Integumentary System: Conditions & Infections

• Integumentary system includes skin, hair, nails, and sebaceous (oil) glands
• Diaphoresis is excessive perspiration
• Cyanosis is skin discoloration due to lack of oxygen
• Skin trauma includes burns, scars, cuts, tears, and keloids

Skin Infections

• Viral skin infections include COVID, shingles, and warts
• Bacterial skin infections include boils, MRSA, and abscesses
• Fungal skin infections include yeast, fungus, and athlete's foot
• Parasitic skin infections include lice and bedbugs

Autoimmune Skin Conditions

• Autoimmune integumentary conditions include psoriasis, eczema, dermatitis, and lupus

Metabolic/Nutritional Skin Disorders

• Metabolic/nutritional disorders are caused by poor nutrition or absorption leading to vitamin deficiencies

Vascular

• Vascular disorders involve cutaneous arteries, veins, and lymphatic vessels
• Examples include ulcers and cherry angiomas (red, benign growths on the skin made of blood vessels)

Pruritus and Prurigo

• Pruritus is itchiness and prurigo is chronic itchiness

Psychological/Neurological Disorders

• Psychological/neurological disorders represents the interactions between the mind and skin such as trichotillomania

Systemic Disorders

• Systemic disorders shows signs through the skin that something is wrong, such as gout, liver disease, or arthritis

Neoplastics and Cancer

• Neoplastics and cancer include freckles, warts, and melanoma

Bacterial Infection Characteristics

• A bacterial infection exhibits swelling, exudate (pus), pain, and odor

Viral Infection Characteristics

• Viral infections occur in clusters, are asymmetrical, and appear in specific regions

Clinical Manifestations of Integumentary Issues

• Pattern
• Morphology (shape, size)
• Location
• Texture
• Symmetry
• Color
• Sensation

Necrosis

• Necrosis is black, dead tissue requiring immediate intervention
• Nevi are moles
• Urticaria are hives

Subjective vs Objective

• Subjective assessment involves the patient's personal report of symptoms, feelings, and history, including itching, pain, and changes.
• Objective assessment involves physical examination using inspection and palpitation
• Skin inspections should be done in an upright or supine position

Steps for a Skin Inspection:

• Inspect skin color
• Look for nevi (moles)
• Check skin integrity
• Check for lesions

Pallor

• Pallor is the lightening of skin than normal due to lack of O2 on skin surface

Checking for Pallor:

• Mucous membranes
• Nail beds
• Palms
• Eyelids

Cyanosis

• Cyanosis is blue, white, or grey discoloration due to lack of O2 in the blood
• Cyanosis can be checked in the mouth, cheeks, mucous membranes, ears, and nose
• Erythema is reddening/darkening of skin due to increased blood flow to capillaries

Brawny Skin

• Brawny skin is brown-red discoloration due to venous insufficiency

Nevi Assesment

• ABCDE is a mnemonic for nevi: asymmetry, border, color, diameter, evolving
• Normal nevi size is less than/equal to 6mm
• Signs of abnormal nevi: greater than 6mm, color, asymmetry, irregular border

Skin Conditions:

• Ulcerations
• Erosions
• Contusions

Primary Skin Lesions:

• Open Sore
• Breakdown top layer of skin
• Discoloration of skin from bruises
• Abscess
• Tooth abscess
• Bulla (fluid-filled blisters)
• Cyst
• Macule & freckle
• Nodule (nevi, xanthoma - fat under Skin)
• Papule (mosquito bite)
• Plaque & eczema
• Pustule & pimple

Skin Conditions

• Tumour (skin cancer)
• Vesicle (cold sore)
• Wheal (hives)

Secondary Lesions:

• Atrophy (skin thinning)
• Crust
• Erosion (loss of epidermis)
• Excoriation (repetitive scratching)
• Fissure (crack/split outer layer of skin)
• Keloid
• Scar
• Ulcer

Nail Color Indications

• White nails may indicate diabetes or liver disease
• Blue nails may indicate hypoxia
• Yellow nails may indicate lung disease or lymphedema
• Red-brown nails may indicate autoimmune disorder
• Blue half nails may indicate poisoning
• Black stripe nails may indicate melanoma
• Greenish-black nails may indicate bacteria infection

Degree if Clubbing

• A degree of clubbing greater than 180° is cause for concern