Structure and function of the integument
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Structure and function of the integument Presentation Transcript

  • 1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1 Structure, Function, and Disorders of the Integument
  • 2. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2 Layers of the Skin  Epidermis  Dermis  Hypodermis
  • 3. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3 Layers of the Skin (cont’d)
  • 4. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4 Layers of the Skin (cont’d)  Dermal appendages:  Nails  Hair  Sebaceous glands  Eccrine and apocrine sweat glands  Blood supply  Papillary capillaries
  • 5. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5 Nails
  • 6. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6 Aging and Skin Integrity  The integumentary system reflects numerous changes from genetic and environmental factors  The skin becomes thinner, drier, wrinkled, and demonstrates a change in pigmentation  Shortening and decrease in the number of capillary loops  Fewer melanocytes and Langerhans cells
  • 7. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7 Aging and Skin Integrity (cont’d)  The integumentary system reflects numerous changes from genetic and environmental factors (cont’d)  Atrophy of the sebaceous, eccrine, and apocrine glands  Changes in hair color  Fewer hair follicles and growth of thinner hair
  • 8. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8 Clinical Manifestations of Skin Dysfunction  Macule  Papule  Patch  Plaque  Wheal  Nodule  Tumor  Vesicle  Bulla  Pustule  Cyst  Telangiectasia  Scale  Lichenification  Keloid  Scar  Excoriation  Fissure  Erosion  Ulcer  Atrophy
  • 9. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9 Pressure Ulcers  Pressure ulcers result from any unrelieved pressure on the skin, causing underlying tissue damage  Pressure  Shearing forces  Friction  Moisture
  • 10. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10 Pressure Ulcers (cont’d)
  • 11. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 Pressure Ulcers (cont’d)  Stages:  I. Nonblanchable erythema of intact skin  II. Partial-thickness skin loss involving epidermis or dermis  III. Full-thickness skin loss involving damage or loss of subcutaneous tissue  IV. Full-thickness skin loss with damage to muscle, bone, or supporting structures
  • 12. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12 Keloids  Elevated, rounded, and firm  Clawlike margins that extend beyond the original site of injury  Excessive collagen formation during dermal connective tissue repair  Common in darkly pigmented skin types and burn scars  Type III collagen is increased
  • 13. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13 Keloids (cont’d)
  • 14. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14 Pruritus  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
  • 15. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15 Pruritus (cont’d)  Pain stimuli at lower intensities can induce itching  Chronic itching can result in infections and scarring due to persistent scratching
  • 16. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16 Disorders of the Skin  Inflammatory disorders  The most common inflammatory disorders of the skin are dermatitis or eczema  There are various types of dermatitis  The disorders are generally characterized by: • Pruritus • Lesions with indistinct borders • Epidermal changes
  • 17. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17 Inflammatory Disorders  Allergic contact dermatitis  Caused by a hypersensitivity type IV reaction  The allergen comes in contact with the skin, binds to a carrier protein to form a sensitizing antigen; Langerhans cells process the antigen and carry it to T cells, which become sensitized to the antigen  Manifestations: • Erythema • Swelling • Pruritus • Vesicular lesions
  • 18. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18 Allergic Contact Dermatitis
  • 19. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19 Inflammatory Disorders  Atopic dermatitis  Type I hypersensitivity: activation of mast cells, eosinophils, T-lymphocytes, and other inflammatory cells  Causes red, weeping crusts and chronic inflammation, lichenification
  • 20. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20 Inflammatory Disorders (cont’d)  Irritant contact dermatitis  Nonimmunologic inflammation of the skin  Chemical irritation from acids or prolonged exposure to irritating substances  Symptoms similar to allergic contact dermatitis  Treatment: remove stimulus
  • 21. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21 Inflammatory Disorders (cont’d)  Stasis dermatitis  Occurs in the legs as a result of venous stasis, edema, and vascular trauma  Sequence of events: • Erythema • Pruritus • Scaling • Petechiae • Ulcerations
  • 22. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22 Inflammatory Disorders (cont’d)  Seborrheic dermatitis  Inflammation of the skin involving the scalp, eyebrows, eyelids, nasolabial folds, and ear canals  Scaly, white, or yellowish plaques
  • 23. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23 Stasis and Seborrheic Dermatitis
  • 24. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24 Papulosquamous Disorders  Psoriasis  Chronic, relapsing, proliferative skin disorder  T cell immune- mediated skin disease  Scaly, thick, silvery, elevated lesions, usually on the scalp, elbows, or knees caused by a high rate of mitosis in the basale layer
  • 25. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25 Papulosquamous Disorders (cont’d)  Psoriasis (cont’d)  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
  • 26. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26 Psoriasis
  • 27. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27 Papulosquamous Disorders  Psoriasis (cont’d)  Plaque psoriasis  Inverse psoriasis  Guttate psoriasis  Pustular psoriasis  Erythrodermic psoriasis
  • 28. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28 Papulosquamous Disorders (cont’d)
  • 29. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29 Papulosquamous Disorders (cont’d)  Pityriasis rosea  Benign, self-limiting inflammatory disorder  Usually occurs during the winter months  Herald patch • Circular, demarcated, salmon-pink, 3- to 4-cm lesion
  • 30. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30 Papulosquamous Disorders (cont’d)
  • 31. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31 Papulosquamous Disorders (cont’d)  Lichen planus  Benign, inflammatory disorder of the skin and mucous membranes  Unknown origin, but T cells, adhesion molecules, inflammatory cytokines, and antigen presenting cells are involved  Nonscaling, violet-colored, 2- to 4-mm lesions  Wrists, ankles, lower legs, genitalia
  • 32. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32 Lichen Planus
  • 33. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33 Papulosquamous Disorders  Acne vulgaris  Inflammatory disease of the pilosebaceous follicles  Acne rosacea  Inflammation of the skin that develops in adulthood  Lesions • Erythematotelangiectatic, papulopustular, phymatous, and ocular • Associated with chronic, inappropriate vasodilation resulting in flushing and sensitivity to the sun
  • 34. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34 Papulosquamous Disorders (cont’d)  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
  • 35. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35 Discoid Lupus Erythematosus
  • 36. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 36 Vesiculobullous Disorders  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
  • 37. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 37 Vesiculobullous Disorders (cont’d)  Pemphigus (cont’d)  Tissue biopsies demonstrate autoantibody presence  Types: • Pemphigus vulgaris (severe) • Pemphigus foliaceus • Pemphigus erythematosus
  • 38. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 38 Vesiculobullous Disorders (cont’d)  Bullous pemphigoid  More benign disease than pemphigus vulgaris  Bound IgG and blistering of the subepidermal skin layer  Subepidermal blistering and eosinophils distinguish pemphigoid from pemphigus
  • 39. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 39 Bullous Pemphigoid
  • 40. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 40 Vesiculobullous Disorders  Erythema multiforme  Acute, recurring disorder of the skin and mucous membranes  Associated with allergic or toxic reactions to drugs or microorganisms  Caused by immune complexes formed and deposited around dermal blood vessels, basement membranes, and keratinocytes
  • 41. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 41 Vesiculobullous Disorders (cont’d)  Erythema multiforme (cont’d)  “Bull’s-eye” or target lesion • Erythematous regions surrounded by rings of alternating edema and inflammation  Bullous lesions form erosions and crusts when they rupture  Affects the mouth, air passages, esophagus, urethra, and conjunctiva  Severe forms: • Stevens-Johnson syndrome (bullous form) • Toxic epidermal necrolysis
  • 42. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 42 Infections  Bacterial infections:  Folliculitis  Furuncles  Carbuncles  Cellulitis  Erysipelas  Impetigo
  • 43. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 43 Furuncle
  • 44. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 44 Infections  Viral infections  Herpes zoster and varicella
  • 45. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 45 Herpes Simplex Virus
  • 46. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 46 Warts  Benign lesions caused by the human papillomavirus (HPV)  Diagnosed by visualization  Condylomata acuminata  Venereal warts
  • 47. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 47 Fungal Infections  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
  • 48. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 48 Tinea Pedis
  • 49. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 49 Fungal Infections  Candidiasis  Caused by Candida albicans  Normally found on the skin, in the GI tract, and in the vagina  Candida albicans can change from a commensal organism to a pathogen • Local environment of moisture and warmth • Systemic administration of antibiotics • Pregnancy • Diabetes mellitus • Cushing disease • Debilitated states • Age younger than 6 months • Immunosuppression • Neoplastic diseases
  • 50. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 50 Vascular Disorders  Cutaneous vasculitis  Results from immune complexes in the small blood vessels • Develops from drugs, bacterial infections, viral infections, or allergens  Lesions • Palpable purpura progressing to hemorrhagic bullae with necrosis and ulceration
  • 51. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 51 Vascular Disorders (cont’d)  Urticaria  Caused by type I hypersensitivity reactions to allergens  Histamine release causes endothelial cells of the skin to contract • Causes leakage of fluid from the vessels  Treatment • Antihistamines and steroids
  • 52. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 52 Vascular Disorders (cont’d)  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
  • 53. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 53 Vascular Disorders (cont’d)  Scleroderma (cont’d)  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
  • 54. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 54 Scleroderma
  • 55. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 55 Insect Bites  Bees  Mosquitoes  Flies
  • 56. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 56 Benign Tumors  Seborrheic keratosis  Keratoacanthoma  Actinic keratosis  Nevi (moles)
  • 57. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 57 Seborrheic Keratosis
  • 58. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 58 Cancer  Basal cell carcinoma  Squamous cell carcinoma  Malignant melanoma  Kaposi sarcoma
  • 59. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 59 Basal Cell Carcinoma
  • 60. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 60 Squamous Cell Carcinoma
  • 61. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 61 Malignant Melanoma
  • 62. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 62 Kaposi Sarcoma
  • 63. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 63 Burns  Partial-thickness burns  First degree  Superficial and deep partial  Second degree  Full-thickness burns  Third degree  “Rule of nines”
  • 64. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 64 Superficial Partial-Thickness Burn
  • 65. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 65 Axillary Burn Scar Contracture
  • 66. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 66 Deep Partial-Thickness Burn
  • 67. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 67 Full-Thickness Burn
  • 68. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 68 Estimating Burn Injury
  • 69. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 69 Burns
  • 70. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 70 Hypertrophic Scarring
  • 71. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 71 Cultured Epithelial Autograft
  • 72. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 72 Frostbite  Skin injury caused by exposure to extreme cold  Usually affects fingers, toes, ears, nose, and cheeks  The “burning reaction” is caused by alternating cycles of vasoconstriction and vasodilation  Inflammation and reperfusion are both part of the pathophysiology
  • 73. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 73 Disorders of the Hair  Male-pattern alopecia  Genetically predisposed response to androgens  Androgen-sensitive and androgen-insensitive follicles
  • 74. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 74 Disorders of the Hair (cont’d)  Female-pattern alopecia  Associated with elevated levels of the serum adrenal androgen dehydroepiandrosterone sulfate  No loss of hair along the frontal hairline
  • 75. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 75 Disorders of the Hair (cont’d)  Alopecia areata  Autoimmune T cell-mediated inflammatory disease against hair follicles that results in baldness  Hirsutism  Androgen-sensitive areas • Abnormal growth and distribution of hair on the face, body, and pubic area in a male pattern that occurs in women
  • 76. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 76 Disorders of the Nail  Paronychia  Acute or chronic infection of the cuticle  Onychomycosis  Fungal or dermatophyte infection of the nail plate