INTEGUMENTARY

SYSTEM
Dr. KEDIR K.
OBJECTIVE
1. Explain common symptoms of diseases affecting the integumentary
system
2. Explain how to perform physical examination of the integumentary
system
3. Explain what primary and secondary skin lesions are
• The integumentary system consists of the skin and the skin
appendages (hair, sebaceous glands, sweat glands and the nails). Its
functions include
• Protection: barrier against the outside
• Protection against dehydration
• Body temperature regulation
•Cutaneous sensation
• Metabolic functions
• Blood reservoir
•Excretion
SKIN
• The largest organ of the human body
Evolution of lesions
• Site of onset
• Manner in which eruption progressed or spread
• Duration
• Periods of resolution or improvement in chronic eruption
• Symptoms associated with the eruption
- Itching, burning, pain and numbness
-Relieving/aggravating factors for the symptom, if any
- Time of day when symptoms are most severe
• Current or recent medications
• Associated systemic symptoms (e.g. malaise, fever)
Components of Dermatological Evaluation
• History (Subjective)
• Physical Examination (Objective)
• Diagnosis (Assessment)
• Plan
• 90% of skin diseases can be properly diagnosed with
meticulous history and proper physical examination

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 History Components
• A dermatologic history is similar to other fields of
medicine and includes:
• Chief Complaint
• History of Present Illness: key Q:
• When? Onset
• Where? Site of onset
• Does it itch or hurt? Symptoms
• How has it spread (pattern of spread)?
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 Cont’d
• Evolution
• How have individual lesions changed?
• Provocative factors? Heat, cold, sun, exercise, travel history,
drug ingestion, pregnancy, season
• Previous treatment(s)?
• Topical and systemic
• Patient initiated/physician prescribed

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 Cont’d

• Past Medical History (PMH)

• Allergies, especially drug allergies
• Atopic history (asthma, hay fever, eczema)
• Habits (smoking, alcohol intake, drug abuse)

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 Cont’d

• Family medical history - (particularly of psoriasis, atopy, melanoma,

hereditary skin d/os)
• Social history - with particular reference to occupation, hobbies,
exposures, travel, injecting drug use
• Sexual history: history of risk factors of HIV: blood transfusions, IV
drugs, sexually active, multiple partners, sexually transmitted disease?

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Physical Examination
• Requirements
• Good lighting
• Adequate privacy
• Light torch
• Spatula
• Magnifying glass and
• Transparent glass slide for diascopy

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 Cont’d

• Thorough cutaneous examination:

• Inspection and palpation are principal
• Examine the scalp, eyelids, ears, genitals, buttocks,
perineal area, and interdigital spaces, the hair, the
nails and the mucus membranes of the mouth

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Inspection and Palpation
 Morphology – Primary/Secondary
 Distribution
 Configuration
 Color
 Size
 Texture

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Morphology
Skin lesions can classified
1. Primary
-The original, uncomplicated lesions
-Identification is important for diagnose
2. Secondary
-Modified primary lesion
-Involution, trauma, application of
medication and infection
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 1. Primary morphology
Macule: flat, nonpalpable lesions < 1cm in diameter, represent a change
in color and are not raised or depressed

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 Cont’d

Patch - is a large macule, similar to a macule but size >1cm

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 Cont’d

Papule: elevated lesions < 1cm in diameter

that can be felt or palpated.

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 Cont’d

Plaque: flat topped or rounded palpable

lesions > 1cm in diameter

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 Cont’d

Nodule: firm papule of >1cm or lesions that

extend into the dermis or subcutaneous
tissue.

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 Cont’d

Vesicle: small, clear, fluid-filled lesion of < 1cm in

diameter.

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 Cont’d

Bulla/blister: a fluid filled cavity size >1cm

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 Cont’d

Pustule: vesicle that contains pus.

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 Cont’d

Urticaria/wheal/hive: elevated lesions caused by

localized edema.

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 Cyst
• Is anencapsulated cavity or sac lined with
true epithelium that contain fluids or semi
solid materials (cells & cell products such
as keratin)

• Sometimes, superficial ... ? vesicles

Tumor
a general term for any mass, benign or malignant
>5cm in diameter

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cutaneous hemmorrages
• Petechia- < 3mm

• Purpura - 3mm-5mm in diameter

• Ecchymosis (bruise)- a macular area of haemorrhage more than 5

mm in diameter

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vascular lesions
• Telangiectasia are persistent dilatations of small capillaries in the
superficial dermis that are visible as fine, bright, no pulsatile red lines

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2. Secondary Lesions
Scale: heaped-up accumulations of horny
epithelium

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 Cont’d

Crust (scab): consists of dried serum, blood, or pus

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 Cont’d

Erosion: open area of skin that results from loss of part

or all of the epidermis

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 Cont’d

Ulcer: full thickness loss of epidermis & some dermis,

heals with scaring

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 Cont’d

Atrophy: thinning of the skin, which

may appear dry and wrinkled, resembling
cigarette paper

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 Cont’d
Fissure: linear split in the epidermis or
dermis.

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 Cont’d

Scar: area of fibrosis that replaces normal

skin after injury. Some scars become hypertrophic or thickened and raised.

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 Cont’d

Keloid: is hypertrophic scar that extend beyond the

original wound margin.

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 Cont’d

Excoriation: Punctate or linear abrasion due to scratching

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 Cont’d

• Lichenification: is thickening of the skin with accentuation of

normal skin markings

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Configuration
• Arrangement and configuration of the lesion:
• linear, grouped, scattered, polycyclic,
reticular, serpiginous, targetoid, arcuate,
annular, dermatomal, discrete, diffuse,
follicular, pedunculated

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 Cont’d

Linear: lesions take

on the shape of a
straight line

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 Cont’d

Annular: lesions are rings

with central clearing.

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 Cont’d

Nummular: lesions are

circular or coin-shaped

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 Cont’d

Target (iris): lesions

appear as rings with central
duskiness

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 Cont’d

Serpiginous: lesions have

linear, branched, and
curving element

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 Cont’d

Reticulated: lesions
have a lacy or
networked pattern

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 Cont’d

Zosteriform describes lesions

clustered in a dermatomal
distribution

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Distribution of the lesion
• Anatomic Location
• Unilateral/symmetric
• Flexure/extensor
• Acral (hands/feet)
• Photo-exposed/protected

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Color
• Pigment (hypo, hyper, de-)
• Violet = Violaceous
• White = Alba
Red = Erythema

Size
 Measured in mm, cm

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 Description of Lesions
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

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Clubbing of the nails
Is characterized by swelling of the distal digit, an increase in the angle between the nail plate and the
proximal nail fold
Common Causes of Clubbing of the nails include: •
Congenital heart diseases(cyanotic type)
• Respiratory Causes
o Bronchiectasis
o Lung abscess
o Lung cancer
o Pulmonary fibrosis
• Gastrointestinal Causes
o Crohn's disease
o Celiac disease
o Cirrhosis o Cystic fibrosis
Thank you