Module 3: Skin, Hair, and Nails
venous star
bluish spider, linear or irregularly shaped; does not blanch with pressure
hematoma
swelling usually clotted blood, confined to an organ, tissue, or space
digital mucous cysts
cyst like structures contain a clear, jelly-like substance
A 60-year-old male patient states that he has a sore above his lip that has not healed and is getting bigger. The nurse observes a red scaly patch with and ulcerated center and sharp margins. These findings are commonly associated with which malignancy? a. Kaposi's sarcoma b. malignant melanoma c. basal cell carcinoma d. squamous cell carcinoma
d
layers of the skin
epidermis dermis hypodermis
callus
superficial area of hyperkeratosis usually occur on the weight-bearing areas not usually tender
hyperkeratosis
clavus (corn)
rubella
german measles mild, febrile, highly communicable viral disease
A patient has multiple solid, red, raised lesions on her legs and groin that she describes as "itchy insect bites." How does the nurse document these lesions? a. wheals b. bullae c. tumors d. plaques
a
elevation/depression shapes
annular - round, clear in middle round - solid throughout in color linear - line diffuse - clustering, scattered, generalized
chloasma/melasma
areas of hyperpigmentations on the face and neck that are associated with pregnancy or the use of hormones
intertriginous surfaces
areas where two skin surfaces may touch
paronychia
inflammation of the paronychium invasion of bacteria between the nail fold and the nail plate
herald patch
initial manifestation of pityriasis rosea single lesion, usually located on the trunk, resembling tine corporis
lichenification
secondary skin lesion rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation often involved flexor surface of extremity ex. chronic dermatitis
scar
secondary skin lesion thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis ex. healed wound or incision
atrophy
secondary skin lesion thinning of skin surface and loss of skin markings skin translucent and paper-like ex. striae; aged skin
herpes zoster
shingles grouped lesions along sensory nerve line varicella-zoster viral (VZV) infection
striae
silver or pink stretch marks secondary to weight gain or pregnancy
unexpected palmar crease
single transverse crease in child with Down syndrome (trisomy 21)
paronychium
skin adjacent to the nail
integumentary system
skin and the accessory structures (hair, nails, sweat glands, and sebaceous glands)
milia
small whitish, discrete papule on the face commonly found during the first 2-3 months of life
cutaneous horns
small, hard projections of the epidermis usually occurring on the forehead and face
acrochordon
small, soft tags of skin, usually appearing on the neck and upper chest pedunculated may or may not be pigmented
koilonychia
spoon nails central depression of the nail with lateral elevation of the nail plate
solar keratosis (actinic keratosis)
squamous cell carcinoma confined to the epidermis
striae gravidarum
stretch marks
tissue integrity
structural intactness and physiologic function of tissues and conditions that affect integrity (perfusion, oxygenation, motion, tactile sensory perception, elimination, nutrition, pain)
alopecia areata
sudden, rapid, patchy loss of hair, usually from the scalp or face
neurofibromatosis
suspected when there are more than 6 cafe au lait spots <5cm prepuberty
basal cell carcinoma
the most common form of skin cancer
beau lines
transverse depression in the nail bed associated with coronary occlusion, hypercalcemia, and skin disease
white banding (Terry nails)
transverse white bands associated with cirrhosis, chronic CHF, diabetes mellitus, and age
subungual hematoma
trauma to the nail plate severe enough to cause immediate bleeding and pain
contact burn
type of burn resulting from making contact with heated objects, such as boiling water, steam, hot cooking oil, fire, and hot objects.
miliaria rubra
"prickly heat" results from immaturity of skin structures caused by sweat retention from occlusion of sweat ducts during periods of heat and high humidity
The nurse knows that the functions of the skin include: Select all that apply: A. Sensory input B. Protection C. Production of vitamin D D. Temperature regulation E. Production of vitamin C F. Sensory output
A, B, C, D These are all functions of the skin. e. and f. The skin does not produce vitamin C or play a role in sensory output.
What are the risk factors for melanoma? (Select all that apply.) A. Inability to tan B. Familial history C. Diet rich in vitamin A D. Fair skin and light eye color E. Exposure to tangential lighting
A, B, D Risk factors for melanoma include an inability to tan, family history (genetic predisposition), and lower amounts of melanin. Vitamin A promotes healthy skin. Tangential lighting is light from the side used in examining patients.
Which finding while assessing the skin in children is suggestive of physical abuse? (Select all that apply.) A. Human bite marks B. Injuries covered by clothing C. Bruising over bony prominences D. Bruising with fingertip grab marks E. Burns consistent with spill with splash marks F. Burns consistent with immersion of buttocks
A, B, D, F Injuries of children that suggest abuse include human bite marks, injuries in areas normally covered by clothing, bruises with fingertip marks, and burns consistent with immersion such as on the buttocks. Bruises that occur with accident falls are more commonly found over bony prominences. Accidental burns are likely to have a pattern consistent with a spill including splash marks.
drug eruptions
IgE-dependent cytotoxic immune complex cell-mediated hypersensitivity idiosyncratic reactions direct release of mast cell mediators
palpate the skin for 5
1. moisture 2. temperature 3. texture 4. turgor 5. mobility
Hormonal changes that occur with puberty cause adolescents to be at risk for which condition? A. Acne B. Striae C. Psoriasis D. Telangiectasis
A Increased levels of androgens that occur with puberty cause an increase in sebum, predisposing adolescents to acne. Striae are stretch marks occurring with weight gain. Psoriasis is an autoimmune disease with patchy, flaky skin lesions. Telangiectasis are lesions caused by dilated capillaries that occur normally and with liver disease.
Select the correct statement regarding skin turgor. A. It reflects the elasticity of the skin. B. It is measured by using skin calipers. C. It is used to assess hydration status in elderly patients. D. It is assessed in the dorsum of the hand in elderly patients.
A Skin turgor reflects the elastic quality of the skin. The skin is pinched up and then released. Calipers are used to measure skinfold thickness in the triceps to estimate body fat stores. Elderly persons naturally have decreased skin turgor because of loss of subcutaneous fat. Skin turgor does not reflect hydration status in elderly patients.
ABCDEF of melanoma
Asymmetry Border Irregularity Color variation Diameter >6mm or growing Elevation Feeling (itching, tingling, stinging)
Upon inspecting the hands, the nurse observes that the patient has a black discoloration of one fingernail. The patient states the nail is painful. What is this finding? A. Ganglion cyst B. Subungual hematoma C. Fungal infection of the nail. D. Pseudomonas aeruginosa infection of the nail
B Subungual hematoma blackens the nail because of a collection of blood under the fingernail. A ganglion cyst is a nodule that overlies tendon sheaths often in the wrist area. Fungal infections cause the nail to crumble. A bacterial infection caused by P. aeruginosa causes the nail to appear black green but is not painful.
boil
Boils form under the skin when bacteria infect and inflame one or more hair follicles. Boils start as red, tender lumps. These fill with pus, grow, then rupture and drain. A carbuncle is a cluster of boils.
Which skin lesion in the elderly patient requires further observation? A. Skin tags B. Solar lentigines C. Actinic keratosis D. Seborrheic keratosis
C Actinic keratosis, a red, scaly plaque occurring in sun-exposed areas, is precancerous. Skin tags, solar lentigines (age spots), and seborrheic keratosis (large, raised, pigmented lesions) do not become malignant.
Which lesion is suspicious for basal cell cancer? A. Cherry angioma B. Freckles after sun exposure C. Crusty sore that does not heal D. A nevus that is irregular in shape
C Basal cell cancer occurs in skin exposed to the sun. It is a shiny lesion that crusts over but does not heal. Cherry angioma and freckles are skin lesions that are not significant. A nevus (mole) that is irregular is suggestive of melanoma.
Which description is correct about intertriginous surfaces of skin? A. Areas prone to friction B. Areas that are exposed to sun C. Areas where skin surfaces meet D. Areas that are covered with hair
C Intertriginous surfaces are areas where skin surfaces meet, such as the groin and under pendulous breasts. The face is exposed to the sun. Soles of feet are prone to friction. The head is covered with hair in areas that are not bald.
What changes are expected in the skin as a person ages? A. Increased sweat production B. Increased production of sebum C. Increased incidence of bruising D. Increase in deposits of subcutaneous fat
C With aging, the blood vessels in the skin become more fragile and more likely to bruise. Elderly people have less ability to sweat and dry skin because of less sebum. The normal layer of subcutaneous fat decreases with age.
A patient is being treated for Lyme disease based on what assessment finding? A. Skin inflamed from a mosquito bite B. Rash with vesicles that follows a dermatome C. Skin lesions that are circular with clear centers D. Red macular rash with appearance of a bull's eye
D Lyme disease is caused by a spirochete carried by deer ticks. The bite causes a red rash that appears as a bull's eye (erythema migrans). Treatment in the early stage prevents disseminated disease and serious complications. Mosquitoes are not a vector for Lyme disease. Shingles, which is caused by herpes zoster, causes vesicles (fluid filled) that follow dermatomes (nerve routes). Ringworm (tinea corporis) is a fungal infection causing circular lesions.
scalp and hair: inspect and palpate
Inspect: -Scalp (smooth, scaling, lesions, color, redness) -Hair (shiny, dull, loss, hygiene) -Facial/body hair (quantity, texture) Palpate: -Scalp ( lesions, mobility) -Hair (soft, brittle, dry) -Facial/body hair (texture, loss)
nails: inspect and palpate
Inspect: -Shape -Unexpected findings -Clubbing Palpate: -Adherence -Capillary refill
traction alopecia
hair loss that is the result of prolonged, tightly pulled hairstyles
A patient with darkly pigmented skin has been admitted to the hospital with hepatitis. What is the best way for the nurse to assess for jaundice in this patient? a. jaundice is best seen in the sclera b. in dark-skinned persons, jaundice results in darkening of the genitalia c. jaundice is best determined by blanching the fingernails d. jaundice cannot be assessed in patients with darkly pigmented skin
a
pruritic urticarial papules and plaques of pregnancy (PUPPP)
a benign dermatosis that usually arises late in the third trimester of a first pregnancy
vernix caseosa
a mixture of sebum and cornfield epidermis that covers the infant's body at birth
cutis marmaorata
a mottled appearance of the body and extremities, esp. in newborns
kaposi sarcoma
a neoplasm of the endothelium and epithelial layer of the skin commonly associated with HIV
acanthosis nigricans (AN)
a nonspecific reaction pattern associated with obesity, certain endocrine syndromes, or malignancies or as an inherited disorder
lyme disease
a tick-borne disease that can lead to multi systemic infection Borrelia burgdorferi
laceration
a wound or irregular tear of the skin
Select all of the following that are pressure points for ulcer. a. Sacrum b. Scapula c. Ear d. Medial Malleolus
a. Sacrum b. Scapula c. Ear d. Medial Malleolus
Excessively oily skin is described by the following term. a. Seborrhea b. Xeroxes c. Striae d. Paronychium
a. Seborrhea
pityriasis rosea
acute, self-limiting inflammation of unknown cause disease of young adults in winter not contagious thought to be viral
candidiasis
affect superficial layers of skin and mucous membranes lesions caused by fungal infections
phases of hair growth
anagen (growth) catagen (atrophy) telogen (rest)
trichotillomania
hair pulling loss of scalp hair can by caused by physical manipulation
tinea pedis
athlete's foot lesions caused by fungal infections
The nurse observes multiple red circular lesions with central clearing that are scattered all over the abdomen and thorax. How does the nurse document the shape and pattern of these lesions? a. gyrate and linear b. annular and generalized c. iris and discrete d. oval and clustered
b
Normal capillary refill should be which of the following? a. <1-2 seconds b. <2-3 seconds c. <3-4 seconds d. <4-5 seconds
b. <2-3 seconds
What is the most common skin condition? a. Rashes b. Pruritus c. Pain d. Wounds
b. Pruritus
This is a highly contagious lesion caused by mites Sarcoptes scabiei. a. Lyme disease b. Scabies c. Lice d. Spider bites
b. Scabies
The loss of pigmentation in skin is described with the following term. a. Jaundice b. Vitiligo c. Dermatitis d. Herald patch
b. Vitiligo
neoplasia
basal cell carcinoma - most common, locally invasive, rarely metastasizes, nodular pigmented lesions with depressed center and rolled borders squamous cell carcinoma - initially appears as a red, scaly patch melanoma - most serious, malignant proliferation of melanocytes, irregularly shaped with color variations kaposi's sarcoma - develops in connective tissue of immunosuppressed, dark blue-purple macule, papule, nodules, and plaques
furuncle
boil a deep-seated infection of the pilosebacious unit most commonly S. aureus
ecchymoses
bruise red-purple non blanchable discolorations produced by injury
signs of abuse
bruises - with distinct patterns, age of bruise, location, story bites - tooth marks, oval shape burns - especially on feet and hands or shape of the object used to burn
patterns of injury in physical abuse
bruises, especially over soft tissues lacerations, especially human bite marks burns, cigarette shape, absence of splash marks hair loss
A 48-year-old woman asks the nurse how to best protect herself from excessive sun exposure while at the beach. Which response would be most appropriate? a. "Limit your time in the sun to 5 minutes every hour." b. "Wear a wet suit that covers your arms and legs." c. "Apply a waterproof sunscreen (SPF 15 or higher) to exposed skin surfaces; reapply at least every 2 hours." d. "Apply sunscreen with a minimum SPF 50 to all skin surfaces before leaving for the beach; this will provide all-day skin coverage."
c
A patient has edema and redness of the skin surrounding the nail on his right index finger. Which data elicited from his history best explains this condition? a. he has a family history of liver disease b. there has been a scabies outbreak among his family members c. he has a new full-time position as a dishwasher at a local restaurant d. he had several warts removed from his hands 2 years ago
c
Which of the following locations would Jaundice be first noted? a. Hands b. Feet c. Eyes d. Sternum
c. Eyes
Which of the following is an example of a macule? a. Impetigo b. Warts c. Freckles d. Candidiasis
c. Freckles
Which of the following is the most serious type of skin cancer? a. Basal cell b. Squamous cell c. Melanoma d. Cellulitis
c. Melanoma
associate changes within lesions (5)
central clearing desquamation karatotic punctation telangiectasias
vascular skin lesions
cherry angioma petechiae - red-purple non blanch able discolorations, less than 1/2 cm, caused by intravascular defects, bleeding, infections purpura - red-purple, non blanch able >1/2cm, caused by bleeding, infections ecchymosis (bruise) - red purple nonblanchable, caused by vascular wall destruction, trauma, vasculitis angioma - fiery red lesions, common on face, arms upper trunk, associated with vitamin b deficiency, alcohol abuse, cirrhosis, red central body with radiating spider like legs that blanch capillary hemangioma (nevus flammeus) telangiectasia vascular spider venous star
herpes varicella
chickenpox lesions erupt in crops painful and highly contagious infectivity lasts about 6 days after final eruptions common in children and young adults
psoriasis
chronic and recurrent disease of keratin synthesis slightly raised erythematous (red) plaques with silvery scales usually develops by age 20 mostly on elbows, knees, buttocks, lower back, and scalp nail pitting
rosacea
chronic inflammatory skin disorder a condition in which certain facial blood vessels enlarge, giving the cheeks and nose a flushed appearance. may be accompanied by rhinopehyma (hypertrophy of nose)
seborrheic dermatitis
chronic, recurrent, erythematous scaling eruption localized in areas where sebaceous glands are concentrated
palmar erythema
common finding in pregnancy diffuse redness covers the entire palmar surface or the thenar and hypothenar eminences
anonychia
complete absence of the nail
The nurse is performing a skin assessment and finds that the patient has milia. In which age group would this be an expected finding? A. Newborns B. Young children C. Adolescents D. Older adults
correct answer: A Milia are small white papules found on the face of a newborn infant. b. c. and d. Milia are not found in young children, adolescents, or older adults.
avascular
has no direct blood supply
The nurse is teaching a parent about risk factors associated with the skin for their school-age child. What would the nurse include as the most common cause of skin lesions for this age group? A. Communicable disease and bacterial infection B. Changes in skin turgor and skin tone C. Maturation of melanocytes, causing changes in skin color D. Skin inflammation from sebaceous gland activity
correct answer: A These spread quickly among those in this age group. b. There are no significant changes in skin tone or turgor. c. This does not produce lesions. d. This describes acne and is common among adolescents.
The nurse is performing a skin assessment on a patient in pain. Which skin layer contains sensory fibers that react to touch, pain, and temperature? A. The epidermis B. The dermis C. The hypodermis D. The subcutaneous tissue
correct answer: B The dermis contains the nerves and vascular supply. a. The epidermis is the outermost skin layer; no sensory fibers are found here. c.The hypodermis contains connective tissue and subcutaneous fat and is not used for sensation. d. Subcutaneous tissue is found in the hypodermis.
A patient comes to the clinic for a skin check. Which finding by the nurse indicates a need to further investigate a lesion? A. The lesion is dark brown. B. The lesion has been present for 20 years. C. The lesion bleeds easily when it is touched. C. The lesion is slightly raised and circumscribed.
correct answer: C A lesion that bleeds easily could be malignant. a. This color is common for nevi. b. This is only a concern if the lesion has recently changed in size or appearance. d. Well-circumscribed lesions tend to be benign lesions.
A patient is concerned because the dermatologist diagnosed macules all over the skin. The patient asks the nurse what could be causing this? The nurse's best response is: A. "Macules need to be watched closely for signs of skin cancer." B. "Macules are warts and should be removed." C. "Macules are freckles are considered normal on the skin." D. "You have an infection and will need an antibiotic."
correct answer: C Another name for macules is freckles. Freckles are considered normal and benign. a. Macules are not considered a risk factor for skin cancer. b. Macules are not warts. d. Macules are not considered infectious.
The nurse is assessing an African-American patient for cyanosis. Cyanosis in dark pigmented skin appears as a(n): A. Yellowish-green skin B. Deeper tone of brown or purple C. Ashen gray color to the skin D. Cluster of dark spots over the skin surface
correct answer: C This is easiest to see in the oral mucous membranes, nail beds, and conjunctiva of the eye. a. This is how jaundiced skin may appear. b. Erythema may appear this way. d. This is how ecchymosis may appear.
The nurse is assessing a patient for nail clubbing. Where should the nurse focus the exam? A. The width of the nail base B. The color of the nail C. The thickness of the nail D. The angle of the nail base
correct answer: D Clubbing is associated with an increased nail bed angle. a. The width is not an indicator of clubbing. b. The color of the nail may indicate cyanosis but not clubbing. c. The thickness of the nail may be affected by trauma, fungal infection, or poor circulation.
The nurse is assessing a patient's skin turgor. Skin turgor is assessed by: A. Auscultating the skin to note the presence of motility sounds B. Pressing on the skin and observing the depression C. Stretching the skin and observing for a degree of flexibility D. Pinching the skin and watching the skin return to place
correct answer: D The skin under the clavicle is frequently used. a. This is never done. b. This might be done to assess for pitting edema. c. This is not done.
The nurse is performing a skin check on a patient. In which age group is seborrheic keratosis an expected finding? A. Newborns B. Young children C. Adolescents D. Older adults
correct answer: D These lesions are fairly common in older adults. a. b. and c. Seborrheic keratosis is not seen in newborns, young children, or adolescents
molluscum fibrosum gravidarum
cutaneous tags can be pedunculated or sessile most often found on the neck and upper chest result from epithelial hyperplasia not inflammatory most resolve spontaneously
When examining a 16-year-old male patient, the nurse notes multiple pustules and comedones on the face. The nurse recognizes that increased activity of which cells or glands produce these manifestations? a. epidermal cells b. eccrine glands c. apocrine glands d. sebaceous glands
d
Which disorder is an example of a vascular lesion? a. dermatofibroma b. vitiligo c. sebaceous cyst d. port wine stain
d
Which of the following angle is considered nail clubbing? a. >45 degrees b. >90 degrees c. >160 degrees d. >180 degrees
d. >180 degrees
pedunculated
having a stalk
border/margin of skin lesions (6)
discrete indistinct active irregular border raised above advancing
skin appendages
eccrine sweat glands apocrine sweat glands sebaceous glands hair nails
warts
epidermal neoplasms caused by viral infection HPV
parts of the nail
eponychium/cuticle nail matrix nail root nail plate paronychium lunula
Secondary skin lesions
expected variations like a scar abnormal secondary lesions result from changes from or trauma to a primary lesion scale lichenification keloid scar excoriation fissure crust erosion ulcer atrophy
lanugo
fine, silky hair that covers the newborn's body, particularly the shoulders and back
pigmentation of skin lesions (11)
flesh pink erythematous salmon tan-brown black pearly pure violaceous yellow white
onychomycosis
fungal infection the nail
herpes simplex
group of 8 DNA viruses outbreaks triggered by sun exposure, stress, fever grouped vesicles with an erythematous base very painful and highly contagious eruptions last about 2 weeks Type 1 oral Type 2 genital
tinea (dermatophytosis)
group of noncandidal fungal infections that involve the stratum corneum, nails, or hair corporis, cruris, capitis, pedis, unguinum
hirsutism
growth of terminal hair in women in the male distribution pattern on the face, body, and pubic areas caused by high androgen levels
hypodermis
innermost and thickest layer of the skin. It invaginates into the dermis and is attached to the latter, immediately above it, by collagen and elastin fibres. It is essentially composed of a type of cells specialised in accumulating and storing fats, known as adipocytes
solar lentiggine (lentigo)
irregular, round, gray-brown macule with a round surface that occur in sun-exposed areas age spots epidermal proliferations early signs of photoaging
keloids
irregularly shaped, elevated, progressively enlarging scar, grows beyond boundaries of wound, caused by excessive collagen formation during healing, can occur from ear piercing or burn or surgical incision, etc
pruritus
itching, most commonly reported symptom of skin disease
foruncle
lesions caused by bacterial infection abscess or boil staphylococcal infection
cellulitis
lesions caused by bacterial infection diffuse acute streptococcal or staphylococcal infection of the skin and subcutaneous tissue red, warm, may have lymphadenopathy
impetigo
lesions caused by bacterial infection highly contagious group a streptococcal infection generally occurs on face, around mouth and nose pustules
folliculitis
lesions caused by bacterial infection inflammation and infection of hair follicles and surrounding dermis
malignant melanoma
lethal form of skin cancer that develops from melanocytes
sebum
lipid rich substance which keeps the skin and hair lubricated
distribution of skin lesions (3)
localized regional generalized
corns
look for these on pressure points flat or slightly elevated circumscribed painful smooth, hard surface can be "soft" or "hard"
onycholysis
loosening of the nail plate with separation from the nail bed that begins at the distal groove
Primary Skin Lesions
macule - freckles, non palpable, usually less than 1 cm papule (nevus/nevi are moles) - less than 1 cm, elevated, palpable, firm, warts patch - bunch (clustering) of macule, irregular shape, non palpable, cafe au last spots, vitiligo plaque wheal - localized area of cutaneous edema of skin, elevated, irregular shape, variable size, may result from bug bite, hives nodule - 1-2 cm, deeper and firmer, elevated, circumscribed tumor - greater than 2 cm, elevated, solid, neoplasms, benign tumor, lipoma vesicle - less than 1 cm, serous fluid, blister, elevated superficial, herpes lesion bulla - greater than 1 cm, blisters pustule - elevated, superficial, filled with purulent (cloudy) fluid, impetigo, acne cyst
freckles
macule - non palpable, usually less than 1 cm
pigmented nevi
moles
keratinization
process undergone by skin cells in which keratin is deposited, causing the cells to become flat, hard, and waterproof, composing the epidermis
nevi
moles typical adult has 40-100 all over body halo- sharp, oval, or circular with depigmented halo intradermal- dome shaped; raised; flesh to black color junction- flat or slightly elevated; dark brown compound- slightly elevated brownish papule: indistinct border hairy- may be present at birth; may cover large area; hair growth may occur after several years
eczematous dermatitis
most common inflammatory skin disorder several forms (irritant contact, allergic contact, atopic)
ingrown nails
nail pierces the lateral nail fold and grows into the dermis
common nail problems
onychomycosis - fungal infection of nail bed caused by tine unguium paronychia - acute or chronic infection of cuticle caused by staphylococci and streptococci, although candida may be causative organism ingrown toenail
epidermis
outermost portion of the skin 1. stratum corneum 2. cellular stratum (germinativum, spinosum, granulosum, sometimes lucidum) connected to dermis by basement membrane avascular
cherry angioma
papule small 1-3 mm, round, ruby red, turns brown with age, increase after 30
common hair problems
pediculosis - lice (corporis or pubis) alopecia areata - chronic inflammatory disease of hair follicles resulting in hair loss on scalp hirsutism - increase in growth of facial, body, or pubic hair in women
seborrheic keratoses
pigmented, raised, warty lesions usually appear on the face or trunk must be distinguished from actinic keratoses, which have malignant potential
macule
primary skin lesion a flat, circumscribed area that is a change in the color of the skin <1cm ex. freckles, flat moles, petechiae, measles
patch
primary skin lesion a flat, non palpable, irregularly-shaped macule >1cm bunch (clustering) of macule, irregular shape, non palpable ex. cafe au last spots, vitiligo, port-wine stains, mongolian spots
papule
primary skin lesion an elevated, firm, circumscribed area <1cm ex. wart (verruca), elevated moles, lichen planus
tumor
primary skin lesion elevated and solid lesion; may or may not be clearly demarcated deeper in dermis >2cm ex. neoplasms, benign tumor, lipoma
cyst
primary skin lesion elevated, circumscribed, encapsulated lesion in dermis or subcutaneous layer filled with liquid or semisolid material ex. sebaceous cyst, cystic acne
vesicle
primary skin lesion elevated, circumscribed, superficial not into dermis filled with serous fluid <1cm ex. varicella, herpes zoster
plaque
primary skin lesion elevated, firm, and rough lesion with flat top surface >1cm ex. psoriasis, seborrheic, and actinic keratoses
nodule
primary skin lesion elevated, firm, circumscribed lesion deeper in dermis than a papule 1-2cm ex. erythema nodosum, lipoma
wheal
primary skin lesion elevated, irregular-shaped area of cutaneous edema solid, transient, variable diameter ex. insect bites, urticaria, allergic reaction
pustule
primary skin lesion elevated, superficial lesion similar to a vesicle but filled with purulent fluid ex. impetigo, acne
telangiectasia
primary skin lesion fine, irregular red lines, caused by dilation of capillaries, hormones and aging ex. rosacea
bulla
primary skin lesion vesicle >1cm ex. blister, pemphigus vulgaris
sebaceous hyperplasia
produces numerous tiny yellow macule and papule in the newborn probably the result of androgen stimulation from the mother commonly occurs on the forehead, cheeks, nose, and chin of the full-ten infant disappears quickly within 1-2 months of life also occur in elderly as yellowish, flattened papule with central depressions
functions of skin
protect against microbial and foreign substance invasion and minor physical trauma restrict body fluid loss by providing a mechanical barrier regulate body temperature through radiation, conduction, convection, and evaporation provide sensory perception via free nerve endings and specialized receptors produce vitamin D from precursors in the skin contribute to BP regulation through constriction of skin blood vessels repair surface wounds by exaggerating the normal process of cell replacement excrete sweat, urea, and lactic acid express emotions
herpes gestationis (pemphigoid gestationis)
rare autoimmune disorder of pregnancy not related to the herpes virus
spider angioma
red central body with radiating spider-like legs that blanch with pressure to the central body
capillary hemangioma (nevus flammeus)
red irregular macular patches
purpura
red-purple non blanchable discolorations larger than 0.5 cm in diameter
petechiae
red-purple non blanchable discolorations smaller than 0.5 cm in diameter considered a type of macule
scarring alopecia
replacement of hair follicles with scar tissue
dermis
richly vascular connective tissue layer of the skin supports and separates the epidermis from the cutaneous adipose tissue elastin, collagen, reticulum fibers sensory nerve fibers autonomic motor nerves arrestors pilgrim muscles
tinea corporis
ringworm lesions caused by fungal infections
shape/arrangement of skin lesions (11)
round/discoid oval annular zosteriform (dermatomal) polycyclic linear iris/target lesion stellate serpiginous reticulate morbilliform
lesions caused by arthropods
scabies lyme disease spider bites
squamous cell carcinoma
second most common form of skin cancer
crust
secondary skin lesion dried serum, blood, or purulent exudates slightly elevated size varies brown, red, black, tan, or straw-colored ex. scab on abrasion, eczema
scale
secondary skin lesion heaped-up, keratinized cells flaky skin irregular thick or thin dry or oily variation in size ex. seborrheic dermatitis or following a drug reaction; dry skin
keloid
secondary skin lesion irregularly shaped, elevated, progressively enlarging scar grows beyond the boundaries of the wound caused by excessive collagen formation during healing
fissure
secondary skin lesion linear crack or break from the epidermis to the dermis may be moist or dry ex. athlete's foot, cracks at the corner of the mouth
ulcer
secondary skin lesion loss of epidermis and dermis, concave, varies in size, exudative, red or bluish, decubitus, nonblanchable erythema ex. decubiti, stasis ulcers
erosion
secondary skin lesion loss of part of the epidermis depressed, moist, glistening follows rupture of a vesicle or bulla ex. varicella, variola after rupture
excoriation
secondary skin lesion loss of the epidermis linear hollowed-out, crusted area ex. abrasion or scratch, scabies
dermatitis
variety of superficial inflammatory conditions atopic - superficial contact - reaction to irritant or allergen seborrheic - chronic (scaly, white/yellowish skin on scalp, eyebrows, ears, axillae, chest, or back) stasis - seen mostly on lower legs of older adults
rubeola
viral measles also called hard measles or red measles koplik spots
sessile
without a stalk