Beruflich Dokumente
Kultur Dokumente
The skin and its appendages are our primary physical presentation to the world.
- stratified structure composed of several functionally related layers
9. What the patient has been doing for the problem, response to
treatment, what makes the condition
worse or better
10. How the patient is adjusting to the problem
B. HAIR
1. Changes: loss or growth, distribution, texture, color
6. What the patient has been doing for the problem, response to
treatment, what makes the condition
worse or better
C. NAILS
1. Changes: splitting, breaking, discoloration, ridging, thickening,
markings, separation from nail bed
6. What the patient has been doing for the problem, response to
treatment, what makes the condition
worse or better
2. Tolerance to sunlight
B. HAIR
1. Previous problems: loss, thinning, unusual growth or distribution,
brittleness, breakage, treatment
C. NAILS
1. Previous Problems: injury bacterial, fungal or viral infection
2. Skin self-examination
- always use good light, minimizing distracting glare
- be aware of locations and appearance of moles and birthmarks
- examine back and other hard-to-see areas using full-length and
hand-held mirrors
- begin with face and scalp and proceed downward
- be aware of dysplastic nevi (those with unexpected changes)
around the shoulders and
back
- be aware of scalp, breast, buttocks, soles of feet and
between toes
- see rather than feel any early signs of mole changes
- consult physician promptly if any pigmented skin spots look like
melanoma
b. color - ranges from dark brown to light tan with pink or yellow
overtones
- callused areas may appear yellow
- vascular flush areas (cheeks, neck, upper chest, genital
area) may appear pink or
red
- may be masked by cosmetics and tanning agents
- look for localized areas of discoloration
- variations include nonpigmented striae (silver or pink
“stretch marks”), freckles,
birthmarks, nevi
- women commonly have chlaosma (melasma) –
hyperpigmentation on the face
and neck associated with pregnancy or use of
hormones
B. HAIR
a. texture - scalp hair may be coarse or fine, curly or straight, and
should be shiny, smooth, and
resilient
- palpate scalp hair for dryness and brittleness that could indicate
systemic disorder
C. NAILS – condition of hair and nails gives a clue about the patient’s level of self-
care and some sense of
emotional order and social integration
1. Inspection
a. color and length – shape and opacity vary considerably
- nail bed color should be variations of pink
- pigment deposits or bands may be present in dark skinned
- edges should be smooth and rounded
- look for nail ridging, grooves, depressions, and pitting
b. configuration and symmetry – nail base angle should measure 160
degrees
- in clubbing, the angle increases and approaches or exceeds 180
degrees
- associated with a variety of respiratory and cardiovascular
diseases, cirrhosis,
colitis, and thyroid diseases
- boggy nail base
2. Palpation – nails should feel hard and smooth with a uniform thickness
- thickening may occur from tight-fitting shoes, chronic trauma,
and some fungal infections
- thinning of the nail may also accompany some nail diseases
- gently squeeze the nail between your thumb and pad of finger to
test for adherence of nail
to nail bed
D. DEVELOPMENTAL VARIATIONS
1. Infants, Children
- first few hours of life, skin may look very red progressing to more
gentle pink
- color is partly determined by chubbiness (less subcutaneous fat,
the redder and more
transparent)
- dark skinned do not always manifest intensity
- exceptions are the nail beds and skin of scrotum
- all newborns are covered to some degree by vernix caseosa
(whitish, moist, cheeselike
substance)
- turgor is an important indication of hydration and nutrition
- seriously dehydrated or very poorly nourished skin will
retain “tenting” after it is
pinched
B. Adolescents
- examination of skin is the same as that for the adult
- may have increased oiliness and perspiration, and increased hair
oiliness
- increased sebum production predisposes to development
of acne
- body odors increase with increased perspiration
C. Pregnant Women
- stretch marks may appear over abdomen, thighs, and breasts
- telangiectasis (vascular spiders) may increase five-fold and will
be found on face, neck,
chest, and arms
- cutaneous tags are either pedunculated or sessile skin tags that
are most often found on
neck and upper chest
D. OLDER ADULTS
- may appear more transparent and paler
- pigment deposits, increased freckling, and hypopigmented
patches
- flaking or scaling over extremities
- skin becomes thinner (especially over bony prominences, dorsal
surface of hands and feet,
forearms, and lower legs) and takes on a parchment like
appearance and texture
- skin often appears to hang loosely
- turgor may not be reliable or valid estimate of hydration status
- greater risk of pressure sores
STAGING OF PRESSURE SORES
Stage I Skin red but not broken
Stage II Damage through epidermis and
dermis
Stage III Damage through to
- subcutaneous tissue
expected findings Stage IV Muscle and possible bone
include: involvement
• Cherry angiomas = tiny, bright ruby-red, round papules that may
brown with time
• Cutaneous tags = small, soft tags of skin usually appearing on
neck and upper chest
• Senile lentigines (age spots) = irregular, round, gray-brown lesions
with rough surface
X. CHILDREN
Café au lait Patches – coffee-colored patches may be either harmless or
indicative of underlying disease
- presence of more than 5 patches with diameters of more than 1 cm in
children under 5 suggests
neurofibromatosis
Seborrheic Dermatitis – chronic, recurrent, erythematous scaling eruption is
localized where sebaceous
glands are concentrated (scalp, back, intertriginous and diaper
diseases)
- scalp lesions are scaling, adherent, thick, yellow, and crusted (cradle
cap) and can spread over the
ear and down the nape of the neck