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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
 Epidermis:
 this is the outer-most layer of the skin
 The main layer is the stratum corneumthis is where cells constantly shed
 and Stratum germinativum- provides cells
to replace the cells in the strata corneum
Skinny on skin
 Layer #2 the Dermis
 Also called the cornium or true skin
 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
Skinny on Skin
 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 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 loss 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
Skinny on Skin
 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
albinism
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
 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 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
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Papules- papular rash
These are firm raised areas
Examples are chicken pox
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
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
 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,
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
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. Fullthickness 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%
 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.
rd
3
degree burn or full
thickness
 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.