INTEGUMENTARY SYSTEM

GENERAL OVERVIEW
DESCRIPTION OF SKIN LESIONS
PRIMARY LESIONS
Macula - flat, circumscribed discoloration of
skin; may have any size or shape
• Papule - solid, elevated lesion less than 1
cm wide
•Nodule - raised, solid
lesion larger than 1 cm
wide.
•Vesicle - circumscribed
elevated lesion less than 1
cm, containing fluid.
•Bulla - a vesicle or
blister larger than 1 cm
wide.
Pustule - circumscribed
raised lesion that contains
pus; may form as a result
of purulent changes in a
vesicle.
•Wheal - elevation of
the skin that lasts less
than 24 hours, caused
by edema of the dermis;
may be surrounded by
erythema or blanching.
•Plaque - solid, elevated
lesion on the skin or mucous membrane, larger than 1
cm in diameter; psoriasis is commonly manifested as
plaques on the skin; leukoplakia is an example of
plaques on mucous membranes.
•Cyst - soft or firm mass in the skin, filled
with semisolid or with liquid material
contained in a sac.
Secondary Lesions
• Secondary lesions involve changes
that take place in primary lesions
that modify them.
•Scale - heaped-up, horny layer of dead
epidermis; may develop as a result of
inflammatory changes.
•Crust - covering formed
by the drying of
serum, blood,
or pus on the skin.
•Excoriation - linear scratch marks or
traumatized areas of skin.
•Fissure - cracks in the skin, usually from
marked drying and long-standing inflammation.
•Ulcer - lesion formed by
local destruction of the
epidermis and by part or all
of the underlying dermis.
•Lichenification - thickening of skin
accompanied by accentuation of skin
markings.
Scar - new formation of connective tissue that replaces
the loss of substance in the dermis as a result of injury or
disease.
•Atrophy - diminution in
size or in loss of skin cells
that causes thinning of the
skin.
Configuration:
A) Linear - in a line.

B) Arciform - in the form of an arc, curved.  

1. Arcuate: having an outline of a curved line or arc. 
2. Annular: ring-shaped 
3. Serpentine: having an outline like a serpent, coiled. 
4. Polycyclic: having two or more rings. 
5. Targetoid:  resembling a target, rings within rings.

C) Circular - having an outline of a full circle without

central clearing. (Guttate - like a gutt or drop.
Nummular or discoid - having the shape and size of a
coin or a disc.)
Shape and Configuration
• Circinate - circular
• Confluent - lesions run together or join
• Discrete - lesions remain separate
• Generalized - widespread eruption
• Grouped - clustering of lesions
• Herpetiform - grouped vesicles
• Iris - ring or a series of concentric circles
• Multiform - more than one kind of skin lesion
• Polymorphous - occurring in several or many
forms
• Reticulated - lacelike network
• Serpiginous - snakelike or creeping eruption
• Telangiectasia - tiny, superficial,
dilated cutaneous vessel; can be seen as
a red thread or line
• Zosteriform or dermatomal - bandlike
distribution, limited to one or more
dermatomes of skin
History and Assessment
• C-haracter
• L-ocation
• I-ntensity
• T-ime
• A-asso. factors
• A-ggravating factors
ASSESSMENT HISTORY

• Characteristics of Rash
• When did the rash first occur? Was the onset
sudden or gradual?
• What site was first affected? Describe the
spread and its severity.
• What was the initial color and configuration of
the rash? Has it changed?
• Is there associated itching, burning, tingling,
pain, or numbness?
• Has it been constant or intermittent?
 DIAGNOSTIC TESTS
LABORATORY TESTS
Microscopy
• Sample taken by scraping, swabbing, or
aspirating a lesion is transferred to a
glass slide for observation or staining.
– Direct visualization of scrapings mixed with
mineral oil to detect scabies, mites, or lice
nits that cling to hair.
– Gram stain may be performed to tentatively
identify bacteria in certain skin infections.
Culture
• Drainage from lesions may be cultured on
specific media to detect causative organism
and sensitivity to antimicrobial therapy
• Usually takes 24 to 48 hours for results;
fungal cultures may take 4 to 5 weeks.
Patch Testing
• Patch testing is an office procedure done in
dermatology to determine if patients are
allergic to contact materials.
• Materials are applied in patches to the skin
and checked for reaction 48 hours after
application and possibly again later.
• Erythema, swelling, papules, and vesicles
indicate an allergic contact dermatitis
rather than an irritant contact dermatitis or
no reaction.
GENERAL PROCEDURES AND
TREATMENT MODALITIES
BATHS AND WET DRESSINGS
• A therapeutic bath is used to apply
medication to the entire skin surface and is
useful in treating widespread eruptions and
general pruritus.
• Baths soothe, soften, and reduce
inflammation, and relieve itching and
dryness.
• Wet dressings and soaks are damp
compresses that contain water, normal
saline solution, aluminum acetate solution, or
magnesium sulfate solution.
• They may be sterile or clean, or warm or
cool, depending on the skin condition and the
area to which they are applied.
THERAPEUTIC BATHS
• Indications
• Vesicular disorders, eczema, atopic dermatitis
• Acute inflammatory conditions.
• Erosions and exudative, crusted surfaces.
OPEN WET DRESSINGS
Indications
• Bacterial infections that require drainage.
• Inflammatory and pruritic conditions.
• Oozing and crusting conditions.
DRESSINGS FOR SKIN CONDITIONS
Occlusive Dressing
• An occlusive dressing is formed by an airtight
plastic or vinyl film applied over medicated areas
of skin (usually with corticosteroids) to enhance
absorption of medication and to promote
moisture retention.
Indications
• Skin conditions with thick scaling, such as
psoriasis (on feet) and lichen simplex chronicus
SKIN BIOPSY
• Removal of a piece of skin by shave, punch,
or excision technique to detect malignancy
or other characteristics of skin disorders.
Types of biopsy.
1. Excisional Biopsy-  In this procedure the entire lump or
tumour is excised and a margin of normal tissue is
present around the lesion together with subcutaneous
fat.
2. Incisional Biopsy-  A portion of the lump is removed
surgically.  This is most commonly used for tumours of
the skin.
A.  Shave Biopsy :   In this procedure the surface
portion is sliced off with a blade.
B. Curette method:  In this procedure the surface of
the lesion is scrapped off.
These methods are done to remove small growth and to
confirm its nature.
C. Punch Biopsy:  This procedure is done to sample skin
rashes and small masses. A small cylinder of skin is
removed. 
WOUND COVERAGE: GRAFTS AND FLAPS
• Wound coverage, using grafts and flaps, is a
type of reconstructive (plastic) surgery
performed to improve the skin's appearance
and function.
Skin graft
• A section of skin tissue is separated from its
blood supply and transferred as free tissue to
a distant (recipient) site; it must obtain
nourishment from capillaries at the recipient
site.
• In dermatology, skin grafting is used to repair
defects that result from excision of skin
tumors and to cover areas of denuded skin.
• Definitions.
– Autografts - grafts done with tissue transplanted
from the patient's own skin.
– Allografts - involve the transplant of tissue from one
individual of the same species; these grafts are also
called allogenic or homografts.
– Xenograft or heterograft - involve the transfer of
tissue from another species.
• Classification by thickness.
– Split thickness (thin, intermediate, or thick) -
graft that is cut at varying thicknesses and is
used to cover large wounds because its total
potential donor area is virtually unlimited.
– Full thickness - graft consists of epidermis and
all of the dermis without the underlying fat; used
to cover wounds that are too large to close
primarily. They are used frequently to cover facial
defects because they provide a better contour
match and less postoperative contracture.
Skin Flaps
• A flap is a segment of tissue that has been
left attached at one end (called a base or
pedicle); the other end has been moved to a
recipient area. It is dependent for its
survival on functioning arterial and venous
blood supplies and on lymphatic drainage in
its pedicle or base.

• Flaps offer the best aesthetic solution

because a flap retains the color, texture,
and thickness match of the donor area.
AESTHETIC PROCEDURES
• Aesthetic procedures (cosmetic surgery)
consist of reconstructive (plastic) surgery
performed to reconstruct or to alter
congenital or acquired defects or to restore
or improve the body's appearance.
Types of Procedures
• Rhytidectomy
• Done through various techniques and incisions to
alleviate skin folds and wrinkles to improve the
appearance of the aging face (face lift).
• The correction can last as long as 10 years, but
results vary with each individual. Skin relaxes with
time, and the muscles
may also relax, but seldom does the face revert to
its preoperative condition.
Rhytidectomy
Blepharoplasty
• Removes loose skin, muscle and excess fat from
upper or lower eyelids. It will not remove lines
at the lateral corners of the eyes.
• The procedure is generally done by either
scalpel under local or general anesthetic or by
carbon dioxide laser
Dermabrasion, Chemical Peel, and Laser
Resurfacing

• Patients with weathered skin, fine wrinkles

(especially at the corner of the eyes and
along the vermilion border), or acne pitting
and scarring may benefit from these
procedures.
Laser Resurfacing
• Dressings, such as Flexan, Vigilon, or
Biobrane, may be applied to the affected
areas immediately and left in place for 24 to
48 hours
• Alternately, the open technique involves
using petroleum jelly and daily face washes
with tepid water.
Liposuction
• Also called body contouring, liposuction reduces
localized deposits of fat not amenable to weight
loss, with a cannula aided by suction or fitted to a
syringe.
• May be done on the face, neck, breasts, abdomen,
flanks, hips, buttocks, and extremities.
Scabies
 Scabies definition

• Scabies is a disease of the skin caused by a mite. {Sarcoptes

scabiei}
The parasite is very tiny almost impossible to see without a
microscope.

• It lives inside the layer of the skin.

• This mite lays their eggs under the skin and feeds on blood.
 Population
Who gets scabies?
• Anyone can have a scabies infestation.

• Scabies can affect people of any age, gender or

race and social levels. But it occurs mostly in children
and young adults.

• Even people who keep themselves very clean can get

scabies.
 
• If a person has had a scabies infestation before, it
can get reinfested again if they are exposed to the
mites.
How the Scabies Disease is
transmitted?
• Scabies mites are highly contagious and are
spread or transmitted by close skin contact
with someone who has scabies. Also
Infestation is easily spread to sexual
partners and household members.
• Scabies can also be spread by sharing
towels, bed sheets, and other personal
belongings.
 Symptoms and Diagnosis

• It causes a severe itchy skin.

• Itching usually get worse at night and while bathing.

• Visible symptoms include rash and bumps between

the fingers wrists, elbows or knees and buttocks also on
the head, neck, palms, and foot soles. with the
appearance scaly or crusty skin.

• Diagnosis - based on the symptoms, or sample of the

skin by gently scraping on the affected areas of the dry
skin.
Exclusion policy for this disease

• Exclude persons with scabies from school or day

care until 24 hours after treatment.

Treatment
• Treating scabies means killing the mites and their
eggs. Prescription skin creams or lotions will kill the
mites and eggs. Medication should be applied as
directed by the doctor. Second treatments may be
prescribed.
Responsibility of the caregiver to stop
the spread of this disease.

• Prevent infections from spreading

by reporting the illness.
• Exclude from the facility the
child or children that are
infected.
• Don’t wait until a break out
occurs!
• Report the infection
to the child care
director
• Clean all of the
child's clothes and
bedding by washing
in very hot water.