View stunning SlideShares in full-screen with the new iOS app!Introducing SlideShare for AndroidExplore all your favorite topics in the SlideShare appGet the SlideShare app to Save for Later — even offline
View stunning SlideShares in full-screen with the new Android app!View stunning SlideShares in full-screen with the new iOS app!
The deeper dermis is made up of proteins and muco-poly-saccharides , thick, gelatinous material that provides a supporting matrix for nerve tissue, blood vessels, sweat and sebum glands, and hair follicles.
is also made up of keratinized cells. Hair is found over most of the body. It grows from hair follicles supplied by blood vessels located in the dermis.
Vellus ,which is short, pale, and fine hair, is located over all of the body.
Terminal hairs , which are dark and coarse, are found on the scalp, brows, and, after puberty, on the legs, axillae , and perineum. The texture and color of hair are highly variable. Hair provides protection by covering the scalp and filtering dust and debris away from the nose, ears, and eyes .
Nails are made up of hard, keratinized cells and grow from a nail root under the cuticle. Other nail structures include the free edge, which overhangs the tip of the finger or toe; the nailbed, or epithelial layer of skin; and the lunula , the proximal part of the nail.
The nailbed’s vascular supply gives the nail a pink color, although the nail itself is generally transparent.The purpose of the nails is to protect the distal portions of the digits and aid in picking up objects.
Other appendages to the integument include the sweat glands and sebaceous glands . There are two types of sweat glands: eccrine glands , which are distributed over much of the body, and apocrine glands , which are limited to the genitalia, axillae, and areolae.
Sebaceous glands are located near hair follicles, over most of the body.
They secrete sebum , which lubricates the hair shaft.
Once you have taken the history, proceed to collect objective data through your physical examination. Even though the skin,hair,and nails are easily accessible and we look at them every day, you still need to be very objective and attentive to details that could easily be overlooked.
Examine the patient’s skin,noting color,odor,and the presence of lesions. Once you have determined the patient’s overall skin coloring, take a moment to decide if the coloring suggests something other than a normal variation.
INSPECTION OF THE SKIN A S S E S S M E N T T E C H N I Q U E S / N O R M A L VA R I AT I O N S ■ Inspect both exposed/unexposed areas for color. ■ Differentiate central cyanosis from peripheral cyanosis by inspecting oral mucosa and conjunctiva. ■ Gently pull lower eyelids down to examine conjunctiva.
Jaundice from liver disease is seen in the sclera and conjunctiva, whereas pseudojaundice— yellow color variations associated with carotemia—is seen on the skin but not in the eyes.
When differentiating peripheral cyanosis (caused by vasoconstriction or decreased circulation) from central cyanosis (caused by hypoxia), check the oral mucous membranes and conjunctiva. Cyanotic mucous membranes and conjunctiva indicate a central process.
Palpate the nail for texture and refill. Nail texture should be uniform and not brittle. Note any grooves or lines or pitting in the nail or nailbed.To check for capillary refill, press on the tip of the nail. It should blanch, and upon release the color should return within 3 seconds.
Inspect hair quantity and distribution. Assess areas for the pattern. Note whether there is actual hair loss, with smooth skin beneath, or whether hair has been broken off near the scalp, with palpable stubble over the skin. True hair loss occurs in many conditions.
Generalized hair loss : Nutritional deficiencies, hypothyroidism, lupus, thyroid disease, and in response to disorders or situations that stress the integumentary system, such as serious illnesses or side effects of medications.
Patchy alopecia associated with alopecia areata, and fungal infections such as tinea capitis.