Chapter 10- Hair, Skin, And Nails

Front 1

Macule- Primary Skin Lesions

Back 1

A flat, circumscribed area that is a change in the color of the skin; less than 1 cm in diameter

Hint 1

Freckles, flat moles (nevi), petechiae, measles, scarlet fever

Front 2

Papule- Primary Skin Lesions

Back 2

An elevated, firm, circum-scribed area less than 1 cm in diameter

Hint 2

Wart (verruca), elevated moles, lichen planus, cherry angioma, skin tag

Front 3

Patch- Primary Skin Lesions

Back 3

A flat, nonpalpable, irregular-shaped macule more than 1 cm in diameter

Hint 3

Vitiligo, port wine stains, mongolian spots, café-au-lait spots

Front 4

Plaque- Primary Skin Lesions

Back 4

Elevated, firm, and rough lesion with flat top surface greater than 1 cm in diameter

Hint 4

Psoriasis, seborrheic and actinic kerato-ses, eczema

Front 5

Wheal- Primary Skin Lesions

Back 5

Elevated irregular-shaped area of cutaneous edema; solid, transient; variable diameter

Hint 5

Insect bites, urticaria, allergic reaction, lu-pus erythematosus

Front 6

Nodule- Primary Skin Lesions

Back 6

Elevated, firm, circumscribed lesion; deeper in dermis than a papule; 1 to 2 cm in diamete

Hint 6

Dermatofibroma ery-thema nodosum, lipomas, melanoma, hemangioma, neuro-fibroma

Front 7

Tumor- Primary Skin Lesions

Back 7

Elevated and solid lesion; may or may not be clearly demarcated; deeper in dermis; greater than 2 cm in diameter

Hint 7

Neoplasms, lipoma, hemangioma

Front 8

Vesicle- Primary Skin Lesions

Back 8

Elevated, circumscribed, superficial, not into dermis; filled with serous fluid; less than 1 cm in diameter

Hint 8

Varicella (chickenpox), herpes zoster (shingles), impetigo, acute eczema

Front 9

Bulla- Primary Skin Lesions

Back 9

Vesicle greater than 1 cm in diameter

Hint 9

Blister, pemphigus vulgaris, lupus erythematosus, impetigo, drug reaction

Front 10

Pustule- Primary Skin Lesions

Back 10

Elevated, superficial lesion; similar to a vesicle but filled with purulent fluid

Hint 10

Impetigo, acne, folliculitis, herpes simplex

Front 11

Cyst- Primary Skin Lesions

Back 11

Elevated, circumscribed, encapsulated lesion; in dermis or subcutaneous layer; filled with liquid or semisolid material

Hint 11

Sebaceous cyst, cystic acne

Front 12

Scale- Secondary Skin Lesions

Back 12

Heaped-up keratinized cells; flaky skin; irregular; thick or thin; dry or oily; variation in size

Hint 12

Flaking of skin with seborrheic dermatitis following scarlet fever, or flaking of skin following a drug reaction; dry skin, pity-riasis rosea, eczema, xerosis

Front 13

Lichenification- Secondary Skin Lesions

Back 13

Rough, thickened epidermis secondary to per-sistent rubbing, itching, or skin irritation; often involves flexor surface of extremity

Hint 13

Chronic dermatitis

Front 14

Keloid- Secondary Skin Lesions

Back 14

Irregular-shaped, elevated, progressively enlarging scar; grows beyond the boundaries of the wound

Hint 14

Keloid formation following surgery

Front 15

Scar- Secondary Skin Lesions

Back 15

Thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis

Hint 15

Healed wound or surgical incision

Front 16

Excoriation- Secondary Skin Lesions

Back 16

Loss of the epidermis; linear hollowed out crusted area

Hint 16

Abrasion or scratch, scabies

Front 17

Fissure- Secondary Skin Lesions

Back 17

Linear crack or break from the epidermis to the dermis; may be moist or dry

Hint 17

Athlete's foot, cracks at the corner of the mouth, chapped hands, eczema, intertrigo labialis

Front 18

Crust- Secondary Skin Lesions

Back 18

Dried drainage or blood; slightly elevated; variable size; colors variablered, black, tan, or mixed

Hint 18

Scab on abrasion, eczema

Front 19

Erosion- Secondary Skin Lesions

Back 19

Loss of part of the epidermis; depressed, moist, glistening; follows rupture of a vesicle or bulla

Hint 19

Varicella, variola after rupture, candidiasis, herpes simplex

Front 20

Ulcer- Secondary Skin Lesions

Back 20

Loss of epidermis and dermis; concave; varies in size

Hint 20

Pressure ulcer, stasis ulcers, syphilis chancre

Front 21

Atrophy- Secondary Skin Lesions

Back 21

Thinning of the skin surface and loss of skin markings; skin appears translucent and paper-like

Hint 21

Aged skin, striae, discoid lupus erythema-tosus

Front 22

Petechiae- Vascular Skin Lesions

Back 22

Tiny, flat, reddish purple, nonblanchable spots in the skin less than 0.5 cm in diameter; appears as tiny red spots pinpoint to pin-head in size

Hint 22

Cause: tiny hemorrhages within the dermal or submu cosa—due to intravascular defects and infection

Front 23

Purpura- Vascular Skin Lesions

Back 23

Flat, reddish purple, non blanchable discoloration in the skin greater than 0.5 cm in diameter

Hint 23

Cause: infection or bleeding disorders resulting in hemorrhage of blood into the skin

Examples: senile, actinic purpura, progressive pig mented purpura, vasculitis purpura, thrombocytopenic purpura

Front 24

Ecchymosis- Vascular Skin Lesions

Back 24

A reddish purple, non blanchable spot of variable size

Hint 24

Cause: trauma to the blood vessel resulting in bleeding under the tissue

Front 25

Angioma- Vascular Skin Lesions

Back 25

Benign tumor consisting of a mass of small blood vessels; can vary in size from very small to large

Hint 25

Examples: cherry angioma, hemangioma, cavernous hemangioma, strawberry hem angioma

Front 26

Capillary Hemangiom- Vascular Skin Lesions

Back 26

A type of angioma that involves the capillaries within the skin producing an irregular macular patch that can vary from light red to dark red, to purple in color

Hint 26

Cause: congenital vascular malformation of capillaries

Example: port wine stain, stork bite

Front 27

Telangiectasia- Vascular Skin Lesions

Back 27

Permanent dilation of preexisting small blood vessels (capillaries, arterioles, or venules) resulting in superficial, fine, irregular red lines within the skin

Hint 27

Causes: rosacea, collagen vascular disease; actinic damage, in-creased estrogen levels

Examples: essential telangiectasia, hereditary hemorrhagic telangiectasia, spider telangiectasia

Front 28

Vascular Spider (Spider Angioma)- Vascular Skin Lesions

Back 28

A type of telangiectasia characterized by a small central red area with radiating spider like legs; this lesion blanches with pressure

Hint 28

Causes: may occur in absence of disease, with pregnancy, in liver disease, or with vitamin B deficiency

Front 29

Venous Star- Vascular Skin Lesions

Back 29

A type of telangiectasia characterized by a nonpalpable bluish star-shaped lesion that may be linear or irregularly shaped

Hint 29

Cause: increased pressure in the superficial veins

Front 30

Stage I Pressure Ulcer

Back 30

A stage I pressure ulcer is an observable pressure–related alteration of intact skin whose indicators, as com-pared to an adjacent or opposite area of the body, may include changes in one or more of the following:

Skin temperature (warmth or coolness)

Tissue consistency (firm or boggy feel)

Sensation (pain, itching)

Hint 30

The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.

Front 31

Stage II Pressure Ulcer

Back 31

Partial-thickness skin loss involving epidermis, dermis, or both.

Hint 31

The ulcer is superficial and appears clinically as an abrasion, blister, or shallow crater.

Front 32

Stage III Pressure Ulcer

Back 32

Full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer manifests clinically as a deep crater with or without undermining of adjacent tissue.

Front 33

State IV Pressure Ulcer

Back 33

Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule). Undermining and sinus tracts may also be associated with stage IV pres-sure ulcers.

Front 34

Dermatitis

Back 34

is used to describe a variety of superficial inflammatory conditions of the skin that can be acute or chronic.

Front 35

Atopic Dermatitis

Back 35

a chronic superficial inflammation of the skin with an unknown cause; it is commonly associated with hay fever and asthma and it is thought to be familial. It is seen in all age groups, although it is more common in infancy and childhood.

Hint 35

Clinical Findings: During infancy and early childhood, red, weeping, crusted lesions appear on the face, scalp, extremities, and diaper area. In older children and adults, lesion characteristics include erythema, scaling, and lichenification. The lesions are usually localized to the hands, feet, arms, and legs (particularly at the antecubital fossa and popliteal space) and are associated with intense pruritus.

Front 36

Contact Dermatitis

Back 36

an inflammatory reaction of the skin in response to irritants or allergens such as metals, plants, chemicals, and detergent. This condition affects people of all ages and ethnic groups.

Hint 36

Clinical Findings:appears as an area of localized erythema that may also include edema, wheals, scales, or vesicles that may weep, ooze, and become crusted. Pruritus is a common associated symptom The inflammatory response can vary from no reaction to extreme; thus it is highly individualized.

Front 37

Seborrheic Dermatitis

Back 37

a chronic inflammation of the skin of unknown cause affecting individuals throughout their entire life, often with periods of remission and exacerbation. (In infants, this condition is known as cradle cap.)

Hint 37

Clinical Findings: The lesions appear as scaly, white, or yellowish plaques involving skin on the scalp, eyebrows, eyelids, nasolabial folds, ears, axillae, chest, and back. Lesions typically cause mild pruritus; lesions on the scalp cause dandruff

Front 38

Stasis Dermatitis

Back 38

an inflammation of the skin on the lower legs most commonly seen in the older adult. It is thought to be caused by venous stasis, chronic edema, and poor peripheral circulation.

Hint 38

Clinical Findings: Initially this condition is characterized by an area or areas of erythema and pruritus followed by scaling, petechiae, and brown pigmentation

Front 39

Psoriasis

Back 39

a common chronic skin disorder that can occur at any age, but usually develops by age 20. The cause is unknown, and the disease can range from mild to severe.

Hint 39

Clinical Findings: The lesions appear as well-circumscribed, slightly raised, erythematous plaques with silvery scales on the surface. The lesions appear most frequently on the elbows, knees, buttocks, lower back, and scalp. A specific characteristic of this condition is the observance of small bleeding points if the lesion is scratched. Associated symptoms include pruritus, burning, and bleeding of the lesions and pitting of the fingernails

Front 40

Pityriasis Rosea

Back 40

a common, acute, self-limiting inflammatory disease that usually occurs in young adults during the winter months. The cause is unknown, but might be associated with a virus.

Hint 40

Clinical Findings: The initial manifestation is a lesion referred to as a “herald patch”—a single lesion, usually located on the trunk, resembling tinea corporis. One to three weeks following the initial lesion, a generalized eruption of pale, erythematous, and macular lesions occurs on the trunk and extremities; occasionally, they appear as vesicular lesions. The client generally feels well but may complain of mild itching.

Front 41

Warts (Verruca)

Back 41

benign lesion caused by human papillomavirus (HPV). Because there are more than 60 different types of HPV, many different types of warts occur in many locations and in many sizes. Warts may appear at any age.

Hint 41

Clinical Findings: Common warts (verrucae vulgaris) are round or irregular-shaped papular lesions that are light gray, yellow, or brownish black. They commonly appear on hands, fingers, elbows, and knees (Fig. 10-23). Plantar warts are found on the sole of the foot and are typically tender to pressure.

Front 42

Herpes Simplex

Back 42

represents a group of eight DNA viruses. Herpes simplex virus (HSV) is a chronic, noncurable condition; between outbreaks, the virus is dormant. Outbreaks are triggered by a number of factors, including sun exposure, stress, and fever.

Hint 42

Clinical Findings: Before the onset of lesions, many clients report a sensation of slight stinging and increased sensitivity. The classic manifestation of HSV is the development of grouped vesicles on an erythematous base. The lesions are very painful and highly contagious after direct contact with skin. Lesions caused by herpes simplex virus type 1 (HSV-1) often appear on the upper lip (often referred to as a cold sore), nose, around the mouth, or on the tongue. Herpes simplex virus type 2 (HSV-2) lesions usually appear on the genitalia. As the lesions erupt they move through maturational stages of vesicles, pustules, and finally crusting. The lesions typically last for approximately 2 weeks.

Front 43

Herpes Varicella (Chickenpox)

Back 43

This is a highly communicable viral infection, spread by droplets, that commonly occurs in children but can also infect adults who did not have the infection as children.

Hint 43

Clinical Findings: The lesions first appear on the trunk and then spread to the extremities and the face. Initially the lesions are macules; they progress to papules, then vesicles, and finally the old vesicles become crusts. The lesions erupt in crops over a period of several days. For this reason, lesions in various stages are seen concurrently. The period of infectivity is from a few days before lesions appear until the final lesions have crusted, usually about 6 days after the first lesions erupt

Front 44

Herpes Zoster (Shingles)

Back 44

A dormant herpes varicella virus causes herpes zoster—which is an acute inflammation by reactivation of the virus. Herpes zoster follows varicella infection years later in some individuals.

Hint 44

Clinical Findings: Linearly grouped vesicles appear along a cutaneous sensory nerve line (dermatome).As the disease progresses, the vesicles turn into pustules followed by crusts. This painful condition is generally unilateral and commonly appears on the trunk and face. Pain may precede lesion eruption by several days.

Front 45

Tinea Infections

Back 45

caused by a number of dermophyte fungal infections involving the skin, hair, and nails that affect children and adults.

Hint 45

Clinical Findings: Tinea corporis (ringworm) involves generalized skin areas (excluding scalp, face, hands, feet, and groin) and appears as circular, well-demarcated lesions that tend to have a clear center. These lesions appear on nonhairy parts of the body. They are hyperpigmented in light-colored skin and hypopigmented in dark-skinned persons. Tinea cruris (“jock itch”) affects the groin area and is characterized by small erythematous and scaling vesicular patches with a well-defined border spreading over the inner and upper surfaces of the thighs. Tinea capitis involves the scalp, causing scaling and pruritis with balding areas due to hair that breaks easily. Tinea pedis is a chronic infection involving the foot (“athlete's foot”). It initially appears as small weeping vesicles and painful macerated areas between the toes and sometimes on the sole of the foot. As the lesions develop, they may become scaly and hard and cause discomfort and itching.

Front 46

Candidiasis

Back 46

This fungal infection is caused by Candida albicans. This fungus is normally found on the skin, mucous membranes, gastrointestinal tract, and vagina, but can cause an infection under certain conditions such as a favorable environment (warm, moist, or tissue maceration); disease states (diabetes, Cushing syndrome, debilitated states, immunosuppression); and systemic antibiotic administration.

Hint 46

Clinical Findings: A Candida infection affects the superficial layers of skin and mucous membranes. It appears as a scaling red rash with sharply demarcated borders. The area is generally a large patch but may have some loose scales. Common areas for candidiasis involving the skin include the genitalia, the inguinal areas, and along gluteal folds.

Front 47

Cellulitis

Back 47

an acute streptococcal or staphylococcal infection of the skin and subcutaneous tissue. Cellulitis can occur at any age and can involve any skin area on the body.

Hint 47

Clinical Findings: The skin is red, warm to the touch, and tender, and appears to be indurated. There may be regional lymphangitic streaks and lymphadenopathy

Front 48

Impetigo

Back 48

a common and highly contagious bacterial infection caused by staphylococcal or streptococcal pathogens. It can occur in any age group; however, impetigo is most prevalent in children, especially among individuals living in crowded conditions with poor sanitation. It occurs most commonly in mid-to-late summer, with the highest incidence in hot, humid climates.

Hint 48

Clinical Findings: This infection appears as an erythematous macule that becomes a vesicle or bulla and finally a honey-colored crust after the vesicles or bullae rupture. The lesions commonly occur on the face around the nose and mouth, although other skin areas can be involved.

Front 49

Folliculitis

Back 49

an inflammation of hair follicles.

Hint 49

Clinical Findings: An acute lesion appears as an area of erythema with a pustule surrounding the hair follicle, most commonly on the scalp and extremities. A chronic condition occurs when deep hair follicles are infected (usually seen in bearded areas).

Front 50

Furuncle or Abscess (Boil)

Back 50

a localized bacterial lesion caused by a staphylococcal pathogen. Furuncles often develop from folliculitis.

Hint 50

Clinical Findings: Initially, a furuncle is a nodule surrounded by erythema and edema. As it progresses, it becomes a pustule; the center (or core) fills with a sanguineous purulent exudate. The skin around a furuncle is red, hot, and extremely tender

Front 51

Scabies

Back 51

a highly contagious infestation associated with the mite Sarcoptes scabiei. The female mite burrows into the superficial layer of skin and lays eggs. Transmission usually occurs with direct skin-to-skin contact.

Hint 51

Clinical Findings: Severe pruritus is the hallmark of scabies. The pruritus is caused by a hypersensitivity to the mite and its feces. The lesions are small papules, vesicles, and burrows that result from the mite entering the skin to lay eggs. The burrows appear as short irregular marks that look as if they were made by the end of a pencil. Areas most commonly affected include the hands, wrists, axillae, genitalia, and inner aspects of the thigh.

Front 52

Lyme Disease

Back 52

occurs after a bite from a tick infected with Borrelia burgdorferi. The large majority of Lyme disease cases in the United States occur in the Northeast states

Hint 52

Clinical Findings: The classic manifestation of Lyme disease is the development of an expanding erythemic rash with central clearing at the site of the tick bite. This rash typically exceeds 5 cm and persists for several weeks. Most individuals also have flulike symptoms (such as fever, headache, muscle aches).

Front 53

Spider Bites

Back 53

The majority of bites that are of concern to humans are caused by two spiders—the black widow spider and the brown recluse spider. Black widow spiders are found throughout the United States; brown recluse spiders are found predominantly in the central and south central United States.

Hint 53

Clinical Findings: The bite of the black widow and brown recluse spiders tends to cause minimal symptoms at the time of the bite. The initial lesion of a black widow spider bite appears as an area of erythema with two red puncta at the bite site. Within a few hours, symptoms of severe abdominal pain and fever typically develop. The bite of a brown recluse spider initially appears as a lesion with erythema and edema that evolves into a necrotic ulcer with erythema and purpura. Other symptoms include fever, nausea, and vomiting.

Front 54

Basal Cell Carcinoma

Back 54

the most common form of skin cancer. It predominantly afflicts light-skinned individuals between ages 40 and 80. It is locally invasive and rarely metastasizes. The incidence increases with age and is more common in males than females

Hint 54

Clinical Findings: The lesion has different forms but usually appears as a nodular pigmented lesion with depressed centers and rolled borders. In some cases the center is ulcerated. It is usually found in areas that have had repeated exposure to the sun or ultraviolet light, such as the face

Front 55

Squamous Cell Carcinoma

Back 55

the second-most frequent form of skin cancer. It is an invasive skin cancer that typically appears on the head and neck and occurs as a result of excessive sun or ultraviolet light exposure. Those most commonly affected are individuals over age 50 who have blue eyes and childhood freckling (light pigmentation). Men are more commonly affected than women

Hint 55

Clinical Findings: Initially this cancer appears as a red, scaly patch that has a sharply demarcated border. As the lesion develops further, it is soft, mobile, and slightly elevated. As the tumor matures, a central ulcer may form with surrounding redness.

Front 56

Melanoma

Back 56

the most serious form of skin cancer. It is a malignant proliferation of pigmented cells (melanocytes). These lesions typically arise from already present nevi.

Hint 56

Clinical Findings: The mnemonic ABCDEF is used to remember the classic manifestations of melanoma: Asymmetry, Border irregularity, Color variation, Diameter greater than 6 mm, Elevation (recent change from a flat to raised lesion), and Feeling (a reported sensation of itching, tingling, or stinging within the lesion). The lesion may have a flaking or scaly texture, and its color may vary from brown to pink to purple, or it may have mixed pigmentation

Front 57

Kaposi's Sarcoma

Back 57

a malignant neoplasm that develops in connective tissues such as cartilage, bone, fat, muscle, blood vessels, or fibrous tissues. It affects those with acquired immunodeficiency syndrome (AIDS) and those who have drug-induced immunosuppression.

Hint 57

Clinical Findings: The initial lesions appear on the lower extremities and are characterized by dark blue-purple macules, papules, nodules, and plaques. The lesions eventually spread all over the body, particularly the trunk, arms, neck, face, and oral mucosa. Associated symptoms are pain and pruritus to the lesions.

Front 58

Pediculosis (Lice)

Back 58

parasites that invade the scalp, body, or pubic hair regions. HirsutismLice on the body are called pediculosis corporis, and pubic lice are called pediculosis pubis.

Hint 58

Clinical Findings: The eggs (nits) are visible as small, white particles at the base of the hair shaft. The skin underlying the infested area may appear red and excoriated.

Front 59

Alopecia Areata

Back 59

a chronic inflammatory disease of the hair follicles resulting in hair loss on the scalp. The cause is unknown, but is associated with autoimmune disorders, metabolic disease, and stressful events.

Hint 59

Clinical Findings: Hair loss is observed in multiple round patch areas of the scalp. The affected areas are either completely smooth or have short shafts of hair. The poorly developed and fragile hair shafts break and will generally grow back within 3 to 4 months, although some individuals suffer total scalp hair loss.

Front 60

Hirsutism

Back 60

a condition associated with an increase in the growth of facial, body, or pubic hair in women. This condition has familial tendency and can be associated with endocrine disorders, menopause, and side effects of medications, especially corticosteroid or androgenic steroid therapy.

Hint 60

Clinical Findings: An increase of body or facial hair is seen; the amount of hair is variable. This condition is more pronounced among dark-pigmented hair. Increased hair growth may or may not be associated with other signs of virilization.

Front 61

Onychomycosis

Back 61

a fungal infection of the nail plate caused by tinea unguium. Although the prevalence is variable, it occurs in up to 18% of the population in given areas.

Hint 61

Clinical Findings: The nail plate turns yellow or white as hyperkeratotic debris accumulates. As the problem progresses, the nail separates from the nail bed, and the nail plate crumbles

Front 62

Paronychia

Back 62

involves an acute or chronic infection of the cuticle. The infection is usually caused by staphylococci and streptococci, although Candida may also be the causative organism.

Hint 62

Clinical Findings: Acute infection involves the rapid onset of very painful inflammation at the base of the nail, often after minor trauma to the area. In some cases an abscess may form. With chronic paronychia the inflammation develops slowly, usually starting at the base of the nail within the cuticle and working up along the sides of the nails (lateral nail folds). Frequent exposure of the hands to moisture is a risk factor for chronic paronychia

Front 63

Ingrown Toenail

Back 63

occurs when the nail grows through the lateral nail and into the skin. This condition usually involves the great toe.

Hint 63

Clinical Findings: The individual experiences pain, redness, and edema. An acute infection may occur, resulting in purulent drainage. Common risk factors for an ingrown toenail include trauma, poorly fitting shoes, and excessive trimming of the lateral nail plate.

Front 64

Clavus (Corn)

Back 64

a lesion that develops secondary to chronic pressure from a shoe over a bony prominence.

Hint 64

Clinical Findings: The corn is a flat or slightly raised, painful lesion that generally has a smooth, hard surface. A “soft” corn is a whitish thickening commonly found between the fourth and fifth toes. A “hard” corn is clearly demarcated and has a conical appearance.