- collagen and elastin matrix with mucopolysaccharide gel also fibroblasts, dermal dendritis cells and macrophages

General Dermatology Flashcards by Leanne Kade

Skin: Adnexal Structures

hair
nails
glands
sensory structures

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Skin: basic role in brief

role in protection, homeostasis and transport of sensations

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Sub cutis

– fat energy store, insulation, fibrous bands anchour skin to fascia

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Dermis

collagen and elastin matrix with mucopolysaccharide gel also fibroblasts, dermal dendritis cells and macrophages

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Epidermis

Out layer – 3 cell types keratinocytes majority of cells

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Melanocytes

– makes melanosomes (collections of melanin) excreted and phagocytoses into keratinocytes where they sit above the nucleus

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Langerhans cells

– process antigens and migrate to lymph nodes to induce an immune response

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Stratum Cornueum

Dead cells with a hard protein envelope; the cells contain keratin and are surrounded by lipids.

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Stratum Lucidum

Dead cells lie within dispersed keratohyalin

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Stratum Granulosum

Keratohyalin and a hard protein envelope for; lamellar bodies release lipids; cells die.
Keratin Granules

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Stratum Spinosum

Keratin fibres and lamellar bodies accumulate

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Stratum Basale

Cells divide by mitosis and some newly formed cells become the cells of the more superficial strata.
Basement membrane
Hemidesmosomes
Desmosomes connecting adjacent cells

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Nail

Hyponychium
Nail plate
Lateral nail fold
Nail bed
Lunula
Cuticle 
Proximal nail fold
Nail matrix

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External Causes:

Photosensitivity

Photosensitivity
Commonly caused by medications
Exposed sites affected
Can be sensitive to UVA, UVB, visible light or a combination of these.

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External Causes: Cold

Cold Injury
Frostbite,
Chilblains
Skin Necrosis

Cold Urticaria

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External Causes: Trauma

Dermatitis Artefacta

self-induced harm

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Internal Causes:

Drug reaction

Vary in severity
Think of OTC drugs
Take a good history!

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Internal causes: autoimmune

Bullous Pemphigoid

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Describing skin lesions

Morphology is the appearance of skin lesions

Small usually means less than 5mm

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Macule

Patch

Macule
- Small flat circumscribed area

Patch
- Larger flat circumscribed area

Papule

Plaque

Papule
- Small raised area

Plaque
- Larger Raised area

Vesicle

Bulla

Vesicle
Small Fluid filled

Bulla
Large Fluid filled

Pustule

Abscess

Pustule
Small Pus filled

Abscess
Large Pus filled

Erosion

Ulcer

Erosion
Loss of Epidermis

Ulcer
Loss of Epidermis and dermis

Macule: Small flat circumscribed area | ...

Macule: Non-palpable change in skin color with distinct borders

Papule: - Small raised area...

Palpable, solid lesion less than 1 cm in diameter

Plaque: -Larger Raised area...

Palpable, solid lesion greater than 1 cm in diameter

Nodule:

Palpable, lesion more than 1 cm in diameter which is taller than it is wide

E.g. Conditions with nodules:

Neurofibromatosis Rheumatoid Nodules

Vesicle: Small fluid filled...

Fluid-containing, superficial, thin-walled cavity less than 1 cm

Bulla: Large fluid filled...

Bulla: Fluid-containing superficial, thin-walled cavity greater than 1 cm

Bulla e.g. condition:

bullous pemphigoid

Erosion:

A skin defect where there has been loss of the epidermis only

Erosion: e.g. condition

Toxic epidermal necrolysis

Ulcer: Loss of Epidermis and dermis...

A skin defect where there has been loss of the epidermis and dermis

Ulcer: e.g. condition

pyoderma gangrenosum

Pustule: Small Pus filled...

Pus containing, superficial, thin-walled cavity

Pustule: e.g. condition

acne

Abscess: Large pus filled...

Abscess:Thick-walled cavity containing pus

Distribution of Dermatosis

... How the skin lesions are scattered or spread out. Skin lesions may be isolated (solitary or single) or multiple. The localisation of multiple lesions in certain regions helps diagnosis, as skin diseases tend to have characteristic distributions. What is the extent of the eruption and its pattern? localised, generalised, symmetrical etc

Most Common Skin Conditions:

``` Acne Psoriasis Rosacea Skin lesions Uritica Warts Leg ulcers Scalp/nail disorders Eczema Infections/infestations ```

Skin in general medicineCutaneous signs are useful in diagnosing many conditions:

``` Erythema Nodosum Sarcoidosis Vasculitis Malignancy Auto-immune conditions ```

Hyperlipidaemia

Eruptive xanthoma on skin, not just eyes

Acanthosis Nigricans

Associated with insulin resistance, obesity, malignancy Flexural distribution Hyperkeratosis and Hyperpigmentation, papules ‘velvety’ appearance

Thyroid Skin Disease

Pretibial myxoedema 5% of Graves Disease Same process behind eyes – mucinosis Other skin changes seen in both hyper and hypothyroidism

Investigations in Dermatology if bacterial infection suspected

Charcoal swab Ask for MC&S Microscopy Culture Sensitivities

Investigations in Dermatology - If viral infection suspected

Viral swab for PCR Can swab vesicle/bulla if vesicular eruption If systemic illness, can take throat swab

Investigations in Dermatology - If fungal infection suspected

Skin scraping Nail clipping Hair sample --> Fungal cultures

Simple way to take a skin biopsy

punch biopsy - epi, derm, subcutis - all three layers of skin