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Unit 3 D&D > DD 03-03-14 08-09am Clinical Dermatology-Terminology and Functions - Dunnick > Flashcards

DD 03-03-14 08-09am Clinical Dermatology-Terminology and Functions - Dunnick Flashcards

1
Q

Skin - key factos

A

Skin is the largest organ
– Weight 4 kg
– Covers 2 square meters of surface area
Skin diseases are common!
– 8.5% diagnoses in Family Practice Clinics
– 30% Pediatric Conditions
Significant economic burden in treating skin disease & skin disease causing loss of days worked.

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2
Q

Function of the skin

A
  1. Decoration/Beauty
  2. Barrier– Physical, LIght, Immunologic
  3. Vitamin D synthesis
  4. Water Homeostasis
  5. Thermoregulation
  6. Insulation/Calorie Reservoir
  7. Touch/Sensation
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3
Q

Structure/Cells Involved in Skin’s Function as a Physical Barrier

A

Epidermis, Keratinocytes

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4
Q

Structure/Cells Involved in Skin’s Function as a Light Barrier

A

Epidermis: Melanocyte

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5
Q

Structure/Cells Involved in Skin’s Function as a Immunologic Barrier

A

Epidermis: Langerhans cells

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6
Q

Structure/Cells Involved in Skin’s Function in Vitamin D synthesis

A

Epidermis: Keratinocytes

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7
Q

Structure/Cells Involved in Skin’s Function in Water homeostasis

A

Epidermis: Keratinocytes
Adnexa: Eccrine glands

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8
Q

Structure/Cells Involved in Skin’s Function in Grasp

A

Adnexa: Nails

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9
Q

Structure/Cells Involved in Skin’s Function in Lubrication of the Skin

A

Adnexa: Sebaceous glands

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10
Q

Structure/Cells Involved in Skin’s Function in Phermones/ Body Odor

A

Adnexa: Apocrine glands

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11
Q

Structure/Cells Involved in Skin’s Function in Thermoregulation

A

Adnexa: Eccrine glands
Dermis: Blood vessels

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12
Q

Structure/Cells Involved in Skin’s Function in Strength & Elasticity

A

Dermis: Fibroblast (Produces collagen and elastin)

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13
Q

Structure/Cells Involved in Skin’s Function in Sensation

A

Dermis: Nerves

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14
Q

Structure/Cells Involved in Skin’s Function in Insulation

A

Subcutaneous Fat

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15
Q

Structure/Cells Involved in Skin’s Function as a Calorie Reserve

A

Subcutaneous Fat

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16
Q

Fitzpatrick Skin Type I

A 
Hair - Red/Blond
Eyes - Blue/Green 
Skin - White
Freckles - +++
Sunburn - Always
Tan - 0
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17
Q

Fitzpatrick Skin Type II

A 
Hair - Blond/Brown
Eyes - Light to Medium
Skin - Fair
Freckles - ++ 
Sunburn - Easily
Tan - Minimally
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18
Q

Fitzpatrick Skin Type III

A 
Hair - Brown
Eyes - Medium to Dark
Skin - Light Brown
Freckles - +
Sunburn - Initially
Tan - Gradually
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19
Q

Fitzpatrick Skin Type IV

A 
Hair - Medium to Dark
Eyes - Dark
Skin - Moderate Brown
Freckles - 0
Sunburn - Minimally
Tan - Tans Well
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20
Q

Fitzpatrick Skin Type V

A 
Hair - Dark
Eyes - Dark
Skin - Dark Brown
Freckles - 0
Sunburn - Rarely
Tan - Dark Tan
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21
Q

Fitzpatrick Skin Type VI

A 
Hair - Dark
Eyes - Dark
Skin - Black
Freckles - 0
Sunburn - Never
Tan - Always Tan
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22
Q

Components of the skin

A

Epidermis
Dermis
Adnexal structures
Subcutaneous Fat

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23
Q

Epidermis

A

a stratified squamous epithelial layer

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24
Q

Dermis

A

An underlying CT layer, which includes:

  • papillary layer (loose CT) immediately under epidermis
  • deeper reticular layer (dense CT)
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25
Q

Adnexal structures

A
  • Apocrine glands
  • Eccrine glands
  • Hair
  • Nails
  • Sebaceous glands
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26
Q

Subcutaneous Fat

A

Composed of adipocytes

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27
Q

Regional variation of skin

A

Thick skin is hairless & found on the palms / soles

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28
Q

Vitamin D Synthesis

A
  1. 7-dehydrocholesterol converted to cholecalciferol (Vitamin D3) in skin by UVB
  2. Cholicalciferol (Vitamin D3) & Ergocalciferol (Vitamin D2) can both be ingested & absorbed through intestines.
  3. Vit D2 & D3 then converted to calcidiol (25-hydroxy Vitamin D) by liver.
  4. 1,25-dihydroxy-Vitamin D (calcitriol) is active form & is synthesized by kidneys.
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29
Q

Cells of the Epidermis

A

Keratinocytes
Melanocytes
Langerhans cells

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30
Q

Keratinocytes

A
  • Form barrier layer
  • Synthesize keratin (major intracellular fibrous protein of skin)
  • Involved in defined cycle of proliferation, differentiation, & apoptosis
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31
Q

Melanocytes - defition / source / location

A
  • Pigment producing cells arising from neural crest
  • Located primarily in basal layer of epidermis, in hair follicles
  • Reside in basal layer of epidermis in 1:10 ratio (melanocyte:keratinocyte)
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32
Q

Melanocytes - action

A
  • Synthesize melanin (tyrosin-derived pigment)
  • Melanin is packaged in granules (melanosomes)
  • These granules are transferred from melanocytes to keratinocytes via dendritic processes
  • Ea/ melanocyte supplies melanin to ~30 nearby keratinocytes
  • Melanin in basal keratinocytes protects DNA from UV damage
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33
Q

Langerhans cells

A

= Dendritic cells in epidermis derived from bone marrow stem cell

  • Found in small numbers in all epidermal layers
  • Participate in cell-mediated immune reactions by processing & presenting antigens (circulate back and forth between skin & lymph nodes)
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34
Q

Skin color variation

A

NOT due to the number of melanocytes in the skin
DUE TO:
- The type of melanin produced:
- The distribution melanosomes

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35
Q

Types of melanin produce

A

Eumelanin: black to brown pigment
Pheomelanin: yellow to red-brown pigment

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36
Q

Distribution of melanosomes in skin

A

Light Skin:
- melanosomes distributed in clusters above nucleus
Dark Skin:
- melanosomes distributed individually throughout cytoplasm

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37
Q

Life cycle of Keratinocytes

A
  • Epidermis is continually renewed by mitosis of keratinocytes in the basal layer & by shedding of dead keratinocytes from the surface
  • Process typically takes 28 days
  • The layered nature of the epidermis (5 layers) is an expression of this developmental sequence
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38
Q

Layers of the Epidermis

A
  1. Stratum basalis (germinativum) = Basal cell Layer
  2. Stratum spinosum
  3. Stratum granulosum
  4. Stratum lucidum
  5. Stratum corneum
39
Q

Stratum basalis (germinativum) = Basal cell Layer

A
  • deepest layer of epidermis
  • Consists of a single layer of columnar or cuboidal cells (keratinocytes)
  • Basal keratinocytes are the stem cells of the epidermis (source of new keratinocytes & thus a site of intense proliferation)
40
Q

Cell attachments in Basal Cell Layer of Epidermis

A

Hemidesmosomes:
- attach basal cells are firmly to basal lamina of dermal epidermal junction

Desmosomes:
- attach keratinocytes to each other

Tonofilaments:
- protein structures (keratin filaments) that insert into dense plaques of desmosomes on cytoplasmic side of plasma membrane

41
Q

Stratum spinosum ;ayer of Epidermis

A
  • Has a “prickly” or spiny appearance due to desmosome attachments between cells
  • Intercellular adhesion depends upon tonofilament-desmosome interaction in the distribution of stress
  • Synthesis of involucrin & membrane coating granules begins in this layer
42
Q

Stratum granulosum layer of Epidermis

A
  • Cells of this layer contain different types of granules
  • Keratohyalin granules contain Profilaggrin (filaggrin precursor).
  • -> Filaggrin cross-links keratin tonofilaments & is important in barrier function of skin
  • Filaggrin is mutated in dry skin conditions including ichthyosis & atopic dermatitis
43
Q

Stratum lucidum layer of Epidermis

A
  • Under light microscope, a thin, light staining band seen only in thick skin
  • Cells of this layer no longer have nuclei or organelles
44
Q

Stratum corneum layer of Epidermis

A
  • Outermost layers of epidermis
  • Keratinocytes have lost their nuclei & organelles and entire cell is filled with keratin
  • Desmosomes still connect tightly packed adjacent cells
45
Q

Layers of the Dermis

A

Papillary Layer

Reticular Layer

46
Q

Papillary Layer

A
  • site of attachment to epidermis & necessary to its development / differentiation
  • contains capillary network (blood supply for epidermis)
  • pathway for defense cells
  • contains Meissner’s corpuscles which sense touch
47
Q

Reticular Layer

A
  • contains extensive collagen & elastic fibers that provide strength & flexibility
  • houses (along w/hypodermis) epidermal derivatives such as glands & hairs, and plays major role in their development & functioning
  • pathway for major blood vessels arranged specifically to facilitate thermoregulation
  • site of nerve tracts & major sensory receptors
  • Pacinian corpuscles sense vibration, pressure & touch
48
Q

Encapsulated touch receptors

A

In dermis
Include:
- Meissner’s corpuscles
- Pacinian corpuscles

49
Q

Meissner’s corpuscles

A
  • detect delicate touch
  • most commonly found in dermal papillae of thick skin
  • consist of Schwann cells & sensory nerve terminals wrapped by fibroblasts & collagen
50
Q

Pacinian corpuscles

A

= rapidly adapting receptors that detect changes in deep pressure (vibrations)
- found in dermis of both thin & thick skin
= large structures resembling an onion
- concentric layers are composed of flattened CT-like cells interspersed w/ intercellular fluid & collagen
- single sensory nerve fibers terminates w/in this structure

51
Q

Adnexal Structures of the Skin

A 
Apocrine sweat glands
Eccrine sweat glands
Hair
Nails
Sebaceous glands
52
Q

Apocrine sweat glands

A
  • Specialized sweat glands located in axillary, pubic & perianal regions
  • -> produce milky, viscid, carb-rich secretion that is initially odorless
  • -> subsequent bacterial action leads to a characteristic axillary body odor
  • begin to function in puberty
  • have ducts which empty into hair follicles just above sebaceous glands
53
Q

Eccrine sweat glands

A
  • Traditional sweat glands distributed over most of the body
  • Not found in lips, under nails or on glans penis, glans clitoris, or labia minora
  • -> Watery, enzyme-rich secretion
  • initially isotonic
  • becomes hypotonic as Na+ reabsorbed by ducts
  • Important for thermoregulation
54
Q

Hair

A
  • Develop in utero w/ downgrowth of epidermis forming a pilosebaceous unit
  • Hair itself consists of central medulla of soft keratin + cortex & cuticle of hard keratin
  • Hair growth is intermittent (growth period of 2-3 years followed by rest period of several months)
  • Pigment comes from melanocytes at base of hair
  • W/contraction of arrector pili muscle (smooth muscle), hairs stand on end (“goose bumps”)
55
Q

Sebaceous glands

A
  • Oil glands which secrete sebum (complex mixture of lipids)
  • develop along w/ hair follicles & empty their secretion into upper 1/3 of hair follicles
  • development accelerated at puberty
56
Q

Types of Primary Skin Lesions

A 
Macule < Patch
Papule < Nodule < Tumor
Plaque
Scale
Wheal
Vesicle < Bulla
Pustule
Atrophy < Erosion < Ulceration
57
Q

Macule

A
  • Circumscribed change in skin color that is flush w/ surrounding skin
  • Lesion is <1.0 cm in diameter (smaller than patch)

Examples:
Solar lentigo
Traumatic purpura

58
Q

Patch

A
  • Circumscribed change in skin color that is flush w/ surrounding skin
  • Lesion is ≥1.0 cm in diameter (bigger than macule)

Examples:
Café au lait spot
Vitiligo

59
Q

Papule

A

= A solid or cystic elevation
- <1.0 cm in diameter (smaller than nodule & tumor)

Examples:
Acne
Eruptive xanthoma

60
Q

Nodule

A

= A solid or cystic elevation

  • > 1.0 cm but <2.0 cm in diameter (larger than papule, smaller than tumor)
  • Example: Dermato-fibroma
61
Q

Tumor

A
  • A solid or cystic elevation
  • > 2.0 cm in diameter (larger than papule/nodule)
  • Example: Follicular cyst
62
Q

Plaque

A
  • An elevated lesion that is >1.0 cm in diameter

- Example: Psoriasis

63
Q

Scale

A

= Desiccated, thin plates of cornified epidermal cells that form flakes on the skin surface
- Example: Ichthyosis

64
Q

Wheal

A

= Circumscribed, flat-topped, firm elevation of skin with a well-demarcated and palpable margin
- Example: Urticaria

65
Q

Vesicle

A

= Circumscribed, elevated lesion containing clear serous or hemorrhagic fluid
= <1 cm in diameter (smaller than bulla)

Examples:

  • Contact dermatitis
  • Herpes simplex
66
Q

Bulla

A

= Circumscribed, elevated lesion containing clear serous or hemorrhagic fluid
= >2 cm in diameter (larger than vesicle)
- Example: Bullous pemphigoid

67
Q

Pustule

A

= A vesicle containing purulent exudate

- Example: Folliculitis

68
Q

Atrophy

A

= A depression from the surface of the skin with underlying loss of epidermal or dermal substance (less severe loss than erosions & ulcerations)
- Example: Lichen sclerosis et atrophicus

69
Q

Erosion

A

= A depression from the surface of the skin with a loss of all or part of the epidermis (more severe loss than atrophy, less severe than ulcerations)
- Example: Burn

= Can be a secondary lesion
- Example: Ruptured bulla

70
Q

Ulceration

A
  • A depression from the surface of the skin with a loss of the entire epidermis and at least some of the dermis (more severe loss than atrophy & erosion)
  • Example: Ecthyma
71
Q

Secondary Lesions result from…

A
  • external forces such as scratching, picking, infection or healing of primary lesions
72
Q

Types of Secondary Lesions

A

Lichenification
Scar
Fissure
Crust

73
Q

Lichenification

A

= Dry, leathery thickening of the skin with exaggerated skin markings
- EX: Chronic eczema

74
Q

Scar

A

= An elevated or depressed area of fibrosis of the dermis or subcutaneous tissue resulting from an antecedent destructive process
- EX: Healing wound

75
Q

Fissure

A

= A deep linear split in the skin extending through the epidermis
- EX: Traumatized eczema

76
Q

Crust

A

= Dried exudates of serum, blood, sebum, or purulent material on the surface of the skin
- EX: Acute and/or secondarily infected eczema

77
Q

Disease caused by Skin chronically exposed to sunlight (face, neck, hands, arms)

A

Actinic keratosis
Basal cell carcinoma
Squamous cell carcinoma

78
Q

Skin disease in central chest, shoulders, & earlobes

A

Keloids

79
Q

Skin disease in extensor arms and legs, intragluteal cleft, umbilicus

A

Psoriasis

80
Q

Skin disease in antecubital fossa, popliteal fossa

A

Atopic dermatitis

81
Q

Skin disease in anterior surface of lower legs

A

Palpable purpura
Pretibial myxedema
Necrobiosis lipoidica diabeticorum
Erythema nodosum

82
Q

Skin disease in axilla & inguinal areas

A

Hidradenitis suppurativa

83
Q

Skin disease in posterior neck & back

A

Folliculitis

84
Q

Skin disease in web spaces of toes & sides of feet

A

Tinea pedis

85
Q

Skin disease in web spaces of fingers & wrists

A

Scabies

86
Q

Skin disease in palms & soles

A

Secondary syphilis

Erythema multiforme

87
Q

Skin disease with Clustered arrangement

A

Herpes simplex

88
Q

Skin disease with Grouped arrangement

A

Lichen planus

Granuloma annulare

89
Q

Skin disease with Linear arrangement

A

Allergic contact dermatitis

90
Q

Skin disease with Zosteriform arrangement

A

Herpes zoster

91
Q

Skin disease with Annular arrangement w/out scale

A 
Urticaria
Hansen disease (leprosy)
92
Q

Skin diseases with Annular arrangement with scale

A

Dermatophytosis

Pityriasis rosea

93
Q

Skin diseases with Coalescing arrangment

A

Psoriasis
Drug hypersensitivity eruption
Viral exanthema
Urticaria

Unit 3 D&D (18 decks)

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