Flashcards in Ch. 13: Integumentary Function Deck (161):
what are the structures of the integumentary system?
skin, hair, nails, mucous membranes, and glands
what are the disorders that can occur with the integumentary system?
congenital defects, advancing age, inflammation, infections, and cancers
what is the hypodermis made of?
soft fatty tissue as well as blood vessels, nerves, and immune cells
what is the dermis made of?
dense irregular connective tissue and very little fat tissue. contains nerves, hair follicles, smooth muscle, glands, blood vessels, and lymphatic vessels
secrete sweat through skin pores in response to the sympathetic nervous system
eccrine glands or merocrine glands
sweat glands that open into hair follicles in the axillae, scalp, face, and external genitalia
skin anomalies that are present at birth or shortly after. most are harmless and may even shrink or disappear with age
what are the ways in which birthmarks may appear?
may be flat or raised, have regular or irregular borders, and have different shades of coloring including black, tan, brown, pale blue, pink, red, or purple
birthmarks that arise from blood vessels that have not formed correctly. what color are these most likely to be?
vascular birthmarks are usually red
what are the different types of vascular birthmarks?
macular stains, port-wine stains, hemangiomas
most common type of vascular birthmark. faint red marks that usually occur on forehead, eyelids, posterior neck, nose, upper lip, or posterior head
when may macular stains be more noticeable?
when the child is crying
by what age are most macular stains gone?
most often fade on their own by 2 years of age, but they may last into adulthood
what are macular stains also known as?
salmon patches, angel kisses, and stork bites
birthmarks that appear as a bright red patch or a nodule of extra blood vessels in the skin
hemangioma or strawberry
what color with deep hemangiomas be? why?
bluish because they involve deeper blood vessels
when do hemangiomas grow?
grow during the first year of life and then usually recede over time
where are many hemangiomas found?
on the head and neck, but they can be anywhere
when will hemangiomas cause complications?
when their location interferes with sight, feeding, breathing, or other bodily functions
discolorations that look like wine was spilled on an area of the body
where do port-wine stains most often occur?
face, neck, arms, and legs
how do port-wine stains change over time?
can be any size, but only grow as the child grows. tend to darken over time and can thicken and have a cobblestone texture in mid adulthood unless treated
will port-wine stains resolve on their own? when should they be assessed for complications?
no, they will not resolve spontaneously. those occuring near the eye should be assessed for possible complications
birthmarks made of clusters of pigmented cells, which cause color in skin
what colors are pigmented birthmarks?
can be many different colors from tan to brown, gray to black, or even blue
what are the most common pigmented birthmarks?
cafe au lai spots, mongolian spots, and moles
very common birthmarks that are the color of coffee
cafe au lait spots
when should a child with cafe au lait spots be evaluated?
if he or she has several spots larger than a quarter - this can be a sign of neurofibromatosis
flat, bluish-gray patches often found on the lower back or buttocks and are more common in individuals with darker complexions
do mongolian spots usually fade?
yes, they usually fade often without treatment by school age
general term for brown nevi
when present at birth, what is a mole called
a congenital nevus and will last a life time
how may a mole appear?
may be tan brown, or black; can be flat or raised; may have hair growth
what can disorders involving melanin result in?
alterations in skin coloring. can leave skin vulnerable to the harmful effects of UV light.
what the disorders involving melanin?
albinism and vitiligo
recessive condition that results in little or no melanin production
why do all forms of albinism cause problems with eye development and function?
melanin plays a role in the development of certain optical nerves
what are the two major types of albinism and how are they different?
type I - caused by defects that affect melanin production
type II - caused by a defect in the P gene; have slight coloring at birth
what is the most severe form of albinism? what do people with this condition look like?
oculocutaneous albinism. have white or pink hair, skin, and iris color and vision problems
type of albinism that affects only the eyes. the affected person's skin and eye colors are usually normal but there is no coloring of the retina
ocular albinism type I
type of albinism caused by a single gene; it can occur with a bleeding disorder as well as with lung and bowel diseases
type of albinism that causes a lack of coloring all over the skin, but not complete
type of localized albinism that causes small areas without skin coloring
type of localized albinism where often a lock of hair that grows on the forehead is affected, or no coloring is present in one or both irises
what are the clinical manifestations of albinism?
skin changes - many result in milky white skin, but skin pigmentation can range from white to nearly the same as relatives without albinism.
hair changes - hair can range from very white to brown. may also have hair that is reddish, yellow, or brown
eye changes - eye color ranges from very light blue to brown and may change with age. somewhat translucent. can appear to be red because of red reflex.
vision changes - nystagmus, strabismus, extreme nearsightedness or farsightedness, photobia, astigmatism, functional blindness
will a person's skin always stay the same color with they have albinism?
no, melanin production may begin or increase during childhood and adolescence, resulting in slight increases in pigmentation; hair color may also change by early adulthood
does albinism impair intellectual development?
no, but people with albinism often experience feelings of social isolation and may experience descrimination. visual issues may become an educational challenge
rare condition characterized by small patchy areas of hypopigmentation
when does vitiligo occur?
when the cells that produce melanin die or no longer form melanin, causing slowly enlarging white patches of irregular shapes on the skin
what races does vitiligo affect?
affects all races, but is more easily seen in people with darker pigmented skin
what are potential causes of vitiligo?
autoimmune conditions, genetic influences, sunburn, and emotional stress. has also been associated with perinicious anemia, hypothyroidism, and Addison's disease
where does depigmentation of vitiligo usually develop first?
on sun exposed areas
when does vitiligo usually first appear?
between 10 and 30 years of age
vitiligo usually appears in one of three patterns. what are these patterns?
focal - depigmentation is limited to one or a few areas of the body
segmental - depigmentation occurs on only one side of the body
generalized - depigmentation is widely spread across many parts of the body, often symmetrically
what are the clinical manifestations of vitiligo?
patchy skin depigmentation, depigmentation of the hair, mucous membranes, and retina
what changes in sensation occur with aging?
pain, vibration, cold, heat, pressure, and touch sensations usually decrease. this may be related to decreased blood flow
what things can influence age related changes to the skin?
environmental factors, genetic makeup, and nutrition contribute to changes, but the greatest single contributing factor is sun exposure
who are more likely to show aging skin changes?
blue-eyed, fair-skinned people are more likely to show these changes than people with darker, more heavily pigmented skin
what happens to the epidermis with aging?
it thins, but the number of cell layers remain unchanged. the number of melanocytes decreases, but the remaining melanocytes increase in size
what do age related changes in the connective tissue cause?
reduced skin strength and elasticity, especially in sun exposed areas of the skin
what happens to the blood vessels in the dermis with aging?
they become fragile, which can lead to bruising, cherry angiomas, and other similar conditions
what age related changes occur in the sebaceous glands?
decreased production of sebum which can lead to difficulty maintaining skin moisture resulting in dryness and itching
what age related changes occur in the subcutaneous layer? what can these cause?
thins with age. increases risk of skin injury and reduces the ability to maintain body temperature. this layer also absorbs some medications, so loss of this layer changes the actions of these medications
what age related changes occur with sweat glands? what can this cause?
produce less sweat. causes difficulty controlling body temperature
benign, soft brown or flesh colored masses that usually occur on the neck and are more common in obese people or those who have diabetes mellitus
are inflammatory integumentary disorders contagious?
acute inflammatory reaction triggered by direct exposure to an irritant or allergen-producing substance. not contagious or life-threatening
what does contact dermatitis vary in severity depending on?
the substance, the area affected, exposure extent, and individual sensitivity
what things can cause irritant contact dermatitis?
chemicals, acids, rubber gloves, and soaps
does irritant contact dermatitis involve the immune system?
no, just the inflammatory response
what are the manifestations of irritant contact dermatitis?
reaction similar to a burn, typically includes erythema and edema but may also include pain, pruruitis, and vesicles (blisters)
what things does allergic contact dermatitis result from?
metals, chemicals, adhesives, cosmetics, and plants. sensitization occurs on the first exposure to the substance, and subsequent exposures to the substance produce manifestations
what type of response is allergic contact dermatitis?
type IV cell-mediated hypersensitivity reaction
when do manifestations of allergic contact dermatitis usually appear? what are they?
24-48 hours after exposure. pruritis, erythema, and edema at the site, but small vesicles may also be present
chronic inflammatory condition that follows an inherited tendency and may be accompanied by asthma and allergic rhinitis. typically affects infants and usually resolves by early adulthood. characterized by remissions and exacerbations.
what might be the cause of atopic eczema?
may result from an immune system malfunction, similar to hypersensitivity. Not caused by allergens!
what complications may occur with atopic eczema?
secondary bacterial infection, neurodermatitis (permanent scarring and discoloration from constant scratching), and eye problems
what does the pattern of atopic eczema tend to rely on?
tends to be age specific
where are skin lesions the most common with atopic eczema?
face, scalp, hands, or feet in young children and the knees and elbows of older children and adults
what may make the clinical manifestations of atopic eczema worse/
allergens, cold and dry air, upper respiratory infections, contact with irritants, dry skin, emotional stress, and extreme temps
what are the clinical manifestations of atopic eczema?
red to brownish-gray colored skin patches, pruritus which may be severe (especially at night), vesicles, thickened, cracked, or scaly skin, irritated sensitive skin from scratching.
raised, erythematous skin lesions that are the result of a type I hypersensitivity reaction usually caused by food or medicine ingestion
urticaria or hives
what may urticaria result from?
aside from food and medication ingestion, it may also result from emotional stress, excessive perspiration, diseases, and infections
when can urticaria become a problem?
when the swelling occurs around the face, impairing breathing. it also may progress to an anaphylactic reaction and shock
will the welts that occur with urticaria blanch?
common chronic inflammatory condition that affects the life cycle of the skin cells. cellular proliferation is significantly increased, causing cells to build up too rapidly on the skin's surface. new cells grow faster than the old ones can be shed.
what is the cause of psoriasis?
the exact cause is unknown, but it has a familial tendency. it is thought to be a result of an autoimmune process in which the body mistakes normal sin cells as foreign and cytokines are released, which stimulate keratinocyte proliferation
when is the onset of psoriasis most common?
between the ages of 15 and 30. may be sudden and severe and the person will experience remissions and exacerbations
what are factors that may trigger exacerbations of psoriasis?
bacterial or viral infections of any location, dry air or dry skin, skin injuries, certain medications, stress, too little or too much sunlight, excessive alcohol consumption
what condition is common along with psoriasis?
arthritis - known as psoriatic arthritis. as many as 30% of persons with psoriasis have this condition
how do psoriatic lesions develop?
begin as a small red papule that enlarges
where to psoriatic lesions most often occur?
on elbox, knees, and trunk, but they can appear anywhere on the body
what are the types of psoriatic lesions?
erythrodermic, guttate, inverse, plaque, pustular
psoriatic lesions that have intense erythema and cover a large area
psoriatic lesions that are small, pink-red spots
psoriatic lesions that have erythema and irritation and occur in the armpits, groin, and skin folds
psoriatic lesions that are thick, red patches covered by flaky, silver-white scales - most common types
psoriatic lesions that are white blisters surrounded by erythema
what are the manifestations (other than skin lesions) that occur with psoriasis?
pruritus, genital lesions in males, joint pain or aching, nail changes such as thickening, yellow-brown spots, dents on the nail surface, and separation of the nail from the base, severe dandruff on the scalp
what bacteria most commonly causes bacterial skin infections?
staphylococcus and streptococcus genra
bacterial infections involving the hair follicles characterized by tender swollen areas that form around hair follicles, often on the neck, breasts, buttocks, and face
bacterial infection that begins in the hair follicles and then spreads to the surrounding dermis that most commonly occurs on the face, neck, axillae, groin, buttocks, and back
furuncle or boil
how does a furuncle lesion start?
as a firm, red, painful nodule that develops into a large, painful mass, which frequently drains large amounts of purulent exudate
clusters of furuncles
common, highly contagious skin infection that typically arises from a break in the skin and spreads easily to others by direct contact with skin or contaminated objects
how do lesions of impetigo usually begin?
as small vesicles that enlarge and rupture, forming he characteristic honey colored crust. these lesions can spread throughout the body through self-transfer of the exudate
what usually causes impetigo?
what happens in impetigo caused by staphylococcus bacteria?
the bacteria produce a toxin that causes impetigo to spread to nearby skin this causes the skin to spread to nearby skin. the toxin attacks collagen, a protein that helps bind skin cells together. once this protein is damaged, bacteria can spread quickly.
what manifestations are common with impetigo?
pruritus is common, and lymphadenopathy can occur near the lesions
bacterial infection deep in the dermis and subcutaneous tissue. usually resulting from a direct invasion through a break in the skin or spreads from an existing wound infection
how does cellulitis usually appear?
as a swollen, warm, tender area of erythema. systemic manifestations of infection are usually present
if untreated, what can cellulitis lead to?
necrotizing fasciitis, septicemia, and septic shock
rare, serious bacterial infection that can aggressively destroy skin, fat, muscle, and other tissue that is typically the result of a highly virulent strain of gram positive beta-hemolytic, group A streptococcus that invades through a minor cut or scrape
how does necrotizing fasciitis progress?
the bacteria begin to grow and release harmful toxins that directly destroy the tissue, disrupt blood flow, and break down mineral in the tissue. the first sign of infection may be a smalle, reddish, painful area on the skin. this area quickly changes to a painful bronze or purple colored patch that grows rapidly. the center of the lesion may become black and necrotic.
what are systemic manifestations that occur with necrotizing fasciitis?
fever, confusion, tachycardia, hypotension, and confusion
what are the complications of necrotizing fasciitis?
gangrene, multisystem organ failure, shock
viral infection typically affecting the lips, mouth, and face that can involve the eyes and result in conjunctivitis and can result in meningoencephalitis
herpes simplex type 1
how is the herpes simplex type I virus transmitted?
through contact with infected saliva
how does herpes simplex type I progress?
the primary infection may be asymptomatic, then the virus remains dormant in the sensory nerve ganglion to the trigeminal nerve until it is reactivated which may be a result of an infection stress, or sun exposure
what are the clinical manifestations of herpes simplex type I?
painful blisters or ulcerations that are preceded by a burning or tingling sensation. they will resolve spontaneously within three weeks, but healing can be accelerated with oral or topical antiviral agents.
condition that appears in the adulthood years after a primary infection of varicella in childhood. caused by the varicella-zoster virus
how does herpes zoster progress?
there is an infection of varicella in the childhood years and the virus lies dormant on a cranial nerve or a spinal nerve dermatome until it becomes activated years later. virus only affects nerves.
what are the clinical manifestations of herpes zoster?
typically unilateral. pain, paresthesia, and a vesicular rash that develops in a line over the area innervated by the affected nerve. skin becomes extremely sensitive and pruritus may be present
what is the appearance of the rash associated with herpes zoster?
may appear red or silvery and occurs on one side of the head or torso depending on the nerve affected. neuralgia or pain may continue long after the rash disappears.
what are verrucae (warts) caused by?
a number of the human papillomaviruses
how are verrucae transmitted?
through direct skin contact between people or with the same person
what causes the warts to develop with the human papillomaviruses? what can the lesions look like?
the virus replicates in the skin cells, causing irregular thickening. lesions can appear, varying in color, shape, and texture depending on the type
causes several types of fungal infections that usually grow in warm, moist places and typically manifest as a circular, erythematous rash which is usually associated with pruritus and burning
what are the manifestations of tinea?
circular, erythematous rash which is usually associated with pruritus and burning; hair loss at the site is common
tinea infection of the body
tinea corpis or ringworm
tinea infection that involves the feet, especially the toes
tinea pedis, or athlete's foot
tinea infection that involves the nails, typically the toenails
how does the infection of tinea unguium progress?
begins at the tip of one or two nails and then usually spreads to the other nails. the nail initially turns white and then brown, causing it to thicken and crack
mite infection of the body that triggers the inflammatory process
what is the life cycle of the scabies mites?
the male mites fertalize the females and then die. the females burrow into the epidermis, laying eggs over a period of several weeks through tracks. after laying the eggs, the female mites die. the larvae then hatch from the eggs and then migrate to the skin surface where they burrow into the skin in search of nutrients and mature to repeat the cycle. the burrowing and fecal matter left by the mites triggers the inflammatory process leading to erythema and pruritus
how does the burrowing of scabies appear?
as small brown streaks on the skin
how is scabies transmitted and why?
usually through close contact because the mites can survive or only short periods without a host
what are the three forms that a lice infestation can take?
pediculus humanus corpus - body louse
pediculus pubic - pubic louse
pediculus humanus capitis - head louse
what is the life cycle of the louse?
the female lice lay eggs on the hair shaft close to the scalp. the nits appear as small white, iridescent shells on the hair. after hatching, the lice bite and suck the blood; in turn, the site of the bite develops a highly pruritic macule or papule
how are lice transmitted?
through close contact
skin injury that can result from thermal or nonthermal sources
what are sources of burns?
dry heat, we head, radiation, friction, heated objects, natural or artificial UV light, electricity, and chemicals
what happens during a burn?
the injury triggers the inflammatory reaction and results in tissue distruction
what does the severity of a burn depend on?
the location, extent, and nature of the injury
what are the three different severities of a burn?
first-degree burns - affect only the epidermis. these cause pain, erythema, and edema
second-degree burns - affect the epidermis and the dermis. these cause pain, erythema, edema, and blistering
third-degree burns - extend into deeper tissues these cause white or blackened, charred skin that may be numb
what are complications that may develop with a burn?
local infection - particularly staphylococcus, sepsis, hypovolemia due to damaged blood vessels and plasma proteins, shock from sepsis or hypovolemia, hypothermia because heat is lost through large injuries, respiratory problems from inhaling hot air or smoke that can burn airways causing inflammation, scarring, contractures
skin condition commonly affecting adolescents where the skin's pores become clogged with oil, debris, and bacteria. the pores can become inflamed, developing into a pustule, nodule, or cyst
what happens if the pustule in acne vulgaris ruptures?
the material inside can spread to the surrounding area and cause an inflammatory reaction
where does acne vulgaris appear?
commonly appears on the face and shoulders, but may also occur on the trunk, arms, legs, and buttocks
what are risk factors for the development of acne vulgaris?
family history, hormonal changes, use of oily cosmetic and hair products, certain medications, high levels of humidity and sweating
chronic inflammatory skin condition that typically affects the face and is prevalent in people who are fair skinned, bruise easily, and women
how may rosacea present?
as erythema, prominent spiderlike blood vessels, swelling, or acne-like eruptions. a thickening of the skin on the nose (rhinophyma), a burning or stinging sensation, and red, watery eyes
how does rosacea progress?
it is a progressive condition characterized by remissions and exacerbations
what are some exacerbation triggers with rosacea?
they are specific to the individual, but include sun or wind exposure, sweating, stress, spicy food, alcohol, hot beverages, hot baths, and cold weather
who are skin cancer rates most common in?
men, caucasians, persons with fair complexions, and those with a family history
what is the most significant risk factor for the development of skin cancer?
what are the three types of skin cancer and how are they different
basal cell carcinoma - most common. develops from abnormal growth of the cells in the lowest layer of the epidermis
squamous cell carcinoma - changes in the squamous cells, found in the middle layer of the epidermis
melanoma - develops in the melanocytes. least common but most serious. often metastasize to other skin areas
how may skin cancers appear?
may be shiny, small, waxy, scaly, rough, firm, red, crusty, bleeding, and so on
what are the warning signs of suspicious skin lesions?
asymmetry, border irregularity, color variation, diameter greater than 6 mm, any skin growth that bleeds or will not heal, any skin growth that changes in appearance over time