Skin, Hair and Nails Flashcards Preview

Physical Diagnosis > Skin, Hair and Nails > Flashcards

Flashcards in Skin, Hair and Nails Deck (79)
1

skin

the heaviest single organ of the body accounting for 16% of body weight and covering the entire body

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skin anatomy

-epidermis
-dermis
-subcutaneous fat
-sebaceous gland
-sweat gland
-pore
-hair follicle

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epidermis

outer layer of skin, lower epithelial cells divide constantly pushing up older cells which then dry up and flake off, lower layer is where melanin is formed (gives pigment color to skin), nourished by dermis

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dermis

a layer of connective tissues which contains capillaries, sensory nerve endings, sweat glands, hair follicles

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sebaceous gland

secretes oil which helps to waterproof the skin and keep skin from drying out, it opens into the hair follicle

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sweat gland

secretes sweat (water), part of the body's cooling mechanism

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pore

opening in skin from a duct or gland

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inspection of the skin

pigmentation, lesions

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Skin type 1

-always burns easily, never tans, extremely sun sensitive
-freckles, reddish hair (all babies and children), blond, blue or green eyes
-scandinavian, celtic
-at greatest risk of developing skin cancer

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Skin type 2

-always burns easily, tans minimally, very sun sensitive
-blond hair, blue or green eyes
-freckles rare
-caucasians
-at greatest risk of developing skin cancer

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Skin type 3

-sometimes burns, tans gradually to light brown, minimally sun sensitive
-still susceptible to UV damage which can lead to skin cancer
-usually dark hair and brown eyes
-no freckles, good tanning ability, very low inclination to sunburn
-central europe

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skin type 4

-burns minimally, always tans to moderate brown, minimally sun sensitive
-dark hair and brown eyes
-light-brown to olive, no freckles, low inclination to sunburn
-south Mediterranean, south american

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skin type 5

-rarely burn, tans well, skin not sensitive to sun
-skin olive, sun in sensitive skin
-middle eastern, asia, some hispanics and afro-american

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skin type 6

-never burns, deeply pigmented, skin not sensitive to sun
-skin offers more protection against UV radiation than other skin types, but skin cancers can occur in people with very dark skin. Your eyes are vulnerable to damage from UV radiation so wear a hat and sunglasses and avoid excessive exposure
-african, afro-american
-melanoprotected

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Vitiligo

-hypopigmentation of skin
-widespread vitiligo is sometimes difficult to know the baseline skin - what is normal vs. abnormal

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jaundice

-hyperbilirubinemia
-causes yellowing of skin
-ictarus - yellowing of sclera of eyes (liver diseases cause this)

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albinism

-total lack of pigmentation
-hair, iris, and skin have lack of pigmentation

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Cafe au lait spots

hyperpigmented spots on skin

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central cyanosis

-seen in mouth, implies systemic problem
-think about system problem resulting in decrease amount of oxygen in blood body wide such as heart or lung disease
product of hypoxia - low oxygen

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peripheral cyanosis

-seen in nails, implies vasoconstriction
-more of a focal or local issues, can occur as a response to stress or cold, shunting of blood away from periphery
-can be seen in fingernails
-product of hypoxia - low oxygen

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skin changes with age

-loss of turgor
-increased motility - can move it around but doesnt go back to normal very easily
-weathering - wrinkles can be apparent
-thinning/transparency
-increase in benign and malignant skin lesions
-asteastosis (pruritic, dry, cracked, fissured skin with scaling)
-comedones

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asteatosis

dry, scaling skin

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comedones

-acne bumps, occur from blocked/plugged sebaceous ducts
-not as much exfoliation happening so they get more plugged ducts in eyes and t zones

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serpiginous

-wavy or snakelike
-typical in some types of contact dermatitis as well

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annular

circular

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vascular

usually blanch with pressure

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macule

flat, circumscribed area of discoloration of the skin or mucous membrane up to 1 cm in its greatest dimension

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papule

solid, elevated lesion of the skin or mucous membrane up to 1 cm in its greatest dimension

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vesicle

fluid-filled, superficial, elevated lesion of the skin or mucous membrane, up to 1 cm in its greatest dimension

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generalized vitiligo

-throughout the body
-widespread macules and patches with hypopigmentation on them

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focal vitiligo

hypopigmentation in one area

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segmental vitiligo

occurs usually on the chest but occurs in distinct areas of the body

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patch

flat, circumscribed area of discoloration of the skin or mucous membrane, with at least one dimension greater than 1 cm

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plaque

solid, elevated lesion of the skin or mucous membrane, with at least one dimension greater than 1 cm

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nodule

solid, elevated lesion of the skin or mucous membrane, with the added dimension of depth into the underlying tissue, with at least one dimension greater than 1 cm

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tumor

solid, elevated lesion of the skin or mucous membrane, with the added dimension of depth into the underlying tissue (to a greater extent than for a nodule), with at least one dimension greater than 1 cm

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bulla

fluid-filled, superficial, elevated lesion of the skin or mucous membrane, with at least one dimension greater than 1 cm

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wheals (hives)

-temporary lesions
-raised, itchy area of the skin that comes and goes
-come about suddenly and last a short amount of time

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cherry angioma

-typically seen in kids but can be seen in adults too
-usually involute or go away within a year or two
-capillary bed tumors (blood vessels)
-benign
-bleed heavily if you try to take them off

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telangectasia (spider vein)

-when they're larger we call them varicose veins
-can occur from chronic alcohol use, rosacia
-benign

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petechiae

<3mm bleeding under the skin (capillary hemorrhage); do not blanch with pressure

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purpura

3-10mm bleeding under the skin

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ecchymosis

>1cm bleeding under the skin

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blue nevus

-appears dark blue
-benign

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senile lentigo

-age spots, liver spots, solar lentigo

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seborrheic keratoses

-barnacles
-borders are sometimes irregular with patchy discoloration
-if it has a stuck on barnacley appearance (cracks and lines throughout lesion)

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actinic keratosis

-extremely common
-crusty, flakey appearance, bleed easily, red under skin

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dysplastic nevus

-multicolored, edges are not regular
-ask about history: how long has it been there, etc.

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ABCDE of skin cancer

A = asymmetry
B = borders
C = color
D = diameter
E = elevation

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Skin Cancers

-Basal cell and squamous cell carcinoma (most common in US, sun exposed areas, head, neck and hands
-melanoma (on the rise, both sun and non-sun exposed areas, associated with intermittent, intesne sun exposure and blistering from sunburns in childhood)

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Basal Cell Carcinoma

-most common form of skin cancer
-result of sun damage to the skin
-enlarge slowly and steadily and can invade neighboring tissue, like the eye, but they usually dont spread to distant parts of the body (metastasize)
-most common in fair skinned adults over 40, usually on the face
-initially translucent nodule which spreads leaving a depressed centera dn a firm elevated border
-tends to bleed often

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squamous cell carcinoma

-can occur on any surface of skin
-sun exposed sites are most common locations for SCC in fair-skinned individuals; involvement of other areas is more common in people with dark skin
frequently manifests as erythematous papules, plaques, or nodules
-hyperkeratosis, ulceration, or hyperpigmentation also may be pregnant
-can develop in sites of chonic wounds, inflammation or scarring
-non-healing ulcers or nodules = sign of SCC
-AKs can resemble SCCs

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Melanoma

-least common type of skin cancer
-most life threatening type
-can be brown, black, or multicolored patches of red, white, and blue
-may have asymmetrical outline with notched or scalloped edges, usually larger than 6mm (1/4 inch)
-can metastasize to other parts of the body if not treated early
-usually presents as brown, purple or black, raised skin lump 1-2cm in size

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vellus hair

-short, fine, inconscpicuous, relatively unpigmented
-leg, arm, trunk, face hair

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terminal hair

-coarse/thick, more conspicuous, pigmented
-eyebrows, scalp, pubic, axillary hair

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alopecia

-pattern of hair loss
-symptoms associated with hair loss (itching, scaling)
-need to notice if its completely smooth, bald skin, or if its borken hair shafts (give you a clue to underlying etiology)
-usually an autoimmune issue if theres bald skin
-patchy alopecia - usually an infectious cause

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Types of excess hair growth

-hairy nevus
-hirsutism
-due to hormone imbalance (elevated testosterone, PCOS)

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Kerion

-pink boggy tissue (squishy): immune response to fungal infection that creates a kerion (tinea capitis may cause this)

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sebaceous cyst

-non tender, feels rubbery
-not considered a vessicle, it is nodular

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pediculosis

head lice

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seborrheic dermatitis

-dandruff
-occurs in oily areas

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nail plate

-firm rectangular shell, gets its pink color from vascular nail bed to which it is attached
-1/4 of nail plate and root is covered by proximal nail folds

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lunula

whitish moon shaped crescent at base of nail

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cuticle

extends from proximal nail fold and serves to seal and protect the space between the fold and plate from external moisture

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lateral nail folds

cover the side of the nail plate

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length that fingernails grow per day

0.1mm

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angle between proximal nail fold and nail plate

usually less than 180 degrees

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examining the nails

color, shape, and lesions

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onychomycosis

fungal infection of the nail, usually occurs on toenails but can occur on fingernails

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paronychia

one of the most common infections of the hand
-localized, superficial infections or abscesses of perionychium (epidermis borderin nails)
-develop when disruption occurs between seal of proximal nail fold and nail plate that allows a portal of entry for invading organisms

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clubbing

-angle of the nail plate is over 180 degrees
-found in congestive heart failure, COPD, lung cancer
-due to hypoxia

72

psoriasis

-chronic skin condition that runs in families
-affects 1-3% of population
-can start at any age
-cause of psoriasis is unknown
-areas of skin grow much faster than normal and form red, scaling patches
-scalp, elbows, and knees are the most common sites
-not contagious
-can form in areas where skin is traumatized

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psoriasis in nails

-causes pitting
-nail pitting in one finger is usually TRAUMA

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Beau's Lines

-deep grooved lines that run from side to side on fingernail
-indentations or ridges in nail plate
-first described by French physician Joseph Honore Simon Beau in 1846
-temporary cessation of cell division in nail matrix (infection or injury to area where nail begins to form)
-other causes: coronary occlusion, hypocalcaemia, skin disease, diabetes, psoriasis, certain drugs (including beta blockers), chemotherapy drugs, or malnutrition

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Muehrcke's nails

-aka leukonychia striata
-white lines (leukonychia) that extend all the way across the nail and lie parallel to lunula (half moon)
-NOT grooved
-the lines are in vascular nail bed under nail plate
-do not move with nail growth
-blanching with pressure
-associated with decreased protein synthesis (may occur during periods of metabolic stress (ie chemotherapy)) and in hypoalbuminemic states (ie nephrotic syndrome)

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hair changes with age

graying and hair thinning or loss

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nail changes with age

thickening, loss of luster, brittleness

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skin, hair, and nails exam

-inspect hair and scalp for nits, lesions, alopecia
-palpate head and scalp for masses, tenderness
-inspect eyebrows and face for symmetry
-inspect skin for color changes, lesions, edema
-palpate skin for temperature changes and edema
-inspect nails for clubbing, cyanosis, grooves, lines, pits
-palpate nail beds for changes

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palpation of the skin

moisture, temperature, texture, mobility and turgor