The integumentary system


The integumentary system is an essential system for massage therapists to study and understand. The skin is divided into two main regions, the epidermis and the dermis; each plays a distinct role in the overall function of the skin. The epidermis is the most superficial layer of the skin and provides the first set of barriers of protection from foreign substances. The epidermis is the layer of skin that can be seen and touched. Does the epidermis contain blood vessels? The epidermis does not have blood vessels. The dermis performs the important functions of providing thermoregulation and supporting the network of blood vessels that supply the epidermis with nutrients. —What function is performed by elastin fibers? The elastin fibers located in the dermis give support and elasticity to the skin. The dermis is attached to an underlying layer of tissue known as the hypodermis. What function does the hypodermis serve? The hypodermis, also known as the subcutaneous layer, stores adipose tissue. What is stored in adipose tissue? Adipose tissue stores fat in the form of triglycerides. Skin is waterproof; it regulates body temperature, retains body fluids, protects against disease, and helps eliminate waste products. What is keratin? Keratin is a tough, insoluble protein that makes the skin tough and almost completely waterproof. All skin is keratinized, and hair and nails differ in the extent of the thickness of the keratin. If pressure is put on some parts of the skin, more keratin is produced, forming thick calluses that protect the layers of skin beneath. —Where the skin enters open body cavities, such as the mouth and the nose, the mucous membranes lack the skin’s keratinization. —Melanin is the pigment that darkens the skin. It absorbs harmful ultraviolet light. The skin develops a €œtan€in response to sun exposure by producing extra melanin. The biological and chemical structure of the skin helps to protect the body from foreign agents. —Sebum is the oily secretion of the sebaceous glands that moistens and protects the skin. Although waterproof, the skin can absorb some substances both beneficial and harmful. Transdermal patches use this ability to deliver medications to the body. The skin provides tactile (touch) sensory information. Nerve endings respond to mechanical and thermal stimulation. How does the skin help to cool off the body? As the blood moves toward the body’s surface and the blood vessels dilate, internal heat is released. Heat can also be dissipated through the evaporation of perspiration produced by the sudoriferous glands. —The sudoriferous glands secrete sweat, the sebaceous glands secrete oils, and the ceruminous glands secrete ear wax. Mammary glands, often considered modified sudoriferous glands, secrete milk. A hair root is produced at the base of the hair follicle, a pocket that extends into the dermis. The hair shaft itself is made of keratin and needs no nourishment because it is no longer alive. Oil from glands in the skin helps prevent the hair shaft from drying out and breaking off. —In fact, the oil gland is part of the hair follicle, and together they are often referred to as the pilosebaceous unit. Nails are densely packed sheets of keratin that grow out from the skin. Nails grow from special epithelial cells at the base of the nail in the region called the nail root. These cells become keratinized as they grow out over the nail bed. Never remove a client’s transdermal patch or ask the client to remove it. Doing so could put the client at risk for medically related issues. —Massaging the area near the transdermal patch could alter the absorption rate of the medication, which could have serious medical side effects. Massage therapists are not legally allowed to diagnose diseases, but they must be able to recognize various symptoms and determine when a client needs to be referred to a health care provider. It is important to be able to recognize diseases that clients might have so that a safe and appropriate massage treatment plan can be developed. —The massage therapist should inspect the skin for color, condition, and temperature. What are some of the skin conditions the massage therapist might encounter? Anything from skin cancer to acne. The answers will vary from infections, masses, bruises, fresh burn. What might skin dryness imply? Skin dryness might be an indication of a possible nervous condition. —What are the symptoms of edema? Stretched, shiny, swollen, and doughy skin are all symptoms of edema. If prolonged pressure to the skin leaves a dent, that is another symptom of edema. If edema is suspected, ascertain the cause of the edema from the client. —The best place to check for skin elevation, or tenting, is the back of the palm. Can swollen lymph nodes be palpated? Swollen lymph nodes suggest infection or even cancer. The therapist should bring this to the attention of the client and discuss the condition with the client to decide whether massage should be performed. Heat suggests infection. General fever suggests a general infection, and local heat suggests a local inflammation. Do not massage inflamed areas. Skin lesions are defined as any deviation from the norm. They can include moles, cysts, warts, and skin tags. Most skin lesions are benign. —Depending on the type and condition of the skin lesion, massage might be contraindicated. A tumor is an elevated and solid lesion located in the dermis. Tumors can be either benign or malignant. Local massage of a solid tumor site should be avoided. A vesicle is a small, circumscribed, fluid-filled sac on the skin surface. It could indicate chickenpox or herpes. Should vesicles be massaged? Massage is contraindicated because of the high possibility of contagion. A bulla, or blister, is similar to a vesicle, but a blister is over 1 cm in diameter. Local massage is contraindicated as the blister could rupture and form an open wound. A pustule is an abscess filled with pus caused by infection. Local massage is contraindicated because of the possibility of rupturing the abscess and spreading the infection. A cyst is a benign swelling in the dermis that forms an elevated lesion on the surface of the skin. Cysts are not generally considered harmful but can cause discomfort. They can also become infected. Should cysts be massaged? Local massage is contraindicated because of the possibility of worsening the inflammation. Telangiectasias are abnormally dilated blood vessels associated with a number of diseases. The abnormally enlarged blood vessels are located near the surface of the skin. —Ask the client if the area is sensitive and, if so, avoid the area during massage. If the area is not sensitive, then use light pressure onlyMoles are usually harmless collections of pigmented cells. So, why is it important to monitor mole changes? In rare cases, moles can become cancerous. Monitoring moles and other pigmented patches is an important step in reducing skin cancer risks, especially malignant melanoma, which might begin in or near a mole or other dark spot on the skin. Redness, edema, and other skin lesions could be signs of serious diseases. Chickenpox is highly contagious, so massage is contraindicated. It appears as a rash of vesicles that become pustules and then crust over. When is the person infected with chickenpox contagious? A person is infectious from about 48 hours before the rash appears until all vesicles are crusted. Does onychomycosis more commonly affect fingernails or toenails? It more commonly affects toenails than fingernails. A petechia is a red or purple spot caused by broken capillaries. Why is local massage contraindicated? Local massage is contraindicated because this condition results from bleeding under the skin, and massage could exacerbate the condition. Psoriasis is dry itchy skin that is painful and should be massaged with caution. If the area is sensitive, do not massage that area. Is this condition contagious? Psoriasis has no known cause, but it is not contagious. Ringworm is not caused by a worm; it is a contagious fungal infection of the skin. It is highly contagious, and massage is contraindicated until the client has fully recovered. How can ringworm be identified? It is identified by raised, red-tinged patches that are itchy and painful. What are the specific massage considerations for scars? Massage therapists need to obtain clearance from the client’s health care provider before massaging recently healed scars. Massage should be performed only when the skin is fully healed and can withstand pressure. Seborrheic keratosis has a pasted-on appearance and can be pink or dark brown in color. It can resemble warts or malignant melanoma. Why is local massage contraindicated? Massage is contraindicated because of the pain and possible damage to tissue. The cause of seborrheic keratosis is unknown. How many spinal nerves are there for each body region (cervical, thoracic, lumbar, and sacral)? There are eight cervical (one for the head, and one for each cervical vertebra), twelve thoracic, five lumbar, and five sacral spinal nerves. Albinism is a congenital condition that is typified by a lack of melanin in the skin, eyes, and hair. Is massage therapy contraindicated? Massage is not contraindicated, but albinos are more prone to sunburn and skin cancer. When might men exhibit chloasma? A similar pattern of pigmentation is associated with chronic liver disease, so men who have liver disease might exhibit chloasma.

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