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Dermatology > Dermis and Subcutaneous Tissue > Flashcards

Dermis and Subcutaneous Tissue Flashcards

1
Q

Dermis

A

ECEM including collagen and elastic fibers for support, strength, elasticity and shape

  • has blood vessels, nerves and adnexal structures
  • dermal dendrocytes, macrophages, fibroblasts and mast cells
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2
Q

Collagen

A

braided fibril comprised of 3 alpha chains

  • 12 different types in skin for integrity and structure
  • type 1 is primary collagen of dermis
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3
Q

Ehlers-Danlos Syndrome (EDS) Type I

A

Classic EDS

  • hypermobility of joints
  • excessive stretching of skin with maintenance of elastic recoil
  • fragile skin
  • atrophic or “fishmouth” scars
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4
Q

EDS Type IV

A

may involve blood vessels, leading to bruising and gastrointestinal and arterial rupture
-no treatment, avoid contact sports and trauma

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5
Q

Elastic fibers

A

Elastin and fibrillin

  • stretch and recoil
  • fibers move across one another readily
  • not well replaced after tissue wounding (scar less elastic)
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6
Q

Pseudozanthoma elasticum (PXE)

A

AR disease from elastic fiber clumping

  • affects skin, eyes, CV system
  • yellow papules of lateral neck and axillae
  • onset in 10s, 20s but not clinically apparent until 30/40s
  • ocular involvement almost 100%
  • claudication, hypertension, angina and heart attack
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7
Q

Marfan Syndrome

A

AD disease with disorder of fibrillin

  • tall stature with disproportionately long limbs
  • ectopia lentis (displacement of the lens of the eye)
  • mitral valve prolapse
  • aortic root dilation
  • aortic dissection
  • arachnodactyly (skeletal issues)
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8
Q

Livedo Reticularis (LR)

A

clinical appearance of reticulated macular erythema of skin

  • most common on lower extremities but also trunk and upper
  • hypoperfusion of the skin due to cold envi exposure
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9
Q

Leukocytoclastic vasculitis (LCV)

A

inflammation of blood vessels caused by medications, infection and autoimmune diseases

  • palpable purpura, reddish-purple, domed papules that do not blanch with pressure, reflecting vascular origin
  • legs, particularly ankles, mostly affected
  • renal insufficiency may occur due to inflam of kidney
  • treatment is to eliminate causative agent/treat underlying disease
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10
Q

Inflammatory phase

A
  • vasoconstriction and clotting cascade to limit bleeding
  • increased vascular permeability leading to edema and pain
  • influx of neutrophils and macrophages
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11
Q

Proliferative phase

A
  • fibroblasts stimulate formation of ECM
  • angiogenesis to create granulation tissue
  • keratinocytes proliferate and migrate to re-epithelialize would (occurs best when moist)
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12
Q

Maturation phase

A
  • wound contraction
  • increasing tensile strength (20% final strength 3 weeks post-injury and final wound strength is 70-80% intact skin)
  • remodeling (scar maturation may take up to 1 year)
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13
Q

Keloid

A

excess collagen deposition forming a firm scar extending beyond margins of original wound

  • collagen stimulates platelets to undergo activation, adhesion and aggregation
  • keloids can be pruritic or painful (mostly asymptomatic)
  • intralesional steroid injections, compression and scar massage may promote scar thinning and remodeling
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14
Q

Granular tissue

A

Neovascularization that provides necessary vascular bed to support nutritional requirement of healing skin
-can impede healing and requires surgical debridement

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15
Q

Pyogenic granuloma

A

Rapidly growing friable vascular lesion that bleeds easily and often arises in sites of trauma
-proliferating vascular tissue fails to reepithelialize unless lesion cauterized or surgically removed

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16
Q

Scleroderma

A 
Acquired sclerosis (hypocellular thickening of collagen)
-subtypes including morphea and systemic sclerosis
17
Q

Morphea (localized scleroderma)

A

expanding erythematous plaque that becomes more indurated

  • central protion becomes hypopigmented and surrounded by lilac-colored ring
  • trunk involved
  • identical histologic appearance to systemic scleroderma but is not associated (biospy doesn’t differentiate)
18
Q

Systemic sclerosis (scleroderma)

A

Limited scleroderma affects face and distal extremities with tight, thickened skin

  • associated Raynaud’s phenomenon
  • associated with CREST syndrome

Diffuse scleroderma involves trunk and proximal extremities

  • cutaneous fibrosis and Raynaud’s phenomenon, pulm fibrosis, renal insufficiency, and cardiac disease
  • poorer prognosis for disease progression
19
Q

Raynaud’s phenomenon

A

episodic color changes in fingers and toes (white, blue, and red) in response to cold exposure

20
Q

CREST syndrome

A

C: calcinosis cutis (calcium deposit in skin)
R: Raynaud’s phenomenon
E: Esophageal dysmotility (causes difficulty swallowing)
S: Sclerodactyly (induration of digits)
T: Telangiectasias (often involves lips, palms, and proximal nail folds)

21
Q

Photoaging

A

repeated, prolonged UV radiation visibly alters skin

  • atrophy, lentigines (large freckles), rhytides (wrinkles), dilated pores, yellow quality
  • yellow due to degenerate elastic fibers (also loss of recoil)
22
Q

Poikiloderma of Civatte

A

combination of telangiectasias, hyperpigmentation, hypopigmentation and atrophy

  • commonly on lateral neck and V of chest
  • UV causes thinning of support around blood vessels
  • actinic purpura
  • prevent with sunscreen and photoprotection
23
Q

Subcutis

A

subcu tissue located between dermis and deep fascia

  • except eyelids and male genitals
  • thermoregulation, energy store, mech buffer
  • composed of lobules of adipocytes (lobules separated by fibrous septa composed of collagen and reticulin)
24
Q

Panniculitis

A

inflammatory disorder of subcu fat

  • tender erythematous, non-ulcerated nodules with ill-defined borders
  • most often on lower extremities
  • most common type = Erythema Nodosum (EN)
25
Q

Erythema Nodosum (EN)

A

delayed type hypersensitivity reaction to variety of antigenic stimuli

  • histologically characterized by inflammation of fibrous septae that separate the fat lobules
  • potential causes = medications, infections, sarcoidosis, inflammatory bowel disease, idopathic
  • treated by eliminating offending medication or treating underlying inflamm disease.

Dermatology (11 decks)

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