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Chapter 12: Skin, Hair, and Nails

Copyright 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Skin, Hair, and Nails

Chapter 12


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Structure and FunctionSubjective DataHealth History Questions

Objective DataThe Physical ExamAbnormal Findings

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Structure of Skin

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Structure of Nails

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Function of the Skin

ProtectionPrevents penetrationPerception

Temperature regulation

IdentificationCommunicationWound repairAbsorption and excretion

Production of vitamin D

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Subjective DataHealth HistoryQuestions

Previous history of skin disease(allergies, hives, psoriasis, or eczema)

Change in moleChange in pigmentation (size or colour)Excessive dryness or moisturePruritus

Excessive bruising

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Subjective DataHealth historyquestions(cont.)

Rash or lesionMedicationsHair lossChange in nailsEnvironmental or occupational

hazardsSelf-care behaviours

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Objective DataThe

Physical ExamPreparationExternal variables that influence skin colourEquipment needed

Strong direct lightingSmall centimetre rulerPenlightGloves

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Objective DataThePhysical Exam(cont.) SkinInspect and palpate

ColourGeneral pigmentationWidespread colour change

PallorErythemaCyanosis

Jaundice

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Objective DataThePhysical Exam(cont.) SkinInspect and palpate (cont.)

TemperatureHypothermiaHyperthermia

MoistureDiaphoresis

Dehydration

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Objective DataThePhysical Exam(cont.)

SkinInspect and palpate (cont.) Texture ThicknessEdemaMobility and turgorVascularity or bruising

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Objective Data The Physical Exam(cont.)

SkinInspect and palpate (cont.)Lesions

ColourElevationPattern or shapeSize

Location and distribution on bodyExudate

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Objective DataThePhysical Exam(cont.)

HairInspect and palpateColour

TextureDistributionLesions

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Objective DataThePhysical Exam(cont.)NailsInspect and palpate

Shape and contourProfile sign

ConsistencyColour

Capillary refill

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Objective DataThePhysical Exam(cont.)Promoting health and self-care

Teach skin self-examination, using theABCDE rule

AasymmetryBborderCcolour

DdiameterEelevation and enlargement

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Abnormal Findings

Common Shapes andConfigurations of LesionsAnnular or circularConfluentDiscreteGrouped

Target or irisLinearPolycyclic

Zosteriform

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Annular or Circular

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Confluent

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Discrete

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Grouped

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Target

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Linear

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Polycyclic

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Zosteriform

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Abnormal FindingsPrimary and Secondary SkinLesionsPrimary skin lesions

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Urticaria (hives) Vesicle Cyst Bulla Pustule

Macule Papule Patch Plaque Nodule Wheal Tumour

Excoriation Scar Atrophic scar Lichenification Keloid

Secondary skin lesions Crust Scale Fissure Erosion Ulcer



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Macule

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Papule

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Nodule

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Wheal

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Vesicle

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p , ,

Cyst

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p , ,

Pustule

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p , ,

Crust

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p

Scale

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Fissure

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Erosion

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Ulcer

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Excoriation

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Scar

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Atrophic Scar

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Lichenification

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Keloid

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Abnormal FindingsVascular LesionsHemangiomas

Port-wine stain(nevus flammeus)Strawberry mark(immature hemangioma)Cavernous hemangioma(mature)

TelangiectasesSpider or star angioma

Venous lake

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Purpuric lesionsPetechiaePurpura

Lesions caused bytrauma or abusePattern injuryHematomaEcchymosis (bruise)



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Lesions caused by traumaor abuse: Pattern injury

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Lesions caused by traumaor abuse: Hematoma

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Lesions caused by traumaor abuse: Ecchymosis

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Canadian Cancer Society Risk Factors

Prolonged exposure to UV rays, individualsmost at riskUnder age 18Fair skinned

History of skin cancerHave freckles or molesHave a family history orUsing medications that increase sensitivity to

UV rays.

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The lesions in theillustrationare best described as?A. GroupedB. ZosteriformC. PolycyclicD. Linear

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