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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
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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 glands
2.These are coiled tubes that extend through
the dermis
3.They open on the surface of the skin at an
opening called a pore
4.They eliminate sweat that contains water, salts
and body waste
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• Gland #2
• Sebaceous glands- these are oil glands
1.They usually open to a hair follicle
2.They produce oil called sebum
3.Sebum is important to keep hair from
becoming dry and brittle
4.Blackheads and pimples occur when an oil
gland becomes plugged with dirt and oil
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• Other parts of the integumentary system:
1. Hair
2. Hair consists of a root that grows in a hollow
tube called a follicle and a hair shaft
3. Protects the body
4. Covers all surfaces of the body except for palms
of hands and soles of the feet
5. Certain conditions cause people to loose hair
called alopecia or baldness- genetic condition
for hair lose on the scalp
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• Nails
1. Protect the fingers and toes from injury
2. 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 bed
4. 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
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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- genetic
See pic……
psoriasis
Skin eruptions
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Impetigo:
Very contagious
Erythema, vesicles with a sticky yellow crust
Infection with strep
impetigo
Skin eruptions
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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 skin
Stage II – blister or open area can be through the dermis
Stage III- open to the fascia
Stage 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 seconddegree 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.