Skin, Hair, and Nails Chapter 9

Lyme Disease

-Caused by tick infected with Borrelia Burgdorferi. -Most commonly reported vectorborne illness in US. -Usually occurs in northeast states. -Expanding erythemic rash with central clearing. -Usually exceeds 5 cm at site of tick bite for several weeks. -Flu like symptoms.

Use OLDCARTS for Hair & Nail assessment as well.

-Changes in Hair/Nails, etc.

Angioma

-Cherry angioma, angioma, hemangioma, cavernous hemangioma, strawberry hemangioma. -Benign tumor consist of a small mass of blood vessels; can very in size from very small to large. -pg. 118

Herpes Varicella

-Chicken pox. -Highly communicable viral infection spread by droplets. -Usually common in children. -Outbreak begins on trunk spreading to extemities and face.

Lichenification (Secondary Lesion)

-Chronic dematitis, psoriasis. -Rough thickened epidermis, secondary to persistent rubbing itching or skin irritation, flexor surfaces of extremity. -pg. 114

Seborrheic Dermatitis

-Chronic inflammation with exasperation and remission. -Occurs throughout life for unknow causes. -Scaly, white or yellowish plaques involving skin on scalp, eyebrows, eyelids, nasoabial folds, ears axillae, chest and back. -May cause pruritus or dandruff if on scalp.

Alopecia Areata

-Chronic inflammatory disease of hair follicles resulting in hair loss on scalp. -Associated with auto-immune disease, metabolic disorders and stessful events.

Atopic Dermatitis

-Chronic superficial inflammation w/UNKNOWN CAUSE. -Commonly associated with hay-fever & asthma (may be familial), -Infancy/early childhood; red weeping, crusted lesion on face, scalp, extremities and diaper area. -Older children/adults; erythema, scaling & lichenification. -Fig. 9-17

Pityriasis Rosea

-Common acute, self-limiting inflammatory disease usually occurs with young adults during winter months. -Unknown cause, maybe virus. -herald patch initial manifestation. -pg. 125

Ingrown toe nail.

-Common problem where nail grows through lateral nail into skin. -Caused by cutting nail too far down the sides.

Capillary Hemangioma (Nevus Flammeus)

-Congenital vascular malformation of capillaries. -Port wine stain, stork bite. -Angioma WITHIN the skin, producing IRREGULAR SHAPE maculaar patch, very from light red to dark red-purple. -pg. 118 bottom.

Abnormal skin color may be evidence of local/systemic diseases. Note?

-Cyanosis, pallor & jaundice.

Erythema (dark skin) (red)

-Deep brown or purple tone w/evidence of increased skin temperature secondary to inflammation

Herpes Simplex

-Deoxyribonucleic acid virus. -Chronic, non-curable, transmitted by contact. -Outbreaks triggered by sun exposure, stress & fever. -Outbreak may be preceded by sensation of stinging. -HSV 1 appear on upper lip, nose, mouth or tongue. -HSV 2 appear on genitalia. -Erupt, vesicles, pustules, crusting.

Nodule (primary skin lesion)

-Dermatofibroma, erythema nodosum, lipomas, melanoma, hemangioma and neurofibroma. -ELEVATED, FIRM, cirumscribed lesion, DEEPER IN DERMIS than papula; 1 -2 CM IN DIAMETER. -pg. 112.

Increased skin thickness is seen in patients with what?

-Diabetes mellitus.

What are common problems associated with hair?

-Dryness, brittleness, hair loss, and pain/dryness to the scalp.

Abnormal Skin: Hyperpigmentation (increase pigmentation) indicates what?

-Endocrine disorder such as Addison's disease. -Liver disease.

Name some chronic illnesses that manifest in the skin (pruritus, excess dryness, discoloration & lesions).

-Examples (Liver failure, renal failure, venous insufficiency, autoimmune disease & cancer).

Hypothyroidism?

-Fine hair. -Thinning eye brows.

Scale (Secondary Lesion)

-Flaking of skin w/seborrheic dermatitis following scarlet fever, or flaking of skin following DRUG REACTION, dry skin, pityrisis rosea, eczema zerosis. -pg. 114

Macule (primary skin lesion)

-Freckle, flat mole (nevil) petechia, measles, scarlet fever. -Flat circumscribed area w/change in color from skin color. -LESS THAN 1 CM IN DIAMETER.

What are the basic structures of the nail?

-Free edge, nail plate/body & nail root/lanula (site of growth). See pg. 99 diagram.

Onychomycosis

-Fungal infection of the nail plate caused by unguium. -Occurs in 18% population. -turns nail plate yellow, white as hyperkeratotic debris accumulate.

What are the basics for skin examination assessment?

-General survey (color, pigmentation, vascularity, bruising, odors, llesions & discolorations). -Move systematically (Head/neck, trunk, arms, legs and back). Head to Toe.

Cyanosis (light skin) (blue)

-Grayish-blue tone. -nail beds, ear lobes, lips mucous membranes, palms & soles of feet.

What is hirusitism?

-Hair growth in women associated with endocrine disorders (PCOS).

What are the "appendages," of the integumentary system?

-Hair, nails & glands. -Appendages are formed at the junction of epidermis & dermis.

The integumentary system is made up of what?

-Hair, nails, sweat glands and sebaceous glands.

Scar (Secondary Lesion)

-Healed wound. -Thin to thick fibrous tissue replacing normal skin post injury. -pg. 115 top.

Impetigo

-Highly contagious streptococcal bacterial infection transmitted by contact. -Most prevalent in children, crowed conditions with poor sanitatio.

Scabies

-Highly contagious, infestation associated with Sarcoptes scabiei. -Female mite burrows into skin and lays eggs. -Transmitted skin to skin. -Small papules, vesicles and burrows that result from mite. -Usually hands, wrists, axillae, genitalia and inner thigh. Look like end of pencil.

What questions does a nurse ask about as part of the assessment for skin, hair and nails?

-Home environment. -Occupational environment. -Travel.

Excessive diaphoresis (sweating)?

-Hyperthermia. -Extreme anxiety, pain or shock. -Excessively moist skin may be metabolic condition like hyperthyroidism.

Hot skin indicates what?

-Hyperthermia. -Fever. -Increased metabolism (hypethyroidism/graves) -Exercise. -If localized (Inflammation, infection, traumatic injury or thermal injury ie. sunburn).

-Excessively thin skin with shiny, transparent appearance is seen in what?

-Hyperthyroidism, arterial insufficiency & aging.

Dull, coarse brittle hair is indicative for what?

-Hypothyroidism. -Nutritional deficiencies? Remember protein! -Exposure to chemicals (dye/perms etc.)

Pustule (primary skin lesion)

-Impetigo, acne, folliculitis, herpes simplex. -Elevated, superficial. -Similar to vesicle, but filled with purulent fluid. -pg. 113.

Hirusitism

-Increase in growth of hair in women. -Endocrine disorders; PCOS, menopause and side effect of corticosteroid or androgenic steroid therapy.

Folliculitis

-Inflammation of hair follicle. -bearded areas.

Stasis Dermatitis

-Inflammation on skin, most commonly seen on older adults. -Areas of erythyma, pruritus, scaling petichiae.

Contact Dermatitis

-Inflammatory reaction of skin in response to irritant or allergans (metals, plants, chemicals or detergent). -Found in area exposed to irritant.

Wheal (primary skin lesion)

-Insect bites, uticaria, allergic reactions, lupus erythematosus. -Elevated IRREGULAR shaped areas of cutaneous edema; solid; transient; variable diameter. -pg. 112

What is the purpose of the papilla in hair?

-It's a capillary loop that supplies nourishment.

PRURITUS

-Itchy skin. -When? Where? Circumstances? Medications? Contact w/animals, foods, drugs, plants?

Keloid (Secondary Lesion)

-Keloid formation following surgery. -Irregular shaped, elevated, progressively enlarging scar, excess collagen formation. -pg. 114.

Hyperkeratosis-Clavis (corn).

-Lesion caused by constant pressure from shoe over bony prominence. -Flat or slightly raised, painful lesion, with smooth hard surface. -A "soft" corn is whitish thickening commonly between 4th & 5th toe. -"Hard Corn" is clearly demarcated w/conical appearance.

Petechiae (light) (lesions)

-Lesions appear as small, reddish pinpoints. May be evident in buccal mucosa or sclera.

Lice

-Lice on body, scalp (pediculosis corporis). -Lice on pubis (pediculosis pubis). -Egg nits visible as small white, particles at base of hair shaft.

Pallor (dark) (pale)

-Lighter than normal skin tone (light) yellowish-brown skin (dark) ashen skin tone; from loss of healthy red tone of skin

Examples of assessment questions.

-Medications? -Changes in skin, hair or nails? -Chronic illnesses? -Occupation? -Exposure to chemicals? -Family history of skin problems, diseases or cancer. -Hygiene for care?

What give hair its color?

-Melanocytes.

Basal Cell Carcinoma

-Most common form of skin cancer. -Affecting light skinned individuals between 40 & 80 years. -Increases with age. -Locally invasive, rarely metastisizes. -More common in males. -Nodular pigmented lesion with depressed center.

Tumor (primary skin lesion)

-Neoplasms, lipoma, hemangioma. -Elevated & solid, may or may not be clearly demarcated; deeper into dermis, GREATER THAN 2 CM in diameter. -pg. 112 bottom.

People who bit their nails may be experiencing?

-Nursing School, STRESS.

Pitting, brittle nails, curmbling and changes in nail color may indicated what?

-Nutritional deficiencies, systemic diseases or localized fungal infections.

Pallor (light) (pale)

-Pale skin appears white/ashen.

Where are Eccrine glands most numerous?

-Palms of hands, soles of feet & forehead.

Ulcer (Secondary Lesion)

-Pressure ulcer, stasis ulcers, syphilis chancre. -Loss of epidermis & dermis; concave; varies in size. -Rupture of a vesicle or bulla -pg. 116.

A decrease in hair on lower extremity might reveal what?

-Problem with arterial circulation.

What are prevention recommendations by the American Cancer Society?

-Protect skin (tightly woven clothing, Minimum 15 SPF & wearing sunglasses (skin around eyes).

Hair that is dry and easily plucked reveals what?

-Protein deficiency?

Problem-Based History addresses the following using the OLDCARTS symptoms assessement.

-Pruritus, Rash, Pain/Discomfort of Skin, Lesions or changes in Mole, Change in Skin color, Skin Texture, Wounds.

Plaque (primary skin lesion)

-Psoriasis, seborrheic and actinic keratoses, eczema. -Elevated firm, rough lesion with flat top surface. -GREATER THAN 1 CM IN DIAMETER. -pg. 112 top.

Pitting nails is commonly associated with what?

-Psoriasis.

When do apocrine glands become active & where are they located?

-Puberty (influenced by hormones). -Axillae, nipples, areolae, anogenital area, eyelids and external ear. -Associated with emotional stimuli. -Secrete odorless fluid with protein, carbohydrates and other substances. -Decomposition leads to body odor (yuck!).

Erythema (light skin) (red)

-Reddish tone w/evidence of increased skin temperature secondary to inflammation.

What are Leukonychia?

-Remember leuk means white. -White spots on nails caused by minor trauma or manipulation of cuticle.

What are the three basic structures of hair?

-Root, shaft and follicle.

What are the common shapes for lesions?

-Round/oval (solid no central clearing). -Annular (round with central clearing). -Iris (pink macula with purple concentric ring). -Gyrate (snake like).

Crust (Secondary Lesion)

-Scab on abrasion, Eczema. -Dried drainage or blood; slightly elevated, variable size colors vary. -pg. 115 bottom.

Poor skin mobility indicates for what?

-Scleroderma.

Cyst (primary skin lesion)

-Sebaceous cyst, cystic acne. -Elevated, circumscribed, encapsulated lesion. -IN DERMIS OR SUBCUTANEOUS LATER. -Filled with liquid or semi-solid. -pg. 113 bottom.

Squamous Cell Carcinoma

-Second most frequent. -Results from excessivel UV light exposure. -Invasive to skin typically occurs on head/neck. -Over 50 with blue eyes & childhood freckles.

What are the patterns of lesions?

-Singular discreet (single separate demarcated-insect bite. -Grouped/clustered (lesions bunched together in little groups (herpes simplex, impetigo). -Polycyclic (annular lesions that contact as they spead; tinea corporis). -Confluent (Lesions that merge & run together over LARGE AREA; pityriasis rosea). -Linear (Lesion form a LINE; poison ivy, contact dermatitis. -Zosteriform (Lesions following a nerve; herpes zoster or shingles) -Generalized (lesions scattered all over; herpes varicella, chicken pox).

What is the most common cancer?

-Skin cancer.

Psoriasis

-Skin disorder that usually develops by age 20. -Inflammatory cytokines activated by HELPER T-CELLS. -Most frequently on Elbows, knees, buttocks, lower back and scalp. -Small bleeding points if scratched. -Pruritus, burning, bleeding lesions and PITTING FINGERNAILS.

Warts (verunca)

-Small benign lesion cause by HPV virus by contact. -A common wart (veruncus vulgaris) are round irregular shaped, gray, yellow, brownish black. -Usually on hands, fingers, elbows knees. -Plantars warts found on sole of foot.

What is a cherry angioma?

-Small, slightly raised, bright red area, typically appearing on face, neck and trunk of body. -Increase in size & number with advanced age.

What is Koilonychia?

-Spoon nails, thin, depressed, lateral edges turned up. -Indicates anemia. -Can be congenital.

The cuticle is called what?

-Statum corneum (epidermal tissue).

What are Eccrine Glands?

-Sweat glands that regulate body temperature by water secretion (evaporation). -Eccrine are most numerous & widespread.

Alopecia (hair loss) is associated with what?

-Systemic diseases. -Autoimmune disorders. -Anemic conditions. -Nutritional deficiencies. -Chemo/radiation. -Hair loss on legs=poor perfusion.

Name of the vascular lesions?

-Telangiectasia. -Cherry angioma. -Purpura. -Ecchymosis (bruise). -Capillary Hemangioma (nevus flammeus). -Vascular Spider (Spider angioma). -Venous Star. -Petechiae.

What is a Telangiectasia?

-Telangiectsia (find, irregular, red line caused by permanent dilation of superficial blood vessels.

Tinea Infections

-Tinea corposis (ring worm involving generalized skin areas; appear as CIRCULAR, WELL DEMARKED W/CLEAR CENTER. -Tinea Crusis (Jock itch, groin area, small erythematous scaling vesicular patches with well defined border. -Tinea Capitus (Athletes foot, small weeping vesicles.

What is a petechiae?

-Tiny hemorrhages within the dermal or submucosa-caused by intravascular defects. -Tiny, flat, reddish-purple, non-blanchable spots in skin less than .5 cm in diameter, appears as tiny red spots or pinpoint to pinhead in size. -pg. 117.

Spider bites

-Usually black widow or brown recluse. -minimal symptoms at time of bite. -Black widow lesion looks like area of erythema with two puncta at bite site (severe abdominal pain and fever. -Brown recluse; erythema & edema followed by necrotic ulcer.

Vesicles (primary skin lesion)

-Varicella, Herpes Zoster, impetigo, acute eczema. -Elevated, circumscribed, superficial, not into dermis. -Filled with serous fluid. -LESS THAN 1 CM in diatmeter. -pg. 113.

Erosion (Secondary Lesion)

-Varicella, variola after rupture, candidiasis, herpes simplex. -Loss of part of the epidermis; depressed, moist, glistening, follows rupture of vesicle or bulla. -pg. 116 top.

Patch (primary skin lesion)

-Vitiligo, port wine stains, mongolian spots, cafe-au-lait spots. -pg. 111 bottom.

Papule (primary skin lesion)

-Wart (verrucal), elevated moles, lichen planus, cherry angioma, neurofibroma, skin tag. -ELEVATED, firm circumscribed area. -LESS THAN 1 CM IN DIAETER. -pg.111.

RASH

-When? Where? Describe appearance? Flat or raised? Itch or burn? Better/worse? Associated symptoms? Allergies to...? Anyone else in family?

Candidiasis albicans

-Yeast infection, found on skin, mucous membranes, gastrointestinal tract and vagina. -Common in times of immunosuppression, diabetes mellitus, Cushing syndrome, debilitated states.

Jaundice (light skin) (yellow)

-Yellowish color in skin -sclera of eyes, finger nails, palms of hands and oral mucosa.

Jaundice (dark skin) (yellow)

-Yellowish to greenish color of skin -sclera of eyes (dont' confuse w/ yellow pigmentation of eyes in dark skinned people) , palms of hands, and soles of feet

Furuncle or Abscess.

-aka. boil; localized bacterial lesion caused by staphylococcal pathogen. Often develop from folliculitis. -Stages from pustule, the center core gills with sanguineous purulent exucate. -Red, hot and extremely tender. -What bible character was covered with boils? Job. Trivia :)

Petechia (dark) (lesions)

-difficult to see -in buccal mucosa of mouth, sclera of eye

Scar (dark)

-frequent keloid development -results in thickened, raised scar

Karposi's Sarcoma

-malignant neoplasm that develops form cartilage, bone, fat, muscle, blood vessels and fibrous tissue. -Affects those with AIDS. -Lesions spread all over body, particularly trunk, arms, face, neck and oral mucosa. -pain & pruritus.

Rash (dark)

-not easily visualized -may be felt w/palpation

What is the skin tissue adjacent to the nail?

-paronychium.

Cool skin is indicative of what?

-shock, hypothermia. -if localized in extremities (poor peripheral perfusion).

Rash (light)

-visualized or felt with light palpation.

Name the 3 layers of skin?

1) Epidermis. 2) Dermis. 3) Subcutaneous or Hypodermis.

What are key facts of dermis?

1) Highly vascular connective tissue. 2) Responsible for nourishing epidermal layer. 3) Blood vessels dilate and constrict in response to external temperature. 4) Contains sensory nerve fibers (touch, pain & temp). 5) Connective tissues allows stretch & contract. 6) Varied thickness 1-4mm.

Examination of lesions should focus upon? Box 9-2

1) Location & distribution. 2) Color? 3) Pattern? 4) Edges? 5) Size? 6) Characteristics?

What is the primary function of the skin?

1) Protect the body from microbial and foreign-substance invasion. 2) Protect internal body structures from minor physical trauma.

What are some other functions of the skin.

1) Retain body fluids and electrolytes. 2) Primary sensory contact w/outside world (Temperature & Textures=touch). 3) Body temperature regulation (radiation, conduction, convection & evaporation). 4) Production of Vitamin D. 5) Excretion of sweat, urea, lactic acid. 6) Expressing emotion (blushing).

Describe the epidermis?

1) Thin outermost layer. 2) Stratified squamous epithelials. 3) Deepest aspect of epidermis is called "stratum germinativum," which is adjacent to the dermis with rich blood supply. 4) Cell generation take place at deepest level of epidermis. 5) New cells pushed toward surface and slowly die as they move away from nutrition source.

Describe subcutaneous layer?

1) hypodermis is not actually skin. 2) Support structure for epidermis & dermis. 3) Composed of loose connective tissue and subcutaneous fat. 4) Fat retains heat, protective cushion & calories.

What are 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

What are secondary lesions?

1.Scale 2. Lichenification 3. Keloid 4. Scar 5. Excoriation 6. Fissure 7. Crust 8. Erosion 9. Ulcer 10. Atrophy

What is the pneumonic for MELANOMA?

A-ASYMMETRY (not round or oval). B-Border (poorly defined or irregular). C-Color (uneven, variegated). D-Diameter (usually bigger than 6mm). E-Elevation (recent change from flat to raised). F-Feeling (sensation of itching, tingling, or stinging within lesion).

Venous Star

Cause-Increased pressure in the superficial veins. -Type of telangiectasia, characterized by a non-palpable BLUISH, start-shaped lesion tht may be linear or irregularly shaped. -pg. 119.

What is a pupura?

Cause-infection or bleeding disorders resulting in hemorrhage of blood into skin. -Examples-senile, actinic purpura, progressive pigmented purpura, vasculitis, purpura, thombocytopenic purpura. -I think you would see this with DIC??? -pg. 118 top.

Ecchymosis

Caused by trauma to the blood vessel resulting in bleeding under the tissue. (Bruise) -Reddish-purple, non-blanchable spot. -pg. 118

Vascular Spider (Spider Angioma)

Causes may occur in absence of disease, with PREGNANCY, in liver disease, or with VITAMIN B DEFICIENCY. -Type of telangiectasia characterized by a small central RED area with radiating spiderlike legs; the LESION BLANCHES with pressure. -pg.119.

Telangiectasia

Causes-rosacea, collagen vascular disease; actinic damage, INCREASED ESTROGEN LEVELS. -Permanent dilation of preexisting small blood vessels. -Resulting in superficial fine, irregular red lines within the skin.

Which layer has no direct blood supply?

Epidermis.

Scar (light)

Narrow scar line

What is OLDCARTS? (remember for problem-based history!)

O-Onset. L-Location. D-Duration. C-Characteristics. A-Aggravating/Alleviating. R-Related symptoms. T-Treatment. S-Severity (pain scale).

What are the characteristics of each stage of a pressure ulcer.

STAGE 1-Intact skin, nonblanchable redness, usually over a bony prominence. STATE 2-Partial-thickness loss of DERMIS, Presents as shiny or dry shallow open ulcer with pink wound bed without slough or bruising, or in-tact open/ruptured serum-filled blister. -Remember first stage WITH BROKEN SKIN. STAGE 3-Full thickness skin loss involving damage to or necrosis of SUBCUTANEOUS TISSUE, Subcutaneous fat may be visible, BUT NOT BONE, TENDON OR MUSCLE. Slough may be present with undermining/tunneling. -STAGE 4 Full thickness tissue loss with exposed bone, tendon & muscle. Slogh or eschar may be present. -Unstageable due to slough hiding true depth.

Pigmented Nevi (moles).

-10 to 40 scattered over body of adult. -Uniform tan/brown. -Less than 5mm. -raised or flat. -sun-exposed body surfaces.

What would one expect on a person who lost their nail?

-A Beau's line. -A groove or transverse depression running across the nail resulting from trauma that temporarily impairs nail formation.

What is important about subaceous glands?

-A lipid-rich substance called sebum. -Sebum lubricates skin and hair. -Found everywhere but palms & soles. -Greatest concentration on face and scalp. -Stimulated by sex hormones.

Excoriation (Secondary Lesion)

-Abrasion, scratch, scabies. -Loss of epidermis, linear, hollowed out. -pg 115.

What is vitligo?

-Acquired condition (thought to be auto-immune). -unpigmented patches of skin common in dark-skinned races.

Paronychia

-Acute or chronic infection of the cuticle. -Usually staphylococcal or stetococci, sometimes candida.

Cellulitis

-Acute streptococcal/staphylococcal infection of the subcutaneous tissue. -Skin is red, warm to touch and tneder.

What are screening recommendations?

-Adults examine skin periodically. -Health care provider for new/unusual lesions.

What factors give hair variation (color, density, pattern)?

-Age, gender, race, hereditary factors.

Atrophy (Secondary Lesion)

-Aged skin, striae, discoid lupus, erhthematosus. -Thinning of skin surface & loss of skin markings; skin appears translucent and paper like. -pg. 116.

Abnormal Skin: Hypopigmentation (absence of pigmentation; pale white skin tone) indicates what?

-Albinism.

What is clubbing?

-Angle of nail bed exceeds 180º -Enlargement of distal fingers. -Indicates chronic respiratory or cardiovascular disease (COPD, Emphysema...) -Assess by placing finger nails back to back. See chart on bottom of pg. 108.

Moles located below waist, on scalp, or breast?

-Are RARELY NORMAL.

Cyanosis (dark-skin) (blue)

-Ashen gray color -easily seen in: conjunctiva, oral mucous membrane, & nail ned

Mobility and Turgor?

-Assessed on skin of forearm or under clavicle. -Poor turgor noted by tenting, suggesting dehydration.

Burns

-Associated with abuse. -Look for immersion burn, glove or stocking, demarcation line in scaling water. -Also contact burns, light bulb, lighter hot iron or cigarette.

Fissure (Secondary Lesion)

-Athletes foot, cracks at corner of moutn, chapped hands, eczema, intertrigo labialis. -linear crack or break from epidermis to dermis, may be moist or dry. -pg. 115

Learning tip.

-Become proficient at describing lesions. -Location, size, and color. -Shape (oval, round, irregular). -Borders (regular & irregular). -Elevation (flat, raised, or sunken). -Characteristics (hard, soft, fluid-filled. -Pattern (if more than one lesion).

Bulla (primary skin lesion)

-Blister, pemphigus, vulgaris, lupos erythematosus, impetigo, DRUG REACTIONS! -Vesicle GREATER THAN 1 CM. -pg. 113.

Ecchymosis (dark skin) (bruise)

-Bruise -deep blue or black tone -difficult to see unless in area of light pigmentation

Eccymosis

-Bruise. -1 to 3 days, purple to deep black. -3 to 6 days, green to brown. -6 to 15 days green to tan to yellow then fades. -Look for patterns associated with abuse such as teeth, cord.

Ecchymosis (light skin) (bruise)

-Bruise. -Dark red, purple, yellow, green depending on age.

Herpes Zoster

-Caused by dormant herpes varicella. -Acute inflamation FOLLOWS CUTANEOUS SENSORY NERVE LINE. -Linearly grouped vesicles.