CHAPTER 12
Disorders of the Integumentary System
LEARNING OUTCOMES
Upon completion of this chapter, the nurse will:
1. Summarize the different disorders of the integumentary system
2. Examine approaches to assess different disorders of the integumentary system
3. Differentiate integumentary system disorders from manifestations of systemic health problems
SKIN DISORDERS: LESIONS
Skin disorders can be divided into primary or secondary lesions. Primary lesions include:
Cyst
Macule or patch
Nodule or tumor
Papule or plaque
Pustule
Vesicle or bulla
Wheal
Secondary lesions include:
Atrophy
Crust
Erosion
Fissure
Keloid
Lichenification
Scales
Scar
Ulcer
Assessing for the presence of these lesions may be challenging when providing telephonic care; however, a great deal of information can be collected through asking focused questions.
Assessing Skin Lesions
Primary Lesion | Question |
Cyst | Do you have any raised areas on the skin that feel like they are filled with fluid? |
Macule or patch | Do you have any freckles or other areas on your skin that are small, round, and of a different color than the rest of your skin? |
Nodule or tumor | Do you have any areas on the skin that feel hard or semisoft and seem to be deeper in the skin surface? |
Papule or plaque | Do you have any skin areas that are elevated and solid like warts or moles? |
Pustule | Do you have any skin areas that are oozing white–yellow colored fluid? |
Vesicle or bulla | Do you have any blisters on your skin? |
Wheal | Do you have any reddened areas on your skin that appear to be the result of an insect bite or hives? |
Secondary Lesion | Question |
Atrophy | Do you have any skin areas that appear thin, wrinkled, dry, and like tissue paper? |
Crust | Do you have any scabs on your skin? |
Erosion | Do you have any scratches on your skin? |
Fissure | Do you have any cracks on the corners of your mouth or on your hands/feet? |
Keloid | Do you have any scar areas that are large and raised? |
Lichenification | Do you have any rough thickened areas that are rubbed consistently like on the elbows or knees? |
Scales | Do you have any small pieces of flaking skin like dandruff? |
Scar | Do you have any areas where the skin has healed and has left a mark? |
Ulcer | Do you have any areas where the layers of the skin have been eroded? |
SKIN DISORDERS: RASHES
Rashes or areas of the skin that are red and irritated can be caused by many things. The most frequent reasons for a rash include:
Medications
Allergies (food, chemicals, or environment)
Systemic illness (infectious diseases)
It can be difficult to assess rashes when providing telephonic care; however, you can assess for possible causes for the disorder. When assessing, keep in mind that some rashes have distinctive patterns such as the rash associated with:
Tinea fungal infections (round in appearance)
Lyme disease (bull’s eye appearance)
Linear along a nerve root (herpes zoster)
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