Integumentary System
Skin Layers & Structures
● Epidermis: Outermost layer; provides barrier protection, prevents fluid loss, contains
melanocytes for pigmentation, constantly regenerates.
● Dermis: Middle layer; supports epidermis, contains blood vessels, nerves, hair follicles,
sweat glands, and sebaceous glands.
● Sebaceous glands: Produce sebum (oil) that lubricates skin and hair; usually
connected to hair follicles.
● Hair: Composed of keratin; protects scalp, regulates temperature, provides sensory
input.
● Nails: Keratinized structures; protect distal fingers and toes, assist in fine motor tasks.
Functions of the Skin
● Protection against pathogens, chemicals, and physical trauma
● Temperature regulation via sweat and vasodilation/constriction
● Sensory perception (pain, touch, pressure, temperature)
● Vitamin D synthesis
● Excretion of waste products (sweat)
● Communication via appearance (blushing, pallor, rashes)
Integumentary System Changes with Aging
● Thinning of epidermis and dermis
● Reduced collagen → decreased elasticity, wrinkles
● Dryness due to decreased sebaceous and sweat glands
, ● Hair becomes thinner or gray
● Nails grow slower, may become brittle
● Decreased immune response → slower wound healing
Common Skin Conditions / Abnormalities
● Keloid: Raised, thickened scar extending beyond original injury
● Hypopigmentation: Loss of skin color (e.g., vitiligo)
● Hyperpigmentation: Darkened skin areas (e.g., melasma, sun exposure)
● Pseudofolliculitis: Razor bumps from ingrown hairs
● Melasma: Dark, patchy facial pigmentation, often hormonal
● Alopecia: Hair loss
● Hirsutism: Excessive hair growth in females (often hormonal)
● Cherry (senile) angioma: Small, bright red papules common in aging
Subjective Data
● Itching, pain, rashes, changes in color or hair/nail growth, wounds that do not heal,
history of sunburns, family history of skin cancer
ABCDEF Assessment for Skin Abnormalities
● A: Asymmetry
● B: Border irregularity
● C: Color variation
● D: Diameter >6mm
● E: Elevation or evolution
, ● F: Funny-looking (any unusual changes)
Components of Objective Data
● Inspect and palpate: color, moisture, temperature, texture, turgor, edema, lesions
● Assess for erythema, pallor, cyanosis, jaundice
● Examine nails: shape, color, thickness, lesions
● Examine hair: distribution, texture, thickness
Assessment of Skin Lesions
● Primary Lesions: Present at onset
○ Macule: Flat, <1cm (freckle)
○ Patch: Flat, >1cm (vitiligo)
○ Papule: Raised, <1cm (wart)
○ Plaque: Raised, >1cm (psoriasis)
○ Nodule: Solid, deep, >1cm (lipoma)
○ Wheal: Raised, transient, itchy (hive)
○ Tumor: Larger, deeper mass
○ Vesicle: Small fluid-filled <1cm (herpes)
○ Bulla: Large fluid-filled >1cm (blister)
○ Cyst: Encapsulated fluid-filled
○ Pustule: Pus-filled (acne)
● Secondary Lesions: Result from trauma or disease progression
○ Fissure: Linear crack
Skin Layers & Structures
● Epidermis: Outermost layer; provides barrier protection, prevents fluid loss, contains
melanocytes for pigmentation, constantly regenerates.
● Dermis: Middle layer; supports epidermis, contains blood vessels, nerves, hair follicles,
sweat glands, and sebaceous glands.
● Sebaceous glands: Produce sebum (oil) that lubricates skin and hair; usually
connected to hair follicles.
● Hair: Composed of keratin; protects scalp, regulates temperature, provides sensory
input.
● Nails: Keratinized structures; protect distal fingers and toes, assist in fine motor tasks.
Functions of the Skin
● Protection against pathogens, chemicals, and physical trauma
● Temperature regulation via sweat and vasodilation/constriction
● Sensory perception (pain, touch, pressure, temperature)
● Vitamin D synthesis
● Excretion of waste products (sweat)
● Communication via appearance (blushing, pallor, rashes)
Integumentary System Changes with Aging
● Thinning of epidermis and dermis
● Reduced collagen → decreased elasticity, wrinkles
● Dryness due to decreased sebaceous and sweat glands
, ● Hair becomes thinner or gray
● Nails grow slower, may become brittle
● Decreased immune response → slower wound healing
Common Skin Conditions / Abnormalities
● Keloid: Raised, thickened scar extending beyond original injury
● Hypopigmentation: Loss of skin color (e.g., vitiligo)
● Hyperpigmentation: Darkened skin areas (e.g., melasma, sun exposure)
● Pseudofolliculitis: Razor bumps from ingrown hairs
● Melasma: Dark, patchy facial pigmentation, often hormonal
● Alopecia: Hair loss
● Hirsutism: Excessive hair growth in females (often hormonal)
● Cherry (senile) angioma: Small, bright red papules common in aging
Subjective Data
● Itching, pain, rashes, changes in color or hair/nail growth, wounds that do not heal,
history of sunburns, family history of skin cancer
ABCDEF Assessment for Skin Abnormalities
● A: Asymmetry
● B: Border irregularity
● C: Color variation
● D: Diameter >6mm
● E: Elevation or evolution
, ● F: Funny-looking (any unusual changes)
Components of Objective Data
● Inspect and palpate: color, moisture, temperature, texture, turgor, edema, lesions
● Assess for erythema, pallor, cyanosis, jaundice
● Examine nails: shape, color, thickness, lesions
● Examine hair: distribution, texture, thickness
Assessment of Skin Lesions
● Primary Lesions: Present at onset
○ Macule: Flat, <1cm (freckle)
○ Patch: Flat, >1cm (vitiligo)
○ Papule: Raised, <1cm (wart)
○ Plaque: Raised, >1cm (psoriasis)
○ Nodule: Solid, deep, >1cm (lipoma)
○ Wheal: Raised, transient, itchy (hive)
○ Tumor: Larger, deeper mass
○ Vesicle: Small fluid-filled <1cm (herpes)
○ Bulla: Large fluid-filled >1cm (blister)
○ Cyst: Encapsulated fluid-filled
○ Pustule: Pus-filled (acne)
● Secondary Lesions: Result from trauma or disease progression
○ Fissure: Linear crack
