CHAPTER 5
Integumentary
System
Skin
• Functions
– Protects; melanin provides color
– Regulates body temperature
– Serves as sensory receptor (touch, pressure, pain,
temperature)
– Provides for elimination of body waste
(perspiration)
– First step of synthesis of vitamin D
Integumentary System
• Skin
– Also called integument or cutaneous membrane
– Epidermis—outer layer of skin
– Dermis—inner layer of skin
– Subcutaneous layer—consists largely of loose
connective tissue and adipose tissue
• Dermatology
– Study of the skin
Integumentary System
• Accessory structures
– Hair
– Nails
– Glands
Layers and Structures of the Skin
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Structure of the Nail
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Question
True or False: The epidermal layer
contains most of the skin’s vital
structures.
Answer
False. The dermis actually contains
structures such as hair follicles, pressure
receptors, and glands.
Question
The half-moon we see at the base of our
fingernails is called the _______.
a. cuticle
b. lunula
c. nail bed
d. edge
Answer
b. It is derived from the Latin word luna,
meaning “moon.”
Skin Lesions
• Abrasion
– Scraping or rubbing away of skin or mucous
membrane as a result of friction to the area
• Example: carpet burn
• Abscess
– Localized collection of pus in any body part that
results from invasion of pus-forming bacteria
• Example: pustule = small abscess
Skin Lesions
• Blister
– Small, thin-walled lesion containing clear fluid
– Also known as a vesicle
• Bulla
– Large blister
Skin Lesions
• Carbuncle
– Circumscribed inflammation of the skin and deeper
tissues; contains pus
• Comedo
– Typical lesion of acne vulgaris
• Example: whitehead = closed comedo
• Example: blackhead = open comedo
Skin Lesions
• Cyst
– Closed sac or pouch in or within the skin; contains
fluid, semifluid, or solid material
• Example: hydrocele = fluid-filled cyst, especially in the
scrotum
• Example: sebaceous cyst = solid-filled cyst
Skin Lesions
• Fissure
– Crack like sore or groove in the skin or mucous
membrane
• Example: anal fissure
• Fistula
– Abnormal passageway between two tubular organs
or from an organ to the body surface
• Example: rectovaginal fistula
Skin Lesions
• Hives
– Circumscribed, slightly elevated lesions on skin;
paler in the center than the surrounding edges
– Also called wheals
• Example: mosquito bite
• Laceration
– Tear in the skin
Skin Lesions
• Macule
– Small, flat discoloration of the skin; neither raised
nor depressed
• Example: bruises, freckles
• Nodule
– Small, circumscribed swelling protruding above the
skin
Skin Lesions
• Papule
– Small, solid, circumscribed elevation on the skin
• Example: pimple
• Polyp
– Small, stalk like growth, protruding upward or
outward from mucous membrane surface
• Example: nasal polyp
Skin Lesions
• Pustule
– Small elevation of skin filled with pus
• Example: small abscess on the skin
• Scales
– Thin flakes of hardened epithelium that are shed
from the epidermis
Skin Lesions
• Ulcer
– Circumscribed, open sore or lesion of skin,
accompanied by inflammation
• Example: decubitus ulcer
• Vesicle
– Small, thin-walled lesion containing clear fluid
• Example: blister
Skin Lesions
• Wheal
– Circumscribed, slightly elevated lesion of the skin
– Paler in the center than the surrounding edges
• Example: hives
Question
Notice that sometimes 2 different terms
are used to describe the same thing. For
instance, if a physician says a patient
has hives, this patient also has
_______.
a. comedos
b. papules
c. cysts
d. wheals
Answer
d. Wheals is the official medical term, and
hives is more of a “layman’s” term.
Question
A patient has a rash consisting of both
macules and papules. What would be
the combined adjective form?
a. maculepapular
b. papulemacular
c. maculopapular
d. papumacular
Answer
c. Maculopapular is the correct combined
adjective form. Remember, the
combining vowel is used because the
second root begins with a consonant.
PATHOLOGICAL
CONDITIONS
Integumentary
System
Acne Vulgaris
• Pronounced
– (ACK-nee vul-GAY-ris)
• Defined
– Common inflammatory dis seen on the face,
chest, back, and neck
– Appears as papules, pustules, and comedos
Albinism
• Pronounced
– (AL-bin-izm)
• Defined
– Condition characterized by the absence of pigment
in the skin, hair, and eyes
• Inherited condition
Burns
• Defined
– Tissue injury produced by flame, heat, chemicals,
radiation, electricity, or gases
– Extent of damage determined by:
• Mode and duration of exposure
• Thermal intensity or temperature
• Anatomic site of the burn
Burns
• First-degree (superficial) burns
– Example: sunburn
• Second-degree (partial-thickness) burns
– Example: flash contact with hot objects, such as
boiling water
• Third-degree (full-thickness) burns
– Example: deep burns from a fire
Callus
• Pronounced
– (CAL-us)
• Defined
– Common, usually painless thickening of the
epidermis at sites of external pressure or friction,
such as weight-bearing areas of the feet and on the
palmar surface of the hands
– Also known as a callosity
Question
True or False: The higher the degree
rating, the deeper the burn.
Answer
True. First-degree is superficial, while
third-degree is full thickness.
Carcinoma, Basal Cell
• Pronounced
– (kar-sih-NOH-mah BAY-sal sell)
• Defined
– A malignant epithelial cell tumor
– Begins as a slightly elevated nodule with a
depression or ulceration in the center
Carcinoma, Basal Cell
• Defined
– As the depression enlarges, the tissue breaks
down, crusts, and bleeds
– Most common malignant tumor of epithelial tissue;
occurs most often on skin exposed to the sun
Carcinoma, Basal Cell
Image courtesy of Robert A. Silverman, M.D.,
Pediatric Dermatology, Georgetown University
Carcinoma, Squamous Cell
• Pronounced
– (kar-sih-NOH-mah SKWAY-mus sell )
• Defined
– Malignancy of the squamous, or scale-like, cells of
the epithelial tissue
– Much faster growing than basal cell carcinoma
– Greater potential for metastasis if not treated
Carcinoma, Squamous Cell
• Frequent sites on sun-exposed areas
– Top of nose
– Forehead
– Margin of external ear
– Back of hands
– Lower lip
Carcinoma, Squamous Cell
Image Courtesy of Robert A. Silverman, M.D., Pediatric
Dermatology, Georgetown University
Dermatitis
• Pronounced
– (der-mah-TYE-tis)
• Defined
– Inflammation of skin, seen in several different forms
– Acute or chronic
– Contact or seborrheic
Eczema
• Pronounced
– (EcK-zeh-mah)
• Defined
– Acute or chronic inflammatory skin condition
characterized by erythema, papules, vesicles,
pustules, scales, crusts, scabs, and intense itching
Exanthematous Viral Diseases
• Pronounced
– (eks-an-THEM-ah-tus VYE-ral dih-ZEEZ-ez)
• Defined
– Skin eruption or rash accompanied by
inflammation, having specific diagnostic features of
an infectious viral disease
Exanthematous Viral Diseases
• Examples
– Rubella = German measles
– Roseola infantum
– Rubeola = red measles
– Erythema infectiosum = fifth disease
Gangrene
• Pronounced
– (GANG-green)
• Defined
– Tissue death due to loss of adequate blood supply,
invasion of bacteria; subsequent decay of enzymes
produces foul odor
• Two forms
– Dry
– Moist
Herpes Zoster
• Pronounced
– (HER-peez ZOS-ter)
• Defined
– Acute viral infection, characterized by painful,
vesicular eruptions on the skin that follow along
nerve pathways of underlying spinal or cranial
nerves
– Highest incidence in adults over 50
Herpes Zoster
Image courtesy of Robert A. Silverman, M.D.,
Pediatric Dermatology, Georgetown University
Hyperkeratosis
• Pronounced
– (high-per-kerr-ah-TOH-sis)
• Defined
– Overgrowth of the horny layer of the epidermis
– Occurs in psoriasis and in the formation of calluses
and corns
Impetigo
• Pronounced
– (im-peh-TYE-goh)
• Defined
– Contagious superficial skin infection characterized
by serous vesicles and pustules filled with millions
of staphylococcus or streptococcus bacteria
Question
This viral infection most commonly flares
up after age 50 and follows along nerve
pathways:
a. eczema
b. rubeola
c. herpes zoster
d. impetigo
Answer
c. Also called “shingles.”
Kaposi’s Sarcoma
• Pronounced
– (CAP-oh-seez sar-KOH-ma)
• Defined
– Rare malignant lesions; begin as soft purple-brown
nodules or plaques on the feet
– Gradually spreads throughout the skin
– Increased incidence in men with AIDS
Keloid
• Pronounced
– (KEE-loyd)
• Defined
– Enlarged, irregularly shaped, elevated scar that
forms due to the presence of large amounts of
collagen during formation of a scar
Keratosis
• Pronounced
– (kerr-ah-TOH-sis)
• Defined
– Skin condition in which there is a thickening and
overgrowth of the cornified epithelium
Seborrheic Keratosis
• Pronounced
– (seb-oh-REE-ik kerr-ah-TOH-sis)
• Defined
– Brown or waxy yellow, wart like lesions that are
loosely attached to the skin surface
– Also known as seborrheic warts
Actinic Keratosis
• Pronounced
– (ak-TIN-ic kerr-ah-TOH-sis)
• Defined
– Premalignant, gray or red-to-brown, hardened
lesion caused by excessive exposure to sunlight
– Also known as solar keratosis
Leukoplakia
• Pronounced
– (loo-koh-PLAY-kee-ah)
• Defined
– White, hard, thickened patches firmly attached to
the mucous membrane, such as mouth, vulva, or
penis
Question
True or False: Keratosis literally means
condition of a horny-like growth in the
upper layer of skin, like a wart or callus.
Answer
True. This originates in the stratum
corneum, the uppermost layers of cells
with no nuclei and a plate-like
appearance.
Malignant Melanoma
• Pronounced
– (mah-LIG-nant mel-ah-NOH-mah)
• Defined
– Malignant skin tumor originating from melanocytes
in preexisting nevi, freckles, or skin with pigment
– Darkly pigmented tumor with irregular surfaces and
b s; variable colors
ABCDs of Malignant Melanomas
• Asymmetry
• B s
• Color
• Diameter
Nevus
• Pronounced
– (NEV-us)
• Defined
– Visual accumulation of melanocytes, creating a flat
or raised, rounded macule or papule with definite
b s
– Commonly known as a mole
Question
Based on the definition of melanoma, what
is the actual meaning of melan-?
a. dark pigment
b. light pigment
c. blue pigment
d. white pigment
Answer
a. Melanocyte is the cell that produces the
dark pigment (melanin) in our skin, hair,
and eyes. Albinism is the absence of this
pigment.
Onychocryptosis
• Pronounced
– (on-ih-koh-krip-TOH-sis)
• Defined
– Ingrown nail
• Most commonly involves the large toe
Onychomycosis
• Pronounced
– (on-ih-koh-my-KOH-sis)
• Defined
– Fungal infection of the nails
Pediculosis
• Pronounced
– (pee-dik-you-LOH-sis)
• Defined
– Highly contagious parasitic infestation caused by
blood-sucking lice
Pediculosis
• Pediculosis capitis
– Head
• Pediculosis corporis
– Body
• Pediculosis palpebrarum
– Eyelashes and eyelids
• Pediculosis pubis
– Pubic hair
Pemphigus
• Pronounced
– (PEM-fih-gus)
• Defined
– Rare, incurable dis manifested by blisters in
the mouth and on the skin
– Spreads to involve large areas of the body
Pilonidal Cyst
• Pronounced
– (pye-loh-NYE-dal SIST)
• Defined
– Closed sac located in the sacrococcygeal area of
the back
– Sometimes noted at birth as a dimple
Psoriasis
• Pronounced
– (soh-RYE-ah-sis)
• Defined
– Common, noninfectious, chronic skin dis
manifested by silvery-white scales over round,
raised, reddened plaques producing itching
(pruritus)
Psoriasis
Image courtesy of Robert A. Silverman, M.D.,
Pediatric Dermatology, Georgetown University
Rosacea
• Pronounced
– (roh-ZAY-she-ah)
• Defined
– Chronic inflammatory skin disease that mainly
affects the skin of the middle third of the face
– Characterized by persistent redness over areas of
the face, nose, and cheeks
Scabies
• Pronounced
– (SKAY-beez)
• Defined
– Highly contagious parasitic infestation caused by
the “human itch mite”
– Results in a rash, pruritus, and slightly raised
thread like skin lines
Scleroderma
• Pronounced
– (sklair-oh-DER-mah)
• Defined
– Gradual thickening of the dermis and swelling of
the hands and feet to a state in which the skin is
anchored to the underlying tissue
– No cure
Systemic Lupus Erythiematosus
• Pronounced
– (sis-TEM-k LOO-pus air-ih-them-ah-TOH-sus)
• Defined
– Chronic, multisystem inflammatory disease
characterized by lesions of the nervous system and
skin, renal problems, and vasculitis
– Characteristic “butterfly rash” is often seen on nose
and face
Tinea
• Pronounced
– (TIN-ee-ah)
• Defined
– Chronic fungal infection of the skin
– Characterized by scaling, itching, and sometimes
painful lesions
– Commonly known as ringworm
Tinea
• Tinea capitis
– Scalp
• Tinea corporis
– Body
• Tinea cruris
– Groin
• Tinea pedis
– Foot
Verruca
• Pronounced
– (ver-ROO-kah)
• Defined
– Benign, circumscribed, elevated skin lesion that
results from hypertrophy of the epidermis
– Commonly known as a wart
– Caused by the human papilloma virus
Verruca
• Verruca vulgaris
– Common wart on face, elbow, fingers, or hands
• Plantar warts
– Singly or in clusters on the sole of the foot
Verruca
• Venereal warts (condyloma acuminata)
– Transmitted by sexual contact
• Seborrheic warts
– Seen in the elderly on the face, neck, chest, or
upper back
– Benign
Question
Which condition is described as a highly
contagious parasitic disease caused by a
mite?
a. verruca vulgaris
b. dermatitis
c. scabies
d. rosacea
Answer
c. The little mite, Sarcoptes scabiei,
burrows under the skin to lay eggs.
DIAGNOSTIC TECHNIQUES,
TREATMENTS, AND
PROCEDURES
Integumentary
System
Diagnostic Techniques, Treatments,
and Procedures
• Allergy testing
– Various procedures used to identify specific
allergens in an individual by exposing the person to
a very small quantity of the allergen
• ImmunoCAP® Allergy Blood Test is more advanced,
convenient, and reliable
• Intradermal, patch, and scratch tests are common
• Cautery
– Heat or caustic substances that burn and scar the
skin
Diagnostic Techniques, Treatments,
and Procedures
• Cryosurgery
– Noninvasive treatment that uses subfreezing
temperature to freeze and destroy tissue
• Curettage and electrodesiccation
– Scraping away of abnormal tissue, followed by
destroying the tumor base with a low-voltage
electrode
Diagnostic Techniques, Treatments,
and Procedures
• Debridement
– Removal of debris, foreign objects, and damaged
or necrotic tissue from a wound to prevent infection
and promote healing
• Dermabrasion
– Removal of the epidermis and a portion of the
dermis with sandpaper or brushes to eliminate the
superficial scars of unwanted tattoos
Diagnostic Techniques, Treatments,
and Procedures
• Dermatoplasty
– Skin transplantation to a body surface damaged by
injury or disease
• Electrodesiccation
– Technique using an electrical spark to burn and
destroy tissue
– Also known as fulguration
Diagnostic Techniques, Treatments,
and Procedures
• Electrosurgery
– Removal or destruction of tissue with an electrical
current
• Escharotomy
– Incision made into the necrotic tissue resulting from
a severe burn
Diagnostic Techniques, Treatments,
and Procedures
• Liposuction
– Aspiration of fat through a suction cannula or
curette to alter the body contours
• Skin biopsy
– Removal of a small piece of tissue from skin lesions
for examination under a microscope to confirm or
establish a diagnosis
Diagnostic Techniques, Treatments,
and Procedures
• Skin graft
– Process of placing tissue on a recipient site, taken
from a donor site, in to provide the protective
mechanisms of skin to an area unable to
regenerate skin
• Wood’s lamp
– Ultraviolet light that is used to examine the scalp
and skin for the purpose of observing fungal spores
Question
True or False: Dermabrasion removes
debris or necrotic tissue and assists in
wound healing.
Answer
False. Debridement is for the removal of
debris, foreign objects, and damaged or
necrotic tissue. This assists in prevention
of infection and the promotion of healing
of the wound.
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