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What is the major function of skin?
How does the skin protect the body?
- against pathogens
- harmful substances
How much of the TBW is skin?
What are the 3 layers of the skin?
- Subcut tissue
What are the appendages of skin?
- sebaceous & sweat glands
what is the most superficial layer of skin?
Explain the epidermis:
- NO BV
- Outer horny layer
- Inner cellular layer
What supplies nutrition to epidermis?
Does the dermis have a blood supply?
What type of tissue is the dermis?
What type of glands are located within dermis?
What does the dermis merge with below?
adipose tissue or subcut tissue
What are the 2 types of hair?
This type of hair is short, fine, less pigmentation?
This type of hair is coarser, pigmented (scalp/eyebrows)?
What protects distal ends of toes & fingers?
These glands are present all over except for palms/soles & produce a fatty substance onto skin surfaces via hair follicles?
What are the 2 different types of sweat glands?
Eccrine & apocrine
Which type of sweat glands help to control body temp?
which type of sweat glands are found in axilla & groin that is stimulated by stress?
What are some common or concerning symptoms of skin?
What is a good question to ask for the health hx for skin?
have you noticed any changes in your skin or hair?
What is a good question for moles?
- have you noticed any moles that have changed size, shape, color, sensation?
- Have you noticed any new moles?
How should the clinician explain the importance of health promotion & counseling when educating patients?
- early detect=moles
- protective skin care measures
- excessive sun exp
Where is skin cancer most prevalent?
This type of skin cancer is most prevelant that is shiny, grows slowly & rarely metastasizes?
basal cell carcinoma
This type of skin cancer comprises about 16% that is crusted, scaly, ulcerated & can metastasize?
squamous cell carcinoma
this type of skin cancer can spread rapidly comprising of only 4%?
What are the HARRM risk factors for melanoma?
- hx=previous melanoma
- Age over 50
- Regular dermatologist absent
- Mole changing
- Male gender
What are the additional risk factors for melanoma?
- greater than or equal 50 common moles
- greater than or equal 1-4 atypical or unusual moles=dysplastic
- red/light hair
- actinic lentigines, macular brown/tan spots
- heavy sun exp
- light eye/skin color-freckles/burn easy
- FHx melanoma
What is the ABCDE method for screening moles for possible melanoma?
- B=Irregular borders=ragged, notched, blurred
- C=variation or change in color=blue or black
- D=diameter greater than or equal 6mm or different from other moles=changing,itching,bleeding
What does the american cancer society recommend skin exams as part of routine cancer screening?
- every 3yrs btwn 20-40
- yearly=over 40
How can you as a clinician do health teaching for patients about melanoma?
- Risk factors
- avoid=sun exp
how should you conduct your own-self skin exam?
- front to back in mirror
- bend elbows & look at forearms, upper arms, palms
- back of legs, feet, space=toes & soles
- back of neck & scalp=hand held mirror
- back & butt=hand held mirror
when do you want to avoid sun exposure?
what type of sun screen is recommended at least?
- SPF 15-screens out 93%
- water resistant
- reapply often
Is there an spf scale for UV-A rays that cause aging?
When does the examination of the skin, hair, nails begin with?
should the patient wear a gown for the skin inspection?
What type of light should be used to inspect skin surface?
- natural light
- artificial light=resembles natural
Does artificial light often distort color?
What should you look for when inspecting color of skin?
- increase/degrease pigmentation
- redness, pallor, cyanosis, yellowing
where is red color of oxyhemoglobin best assessed?
- fingertips, lips, muc mem
- dark skin=palms & soles
Where should you look for central cyanosis?
where should you look for jaundice?
What should you note when accessing moisture of skin?
How do you test temp of skin?
back of fingertips & ID=warmth,cooliness skin
What to note about texture of skin?
rough or smooth
How do you test for mobility & turgor?
lift fold of skin at hand/wrist
What to take note of with skin lesions?
- anatomic location
What are the 8 types of primary skin lesions?
What are the 8 types of secondary skin lesions?
What are the dermatologic basics?
- flex & ext areas
- palms & soles
- fingerwebs, groin, feet
- scalp, ears, central face
What dermatologic issue can happen in the flexural areas?
atopic dermatitis & acanthosis nigracans
What derm issue can happen in the ext surfaces?
What derm issue in palms/soles?
syphilis & hand/foot disease
What can develop in groin, feet & fingerwebs?
What can develop in scalp, ears, central face?
What can a red color tell you?
vascular: cherry angioma, spider angioma
What can a blue color tell you?
Blue nevus, mongolian sopt
what can a yellow color tell you?
what can a white color tell you?
what can a black color tell you?
melanocytic nevus & melanoma
what can a purple or violaeceous color tell you?
what are some changes in melanin?
- tinea versicolor
What are some purpuric lesions?
What are some skin tumors?
- actinic keratosis
- seborrheic keratosis
- Kaposi' sarcoma
What is described by a superficial flattened papules, covered by a dry scale with multiple round or irregular pink tan grayish that appear on sun exposed areas and are benign but may give rise to SQ CC?
What is a common benign lesion that is yellowish to brown papules with slightly greasy or warty & typically multiple & symetrically distributed?
What is a Slow growing malignancy,Seldom metastasizes,Most common in fair skinned adults over 40,Usually on face,Usually starts as translucent nodule, which spreads leaving a depressed center and a firm elevated border Often accompanied by telangiectatic vessels?
What is usually on sun exposed areas of skin,Fair haired adults over 60
- May develop actinic keratosis,Grows more quickly than basal cell?
- squamous cell carcinoma
Appears in AIDS,Malignant tumor has many forms,Can appear almost anywhere on body,Lesions multiple,May involve internal structures?
Why do bedbound patients get pressure sores?
sustained compression obliterates arteriolar & capillary blood flow to skin
What are the skin lesions patterns & shapes?
example of linear skin lesion
linear epidermal nevus
example of geographic skin lesion
example of clustered skin lesion pattern
example of serpignous skin lesion pattern
example of annular skin lesion pattern
small flatspot up to 1.0cm
flat spot 1.0cm or larger
example of macule
example of patch
cafe au lait spot
elevated superficial & 1.0cm or larger that is formed by papules
a palpable elevation that is up to 1.0cm
a marble like deeper & firmer than papule that is greater than .5cm
a nodule filled with a liquid or semisolid
an irregular relatively transcient superficial localized with edema
up to 1.0cm that is filled w/serous fluid
greater than 1.0cm that is filled w/serous fluid
minute slightly raised tunnel epidermis that is in the fingerwebs & sides fingers that is 5-15mm, linear & curvy grayline
thin flake of dead exfoliated in the epidermis
dried residue of skin exudate that has serum, pus, blood (impetigo)
visible palpable thickening of the epidermis with rough skin (neurodermatis)
conn tissue that arises in injury/disease due to a hypertrophic scar from a steroid injection
hypertrophic scaring that extends beyond borders from injury in the earlobe
nonscarring loss superficial epiderms on moist skin surface with no bleeding
linear or punctuate erosion caused by stratching from a cat stratch
line or crack in skin caused by excessive dryness (athletes foo)
deep loss epidermis & dermis that bleeds & scars
3 types of vascular lesion
- spider angioma
- spider vein
- cherry angioma
fiery red that is up to 2cm surrounded by erythema on face, neck or arms
bluish with varying size & shape that appears near the veins in the legs (varicose)
bright or ruby red that is 1-3mm that turns brownish in time that is surrounded by a pale halo
deep red or reddish purple that fades in time that is 1-3mm
deep red or reddish purple that fades in time that is larger than a petechia
purple or purplish blue which fades to green yellow or brown that is larger than 3mm with round & irregular & has a central hematoma
common mole that is round/oval shape with sharp defined borders that is uniform in color with a diameter less than 6mm
round oval pathches of hair loss with no visible scaling/inflammation
round scaling alopecia with hairs broken off usually caused by a fungal infection
superficial infection in the proximal & lateral nail folds that is seen as red, swollen & tender
bulbous swelling in the fingers with losing the angle btwn nail & nail fold
clubbing of fingers
separation of the opaque nail plate from the pink nail bed