CHAPTER 5 Integumentary System

Integumentary System Skin Accessory structures Integument or cutaneous membrane Epidermis Dermis Subcutaneous layer Accessory structures Hair Nails Glands

Layers and Structures of the Skin

Skin Lesions Abrasion Abscess Scraping or rubbing away of skin or mucous membrane as a result of friction to the area Example: carpet burn Abscess Localized collection of pus in any body part that results from invasion of pus-forming bacteria Example: pustule = small abscess

Skin Lesions Bedsore Blister Ulcer in skin over a bony prominence Also known as pressure ulcer Example: decubitus ulcer Blister Small, thin-walled lesion containing clear fluid Also known as a vesicle

Skin Lesions Bulla Carbuncle Comedo Large blister Circumscribed inflammation of skin and deeper tissues; contains pus Comedo Typical lesion of acne vulgaris Example: whitehead = closed comedo Example: blackhead = open comedo

Skin Lesions Cyst Closed sac or pouch in or within the skin; contains fluid, semifluid, or solid material Example: hydrocele = fluid-filled cyst Example: sebaceous cyst = solid-filled cyst

Skin Lesions Fissure Fistula Cracklike sore or groove in the skin or mucous membrane Example: anal fissure Fistula Abnormal passageway between two tubular organs; or from an organ to the body surface Example: recto-vaginal fistula

Skin Lesions Hives Laceration Circumscribed, slightly elevated lesions on skin; paler in center than surrounding edges Also called wheals Example: mosquito bite Laceration Tear in skin; torn, jagged wound

Skin Lesions Macule Nodule Small flat, discoloration of the skin; neither raised nor depressed Example: bruises, freckles Nodule Small, circumscribed swelling protruding above the skin

Skin Lesions Papule Polyp Small, solid, circumscribed elevation on the skin Example: pimple, wart, elevated mole Polyp Small, stalklike growth, protruding upward or outward from membrane surface Example: nasal polyp

Skin Lesions Pustule Scales Ulcer Small elevation of skin filled with pus Example: small abscess on the skin Scales Thin flakes of hardened epithelium that are shed from the epidermis Ulcer Circumscribed, open sore or lesion of skin, accompanied by inflammation Example: decubitus ulcer

Skin Lesions Vesicle Wheal Small, thin-walled, lesion containing clear fluid Example: blister Wheal Circumscribed, slightly elevated lesion of the skin Paler in center than surrounding edges Example: hives

PATHOLOGICAL CONDITIONS Integumentary System

Acne Vulgaris Pronounced Defined (ACK-nee-vul-GAY-ris) Common inflammatory disorder seen on face, chest, back, and neck Appears as papules, pustules, and comedos

Albinism Pronounced Defined (AL-bin-izm) Condition characterized by absence of pigment in the skin, hair, and eyes

Burns Defined Tissue injury produced by flame, heat, chemicals, radiation, electricity, or gases Extent of damage determined by: Mode and duration of exposure Thermal intensity or temperature Anatomic site of the burn

Burns First-degree or superficial burns Example: sunburn Second-degree or partial-thickness burns Example: flash contact with hot objects Third-degree or full-thickness burns Example: deep burns from a fire

Callus Pronounced Defined (CAL-us) Common, usually painless thickening of the epidermis at sites of external pressure or friction, such as weight-bearing areas of the feet and on the palmar surface of the hands Also known as a callosity

Carcinoma, Basal Cell Pronounced Defined (car-sih-NOH-mah BAY-sal sell) Defined Most common malignant tumor of epithelial tissue, occurring most often on areas of skin that are exposed to the sun Presents as a slightly elevated nodule with a depression or ulceration in the center that becomes more obvious as the tumor grows

Carcinoma, Squamous Cell Pronounced (car-sih-NOH-mah SKWAY-mus sell ) Defined Malignancy of the squamous, or scalelike, cells of the epithelial tissue Much faster growing than basal cell carcinoma Greater potential for metastasis if not treated

Carcinoma, Squamous Cell Frequent sites on sun-exposed areas Top of nose Forehead Margin of external ear Back of hands Lower lip

Dermatitis Pronounced Defined (der-mah-TYE-tis) Inflammation of skin, seen in several different forms Acute or chronic Contact or seborrheic

Eczema Pronounced Defined (EK-zeh-mah) Acute or chronic inflammatory skin condition characterized by erythema, papules, vesicles, pustules, scales, crusts, scabs, and itching

Exanthematous Viral Diseases Pronounced (eks-an-THEM-ah-tus viral diseases) Defined Skin eruption or rash accompanied by inflammation, having specific diagnostic features of an infectious viral disease

Exanthematous Viral Diseases Examples: Rubella = German Measles = 3 day measles Roseola Infantum Rubeola = Red Measles = 7-10 day measles Erythema Infectiosum = Fifth disease

Gangrene Pronounced Defined (GANG-green) Tissue death due to loss of adequate blood supply, invasion of bacteria, subsequent decay with foul odor

Herpes Zoster Pronounced Defined (HER-peez ZOS-ter) Acute viral infection, characterized by painful, vesicular eruptions on the skin that follow along nerve pathways of underlying spinal or cranial nerves Highest incidence in adults over 50

Herpes Zoster Image courtesy of Robert A. Silverman, M.D., Pediatric Dermatology, Georgetown University

Impetigo Pronounced Defined (Im-peh-TYE-goh) Contagious superficial skin infection characterized by serous vesicles and pustules filled with millions of staphylococcus or streptococcus bacteria Usually forming on the face

Kaposi’s Sarcoma Pronounced Defined (CAP-oh-seez sar-KOH-ma) Rare malignant lesions beginning as soft purple-brown nodules or plaques on the feet Gradually spreads throughout skin Increased incidence in men with AIDS

Keloid Pronounced Defined (KEE-loyd) Enlarged, irregularly shaped, elevated scar that forms due to the presence of large amounts of collagen during formation of a scar

Keratosis Pronounced Defined (kair-ah-TOH-sis) Skin condition in which there is a thickening and overgrowth of the cornified epithelium

Seborrheic Keratosis Pronounced Defined (seb-oh-REE-ik kair-ah-TOH-sis) Defined Brown or waxy yellow wart-like lesions that are loosely attached to the skin Also known as senile warts

Actinic Keratosis Pronounced Defined (ak-TIN-ic kair-ah-TOH-sis) Premalignant, gray or red-to-brown, hardened lesion caused by excessive exposure to sunlight Also known as solar keratosis

Leukoplakia Pronounced Defined (loo-koh-PLAY-kee-ah) White, hard, thickened patches firmly attached to the mucous membrane In mouth, vulva, or penis

Malignant Melanoma Pronounced Defined (mah-LIG-nant mel-ah-NOH-mah) Malignant skin tumor originating from melanocytes in preexisting nevi, freckles, or skin with pigment Darkly pigmented tumor with irregular surfaces and borders; variable colors

ABCDs of Malignant Melanomas Asymmetry Borders Color Diameter

Nevus Pronounced Defined (NEV-us) Visual accumulation of melanocytes, creating a flat or raised rounded macule or papule with definite borders Commonly known as a mole

Onychocryptosis Pronounced Defined (on-ih-koh-krip-TOH-sis) Ingrown nail Most commonly involves the large toe

Onychomycosis Pronounced Defined (on-ih-koh-my-KOH-sis) Fungal infection of the nails

Pediculosis Pronounced Defined (pee-dik-you-LOH-sis) Highly contagious parasitic infestation caused by blood-sucking lice

Pediculosis Pediculosis capitis Pediculosis corporis Head Pediculosis corporis Body Pediculosis palpebrarum Eyelashes and eyelids Pediculosis pubis Pubic hair

Pemphigus Pronounced Defined (PEM-fih-gus) Rare, incurable disorder manifested by blisters in the mouth and on the skin Spreads to involve large areas of the body

Pilonidal Cyst Pronounced Defined (pye-loh-NYE-dal SIST) Closed sac located in the sacrococcygeal area of the back Sometimes noted at birth as a dimple

Psoriasis Pronounced Defined (soh-RYE-ah-sis) Common, noninfectious, chronic skin disorder manifested by silvery-white scales over round, raised, reddened plaques producing itching Pruritus

Rosacea Pronounced Defined (roh-ZAY-she-ah) Chronic inflammatory skin disease that mainly affects the skin of the middle third of the face Characterized by persistent redness over the areas of the face, nose, and cheeks

Scabies Pronounced Defined (SKAY-beez) Highly contagious parasitic infestation caused by the “human itch mite” Resulting in a rash, pruritus, and a feeling in the skin of “something crawling”

Scleroderma Pronounced Defined (sklair-ah-DER-mah) Gradual thickening of the dermis and swelling of the hands and feet to a state in which the skin is anchored to the underlying tissue

Systemic Lupus Erythematosus Pronounced (sis-TEM-ic LOO-pus air-ih-them-ah-TOH-sis) Defined Chronic, multi-system, inflammatory disease characterized by lesions of the nervous system and skin, renal problems, and vasculitis Characteristic “Butterfly rash” is often seen on nose and face

Tinea Pronounced Defined (TIN-ee-ah) Chronic fungal infection of the skin Characterized by scaling, itching, and sometimes painful lesions

Tinea Tinea capitis Tinea corporis Tinea cruris Tinea pedis Scalp Body Groin Tinea pedis Foot

Verruca Pronounced Defined (ver-ROO-kah) Benign, circumscribed, elevated skin lesion that results from hypertrophy of the epidermis Commonly known as a wart

Verruca Verruca vulgaris Plantar warts Venereal warts Seborrheic warts Common wart on face, elbow, fingers, or hands Plantar warts Singly or in clusters on the sole of the foot Venereal warts Transmitted by sexual contact Seborrheic warts Seen in the elderly on the face, neck, chest, or upper back

DIAGNOSTIC TECHNIQUES, TREATMENTS AND PROCEDURES Integumentary System

Diagnostic Techniques, Treatments, and Procedures Allergy testing Various procedures used to identify specific allergens in an individual by exposing the person to a very small quantity of the allergen Cautery Heat or caustic substances that burn and scar the skin

Diagnostic Techniques, Treatments, and Procedures Cryosurgery Noninvasive treatment that uses subfreezing temperature to freeze and destroy tissue Curettage and electrodesiccation Scraping away of abnormal tissue, followed by destroying the tumor base with a low-voltage electrode

Diagnostic Techniques, Treatments, and Procedures Debridement Removal of debris, foreign objects, and damaged or necrotic tissue from a wound in order to prevent infection and promote healing Dermabrasion Removal of the epidermis and a portion of the dermis with sandpaper or brushes in order to eliminate superficial scars of unwanted tattoos

Diagnostic Techniques, Treatments, and Procedures Dermatoplasty Skin transplantation to a body surface damaged by injury or disease Electrodesiccation Technique using an electrical spark to burn and destroy tissue Also known as fulguration

Diagnostic Techniques, Treatments, and Procedures Electrosurgery Removal or destruction of tissue with an electrical current Escharotomy Incision made into the necrotic tissue resulting from a severe burn

Diagnostic Techniques, Treatments, and Procedures Liposuction Aspiration of fat through a suction cannula or curette to alter the body contours Skin biopsy Removal of a small piece of tissue from skin lesions for examination under a microscope to confirm or establish a diagnosis

Diagnostic Techniques, Treatments, and Procedures Skin graft Process of placing tissue on a recipient site, taken from a donor site, in order to provide the protective mechanisms of skin to an area unable to regenerate skin Wood’s lamp Ultraviolet light that is used to examine the scalp and skin for the purpose of observing fungal spores