1. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Skin, Hair, and Nails Chapter 12

2. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-2  Structure and Function  Subjective Data—Health History Questions  Objective Data—The Physical Exam  Abnormal Findings

3. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-3 Structure and Function  Epidermal appendages 1. Hair 2. Sebaceous glands 3. Sweat glands  Eccrine glands  Apocrine glands 4. Nails  Skin—three layers 1. Epidermis  Stratum germinativum or basal cell layer  Stratum corneum or horny cell layer  Derivation of skin color 2. Dermis  Connective tissue or collagen  Elastic tissue 3. Subcutaneous layer

4. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-4 Structure of Skin

5. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-5 Structure of Nails

6. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-6  Protection  Prevents penetration  Perception  Temperature regulation  Identification  Communication  Wound repair  Absorption and excretion  Production of vitamin D Function of the Skin

7. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-7 Subjective Data— Health History Questions  Previous history of skin disease (allergies, hives, psoriasis, or eczema)  Change in mole  Change in pigmentation (size or color)  Excessive dryness or moisture  Pruritus  Excessive bruising

8. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-8 Subjective Data— Health history questions (cont.)  Rash or lesion  Medications  Hair loss  Change in nails  Environmental or occupational hazards  Self-care behaviors

9. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-9 Objective Data—The Physical Exam  Preparation  External variables that influence skin color  Equipment needed  Strong direct lighting  Small centimeter ruler  Penlight  Gloves  For special procedures Wood’s light Wood’s light Magnifying glass Magnifying glass Materials for laboratory tests: KOH, glass slide Materials for laboratory tests: KOH, glass slide

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-10  Skin—Inspect and palpate  Color  General pigmentation  Widespread color change Pallor Pallor Erythema Erythema Cyanosis Cyanosis Jaundice Jaundice Objective Data—The Physical Exam (cont.)

11. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-11  Skin—Inspect and palpate (cont.)  Temperature  Hypothermia  Hyperthermia  Moisture  Diaphoresis  Dehydration Objective Data—The Physical Exam (cont.)

12. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-12  Skin—Inspect and palpate (cont.)  Texture  Thickness  Edema  Mobility and turgor  Vascularity or bruising Objective Data—The Physical Exam (cont.)

13. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-13 Objective Data— The Physical Exam (cont.)  Skin—Inspect and palpate (cont.)  Lesions  Color  Elevation  Pattern or shape  Size  Location and distribution on body  Exudate

14. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-14  Hair—Inspect and palpate  Color  Texture  Distribution  Lesions Objective Data—The Physical Exam (cont.)

15. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-15  Nails—Inspect and palpate  Shape and contour  Profile sign  Consistency  Color  Capillary refill Objective Data—The Physical Exam (cont.)

16. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-16  Promoting health and self-care  Teach skin self-examination, using the ABCDE rule  A—asymmetry  B—border  C—color  D—diameter  E—elevation and enlargement Objective Data—The Physical Exam (cont.)

17. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-17 Abnormal Findings Common Shapes and Configurations of Lesions  Annular or circular  Confluent  Discrete  Grouped  Gyrate  Target or iris  Linear  Polycyclic  Zosteriform

18. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-18 Annular or Circular

19. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-19 Confluent

20. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-20 Discrete

21. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-21 Grouped

22. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-22 Gyrate

23. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-23 Target

24. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-24 Linear

25. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-25 Polycyclic

26. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-26 Zosteriform

27. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-27 ─Urticaria (hives) ─Vesicle ─Cyst ─Bulla ─Pustule Primary skin lesions ─Macule ─Papule ─Patch ─Plaque ─Nodule ─Wheal ─Tumor ─Excoriation ─Scar ─Atrophic scar ─Lichenification ─Keloid Secondary skin lesions ─Crust ─Scale ─Fissure ─Erosion ─Ulcer Abnormal Findings Primary and Secondary Skin Lesions

28. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-28 Macule

29. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-29 Papule

30. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-30 Nodule

31. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-31 Wheal

32. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-32 Vesicle

33. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-33 Cyst

34. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-34 Pustule

35. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-35 Crust

36. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-36 Scale

37. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-37 Fissure

38. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-38 Erosion

39. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-39 Ulcer

40. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-40 Excoriation

41. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-41 Scar

42. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-42 Atrophic Scar

43. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-43 Lichenification

44. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-44 Keloid

45. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-45 Abnormal Findings Vascular Lesions  Hemangiomas  Port-wine stain (nevus flammeus)  Strawberry mark (immature hemangioma)  Cavernous hemangioma (mature)  Telangiectases  Spider or star angioma  Venous lake  Purpuric lesions  Petechiae  Purpura  Lesions caused by trauma or abuse  Pattern injury  Hematoma  Ecchymosis (bruise)

46. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-46 Lesions caused by trauma or abuse: Pattern injury

47. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-47 Lesions caused by trauma or abuse: Hematoma

48. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-48 Lesions caused by trauma or abuse: Ecchymosis

49. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-49 Abnormal Findings Common Skin Lesions in Children  Diaper dermatitis  Interigo (candidiasis)  Impetigo  Atopic dermatitis (eczema)  Measles (rubeola)  German measles (rubella)  Chickenpox (varicella)

50. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-50 Abnormal Findings Common Skin Lesions  Primary contact dermatitis  Allergic drug reaction  Tinea corporis (ringworm of the body)  Tinea pedis (ringworm of the foot)  Psoriasis  Tinea versicolor  Labial herpes simplex (cold sores)  Herpes zoster (shingles)  Erythema migrans of Lyme disease

51. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-51 Abnormal Findings Malignant Skin Lesions  Basal cell carcinoma  Squamous cell carcinoma  Malignant melanoma

52. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-52 Abnormal Findings Skin Lesions Associated with AIDS  Epidemic Kaposi’s sarcoma  Patch stage  Plaque stage  Advanced disease

53. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-53 Abnormal Findings Infectious Disease as a Biological Weapon  Anthrax  Smallpox (variola major)

54. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-54 Abnormal Findings Abnormal Conditions of Hair  Seborrheic dermatitis (cradle cap)  Tinea capitis (scalp ringworm)  Toxic alopecia  Alopecia areata  Traumatic alopecia, traction alopecia  Trichotillomania  Pediculosis capitis (head lice)  Folliculitis  Hirsutism  Furuncle and abscess

55. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-55 Abnormal Findings Abnormal Conditions of the Nails  Koilonychia (spoon nails)  Paronychia  Beau’s line  Splinter hemorrhages  Late clubbing  Onycholysis  Habit-tic dystrophy  Pitting

56. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-56 A patient who is admitted for liver failure would be likely to show which of the following skin changes? A.Cyanosis B.Flushing C.Rubor D.Jaundice

57. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 12: Chapter 12: Skin, Hair, and Nails Slide 12-57 The lesions in the illustration are best described as? A.Grouped B.Zosteriform C.Polycyclic D.Linear