Dermatology Flashcards
5 layers of the epidermis
Come Let’s Get Sun Burn
- Stratum Corneum (outermost layer)
- Stratum Lucidum (only in palms and soles)
- Stratum Granulosum
- Stratum Spinosum
- Stratum Basale (germinativum)
which is the outermost layer of the epidermis?
stratum corneum
Cells of the epidermis
- melanocytes
- keratinocytes
- Langerhans’ (immune functions)
- merkel’s cell
the layer of the skin beneath the epidermis
dermis
the dermis consist of what type of fibers?
collagen, elastin, and reticular fibers
the thickness of the epidermis
from 0.5mm on the eyelid to 1.5mm on palms and soles
the thickness of the dermis
from 0.3mm on eyelid to 3.0mm on the back
layers of the dermis
- Papillary layer: upper layer
- Reticular layer: contains hair follicles, sweat glands, oil glands, vessels and nerves
which layer of the skin contains the hair follicles?
the reticular layer of the dermis
also contains sweat glands, sebaceous glands, vessels, and nerves
Functions of the skin
- Protection: an anatomical barrier between the internal and external environment
- Sensation
- Heat regulation
- Evaporation
- Storage and synthesis: acts a storage center for lipids and water as well as a means of syntheses of Vit B and D
- Excretion
- Absorption
A circumscribed, flat discoloration that may be hypopigmented or hyperpigmented (brown, blue, red, black, white).
Macule
An example of a macule is a freckle.
macule
An elevated, solid lesion up to .5cm in diameter, color varies.
Papule
A circumscribed, elevated, superficial solid lesion more than .5cm in diameter, often formed by a confluence of papules
Plaque
A circumscribed, elevated solid lesion more than .5cm in diameter;
Nodule
a large nodule is referred to as a tumor.
A circumscribed collection of leukocytes and free fluid that varies in size.
(yellow or white, infection)
Pustule
A circumscribed collection of free fluid up to .5cm in diameter.
(chickenpox)
Vesicle
A circumscribed collection of free fluid more than .5cm in diameter.
Bulla
A firm edematous plaque resulting from an infiltration of the dermis with fluid; blanches with touch; allergies; mosquito bites
Wheal
wheals are transient and may last only a few hours. (Seen in allergic reaction - Hives)
Excess dead epidermal cells that are produced by an abnormal keratinization and shedding
Scales
A focal loss of epidermis
Erosion
A focal loss of epidermis and dermis. ( heals with scarring)
Ulcer
A linear loss of epidermis and dermis with sharply defined vertical walls.
Fissure
Circumscribed lesion with a wall and a lumen, may contain fluid or solid matter
Cyst
Multisystem disease of unknown origin characterized by the production of numerous autoantibodies. More common in women (20-40 y/o). A characteristic malar rash, also known as the butterfly rash, is a hallmark of the disease. The malar rash is fixed erythema, flat or raised, or the malar eminences, tending to spare the nasolabial folds. Lupus attacks the heart, lungs, CNS system, joints, vessels, and skin.
Systemic Lupus Erythematosus
true or false: viral infections are associated with autoimmune diseases
true
a papulosquamous disease, is genetic in nature, and episodic. Manifests with a rash and ARTHRITIS. Stress may precipitate an episode. The lesions are distinctive. They begin as red, silvery, scaling papules that coalesce to form round to oval plaques. The rash affects mostly extensor surfaces.
PSORIASIS
Psoriasis also has systemic manifestations. Treatment consists generally of
steroids and immunosuppressives.
Plaquerül, oral steroids are used to control _______ as are immunosuppressives. The morbidity and mortality associated with this multisystemic disease is high.
Lupus
is a sharply demarcated yellowish deposit of cholesterol underneath the skin, usually on or around the eyelids. Highly Associated with hyperlipidemia. May be found in patients with primary hypercholesterolemia and diabetes type Il (syndrome X) .
Xanthelasma (or xanthelasma palpebrarum)
Velvety thickening and hyperpigmentation of the skin, commonly found on the neck and axillae. Associated with Diabetes Type Il, Obesity, and Polycystic ovarian disease.
ACANTHOSIS NIGRICANS
Treatment of the underlying disease can lead to resolution of the rash.
(classically the bull’s eye rash) are caused by the bacterial spireehete Borrelia burgdoferi and are transmitted by Ioxedes deer ticks.
LYME DISEASE and erythema migrans
15,000 cases of Lyme disease are reported each year.
Lyme Disease begins as a local infection but can become systemic (with arthralgias and CNS/Cardiac manifestations) over time. Treatment is with
antibiotics, specifically Doxycyline.
Doxycyline
antibiotic to treat Lyme Disease
Skin infection characterized by erythema, edema. and pain. In most patients, there is a fever and leukocytosis. Pathogens enter at sites of local trauma or abrasions. Common organisms are staph aureus and staph epidermidis.
CELLULITIS
Yeast infection of the mouth with C. Albicans. The infection appears as a white, creamy exudate or white, flaky, adherent plaques. The underlying mucosa is red and sore. A specimen may be taken by gentle scraping with a tongue. Pseudohyphae are readily identified under a microscope.
FUNGAL INFECTIONS Oral Candidiasis
Oral candidiasis in adults is found in
immunocompromised patients such as those with HIK diabetes, the elderly, or patients on chronic steroids.
Tinea means
fungus infection.
Tinea on the body appears in a classic
ringworm pattern
Tinea of the feet also called
athlete’s foot is associated with lesions, scaling, peeling and weeping between the toes.
Treatment of Tinea corporis and pedis are
antifungal topical preparations (clotrimazole.)
Tinea capitis is often treated with
oral antifungals (griseofulvin.)
Fungal infections of the nails. Manifests as thickened, discolored, yellowed, brittle nails. More common on the feet than hands. Most common digits affected - Great toe and 5”‘ toe.
ONYCHOMYCOSIS
ONYCHOMYCOSIS treatment
- Treat with topical antifungals, oral antifungals, and/or nail removal.
- Unfortunately, these infections are often very resistant to treatment.
A cutaneous viral infection involving the skin of a single dermatome. Results from a reactivation of the varicella virus. The rash appears as a unilateral cluster of vesicles of varying size that travel along a single dermatome. The rash is confined to a dermatome and does not cross the midline of the body. Is intensely painful and often the pain persists after the rash has resolved.
The Herpes Zoster (SHINGLES)
True or false: Only in immunocompromised patients, i.e., AIDS, malignancy, DM is Herpes Zoster disseminated (crossing midline and involving more than one dermatome.)
true
this is intensely painful and often the pain persists after the rash has resolved.
Herpes Zoster (Shingles)
Viral infection. Two distinct viruses - HSV l and HSV 2. HSV 1 is more associated with isolated oral lesions. HSV 2 is associated with genital herpes. The characteristic lesions are grouped vesicles on an erythematous base.
HERPES SIMPLEX VIRUS
Treatment of herpes simplex virus consists of
- application or oral antivirals such as valtrex or acyclovir.
- cannot be cured, virus may remain dormant
True or false: treatment of herpes simplex virus can reduce viral load and decrease the duration of symptoms, but cannot cure the disease. The virus may remain dormant but is not eradicated. Patients have cyclical infections throughout their lifetime.
true
benign epidermal neoplasms that are caused by human papilloma viruses
Warts
Warts commonly appear at sites of
trauma.
infections are self-limited and may last for years.
The lesions are papular, vary in size and shape and may be flesh colored, gray-brown, with black dots on the surface.
Warts
- Warts on the plantar surface of the foot may be intensely painful as they compress the surrounding tissue when weight bearing.
- Warts elsewhere on the body are painless
Treatment of warts consists of
- Cryotherapy or surgical removal.
- Warts are often resistant to treatment attempts.
a single-stranded RNA flavirius/arbovirus that is predominantly transmitted via the bite of the aedes aegypti or the aedes albopictus mosquito, both of which are endemic in NYC. The aedes aegypti female mosquito is an aggressive day biter and will follow you into your home to bite you to in order to obtain a protein meal to nourish it’s eggs.
ZIKA
The zika virus will be transmitted to you via the mosquito’s
saliva
Infection with the ZIKA virus leads to a mild illness that manifests with
macular/popularerythematousrash andconjunctivitis
The infection of zika virus in adults and children is predominantly
benign and self-limiting.
However, the vertical transmission that occurs from mother to fetus results is catastrophic in that it leads to microcephaly in newborns.
a highly contagious disease caused by the mite sarcopetes scabiei hominis. The mite is a parasite to humans affecting first the stratum corneum layer of the skin
SCABIES
what is responsible for some of the itching from scabies?
Eggs laid and fecal pellets are deposited in the burrow. The feces act as an irritant and are responsible for some of the itching. After a number of larvae reach maturity the adult mites migrate and cause intense itching and generalized pruritis.
Treatment of scabies consists of
LINDANE or ELIMITE cream applied twice in the course of two week period.
Careful cleaning of households is also critical.
Presents secondary to contact with sap material called urushiol of the genus Rhus
Poison Ivy, Poison Oak, Poison Sumac
contact dermatitis
Characteristic lesions are linear vesicles and are created when part of the plant is drawn across the skin surface or from streaking when scratching.
contact dermatitis
contact dermatitis (Poison Ivy, Poison Oak, Poison Sumac) treatment
Topical steroids are the treatment of choice.
For extensive, severe cases, oral steroids may be given.
Characteristic lesions are hives. Hives are firm, erythematous, edematous lesions that blanch when compressed. Due to ingestion of medications, foods of which patients have hypersensitivity.
Allergic reaction
allergic reaction treatment
- Treatment consists of elimination of allergen
- epinephrine if airway compromise, antihistamines (Benadryl), steroids, and fluids.
occurs in the deep layers of the skin near the eyes and mouth due to an allergic reaction.
Angioedema
- emergency, call the ambulance!
- Benadryl while the ambulance arrives
- Beware of airway compromise in these patients. (these are the patients that need epinephrine.)
most common form of skin cancer
basal cell carcinoma
Skin cancer
- Basal cell carcinoma
- Squamous cell carcinoma: higer risk!
- Melanoma
is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye
Melanoma
It is one of the rarer types of skin cancer but causes the majority of skin cancer-related deaths.
melanoma
Despite many years of intensive laboratory and clinical research, the sole effective cure of melanoma is
surgical resection of the primary tumor before it achieves a thickness greater than l mm.
- Assymetric
- Borders (abnormal)
- Color (variable)
- Diameter
- Evolution (enlargement)
MELANOMA
risk factors for squamous cell carcinoma
Sunlight exposure and immunosuppression are risk factors for SCC of the skin.
The risk of metastasis is larger than with basal cell carcinoma.
Basal cell carcinoma is rarely life-threatening but, if left untreated, can be disfiguring, cause bleeding, and produce local destruction (e.g., eye, ear, nose, lip). Basal cell skin cancer almost never spreads; but, if untreated, it may grow into surrounding areas and nearby tissues and bone.
true!
