Skin, Hair, and Nails

Chapter 12

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 12: Skin, Hair, and Nails

Structure and Function

Subjective DataHealth History Questions

Objective DataThe Physical Exam

Abnormal Findings

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-2

Chapter 12: Skin, Hair, and Nails

Structure and Function

Skinthree layers
1. Epidermis

Stratum germinativum or
basal cell layer

Stratum corneum or horny

cell layer

Derivation of skin color

2. Dermis

Connective tissue or collagen

Elastic tissue

Epidermal appendages
1. Hair
2. Sebaceous glands
3. Sweat glands

Eccrine glands

Apocrine glands

4. Nails

3. Subcutaneous layer

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-3

Chapter 12: Skin, Hair, and Nails

Structure of Skin

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-4

Chapter 12: Skin, Hair, and Nails

Structure of Nails

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-5

Chapter 12: Skin, Hair, and Nails

Function of the Skin

Protection
Prevents penetration
Perception
Temperature regulation
Identification
Communication
Wound repair
Absorption and excretion
Production of vitamin D
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-6

Chapter 12: Skin, Hair, and Nails

Subjective Data
Health History Questions

Previous history of skin disease

(allergies, hives, psoriasis, or eczema)

Change in mole

Change in pigmentation (size or color)

Excessive dryness or moisture

Pruritus

Excessive bruising
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-7

Chapter 12: Skin, Hair, and Nails

Subjective Data
Health history questions
(cont.)

Rash or lesion

Medications

Hair loss

Change in nails

Environmental or occupational hazards

Self-care behaviors
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-8

Chapter 12: Skin, Hair, and Nails

Objective DataThe Physical Exam

Preparation

External variables that influence skin color

Equipment needed

Strong direct lighting

Small centimeter ruler
Penlight
Gloves
For special procedures
Woods light
Magnifying glass
Materials for laboratory tests: KOH, glass slide

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-9

Chapter 12: Skin, Hair, and Nails

Objective DataThe Physical Exam

(cont.)

SkinInspect and palpate

Color

General pigmentation

Widespread color change

Pallor
Erythema
Cyanosis
Jaundice

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-10

Chapter 12: Skin, Hair, and Nails

Objective DataThe Physical Exam

(cont.)

SkinInspect and palpate (cont.)

Temperature

Hypothermia

Hyperthermia

Moisture

Diaphoresis

Dehydration

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-11

Chapter 12: Skin, Hair, and Nails

Objective DataThe Physical Exam

(cont.)

SkinInspect and palpate (cont.)

Texture

Thickness

Edema

Mobility and turgor

Vascularity or bruising

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-12

Chapter 12: Skin, Hair, and Nails

Objective Data
The Physical Exam (cont.)

SkinInspect and palpate (cont.)

Lesions

Color

Elevation

Pattern or shape

Size

Location and distribution on body

Exudate
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-13

Chapter 12: Skin, Hair, and Nails

Objective DataThe Physical Exam

(cont.)

HairInspect and palpate

Color

Texture

Distribution

Lesions

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-14

Chapter 12: Skin, Hair, and Nails

Objective DataThe Physical Exam

(cont.)

NailsInspect and palpate

Shape and contour

Profile sign

Consistency

Color

Capillary refill

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-15

Chapter 12: Skin, Hair, and Nails

Objective DataThe Physical Exam

(cont.)

Promoting health and self-care

Teach skin self-examination, using the

ABCDE rule

Aasymmetry

Bborder

Ccolor

Ddiameter

Eelevation and enlargement

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-16

Chapter 12: Skin, Hair, and Nails

Abnormal Findings
Common Shapes and
Configurations of Lesions

Annular or circular

Confluent

Discrete

Grouped

Gyrate

Target or iris

Linear

Polycyclic

Zosteriform
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-17

Chapter 12: Skin, Hair, and Nails

Annular or Circular

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-18

Chapter 12: Skin, Hair, and Nails

Confluent

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-19

Chapter 12: Skin, Hair, and Nails

Discrete

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-20

Chapter 12: Skin, Hair, and Nails

Grouped

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-21

Chapter 12: Skin, Hair, and Nails

Gyrate

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-22

Chapter 12: Skin, Hair, and Nails

Target

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-23

Chapter 12: Skin, Hair, and Nails

Linear

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-24

Chapter 12: Skin, Hair, and Nails

Polycyclic

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-25

Chapter 12: Skin, Hair, and Nails

Zosteriform

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-26

Chapter 12: Skin, Hair, and Nails

Abnormal Findings

Primary and Secondary Skin Lesions

Primary skin lesions

Macule

Papule

Patch

Plaque

Nodule

Wheal

Tumor

Urticaria
(hives)
Vesicle
Cyst
Bulla
Pustule

Secondary skin lesions

Scale

Fissure

Erosion
Ulcer
Crust

Excoriation
Scar
Atrophic scar
Lichenification
Keloid

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-27

Chapter 12: Skin, Hair, and Nails

Macule

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-28

Chapter 12: Skin, Hair, and Nails

Papule

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-29

Chapter 12: Skin, Hair, and Nails

Nodule

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-30

Chapter 12: Skin, Hair, and Nails

Wheal

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-31

Chapter 12: Skin, Hair, and Nails

Vesicle

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-32

Chapter 12: Skin, Hair, and Nails

Cyst

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-33

Chapter 12: Skin, Hair, and Nails

Pustule

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-34

Chapter 12: Skin, Hair, and Nails

Crust

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-35

Chapter 12: Skin, Hair, and Nails

Scale

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-36

Chapter 12: Skin, Hair, and Nails

Fissure

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-37

Chapter 12: Skin, Hair, and Nails

Erosion

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-38

Chapter 12: Skin, Hair, and Nails

Ulcer

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-39

Chapter 12: Skin, Hair, and Nails

Excoriation

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-40

Chapter 12: Skin, Hair, and Nails

Scar

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-41

Chapter 12: Skin, Hair, and Nails

Atrophic Scar

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-42

Chapter 12: Skin, Hair, and Nails

Lichenification

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-43

Chapter 12: Skin, Hair, and Nails

Keloid

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-44

Chapter 12: Skin, Hair, and Nails

Abnormal Findings
Vascular Lesions

Hemangiomas

Port-wine stain
(nevus flammeus)
Strawberry mark
(immature hemangioma)
Cavernous hemangioma
(mature)

Telangiectases

Spider or star angioma

Venous lake

Purpuric lesions

Petechiae

Purpura

Lesions caused by
trauma or abuse

Pattern injury

Hematoma

Ecchymosis (bruise)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-45

Chapter 12: Skin, Hair, and Nails

Lesions caused by trauma or abuse:

Pattern injury

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-46

Chapter 12: Skin, Hair, and Nails

Lesions caused by trauma or abuse:

Hematoma

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-47

Chapter 12: Skin, Hair, and Nails

Lesions caused by trauma or abuse:

Ecchymosis

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-48

Chapter 12: Skin, Hair, and Nails

Abnormal Findings
Common Skin Lesions in Children

Diaper dermatitis

Interigo (candidiasis)

Impetigo

Atopic dermatitis (eczema)

Measles (rubeola)

German measles (rubella)

Chickenpox (varicella)
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-49

Chapter 12: Skin, Hair, and Nails

Abnormal Findings
Common Skin Lesions

Primary contact dermatitis

Allergic drug reaction

Tinea corporis (ringworm of the body)

Tinea pedis (ringworm of the foot)

Psoriasis

Tinea versicolor

Labial herpes simplex (cold sores)

Herpes zoster (shingles)

Erythema migrans of Lyme disease

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-50

Chapter 12: Skin, Hair, and Nails

Abnormal Findings
Malignant Skin Lesions

Basal cell carcinoma

Squamous cell carcinoma

Malignant melanoma

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-51

Chapter 12: Skin, Hair, and Nails

Abnormal Findings
Skin Lesions Associated with AIDS

Epidemic Kaposis sarcoma

Patch stage

Plaque stage

Advanced disease

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-52

Chapter 12: Skin, Hair, and Nails

Abnormal Findings
Infectious Disease as a Biological Weapon

Anthrax

Smallpox (variola major)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-53

Chapter 12: Skin, Hair, and Nails

Abnormal Findings
Abnormal Conditions of Hair

Seborrheic dermatitis (cradle cap)

Tinea capitis (scalp ringworm)
Toxic alopecia
Alopecia areata
Traumatic alopecia, traction alopecia
Trichotillomania
Pediculosis capitis (head lice)
Folliculitis
Hirsutism
Furuncle and abscess
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-54

Chapter 12: Skin, Hair, and Nails

Abnormal Findings
Abnormal Conditions of the Nails

Koilonychia (spoon nails)

Paronychia

Beaus line

Splinter hemorrhages

Late clubbing

Onycholysis

Habit-tic dystrophy

Pitting
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-55

Chapter 12: Skin, Hair, and Nails

A patient who is admitted for liver failure

would be likely to show which of the
following skin changes?
A.

Cyanosis

B.

Flushing

C.

Rubor

D.

Jaundice

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-56

Chapter 12: Skin, Hair, and Nails

The lesions in the illustration

are best described as?
A.

Grouped

B.

Zosteriform

C.

Polycyclic

D.

Linear

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 12-57