Integumentary System

Altered Functions

Vocabulary
DermaMelan/oPachySubtrich/oCyan/oOnych/oXer/oHidr/oKerat/oXanth/oFollicul/oDactyl/oIntra-

Integumentary Regions
Skin
Epidermis Dermis

Hypodermis Sensory receptors Muscle Adnexa

Hair and follicle Glands
Sweat Sebaceous

Nails

Epidermis Histology Overview

Epidermis Strata Histology

C = corneum G = granulosum S = spinosum B = basale

Underlying Disorders
Genetic Connective tissue Blood supply Neoplasia Drug Reactions Immune

Primary Lesions
Macules: colored circumscribed flat area, size varies, < 1cm Papules: discolored raised area, < 2cm Plaques: raised flat top area, > 1cm Patches: circumscribed flat area of discoloration, < 1cm Nodules: solid raised area, above or below skin, <1 cm Tumor: discolored raised area, > 2cm Wheals: slightly raised area with edema, size varies Vesicles/Blister: fluid filled raised area < 0.5cm Bulla/Cyst: fluid filled raised area, > 0.5cm Pustules: pus-filled raised area, size varies

Macule

Nodule

Papule

Bulla

Secondary Lesions
Erosions Ulcers Fissures Cracks Scales Excoriation Keloid Scar Lichenification

Cracks and Fissures

Ulcer and Erosion

Excoriation

Lichenification

Scar Formation

Keloid

Epidermal Cells

Keratinocytes

Keratinocyte Hypertrophy

Melanocyte location and function

Melanosomes with Melanin

Melanin

Melanosis

Langerhans Dendritic Cells

Skin Cancers

Skin Cancer ABCD and E (evolving)

Etiology
UV exposure
UV A UV B

Genetic Prevention
Sun block
UVA UVB

Clothing Window tinting

Skin Tumors
Benign
Seborrheic keratitis Keratocanthoma Verucae (warts) Actinic keratitis

Malignant
Basal Cell carcinoma Squamous Cell carcinoma Dysplastic nevi Malignant melanoma

Seborrheic Keratosis

Keratocanthoma

Verrucae

Actinic Keratitis

Basal Cell Carcinoma

Squamous Cell Carcinoma

Epidermal Cancers Compared

Malignant Melanoma

Merkel Cell Carcinoma

Dermis

Dermal Papilla and Reticular Dermis

Lines of Cleavage

Aging = Wrinkles?
Skin changes
Chronological aging Photo-aging (sun damage) Chemical toxins

Cause
Decrease in collagen (inactive fibroblasts) Increase in proteolytic activity due to collagenase

Hypodermis

Subcutaneous tissue

Clinical Application

Dermatitis (Eczema)
Atopic Contact Seborrheic Drug eruption Photo-eczematous

Dermatitis reactions

Presentation Papulovesicular Oozing with crusts Scaling plaques

Contact Dermatitis

Seborrheic Dermatitis

Dandruff; Cradle Cap

Drug Eruption

Photoeczematous
UV Genetic: Porphyria Drug Induced
Oral Topical

Lupus

Venous Stasis Dermatitis

Cutaneous Membrane

Insect Bites

Chiggers

Biting Flies

Mosquitoes

Spider Bites

Bacterial Lesion Appearance/ Causes

Furunculosis Folliculitis Impetigo Cellulitis Staph aureus Pseudomonas Gram (-) enterics Beta hemolytic Strep Mycobacterium Clostridium

MRSA
Bacteria: Staph. aureus Disease: Pyodermas Transmission:
Direct, topical Open wound entry

Culture and Sensitivity ID Drug Resistance

Beta lactamase Alternate method of cell wall synthesis

VRE
Vancomycin Risk factors
Hospitalization Immunocompromised Neutropenia ICU Dialysis

Impetigo
Staph; Strep Cut or scratch Honey colored oozing sores Lip / nose region After a cold Scratching can spread to other areas

Cellulitis

Gangrene

Streptococcus

Leprosy

Erysipelas
Group A Strep Cellulitis

Necrotizing Fasciitis
Strep pyogenes Fascial planes Source
Skin Bowel

Aka, Streptococcal gangrene Post op concern

Scarlet Fever

Fungal Infections

Microsporum Trichophyton Epidermophyton

Microsporum

Trichophton

Tinea Capitus

Tinea corpus

Tinea pedis

Epidermatophyton

Candida albicans

Viral Infections
Papilloma Herpes Morbillivirus Rubella Parvovirus

HPV

Papilloma

Herpes: HSV-1, HSV-2

Herpes: Varicella Zoster Virus

Shingles

Rubeola
Paramyxovirus 5 day or hard measles Respiratory spread Exanthem rash White spots in red Fever; cough Neurological

Rubella

Erythema Infectiosum (Fifth Disease)

Parvovirus B19 Mild rash (slapped cheek Face Limbs Trunk Respiratory secretions direct contact spread Pain, fever, itching

Idiopathic/Immune
Acne Psoriasis Rosacea Pemphigus Scleroderma Erythema multiforme Vitiligo

Acne Vulgaris

Propionibacterium acnes Staph epidermidis

Psoriasis

Rosacea

Pemphigus
Autoimmune Blistering

Scleroderma

Erythema Muliforme

Vitiligo

Urticaria

Porphyria

Genetic Enzyme Deficiency

Adnexa

Sweat Glands

Hair and Follicle

Hair/ Follicle Disorders

Alopecia Genetic: baldness
Male Female

Hirsutism Parasitic Infectious

Bacterial Fungal

Folliculitis

Scabies

Pediculosis

Head Louse

Body Louse

Nail Disorders
Clubbing Paronchyma Onchomycosis

Clubbing

Fungal Infections

Sensory

Burn Classification

Skin Layers Affected

Rule of 9s

Artificial Skin

Hormone EGF: Epidermal Growth Factor

Frostbite

Injury
Blunt force trauma: blows, impact injury Contusion Abrasion Laceration Sharp Force
Incised wound Stab wound Puncture wound

GSW

Puncture Wound

Laceration

Wounds compared

GSW

Entrance Wound

Exit Wounds

Summary

Process and Timeframe

Histology of Repair

Suture

Questions?

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