Physical Examination of the Skin, Hair & Nails PDF Summer 2023

Physical Examination of the Skin, Hair & Nails Pat Kenney-Moore EdD, PA-C Physical Diagnosis Summer 2023 Physical Examination of the Skin, Hair & Nails  Why examine the skin, hair & nails?  Largest organ in the body  About 7 percent of all adult outpatients have a primary skin complaint  60 perc...

Physical Examination of the Skin, Hair & Nails Pat Kenney-Moore EdD, PA-C Physical Diagnosis Summer 2023 Physical Examination of the Skin, Hair & Nails  Why examine the skin, hair & nails?  Largest organ in the body  About 7 percent of all adult outpatients have a primary skin complaint  60 percent of outpatient visits for skin disease are made to non-dermatologists  Patients with common, chronic medical conditions, such as obesity and diabetes, have increased numbers of skin conditions Physical Examination of the Skin, Hair & Nails Physical Examination of the Skin, Hair & Nails  Over 12 million medical office visits are made by adolescents and young children for skin concerns  Expression of “humanness”  More than one-half of patients also have great interest in skin care products or use alternative treatment modalities that may impact the skin, such as herbs and food supplements Physical Examination of the Skin, Hair & Nails  External manifestations of disease  Genetic syndromes and congenital disorders  Endocrine/metabolic disorder  Other systemic diseases states  Infections  Skin, hair & nails provide a mirror on occupational/leisure activities and use of drugs  Abnormalities have a profound social impact on patients  Loss of self esteem  Social isolation and disruption of intimacy in severe cases Examination of the Skin  Covers the entire outside of the body and weighs approximately six pounds  Serves as a protective shield against heat, light, injury, and infection  Regulates body temperature  Stores water, fat, and vitamin D  Can sense painful and pleasant stimulation  Skin characteristics vary (i.e., thickness, color, texture) depending on location 1 Anatomy of the Skin A deeper look Skin Facts Skin Facts  The epidermis is the thin outer layer of the skin made up of four - five layers:      stratum corneum (horny layer) -contains continually shedding, dead keratinocytes (the primary cell type of the epidermis). The keratin, a protein formed from dead cells, protects the skin from harmful substances. Stratum lucidum – found only in the thick skin of palms, soles, and digits. Stratum granulosum Stratum spinosum – desmosomes to join cells and Langerhans cells basal layer/ basement membrane - Inner layer of the epidermis, containing basal cells that continually divide, forming new keratinocytes. These migrate upward over 4 weeks replacing the old ones that are shed. Also contains Merkel cell and melanocytes Skin Facts Sweet  Eccrine glands – true sweat glands, open onto surface of the skin and provide cooling of the skin from evaporation  Apocrine glands under the arms, in the groin, and in a few other smaller regions of the body. Secretions produce little or no odors in themselves, bacteria that accumulate in the nearby hair can result in characteristic odors  The dermis is the middle layer of the skin and contains  blood vessels  lymph vessels  hair follicles  sweat glands  The dermis is held together by a protein called collagen, made by fibroblasts (skin cells that give the skin its strength and resilience). This layer also contains pain and touch receptors.  The subcutis is the deepest layer of skin and is also known as the subcutaneous layer or hypodermis. Consists of a network of collagen and fat cells, helps conserve the body's heat while protecting other organs from injury by acting as a "shock absorber." Hair Facts  Follicular life cycle can be divided into 3 phases  The anagen phase is the phase of active growth and lasts approximately 3-4 years. Approximately 84% of scalp follicles are in the anagen phase  The catagen phase marks follicular regression and lasts approximately 2-3 weeks. 1-2% of follicles are in the catagen phase  The telogen phase represents a resting period and lasts approximately 3 months. 10-15% of all hair follicles are in the telogen phase abiucanetahairbraining 2 Hair Anatomy Nail Facts  Composed of keratinized structure from the nail plate  Grow 0.1 mm/day - individual rates depend on age, time of year, activity level, and heredity.  6 months to completely regrow (toenails up to 12 or more months)  Nails on a person's dominant hand (right vs. left) grow faster, and men's nails grow more quickly than women's  Nail growth is affected by disease, hormone imbalance, and the aging process  Nail disorders comprise about 10 percent of all skin conditions Anatomy of the Nail Physical Examination of the Skin  “Approach to the Patient”  Inspection and Palpation for      Color Moistness/dryness Temperature Texture Turgor  Includes assessment of mucus membranes and intertriginous areas Physical Examination of the Skin Physical Examination of the Skin Arrangement / Description  Determine the following components for any found dermatologic lesions:     Location and distribution Lesion type – primary vs. secondary Lesion arrangement Assessment for cutaneous color changes 3 Physical Examination of the Skin Physical Examination of the Skin  Distribution      Sun exposed vs. covered by clothing Flexural vs. extensor Stocking and glove Face, shoulders, back Truncal Notelevated Colorchangein skin Physical Examination of the Skin Primary vs. Secondary Lesions Primary Skin Lesions  Primary Lesions  Papules  Skin lesion as it first appears  Macules  Include freckles, junctional nevi, tattoos, mongolian spots, vitiligo  Up to 1 cm  Greater than 1 its called a patch  Includes milia, sebaceous hyperplasia, nevi, warts, dermatofibroma, seborrheic keratoses etc.  Up to 1 cm  Greater than 1 cm its called a plaque Use the size designations on these slides rather than the ones indicated in Seidel's Primary Skin Lesions Primary Skin Lesions  Plaques  Wheals  Include eczema, lichen planus, psoriasis, tinea corporis, Paget’s disease, seborrheic dermatitis  Larger than 1 cm in size  Include angioedema, dermographism, hives, choliergic urticaria, mastocytosis  Varying sizes  Transient and erythematous 4 Primary Skin Lesions Primary Skin Lesions  Vesicles and Bullae  Pustules  Includes folliculitis, pyoderma gangrenosum, impetigo, hidradenitis suppuritiva, gonococcemia  Include chicken pox (varicella), herpes simplex, herpes zoster, pemphigus vulgaris, bullous pemphigoid  Vesicles up to 1cm  Bullae over 1 cm Physical Examination of the Skin Secondary Lesions Physical Examination of the Skin Secondary Lesions  Secondary lesions are transformed primary lesions Physical Examination of the Skin – Cutaneous Color Changes Physical Examination of the Nails  Inspection and Palpation  Shape  Color  Lesions or other abnormalities     Pigmented deposits – melanoma Pitting Spooning Clubbing 5 Physical Examination of the Hair  Inspection & Palpation     Quantity and distribution Color Texture Presence of abnormalities  Alopecia Health Promotion Disease Prevention  Basal cell carcinoma  Squamous cell carcinoma  Melanoma Diagnostic Techniques to Evaluate Disorders of the Skin, Hair & Nails Woods light Dermoscopy Diascopy Direct microscopy Biopsy – punch, incisional, excisional, shave  Patch and prick skin testing      Health Promotion Disease Prevention  American Cancer Society  Recommends monthly self-exams and examination as part of a routine cancerrelated checkup  Slip! Slop! Slap! Wrap! Guidelines®  Avoid sun exposure during midday hours  Use sunscreen daily – even in Oregon!  Avoid tanning beds and sun lamps 6