#7 skin, hair, nails

• Layers of the skin

  Epidermis

  Dermis

  Subcutaneous layer / hypodermis
• Order of epidermis from Outermost to Innermost layer

  Stratum corneum

  Stratum lucidum

  Stratum granulosum

  Stratum germinativum
• Stratum germinativum (basal cell layer)


  > Mitosis occurs here
• Stratum germinativum (basal cell layer)


  > Contains melanocytes -> melanin
• Stratum corneum

  As cells rise, they die and their cytoplasm is converted to keratin which have a rough and horny texture
• Stratum corneum

  Undergoes constant shedding
• Dermis


  Mostly connective tissue, primarily collagen
• Dermis


  Provides support and nourishment of epidermis
• Dermis consists of

  Blood vessels, nerves, muscles, sweat glands, sebaceous glands, hair follicles
• Sebaceous glands


  Produces sebum through hair follicles -> makes skin oily -> prevents water loss
• Sweat glands - 2 kinds

  Eccrine

  Apocrine
• Eccrine


  Smaller, coiled tubules which open to skin surface and is locates over the entire skin
• Apocrine


  Larger, open to hair follicles. Locate mainly in axillae, areolae of the breast, and genital area which are relatively small and non functional until puberty.
• Apocrine produces..

  Thick secretions which react with bacteria on the skin surface to produce body odor
• Subcutaneous layer (Hypodermis)


  Consist mostly of fats
• Subcutaneous layer (hypodermis)


  Provides protection, insulation, and caloric source
• Hair


  Composed of keratin
• Hair - can be fine (vellus hair) or darker and thicker (terminal hair)
• Nails


  These are composed of keratin
• Developmental considerations

  Infants

  Pregnancy

  Aging
• lanugo


  Fine soft hair present at birth
• In infants skin is...

  Thinner, less fat -> more prone to dehydration and hypothermia
• Pregnancy -> Linea nigra

  Line down midline of abdomen
• Pregnancy -> Chloasma


  Face of pregnancy
• Pregnancy -> striae gravidarum


  Stretch marks
• Aging (changes)


  Stratum corneum thins, loss of collagen, elastin and fats, decrease of sebaceous and sweat glands
• Aging (effect of changes)

  More prone to dehydration and hypothermia
• History (11)

  History of skin disease

  Change in pigmentation

  Change in a mole

  Pruritus

  Excessive bruising

  Rash or lesion

  Medications

  Hair loss or growth

  Change in nails

  Exposure to hazards

  Self care
• Use of non sterile equipment for tattoos

  Increase risk of hepa C
• Xerosis


  Dry skin
• Seborrhea


  Oily skin
• Rash or lesion (OLSCDAAP)

  O - ONSET

  L - LOCATION

  S - SPREAD

  C - CHARACTER OR QUALITY

  D - DURATION

  A - ASSOCIATIVE FACTORS

  A - ALLEVIATING AND AGGRAVATING FACTORS

  P - PATIENT'S PERRCEPTION
• Hirsutism

  Unusual hair growth
• Freckles


  Macules
• Nevi


  moles
• Kinds of nevi

  Junctional nevi

  Compound Nevi

  Dysplastic Nevi
• Junctional nevi


  Macular only
• Compound nevi


  Macular and papular
• Dysplastic Nevi


  Precancerous
• Vitiligo


  Absence of melanin in patchy areas