Ch 5 Integumentary Pathology

Chapter 5

Integumentary
System

Pathology

1

Diseases and
Disorders of the
Integumentary
System

Common Signs

•Skin
discoloration or
redness
•Itching, weeping,
or bleeding
lesions
•Blisters, macules,
papules
•Scaly or flaky skin
surface
•New or changing
lesions

2

• C&S

• Biopsy

• Wood Light Exam

• Turgor

Tx

• Cryosurgery

• I&D

• Debridement

• LASER

• Mohs

• Onychectomy/Rhytidectomy

• PDT/Phototherapy

​Dx

Diagnostics/Treatments

Acne Vulgaris

• Definition

• Common inflammatory disease of

sebaceous glands and hair follicles

• Types

• Whitehead, blackhead, cystic acne

• Etiology

• Clogging of hair follicles with dead skin cells
• Risk factors include hormonal changes, use

of oily substances, skin bacteria, some
medications, diet

• Signs and symptoms

• Whiteheads, blackheads, pimples, painful

nodules, cystic lesions

3

Acne
Vulgaris

• Diagnostic procedures

• PE

• Treatment

• Medications

• Retinoid-like compounds, antibiotics,

salicylic and azelaic acids, dapsone,
anti-androgens, combined oral
contraceptives

• Therapies

• Chemical peel, laser and

photodynamic therapies, steroid
injections, extractions

4

Alopecia

•Definition

• Complete or partial loss of hair from the head or other parts of the body
• Types

• Areata, androgenetic

•Etiology

• Genetics, stress, certain medications and diseases, chemotherapy and

radiation

•Signs and symptoms

• Sudden or gradual hair loss, sometimes in circular patches, sometimes all

over the body

5

Alopecia

• Diagnostic procedures

• PE focusing on areas

of hair loss, labs, “pull
test,” light
microscopy, scalp
biopsy

• Treatment

• Surgery, medications

6

Burns

7

• Injury to skin caused by heat or

radiation

• Four classifications based on depth

of involvement
• First-degree: epidermis
• Second-degree: epidermis and part

of dermis

• Third-degree: epidermis, dermis,

and subcutaneous tissue

• Fourth-degree: epidermis, dermis,

subcutaneous tissue, into muscle
and bone

Definition

• Heat, freezing cold temperatures,

chemicals, sunlight, radiation, and
electricity

Etiology

Burns

•Signs and symptoms

•First-degree

•Red, painful, dry, not
blistered

•Second-degree

•Severely painful red,
blistered, and swollen;
scars may form

•Third-degree burn

•Minimally painful white
or blackened and
charred

•Fourth-degree or deep
full-thickness burn

•No feeling, leathery, dry

8

Burns

9

Diagnostic procedures

• Examination of entire area with

calculation of total body surface area
involved

Treatments

• First- and second-degree

• May be treated at home

• Third- and fourth-degree

• Medical emergency
• IV fluids, pain medications, OT and PT,

skin grafts, plastic surgery,
escharotomy

Carcinomas of
the Skin

• Definition

• Cancer of the skin
• Three most common types

• Basal cell
• Squamous cell
• Melanoma

• Etiology

• Damage to skin cell DNA, often caused by UV

light

• Risk factors include history of sunburns,

excessive sun exposure, fair skin, moles, family
and/or personal history of skin cancer, radiation
exposure, weakened immune system

10

Carcinoma of the Skin

•Signs and symptoms

• Basal cell carcinoma

• Waxy or pearly bump; dark lesion, scaly reddish patch, or a reoccurring bleeding sore

• Squamous cell carcinoma

• Firm red nodule or a flat lesion with scaly, crusted surface

• Melanoma

• Large brown spot with darker pigments; a mole that changes appearance (color, size, or

feel); small lesion with irregular borders; different colors (red, white, blue, black); itchy
lesions

11

Carcinoma of the Skin

• Diagnostic procedures

• Skin exam, biopsy, additional tests if cancer

found

• Treatments

• Based on size, depth, location, and type
• Surgery, radiation therapy, chemotherapy,

photodynamic therapy, biological therapy

12

Cellulitis

•Definition

•Common bacterial infection of the skin that can affect the
dermis, subcutaneous tissue, and sometimes the muscle

•Etiology

•Staphylococcus and streptococcus bacteria introduced via
injuries, insect bites, ulcers
•Risk factors include peripheral vascular disease, suppressed
immune system, and diabetes

•Signs and symptoms

•Fatigue, fever, chills, sweating, pain, tenderness, redness,
warmth, inflammation, muscle and joint achiness and
stiffness, nausea, vomiting

13

Cellulitis

• Diagnostic procedures

• PE, progressive

monitoring (marking
edges), blood work,
fluid culture, biopsy

• Treatments

• Antibiotics, pain

medication, warm
compresses, rest,
elevation of affected
area, intravenous (IV)
antibiotics and
hospitalization if
severe

14

Decubitus

Ulcer

15

• Area of skin damaged from long term

pressure that limits blood flow

Definition

• Friction, shearing, and continual

pressure on the skin

• Risk factors include immobility,

incontinence, poor nutrition, loss of
feeling, disorders affecting blood flow

Etiology

• Unusual skin color, swelling,

drainage, tender areas, changes in
skin temperature

Signs and symptoms

Decubitus
Ulcer

• Diagnostic procedures

• Examination of ulcer and determination

of stage

• Stage 1: area is red and painful,

doesn’t blanch when pressed

• Stage 2: blisters or open sore; area

around sore is irritated and red

• Stage 3: Crater (open, sunken hole);

tissue below skin affected

• Stage 4: Damage impacts muscle,

bone, tendons, or joints

• Treatment

• Reducing pressure, wound care, surgery,

pain medications

16

Atopic Dermatitis

•Definition

•Inflammation of the skin

•Etiology

•Unknown, but genetics and “triggers” are suspected

•Signs and symptoms

•Dry, itchy, scaly skin, reddish-brownish patches, small
bumps

•Diagnostic procedures

•History and PE

•Treatments

•Medications and therapies

17

Contact
Dermatitis

• Definition

• Inflammation of the

skin after direct
contact with a
substance

• Types

• Irritant
• Allergic

• Etiology

• Irritant

• Exposure to

alkaline or acid
substances

• Allergic

• Exposure to

allergens

18

Contact

Dermatitis

19

Signs and symptoms
• Rash

Diagnostic procedures
• History and PE, allergy

testing, skin biopsy or culture

Treatments
• Dependent on cause; may

include cleansing,
moisturizers, topical
corticosteroids, antipruritics

Seborrheic Dermatitis

• Definition

• Common skin disease that causes a rash

• Etiology

• Topical yeast, genetics, cold and dry

environments, overall health, certain
medical conditions

• Signs and symptoms

• Scaly, greasy, moist patches that flake off,

with reddened skin below; occurring on
scalp, ears, eyebrows, eye lids, upper chest
and back, armpits, ear canals, genitals;
causes itching and burning in adolescents
and adults

20

Seborrheic
Dermatitis

• Diagnostic procedures

• History and PE, skin biopsy

• Treatments

• Dependent on age and

location; for infants, mild
baby shampoo and light
brushing daily; for others,
steroid creams, ointments,
shampoos; antifungal gels,
creams, or shampoos; oral
antifungals

21

Dermatophytosis

•Definition

• Common superficial fungal

infection of skin and nails

• Named for body part infected

• Tinea capitis (scalp)
• Tinea corporis (arms and legs)
• Tinea cruris (groin)
• Tinea pedis (feet)
• Tinea unguium (nails)

•Etiology

• Approximately 40 kinds of

fungus; some forms are
contagious

22

Dermatophytosis

• Signs and symptoms

• Red, itchy, flaking or peeling skin;

burning or stinging pain; scaly
ring-shaped area; blisters

• Diagnostic procedures

• History and exam, KOH exam, skin

culture, skin biopsy

• Treatments

• Antifungal medications, maintenance of

clean, dry affected areas

23

Impetigo

• Definition

• Common, highly contagious bacterial infection

• Etiology

• Streptococcus, staphylococcus, and methicillin-resistant staph aureus

• Signs and symptoms

• Single spot of rash that spreads with scratching; itchy, yellow- or

honey-colored pus-filled blisters that may crust; usually found on face,
lips, arms, legs; swollen lymph nodes

24

Impetigo

• Diagnostic procedures

• History and PE,

culture

• Treatments

• Antibacterial

cream and oral
antibiotics for
severe infections,
washing with
antibacterial soap
several times a day

25

Kaposi
Sarcoma

• Definition

• Cancer that causes abnormal tissue

to grow in skin, mucous membrane
lining of GI tract, lymph nodes, lungs,
and other organs

• Etiology

• HHV-8 in presence of weakened

immune system

• Signs and symptoms

• Purple, red, brown flat or raised

spots on skin, commonly seen on
feet, legs, and face; may occur in
mucous membranes and in lungs,
causing hemoptysis

26

Kaposi
Sarcoma

• Diagnostic procedures

• History and PE, fecal occult

blood test, chest x-ray,
bronchoscopy, upper
endoscopy, colonoscopy

• Treatments

• Depends on cause of

weakened immune system;
minor surgery, cryotherapy,
or electrodessication to
remove lesions; low-dose
radiation; chemotherapy
injections into lesion;
topical vitamin A drug

27

Pediculosis
and Scabies

•Definition

•Common types of parasitic infections

•Pediculosis types

•Capitus (head)

•Corporis (body)

•Pubis (pubic)

•Scabies

•Etiology

•Close contact with an infected person or sharing of fomites

28

Pediculosis and Scabies

• Signs and symptoms

• Intense itching; tickling sensation when parasites move
• Lice

• Small red bumps on skin, nits on hair (head, body, pubic)

• Scabies

• Little burrows under skin, frequently in folds such as between

fingers and toes, waist, armpits, knees, elbows

• Diagnostic procedures

• Lice

• Visual exam with magnifying glass, Wood light

• Scabies

• Visual exam and skin scraping

29

Pediculosis and
Scabies

• Treatments

• Prescription shampoo, body

wash, lotion; washing of hair,
body, clothing, bedding,
personal items, furniture with
hot, soapy water

30

Pilonidal Cyst

•Definition

• Abnormal pocket of skin containing skin and hair

debris, usually located near tailbone

•Etiology

• Unclear, but may be related to ingrown hair
• Risk factors include obesity, trauma, excessive coarse

and curly body hair, being male

•Signs and symptoms

• Pus; warm, tender, swollen area near tailbone; fever

(rare)

31

Pilonidal
Cyst

• Diagnostic procedures

• History and PE

• Treatments

• For abscess, I&D

32

Pityriasis Versicolor

• Definition

• Common fungal infection that interferes

with normal pigmentation; frequently
occurs in teens and young adults

• Etiology

• Overgrowth of common skin fungus caused

by hot, humid weather; oily skin; hormonal
changes; weakened immune system

• Signs and symptoms

• Lighter or darker discolored patches on

back, chest, upper arms, neck; possible
itching and scaling

33

Pityriasis
Versicolor

• Diagnostic procedures

• History and PE,

skin biopsy

• Treatments

• Oral and topical

antifungals

34

Psoriasis

•Definition

• Common, chronic disease that causes itchy or sore patches of red skin with

thick, silvery scales; many types, and may progress to psoriatic arthritis

•Etiology

• Autoimmune disease in which skin regenerates too quickly; triggered by

infections, weather, injury, stress, drugs, alcohol

35

Psoriasis

•Signs and symptoms

•Patches of red skin with thick, silvery scales; dry, cracked
skin; itching, burning, soreness; stiff, swollen joints; most
commonly affected areas include lower back, elbows,
knees, legs, soles, palms, face, scalp

•Diagnostic procedures

•History, PE, skin biopsy

•Treatments

•Topical, oral, or injected medications, light therapy

36

Rosacea

•Definition

•Chronic condition affecting skin and sometimes eye, causing
redness and pimples

•Etiology

•Unknown, but may be a combination of genetics and
environment
•Risk factors include being female, fair skin, age

•Signs and symptoms

•Facial flushing or redness; acne and small red lines under skin;
swollen, thick skin on nose, forehead, chin, cheeks; red, dry,
itchy eyes; vision problems possible)

37

Rosacea

• Diagnostic procedures

• History and skin

exam

• Treatments

• Topical and oral

medications, light
therapy

38

Scleroderma

•Definition

• Buildup of collagen in the skin and

elsewhere in the body, including possibly
the small artery walls

•Etiology

• Autoimmune disorder
• Risk factors include being female

•Signs and symptoms

• Raynaud phenomenon; hair loss; finger and

toe ulcers; small white bumps below skin;
joint pain, stiffness, swelling; difficulty
swallowing; heartburn; bloating;
constipation; heart arrhythmias; kidney
failure

39

Scleroderma

• Diagnostic procedures

• History, PE, blood

and urine tests,
imaging

• Treatments

• No specific

Tx:
corticosteroids &
immunosuppressants may be used

40

Questions?

56

Additional Integumentary Systems
Diseases and Disorders

• Albinism Peritonitis
• Candidiasis Pleural effusion
• Corns, calluses Pleuritis
• Folliculitis Vitiligo
• Furuncle Warts
• Hemangioma
• Hidradenitis
• Hirsutism
• Hyperhidrosis
• Nevus

41

ALBINISM

42

Candidiasis

43

CORNS, CALLUSES

44

FOLLICULITIS

45

FURUNCLE

• AKA BOIL
• CARBUNCLE IS CLUSTER OF FURUNCLES

46

HEMANGIOMA

47

HIDRADENITIS

48

HIRSUTISM

49

HYPERHIDROSIS

50

NEVUS/NEVI

51

VITILIGO

52

WARTS

53

Life Span Changes

•Infants

• Vernix
• Lanugo

•Infants and children

• Congenital nevi
• Mongolian spots
• Café-au-lait spots
• Port-wine stains
• Hemangiomas
• Stork bites

54

Life Span
Changes

•Adulthood

•Thinning epidermis and subcutaneous fat layer

•Decreased melanocytes

•Large pigmented spots

•Connective tissue changes

•Senile purpura

•Decreased sebaceous gland activity

•Decreased sudoriferous gland activity

•Skin changes

•Environment, nutrition, genes

55

Questions?

56