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270 Cards in this Set

  • Front
  • Back
What are the 3 main layers of the skin?
Subcutaneous Tissue
What are the 5 layers of the epidermis?
Stratum Corneum
Cellular Stratum

Cellular Stratum consists of:
Stratum Lucidum (present only in thick skin)
Stratum Granulosum
Stratum Spinosum
Stratum Germinativum (AKA: Stratum basale)
What are some functions of the skin?
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
Is the epidermis vascular or avascular?
It relies on the dermis for nutrition
In what layer are keratin cells formed?
Stratum germinativum
What layer contains melanocytes?

What do they synthesize?

What makes up the dermis?
reticulum fibers
nerve fibers
arrectores pilorum muscles
What are arrectores pilorum muscles?
tiny muscles in the dermis that make hair stand up
What is the hypodermis?

what is it made of?
it connects the dermis to the underlying organs

loose connective tissue filled with fatty cells
What is the function of the hypodermis?
generates heat, provides insulation, shock absorption, and reserves calories
What are the 5 appendages of the skin?
eccrine sweat glands
apocrine glands
sebaceous glands
What is the main function of eccrine sweat glands?
maintain body temp by secretion of water
Where are the places you will not see eccrine sweat glands?
lip margins
nail beds
inner surface of prepuce (fore skin)
glans penis
What will you find appocrine sweat glands?
anogenital area
external ears
In response to emotional stimuli, what will appocrine glands secrete?
white fluid containing protein, carbohydrate, and other substances
What type of smell does the appocrine glands secrete?
the fluid is odorless

the odor comes from bacterial decomposition in the sweat
What do sebaceous glands secrete?
a lipid-rich substance that keeps skin and hair from drying out
What stimulates the secretory activity of sebaceous glands?
Sex hormones

(primarily testosterone)
What are the 3 parts of a hair?
What is the papilla of the hair follicle?
loop of capillaries at the base of the follicle that supplies nourishment for growth
What determines the color of hair?
melanocytes at the base of the shaft
What are the 2 kinds of hair found in adults?
vellus and terminal
Describe vellus hair.
short, fine, soft, and nonpigmented
Describe terminal hair.
coarse, long, thick, and usually pigmented
What are the 3 cyclic changes a hair can go through?
anagen (growth)
catagen (atrophy)
telogen (rest)
What is the composition of nails?
hard plates of keratin
Is the nail bed vascular or avascular?
highly vascular
What is another name for the cuticle of the nail?
What is the name of the soft tissue surrounding the nail border?
What is desquamation?
Shedding of the skin

occurs in infants at birth or shortly after
What is venix caseosa?
a mixture of sebum and cornified epidermis that cover the infant's body at birth
Why are infants predisposed to hypothermia?
The subcutaneous fat layer is poorly developed
What is languo?
fine, silky hair that covers a newborn's shoulders and back
When is languo shed?
within 10-14 days
Do newborns shed the hair they have on their head?
Yes, most of their hair is shed by about 2-3 months and replaced with permanent hair with new texture and color
In infants, when do the eccrine glands begin to function?
after the first month of life
What glands do not function in infants?
appocrine glands

These glands become active during adolescence
Why are adolescents predisposed to acne?
Because hormones increase sebum production with give skin an oily appearance
Where could you find terminal hair in an adolescent?
axillae and pubic areas

and on face of male
Why do pregnant ladies hands and feet swell?
increased blood flow from vasodilation and increased numbers in capillaries
Why does sweat activity increase in pregnant women?
to assist in dissipating the excess heat caused by the increased metabolism during pregnancy
Where do pregnant women have increased skin pigmentation and darkening?
face, nipples, areolae, axillae, vulva, perianal skin, and umbilicus
Why does skin become drier in older adults?
sebaceous and sweat gland activity decreases
What happens to the dermis in older adults?
vascularity decreases
loses collagen and elastic fibers
shrinks (causing skin to wrinkle)
What happens to the epidermis in older adults?
thins, flattens, and permeability increases
In what type of people would you see less wrinkling with age?
blacks, yellows, and obese people
What happens to the subcutaneous tissue in older adults?
decreases (particularly in extremities)
giving joints a bony appearance
Why do older adults have grey hair?
decrease number in functioning melaocytes

(hair of whites turn grey before hair of blacks and Asians)
Which phase of the hair cycle decreases in older adults?

anagen phase

decreased hormones
What regions tend to deepen in older adults?
How does the texture of hair change in older adults?
changes from terminal to vellus
In older adults, which hair changes from vellus to terminal?
nares and tragus of men

Women also produce increased coarse facial hair because of higher androgen/estrogen ratios
What will you notice during a skin exam in a patient with peripheral vascular disease?
peripheral extremity hair loss
In older adults, why does nail growth slow?
decrease peripheral circulation
What happens to the nails of older adults?
they become thicker, brittle, hard, yellowish, they develop longitudinal ridges and are prone to splitting in layers
Clinical Pearl:
Why are those who use 30 spf sunscreen still at risk for a significant sunburn?
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
What equipment is needed to perform a skin exam?
flashlight with transilluminator
handheld magnifying lens
wood's lamp
What two techniques are used during a skin exam
Inspection and palpation
What is the most important tool during a skin exam?
Your own eyes and power of observation
Daylight provides the best lighting for skin inspection. If daylight is insufficient, supplement with...
fluorescent lighting
What type of lighting is helpful in assessing contour?
What is the "bird's-eye view"?
the overall visual sweep of the body
What are intertriginous surfaces?
Areas of skin that tough or rub together
Traditional health practices of certain cultural groups should not be confused with disease.

What is "coining" or "cupping" in Asian subcultures?
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
Where is the thinnest skin on the body?


soles, palms, and elbows
What are corns?
flat or slightly elevated circumscribed painful lesions with a smooth or hard surface
What causes "soft" corns?
pressure of a bony prominence against a softer tissue

they appear as whitish thickening

commonly seen b/w the 3rd and 5th toes
What causes "hard" corns?
they occur over bony prominences where pressure is exerted

they are sharply delineated and have a conical appearance
What is a callus?
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
What is nevi?
Where are dysplastic (atypical) nevi typically seen?
Men: upper back

Women: legs
What is chloasma or melasma?
areas of hyperpigmentation on the face and neck in pregnant women.

*more noticeable in darker skinned women
What are pigmentary demarcation lines?
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
How can you tell a dysplastic mole from melanoma?
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
Do nevi occur more in light skin or dark skin individuals?
more ofter in lighter skinned individuals

*Sun exposure will increase numbers
*increase number with age, peak in 40-50s, diminish after that
What is characteristic of a halo nevus?
sharp, oval, or circular
depigmented halo around mole
may undergo morphologic changes
usually disappears and halo repigments
Where do you normally find halo nevus?

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
flesh to black color
may be pedunculated or hair bearing
Where do you normally find intradermal nevus?

on cells limited to dermis

no indication for removal other than cosmetic
What is characteristic of a junction nevus?
slightly elevated
dark brown
Where do you normally see junction nevus?

nevus cells lining dermoepidermal junction

should be removed if exposed to repeated trauma
What is characteristic of compound nevus?
slightly elevated brownish papule
indistinct border
Where do you normally see compound nevus?

nevus cells in dermis and lining dermoepidermal junction

should be removed if exposed to repeated trauma
What is characteristic of hairy nevus?

may be present at birth
may cover large area
hair growth may occur after several years

should be removed if changes occur
The typical adult has how many moles total?
A blueish hue of lips and gums may be normal in what type of people?
dark skinned people
Cardiovascular disease and diabetes mellitus may cause what changes in skin appearance in the lower extremity?
pale, shiny
Purple discoloration produced by injury is called...
purple discoloration by other causes are called....
petechiae if smaller than .5cm in diameter

purpura if larger than .5cm in diameter
What is a telangiectasia?
capillary spider or spider angioma
How do you tell the difference b/w a capillary spider and a spider angioma?
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
What could be the cause of a generalized brown pigment change?
Pituitary, adrenal, or liver disease
What could be the cause of a generalized white pigment change?
What could be the cause of increased cutaneous blood flow in a localized region?
(red pigment change)
What could be the cause of increased cutaneous blood flow with general distribution? (red pigment change)
fever, viral exanthem, urticaria
What would be the result of red pigment change from increased intravascular red blood cells?
What could be the result of a generalized pigment change of yellow?
liver disease (jaundice)


hypothyroidism, increased intake of vegetables containing carotene
(everywhere except sclera)
What would be the result of a blue pigment change on the lips, mouth, and nail beds?
cardiovascular and pulmonary disease

(increased unsaturated hemoglobin secondary to hypoxia)
What side of the hand should be used in sensing temperature symmetry?
dorsal side
What can cause purpura?
intravascular defects or infection
What can cause petechiae?
intravascular defects and infection
What can cause ecchymoses?
vascular wall destruction
What can cause spider angioma?
liver disease
vitamin B deficiency
What can cause venous star- bluish spider?
increased pressure in superficial veins
What can cause telangiectasia?
dilation of capillaries
What can cause capillary hemangioma?
Dilation of dermal capillaries
Skin gives multiple types of odor suggesting a variety of problems.

What is the cause of rotten apples odor?
Clostridium gas gangrene
Proteus infection
pseudomonas infection
(especially burns)
stale beer
Tuberculous lymphadenitis (scrofula)
Anerobic infection; scurvy
intestinal obstruction; perionitis
mousy, musty
What might be the cause of hyperkeratoses?
a systematic disorder such as arsenic or other toxic exposure
Where on the patient should turgor be tested?

Why might recoil of the skin be altered?
forearm or sternal area

dehydration, if edema is present, or it could be indicative of a CT disease such as scleroderma
What is a catch all term that collectively describes any pathologic skin change or occurrence?
skin lesion
What is a primary lesion?

secondary lesion?
those that occur as initial spontaneous manifestations of pathologic disease

those that result from later evolution of or external trauma to a primary lesion
What is the purpose of a wood's lamp?
to look for infection

a yellow-green flourescence indicates the presence of fungal infection
What characteristics should be described in a skin lesion?
size, shape, color, texture, elevation/depression, attachment to base, exudates, configuration, location/distribution
What is a flat, circumscribed area that is a change in the color of the skin; less than 1 cm in diameter?

(freckles, flat moles, petechiae, measles, scarlet fever)
What is an elevated, firm, circumscribed area; less than 1cm in diameter?

(wart/verruca, elevated moles, lichen planus)
What is a flat, nonpalpable irregular-shaped macule greater than 1cm in diameter?

(vitiligo, port-wine stains, mongolian spots, cafe au lait patch)
What is an elevated, firm, and rough lesion with a flat top surface greater than 1cm in diameter?

(pasoriasis, seborrheic, and actinic keratoses)
What is an elevated, irregular shape area of cutaneous edema; solid, transient, variable, diameter?

(insect bites, urticaria, allergic reaction)
What is an elevated, firm, circumscribed lesion; deeper in dermis than papule; 1cm-2cm in diameter?

(eythema nodosum, lipoma)
What is an elevated and solid lesion; may or may not be clearly demarcated; deeper in dermis; greater than 2 cm in diameter?

(neoplasms, benign tumor, lipoma)
What is an elevated, circumscribed, superficial, not into dermis; filled with serous fluid; less than 1cm in diameter?

(varicella, herpes zoster/shingles)
What is a vesicle greater than 1 cm in diameter?

(blister, pemphigus vulgaris)
What is an elevated, superficial lesion; similar to a vesicle but filled with purulent fluid?

(impetigo, acne)
What is elevated, circumscribed, encapsulated lesion; in dermis or subcutaneous layer; filled with liquid or semisolis material?

(sebaceous cyst, cyst acne)
What is fine, irregular, red lines, produced by capillary dilation?

(telangiectasia in rosacea)
What is heaped-up, keratinized cells, flaky skin; irregular; thick or thin, dry or oily, variation in size

(flaking of skin with seborrheic dermatitis following scarlet fever or flaking of skin following a drug reaction; dry skin)
What is rough thickened epidermis secondary to persistent rubbing, itching, or skin irritation, often involves flexor surface of extremity?

(chronic dermatitis)
What is irregular-shaped,elevated, progressively enlarging scar; grows beyond the boundaries of a wound; cause by excessive collagen formation during healing?

(keloid formation during surgery)
What is thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis?

(heal wound or surgical incision)
What is loss of the epidermis; linear hollowed-out, crusted area?

(abrasion or scratch , scabies)
What is a linear crack or break from the epidermis to the dermis; may be moist or dry?

(athlete's foot, cracks at the corner of the mouth)
What is the loss of part of the epidermis; depressed, moist, glistening; follows rupture of a vesicle or bulla?

(varicella, variola after rupture)
What is the loss of epidermis and dermis; concave; varies in size?

(Decubiti, stasis ulcers)
What is a dried serum, blood or purulent exudates; slightly elevated,; size varies; brown, red, black, tan, or straw-colored?

(scab on abrasion, eczema)
What is the thinning of skin surface and loss of skin markings; skin translucent and paper-like?

(striae, aged skin)
What does discoid describe?
coin shaped (no central clearing)
annular shape
round, active margins with central clearing
Zosteriform (dermatomal) shape
following a nerve or segment of the body
Polycyclic shape
Interlocking or coalesced circles (formed by enlargement of annular lesions)
Iris/target lesion shape
pink macules with purple central papules
Stellate shape
Star shaped
Serpiginous shape
snakelike or wavy line track
Reticulate shape
netlike or lacy
Morbilliform shape
Measles like: maculopapular lesions that become confluent on the face and body
What are 3 ways you can describe the distribution of a skin lesion
discrete border
well demarcated or defined, able to draw a line around it with confidence
indistinct border
poorly defined, have borders that merge into normal skin or outlying ill-shaped papules
active border
margin of lesion shows greater activity than center
irregular border
non-smooth or notched margin
border raised above
center of lesion is depressed compared to that of the edge
Advancing border
expanding at margins
central clearing change
an erythematous border surrounds lighter skin
desquamation change
peeling or sloughing of skin
keratotic change
hypertrophic stratum corneum
Punctation change
cntral embilication or dimpling
telangiectasias change
dilated blood vessels within lesion blanch completely, may be markers of systemic disease
What are some pigmentations associated with lesions?
flesh, pink, erythematous, slamon (orange-pink), tan-brown, black, pearly (shiny white), purple, violaceous (light violet), yellow, white
What hours of the day should you avoid sun exposure?
peak hrs for harmful UV radiation
What type of sunscreen should you use?
30 or higher that blocks UVA and UVB
reapply after swimming, sweating, or toweling dry
The American Cancer society advocates what phrase to catch the attention of children for sun exposure?
"Slip! Slop! Slap!... and Wrap"

slip on a shirt, slop on sunscreen, slap on a hat, wrap on sunglasses
What do you look for while palpating the hair?
Texture, color, distribution, quantity, resiliency
What should the hair not be?
dull, dry, or brittle

may indicate systemic disorder
Hair loss may indicate?
Poor circulation or nutritional deficit
Where do men and women genetically often display hair loss?
on the scalp in response to androgens
What is alopecia?
hair loss
Where do you normally see vellus hair?
cover the body
Where do you normally see terminal hair?
scalp, pubic, axillary, maybe arms and legs, and the beard of men
Describe the pubic hair pattern of a female.
inverted triangle

hair may extend to umbilicus
Describe the pubic hair pattern of males.
upright triangle extending midline to the umbilicus
What is hirsutism in women?
growth of terminal hair in a male distribution pattern on face, body, and pubic area'

may be a sign of endocrine disorder
What should be inspected with the nails?
color, length, configuration, and cleanliness

are they bitten?
are they clean?
nails give you a sense of self-care
What would you expect to see in a person subject to repeated water immersion of the nails?
peeling nails

(the plate splitting into layers)
On the nails, what is usually associated with pain?
ingrown nails and infection
What color should the nail bed be?
variations of pink
What may yellowing nails indicate?
fungal infections
chronic respiratory disease
Are pigment deposits or bands expected in the nails?
yes, in persons with dark skin

In persons with white skin, it may indicate melanoma
What is proximal fungal infection associated with?
HIV infection
Diffuse darkening of the nails may be from....
antimalaria drug
candidal infection
chronic trauma (tight fitting shoes)
Green-black discoloration may be associated with...
pseudomonas infection

may be similar to injury, but pseudomonas infection is painless
What may blue nails indicate?

One single blue nail?
Cold room, asthma, cardiac disorders, anemia, poison, medication side effects, or Wilson disease (inherited disorder of copper metabolism)

melanoma, or bruising from trauma
Longitudinal red or brown streaks on nails may indicate....
severe psoriasis of nail matrix
minor injury to nail fold
Why could there be white spots of the nail plate?
cuticle manipulation or mild trauma

need to be differentiated from white streaks or traverse white bands that could indicate systemic disorder
What would you expect to find upon separation of the nail bed from the nail plate?
white, yellow, green tinge on the nonadherent portion of the nail
How should the nail plate appear?
smooth, flat, or slightly convex
What is anonychia?
complete absence of the nail

could be a congenital condition
What is the most common cause of transverse grooves in the thumb?
picking at the thumb with the index finger

(habit-tic deformity)
Transverse ripping of the nail plate may be from...
chronic inflammation that occurs with chronic paronychia (swollen area around the nail) or chronic eczema
What are terry nails?
nails appear white with dark red tip
What is onycholysis?
detachment of the nail bed starting from its distal or lateral attachment

(displays an S-like shape)
What is koilonychia?
Spooning of the nail

(end of the nail plate goes up)
What are beau lines in the nails?
transverse grooving
Why may transverse depressions that appear at the base of the lunula occur?
may occur after stress that temporarily interrupts nail formation
Why might there be depressions in all nails?
systemic disease such as syphilis, disorders producing high fevers, peripheral vascular disease, or uncontrolled diabetes mellitus
What is pitting most commonly seen with?
What nail changes would you see in secondary syphilis?
broadening and flatting
What is the normal degrees of the nail base angle?
160 degrees
What are 2 ways to observe nail base angle?
Shamroth test
using a flat edge
What is clubbing associated with?
respiratory and cardiovascular disease
thyroid disease
How should the nails feel upon palpation?
firm, adherent, thick
What could cause thickening of the nail?
tight fitting shoes, chronic trauma, fungal infection
Pain in the nail groove could be secondary to...
Separation of the nail plate from the nail bed is commonly seen in...
psoriasis, trauma, candidal, psudomonas infections, or some medications
A boggy nail accompanies...
How is skin color partly determined by chubbiness?
the less cutaneous fat, the redder and more transparent the skin
Where do dark skinned babies manifest the intensity of melanosis?
on nail beds and skin of scrotum
About how many newborns present with jaundice?

starts with day 1 and disappears by day 8-10
may persist for as long as 3-4 weeks
When examining for jaundice in a newborn, where do you look? why?
oral mucosa and sclera of the eyes

can be detected more easily in these areas
Where should pay special attention when checking newborns skin for defects?
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)
What is cutis marmorata?
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)
What is acrocyanosis?
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
What is Erythema toxicum?
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)
What are mongolian spots?
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
What are salmon patches ("stork bites")?
flat, deep pink localized areas seen on the mid-forehead, eyelids, upper lip, and back of neck

represents a common caoillary vascular formation
What is faun tail nevus?
Tuft of hair overlying the spinal column at birth (lumbosacral area)

may be associated with spina bifida occulta
What is epidermal verrucous nevi?
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
What is cafe au lait macules?
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

may be associated with neurofibromatosis, pulmonary stenosis, temporal lobe dysrhythmia, or tuberous sclerosis

to be diagnosed neurofibromatosis, 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
What might freckling in the axillary or inguinal area indicate?

may occur in conjunction with cafe au lait macules
what is an ash leaf macule?
white macules present at birth most commonly on the trunk associated with tuberous sclerosis
What is facial port-wine stain?
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
What is port-wine stain of the limb and/or trunk?
when accompanied by varicosities and hypertrophy of underlying soft tissues and bones, may be associated with orthopedic problems
What is congenital lymphedema with or without transient hemangiomas?
May be associated with gonadal dygenesis caused by the absence of an X chromosome, producing a XO karotype (turner's syndrome)
What is supernumerary nipples?
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
What is "Hair collar" sign?
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
On the feet and hands, what is an indicator of maturity in a newborn?

the older the baby, the more creases there are
What is dermatoglyphics?
The study of crease patterns on the hands of feet of newborns in association with certain abnormalities
What type of crease is commonly associated with down syndrome?
single transverse crease in the palm
What is vernix caseosa?
whitish, moist, cheese-like substance that commonly cover newborns
Why are infants susceptible to hypothermia?
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
What is milia?
small whitish discrete papules on the face from immature sebaceous glands getting plugged by sebum
What is sebaceous hyperplasia?
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
Where do you test for tugor in a newborn?
abdominal skin

can better indicate hydration and nutrition than in an adult
What is the degree of dehydration is the skin returns to normal in <2 seconds?
<5% loss of body weight
What is the degree of dehydration is the skin returns to normal in 2-3 seconds?
5% to 8% loss of body weight
What is the degree of dehydration is the skin returns to normal in 3-4 seconds?
9%-10% loss of body weight
What is the degree of dehydration is the skin returns to normal in >4 seconds?
>10% loss of body weight
What is Dennie-Morgan fold?
extra crease or pleat of skin below the eye in an infant due to chronic rubbing and inflammation of the eyes
What skin change would you noticed most in an adolescent?

predisposes them to acne
What is striae gravidarum?
stretch marks in pregnant women

may appear on abdomen, thighs, and breast during 2nd trimester

fade after delivery, but never disappear
Describe telangiectasias during pregnancy.
increase 5-fold

face, neck, chest, arms

appear during 2-5 month of preganancy
resolve after delivery
What happens to hemangiomas that are present before pregnancy?
they increase in size

new ones may develop
What are cutaneous tags in pregancy? (molluscum fibrosum gravidarum)
skin tags that are found on the neck and upper chest

result from epithelial hyperplasia and are not inflammatory

most resolve spontaneously
Where is increase in pigmentation found in pregnant women?
areolae, nipples, vulvar and prianal regions, axillae, and the linea alba

(pigmentation of the linea alba is called linea nigra)
What happens to pre-existing freckles (nevi) during pregnancy?
darker and increase in size

new ones might form
What is cholasma? or "mask of pregnancy"?
found on forehead, cheeks, bridge of nose, and chin

blotchy in appearance
During pregnancy, where is redness found in the hands?
covers the entire palmar surface

disappears after delivery
Is itching over the abdomen and breast of concern during pregnancy?
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)
During pregnancy, because of the hormones, hair loss is....

2-4 months after delivery, increased hair shedding occurs
regrowth will occur 6-12 months
Acne may be aggrevated in the 1st trimester, but usually improves in the ....
3rd trimester
Describe skin changes in older adults.
more transparent (thinner)
increased freckling
nonuniform pigmentation
dry skin
loss of elasticity

tugor might not be a good assessment of hydration
What are decubitus ulcers in older adults?
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
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)
patients on aspirin therapy
Describe stage 1 of decubitus ulcers.
Nonblanchable erythema of intact skin
Describe stage 2 of decubitus ulcers.
Partial-thickness skin loss involving epidermis or dermis. No subcutaneous tissue is visible
Describe stage 3 of decubitus ulcers?
Full-thickness skin loss. The fascia of the underlying tissue is intact
Describe stage 4 of decubitus ulcers?
extended into bone or muscle
What is a cherry angiomas?
Tiny, bright ruby-red papules that may become brown with time.

Occur in almost everyone over 30 and increase with age
What is seborrheic keratoses?
pigmented, raised, warty lesions, usually on the face or trunk

must be distinguished from actinic keratoses, which have malignant potential
What are arochordon?
cutaneous tags
small, soft, usually appearing on neck and upper chest
attached to the body by a narrow stalk (pedunculated)
What are cutaneous horns?
small hard projections of epidermis usually on the forehead and face
What are solar lentigines?
irregular, round, gray-brown macules with a round surface that occur in sun-exposed areas

"age spots"
or incorrectly, "liver spots"

early signs of photoaging of the skin
Describe the hair change in older adults.
grey or white
terminal hair becomes vellus
men show an increase in coarse aural, nasal, and eyebrow hair
women develop coarse facial hair
symmetric balding
Describe the nail change in older adults.
yellowish color
may lose transparency

These changes are more common in the toenails
Clinical pearl:
Why would you see bald spots in children?
9 times out of 10 it is ringworm of the scalp, alopecia areata, or trichotillomania (a compulsive pulling out of the hair)

trichotillomania 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