N202 Skin, Hair Nails pg 5-9

• Color- skin tone, white, black, blue etc..
• Elevation- flat, raised, predunculated (stalk- such as a skin tag)
• Configuration- shape or pattern
• Size- metric (mm, cm)
• Number- 1 or numerous
• Location- (body part) & distribution (localized vers generalized)
• Discharge or exudate ( describe color, odor)

• A lesion that develops on previously normal structures
• It is the initial lesion

• A lesion that changes over time because of a factor such as scratching or infection.
• Results from changes in the primary lesion

• Flat lesions: Macule, Patch
• Raised lesions: Papule, Plaques, Nodule, Tumor, Wheal, Urticaria
• Fluid Filled lesions: Vesicle, Bulla, Pustule, Cyst

Macule: flat circumscribed, discolored, less than 1cm. (ex freckles, nevi, solar lentigens "liver spots", petechia

Patch: flat, irregular, larger than 1cm (ex vitiligo, Mongolian spots, cafe au lait spot, measle rash)

• Papule: solid, elevated, circumscribed, less than 1cm. (ex elevated nevus, wart (verrucal))
• Plaques: coalesced papules greater than 1cm (ex psoriasis)
• Nodule: solid, elevated, 1-2cm (lipoma = fatty growth)
• Tumor: larger than a few cm, firm or soft (lipoma)
• Wheal: Superficial, raised, erythematous, irregular ( allergic rxn, PPD, mosquito bite)-causes interstiial edema
• Urticaria: (hives) wheals coalesce (or grow together) to form extensive rxn, intensive allergic rxn

• Vesicle: elevated cavity with clear fluid, up to 1cm. (ex herpes simplex, varicella (chix pox), herpes zoster (shingles), contact dermatitis (posion ivy)
• Bulla: elevated cavity with fluid, larger than 1cm (blister, burns)
• Pustule: contains pus, filled with leukocytes (ex acne, impetigo)
• Cyst: encapsulated fluid filled cavity in dermis or sub-q (ex sebaceous cyst), elevates skin

• Crust: Thickened dry exudate (dried serum/blood/pus) on top of primary lesion (scab) (ex. rupture of herpes vesicles results from crust with erythematous base, impetigo (staph & strep))
• Scale: compact flakes of skin ( ex. psoriasis (white-silvery), seborrheic dermatitis (yellow-greasy), seborrhea (dandruff))
• Fissure: linear crack (cheilosis (corners of mouth), callused heels, tinea pedis (athletes foot)-between toes)
• Erosion: shallow depression, moist, no bleeding, no scar (effects epidermis, varicella rupture)
• Ulcer: deep depression into dermis, leaves scar (stasis ulcer, pressure sore)
• Excoriation: superficial abrasion (dermatitis) -red open sores
• Scar: conncetive tissue replacing normal tissue (two types: atrophic & hypertrophic)
• Lichenification: thickening of skin (eczema (atopic dermatitis), chronic sun exposure)

• Atrophic: depressed scar - stretch marks (striae)
• Hypertrophic: excess scar tissue secondary to increased collagen formation (keloid)

• Ring, clear center
• An ex is tinea corporus (ring worm), pityriasis rosea

1/2 ring

Isolated

lesions run together (urticaria or hives)

• clusters of lesions
• ex vesicles of contact dermatitis

coiled, spiral, snake like

• solid center, like a bulls eye
• ex. erythema multiform

scratch, streak, line or stripe

like lace pattern (mottled appearance) ex sitting in the hot tub too long

• Linear vesicles along a nerve route
• ex. shingles (herpes zoster)
• Vaccine available to prevent shingles for 60 years and older

• An ultraviolet light filtered through a special glass
• Use it to detect fluorescing lesions
• Coral red color = bacterial
• Blue/ green color = fungal

• It is a microscopic examination of skin scrapings, it helps diagnose superficial fungal infections.
• Use sharp sterile blade and lightly scrape the scale from edge of the lesion
• Place on clean slide
• Add a drop of KOH
• Fungal infection can be seen under microscope

Ringworm, It is a fungal infection

Jock itch - often spread from feet (put socks on before pants)

Athlete's foot

• Fungal scalp infection
• ex cradle cap

• Most deadly cancer
• Highly metastatic
• Grows deep, not wide
• 1/2 rise from pre-existing nevi
• High risk (fair skin, sun exposure)
• Use the ABCD for characteristics

• Asymmetry: not regularly round or oval, ragged edges or poorly defined margins
• Border: irregularity (notching, scalloping, ragged edges or poorly defined margins)
• Color: variations (areas of brown, tan, black, blue, red, white or combination)
• Diameter: greater than 6mm (the size of pencil eraser)
• Elevation and Enlargement

• Also called BCC
• Most common skin cancer
• grows slowly, seldom metastasizes
• usually appears on face (most common in fair skin older than 40 yrs
• Usually starts as skin colored papule/nodule with overlying telangicetasia(small dilated blood vessels)
• May develop a depressed center

• Also known as SCC
• Grows rapidly
• Usually appears on hands or head (sun exposed areas, usually older than 60 yrs
• Erythematous scaly patch 1cm or more
• Develops central ulcer

• Also called AK
• pink, scaly papules- may be precursor to SCC

blackheads, very common in adolescents

White heads, common in adolescents

• Raised, crusty, irregular lesions. Look "stuck on" sometimes waxy, non cancerous located on trunk, face, hands (genetic)
• Common in the aging adult

White hairline markings from trauma or picking at cuticle (normally found)

160 or less

• Nail straighten out to greater than 180 and nail bed becomes spongy
• Related to chronic hypoxia- COPD, Lung CA, CHD

• 4-5 reddish-brown streaks in nail
• Indicates bacterial endo carditis, trauma

• Spoon nails/ concave
• Iron deficiency anemia

Inflammation/infection of skin around nail bed

Loosening of nail plate (fungal infection)

psoriasis

• bleeding under the nail plate, painful, may need to be drained by drilling a hole to release pressure
• ex car door slam

• Cuts the nail at an angle
• Diabetes patients are at risk for infection

Picking at nail with index finger

• less that 2 sec
• If more than 2 sec this could mean altered peripheral circulation