Transcript Anatomy & Physiology

Denver School of Nursing – ADN & BSN Programs
No Laboratory component for this class
BIO 206 & 308 – Week 11 CH29 & 39 Integument Path
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Epidermis
Dermis
Hypodermis
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Dermal appendages
 Nails
 Hair
 Sebaceous glands
 Eccrine and apocrine sweat glands
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Blood supply
 Papillary capillaries
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Macule
Papule
Patch
Plaque
Wheal
Nodule
Tumor
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Vesicle
Bulla
Pustule
Cyst
Telangiectasia
Scale
Lichenification
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Keloid
Scar
Excoriation
Fissure
Erosion
Ulcer
Atrophy
Macule is a circumscribed, flat discoloration that is
brown, blue, red, or hypopigmented
Papule is an elevated solid lesion up to
0.5 cm in diameter; color varies; papules
might fuse to form plaque
Vesicle, a circumscribed collection of free fluid up to
0.5cm in diameter
Ulcer is a focal loss of epidermis and dermis; ulcers
heal with scarrin
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Pressure ulcers result from any
unrelieved pressure on the skin,
causing underlying tissue damage
 Pressure
 Shearing forces
 Friction
 Moisture
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Stages
 SI - Nonblanchable erythema of intact skin
 SII - Partial-thickness skin loss involving
epidermis or dermis
 SIII - Full-thickness skin loss involving
damage or loss of subcutaneous tissue
 SIV - Full-thickness skin loss with damage
to muscle, bone, or supporting structures
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Stage I
Image source: http://www.hollister.com/
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Stage II
Image source: http://www.hollister.com/
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Stage III
Image source: http://www.hollister.com/
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Stage IV
Image source: http://www.hollister.com/
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Stage IV – Why these locations?
Image source: http://www.hollister.com/
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Images of Decubitus Ulcers were used from
Hollister Incorporated. Props to them for
helping to educate health care personnel in the
critical importance of proper skin care.
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Nutrition
Mobilization
Pressure
Shearing force
Moisture
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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
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disorders including:
 Psoriasis
 Adult Acne conditions
 Lupus erythematosus
 Pemphigus
 Psoriasis
 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
 Psoriasis – Non specific skin
Inflammation peak onset 15 – 35y/o
 Plaque psoriasis
 Inverse psoriasis
 Guttate psoriasis
 Pustular psoriasis
 Erythrodermic psoriasis
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Acne rosacea
 Most common in middle aged women
 Red central portion of the face with small
erythematous papules surmounted by
pinpoint pustules
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Acne vulgaris
 Inflammatory disease of the pilosebaceous follicles
 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
 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
 Pemphigus
 Tissue biopsies demonstrate
autoantibody presence
 Types
▪ Pemphigus vulgaris (most severe)
▪ Pemphigus foliaceus (less severe and has
presence of IgA)
▪ Pemphigus erythematosus (symptoms
resemble lupus erythematosus)
 Bacterial infections
 Folliculitis – inflammation of ?
 Furuncles – “boil” – pus filled colonization
 Carbuncles – multiple furuncles that often
fistula with dermis infections
 Cellulitis – Staph / Strep (Dermis & SQ)
 Erysipelas – type of Cellulitis - usually caused by
Group A Beta hemolytic Strep (Dermis)
 Impetigo – Same as cellulitis but NO SQ
 Viral
infections
 Herpes zoster and varicella
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Fungi causing superficial skin lesions
are called dermatophytes
Fungal disorders are called mycoses;
mycoses caused by dermatophytes are
termed tinea
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Tinea capitis (scalp)
Tinea pedis (athlete’s foot)
Tinea corporis (ringworm)
Tinea cruris (groin, jock itch)
Tinea unguium (nails) or onychomycosis
 Candidiasis
 Caused by Candida albicans
 Normally found on the skin, in the GI tract,
and in the vagina
 C. albicans can change from a commensal
organism to a pathogen
▪ Local environment of moisture and warmth,
systemic administration of antibiotics, pregnancy,
diabetes mellitus, Cushing’s disease, debilitated
states, age younger than 6 months,
immunosuppression, and neoplastic diseases
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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
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Scleroderma
 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
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Seborrheic keratosis
Keratoacanthoma
Actinic keratosis
Nevi (moles)
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Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma***
Kaposi sarcoma**
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75% increase in melanoma with
tanning booth exposure before age 30
FDA recommends tanning for teens
only with a signed consent form…by
their parents
>1,000,000 new skin cancers per year
in USA
 Ultraviolet light… sun & tanning booths
 Sunless tanning products
 Avoid “multiple mutations over time”
Image Source: googleimages.com
Image Source: medscape.com
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The following pictures are from an individual
named Heba that lives in Egypt, and she has
donated them to advance the future of
nursing. = )
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February 2010
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February 2010
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February 2010
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6 Months post grafting
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6 Months post grafting
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6 Months post grafting
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9 Months post grafting!
(November 2010)
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12 Months post grafting!
(January 2011)
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Special Thanks to Heba for allowing us to use her pictures to
help train the next generation of legendary nurses!
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Partial-thickness burns
 First degree
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Superficial and deep partial
 Second degree
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Full-thickness burns
 Third degree
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“Rule of nines”
Image Source: http://www.burn-recovery.org
Image Source: http://www.burn-recovery.org
Image Source: http://www.burn-recovery.org