Integumentary System

PuturosP. (MD)
April 6, 2022
Lecture outlines
• Introduction
• Skin
• Hair
• Nail
• History
• Physical Examination/ Objective Assessment
 Introduction
Integumentary System
• Part of organ that protects interior organs
• It study is of dermatology
• Comprises of
• Skin
• Nails
• Hair
 Skin
Basic structure of the skin
• The largest organ in our body…
• comprises about 15% of the body weight , 10% of total circulation

• Human skin is composed of three layers:

• Epidermis,
• Dermis,
• Subcutaneous Tissue (Panniculus)
 Skin con’t …..
Epidermis
• outermost layer, is formed by an ordered arrangement of
cells called keratinocytes
• Their basic function is to synthesize keratin, a filamentous
protein that serves a protective function.
Dermis
• middle layer. Its principal constituent is the fibrillar
structural protein collagen.
Panniculus
• composed of lobules of lipocytes
Functions of the Skin
• Mechanical function
• Thermoregulation
• Sensory and autonomic function
• Immunologic function
• Vitamin D synthesis
• Exertion
• Sociosexual function
History and Physical Examination
INTEGUMENTARY History
• Itching, burning, rash, generalized/localized eruption,
pain, pigmentary changes, swelling, ulceration etc are
presenting symptoms.
• Elaborating enquiries are made about complaints
in terms of onset, duration, progression, distribution,
treatments taken etc
• Hx of similar illness previously or in the family, self &/or
family Hx of atopic Dss & other illness should be
enquired
• Occupational & social Hx
INTEGUMENTARY Physical Examination…………….
• Complete cutaneous examination
• Scalp, eyelids, ears, genitals, buttocks, perineal area, and interdigital
spaces; the hair; the nails; and the mucus membranes of the mouth,
eyes, anus, and genitals
INTEGUMENTARY Physical Examination…………….
• Ideal conditions for the complete skin examination
-excellent lighting, bright – natural
-fully undressed, a gown
-remove makeup or eyeglasses
-examining table at a comfortable height
-gynecologic stirps
-comfortable room temperature
-chaperone
INTEGUMENTARY Physical Examination…………….

Recommended tools
• A magnifying tool such as a loupe, magnifying glass, or dermatoscope.
• A bright focused light such as a flashlight or penlight to sidelight
lesions.
• Glass slides or a hand magnifier for diascopy.
• Alcohol pads to remove scale or surface oil.
• Gauze pads or tissues with water for removing makeup.
INTEGUMENTARY Physical Examination…………….
• Gloves to be used for examination when scabies or another highly infectious
condition (secondary syphilis) is suspected, when examining mucus membranes,
vulvar and genital areas, and when performing any procedure.
• A ruler for measuring lesions.
• Number 15 and number 11 scalpel blades for scraping or incising lesions,
respectively.
• A camera for photographic documentation.
• A Wood's lamp (365 nm) for highlighting subtle pigmentary changes.
INTEGUMENTARY Physical Examination…………….

While describing skin lesions, the following features should be

identified:-
Four cardinal features
◦ Type of lesion:
◦ Shape of individual lesions:
◦ Arrangement of multiple lesions:
◦ Distribution
 Extent of involvement
 Pattern
INTEGUMENTARY Physical Examination…………….
Four cardinal features

◦ Type of lesion: macule, papule, nodule, vesicle, etc.

◦ Shape of individual lesions: annular, iris, arciform, linear, round, oval, umbilicated, etc.
◦ Arrangement of multiple lesions: isolated, scattered, grouped, linear, herpetiform,
zosteriform, etc.
◦ Distribution (be sure to examine scalp, mouth, palms, and soles)
 Extent of involvement: circumscribed, regional, generalized, universal?
What percentage of the body surface is involved?
 Pattern: symmetry, exposed areas, sites of pressure, intertriginous
areas?
INTEGUMENTARY Physical Examination…………….
Papule

-a solid, elevated
lesion less than 0.5
cm in size
INTEGUMENTARY Physical Examination…………….
Plaque

-solid plateau-like
elevation
-width >> height
diameter > 0.5 cm
INTEGUMENTARY Physical Examination…………….
Nodule
-a solid, round or
ellipsoidal, palpable
lesion that has a
diameter larger than
0.5 cm.
-depth of
involvement and/or
substantive Having a firm basis

palpability
INTEGUMENTARY Physical Examination…………….
Vesicle

-a fluid filled cavity

size <0.5cm
INTEGUMENTARY Physical Examination…………….
Bulla/blister

-a fluid filled cavity size

>0.5cm
INTEGUMENTARY Physical Examination…………….
Pustule

-a vesicle filled with pus

INTEGUMENTARY Physical Examination…………….
Cyst
-an encapsulated cavity
or sac lined with a
true epithelium that
contains fluid or
semisolid material
(cells and cell
products such as
keratin
INTEGUMENTARY Physical Examination…………….
Secondary Lesions

Erosion
-loss of a portion or
all of the viable
epidermal or mucosal
epithelium
-heals without
scaring
INTEGUMENTARY Physical Examination…………….
Ulcer

-full thickness loss of

epidermis & some
dermis,
-heals with scaring
INTEGUMENTARY Physical Examination…………….
Atrophy
-depression of the
surface due to
thinning of
the epidermis or
dermis. There are
often fine
wrinkles & the blood
vessels easily seen
under the skin
INTEGUMENTARY Physical Examination…………….
Fissure

-linear split in the

epidermis or dermis
at an orifice( angle of
the mouth or anus)
over a joint or along a
skin crease.
Surface features
- Scale : dry/flaky surface due to abnormal stratum
corneum with accumulation of or increased shedding of
keratinocytes
-Crust : serum, blood or pus that has dried/ accumulated on
the surface
-Excoriations : are surface excavations of epidermis that
result from scratching
- Lichenification : thickening of the epidermis with
increased skin markings due to persistent scratching.
Hair
• Color
• Fragility
• Texture
• Distribution
Nails
• Shape
• Color
• Lesions or deformity
• Curvature
Thank you