Denver School of Nursing – ADN & BSN ProgramsNo Laboratory component for this class

BIO 206 & 308 – Week 11 CH29 & 39 Integument Path

Epidermis Dermis Hypodermis

Dermal appendages Nails Hair Sebaceous glands Eccrine and apocrine sweat glands

Blood supply Papillary capillaries

Macule Papule Patch Plaque Wheal Nodule Tumor

VesicleVesicle BullaBulla PustulePustule CystCyst TelangiectasiTelangiectasiaa

ScaleScale LichenificatioLichenificationn

KeloidKeloid ScarScar ExcoriatioExcoriationn

FissureFissure ErosionErosion UlcerUlcer AtrophyAtrophy

Macule is a circumscribed, flat discoloration that is brown, blue, red, or hypopigmented

Papule is an elevated solid lesion up to 0.5 cm in diameter; color varies; papules might fuse to form plaque

Vesicle, a circumscribed collection of free fluid up to 0.5cm in diameter

Ulcer is a focal loss of epidermis and dermis; ulcers heal with scarrin

Pressure ulcers result from any unrelieved pressure on the skin, causing underlying tissue damage Pressure Shearing forces Friction Moisture

Stages SI - Nonblanchable erythema of intact skin

SII - Partial-thickness skin loss involving epidermis or dermis

SIII - Full-thickness skin loss involving damage or loss of subcutaneous tissue

SIV - Full-thickness skin loss with damage to muscle, bone, or supporting structures

Stage I

Image source: http://www.hollister.com/

Stage II

Image source: http://www.hollister.com/

Stage III

Image source: http://www.hollister.com/

Stage IV

Image source: http://www.hollister.com/

Stage IV – Why these locations?

Image source: http://www.hollister.com/

Images of Decubitus Ulcers were used from Hollister Incorporated. Props to them for helping to educate health care personnel in the critical importance of proper skin care.

Nutrition Mobilization Pressure Shearing force Moisture

Itching Most common symptom of

primary skin disorders Itch is carried by specific

unmyelinated C-nerve fibers and is triggered by a number of itch mediators

The CNS can modulate the itch response

Skin disorders including: Psoriasis Adult Acne conditions Lupus erythematosus Pemphigus

Psoriasis Shows evidence of dermal and epidermal

thickening Epidermal turnover goes from 26 to 30 days

to 3 to 4 days Cells do not have time to mature or

adequately keratinize

Psoriasis – Non specific skin Inflammation peak onset 15 – 35y/o Plaque psoriasis Inverse psoriasis Guttate psoriasis Pustular psoriasis Erythrodermic psoriasis

Acne rosacea Most common in middle aged women Red central portion of the face with small

erythematous papules surmounted by pinpoint pustules

Acne vulgaris Inflammatory disease of the pilosebaceous follicles

Lupus erythematosus Inflammatory, autoimmune disease with

cutaneous manifestations Discoid lupus erythematosus

▪ Restricted to the skin▪ Photosensitivity▪ Butterfly pattern over the nose and cheeks

Systemic lupus erythematosus

Pemphigus Rare, chronic, blister-forming disease of

the skin and oral mucous membranes Blisters form in the deep or superficial

epidermis Autoimmune disease caused by

circulating IgG autoantibodies▪ The antibodies are against the cell surface

adhesion molecule, desmoglein in the suprabasal layer of the epidermis

Pemphigus Tissue biopsies demonstrate

autoantibody presence Types

▪ Pemphigus vulgaris (most severe) ▪ Pemphigus foliaceus (less severe and has

presence of IgA)▪ Pemphigus erythematosus (symptoms

resemble lupus erythematosus)

Bacterial infections Folliculitis – inflammation of ? Furuncles – “boil” – pus filled colonization Carbuncles – multiple furuncles that often

fistula with dermis infections Cellulitis – Staph / Strep (Dermis & SQ) Erysipelas – type of Cellulitis - usually caused by

Group A Beta hemolytic Strep (Dermis) Impetigo – Same as cellulitis but NO SQ

Viral infections Herpes zoster and varicella

Fungi causing superficial skin lesions are called dermatophytes

Fungal disorders are called mycoses; mycoses caused by dermatophytes are termed tinea Tinea capitis (scalp) Tinea pedis (athlete’s foot) Tinea corporis (ringworm) Tinea cruris (groin, jock itch) Tinea unguium (nails) or onychomycosis

Candidiasis Caused by Candida albicans Normally found on the skin, in the GI tract,

and in the vagina C. albicans can change from a commensal

organism to a pathogen▪ Local environment of moisture and warmth,

systemic administration of antibiotics, pregnancy, diabetes mellitus, Cushing’s disease, debilitated states, age younger than 6 months, immunosuppression, and neoplastic diseases

Scleroderma Sclerosis of the skin that can progress to the

internal organs The disease is associated with several antibodies Lesions exhibit massive deposits of collagen with

inflammation, vascular changes, and capillary dilation

Skin is hard, hypopigmented, taut, and tightly connected to underlying tissue

Scleroderma Facial skin becomes very tight Fingers become tapered and flexed; nails

and fingertips can be lost from atrophy Mouth may not open completely 50% of patients die within 5 years

Seborrheic keratosisKeratoacanthomaActinic keratosisNevi (moles)

Basal cell carcinomaSquamous cell carcinomaMalignant melanoma***Kaposi sarcoma**

75% increase in melanoma with tanning booth exposure before age 30

FDA recommends tanning for teens only with a signed consent form…by their parents

>1,000,000 new skin cancers per year in USA Ultraviolet light… sun & tanning booths Sunless tanning products Avoid “multiple mutations over time”

Image Source: googleimages.com

Image Source: medscape.com

The following pictures are from an individual named Heba that lives in Egypt, and she has donated them to advance the future of nursing. = )

February 2010

February 2010

February 2010

6 Months post grafting

6 Months post grafting

6 Months post grafting

9 Months post grafting!

(November 2010)

12 Months post grafting!

(January 2011)

Special Thanks to Heba for allowing us to use her pictures to help train the next generation of legendary nurses!

Partial-thickness burns First degree

Superficial and deep partial Second degree

Full-thickness burns Third degree

“Rule of nines”

Image Source: http://www.burn-recovery.org

Image Source: http://www.burn-recovery.org

Image Source: http://www.burn-recovery.org