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201 Cards in this Set
- Front
- Back
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Epidermis |
Outer Layer of skin Avascular, won't bleed Very Thin |
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Dermis |
Inner Layer of skin Contains Nerves, sensory receptors, blood vessels, lymphatics Wounds in dermis are painful and bleed |
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Eccrine Glands |
In Dermis Produces sweat/perspiration (Saline) Matures at 2 months of age, infants begin to perspire |
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Apocrine Glands |
In Dermis Open into hair follicles Activated during puberty Secrete fluid in response to emotional stimuli and heat Decomposition of apocrine sweat produces body odor (action of bacteria on fluid) Located in axillae, nipples, areolae, anogenital area, eyelids and external ears Secretion decreases with aging: elderly more prone to overheating |
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Sebaceous Glands |
In dermis Secretes sebum (oil) that lubricates skin and nails Oils secretions leads to soft and supple skin Decreased oil leads to dry skin and wrinkles Concentrated in scalp and face, absent on palms and soles. |
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Cradle cap |
Overproduction of sebum in head of child from sebaceous glands |
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Acne |
Excessive oil on face from sebaceous glands |
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Seborrheic dermatitis |
Excessive oil/sebum from sebaceous glands |
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Hair |
In dermal layer Vellus and Terminal |
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Vellus Hair |
Not described on physical exam Fine, soft, non-pigmented Covers body except palms and soles, umbilicus, glans penis, inside labia |
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Terminal Hair |
Course, thick, pigmented On scalp, eyebrows, eyelashes, axillae, pubic area, chest and face in males |
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Subcutaneous Tissues |
Adipose or hypodermis Layer below the skin Insulation, temperature regulation |
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Skin Functions |
Protects: prevents invasion of bacteria and loss of fluid/electrolytes Sensory perception: pain, touch, temp, pressure Thermoregulation: r/t sweat and fat insulation Replaces cells in surface of wounds: aides in wound repair, wounds heal from inside out Absorption and excretion: metabolic waste Vitamin D production |
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Sensory Perception |
Important in protecting from injury Absent in diabetic neuropathy or ETOH abuse Puts them at risk for injury |
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Metabolic Waste |
Sweat, lactic acid, urea In renal failure, kidneys can't excrete waste so it seeps out of skin |
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Uremic Frost |
Urea, uremic waste R/t kidney failure Seeps out of skin |
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Vitamin D production |
Compounds are converted into Vit D when ultraviolet light comes into contact with skin surface Vit D is necessary for absorption of calcium The use of sunscreen may interfere with production of Vit D |
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Previous history of skin disease |
Allergies Psoriasis Atopic/Allergic dermatitis, ie. eczema Acne |
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Acanthosis Nigricans |
Hyperpigmented brownish velvety plaque seen in skin folds of neck, axilla, knuckles Associated with insulin resistance as seen in DM |
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Dysplastic Mole |
A change which may indicate a precancer or cancerous condition |
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Xerosis |
Excessive dry skin Seen in elderly Decreased sebum |
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Seborrhea |
Dandruff Oily flakes of skin Usually at scalp line and with erythema |
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Sebaceous Hyperplasia |
Enlarged Pore Donut appearance |
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Pruritus |
Itching Common with age (r/t xerosis) Common in liver/kidney disease (r/t decreased metabolism and excretion of waste) Unexplained: check renal function tests (BUN, Cr, GFR) and liver tests (ALT, AST) |
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Excessive bruising |
Abuse, clotting disorder, falls (r/t arrhythmia, neurologic disorders, ETOH, medication) |
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Medications that cause skin problems |
May cause eruptions, rashes, pruritus, and photosensitivity (sunburn) Tetracycline: photosensitivity HCTZ: Rash, d/t sulfa allergy PCN: rash and pruritus, r/t allergy |
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Stevens-Johnson Syndrome |
life threatening systemic allergic skin reaction |
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Alopecia |
Diffuse, patchy, or total hair loss May be r/t chemotherapy, familial, trauma/burns, stress * When stress is relieved, hair grows back |
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Trichtotillomania |
Compulsive pulling of hair from scalp, brows, r lashes Nervous condition |
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Hirsutism |
Excess terminal hair growth from increased androgen production by adrenal glands Most obviously seen on the face of women, but can by whole body Seen with PCOS Can effect men, they have thick beard growth or change in hair character |
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Sun exposure |
Increases skin cancer risk 1/5 are diagnosed with skin cancer |
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Self-care behaviors: skin |
sunscreen, soaps, cosmetics |
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Skin assessment |
Integrated throughout physical assessment Assess sun exposed areas (esp face, ears, nose) Assess Intertriginous areas for fungus Assess feet, particularly in diabetics Identify piercing and skin condition (infection, redness, discharge) Describe skin color: pinkish tan, light to dark brown, olive |
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Intertriginous area |
Skin folds Groin, neck, under breast, under pannis Susceptable to yeast and fungus |
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Localized color change |
Vitiligo Freckles Pigmented Nevi Birthmarks |
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Vitiligo |
Localized color change Absence of melanin pigment in patchy areas More common in dark skinned people Progressive |
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Ephelides |
Freckles Small, flat, brown macules Indicates sun exposure |
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Pigmented nevi |
Moles Inspect for changes Dark Most mellanoma originates from pigmented nevi |
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Birthmarks |
Can only be diagnosed if pt reports it's been present from birth |
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Pallor |
White or lighter coloration, may look ashen gray with brown/black skinned individuals Caused by: - Anxiety/fear: vasoconstriction r/t SNS stimulation - Cold/Cigarette smoking: peripheral vasoconstriction - Shock: shunting blood from periphery - Arterial insufficiency/anemia: decreased blood supply to PV system Albinism Vitiligo |
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Erythema |
Redness or flushing Caused by: - Hyperemia - Polycythemia (icreased RBC, polycythemia vera) - Venous stasis - Carbon monoxide poisoning
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Hyperemia |
Excess blood of superficial capillaries Fever, local inflammation (also associated with heat), increased emotions (blushing) |
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Cellulitis |
Warm to touch Entry point of infection cannot always be identified Cellulitis of an extremity - rest the extremity because movement of the muscle drives the infection deeper into tissues |
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Cyanosis |
Bluish, grayish D/t decreased perfusion of tissues Tissue hypoxia |
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Central cyanosis |
5 gms of unoxygenated Hgb r/t cardiopulmonary problems Seen at lips, tongue, oral mucosa Very late sign of hypoxia May not be seen in anemia because there is not enough unoxygenated Hgb to show color change |
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Peripheral cyanosis |
r/t vasoconstriction Exposure to cold Inspect nail beds, extremities, ear lobes |
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Jaundice |
Yellow, icteric/icterus Bilirubin is byproduct of RBC breakdown, normally excreted through GI tract If in liver failure: can't breakdown bili Jaundice results from rising amt of bili in the blood with reabsorption into skin Seen in eyes, hard and soft palate, skin Causes: - Bili obstruction: prevents excretion of bili into GI tract, clay stools, dark urine - Ineffective breakdown of bilirubin r/t liver disease, immature livers (newborn infants) |
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Jaundice in infants |
Immature livers can't excrete bilirubin into GI tract Placed under UV light (bili light) Aids in breakdown of bilirubin |
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Hypothermia |
r/t decreased circulation Generalied = shock Localized = peripheral arterial insufficiency |
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Hyperthermia |
Generalized: increased metabolic rate, hyperthyroidism, fever, heavy exercise Localized: inflammation, infection |
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Perspiration |
Normal sweating |
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Diaphoresis |
Profuse sweating |
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Dehydration |
Dry skin and mucous membranes Thirst - late sign of dehydration |
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Texture |
Smooth vs rough |
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Calluses |
Thickened area of dead skin Common on hands and feet |
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Corns |
Thickened areas of dead skin Similar to calluses except they have an inner core Core can be soft or hard |
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Thinning of skin |
R/t arterial insufficiency Thin, shiny, hairless skin |
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Turgor |
Pinch skin on anterior chest, below clavicle or forearm Turgor is how quickly the skin returns back to shape Poor turgor: tenting, failure to return to position, indication dehydration Don't test hands on elderly, false positives r/t loose skin with poor elasticity |
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Hygiene |
Clean and free of odor Decreased hygeine may be a sign of mental or physical illness May be cultural, different frequency of bathing, different |
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Cherry Angioma |
Tiny blood blister Genetic Bright red papular lesion, 1-5 mm Located on trunk, upper chest, extremities (primarily upper) Normally increase with age |
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Telangiectases |
Permanently dilated superficial blood vessels: venules, capillaries, arterioles Fine, irregular, red lines Spider angioma Venous star |
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Spider angiomas |
Central arteriole with capillary radiations Fiery red Blanches with pressure |
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Venous star |
Bluish spider angioma Non-blanching with pressure Associated with increased venous pressure, primarily located on legs Seen with varicose veins |
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Petechiae |
1-3 mm, deep red, rounded Results from superficial capillary bleeding Caused by bacteremia, bleeding disorders (thrombocytopenia), decreased plts May need blood cultures Differs from bruise because it has no stages of healing |
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Purpura |
Extensive confluent patch of petechiae Reddish purple, irregular Senile purpura r/t thinning skin Minor trauma to skin |
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Ecchymosis |
Larger patch of capillary bleeding R/t trauma, bleeding disorders or liver dysfunction Purple/blue fading to green, yellow, brown as it heals |
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Hematoma |
Subcutaneous nodule Raised bruise |
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Pattern injuries |
Suspect abuse Scalding, belt strap/buckles, cigarette burns |
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Characteristics of lesions |
Color (increased pigmentation, blue, white, etc) Elevation (flat, raised, pedunculated) Configuration (shape or pattern) Size (metric) Number (discrete, multiple) Location (body part) Distribution (localized vs generalized) Discharge, exudate (color, odor) |
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Stalk |
Skin tag Overgrowth of epidermis |
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Types of lesions |
Primary (initial lesion) Secondary (results from changes in primary lesion: scratching, infection, popping a blister) |
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Secondary lesion |
Difficult to diagnose after primary lesion becomes secondary lesion |
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Macule |
Flat lesions Flat, circumscribed, discolored, <1 cm Freckles, solar lentigens, flat nevi, petechia |
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Solar lentigens |
"Liver spots" Sun damaged |
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Patch |
Flat lesion, nonpalpable irregular, > 1cm, individual maculas run together into larger mass Psoriasis, vitiligo, port-wine stains, Mongolian spots, cafe au lait patch |
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Papule |
Raised lesion, firm Solid elevated, circumscribed, < 1 cm Raised Nevus, wart (verruca), lichen planus |
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Verruca |
Raised lesion/Papule Wart |
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Plaques |
Raised lesion, firm, rough lesion, flat top surgace Coalesced papules > 1 cm, individuals run together to larger mass Psoriasis, seborrheic and actinic keratoses |
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Nodule |
Raised lesion, elevated, firm, circumscribed, deeper in dermis than papule Solid, elevated, 1-2 cm Lipoma (fatty growth), erythema nodosum |
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Tumor |
Raised lesion, solid, sometimes clearly demarcated, deep in dermis Larger than a few centimeters Firm or soft (lipoma), neoplams, benign tumor |
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Wheal |
Raised lesion, cutaneous edema, solid, transient, variable diameter Superficial, raised, erythmatous, irregular Allergic reaction, PPD, mosquito bite Caused by interstitial edema |
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Urticaria |
Raised lesion Hives Wheals coalesce to form extensive reaction Intensely pruritic - inflammatory response |
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Vesicle |
Fluid filled, circumscribed, superficial, not into dermis Elevated cavity with clear fluid, < 1 cm herpes simplex, varicella (chicken pox), herpes zoster (shingles), contact dermatitis (poison ivy) |
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Herpes Zoster |
Fluid filled Pain often precedes lesion Brought on by stress Follows nerve route |
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Bulla |
Fluid filled, larger vesicle Elevated cavity with fluid, > 1 cm Blister, burns, pemphigus vulgaris |
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Pustule |
Fluid filled, superficial, elevated, similar to vesicle but filled with pus Contains pus, filled with leukocytes Not necessarily infected Acne, impetigo |
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Cyst |
Fluid filled or semisolid material filled Never cancerous, encapsulated lesion Encapsulated fluid filled cavity in dermis or subcutaneous layer If deep, may be hard to differentiate from nodule or tumor Sebaceous cyst, breast cyst, cystic acne |
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Crust |
Thickened dried exudate Dried serum, blood, pus on top of a primary lesion, slightly elevated AKA scab Ruptured herpes vesicle results in crust with erythematous base Impetigo (staph and strep), common in children, no scarring Eczema |
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Scale |
Compact flakes of skin, heaped up, keratinized cells, irregular, thick or thin, dry or oily Psoriasis (white-silvery), seborrheic dermatitis (yellow-greasy), seborrhea (dandruff), drug reaction, dry skin |
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Fissure |
Linear crack or break from epidermis to dermis, may be moist or dry Cheilosis (corners of mouth), callused heels, tinea pedis (fissure between toes, athletes foot) |
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Erosion |
Shallow depression, moist/glistening, no bleeding, loss of part of epidermis, follows rupture of vesicle or bulla Affects epidermis Varicella, variola after rupture |
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Ulcer |
Deep depression into dermis, loss of epidermis and dermis, concave, varies in size, leaves scar Stasis ulcer, pressure sore, decubiti |
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Excoriation |
Superficial abrasion, loss of epidermis, linear hollowed-out, crusted area Red, open sores Dermatitis, abrasion or scratch, scabies |
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Scar |
Connective tissue replacing normal tissue Thin to thick fibrous tissue that replaces normal skin following injury or laceration |
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Atrophic scar |
Depressed scar, thinning of skin surface and loss of skin markings, skin translucent and paper like "Atrophy" Stretch marks, striae |
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Hypertrophic scar |
Excess scar tissue r/t increased collagen formation, irregular shape, elevated, progressively enlarging, grows beyond boundaries of initial wound Keloid Removing keloid can cause reoccurance, but larger |
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Lichenification |
Lichen = Mold Thickening of skin, rough, secondary to persistent rubbing or itching, often flexor surface Eczema (atopic dermatitis), chronic sun exposure, chronic dermatitis |
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Eczema |
Atopic dermatitis Allergic |
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Annular |
Clear center Tinea corporus (ring worm) Pityriasis rosea |
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Semiannular |
1/2 ring Moon/crescent shape |
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Discrete |
Isolated |
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Confluent |
Lesions run together Appear as one Urticaria |
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Grouped |
Clusters of lesions Individual lesions can still be identified |
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Gyrate |
Coiled, spiral, snake-like |
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Iris/Target |
Solid center Bulls eye Lyme's disease |
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Linear |
Scratch |
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Webb-like/Lace |
Mottled appearance Splotchy |
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Zosteriform |
Linear vesicles along nerve route s/p shingles Herpes Zoster Very painful |
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Zostavax |
Vaccine for the prevention of shingles Recommended for persons 60 and older |
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Post herpetic neuralgia |
Pain syndrome Lasts months after outbreak Shingles and its sequela may be prevented vaccine |
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Wood's light |
Shine on skin Coral red - bacterial Blue/green - fungal |
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KOH |
Potassium hydroxide Collect a skin scraping with the side of a scalpal and apply KOH Fungal infections seen |
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Tinea Corporis |
Fungal infection Ringworm |
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Tinea Cruris |
Fungal infection Jock itch, spread from feet Put socks on before pants |
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Tinea Pedis |
Fungal infection Athlete's feet Mild dry skin, peeling |
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Tinea Capitus |
Fungal scalp infection Cradle cap |
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Skin Cancer |
Malignant Melanoma Basal Cell Cancer Squamous Cell Cancer |
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Malignant Melanoma |
Most deadly skin cancer Highly Metastatic, grows deep, not wide 1/2 arise from preexisting nevi High risk: fair skin, sun exposure Characteristics: ABCD |
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ABCD |
Asymmetry (1/2 unlike the other) Border: iregular, dermatoscope helpful Color: varied within lesion, tan, brown, black, patriotic lesion (red, white, blue) Diameter > 6mm |
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Basal Cell Cancer |
BCC Most common type of skin cancer Grows slowly, rarely metastasizes Usually on face, most common on fair skinned > 40 yrs old, r/t sun exposure Usually starts as skin colored papule/nodule with overlying telangiectasia (ie skin colord bump with blood blister) May develop a depressed center |
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Squamous Cell Cancer |
SCC Grows rapidly, usually on hands or head r/t sun exposure, usually in > 60 yr olds Erythematous scaly patch 1 cm or more Develops central ulcer |
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Actinic Keratosis |
AK Pink, scaly papules May be a precursorto SCC Remove them with liquid nitrogen Retreat annually |
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Furuncle |
Nonmalignant Lesion Boil Staph infection of a hair follicle or dermis |
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Eczema |
Nonmalignant Lesions Atopic/allergic dermatitis Flexor surface on AC or behind knees |
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Folliculitis |
Nonmalignant Lesion Infection of hair follicle, difficult to treat, Exacerbated by shaving, change razors |
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Cellulitis |
Nonmalignant Lesion Staph/Strep infection Very serious |
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Herpes Simplex |
Nonmalignant Lesion Type 1: Cold sore, fever blister Type 2: genital herpes Vesicle from virus Tenderness, paresthesia, burning |
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Herpes Zoster |
Nonmalignant Lesion Vesicle from virus Chick pox, varicella Follows a nerve root, dermatomal distribution Pain and burning may precede lesion by 4-5 days Doesn't cross midline |
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Post Herpetic Neuralgia |
Pain disorder, may last months after shigles outbreak |
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Pityriasis Rosea |
Nonmalignant Lesion Common, unknown cause Onset is a herald patch Erythematous lesion on extremities and trunk Christmas tree pattern Self-limiting, a few weeks, not contagious |
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Psoriasis |
Nonmalignant lesion Marked by silver scales, plaque |
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Rubella |
Nonmalignant lesion German measles, prevented by immunization Mild viral disease |
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Rubeola |
Nonmalignant lesion Measles, prevented by immunization Most sever type Look for Koplic spots on buccal mucosa |
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Rosacea |
Nonmalignant lesion Cause unknown, fair complexion, variable length Affects nose and face, no itching, flushing, no comedones Characterized by pustules, erythema, telangectasia, and hyperplasia (rhynophyma) of nose |
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Hair |
Color: graying r/t genetics Texture: fine/coarse, shiny/dull, straight and curly, brittle Distribution: normal male and female pattern Inspect Scalp: seborrhea (dandruff), lice or nits on hair shaft |
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Vellus Hair |
Replaces lanugo (fine downy hair) a few months after birth |
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Terminal Hair |
May be present at birth on the scalp Soft, may become patchy, mostly at temples and occiput |
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Vernix Caseos |
Thick, cheesy substance consisting of sebum and shed epithelial cells Present at birth |
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Infants and children: Cradle cap |
Increased sebaceous gland secretion at birth Cradle cap for first few weeks Seborrheic dermatitis, oily rash
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Milia |
Tiny white papules on face of infants from sebum occluded follicles |
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Newborn Inefficient pigmentation |
Skin lighter until melanin matures Includes black infants |
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Infantile Physiologic Jaundice |
Half of newborns after 3rd or 4th day r/t hemolysis of RBCs |
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Infants ineffective tempterature regulation |
Decreased subcutaneous fat Decreased skin contractility and shivering in response to cold Absence of sweat gland function in response to heat Eccrine gland begins minimal functioning in the first few months |
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Puberty |
Increased secretion of apocrine glands - body odor Increased secretion of eccrine sweat glands - perspiration Increased secretion of sebaceous glands - oily skin, acne Increased fat deposits - especially females Secondary sex characteristic development: - Males: pubic, axillary, facial hair - Females: pubic, axillary hair, areolae enlarged and darkened, breast tissue develops |
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Open comedones |
Blackheads |
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Closed comedones |
Whiteheads |
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Pregnancy |
Many changes r/t increased estrogen levels Striae (stretch marks): Abd, breasts, thighs, r/t fragile connective tissue Vascular spiders (spider angiomas) Palmar erythema: increased estrogen Increased pigment in areolae and nipples, vulva and sometimes middle abdomen or face Increased fat deposits (thigh and buttocks) |
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Linea nigra |
Dark line, increased pigmentation in mid abd on pregnant women |
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Chloasma |
Increased pigmentation of face Found in pregnant women, disappears after delivery |
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Sun related changes: aged adult |
Solar lentigine: flat brown macules (liver spots) Actinic Keratosis Wrinkling r/t thinning dermis |
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Seborrheic Keratosis |
Raised, crusty, irregular lesion "Stuck on" appearance Different from AK's Sometimes waxy, non-cancerous/benign Located on trunk, face, hands Genetic link May be removed for cosmetic purposes |
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Xerosis |
Dry skin r/t decreased sweat and sebacceous glands Increased risk of heat stroke |
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Skin tags |
Overgrowth of normal skin, not significant |
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Senile purpura |
Superficial hemorrhages with minor trauma r/t increased vascular fragility Increased incidence in sun damaged skin |
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Shearing/Tearing injuries |
r/t loss of callogen in dermis |
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Sagging skin |
r/t loss of elasticity |
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Risks for aged adult |
Risk for skin disease and breakdown r/t thinning skin, decreased vascularity fragility Loss of subcutaneous layer, decreased nutrition, increased sedentary lifestyle |
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Cutaneous Horn |
Caution regarding underlying skin cancer Overgrowth of epidermal tissie Should be removed and biopsied |
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Aged adult hair changes |
Graying: decreased functioning melanocytes in hair matrix Changes in distribution: - Thinning in males and females - Men have increased coarse terminal hair, mostly in nose, ears, eyebrows |
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Aged Adult hormone changes |
Decreased testosterone: decreased axillary and pubic hair Decreased estrogen/testosterone unopposed (female): bristly facial hair |
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Cultural considerations |
Increased melanin: African Americans, Native Americans, protects from UVL, decreases incidence of skin cancer Decreased Apocrine glands: Asians and Native Americans, decreased body odor Increased Apocrine glands: Whites and Blacks |
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Nails |
Inspect and palpate: note color, shape, lesions, normally translucent |
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Nail color |
Translucent plate, linear bands or streaks may occure in darker skinned people |
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Leukonchia Striata |
White, hairline marking from trauma or picking at cuticle Normally found Scars as nail grows |
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Clubbing |
Nail angle straightens out to > 180 degrees, nailbed becomes spongy r/t chronic hypoxia ie. COPD, lung CA, CHD "Loses diamond shape" |
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Normal nail angle |
Less than 160 degrees Has a diamond shape |
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Cyanosis, peripheral |
Abnormal finding in nail beds |
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Brown linear streaks of nail |
Found in fair skinned people Melanoma |
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Splinter hemorrhages |
4-5 reddish-brown streaks in nail Bacterial endocarditis, trauma |
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Koilonychia |
Spoon nails, concave Iron deficiency anemia |
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Paronychia |
Inflammation/infection of skin around nail bed Happens when pt picks at cuticle Treat with topical or systemic antibiotics |
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Onycholysis |
Loosening of nail plate Fungal infection, nail falls off |
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Pitting of nails |
Seen in psoriasis |
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Subungual hematoma |
Bleeding under nail plate Very painful r/t trauma Increased pressure under nail, treat by drilling a hole in nail to release pressure |
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Ingrown nail |
Treat with marginectomy: removing the part of the nail that is growing into skin happens when nails are cut at an angle instead of across |
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Habit-tic deformity |
Picking at nail with index finger Usually permanent |
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Beau lines |
Deep horizontal or transverse depressions in the nails |
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Terry nails |
seen with cirrhosis or hypoalbuminemia |
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Capillary refill |
Should be less than 2 seconds If greater there is altered peripheral circulation Remove nail polish to fully assess |
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Melanoma risk factors |
Family hx Personal hx Moles: dysplastic, atypical nevi, nurmerous non dysplastic nevi, large congenital nevus >15 cm Exposure to sun/UV light: severe, blistering sunburns as child/teen, indoor tanning device Immunosupression Fair skin, light eyes Sun sensitivity, relative inability to tan |
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Basal and Squamous cell cancer risk factors |
Age > 50 Exposure to sun/UV light: - Chronic/cumulative: squamous - Intermittent: basal Fair, freckled, ruddy Light hair or eyes Tendency to sunburn easily Geographic location Exposure to arsenic, creosote, coal tar and petroleum products Overexposure to radium, radioisotopes, XR Repeated trauma, skin irritation Precancerous dematoses |
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Skin types |
I: always burn, never tan, sensitive to UV II: Burns easily, tans minimally III: Burns moderately, tans gradually light brown IV: Burns minimally, always tans well mod brown V: Rarely burns, tans profusely dark VI: Never burns, deeply pigmented, least sensitive to UV |
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Carotenemia |
Infants who eat baby foods yellow pigmented Increases beta-carotene levels, yellows skin but not sclera |
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Halo Nevi |
Sharp, oval, circular Depigmented around mole May undergo changes, disappears and halo repigments Usually on back of young adult Usually benign, biopsy indicated because similar process as melanoma |
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Intradermal Nevi |
Dome-shaped, raised, flesh to black color, may be pedunculated or hair bearing Cells limited to dermis Only cosmetic removal indicated |
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Junction Nevus |
Flat or slightly elevated, dark brown Nevus cells lining dermoepidermal junction Removed if exposed to repeated trauma |
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Compound Nevus |
Slightly elevated brownish papule, indistinct border Nevus cells in dermis and lining dermoepidermal junction Should remove if exposed to repeated trauma |
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Hairy nevus |
May be present at birth, cover large area, hair growth may occur after several years Should be removed if changes occur |
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Dysplastic mole: color |
Mixture of tan, brown, black, red/pink Moles on one person do not look alike
Normal: uniformly brown, all moles on the individual look similar |
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Dysplastic mole: shape |
Irregular border, may include notches or fade into surrounding skin, include a flat portion level with skin
Normal: round or oval, defined border, separates mole from surrounding skin |
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Dysplastic mole: surface |
May be smooth, slightly scaly, have a rough or irregular (pebbly) appearance
Normal: Begins as flat, smooth spot on skin and becomes raised, forms a smooth bump |
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Dysplastic mole: size |
Often larger than 6 mm and sometimes larger than 10 mm
Normal: less than 6 mm, size of pencil eraser |
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Dysplastic mole: number |
Many people do not have an increased number, some people severely affected have >100
Normal: typical adults have 10-40 moles scattered |
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Dysplastic mole: location |
May occur anywhere on body, most common on back, may also appear below waist, scalp, breast, and buttock
Usually above the waist, sun-exposed areas, scalp, breast and buttocks rarely have moles |
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Dysplastic mole vs melanoma |
Nevi: predominantly on trunk, large > 5 mm, flat component. Ill-defined border, round, oval, irregular shape, color brown but can be mottled.
Melanoma: border is more irregular, lesions larger >6 mm, color variation within he lesion |
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Eczematous Dermatitis |
Most common inflammatory skin disorder Several forms: irritant contact dermatitis, allergic contact dermatitis, atopic dermatitis Intercellular edema and epidermal breakdown Excoriation from scratching predisposes infection and crust formation |
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Folliculitis |
Inflammation of hair follicle and surrounding dermis Inflammatory cells within the follicle creates a follicular-based pustule, superficial or deep Deep can result in chronic lesion, scarring or hair loss Papules and pustules, pruritis, discomfort r/t frequent shaving, immunosuppression, hot tubs without chlorine, dermatoses, long-term abx use, occlusive clothing, hot humid temps, DM, obesity |
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Furuncle |
Boil, deep-seated infection of pilosebaceous unit Staph most common, abcess that spreads to surrounding dermis and subcutaneous tissue May be alone or spread to multiple follicles Tender re nodule becomes pustular, red hot skin, lesion filled with pus with core |
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Cellulitis |
Diffuse, acute infection of skin and subcutaneous tissue Usually staph or strep Break in skin, pain swelling, may have fever, red, hot, tender, indurated, borders not demarcated, LAD and lymphangitic streaks |
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Psoriasis |
Chronic recurrent disease of keratin synthesis Multifactorial origin, genetic, immune regulation Increased epidermal cell turnover, thickened skin with copious scale Pruritis, well-circumscribed, dry, silvery scaling papules and plaques Common on back, buttock, extensor surfaces, scalp Can be associated with psoriatic arthritis |
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Lyme disease |
Tick-borne disease, multi-system infection Borrelia burgdorferi Fatigue, anorexia, HA, erythema migrans skin lesion (bullseye) Dissemination and late: neurologiv symptoms, facial palsy, mningitis, encephalitis, carditis, syncope, palpitations, dyspnea, CP, arthritis atrophicans |
