WM420 Lect 1 Integumentary System Diseases PDF

Chapter 18 Integumentary System Diseases VUIM Anatomy and Physiology The skin is the largest organ of the body. It is a large, durable, and pliable organ 1. is the first line of protection for the body against invading organisms. 2. Provides a sense of touch, heat and cold, and...

Chapter 18 Integumentary System Diseases VUIM Anatomy and Physiology The skin is the largest organ of the body. It is a large, durable, and pliable organ 1. is the first line of protection for the body against invading organisms. 2. Provides a sense of touch, heat and cold, and pain and 3. Helps stabilize temperature and fluid and electrolyte balance. Anatomy and Physiology The skin is composed of two layers: epidermis dermis with a subcutaneous (hypodermis) level Anatomy and Physiology ▪ Epidermis composed of five layers: Stratified squamous epithelial cells 1. the stratum corneum, 2. stratum lucidum, 3. Stratum granulosum, 4. stratum spinosum 5. stratum basale. Anatomy and Physiology ▪ Epidermis most are keratinocytes Melanocytes Produce melanin  Anatomy and Physiology ▪ Dermis deeper layer, consisting of connective tissue and other cells Blood vessels traverse provide nutrients and oxygen, regulate heat remove waste products. Nerves form a network provide the sensations of heat, cold, pain, and touch. Anatomy and Physiology ▪ Dermis Embedded in the dermis 1. Sebaceous glands produce oil called sebum. 2. Apocrine sweat glands are located in the - underarms (axillae), - around the nipples - around the umbilicus, - anus, and genital areas. are inactive until puberty Anatomy and Physiology ▪ Dermis Embedded in the dermis 3. Apocrine sweat glands Secrete through hair follicles are located in the - underarms (axillae), - around the nipples - around the umbilicus, - anus, and genital areas. - are inactive until puberty Odorless (bacteria causes odor) Anatomy and Physiology ▪ Dermis Embedded in the dermis 4. Eccrine sweat glands Secrete through hair follicles/ pores are found through out the body help the body regulate heat. Anatomy and Physiology ▪ Dermis Embedded in the dermis 5. Hair Follicles an average growth of about 1 cm per month 6. Nails composed of keratin Reflects health status, nutrition Anatomy and Physiology ▪ Subcutaneous composed of connective tissue containing fat cells and blood vessels and protects the body against cold. The amount of fat varies considerably with the individual. Common Signs & Symptoms Skin lesion (LEE-zhun): any discontinuity or abnormality of tissue. Lesions can be hard, soft, flat, raised, large, small, reddened, crusted, fluid-filled, or pus-filled, Pain Pruritus or itching Edema: swelling Erythema: skin redness Inflammation Common Signs & Symptoms Skin lesion (LEE-zhun): any discontinuity or abnormality of tissue. Lesions can be hard, soft, flat, raised, large, small, reddened, crusted, fluid-filled, or pus-filled, Pain Pruritus or itching Edema: swelling Erythema: skin redness Inflammation Diagnostic Tests Biopsy - nodules and chronic lesions Culture and sensitivity - bacterial infections. Blood tests - systemic infection or metabolic disorder Congenital Integumentary Disorders Story, Chapter 13 Birthmarks skin anomalies that are present at birth or shortly after. Most are harmless and may even shrink or disappear with age. Birthmarks vary from barely noticeable to disfiguring. Have different shades of coloring brown, tan, black, pale blue, pink, red, or purple. Birthmarks cannot be prevented and are not the result of anything done or not done during pregnancy. Two types of birthmarks are distinguished 1. Vascular 2. Pigmented Vascular Birthmarks Arise from blood vessels that have not formed correctly are generally red Types of vascular birthmarks Macular stains Hemangiomas Port-wine stains. Vascular Birthmarks Macular Stains - also called salmon patches, angel kisses, and stork bites The most common type of vascular birthmark Faint red marks often occur on the forehead, eyelids, posterior neck, nose, upper lip, or posterior head. On a baby, these birthmarks may be more noticeable when crying. Most often these marks fade on their own by 2 years of age Or may last into adulthood. Vascular Birthmarks Hemangiomas - also referred to as strawberries Appear as a bright red patch or a nodule of extra blood vessels in the skin. They may be either superficial or deep. The deep hemangiomas - may be bluish because they involve deeper blood vessels. Hemangiomas grow during the first year of life and then usually recede over time. Some larger ones may leave scars as they regress; Can be corrected by minor plastic surgery. Mainly found on the head or neck, or can appear anywhere. Most are benign and not associated with other medical conditions. They can cause complications - if their location interferes with sight, feeding, breathing, or other bodily functions. often are treated with steroids Vascular Birthmarks Port-wine stains discolorations that look like wine was spilled on an area of the body. Most often occur on the face, neck, arms, and legs. Can be any size They grow only as the child grows. Tend to darken over time Can thicken Have a cobblestone texture in mid-adulthood unless treated. Will not resolve spontaneously Ones near the eye should be assessed for possible complications. Laser therapy is the treatment of choice Pigmented Birthmarks Are made of a cluster of pigment cells, which cause color in skin. Many different colors tan to brown, gray to black, or even blue. The most common pigmented birthmarks are Café au lait spots Mongolian spots Moles  Pigmented Birthmarks Café au lait spots very common color of coffee with milk Can appear anywhere on the body and sometimes increase in number as a child gets older. One café au lait spot alone !is not usually a concern If several spots larger than a quarter, !can be a sign of neurofibromatosis !should be further evaluated Neurofibromatosis - Pediatrics - Merck Manuals Professional Edition  Pigmented Birthmarks Mongolian spots flat, bluish-gray patches often found on the lower back or buttocks. most common on individuals with darker complexions, such as children of Asian, American Indian, African, Hispanic, and Southern European descent. They usually fade, often completely, by school age without treatment. Pigmented Birthmarks Moles - congenital nevus, hairy nevi, brown nevi Most people get moles at some point in life. When present at birth - a congenital nevus will last a lifetime. Large or giant congenital nevi more likely to develop into skin cancer (melanoma) later in life; All moles should be monitored for cancerous changes. Moles can be tan, brown, or black flat or raised may have hair growth ABCDE For Checking Skin Lesions Asymmetry: the shape of ½ does not match the other. Borders: Irregular borders – uneven, non distinct Color: Dark/more than one shade or mixed colors Diameter: > 6mm (>1/4 inches) Evolving: any change lesions that have rapid growth need to be evaluated/biopsied Lesions that have hair growing out of them are typically benign lesions https://www.theeyeassociates.com/remember- the-abcdes-of-melanoma/ Disorders of Melanin - Albinism Recessive condition that results in little or no melanin production The most severe form of albinism is oculocutaneous albinism. Appear to have white or pink hair, skin, and iris color; They also have vision problems. Disorders of Melanin - Vitiligo Small patchy areas of hypopigmentation The cells that produce melanin (melanocytes) die or no longer form melanin causing slowly enlarging white patches of irregular shapes on the skin. More noticeable and disfiguring in people with dark skin tones. Autoimmune condition, genetic influences, sunburn, and emotional stress Associated with Pernicious anemia hypothyroidism Addison’s disease Often first appears between 10 and 30 years of age. Diagnosis: Wood’s light https://www.msdmanuals.com/professional/multimedia/ image/vitiligo-accentuated-under-a-wood-light Other Common Skin Diseases Infections Metabolic Hypersensitivity, Idiopathic Disorders Tumors Common Skin Diseases – Infections Viral Diseases: Herpes 1. Cold sores and fever blisters (herpes simplex 1 or HSV-1). 2. Genital herpes (herpes simplex 2, HSV-2, or herpes genitalias). Common Skin Diseases – Infections Viral Diseases: Herpes 3. Chicken pox (herpes varicella zoster, VZV) 4. Shingles (herpes zoster, VZV). 5. Other, rarer herpes: - ocular herpes - Herpes simplex encephalitis - neonatal herpes simplex. - These cases can lead to blindness and high levels of morbidity and mortality, respectively. Common Skin Diseases – Infections Viral Diseases: Herpes Symptoms inflammation of the skin and clusters of fluid-filled vesicles The infection is painful, embarrassing, and often recurrent. Diagnosis is made by observation of vesicles positive viral culture blood testing for herpes antibodies. Treatment virus is treatable but remains in the body for life. flares up, due to decreased immunity / with stress. Valacyclovir, acyclovir, famciclovir Vaccination Common Skin Diseases – Infections Viral Diseases: (Human Papilloma Virus, HPV) Verrucae (warts) Common warts Predominantly on the hands/fingers of children Lesions are contagious and are spread by scratching and direct contact. painless and harmless and often disappear spontaneously. Common warts occurring in adults – rule out skin cancers. Treatment topically with over-the-counter medications containing salicylic acid such as Trans-Ver-Sal, Sal-Acid Plaster, or Sal-Plant Gel Common Skin Diseases – Infections Viral Diseases: HPV Plantar warts Appear on the smooth on the sole of the foot. usually grows inward, feels like a hard lump. contain small, clotted blood vessels that appear like dark splinters inside the wart and give it a cauliflower-like appearance This wart commonly causes pain with walking ! Treatment surgical removal is often the treatment of choice.  Common Skin Diseases – Infections Viral Diseases: HPV Cervical Cancer usually a squamous cell carcinoma caused by human papillomavirus infection 3rd most common gynecological disease/8th common female cancer Prevention 1. Screening test - In 2020, the American Cancer Society (ACS) issued new guidelines for cervical cancer screening HPV test Pap (Papanicolaou ) smear it should be started at age 25 years, rather than 30 years, and done every 5 years 2. Vaccination before sexually active Common Skin Diseases – Infections Viral Diseases: Measles Highly contagious childhood disease Maculopapular skin rash Common Skin Diseases – Infections Bacterial Diseases: Impetigo - affects the face and hands of children, Streptococcus and Staphylococcus bacteria Folliculitis - inflammation and infection of the hair follicle and can occur anywhere on the skin. Abscess - mall abscess occurring in the tissues of the skin Furuncle - occur around a hair follicle and can develop during an acute case of folliculitis. Carbuncle - larger abscesses and involve several interconnected furuncles. Common Skin Diseases – Infections Bacterial Diseases: Cellulitis - diffuse, or spreading, inflammation (swollen, warm, tender area of erythema) of the skin and subcutaneous tissue Erysipelas - acute infection of the dermis that extends into underlying fat tissue. Note the sharp line of demarcation and bright red color, features that distinguish erysipelas from cellulitis. Common Skin Diseases – Infections Bacterial Diseases: Lyme Disease first discovered in 1975 in the town of Lyme, Connecticut most common tick-borne disease in the United States A characteristic bull’s-eye skin rash is a common sign Symptoms can include flu-like symptoms, arthritis, malaise, chills, and fever. Diagnosis History of exposure to infected ticks Blood testing for Abs Common Metabolic Skin Diseases Acne Vulgaris: inflammation of the sebaceous (oil-secreting) glands and hair follicles of the skin Occurs at puberty (increased sex hormones) Androgen causes an increase in the size and activity of the sebaceous glands Hereditary, food allergies, endocrine disorders Lack of sleep  Common Metabolic Skin Diseases Seborrheic Dermatitis: Affects the sebaceous (oil-secreting) glands of the skin Cradle cap in infants Dandruff – affecting the scalp of adults Sebaceous Cysts: pilonidal cyst, which develops around a hair in the sacrococcygeal area Common Metabolic Skin Diseases Hypersensitivity or Immune Disease Eczema – also called atopic dermatitis Is a common chronic inflammatory condition Inherited tendency and may be accompanied by asthma and allergic rhinitis. Most common in infants, but usually resolves by early adulthood https://www.msdmanuals.com: atopic dermatitis Common Metabolic Skin Diseases Hypersensitivity or Immune Disease Urticaria – hives, nettle rash, welts, vascular reaction of the skin Type 1 Hypersensitivity Immune reaction Contact with external irritant – insect bites, pollen, or plants Often triggered by Food (e.g., shellfish and nuts) or medicine (e.g., antibiotics, contrast dye) Histamine release is initiated by these substances or conditions. Contact Dermatitis – acute or chronic Allergens – costmetic, laundary product, plant, jewlry, paint, drug, plastic, Common Metabolic Skin Diseases Hypersensitivity or Immune Disease Scleroderma - chronic autoimmune disorder characterized by hardening, thickening, and shrinking of the connective tissues of the body, including the skin begins with the skin and connective tissues, attracting cells that stimulate the production of collagen, leading to the disorder. Idiopathic Skin Diseases Hypersensitivity or Immune Disease Psoriasis – chronic inflammatory between the ages of 15 and 35 Not contagious Rapid build up of proliferative cellular replacement of epidermal cells characterized by red, raised lesions with distinct borders and silvery scales generally occur on the elbows, knees, and scalp. as many as 30% of persons with psoriasis also have arthritis - psoriatic arthritis. Idiopathic Skin Diseases Hypersensitivity or Immune Disease Rosacea –chronic Individuals affected blush easily and tend to be fair-skinned, female between the ages of 30 and 50 enlargement of the blood vessels just under the skin Symptoms. The facial skin appears red with swelling or skin eruptions similar to acne.  Skin Diseases – Benign Tumors Keloid– a raised, firm, irregularly shaped mass of scar tissue that develops following trauma or surgical incision. Hemangioma Most common childhood tumor 50% disappearing by age 5, majority by puberty made up of small blood vessels forming a reddish or purplish birthmark  Skin Diseases – Premalignant/ Malignant Tumors Basal Cell Carcinoma – most common skin cancer fair skinned, blonde, and blue- or gray-eyed individuals. Slow growing Does not metastasize Near eyes and mouth a raised nodule with a depressed or dented center;  Skin Diseases – Premalignant/ Malignant Tumors Squamous Cell Carcinoma to grow more rapidly and become metastatic. Tends to occur on the sun-exposed skin of those with fair complexion. It most commonly appears on people over age 50. firm, red nodule with crusts or a slightly elevated plaque A sore that does not heal or actually bleeds easily Skin Diseases – Premalignant/ Malignant Tumors Malignant Melanoma (melan = black, oma = tumor) is the most serious type of skin cancer Metastasize quickly tan, brown, or dark brown in color Uncontrolled growth of melanocytes it arises in a mole and causes a change in size and color of the mole. Skin Diseases – Premalignant/ Malignant Tumors Kaposi’s Sarcoma development of this neoplasm has increased in conjunction with the increase in the AIDS-affected population. Painless, malignant vascular skin tumor characterized by bluish-red cutaneous patches that grow under the skin, most often on the face and legs Skin Diseases – Abnormal Pigmented Lesions Ephelis - a freckle and is indicative of skin damage due to sunburn. hyperreactive melanocytes to sunlight, causing the darkened lesion. Common in children and tend to fade in adults. Lentigo - small brown spot occurring on the face, neck, and back of the hands of older adults. called liver spots are not due to aging but to years of overexposure to the sun. Nevus - a mole. can be brown, black, or pink-colored are often due to a collection of melanocytes can appear on any area of the body, vary in size and shape, occur singly or in multiples. Skin Diseases – Abnormal Pigmented Lesions Albinism - hereditary disorder characterized by a decrease or total absence of pigment in the skin, hair, and eyes have pale skin, white hair, and pale blue or pink eyes. suffer from extreme sunburn Vitiligo - Characterized by destruction of melanocytes in small or large patches of skin immune disorder. Melasma - dark patches of skin on the face, especially the cheeks common in pregnant females and those taking birth control pills. It is commonly called the mask of pregnancy. usually disappears after delivery or discontinuation of birth control pills. Male Pattern Baldness - alopecia A human naturally loses 40 to 100 strands of hair a day. a common cause of hair loss in men and is an inherited trait passed to males by their mothers. influenced by male sex hormones often begins around age 30 receding front hairline and loss of hair on the top and back portion of the head  Burns by fire, steam, exposure to hot liquids or items, chemicals, and electricity. The degree of tissue injury is related to the intensity and duration of exposure 1st degree Burns fairly common characterized by pain, skin redness, and swelling involve only the epidermis and are often the result of sunburn Heal within a week, followed by peeling of the damaged epidermis Burns 2nd degree Burns partial-thickness burns involve the epidermis and dermis characterized by extreme pain, redness, and swelling, blisters, open wounds  Burns 3rd degree Burns full-thickness burns epidermis and entire dermis, exposing layers of fat, muscle, and bone. characterized by “painless” - nerves in the dermis have been destroyed But still have extreme pain - the pain is due to a layering of degrees of burn, with 1st - and 2nd - degree areas surrounding the third-degree areas. Burns Rule of 9’s Used to calculate % of body surface burned The amount of body surface burned generally correlates with the chance of survival for the affected individual. body burns of 25% to 30% of the body are extremely serious, 60% body burns are usually fatal.  Effect of Aging With aging, the epidermis thins, even though the number of cell layers remains unchanged. The number of melanocytes decreases, but the remaining melanocytes increase in size. Aging skin thus appears thin, pale, and translucent. Lentigos - Large pigmented spots, age spots, liver spots may appear in sun exposed areas Effect of Aging Smokers get 10 times more skin wrinkles than nonsmokers. Xerosis – dry skin a major problem in older adults might have flaky, scaly skin and pruritus due to decrease production of sebum sweat and sebaceous glands do not function as well youthful elasticity of the skin is lost, causing wrinkles and an aged appearance Sun exposure exacerbates Nails - become thicker and might be difficult to trim. Hair – becomes thinner and brittle with extensive hair loss and graying