Integumentary System

Altered Functions

Vocabulary

Derma-

Melan/o-

Pachy-

Sub-

trich/o-

Cyan/o-

Onych/o-

Xer/o-

Hidr/o-

Kerat/o-

Xanth/o-

Follicul/o-

Dactyl/o-

Intra-

Integumentary Regions

Skin– Epidermis– Dermis

HypodermisSensory receptorsMuscleAdnexa– Hair and follicle– Glands

• Sweat• Sebaceous

– Nails

Epidermis Histology Overview

Epidermis Strata Histology

C = corneumG = granulosumS = spinosumB = basale

Underlying Disorders

Genetic

Connective tissue

Blood supply

Neoplasia

Drug Reactions

Immune

Primary Lesions

Macules: colored circumscribed flat area, size varies, < 1cmPapules: discolored raised area, < 2cmPlaques: raised flat top area, > 1cmPatches: circumscribed flat area of discoloration, < 1cmNodules: solid raised area, above or below skin, <1 cmTumor: discolored raised area, > 2cmWheals: slightly raised area with edema, size variesVesicles/Blister: fluid filled raised area < 0.5cmBulla/Cyst: fluid filled raised area, > 0.5cmPustules: pus-filled raised area, size varies

Macule

Nodule

Papule

Bulla

Secondary Lesions

Erosions

Ulcers

Fissures

Cracks

Scales

Excoriation

Keloid

Scar

Lichenification

Cracks and Fissures

Ulcer and Erosion

Excoriation

Lichenification

Scar Formation

Keloid

Epidermal Cells

Keratinocytes

Keratinocyte Hypertrophy

Melanocyte location and function

Melanosomes with Melanin

Melanin

Melanosis

Langerhans Dendritic Cells

Skin Cancers

Skin Cancer ABCD and E (evolving)

Etiology

UV exposure – UV A– UV B

GeneticPrevention– Sun block

• UVA• UVB

– Clothing– Window tinting

Skin Tumors

Benign– Seborrheic keratitis

– Keratocanthoma

– Verucae (warts)

– Actinic keratitis

Malignant– Basal Cell carcinoma

– Squamous Cell carcinoma

– Dysplastic nevi

– Malignant melanoma

Seborrheic Keratosis

Keratocanthoma

Verrucae

Actinic Keratitis

Basal Cell Carcinoma

Squamous Cell Carcinoma

Epidermal Cancers Compared

Malignant Melanoma

Merkel Cell Carcinoma

Dermis

Dermal Papilla and Reticular Dermis

Lines of Cleavage

Aging = Wrinkles?

Skin changes– Chronological aging

– Photo-aging (sun damage)

– Chemical toxins

Cause– Decrease in collagen

(inactive fibroblasts)

– Increase in proteolytic activity due to collagenase

Hypodermis

Subcutaneous tissue

Clinical Application

Dermatitis (Eczema)

Atopic

Contact

Seborrheic

Drug eruption

Photo-eczematous

Dermatitis reactions

Presentation Papulovesicular Oozing with crusts Scaling plaques

Contact Dermatitis

Seborrheic Dermatitis

Dandruff; Cradle Cap

Drug Eruption

Photoeczematous

UV

Genetic: Porphyria

Drug Induced– Oral– Topical

Lupus

Venous Stasis Dermatitis

Cutaneous Membrane

Insect Bites

Chiggers

Biting Flies

Mosquitoes

Spider Bites

Bacterial Lesion Appearance/ Causes

Furunculosis

Folliculitis

Impetigo

Cellulitis

Staph aureus

Pseudomonas

Gram (-) enterics

Beta hemolytic Strep

Mycobacterium

Clostridium

MRSA

Bacteria: Staph. aureus

Disease: Pyodermas

Transmission:– Direct, topical

– Open wound entry

Culture and Sensitivity ID

Drug Resistance– Beta lactamase

– Alternate method of cell wall synthesis

VRE

Vancomycin

Risk factors– Hospitalization

– Immunocompromised

– Neutropenia

– ICU

– Dialysis

Impetigo

Staph; Strep

Cut or scratch

Honey colored oozing sores

Lip / nose region

After a cold

Scratching can spread to other areas

Cellulitis

Gangrene

Streptococcus

Leprosy

Erysipelas

Group A Strep

Cellulitis

Necrotizing Fasciitis

Strep pyogenes

Fascial planes

Source– Skin

– Bowel

Aka, Streptococcal gangrene

Post op concern

Scarlet Fever

Fungal Infections

Microsporum

Trichophyton

Epidermophyton

Microsporum

Trichophton

Tinea Capitus

Tinea corpus

Tinea pedis

Epidermatophyton

Candida albicans

Viral Infections

Papilloma

Herpes

Morbillivirus

Rubella

Parvovirus

HPV

Papilloma

Herpes: HSV-1, HSV-2

Herpes: Varicella Zoster Virus

Shingles

Rubeola

Paramyxovirus

5 day or hard measles

Respiratory spread

Exanthem rash– White spots in red

Fever; cough

Neurological

Rubella

Erythema Infectiosum (Fifth Disease)

Parvovirus B19

Mild rash (slapped cheek– Face– Limbs– Trunk

Respiratory secretions – direct contact spread

Pain, fever, itching

Idiopathic/Immune

Acne

Psoriasis

Rosacea

Pemphigus

Scleroderma

Erythema multiforme

Vitiligo

Acne Vulgaris

Propionibacterium acnesStaph epidermidis

Psoriasis

Rosacea

Pemphigus

Autoimmune

Blistering

Scleroderma

Erythema Muliforme

Vitiligo

Urticaria

Porphyria

Genetic Enzyme Deficiency

Adnexa

Sweat Glands

Hair and Follicle

Hair/ Follicle Disorders

AlopeciaGenetic: baldness– Male– Female

HirsutismParasiticInfectious– Bacterial– Fungal

Folliculitis

Scabies

Pediculosis

Head Louse

Body Louse

Nail Disorders

Clubbing

Paronchyma

Onchomycosis

Clubbing

Fungal Infections

Sensory

Burn Classification

Skin Layers Affected

Rule of 9’s

Artificial Skin

HormoneEGF:EpidermalGrowth Factor

Frostbite

Injury

Blunt force trauma: blows, impact injuryContusionAbrasionLacerationSharp Force– Incised wound– Stab wound– Puncture wound

GSW

Puncture Wound

Laceration

Wounds compared

GSW

Entrance Wound Exit Wounds

Summary

Process and Timeframe

Histology of Repair

Suture

Questions?

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