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Altered Integument Concept Maps. Gary Schofield, RN. Infections Bacterial: Folliculitis, Foruncle, Carbuncles, Cellulitis, Erysipelas Viral: Herpes (Simplex,Zoster, Varicella), Warts Fungal: Tinea, Candidiasis. INFLAMATORY

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Bacterial: Folliculitis, Foruncle, Carbuncles, Cellulitis, Erysipelas

Viral: Herpes (Simplex,Zoster, Varicella), Warts

Fungal: Tinea, Candidiasis


Eczema, Atopic, Dermatitis-Contact (Allergic, Irritant), Stasis, Seborrheic


Vesiculobullous (Vesicle Formation)

Pemphigus (Vulgaris,Vegetans, Foliaceus, Erythematous)

Bullous Phemphoid

Erythema Multiforme: (Steven-Johnson Syndrome & Toxic Epidermal Necrolysis)


Inflamatory process associated with papules, scales, plaques, & erythema

Psoriasis, Pityriasis Rosea, Lichen Planus, Acne (Vulgarius, Rosacea), Lupus Erythematous [Dicoid (DLE) Systemic (SLE)]


(Commonly assoc. with skin disease)

Cutaneous vasculitis



Insect Bites

Ticks (Rocky Mt Spotted Fever, Lyme Disease)

Mosquitoes (Malaria, Yellow Fever)


Frost Bite

Affects fingers, ears, toes, & cheeks


Basal Cell (Surface epithelial -Most Common)

Squamous Cell -Epidermis

Malignan Melanoma –originates in melanocytes

Kaposi Sarcoma –vascular malignancy

Benign Tumors

Seborrheic Keratosis


Actinic Keratosis

Nevi (moles)

Clinical Manifestations of Skin Dysfunction

Lesions, Keloids, Pressure Ulcers, Pruritis,

Disorders of the Hair

Alopecia (Male pattern, Female pattern)

Areata – usually temporary baldness

Hirsutism – could indicate polycystic ovaries, adrenal hyperplasia, or adrenal tumor

Disorders of the Nail

Paronychia – acute or chronic infection of the cuticle

Onychomycosis – fungal or dermatophyte infectionof the nail plate


Skin Biopsy


Microscopic Immunofluorescense


Gram Stain

Skin Diagnostic Procedures

Side Lighting


Skin Scrapings

Wood Lamp Exam

Patch & Scratch Tests




Macule – ↓ 1cm, flat, change in color

Scale – heaped-up, keratinized cells, flaky skin

Papule – ↓ 1 cm, elevated and firm

Lichenification – rough, thickened epidermis, flexor surface of extremity

Patch – Flat, nonpalpable, ↑ 1 cm

Keloid – irregular-shaped, elevated, enlarging scar, beyond boundaries of the wound, excessive collagen formation during healing

Plaque – elevated, firm, rough, ↑ 1cm

Wheal – elevated, irregular shape, solid, transient

Scar – thin-thick fibrous tissue that replaces normal skin, to the dermis

Nodule – elevated, firm, circumscribed, deeper in dermis 1-2 cm

Excoriation – loss of the epidermis, linear, hollowed-out, crusted area

Tumor – elevated, solid, clearly demarkated, deeper in dermis ↑ 2 cm

Fissure – linear crack or break from the epidermis to dermis, may be moist or dry

Vesicle – elevated circumscribed, superficial, filled with serous fluid ↓ 1cm

Ulceration – loss of epidermis and dermis, concave, varies in size

Bulla - vesicle ↑ 1 cm

Atrophy – thinning of the skin surface, loss of skin markings

Pustule – elevated, superficial, filled with purulent fluid

Cyst – elevated, circumscribed, encapsulated, dermis/ subcutaneous layer, liquid filled or semisolid

Telangiectasa – fine, irregular red lines, capillary dilation

Special Lesions

Comedone – a plug of sebaceous and keratin material lodged in a hair follicle (Blackhead

Burrow – narrow, raised, irregular cannel caused by parasite

Petechiae – circumscribed area of blood less than 0.5 cm in diameter

Purpura – circumscribed area of blood greater than 0.5 cm in diameter

Skin Lesions


Acne Vulgaris

Most common skin disease; affects 85% population ages 12-25. Severe acne runs in families; Causes unknown

Skin Disorders in Children

Vascular Disorders

Strawberry Hemangioms – raised vascular lesions

Cavernous Hemangioma –larger more mature vessels than above

Salmon Patches – macular, pink lesions fade with age

Port-Wine stains – congenital malformations of dermal capillaries; does not fade with age

Minor to Severe

Localized or General


Atopic – most common cause of eczema in children

Diaper – most common skin disorder of infancy/early childhood

Insect Bites/ Paracites

Scabies – contagious; caused by itch mite

Pediculosis -lice




Milaria –dematosis common in infants

Erythema Toxicum


Toxic Epidermal Necrolysis – hypersensitive reactions to drugs usual cause; treat like burn; must differientiate with biopsy



Molluscum Contagiosum – highly contagious

Rubella- German Measles

Rubeola – highly contagious

Roseola – 6mos – 2 y/o

Chicken Pox/ Herpes Zoster - Varicella


Impetigo – Bullous (Staph aureus), Vesicular (Group A Strep), Staphyloccal Scalded-Skin Syndrome [(SSSS)- usually seen in infants and children <5 years]


Tina Capitis- involves scalp; most common fungal infection 2-10 yrs

Tina Corporis- superficial dermatophyte

Thrush – Candida in mucous membranes of month


No metastasizes beyond the skin

Less common in dark-skinned people Melanin- Protective Factor

Slow Growth Rate

Results of a defect that prevents shedding of cells by normal keratinization process

Lack of normal keratin proteins

Start as a nodule

Exposure (Sunlight) = Ultraviolet Radiation

Strongest 10:00am – 3:00pm

Protection during 1st 10-20 yrs ↓ risk

3 Stages of Growth

- Initiation

- Progression

- Metastasis

Affects epidermis

Significantly more malignant than basal cell if untreated

75% of cases located on neck and head

Countries with high arsenic in drinking water have ↑ predonminance

Outdoor Workers = ↑ incident

Basal Cell Carcinoma


Rad Theapy, Surgery, Electrodisiccation, Cryosurgery

Mutation of p53 tumor

Suppressor Gene

Squamous Cell Carcinoma

Malignant tumor of the skin

Originates in melanocytes

Incidence is increasing

Young-Middle Age Adults ↑ risk

Malignant Melanoma


- Color and/or size change

- Irregular notched margin

- Itching, Bleeding, Oozing, Nodularity

- Scab formation or Ulceration

Nevus Types

● Junctional

● Compound

● Intradermal

Nevus (mole) – aggregation of melanocytes

Most are not suspicious

Suspect = Removal


Exposure to UV Light Solar and Artificial

Risk Factors

Malignant Melanoma

Malignant Degeneration of Melanocytes

Steroid Hormone Activity

Light Skin

Easy to Sunburn

Genetic Predisposition

Basal Layer of Epidermis

Benign Melanocvtic Nevus

Facial Hair


10-15% of cutaneous menanoma

50-80 yrs old at diagnosis

Location: Head, Neck, Dorsum of Hands

Pigmentation According to Thickness

● <1.5 mm (Level I,II) Tan & Brown

● >1.5mm (Level III) Tan, Brown Blue-Black

● >1.5mm (Level IV,V) Nodule

Lentigo Malignant Melanoma (LMM)

70% of Cutaneous Melanoma

Location: Legs of Females & ↑ Back Both Genders

Superficial Spreading Melanoma (SSM)

Clinical Varieties of Cutaneous Melanoma

20-60 yrs at diagnosis

Primary Nodular Melanoma (PNM)

12% of Cutaneous Melanoma

No Specific Site Preference

>1.5 mm (Level III) small nodule, any hue

>1.5 (Level IV,V) large nodule, any hue

Acral-Lentiginous Melanoma

2-8% Whites, 75% Blacks, Hispanic, Asian

20-60 yrs old

Palms, Soles of Feet, Mucous Membranes Affected

Blue-Black in hue


Corwin, E. J. (2000). Handbook of Pathophysiology (2nd ed.). Philadelphia, PA: Lippincott.

Nicol, N. H. & Huether, S. E. (2006). Alterations of the integument in children. In K. L. McCance & S. Huether (Eds.), Pathophsiology: The Biologic Basis for Disease in Adults & Children (pp.1609- 1623). St Louis, MO: ElSevier Mosby.

Nicol, N. H., Huether, S. E. & Weber, R. (2006). Structure, function, and disorders of the integument. In K. L. McCance & S. Huether (Eds.), Pathophsiology: The Biologic Basis for Disease in Adults & Children (pp.1573-1607). St Louis, MO: ElSevier Mosby.