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Integumentary S/Sx
Lewis Chapter 22
| Question | Answer |
|---|---|
| Hyperthyroidism | Increased sweating, warm skin with persistent flush, thin nails, alopecia. Fine, soft hair |
| Hypothyroidism | Cold, dry, pale to yellow skin. Generalized nonpitting edema. Dry, coarse, brittle hair. Brittle, slow-growing nails |
| Glucocorticoid excess (Cushing syndrome) | Atrophy, striae, epidermal thinning, telangiectasia, acne. Decreased subQ fat over extremities. Thin, loose dermis. Impaired wound healing. Increased vascular fragility. Mild hirsutism. Collection of fat over clavicles, back of neck, abdomen, and face |
| Addison's disease | Loss of body hair (especially axillary), generalized hyperpigmentation (accentuated in folds) |
| Androgen excess | Enlarged facial pores, male sex characteristics, acne, acceleration of coarse hair growth |
| Androgen deficiency | Development of sparse hair. Marked reduction in sebum production |
| Hypoparathyroidism | Opaque, brittle nails with transverse ridges. Coarse, sparse hair with patchy alopecia |
| Hyperpituitarism (acromegaly) | Coarsened skin, deepened lines. Increased oiliness and sweating, acne. Increased number of nevi, hyperpigmentation; hypertrichosis (excess hair growth) |
| Diabetes mellitus | Erythematous plaques of shins, delayed wound healing, neuropathy, acanthosis nigricans (velvety, dark skin on the neck and in skin folds) |
| Primary syphilis | Chancre |
| Secondary syphilis | Generalized skin lesions, alopecia |
| Tertiary syphilis | Gummas |
| Paget’s disease | Eczematous patch of nipple and areola |
| Inflammatory bowel disease | Mouth ulcers, erythema nodosum |
| Liver disease and biliary tract obstruction | Jaundice, itching, pigmentary abnormalities, alterations in nails and hair, spider angiomas, telangiectasia |
| Deficiency of essential fatty acids | Scaly skin |
| Malabsorption syndrome | Acquired ichthyosis (dry, scaly skin) |
| Cystic fibrosis | Abnormal sweat gland function |
| Systemic lupus erythematosus | Discoid lesions, maculopapular semiconfluent rash (butterfly rash), alopecia, mouth ulcers |
| Scleroderma | Leathery hardening and stiffness of skin |
| Dermatomyositis | Edema; purplish-red upper eyelids; scaly, macular erythema over knuckles |
| Vitamin B1 (thiamine) deficiency | Edema, redness of soles of feet |
| Vitamin B2 (riboflavin) deficiency | Red fissures at corner of mouth, glossitis |
| Nicotinic acid (niacin) deficiency | Redness of exposed areas of skin of hand or foot, face, or neck; infected dermatitis |
| Vitamin C deficiency | Petechiae, purpura, bleeding gums |
| Hodgkin's lymphoma | Pruritus, sensitive skin |
| Non-Hodgkin's lymphoma | Papules, nodules, plaques, pruritus |
| HIV infection | Kaposi sarcoma, eosinophilic folliculitis |
| Rheumatic heart disease | Petechiae, urticaria, nodules, erythema |
| Thromboangiitis obliterans (Buerger's disease) | Pallor or cyanosis, gangrene, ulceration |
| Peripheral vascular disease | Loss of hair on hands and feet. Delayed capillary filling. Dependent rubor (redness), pain |
| Venous ulcers | Leathery, brownish skin on lower leg; pruritus, concave lesion with edema. Scar tissue with healing |
| Inadequate oxygenation due to respiratory disease | Cyanosis |
| Anemia | Pallor, hyperpigmentation, pale mucous membranes, hair loss, nail dystrophy |
| Clotting disorders | Purpura, petechiae, ecchymosis |
| Chronic kidney disease | Dry skin, pruritus, uremic frost, pallor, bruises |
| Spinal cord trauma | Trophic changes in skin resulting from sensory denervation, pressure ulcers, anesthesia, paresthesias |
| Macule | Circumscribed, flat area with a change in skin color. <0.5 cm in diameter. If lesion >0.5 cm, it is a patch. Examples: freckles, petechiae, measles, flat mole (nevus), café-au-lait spots, vitiligo (complete depigmentation) |
| Papule | Elevated, solid lesion. <0.5 cm in diameter. If lesion is >0.5 cm in diameter, it is a nodule. Examples: wart (verruca), elevated moles, lipoma, basal cell carcinoma |
| Vesicle | Circumscribed, superficial collection of serous fluid. <0.5 cm in diameter Examples: varicella (chickenpox), herpes zoster (shingles), second-degree burn |
| Plaque | Circumscribed, elevated, superficial, solid lesion. >0.5 cm in diameter Examples: psoriasis, seborrheic and actinic keratoses |
| Wheal | Firm, edematous, irregularly shaped area. Diameter variable Examples: insect bite, urticaria |
| Pustule | Elevated, superficial lesion filled with purulent fluid Examples: acne, impetigo |
| Fissure | Linear crack or break from the epidermis to the dermis. Dry or moist Examples: athlete's foot, cracks at corner of the mouth |
| Scale | Excess, dead epidermal cells produced by abnormal keratinization and shedding Examples: flaking of skin after a drug reaction or sunburn |
| Scar | Abnormal formation of connective tissue that replaces normal skin Examples: surgical incision, healed wound |
| Ulcer | Loss of the epidermis, extending into the dermis. Crater-like, irregular shape Examples: pressure ulcer, chancre |
| Atrophy | Depression in skin resulting from thinning of the epidermis or dermis Examples: aged skin, striae |
| Excoriation | Area in which epidermis is missing, exposing the dermis Examples: abrasion, scratch |
| Antidepressants that cause photosensitivity | amitriptyline, doxepin, venlafaxine |
| Antidysrhythmics that cause photosensitivity | quinidine, amiodarone (Cordarone) |
| Antihistamines that cause photosensitivity | diphenhydramine, chlorpheniramine, clemastine, cetirizine (Zyrtec) |
| Antimicrobials that cause photosensitivity | tetracycline, sulfamethoxazole, azithromycin (Zithromax), ciprofloxacin (Cipro) |
| Antifungals that cause photosensitivity | griseofulvin, ketoconazole |
| Antipsychotics that cause photosensitivity | chlorpromazine, haloperidol |
| Chemotherapy that cause photosensitivity | methotrexate, dacarbazine (DTIC), 5-fluorouracil (5-FU) |
| Diuretics that cause photosensitivity | furosemide (Lasix), hydrochlorothiazide |
| Hypoglycemics that cause photosensitivity | tolbutamide, glipizide (Glucotrol), glyburide |
| NSAIDs that cause photosensitivity | diclofenac (Voltaren), piroxicam (Feldene), sulindac |
| Tretinoin (Retin-A, Renova) Indications, Side Effects & Teaching | Improves appearance of photodamaged skin-wrinkles. Reduces actinic keratoses Erythema, swelling, flaking, pigmentation changes. Teratogenic. Increases phototoxicity. Apply at night since it is inactivated by light. avoid abrasive/drying facial cleanser |
| Chemical Peels (e.g., Beta Hydroxy Acid, Jessner's Peel, TCA) Indications, Side Effects & Teaching | Improves appearance of photodamaged skin, acne scarring, actinic and seborrheic keratoses Moderate swelling and crusting for 1 wk. Redness for 6-8 wk. Pink tone possible for several mo. Photosensitivity Avoid sun for 6 mo to prevent hyperpigmentation. |
| Microdermabrasion Indications, Side Effects & Teaching | Smoothes appearance of photodamaged and wrinkled skin, acne scarring Light pink tone that resolves within 24 hr. Photosensitivity Generous application of emollients and sunscreen |
| α-Hydroxy Acids (e.g., Glycolic Acid, Lactic Acid) Indications, Side Effects & Teaching | Smoothes appearance of photodamaged and wrinkled skin, acne scarring Photosensitivity, slight irritation at lower concentrations, severe redness, oozing, and flaking skin possible with higher concentrations Use sunscreen and sun avoidance measures. |
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