8ChapterSkin Disordersand DiseasesChapter OutlineWhy Study Skin Disordersand Diseases?Disorders and Diseasesof the SkinDisorders of the Sebaceous(Oil) GlandsDisorders of the Sudoriferous(Sweat) GlandsInflammations and CommonInfections of the SkinPigment Disorders of the SkinHypertrophies of the SkinAcne and Problem SkinAging Skin IssuesThe Sun and Its EffectsContact DermatitisCopyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Grafica, 2010; used under license from Shutterstock.com.Skin Cancer
Learning ObjectivesAfter completing this chapter, you will be able to:LO1 Recognize common skin lesions.LO2 Describe the disorders of the sebaceous glands.LO3 Name and describe changes in skin pigmentation.LO4 Identify the forms of skin cancer.LO5 Understand the two major causes of acne and how to treat them.LO6 List the factors that contribute to the aging of the skin.LO7 Explain the effects of overexposure to the sun on the skin.LO8 Understand what contact dermatitis is and know how it can be prevented.Key TermsPage number indicates where in the chapter the term is used.albinismpg. 183allergic contactdermatitis (ACD)pg. 190anaerobicpg. 186anhidrosispg. 181basal cell carcinomapg. 184bromhidrosispg. 181bullapg. 178chloasma (liverspots)pg. 183closed comedo(whitehead)pg. 180conjunctivitis(pinkeye)pg. 182contact dermatitispg. 190crustpg. 179cystpg. 178dermatitispg. 182dyschromiaspg. 183eczemapg. 182excoriationpg. 180hypopigmentationpg. 183extrinsic factorspg. 187impetigopg. 182fissurepg. 180intrinsic factorspg. 187free radicalspg. 188irritant contactdermatitis (ICD)pg. 191herpes simplexpg. 182hyperhidrosispg. 181hyperpigmentationpg. 183hypertrophypg. 184keloidpg. 180keratomapg. 184lentiginespg. 183Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.8
Key TermsPage number indicates where in the chapter the term is used.lesionpg. 178nodulepg. 178leukodermapg. 183noncomedogenicpg. 187maculepg. 178primary lesionspg. 178malignantmelanomapg. 184psoriasispg. 182retentionhyperkeratosispg. 186miliapg. 180miliaria rubra(prickly heat)pg. 181molepg. 184nevus (birthmark)pg. 1838176rosaceapg. 181scalepg. 180scar (cicatrix)pg. 180sebaceous cystpg. 181seborrheicdermatitispg. 181secondary skinlesionspg. 179sensitizationpg. 190skin tagpg. 184squamous cellcarcinomapg. 184stainpg. 183tuberclepg. 179tumorpg. 179ulcerpg. 180verruca (wart)pg. 184vesiclepg. 179vitiligopg. 183whealpg. 179tanpg. 183telangiectasispg. 181Chapter 8 Skin Disorders and DiseasesPart 2: General SciencesCopyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Are you interested in skin care? Have you always thought thatit would be interesting to understand the way that the skinfunctions and how it can be improved and beautified? If so,then skin care is a possible area of specialty for you!Skin care specialists are in high demand in many salons and spas andearn excellent salaries. Some stylists find caring for the skin less arduousand physically demanding than styling hair and choose to balance theirday by scheduling services in both areas. Whatever your reason, skincare is an area of rapid change and growth and a topic on most clients’minds. Knowing the basics of skin care and how the skin functions willallow you to advise clients on their skin care regimens when they seekyour professional opinion.WHY STUDY SKINDISORDERS AND DISEASES?Cosmetologists should study and have a thorough understandingof skin disorders and diseases for the following reasons: In order to provide even the most basic of skin care services, youmust understand the underlying structure of the skin and commonskin problems. You must be able to recognize adverse conditions, including inflamedskin conditions, skin diseases, and infectious skin disorders, andyou must know which of these conditions are treatable by thecosmetologist and which need to be referred to a medical doctor. Knowing about and being able to offer skin care treatments addsanother dimension of service for your clients. Kurhan, 2010; used under license from Shutterstock.com.Disorders and Diseasesof the SkinLike any other organ of the body, the skin is susceptible to avariety of diseases, disorders, and ailments. In your work as apractitioner, you will often see skin and scalp disorders, soyou must be prepared to recognize certain common skinconditions and know which you can help to treat andwhich must be referred to a physician. Occasionally,you may be asked to apply or use on a client a scalptreatment prescribed by a physician. These must beapplied in accordance with a physician’s directions.A dermatologist is a physician who specializes indiseases and disorders of the skin, hair, and nails.Dermatologists attend four years of college, fouryears of medical school, and then about fourPart 2: General SciencesChapter 8 Skin Disorders and Diseases177Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.8
nodosum,nlyBulla (plural:bullae):Macule(plural:maculae):It is very important that a salon not serve a client who is(plural:suffering from anMaculeinflamedskinmaculae):disorder, infectious or not,Localized changes in skinwithout a physician’s notepermittingthe client to receivecolor ofless than 1 cmin diameterservices. The cosmetologistshouldbe able to recognize es in skinFreckleconditions and sensitivelysuggestthatproper measures becolorof lessmaculae):than 1 cmMacule(plural:indiametertaken to prevent moreseriousconsequences.Localizedin skinMacule(plural:changesmaculae):Sameas a changesvesicle onlyLocalizedin skinWheal:color ofthanless0.5thangreatercm1 cmLocalizededema in thein miscausing irregularExample:dermatitis,largeSameas athatvesicleonlyelevationmaybe ural:pale ple:Sameas abullae):vesicle onlyBullaContact(plural:dermatitis,largeInsect biteor0.5a rns,Example:greaterthan0.5cmPapule:bulbous dermatitis,impetigo, pemphigusContactlargeExample:Solid,elevated titis,largethan0.5 cmin ules into the dermis orTubercle:subcutaneous tissues, 0.5-2 cmSolid and elevated; however,Example:itextendsdeeper thanLipoma,erythema,nodosum,Tubercle:papulesthe dermisorcyst tissues,0.5-2 cmitextendsdeeperthanSolid and elevated; however,Example:papulesintothe rmisor cmcystPustule:Accumulation offluid orlayersbullaeofthatthe upperthe ithpus,elevatedmass l:maculae):usuallydescribedaslessserousfluid;less than0.5 tExample:Herpes simplex, herpesinAcne,diameterbecomefilled oxExample:usuallydescribedas tule:Frecklethan0.5 atExample:usuallydescribedaslessbecomefilled withpus,Acne,impetigo,furuncles,than0.5describedcm in diameterWheal:usuallyascarbuncles, folliculitislessExample:Localizededemain thethan0.5 cmin sThesameasa noduleSolid,elevatedlesionlesselevationthatmaybe onlyredAcne,impetigo,furuncles,greaterthan2 cmthancmin ample:Example:Tumor:Carcinomaas advancedWarts,elevatedInsectbite (suchornevia hiveThesameas a nodulebreastcarcinoma);not onlybasal cellgreaterthan 2cellcmof the skinor squamousTumor:Example:The same as a nodule onlyTumor:Carcinoma(suchgreaterthan2 nodulecmas advancedThesameas abreastcarcinoma);not onlybasal cellExample:greaterthan2cmof the breastcarcinoma);basal cellCarcinoma(such asnotadvancedVesicle:orsquamouscell ofnotthebasalskin cellbreastcarcinoma);Accumulation of fluid betweenor squamous cell of the skinthe upper layers of the Localizedchangesin skinserousfluid;less than0.5 cmcolor of less than 1 cmExample:indiameterHerpessimplex, herpesExample:zoster, ot basal cellthe skinhowever,hanrmis ores, 0.5-2 cmnodosum,hatpus,as lessmeteryuncles,itisrges,mphigusule onlyowever,nadvancednotorbasal ,mphigusWheal:Localized edema in tedlesionlesselevationmay be redthan0.5 cmthatin diameteror paleExample:Example:Warts, elevated neviInsect bite or a hiveowever,ndvancedmisor cellt basal, 0.5-2heskin cmdosum,ncles,syears of specialty training in dermatology. Many haveadditional training in internal medicine, because someskin symptoms may be reflective of internal disease.Cosmetologists refer clients with medical issues todermatologists more than any other type of physician.Accumulation of fluid betweenthe upper layers of the skin;elevated mass containingserous fluid; less than 0.5 cmExample:Herpes simplex, herpeszoster, chickenpoxuncles,tistus,essterVesicle:Figure 8–1Primary skin lesions. These illustrations showthe size, elevation or depression, and layers ofthe skin that are affected in each type of lesion.Vesicle:8Example:color of lessthan 1incmLocalizedchangesskinFreckleindiameterNumerous importanttermscolorof relatingless than 1tocmskin, scalp, and ess are described indisorders that youExample:shouldbefamiliarwithFrecklethan 0.5 cm in diameterFrecklesubsequent sections.Example:Papule:Warts, elevated neviSolid, elevated lesion lessthanSkin0.5 cm in diameterPapule:Lesions ofExample:theSolid, elevated lesion lessPapule:Warts,elevatedneviA lesion (LEE-zhun)is a markthe skin that may indicatethancm inondiameterSolid,0.5elevatedlesion lessExample:thancm in diameteran injury or damage Warts,that0.5changesthe structure of tissues orelevated neviorgans. A lesion Example:can beassimpleasWarts, elevated nevia freckle or as dangerousVesicle:as a skin cancer. Lesionscan indicatedisorders orAccumulationof fluidskinbetweenthemayupperindicatelayers of theskin; internal diseases.diseases and sometimesotherelevated mass containingVesicle:Being familiar withtheprincipalskinserousfluid; lessthanlesions0.5 cm will help youAccumulationof fluid betweenExample:be able to n;that may and mayHerpes simplex, poxAccumulationoffluidbetweennot be treated in Vesicle:a salonor spa (Figure 8–1).serous fluid; less than 0.5 cmthe upper layersof theskin;Accumulationof sscontainingthan0.5 s fluid; less than 0.5 cmHerpessimplex,herpesThe terms for differentlesionslistedbelow often ferences in the areaelevationof the skinlayersaffected and thethat maybe redzoster, chickenpoxor palesize of the lesion.Wheal:Localized edema in theExample:epidermisirregularInsectbitecausingor a hiveWheal:Primary lesions are lesionsthatathedifferentcolor thanelevationthat usingirregularthe color of the skinand/orlesionsLocalizededemainthatthe are raised aboveExample:elevationthatmayirregularbe redepidermiscausingbiteorahivethe surface of the skin.InsectRequiresmedicalreferral.or pale that may be redelevationExample:or paleInsect biteor a hiveBulla (BULL-uh),(plural:bullae,BULL-ay), is a largeExample:Insect bite or a hivePrimary Lesions of the Skinblister containing a watery fluid; similar to a vesicle butlarger (Figure 8–2). Requires medical referral.Cyst (SIST) is a closed, abnormally developed sac thatcontains fluid, pus, semifluid, or morbid matter, aboveor below the skin. Cysts are frequently seen in severeacne cases. Requires medical referral.Macule (MAK-yool), (plural: maculae, MAK-yuh-ly),is any flat spot or discoloration on the skin, such as afreckle or a red spot, left after a pimple has healed.Nodule (NOD-yool) is a solid bump larger than.4 inches (1 centimeter) that can be easily felt.Requires medical referral.Accumulation of fluid betweenthe upper layers of the skin;elevated mass containingserous fluid; less than 0.5 cmChapter 8 Skin Disorders and DiseasesExample:Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Herpessimplex, herpesEditorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.zoster, chickenpox178Part 2: General Sciences Milady, a part of Cengage Learning.hatpus,s lessmeter
Pustule is a raised, inflamed, papulewith a white or yellow centercontaining pus in the top of thelesion referred to as the head of thepimple (Figure 8–3).Reprinted with permission from the American Academy ofDermatology. All rights reserved.Reprinted with permission from the AmericanAcademy of Dermatology. All rights reserved.Papule is a small elevation on theskin that contains no fluid but maydevelop pus. Papules are frequentlyseen in acne.Figure 8–2Bullae.Tubercle (TOO-bur-kul) is anabnormal, rounded, solid lump above, within, or under the skin; largerthan a papule. Requires medical referral.Figure 8–3Papules and pustules.Tumor (TOO-mur) is an abnormal mass varying in size, shape, andcolor. Tumors are sometimes associated with cancer, but the term tumorcan mean any sort of abnormal mass. Requires medical referral.Timothy Berger, MD, Associate Clinical Professor, University ofCalifornia, San Francisco.Vesicle (VES-ih-kel) is a small blister or sac containing clear fluid, lyingwithin or just beneath the epidermis. Poison ivy and poison oak, forexample, produce vesicles (Figure 8–4). Requires medical referral.Wheal (WHEEL) is an itchy, swollen lesion that lasts only a few hours;caused by a blow or scratch, the bite of an insect, urticaria (skin allergy),or the sting of a nettle. Examples include hives and mosquito bites.Secondary LesionsSecondary skin lesions are characterized by piles of material on theskin surface, such as a crust or scab, or by depressions in the skinsurface, such as an ulcer (Figure 8–5).Crust is dead cells that form over a wound or blemish while it is healing;an accumulation of sebum and pus, sometimes mixed with epidermalmaterial. An example is the scab on a sore. Milady, a part of Cengage Learning.ScarCrustFigure 8–4Poison oak vesicles.UlcerFigure 8–5Secondary skin lesions.ScalePart 2: General SciencesFissureÉxcoriationChapter 8 Skin Disorders and Diseases179Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.8
Excoriation (ek-skor-ee-AY-shun) is a skin sore or abrasion producedby scratching or scraping.Fissure (FISH-ur) is a crack in the skin that penetrates the dermis.Examples are severely cracked and/or chapped hands or lips.Keloid (KEE-loyd) is a thick scar resulting from excessive growthof fibrous tissue (Figure 8–6).Scale is any thin dry or oily plate of epidermal flakes. An exampleis abnormal or excessive dandruff.Scar, also known as cicatrix (SIK-uh-triks), is a lightly raised markon the skin formed after an injury or lesion of the skin has healed.Figure 8–6Keloids.Ulcer (UL-sur) is an open lesion on the skin or mucous membraneof the body, accompanied by loss of skin depth and possibly weepingof fluids or pus. Requires medical referral.LO1Disorders of the Sebaceous(Oil) GlandsAn open comedo, also known as a blackhead, is a hair follicle filledwith keratin and sebum. Comedones appear most frequently on theface, especially in the T-zone, the center of the face (Figure 8–7). Whenthe sebum of the comedo is exposed to the environment, it oxidizesand turns black. When the follicle is closed and not exposed to theenvironment, the sebum remains a white or cream color and is a closedcomedo, also known as whitehead, and appears as a small bump justunder the skin surface.Comedones can be removed by trained beauty professionals as longas proper procedures are employed and the procedure is performed ina sanitary environment using extraction implements that have beenproperly cleaned and disinfected.Figure 8–7Comedones.Milia (MIL-ee-uh) are benign, keratin-filled cysts that appear justunder the epidermis and have no visible opening. They resemble smallsesame seeds and are almost always perfectly round. They are commonlyassociated with newborn babies but can appear on the skin of people ofall ages. They are usually found around the eyes, cheeks, and forehead,and they appear as small, whitish masses (Figure 8–8). Depending onthe state, milia can be treated in the salon or spa.Figure 8–8Milia.8Acne, also known as acne vulgaris, is a skin disorder characterized bychronic inflammation of the sebaceous glands from retained secretionsand bacteria known as propionibacterium acnes (P. acnes), the scientificterm for acne bacteria. Acne will be discussed in further detail later inthis chapter (Figure 8–9).180Chapter 8 Skin Disorders and DiseasesPart 2: General SciencesCopyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.Reprinted with permission from the American Academy of Dermatology. All rights reserved.There are several common disorders of the sebaceous (oil) glands thatthe cosmetologist should be able to understand and identify.
Courtesy of www.dermnet.com.Rosacea (roh-ZAY-shuh), formerly called acne rosacea, is a chroniccondition that appears primarily on the cheeks and nose. It ischaracterized by flushing (redness), telangiectasis (tee-lang-jek-tayshuhz) (distended or dilated surface blood vessels), and, in some cases,the formation of papules and pustules. The cause of rosacea is unknown,but the condition is thought to be genetic. Certain factors are knownto aggravate the condition in some individuals. These include exposureto heat, sun, and very cold weather; ingestion of spicy foods, caffeine,and alcohol; and stress. Rosacea can be treated and kept under controlby using medication prescribed by a dermatologist, using proper skincare products designed for especially sensitive skin, and avoiding theaggravating flare factors listed above (Figure 8–11).LO2Figure 8–9Acne.Figure 8–10Seborrheic dermatitis.Reprinted with permission from the American Academy ofDermatology. All rights reserved.Seborrheic dermatitis (seb-oh-REE-ick derm-ah-TIE-tus) is a skincondition caused by an inflammation of the sebaceous glands. It is oftencharacterized by redness, dry or oily scaling, crusting, and/or itchiness(Figure 8–10). The red, flaky skin often appears in the eyebrows andbeard, in the scalp and hairline, at the middle of the forehead, and alongthe sides of the nose. Mild flares of seborrheic dermatitis are sometimestreated with cortisone creams. Seborrheic dermatitis is a medicalcondition, but it can be helped in the salon with the application ofnon-fatty skin care products designed for sensitive skin. Severe casesshould be referred to a dermatologist, who will often prescribe topicalantifungal medications.Larry Hamill.Sebaceous cyst is a large protruding pocket-like lesion filled withsebum. Sebaceous cysts are frequently seen on the scalp and the back.They should be removed surgically by a dermatologist.Disorders of theSudoriferous (Sweat) GlandsAnhidrosis (an-hih-DROH-sis) is a deficiency in perspiration, oftena result of fever or certain skin diseases. Requires medical referral.Bromhidrosis (broh-mih-DROH-sis) is foul-smelling perspiration,usually noticeable in the armpits or on the feet, that is caused bybacteria. Severe cases require medical referral.Figure 8–11Rosacea.Hyperhidrosis (hy-per-hy-DROH-sis) is excessive sweating, causedby heat or general body weakness. Requires medical referral.Miliaria rubra (mil-ee-AIR-ee-ah ROOB-rah), also known asprickly heat, is an acute inflammatory disorder of the sweat glands,characterized by the eruption of small red vesicles and accompaniedby burning, itching skin. It is caused by exposure to excessive heat andusually clears in a short time without treatment.Part 2: General SciencesChapter 8 Skin Disorders and Diseases181Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.8
Inflammations and CommonInfections of the SkinConjunctivitis (kuhn-juhngk-tuh-VAHY-tis), also known as pinkeye,is a common bacterial infection of the eyes. It is extremely contagious,and clients who have conjunctivitis or obviously irritated eyes shouldbe politely rescheduled and referred to a physician immediately. Anyproduct or implements touching infected eyes must be thrown away.Courtesy of www.dermnet.com.Dermatitis (dur-muh-TY-tis) is a term broadly used to describe anyinflammatory condition of the skin.Eczema (EG-zuh-muh) is an inflammatory, uncomfortable, andoften chronic disease of the skin, characterized by moderate to severeinflammation, scaling, and sometimes severe itching. There are severaldifferent types of eczema. The most common type is atopic eczema,which is an inherited genetic disorder. All cases of eczema should bereferred to a physician for treatment, which is often topical cortisone.Eczema is not contagious (Figure 8–12).Figure 8–12Eczema.Reprinted with permission from the AmericanAcademy of Dermatology. All rights reserved.Herpes simplex (HER-peez SIM-pleks) is a recurring viral infectionthat often presents as a fever blister or cold sore. It is characterized bythe eruption of a single vesicle or group of vesicles on a red swollenbase. The blisters usually appear on the lips, nostrils, or other part ofthe face, and the sores can last up to three weeks. Herpes simplex iscontagious (Figure 8–13) and requires medical referral. Drugs are nowavailable to control the symptoms, but the virus always remains in thebody of infected persons.Impetigo (im-pet-EYE-go) is a contagious bacterial skin infectioncharacterized by weeping lesions. Impetigo normally occurs on theface (especially the chin area) and is most frequently seen in children.Clients with any type of weeping open facial lesions should be politelyrescheduled and referred to a physician immediately.Figure 8–13Herpes simplex.Reprinted with permission from the AmericanAcademy of Dermatology. All rights reserved.Psoriasis (suh-RY-uh-sis) is a skin disease characterized by redpatches covered with silver-white scales and is usually found on thescalp, elbows, knees, chest, and lower back. Psoriasis is caused by theskin cells turning over faster than normal. It rarely occurs on the face.When the condition is irritated, bleeding points can occur. Psoriasisis not contagious (Figure 8–14), but it requires medical referral. It istreatable, but it is not curable.Pigment Disorders of the SkinFigure 8–14Psoriasis.8Pigment can be affected by internal factors such as heredity orhormonal fluctuations, or by outside factors such as prolonged exposure182Chapter 8 Skin Disorders and DiseasesPart 2: General SciencesCopyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
to the sun. Abnormal colorations, known as dyschromias (dis-chromeee-uhs), accompany skin disorders and many systemic disorders. Achange in pigmentation can also be observed when certain drugs arebeing taken internally. The following terms relate to changes in thepigmentation of the skin:Hyperpigmentation (hy-pur-pig-men-TAY-shun) means darker thannormal pigmentation, appearing as dark splotches. Hypopigmentation(hy-poh-pig-men-TAY-shun) is the absence of pigment, resulting inlight or white splotches.Reprinted with permission from the American Academy of Dermatology. All rights reserved.Albinism (AL-bi-niz-em) is congenital hypopigmentation, or absenceof melanin pigment in the body, including the skin, hair, and eyes. Hairis silky white. The skin is pinkish white and will not tan. The eyes arepink, and the skin is sensitive to light and ages early.Chloasma (kloh-AZ-mah), also known as liver spots, is a conditioncharacterized by hyperpigmentation on the skin in spots that are notelevated. This is just a commonly-used term; the spots have nothing todo with the liver. They are generally caused by cumulative sun exposure.They can be helped by exfoliation treatments or can be treated by adermatologist.Lentigines (len-TIJ-e-neez) (singular: lentigo, len-TY-goh) is thetechnical term for freckles, small yellow-colored to brown-colored spotson skin exposed to sunlight and air.Leukoderma (loo-koh-DUR-muh) is a skin disorder characterized bylight abnormal patches (hypopigmentation); it is caused by a burn orcongenital disease that destroys the pigment-producing cells. Examplesare vitiligo and albinism.Figure 8–15Port wine stain.Nevus (NEE-vus), also known as birthmark, is a small or largemalformation of the skin due to abnormal pigmentation or dilatedcapillaries.Courtesy of www.dermnet.com.Stain is an abnormal brown-colored or wine-colored skin discolorationwith a circular or irregular shape (Figure 8–15). Its permanent color isdue to the presence of darker pigment. Stains can be present at birth,or they can appear during aging, after certain diseases, or after thedisappearance of moles, freckles, and liver spots. The cause is oftenunknown.Tan is the change in pigmentation of skin caused by exposure to thesun or ultraviolet light.Vitiligo (vi-til-EYE-goh) is a hereditary condition that causeshypopigmented spots and splotches on the skin that may be related tothyroid conditions (Figure 8–16). Skin with vitiligo must be protectedfrom overexposure to the sun.LO3Part 2: General SciencesFigure 8–16Vitiligo.Chapter 8 Skin Disorders and Diseases183Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove
of skin disorders and diseases for the following reasons: In order to provide even the most basic of skin care services, you must understand the underlying structure of the skin and common skin problems. You must be able to recognize adverse conditions, including inflamed skin conditions, skin diseases, and infectious skin disorders, and
Part One: Heir of Ash Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26 Chapter 27 Chapter 28 Chapter 29 Chapter 30 .
TO KILL A MOCKINGBIRD. Contents Dedication Epigraph Part One Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Part Two Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18. Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26
DEDICATION PART ONE Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 PART TWO Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 .
About the husband’s secret. Dedication Epigraph Pandora Monday Chapter One Chapter Two Chapter Three Chapter Four Chapter Five Tuesday Chapter Six Chapter Seven. Chapter Eight Chapter Nine Chapter Ten Chapter Eleven Chapter Twelve Chapter Thirteen Chapter Fourteen Chapter Fifteen Chapter Sixteen Chapter Seventeen Chapter Eighteen
18.4 35 18.5 35 I Solutions to Applying the Concepts Questions II Answers to End-of-chapter Conceptual Questions Chapter 1 37 Chapter 2 38 Chapter 3 39 Chapter 4 40 Chapter 5 43 Chapter 6 45 Chapter 7 46 Chapter 8 47 Chapter 9 50 Chapter 10 52 Chapter 11 55 Chapter 12 56 Chapter 13 57 Chapter 14 61 Chapter 15 62 Chapter 16 63 Chapter 17 65 .
HUNTER. Special thanks to Kate Cary. Contents Cover Title Page Prologue Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter
Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 . Within was a room as familiar to her as her home back in Oparium. A large desk was situated i
Example risk assessment for food preparation, cooking and service This example risk assessment applies to restaurants, cafés, sandwich bars, pubs, takeaways or hotel kitchens.