–filled, which is the definition of the three terms—area filled with clear fluid. If it was full of pus (infected), it would be termed a pustule or abscess. How we describe the lesions tells the next provider or reader much about the lesion and even expectations of wellness.

8. Secondary skin descriptions
Lichenification
Scale
Annular
Nummular
Burrows
Crust
Cysts
Bite
I should have added BITE to the secondary descriptions. This is a dog bite with at least 6 puncture wounds in a mouth pattern. Human bite, bat bites, dog bites, it makes no difference the skin does not like them. The bacteria from the dog’s teeth is essentially inoculated in the dermis and hypodermis and it is a warm, dark, wet, and happy place for bacteria to grow. Then, you will have crusting. All descriptives give the reader a starting point from day 1… a measure on how things are improving or not.

9. More secondary descriptives
Atrophy
Scars
Keloids
Bunions
Calluses
Rashes
Ulcers
Fissures
Bunions are actually a combination of the underlying bone AND the skin reacting to the constant pressure of shoes. The skin reacts to many irritants from poison ivy to viral illness to skin that is too dry or too wet. The photo is a skin graft over the forefoot. You can see areas of raised scarring—this is keloid and other places where it has flattened out and become atrophied. This is not normal skin tissue, it has a poor blood supply because it was just epidermis and any injury to it could send the patient back for more surgery.

10. Hair, an accessory Trich/o > hair Pil/o > hair Alopecia
Alopecia aerata
Trich/o/myc/osis
Pil/o/nidal
Compared to the animals we are pretty hairless but when you count them all up we have 5 million plus. Hair is protective, it helps warm, it is a warning system, and it helps keep debris off the skin, out of eye, ears and nose. Hair is properly part of the epidermis, the epithelial cells dive deep (invaginate) to set the hair bulb and its associated sebaceous gland (oil gland). The tiny arrector pili muscle raised our ‘hackles’ when it is cold (generating heat), when we are scared or when a fly lands on our arm.

11. Skin glands Sebaceous Sweat > hidr/o Eccrine
Secrete water and electrolytes
Sudoriferous
Apocrine
Responsible for odors
Ceruminous
Ear wax
Sweating is an important function of wellness. Sweat modifies our temperature, more sweating to let more heat out. Shivering on the other hand is designed to generate heat for all those arrector pili muscles working and we don’t sweat when it cold. A common ailment is hyperhidrosis is too much sweating common to the feet. Sweating does not create odor. The sudoriferous glands do.

12. Nails Onych/o Ungu/o Onych/o/myc/osis Par/onych/ia Sub/ungu/al
An ingrown toe nail is a common ailment of the nails—this is paronychia, the hard nail is literally trying to grow into the skin, it cannot clear the edge. A partial nail removal is often done after the infection is calmed down > Partial onychectomy. Onychomycosis is the fungal infection of the nails that usually takes oral anti-fungal medications.

13. Designed Punctures
The medical folks are always blood letting or poking a needle in the skin for a variety of reasons. Intradermal puts the medication into the dermal layer, just beneath the epidermis. A common use for this is the TB skin test that makes a perfect little round wheal when done correctly (see the figure). Subcutaneous will bypass the epidermis and dermis and put medications into the fatty connective tissue. IM is a shot into the muscle. Drawing blood and giving intravenous medication puts the needle into the vein.

14. SKIN INJURY
There are many terms to describe skin injury. Lacerations, abrasions, and punctures actually break through the epidermis and/or dermis. Contusions bruise the tissue with disseminated blood. A hematoma is a collection of blood trapped. It is like a bulla or vesicle except it is filled with blood. These can be emergencies if they occur over a major vessel or nerve due to the compression the mass creates. It takes up space!

15. Cleavage Lines Early textbook drawing of 1903
Depicts natural texture lines.
Each ridge of the epidermis is dotted with many sweat pores for its entire length and is anchored to the  dermis by a double row the peglike protuberances, or papillae we have seen in the illustrations. Injuries such as superficial burns, abrasions, or cuts do not affect the ridge structure or alter the dermal papillae, and the original pattern is duplicated in any new skin that grows. Those same ridges give the rest of our skin our cleavage lines, the line a surgeon wants to follow to minimize damage as seen in this early textbook drawing of 1903.

16. Burns 1st degree: red and painful > epidermis
2nd degree: red and vesicles with bullae > dermis
3rd degree: red, vesicles & bullae, and subcutaneous tissue even muscle > Subcutaneous
In years past a 4th degree included the muscle and the 5th degree was bone. These are seldom used any more because the damage is done at the 3rd degree. The science of burn care improves on a daily basis. 30 years ago a person with 60% burns did not live, today they do. It is a slow process though--dependent on avoiding infections and maintaining fluids for the patient. The patient pictures had full 3rd degree to his back and arm.

17. Bruises Contusion Ecchymosis Petechia Bruise Purpura Hemat/oma
This photograph could be described by all these terms except petechia. If it is raised it is more likely going to be called a contusion or hematoma. They are commonly interchanged. I would term this an ecchymosis due to its size and deep purple coloring.

18. Destruction Ablation > destruction of tissue or function
Fulguration > destroy by high frequency electric current
Curettage > scraping inside a cavity to remove tissue
Cryosurgery > destroy tissue with liquid nitrogen
Cautery > device to scar, burn, or cut tissue
Electr/o/dessic/ation > destroy or seal tissues with monopolar electrical current
Surgery in and outside the body includes these destructive processes. Fulguration and electrodessication are essentially the same process, named at different times. In the OR (operating room), we ask for the ‘Bovie’ which is a brand of these instruments. All electrical destruction requires the machine to be grounded to avoid electrocuting the surgery staff and patient.

19. Initial Sets BCC C&S ED&C FST GBS I&D HIV HPV HSV IM, IV PST SCC VZV
MMS
This learning encounter has an abundance of acronyms that are not only used in reference to skin but to other body systems as well.
BCC > Basal cell carcinoma
C&S > Culture and sensitivity (to grow bacteria, virus, fungi)
ED&C > Electrodesiccation & curettage
FST > Full skin thickness
GBS > Group B strep a potentially serious skin infection
I&D > Incision and drainage
HIV > Human immunodeficiency virus
HPV > Human papilloma virus
HSV > Herpes simplex virus
IM, IV > layers of skin to poke: intramuscular, intravenous, subcutaneous
PST > Partial skin thickness
SCC > Squamous cell carcinoma
VZV > Varicella zoster virus (shingles)
MMS > Mohs micrographic surgery

20. Linking Forms Adip/o > fat Arteri/o > artery
Bas/o > basic, neutral
Capillo/ > capillary
Cocc/i > round
Corne/o > hard, scaly
Dendr/o > branching
Elast/o > elastic
Fasci/o > band
Fibr/o > fiber
Follicul/o > follicle
Hidr/o > sweat
Myc/o > fungus
Ped/o > foot or child
Py/o > pus
Theli/o > layers
You will have noticed that many linking forms, suffixes, and prefixes are repeating unit to unit, this is because repetition is good AND the systems interact and depend on each other.
For your end of lecture question, give the linking forms for
Wrinkle
Oily
Grape cluster
Hair
Vein
Answers will be on the last slide.

21. Building Words Onychomalacia Dendrocyte Dermoplasty Arteriorrhaphy
Elastoid
Fibrocystoma
Eosinophil
Pyogenic
Cellulitis
Streptococcus
Hemostasis
Intravenous
Subungual
Hyperhidrosis
A little word building exercise for you. Look for the word root, the prefixes and suffixes, look up the word. Then build some of your own. Practice, practice, practice.

22. Answers Wrinkle > Rhytid/o Oily > Seb/o or Sebace/o
Grape cluster > Staphyl/o
Hair > Trich/o or Pil/o
Vein > Ven/o
Good job – did you get fibrocystoma? You had not seen it yet. You are on track! Study well.

23. Building Words Answers
Onych/o/malacia
Dendr/o/cyte
Derm/oplasty
Arteri/o/rrhaphy
Elast/oid
Fibr/o/cyst/oma
Eosin/o/phil
Py/o/gen/ic
Cellul/itis
Strept/o/coccus
Hem/o/stasis
Intra/ven/ous
Sub/ungu/al
Hyper/hidr/osis
A little word building exercise for you. Look for the word root, the prefixes and suffixes, look up the word. Then build some of your own. Practice, practice, practice.
Onychomalacia > softening of the nails
Dendrocyte > branching cells
Dermoplasty > repair of the skin
Arteriorrhaphy > suturing an artery
Elastoid > like elastic
Fibrocystoma > tumor of fibrous sac
Eosinophil > to like ‘rosy’ color (type of WBC)
Pyogenic > related to beginning fever (heat)
Cellulitis > inflammation of the cells
Streptococcus > bacteria type, curved strand of round elements
Hemostasis > to stop bleeding
Intravenous > related to inside the vein
Subungual > pertaining to under the nail
Hyperhidrosis > abnormal condition of excessive sweating

24. Copyright©2009 Taylor & Francis Group, an informa business
References
Slide 15: Textbook of Operations 1903 by Theodore Kocher and Harold Stiles. Subject: Surgery. Publisher: London, Adam and Chablack. Public Domain.
Slide17:
surgery_bruise.jpg. Public Domain
Copyright©2009 Taylor & Francis Group, an informa business