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Dermatology Flashcards

1
Q

4 major layers of skin

A

Epidermis

Basement membrane (dermal-epidermal junction)

Dermis

Subcutaneous fat

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2
Q

What kind of cells compose the epidermis

A

Keratinocytes

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3
Q

What are the 5 layers of the epidermis?

A

Stratum basale
Stratum spinosum
Stratum granulosum
Stratum lucidum(Only on palms+soles)
Stratum corneum

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4
Q

Describe cellular progression in the epidermis

A

Cellular progression from basal layer → surface in ~30 days
Accelerated in skin diseases (e.g. psoriasis)

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5
Q

What are the 3 ‘other’ cells in the epidermis and what are their functions?

A

Melanocytes
Dendritic
Distribute melanin pigment (in melanosomes) to keratinocytes
Number of melanocytes = among skin types.

Langerhans cells
Dendritic
Antigen‐presenting cells

Merkel cells
Mechanosensory receptors

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6
Q

What are the kinds of junctions between cells in the epidermis and what are they useful for?

A

-Gap junctions
Essential for cell synchronization, cell differentiation, cell growth and metabolic coordination

-Adherens junctions

-Desmosomes
Major adhesion complex in epidermis
Anchor keratin intermediate filaments to cell membrane and bridge adjacent keratinocytes,
Allow cells to withstand trauma.

-Tight junctions
Role in barrier integrity and cell polarity

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7
Q
A

Melanocyte
Merkel cell
Langerhans cell

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8
Q

2 layers of the dermis and what does the ECM provide?

A

Papillary dermis

Reticular dermis

Supporting (extracellular) matrix– provides resilience

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9
Q

What are the cells present in the dermis?

A

Fibroblasts: primary cells within dermis
Also present:
Histiocytes
Mast cells
Neutrophils
Lymphocytes
Dermal dendritic cells

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9
Q

What are the major molecules that make up the dermis and what are their properties

A

Proteins
Collagen (80-85% of dermis) – mainly types I and III
Elastic fibres (2-4%) – fibrillin, elastin

Glycoproteins – fibronectin, fibulin, intregrins
– facilitate cell adhesion and cell motility

Ground substance – between dermal collagen and elastic tissue – glycosaminoglycan / proteoglycan

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10
Q
A

C

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11
Q

Is the epidermis vascular?

A

No, avascular

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12
Q

Describe the innervation of the skin

A

Sensory
Free, hair follicles, expanded tips

Autonomic
Eccrine: Cholinergic and andrenergic
Apocrine: Andrenergic only

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13
Q

Where are they most abundant and what is the function of meissners’ corpuscle?

A

Most concentrated in thick hairless skin, (finger pads and lips)
Light Touch (+slow vibration)

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14
Q

Where are they most abundant and what is the function of ruffinis’ corpuscle?

A

Highest density around fingernails
Sensitive to skin stretch
Monitors slippage of objects

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15
Q

What organisms form the majority of the skin microbiota?

A

Bacteria, viruses, fungi
(Predominantly Actinobacteria (including Propionibacteria and Corynebacteria), Firmicutes (Clostridia and Bacilli [Staphylococcus] , Bacteroidetes & Proteobacteria)

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15
Q

Is the merkel cell encapsulated and what is its function?

A

(unencapsulated)
Light / sustained touch, pressure

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16
Q

Where are they found and what is the function of the pacinian corpuscle?

A

Dermal papillae of hands and feet
Deep pressure and vibration (deep touch)
Vibrational role - detects surface texture

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17
Q
A
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18
Q
A

C

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19
Q

What is the role of the skin microbiota?

A

Role in immune-modulation and epithelial health

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20
Q

6 skin functions

A

Physical barrier
Immunological barrier
Thermoregulation
Sensation
Metabolism
Aesthetic appearance

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21
Q

How do langerhans cells regulate the adaptive immune response?

A

Specialized at “sensing” environment

Extend dendritic processes through intercellular tight junctions to sample outermost layers of skin (stratum corneum)

Interpret microenvironmental context → determine appropriate quality of immune response.

In absence of danger, promote expansion and activation of skin-resident regulatory - cells (Tregs)

When toll-like receptors (TLRs) sense danger (via pathogen associated molecular patterns [PAMP]) → rapid initiation of innate antimicrobial responses

Induction of adaptive response - power and specificity of T-cell / B-cell and antibodies (immunoglobulins)

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21
Q

How do toll-like receptors detect danger?

A

PAMPs(Pathogen associated molecular patterns)

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22
What is the function of antimicrobial peptides?
Keratinocyte‐derived endogenous antibiotics (defensins and cathelicidins) → innate immune defence against bacteria, viruses and fungi
23
What are the differences between the innate and adaptive immune system?
24
What cells detect pathogens in the dermis and what does their activation lead to
**Tissue‐resident T-cells Macrophages Dendritic cells** Rapid, effective immunological backup if epidermis breached
25
What layers of skin reduce water and protein loss?
**Cornified cell envelope and stratum corneum** restrict water and protein loss from skin
26
What in the skin protects from UV-DNA damage?
Melanin in basal keratinocytes - protection against UV-induced DNA damage
26
What layer of the skin reduces trauma?
Subcutaneous fat
27
How does extensive skin damage affect our cardiac and renal function?
high-output cardiac & renal failure in extensive skin disease
28
How does the body regulate temperature in increased temperature?
29
Apart from regulating temperature, what other function does the eccrine system regulate in the body?
Role in fluid balance
30
What are the metabolic functions of the skin?
-Vitamin D synthesis -Subcutaneous fat **Calorie reserve 80% of total body fat (in non-obese) Hormone (leptin) release - acts on hypothalamus → regulates hunger & energy metabolism**
31
What are the major roles of the skin in terms of aesthetics?
Increased risk of suicide with poor skin Psychosexual function
32
B
33
What are the appendages on the skin?
1. Pilosebaceous units ( from Latin : pilus which means hair) 2. Sweat glands 3. Nails
34
6 functions of the hair
Protection against external factors Sebum Apocrine sweat Thermoregulation Social and sexual interaction Epithelial and melanocyte stem cells
35
Nail plate Nail bed(deep to plate) Cuticle Proximal nail fold Onychodermal band Lateral nail fold Lunula-visible nail matrix
36
Where are terminal hairs found?
Terminal hairs → scalp, eyebrows and eyelashes
37
Where are vellus hairs found?
Rest of body → vellus hairs (except palms, soles, mucosal regions of lips, and external genitalia)
38
What is the structure of a hair?
**Infundibulum** Uppermost portion of the hair follicle extending from opening of sebaceous gland to surface of the skin **Isthmus** Lower portion of upper part of hair follicle between opening of sebaceous gland and insertion of arrector pili muscle Epithelium keratinization begins with lack of granular layer named “trichilemmal keratinization”
38
What are the 3 phases of the hair cycle and how long do they last?
**Anagen (where new hair forms and grows)** 85% of hair; lasts 2-6 years **Catagen (regressing phase)** 1% of hair; lasts 3 weeks **Telogen (resting phase)** 10-15% of hair; lasts 3 months Then loss of old hair.
38
What is in the pilocebaceous unit and what is the function of the arrector pili?
Pilosebaceous unit: **hair shaft, hair follicle, sebaceous gland** Arrector pili (smooth muscle) extends at angle between surface of dermis and point in follicle wall.
39
What is the difference in distribution and opening between eccrine and apocrine sweat glands?
Eccrine sweat glands -almost everywhere on the skin -open directly onto the skin’s surface Apocrine sweat glands -in areas with many hair follicles such as the scalp, armpits, groin -open into the hair follicle
40
Describe the structure of the nail
Final product of proliferation and differentiation of nail matrix keratinocytes Emerges from proximal nail fold Grows at 1-3mm/month Firmly attached to nail-bed Detaches at hyponychium Lined laterally by lateral nail folds
41
(Top left>Bottom right) Proximal nail fold Matrix Nail bed Nail plate
42
What is the only visible portion of the nail matrix
Lunula
43
What is the function and location of the nail matrix?
**Produces nail plate** **Lies under proximal nail fold, above bone of distal phalanx (to which it is connected by a tendon** Nail matrix keratinocytes differentiate → lose their nuclei and are strictly adherent - cytoplasm completely filled by hard keratins Also contains melanocytes
43
5 functions of the nails
Protection of distal phalanx Counterpressure effect to pulp - important for walking and tactile sensation Increase dexterity / manipulation of small objects Enhance sensory discrimination Scratching or grooming
44
C
45
C
45
D
46
B
47
A
48
D
49
D
49
A
50
C
51
D
52
D
53
B-pitting
54
Onchylosis
55
A
56
B
57
What is the most common systemic manifestation of psoriasis?
Psoriatic arthritis
58
What are the common involvement sites for psoriasis
scalp, elbows and knees, followed by nails, hands, feet and trunk (including intergluteal fold)
59
What kind of skin lesions are associated with psoriasis
Sharply demarcated, scaly, erythematous plaques
60
What is the general pathophysiology of psoriasis?
1. Stressed keratinocytes release DNA / RNA 2. dDCs migrate to lymph nodes
61
What are these lesions indicative of?
Psoriasis
62
What are these lesions indicative of?
Psoriasis
63
How can you manage psoriasis through lifestyle?
By managing: Alcohol Smoking Co-morbidities
64
What other conditions is atopic eczema associated with?
Asthma, rhino-conjunctivitis
65
Outline the psoriasis therapeutic ladder?
**Topical therapies** Vitamin D analogues Topical corticosteroids Retinoids Topical tacrolimus / pimecrolimus **Phototherapy** Narrowband UVB PUVA (Psoralen + UVA) **Acitretin** **Systemic immunosuppression** Methotrexate Ciclosporin **'Advanced' therapies** PDE4 inhibitors (Apremilast) Biologics (anti-TNF-α, anti-IL-17, anti-IL23)
66
What is Flexural inflammation and lichenification in children and adults indicative of?
Atopic eczema
67
How can you manage atopic eczema on the daily?
Daily emollients and anti-inflammatory therapy
68
What is the source of atopic eczema?
Complex genetic disease with environmental influences
69
Outline the pathophysiology of eczema
**Barrier defect** Filaggrin - bind and aggregate keratin bundles & intermediate filaments → form cellular scaffold in corneocytes Reduced extracellular lipids & impaired ceramide production Increased transepidermal water loss (TEWL) Impaired protection against microbes and environmental allergens **Immune dysregulation** Staphylococcal superantigens stimulate Th2 lymphocyte responses and subvert T‐reg T-cell infiltrate - bias towards Th2 responses Role of microbiome? Eosinophils
70
What are the clinical features of infantile atopic eczema?
Erythematous, oedematous papule & plaques ± vesiculation Lichenification, crusting and excoriation and dyspigmentation postinflammatory dyspigmentation
71
What are these skin lesions indicative of?
Atopic eczema
72
What is present in this image?
Fissuring
73
What are these skin lesions indicative of?
Allergic contact dermatitis
74
What are these skin lesions indicative of?
**Impetiginisation**-Gold crust Staphylococcus aureus
74
What is this lesion indicative of?
Venous stasis eczema
75
What is this skin condition called?
Erythroderma-Skin failure
76
What are these skin lesions indicative of?
Eczema herpeticum -Emergency -**HSV(Herpes simplex virus)**
77
How can you manage atopic eczema without medication?
**Lifestyle** Emollients Omission of soap **Clinical Nurse Specialist involvement** Topical application technique Day treatment Habit reversal **Co-morbidities Patch testing Biopsy**
78
Outline the therapeutic ladder for atopic eczema
**Topical therapies** Topical corticosteroids - correct potency for correct site Topical tacrolimus / pimecrolimus **Phototherapy** Narrowband UVB PUVA (hand dermatitis) **Systemic immunosuppression** Methotrexate Ciclosporin Azathioprine **Advanced therapies** Biologics (anti-IL-4α, anti-IL13) JAK inhibitors
79
What is the fingertip-unit guide and how much of a topical drug should you use for: Face and neck Back and buttocks Chest+abdo Entire arm and hand Each hand Entire leg and foot
80
What are potential risks and necessities of using topical immunomodulators
Underuse (poor adherence) Overuse of topical corticosteroids (tachyphylaxis / adverse effects) **Counselling critical** Adverse effects Amount to use – Fingertip unit Correct steroid used(ladder)
81
What are the topical steroids from least to most potent
Hydrocortisone Clobetasone(Eumovate) Betamethasone(Betnovate) Mometasone(Elocon) Clobetasol(Dermovate) (HCBMC)
82
What are the adverse effects of topical steroids?
Rare: skin atrophy, folliculitis, exacerbation of acne and rosacea, infection Very rare: perioral dermatitis, rebound syndrome (tachyphylaxis), allergy (to steroid itself or vehicle) Extremely rare: hormonal imbalance (suppression of hypothalamic-pituitary-adrenal axis), hirsuitism
83
What can you use to remove the risk of skin atrophy from topical steroids?
Topical calcineurin inhibitors
84
A

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