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Chapter 16: Skin
Find this out on page 650 in your book:
What the name for the system that includes skin? How much does our skin weigh? How much surface area does it cover?
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Chapter Goals
Name the layers of the skin and the accessory structures associated with the skin.
Build medical words using the combining forms that are related to the specialty of dermatology.
Identify lesions, signs, and symptoms, and pathologic conditions that relate to the skin.
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Chapter Goals
Describe laboratory tests and clinical procedures that pertain to the skin and recognize relevant abbreviations.
Apply your new knowledge to understanding medical terms in their proper contexts, such as medical reports and records.
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Introduction
● the skin and its accessory structures (hair, nails and glands) make up the integumentary system of
the body
● weighs 8-10 lb ● covers 22 square feet
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Functions of Skin
provides protective membrane - guards the deeper tissues against excessive loss of water, salts and heat - protects against pathogens
glands lubricate and cool the skin
receptor for sensations (pain, temp, pressure and touch)
helps maintain body temperature
(thermoregulation)
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Anatomy of the Skin
Epidermis: outermost, thin cellular membrane - contains keratin
Dermis: dense, fibrous, connective tissue layer - contains collagen
Subcutaneous tissue (hypodermis): thick, fat-
containing tissue
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Acessory Organs of the Skin
HAIR: cells filled with the hard protein; keratin
Hair follicles: shafts that hold the hair
Five million hairs on body; 100,000 on head Melanocytes at the root form the color Grow .5 inch (1.3 cm) per month Cutting does not affect growth
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Accessory Organs of the Skin
(cont’d)
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Accessory Organs of Skin
(cont’d)
NAILS: hard keratin
plates covering toes and fingers
lunula cuticle paronychium
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Accessory Organs of Skin
(cont’d)
GLANDS: sebaceous and sweat
Sebaceous glands secrete oily sebum into hair follicle to lubricate.
Sweat glands secrete into pores to moisten and cool.
Both are subject to bacterial growth.
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Accessory Organs of Skin
(cont’d)
Sebaceous gland:
Oil secreting gland in the dermis that is associated with hair follicles
Eccrine sweat gland:
Most numerous sweat producing exocrine gland
Apocrine sweat gland.
Sweat gland located in the axilla (armpit) and genital areas
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Colors – combining forms
● memorize this table
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Skin Pathology
CUTANEOUS LESIONS
● a lesion is an area of abnormal tissue anywhere on the body - it may be caused by trauma or disease
crust - collection of dried serum and cellular debris (scab, eczema, impetigo, seborrhea)
cyst - thick-walled, closed sac / pouch containing fluid or semisolid material
erosion - wearing away of the epidermis (dermoepidermal junction) - occur due to inflammation
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or injury
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Skin Pathology
CUTANEOUS LESIONS
fissure - grove or crack-like sore macule - flat lesion < 1cm in diameter (freckles, tattoo marks, flat moles)
nodule - solid, round or oval elevated lesion > 1cm in diameter (enlarge lymph node or solid growths)
papule - small (< 1cm), solid elevation of the skin (pimples - if confluent called plaques)
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Skin Pathology
CUTANEOUS LESIONS
polyp - growth extending from the surface of a mucous membrane (type of papule commonly found in nose / sinuses, colon, bladder and uterus)
pustule - papule containing pus (small abscess) ulcer - open sore on the skin or mucous membranes (deeper than an erosion)
vesicle - small collection (papule) of clear fluid (serum); blister (vesicles form in burns, allergies, dermatitis)
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Skin Pathology
CUTANEOUS LESIONS
wheal - smooth, edematous (swollen) papule or plaque that is redder or paler than the surrounding skin (often accompanied by itching and are seen in hives, anaphylaxis and insect bites)
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Cutaneous Lesions (p 662)
1. Crust 2. Cyst 3. Erosion 4. Fissure 5. Macule 6. Nodule 7. Papule 8. Polyp 9. Pustule 10.Ulcer 11.Vesicle 12.Wheal
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Signs and Symptoms
alopecia: absence of hair where it normally grows
alopecia or baldness may be hereditary (male pattern baldness) or it may be caused by disease, injury or treatment (chemotherapy)
alopecia areata - autoimmune disease - hair falls out in patches without scarring or inflammation
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Signs and Symptoms
ecchymosis: blue-black marks (bruise) on the skin
caused by hemorrhages into the skin from injury or spontaneous leaking of blood from vessels
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Signs and Symptoms
petechia: small pinpoint hemorrhage
smaller versions of ecchymoses - both ecchymoses and petechiae are forms of purpura (bleeding into the skin)
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Signs and Symptoms
pruritus - itching
symptom associated with most forms of dermatitis arises from stimulation of the nerves in the skin
urticaria: acute allergic reaction with red, round wheals on skin
commonly due to food allergies (shelfish and strawberries) localized edema occurs as well
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ABNORMAL CONDITIONS
acne: papular and pustular eruption of skin with increased production of sebum
acne vulgaris (ordinary) is a buildup of sebum and keratin in the pores of the skin
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ABNORMAL CONDITIONS
burns: injury to tissue due to heat, chemical, electric shock, lightning or radiation.
first-degree burn - superficial epidermal lesions,
erythema, hyperesthesia and no blisters
second-degree burn (partial thickness) - epidermal and
dermal lesions, erythema, blisters and hyperesthesia
second degree burn
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ABNORMAL CONDITIONS
burns: injury to tissue due to heat, chemical, electric shock, lightning or radiation
third-degree burns (full thickness) - epidermis and dermis are destroyed (necrosis) and subcutaneous layer damaged, leaving charred, white tissue
third degree burn
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ABNORMAL CONDITIONS
cellulitis: diffuse acute infection of skin marked by local heat, redness, pain and swelling
abscess formation and tissue destruction can occur without appropriate antibiotic therapy
eczema: inflammation of skin with erythematous, papulovesicular lesions caused by allergy
chronic or acute atopic dermatitis is accompanied by pruritus
treatment usually corticosteriods
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ABNORMAL CONDITIONS
exanthematous viral diseases: rash (exanthem) of
the skin due to virus
examples: rubella (German measles), rubeola (measles) and varicella (chicken pox)
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ABNORMAL CONDITIONS
gangrene: death of tissue associated with loss of blood supply
ischemia from injury, inflammation, frostbite, diabetes or arteriosclerosis can lead to necrosis followed by bacterial infection and putrefaction
impetigo: bacterial inflammatory skin disease characterized by vesicles, pustules and crusted-over lesions
contagious pyoderma caused by Staphylococci or
Streptococci
treatment with systemic antibiotics and cleaning lesions
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ABNORMAL CONDITIONS
psoriasis: chronic recurrent dermatosis marked by itchy, scaly, red plaques covered by silvery gray scales
not infectious or contagious but autoimmune - caused by in increased rate of growth of the basal layer of epidermis
scabies: contagious, parasitic infection (mites) of the skin with intense pruritus
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ABNORMAL CONDITIONS
scleroderma: chronic, progressive disease of skin and internal organs with hardening and shrinking of connective tissue (autoimmune)
fibrous, scar-like tissue forms in the skin, heart, lungs, kidneys and esophagus
palliative treatment - immunosuppressives / antiinflammatory agents, physical therapy
immunosuppressives
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ABNORMAL CONDITIONS
systemic lupus erythematosus (SLE): chronic
autoimmune disease of collagen in the skin, joints and internal organs
“butterfly” pattern of redness over cheeks and nose primarily affects females treatment includes corticosteroids and
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ABNORMAL CONDITIONS
tinea - infection of the skin caused by a fungus
tinea corporis (ringworm) - infection is in a ring-like pattern
- highly contagious with severe pruritis
tinea pedis (athletes foot), tinea capitis (scalp),tinea barbae
(under the beard), tinea unguiun (nails)
treatment with antifungal agents
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ABNORMAL CONDITIONS
vitiligo: loss of pigment (depigmentation) in areas of skin (milk-white patches)
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SKIN NEOPLASMS - BENIGN
callus - increased growth of cells in the keratin layer of the epidermis caused by pressure or friction
keloid - hypertrophied, thickened scar developing after trauma or surgical incision
excessive collagen formation in the skin during connective tissue repair
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SKIN NEOPLASMS - BENIGN
keratosis: thickened and rough lesion of the epidermis - associated with aging or skin dammage
leukoplakia: white thickened patches of the mucous membrane tissue of the tongue or cheek
nevus: pigmented lesion of the skin (moles)
dysplastic nevi - moles with atypical cells that may progress to skin cancer
verruca: epidermal growth (wart)
caused by a virus
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SKIN NEOPLASMS - MALIGNANT
basal cell carcinoma - malignant tumor of the basal
cell layer of the epidermis
most frequent type of skin cancer slow growing tumor - chronically sun-exposed skin almost never metastasizes treatment - surgical removal
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SKIN NEOPLASMS - MALIGNANT
squamous cell carcinoma - malignant tumor of the
squamous epithelial cells in the epidermis
● tumors may grow anywhere there is squamous epithelium
(mouth, larynx, bladder, esophagus, lungs)
● treatment - surgical removal, cryotherapy, electrodesiccation or radiotherapy
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SKIN NEOPLASMS - MALIGNANT
malignant melanoma - cancerous growth composed
of melanocytes
● genetic predisposition combined with exposure to ultraviolet light
● usually begins as a mottled, light brown to black macule with irregular borders - lesion may turn shades of red, blue, white and may crust and bleed
● often arise from preexisting moles (dysplastic nevi) and frequently appear on upper back, lower legs, arms and neck
● biopsy required to confirm diagnosis ● melanomas can metastasize to lung, liver, bone and brain ● treatment - excision, regional lymphadenectomy, chemotherapy / immunotherapy or radiotherapy
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SkinNeoplasms — Cancerous (cont’d)
the ABCDs of malignant melanoma.
A. asymmetry
B. border irregular
or circumscribed
C. color
varies from one area to another
D. Diameter
usually larger than 6mm
shades of brown, black (white, red, blue)
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SKIN NEOPLASMS - MALIGNANT
Kaposi sarcoma - malignant, vascular, neoplastic growth characterized by cutaneous nodules
● frequently arises on lower extremities ● nodules range in color from deep pink to dark blue or purple
● one form associated with AIDS
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