Integumentary System Abnormalities

• The integumentary system is composed of the skin, the largest organ of the body, along with its accessory organs like hair, glands, and nails
• The average human body is covered with about 2 square meters (22 square feet) of skin, weighing about 6 pounds (2.7 kilograms)
• The skin acts as a barrier to microorganisms, water, and excessive sunlight, regulates body fluids and temperature, absorbs some substances like gases and harmful chemicals, synthesizes melanin, keratin, and vitamin D, and contains sensory receptors
• Keratin, found in the deepest layer of the epidermis, toughens and waterproofs the skin through a process called keratinization
• Cornification is the flattening and drying of the outer stratum corneum of the epidermis, an important protective adaptation of the skin
• Normal skin color is determined by three pigments: melanin, carotene, and hemoglobin
• Melanin, a brown-black pigment, is formed in cells called melanocytes found throughout the stratum basale and stratum spinosum
• Carotene, a yellowish pigment, is abundant in the skin of people of Asian descent and, together with melanin, accounts for their yellow tan skin
• Hemoglobin, not a skin pigment, is the oxygen-binding pigment found in red blood cells, giving the skin a pinkish tone when oxygenated blood flows through the dermis
• Skin color can indicate certain conditions or diseases like cyanosis (bluish hue) in cardiovascular or respiratory diseases and jaundice (yellowish skin) due to excess bile pigment in the blood, often caused by liver abnormalities
• Hair, found everywhere in the body, serves primarily for protection against sunlight, airborne particles, and mechanical injury, and secondarily for individual distinction and as a sexual attractant
• Nails, formed from the outer layer of the epidermis, protect the digits and aid in grasping and picking up small objects
• Skin glands include sebaceous glands (oil glands) that secrete sebum, sweat glands that excrete perspiration, mammary glands found within the breasts, and ceruminous glands found in the external auditory canal that secrete cerumin (earwax)
• Pressure areas, common over bony projections like the hip, ankle, shoulder, or elbow, can lead to decubitus ulcers, impairments of skin integrity due to localized areas of infarcted soft tissues when pressure is applied
• Decubitus ulcers have stages:

  • Stage I: red area that returns to normal color after 10-15 mins. of pressure relief, such as turning the client
  • Stage II: top layer of skin missing, shallow ulcer with a pink to red base, white or yellow scar present
  • Stage III: ulcer extends to dermis and subcutaneous tissues, with a white, gray, yellow scar at the bottom and purulent drainage
  • Stage IV: deep ulcers extend into muscles and bones, foul-smelling with a brown/black scar and purulent drainage
• Common skin lesions include primary lesions like bulla, plaque, macule, papule, pustule, nodule, vesicle, wheal, cyst, and secondary lesions like scales, crusts, excoriations, fissures, ulcers, lichenification, scars, atrophy, ecchymosis, petechia, spider angioma, and keloid
• Lyme disease, caused by the spirochete Borrelia burgdorferi and transmitted by ticks, can present with early rash accompanied by regional lymphadenopathy and later neurologic manifestations ranging from Bell’s palsy to Guillane Barre’- like syndrome or dementia are possible, affecting skin, joints, eyes, and heart
• Pruritus, or itching, common in dermatologic disorders, can be caused by various factors like medications, chemicals, prickly heat, radiation, chemotherapy, infections, or psychological reasons
• Common complaints in dermatologic disorders cause alterations in comfort and changes in the integrity of the skin
• Causes of Pruritus:

  • Oral medications
  • Application of certain drugs, soaps, and chemicals
  • Prickly heat (miliaria); contact with woolen garments
  • Side effects of radiation, chemo, analgesics, or antibiotic therapy, or a symptom of infection
  • Psychological factors
• Type of Secretory Disorders:

  Seborrheic dermatoses is a chronic inflammatory disease of the skin with a predilection for areas well supplied with sebaceous glands or between skin folds
• Signs and symptoms of seborrheic dermatoses:

  • Fine scaling of the scalp (dry, moist, or greasy)
  • Patches of sallow, greasy appearing skin with or without scaling and erythema
  • Pruritus leading to infection and excoriation
• Type of Secretory Disorders:

  Acne vulgaris is a common follicular disorder affecting susceptible pilosebaceous follicles, characterized by closed comedones, open comedones, papules, pustules, nodules, and cysts
• Type of Bacterial Infections

  Impetigo is a contagious skin infection caused by streptococci, staphylococci, or multiple bacteria, starting as small red macules that become thin-walled vesicles covered with a honey-yellow crust
• Type of Follicular (Bacterial)

  Folliculitis is a staphylococcal infection within hair follicles, presenting as single or multiple papules or pustules near hair follicles, commonly seen in the beard area of men who shave and on women’s legs
• Type of Follicular (Bacterial)

  Furuncles start as small, red, raised painful pimples, progressing to involve the skin and subcutaneous fatty tissue, causing tenderness, pain, and surrounding cellulitis
• Type of Follicular (Bacterial)

  Carbuncles are abscesses of the skin and subcutaneous tissue, larger and more deep-seated than furuncles, common on the back of the neck and buttocks
• Type of Viral Infection

  Herpes zoster is an inflammatory condition causing a painful vesicular eruption along nerve distributions, with symptoms like pain, itching, tenderness, malaise, GIT disorders, and vesicles that rupture and form crusts
• Type of Mycotic (Fungal Infections)

  Tinea pedis (athlete's foot) presents with pruritus on the soles of feet and between toes, showing inflamed vesicles in acute cases or a scaly, dusky, or red rash in chronic cases
• Type of Mycotic (Fungal Infections)

  Tinea corporis starts with an erythematous macule advancing to rings of papules or vesicles with central clearing, found in clusters and may extend to the scalp, hair, or nails
• Type of Mycotic (Fungal Infections)

  Tinea capitis is a contagious infection of the hair shaft common in children, showing round patches of redness and scaling with small pustules or papules at the edges
• Type of Mycotic (Fungal Infections)

  Tinea cruris (jock itch) presents with pruritus, small red scaly patches extending to circular plaques with elevated scaly or vesicular borders, often seen in joggers, obese persons, and those wearing tight underclothing
• Type of Mycotic (Fungal Infections)

  Tinea unguium (ringworm of nails) is more common in toenails, associated with long-standing fungal infection of feet, leading to thickened, crumbly nails lacking luster and potentially destroyed nails
• Type of Pediculosis (Lice Infestation)

  Pediculosis capitis is an infestation of the scalp by head lice, causing intense itching, scratching, pustules, crusts, matted hair, impetigo, and furunculosis, transmitted through direct physical contact or indirectly through infested items
• Type of Pediculosis (Lice Infestation)

  Pediculosis corporis is an infestation of the body by body lice, living in the seams of underwear and clothing, leading to hemorrhagic points, widespread excoriation, parallel linear scratches, eczema, thickened, dry, scaly skin with dark pigmented areas
• Contact dermatitis is an inflammatory reaction of the skin to physical, chemical, or biological agents, manifesting as itching, burning, erythema, edema, papules, vesicles, crusting, drying, fissuring, peeling, thickening of the skin (lichenification), pigmentation (coloration), and secondary bacterial invasion
• Psoriasis is a chronic, non-infectious, inflammatory skin disorder involving keratin synthesis, with possible causes including stress, trauma, infection, and changes in climate, presenting in various types like plaque, guttate, inverse, erythrodermic, and pustular
• Exfoliative dermatitis is a serious condition characterized by progressive inflammation with erythema and scaling, often associated with chills, fever, prostration, severe toxicity, and pruritus
• Pemphigus vulgaris is a serious autoimmune disease of the skin and mucous membranes, characterized by blisters on normal skin and mucous (mouth, esophagus, conjunctiva, vagina), with manifestations like painful erosions, bullae, crusting, oozing, offensive odor due to bullae, positive Nikolsky's sign, Erode skin heals slowly, and bacterial superinfection
• What are the Skin Accessories?

  Hair, nails, sweat glands, and glands.