Sweat glands Apocrine gland Found chiefly in the axilla and
genital regions. They open into the hair follicle and stimulated by
emotional stress. Eccrine glands They are widely distributed and
they directly open into the skin and help to controlee the body
temperature through sweat production.
Slide 5
Physical Examination Obtain history Inspection Palpation Gloves
are worn during examination
Slide 6
The skin color depends on the melanin pigment, genetically
determined and it increases by sunlight. Oxyhemoglobin Bright red
pigment predominates. present in capillaries and arteries.
Slide 7
Carotene is golden yellow pigment found in subcutaneous fat and
heavily keratinized area such as palms and soles.
Slide 8
Deoxyhemoglobin darker and blue pigment occurs when
oxyhemoglobin looses its oxygen
Slide 9
Hair Vellus hair-short, fine inconspicuous and unpigmented
Terminal hair coarser, thicker,more conspicuous and pigmented.
Scalp hair and eyebrows
Slide 10
Physical Examination Observe for: Color Temperature Moisture
Dryness
Slide 11
Physical Examination Skin texture (rough-smooth) Lesions
Vascularity Mobility Texture of hair and nails Skin turgor
Slide 12
Physical Examination Color Varies from person to person
Pigmentations Sunburn, inflammation- Pink or Reddish hue Pallor
Decreased skin tones
Physical Examination Color Dark skinned persons Have reddish
base and undertones Buccal mucosa, tongue, lips,nails normally
appear pink Cyanosis-skin assumes grayish cast Age related
changes
Wounds Abrasion skin is rubbed or scraped off Lacerations torn,
ragged, irregular edges made by blunt objects Avulsions the tearing
away of tissue from a body part Incisions cuts made by sharp
cutting instruments Punctures caused by objects that penetrate
tissue while leaving a small surface opening Amputations traumatic
is the nonsurgical removal of a limb from the body
Slide 17
petechiaetelangiectasia:purpura Vascular Lesions
Slide 18
Psoriasis well demarcated, raised, red, scaly plaques typically
elevated, >10 mm with thick silvery scale hyperproliferation,
inflammation of dermis and epidermis common, ~1 to 5% population
bimodal onset 16-22 & 57-60 yrs unknown cause, ~50% familial
non-mendelian inheritance, associated MHC CW6, B13, B17
environmental trigger; injury, sunburn, HIV, haem Strep., stress,
alcohol, drugs; blockers chloroquine
Slide 19
Clinical Variants Plaque psoriasis; large well- demarcated
plaques usually on arms, legs, back or scalp is the most common
form Gutate psoriasis; lesions appear as multiple small red raised
scaly patches, usually all over the trunk. Occurs in young people
following a Strep throat infection.
Slide 20
Pityriasis Rosea mild inflammatory skin disease diffuse scaly
plaques or papules unknown cause, virus suspected mostly women
10-35 yr, peaks in cooler months begins with herald patchon trunk
centripetal eruption 7 -14 days later prodromal malaise and
headache Rose or fawn coloured, raised edge collarette (tinea)
Remits in 5 weeks, recurrence rare, sun hastens resolution
Slide 21
Lichen Planus hepatitis C liver disease graft versus host
disease recurrent, pruritic, inflammatory rash small polygonal flat
violaceous papules may coalesce in scaly patches often accompanied
by oral lesions T cell autoimmune reaction to basal keratinocytes +
genetic disposition triggered by a variety of blockers
antimalarials NSAIDS drugs; symetrically distributed on wrists,
legs trunk, penis
Slide 22
Insect Bites A variety of insect bite can cause a blisters;
fleas (pets) bedbugs scabies, knats/midges, bees wasps more common
in young children sometimes misdiagnosed eg as chickenpox.
Slide 23
Dermatitis superficial inflammation of the skin characterized
byredness oedema oozing crusting scaling (vesicles) Eczema used
interchangeably with dermatitis pruritis
Slide 24
Slide 25
chronic phase, scratching rubbing causes skin to lichenify may
become generalised, often present in flexural creases associated
food intolerance, wool, sensitivity to sweating often improves by
age 5; early asthma, Atopic Dermatitis
Herpes simplex is a common viral infection that presents with
localised blistering There are two main types of herpes simplex
virus (HSV), although there is considerable overlap. Type 1, which
is mainly associated with facial infections (cold sores or fever
blisters) Type 2, which is mainly genital (genital herpes)genital
herpes
Slide 29
Recurrences can be triggered by: Minor trauma to the affected
area Other infections including minor upper respiratory tract
infections Ultraviolet radiation (sun exposure) Hormonal factors
(in women, flares are not uncommon prior to menstruation) Emotional
stress Operations or procedures performed on the face Dental
surger
Slide 30
Herpes Zoster {Shingles} Acute inflammatory and infectious
disorder Painful vesicular eruption Bright red edematous plaques
along the nerve from one or more posterior ganglia
Slide 31
Herpes Zoster {Shingles} contd Eruption follows the course of
the nerve Almost always unilateral
Slide 32
Cause Varicella-zoster virus (like chicken-pox) Incubation
period 7-21 days Vesicles appear in 3-4 days Occur posteriorly
Progress anteriorly & peripherally Along dermatome Duration 10
days to 5 weeks
Slide 33
Occurs most frequently in Elderly Immunosuppressed Malignancy
or injury to spinal or cranial nerve
Slide 34
Complications Facial and acoustic nerve involvement Hearing
loss Tinnitus Facial paralysis Vertigo painful
Slide 35
Complications Full thickness skin necrosis and scarring
Systematic infection from scratching, causing virus to enter blood
stream
Slide 36
Medical treatment Control outbreak Reduce pain and discomfort
Prevent complications Acyclovir (Zovirax) IV, PO, topically
Corticosteroids Antihistamines Antibiotics
Slide 37
Parasitic Skin Infections (PSI) Higher risk situations? Poor
hygiene Living in close quarters
Slide 38
Pediculosis- Lice (PSI) Infestation by human lice Pediculosis
capitis-head Pediculosis corporis-body Pediculosis pubis- pubic or
crab
Slide 39
Scabies (PSI) Contagious skin disease, caused by itch mite
Sarcoptes scabiei. Transmitted by Close-prolonged contact with
Infested companion Infested bedding
Slide 40
Scabies (PSI) Characterized by Epidermal curved or linear
ridges Follicular papules Pruritus Palms More intense and
unbearable at night White visible epidermal ridges by Mite
burrowing into outer layers of skin
Scabies (PSI) Treatment Topical sulfur preparations One-two
applications daily Launder personal items No disinfectant
Slide 43
scabies
Slide 44
Ringworm (PSI) Ringworm - an infection caused by a fungus Jock
itch form of ringworm on groin area Athletes foot fungal infection
of foot (feet) Fungus live and spread on the top layer of the skin
and on the hair grow best in warm, moist areas, contagious via
skin-to-skin contact with a person or animal that has it or when
you share things like towels, clothing, or sports gear. You can
also get ringworm by touching an infected dog or cat, although this
form of ringworm is not common.
Slide 45
Tinea vesicular
Slide 46
Psoriasis Lifelong disorder Exacerbations Remissions Cannot be
cured
Slide 47
Psoriasis Pathophysiology Scaling disorder Underlying dermal
inflammation Abnormality in proliferation of epidermal cells in
outer skin layers Normal 28 days to shed cells Psoriasis Cells shed
every 4-5 days
Slide 48
Psoriasis Cause-unknown Genetic predisposition Environmental
factors May appear after skin trauma Sunburn Surgery
Slide 49
Psoriasis Improves in warmer climates Aggravated by Infections
Streptococcal throat infection Candida infections Hormonal changes
Psychological stress
Slide 50
Psoriasis Assessment History Family history Age at onset
Disease progression Pattern of recurrences Gradual or sudden
Slide 51
Psoriasis Vulgaris {Ordinary/Common} Most common Thick
erythematous papules or plaques Surrounded by silvery white
scales
Slide 52
Psoriasis Vulgaris {Ordinary/Common} Common sites Scalp Elbows
Trunk Knees Sacrum Extensor surfaces of limbs
Slide 53
Skin Cancers Overexposure to sunlight Common skin cancers
Squamous cell carcinoma Basal cell carcinoma Melanoma
Slide 54
Actinic Keratosis Pre-malignant lesions Cells of epidermis
Chronically sun-damaged skin Can lead to squamous cell
carcinoma
Slide 55
Squamous Cell Carcinoma Malignant neoplasms of epidermis Invade
locally Potentially metastic Ear Lip External genitalia Cause
Repeated irritation or injury
Slide 56
Basal Cell Carcinoma Basal cell layer of epidermis Lesions go
unnoticed Metastasis rare Underlying tissue destruction progresses
to underlying vital structure
Slide 57
Melanomas Pigmented malignant lesions Originate in
melanin-producing cells of epidermis
Slide 58
Melanomas Risk factors Genetic predisposition Excessive
exposure to UV light Precursor lesions resembling unusual moles
Highly metastatic Survival depends on early diagnosis and
treatment
Slide 59
Skin Cancers Prevention Avoid exposure to sunlight Use of
sunscreen SPF30 or greater
Slide 60
Skin Cancers Assessment Age Race Family history Removal of skin
growths
Slide 61
Skin Cancers Assessment Change in Size, Color, Sensation Of any
Mole, Birthmark, Wart, Scar Hair-bearing areas of body
Slide 62
Skin Cancers Interventions: Radiation therapy Elderly Large,
deeply invasive basal cell tumors Poor risk for surgery Malignant
melanoma resistant May be used in combination with systemic
chemotherapy
Slide 63
Pressure Ulcers Etiology
Slide 64
Pressure Ulcers Etiology Immobility Impaired sensory perception
or cognition Decreased tissue perfusion Decreased nutritional
status Friction and shear Increased moisture
Slide 65
Pressure Ulcers Stages
Slide 66
Pressure Ulcers Stages Stage I Non-blanchable erythema Tissue
swelling C/O discomfort Stage II Break in skin Epidermis Dermis
Necrosis
Slide 67
Pressure Ulcers Stages Stage III Subcutaneous tissue Deep
crater With undermining Without undermining Stage IV Underlying
structures May have large undermined area
pick-like depressions in the nails (nail pitting) are common in
people who have psoriasis a condition characterized by scaly
patches on the skin.
Slide 74
Terry's nails most of the nails appear white except for a
narrow pink band at the tip. Terry's nails can sometimes be
attributed to aging. In other cases, Terry's nails can be a sign of
a serious underlying condition, such as liver disease, congestive
heart failure, kidney failure or diabetes.