Assessment of the Skin

Importance of the Skin

• Largest organ of the body
• Functions:
  • Barrier protection
  • Sensation
  • Fluid balance
  • Temperature regulation
  • Vitamin D production
  • Supports immune system

Structure of the Skin

• Epidermis (outer layer):
  • Contains keratinocytes, melanocytes, Merkle cells, and Langerhans cells
  • Functions in protection, color, and sensory transport
• Dermis (middle layer):
  • Contains blood/lymph vessels, nerves, sweat/sebaceous glands, and hair roots
• Subcutaneous Layer (inner layer):
  • Contains adipose and connective tissues

Changes with Aging

• Skin becomes thin, uneven pigmentation
• Development of wrinkles, skin folds, decreased elasticity
• Hair thins, skin becomes fragile, reduced healing ability
• Common benign changes:
  • Cherry angiomas
  • Solar lentigo (liver spots)
  • Seborrheic keratosis
  • Xanthelasma

Skin Assessment

• Conduct head-to-toe examination
• Inspect skin, mucosa, scalp, hair, and nails
• Consider color, temperature, moisture, texture
• Evaluate lesions for:
  • Type (primary vs. secondary)
  • Color, size, location, pattern, distribution
• Importance of photographic documentation
• Collect detailed patient history
  • Onset, symptoms, allergies, family history, medications, occupational and travel history
• Reference chart and images on pages 1803-1807

Primary Skin Lesions

• Macules and Patches: Flat discolorations (e.g., freckles)
• Papules and Plaques: Elevated, palpable, solid (e.g., warts, psoriasis)
• Nodules and Tumors: Larger solid masses (e.g., lipomas)
• Vesicles and Bullae: Fluid-filled blisters (e.g., herpes, burns)
• Wheals: Elevated, irregular borders (e.g., hives)
• Pustules: Pus-filled (e.g., acne)
• Cysts: Encapsulated fluid/semi-solid mass

Secondary Lesions

• Erosion: Loss of epidermis (e.g., scratch)
• Ulcer: Loss beyond dermis (e.g., pressure ulcers)
• Fissure: Crack in skin (e.g., chapped lips)
• Scales: Flakes of dead skin (e.g., dandruff)
• Crust: Dried residue (e.g., scabs)
• Scar: Healed wound, varies by age
• Keloid: Raised scar
• Atrophy: Thin, frail skin (e.g., due to arterial insufficiency)
• Lichenification: Thickened skin from irritation

Vascular Skin Lesions

• Petechiae: Small red/purple spots
• Ecchymosis: Large irregular macular lesions
• Cherry Angiomas: Normal with age
• Spider Angiomas: Red arterial lesions
• Telangiectasias: Raised varicose veins

Patterns of Skin Lesions

• Linear: In a line (e.g., poison ivy)
• Annular: Circular (e.g., ringworm)
• Arciform: Partial ring (e.g., syphilis)
• Zosteriform: Along nerve path (e.g., shingles)
• Grouped: Clustered
• Discrete: Separate and distinct
• Confluent: Merged together

Systemic Disease Effects

• Diabetes:
  • Diabetic dermopathy
  • Stasis dermatitis
  • Leg/foot ulcers
• HIV:
  • Kaposi's sarcoma
  • Molluscum contagiosum
  • Oral candidiasis
• Infections: Bacterial, fungal, or dermatophyte

Diagnostic Studies

• Biopsy: For malignancies
• Patch Testing: Allergies
• Skin Scraping: Fungal detection
• Tzanck Smear: For blistering conditions
• Woods Light Exam: Determines injury depth

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Note: Review videos, charts, and books for visual examples and detailed procedures.