Skin, Hair& Nails

Prepared by: Jeffrey Esteron

Skin:
has 2 layersouter(epidermis)
& inner
supportive
dermis. Beneath
a third the
subcutaneous
layer of adipose
tissue.
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Epidermis:
a protective barrier, contain melanin,
thin except on the surfaces exposed
to friction, as palms &soles, its a
vascular, nourished by blood vessels
in the dermis below. Skin color is
derived from three sources:
brown from melanin.s
yellow from carotene.
red-purple from underlying vascular
bed.
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Dermis:
its the inner
supportive layer
consist of
collagen that
allows skin to
stretch.
nerves, sensory
receptors, blood
vessels,
lymphatic.
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Subcutaneous layer:
adipose tissue(fat cells), for
temperature control& cushion
effect, also increased mobility

Epidermal appendages:

- hair- Sebaceous Glands

(sebum)- Sweat Glands(eccrine
produce sweat & apocrine
produce milky secretion into
hair follicles when have
emotional &sexual stimulation)Nails.
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Nails
Posterior nail
fold &lateral
Nail plate & nail
matrix
Nail bed
lunula

v Functions of the Skin:

1- protection from
physical, chemical,
thermal & light
sources.
2-Prevent penetration of
microorganisms & loss
of water& electrolytes.
3- Perception: sensory
surface for touch, pain,
temperature
4- Temperature
regulation: through
sweat glands& heat
storage

5- Identification: facial
characteristics, color&
fingerprints.
6 Communication:non
verbal communication
(facial expression,
body posture)
7- Wound repair: cell
replacement
8- Excretion of metabolic
waste
9- Production of vitamin
D(ultraviolet light
convert cholesterol
into vitamin D
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**Subjective Data:
1. previous hx of skin disease as
allergies
2. change in color or pigmentation,
generalized change suggests
systemic illness(pallor-jaundicecyanosis).
3. change in mole: suggest
neoplasm.
4. Excessive dryness or moisture:
seborrhea-oily, xerosis- dry.
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 5. purities: where &when it

start, occurs with dry skin,
aging, drug reactions, lice.
Scratching may cause
excoriation of primary lesion
6. excessive bruising: where on
the body- how did happenhow
long you had it, possibility of
abuse or dizziness of
neurological or cardiovascular
origin.
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 7. rash or lesion: onset- locationwhere spread- quality- colortender-warm- duration-anyone at

home or work with similar rash,
tried new food? identify primary
site.
8. medications: prescription &
over-the- counter, how long on
medication.drugs may increase
sun light sensitivity as thiazides
diuretics
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9. hair loss: a gradual or sudden

onset? symmetrical? unusual hair
growth? Alopecia -Hirstuisim
10. change in nails: shape-color
brittleness
11. Environmental or occupational
hazards: as dyes, chemicals,
radiation, sun exposure, insect
bitten, exposure to plants, animals?
may result a skin neoplasm people
at risk: farmers-sailors- those over
40.
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12. self-care behaviors: cosmeticssoap-chemicals usage.

Danger signs: ABCDE
Asymmetry of lesion
Border
Color variation
Diameter
elevation
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** Objective data:
Preparation: equipment needed; direct
lighting(natural daylight is ideal but not
always available)- ruler-penlight-gloves.
Comprehensive physical exam: skin
assessment is integrated throughout the
complete exam, at the beginning assessing
hands &fingernails, to accustom him to
your touch. Inspect toes &its nails too.
The regional exam : remove his clothes,
stands back at first to get an overall
impression, to reveal distribution pattern.
inspect mucous membrane too.
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External variables influencing

skin color(projector)

- Emotions as fear cause

vasoconstriction false pallor
- Environment as hot room cause
vasodilatation false Erythema
- Physical as prolonged elevation
cause decreased arterial perfusion
pallor whereas dependent position
cause venous pooling redness.
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** INSPECT & PALPATE SKIN:

Color: normally consistent with
genetic background, examples;
a.Freckles__ small ,flat macules of
brown melanin pigment that occur on
sun exposed skin.
b.Mole__ a proliferation of
melanocytes , tan to brown color, flat
or raised
c.Birthmarks__ tan to brown in color.
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# Color change: note if it

transient or is due to pathology.

a. Pallor: when red-pink tones

from the oxygenated hgb in the
blood are lost, skin takes
collagen color(white),causes:
stress-smoking
generalized pallor can be
observed in the mucous
membranes, lips , conjunctiva&
nailbeds.
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B. Jaundice:
a yellow color indicating rising
amounts of bilirubin in the blood,
first noted in the hard & soft
palate in the mouth & sclera.

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C. Cyanosis:
a bluish color,
the tissues are
not adequately
perfused with
oxygenated
blood.

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D.Erythema:
intense redness
due to excess
blood(hyperemia) in
the detailed
superficial
capillaries,
expected with
fever , local
inflammation or
emotional
reactions.
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Skin assessment:cont
# Temperature: use the backs(dorsa) of
your hands bilaterally, should be warm .
- hypothermia hyperthermia
# Moisture: moist appears normally on the
face, hands, axilla& skinfolds in response
to activity, a warm environment or anxiety.
Diaphoresis as in heavy activity or fever.
Dehydration in oral mucous membranes.
# Texture: smooth & firm with an even
surface.
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 # Thickness: epidermis is uniformly

thin. A callus is a circumscribed
overgrowth of epidermis & is an
adaptation to excessive pressure
from the friction of work .
# Edema: fluid accumulating in the
intercellular spaces, imprint your
thumbs firmly against the ankle
malleous or tibia. normally the skin
surface stays smooth. If your
pressure leaves a dent in the skin,
pitting edema is present, graded on
4 points scale:
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Edema:

+ 1: mild pitting
+2 moderate
+3 deep
+4 very deep

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 # Mobility & Turgor: pinch up a large

fold of skin on the anterior chest
under the clavicle, mobility is the
skins ease of rising & turgor is its
ability to return to place promptly
when released, this reflects the
elasticity of skin.
# Vacularity or Bruising: angiomas ,
smooth, slightly raised bright red
dots that commonly appear on the
trunk in all adults over 30.

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# Lesions:
note the; color-elevation-shapesize- location& distribution-any
exudates.

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** INSPECT & PALPATE THE

HAIR:

- color
- texture
- distribution
-lesions

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**INSPECT & PALPATE THE

NAILS:

shape & contour:

normally slightly
curved or flat,
edge are
smooth,
rounded& clean

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Nails assessment:
a. the profile sign: index finger note
the angle of the nail base, it should
be about 160 degrees, curved nails
with a convex profile
B. consistency: surface is smooth &
regular, not brittle or splitting, firmly
adhere to the nail bed.

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 C. Color: even, pink nail bed

underneath. All people normally
may have white hairline linear
markings from trauma or
picking at the cuticle.
d. Capillary refill: depress nail
edge to blanch then release
noting return of color, return is
instant, or at least within a few
seconds in a cold environment,
indicates the status of the
peripheral circulation.
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*** skin lesions:

** Primary &secondary lesions
page 176-185

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