Skin, hair, and nails
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What is actinic purpura?
Purple patches from leaky capillaries.
Characteristics of childbearing women?
- Increased blood flow to the skin (hands and feet)
- acceleration of west and sebaceous glands
- Vascular spiders and hemangiomas (increased in size)
- Skin thickens, fat is deposited in sub dermal layers
- increased pigmentation.
- Linea Nigra: increased melanocyte stimulation hormone.
What are basal cell carcinoma?
- They are the most common cancer cell (immature cells) of the epidermis, around 80%.
- Usually found in sun exposure areas: Head and neck.
- Shiny and translucent, they grow slowly and rarely metastasize.
What are squamous cell carcinoma?
- usually more mature cells in the epidermis than basal cell carcinoma.
- Comprises 16% of skin cancer.
- Crusted, scaly, and ulcerated, they rarely metastasize.
What is melanoma?
- Arise from pigment-productin melanocytes in the epidermis.
- It is the most lethal.
- Accounts for the remaining 4 to 5%.
- Indoor tanning increases risk by 75%.
- It is increasing more rapidly than any other cancer.
What are Melanoma risk factors?
- >50 moles, 1-4 atypical or unusual moles.
- Red/light hair; light/fair skin, light eye color.
- Heavy sun exposure.
- Family history.
What are the ABCDE for screening moles for possible melanoma?
- A: asymmetry.
- B: Borders. Irregular borders, especially ragged, notched, or blurred.
- C: change in color. Variation, specially blue or black.
- D: Diameter. >= 6 mm or different from other moles, especially changing, itching, or bleeding.
- E: Elevation/Enlargement.
What is alopecia?
The partial or complete absence of hair from areas of the body where it normally grows; baldness.
What aspects of the skin should be examined?
- Mobility and Turgor:
What aspects should of the hair should be examined?
- Palpate and inspect hair.
- Quantity, distribution (alopecia), and texture.
What is Macule?
- Flat, non palpable area of discoloration
- smaller than 1 cm.
- freckles or nevi.
- freckles or nevi:
what are patches?
- Flat, non palpable areas of skin discoloration.
- Larger than 1 cm.
- Virtiligo (white patches).
What are papules?
- Raised, palpable (same size as macules, but palpable).
- less than 1 cm.
- warts, elevated moles.
What are plaques?
- Raised, palpable, rough.
- greater than 1 cm.
- confluence of papules.
- EX: pcoriasis, actinin keratoses.
what are vesicles?
- Fluid filled (serous fluid) circumscribed.
- Raised lesions,
- Less than 1 cm
- EX: herpes simplex, small pox.
What is Bullae?
- Vesicles> 1 cm
- EX: burns, large blisters.
what are Pustules?
- Similar to vesicles but with pus (cloudy purulent)
- Viscous to solid inconsistency.
- EX: impetigo, acne.
what are wheals?
- Raised circumscribed, edematous plaques.
- Pink or pale. (itchy, allergic rxn)
- Tansient. (they come and go)
- Mosquito bites, uticaria
what are Nodules?
- Raised palpable
- Larger than 1 cm.
- Deep into dermis or outwards.
- EX: Rheumatoid arthritis.
What are tumors?
- Nodules that are > 2cm.
- Or poorly demarcated. (weird shapes)
- They could be benign or malignant.
What is a cyst?
- Raised, encapsulated
- Fluid filled lesions.
- EX: sebaceous cyst, cystic acne.
What is petechiae?
- Reddish-purple discoloration. (bleeding or brushing, broken vessels)
- Small and flat.
- <0.5 cm
- Do not blanche.
What is purpura?
- Large patches
- Looks like bruising.
- Does not blanche.
What is excoriations?
- Secondary lesion
- Scratch marks.
- Raised and linear.
- May appear as crust of primary lesion that has been scratched off.
- EX: abrasion, scratches from scabies.
what is Lichenification?
- Secondary lesion.
- Thickening of the skin. (the skin over time reacts and becomes hard)
- Hardened and leather like.
- Flexor surface of extremity.
- EX: Chronic pruritis, chronic dermatitis.
what are scales?
- Raised lesions.
- Thickening of the uppermost layer of the epidermis.
- White, gray, or tan.
- Small to large.
- EX: dandruff, psoriasis, ringworm.
What are crusts?
- Raised lesions, dried serum or blood cells.
- EX: impetigo.
What are erosions?
- Depressed lesions.
- epidermis is removed or sloughed.
- Moist, usually red, well circumscribed.
- EX: ruptured chicken pox vesicle.
What are ulcers?
- Depressed lesions epidermis and part of all of dermis. (bigger than erosions)
- Concave lesions.
- Moist, inflamed or hemorrhagic.
- EX: Decubitus ulcer (bed sores)
What are the stages of decubitus ulcer (pressure ulcer)?
- I: intact skin red but not broken.
- II: Partial thickness skin erosion with loss of epidermis. Superficial, looks shallow. (starts to open the epidermis)
- III: Full thickness extending into the subcutaneous tissue. Crater-like. (need packing)
- IV: Full thickness involves all skin layers and exposes muscle, tendon, or even bone.
- * Can use Braden scale to predict risk of pressure ulcer.
What are fissures?
- Depressed lesions. (really dry skin)
- Narrow and linear skin cracks.
- Penetrate through the dermis.
- EX: Athletes foot.
what is atrophy?
- Nonspecific end product of skin disorder.
- Pale, shiny area with loss of skin markings and full skin thickness.
- EX: Steroid use, aged skin.
what is Melanoma lesions?
- Asymmetry lesions.
- Border are irregular.
- Color blue/black or variegated.
- Diameter > 6mm.
What are the parts of the nails?
What is onycholysis?
- Separation of nail plate from the nail bed.
- It is very difficult to treat. (fungus).
- EX: thyroid disease, psoriasis, mycosis of the nails.
What is nail pitting?
- Early signs of psoriasis.
- Small depression in the nail.
What is nail clubbing?
- Condition results from low oxygen levels in your blood and could be a sign of lung problems (COP, asthma, or some type of hypoxia)
What is spooning/koilonychia?
- Iron deficiency.
What is Terry's nails?
- Whitening of the proximal 80% of the nail.
- Small rim peripheral reddening.
- Older adults.
- They are not dx, they are just interesting parts to assess.
- EX: heart failure, cirrhosis, adult onset DM.
what are Beau's lines?
- Transverse grooves on the fingernails. (seriously ill)
- EX: After an MI, malnutrition, DM
What is alopecia?
- Area of hair loss.
- Traction alopecia:
what are some questions to ask the pt abt skin, hair, and nails?
- Have you noticed any changes in your skin or your hair?
- Have you noticed any moles that have changed size, shape, color, or sensation?
- Have you noticed any new moles?
- ask everyone what grooming products do they use.
what are the characteristics of older adults skin, nails, and hair?
- wrinkle and loses turgor (elasticity)
- Vascularity decreases: looks more pale.
- Actinic purpuraL purple patches from leaky capillaries.
- Nails yellow and thicken.
- Hair: loses pigment, amount of scalp hair decreases, diameter of hair shaft decreases, hair loss in all areas of the body.
- Females: facial hair after 55 yrs.
- Some of the changes may not be as prominent in darker skinned individuals.
- Sebaceous and sweat glands decreased.
What are the characteristics of children/adolecents skin, hair, and nails?
- Skin thinner and sensitive to hear and sun.
- Smooth and soft, not as "tough"
- Subcutaneous fat less developed and risk for hypothermia.
- Lanugo (soft hair on back) shed 4 months.
- Eccrie glands function after 1st month (so cannot sweat)
- Apocrine glands not producing.
- Adolescent: Aprocrine glands enlarge and become active, sebaceous glands increase sebum, coarse remittal hair (pubic and axillae)
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