Structure, Function, and Disorders of the Integument

Structure, Function, and Disorders of the Integument

Anatomy and Physiology
The skin (combined with its appendages) is the largest organ of the body Hair Nails Sebaceous glands Eccrine and apocrine sweat glands

Function of Skin Cover- protects from germs, dehydration, injury
First line of defense Regulates body temperature Site of many nerve endings Body temp regulation- evaporation of h20 (sweat) rids body of heat. Dogs

Skin Functions Regulates body temperature Helps regulate fluid balance
regulates heat loss Helps regulate fluid balance absorbs water prevents excessive water & electrolyte loss. Slow loss up to 600 ml daily by evaporation Immune Response Function inflammatory process

Skin Functions Vitamin production
exposure to UV light allows for the conversion of substances necessary for synthesizing vitamin D Necessary to prevent osteoporosis, rickets

Temporary storage of glucose, fat, water and salt.
Can absorb chemical substances Nitroglycerin patch Ointment for rashes

Functional Review Protector and barrier between internal organs and external environment Barrier against foreign body intrusions against invading bacteria and foreign matter Transmits sensation – nerve receptors allows for feelings of temperature, pain, light touch and pressure

Maintains body surface integrity by ongoing cell replacement and increased regeneration for wound repair Maintains a buffered protective skin film by eccrine and sebaceous glands to protect against microbial and fungal agents

Delays hypersensitivity reactions to foreign substances Indicates emotion through color change

One Square Centimeter of Skin Contains...
3,000,000 cells 10 hairs. 1 yard of blood vessels. 4 yards of nerves. 700 sweat glands. 200 nerve endings to record pain. 3000 sensory cells at the end of nerve fibers

Skin- 3 basic layers Epidermis- epithelial cells with no blood
Avascular Dermis- True skin made of connective tissue and is vascular Hypodermis- aka subcutaneous. Attaches integument to muscle Stratum geminativum

Layers of the Skin Dermis Subcutaneous layer
Collagen, elastin, reticulum, and a gel-like ground substance Hair follicles, sebaceous glands, sweat glands, blood vessels, lymphatic vessels, nerves Fibroblasts, mast cells, macrophages Subcutaneous layer Adipocytes Dermal and subcutaneous collagen are continuous

Layers of the Skin Dermal appendages Blood supply Nails Hair
Sebaceous glands Eccrine and apocrine sweat glands Blood supply Papillary capillaries

Aging and Skin Integrity
The integumentary system reflects numerous changes from genetic and environmental factors The skin becomes thinner, drier, wrinkled, and demonstrates a changes in pigmentation Shortening and decrease in the number of capillary loops Fewer melanocytes and Langerhans cells

Aging and Skin Integrity
Atrophy of the sebaceous, eccrine, and apocrine glands Changes in hair color Fewer hair follicles and growth of thinner hair

Gerontology Considerations
Watch for significant changes in aging: Decrease immunity functions Susceptibility to infections Poor nutrition Decrease collagen production – loss of subcutaneous Thinning of epidermal skin layers Increase skin problems

Gerontology Considerations
Taking more medications Excessive environmental exposure Dryness, wrinkling Uneven pigmentation Various proliferative lesions

Characteristics of skin lesions
ATROPHY Thinning of the skin surface and loss of skin markings Skin appears translucent and paperlike

Cherry Angiomas Elderly bright red moles on the skin Papules Benign

History and Examination
Relevant information; - systemic disease diabetes, hepatitis use of medications toxic epidermal necrolysis similar cases in family atopy - longterm sun exposure tumours occupation contact dermatitis geographic location insect bites, lyme disease - previous skin diseases - sexual history syphilis, gonorrhea history of particular lesion, movement, size

Assessment of the Skin Prepare the patient: explain the purpose and provide privacy and coverings Ask assessment questions Inspect the patient’s entire body including mucosa, scalp, hair, and nails

Assessment of the Skin Wear gloves
Assess any lesions; palpate and measure them Note hair distribution Photographs may be used to document nature and extent of skin conditions and to document progress resulting from treatment; they may also be used to track moles

Skin Assessment Visual inspection Palpation Olfactory senses
Adequate lighting Remove necessary clothing while providing respect and privacy Appropriate client positions

Assessing the Skin Lesions: Lightly palpate any lesions to detect tenderness, firmness, and depth. Measure length, width, and depth also. Birthmarks/Moles: Note location, color, shape, and size. Assess with the following four warning signs (ABCD) that might indicate the presence of skin cancer: A little later

Visible changes if the Skin
Changes in skin color texture Eczema, infections Assess the vascularity & hydration of skin Edema – swelling, pitting edema mm mm mm mm Nails – configuration, consistency, color Hair – color and distribution, alopecia, location

Visual inspection Skin color: Palor Cyanosis Jaundice Erythema
Hyperpigmentation Hypopigmentation – vitiligo

Assessing light to dark skin
Description Light skin Dark skin Cyanosis - bluish Bluish tinge Ashen gray Pallor - paleness Loss of rosy glow Ashen gray (dark skin) Yellowish brown (brown skin) Erythema - redness Visible redness Diffused; rely on palpation of warmth or edema Petechiae – small size pinpoint ecchyumosis Purplish pinpoints Usually invisible; check oral Mucosa, conjunctiva, eyelids, conjunctiva covering eyeballs.

Assessing light to dark skin
Description Light skin Dark skin Jaundice - yellow Yellow sclera, skin, fingernails, soles, palms, oral mucosa Reliable on sclera, hard palate, palms and soles. Ecchymosis – large diffused bluish black Purplish to yellow-green Difficult to see, check mouth or conjunctiva Brown-Tan – cortisol deficiency, increased melanin production Bronze; Tan to light brown Easily masked.

A particular terminology has developed to define skin lesions
Description A particular terminology has developed to define skin lesions primary: describes morphology or lesion type macule, papule, plaque, wheal, cyst, nodule, tumor, vesicle, bulla and pustule. secondary: configuration, texture, scale, crust, lichenification, scar, excoriation, fissure, ulceration, ulcer, erosion and atrophy. vascular lesions: blood sequellae, pathology purpura, petechiae, ecchymoses, telangiectasia shape: annular, serpiginous, flat-topped, domed

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 Circumscribed Flat Discoloration Brown Blue Red Hypo-pigmented

MACULE Freckles Flat moles (nevi) Petechiae Measles Scarlet fever Macule/patch (mongolian spot)

molluscum contagiosum
Papule Solid raised lesion that has distinct borders and is less than 1 cm in diameter. May have a variety of shapes in profile (domed, flat-topped, umbilicated) and may be associated with secondary features such as crusts or scales scabies molluscum contagiosum

PAPULE Circumscribed Elevated Superficial Solid lesion > 0.5 cm in diameter Often confluent

PAPULE Wart Elevated mole Lichen planus Venereal wart

PLAQUE Elevated Firm Rough Flat-top > 1cm in diameter A solid, raised, flat-topped lesion greater than 1 cm. in diameter. It is analogous to the geological formation, the plateau PLAQUE Psoriasis Seborrheic keratoses Actinic keratoses Plaque (psoriasis)

Wheal (hive) WHEAL Elevated Irregular shaped Cutaneous edema Solid
An area of edema in the upper epidermis “Edematous, transient papule or plaque caused by infiltration of dermis by fluid WHEAL Elevated Irregular shaped Cutaneous edema Solid Transient Variable diameter An elevated, white to pink edematous lesion that is unstable and associated with pruritus. Wheals are evanescent – they appear and disappear quickly. Seen in mosquito bites and hives.

WHEAL Urticaria Insect bite Allergic reaction Desired technique

Deeper in dermis than a papule
Nodule Nodule is a raised solid lesion more than 1 cm. and may be in the epidermis, dermis, or subcutaneous tissue NODULE Elevated Firm Circumscribed Deeper in dermis than a papule 1-2 cm in diameter

NODULE Erythema nodosum Lipoma

TUMOR Elevated Solid May or may not be clearly demarcated Deeper in dermis >2 cm in diameter

TUMOR Neoplasm Benign Lipoma hemangioma

VESICLE Elevated Circumscribed Superficial Filled with serous fluid <1 cm in diameter

Vesicle Raised lesions less than 5mm. in diameter that are filled with clear fluid (blister)

VESICLE Varicella (chicken pox) Herpes Zoster (shingles)

BULLA Vesicle greater than 1 cm in diameter

BULLA Blister Pemphigus vulgaris

PUSTULE Elevated Superficial Similar to vesicle but filled with purulent fluid Circumscribed elevated lesions that contain pus They are most commonly infected (as in folliculitis) but may be sterile (as in pustular psoriasis)

PUSTULE Impetigo acne

Cyst Elevated Circumscribed Encapsulated In dermis or subcutaneous layer Filled with liquid or semisolid material

ULCER Loss of epidermis and dermis Concave Varies in size

FISSURE Linear crack or break from the epidermis to the dermis May be moist or dry

FISSURE Athlete’s foot Crack at the corner of the mouth

SCALE Heaped-up Keratinized cells Flaky skin Irregular Thick or thin Dry or oily Variation in size

SCALE Flaking of skin with seborrheic dermatitis following Scarlet fever Drug reaction Dry skin

LICHENIFICATION Rough Thickened epidermis secondary to persistent rubbing, itching, or skin irritation Often involves flexor surface of extremities

LICHENIFICATION Chronic dermatitis Eczema Contact dermatitis.

EROSION Loss of part of the epidermis Depressed Moist Glistening Follows rupture of a vesicle or bulla

EROSION Varicella Variola after rupture

TELANGIECTASIA Fine Dilation of capillaries Irregular red line

PURPURA Red-purple nonblanchable discoloration Greater than 0.5 cm in diameter

SPIDER ANGIOMA Red central body with radiating spider-like legs Blanch with pressure to central body

Close-up of a spider angioma in a male with cirrhosis of the liver These are AV fistulas and will disappear when the central portion of the lesion is compressed. SPIDER ANGIOMA Liver disease Vitamin B deficiency idiopathic

PETECHIAE Red-purple nonblanchable discoloration

PETECHIAE Intravascular defects Infection Found in the mouth Vancomycin-Induced Thrombocytopenia

VENOUS STAR A small red nodule formed by a dilated vein in the skin. Caused by increased venous pressure Bluish spider Linear or irregularly shaped Does not blanch with pressure

VENOUS STAR Increased pressure in superficial veins

CAPILLARY HEMANGIOMA (Nevus flammeus) Red Irregular Macular patches

CAPILLARY HEMANGIOMA (Nevus flammeus) Dilation of dermal capillaries

Structure, Function, and Disorders of the Integument

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Structure, Function, and Disorders of the Integument

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