• It is a large sensory organ to touch.


  • Protect underlined tissue and organs.
  • Regulation of Temperature.
  • Excretion of salt and water.
  • 1st line defense mechanism against infection.
  • Receive stimuli from external environment such as pain, touch, pressure, temperature, cold, and relay that information to CNS.
  • Synthesis of vit D which is absorbed form sunlight necessary for calcium metabolism.
  • Stores nutrient.
  • Protect body from dehydration.

Layers of Skin   

  • Epidermis
  • Dermis
  • Hypodermis (Subcutaneous fat)  

Epidermis Layers   

  • Stratum Cornum.
  • Stratum Lucicum.
  • Stratum Granulisom.
  • Stratum spinosm.
  • Stratum Basila.  

Appendages of epidermis   

  • Nail
  • Hair
  • Glands
    • Sweat gland,
    • Sebaceous gland.  

Normal Bacterial flora   

  • ph of skin 4.2 – 5.6.
  • Normal bacterial flora are gram +ve and –ve Staphylococcus, Pseudomonas, and streptococcus.

Risk Factors 

    • Exposure to chemical,
    • Environmental pollutant,
    • Exposure to radiation,
    • Exposure to sunlight,
    • Lack of personal hygiene,
    • Use of cosmetic and harsh soap,
    • Nutritional deficiency,
    • Moderate to severe mental stress,
    • Infection and injury,
    • Changes associated with aging.

Diagnosis Procedure 

  1. Skin biopsy   
  • Obtain a small part of skin by incision, excision, patch, or share method.  

Nursing responsibility    

  • Written consent,
  • stop anticoagulant,
  • Clean the sight,
  • sight should be observed for bleeding,
  • Dressing should be kept for 8 hr after cleaning the sight and apply antibiotics.
  1. Skin Culture   
  • A small skin culture sample is obtained with a sterile applicator to an appropriate type of culture tube.
  • Viral culture is placed immediately over ice.
  • Sample should be taken before starting antibiotics.


  1. Wood’s light examination   
  • Skin is viewed under ultra violet light through a special wood glass to identify superficial infection of the skin.  

Nursing Responsibility 

  • Darken the room prior to examination.
  • Assist the client while adjustment from darken room to the light.


  1. Skin testing    
  • Administration of an allergen to the skin surface or into dermis by patch, scratch, or intra-dermal technique.

Nursing responsibility

  • Stop systemic corticosteroids, antihistamines, 2days before the test.
  • Obtain written consent.
  • Emergency equipment should be ready (resuscitation )  

Post procedure Responsibility   

  • Avoid vigorous activity that may produce sweating if a patch test was performed.
  • If a patch is loosen of fails it should not be replace.
  • Record the date, time, and sight of the test.
  • Record the date and time of follow up sight reading.
  • Monitor edema, size, indurations, color changes erythema, papuls, and vesicle.


Type :

  • Primary lesion
    • Macula

Flat, circumscribed, discoloration, of the skin in any size and shape.

  • Papules

Solid elevated lesion less than 1 cm.

  • Nodules

Solid elevated lesion larger than 1 cm wide.

  • Vesicle  

Fluid filled sac less then 1 cm.

  • Bulla

A vesicle or blister greater than 1 cm.

  • Pustule

Raised lesion which contain puss.

  • Plaque

Solid elevated lesion that present on the skin and mucous membrane larger than 1 cm.

  • Cyst

Soft or firm mass in the skin filled with semisolid or with liquid materials in the sac.

  • Secondary lesion
    • Scale

Heaped up, horny layer of dead epidermis as a result of inflammatory changes.

  • Crust

Covering formed by the dry serum, blood or puss.   

  • Excoriation

Linea scratch mark or traumatized area of skin.   

  • Fissure

Crack in the skin due to inflammation.   

  • Ulcer  

Lesion formed by local destruction of epidermis and part of dermis.

  • Scar

New formation of connective tissue that replace the loss of subcutaneous tissue in the dermis as a result of injury.

  • Atrophy

Wasting of the skin cells that cause thinning of the skin.

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