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303 Cards in this Set
- Front
- Back
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What are the 3 main layers of the skin? |
Epidermis Dermis Subcutaneous Tissue
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What are the 4 layers of the epidermis?
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Stratum, Corneum Cellular Stratum, Cellular Stratum consists of: Stratum Lucidum (present only in thick skin) (spinosum?), Stratum Granulosum, Stratum Germinativum
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What are some functions of the skin?
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Protect against foreign invasion , Provides mechanical barrier to reduce water loss, Regulate body temp, Provide sensory input, Produce vitamin D, Contribute to BP through constriction of skin blood vessels, Repair surface wounds, Excrete sweat, urea, and lactic acid, Express emotions
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Is the epidermis vascular or avascular?
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avascular: It relies on the dermis for nutrition
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In what layer are keratin cells formed?
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Stratum germinativum
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What layer contains melanocytes? What do they synthesize?
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germinativum; melanin
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What makes up the dermis?
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elastin, collagen, and reticulum fibers
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What are arrectores pilorum muscles?
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tiny muscles in the dermis that make hair stand up
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What is the hypodermis? what is it made of?
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it connects the dermis to the underlying organs; loose connective tissue filled with fatty cells
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What is the function of the hypodermis?
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generates heat, provides insulation, shock absorption, and reserves calories
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What are the 5 appendages of the skin?
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eccrine sweat glands, apocrine glands, sebaceous glands, hair, nails
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What is the main function of eccrine sweat glands?
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maintain body temp by secretion of water
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Where are the places you will not see eccrine sweat glands?
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lip margins, eardrums, nail beds, inner surface of prepuce (fore skin), glans penis
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What will you find appocrine sweat glands?
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axillae, nipples, areolae, anogenital area, eyelids, external ears
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In response to emotional stimuli, what will appocrine glands secrete?
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white fluid containing protein, carbohydrate, and other substances
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What type of smell does the appocrine glands secrete?
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the fluid is odorless; the odor comes from bacterial decomposition in the sweat
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What do sebaceous glands secrete?
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sebum: a lipid-rich substance that keeps skin and hair from drying out
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What stimulates the secretory activity of sebaceous glands?
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Sex hormones (primarily testosterone)
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What are the 3 parts of a hair?
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root, shaft, follicle
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What is the papilla of the hair follicle?
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loop of capillaries at the base of the follicle that supplies nourishment for growth
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What determines the color of hair?
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melanocytes at the base of the shaft
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What are the 2 kinds of hair found in adults?
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vellus and terminal
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Describe vellus hair.
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short, fine, soft, and nonpigmented
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Describe terminal hair.
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coarse, long, thick, and usually pigmented
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What are the 3 cyclic changes a hair can go through?
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anagen (growth), catagen (atrophy), telogen (rest)
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What is the composition of nails?
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hard plates of keratin
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Is the nail bed vascular or avascular?
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highly vascular
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What is another name for the cuticle of the nail?
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eponychium
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What is the name of the soft tissue surrounding the nail border?
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paronychium
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What is desquamation?
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Shedding of the skin; occurs in infants at birth or shortly after
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What is venix caseosa?
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a mixture of sebum and cornified epidermis that cover the infant's body at birth
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Why are infants predisposed to hypothermia?
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The subcutaneous fat layer is poorly developed
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What is languo?
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fine, silky hair that covers a newborn's shoulders and back
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When is languo shed?
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within 10-14 days
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Do newborns shed the hair they have on their head?
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Yes, most of their hair is shed by about 2-3 months and replaced with permanent hair with new texture and color
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In infants, when do the eccrine glands begin to function?
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after the first month of life
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What glands do not function in infants?
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appocrine glands ; These glands become active during adolescence
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Why are adolescents predisposed to acne?
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Because hormones increase sebum production with give skin an oily appearance
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Where could you find terminal hair in an adolescent?
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axillae and pubic areas and on face of male
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Why do pregnant ladies hands and feet swell?
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increased blood flow from vasodilation and increased numbers in capillaries
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Why does sweat activity increase in pregnant women?
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to assist in dissipating the excess heat caused by the increased metabolism during pregnancy |
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Where do pregnant women have increased skin pigmentation and darkening?
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face, nipples, areolae, axillae, vulva, perianal skin, and umbilicus
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Why does skin become drier in older adults?
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sebaceous and sweat gland activity decreases
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What happens to the dermis in older adults?
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vascularity decreases. loses collagen and elastic fibers, shrinks (causing skin to wrinkle)
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What happens to the epidermis in older adults?
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thins, flattens, and permeability increases
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In what type of people would you see less wrinkling with age?
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blacks, yellows, and obese people
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What happens to the subcutaneous tissue in older adults?
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decreases (particularly in extremities), giving joints a bony appearance
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Why do older adults have grey hair?
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decrease number in functioning melaocytes (hair of whites turn grey before hair of blacks and Asians)
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Which phase of the hair cycle decreases in older adults?why?
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anagen phase; decreased hormones
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What regions tend to deepen in older adults?
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thoracic, axillary, supraclavicular
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How does the texture of hair change in older adults?
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changes from terminal to vellus
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In older adults, which hair changes from vellus to terminal?
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nares and tragus of men, Women also produce increased coarse facial hair because of higher androgen/estrogen ratios
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What will you notice during a skin exam in a patient with peripheral vascular disease?
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peripheral extremity hair loss
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In older adults, why does nail growth slow?
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decrease peripheral circulation
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What happens to the nails of older adults?
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they become thicker, brittle, hard, yellowish, they develop longitudinal ridges and are prone to splitting in layers
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Clinical Pearl: Why are those who use 30 spf sunscreen still at risk for a significant sunburn?
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Because they don't use enough thy think they are protected, and they stay in the sun too long sunscreen needs to be applied 15-20 minutes before exposure, reapply after swimming, reapply after 2-3 hours of exposure
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What equipment is needed to perform a skin exam?
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ruler, flashlight with transilluminator, handheld, magnifying lens, wood's lamp
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What two techniques are used during a skin exam
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Inspection and palpation
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What is the most important tool during a skin exam?
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Your own eyes and power of observation
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Daylight provides the best lighting for skin inspection. If daylight is insufficient, supplement with...
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fluorescent lighting
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What type of lighting is helpful in assessing contour?
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tangential
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What is the "bird's-eye view"?
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the overall visual sweep of the body
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What are intertriginous surfaces?
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Areas of skin that tough or rub together
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What is "coining" or "cupping" in Asian subcultures?
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Coin is dipped into mentholated oil and is vigorously rubbed across the skin in a prescribed manner causing mild dermabrasion ; This process is believed to restore balance; Cupping is a series of small heated glasses are placed on the skin, forming a suction that leaves a red circular mark, This process is believed to draw out the bad force
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Where is the thinnest skin on the body?Thickest?
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eyelids; soles, palms, and elbows
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What are corns?
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flat or slightly elevated circumscribed painful lesions with a smooth or hard surface
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What causes "soft" corns?
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pressure of a bony prominence against a softer tissue they appear as whitish thickening commonly seen b/w the 3rd and 5th toes
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What causes "hard" corns?
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they occur over bony prominences where pressure is exerted they are sharply delineated and have a conical appearance
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What is a callus?
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A superficial area of hyperkeratosis usually occur on the weight bearing surfaces of the feet and the palms of the hands these are less well demarcated than corns and are usually not tender may appear yellow in color
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What is nevi?
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moles
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Where are dysplastic (atypical) nevi typically seen?
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Men: upper back Women: legs
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What is chloasma or melasma?
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areas of hyperpigmentation on the face and neck in pregnant women. *more noticeable in darker skinned women
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What are pigmentary demarcation lines?
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normal lines that mark the border between the darker surface of outward facing skin and the lighter surface of the inward facing skin; 70% in blacks, 11% in whites, Asians and Indians fall b/w these 2 numbers
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How can you tell a dysplastic mole from melanoma?
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dysplastic nevi normally occur on the truck greater than 5mm, flat, border is ill defined, shape can be mottled with brown, pink and tan; melanoma has an irregular border, greater than 6mm, can be tan-brown, dark brown, black, pink, red, gray, blue, white. *Individuals with dyplastic moles are at increased risk for melanoma
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Do nevi occur more in light skin or dark skin individuals?
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more ofter in lighter skinned individuals *Sun exposure will increase numbers *increase number with age, peak in 40-50s, diminish after that
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What is characteristic of a halo nevus?
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sharp, oval, or circular, depigmented halo around mole, may undergo morphologic changes, usually disappears and halo repigments
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Where do you normally find halo nevus? Significant?
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on back of young adult usually benign, biopsy indicated because same process can occur around melanoma, What is characteristic of a intradermal nevus? dome shaped, raised, flesh to black color, may be pedunculated or hair bearing
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Where do you normally find intradermal nevus?significant?
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on cells limited to dermis, no indication for removal other than cosmetic
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What is characteristic of a junction nevus?
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slightly elevated, dark brown
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Where do you normally see junction nevus?significant?
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nevus cells lining dermoepidermal junction, should be removed if exposed to repeated trauma
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What is characteristic of compound nevus?
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slightly elevated brownish papule, indistinct border
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Where do you normally see compound nevus? significant?
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nevus cells in dermis and lining dermoepidermal junction; should be removed if exposed to repeated trauma
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What is characteristic of hairy nevus?significant?
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may be present at birth, may cover large area, hair growth may occur after several years , should be removed if changes occur
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The typical adult has how many moles total?
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10-40
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A blueish hue of lips and gums may be normal in what type of people?
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dark skinned people
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Cardiovascular disease and diabetes mellitus may cause what changes in skin appearance in the lower extremity?
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pale, shiny
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Purple discoloration produced by injury is called...
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ecchymoses
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purple discoloration by other causes are called....
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petechiae if smaller than .5cm in diameter; purpura if larger than .5cm in diameter
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What is a telangiectasia?
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capillary spider or spider angioma
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How do you tell the difference b/w a capillary spider and a spider angioma?
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when you blanch capillary spiders, they will refill in a erratic, non-organized way. They are little masses of venules; Spider angiomas are arterial, they will refill in a very organized way. From center out, evenly in all ways
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What could be the cause of a generalized brown pigment change?
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Pituitary, adrenal, or liver disease
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What could be the cause of a generalized white pigment change?
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albinism
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What could be the cause of increased cutaneous blood flow in a localized region?
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(red pigment change) Inflammation
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What could be the cause of increased cutaneous blood flow with general distribution?
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(red pigment change) fever, viral exanthem, urticaria
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What would be the result of red pigment change from increased intravascular red blood cells?
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polycythemia
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What could be the result of a generalized pigment change of yellow?
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liver disease (jaundice) OR hypothyroidism, increased intake of vegetables containing carotene (everywhere except sclera)
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What would be the result of a blue pigment change on the lips, mouth, and nail beds?
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cardiovascular and pulmonary disease (increased unsaturated hemoglobin secondary to hypoxia)
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What side of the hand should be used in sensing temperature symmetry?
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dorsal side
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What can cause purpura?
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intravascular defects or infection
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What can cause petechiae?
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intravascular defects and infection
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What can cause ecchymoses?
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vascular wall destruction, trauma, vasculitis
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What can cause spider angioma?
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liver disease, vitamin B deficiency, idiopathic
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What can cause venous star- bluish spider?
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increased pressure in superficial veins
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What can cause telangiectasia?
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dilation of capillaries
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What can cause capillary hemangioma?
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Dilation of dermal capillaries
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What is the cause of rotten apples odor?
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Clostridium gas gangrene
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Mousy
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Proteus infection
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Grapelike
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pseudomonas infection (especially burns)
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Pungent
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schizophrenia
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stale beer
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Tuberculous lymphadenitis (scrofula)
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putrid
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Anerobic infection; scurvy
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feculent
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intestinal obstruction; perionitis
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mousy, musty
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phenylketonuria
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What might be the cause of hyperkeratoses?
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a systematic disorder such as arsenic or other toxic exposure
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Where on the patient should turgor be tested? Why might recoil of the skin be altered?
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forearm or sternal area ; dehydration, if edema is present, or it could be indicative of a CT disease such as scleroderma
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What is a catch all term that collectively describes any pathologic skin change or occurrence?
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skin lesion
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What is a primary lesion? secondary lesion?
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those that occur as initial spontaneous manifestations of pathologic disease; those that result from later evolution of or external trauma to a primary lesion
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What is the purpose of a wood's lamp?
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to look for infection, a yellow-green flourescence indicates the presence of fungal infection
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What characteristics should be described in a skin lesion?
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size, shape, color, texture, elevation/depression, attachment to base, exudates, configuration, location/distribution
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What is a flat, circumscribed area that is a change in the color of the skin; less than 1 cm in diameter?
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Macule (freckles, flat moles, petechiae, measles, scarlet fever)
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What is an elevated, firm, circumscribed area; less than 1cm in diameter?
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Papule (wart/verruca, elevated moles, lichen planus)
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What is a flat, nonpalpable irregular-shaped macule greater than 1cm in diameter?
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Patch (vitiligo, port-wine stains, mongolian spots, cafe au lait patch)
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What is an elevated, firm, and rough lesion with a flat top surface greater than 1cm in diameter?
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Plaque (pasoriasis, seborrheic, and actinic keratoses)
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What is an elevated, irregular shape area of cutaneous edema; solid, transient, variable, diameter?
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Wheal (insect bites, urticaria, allergic reaction, like hives)
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What is an elevated, firm, circumscribed lesion; deeper in dermis than papule; 1cm-2cm in diameter?
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Nodule (eythema nodosum, lipoma)
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What is an elevated and solid lesion; may or may not be clearly demarcated; deeper in dermis; greater than 2 cm in diameter?
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tumor (neoplasms, benign tumor, lipoma)
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What is an elevated, circumscribed, superficial, not into dermis; filled with serous fluid; less than 1cm in diameter?
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vesicle (varicella, herpes zoster/shingles)
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What is a vesicle greater than 1 cm in diameter?
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Bulla (blister, pemphigus vulgaris)
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What is an elevated, superficial lesion; similar to a vesicle but filled with purulent fluid?
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pustule (impetigo, acne)
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What is elevated, circumscribed, encapsulated lesion; in dermis or subcutaneous layer; filled with liquid or semisolis material?
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Cyst (sebaceous cyst, cyst acne)
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What is fine, irregular, red lines, produced by capillary dilation?
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Telangiectasia (telangiectasia in rosacea)
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What is head-up, keratinized cells, flaky skin; irregular; thick or thin, dry or oily, variation in size
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Scale (flaking of skin with seborrheic dermatitis following scarlet fever or flaking of skin following a drug reaction; dry skin)
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What is rough thickened epidermis secondary to persistent rubbing, itching, or skin irritation, often involves flexor surface of extremity?
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lichenification (chronic dermatitis)
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What is irregular-shaped,elevated, progressively enlarging scar; grows beyond the boundaries of a wound; cause by excessive collagen formation during healing?
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Keloid (keloid formation during surgery)
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What is thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis?
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Scar (heal wound or surgical incision)
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What is loss of the epidermis; linear hollowed-out, crusted area?
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excoriation (abrasion or scratch , scabies)
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What is a linear crack or break from the epidermis to the dermis; may be moist or dry?
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fissure (athlete's foot, cracks at the corner of the mouth)
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What is the loss of part of the epidermis; depressed, moist, glistening; follows rupture of a vesicle or bulla?
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Erosion (varicella, variola after rupture)
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What is the loss of epidermis and dermis; concave; varies in size?
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Ulcer (Decubiti, stasis ulcers)
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What is a dried serum, blood or purulent exudates; slightly elevated,; size varies; brown, red, black, tan, or straw-colored?
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Crust (scab on abrasion, eczema)
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What is the thinning of skin surface and loss of skin markings; skin translucent and paper-like?
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Atrophy (striae, aged skin)
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What does discoid/round describe?
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coin shaped (no central clearing)
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annular shape
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round, active margins with central clearing
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Zosteriform (dermatomal) shape
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following a nerve or segment of the body
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Polycyclic shape
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Interlocking or coalesced circles (formed by enlargement of annular lesions)
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Iris/target lesion shape
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pink macules with purple central papules
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Stellate shape
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Star shaped
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Serpiginous shape
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snakelike or wavy line track
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Reticulate shape
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netlike or lacy
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Morbilliform shape
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Measles like: maculopapular lesions that become confluent on the face and body
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What are 3 ways you can describe the distribution of a skin lesion
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localized, regional, generalized
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discrete border
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well demarcated or defined, able to draw a line around it with confidence
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indistinct border
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poorly defined, have borders that merge into normal skin or outlying ill-shaped papules
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active border
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margin of lesion shows greater activity than center
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irregular border
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non-smooth or notched margin border raised above center of lesion is depressed compared to that of the edge
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Advancing border
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expanding at margins
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central clearing change
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an erythematous border surrounds lighter skin
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desquamation change
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peeling or sloughing of skin
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keratotic change
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hypertrophic stratum corneum
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Punctation change
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cntral embilication or dimpling
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telangiectasias change
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dilated blood vessels within lesion blanch completely, may be markers of systemic disease
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What are some pigmentations associated with lesions?
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flesh, pink, erythematous, slamon (orange-pink), tan-brown, black, pearly (shiny white), purple, violaceous (light violet), yellow, white
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What hours of the day should you avoid sun exposure?
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10am-4pm peak hrs for harmful UV radiation
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What type of sunscreen should you use?
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30 or higher that blocks UVA and UVB, reapply after swimming, sweating, or toweling dry
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The American Cancer society advocates what phrase to catch the attention of children for sun exposure?
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"Slip! Slop! Slap!... and Wrap" slip on a shirt, slop on sunscreen, slap on a hat, wrap on sunglasses
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What do you look for while palpating the hair?
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Texture, color, distribution, quantity, resiliency
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What should the hair not be?
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dull, dry, or brittle; may indicate systemic disorder
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Hair loss may indicate?
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Poor circulation or nutritional deficit
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Where do men and women genetically often display hair loss?
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on the scalp in response to androgens
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What is alopecia?
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hair loss
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Where do you normally see vellus hair?
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cover the body
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Where do you normally see terminal hair?
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scalp, pubic, axillary, maybe arms and legs, and the beard of men
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Describe the pubic hair pattern of a female.
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inverted triangle hair may extend to umbilicus
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Describe the pubic hair pattern of males.
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upright triangle extending midline to the umbilicus
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What is hirsutism in women?
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growth of terminal hair in a male distribution pattern on face, body, and pubic area'; may be a sign of endocrine disorder
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What should be inspected with the nails?
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color, length, configuration, and cleanliness; are they bitten?; are they clean? nails give you a sense of self-care
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What would you expect to see in a person subject to repeated water immersion of the nails?
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peeling nails (the plate splitting into layers)
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On the nails, what is usually associated with pain?
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ingrown nails and infection
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What color should the nail bed be?
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variations of pink
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What may yellowing nails indicate?
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psoriasis, fungal infections, chronic respiratory disease
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Are pigment deposits or bands expected in the nails?
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yes, in persons with dark skin; In persons with white skin, it may indicate melanoma
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What is proximal fungal infection associated with?
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HIV infection
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Diffuse darkening of the nails may be from....
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antimalaria drug, candidal infection, hyperbilirubinemia, chronic trauma (tight fitting shoes)
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Green-black discoloration may be associated with...
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pseudomonas infection, may be similar to injury, but pseudomonas infection is painless
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What may blue nails indicate?One single blue nail?
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Cold room, asthma, cardiac disorders, anemia, poison, medication side effects, or Wilson disease (inherited disorder of copper metabolism) melanoma, or bruising from trauma
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Longitudinal red or brown streaks on nails may indicate....
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endocardidtis, vasculitis, severe psoriasis of nail matrix, minor injury to nail fold
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Why could there be white spots of the nail plate?
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cuticle manipulation or mild trauma, need to be differentiated from white streaks or traverse white bands that could indicate systemic disorder
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What would you expect to find upon separation of the nail bed from the nail plate?
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white, yellow, green tinge on the nonadherent portion of the nail
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How should the nail plate appear?
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smooth, flat, or slightly convex
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What is anonychia?
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complete absence of the nail, could be a congenital condition
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What is the most common cause of transverse grooves in the thumb?
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picking at the thumb with the index finger (habit-tic deformity)
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Transverse ripping of the nail plate may be from...
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chronic inflammation that occurs with chronic, paronychia (swollen area around the nail) or chronic eczema
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What are terry nails?
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nails appear white with dark red tip
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What is onycholysis?
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detachment of the nail bed starting from its distal or lateral attachment (displays an S-like shape)
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What is koilonychia?
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Spooning of the nail (end of the nail plate goes up)
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What are beau lines in the nails?
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transverse grooving
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Why may transverse depressions that appear at the base of the lunula occur?
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may occur after stress that temporarily interrupts nail formation
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Why might there be depressions in all nails?
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systemic disease such as syphilis, disorders producing high fevers, peripheral vascular disease, or uncontrolled diabetes mellitus
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What is pitting most commonly seen with?
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psoriasis
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What nail changes would you see in secondary syphilis?
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broadening and flatting
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What is the normal degrees of the nail base angle?
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160 degrees
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What are 2 ways to observe nail base angle?
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Shamroth using a flat edge
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What is clubbing associated with?
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respiratory and cardiovascular disease, cirrhosis. colitis, thyroid disease
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How should the nails feel upon palpation?
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firm, adherent, thick
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What could cause thickening of the nail?
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tight fitting shoes, chronic trauma, fungal infection
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Pain in the nail groove could be secondary to...
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ischemia
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Separation of the nail plate from the nail bed is commonly seen in...
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psoriasis, trauma, candidal, psudomonas infections, or some medications
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A boggy nail accompanies...
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clubbing
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How is skin color partly determined by chubbiness?
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the less cutaneous fat, the redder and more transparent the skin
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Where do dark skinned babies manifest the intensity of melanosis?
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on nail beds and skin of scrotum
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About how many newborns present with jaundice?
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50%; starts with day 1 and disappears by day 8-10, may persist for as long as 3-4 weeks
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When examining for jaundice in a newborn, where do you look? why?
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oral mucosa and sclera of the eyes, can be detected more easily in these areas
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Where should pay special attention when checking newborns skin for defects?
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length of the spine, midline of the head, from the nape of the neck to the bridge of the nose, the neck extending to the ear, (may offer clues about brachial sinus tracts of brachial cleft cysts)
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What is cutis marmorata?
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transient mottling when infant is exposed to temp change, (lacy blue cutaneous pattern) (this is expected in a newborn however, more common in premature infants and children with down syndrome or hypothyroidism)
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What is acrocyanosis?
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Cyanosis of the hands and feet (expected in a newborn) more intense in the feet; if it persists, a cardiac or pulmonary defect should be suspected
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What is Erythema toxicum?
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pink papular rash with vesicles superimposed on the thorax, back, buttocks, and abdomen (expected change in newborn after 24-48 hrs, resolves after several days)
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What are mongolian spots?
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Irregular areas of deep blue pigmentation, usually in the sacral and gluteal regions Typically seen in newborns of dark skin decent. Disappear in preschool years, easily mistaken for bruises
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What are salmon patches ("stork bites")?
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flat, deep pink localized areas seen on the mid-forehead, eyelids, upper lip, and back of neck, represents a common caoillary vascular formation
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What is faun tail nevus?
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Tuft of hair overlying the spinal column at birth (lumbosacral area), may be associated with spina bifida occulta
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What is epidermal verrucous nevi?
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Warty lesions in a linear or whorled pattern that may be pigmented or skin colored, present at birth or early childhood, associated with skeletal, CNS, and ocular abnormalities
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What is cafe au lait macules?
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flat, evenly pigmented spots varying in color from light brown or black in dark skin, "coffee color", larger than 5mm in diameter, present at birth or shortly after
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Cafe au lait may be associated with?
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neurofibromatosis, pulmonary stenosis, temporal lobe dysrhythmia, or tuberous sclerosis
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To be diagnosed neurofibromatosis....
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six or more cafe-au-lait macules more than 5mm in greatest diameter in prepubertal individuals or more than 15mm in greatest diameter after puberty must be seen
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What might freckling in the axillary or inguinal area indicate?
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neurofibromatosis; may occur in conjunction with cafe au lait macules
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what is an ash leaf macule?
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white macules present at birth most commonly on the trunk associated with tuberous sclerosis
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What is facial port-wine stain?
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involving the opthalmic division of the trigeminal nerve, may be associated with occular defects (glaucoma), may be accompanied by angiomatous malformation of the meninges resulting in atrophy and calcification of the adjacent cerebral cortex
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What is port-wine stain of the limb and/or trunk?
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when accompanied by varicosities and hypertrophy of underlying soft tissues and bones, may be associated with orthopedic problems
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What is congenital lymphedema with or without transient hemangiomas?
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May be associated with gonadal dygenesis caused by the absence of an X chromosome, producing a XO karotype (turner's syndrome)
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What is supernumerary nipples?
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congenital accessory nipples with or without glandular tissue, located along the mammary ridge, may be associated with renal abnormalities, especially in the presence of other minor anomalies, particularly in whites
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What is "Hair collar" sign?
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a ring of long, dark, coarse hair surrounding a midline scalp nodule in infants is usually an isolated cutaneous anomaly that may indicate neural tube closure defects of the scalp
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On the feet and hands, what is an indicator of maturity in a newborn?
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creases, the older the baby, the more creases there are
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What is dermatoglyphics?
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The study of crease patterns on the hands of feet of newborns in association with certain abnormalities
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What type of crease is commonly associated with down syndrome?
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single transverse crease in the palm
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What is vernix caseosa?
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whitish, moist, cheese-like substance that commonly cover newborns
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Why are infants susceptible to hypothermia?
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poorly developed subcutaneous fat, relatively large body surface area (providing greater area for heat loss), and inability to shiver, loss heat 4x more than an adult
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What is milia?
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small whitish discrete papules on the face from immature sebaceous glands getting plugged by sebum
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What is sebaceous hyperplasia?
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produces tiny yellow macules and papules in a newborn, probably as a result of androgen stimulation from the mother; forehead, cheeks, nose, an chin; disappears at 1-2 months
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Where do you test for tugor in a newborn?
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abdominal skin; can better indicate hydration and nutrition than in an adult
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What is the degree of dehydration is the skin returns to normal in <2 seconds?
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<5% loss of body weight
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What is the degree of dehydration is the skin returns to normal in 2-3 seconds?
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5% to 8% loss of body weight
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What is the degree of dehydration is the skin returns to normal in 3-4 seconds?
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9%-10% loss of body weight
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What is the degree of dehydration is the skin returns to normal in >4 seconds?
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>10% loss of body weight
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What is Dennie-Morgan fold?
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extra crease or pleat of skin below the eye in an infant due to chronic rubbing and inflammation of the eyes
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What skin change would you noticed most in an adolescent?
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oiliness; predisposes them to acne
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What is striae gravidarum?
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stretch marks in pregnant women, may appear on abdomen, thighs, and breast during 2nd trimester fade after delivery, but never disappear
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Describe telangiectasias during pregnancy.
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increase 5-fold, face, neck, chest, arms, appear during 2-5 month of pregnancy, resolve after delivery
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What happens to hemangiomas that are present before pregnancy?
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they increase in size, new ones may develop
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What are cutaneous tags in pregancy? (molluscum fibrosum gravidarum)
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skin tags that are found on the neck and upper chest ,result from epithelial hyperplasia and are not inflammatory, most resolve spontaneously
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Where is increase in pigmentation forund in pregnant women?
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areolae, nipples, vulvar and prianal regions, axillae, and the linea alba
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Pigmentation of the linea alba is called?
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linea nigra
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What happens to pre-existing freckles (nevi) during pregnancy?
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darker and increase in size, new ones might form
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What is cholasma? or "mask of pregnancy"?
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found on forehead, cheeks, bridge of nose, and chin, blotchy in appearance
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During pregnancy, where is redness found in the hands?
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covers the entire palmar surface, disappears after delivery
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Is itching over the abdomen and breast of concern during pregnancy?
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no, it is common due to the stretching *unless it is associated with a rash or jaundice * itching can be cause by impaired flow of bile from liver (this kind is associated with itching on palms ans soles)
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During pregnancy, because of the hormones, hair loss is....
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decreased, 2-4 months after delivery, increased hair shedding occurs; regrowth will occur 6-12 months
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Acne may be aggrevated in the 1st trimester, but usually improves in the ....
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3rd trimester
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Describe skin changes in older adults.
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more transparent (thinner), paler, increased freckling, nonuniform pigmentation, dry skin, loss of elasticity, wrinkling , tugor might not be a good assessment of hydration
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What are decubitus ulcers in older adults?
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pressure sores or bed sores due to immobility combined with decreased peripheral vascular circulation; Heals and sacrum are common sites in patients confined to a bed
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In what type of patients do you commonly see purpura, particularly on the dorsal surface of the hand and lower arm. (areas that get bumped)
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patients on aspirin therapy
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Describe stage 1 of decubitus ulcers.
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Nonblanchable erythema of intact skin
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Describe stage 2 of decubitus ulcers.
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Partial-thickness skin loss involving epidermis or dermis. No subcutaneous tissue is visible
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Describe stage 3 of decubitus ulcers?
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Full-thickness skin loss. The fascia of the underlying tissue is intact
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Describe stage 4 of decubitus ulcers?
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extended into bone or muscle
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What is a cherry angiomas?
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Tiny, bright ruby-red papules that may become brown with time. Occur in almost everyone over 30 and increase with age
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What is seborrheic keratoses?
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pigmented, raised, warty lesions, usually on the face or trunk must be distinguished from actinic keratoses, which have malignant potential
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What are arochordon?
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cutaneous tags, small, soft, usually appearing on neck and upper chest attached to the body by a narrow stalk (pedunculated)
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What are solar lentigines?
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irregular, round, gray-brown macules with a round surface that occur in sun-exposed areas "age spots" or incorrectly, "liver spots"
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Describe the hair change in older adults.
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grey or white, terminal hair becomes vellus; men show an increase in coarse aural, nasal, and eyebrow hair; women develop coarse facial hair
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Describe the nail change in older adults.
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thick, brittle, deformed, misshapen, striated, distorted, peeling, yellowish color, may lose transparency; These changes are more common in the toenails
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Why would you see bald spots in children?
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9 times out of 10 it is ringworm of the scalp, alopecia areata, or trichotillomania (a compulsive pulling out of the hair)
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trichotillomania....
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can sometimes lead to trichobezoar, a large obstructive lump of hair in the stomach that forms after the child has swallowed the hair he/she just pulled out
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where is the stratum lucid found? |
only in the thicker skin of the palms and soles and lies just below the stratum corneum |
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what is the Wood's lamp? |
- can be used to evaluate epidermal hypo pigmented or hyper pigmented lesions and to distinguish fluorescing lesions |
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what does a yellow- green fluorescence indicates? |
presence of some types of fungal infection |
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what a transillumination may be used for? |
to determine the presence of fluid in cysts and masses |
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how should you use a transilluminator? |
darken the room and place the tip of the transilluminator against the side of the cyst or mass. Fluid-filled lesions will transilluminate with a red glow, whereas solid lesions will not |
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slip! slop! slap! wrap! |
slip on a shirt slop on sunscreen slap on a hat wrap on sunglasses |
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nodule |
deeper in the dermis, 1-2 cm in diameter |
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tumor |
elevated and solid lesion; deeper in the dermis, greater than 2 cm |
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bulla |
vesicle greater than 1 cm |
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vesicle |
filled with serous fluid; less than 1 cm |
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pustule |
vesicle filled with purulent fluid |
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cyst |
elevated, circumscribed, encapsulated lesion; in the dermis or subcutaneous layer; filled with liquid or semisolid material |
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types of primary skin lesions |
1- macule 2- papule 3- patch 4- plaque 5- wheal 6- nodule 7- tumor 8-vesicle 9- bulla 10 -pustule 11- cyst 12- telangectasia
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types of secondary skin lesions |
1- scale 2- lichenification 3- keloid 4- scar 5- excoriation 6- fissure 7- erosion: follows rupture of vesicle or bulla 8- ulcer 9- crust 10- atrophy |
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hirsutism may be a sign of what? |
hormonal disorder |
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in whom is peeling nails most usually found? |
in individuals whose hands are subject to repeated water immersions |
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what is leukonychia punctate? |
white spots in the nail plate result from cuticle manipulation or other forms of mild trauma that injure the nail matrix |
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what does longitudinal white streaks or transverse white bands indicate? |
systemic disorder |
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in who are pigmented bands expected to be found? |
in persons with dark skin |
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how should a nail plate appear? |
smooth and flat or slightly convex |
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what is anonychia? |
complete absence of the nail |
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depressions that occur in all nails is usually a response to what? |
systemic disease, including syphilis, disorders producing high fevers, peripheral vascular disease, and uncontrolled diabetes mellitus |
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what is the nail angle in clubbing? |
the angle increases and approaches or exceeds 180 degrees |
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separation of the nail plate from the bed is common in what conditions? |
psoriasis, trauma, candidal, or pseudomonas infection and some medications |
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what is cutis marmorata? |
a mottled appearance of the body and extremities - is part of the newborn's response to changes in ambient temperature, whether cooling or heating |
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what is acrocyanosis? |
cyanosis of hands and feet |
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what are mongolian spots? |
hyperpigmented patches. They are common in babies with dark skin |
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when should you be suspicious of neurofibromatosis-1 (NF-1)? |
if there are six or more cafe au lair macules more than 5mm in greatest diameter in prepubertal individuals or more than 15mm in greatest diameter after puberty |
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what is milia? |
a small whitish, discrete papules on the face normally found in the first 2 or 3 months of life |
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what is a Dennie-Morgan fold? |
extra crease or pleat of skin below the eye probably secondary to chronic rubbing and inflammation |
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how is it called pigmentation of the linea alba? |
linea nigra. It extends from the symphysis pubis to the top of the fundus in the midline |
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since the loss of skin turgor is a common finding in older individuals, how should you determine hydration status? |
check amount of saliva, urine output, and urine specific gravity |
