Chapter Four

1. Chapter Four Skin and subcutaneous tissue

2. Composition and Function of the Skin • Composition • Skini- 1st line defense from injury • Subcutaneous tissue- fat • Hair- • Nails • Sweat & sebaceous glands • Function • First line of defense • Temperature regulation • Sensation • Synthesis of vitamin D • Elimination of waste Word Parts derm/o, dermat/o, cutane/o = skin sub- = under trich/o, pil/o = hair onych/o, ungu/o = nail hidr/o, sudor/i = sweat seb/o, sebac/o = oil, sebum

3. Diagram of the Skin

4. Layersof the Skin • Epidermis- outermmost layer • Dermis/corium- middle • Hypodermis/subcutaneous layer- fat and connective tissue Word Parts epi- = above derm/o = skin a- = no, not without vascul/o = vessel -ar = pertaining to hypo- = below sub- = below cutane/o = skin adip/o, lip/o = fat

5. Epidermis • Composition • Stratified squamous epithelium • Basal layer: stratum germinativum • Stratum spinosum • Stratum granulosum • Stratum lucidum • Stratum corneum • Keratinocytes • Keratin • Melanocytes • Melanin Word Parts squam/o = scaly bas/o = basal germ/i = sprout nat/o = birth corne/o = hard, horny kerat/o = hard, horny -cyte = cell -in = substance melan/o = black

6. Diagram of the Skin

7. Dermis • Composed of vascular connective tissue • Structures • Blood and lymphatic vessels • Nerves • Hair follicles • Sebaceous and sudoriferous glands (oil and sweat) • Meissner’s corpuscles- provide sensitivity to light and touch • Pacinian corpuscles- sense pressure Word Parts follicul/o = follicle hidraden/o = sweat gland

8. Subcutaneous Tissue • Adipose tissue Word Parts sub- = under cutane/o = skin -ous = pertaining to adip/o = fat -ose = pertaining to, full of

9. Review Question • The hair follicles are located in the: A. dermis B. epidermis C. subcutaneous tissue

10. Glands • Sudoriferous glands: eccrine in hands feet and forehead secrete sweat and apocrine in armpits and groin • Pores • Perspiration • Locations • Sebaceous glands- oil • Sebum- secretion of oil from sebaceous glands Word Parts sudor/i = sweat -ferous = carrying hidr/o = sweat ec- = out, outward -crine = to secrete apo- = separate, away from sebum = seb/o

11. Hair • Follicles- root and strand of each hair in the dermis • Shaft- part of the hair you can see • Papilla –part underneath the shaft, that you can’t see Word Parts trich/o, pil/o = hair follicul/o = follicle papill/o = papilla eu- = healthy, normal phe/o = dark

12. Nails • Nail body • Nail root • Nail bed • Lunula • Eponychium (cuticle) • Paronychium- folds Near the sides of nail Word Parts onych/o, ungu/o = nails epi- = above par- = near -um = structure The nail

13. Primary Lesions • Nodules- palpable solid lesions • Cysts-semisolid nodule • Tumors- modle more than 2 cm • Hematomas- collection of blood trapped in tissue Word Parts nod/o = knot -ule = small cyst/o = sac, bladder hemat/o = blood -oma = tumor, mass

14. Primary Lesions • Petechia- tiny bruise in dermal layer • Ecchymosis- bruise into the subcu layer • Purpura- massive hemorrhage under skin. Word Parts ec- = out chym/o = juice -osis = abnormal condition purpur/o = purple -a = noun ending Ecchymosis

15. Primary Lesions • Macules- flat less than 1 cm • Patches • Papules- raised solid less than 1cm • Plaques • Wheals-elevated and localized, such as a bug bite Word Parts macul/o = spot papul/o = pimple, papule

16. Primary Lesions • Vesicles/bullae- elevated and containing fluid and smaller than ½ cm • Pustules- elevated and containg pus • Telangiectasia- permanent dilation of groups of capillaries and venules. Word Parts vesicul/o = blister or small sac pustul/o = pustule tel/e = far angi/o = vessel -ectasia = dilation

17. Secondary Lesions • Atrophy- paper think wasted skin seen in aging and stretch marks • Striae (stretch marks) • Cicatrix/cicatrices – scar Be Careful! Don’t confuse strata, meaning layers, with striae, meaning stretch marks. Word Parts a- = no, not, without -trophy = process of nourishment eschar/o = scab Cicatrix

18. Secondary Lesions • Keloid- type of scar that is an overgrowth • Eschar- dried blood or pus, or scab • Fissure- cracklike lesion • Ulcer- craterlike lesion Word Parts eschar/o = scab Keloid Fissure

19. Infections of the Skin and Subcutaneous Tissue (L00-L08) and Bullous Disorders (L10-L14) • Cellulitis- acute inflammation within solid tissue • Omphalitis- inflammation of the navel • Onychia- inflammation of a fingernail • Paronychia- infection of the skin beside the nail • Pyoderma- a bacterial skin disease containing pus • Pilonidal cyst- growth of hair in a cyst Word Parts cellul/o = cell -itis = inflammation omphal/o = umbilicus onych/o = nail -ia = condition par- = near py/o = pus -derma = skin condition pil/o = hair nid/o = nest cyst/o = sac, bladder Cellulitis of upper leg

20. paronychia pyoderma

21. Infections of the Skin and Subcutaneous Tissue (L00-L08) and BullousDisorders (L10-L14) • Abscess- collection of pus anywhere in the body • Furuncle – staphylococcal skin infection originating in a gland • Carbuncle- two or more furncles connected by subcutateous pockets • Impetigo- vesicopustular skin infection in children. carbuncle Furuncle Impetigo

22. Dermatitis and Eczema (L20-L30) • Atopic dermatitis- chronic, pruitic, superficial inflammation of the skin associated with allergies • Contact dermatitis- irritated or allergic response of the skin that can lead to acute or chronic inflammation. • Eczema- inflammation of the skin characteried by vesicles, weeping and pruritus • Pruritus- itching • Seborrheic dermatitis- scaling disease of the scalp and face Word Parts a- = no, not, without top/o = place, location dermat/o = skin -itis = inflammation prurit/o = itching seb/o = sebum -rrheic = pertaining to discharge Contact dermatitis

23. Atopic dermatitis exczema Seborrheic dermatitis

24. Papulosquamous (L40-L45), Urticaria and Erythema (L49-L54), and Radiation Related Disorders of Skin and Subcutaneous Tissue (L55-L59) • Psoriasis- chronic skin disorder characteried by salmon red patches cover by thick dry silvery scales • Actinic keratosis- skin lesions caused by prolonged sun exposure • Urticaria- wheals, or hives Word Parts act/i = rays -in = substance kerat/o = hard, horny -osis = abnormal condition Psoriasis urticaria Actinic keratosis

25. Disorders of Skin Appendages (L60-L75) • Acne vulgaris • Comedones- plugs of • Oil that partially block • A pore • Alopecia- hair loss Alopecia

26. Disorders of Skin Appendages (L60-L75) • Anhidrosis- little or no sweat production • Hidradenitis suppurativa- inflammation of sweat glands • Hyperhidrosis- excessive sweating • Bromhidrosis- abnormal body odor • Hypertrichosis- excessive hair • Folliculitis- inflammation of hair follicles Word Parts an- = no, not, without hidr/o = sweat hidraden/o = sweat gland hyper- = excessive brom/o = odor, stench trich/o = hair follicul/o = follicle Hidradenitis suppurativa

27. Disorders of Skin Appendages (L60-L75) • Hypertrichosis- excessive hair • Poliosis- localized patch of gray or white hair due to lack of melanin caused by disease • Keratinous cyst- benign cavity filled with oil and epithelial debris • Milia- tiny keratinous cysts caused by clogged oil ducts • Miliaria– vesicles and papules surrounded by redness caused by occlusion of sweat ducts during times of exposure to heat and high humidity Word Parts hyper- = excessive trich/o = hair -osis = abnormal condition poli/o = gray kerat/o = hard, horny -in = substance -ous = pertaining to milia miliaria

28. Disorders of Skin Appendages (L60-L75) • Onychocryptosis- hidden or ingrown nail • Onycholysis- separation of the nail plate from the bed • Onychomalacia- soft nails • Onychogryphosis- thick and curved finger or toe nails • Onychodystrophy- abdnormally developed finger or toe nails. Word Parts onych/o = nail crypt/o = hidden -lysis = loosening -malacia = softening gryph/o = curved dys- = abnormal -trophy = nourishment, development Onycholysis

29. Stages 1-4 decubitus ulcers Other Disorders of the Skin and Subcutaneous Tissue (L80- L99) • Callus- thickening of the stratum corneum at locations of external pressure or friction. • Corn/clavus- condensed epithelial cells overlaying a bony prominence as the Result of pressure • Pressure sore/decubitus ulcer/bedsore- results from immobilized patients, inflammation, ulcer or sore • Ichthyosis- dry skin that has the scaly appearanc • e of a fish.

30. Other Disorders of the Skin and Subcutaneous Tissue (L80- L99) • Dyschromia- abnormality of skin pigmentation • Hyperchromia- increased pigmentation • Hypochromia- decreased pigmentation • Vitiligo- irregular patches of pigment • Leukoderma- loss of pigmentation Word Parts dys- = abnormal chrom/o = color hyper- = excessive hypo- = decreased leuk/o = white -derma = skin Vitiligo

31. Other Disorders of the Skin and Subcutaneous Tissue (L80- L99) • Lentigo- age spots • Skin tags- soft lesions that are an outgrowth of epidermis and dermal tissue • Discoid lupus erythematosus (DLE)- autoimmune skin condition characterized by red, round-shaped lesions • Seborrheic keratosis- benign pigmented warty lesion • Xerosis cutis- dry skin Word Parts disc/o = disc erythemat/o = red seb/o = sebum -rrheic = pertaining to drainage ketat/o = hard, horny -osis = abnormal condition xer/o = dry cut/o = skin -is = noun ending

32. Herpes zoster Viral Infections Characterized by Skin and Mucous Membrane Lesions (B00-B09) • Exanthematous diseases • Herpes simplex virus (HSV) • HSV-1- cold sores • HSV-2- genital herpes • Herpes zoster- painful rash, part of chicken pox family • Verruca- wart Verruca

33. Mycoses • Candidiasis-yeast infection of skin • Dermatomycoses • Tinea • Capitis- scalp ringworm • Corporis-ringworm • Cruris-jock itch • Pedis- athlete’s foot • Onychomycosis- nail fungus Word Parts dermat/o = skin myc/o = fungus -osis = abnormal condition capit/o = head -is = structure corpor/o = body crur/o = leg ped/o = foot onych/o = nail Onychomycosis Tinea corporis

34. Pediculosis, Acariasis, and Other Infestations (B85-B89) • Pediculosis- lice • Scabies- mite infestation Word Parts pedicul/i = lice -osis = abnormal condition Pediculosis

35. Burns • Degrees of burns • First/superficial thickness • Second • Superficial partial thickness • Deep partial thickness • Third/full thickness • Fourth/deep full thickness

36. Benign Skin Growths • Angioma- localized vascular lesion • Hemangioma • Dermatofibroma- fibrous tumor of the skin that is painless, round, firm and usually found on the extremeties • Lipoma- fatty tumor that is soft and movable. Word Parts angi/o = vessel -oma = tumor dermat/o = skin fibr/o = fiber lip/o = fat Hemangioma Lipoma

37. Dysplastic nevus Benign Skin Growths • Dysplastic nevus- mole

38. Squamous cell carcinoma Malignant Neoplasms • Basal cell carcinoma (BCC) • Kaposi’s sarcoma (KS) • Malignant melanoma • Squamous cell carcinoma (SCC) Squamous cell carcinoma on the ear Malignant melanoma on arm

39. Biopsies (Bx) • Excisional biopsy- entire tumor removed • Exfoliation-scraping or shaving samples • Incisional biopsy-cutting of a wedge of tissue • Needle aspiration- withdrawing fluid • Punch biopsy- using a punch to extract core Punch biopsy

40. Sweat test Laboratory Tests • Bacterial analyses • Fungal tests • Sweat tests • Tuberculosis (TB) skin tests Mantoux test

41. Laboratory Tests • Tzanck test- examining lesions under microscope for herpes and herpes zoster • Viral culture- sampling of vesicular fluid for the purpose of identifying a virus • Wood’s light examination- identifies skin infections through ultraviolet light such as tinea capitis • Wound and abscess cultures-lab samplings that can identify pathogens Wood’s light examination

42. Autograft Grafting Techniques and Other Therapies • Skin grafting (SG) • Dermatome • Graft sources • Autograft • Allograft • Xenograft • Types of grafts • Flap • Split-thickness skin graft (STSG) • Full-thickness skin graft Epithelial autograft Dermatome

43. Grafting Techniques and Other Therapies • Laser therapy • Occlusive therapy • Psoralen plus ultraviolet A (PUVA) therapy

44. Tissue Removal and Other Procedures • Cauterization • Cryosurgery • Curettage- scraping • Débridement- removing debris Curettage

45. Escharotomy Tissue Removal and Other Procedures • Escharotomy- surgical incision into dead tissue resulting from severe burn • Incision and drainage (I&D)- cutting open and removing contents of a wound or cyst • Shaving/paring- slicing thin sheets of tissue to remove lesions

46. Mohs Surgery Repeated removal and microscopic examination of layers of a tumor until no cancerous cells are present.

47. Tissue Removal and Other Procedures • Onychectomy- removal of a nail • Onychoplasty- surgical treatment that usually includes removing the nail matrix • Onychotomy- cutting the nail to drain subungal hematoma Word Parts onych/o = nail -ectomy = cutting out -plasty = surgically formation -tomy = cutting

48. Cosmetic Procedures • Blepharoplasty- surgical repair of eyelid • Chemical peel- use of acid to produce mild burn to remove wrinkles • Dermabrasion-resurface skin • Dermatoplasty-transplant of living skin Word Parts blephar/o = eyelid -plasty = surgically forming derm/o = skin -abrasion = scraping Dermabrasion Chemical peel

49. Cosmetic Procedures • Lipectomy- removal of fat tissue • Liposuction- removing fat with suction pump • Rhytidectomy- face lift Word Parts lip/o = fat -ectomy = cutting out lip/o = fat rhytid/o = wrinkle Liposuction of the neck

50. Pharmacology • Anesthetic agents- reduce pain and discomfort • Antibacterials – prevent and treat bacteria • Antifungals –prevent and treat fungal infections • Antihistamines- reduce allergies • Anti-inflammatories- reduce inflammation • Antipsoriatics –treat psoriasis • Antiseptics – prevent infection by destroying microbials • Antivirals- reduce the effect of viruses.