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Understanding Skin, Hair, and Nails Anatomy

Learn about the integumentary system, skin lesion classification, common skin conditions, hair/nail pathophysiology, risk factors for skin cancer, skin/hair/nail care habits, lesions examination, & wound evaluation techniques.

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Understanding Skin, Hair, and Nails Anatomy

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  1. Chapter 10 Skin, Hair, and Nails

  2. Competencies • Describe the anatomy and physiology of the integumentary system. • Explain the process of describing and classifying skin lesions. • Identify common skin lesions and discuss possible etiologies. (continues)

  3. Competencies • Identify pathophysiological changes to hair and nails and discuss possible etiologies. • State the warning signs of carcinoma in pigmented lesions. (continues)

  4. Competencies • Describe methods used to examine integumentary changes in both light- and dark-skinned patients.

  5. Integumentary System • Covers approximately 20 square feet on the average adult • Thickness varies from 0.2 mm to 1.5 mm (continues)

  6. Integumentary System • Layers • Epidermis • Dermis • Hypodermis (subcutaneous tissue)

  7. Glands of the Skin • Sebaceous • Sebum-producing glands • Found everywhere in dermis except for the palmar and plantar surfaces • Sweat • Apocrine glands • Eccrine glands

  8. Hair • Distributed over the entire body surface except palmar and plantar surfaces, lips, nipples, and glans penis • Vellus • Terminal hair (continues)

  9. Hair • Hair shaft is composed of the cuticle, cortex, and medulla • Melanocytes

  10. Matrix Nail plate Nail root Nail bed Nails • Periungual tissues • Lunula • Examine color of nail bed

  11. Functions of the Skin • Serves as a protective barrier • Temperature regulation • Sensory organ—pain, touch, pressure, temperature • Serves as an organ of excretion

  12. Functions of Hair and Nails • Hair • Warmth • Protection • Sensation • Nails • Protection to distal surface of digits

  13. Melanoma Risk Factors • Ultraviolet light exposure • Family history of skin cancer • Severe sunburns as a teenager or child • Fair-skinned people with light-colored eyes and hair (continues)

  14. Melanoma Risk Factors • > 50 moles • Dysplastic nevi • Age > 65 years old

  15. Basal and Squamous Cell Cancer Risk Factors • Ultraviolet light exposure • Fair-skinned people with light-colored hair and eyes • Chemical exposure • Radiation therapy • Personal history of skin cancer • Smoking

  16. Skin Care Habits • Ask the patient questions to determine use of • skin care products • hair removal products • home remedies to treat skin irritations • a tanning bed • sun protection (continues)

  17. Skin Care Habits • Ask the patient questions to determine • frequency of bathing or showering • previous reaction to jewelry (metal)

  18. Hair Care Habits • Ask the patient questions to determine use of • hair care products • chemicals on hair • wig or hairpiece • hair dryer, heated curlers, or curling iron • Ask if patient has experienced changes to hair (color, texture, or loss)

  19. Nail Care Habits • Ask the patient questions to determine • type of nail care practiced, including manicures or pedicures • nail biting • nail splitting or discoloration

  20. General Examination of Integumentary System • Well-lit room • Good visualization • Explain examination process to patient • Provide warmth and privacy • Cephalocaudal examination

  21. Equipment • Magnifying glass • Good lighting, natural light preferred • Penlight (continues)

  22. Equipment • Clean gloves • Microscope slide • Small centimeter ruler

  23. Inspection of the Skin • Cephalocaudal approach • Anterior and lateral aspects of skin • Dorsal and palmar surfaces of skin (continues)

  24. Inspection of the Skin • Color • Cyanosis • Jaundice • Carotenemia • Pallor • Redness • Dependent rubor (continues)

  25. Inspection of the Skin • Bleeding • Assess mucous membranes, previous venipuncture sites, or lesions • Petechiae • Purpura • Ecchymosis • May be sign of physical abuse (continues)

  26. Inspection of the Skin • Vascularity • Spider angioma • Venous star • Cherry angioma • Strawberry hemangioma • Nevus flammeus • Necrosis (continues)

  27. Inspection of the Skin • Lesions • Document anatomic location • Assess arrangement or grouping: localized, regionalized, or generalized • Note if any exudate present • Note the morphology

  28. Mnemonic for Evaluating Lesion • A (asymmetrical) • B (borders) • C (color) • D (diameter) • E (elevation)

  29. Types of Lesions • Nonpalpable • Macule • Patch (continues)

  30. Types of Lesions • Palpable • Papule • Plaque • Nodule • Tumor • Wheal (continues)

  31. Types of Lesions • Fluid-filled cavity • Vesicle • Bullae • Pustule • Cyst (continues)

  32. Types of Lesions • Above the skin surface • Scales • Lichenification • Crust • Atrophy (continues)

  33. Types of Lesions • Below the skin surface • Erosion • Fissure • Ulcer • Scar • Keloid • Excoriation

  34. Wound Evaluation • Location • Color • Drainage • Odor • Size • Depth (continues)

  35. Wound Evaluation • Measure the borders • Draw a picture to depict wound

  36. Stages of Pressure Ulcers • Stage 1 • Skin is reddened but intact • Stage 2 • Epidermal and dermal layers are injured (continues)

  37. Stages of Pressure Ulcers • Stage 3 • Subcutaneous tissues are injured • Stage 4 • Muscle and perhaps bone are injured

  38. Identifying Burns • First-degree • Epidermis is injured or destroyed • Skin is red, dry, painful (continues)

  39. Identifying Burns • Second-degree • Epidermis and upper layers of dermis are destroyed • Skin is red, blistery, painful • Also called partial-thickness burn (continues)

  40. Identifying Burns • Third-degree • Epidermis and dermis are destroyed, subcutaneous tissue is injured • Hair follicles, sweat glands, and nerve endings are destroyed • Skin is white, red, black, tan, or brown • Also called full-thickness burn (continues)

  41. Identifying Burns • Fourth-degree • Epidermis, dermis are destroyed • Subcutaneous tissue, muscle, and bone may be injured • Hair follicles, sweat glands, and nerve endings are destroyed • Skin is white, red, black, tan, or brown

  42. Palpation of the Skin • Moisture • Xerosis • Diaphoresis • Temperature • Hypothermia • Hyperthermia (continues)

  43. Palpation of the Skin • Tenderness • Should be nontender • Tenderness can be localized or generalized (continues)

  44. Palpation of the Skin • Texture • Smooth • Rough • Turgor • Decrease may be associated with dehydration (continues)

  45. Palpation of the Skin • Edema • Note the presence of fluid accumulation in the intercellular spaces • Assess dependent areas • Use 4-point scale to rate severity • Assess symmetry

  46. Pitting Nonpitting Angioedema Dependent Types of Edema • Inflammatory • Noninflammatory • Lymphedema

  47. Inspection of Hair • Color • Distribution • Alopecia • Hirsutism • Scalp lesions • Palpate texture

  48. Inspection of Nails • Color • Shape and configuration • Nail angles • Palpate texture

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