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Structure and function of the integument
1.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1 Structure, Function, and Disorders of the Integument
2.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2 Layers of the Skin Epidermis Dermis Hypodermis
3.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3 Layers of the Skin (cont’d)
4.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4 Layers of the Skin (cont’d) Dermal appendages: Nails Hair Sebaceous glands Eccrine and apocrine sweat glands Blood supply Papillary capillaries
5.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5 Nails
6.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6 Aging and Skin Integrity The integumentary system reflects numerous changes from genetic and environmental factors The skin becomes thinner, drier, wrinkled, and demonstrates a change in pigmentation Shortening and decrease in the number of capillary loops Fewer melanocytes and Langerhans cells
7.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7 Aging and Skin Integrity (cont’d) The integumentary system reflects numerous changes from genetic and environmental factors (cont’d) Atrophy of the sebaceous, eccrine, and apocrine glands Changes in hair color Fewer hair follicles and growth of thinner hair
8.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8 Clinical Manifestations of Skin Dysfunction Macule Papule Patch Plaque Wheal Nodule Tumor Vesicle Bulla Pustule Cyst Telangiectasia Scale Lichenification Keloid Scar Excoriation Fissure Erosion Ulcer Atrophy
9.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9 Pressure Ulcers Pressure ulcers result from any unrelieved pressure on the skin, causing underlying tissue damage Pressure Shearing forces Friction Moisture
10.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10 Pressure Ulcers (cont’d)
11.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 Pressure Ulcers (cont’d) Stages: I. Nonblanchable erythema of intact skin II. Partial-thickness skin loss involving epidermis or dermis III. Full-thickness skin loss involving damage or loss of subcutaneous tissue IV. Full-thickness skin loss with damage to muscle, bone, or supporting structures
12.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12 Keloids Elevated, rounded, and firm Clawlike margins that extend beyond the original site of injury Excessive collagen formation during dermal connective tissue repair Common in darkly pigmented skin types and burn scars Type III collagen is increased
13.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13 Keloids (cont’d)
14.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14 Pruritus Itching Most common symptom of primary skin disorders Itch is carried by specific unmyelinated C- nerve fibers and is triggered by a number of itch mediators The CNS can modulate the itch response
15.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15 Pruritus (cont’d) Pain stimuli at lower intensities can induce itching Chronic itching can result in infections and scarring due to persistent scratching
16.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16 Disorders of the Skin Inflammatory disorders The most common inflammatory disorders of the skin are dermatitis or eczema There are various types of dermatitis The disorders are generally characterized by: • Pruritus • Lesions with indistinct borders • Epidermal changes
17.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17 Inflammatory Disorders Allergic contact dermatitis Caused by a hypersensitivity type IV reaction The allergen comes in contact with the skin, binds to a carrier protein to form a sensitizing antigen; Langerhans cells process the antigen and carry it to T cells, which become sensitized to the antigen Manifestations: • Erythema • Swelling • Pruritus • Vesicular lesions
18.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18 Allergic Contact Dermatitis
19.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19 Inflammatory Disorders Atopic dermatitis Type I hypersensitivity: activation of mast cells, eosinophils, T-lymphocytes, and other inflammatory cells Causes red, weeping crusts and chronic inflammation, lichenification
20.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20 Inflammatory Disorders (cont’d) Irritant contact dermatitis Nonimmunologic inflammation of the skin Chemical irritation from acids or prolonged exposure to irritating substances Symptoms similar to allergic contact dermatitis Treatment: remove stimulus
21.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21 Inflammatory Disorders (cont’d) Stasis dermatitis Occurs in the legs as a result of venous stasis, edema, and vascular trauma Sequence of events: • Erythema • Pruritus • Scaling • Petechiae • Ulcerations
22.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22 Inflammatory Disorders (cont’d) Seborrheic dermatitis Inflammation of the skin involving the scalp, eyebrows, eyelids, nasolabial folds, and ear canals Scaly, white, or yellowish plaques
23.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23 Stasis and Seborrheic Dermatitis
24.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24 Papulosquamous Disorders Psoriasis Chronic, relapsing, proliferative skin disorder T cell immune- mediated skin disease Scaly, thick, silvery, elevated lesions, usually on the scalp, elbows, or knees caused by a high rate of mitosis in the basale layer
25.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25 Papulosquamous Disorders (cont’d) Psoriasis (cont’d) Shows evidence of dermal and epidermal thickening Epidermal turnover goes from 26 to 30 days to 3 to 4 days Cells do not have time to mature or adequately keratinize
26.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26 Psoriasis
27.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27 Papulosquamous Disorders Psoriasis (cont’d) Plaque psoriasis Inverse psoriasis Guttate psoriasis Pustular psoriasis Erythrodermic psoriasis
28.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28 Papulosquamous Disorders (cont’d)
29.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29 Papulosquamous Disorders (cont’d) Pityriasis rosea Benign, self-limiting inflammatory disorder Usually occurs during the winter months Herald patch • Circular, demarcated, salmon-pink, 3- to 4-cm lesion
30.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30 Papulosquamous Disorders (cont’d)
31.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31 Papulosquamous Disorders (cont’d) Lichen planus Benign, inflammatory disorder of the skin and mucous membranes Unknown origin, but T cells, adhesion molecules, inflammatory cytokines, and antigen presenting cells are involved Nonscaling, violet-colored, 2- to 4-mm lesions Wrists, ankles, lower legs, genitalia
32.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32 Lichen Planus
33.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33 Papulosquamous Disorders Acne vulgaris Inflammatory disease of the pilosebaceous follicles Acne rosacea Inflammation of the skin that develops in adulthood Lesions • Erythematotelangiectatic, papulopustular, phymatous, and ocular • Associated with chronic, inappropriate vasodilation resulting in flushing and sensitivity to the sun
34.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34 Papulosquamous Disorders (cont’d) Lupus erythematosus Inflammatory, autoimmune disease with cutaneous manifestations Discoid lupus erythematosus • Restricted to the skin • Photosensitivity • Butterfly pattern over the nose and cheeks Systemic lupus erythematosus
35.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35 Discoid Lupus Erythematosus
36.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 36 Vesiculobullous Disorders Pemphigus Rare, chronic, blister-forming disease of the skin and oral mucous membranes Blisters form in the deep or superficial epidermis Autoimmune disease caused by circulating IgG autoantibodies • The antibodies are against the cell surface adhesion molecule, desmoglein in the suprabasal layer of the epidermis
37.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 37 Vesiculobullous Disorders (cont’d) Pemphigus (cont’d) Tissue biopsies demonstrate autoantibody presence Types: • Pemphigus vulgaris (severe) • Pemphigus foliaceus • Pemphigus erythematosus
38.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 38 Vesiculobullous Disorders (cont’d) Bullous pemphigoid More benign disease than pemphigus vulgaris Bound IgG and blistering of the subepidermal skin layer Subepidermal blistering and eosinophils distinguish pemphigoid from pemphigus
39.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 39 Bullous Pemphigoid
40.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 40 Vesiculobullous Disorders Erythema multiforme Acute, recurring disorder of the skin and mucous membranes Associated with allergic or toxic reactions to drugs or microorganisms Caused by immune complexes formed and deposited around dermal blood vessels, basement membranes, and keratinocytes
41.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 41 Vesiculobullous Disorders (cont’d) Erythema multiforme (cont’d) “Bull’s-eye” or target lesion • Erythematous regions surrounded by rings of alternating edema and inflammation Bullous lesions form erosions and crusts when they rupture Affects the mouth, air passages, esophagus, urethra, and conjunctiva Severe forms: • Stevens-Johnson syndrome (bullous form) • Toxic epidermal necrolysis
42.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 42 Infections Bacterial infections: Folliculitis Furuncles Carbuncles Cellulitis Erysipelas Impetigo
43.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 43 Furuncle
44.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 44 Infections Viral infections Herpes zoster and varicella
45.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 45 Herpes Simplex Virus
46.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 46 Warts Benign lesions caused by the human papillomavirus (HPV) Diagnosed by visualization Condylomata acuminata Venereal warts
47.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 47 Fungal Infections Fungi causing superficial skin lesions are called dermatophytes Fungal disorders are called mycoses; mycoses caused by dermatophytes are termed tinea Tinea capitis (scalp) Tinea pedis (athlete’s foot) Tinea corporis (ringworm) Tinea cruris (groin, jock itch) Tinea unguium (nails) or onychomycosis
48.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 48 Tinea Pedis
49.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 49 Fungal Infections Candidiasis Caused by Candida albicans Normally found on the skin, in the GI tract, and in the vagina Candida albicans can change from a commensal organism to a pathogen • Local environment of moisture and warmth • Systemic administration of antibiotics • Pregnancy • Diabetes mellitus • Cushing disease • Debilitated states • Age younger than 6 months • Immunosuppression • Neoplastic diseases
50.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 50 Vascular Disorders Cutaneous vasculitis Results from immune complexes in the small blood vessels • Develops from drugs, bacterial infections, viral infections, or allergens Lesions • Palpable purpura progressing to hemorrhagic bullae with necrosis and ulceration
51.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 51 Vascular Disorders (cont’d) Urticaria Caused by type I hypersensitivity reactions to allergens Histamine release causes endothelial cells of the skin to contract • Causes leakage of fluid from the vessels Treatment • Antihistamines and steroids
52.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 52 Vascular Disorders (cont’d) Scleroderma Sclerosis of the skin that can progress to the internal organs The disease is associated with several antibodies Lesions exhibit massive deposits of collagen with inflammation, vascular changes, and capillary dilation Skin is hard, hypopigmented, taut, and tightly connected to underlying tissue
53.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 53 Vascular Disorders (cont’d) Scleroderma (cont’d) Facial skin becomes very tight Fingers become tapered and flexed; nails and fingertips can be lost from atrophy Mouth may not open completely 50% of patients die within 5 years
54.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 54 Scleroderma
55.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 55 Insect Bites Bees Mosquitoes Flies
56.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 56 Benign Tumors Seborrheic keratosis Keratoacanthoma Actinic keratosis Nevi (moles)
57.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 57 Seborrheic Keratosis
58.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 58 Cancer Basal cell carcinoma Squamous cell carcinoma Malignant melanoma Kaposi sarcoma
59.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 59 Basal Cell Carcinoma
60.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 60 Squamous Cell Carcinoma
61.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 61 Malignant Melanoma
62.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 62 Kaposi Sarcoma
63.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 63 Burns Partial-thickness burns First degree Superficial and deep partial Second degree Full-thickness burns Third degree “Rule of nines”
64.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 64 Superficial Partial-Thickness Burn
65.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 65 Axillary Burn Scar Contracture
66.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 66 Deep Partial-Thickness Burn
67.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 67 Full-Thickness Burn
68.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 68 Estimating Burn Injury
69.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 69 Burns
70.
Mosby items and
derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 70 Hypertrophic Scarring
71.
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derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 71 Cultured Epithelial Autograft
72.
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derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 72 Frostbite Skin injury caused by exposure to extreme cold Usually affects fingers, toes, ears, nose, and cheeks The “burning reaction” is caused by alternating cycles of vasoconstriction and vasodilation Inflammation and reperfusion are both part of the pathophysiology
73.
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derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 73 Disorders of the Hair Male-pattern alopecia Genetically predisposed response to androgens Androgen-sensitive and androgen-insensitive follicles
74.
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derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 74 Disorders of the Hair (cont’d) Female-pattern alopecia Associated with elevated levels of the serum adrenal androgen dehydroepiandrosterone sulfate No loss of hair along the frontal hairline
75.
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derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 75 Disorders of the Hair (cont’d) Alopecia areata Autoimmune T cell-mediated inflammatory disease against hair follicles that results in baldness Hirsutism Androgen-sensitive areas • Abnormal growth and distribution of hair on the face, body, and pubic area in a male pattern that occurs in women
76.
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derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 76 Disorders of the Nail Paronychia Acute or chronic infection of the cuticle Onychomycosis Fungal or dermatophyte infection of the nail plate
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