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