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156 Cards in this Set

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stratum germinativum
prootective barrier forms new skin cells called keratin
melanin
gives brown tones to the skin and hair
Vellus hair
(fine faint hair) that covers most of the body except the palms and soles, the dorsa of the distal parts of the fingers, umbilicus, the glans penis and inside the labia
terminal hair
the darker thicker hair that grows on the scalp and eyebrows and after puberty on the axillae, pubic area, and the face and chest in the male
Sebaceous gland
produce sebum
oils and lubicates skin
not on palms and soles
Eccrine sweat gland
secreate sweat on skin surface
Normal Nail Plate
with fine longitudinal ridges that become prominent in aging
Normal Lunula
white opaque semilunar area at the proximal end of the nail
cuticle
cover and protect the nail matrix
What is the function of the skin?
protection
prevents penetration
perception
temperature regulation
Skin produces which vitamin?
ultraviolet light converts cholesterol into vitamin D
Lanugo
The fine downy hair of the new born.
In the first few months after birth, this is replaced by fine vellus hair.
Terminal hair on infant
soft, patchy loss at the temples and occiput
Vernix caseosa
thick, cheesy substance made up of sebum and shed epithelial cells.
Linea nigra
increased pigment of the abdomend on the pregnant female
chloasma
increased pigmend in the face of the pregnant female
What happens to the skin of an aging adult?
loses elasity, folds and sag, parchment thin, lax, dry and
stratum corneum thins and flattens,
loss of elastin, collagen, and subcutaneus fat and reduction in muscle tone.
Loss of collagen increases the risk for terring injuries.
Decreased sweat glands increases the risk of sun stroke.
Senile purpura
vascularity of the skin diminishes, while the vascular fragility increases, minor trasuma may produce dark red discolored areas
How does the Striae gravidarum change in a pregnant female?
connective tissue developes increasing fragility which develops in the skin of abdomen, breast, or thighs.
eczema
noncontagious inflammatory skin disease
Objective: redness, itching, outbreak of lessions that ay discharge and become encrusted and scaly
Psoriasis
noncontagious inflammatory skin disease
Objective: recurring reddish patches covered with silvery scales
Generalized change in skin color suggest?
pallor, jaundice, cyanosis
seborrea
oily
xerosis
dry
Pruritus
Most common of skin symptoms.
Occurs with dry skin, aging, drug reactions, allergy, obstructive jaundice, uremia, lice
Alopeca
significant hair loss
Hirsutism
Unusual Hair growth
malignant melanoma
happens in later years of life caused by one or more severe sunburns before 18 years of age
The palms of the hands and soles of the feet have an extra epidermal layer called?
Stratum lucidum
What causes pallor?
peripheral vasoconstriction
False: fear, anger
What causes erythema?
Flushing in face and neck
False: embarrassment
What causes erythema?
vasodilation
False: hot room
How does cigarette smoking influence skin color?
False pallor due to vasoconstriction
What would cause false pallor, collness.
Vasoconstriction sue to chilly room
What would prolonged elevation cause?
pallor, coolness duce to decreased arterial perfusion
What would immobilizatiom or prolonged inactivity cause?
pallor, coolness, nail beds pale, prolonged capillary filling time due to slowed circulation
Where do dark skined people have areas of lighter pigmentation?
palms, nail beds, and lips
vitiligo
complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, body folds, and around orifices.
ephelides
(freckles) small, flat macules of brown melanin pigment that occur on sun exposed skin
nevus
(mole)- proliferation of melanocytes, tan to brown color, flat or raised. Acquired nevi are characterized by their symmetry, small sixe (6mm or less), smooth borders, and skingle uniform pigmentation.
Junctional nevus
macular only and occurs in children and adolescents. It progresses to the nivi in young adults that and macular and papular.
Birth marks
tan to brown
What color is pallor?
white
What color is erythema?
red
What color is cyanosis?
blue
What are the inaccurate skin signs of dark-skinned people?
amount of color pigment may mask color change
What causes palor?
high stress states that cause vasoconstriction

Other causes are cold, smooking, and edema.

Seen in the mucous membrane, lips, and nail beds.
Where do you acess palor of anemia?
palperbral conjunctva and nail beds
What causes erythema?
Intense redness of the skin

Expected with fever, local inflammation, or bludshing in cheecks, neck and upper chest
Cyanosis
tissues are not adequately perfused with oxygenated blod
What causes cyanosis
is asociated with decreased oxygenatio of the brain and changes in level of consciousness, respritory distress
What does ashen gray color in dark skin or marked pallor in whites cccur with?
anemia, shock, arterial insufficiency
Jaundice
yellow color, indicating rising amounts of bilirubin in the bood.
Found in hard and soft palate in the mouth and in sclera.

Exception: common yellow calluses on palms and soles are not jaundice
How do you check skin temperture?
Use backs (dorsa) of hands to palpate the person and chekc bilaterally

skin should be warm and equal bilateraly
Hypothermia
Coolness

Localized coolness is expected with immobilzed extremity.
Hyperthermia
increased metabolic rate such as fever.

Localized area feels hyperthermic with trauma, infection, or sunburn.
Diaphoresis
profuse perspiration
Dehydratin
Normal: membranes look smooth and moist
Abnormal: dehydration in the oral mucous membranes
What is normal texture?
Skin fells smooth and firm, with an even surface.
Callus
circumscribed overgrowth of epidermis and is an adaptation to excessive pressure fro the friction of work and weight bearing.
What does jaundice occour with?
hepatitis, cirrhosis, sickle-cell disease, transfusion reaction, and hemolytic disease of the newborn.
What accompanies jaundice?
light or clay colored stools and dark golden urine often accompany jaundice in both light and dark skinned people.
What abnormal finding occurs with hyperthermia?
peripheral arterial insufficiency and Raynauds disease
How is the skin effcted by hyperthyroidism?
Hyperthyoidism has an increased metabolic rate, xausing warm, moist skin.
How does hyperthyoidism effect the skin?
skin feels smoother and softer, like velvet.
How is the skin texture effected by hypothyroidism?
skin feels rough, dry, flaky.
Very thin, shiny skin (atrophic) occours with?
arterial insufficiency
Edema
abnormal fluid accumulating in intercellular spaces
How do you check for edema?
imprint your thumbs firmly against the ankle malleolus or tibia.
Normaly the skin stays smooth. If your pressure leaves leaves a dent in the skin "pitting" edema is present.
Explain the four point grad scale for Edema.
1+ Mild pittling, slight indentation, no percepticle swelling of the legs

2+ Moderate pitting, indentation subsides rapidly

3+ Deep pitting, indentation remains for a short time, leg looks swollen

4+ Very deep pittling, indentation lasts a long time, leg is very swollen
What is dependent edema?
Edeam in the feet, ankles, and sacral areas. Skin looks puffy and tight.
You note a pig skin or Peau d' orange
What is the cause of Unilateral Edema?
consider a local or peripheral cause
How do you test for mobility and turgor?
Pinch up a large fold of skin on the anterior chest under the clavicle. Mobility is the skin rising and tugor is its ability to return to place promply.
What happens to mobility when edema is present?
mobility is decreased
What are signs of poor tugor?
severe dehydration or weight loos; the pinched skin recedes slowly or "tents" and stands by itself.
Scleroderma
"hard skin", a chronic connective tissue disorder associated with decreased moility.
Cherry (senile agniomas)
small (1-5mm), smooth, slightly raised bright red dots that commonly appear on the trunk in all adults over 30.
Not Significant
ecchymosis
bursing, should be exspected with trauma of life
There are normally no venous dilations or varicosities.
What bruises should raise concern about physical abuse?
multiple burises at different stages of healing and excessive burises above knees or elbows should raise concern
If there are tattoos on PT's body what do you do?
document the presence of any tattoos
Advise the person tattos increase the risk of hepatitis C.
How would you document a lesion?
1. color
2. elevation
3. Pattern or shape
4. Size, in centimeters
5. location and distribution on body
6. any exudate (liquid)
What is a primary lesion?
lesion that devolops on previously unaltered skin
What is a secondary lesion?
a lesion that changes over time or changes becuase of scratching or infection.
What can you do to identigy a macular rash in a dark skinned person?
streching the area of skin between your thumb and index finger decreases(blances) the normal underlying red tones.
Red macules from dilated blood vessels with blanch mementarily, whereas those from extravasted blood (petechiae) does not.
What do lesions with blue-green fluorescence indicate?
fungal infection, such as tinea capitis (scalp ringworm)
What causes graying hair?
reduced melanin production in the follicles
What is a sign of tinea capitis?
Gray, scaly, well-defined areas with broken hairs
Hirsutism
excess body hair
Seborrhea
dandruff
Profile Sign
view the index finger at if profile and note the angle of the nail base, it should be 160 degrees
congenital chronic cyanotic heart disease, emphysema and chronic bronchitis.
What would pits, transverse grooves, or lines indicate?
nutrient deficiecy or acute illness.
A spongy nail base accompanies what?
clubbing
Brown linear streaks are abnormal in light skinned people and may indicate what?
melanoma
Capillary refill
indicates the status of the peripheral circulation.
A sluggish color return takes longer than 1 or 2 seconds.
What do you consider when their are cyanotic nail beds or sluggish corlor return
cardiovasuclar or respiratory dysfuncion
Senile lentigines
commonly called liver spots are are small, flat, brown macules due to extensive sun exposure. They appear on the forearms and dorsa of the hands. Not malignant and require no treatment.
Keratosis
raided, thickened areas of pigmentationthat loook crusted, scaly, and warty.
senile keratosis
red tan scaly plaques that increase over the years to become raised and roughened. May have a silvery white scale adherent to the plaque. PREMALIGANT - squamous cell carcinoma
Acrochordons
skin tags on eyelids, cheecks, and neck, axillae, trunk
Sebaceous hyperplasia
raised yellow papules with a central depression
How does the skin change in elders?
thin as archment, tugor is decreased, skin tents
Fungal infection are common
alopecia
balding
Vitilgo
patchy depigmentation from destruction of melanocytes
Pallor: anemia difference in light and dark skin.
due to decreased hematocrit and (shock) decreased perfusion, vasoconstriction

Light skin: generalized pallor

Dark skin: Brown skin appears yellow brown, dull; black skin appears ashen gray, check areas with less pigmentation, such as conjunctivae, mucous membranes
How does pallor due to local arterial insufficiency differ with skin color?
Light skin: marked localized pallor: lower extremities, especially when elevated

Dark skin: ashen gray, dull, coll to palpitation
How does pallor due to albinism: total absence of pigment melanin thoughout the integument
light skin: whitish pink

Dark skin: tan, cream, white
How does pallor due to Vitiligo, patchy depigmentation from destruction of melanocytes change with skin color?
Light skin: patchy milky white spots, oftern symetrical bilaterally

Dark skin: same
How does cyanosis, increased amount of unoxygenated hemoglobin differ with skin color?
Light skin: dusky blue

Dark skin: dark but dull, lifeless, only severe cyanosis is apparent in skin - check conjunctivae, oral mucosa, nail beds.
What causes central and periphearal cyanosis and what is a sign?
Central - chronic heart and lung disease cause arterial desaturation

Peripheal - exposure to cold, anxiety, nail bed dusky
Erythema caused by hyperemia, te increased blood flow through engorged arterioles, such as in inflammation, fever, alcohol intake, blushing differs in skin color how?
light skin: red bright pink

Dark skin: purplish tinge, but difficult to see, palpate for increased warmth with inflammation, taut skin and hardening of deep tissues
Erythema caused by polycythemia, increased red blood cells, capillary stasis differs in skin color how?
Light skin: bright cherry red in face and upper torso

Dark skin: well concealed by pigment check for redness of lips
Erythema cuased by carbon monoxide poisoning differs in skin color how?
Light skin: bright cherry red in face and upper torso

Dark skin: cherry red color i nail beds, lips, and oral mucosa
Erythema caused by venous stasis, decreased blood flow from area, engorged venules differs in skin color how?
Light skin: dusky rubor of dependent extremities, a prelude to necrosis with presure sore

Light skin: easily masked, use palpaiton for warmth or edema
Jaundice caused by increased serum bilirubin, over 2 to 3 mg/100 ml due to liver inflammation or hemolytic disease, such as after severe burns, some infections differs in skin color how?
light skin: yellow in sclera, hard palate, mucous membrane, then over skin

Dark skin: check sclera for yellow near limbus; do not mistake normal yellowish fatty deposits in the periphery under the eyelids for jaundice - Jaundice best noted in junction of hard and soft alate and also palms
Jaundice caused by carotenemia, increased serum carotene form ingesiton of large amounts of carotene rich foods such as after severe burns, some infections difer in skin color how?
Light skin: yellow orange in forehead, palms and soles, nasolabial folds, but no yellowing in sclera or mucous membranes

Dark skin: yellow orange tinge in palms and soles
Jaundice caused by uremia, renal failure cuses retained uro chrome pigments in the blood
Orange green or gray overlying pallor of anemia; may alos have ecchymoses and purpura

Dark skin: easily masked; rely on laboratory and clinical findings
Brown Tan caused by Addison's disease, cortisol deficiency stimulates increased melanin production
Light skin: bronzed appearance,an "external tan" most apparent around nipples, perineum, genitalia, and pressure points (inner thighs, buttocks, elbow, axillae)

Dark skin: Easily masked; rely on lab and clinical findings
Brown-Tan cuased by Cafe au lait spost, due to increased malanin pigment in basal cell layer differs in skin color how?
Light skin: tan to light borwn, irregularyly shaped, oval patch with well defined borders
Annular lesion
circular, begins in center and spreads to periphery.
confluent lesion
lesions run together
eg. urticaria(hives)
discrete
distinct, individual lesions that remain separate
grouped
cluster of lesions
target
or iris, resembles iris of cye concentric rings of color in the sesions
Polycyclic
annular lesions grow togeter
gyrate
twisted, coiled spiral, snakelike
linear
scratch, streak, like, or stripe
zosteriform
linear arrangement along a nerve roupe
eg. herpes zoster
Macule
soley a color change, flat and circumscribed, less than 1 cm. Ex freckles, flat nevi, hypopigmentation, petehiae, measles, scarlet fever
primary Lesion
patch
macules that are larger than 1 cm. ex. mongolian spot, vitiligo, cafe au lait spot, chloasma, measles rash
primary lesion
Nodule
solid, elevated, hard or soft, larger than 1 cm.
May be deeper than papule
primary lesion
Tumor
larger than a few centimeters in diameter, firm or soft, deeper into dermis, may be benign or maligant
ex. lipoma, hemangioma
primary lesion
papule
something you can feel ie, solid, elevated, circumscribed, less than 1 cm diameter, due to superficial thikening in the epidermis. ex. elvated nevus (mole), lichen planus, molluscum, wart (verruca)
Primary lesion
plaque
papules coalesce to form surface elevation wider than 1 cm. A plateeaulike, disk-shaped lesion. ex. psoriasis, lichen planus
primary lesion
wheal
superficail, raised, transient, and erythematous, slightly iregular shape due to edema (fluid held diffusely in the tissures) ex. mosquito bite, allergic reacton, dermographism
primary lesion
Urticaria (hives)
wheals coalesce to form extensive reaciton, intensely pruritic
primary lesion
cyst
encapsulated fluid filled cavity in dermis or subcutanous layer, tensely elevatong skin ex. sebaceus cyst, wen
primary lesion
Vesicle
elevated cavity containing free fluid, up to 1cm. Clear serum flows if wall is ruptured. ex. herpes simplex, early varicella (chickenpox), herpes zoster (shingles), contact dermatis
primary lesion
Bulla
larger than 1 cm diameter, usually single chambered (unilocular), superficial in epidermis, it is thin walled, so it ruptures easily examples: fricktion blister, pemphigus, burns, contact dermatitis.
primary lesion
pustule
turbid fluid (pus) in the cavity. Circumscribed and elevated. ex. impetigo, acne.
primary lesion
crust
thickened, dried out exudate left when vesicles/pustules burst or dry up. ex. impetigo
Fissure
linear crack with abrupt edges, entends into dermis, dry or moist
ex. cheilosis - at corners of mouth due to excess moiture, athlete foot.
scale
compact, edsiccated flakes of skin, dry or greasy, silvery or white, from shedding to dead excess keratin cells. ex. scarlet fever, psoriiasis
erosion
scooped out but shallow depression. Superficial, epidermis lost, moish but no bleeding, heals without scar because erosion does not extend into dermis.
ulcer
deeper depresson extenidng into dermis, irreguar shape may bleed, leaves scar when heals. Examples, stasis ulcer pressure sore, chancre.
Scar
after a skin lesion is repaired, normal tissue is lost and replaced whith connective tissue (collagen). This is a permanent fibrotic change.
Lichenification
prolonged intense scratching eventually thickens the skin and produces packed sets of papules, lookes lakes surface or moss or lichen
excoriation
self inflicted abrasion, superficial, sometimes crusted scratches from intense itching. Examples: insect bites, scabies, dermatitis, varicella.
Atrophic scar
resulting skin level depressed with loss of tissue, a thinning of the epidermis ex. striae
Keloid
a hypertrophic scar. excess scar tissue. May increase long after healing occurs. Higher insidence amoung blacks.
excoriation
self inflicted abrasion, superficial, sometimes crusted, scratches from intense itching. ex. insect bites, scabies, dermatitis, varicella
Atrophic scar
resulting skin level depressed with loss of tissue, a thining of the epidermis. ex striae
apocrine sweat gland
thick, milky secretion and into the hair follicles, axillae, anogenital area, nipples, and navel and are vestigial in humans. they become active during puberty, and secretion occurs with emotional and sexual stimulation.
Stawberry hemangioma
raised bright red area wit ell defined borders about 2-3cm in diameter.
Does not blanch
Disapears by 5-7
requires no treatment
Nevus Flammeus (pork-wine-stain)
large, flat macular patch covering the sclap or face, frequently along CN V.
Dark red, bluish or purplish and intensifies with crying, exertion or exposure to heat or cold.
Cavernous hemangioma (mature)
reddish - bue, irregualry shaped, solid and spongy mass of blood vessels.
Benign
Spider or star angioma
fiery, star shaped marking with a solid circular center. Capillary radiations extend from the central arterial boudy.