ch 7 integumentary PATH

SKIN Main Ideas

100

The skin is the second largest organ in the body 

True or False?

FALSE! Largest organ of the
body 

200

what IS THE SKINS PRIMARY FUNCTION?

Protect underlying structures

 External injury

 Harmful substances

300

Names the functions of the skin

 Insulator
 Holds organs together
 Sensory perception
 Contribution to fluid balance
 Controlling temperature
 Absorbing UV radiation and metabolizing Vit D
 Synthesizing epidermal lipids

400

Explain how the skin helps synthesis vitamin D 

500

S&S of skin pathology's 

 Pruritus- itching 

 Urticaria- hives 

 Rash- generalized term for eruption on the skin 

 Blisters- fluid-containing elevated lesions 

 Xeroderma- excessive dryness of the skin

600

What is a generalized term for a rupture on the skin? 

Rash

700

A term that describes a fluid filled lesion 

Blister 

Aging and the integumentary system

100

How does our skin change with age?

 Changes all throughout the lifespan
 Changes denoting senescence
 Aging process
 Cumulative effects of exposure to sunlight
 Environmental factors
 Structural and functional changes
 Diminished pain perception
 Increased vulnerability to injury
 Decreased vascularity (slower healing)
 Weakened inflammatory response (slowing healing)

200

What are some visible indications of aging?

 Lax skin Vascular changes: decreased elasticity of blood

vessel walls

Dermal or epidermal degenerative changes
Wrinkling 

Blood vessels within the reticular dermis

decreased in number and thinner walls

300

What causes wrinkles?

 Loss of elastin fibers
 Weakened collagen
 Decreased subcutaneous fat 

400

What is a primary factor in loss of protective functions of skin?

Diminished barrier function of the stratum
corneum

As this layer becomes thinner- skin becomes
translucent, paper-thin-> reacting more readily to
minor changes in humidity, temperature and
irritants 

Decreased protection to UV radiation- due to fewer melanocytes  

500

What is the body’s principal supplier of Vit D

Epidermis

When 7-dehydrocholesterol is exposed to
sunlight= Vit D- decreased hormone after age 65

Skin Disorders

100

What are some common skin disorders

 Atopic dermatitis
 Contact dermatitis
 Eczema and dermatitis
 Stasis dermatitis
 Environmental dermatoses
 Rosacea

200

Chronic inflammatory skin disease

 Most common type of eczema

 Affects more than 10% of children

 Common in a group of associated allergic

disorders: asthma, allergic rhinitis

 Infancy: red, oozing, crusting rash

 Chronic: dry, thickened,

 Rash localized to flexor surfaces of folds of skin

 Goal: stop inflammatory cycle

 Also keep skin clean

Atopic dermatitis

300

 Acute or chronic inflammation
 Caused by exposure to a chemical, mechanical,
physical or biologic agent
 Common environmental skin disease
 Common sensitizers
 Nickel (jewelry)
 Chromates (leathers)
 Wool fats (lanolin- moistures)
 Rubber additives
 Topical anesthetics
 Silicone (prosthetics)
 Removal of offending agent then treat skin

Contact dermatitis

400

 Group of disorders of superficial inflammation
 3 stages
 Acute dermatitis: erosions with serous exudate,
intensively pruritic
 Subacute dermatitis: erythematous, excoriated
scaling papules
 Chronic dermatitis: thickened skin
 Common in older population
 Can be medication related

Eczema and dermatitis 

500

 Areas of very dry, thin skin and sometimes
shallow ulcers of the lower legs
 Primary due to venous insufficiency
 Commonly hx of vericose veins or DVT
 Slowed venous return-> leg edema -> hypoxic
tissue-> poorly nourished tissue begins to necrose
 Compression and walking important

Stasis Dermatitis 

600

Chronic facial disorder of middle-aged and
older people
 Facial blushing
 Large vascular component

Rosacea 

Skin Infections

100

Name some common skin infections 

 Bacterial infections
 Impetigo
 Cellulitis
 Viral infections
 Fungal infections
 Parasitic infections

200

Describe a bacterial infections

 Skin harbors a variety of bacterial flora
 Degree of pathogenicity depends
 Invasiveness and toxigenicity
 Integrity of the skin
 Barrier of the host
 Immune and cellular defenses

300

Superficial skin infection
 Commonly caused by staphylococci or
streptococci
 Infants and young children and older adults
 Schools and overcrowded living environments
 Spread by direct contact, environmental
contact or arthropod vector
 Macules (flat)-> vesicles-> pus filled
 Scratching spreads infection: autoinoculation

Impetigo

400

Rapidly spreading acute inflammation with
infection of the skin and subcutaneous tissue
 Spreads widely through tissue spaces
 Affects the extremities most often
 Requires IV antibiotic treatment

Cellulitis

500

an infection that uses intracellular substances of the host cells and are unable to provide for their own
metabolic needs or reproduce themselves

Viral infections 

600

A benign viral infections of the skin
and adjacent mucous membranes caused by HPV

WARTS

700

How to treat viral skin infections 

Cryotherapy: cosmetically preferred but painful->
epidermal necrosis and peels off with wart
Acids: painted on daily
Electrodesiccation: high frequency electric current

800

Fungi Infections 

Fungi that invade the ________, ____ and
____-> can spread without treatment
 Superficial- live on- not in the skin
 Confined to the dead skin keratin layers

Stratum corneum, Hair, and Nails 

900

A type in fungi infection...

Ring shaped pigmented patches
 Direct skin contact or contaminated objects

Ring worm

1000

A type of fungi infection

Erythema, pruritus between toes-> sole

 Can be an entry for other types of infection

Athlete’s foot (tinea pedis)

1100

 Mites-> highly contagious skin eruption
 Easily transmitted by skin-to-skin contact or by
contact with contaminated objects

Female mite burrows into the skin and lays eggs  

Scabies 

Skin disorders associated with immune dysfunction

100

What are some common skin disorders associated with immune dysfunction?

 Psoriasis
 Cutaneous lupus erythematous
 Systemic sclerosis
 Polymyositis and dermatomyositis

200

Chronic, inherited, recurrent inflammatory but

noninfectious dermatosis

 Well defined erythematous plaques

 Scalp, knees, skin folds, lower back

 Flare ups in winter due to dry skin

 Cause is unknown- appears to be hereditary and

may have a possible immune component

 Once present becomes chronic that may go in

and out of remission

Psoriasis 

300

 Chronic inflammatory autoimmune disorder of

connective tissues- which primarily affects the

skin

 Chronic skin eruptions on sun-exposed skin that

can lead to scarring and permanent

disfigurement if left untreated

 Discoid lesions can develop from the rash

 Raised edges and sunken centers

 Usually in areas exposed to sunlight

Cutaneous lupus erythematosus

400

Diffuse connective tissue disease – causing fibrosis of the skin, joints, blood vessels and internal organs
 Idiopathic origin
 Distinctive widespread vascular changes
 Known in past as scleroderma- although this just refers to the thickening of the skin

Systemic sclerosis

500

What are the 3 stages of Systemic sclerosis ?

 Edematous- bilateral non-pitting edema- mostly fingers and
hands-> up the arm
 Sclerotic- replacement of edema by thick hard skin
 Decreased flexibility
 Atrophic – thinning of the skin- especially over contractures
 Higher risk of ulceration

Thermal injuries

100

Name two types of cold injuries? 

 Localized- frostbite
 Systemic- hypothermia

200

True or false :

Severe cold affects all organs: especially the
CNS and cardiovascular system

TRUE!!

300

Name some cold injury risk factors 

 Lack of insulating body fat
 Older age
 Drug or alcohol use
 Cardiac disease
 Psychiatric illness
 Motor vehicle problems
 Smoking

400

Injuries that result from direct contact with or
exposure to any thermal, chemical, electrical
or radiation source

Burns

500

3 phases of the patient with major burns

 Emergent and resuscitation phase
 Begins at the time of injury and concludes with the restoration of
capillary permeability – usually 48-72 hours after injury
 Resuscitation phase- initiation of fluid resuscitation measures and
ends when capillary integrity returns to near normal levels
 Acute phase
 When the patient is hemodynamically stable, capillary permeability
restored, diuresis has begun and continues until wound closure is
achieved
 Rehabilitation phase
 Gaining independence through functional achievements

600

What is an Ulcer?

What puts you at risk for them? 

lesion caused by unrelieved pressure-> resulting
in damage to underlying tissue 

 Risk factors
 Interface pressure
 Friction
 Shearing (forces in opposite direction)
 Maceration
 Decreased skin resilience (dehydration
 Malnutrition
 Decreased circulation