1. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Chapter 4 Integumentary System

2. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-2 Objectives  Identify organs and structures of the integumentary system.  Define and spell the word parts related to the integumentary system  Define, pronounce and spell disease and disorder terms related to the integumentary system.

3. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-3 Integumentary System Function  The skin forms a protective covering that when unbroken prevents entry of bacteria and other invading organisms. The skin also protects the body from water loss and from damaging effects of ultraviolet light. Other functions include regulation of body temperature and synthesis of vitamin D. The integumentary system comprises the skin, nails, and sweat and oil glands.

4. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-4 Structure of the Skin

5. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-5 Major Structures of the Skin  epidermis: outer layer of skin  keratin: horny, or cornified, layer composed of protein  melanin: color, or pigmentation, of skin  dermis (also called “true skin”): the inner layer of skin

6. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-6 Major Structures of the Skin (cont’d.)  sudoriferous glands: tiny, coiled, tubular structures that emerge through pores on skin’s surface  sebaceous glands: secrete sebum (oil) into the hair follicles, where the hair shafts pass through the dermis

7. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-7 Accessory Structures of the Skin  hair: compressed, keratinized cells that arise from hair follicles (sacs that enclose the hair fibers)  nails: originate in the epidermis; found on the upper surface of the ends of the fingers and toes

8. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-8 Combining Forms for the Integumentary System  cutane/o, derm/o, dermat/o - skin  hidr/o - sweat  kerat/o – hard, horny tissue  onych/o, ungu/o - nail  seb/o - sebum  trich/o - hair

9. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-9 Cross Section of the Skin

10. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-10 Combining Forms Commonly Used with Integumentary System Terms  aut/o - self  bi/o - life  coni/o - dust  crypt/o - hidden  heter/o - other  myc/o - fungus  necr/o – death; cells, body  pachy/o - thick  rhytid/o - wrinkles  staphyl/o - grapelike  strept/o - twisted  xer/o - dry

11. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-11 Prefixes  epi- - on, upon, over  intra- - within  para- - beside, beyond, around, abnormal  per- - through  sub- - under, below  trans- - through, across, beyond

12. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-12 Suffixes  -a – noun suffix no meaning  -coccus – berry shaped  -ectomy – excision or surgical removal  -ia – diseased or abnormal state, condition of  -itis - inflammation  -malacia - softening  -opsy – view of, viewing  -phagia – eating or swallowing  -plasty – surgical repair  -rrhea – flow, discharge  -tome – instrument used to cut

13. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-13 Clicker Question Which of the following means “eating or swallowing”? a) pachy/o b) -phagia c) -plasty

14. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-14 Disease and Disorder Terms Built From Word Parts  Dermatitis – inflammation of the skin  Dermatoconiosis – abnormal condition of the skin caused by dust  Dermatofibroma – fibrous tumor of the skin  Hidradenitis – inflammation of the sweat gland  Leiodermia – condition of smooth skin  Oncychocryptosis – abnormal condition of hidden or ingrown nail  Onychomalacia – softening of the nails

15. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-15  Onychomycosis – abnormal condition of fungus in the nails  Onychophagia – eating of the nails (nail biting)  Pachyderma – thickening of the skin  Paronychia – diseased state around the nail  Seborrhea – discharge of sebum  Trichomycosis – abnormal condition of fungus in the hair  Xeroderma – dry skin

16. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-16 The -a Ending The -a ending in the terms “pachyderma,” “xeroderma,” “erythroderma,” “leukoderma,” and “xanthoderma” is a noun suffix and has no meaning

17. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-17 Analyze and Define WR /CV/ WR / S onych/o/myc/osis abnormal condition CF / of fungus in the nail  dermatoconiosis  hydradenitis  dermatitis

18. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-18 Disease and Disorder Terms Not Built From Word Parts  Abrasion – scraping away of the skin by mechanical process or injury  Abscess – localized collection of pus  Acne – inflammatory disease of the skin involving sebaceous glands and hair follicles  actinic keratosis – precancerous skin condition of horny tissue formation that results excessive exposure to sunlight. May become squamous cell carcinoma  Albinism – congenital hereditary condition characterized by partial or total lack of pigment in the skin, hari, and eyes  basal cell carcinoma (BCC) – epithelial tumor arising from the epidermis. Seldom metastasizes but invades local tissue.  Candidiasis – an infection of the skin, mouth (also called thrush), or vagina cause by yeast. It is normally present in the mucous membranes; overgrowth causes an infection.

19. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-19  Carbuncle – skin infection composed of a cluster of boils caused by staphylococcal bacteria  Cellulitis – inflammation of the skin and subcutaneous tissue caused by infection leading redness, swelling and fever  Contusion – injury with no break in the skin, characterized by pain, swelling, and discoloration (bruise)  Eczema – noninfectious, inflammatory skin disease, characterized by redness, blisters, scabs and itching.  Fissure – slit or cracklike sore in the skin  Furuncle – painful skin node caused by staphylococcal bacteria in a hair follicle (boil)  Gangrene – death of tissue caused by loss of blood supply followed by bacterial invasion (form of necrosis)

20. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-20 Disease and Disorder Terms Not Built From Word Parts (cont’d.)  Herpes – inflammatory skin disease caused by herpes virus characterized by small blisters in clusters. Many types (simplex, zoster – causes shingles)  Impetigo – superficial skin infection characterized by pustules and caused by either staph or strep.  Kaposi sarcoma – cancerous condition starting as purple or brown papules on the lower extremities that spreads through the skin to the lymph nodes and internal organs. Seen a lot with AIDS.  Laceration – torn, ragged-edged wound  Lesion – any visible change in tissue resulting from injury or disease. Includes sores, wounds, ulcers, and tumors  Pediculosis – invasion into the skin and hair by lice  Psoriasis – chronic skin condition with red lesions and silvery scales  Rosacea – disorder of the skin that produces erythema, papules, pustules, and broken blood vessels, usually occurring on the central area of the face in people older than 30  Scabies – Skin infection caused by the itch mite. Papule eruptions from female burrowing and laying eggs. Severe itching.

21. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-21  Scleroderma – chronic hardening of the connective tissue of the skin and other body organs.  Shingles – development of painful, inflamed blisters that follow the nerve routes; cause by the same virus that causes chickenpox  squamous cell carcinoma (SqCCA) – a malignant growth that develops from scale-like epithelial tissue. Potential for metastasis. Chronic exposure to sunlight  systemic lupus erythematosus (SLE) – inflammatory disease involving the skin, joints, kidneys and nervous system. Autoimmune. Will go into remission. Can affect other organs.  Tinea – fungal infection of the skin. Affects keratin of skin, hair, nails. Tinea capitus (scalp), T. corporis (body), T pedis (foot)  Urticaria – itching skin eruption composed of sheals of varying size and shape. (Hives)

22. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-22 Common Skin Disorders

23. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-23 Common Skin Disorders (cont’d.)

24. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-24 Common Skin Disorders (cont’d.)

25. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-25 Cancers of the Skin Squamous cell carcinoma Melanoma Actinic keratosisBasal cell carcinoma Kaposi sarcoma

26. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-26 Clicker Question Shingles is also called a) tinea b) herpes zoster c) impetigo

27. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-27 Surgical Terms Built from Word Parts  Biopsy – Removal of living tissue to be viewed under microscope  Dermatoautoplasty – surgical repair using one’s own skin (autograft)  Dermatoheteroplasty – surgical repair using skin from others (allograft)  Dermatoplasty – surgical repair of the skin  Dermatome – instrument used to cut skin  Onychectomy – excision of a nail  Rhytidectomy – excision of wrinkles (facelift)  Rhytidoplasty – surgical repair of wrinkles

28. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-28 Surgical Terms Not Built from Word Parts  Cauterization – destruction of tissue with hot or cold insturments, electrical current or caustic substance (cautery)  Cryosurgery – destruction of tissue by using extreme cold (liquid nitrogen)  Debridement – removal of contaminated or dead tissue and foreign matter from an open wound  Dermabrasion – procedure to remove skin scars with abrasive material, such as sandpaper

29.  Excision – removal by cutting  Incision – surgical cut or wound produced by a sharp instrument  incision and drainage (I&D) – cut made to allow free flow or withdrawl of fluids from a lesion, wound or cavity  laser surgery – procedure using an instrument that emits a high powered beam of light used to cut, burn, vaporize, or destroy tissue  Mohs surgery – technique of microscopically controlled serial excisions of skin cancers  Suturing – to stitch edges of a wound surgically. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-29

30. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-30 Complementary Terms Built from Word Parts  Dermatologist – physician who studies and treats skin diseases  dermatology (derm) – study of the skin; diagnosis and treatment  Epidermal – pertaining to upon the skin  Erythroderma – red skin (abnormal redness)  Hypodermic – pertaining to under the skin  intradermal (ID) = pertaining to within the skin  Keratogenic – originating in horny tissue  Leukoderma – white skin (less color than normal)  Necrosis – abnormal condition of death (cells and tissues die)

31. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-31  Percutaneous – pertaining to through the skin  staphylococcus (staph) – berry shaped bacteria in grapelike clusters (pl. staphylococci)  streptococcus (strep) – berry shaped bacteria in twisted chains (pl. streptococci)  subcutaneous (subcut) – pertaining to under the skin  transdermal (TD) – pertaining to through the skin  Ungual – pertaining to the nail  Xanthoderma – yellow skin (jaundice)

32. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-32 Routes of Administration 1. Intradermal 2. Subcutaneous, hypodermic 3. Transdermal

33. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-33 Complementary Terms Not Built from Word Parts  Adipose – fat, fatty  Allergy – hypersensitivity to a substance  Alopecia – loss of hair  Bacteria – single-celled microorganisms that reporduce by cell division and may cause infection by invading body tissue  Cicatrix - scar  Cyst – a closed sac containing fluid or semisolid material  cytomegalovirus (CMV) – a herpes-type virus that usually causes disease when the immune system is compromised

34. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-34  Diaphoresis – profuse sweating  Ecchymosis – escape of blood into the tissues, causing superficial discoloration (bruise)  Edema – puffy swelling of tissue from the accumulation of fluid  Emollient – agent that softens or soothes the skin  Erythema - redness  Fungus – organism that feeds by absorbing organic molecules from its surroundings and my cause infection by invading body tissue; reproduces by budding (yeast); or spore formation (mold)  Induration – abnormal hard spots

35. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-35 Complementary Terms Not Built from Word Parts (cont’d.)  Jaundice – condition characterized by yellow tinge to the skin (xanthoderma)  Keloid – overgrowth of scar tissue  Leukoplakia – condition characterized by white spots or patches on the mucous membrane (precancerous?)  Macule – flat, colored spot on the skin  nevus (pL nevi) – circumscribed malformation of the skin, usually brown, black or flesh colored. Congenital is a birthmark, otherwise also called a mole.  Nodule – small knotlike mass that can be felt by touch  Pallor - paleness  Papule – small, solid skin elevation (pimple)  petechia (pl. petechiae) – a pinpoint skin hemorrhage

36. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-36  pressure ulcer (decub) – eroded sore on the skin caused by prolonged pressure, often occurring in bedridden patients. (decubitus ulcer or bed sore)  Pruritus – severe itching  Purpura – disorder characterized by hemorrhages into the tissue, giving the skin a purple-red discoloration  Pustule – elevation of the skin containing pus  Ulcer – eroded sore on the skin or mucous membrane

37.  Verruca – circumscribed cutaneous elevation caused by a virus (wart)  Vesicle – small elevation of the epidermis containing liquid (blister)  Virus – minute microorganism, much smaller than bacterium, characterized by a lack of independent metabolism and the ability to replicate only within living host cells; may cause infection by invading body tissue  Wheal = transitory, itchy elevation of the skin with a white center and a red surrounding area; a wheal is an individual urticaria (hive) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-37

38. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-38 Burn Keloid

39. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-39 Stage 2 Pressure Ulcer

40. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-40 Clicker Question The term which means profuse sweating is a) ecchymosis b) emollient c) diaphoresis

41. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-41 Abbreviations  BCC – basal cell carcinoma  Bx - biopsy  CMV = cytomegalovirus  Decub – pressure ulcer  Derm - dermatology  I & D – incision and drainage  I D - intradermal  SLE – systemic lupus erythematosus  SqCCA – squamous cell carcinoma  Staph - staphylococcus  Strep - streptococcus  Subcut - subcutaneous  TD - transdermal

42. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.4-42 Read Medical Terms In Use Emily visited the dermatology clinic because of pruritus secondary to dermatitis involving her scalp, arms, and legs. A diagnosis of psoriasis was made. Eczema, scabies, and tinea were considered in the differential diagnosis. An emollient cream was prescribed. In addition the patient showed the dermatologist the tender, discolored, thickened nall of her right great toe. Emily learned she had onychomycosis, for which she was given an additional prescription for an oral antifungal drug.