Integumentary System

Inspection

Bruises in Children.pdf

Nevi

Commonly occurring nevi. A. Junction nevus. Color and shape of this black lesion are uniform.

B. Compound nevus. Center is elevated and surrounding area is flat, retaining features of a junction nevus.

C. Dermal nevus. Papillomatous with soft, flabby, wrinkled surface.

Basal Cell Carcinoma

Common presentations of basal cell carcinoma.

Squamous Cell Carcinoma

Malignant Melanoma

ABCD changes in moles

Vitiligo.

The absence of melanin produces patches of unpigmented skin or hair, such as with vitiligo.

Petechiae.

Bleeding into the skin results in ecchymoses (i.e., bruising); pinpoint bleeding from capillaries occurs is called petechiae (smaller than 0.5 cm in diameter) or purpura (larger than 0.5 cm in diameter).

Senile purpura.

Characteristics and causes of vascular skin lesions.

Palpation

As you inspect, palpate the skin for moisture, temperature, texture, turgor, and elasticity.
Palpation may yield additional data for describing lesions, particularly in relation to elevation or depression.
The skin should range from cool to warm to the touch.
- Use the dorsal surface of your hands or fingers because these areas are most sensitive to temperature perception.

Testing skin turgor.

The skin should move easily when pinched and return to place immediately when released.

Poor skin turgor can indicate severe dehydration.

Skin Lesions

"Skin lesion" is a general term that collectively describes any pathologic skin change or occurrence.
- Primary = Those that occur spontaneous manifestations of a pathologic process
- Secondary = Those that result from later evolution or external trauma to a primary lesion

Smell

Clostridium gas gangrene

Proteus infection

Pseudomonas infection

Tuberculous lymphadenitis

Anaerobic infection, scurvy

Intestinal obstruction, peritonitis

Phenylketonuria

Nail

Inspection

Pigmented bands in nails are expected in persons with dark skin.

Aging nails. Longitudinal ridging of the nail is a common expected variation.

White spots on nail from injury (leukonychia punctate).

White spots in the nail plate (leukonychia punctate), a common finding, result from cuticle manipulation or other forms of mild trauma that injure the nail matrix.

Median nail dystrophy.

Transverse grooves result from repeated injury to the nail, usually the thumb, as with chronic manipulation to the proximal nail fold. The most common cause is picking at the thumb with the index finger (habit-tc deformity).

Schamroth technique.

A. Patient with healthy nails, illustrating window.

Schamroth technique.

B. Patient with nail clubbing, illustrating loss of the window and prominent distal angle.

Finger clubbing. Nail is enlarged and curved.

Clubbing is associated with a variety of respiratory and cardiovascular diseases, cirrhosis, colitis, and thyroid disease.

Nails: unexpected findings and appearance.

Palpation

Gently squeeze the nail between your thumb and the pad of your finger to test for adherence of the nail to the nail bed.
The nail base should feel firm.
A boggy nail base accompanies clubbing.

Testing nail bed adherence.

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