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Assessment of the Integumentary
System: Skin, Hair, and Nails
Health Assessment Across the
Lifespan
NRS 102
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 12: Skin, Hair, and Nails

Structure and Function

Subjective Data—Health History Questions

Objective Data—The Physical Exam

Abnormal Findings
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-2
Chapter 12: Skin, Hair, and Nails
Structure and Function

Skin—three layers
1. Epidermis

Epidermal appendages
1. Hair

Stratum germinativum
or basal cell layer
2. Sebaceous glands

Stratum corneum or
horny cell layer
3. Sweat glands

Derivation of skin color
2. Dermis

Connective tissue or
collagen

Elastic tissue

Eccrine glands

Apocrine glands
4. Nails
3. Subcutaneous layer
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-3
Chapter 12: Skin, Hair, and Nails
Structure of Skin
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-4
Chapter 12: Skin, Hair, and Nails
Structure of Nails
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-5
Chapter 12: Skin, Hair, and Nails
Function of the Skin

Protection

Prevents penetration

Perception

Temperature regulation

Identification

Communication

Wound repair

Absorption and excretion

Production of vitamin D
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-6
Chapter 12: Skin, Hair, and Nails
Subjective Data—
Health History Questions

Previous history of skin disease
(allergies, hives, psoriasis, or eczema)

Change in mole

Change in pigmentation (size or color)

Excessive dryness or moisture

Pruritus

Excessive bruising
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-7
Chapter 12: Skin, Hair, and Nails
Subjective Data—
Health history questions
(cont.)

Rash or lesion

Medications

Hair loss

Change in nails

Environmental or occupational hazards

Self-care behaviors
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-8
Chapter 12: Skin, Hair, and Nails
Objective Data—The Physical Exam

Preparation


External variables that influence skin color
Equipment needed

Strong direct lighting
 Small centimeter ruler
 Penlight


Gloves
For special procedures
• Wood’s light
• Magnifying glass
• Materials for laboratory tests: KOH, glass slide
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-9
Chapter 12: Skin, Hair, and Nails
Objective Data—The Physical Exam
(cont.)

Skin—Inspect and palpate

Color

General pigmentation

Widespread color change
• Pallor
• Erythema
• Cyanosis
• Jaundice
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-10
Chapter 12: Skin, Hair, and Nails
Objective Data—The Physical Exam
(cont.)

Skin—Inspect and palpate (cont.)

Temperature


Hypothermia

Hyperthermia
Moisture

Diaphoresis

Dehydration
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-11
Chapter 12: Skin, Hair, and Nails
Objective Data—The Physical Exam
(cont.)

Skin—Inspect and palpate (cont.)

Texture

Thickness

Edema

Mobility and turgor

Vascularity or bruising
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-12
Chapter 12: Skin, Hair, and Nails
Objective Data—
The Physical Exam (cont.)

Skin—Inspect and palpate (cont.)

Lesions

Color

Elevation

Pattern or shape

Size

Location and distribution on body

Exudate
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-13
Chapter 12: Skin, Hair, and Nails
Objective Data—The Physical Exam
(cont.)

Hair—Inspect and palpate

Color

Texture

Distribution

Lesions
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-14
Chapter 12: Skin, Hair, and Nails
Objective Data—The Physical Exam
(cont.)

Nails—Inspect and palpate

Shape and contour

Profile sign

Consistency

Color

Capillary refill
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-15
Chapter 12: Skin, Hair, and Nails
Objective Data—The Physical Exam
(cont.)

Promoting health and self-care

Teach skin self-examination, using the
ABCDE rule

A—asymmetry

B—border

C—color

D—diameter

E—elevation and enlargement
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-16
Chapter 12: Skin, Hair, and Nails
Abnormal Findings
Common Shapes and
Configurations of Lesions

Annular or circular

Confluent

Discrete

Grouped

Gyrate

Target or iris

Linear

Polycyclic

Zosteriform
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-17
Chapter 12: Skin, Hair, and Nails
Annular or Circular
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-18
Chapter 12: Skin, Hair, and Nails
Confluent
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-19
Chapter 12: Skin, Hair, and Nails
Discrete
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-20
Chapter 12: Skin, Hair, and Nails
Grouped
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
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Chapter 12: Skin, Hair, and Nails
Gyrate
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-22
Chapter 12: Skin, Hair, and Nails
Target
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-23
Chapter 12: Skin, Hair, and Nails
Linear
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-24
Chapter 12: Skin, Hair, and Nails
Polycyclic
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-25
Chapter 12: Skin, Hair, and Nails
Zosteriform
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-26
Chapter 12: Skin, Hair, and Nails
Abnormal Findings
Primary and Secondary Skin Lesions
Primary skin lesions
─ Macule
─ Papule
─ Patch
─ Plaque
─ Nodule
─ Urticaria
(hives)
─ Vesicle
─ Cyst
─ Bulla
─ Pustule
Secondary skin lesions
─ Crust
─
─
─
─
─
─
Scale
─
Fissure
─
Erosion
─
Ulcer
Excoriation
Scar
Atrophic scar
Lichenification
Keloid
─ Wheal
─ Tumor
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-27
Chapter 12: Skin, Hair, and Nails
Macule
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-28
Chapter 12: Skin, Hair, and Nails
Papule
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-29
Chapter 12: Skin, Hair, and Nails
Nodule
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-30
Chapter 12: Skin, Hair, and Nails
Wheal
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-31
Chapter 12: Skin, Hair, and Nails
Vesicle
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-32
Chapter 12: Skin, Hair, and Nails
Cyst
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-33
Chapter 12: Skin, Hair, and Nails
Pustule
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-34
Chapter 12: Skin, Hair, and Nails
Crust
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-35
Chapter 12: Skin, Hair, and Nails
Scale
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-36
Chapter 12: Skin, Hair, and Nails
Fissure
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-37
Chapter 12: Skin, Hair, and Nails
Erosion
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-38
Chapter 12: Skin, Hair, and Nails
Ulcer
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-39
Chapter 12: Skin, Hair, and Nails
Excoriation
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-40
Chapter 12: Skin, Hair, and Nails
Scar
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-41
Chapter 12: Skin, Hair, and Nails
Atrophic Scar
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-42
Chapter 12: Skin, Hair, and Nails
Lichenification
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-43
Chapter 12: Skin, Hair, and Nails
Keloid
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-44
Chapter 12: Skin, Hair, and Nails
Abnormal Findings
Vascular Lesions

Hemangiomas





Port-wine stain
(nevus flammeus)
Strawberry mark
(immature hemangioma)
Cavernous hemangioma
(mature)
Telangiectases

Spider or star angioma

Venous lake

Purpuric lesions

Petechiae

Purpura
Lesions caused by
trauma or abuse

Pattern injury

Hematoma

Ecchymosis (bruise)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-45
Chapter 12: Skin, Hair, and Nails
Lesions caused by trauma or abuse:
Pattern injury
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-46
Chapter 12: Skin, Hair, and Nails
Lesions caused by trauma or abuse:
Hematoma
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-47
Chapter 12: Skin, Hair, and Nails
Lesions caused by trauma or abuse:
Ecchymosis
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-48
Chapter 12: Skin, Hair, and Nails
Abnormal Findings
Common Skin Lesions in Children

Diaper dermatitis

Interigo (candidiasis)

Impetigo

Atopic dermatitis (eczema)

Measles (rubeola)

German measles (rubella)

Chickenpox (varicella)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-49
Chapter 12: Skin, Hair, and Nails
Abnormal Findings
Common Skin Lesions

Primary contact dermatitis

Allergic drug reaction

Tinea corporis (ringworm of the body)

Tinea pedis (ringworm of the foot)

Psoriasis

Tinea versicolor

Labial herpes simplex (cold sores)

Herpes zoster (shingles)

Erythema migrans of Lyme disease
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-50
Chapter 12: Skin, Hair, and Nails
Abnormal Findings
Malignant Skin Lesions

Basal cell carcinoma

Squamous cell carcinoma

Malignant melanoma
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-51
Chapter 12: Skin, Hair, and Nails
Abnormal Findings
Skin Lesions Associated with AIDS

Epidemic Kaposi’s sarcoma

Patch stage

Plaque stage

Advanced disease
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-52
Chapter 12: Skin, Hair, and Nails
Abnormal Findings
Infectious Disease as a Biological Weapon

Anthrax

Smallpox (variola major)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-53
Chapter 12: Skin, Hair, and Nails
Abnormal Findings
Abnormal Conditions of Hair






Seborrheic dermatitis (cradle cap)
Tinea capitis (scalp ringworm)
Toxic alopecia
Alopecia areata
Traumatic alopecia, traction alopecia
Trichotillomania

Pediculosis capitis (head lice)
Folliculitis

Hirsutism

Furuncle and abscess

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-54
Chapter 12: Skin, Hair, and Nails
Abnormal Findings
Abnormal Conditions of the Nails

Koilonychia (spoon nails)

Paronychia

Beau’s line

Splinter hemorrhages

Late clubbing

Onycholysis

Habit-tic dystrophy

Pitting
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-55
Chapter 12: Skin, Hair, and Nails
A patient who is admitted for liver failure
would be likely to show which of the
following skin changes?
A. Cyanosis
B. Flushing
C. Rubor
D. Jaundice
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-56
Chapter 12: Skin, Hair, and Nails
The lesions in the illustration
are best described as?
A. Grouped
B. Zosteriform
C. Polycyclic
D. Linear
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 12-57