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