1. Integumentary System University of Karbala / college of nursing Instructor assistance /Safi Dakhil nawam /2014-2015

2. Upon completion of this chapter, you will be able to: 1.Locate and describe the structures of the integumentary system. 2.Recognize, pronounce, spell, and build words related to the integumentary system. 3.Describe pathological conditions, diagnostic and therapeutic procedures, and other terms related to the integumentary system.

3. This section introduces important integumentary system terms and their definitions. Term Definition adipose adip: fat -ose: pertaining to, relating to Fatty; pertaining to fat androgen Generic term for an agent, usually a hormone (testosterone) that stimulates activity of the accessory male sex organs or dorsal dors: back (of body) -al: pertaining to; relating to Indicating a position; pertaining to the back or posterior (of a structure) ductule duct: to lead; carry -ule: small, minute A very small duct

4. This section introduces important integumentary system terms and their definitions cont. Term Definition homeostasis homeo-: same, alike -stasis: standing still Relative constancy or equilibrium in the internal environment of the body, which is maintained by the ever-changing processes of feedback and regulation in response to external or internal changes hypodermis hypo- :under,below,deficient derm: skin -is: noun ending Subcutaneous tissue layer below the dermis integument A covering (the skin) consisting of the epidermis and dermis, or corium systemic Pertaining to the entire body rather than to one of its individual parts

5. Anatomy and Physiology The integumentary system consists of the skin and its epidermal structures (integumentary glands, hair, and nails). The skin, also called integument, covers and protects all outer surfaces of the body and performs many vital functions. Its elaborate system of distinct tissues includes 1.Glands that produce several types of secretions. 2.Nerves that transmit impulses. 3.Blood vessels that help regulate body temperature.

7. Skin The skin protects underlying structures from injury and provides sensory information to the brain. Below the skin’s surface is an complicated network of nerve fibers that register sensations of temperature, pain, and pressure. Other important functions of the skin are protecting the body against ultraviolet rays, regulating body temperature, and preventing dehydration. Acts as a reservoir for food and water and is responsible for the synthesis of vitamin D when exposed to sunlight. consists of two distinct layers: the epidermis and the dermis. A subcutaneous layer of tissue binds the skin to underlying structures.

8. Epidermis The outer layer, the skin 1. epidermis, is thick (comprised of five layers) on the palms of the hands and the soles of the feet but relatively thin over most other areas. Although the epidermis is composed of four or five sublayers called strata, the stratum corneum and the stratum germinativum (basal layer) are of greatest importance. The stratum corneum is composed of dead flat cells that lack a blood supply and sensory

9. Dermis The second layer of the skin 1.dermis (corium), lies directly under the epidermis. It is composed of living tissue and contains numerous capillaries, lymphatic vessels, and nerve endings. Hair follicles, sebaceous (oil) glands, and sweat glands are also located in the dermis. 2.The hypodermis 3.subcutaneous tissue, is composed primarily of loose connective tissue and adipose tissue interlaced with blood vessels. It binds the dermis to underlying structures. The hypodermis stores fats, and regulates temperature.

10. Accessory Organs of the Skin The accessory organs of the skin consist of integumentary glands, hair, and nails. All of these structures are formed from the epidermis. The glands play an important role in body defense and maintaining homeostasis, whereas the hair and nails have more limited functional roles.

11. Glands Two important glands located in the dermis produce secretions: the 1.Sudoriferous glands produce sweat. 2.Sebaceous glands produce oil. These two glands are known as exocrine glands because they secrete substances through ducts to an outer surface of the body rather than directly into the bloodstream. The sudoriferous glands secrete perspiration or sweat onto the surface of the skin through openings. openings are most plentiful on the palms, soles, forehead, and armpits (axillae). The main functions of the sudoriferous glands are to cool the body by evaporation, excrete waste products, and moisten surface cells.

12. Hair Hair is found on nearly all parts of the body, except for the lips, nipples, palms of the hands, soles of the feet, and parts of the external genitalia. The visible part of the hair is the: 1.hair shaft; the part that is embedded in the dermis is the hair root. The root, together with its coverings, forms the 2.hair follicle. At the bottom of the follicle is a loop of capillaries enclosed in a covering called the 3.papilla. The cluster of epithelial cells lying over the papilla reproduces and is responsible for the eventual formation of the hair shaft. As long as these cells remain alive, hair will regenerate even if it is cut, plucked, or otherwise removed. Baldness (alopecia) occurs when the hairs of the scalp are not replaced because of death of the papilla. Like skin color, hair color is related to the amount of pigment produced by epidermal melanocytes.

13. Nails The nails protect the tips of the fingers and toes from bruises and injuries. (See Figure 5–2.) Each nail is formed in the nail root and is composed of keratinized stratified squamous epithelial cells producing a very tough covering. As the nail grows, it stays attached and slides forward over the layer of epithelium called the nail bed. This epithelial layer is continuous with the epithelium of the skin. Most of the nail body appears pink because of the underlying vascular tissue. The half-moon shaped area at the base of the nail, the lunula, is the region where new growth occurs. The lunula has a whitish appearance because the vascular tissue underneath does not show through

15. Medical Word Elements This section introduces combining forms, suffixes, and prefixes related to the integumentary system. ElementMeaningWord analysis COMBINING FORMS adip/o lip/o steat/o fat adip/osis : abnormal accumulation of fat in the body -osis: abnormal condition; increase (used primarily with blood cells) lip/o/cele : hernia containing fat or fatty tissue -cele: hernia, swelling steat/itis : inflammation of adipose (fatty) tissue -itis: inflammation cutane/o dermat/o derm/o Skin sub/cutane/ous : beneath the skin sub-: under, below -ous: pertaining to, relating to dermat/o/plasty : plastic surgery of the skin, as in skin grafting -plasty: surgical repair hypo/derm/ic : under or inserted under the skin, as in a hypodermic injection hypo-: under, below -ic: pertaining to, relating to hidr/o sudor/o Sweathidr/aden/itis : inflammation of the sweat glands aden: gland -itis: inflammation do not confuse hidr/o (sweat) with hydr/o (water). sudor/esis : profuse sweating -esis: condition

16. ichthy/oDry, scaly ichthy/osis : any of several dermatologic conditions in which the skin is dry and hyperkeratotic (hardened), resembling fish scales -osis: abnormal condition; increase (used primarily with blood cells) A mild form called winter itch is commonly seen on the legs of older patients, especially during the winter months. kerat/o horny tissue; hard; cornea kerat/osis : thickened area of the epidermis; any horny growth on the skin (such as a callus or wart) -osis: abnormal condition; increase (used primarily with blood cells) Melan/oBlak melan/oma : malignant tumor of melanocytes that commonly begins in a darkly pigmented mole and can metastasize widely -oma: tumor myc/o fungus (plural, fungi) dermat/o/myc/osis : fungal infection of the skin dermat/o: skin -osis: abnormal condition; increase (used primarily with blood cells)

17. onych/o ungu/o Nail onych/o/malacia: abnormal softening of the nails -malacia: softening ungu/al : pertaining to the nails -al: pertaining to, relating to scler/o hardening; sclera (white of eye) scler/o/derma : chronic hardening and thickening of the skin caused by new collagen formation -derma: skin Scleroderma is most common in middle-aged women and may occur in a localized form or as a systemic disease. seb/o sebum, sebaceous seb/o/rrhea : excessive secretion or discharge of sebum -rrhea: discharge, flow Sebum is an oil secretion of the sebaceous glands. Squam/ o Scale squam/ous : relating to or covered with scales -ous: pertaining to, relating to Xer/oDryxer/o/derma : chronic skin condition characterized by dryness and roughness -derma: skin xeroderma is a mild form of ichthyosis.

18. -cyte Cell lip/o/cyte : fat cell lip/o: fat -derma Skin py/o/derma : any pyogenic infection of the skin py/o: pus Pyoderma may be primary, such as impetigo, or secondary to a previous Condition -logist specialist in the study of dermat/o/logist : physician specializing in treatment of skin disorders dermat/o: skin -logy study of dermat/o/logy : study of the skin and its diseases dermat/o: skin -therapy Treatment cry/o/therapy : destruction of tissue by freezing with liquid nitrogen cry/o: cold Cutaneous warts and actinic keratosis are common skin disorders that are responsive to cryotherapy treatment.

19. prefixes Andiaepi without, not an/hidr/osis : diminished or complete absence of sweat hidr: sweat -osis: abnormal condition; increase (used primarily with blood cells) dia/phoresis Andiaepi through, across dia/phoresis : condition of profuse sweating; also called sudoresis or hyperhidrosis -phoresis: carrying, transmission Andiaepi above, upon epi/derm/is: outermost layer of the skin derm: skin -is: noun ending Hyper- excessive, above normal hyper/hidr/osis : excessive or profuse sweating; also called diaphoresis or sudoresis hidr: sweat -osis: abnormal condition; increase (used primarily with blood cells) sub/ungu/ -sub under, below sub/ungu/al : pertaining to the area beneath the nail of a finger or toe ungu: nail -al: pertaining to, relating to

20. Pathology The general appearance and condition of the skin are clinically important because they may provide signs to body conditions or dysfunctions. Pale skin may indicate shock; red, flushed, very warm skin may indicate fever and infection. A rash may indicate allergies or local infections. Dermatology is the branch of medicine concerned with skin disease, and the relationship of cutaneous lesions to systemic disease. The physician who specializes in the diagnosis and treatment of skin disease is known as a dermatologist.

21. Skin Lesions Lesions are areas of pathologically altered tissue caused by disease, injury, or a wound due to external factors or internal disease. Evaluation of skin lesions, injuries, or changes to tissue helps establish the diagnosis of skin disorders. Lesions are described as 1.primary or secondary. Primary skin lesions are the initial reaction to pathologically altered tissue and may be flat or elevated. 2.Secondary skin lesions are the changes that take place in the primary lesion due to infection, scratching, trauma, or various stages of a disease. Lesions are also described by their appearance, color, location, and size as measured in centimeters.

23. The Primary Lesions1 Primary lesions are physical changes in the skin considered to be caused directly by the disease process. Types of primary lesions are rarely specific to a single disease entity. MACULE A macule is a change in the color of the skin. It is flat, if you were to close your eyes and run your fingers over the surface of a purely macular lesion, you could not detect it. A macule greater than 1 cm. may be referred to as a patch. MACULE PAPULEA papule is a solid raised lesion that has distinct borders and is less than 1 cm in diameter. Papules may have a variety of shapes in profile (domed, flat-topped, umbilicated) and may be associated with secondary features such as crusts or scales. PAPULE NODULE A nodule is a raised solid lesion more than 1 cm. and may be in the epidermis, dermis, or subcutaneous tissue. NODULE TUMOR A tumor is a solid mass of the skin or subcutaneous tissue; it is larger than a nodule. (Please bear in mind this definition does not at all mean that the lesion is a neoplasm.) TUMOR VESICLE Vesicles are raised lesions less than 1 cm. in diameter that are filled with clear fluid.VESICLE BULLAE Bullae are circumscribed fluid-filled lesions that are greater than 1 cm. in diameter. BULLAE PUSTULE Pustules are circumscribed elevated lesions that contain pus. They are most commonly infected (as in folliculitis) but may be sterile (as in pustular psoriasis)PUSTULE 9. WHEALA wheal is an area of edema in the upper epidermis.WHEAL

25. The Secondary Lesions Secondary lesions may evolve from primary lesions, or may be caused by external forces such as scratching, trauma, infection, or the healing process. The distinction between a primary and secondary lesion is not always clear. 1.SCALE Scale consists of flakes or plates that represent compacted desquamated layers of stratum corneum. Desquamation occurs when there are peeling sheets of scale following acute injury to the skin.SCALE 2.CRUST Crusting is the result of the drying of plasma or exudate on the skin. Please remember that crusting is different from scaling. The two terms refer to different phenomena and are not interchangeable. One can usually be distinguished from the other by appearance alone.CRUST 3.ATROPHY Atrophy is thinning or absence of the epidermis or subcutaneous fat.ATROPHY 4.LICHENIFICATION "Lichenification" refers to a thickening of the epidermis seen with exaggeration of normal skin lines. It is usually due to chronic rubbing or scratching of an area.LICHENIFICATION 5.EXCORIATION Excoriations are traumatized or abraded skin caused by scratching or rubbing.EXCORIATION 6.FISSURE A fissure is linear cleavage of skin which extends into the dermis.FISSURE 7.ULCERATION Ulcerations occur when there is necrosis of the epidermis and dermis and sometimes of the underlying subcutaneous tissue.ULCERATION 8. SCAR Scars are the permanent fibrotic changes that occur on the skin following damage to the dermis. Scars may have secondary pigment characteristics.SCAR 9. ESCHAR An eschar is a hard, usually darkened, plaque covering an ulcer implying extensive tissue necrosis, infarcts or gangrene.ESCHAR 10.KELOIDSKeloids are an exaggerated connective tissue response of injured skin that extend beyond the edges of the original wound

26. Burns 1.Burns are tissue injuries caused by contact with thermal, chemical, electrical, or radioactive\ agents. 2. generally occur on the skin, they can also involve the respiratory and digestive tract linings. 3.Burns that have a local effect (local tissue destruction) are not as serious as those that have a systemic effect. 4.Systemic effects are life threatening and may include: dehydration Shock infection. 5. urns are usually classified as first-, second-, or third- degree. 6. The extent of injury and degree of severity determine a burn’s classification.

27. 1. In first-degree burns, the epidermis is damaged. Symptoms are restricted to local effects, such as skin redness (erythema) and acute sensitivity to such sensory stimuli as touch, heat, or cold (hyperesthesia). A first-degree burn does not blister and heals without scar formation. Examples are damaged skin caused by sunburn or scalding with hot water. Second-degree burns are deep burns that damage both the epidermis and part of the dermis.

28. 1. Second-degree burns are more painful, and recovery is usually slow but complete with no scar formation 2.In third-degree burns, both the epidermis and the dermis are destroyed and some of the underlying connective tissue is damaged, leaving the skin waxy and charred with insensitivity to touch. Because of such extensive destruction, ulcerating wounds develop and the body attempts to heal itself by forming scar tissue. Skin grafts (dermatoplasty) are frequently used to assist recovery.