NATIONAL REVIEW COURSE. Integumentary System

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1 NATIONAL REVIEW COURSE Integumentary System I. Integument A. The largest organ of the body covering all external surfaces and lining cavities that are exposed to the outside environment (e.g. mouth, nasal cavity, vagina, etc.) B. Forms a total surface area of greater than two square meters and comprises approximately 8% of the total body mass. C. Ranges in thickness from 1.5 mm to 4 mm. D. Consists of the skin and its appendages (e.g. hair, nails, glands) E. Animation: Components of Skin * II. Functions of the Integument A. Site of intercommunication between the environment and body. B. Barrier resisting microbial invasion. C. Protective barrier that resists mechanical, chemical, osmotic, thermal, and photic damage. D. Capable of absorbing a variety of chemical substances. E. Excretory function helps rid the body of excess substances. F. One of the primary sites of the immune systems establishment of the immune response. G. Serves may biochemical functions such assisting in the formation of vitamin D and various growth factors. H. Regulates body temperature via control of local blood capillaries and through evaporative cooling from sweating. I. Involved in sociosexual communication and identification. J. Major sense organ populated by many nerve receptors for touch, pain, temperature, mechanical, and pleasurable stimuli. K. Frictional features assists in grasping, manipulation, and locomotion. L. Reflects the general state of health in the body. III. Epidermis A. Superficial most layer consisting of several strata (sub-layers); composed mostly of squamous epithelial cells. B. Keratinized epithelium: 1. Cytoplasm is replaced by a fibrous, waxy protein called keratin. 2. Found on the body s outer surfaces. C. Nonkeratinized epithelium: 1. Found lining the body s outer cavities. D. Strata of the epidermis (deep to superficial): 1. Stratum basal (germinativum) 2. Stratum spinosum 3. Stratum granulosum 4. Stratum lucidum 5. Stratum corneum *

2 IV. E. Stratum basale (germinativum) 1. Base/growth layer 2. Connects the epidermis to the underlying dermis. 3. Consists of stem cells that divide and give rise to form more superficial layers of keratinocytes. 4. Contains melanocytes. a. Pigment producing cells (melanin) that protects against the UV rays of the sun. b. Pheomelanin red/orange pigment c. Eumelanin brown/black pigment d. Everyone produces both types of melanin just in differing amounts. F. Stratum spinosum 1. Spiny layer due to the many surface projections from the cells that allow the cells to bind together. 2. Thick layer of many mature keratinocytes with greater amounts of cytoplasmic keratin. 3. Layer in which melanin is deposited. G. Stratum granulosum 1. Grainy layer due to the keratin granules found in the cytoplasm. 2. Cells become flatter and the cytoplasm becomes more compressed. H. Stratum lucidum 1. Clear layer. 2. Found only in non-hairy skin (thick skin) of the palms of the hands and soles of the feet. I. Stratum corneum 1. Horned layer due to the formation of horns from this layer is some animals. 2. Closely packed layers of dead cells with high concentrations of keratin proteins. 3. Cells on the surface provide waterproofing and are able to slough off for protection. Dermis A. Known as the true skin. B. Located below the epidermis. C. Composed of connective tissue, blood vessels, glands, muscle tissue, nerve endings, and hair follicles. 1. Blood vessels bring blood to the epidermis above and regulate body temperature. 2. Arrector pili smooth muscle tissue attached to the root of the hair follicles; contracts when the person is scared or cold; responsible for goose bumps. 3. Nerve endings general sensory receptors for pressure, temperature, and pain. V. Subcutaneous Layer A. Also known as superficial facia or hypodermis.

3 VI. B. Deepest layer of the integument located beneath the dermis. C. Composed mostly of connective tissue (primarily adipose) and blood vessels. D. Varies in thickness depending on location in the body, age, gender, and overall health. Appendages of the Integument A. Glands 1. Sebaceous glands - located along the shaft of the hair; secretes sebum (oil) that lubricates the stratum corneum and adds to its waterproof quality. 2. Sudoriferous glands produce and secrete sweat; used to eliminate some wastes and cools the body through evaporation. a. Eccrine glands most numerous sweat glands; produces watery sweat for body cooling. b. Apocrine glands larger sweat glands located in the axilla, pubic region, and perianal region; secretes a viscous and odoriferous fluid; become active at puberty. i. Mammary glands specialized apocrine glands in the breasts that secrete milk. 3. Ceruminous glands located in the external ear canal that secrete cerumen (wax). 4. Animation: Sweating * B. Hair consists of a shaft, root, and bulb; provides limited protection. C. Nails hardended stratum corneum; protects ends of digits. Diseases of the Integumentary System VII. General Terminology A. Skin lesion any skin abnormality 1. Macule a flat, reddened patch of skin. 2. Paplule a raised, reddened bump. 3. Vesicle a blister-like growth containing clear fluid. 4. Blister a bubble of fluid caused by separation of the epidermis from the dermis. 5. Pustule a small blister filled with pus. B. Dermatosis any skin disorder that does not involved inflammation. C. Dermatitis acute or chronic skin inflammation from any cause. D. Pruritis itching. VIII. Tumors A. Neoplasms [neo = new; plasm = growth] tumors; abnormal rapidly growing tissue. B. Hyperplasia [hyper = more than; plasis = formation] excessive formation of normal cells resulting in an abnormal number of cells. C. Metastasis the spread of a tumor from its site of origin to distant sites. *

4 IX. Benign Tumors A. Nonspreading, localized tumors that usually grow slowly. 1. Osteoma benign bone tumor. 2. Lipoma benign fatty tumor. 3. Nevus birthmark or mole. 4. Papilloma benign growth on the skin or mucous membranes. 5. Myoma benign muscle tumor. 6. Angioma benign blood vessel tumor. 7. Adenoma benign tumor of the glands. 8. Chondroma benign tumor of cartilage. 9. Lymphoma lymph tissue tumor (benign or malignant). X. Malignant Tumors A. Cancer tumors that are able to metastasize. B. Mutation a change or alteration in the genetic code. C. Sarcoma a malignant tumor arising in tissue other than epithelial tissue. D. Animation: Skin Conditions * E. Animation: Sun s Effect on Skin * F. Carcinoma a malignant tumor of epithelial tissue. 1. Melanoma a. Involves the melanocytes of the skin. b. Approximately 2% of all skin cancers. c. Most deadly of all skin cancers (>50% mortality). d. Metastasizes quickly. 2. Basal cell carcinoma a. Caused by the development of neoplastic cells in the stratum basale. b. Approximately 60% of all skin cancers. c. Rarely metastasizes. 3. Squamous cell carcinoma a. Caused by development of neoplastic cells in the superficial layers of the epidermis (above stratum basale). b. Approximately 35% of all skin cancers. c. Can metastasize to the underlying layers of skin. XI. ABCD s of Skin Cancer A. Asymmetry when half of the mole does not match the other half. B. Border when the border (edges) of the mole are ragged or irregular. C. Color when the color of the mole varies throughout. D. Diameter if the mole s diameter is greater than a pencil eraser. XII. Bacterial Disorders A. Cellulitis noncontagious inflammation of the skin and deeper tissues. 1. Cause: widespread Staphylococcus. 2. Indications/Contraindications: may be associated with a contagious condition; consult with client s doctor. *

5 B. Impetigo contagious skin infection; characterized by localized skin redness and vesicles around the nose, mouth, axilla, groin, hands, and feet that burst and form crusts. 1. Cause: Streptococcus or Staphylococcus. 2. Indications/Contraindications: avoid affected area; consult with client s doctor. C. Folliculitis contagious inflammation of a hair follicle; often contracted from hot tubs. 1. Cause: Staphlococcus, Pseudomonas. 2. Indications/Contraindications: do not massage infected region; refer to doctor. D. Acne noncontagious inflammation of the sebaceous glands in the skin. 1. Cause: hypersecretion of sebum (oil) owing to hormonal changes in the body. 2. Indications/Contraindications: not contagious; avoid massage if affected areas are painful, itching, or weeping. XIII. Viral Disorders A. Fever blisters (herpes simplex) open sores and vesicles around the lips and gums; contagious condition. 1. Cause: herpes simplex virus type I 2. Indications/Contraindications: do not massage affected area. B. Chickenpox characterized by a rash that develops into pustules and vesicles lasting approximately 5 to 7 days. 1. Cause: acute form of varicella-zoster virus (VZV) infection transmitted through airborne route; VZV grows in the respiratory tract and is spread through the body by the lymphatic and circulatory systems. 2. Indications/Contraindications: do not massage; wait for rash to subside. C. Shingles (herpes zoster) an eruption of a rash and pustules along a dermatome (sensory area of skin innervated by one particular spinal nerve) of the nerve root; burning pain typically precedes the classic dermatomal rash by several days; causes intense pain and can persist for several months after the rash resolves; can be highly debilitating. 1. Cause: delayed or recurrent form of VZV infection; virus remains dormant in nerve tissue after a typical VZV infection that causes chickenpox, but may become reactivated years later. 2. Indications/Contraindications: do not massage affected area; refer to doctor. D. Warts (verrucae) contagious infection of the epidermis; many different varieties. 1. Cause: viral infection. 2. Indications/Contraindications: contagious; no not massage affected area. IX. Fungal Disorders A. Tinea (ringworm) itchy, shallow lesions; occur in various locations.

6 1. Cause: fungal infection. 2. Indications/Contraindications: avoid affected area; refer to doctor. 3. Types a. Tinea capitis - scalp b. Tinea pedis athlete s foot c. Tinea cruris jock itch d. Tinea corporus body e. Tinea barbae beard X. Parasitic Disorders A. Scabies itchy eruptions that usually affect the webs of the hands, wrists, elbows, gluteal cleft, or nipples; papules and vesicles are common. 1. Cause: Sarcoptes scabiei (itch mite) infection. 2. Indications/Contraindications: avoid affected area; refer to doctor. B. Pediculosis (lice/crabs) itchiness of the scalp, pubic area, or other places on the skin. 1. Cause: blood-sucking lice transmitted through personal contact and sharing of combs, brushes, bedding, towels, and clothing. 2. Indications/Contraindications: avoid direct contact with clients; refer to doctor. XI. Other Skin Disorders A. Psoriasis chronic skin disorder characterized by oval, silvery, plaquelike scales with patches of red, especially on the scalp, ears, genitalia, and skin over bony prominences such as the elbows, knees, hands, feet, and low back. 1. Cause: unknown; suspected genetic influence; triggers such as emotional stress, skin injury, and/or medications cause outbreak. 2. Indications/Contraindications: avoid affected areas if painful, itching, or weeping; massage can reduce stress, which can aggravate the condition; refer to a doctor. B. Scleroderma (Progressive systemic sclerosis) autoimmune disease characterized by deposition of collagen in the skin, lungs, heart, kidneys, and gastrointestinal tract; more frequent in females; signs include inflexible, cold-sensitive fingers and a masklike face; esophageal dysfunction, calcium deposits under the skin, and development of red spots under the tongue and in the mouth. 1. Cause: autoimmune disorder; specific cause unknown. 2. Indications/Contraindications: avoid affected region; refer to doctor. C. Atopic eczema (atopic dermatitis) noncontagious, general inflammation of the skin; characterized by blisterlike formations that burst and form crusts; commonly involves the scalp, arms, trunk, and legs; may develop dry, pigmented areas of skin that begin around the elbows and knees and spread to the neck, hands, or feet. 1. Cause: unknown; may be an allergic reaction. 2. Indications/Contraindications: do not massage any areas that are painful, itchy, or weeping.

7 XII. D. Systemic lupus erythematosus (SLE, lupus) chronic inflammatory disease that often shows periods of exacerbation and relapse; renal failure and central nervous system problems are the most common causes of death, but can affect most body systems; predominantly affects females and African-Americans; sometimes manifests itself as a butterfly rash across the nose and cheeks, giving the appearance of a wolf (thus lupus meaning wolf ). 1. Cause: autoimmune disorder of unknown cause in which the body produces an immune response against the cells nuclei. 2. Indications/Contraindications: refer to doctor. E. Urticaria (hives) itchy skin eruptions. 1. Cause: usually an allergic response; may be influenced by psychogenic factors (stress). 2. Indications/Contraindications: do not massage any affected areas that are painful, itchy, or weeping. F. Decubitus ulcers (bedsores) dark patches or ulerations of the skin that lead to necrosis of the skin 1. Cause: prolonged pressure over bony prominences, usually from lying or sitting in one position for too long without moving. 2. Indications/Contraindications: do not massage affected area; massage as a preventive measure is most effective in improving circulation and alleviating pressure. Burns A. Indications/Contraindications: consult with client s doctor; avoid the area if painful. B. First-degree burn affects the epidermis; redness of the skin is usually followed by shedding of the skin. C. Second-degree burn affects the epidermis and dermis; redness and blistering; can leave scars when healed. D. Third-degree burn affects all layers of the skin and frequently some of the underlying tissue; open wounds with black charring and white patches of necrotic tissue; leaves scars when healed. Sample Questions The oily substance that is secreted by the skin is: A. cytoplasm B. synovium C. sebum D. serum What glands are also known as the sweat glands? A. Apocrine glands B. Holocrine glands C. Ceruminous glands D. Sebaceous glands

8 Name the glands that produce and secrete a fluid that is approximately 99% water; contains some electrolytes, salts, and urea; and cools the body by removing heat through evaporation. A. Sudoriferous glands B. Ceruminous glands C. Bartholin glands D. Salivatory glands What are the specialized secretory glands located in the external ear canal that secrete earwax? A. Auricular glands B. Ossicular glands C. Ceruminous glands D. Tympanic glands What is the deadliest type of skin cancer? A. Squamous cell B. Melanoma C. Basal cell D. Stratified cell What part of the nail should be kept trim and cut for massage therapists? A. The lunula B. The free edge C. The epidermis D. Nail bed Which of the following is not a function of the integumentary system? A. Protection B. Storage of minerals C. Thermal regulation D. Excretion Which of the following is a malignant tumor of epithelial tissue? A. Carcinoma B. Lipoma C. Sarcoma D. Adenoma Which of the following diseases is characterized by deposition of collagen in the skin, lungs, heart, kidneys, and gastrointestinal tract? A. Urticaria B. Pruritus C. Decubitus ulcers D. Scleroderma Which of the following is a viral infection characterized by the development of pustules along a dermatomal pattern? A. Shingles B. Impetigo C. Chickenpox D. Carcinoma

9 A myoma is a tumor of: A. nerve tissue B. cartilaginous tissue C. muscle tissue D. eye tissue Tinea cruris is also called: A. shingles B. athlete s foot C. jock itch D. hives Which of the following is an autoimmune disorder that affects the skin? A. Impetigo B. Scleroderma C. Scabies D. Tinea cruris Which of the following will most likely develop if a person lies in bed without shifting or moving and experiences prolonged pressure over bony prominences? A. Urticaria B. Decubitis ulcers C. Scoliosis D. Osteomyelitis Which of the following types of burns is characterized by open wounds with black charring and white patches of necrotic tissue? A. Third-degree burn B. Second-degree burn C. First-degree burn D. Fourth-degree burn Warts are: A. a contagious infection of the epidermal layer of skin. B. a noncontagious infection of the subcutaneous layer of the skin. C. a noncontagious infection of the epidermal layer of the skin. D. a contagious infection of the subcutaneous layer of the skin. A birthmark or mole is a: A. vesicle B. papule C. nevus D. papillae Hodgkin disease is: A. an infection of filarial worms in the lymphatic system that causes lymph blockage and enlargement of body parts. B. a contagious disease spread by direct contact that produces swollen lymph nodes and submandibular glands. C. a type of malignant lymphoma that causes decreased lymphoid function and immunodeficiency. D. enlargement of the spleen,

10 If a client comes to you with psoriasis and is requesting a massage, what should you do? A. Make sure you wash and clean the area before giving the massage. B. Tell the client politely that you cannot give them a massage because it is contraindicated. C. Proceed with the massage, but avoid the area. D. Refer them to a physician for clearance.