Transcript Airgas template - Acupuncture and Massage College

Chapter 5:
The Skin, Hair, and Nails
Anatomy and Physiology
• Major function of skin is to keep body in homeostasis
• Heaviest single organ in body
– 16% of body weight
• Three layers
– Epidermis
– Dermis
– Subcutaneous tissue
Anatomy and Physiology
• Hair, nails and sebaceous and sweat glands are
appendages of skin
• Hair
– Vellus hair – short, fine, less pigmentation
– Terminal hair – coarser, pigmented (scalp/eyebrows)
• Nails
– Protect distal ends of fingers/toes
• Sebaceous glands – present all surfaces except
palms/soles
• Sweat glands – help control body temperature
The Health History
• Common or Concerning Symptoms
– Hair loss
– Rash
– Moles
• Ask the patient
– “Have you noticed any changes in your skin?
...your hair? ...?”
– “Have you noticed any moles that have changed size,
shape, color or sensation?”
– “Any new moles?”
Skin Cancers
• Basal Cell Carcinoma
– 80% of skin cancers
– Shiny, translucent, grow slowly; rarely metastasize
• Squamous Cell Carcinoma
– 16% skin cancer
– Crusted, scaly, ulcerated; can metastasize
• Melanoma
– 4% skin cancer
– Rapidly increasing in frequency
– Spread rapidly
Risk Factors for Melanoma
• ≥ 50 common moles
• ≥ 1-4 atypical or unusual moles (especially if dysplastic)
• Red or light hair
• Actinic lentigenes, macular brown or tan spots (usually
on sun exposed areas)
• Heavy sun exposure
• Light eye or skin color (especially freckles/burns easily)
• Family history of melanoma
ABCDE: Screening Moles for Possible
Melanoma
• A for asymmetry
• B or irregular borders, especially ragged, notched or
blurred
• C for variation or change in color, especially blue or
black
• D for diameter ≥ 6mm or different from others,
especially changing, itching or bleeding
• E for elevation or enlargement
Preventive Strategies
• Reduce sun exposure
– Especially midday
• Ultraviolet B rays (UV-B), most common
cause of skin cancer are most intense
• Use sunscreens
Techniques of Examination
• Examination of the skin, hair and nails begins with the
General Survey of the patient
• Make sure the patient wears a gown
– Drape appropriately to facilitate close inspection of
hair, anterior and posterior surfaces of body,
palms/soles and webspaces
• Inspect entire skin surface in good light
– Preferably natural light (artificial light that resembles)
• Artificial light often distorts colors
Techniques of Examination
• Inspect and palpate skin
• Note characteristics of:
– Color
– Moisture
– Temperature
– Texture
– Mobility and Turgor
– Lesions
Techniques of Examination
• Color
– Patients often notice change in color before physician
– ask them
– Look for increased pigmentation, loss of pigmentation
– Look for redness, pallor, cyanosis and yellowing
• Red color of oxyhemoglobin best assessed at
fingertips, lips and mucous membranes
• In dark-skinned people palms and soles
• For central cyanosis look in lips, oral mucosa
and tongue
• Jaundice - sclera
Techniques of Examination
• Moisture
– Dryness, sweating and oiliness
• Temperature
– Use back of fingertips
– Identify warmth or coolness of skin
• Texture
– Roughness or smoothness
• Mobility and Turgor
– Lift fold of skin
– Note ease with which it lifts up (mobility) and speed with
which it returns to place (turgor)
Techniques of Examination
• Lesions
– Note characteristics
• Anatomic location and distribution
• Patterns and shapes
• Type of lesion (macules, papules, nevi, vesicle)
• Color
Techniques of Examination
• Hair
– Inspect and palpate
– Note quantity, distribution and texture
• Nails
– Inspect and palpate fingernails/toenails
– Note color and shape
– Note lesions
• Longitudinal bands of pigment may be a normal
finding in people with darker skin