CHAPTER

4 Integumentary System

Pretest
Multiple Choice. Select the best answer, and write the letter
of your choice to the left of each number. To check your
answers go to Appendix 11.

1. The uppermost portion of the skin is called the

a. fossa
b. cuticle
c. epidermis
d. epiphysis
2. The glands that secrete an oily substance that
lubricates the skin are the
a. mammary glands
b. sebaceous glands
c. sweat glands
d. ceruminous glands
3. The rule of nines is a system used to evaluate
a. burns
b. fever
c. immunity
d. inflammation
4. A pigmented skin tumor is a(n)
a. chondrosarcoma
b. melanoma
c. lymphoma
d. adenoma
5. The root hidr/o pertains to
a. saliva
b. tears
c. mucus
d. sweat
6. Onychomycosis is a fungal infection of a(n)
a. eyelid
b. hair
c. nail
d. bone

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 Learning Objectives
After careful study of this chapter, you should be able to:

1 Define and list the functions of the integumentary 6 Identify and use roots pertaining to the integumentary
system. P126 system. P129
2 Compare the locations and structures of the epidermis, 7 Describe the main disorders that affect the skin. P130
dermis, and subcutaneous tissues. P126
8 Interpret abbreviations used in the study and treatment of
3 Describe the roles of keratin and melanin in the skin. P126 the skin. P141
4 Name and describe the glands in the skin. P126 9 Identify and analyze medical terms and abbreviations in
chapter case studies. PP125, 148
5 Describe the structure of hair and nails. P127

Case Study: Kathleen’s Pressure Ulcer

Chief Complaint Kathleen moaned when the nurse palpated the lesion. The
Kathleen, an elderly woman in failing nurse also noted reddened areas on Kathleen’s elbows and
health, had recently moved in heels. The remainder of the examination saw no change
with her daughter after her hospitalization for a stroke. from the previous visit.
The daughter reported to the home care nurse that her
Clinical Course
mother had minimal appetite and was confused and
The nurse provided Kathleen’s daughter with instructions
disoriented and that a blister had developed on her lower
for proper skin care, incontinence management, enhanced
back since she had been confined to bed.
nutrition, and frequent repositioning to prevent pressure
Examination ischemia to the prominent body areas. However, 6 months
During the biweekly visit, the home care nurse spoke later, Kathleen’s pressure ulcer had deteriorated to
with the daughter and then went in to see the mother. class III. She was hospitalized under the care of a plastic
On her initial assessment, the nurse noted that Kathleen surgeon and wound care nurse. Surgery was scheduled
had lost weight since her last visit and that her skin was for debridement of the sacral wound and closure with
dry, with poor skin turgor pressure. She also observed that a full­thickness skin graft (FTSG) taken from her thigh.
the mother was wearing an “adult diaper,” which was wet. Kathleen was discharged 8 days later to a long­term care
The nurse took the mother’s BP, HR, and R, which were facility with orders for an alternating pressure mattress,
normal. She assessed the mother’s mental status and then position change every 2 hours, supplemental nutrition,
proceeded to a skin assessment paying special attention and meticulous wound care.
to the bony prominences. After examining Kathleen’s
sacrum, the nurse noted a nickel­sized open area, 2 cm in Case Study Revisited: Once you complete this
diameter and 1 cm in depth (stage II pressure ulcer), with chapter, please review the case follow-up on p. 142.
a 0.5­cm reddened surrounding area with no drainage.

Ancillaries At-A-Glance
Visit the web resource to access the following resources.

Chapter 4 ■ Integumentary System 125

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 126 Part II ■ Body Systems

Learning Resources
■ eBook ■ TestPrep
■ A&P Module with Heart & Lung Sounds ■ Animations
■ Image Bank ■ Audio Pronunciation Glossary

Introduction deepest epidermal layer, the stratum basale, or basal layer,

produces new cells. As these cells gradually rise toward the
The skin and its associated structures make up the integu­ surface, they die and become filled with keratin, a protein
mentary system. This body­covering system protects against that thickens and toughens the skin. The outermost epider­
infection, dehydration, ultraviolet radiation, and injury. mal layer, the stratum corneum or horny layer, is composed
Extensive damage to the skin, such as by burns, can result of flat, dead, protective cells that are constantly being shed
in a host of dangerous complications. and replaced. Some of the cells in the epidermis produce
The skin helps to regulate temperature by evaporation of melanin, a pigment that gives the skin color and protects
sweat and by changes in the diameter of surface blood vessels, against sunlight. Irregular spots of melanin form freckles.
which control how much heat is lost to the environment. The The dermis is beneath the epidermis. It contains con­
skin also contains receptors for the sensory perceptions of touch, nective tissue, nerves, blood vessels, lymphatics, and sensory
temperature, pressure, and pain. Medication can be delivered receptors. This layer supplies nourishment and support for
through the skin from patches, as explained in BOX 4-1. the skin. The subcutaneous layer beneath the dermis is com­
The word derma (from Greek) means “skin” and is posed mainly of connective tissue and fat.
used as an ending in words pertaining to the skin, such as
xeroderma (dryness of the skin) and scleroderma (harden­
ing of the skin). The adjective cutaneous refers to the skin
and is from the Latin word cutis for skin. Like the eyes, the
Associated Skin Structures
skin is a readily visible reflection of one’s health. Its color, Specialized structures within the skin are part of the integ­
texture, and resilience reveal much, as does the condition of umentary system:
the hair and nails.
■ The sweat (sudoriferous) glands act mainly in tempera­
ture regulation by releasing a watery fluid that evaporates
Anatomy of the Skin to cool the body.
The skin’s outermost portion is the epidermis, consisting of ■ The sebaceous glands release an oily fluid, sebum, that
four to five layers (strata) of epithelial cells (FIG. 4-1). The lubricates the hair and skin and prevents drying.

CLINICAL PERSPECTIVES BOX 4-1

Medication Patches: No Bitter Pill to Swallow

For most people, pills are a convenient way to take medica- important to know when the medication’s effects disappear
tion, but for some, they have drawbacks. Pills must be taken after the patch is removed. Because the body continues to
at regular intervals to ensure consistent dosing, and they must absorb what has already diffused into the skin, removing the
be digested and absorbed into the bloodstream before they patch does not entirely remove the medicine. There is also a
can begin to work. For those who have difficulty swallowing danger that patches may become unsafe when heated, as by
or digesting pills, transdermal (TD) patches offer an effective exercise, high fever, or a hot environment, such as a hot tub,
alternative to oral medications. heating pad, or sauna. When heat dilates the capillaries in the
TD patches deliver a consistent dose of medication that skin, a dangerous increase in dosage may result as more med-
diffuses at a constant rate through the skin into the blood- ication enters the blood.
stream. There is no daily schedule to follow, nothing to A recent advance in TD drug delivery is iontophoresis.
swallow, and no stomach upset. TD patches can also deliver Based on the principle that like charges repel each other, this
medication to unconscious patients, who would otherwise method uses a mild electrical current to move ionic drugs
require intravenous drug delivery. TD patches are used in through the skin. A small electrical device attached to the
hormone replacement therapy, to treat heart disease, to patch uses positive current to “push” positively charged drug
manage pain, and to suppress motion sickness. Nicotine molecules through the skin and a negative current to push
patches are also used as part of programs to quit smoking. negatively charged ones. Even though very low levels of
TD patches must be used carefully. Drug diffusion electricity are used, people with pacemakers should not use
through the skin takes time, so it is important to know how iontophoretic patches. Another disadvantage of these patches
long the patch must be in place before it is effective. It is also is that they can move only ionic drugs through the skin.

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 Chapter 4 ■ Integumentary System 127

Nerve endings

Pore (opening
of sweat gland)

Hair
Stratum corneum

Touch receptor
Epidermis (Meissner corpuscle)

Stratum basale
Skin (stem cell layer)

Dermal papilla
Dermis 4
Sebaceous
(oil) gland

Pressure receptor
(Pacinian corpuscle)
Sweat gland

Subcutaneous
layer

Artery
Nerve
Vein

Adipose Hair follicle Arrector pili

tissue muscle
FIGURE 4-1 Cross-section of the skin. The skin layers and associated structures are shown.

■■ Hair is widely distributed over the body. Each hair ■■ Nails develop from a growing region at the proximal end
develops within a sheath or hair follicle and grows from (FIG. 4-2). The cuticle, technically named the eponychium
its base within the skin’s deep layers. A small muscle (ep-o-NIK-e-um), is an extension of the epidermis onto
(arrector pili) attached to the follicle raises the hair to the surface of the nail plate. A lighter region distal to the
produce “goosebumps” when one is frightened or cold cuticle is called the lunula because it looks like a half
(see FIG. 4-1). In animals this is a warning sign and a moon. Here the underlying skin is thicker, and blood
means of insulation. does not show as much through the nail.

Free edge Nail plate Lunula Cuticle Nail bed Lunula

Nail plate Cuticle Nail root

Distal bone Growth region

of finger (nail matrix)
A B
FIGURE 4-2 Nail structure. A. Photograph of a nail, superior view. B. Midsagittal section of a fingertip showing the
growth region and tissue surrounding the nail plate.
 128 Part II ■ Body Systems

Hair and nails are composed of nonliving material con­

sisting mainly of keratin. Both function in protection.

Terminology Key Terms

The terms listed below are emphasized in this chapter. Knowing them will help you organize and prioritize your learning.
These boldface terms are also found, collectively, with all chapter key terms in the Glossary.
Normal Structure and Function
cutaneous Pertaining to the skin (from Latin cutis, meaning “skin”)
ku­TA­ne­us

derma Skin (from Greek)

DER­mah

dermis The layer of the skin between the epidermis and the subcutaneous tissue; the true skin or corium
DER­mis

epidermis The outermost layer of the skin (from epi­, meaning “upon or over” and derm, meaning “skin”)
ep­ih­DER­mis

hair A thread­like keratinized outgrowth from the skin (root: trich/o)

har

hair follicle The sheath in which a hair develops

FOL­ih­kl

integumentary system The skin and its associated glands, hair, and nails
in­teg­u­MEN­tah­re

keratin A protein that thickens and toughens the skin and makes up hair and nails (root: kerat/o)
KER­ah­tin

melanin A dark pigment that gives color to the hair and skin and protects the skin against the sun’s radiation
MEL­ah­nin (root: melan/o)

nail A plate­like keratinized outgrowth of the skin that covers the dorsal surface of the terminal phalanges
nale (root: onych/o)

sebaceous gland A skin gland that produces sebum; usually associated with a hair follicle (root: seb/o)
se­BA­shus

sebum A fatty secretion of the sebaceous glands that lubricates the hair and skin
SE­bum (root: seb/o)

skin The tissue that covers the body; the integument (roots: derm/o, dermat/o)

subcutaneous layer The layer of tissue beneath the skin; also called the hypodermis
sub­ku­TA­ne­us

sweat gland A gland that releases a watery fluid (perspiration) to the skin surface in order to cool the body. Certain
swet sweat glands, located mainly in the armpits and groin area, release secretions with some cellular
material in response to stress. A sudoriferous (su­dor­IF­er­us) gland. (root: hidr/o)

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 Chapter 4 ■ Integumentary System 129

Roots Pertaining to the Integumentary System

See TABLE 4-1.

Table 4-1 Roots Pertaining to the Skin and Associated Structures

Root Meaning Example Definition of Example
derm/o, dermat/o skin dermabrasion surgical procedure used to resurface the skin and
derm­ah­BRA­zhun remove imperfections
kerat/o keratin, horny layer of the skin keratinous containing keratin; horny
keh­RAT­ih­nus
melan/o dark, black, melanin melanosome a small cellular body that produces melanin
MEL­ah­no­some
hidr/o sweat, perspiration anhidrosis
an­hi­DRO­sis
absence of sweating
4
seb/o sebum, sebaceous gland seborrhea excess flow of sebum (adjective: seborrheic)
seb­or­E­ah
trich/o hair trichomycosis fungal infection of the hair
trik­o­mi­KO­sis
onych/o nail onychia inflammation of the nail and nail bed (Note: not
o­NIK­e­ah an ­itis ending)

Exercise 4-1
Complete the exercise. To check your answers go to Appendix 11.

Identify and define the roots in the following words.

Root Meaning of Root

1. hypodermis (hi­po­DER­mis) _______ ______________________________________
2. seborrheic (seb­o­RE­ik) _______ ______________________________________
3. hypermelanosis (hi­per­mel­ah­NO­sis) _______ ______________________________________
4. dyskeratosis (dis­ker­ah­TO­sis) _______ ______________________________________
5. hypohidrosis (hi­po­hi­DRO­sis) _______ ______________________________________
6. hypertrichosis (hi­per­trih­KO­sis) _______ ______________________________________
7. eponychium (ep­o­NIK­e­um) _______ ______________________________________

Fill in the blanks.

8. Dermatopathology (der­mah­to­pah­THOL­o­je) is study of diseases of the ________________________________.

9. Keratolysis (ker­ah­TOL­ih­sis) is loosening of the skin’s ________________________________________________.
10. A melanocyte (MEL­ah­no­site) is a cell that produces __________________________________________________.
11. Trichoid (TRIK­oyd) means resembling a(n) __________________________________________________________.
12. Onychomycosis (on­ih­ko­mi­KO­sis) is a fungal infection of a(n) ________________________________________.
13. Hidradenitis (hi­drad­eh­NI­tis) is inflammation of a gland that produces _________________________________.
14. A hypodermic (hi­po­DER­mik) injection is given under the _____________________________________________.

(continued)

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 130 Part II ■ Body Systems

Exercise 4-1 (Continued)

Write words for the following definitions.

15. loosening or separation of the skin ________________________________________________

16. study of the skin and skin diseases ________________________________________________
17. softening of a nail ________________________________________________
18. excess production of sweat ________________________________________________
19. study of the hair ________________________________________________
20. instrument for cutting the skin ________________________________________________
21. formation (­genesis) of keratin ________________________________________________
22. a tumor containing melanin ________________________________________________

Use ­derma as a suffix meaning “skin” to write words for the following. Use the word part appendices if needed.

23. hardening of the skin ________________________________________________

24. presence of pus in the skin ________________________________________________

Clinical Aspects of the Skin photographs of specific skin disorders. The study of the skin
and skin diseases is dermatology, but careful observation
Many diseases are manifested by changes in the quality of of the skin, hair, and nails should be part of every phys­
the skin or by specific lesions. Some types of skin lesions ical examination. The skin should be examined for color,
are described and illustrated in BOX 4-2 and appear later in unusual pigmentation, and lesions. It should be palpated to

FOR YOUR REFERENCE BOX 4-2

Types of Skin Lesions

Lesion Description

bulla raised, fluid­filled lesion larger than a vesicle (plural: bullae) (see FIGS. 4-5B and 4-7)
BUL-ah
fissure crack or break in the skin
FISH-ure
macule flat, colored spot less than 1 cm in size. A larger spot is called a patch
MAK-ule
nodule solid, raised lesion larger than a papule; often indicative of systemic disease (see FIG. 4-9)
NOD-ule
papule firm, circular, raised surface lesion less than 1 cm in size, such as a pimple (see FIG. 4-8)
PAP-ule
plaque superficial, flat, or slightly raised differentiated patch more than 1 cm in diameter (see FIG. 4-6)
plak
pustule raised pus­filled lesion; often in a hair follicle or sweat pore (see FIG. 4-13)
PUS-tule
ulcer lesion resulting from destruction of the skin and perhaps subcutaneous tissue (see FIG. 4-18)
UL-ser
vesicle fluid-filled, raised lesion less than 5 mm in size; a blister or bleb
VES-ih-kl
wheal smooth, rounded, slightly raised area often associated with itching; seen in urticaria (hives), such as that
wele resulting from allergy (see FIG. 4-17)

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 Chapter 4 ■ Integumentary System 131

HEALTH PROFESSIONS BOX 4-3

Nurse Practitioners

A nurse practitioner (NP) is a nurse with a professional degree but most work in collaboration with physicians. They focus not
beyond registered nurse (RN) who provides healthcare services only on treatment of disease but also on disease prevention,
similar to those of a physician. All NPs have a master’s degree patient education, and counseling. Such early intervention
in nursing and postmaster’s, or doctoral education. They can and education can lower overall healthcare costs.
specialize in areas such as acute care, family health, neonatol- NPs are licensed to practice in all U.S. states and must fol-
ogy, or gerontology and medical specialties such as oncology low the rules and regulations of the state in which they are
or psychiatry. Their advanced education allows them to inde- licensed. In most states, they are able to prescribe medications
pendently diagnose and treat patients, order testing, perform without a physician’s cosignature, and they may bill insurance
minor surgeries, and often prescribe medications. Many NPs agencies for services. Their professional organization is the
practice autonomously, with so-called “full practice authority,” American Academy of Nurse Practitioners at [Link].
4

evaluate its texture, temperature, moisture, firmness, and health, and good nutrition. The edges of a deep wound
any tenderness. BOX 4-3 on nurse practitioners, who, like should be joined by sutures, either stitches or, for simple
other healthcare professionals, observe the skin when per­ cuts in areas that can be kept dry and immobilized, with a
forming physical examinations. tissue adhesive (glue). Healing is accompanied by scar for­
mation or cicatrization (an alternative name for a scar is
a cicatrix). Permanent scarring is lessened by appropriate
WOUNDS wound care, but some people, especially those of African or
Wounds are caused by trauma, as in cases of accidents or Asian descent, may tend to form keloids because of excess
attacks, or by surgery and other therapeutic or diagnostic collagen formation during healing (FIG. 4-3). Plastic surgery
procedures. Wounds may affect not only the injured area can often improve keloids and other unsightly scars.
but also other body systems. Infection and hemorrhage Various types of dressings are used to protect wounded
may complicate wounds, as do dehiscence, disruption of areas and promote healing. Vacuum­assisted closure (VAC)
the wound layers, and evisceration, protrusion of internal uses negative pressure to close the tissues and begin the heal­
organs through the lesion. ing process. Healing may be promoted by debridement, the
As a wound heals, fluid and cells drain from the dam­ removal of dead or damaged tissue from a wound. BOX 4-4
aged tissue. This drainage, called exudate, may be clear, mentions the origin of the word debridement and gives the
bloody (sanguinous), or pus­containing (purulent). Tubes meaning of other medical terms taken from French. Debride­
may be used to remove exudate from the site of a wound. ment may be accomplished by cutting or scrubbing away the
Proper wound healing depends on cleanliness and care dead tissue or by means of enzymes. A thick, dark crust or
of the lesion and also on proper circulation, good general scab (eschar) may be removed in an escharotomy.

FIGURE 4-3 Keloid. Marked overgrowth of scar tissue following earlobe piercing.

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 132 Part II ■ Body Systems

FOCUS ON WORDS BOX 4-4

The French Connection

Many scientific and medical terms are adapted from foreign the skull on the side opposite the blow. Contrecoup in French
languages. Most roots come from Latin and Greek; others are means “counterblow.” Tic douloureux, a disorder causing pain
derived from German or French. Sometimes a foreign word along the path of the trigeminal nerve in the face, translates
is used “as is.” Debridement, removal of dead or damaged tis- literally as“painful spasm.” A sound heard while listening to the
sue from a wound, comes from French, meaning removal of body with a stethoscope is a bruit, a word in French that liter-
a restraint, such as the bridle of a harness. Also from French, ally means “noise.” Lavage, which refers to irrigation of a cavity,
a contrecoup injury occurs when the head is thrown forward is a French word meaning “washing.”
and back, as in a car accident, and the brain is injured by hitting

Deep wounds may require skin grafting for proper assigned percentages in multiples of nine (FIG. 4-4). The more
healing. Grafts may be a full­thickness skin graft (FTSG), accurate Lund and Browder method divides the body into
which consists of the epidermis and dermis, or a split­thickness small areas and estimates the proportion of BSA contrib­
skin graft (STSG), consisting of the epidermis only. Skin is uted by each.
cut for grafting with a dermatome. Infection is a common complication of burns because
a person’s major defense against bacterial invasion is dam­
Burns aged. Respiratory complications and shock may also occur.
Most burns are caused by hot objects, explosions, or scald­ Treatment of burns includes respiratory care, adminis­
ing with hot liquids. They may also be caused by electricity, tration of fluids, wound care, and pain control. Monitoring
contact with harmful chemicals, or abrasion. Sunlight can for cardiovascular complications, infections, and signs of
also cause severe burns that may result in serious illness. posttraumatic stress is also important.
Burns are assessed in terms of the depth of damage and the
percentage of body surface area (BSA) involved. Depth of
tissue destruction is categorized as follows:

1. Superficial—involves the epidermis only. The skin is red

and dry; there is minimal pain. Typical causes are mild 4.5% 4.5%
sunburn and very short heat exposure. This type of burn
is also called a first­degree burn. The skin will whiten
(blanch) when pressed and then turn bright red again
when released.
2. Superficial partial thickness—involves the epidermis and
18% 18%
a superficial portion of the dermis. The tissue reddens
and blisters and is painful, as in cases of severe sunburn 4.5% 4.5% 4.5% 4.5%
or scalding.
3. Deep partial thickness—involves the epidermis and both
1%
superficial and deeper regions of the dermis. The tissue
may be blistered with a weeping surface or dry because
9% 9% 9% 9%
of sweat gland damage. These burns may be less pain­
ful than superficial burns because of nerve damage. The
blisters may fill with blood due to dermal capillary dam­
age. Causes include scalding and exposure to flame or
hot grease. Superficial and deep partial thickness burns
are also classified as second­degree burns.
4. Full thickness—involves the full skin and sometimes
subcutaneous tissue and underlying tissues as well. The
tissue is broken, dry and pale, or charred. These injuries
may require skin grafting and may result in loss of dig­ Anterior Posterior
its or limbs. Full­thickness burns are also classified as
third­degree or fourth­degree burns. FIGURE 4-4 The rule of nines. Percentage of body surface area
(BSA) in the adult is estimated by sectioning the body surface into
The amount of BSA involved in a burn may be estimated areas with numerical values related to nine. This method is used to
by using the rule of nines, in which areas of body surface are evaluate the extent of skin burns.

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 Chapter 4 ■ Integumentary System 133

A B 4
FIGURE 4-5 Dermatitis. A. Atopic dermatitis (eczema) on an infant’s wrist. B. Contact dermatitis from shoe material. Note
several fluid­filled bullae (see BOX 4-2).

Pressure Ulcers PSORIASIS

Pressure ulcers are necrotic skin lesions that appear where
Psoriasis is a chronic overgrowth (hyperplasia) of the epi­
the body rests on skin that covers bony projections, such as
dermis, producing large, erythematous (red) plaques with
the sacrum, heel, elbow, ischial bone of the pelvis, or greater
silvery scales (FIG. 4-6; see also plaques, BOX 4-2). The cause is
trochanter of the femur (see ulcer, BOX 4-2, and Kathleen’s
unknown, but there is sometimes a hereditary pattern, and
opening case study). The pressure interrupts circulation,
autoimmunity may be involved.
leading to thrombosis, ulceration, and tissue death (necrosis).
Dermatologists treat psoriasis in the following ways
Poor general health, malnutrition, age, obesity, and infec­
depending on severity:
tion contribute to the development of pressure ulcers.
Pressure ulcer lesions first appear as redness of the skin. 1. Topical agents, including corticosteroids, immunosup­
If ignored, they may penetrate the skin and underlying mus­ pressants, vitamins A and D
cle, extending even to bone, and may require months to heal.
2. Phototherapy—exposure to ultraviolet B (UVB) light;
Pads or mattresses to relieve pressure, regular cleans­
administration of the drug psoralen (P) to increase skin
ing and drying of the skin, frequent change in position, and
sensitivity to light followed by exposure to ultraviolet A
good nutrition help to prevent pressure ulcers. Other terms
(UVA) light; laser treatment
for pressure ulcers are decubitus ulcer and bedsore. Both of
these terms refer to lying down in bed, although pressure 3. Systemic suppression of the immune system
ulcers may appear in anyone with limited movement, not
only those who are confined to bed.

DERMATITIS
Dermatitis is a general term for inflammation of the skin,
which may be acute or chronic. Mild forms show erythema
(redness) and edema and sometimes pruritus (itching), but
the condition may worsen to include deeper lesions and sec­
ondary bacterial infections. A chronic allergic form of this
disorder that appears early in childhood is called atopic
dermatitis or eczema (FIG. 4-5). Although its exact cause
is unknown, atopic dermatitis is made worse by allergies,
infection, temperature extremes, and skin irritants. Patients
have tried a variety of treatments for this disorder over the
years. Clinicians are currently studying biologic drugs tar­
geting specific immune system components that are over­
produced in cases of eczema and other allergic disorders.
Other forms of dermatitis include contact dermatitis,
caused by allergens or chemical irritants (see FIG. 4-5B);
seborrheic dermatitis, which involves areas with many
sebaceous glands, such as the scalp and face; and stasis der­ FIGURE 4-6 Psoriasis. Plaques with scales seen at the front of the
matitis, caused by poor circulation. knee (see plaque, BOX 4-2).

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 134 Part II ■ Body Systems

The discoid form (DLE) involves only the skin. It is seen

as rough, raised, erythematous papules that are worsened
by exposure to the ultraviolet radiation in sunlight (FIG. 4-8).
Lupus skin lesions are confined to the face and scalp and
may form a typical butterfly­shaped rash across the nose
and cheeks.
Scleroderma is a disease of unknown cause that involves
thickening and tightening of the skin. There is gradual fibro­
sis of the dermis because of collagen overproduction. Sweat
glands and hair follicles are also involved. A very early sign
of scleroderma is Raynaud disease, in which blood vessels in
the fingers and toes constrict in the cold, causing numbness,
pain, coldness, and tingling. Skin symptoms first appear on
FIGURE 4-7 Pemphigus. Blisters (bullae) are seen on the forearm the forearms and around the mouth. Internal organs become
(see bulla, BOX 4-2). involved in a diffuse form of scleroderma called progressive
systemic sclerosis (PSS).

AUTOIMMUNE DISORDERS SKIN CANCER

The diseases discussed below are caused, at least in part, Skin cancer is the most common type of human cancer.
by autoimmune reactions. They are diagnosed by biopsy of Its incidence has been increasing in recent years, mainly
lesions and by antibody studies. because of the mutation­causing effects of sunlight’s ultravi­
Pemphigus is characterized by the formation of bullae olet rays. Squamous cell carcinoma and basal cell carcinoma
(blisters) in the skin and mucous membranes caused by a sep­ are both cancers of epithelial cells. Both appear in areas
aration of epidermal cells from underlying layers (FIG. 4-7; exposed to sunlight, such as the face and hands. Basal cell
see also bulla, BOX 4-2). Rupture of these lesions leaves deeper carcinoma constitutes more than 75% of all skin cancers. It
skin areas unprotected from infection and fluid loss, much as usually appears as a smooth, pearly papule (FIG. 4-9; see also
in cases of burns. The cause is an autoimmune reaction to epi­ papules, BOX 4-2). Because these cancers are easily seen and
thelial cells. Pemphigus is fatal unless treated by suppressing do not metastasize, the cure rate after excision is greater
the immune system. than 95%.
Lupus erythematosus (LE) is a chronic inflammatory Squamous cell carcinoma appears as a painless, firm,
autoimmune disease of connective tissue. The more wide­ red nodule or plaque that may develop surface scales, ulcer­
spread form of the disease, systemic lupus erythematosus ation, or crusting (FIG. 4-10; see also BOX 4-2). This cancer
(SLE), involves the skin and other organs. SLE is more may invade underlying tissue but tends not to metasta­
prevalent in women than in men and has a higher incidence size. It is treated by surgical removal and sometimes with
among Asians and blacks than among other populations. x­irradiation or chemotherapy.

FIGURE 4-8 Discoid (cutaneous) lupus erythematosus. FIGURE 4-9 Basal cell carcinoma. An initial translucent nodule
Erythematous papules and plaques in a typical sun­exposed has spread, leaving a depressed center and a firm, elevated border
distribution on the chest (see plaque, BOX 4-2). (see nodule, BOX 4-2).

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 Chapter 4 ■ Integumentary System 135

FIGURE 4-10 Squamous cell carcinoma. Lesions are shown on the face and the 4
back of the hand, sun­exposed areas that are commonly affected.

A B C
FIGURE 4-11 Melanoma. Several characteristics are shown. A. Asymmetry. B. Irregular borders. C. Variation in color, a
diameter greater than 6 mm, and elevation.

Melanoma results from a malignant overgrowth of begins to invade the deeper skin tissues and to metasta­
melanocytes, the pigment­producing cells in the epider­ size through blood and lymph. Predisposing factors for
mis. It can arise anywhere in the body where melanocytes melanoma include severe sunburn and frequent tanning.
are found and is the most dangerous form of skin cancer The prognosis for cure is good if the lesion is recognized
because of its tendency to metastasize. This cancer appears and removed surgically before it enters this invasive stage.
as a lesion that is variable in color with an irregular border Kaposi sarcoma, once considered rare, is now seen fre­
(FIG. 4-11). A melanoma shows the so­called ABCDE factors: quently in association with AIDS. It usually appears as distinct
asymmetry, uneven borders, different colors, diameter of brownish areas on the legs. These plaques become raised and
more than 6 millimeters, and evolution (change). The tumor firm as the tumor progresses. In those with weakened immune
may spread superficially for up to 1 or 2 years before it systems, such as patients with AIDS, the cancer can metastasize.

Terminology Key Terms

The terms listed below are emphasized in this chapter. Knowing them will help you organize and prioritize your learning.
These boldface terms are also found, collectively, with all chapter key terms in the Glossary.
Clinical Aspects
atopic dermatitis Hereditary, allergic, chronic skin inflammation with pruritus (itching); eczema
ah­TOP­ik der­mah­TI­tis

basal cell carcinoma An epithelial tumor that rarely metastasizes and has a high cure rate with surgical removal
BA­sal

cicatrization The process of scar formation; a scar is a cicatrix (SIK­ah­triks)

sik­ah­trih­ZA­shun

(continued)

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 136 Part II ■ Body Systems

Terminology Key Terms (Continued)

debridement Removal of dead or damaged tissue, as from a wound
da­brede­MON

dehiscence Splitting or bursting, as when the layers of a wound separate

de­HIS­ens

dermatitis Inflammation of the skin, often associated with redness and itching; may be caused by allergy,
der­mah­TI­tis irritants (contact dermatitis), or a variety of diseases

dermatology Study of the skin and diseases of the skin

der­mah­TOL­o­je

dermatome Instrument for cutting thin skin sections for grafting

DER­mah­tome

eczema A general term for skin inflammation with redness, lesions, and itching; atopic dermatitis
EK­ze­mah

erythema Diffuse redness of the skin

er­ih­THE­mah

escharotomy Removal of scab tissue resulting from burns or other skin injuries; a scab or crust is an eschar
es­kar­OT­o­me (ES­kar)

evisceration Protrusion of internal organs (viscera) through an opening, as through a wound

e­vis­er­A­shun

exudate Material, which may include fluid, cells, pus, or blood, that escapes from damaged tissue
EKS­u­date

Kaposi sarcoma Cancerous lesion of the skin and other tissues seen most often in patients with AIDS
KAP­o­se

keloid A raised, thickened scar caused by tissue overgrowth during scar formation
KE­loyd

lupus erythematosus (LE) A chronic, inflammatory, autoimmune disease of connective tissue that often involves the skin;
LU­pus er­ih­the­mah­TO­sis types include the more widespread systemic lupus erythematosus (SLE) and a discoid form
(DLE) that involves only the skin

melanoma A metastasizing pigmented skin tumor that arises from melanocytes; malignant melanoma
mel­ah­NO­mah

pemphigus An autoimmune disease of the skin characterized by sudden, intermittent formation of bullae
PEM­fih­gus (blisters); may be fatal if untreated

pressure ulcer An ulcer caused by pressure to an area of the body, as from a bed or chair; decubitus
(de­KU­bih­tus) ulcer, bedsore, pressure sore

pruritus Severe itching

pru­RI­tus

psoriasis A chronic hereditary dermatitis with red lesions covered by silvery scales
so­RI­ah­sis

rule of nines A method for estimating the extent of body surface area involved in a burn by assigning
percentages in multiples of nine to various body regions

scleroderma A chronic disease that is characterized by thickening and tightening of the skin and that often
sklere­o­DER­mah involves internal organs in a form called progressive systemic sclerosis (PSS)

squamous cell carcinoma An epidermal cancer that may invade deeper tissues but tends not to metastasize
SKWA­mus

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 Chapter 4 ■ Integumentary System 137

Terminology Enrichment Terms

The terms listed below expand on the key terms to increase your knowledge of this chapter topic.
Symptoms and Conditions
acne An inflammatory disease of the sebaceous glands and hair follicles usually associated with
AK­ne excess sebum secretion; acne vulgaris

actinic Pertaining to the effects of radiant energy, such as sunlight, ultraviolet light, and x­rays
ak­TIN­ik

albinism A hereditary lack of pigment in the skin, hair, and eyes

AL­bin­izm

alopecia
4
Absence or loss of hair; baldness
al­o­PE­she­ah

Beau lines White lines across the fingernails; usually a sign of systemic disease or injury (FIG. 4-12)
bo

bromhidrosis Sweat that has a foul odor because of bacterial decomposition; also spelled bromidrosis
brom­hi­DRO­sis (bro­mih­DRO­sis)

carbuncle A localized infection of the skin and subcutaneous tissue, usually caused by staphylococcus,
CAR­bung­kl and associated with pain and discharge of pus

comedo A plug of sebum, often containing bacteria, in a hair follicle; a blackhead (plural: comedones)
KOM­eh­do

dermatophytosis Fungal infection of the skin, especially between the toes; athlete’s foot (root phyt/o means
der­mah­to­fi­TO­sis “plant”)

diaphoresis Profuse sweating

di­ah­fo­RE­sis

dyskeratosis Any abnormality in keratin formation in epithelial cells

dis­ker­ah­TO­sis

ecchymosis A collection of blood under the skin caused by leakage from small vessels
ek­ih­MO­sis

erysipelas An acute infectious skin disease with localized redness and swelling and systemic symptoms
er­ih­SIP­eh­las

(continued)

FIGURE 4-12 Beau lines. These transverse depressions in the nails are associated
with acute severe illness.

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 138 Part II ■ Body Systems

Terminology Enrichment Terms (Continued)

erythema nodosum Inflammation of subcutaneous tissues resulting in tender, erythematous nodules; may be an
no­DO­sum abnormal immune response to a systemic disease, an infection, or a drug

exanthema Any cutaneous eruption that accompanies a disease, such as measles; a rash
ek­zan­THE­mah

excoriation Lesion caused by scratching or abrasion

eks­ko­re­A­shun

folliculitis Inflammation of a hair follicle

fo­lik­u­LI­tis

furuncle A painful skin nodule caused by staphylococci that enter through a hair follicle; a boil
FU­rung­kl

hemangioma A benign tumor of blood vessels; in the skin, called birthmarks or port wine stains
he­man­je­O­mah

herpes simplex A group of acute infections caused by herpes simplex virus; type I herpes simplex virus
HER­peze SIM­pleks produces fluid­filled vesicles, usually on the lips, after fever, sun exposure, injury, or stress, also
called cold sore or fever blister; type II infections usually involve the genital organs

hirsutism Excessive growth of hair

HIR­su­tizm

ichthyosis A dry, scaly condition of the skin (from the root ichthy/o, meaning “fish”)
ik­the­O­sis

impetigo A bacterial skin infection with pustules that rupture and form crusts; most commonly seen in
im­peh­TI­go children, usually on the face (FIG. 4-13; see also pustules, BOX 4-2)

keratosis Any skin condition marked by thickened or horny growth; seborrheic keratosis is a benign
ker­ah­TO­sis tumor, yellow or light brown in color, that appears in the elderly; actinic keratosis is caused by
exposure to sunlight and may lead to squamous cell carcinoma

lichenification Thickened marks caused by chronic rubbing, as seen in atopic dermatitis (a lichen is a flat,
li­ken­ih­fih­KA­shun branching type of plant that grows on rocks and bark) (FIG. 4-14)

FIGURE 4-13 Impetigo. This bacterial skin infection, seen here on the nostril, FIGURE 4-14 Lichenification. Skin shows thickened
causes pustules that rupture and form crusts (see pustule, BOX 4-2). areas from chronic rubbing, as seen in atopic dermatitis.

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 Chapter 4 ■ Integumentary System 139

Terminology Enrichment Terms (Continued)

mycosis fungoides A rare malignant disease that originates in the skin and involves the internal organs and
mi­KO­sis fun­GOY­deze lymph nodes; there are large, painful, ulcerating tumors

nevus A defined discoloration of the skin; a congenital vascular skin tumor; a mole, birthmark
NE­vus

paronychia Infection around a nail (FIG. 4-15) caused by bacteria or fungi; may affect multiple nails
par­o­NIK­e­ah

pediculosis Infestation with lice

peh­dik­u­LO­sis

petechiae Flat, pinpoint, purplish­red spots caused by bleeding within the skin or mucous membrane
pe­TE­ke­e (singular: petechia) 4
photosensitization Sensitization of the skin to light, usually from the action of drugs, plant products, or other
fo­to­sen­sih­tih­ZA­shun substances

purpura A condition characterized by hemorrhages into the skin and other tissues
PUR­pu­rah

rosacea A condition of unknown cause involving redness of the skin, pustules, and overactivity of
ro­ZA­she­ah sebaceous glands, mainly on the face

scabies A highly contagious skin disease caused by a mite

SKA­beze

senile lentigines Brown macules that appear on sun­exposed skin in adults; liver spots
len­TIJ­ih­neze

shingles An acute eruption of vesicles along the path of a nerve; herpes zoster (HER­peze ZOS­ter);
caused by the same virus that causes chickenpox

tinea A fungal skin infection; ringworm (FIG. 4-16)

TIN­e­ah

tinea versicolor Superficial chronic fungal infection that causes varied skin pigmentation
VER­sih­kol­or

(continued)

FIGURE 4-15 Paronychia. Infection and inflammation of the proximal and FIGURE 4-16 Tinea corporis. Ringworm infection
lateral nail folds is shown. seen on the body.

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 140 Part II ■ Body Systems

Terminology Enrichment Terms (Continued)

urticaria A skin reaction marked by temporary, smooth, raised areas (wheals) associated with itching;
ur­tih­KAR­e­ah hives (FIG. 4-17; see also wheals, BOX 4-2)

venous stasis ulcer Ulcer caused by venous insufficiency and stasis of venous blood; usually forms near the ankle
(FIG. 4-18; see also ulcer, BOX 4-2)

verruca A small, usually benign epidermal tumor caused by human papilloma virus (HPV); a wart
ver­RU­kah

vitiligo Patchy disappearance of pigment in the skin; leukoderma (FIG. 4-19)

vit­ih­LI­go

xeroderma pigmentosum A fatal hereditary disease that begins in childhood with skin discolorations and ulcers and
ze­ro­DER­mah pig­men­TO­sum muscle atrophy; there is increased sensitivity to the sun and increased susceptibility to cancer

FIGURE 4-17 Urticaria (hives). Wheals associated with

drug allergy are shown in an infant (see wheal, BOX 4-2).

FIGURE 4-18 Venous stasis ulcer. Lesion on the ankle caused by FIGURE 4-19 Vitiligo. Depigmented macules appear on the
venous insufficiency and blood stasis (see ulcer, BOX 4-2). skin and may merge into large areas that lack melanin. The brown
pigment seen in the illustration is the person’s normal skin color; the
pale areas are caused by vitiligo.

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 Chapter 4 ■ Integumentary System 141

Terminology Enrichment Terms (Continued)

Diagnosis and Treatment
aloe A gel from leaves of the plant Aloe vera that is used in treatment of burns and minor skin
AH­lo irritations

antipruritic Agent that prevents or relieves itching

an­te­pru­RIT­ik

cautery Destruction of tissue by physical or chemical means; cauterization; also the instrument or
KAW­ter­e chemical used for this purpose

dermabrasion A plastic surgical procedure for removing scars or birthmarks by chemical or mechanical
DERM­ah­bra­zhun destruction of epidermal tissue

dermatoplasty Transplantation of human skin; skin grafting

4
DER­mah­to­plas­te

diascopy Examination of skin lesions by pressing a glass plate against the skin
di­AS­ko­pe

fulguration Destruction of tissue by high­frequency electric sparks

ful­gu­RA­shun

skin turgor Resistance of the skin to deformation; evidenced by the ability of the skin to return to position
TUR­gor when pinched; skin turgor is a measure of the skin’s elasticity and state of hydration; typically
declines with age and when decreased may also be a sign of poor nutrition

Wood lamp An ultraviolet light used to diagnose fungal infections

Terminology Abbreviations
The abbreviations listed below are emphasized in this chapter. These are also found, collectively, with all chapter
abbreviations in Appendix 2.
ABCDE Asymmetry, uneven borders, different colors, SCLE Subacute cutaneous lupus erythematosus
diameter of more than 6 millimeters, and
evolution (change). SLE Systemic lupus erythematosus

BSA Body surface area SPF Sun protection factor

DLE Discoid lupus erythematosus STSG Split­thickness skin graft

FTSG Full­thickness skin graft UV Ultraviolet

LE Lupus erythematosus UVA Ultraviolet A

PSS Progressive systemic sclerosis UVB Ultraviolet B

PUVA Psoralen ultraviolet A VAC Vacuum­assisted closure

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 142 Part II ■ Body Systems

Case Study Revisited

Kathleen’s Follow-Up improved. She also showed less confusion. Kathleen’s

Kathleen made progress while in the long­term care daughter visited her frequently. She was thus able to
facility. She also worked with a physical therapist (PT) observe and assist with her mother’s activities and
and occupational therapist (OT) and began performing receive instruction for her care firsthand. Goals were
simple activities of daily living (ADL). The therapists set to evaluate Kathleen’s progress. Discharge plans
performed range of motion (ROM) activities on a reg- were made to have her return home at an appropriate
ular schedule to both the stroke-affected and unaf­ time. In expectation of her mother’s return, her daugh­
fected sides. With the increase in activity and improved ter had made arrangements for a home healthcare
nutrition, Kathleen’s circulation and skin condition worker to assist in her care.

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 4
CHAPTER

Review

These questions test your understanding of the content introduced in this chapter. Follow the instructions for each exercise
and check your answers in Appendix 11.

LABELING EXERCISE
CROSS-SECTION OF THE SKIN
Write the name of each numbered part on the corresponding line of the answer sheet.

Adipose tissue
Arrector pili muscle
Pressure receptor
Sebaceous (oil) gland
14 4
Artery Skin 16
9
Dermis Stratum basale (growing
3
Epidermis layer)
Hair Stratum corneum 1 18
Hair follicle Subcutaneous layer
2
Nerve Sweat gland
Nerve endings Touch receptor 5 17
Pore (opening of sweat gland) Vein 4
19
15
1. _______________________________________________
2. _______________________________________________ 6

3. _______________________________________________ 11
13
4. _______________________________________________ 12
7 8 10
5. _______________________________________________
6. _______________________________________________
7. _______________________________________________
8. _______________________________________________ 14. _______________________________________________
9. _______________________________________________ 15. _______________________________________________
10. _______________________________________________ 16. _______________________________________________
11. _______________________________________________ 17. _______________________________________________
12. _______________________________________________ 18. _______________________________________________
13. _______________________________________________ 19. _______________________________________________

143

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 144 Part II ■ Body Systems

TERMINOLOGY
MATCHING
1. cicatrization a. redness of the skin
2. erythema b. severe itching
3. eczema c. material that escapes from damaged tissue
4. pruritus d. atopic dermatitis
5. exudate e. scar formation

6. stratum basale a. oily skin secretion

7. hypodermis b. sheath that contains a hair
8. sebum c. subcutaneous layer
9. stratum corneum d. growing layer of the epidermis
10. follicle e. thickened layer of the epidermis

Enrichment Terms
11. alopecia a. profuse sweating
12. excoriation b. lesion caused by scratching or abrasion
13. nevus c. mole or birthmark
14. diaphoresis d. blackhead
15. comedo e. baldness

16. rosacea a. condition causing redness and pustules, mainly on the face
17. tinea b. fungal skin infection
18. bromhidrosis c. infection around a nail
19. albinism d. lack of skin pigmentation
20. paronychia e. sweat with a foul odor

FILL IN THE BLANKS

Complete the sentence with the correct term(s).

21. The main pigment in skin is ____________________________________________________________________________ .

22. The oil­producing glands of the skin are the ______________________________________________________________ .
23. A sudoriferous gland produces __________________________________________________________________________ .
24. The adjective cutaneous refers to the ____________________________________________________________________ .
25. Dermabrasion (der­mah­BRA­zhun) is surface scraping of the _______________________________________________ .
26. The protein that thickens the skin and makes up hair and nails is ____________________________________________ .
27. Schizonychia (skiz­o­NIK­e­ah) is splitting of a(n) _________________________________________________________ .

Refer to Kathleen’s opening case study.

28. Two other terms for a pressure ulcer are _________________________________________________________________ .

29. When the nurse palpated Kathleen’s lesion, she used her sense of _____________________________________________ .
30. Part of Kathleen’s treatment was removal of dead skin from her lesion. This process is called ____________________ .
31. The abbreviation FTSG refers to a(n) ____________________________________________________________________ .
32. A term for lack of blood (root: hem/o) to tissue is _________________________________________________________ .
33. The medical specialist who treated Kathleen’s deteriorating pressure ulcer was a(n) _____________________________ .

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 Chapter 4 ■ Integumentary System 145

DEFINITIONS
Define the following words.

34. xeroderma (ze­ro­DER­mah) ____________________________________________________________________________

35. dyskeratosis (dis­ker­ah­TO­sis) __________________________________________________________________________
36. seborrhea (seb­or­E­ah) _________________________________________________________________________________
37. pachyderma (pak­e­DER­mah) __________________________________________________________________________
38. onychia (o­NIK­e­ah) __________________________________________________________________________________
39. hypermelanosis (hi­per­mel­ah­NO­sis) ___________________________________________________________________
40. percutaneous (per­ku­TA­ne­us) __________________________________________________________________________
41. keratogenic (ker­ah­to­JEN­ik) __________________________________________________________________________
4
Write words for the following definitions.

42. pertaining to discharge of sebum _________________________________________________________________________

43. excess production of keratin _____________________________________________________________________________
44. instrument for cutting the skin ___________________________________________________________________________
45. tumor containing melanin _______________________________________________________________________________
46. cell that produces melanin ______________________________________________________________________________
47. hardening of the skin ___________________________________________________________________________________

Use the word hidrosis (sweating) as an ending for words with the following meanings.

48. absence of sweating ____________________________________________________________________________________

49. excess sweating ________________________________________________________________________________________
50. excretion of colored (chrom/o) sweat _____________________________________________________________________

PLURALS
Give the plural form for the following key and enrichment terms.

51. bulla _________________________________________________________________________________________________

52. ecchymosis ___________________________________________________________________________________________
53. fungus _______________________________________________________________________________________________
54. comedo ______________________________________________________________________________________________
55. staphylococcus ________________________________________________________________________________________

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 146 Part II ■ Body Systems

TRUE–FALSE
Examine the following statements. If the statement is true, write T in the first blank. If the statement is false, write F in
the first blank, and correct the statement by replacing the underlined word in the second blank.

True or False Correct Answer

56. The skin and its associated structures make up the __________________ _______________________________
integumentary system.
57. The root trich/o refers to hair. __________________ _______________________________
58. The dermis is between the epidermis and the __________________ _______________________________
subcutaneous layer.
59. A cicatrix is a scar. __________________ _______________________________
60. Hirsutism is excess growth of nails. __________________ _______________________________

WORD BUILDING
Write a word for the following definitions using the word parts provided. Each word part can be used more than once.

­lysis onych/o ­sis myc/o path/o dermat/o ­y log/o ­oid trich/o

61. loosening or separation of the skin _______________________________________________________________________

62. fungal infection of a nail ________________________________________________________________________________
63. resembling a hair ______________________________________________________________________________________
64. study of hair __________________________________________________________________________________________
65. loosening of a nail _____________________________________________________________________________________
66. like or resembling skin _________________________________________________________________________________
67. any disease of a nail ____________________________________________________________________________________
68. fungal infection of the hair ______________________________________________________________________________
69. any disease of the skin __________________________________________________________________________________
70. study and treatment of the skin __________________________________________________________________________

ELIMINATIONS
In each of the sets below, underline the word that does not fit in with the rest, and explain the reason for your choice.

71. nodule — vesicle — keloid — macule — papule

______________________________________________________________________________________________________
72. impetigo — escharotomy — psoriasis — dermatitis — pemphigus
______________________________________________________________________________________________________
73. SLE — PSS — SCLE — BSA — DLE
______________________________________________________________________________________________________

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 Chapter 4 ■ Integumentary System 147

WORD ANALYSIS
Define the following words, and give the meaning of the word parts in each. Use a dictionary if necessary.

74. dermatophytosis (der­mah­to­fi­TO­sis)

a. dermat/o __________________________________________________________________________________________
b. phyt/o _____________________________________________________________________________________________
c. ­sis _______________________________________________________________________________________________
75. hidradenoma (hi­drad­eh­NO­mah)
a. hidr/o _____________________________________________________________________________________________
b. aden/o ____________________________________________________________________________________________
c. ­oma ______________________________________________________________________________________________
4
76. onychocryptosis (on­ih­ko­krip­TO­sis)
a. onych/o ___________________________________________________________________________________________
b. crypt/o ____________________________________________________________________________________________
c. ­sis _______________________________________________________________________________________________
77. achromotrichia (ah­kro­mo­TRIK­e­ah)
a. a­ _________________________________________________________________________________________________
b. chrom/o ___________________________________________________________________________________________
c. trich/o _____________________________________________________________________________________________
d. ­ia ________________________________________________________________________________________________

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 Additional Case Studies

Case Study 4-1: Basal Cell Carcinoma

Joanne, a 32 y/o fitness instructor, had noticed a “tiny it might be a malignant melanoma. On examination, the
hard lump” at the base of her left nostril while cleansing dermatologist noted a small pearly-white nodule at the
her face. The lesion had been present for about 2 months lower portion of the left ala (outer flared portion of the
when she consulted a dermatologist. She had recently nostril). There were no other lesions on her face or neck.
moved north from Florida, where she had worked as a A plastic surgeon excised the lesion and was able to
lifeguard. She thought the lump might have been trig- reapproximate the wound edges without a full­thickness
gered by the regular tanning salon sessions she had used skin graft (FTSG). The pathology report identified the
to retain her tan because it did not resemble the acne lesion as a basal cell carcinoma with clean margins of
pustules, blackheads, or resulting scars of her adolescent normal skin and subcutaneous tissue and stated that the
years. Although dermabrasion had removed the obvious entire lesion had been excised. Joanne was advised to
acne scars and left several areas of dense skin, this lump wear SPF 30 sun protection on her face at all times and to
was brown-pigmented and different. Joanne was afraid avoid excessive sun exposure and tanning salons.

Case Study 4-1 Questions

Follow the instructions for each question and check your answers in Appendix 11.

Multiple Choice. Select the best answer, and write the letter of your choice to the left of each number.
1. Joanne’s basal cell carcinoma may have been 3. Which skin cancer is an overgrowth of pigment-
caused by chronic exposure to the sun and producing epidermal cells?
use of an ultraviolet tanning bed. The scientific a. basal cell carcinoma
explanation for this is the b. Kaposi sarcoma
a. autoimmune response c. cutaneous lymphoma
b. actinic effect d. melanoma
c. allergic reaction 4. Basal cell carcinoma involves
d. sunblock tanning lotion theory a. subcutaneous tissue
2. The characteristic pimples of adolescent acne b. hair follicles
are whiteheads and blackheads. The medical c. connective tissue
terms for these lesions are d. epithelial cells
a. vesicles and macules
b. pustules and blisters
c. pustules and comedones
d. furuncles and sebaceous cysts

Write terms from the case study with the following meanings.

5. skin sanding procedure ________________________________________________________________________________

6. a solid raised lesion larger than a papule __________________________________________________________________
7. physician who cares for patients with skin diseases _________________________________________________________
8. layer of connective tissue and fat beneath the dermis _______________________________________________________

Define the following abbreviations. See Appendix 2 if needed.

9. FTSG ________________________________________________________________________________________________
10. SPF ________________________________________________________________________________________________
148

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 Case Study 4-2: Cutaneous Lymphoma
Laurie, a 52 y/o female research chemist, has had a history of the mouth and tongue. Laurie was hospitalized and
of T-cell lymphoma for 8 years. She was initially treated given two courses of topical chemotherapy. She was
with systemic chemotherapy with methotrexate, until she referred to dental medicine for treatment of the oral
developed mouth ulcers. Continued therapy with topical lesions and was discharged in stable condition with an
chemotherapeutic agents brought measurable improve-
ment. She also had a history of hidradenitis.
appointment for follow­up in 4 weeks. Her discharge
medications included the application of 2% hydrocorti-
4
A recent physical examination showed diffuse sone ointment to the affected lesions hs, Keralyt gel bid
erythroderma with scaling and hyperkeratosis, plus for the hyperkeratosis, and Dyclone and Benadryl for
alopecia. She had painful leukoplakia and ulcerations her stomatitis prn.

Case Study 4-2 Questions

Follow the instructions for each question and check your answers in Appendix 11.

Multiple Choice. Select the best answer, and write the letter of your choice to the left of each number.
1. Hidradenitis is inflammation of a 4. An example of a topical drug is a
a. sweat gland a. systemic chemotherapeutic agent
b. salivary gland b. drug derived from rainforest plants
c. sebaceous gland c. skin ointment
d. meibomian gland d. Benadryl capsule, 25 mg
2. Leukoplakia is 5. Stomatitis, a common side effect of systemic
a. baldness chemotherapy, is an inflammatory condition of
b. ulceration the
c. formation of white patches in the mouth a. mouth
d. formation of yellow patches on the skin b. stomach
3. Hydrocortisone is a(n) c. teeth and hair
a. vitamin d. debridement
b. steroid
c. analgesic
d. diuretic

Write terms from the case study with the following meanings.

6. diffuse redness of the skin ______________________________________________________________________________

7. increased production of keratin in the skin ________________________________________________________________

Define the following abbreviations. See Appendix 2 if needed.

8. hs ________________________________________________________________________________________________
9. bid ________________________________________________________________________________________________
10. prn ________________________________________________________________________________________________

149

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