CHAPTER 5

Integumentary System

Integumentary System
Skin
Integument or cutaneous membrane Epidermis Dermis Subcutaneous layer

Accessory structures
Hair Nails Glands
2

Layers and Structures of the Skin

Skin Lesions
Abrasion
Scraping or rubbing away of skin or mucous membrane as a result of friction to the area
Example: carpet burn

Abscess
Localized collection of pus in any body part that results from invasion of pus-forming bacteria
Example: pustule = small abscess
4

Skin Lesions
Bedsore
Ulcer in skin over a bony prominence Also known as pressure ulcer
Example: decubitus ulcer

Blister
Small, thin-walled lesion containing clear fluid Also known as a vesicle

Skin Lesions
Bulla
Large blister

Carbuncle
Circumscribed inflammation of skin and deeper tissues; contains pus

Comedo
Typical lesion of acne vulgaris
Example: whitehead = closed comedo Example: blackhead = open comedo
6

Skin Lesions
Cyst
Closed sac or pouch in or within the skin; contains fluid, semifluid, or solid material
Example: hydrocele = fluid-filled cyst Example: sebaceous cyst = solid-filled cyst

Skin Lesions
Fissure
Cracklike sore or groove in the skin or mucous membrane
Example: anal fissure

Fistula
Abnormal passageway between two tubular organs; or from an organ to the body surface
Example: recto-vaginal fistula

Skin Lesions
Hives
Circumscribed, slightly elevated lesions on skin; paler in center than surrounding edges Also called wheals
Example: mosquito bite

Laceration
Tear in skin; torn, jagged wound

Skin Lesions
Macule
Small flat, discoloration of the skin; neither raised nor depressed
Example: bruises, freckles

Nodule
Small, circumscribed swelling protruding above the skin

10

Skin Lesions
Papule
Small, solid, circumscribed elevation on the skin Example: pimple, wart, elevated mole

Polyp
Small, stalklike growth, protruding upward or outward from membrane surface Example: nasal polyp
11

Skin Lesions
Pustule
Small elevation of skin filled with pus
Example: small abscess on the skin

Scales
Thin flakes of hardened epithelium that are shed from the epidermis

Ulcer
Circumscribed, open sore or lesion of skin, accompanied by inflammation
Example: decubitus ulcer
12

Skin Lesions
Vesicle
Small, thin-walled, lesion containing clear fluid
Example: blister

Wheal
Circumscribed, slightly elevated lesion of the skin Paler in center than surrounding edges
Example: hives

13

PATHOLOGICAL CONDITIONS

Integumentary System

Acne Vulgaris
Pronounced
(ACK-nee-vul-GAY-ris)

Defined
Common inflammatory disorder seen on face, chest, back, and neck Appears as papules, pustules, and comedos

15

Albinism
Pronounced
(AL-bin-izm)

Defined
Condition characterized by absence of pigment in the skin, hair, and eyes

16

Burns
Defined
Tissue injury produced by flame, heat, chemicals, radiation, electricity, or gases Extent of damage determined by:
Mode and duration of exposure Thermal intensity or temperature Anatomic site of the burn

17

Burns
First-degree or superficial burns
Example: sunburn

Second-degree or partial-thickness burns

Example: flash contact with hot objects

Third-degree or full-thickness burns

Example: deep burns from a fire

18

Callus
Pronounced
(CAL-us)

Defined
Common, usually painless thickening of the epidermis at sites of external pressure or friction, such as weight-bearing areas of the feet and on the palmar surface of the hands
Also known as a callosity

19

Carcinoma, Basal Cell

Pronounced
(car-sih-NOH-mah BAY-sal sell)

Defined
Most common malignant tumor of epithelial tissue, occurring most often on areas of skin that are exposed to the sun
Presents as a slightly elevated nodule with a depression or ulceration in the center that becomes more obvious as the tumor grows
20

Carcinoma, Squamous Cell

Pronounced
(car-sih-NOH-mah SKWAY-mus sell )

Defined
Malignancy of the squamous, or scalelike, cells of the epithelial tissue Much faster growing than basal cell carcinoma Greater potential for metastasis if not treated
21

Carcinoma, Squamous Cell

Frequent sites on sun-exposed areas
Top of nose Forehead Margin of external ear Back of hands Lower lip

22

Dermatitis
Pronounced
(der-mah-TYE-tis)

Defined
Inflammation of skin, seen in several different forms Acute or chronic Contact or seborrheic

23

Eczema
Pronounced
(EK-zeh-mah)

Defined
Acute or chronic inflammatory skin condition characterized by erythema, papules, vesicles, pustules, scales, crusts, scabs, and itching

24

Exanthematous Viral Diseases

Pronounced
(eks-an-THEM-ah-tus viral diseases)

Defined
Skin eruption or rash accompanied by inflammation, having specific diagnostic features of an infectious viral disease

25

Exanthematous Viral Diseases

Examples:
Rubella = German Measles = 3 day measles Roseola Infantum Rubeola = Red Measles = 7-10 day measles Erythema Infectiosum = Fifth disease

26

Gangrene
Pronounced
(GANG-green)

Defined
Tissue death due to loss of adequate blood supply, invasion of bacteria, subsequent decay with foul odor

27

Herpes Zoster
Pronounced
(HER-peez ZOS-ter)

Defined
Acute viral infection, characterized by painful, vesicular eruptions on the skin that follow along nerve pathways of underlying spinal or cranial nerves Highest incidence in adults over 50

28

Herpes Zoster

Image courtesy of Robert A. Silverman, M.D., Pediatric Dermatology, Georgetown University

29

Impetigo
Pronounced
(Im-peh-TYE-goh)

Defined
Contagious superficial skin infection characterized by serous vesicles and pustules filled with millions of staphylococcus or streptococcus bacteria
Usually forming on the face

30

Kaposis Sarcoma
Pronounced
(CAP-oh-seez sar-KOH-ma)

Defined
Rare malignant lesions beginning as soft purple-brown nodules or plaques on the feet Gradually spreads throughout skin Increased incidence in men with AIDS

31

Keloid
Pronounced
(KEE-loyd)

Defined
Enlarged, irregularly shaped, elevated scar that forms due to the presence of large amounts of collagen during formation of a scar

32

Keratosis
Pronounced
(kair-ah-TOH-sis)

Defined
Skin condition in which there is a thickening and overgrowth of the cornified epithelium

33

Seborrheic Keratosis
Pronounced
(seb-oh-REE-ik kair-ah-TOH-sis)

Defined
Brown or waxy yellow wart-like lesions that are loosely attached to the skin Also known as senile warts

34

Actinic Keratosis
Pronounced
(ak-TIN-ic kair-ah-TOH-sis)

Defined
Premalignant, gray or red-to-brown, hardened lesion caused by excessive exposure to sunlight Also known as solar keratosis

35

Leukoplakia
Pronounced
(loo-koh-PLAY-kee-ah)

Defined
White, hard, thickened patches firmly attached to the mucous membrane
In mouth, vulva, or penis

36

Malignant Melanoma
Pronounced
(mah-LIG-nant mel-ah-NOH-mah)

Defined
Malignant skin tumor originating from melanocytes in preexisting nevi, freckles, or skin with pigment Darkly pigmented tumor with irregular surfaces and borders; variable colors
37

ABCDs of Malignant Melanomas

Asymmetry Borders Color Diameter

38

Nevus
Pronounced
(NEV-us)

Defined
Visual accumulation of melanocytes, creating a flat or raised rounded macule or papule with definite borders Commonly known as a mole

39

Onychocryptosis
Pronounced
(on-ih-koh-krip-TOH-sis)

Defined
Ingrown nail
Most commonly involves the large toe

40

Onychomycosis
Pronounced
(on-ih-koh-my-KOH-sis)

Defined
Fungal infection of the nails

41

Pediculosis
Pronounced
(pee-dik-you-LOH-sis)

Defined
Highly contagious parasitic infestation caused by blood-sucking lice

42

Pediculosis
Pediculosis capitis
Head

Pediculosis corporis
Body

Pediculosis palpebrarum
Eyelashes and eyelids

Pediculosis pubis
Pubic hair
43

Pemphigus
Pronounced
(PEM-fih-gus)

Defined
Rare, incurable disorder manifested by blisters in the mouth and on the skin Spreads to involve large areas of the body

44

Pilonidal Cyst
Pronounced
(pye-loh-NYE-dal SIST)

Defined
Closed sac located in the sacrococcygeal area of the back Sometimes noted at birth as a dimple

45

Psoriasis
Pronounced
(soh-RYE-ah-sis)

Defined
Common, noninfectious, chronic skin disorder manifested by silvery-white scales over round, raised, reddened plaques producing itching Pruritus

46

Rosacea
Pronounced
(roh-ZAY-she-ah)

Defined
Chronic inflammatory skin disease that mainly affects the skin of the middle third of the face
Characterized by persistent redness over the areas of the face, nose, and cheeks

47

Scabies
Pronounced
(SKAY-beez)

Defined
Highly contagious parasitic infestation caused by the human itch mite Resulting in a rash, pruritus, and a feeling in the skin of something crawling

48

Scleroderma
Pronounced
(sklair-ah-DER-mah)

Defined
Gradual thickening of the dermis and swelling of the hands and feet to a state in which the skin is anchored to the underlying tissue

49

Systemic Lupus Erythematosus

Pronounced
(sis-TEM-ic LOO-pus air-ih-them-ah-TOHsis)

Defined
Chronic, multi-system, inflammatory disease characterized by lesions of the nervous system and skin, renal problems, and vasculitis Characteristic Butterfly rash is often seen on nose and face
50

Tinea
Pronounced
(TIN-ee-ah)

Defined
Chronic fungal infection of the skin Characterized by scaling, itching, and sometimes painful lesions

51

Tinea
Tinea capitis
Scalp

Tinea corporis
Body

Tinea cruris
Groin

Tinea pedis
Foot
52

Verruca
Pronounced
(ver-ROO-kah)

Defined
Benign, circumscribed, elevated skin lesion that results from hypertrophy of the epidermis Commonly known as a wart

53

Verruca
Verruca vulgaris
Common wart on face, elbow, fingers, or hands

Plantar warts
Singly or in clusters on the sole of the foot

Venereal warts
Transmitted by sexual contact

Seborrheic warts
Seen in the elderly on the face, neck, chest, or upper back
54

DIAGNOSTIC TECHNIQUES, TREATMENTS AND PROCEDURES

Integumentary System

Diagnostic Techniques, Treatments, and Procedures

Allergy testing
Various procedures used to identify specific allergens in an individual by exposing the person to a very small quantity of the allergen

Cautery
Heat or caustic substances that burn and scar the skin

56

Diagnostic Techniques, Treatments, and Procedures

Cryosurgery
Noninvasive treatment that uses subfreezing temperature to freeze and destroy tissue

Curettage and electrodesiccation

Scraping away of abnormal tissue, followed by destroying the tumor base with a lowvoltage electrode

57

Diagnostic Techniques, Treatments, and Procedures

Debridement
Removal of debris, foreign objects, and damaged or necrotic tissue from a wound in order to prevent infection and promote healing

Dermabrasion
Removal of the epidermis and a portion of the dermis with sandpaper or brushes in order to eliminate superficial scars of unwanted tattoos
58

Diagnostic Techniques, Treatments, and Procedures

Dermatoplasty
Skin transplantation to a body surface damaged by injury or disease

Electrodesiccation
Technique using an electrical spark to burn and destroy tissue Also known as fulguration

59

Diagnostic Techniques, Treatments, and Procedures

Electrosurgery
Removal or destruction of tissue with an electrical current

Escharotomy
Incision made into the necrotic tissue resulting from a severe burn

60

Diagnostic Techniques, Treatments, and Procedures

Liposuction
Aspiration of fat through a suction cannula or curette to alter the body contours

Skin biopsy
Removal of a small piece of tissue from skin lesions for examination under a microscope to confirm or establish a diagnosis

61

Diagnostic Techniques, Treatments, and Procedures

Skin graft
Process of placing tissue on a recipient site, taken from a donor site, in order to provide the protective mechanisms of skin to an area unable to regenerate skin

Woods lamp
Ultraviolet light that is used to examine the scalp and skin for the purpose of observing fungal spores
62