Module 4: Integument Disorders

THE TERMS COMMONLY USED TO DESCRIBE SKIN LESIONS INCLUDE THE FOLLOWING _______: thinning and loss of skin layers ______: large blister (greater than 0.5 cm in diameter) ____: dried yellowish and yellow-brown exudate on the skin _____: reddened skin; area blanches with pressure _____: scratch that breaks the skin's surface _____: crack in the skin that breaks through keratin _____: hardening or thickening of the skin _____: irregular, elevated scar tissue formed by excessive collagen growth during wound healing

Atrophy Bulla Crust Erythema Excoriation Fissure Induration Keloid

_____ ____ _____ the most common form of skin cancer and accounts for more than 90% of all skin cancer in the United States. These cancers rarely metastasize to other parts of the body. They can grow deeply and invade surrounding tissue.

BASAL CELL CARCINOMA

ECZEMA TREATMENT Treatment involves_____ ___; good skin care; and avoidance of stress, foods, drinks, and temperature changes that exacerbate the eczema or its symptoms. ______ and occasionally_____ corticosteroids are used. Immune____ are showing positive results without side effects.

allergen control Topical, systemic modulators

SCC DIAGNOSIS AND TREATMENT Diagnosis must be confirmed with a_____. Treatment options are similar to those of melanoma. Most patients with localized SCC have cure rates that range from 85% to 95% or greater.

biopsy

Basal Cell sarcoma treatment Similar to melanoma, a _____ is necessary for diagnosis. Treatment is also similar to melanoma. However, most cases of basal cell cancer can be cured with_____ alone.

biopsy surgery

Alert! A common warning sign of melanoma is_____. A change to the shape, color, or diameter of a mole can be a warning sign of melanoma. Other changes that could indicate melanoma include a mole that becomes_____, or begins to___ OR _____.

change painful bleed or itch

A ______ is the prototypical lesion in acne; it is a plug of sebaceous and necrotic cellular material within the opening of a hair follicle. The follicle may be open (blackhead) or almost closed (whitehead). The lesions most commonly appear on exposed areas of the face, chest, and back.

comedone

Melanoma originates in _____, the cells that produce the pigment melanin, which colors our skin, hair, and eyes. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue, or white. Approximately 30% of melanomas occur in a nevus. Melanoma begins on the surface, but it penetrates deep into the skin and invades the____ & _____ ____, and then metastasizes throughout the body.

melanocytes blood and lymphatic vessels

NAIL DISORDERS An obvious black region under the nail can indicate _____ beneath the nail or _____ ____- caused by trauma. Persons often show short white lines in the nail, called ______. These may be caused by trauma to the nail. _______ ___ are transverse white lines that span the nail width that are indicative of hypoalbuminemia.

melanoma subungual hemorrhage leukonychia Muehrke's lines

SC ABIES Scabies is often suspected when small____ and visible wavy or linear ____ are present on the interdigital webs of the fingers and toes, folds of the skin, nipples, or genitalia. The lesions are itchy; the skin around the burrows is usually excoriated.

papules burrows

PSORIASIS Topical agents, emollients, coal tar products, other agents that ___ & ____the skin, and steroids are used with varying results. Exposure to____ & ____ baths are known to be helpful. Drugs such as methotrexate, steroids, cyclosporine, and the retinoids are used systemically. Psoriasis lesions____ when the scales are removed. This diagnostic finding, _____ sign, differentiates psoriasis from other skin disorders.

soften and hydrate sunlight and saltwater bleed, Auspitz

TREATMENT OF MELANOMA This procedure involves complete____ ____ of the melanoma and some healthy skin around the growth. Removing some healthy skin is called "_____ _____. " This ensures that all ____ ____are removed. Treatment for melanoma depends on the____.

surgical removal taking margins cancerous cells stage

Fungal/Mycotic Infections Types: 2 Diagnosis -Diagnosis of superficial fungal infections is made clinically by a____ _____ of scrapings from the lesions, or by visualizing the lesions with a____ ___. -When viewed under a Wood's light, fungi take on a fluorescent yellow-green appearance.

-Candida albicans (yeast) -Tinea (ringworm): dermatophyte microscopic examination Wood's light

ABCDE CHARACTERISTICS OF MALIGNANT MEL ANOMA _______: one half that is unlike the other _______: an irregular, scalloped, or poorly defined border _______: varied from one area to another; shades of tan, brown, and black; sometimes white, red, or blue _______: usually greater than 6 mm, or the size of a pencil eraser, when diagnosed, but they can be smaller _______: a mole or skin lesion that looks different from the rest or is changing in size, shape, or color

A: Asymmetry B: Border C: Color D: Diameter E: Evolving

_______ ________ Inflammation of the sebaceous glands Affects middle-age adults Erythematous papules and pustules Appear in the middle third of the face but may extend to the forehead and chin Inflammatory process of rosacea affects the nose; it produces an unsightly, irreversible swelling and inflammation called ______. ____ ____ and_____ ____ accentuate the vasodilation and inflammation of this disease.

ACNE ROSACEA rhinophyma Heat exposure alcohol consumption

ACNE _____ _____, a common multifactored inflammatory disorder of the sebaceous glands, affects 85% of the population between the ages of 12 to 25 years. _____ are inflammatory papules, pustules, nodules, noninflammatory open or closed comedones, and cysts. _______ ______ colonize the lesions of acne.

Acne vulgaris Lesions Propionibacterium acnes (P. acnes)

_____ _____, a premalignant lesion found on skin that has been damaged by the ultraviolet rays of the sun, is common in fair-skinned persons. The lesions present as patches of rough, scaly, red plaques. The surrounding tissues are red and may show_______ (branches of delicate capillaries). The lesions of actinic keratosis should be examined and biopsied because they can progress to_____ ____ _____, a metastatic disease.

Actinic keratosis telangiectasia squamous cell carcinoma

____ _____is a skin reaction that is commonly caused by allergy. Lesions, also called_____, appear suddenly on the skin or mucous membranes and blanch with pressure. Severe cases can include______ of the lips and eyes; facial edema. can also occur as a chronic skin reaction caused by an_____ ____. The release of histamine from the granules of mast cells is the cause

Acute urticaria wheals angioedema unknown allergen

DISORDERS OF SKIN COLOR _____: genetic disorder, deprives skin, hair, and eyes of pigment. It leaves a person with diminished vision and extreme sensitivity to light and ultraviolet rays. ______: is an acquired skin condition characterized by abnormalities in the production of melanin. It presents as a series of discolored patches on the skin. _____: also called chloasma, by contrast, is characterized by the appearance of dark macules on the face.

Albinism Vitiligo Melasma

Acute urticaria occurs as a discrete, sudden episode, often following the ingestion of medicine, food, or drinks, or following insect stings, viral infections, and exposure to dust mites, pollens, and chemicals. ____ ___ children, especially those with eczema and rhinitis, are particularly susceptible to acute urticaria.

Allergy-prone

URTICARIA TREATMENT _____ are prescribed in acute urticaria. Injectable_____ is used if the swelling is severe. History and allergy testing may determine the trigger of urticaria. Avoidance or discontinuation of the offending agents holds the key to prevention.

Antihistamines epinephrine

NAIL DISORDER -Chronic illness can cause pitting of the nails or depressions called _____ _____. -______is commonly associated with psoriasis. -_____ _____are transverse linear depressions across the nail that can also be caused by trauma or Raynaud's syndrome. -______ ___ _____, also called______, can occur in thyroid or liver disorders, cardiovascular disease, or iron deficiency.

Beau's lines Pitting Beau's lines Spooning of nails, koilonychia

TOXIC SPIDER BITES ____ ___ spider ___ ___spider Spider bites present as target marks, pale areas surrounded by red rings. Local itching, rash, and burning are present. Systemic symptoms: cramping pain, weakness, fever, sweating, nausea, and vomiting. Severe symptoms include difficulty breathing and increased blood pressure.

Black widow Brown reclusive

TICK BITE Ticks carry the spirochete bacteria____ ____. ____ & ____ carry ticks. Ticks live in forested woods. Ticks --> bite humans --> cause Borrelia infection called____ ___

Borrelia burgdorferi Deer and squirrels Lyme disease.

_____ _____is an autoimmune disorder, but extensive laboratory workups usually fail to identify a causal agent. Immunoglobulin G antibodies circulate to a subunit of the immunoglobulin E receptor. These antibodies activate the release of histamine from basophils and mast cells. It may manifest an underlying disease, certain cancers, collagen diseases, or hepatitis B.

Chronic urticaria

BED BUGS ' Bed bugs, known as___ ____, are insects associated with a lack of clean mattresses or bedding. They bite children and adults who sleep in unsanitary conditions. Homeless persons are at particular risk of bed bug bites. Although the bite itself is painless, the person awakes to find itchy skin. More careful examination of the skin reveals red wheals arranged in linear patterns and purpuric reactions.

Cimex lectularius

_____ ___, another type of skin inflammation, represents____ ____ to materials such as metals, chemicals, drugs, and poison ivy. Contact dermatitis affects the head, neck, trunk, arms, hands, abdomen, groin, and lower extremities. It is an allergic skin reaction that usually occurs days after the skin contact with the allergen. Emollients and topical anti-inflammatory medication are standard therapy.

Contact dermatitis delayed hypersensitivity

STAGES THAT PREDISPOSE INDIVIDUALS TO MALIGNANT MELANOMA Benign nevus -> _______ nevus -> ______ growth phase of melanoma -> ______ growth phase of melanoma -> _____ ____ melanoma

Dysplastic, Radial, Vertical, Metastatic malignant

often have family histories of asthma or hay fever. The individual has elevated immunoglobulin IgE levels, as it is associated with allergy or type I hypersensitivity reactions.

ECZEMA

_____ Adolescents and adults with have dry, lichenified lesions that are either hypo- or hyperpigmented; these lesions are usually seen in the antecubital and popliteal areas, spreading to the neck, hands, feet, eyelids, and behind the ears. Because these lesions are itchy, inflammation and infection occur.

ECZEMA (ATOPIC DERMATITIS)

______ ____, an autoimmune disease, is an acute, recurring inflammatory disorder of the skin and mucous membranes associated with allergic or toxic reactions to drugs or microorganisms. immune complex formation and deposits of complement C3, IgM, and fibrinogen develop around superficial dermal vessels, the basement membrane, and keratinocytes. The characteristic "bull's eye" lesion appears on the skin as a central, inflamed, red area surrounded by concentric rings of red, swollen tissue.

Erythema multiforme

____ ____ occur when the flea bites its host, most commonly either a human, cat, or dog. Flea bites appear as small, brown lesions, hemorrhagic punctures surrounded by a red, urticarial patch. These bites, which exhibit a____ ____, are usually found around the____ and on the____. The lesions from the bites are often seen in sets of_____.

FLEA BITES (PULICOSIS) zigzag pattern waist, legs three

RISK FACTORS FOR MELANOMA _____ ___ ____ skin that tans poorly or burns easily ____ ___ ___ hair, and blue or green eyes Having____-____ or more moles Having_____ ____ ____-looking moles that are typically larger in size (may be referred to as dysplastic or atypical moles) History of_____ or____ ___ use _____ _____who have had melanoma ______ caused by disease, organ transplant, or medication _____ melanoma or another skin cancer ____ years of age or older

Fair, sun-sensitive Red or blond 50 to 100 unusual or irregular sunburns, indoor tanning Blood relatives (parents, children, siblings, cousins, aunts, uncles) Immunosuppression Previous 50

BIRTHMARKS _________, benign tumors of blood vessels, are apparent in 30% of newborns, with females more likely to be affected. _____ ____ are permanent blood vessel abnormalities affecting 0.5% of the population. At birth, these lesions look like pink patches; as the child ages, the birthmark darkens and becomes larger. ______ _____, by contrast, are enlarged blood vessels that grow rapidly after birth and resolve by 6 years of age. ____ ___ are enlarged blood vessels that grow with age. _____ _____ is a benign darkened area of skin, commonly found on the back or buttocks.

Hemangiomas Portwine stains Strawberry hemangiomas Spider veins Mongolian spot

_____ _____, which include bites from bees, wasps, and fleas, are another common source of skin injury. These bites cause local inflammation, irritation, swelling, and itching. Some hymenoptera bites trigger the severe allergic reaction termed_____.

Hymenoptera bites anaphylaxis

DISORDERS OF SWEAT GLANDS ________: excessive sweat production ________: decreased sweat production ________ ______: Sweat glands become obstructed and inflamed and tender areas of swelling develop under the arm or in the groin. Bacterial infection is common, causing a purulent exudate that drains from the swollen, erythematous, tender glands onto the skin surface.

Hyperhydrosis Anhidrosis Hidradenitis Suppurativa

AS PART OF THE EXAMINATION OF THE SKIN, IT IS IMPORTANT TO CONDUCT A COMPLETE HISTORY THAT ELICITS INFORMATION ABOUT: -____appearance of the lesion -______ associated with its eruption -History of______ -_______ use -Exposure to _____,____, & ____ ____ - Other associated____ symptoms -Current or previous_____ - Presence of_______ -_____ the patient has used to treat his or her skin lesions

Initial Symptoms allergies Medication insects, irritants, or ultraviolet light systemic illnesses photosensitivity Remedies

_____ attach to skin, biting and sucking blood. They can live on clothing for up to a month. Lice bites produce reddened macules, inflammation, hyperpigmentation, and parallel scratch marks. _____ ____ = pubic lice infestation Diagnosis of lice is made by finding the lice or lice eggs, called nits, in the clothing, bed linen, or the hair of the person who has been bitten. Definitive treatment requires the destruction of lice with special____, ___ & ____. Fine combs are used to determine if there are nits in hairy parts of the body.

LICE (PEDICULOSIS) Pediculosis pubis soaps, shampoos, and rinses

______ ____are pigmented macules with well- defined borders. Slow growing, they can reach a size of 5 cm. Over time, the lesions may become raised and wartlike in appearance. Lentigo maligna can become malignant melanoma.

Lentigo maligna

______, premalignant skin lesions, usually appear as brown spots that appear on sun-exposed areas. Commonly called solar lentigos, liver spots, or age spots, these lesions are benign, but they bear watching because there is also a______ _____ that appears as a freckle on sun-exposed areas.

Lentigos lentigo maligna

CHRONIC URTICARIA TREATMENT _____ ____ may also be prescribed. Local therapy such as____ ____ may also be helpful. Persons with histories of_____, extreme swelling of the face and throat, should carry injectable____ with them. Oral_____ and______ are used when urticaria persists.

Leukotriene antagonists oatmeal baths angioedema epinephrine corticosteroids, antidepressants

____ ____; flat-topped, small, purple papules with irregular borders, covered with a shiny, white lacelike pattern. It is a common, chronic disease of the skin and mucous membranes, particularly the oral mucosa.

Lichen planus

_____: hardening or thickening of the skin with markings; develops from repeated trauma (eg, scratching) _____: defined, flat area of altered pigmentation _____: solid lump greater than 0.5 cm in diameter _____: raised, well-defined lesion, usually smaller than 0.5 cm in diameter _____: raised, flat-topped lesion, usually greater than 2 cm in diameter _____: purplish lesion caused by free red blood cells in the skin; this lesion does not blanch on pressure and may be nodular

Lichenification Macule Nodule Papule Plaque Purpura

TICKBORNE DISEASES 5

Lyme disease Rocky Mountain Spotted Fever Tularemia Encephalitis

_____ _____ most frequently diagnosed in 55- to 64-year-olds. Caucasian males have the highest rate of contracting melanoma with an average age of 61 at diagnosis. The incidence of melanoma has increased 300% in the past 40 years

MALIGNANT MELANOMA

_____ _____produces a localized, itchy wheal. Sweat attracts mosquitoes, which need protein to produce eggs. In tropical countries, mosquitoes can carry malaria, yellow fever, dengue fever, and encephalitis. Outbreaks of mosquito-borne West Nile viral infections have occurred.

MOSQUITO BITE

TYPES OF SKIN CANCER Skin cancer is by far the most common type of cancer. 3

Malignant melanoma Basal cell carcinoma Squamous cell carcinoma

STAGES OF MELANOMA Stage 0; in situ- Stage I-II - Stage III- Stage IV-

Melanoma is confined to the epidermis (top layer of skin). Melanoma is confined to the skin, but has increasing thickness and the skin may be intact or ulcerated (top layer of skin is absent). Melanoma has spread to a nearby lymph node and is found in increasing amounts within one or more lymph nodes. Melanoma has spread to internal organs, beyond the closest lymph nodes to other lymph nodes, or areas of skin far from the original tumor.

_____ ______ causes small bumps to appear on the skin. The bumps are smooth, waxy, and small, about the size of a pin. Their central core is filled with a white cheeselike substance. The virus that causes this illness can live in warm water and can be transmitted in spas, baths, and heated swimming pools.

Molluscum contagiosum

PRECANCEROUS SKIN LESIONS Common on the sun-exposed areas of the body, particularly the facial areas: 3 Lesions should be periodically assessed as these can undergo cancerous changes.

Nevi Actinic keratosis Lentigos

_____, or moles, are probably the most common benign skin tumors. These lesions, which can be pigmented or depigmented, develop from melanocytes during childhood, usually between 3 to 5 years of age. They present as ____ & _____ and vary in size. _____ or _____ nevi are those that are irregular in shape, variegated in color, and have a high susceptibility to cancerous change. These lesions require clinical examination to rule out skin cancer. Persons with a high number of nevi on the body should consult a dermatologist periodically for a whole body skin assessment.

Nevi papules and nodules Atypical or dysplastic

FUNGAL INFECTION OF NAIL ______ is the term for a fungal or yeast infection that involves the proximal and lateral nail folds. ______ _____ can also infect the space between the nail plate and the nail bed. Like other organisms that invade the paronychial fold, pseudomonas thrive on _____. Most infectious agents discolor the nails, causing them to darken; the degree of discoloration indicates the depth of the ______. A bacterial or fungal invasion may be deep enough to cause the nail plate to separate from the nail bed, a process called ________.

Onychomycosis Pseudomonas bacteria moisture infection onycholysis

DYSPLASTIC NEVUS --> Any change in size, color, border, or appearance of a nevus can indicate malignant melanoma. A _____ _____ can be considered a premalignant stage of melanoma.

PREMALIGNANT dysplastic nevus

_______ _____ or ______ infection is the most common cause of nail disease. When the paronychial fold, a seal between the nail plate and the surrounding tissue, is broken, bacteria and fungi can invade the tissue producing pain, redness, and swelling called a paronychia. An acute paronychia is most often caused by _____ _____ and an abscess is commonly present. Chronic paronychias are commonly caused by ________ infection.

Paronychia Bacterial or fungal Staphylococcus aureus Candida (yeast)

____ ____are bruises, wounds, or those injuries whose shape suggests the instrument that afflicted them, such as belt buckles, irons, or burning cigarettes. These injuries indicate____ _____

Pattern injuries physical abuse.

_____ ____, an oval, macular, or papular rash surrounded by erythema, appears spontaneously on the skin of young adults. Its cause is unknown. The first lesion is a solitary patch, called a____ ____, that usually appears on the neck or trunk. As this lesion enlarges and begins to fade, usually between days 2 and 10, successive patches appear on the neck and trunk. When the patches appear on the back they form a____ ____ ____. The patches are itchy, but they clear in 6 to 8 weeks.

Pityriasis rosea Herald patch Christmas tree pattern

____ _____, also called decubitus ulcers and bedsores, are the most common of the skin ulcers. Pressure causes diminished blood flow to the skin, especially skin covering____ ____, which is particularly vulnerable to pressure.

Pressure ulcers bony prominences

_____, a genetic, chronic thickening of the epidermis that presents as overlying silver-white scales covering red, circumscribed, thickened plaques, is a disease of unknown cause. a T cell-mediated autoimmune response to an antigen. Although the lesions can appear anywhere on the body, they are frequently seen on the extensor surfaces of elbows and knees, and on the scalp.

Psoriasis

_____: papule filled with pus _____: fragment of dry skin _____: permanent replacement of normal skin with connective tissue ______: fine, irregular red lines produced by dilatation of the capillaries _____: loss of epidermal and dermal tissue _____: blister smaller than 0.5 cm in diameter ______: transient pale, elevated papules with pink margins

Pustule Scale Scar Telangiectasia Ulcer Vesicle (blister) Wheals (urticaria)

_______ ____ _____ Most cases will be caused by exposure to the sun's harmful ultraviolet (UV) rays. The risk of developing SCC also increases with____ because each exposure to UV rays causes more damage to the skin. As this damage accumulates, the risk of developing SCC cancer grows. SCC appears as a ____,____, OR _____ patch on the skin, a nonhealing ulcer, or a firm red nodule. Some SCCs develop from small, scaly lesions called_____ _____, which also are caused by exposure to the sun's UV rays.

SQUAMOUS CELL CARCINOMA (SCC) age red, crusted or scaly actinic keratosesed

_____, caused by mites, is associated with poverty, malnutrition, and sexual promiscuity around the world. Usually scabies is spread by skin-to-skin contact, but it can be spread via objects, clothing, and bedding because mites can survive for several days without contact with the skin's blood supply.

Scabies

_____ ____is an inflammation of the skin caused by excessive secretions of the sebaceous glands. Its lesions are red, usually on the face and scalp, and yield yellow to yellow-brown scales known as dandruff. The lesions appear to be greasy, inflamed, and itchy. Removal of scales by frequent washing of the skin and shampooing of the hair provides some relief of this condition.

Seborrheic dermatitis

FUNCTIONS OF SKIN 7

Temperature control Barrier protection Excretion and absorption Vitamin D production Immunosurveillance Mirror for internal disease processes Indicator of general health

____ ____are also related to diminished circulation and are usually found in the lower extremities. Venous insufficiency, obesity, pregnancy, family history, old age, and blood clotting disorders are factors associated with the development of stasis ulcers

Stasis ulcers

HAIR DISORDERS _____ _____: Poorly understood condition. Affects the growing or resting cycle of hair follicles. The number of resting follicles increases and the number of growing follicles decreases. The result is a generalized thinning of hair over the entire scalp. This _____ type of hair loss is often associated with chronic stress and nutritional deficiencies. ______ _____: Sudden loss of hair in one area of the scalp. The cause is unknown and usually the hair grows back in several months.

Telogen Effluvium reversible Alopecia areata

_____ _____ _____ is a vesiculobullous form of the erythema multiforme. Bullae appear on mucous membranes and as plaques on extensor surfaces of the extremities. When these bullae rupture, they leave____ & ______. The mouth, airways, esophagus, urethra, and conjunctiva may be involved.

Toxic epidermal necrolysis (Stevens-Johnson syndrome) erosions and crusts

_____ ___ ___ ____ (also called verrucae) are benign lesions of the skin caused by the human papilloma virus (HPV). Transmitted by touch, they are round, rough, and gray-colored lesions that can occur anywhere on the body. ____ warts, located at pressure points on the feet, usually cause discomfort and are often removed surgically. ____ warts are caused by certain strains of HPV.

VIRAL SKIN DISEASE Warts Plantar Genital

NAIL DISORDERS -______ ____ _____where nails thicken and discolor occurs in rheumatoid arthritis, immunodeficiency, malignancies, or pulmonary problems. -_____ _____of the nails occur in endocarditis. -______, where the nails separate from the nail beds, can occur in thyroid or autoimmune disease.

Yellow nail syndrome Splinter hemorrhages Onycholysis

BASAL CELL CARCINOMA The____ is the most common location for basal cell lesions. _____ ____ from the sun is the main cause of basal cell cancer, but artificial sources of UV radiation, such as tanning beds, can also it. Most basal cell cancers appear after age 50, but the sun's damaging effects begin at an early age.

face Ultraviolet (U V) radiation

STAGES OF MELANOMA In staging melanoma, the thicker the lesion or signs of spread the worse the prognosis. Stage I and II, Stage III Stage IV

primary tumors that have not spread, have an 85% 5-year survival rate. melanoma have palpable regional lymph nodes and a 50% 5-year survival rate. is distant metastatic disease and has a lower than 5% 5-year survival rate.

DIAGNOSTIC STUDIES IN MELANOMA -Biopsy -Recorded by chart or photography for follow-up -Computer image analyses are often used to appraise___ ___. -Chest x-ray -CT brain scan -MRI brain scan -____ ____of lymph nodes is necessary to look for any evidence of metastases. -Positron emission tomography CT scan is commonly used to look for_____.

suspicious lesions, Ultrasound testing, metastases

TICK BITES; LYME DISEASE Tick bites can produce____ ____, such as fever, chills, headache, abdominal pain, and vomiting; symptoms can occur as late as 2 weeks after the original bite. -Signs include the characteristic "bulls-eye" rash; erythema migrans

systemic reactions

A basal cell carcinoma usually begins as a small, dome-shaped bump and is often covered by small, superficial blood vessels called_______. The texture of the lesion is often ____ & _____, sometimes referred to as "pearly." Basal cell carcinomas grow slowly and deeply, taking months or years to become sizable.

telangiectasias shiny and translucent

AGING OF THE SKIN -With age, the skin loses ____ ___ and becomes less _____. -Changes in connective tissue reduce the skin's ____ & ____ -This process of skin aging, called_____, is more pronounced in sun-damaged skin. -Large pigmented spots, called ____ ___ or ______, appear on fair, sun-damaged areas of the skin, usually on the hands, forearms, and face

tensile strength flexible elasticity or turgor. elastosis age spots lentigos

TREATMENT OF FUNGAL INFECTION Treatment of superficial fungal infections is simple and involves the use of____ and, in difficult cases,_____ (oral or intravenous) antifungal agents. Some persons do not tolerate systemic antifungal agents because these drugs interact with other medications. Toxic reactions to antifungal medication, especially liver toxicity, have been reported.

topical systemic

In children and young adults, bullous erythema multiforme is called_____ _____ _____ or Stevens-Johnson syndrome. Underlying infections need to be treated and the drug or microorganism that triggered the skin's response needs to be identified and eliminated.

toxic epidermal necrolysis

Etiology: Melanoma comes from exposure to_____ ____, especially in fair-skinned people. A history of sunburns, especially blistering sunburns as a child or teenager, has been shown to increase the risk of developing melanoma. Risk increased in dysplastic nevi (precancerous moles), fair skin, light-colored eyes, freckles, and skin that burns easily or tans poorly. UV radiation from indoor tanning equipment increases the risk of melanoma.

ultraviolet (UV) radiation

DRY SKIN Dry skin:_____ Dry skin appears to be rough, scaly, and wrinkled. Skin dryness can be caused by dehydration of the ________ ____, changes in ____ ___ secretions, decreased____, and a flattening of the _____ _____, which reduce the ability of fluids to move between the skin's layers. ____ ___ is more easily bruised and irritated. _______ is the major symptom of dry skin; excoriation of the extremities, abdomen, back, and waist are found on examination of dry skin.

xerosis stratum corneum sebaceous gland sweat epidermal ridges Dry skin Pruritus (itching)