SKINNY ON SKIN

Integumentary system

• The integumentary system is the largest organ of the body

• It is a membrane because it covers the body• It is called a system because it has organs and

other parts that work together for a particular function

Layers of the skin

• Epidermis:• this is the outer-most layer of the skin• This layer is made up of 5 smaller layers• The main layers are the stratum corneum- this

is where cells constantly shed• and Stratum germinativum- provides cells to

replace the cells in the strata corneum

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• Layer #2 the Dermis• Also called the cornium or true skin• This has the framework of elastic connective

tissue• It contains blood vessels, lymph vessels,

nerves, involuntary muscle, sweat and oil glands and hair follicles

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• The top of the dermis is covered in papillae• A. Fits into ridges on the stratum

germinativum of the epidermis• B. Ridges form lines or striations on the skin• C. Pattern of ridges is unique for each

individual- this is you fingerprint or foot print used for ID

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• Layer #3 is the fascia or hypodermis• This is the innermost layer of skin• It is made from elastic and fibrous connective

tissue and adipose tissue (fatty tissue)• It connects skin to the underlying muscles

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• Glands of the skin:1.Sudoriferous glands- sweat glands2.These are coiled tubes that extend through

the dermis3.They open on the surface of the skin at an

opening called a pore4.They eliminate sweat that contains water,

salts and body waste

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• Gland #2• Sebaceous glands- these are oil glands1.They usually open to a hair follicle2.They produce oil called sebum3.Sebum is important to keep hair from

becoming dry and brittle4.Blackheads and pimples occur when an oil

gland becomes plugged with dirt and oil

Skinny on Skin• Other parts of the integumentary system:1. Hair2. Hair consists of a root that grows in a hollow

tube called a follicle and a hair shaft3. Protects the body4. Covers all surfaces of the body except for palms

of hands and soles of the feet5. Certain conditions cause people to loose hair

called alopecia or baldness- genetic condition for hair lose on the scalp

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• Nails1.Protect the fingers and toes from injury2.Nails are made of keratinized epidermal cells

which are packed closely together to form a thick dense surface

3.Nail cells are formed in a nail bed4.Cells will regrow if lost if nail bed is not

damaged

Functions of the integumentary systems

• 1. protection- it is a barrier for ultraviolet rays from the sun

• Protects against pathogens or germs• Holds moisture in and prevents deeper tissues

from drying out

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• 2. sensory perception

• Nerves are present in the skin

• Responds to pain, pressure, temperature, and touch

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• 3. regulation of body temp-• Blood vessels in the skin help the body to

retain or lose heat• If blood vessels dilate or get larger, they allow

excess heat to escape through the skin• If blood vessels constrict, they get smaller and

retain heat• Sudoriferous glands help cool the skin through

the evaporation of sweat

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• 4. storage • Skin has tissues for temporary storage of fat,

glucose ( sugar) water vitamins and salts.

• Skin stores adipose tissue (fat) in the subcutaneous connective tissue, which is a source of energy

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• 5. absorption- certain substances can be absorbed through the skin like medications for pain, motion sickness, heart medication and nicotine patches to stop smoking

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• 6. excretion• Skin helps the body eliminate salt , waste and

water

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• 7. production• Skin can help produce vitamin D.• It uses ultraviolet rays from the sun to form an

initial molecule of Vit. D that matures in the liver

Skin color

• Skin color or pigmentation is inherited and determined by pigments in the epidermis

• Melanin:• 1. Absorbs ultraviolet light to darken the skin• 2. Small concentrated areas of melanin

pigment form freckles

Skin color

• Albino- the absence of color pigment

• Skin might have a pinkish tint

• Hair can be yellow or white

• Eyes are red in color and very sensitive to light

albinsim

Abnormal colors

• Erythema- caused by burns or blockage of a blood vessel

• Red color• See picture…..

erythema

Abnormal colors

• Jaundice- yellowish discoloration caused by the presence of bile in the blood as a result of liver or gallbladder disease.

• Also can be seen in diseases that destroy red blood cells

• See picture……..

jaundice

Abnormal color

• Cyanosis- a bluish discoloration caused by insufficient oxygen, associated with heart, lung and circulatory diseases

• See pic……

Abnormal color

• Vitiligo• A loss of pigment in certain areas, usually seen

in autoimmune diseases like hashimoto’s thyroid

• See pic……

vitiligo

tell your table buddy who had vitiligo and was called the king of pop

Abnormal color

• Bruising-• Also called ecchymosis • Happens when blood escapes and clots

beneath the skin• Hematoma- swollen hard bruised area• Vitamin C deficiency• Can be seen with hemophilia patients

Skin injuries

• Sun damage• Clumps elastin fibers which leads to leathery

skin• Can lead to a temporary depression of the

immune system• Can cause DNA alteration which can lead to

skin cancer• See pic of melanoma……….

melanoma

Skin injury• Sun types:• Type 1- always burns needs spf 30• Type 2- always burns easily tans minimally fair skin

needs spf 30-15• Type 3- burns moderately, tans gradually, fair to

medium skin- spf 30-15• Type 4 burns minimally always tans well, medium skin

needs spf 30-15-8• Type 5- rarely burns tans easily olive or dark skin spf

15-8• Type 6- never burns, very dark skin spf 8

Skin injury

• Sun burns can range:• 1st degree- superficial• 2nd degree- partial thickness• 3rd degree- full thickness- may require

hospitalization

2nd degree burn

3rd degree burn or full thickness

Skin eruptions

• Macules- macular rash• Flat spots on the skin• Example : flat spots involved with disease

(5th’s disease, or Rocky Mountain spotted fever)

• See pic….

macular

Skin eruptions

• Papules- papular rash• These are firm raised areas• Examples are chicken pox, pimples, and

syphilis• See pic…..

papular

Skin eruptions

• Vesicles- these are blisters or sacs full of fluid• Sometimes seen with herpes patients

vesicles

Skin eruptions

• Pustules- sacs filled with pus• Example: pimples or acne• No pic- sorry I’m sure you’ve all seen a

pimple!

Skin eruptions

• Crust- or scabs• These are dried areas of pus or blood

Skin eruptions

• Wheals- itchy elevated areas as seen with hives or insect bites

• See pic…..

wheals

psoriasis

• Patchy erythema and scales• This can be from chronic inflammatory

disease- geneticSee pic……

psoriasis

Skin eruptions

• Impetigo:• Very contagious• Erythema, vesicles with a sticky yellow crust• Infection with strep

impetigo

Skin eruptions

• warts• Painless except for plantar warts• Caused by a virus• Can also be venereal HPV- there is a vaccine

to help with several of the strains- very contagious

warts

Skin eruptions• Herpes simplex I- • These are cold sores• can be spread through kissing or sharing

objects such as toothbrushes or eating utensils or general illness (from mild illnesses to serious conditions)fatigue, physical or emotional stress

• Blisters that are inflamed around the mouth• Viral, no cure, contagious

Herpes simplex I

Skin eruptions

• Herpes zoster- shingles after chickenpox• Viral infection with fever and malaise• Vesicles run along nerve pathways, will only

see shingles on one side• If you had chicken pox, the virus can lie

dormant in the nerve root, and in times when the body is stressed, it can flare up

Herpes zoster

Skin eruptions

• tinea-dermatophytosis• Fungal infection, including athlete’s foot,

called ringworm, jock itch• It is infectious and contagious• antifungal medications

tinea

Skin eruptions

• Furuncles (boils) carbuncles (large swollen erythematous lesions)

• Can be caused by staph or strep infections• May need surgical intervention

carbuncle

Skin eruptions

• Ulcers- deep loss of skin that may extend to the dermis • Decubitis - on or over boney prominences, can also be

called bed sores• Can be staged:Stage I- redness, firm, heat, intact skinStage II – blister or open area can be through the dermisStage III- open to the fasciaStage IV- full thickness down through muscle or bone

Pressure ulcer stage I

Pressure ulcer stage II

Pressure ulcer stage III

Pressure ulcer stage IV

Do NOT put pillows under your knees. It puts pressure on your heels.NEVER drag yourself to change your position or get in or out of bed. Dragging will cause skin breakdown. Get help if you need moving in bed or getting in or out of bed.If someone else moves you, they should lift you or use a draw sheet (a special sheet used for this purpose) to move you.Change your position every 1 - 2 hours to keep the pressure off any one spot.Sheets and clothing should be dry and smooth, with no wrinkles.Remove any objects such as pins, pencils or pens, or coins from your bed.Do not raise the head of your bed to more than a 30-degree angle. Being flatter keeps your body from sliding down. Sliding may harm your skin.

Skin eruptions

• Paronychia- this is an infected hangnail

paronychia

Skin eruptions

• Sebaceous cyst- blockage of duct of a sebaceous gland

Sebaceous cyst

Skin eruptions

• Diaper rash- can be dark red areas• Can have swelling• Will have irregular borders and usually

irritated where the diapers are more constricting

Diaper trash- jk rash

Other skin considerations

• Venomous bites-brown recluse• Area will become necrotic (dark purple to

black) and begin to slough• Causes skin to erode and for an open wound• Many people mistake MRSA for spider bites• See pic…..

Brown recluse

MRSA

• Methicillin Resistant Staphylococcus Aureaus• A staph infection from the staph aureus

bacteria that has become resistant to Methicillin antibiotics

• Very contagious spread by contact- use precautions

MRSA

Body lice

• Body lice are parasitic insects that live on clothing and bedding used by infested persons.

• Body lice frequently lay their eggs on or near the seams of clothing.

• Body lice must feed on blood and usually only move to the skin to feed.

BODY LICE

scabies

• Human scabies is caused by an infestation of the skin by the human itch mite

• The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs.

• The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies

• prescription lotion

scabies

burns

• First degree- This means a superficial burn. The surface of the skin is damaged, but the epidermis is still intact, and therefore able to perform its functions (control temperature and protect from infection or injury)

Burns

• 2nd degree:• This means damage that has extended

through the epidermis and into the dermis . Second-degree burns also are known as partial-thickness burns. The presence of second degree burns indicates a loss of skin function. Blisters are the first sign of a second-degree burn. As the epidermis is destroyed, it begins to separate from the dermis.

Burns

• Third degree or full thickness:• This indicates the burn has destroyed both the

epidermis and dermis. The victim has the same trouble with fluid loss, heat loss, and infection that come with second-degree burns. Full-thickness burns also cause nerve death, so the victim may not be able to feel anything in the area of the burn.

Burns• Rule of nines:• You can estimate the body surface area on an adult that has been burned

by using multiples of 9.• An adult who has been burned, the percent of the body involved can be

calculated as follows:• Head = 9%• Chest (front) = 9%• Abdomen (front) = 9%• Upper/mid/low back and buttocks = 18%• Each arm = 9%• Each palm = 1%• Groin = 1%• Each leg = 18% total (front = 9%, back = 9%)• As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front

chest and abdomen were burned, this would involve 55% of the body.

• How would you use the rule of 9's to determine % of surface area burned in a patient with burns on the face, chest and front of one arm.

Exit ticket

• Develop a plan, using 3 simple things, to prevent pressure sores from happening in bed-bound patients.