Skin, Hair, and Nails Lecture Notes PDF

Skin, Hair, and Nails Chapter 13  Structure and Function š Layers of skin 1. Epidermis š Epidermal appendages šStratum germinativum 1. Hair (basal cell layer) šStratum corneum (horny 2. Se...

Skin, Hair, and Nails Chapter 13  Structure and Function š Layers of skin 1. Epidermis š Epidermal appendages šStratum germinativum 1. Hair (basal cell layer) šStratum corneum (horny 2. Sebaceous glands cell layer) 3. Sweat glands 2. Dermis š Eccrine glands šConnective tissue š Apocrine glands (collagen) 4. Nails šElastic tissue 3. Subcutaneous layer šAdipose tissue Copyright © 2019 Elsevier, Inc.  Structure Skin Nails Copyright © 2019 Elsevier, Inc. Function of the Skin š Protection š Prevents penetration š Perception š Temperature regulation š Identification š Communication š Wound repair š Absorption and excretion š Production of vitamin D Copyright © 2019 Elsevier, Inc. Developmental Considerations in the older adult š Older adults š Slow atrophy of skin structures š Loss of elasticity, collagen, subcutaneous fat š Thinning of stratum corneum and dermis š Decreased sweat and sebaceous glands š Greater risk for heat stroke š Senile purpura š Increased risk for skin disease š Change in hair distribution š Psychological impact of visible aging Copyright © 2019 Elsevier, Inc.  Cultural and Social Considerations š Recognition of unique clinical manifestations of disease š Related to variation in skin pigmentation and hair texture š Genetic advantage of dark pigmentation and lower incidence of skin cancer š Variation in sexual skin areas affected by hormones š Environmental adaptations affecting sweat glands Copyright © 2019 Elsevier, Inc. Subjective Data: Health History š Previous history of skin disease š Rash or lesion (allergies, hives, psoriasis, or eczema) š Medications š Change in pigmentation š Hair loss š Change in mole (size or š Change in nails colour) š Excessive dryness or š Environmental or moisture occupational hazards š Pruritus š Self-care behaviours š Excessive bruising Copyright © 2019 Elsevier, Inc.  Additional History Questions š Infants and children š Adolescents š Birthmarks š Skin problems š Skin colour changes š Jaundice š Older adults š Cyanosis š Skin changes š Allergic rash š Delay in wound healing š Diaper rash š Skin pain š Burns or bruises š Foot/nail changes š Exposure to contagious š Falling skin conditions š Diabetes or š Self-destructive habits cardiovascular disease š Sun protection š Skin and Nail care Copyright © 2019 Elsevier, Inc. Promoting Health: Tanning/ Artificial Tanning and Skin Cancer Risk Canadian Cancer Society risk factors šProlonged exposure to ultraviolet (UV) rays šIndividuals most at risk š History of skin cancer š Under 18 years of age š Fair skinned š Have freckles or moles š Have a family history š Using medications that increase sensitivity to UV rays Tanning beds: Are they safe? What is the issue, or is there one? Copyright © 2019 Elsevier, Inc. Objective Data: Physical Examination – Setting the Stage š Preparation š External variables that influence skin colour š Equipment needed š Strong direct lighting š Small centimetre ruler š Penlight š Gloves Copyright © 2019 Elsevier, Inc. Objective Data: Skin š Inspect and palpate š Colour š Temperature – hypothermia/hyperthermia š Moisture – diaphoresis/dehydration š Texture š Lesions Copyright © 2019 Elsevier, Inc. Abnormal Findings š Common shapes and configurations of lesions š Annular or circular š Confluent š Discrete š Grouped š Gyrate š Target or iris š Linear š Polycyclic š Zosteriform Copyright © 2019 Elsevier, Inc.  Developmental Considerations: Objective Data šOlder adult šSenile lentigines (liver spots) šKeratoses: seborrheic šSkin tags šSebaceous hyperplasia šThin, parchment-like skin šSkin “tents” by itself Copyright © 2019 Elsevier, Inc.  Types of Skin Lesions š Primary Skin Lesions: š Macule, papule, patch, plaque, nodule, wheal, tumour, urticaria (hives), vesicle, cyst, bulla, or pustule š Secondary Skin Lesions: š Crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, lichenification, or keloid Copyright © 2019 Elsevier, Inc.  Pressure Ulcers š Appear on the skin over a bony prominence when circulation is impaired (confined to bed, immobilized) š Risk factors: impaired mobility, thin fragile skin of aging, decreased sensory perception, impaired level of consciousness, moisture from urine or stool incontinence, excessive perspiration or wound drainage, shearing injury, poor nutrition, and infection š Assessed by stage (I–IV), depending on depth Copyright © 2019 Elsevier, Inc.  Lesions by Trauma or Abuse Pattern of Injury Hematoma Copyright © 2019 Elsevier, Inc. Types of Vascular Lesions Vascular lesions š Hemangiomas š Purpuric lesions š Port-wine stain (nevus flammeus) š Petechiae š Strawberry mark š Purpura (immature hemangioma) š Lesions caused by trauma or š Cavernous hemangioma abuse (mature) š Pattern of injury š Telangiectases š Hematoma š Spider or star angioma š Ecchymosis (bruise) š Venous lake Copyright © 2019 Elsevier, Inc. Hemangiomas Purpuric Lesions Common Skin Lesions Common š Primary contact dermatitis š Allergic drug reaction š Tinea corporis (ringworm of the body) š Tinea pedis (ringworm of the foot) š Psoriasis š Tinea versicolor š Herpes zoster (shingles) š Erythema migrans of Lyme disease Copyright © 2019 Elsevier, Inc.  Abnormal Skin Lesions Malignant Associated with AIDS š Basal cell carcinoma š AIDS-related Kaposi’s š Squamous cell sarcoma carcinoma š Patch stage š Malignant melanoma š Plaque stage š Metastatic malignant š Advanced disease melanoma Copyright © 2019 Elsevier, Inc. Skin Cancers Karposi Sarcoma  Objective Data: Inspect & Palpate Hair Nails š Shape and contour š Colour š Profile Sign š Texture š Consistency š Distribution š Colour š Lesions š Capillary refill Copyright © 2019 Elsevier, Inc.  Abnormal Conditions of Hair š Seborrheic dermatitis (“cradle cap”) š Tinea capitis (scalp ringworm) š Toxic alopecia š Alopecia areata š Traumatic alopecia, traction alopecia š Trichotillomania š Pediculosis capitis (head lice) š Folliculitis š Hirsutism š Furuncle and abscess Copyright © 2019 Elsevier, Inc.  Abnormal Conditions of Nails š Scabies š Paronychia š Beau’s line (leukonychia striata) š Splinter hemorrhages š Onycholysis š Late clubbing š Pitting š Habit-tic dystrophy Copyright © 2019 Elsevier, Inc.  Health Promotion š Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. š From the Ottawa Charter. for Health