Integumentary System Altered Functions

Vocabulary Derma- Melan/o- Pachy- Sub- trich/o- Cyan/o- Onych/o- Xer/o- Hidr/o- Kerat/o- Xanth/o- Follicul/o- Dactyl/o- Intra-

Integumentary Regions Skin –Epidermis –Dermis Hypodermis Sensory receptors Muscle Adnexa –Hair and follicle –Glands Sweat Sebaceous –Nails

Epidermis Histology Overview

Epidermis Strata Histology C = corneum G = granulosum S = spinosum B = basale

Underlying Disorders Genetic Connective tissue Blood supply Neoplasia Drug Reactions Immune

Primary Lesions Macules: colored circumscribed flat area, size varies, < 1cm Papules: discolored raised area, < 2cm Plaques: raised flat top area, > 1cm Patches: circumscribed flat area of discoloration, < 1cm Nodules: solid raised area, above or below skin, <1 cm Tumor: discolored raised area, > 2cm Wheals: slightly raised area with edema, size varies Vesicles/Blister: fluid filled raised area < 0.5cm Bulla/Cyst: fluid filled raised area, > 0.5cm Pustules: pus-filled raised area, size varies

Macule

Nodule

Papule

Bulla

Secondary Lesions Erosions Ulcers Fissures Cracks Scales Excoriation Keloid Scar Lichenification

Cracks and Fissures

Ulcer and Erosion

Excoriation

Lichenification

Scar Formation

Keloid

Epidermal Cells

Keratinocytes

Keratinocyte Hypertrophy

Melanocyte location and function

Melanosomes with Melanin

Melanin

Melanosis

Langerhans Dendritic Cells

Skin Cancers

Skin Cancer ABCD and E (evolving)

Etiology UV exposure –UV A –UV B Genetic Prevention –Sun block UVA UVB –Clothing –Window tinting

Skin Tumors Benign –Seborrheic keratitis –Keratocanthoma –Verucae (warts) –Actinic keratitis Malignant –Basal Cell carcinoma –Squamous Cell carcinoma –Dysplastic nevi –Malignant melanoma

Seborrheic Keratosis

Keratocanthoma

Verrucae

Actinic Keratitis

Basal Cell Carcinoma

Squamous Cell Carcinoma

Epidermal Cancers Compared

Malignant Melanoma

Merkel Cell Carcinoma

Dermis

Dermal Papilla and Reticular Dermis

Lines of Cleavage

Aging = Wrinkles? Skin changes –Chronological aging –Photo-aging (sun damage) –Chemical toxins Cause –Decrease in collagen (inactive fibroblasts) –Increase in proteolytic activity due to collagenase

Hypodermis

Subcutaneous tissue

Clinical Application

Dermatitis (Eczema) Atopic Contact Seborrheic Drug eruption Photo-eczematous

Dermatitis reactions Presentation Papulovesicular Oozing with crusts Scaling plaques

Contact Dermatitis

Seborrheic Dermatitis Dandruff; Cradle Cap

Drug Eruption

Photoeczematous UV Genetic: Porphyria Drug Induced –Oral –Topical Lupus

Venous Stasis Dermatitis

Cutaneous Membrane

Insect Bites

Chiggers

Biting Flies

Mosquitoes

Spider Bites

Bacterial Lesion Appearance/ Causes Furunculosis Folliculitis Impetigo Cellulitis Staph aureus Pseudomonas Gram (-) enterics Beta hemolytic Strep Mycobacterium Clostridium

MRSA Bacteria: Staph. aureus Disease: Pyodermas Transmission: –Direct, topical –Open wound entry Culture and Sensitivity ID Drug Resistance –Beta lactamase –Alternate method of cell wall synthesis

VRE Vancomycin Risk factors –Hospitalization –Immunocompromised –Neutropenia –ICU –Dialysis

Impetigo Staph; Strep Cut or scratch Honey colored oozing sores Lip / nose region After a cold Scratching can spread to other areas

Cellulitis

Gangrene

Streptococcus

Leprosy

Erysipelas Group A Strep Cellulitis

Necrotizing Fasciitis Strep pyogenes Fascial planes Source –Skin –Bowel Aka, Streptococcal gangrene Post op concern

Scarlet Fever

Fungal Infections Microsporum Trichophyton Epidermophyton

Microsporum

Trichophton

Tinea Capitus

Tinea corpus

Tinea pedis

Epidermatophyton

Candida albicans

Viral Infections Papilloma Herpes Morbillivirus Rubella Parvovirus

HPV

Papilloma

Herpes: HSV-1, HSV-2

Herpes: Varicella Zoster Virus

Shingles

Rubeola Paramyxovirus 5 day or hard measles Respiratory spread Exanthem rash –White spots in red Fever; cough Neurological

Rubella

Erythema Infectiosum (Fifth Disease) Parvovirus B19 Mild rash (slapped cheek –Face –Limbs –Trunk Respiratory secretions – direct contact spread Pain, fever, itching

Idiopathic/Immune Acne Psoriasis Rosacea Pemphigus Scleroderma Erythema multiforme Vitiligo

Acne Vulgaris

Propionibacterium acnes Staph epidermidis

Psoriasis

Rosacea

Pemphigus Autoimmune Blistering

Scleroderma

Erythema Muliforme

Vitiligo

Urticaria

Porphyria

Genetic Enzyme Deficiency

Adnexa

Sweat Glands

Hair and Follicle

Hair/ Follicle Disorders Alopecia Genetic: baldness –Male –Female Hirsutism Parasitic Infectious –Bacterial –Fungal

Folliculitis

Scabies

Pediculosis

Head Louse

Body Louse

Nail Disorders Clubbing Paronchyma Onchomycosis

Clubbing

Fungal Infections

Sensory

Burn Classification

Skin Layers Affected

Rule of 9’s

Artificial Skin Hormone EGF: Epidermal Growth Factor

Frostbite

Injury Blunt force trauma: blows, impact injury Contusion Abrasion Laceration Sharp Force –Incised wound –Stab wound –Puncture wound GSW

Puncture Wound

Laceration

Wounds compared

GSW Entrance WoundExit Wounds

Summary

Process and Timeframe

Histology of Repair

Suture

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