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Integumentary S/Sx

Lewis Chapter 22

Hyperthyroidism Increased sweating, warm skin with persistent flush, thin nails, alopecia. Fine, soft hair
Hypothyroidism Cold, dry, pale to yellow skin. Generalized nonpitting edema. Dry, coarse, brittle hair. Brittle, slow-growing nails
Glucocorticoid excess (Cushing syndrome) Atrophy, striae, epidermal thinning, telangiectasia, acne. Decreased subQ fat over extremities. Thin, loose dermis. Impaired wound healing. Increased vascular fragility. Mild hirsutism. Collection of fat over clavicles, back of neck, abdomen, and face
Addison's disease Loss of body hair (especially axillary), generalized hyperpigmentation (accentuated in folds)
Androgen excess Enlarged facial pores, male sex characteristics, acne, acceleration of coarse hair growth
Androgen deficiency Development of sparse hair. Marked reduction in sebum production
Hypoparathyroidism Opaque, brittle nails with transverse ridges. Coarse, sparse hair with patchy alopecia
Hyperpituitarism (acromegaly) Coarsened skin, deepened lines. Increased oiliness and sweating, acne. Increased number of nevi, hyperpigmentation; hypertrichosis (excess hair growth)
Diabetes mellitus Erythematous plaques of shins, delayed wound healing, neuropathy, acanthosis nigricans (velvety, dark skin on the neck and in skin folds)
Primary syphilis Chancre
Secondary syphilis Generalized skin lesions, alopecia
Tertiary syphilis Gummas
Paget’s disease Eczematous patch of nipple and areola
Inflammatory bowel disease Mouth ulcers, erythema nodosum
Liver disease and biliary tract obstruction Jaundice, itching, pigmentary abnormalities, alterations in nails and hair, spider angiomas, telangiectasia
Deficiency of essential fatty acids Scaly skin
Malabsorption syndrome Acquired ichthyosis (dry, scaly skin)
Cystic fibrosis Abnormal sweat gland function
Systemic lupus erythematosus Discoid lesions, maculopapular semiconfluent rash (butterfly rash), alopecia, mouth ulcers
Scleroderma Leathery hardening and stiffness of skin
Dermatomyositis Edema; purplish-red upper eyelids; scaly, macular erythema over knuckles
Vitamin B1 (thiamine) deficiency Edema, redness of soles of feet
Vitamin B2 (riboflavin) deficiency Red fissures at corner of mouth, glossitis
Nicotinic acid (niacin) deficiency Redness of exposed areas of skin of hand or foot, face, or neck; infected dermatitis
Vitamin C deficiency Petechiae, purpura, bleeding gums
Hodgkin's lymphoma Pruritus, sensitive skin
Non-Hodgkin's lymphoma Papules, nodules, plaques, pruritus
HIV infection Kaposi sarcoma, eosinophilic folliculitis
Rheumatic heart disease Petechiae, urticaria, nodules, erythema
Thromboangiitis obliterans (Buerger's disease) Pallor or cyanosis, gangrene, ulceration
Peripheral vascular disease Loss of hair on hands and feet. Delayed capillary filling. Dependent rubor (redness), pain
Venous ulcers Leathery, brownish skin on lower leg; pruritus, concave lesion with edema. Scar tissue with healing
Inadequate oxygenation due to respiratory disease Cyanosis
Anemia Pallor, hyperpigmentation, pale mucous membranes, hair loss, nail dystrophy
Clotting disorders Purpura, petechiae, ecchymosis
Chronic kidney disease Dry skin, pruritus, uremic frost, pallor, bruises
Spinal cord trauma Trophic changes in skin resulting from sensory denervation, pressure ulcers, anesthesia, paresthesias
Macule Circumscribed, flat area with a change in skin color. <0.5 cm in diameter. If lesion >0.5 cm, it is a patch. Examples: freckles, petechiae, measles, flat mole (nevus), café-au-lait spots, vitiligo (complete depigmentation)
Papule Elevated, solid lesion. <0.5 cm in diameter. If lesion is >0.5 cm in diameter, it is a nodule. Examples: wart (verruca), elevated moles, lipoma, basal cell carcinoma
Vesicle Circumscribed, superficial collection of serous fluid. <0.5 cm in diameter Examples: varicella (chickenpox), herpes zoster (shingles), second-degree burn
Plaque Circumscribed, elevated, superficial, solid lesion. >0.5 cm in diameter Examples: psoriasis, seborrheic and actinic keratoses
Wheal Firm, edematous, irregularly shaped area. Diameter variable Examples: insect bite, urticaria
Pustule Elevated, superficial lesion filled with purulent fluid Examples: acne, impetigo
Fissure Linear crack or break from the epidermis to the dermis. Dry or moist Examples: athlete's foot, cracks at corner of the mouth
Scale Excess, dead epidermal cells produced by abnormal keratinization and shedding Examples: flaking of skin after a drug reaction or sunburn
Scar Abnormal formation of connective tissue that replaces normal skin Examples: surgical incision, healed wound
Ulcer Loss of the epidermis, extending into the dermis. Crater-like, irregular shape Examples: pressure ulcer, chancre
Atrophy Depression in skin resulting from thinning of the epidermis or dermis Examples: aged skin, striae
Excoriation Area in which epidermis is missing, exposing the dermis Examples: abrasion, scratch
Antidepressants that cause photosensitivity amitriptyline, doxepin, venlafaxine
Antidysrhythmics that cause photosensitivity quinidine, amiodarone (Cordarone)
Antihistamines that cause photosensitivity diphenhydramine, chlorpheniramine, clemastine, cetirizine (Zyrtec)
Antimicrobials that cause photosensitivity tetracycline, sulfamethoxazole, azithromycin (Zithromax), ciprofloxacin (Cipro)
Antifungals that cause photosensitivity griseofulvin, ketoconazole
Antipsychotics that cause photosensitivity chlorpromazine, haloperidol
Chemotherapy that cause photosensitivity methotrexate, dacarbazine (DTIC), 5-fluorouracil (5-FU)
Diuretics that cause photosensitivity furosemide (Lasix), hydrochlorothiazide
Hypoglycemics that cause photosensitivity tolbutamide, glipizide (Glucotrol), glyburide
NSAIDs that cause photosensitivity diclofenac (Voltaren), piroxicam (Feldene), sulindac
Tretinoin (Retin-A, Renova) Indications, Side Effects & Teaching Improves appearance of photodamaged skin-wrinkles. Reduces actinic keratoses Erythema, swelling, flaking, pigmentation changes. Teratogenic. Increases phototoxicity. Apply at night since it is inactivated by light. avoid abrasive/drying facial cleanser
Chemical Peels (e.g., Beta Hydroxy Acid, Jessner's Peel, TCA) Indications, Side Effects & Teaching Improves appearance of photodamaged skin, acne scarring, actinic and seborrheic keratoses Moderate swelling and crusting for 1 wk. Redness for 6-8 wk. Pink tone possible for several mo. Photosensitivity Avoid sun for 6 mo to prevent hyperpigmentation.
Microdermabrasion Indications, Side Effects & Teaching Smoothes appearance of photodamaged and wrinkled skin, acne scarring Light pink tone that resolves within 24 hr. Photosensitivity Generous application of emollients and sunscreen
α-Hydroxy Acids (e.g., Glycolic Acid, Lactic Acid) Indications, Side Effects & Teaching Smoothes appearance of photodamaged and wrinkled skin, acne scarring Photosensitivity, slight irritation at lower concentrations, severe redness, oozing, and flaking skin possible with higher concentrations Use sunscreen and sun avoidance measures.
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