Download skin lesions

IN THE NAME OWNER OF BEAUTY
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The Integumentary System
Instructor:
Shahnaz pouladi
Bushehr Medical Science University
Nursing and Midwifery Faculty
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Three Layers of skin:
Epidermis:
Stratified squamous
epithelium; outer
layer is "keratinized"
or "cornified"
Dermis:
Dense irregular
connective tissue
Hypodermis:
Adipose connective
tissue (technically not
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part
of system)
Epidermis: Avascular.
Depends on blood vessels in underlying
dermis for its nutrition
Cells formed by
mitosis in deepest,
or basal layer, then
get pushed into
more superficial
layers or "strata"
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(Epidermis)
Stratum Basale = Single row of dividing cells
Stratum Spinosum = Three or four layers of cells;
Some cell division
Stratum Granulosum = Three or four layers of cells;
Actively synthesizing protein
keratin
Stratum Lucidum = One or two layers of dying cells
Stratum Corneum = Many layers of flat, dead, scale-like
cells full of keratin
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Primary cell type in epidermis = keratinocytes
which produce large amounts of protein keratin
Other cell types:
Melanocytes produce
pigment melanin &
transfer it to keratinocytes
Langerhans cells (really
macrophages) clean up
debris
Merkel cells detect touch
and pressure; transfer this
information to sensory
receptors in the dermis
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Functions of the skin
• 1. Protection
– First line of defense
– Keratin: protects body from water loss, barrier for
environmental factors (stratum corneum)
– Melanin: keeps UV rays from penetrating
– Surface film: sweat, oil, etc
– Basal layer: composed of collagen(tissue
organization and regeneration, selective
permeability, physical barrier, bind)
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Functions of the skin
• 2. Sensation
– Pressure, touch, temp, pain, etc
– Two specialized receptors:
• Meissner corpuscle – detects light pressure
• Pacinian corpuscle – detects deep pressure
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Functions of the skin
• 3. Fluid balance
• The stratum corneum has the capacity to
absorb water
• Skin damage (burn)
• The skin is not completely impermeable to
water. (evaporation) 600cc/day
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Functions of the skin
• 4. Body temperature
– Body produces heat (metabolism of foods)
– Body releases 80% of heat through skin
– On a hot day the skin releases almost 3000
calories of body heat (enough to boil five gallons
of water)
– Heat loss is controlled by negative feedback loop
– Skin blood flow
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Functions of the skin
• 3. Produces Vitamin D
– Uv rays combine with skin to make cholecalciferol
– Cholecalciferol is transported to the liver and
kidneys where it is changed to vit D
– Vitamin D is essential for preventing osteoprosis
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Functions of the skin
• Immune response function
• Langerhans cells facilitate the uptake of IgEassociated allergens
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Skin and Aging Process
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Assessment of the Skin
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Preparation
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Equipment
Well-lit Room
Comfortable Environment
Hand washing
Appropriate use of Gloves
Privacy/Draping
Organized Assessment
Explanations
PHYSICAL ASSESSMENT
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Physical Assessment
• Inspection
– Color
– Bleeding
– Ecchymosis
– Vascularity
– Lesions
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Physical Assessment
• Palpation
– Moisture
– Temperature
– Texture
– Turgor
– Edema
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• Color
– Normal=Uniformed whitish pink or brown
– Abnormal
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Cyanosis
Jaundice
Carotenemia
Albinism
Vitiligo
Cyanosis
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Jaundice
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Carotenemia
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Albinism
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Vitiligo
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Physical Assessment
• Bleeding, Ecchymosis, Vascularity
– Normal=No areas
– Abnormal
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Spontaneous Bleeding
Petechiae
Ecchymosis
Venous Star
Necrosis
Petechiae
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Ecchymosis
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Venous Star
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Necrosis
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Lesions
• Lesions
– Normal=No lesions except freckles, birthmarks,
nevi (flat moles)
– Abnormal
• Rashes
• Pressure Ulcers
• Burns
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SKIN LESIONS
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Kind of lesions in dermatology
1- Primary Skin Lesions
2-Secondary Skin Lesions
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PRIMARY LESIONS
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macule
• Flat, circumscribed skin
discoloration that lacks
surface elevation or
depression
• Lesser than 1cm
• Vitiligo
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Patch
• Flat, circumscribed skin
discoloration, a very
large macule
• Vitiligo
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Papule
• Elevated, solid lesion
<0.5 cm in diameter
• B.C.C
• Intradermal Nevi
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Plaque
• Elevated,
solid”confluence of
papule”>0.5 cm in
diameter that lacks a
deep component
• Psoriasis
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Nodule
• Elevated, solid
lesion>0.5 cm in
diameter, a largerdeeper papule
• Lipoma
• Rheumatoid nudule
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Vesicle
• Plaque that contains
clear fluid ,a blister
• Lesser than .5 cm
• Herpes simplex
• Herpes zoster
• Contact dermatitis
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Bulla
• Localized fluid
collection>0.5 cm in
diameter, a large vesicle
• Pemphigus vulgaris
• Bullous impetigo
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Pustule
• Vesicle or bulla that
contains purulent
material
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Folliculitis
Impetigo
Acne
Pustular psoriasis
Wheal (Hive)
• Firm,edematous,plaque
that is evanescent and
pruritic
• Urticaria
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Cyst
• Nodule that contains
fluid semisolidmaterial
• Sebaceous cyst
• Epidermal cysts
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SECONDARY
LESIONS
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Crust
• A collection of cellular
debris ,dried serum, and
blood
• Impetigo
• Herpes, eczema
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Erosion
• A partial focal loss of
epidermis, heals
without scarring
• Ruptured vesicles
• Scratch marks
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Scale
• Thick stratum corneum that
results from
hyperproliferation or
increased cohesion of
keratinocytes
• dandruff
• Psoriasis
• Dry skin
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Ulcer
• A full-thickness, focal
loss of dermis, heals
with scarring
• Bed sore
• Syphlis
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Fissure
• Vertical loss of
epidermis and dermis
with sharply defined
walls, crack in skin
• Chapped lips or hands
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Scar
• A collection of new
connective tissue, may be
hypertrophic or atrohic scar
• Burn
• Acne
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Atrophy
• Thinning of the
epidermis, dermis or fat
that cause depression in
the skin surface
• Aged skin
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Lichenification
• Focal area of thickened
skin produced by
chronic scratching or
rubbing
• Contact Dermatitis
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Keloid
• Hypertrophied scar
tissue, elevated,
irregular,
• Surgical incision
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BACTERIAL SKIN INFECTIONS
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Folliculitis, Furuncles, Carbuncles
• Folliculitis is an infection of bacterial or fungal
origin that arises within the hair follicles
• Lesions may be superficial or deep
• Single or multiple papules or pustules appear
close to the hair folicle
• Beard area in men and women’s leg
• Usually caused by staph.
• Pseudofolliculitis barbae (shaving bumps)
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Folliculitis
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Furuncle
• An acute inflammation arising deep in one or more
hair follicle and spreading into the surrounding
dermis
• Furunculosis is multiple or recurrent lesions
• Occur anywhere and more in pressure area
• Start as a small, red, raised, painful pimple after a
few days convert to furuncle (center become yellow
or black)
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Furuncle
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Carbuncle
• An abscess of the skin and subcutaneous tissue that
represents an extension of a furuncle that has
invaded several follicles and is large and deep seated.
• Usually caused by a staph
• Appear most commonly in thick skin and inelastic
• Result fever, pain, leukocytosis
• More likely in pt. with underlying systemic disease
(diabetes, hematologic malignancy, in person that
use immune suppressive drugs)
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Carbuncle
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Medical management
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Not to rupture protective wall of leasons
The boil or pimple should never be squeezed
Systematic antibiotic therapy:
Oral cloxacillin and dicloxacillin
Cephalosporin and erythromycin
When the pus has localized small, incision and
drainage induced
NONINFECTIOUS INFLAMMATORY
DERMATOSIS
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Psoriasis
• The most common skin disease
• 2% of population
• A chronic disease stem from a hereditary defect that cause
overproduction of keratin
• Most common in 15-35 years
• Pathophysiology
- Immunologic basis
• Trigger factors
- Emotional stress, trauma, infections, seasonal and hormonal
changes
- The cell in the basal layer of the skin divide too quickly and
63 the normal events of cell maturation and growth cannot occur
Psoriasis
• C/M
• Red lesions with raised patches of skin
covered with silvery scales that are pruritic
• Involve the nails in one half of the pt. with
pitting, discoloration, beneath the free edges,
and separation of the nail plate
• Bilateral symmetry of lesions
• Most in scalp, elbow, knee, back, genitalia, nail
• Arthritis
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Psoriasis
• Assessment and diagnostic finding
- Presence of the classic plaque-type
lesions
- Sign of nail and scalp
- Skin biopsy has little diagnostic value
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Psoriasis
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M/M
Control of stress
Pharmacologic therapy:
Topical agents: topical corticosteroids and covering skin with occlusive
dressing, nonsteroidal treatments are calcipotriene ( a synthetic derivative
of calcitriol or vitamin D) and tazarotene ( topical retinoid)
Systemic agents:
Infliximab (a monoclonal antibody against tumour necrosis factor alpha
(TNF-α) used to treat autoimmune diseases)
Etanercept (a TNF inhibitor)
Efalizumb ( monoclonal antibody)
Alefacept ( immunosuppressive drug)
Adalimumab (the third TNF inhibitor)
M/M in Psoriasis
- Oral agents: methotrexate, cyclosporine A
(an immunosuppressant drug )oral retinoids
(Etretinate)
- Photochemotherapy: photosensitizing oral
medication with exposure to ultraviolet-A light
(PUVA).
- Photosensitizing medication (8methoxypsoralen)
- Phototherapy in the ultraviolet-B (UVB)
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Psoriasis
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BLISTERING DISEASE
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Pemphigus
• Pemphigus is a group of serious disease of the skin
characterized by the appearance of bullae.
• An autoimmune disease involving IgG
• A blister forms from the antigen-antibody
• Highest incidence in Jewish or Mediterranean
• Associated with penicillins and captopril and myasthenia
gravis
• C/M
• Oral lesions that are painful, bleed easily and oozing,
Nikolsky’s sign
• Complications : secondary bacterial infection, fluid and
electrolyte imbalance, hypoalbuminemia
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Pemphigus
• M/M
• Goals : prevent loss of serum and the
development of secondary infection and to
promote reepithelization
• Corticosteroid priscription
• Immunosuppressive agents : azathioprine,
cyclophosphamide, gold
• plasmapheresis
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Pemphigus
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