1. Integumentary System Altered Functions

2. Vocabulary Derma- Melan/o- Pachy- Sub- trich/o- Cyan/o- Onych/o- Xer/o- Hidr/o- Kerat/o- Xanth/o- Follicul/o- Dactyl/o- Intra-

3. Integumentary Regions Skin –Epidermis –Dermis Hypodermis Sensory receptors Muscle Adnexa –Hair and follicle –Glands Sweat Sebaceous –Nails

4. Epidermis Histology Overview

5. Epidermis Strata Histology C = corneum G = granulosum S = spinosum B = basale

6. Underlying Disorders Genetic Connective tissue Blood supply Neoplasia Drug Reactions Immune

7. Primary Lesions Macules: colored circumscribed flat area, size varies, < 1cm Papules: discolored raised area, < 2cm Plaques: raised flat top area, > 1cm Patches: circumscribed flat area of discoloration, < 1cm Nodules: solid raised area, above or below skin, <1 cm Tumor: discolored raised area, > 2cm Wheals: slightly raised area with edema, size varies Vesicles/Blister: fluid filled raised area < 0.5cm Bulla/Cyst: fluid filled raised area, > 0.5cm Pustules: pus-filled raised area, size varies

9. Macule

10. Nodule

11. Papule

12. Bulla

13. Secondary Lesions Erosions Ulcers Fissures Cracks Scales Excoriation Keloid Scar Lichenification

14. Cracks and Fissures

15. Ulcer and Erosion

16. Excoriation

17. Lichenification

18. Scar Formation

19. Keloid

21. Epidermal Cells

23. Keratinocytes

24. Keratinocyte Hypertrophy

25. Melanocyte location and function

26. Melanosomes with Melanin

27. Melanin

28. Melanosis

29. Langerhans Dendritic Cells

30. Skin Cancers

31. Skin Cancer ABCD and E (evolving)

32. Etiology UV exposure –UV A –UV B Genetic Prevention –Sun block UVA UVB –Clothing –Window tinting

33. Skin Tumors Benign –Seborrheic keratitis –Keratocanthoma –Verucae (warts) –Actinic keratitis Malignant –Basal Cell carcinoma –Squamous Cell carcinoma –Dysplastic nevi –Malignant melanoma

34. Seborrheic Keratosis

35. Keratocanthoma

36. Verrucae

37. Actinic Keratitis

38. Basal Cell Carcinoma

39. Squamous Cell Carcinoma

40. Epidermal Cancers Compared

41. Malignant Melanoma

42. Merkel Cell Carcinoma

43. Dermis

44. Dermal Papilla and Reticular Dermis

45. Lines of Cleavage

46. Aging = Wrinkles? Skin changes –Chronological aging –Photo-aging (sun damage) –Chemical toxins Cause –Decrease in collagen (inactive fibroblasts) –Increase in proteolytic activity due to collagenase

47. Hypodermis

48. Subcutaneous tissue

49. Clinical Application

51. Dermatitis (Eczema) Atopic Contact Seborrheic Drug eruption Photo-eczematous

52. Dermatitis reactions Presentation Papulovesicular Oozing with crusts Scaling plaques

53. Contact Dermatitis

54. Seborrheic Dermatitis Dandruff; Cradle Cap

55. Drug Eruption

56. Photoeczematous UV Genetic: Porphyria Drug Induced –Oral –Topical Lupus

57. Venous Stasis Dermatitis

58. Cutaneous Membrane

59. Insect Bites

60. Chiggers

61. Biting Flies

62. Mosquitoes

63. Spider Bites

64. Bacterial Lesion Appearance/ Causes Furunculosis Folliculitis Impetigo Cellulitis Staph aureus Pseudomonas Gram (-) enterics Beta hemolytic Strep Mycobacterium Clostridium

66. MRSA Bacteria: Staph. aureus Disease: Pyodermas Transmission: –Direct, topical –Open wound entry Culture and Sensitivity ID Drug Resistance –Beta lactamase –Alternate method of cell wall synthesis

67. VRE Vancomycin Risk factors –Hospitalization –Immunocompromised –Neutropenia –ICU –Dialysis

68. Impetigo Staph; Strep Cut or scratch Honey colored oozing sores Lip / nose region After a cold Scratching can spread to other areas

69. Cellulitis

70. Gangrene

71. Streptococcus

72. Leprosy

73. Erysipelas Group A Strep Cellulitis

74. Necrotizing Fasciitis Strep pyogenes Fascial planes Source –Skin –Bowel Aka, Streptococcal gangrene Post op concern

75. Scarlet Fever

76. Fungal Infections Microsporum Trichophyton Epidermophyton

77. Microsporum

78. Trichophton

79. Tinea Capitus

80. Tinea corpus

81. Tinea pedis

82. Epidermatophyton

83. Candida albicans

84. Viral Infections Papilloma Herpes Morbillivirus Rubella Parvovirus

85. HPV

86. Papilloma

87. Herpes: HSV-1, HSV-2

88. Herpes: Varicella Zoster Virus

89. Shingles

90. Rubeola Paramyxovirus 5 day or hard measles Respiratory spread Exanthem rash –White spots in red Fever; cough Neurological

92. Rubella

93. Erythema Infectiosum (Fifth Disease) Parvovirus B19 Mild rash (slapped cheek –Face –Limbs –Trunk Respiratory secretions – direct contact spread Pain, fever, itching

94. Idiopathic/Immune Acne Psoriasis Rosacea Pemphigus Scleroderma Erythema multiforme Vitiligo

95. Acne Vulgaris

96. Propionibacterium acnes Staph epidermidis

97. Psoriasis

98. Rosacea

99. Pemphigus Autoimmune Blistering

100. Scleroderma

101. Erythema Muliforme

102. Vitiligo

103. Urticaria

104. Porphyria

105. Genetic Enzyme Deficiency

106. Adnexa

107. Sweat Glands

108. Hair and Follicle

109. Hair/ Follicle Disorders Alopecia Genetic: baldness –Male –Female Hirsutism Parasitic Infectious –Bacterial –Fungal

110. Folliculitis

111. Scabies

112. Pediculosis

113. Head Louse

114. Body Louse

115. Nail Disorders Clubbing Paronchyma Onchomycosis

116. Clubbing

117. Fungal Infections

118. Sensory

119. Burn Classification

120. Skin Layers Affected

121. Rule of 9’s

122. Artificial Skin Hormone EGF: Epidermal Growth Factor

123. Frostbite

124. Injury Blunt force trauma: blows, impact injury Contusion Abrasion Laceration Sharp Force –Incised wound –Stab wound –Puncture wound GSW

125. Puncture Wound

126. Laceration

127. Wounds compared

128. GSW Entrance WoundExit Wounds

129. Summary

131. Process and Timeframe

132. Histology of Repair

133. Suture

134. Questions? Fish Spa