General information Flashcards
GUT/SKIN AXIS
Common characteristics shared by gut and skin (7)
- Heavily Vascularized
- Richly perfused
- Densely innervated
- Integrated to the immune system
- Highly associated with the endocrine system
- Extensively colonized with recognizable microbiota
- Both helps our body to communicate with its external environment
SKIN PATHOLOGIES AND GUT
Numerous intestinal pathologies have been linked to skin comorbidities. Intestinal dysbiosis is associated with what inflammatory skin pathologies? (4)
- Atopic dermatitis
- Psoriasis
- Acne Rosacea
- Acne vulgaris
BRANCHES OF SKIN DISORDERS
Types of skin disorders
- Inflammatory disorders
- Infections
- Disorders of hair follicles and sebaceous glands
- Alterations in skin pigmentation
- Neoplasia and alterations in cell differentiation
- Disorders related to sweat glands
Name the 3 skin conditions in top 10 most prevalent globally in 2010
- Fungal skin diseases
- Other skin and subcutaneous diseases
- Acne vulgaris
Name the 5 skin conditions in top 50 most prevalent
- Pruritus
- Eczema
- Impetigo
- Molluscum contagiosum/warts
- Scabies
Describe the Etiology/cause and appearance of the following 15 most common disorders:
- Eczema
- Psoriasis
- Acne vulgaris
- Pruritus (itching
without attributable
cause) - Alopecia areata
- Decubitus ulcer
- Urticaria
- Scabies
- Fungal skin diseases
- Impetigo
- Abscess
- Bacterial skin diseases
- Cellulitis
- Viral warts
- Molluscum
contagiosum
How do you assess skin condition?
- You observe the eyes
- Colour/palor of skin
- Hair distribution
- Lumps
- Cuts/grazes/trauma/bruising
- Derma (hydration, elasticity, irritation, reactions)
- Nails
What produces melanin and what can change the function of these cells?
Melanocytes,
and any change to hormones or genetics can change the functional state
COLOUR VARIATION
What are birth marks?
Vascular abnormalities/pigmented melanocytes
COLOUR VARIATION
What are moles? (3)
- They are concentrated bumps of melanin
- May develop throughout life
- Harmless, but susceptible to malignancy
COLOUR VARIATION
How many moles can a person have?
Average 30, up to 400. They should be monitored regularly
COLOUR VARIATION
What size are cafe au lait spots and at what size should you be concerned that a DDx should include neurofibromatosis?
0.5-1.5cm are the usual size. Any cafe au lait spots larger than 1.5cm you should consider possibility of neurofibromatosis
COLOUR VARIATION
What is Tinea versicolour - What is its appearance and cause? How is it treated?
It is a yeast infection of the skin. It looks flaky and interrupts the normal pigmentation of the skin. It is due to changes in UV and occurs within immunocompromised persons
Treated with anti-fungal creams
COLOUR VARIATION
What is Vitiligo? What is its appearance and cause? How is it treated?
Vitiligo is an acquired depigmenting disorder of the skin, in which pigment cells (melanocytes) are lost. Vitiligo is due to the loss or destruction of melanocytes, which are the cells that produce melanin. Vitiligo is thought to be a systemic autoimmune disorder, associated with deregulated innate immune response (different classifications of vitiligo are thought to have different pathophysiology)
There is no cure, but steroids and immunosuppressive drugs can improve appearance of the skin. There is also topical ointments as well as re-pigmentation through surgery or depigmentation through various methods
COLOUR VARIATION
What is Cyanosis? What is its appearance and cause? How is it treated?
Cyanosis refers to a bluish-purple hue to the skin. It is most easily seen where the skin is thin. Cyanosis indicates a person may have deoxygenated hemoglobin or disorders of abnormal hemoglobin
Causes of Cyanosis:
- Hypoventilation
- Pulmonary causes (leading to ventilation-perfusion mismatch)
- Cardiovascular causes
- Polycrythemia
- High altitude
- Hypothermia
- Obstructive sleep apnea
Treatment focuses on managing the underlying condition
COLOUR VARIATION
What is Jaundice? What is its appearance and cause? How is it treated?
Jaundice is the yellow discoloration of skin, eyes and bodily fluids. Jaundice is caused by hyperbilirubinaemia
Causes of excess bilirubin:
- Hepatitis
- Acetaminophen overdose
- Chronic liver disease (alcohol abuse/excessive smoking)
- Gallstones
- Blood disorders
- Cancer of the pancreas
- Bile buildup in gallbladder
Bilirubin is part of the pigment released from used, broken down red blood cells. If there’s a dysfunction with the liver, it is unable to filter this pigment and is then excreted into feces and 10-20% undergoes enterohepatic circulation
Treatment focuses on managing the underlying condition
COLOUR VARIATION
What is Carotenosis? What is its appearance and cause? What are the associated conditions? How is it treated?
Carotenosis is a benign and reversible medical condition where an excess of dietary carotenoids results in orange discoloration of the outermost skin layer. It is caused by excessive dietary intake of β-carotene
Associated medical conditions include:
- Diabetes mellitus
- Hypothyroidism
- Liver disease
- Kidney disease
- Anorexia nervosa
Treatment is usually a matter of reducing carotene intake
Patients with secondary carotenaemia should be treated for the underlying condition
COLOUR VARIATION
What is Atopic dermatitis? What is its appearance and cause? How is it treated?
Atopic dermatitis (Eczema) is a condition that makes the skin red and itchy. It tends to be chronic
Treated with medications - steroids, antihistamine or topical antiseptic. Certain creams may provide relief from itching
TRAUMA
What is Echymosis?
Bruising caused by direct trauma to the skin
BRUISING
If someone bruises easily, what is this a sign of? and what changes in colour are seen?
- A bleeding disorder or liver disease
- Changes in colour from purple-blue-green-yellow-brown. This helps age the bruise
VASCULAR
What is Vasculitis? What is its appearance and cause? How is it treated?
It is an inflammation of blood vessels due to infection, foreign body, rheumatoid arthritis (RA) or primary (autoimmune) failure
Skin lesions may be flat and red (macules), nodules or more substantial hemorrhages under the skin (purpura)
Will depend on the type of vasculitis and organs affected. Treated with corticosteroids, immunosuppressive drugs or plasma exchange when patient presents with pulmonary hemorrhage
VASCULAR
Someone with tracking marks - what do you need to consider?
That the marks could be from drug use, blood donation or from hospital admission
ERUPTIONS
Define Erythrosquamous
Erythro - Red/reddish
Squamous - Scaly layer of epithelium that consists of very thin flattened cells
Erythrosquamous skin disorder - Red scaly epithelium
ERUPTIONS
What is Psoriasis? What is its appearance and cause? How is it treated?
Erythrodermic psoriasis is (red/scaly) skin disease that is itchy and often covers large sections of the body. It is caused due to systemic inflammation. It is a chronic autoimmune condition that causes rapid build up of cells.
(Abnormal proliferation of keratinocytes and excessive immune cell infiltration in the dermis and epidermis)
Treatments include emollients and cooling wet dressings, immunosuppressant drugs and antibiotics to manage inflammation
ERUPTIONS
What is Atopic eczema? What is its appearance and cause? How is it treated?
(Erythrosquamous) Atopic Eczema is a chronic, inherited, inflammatory skin condition that has a dry, itchy red appearance. It is caused by immune system activation, genetics and environmental triggers (weather) and stress.
Treatment can include antihistamine to target immune system, corticosteroids to reduce swelling and redness and moisturiser to combat environmental triggers
ERUPTIONS
What is Tinea corporis? What is its appearance and cause? How is it treated?
Tinea corporis is a dermatophyte (ringworm appearance) infection. It is a superficial fungal infection and highly contagious. It is treated using a topical antifungal ointment or oral if involved site is hair bearing
ERUPTIONS
What is Varicella-zoster? What is its appearance?
Varicella-zoster is a herpes virus that causes chickenpox/shingles. The herpes simplex virus appears as blisters (clustered vesicles/ulcers)
PUSTULAR AND CRUSTED LESIONS
What conditions cause pustular crusted lesions? (9)
- Acne vulgaris
- Acne rosacea
- Impetigo
- Staph aureus/strep pyogenes
- Folliculitis
- Viral lesions
- Pustular psoriasis
- Dermatophyte infections
- Itching/swollen lymph nodes
PUSTULAR AND CRUSTED LESIONS
What is Acne vulgaris? What is its appearance and cause?
Acne vulgaris is a skin condition that occurs when hair follicles are blocked with dead skin cells, bacteria, and oil (sebum). The blocked follicles cause blemishes on the skin, including pimples, blackheads, whiteheads, and cysts
PUSTULAR AND CRUSTED LESIONS
What is Acne rosacea? What is its appearance and cause?
Acne rosacea, is a non-contagious skin inflammation (linked to the immune system) that exclusively affects the face (cheeks and nose). The small surface blood vessels (capillaries) of the skin enlarge, giving the appearance of a permanent flush.
NOT TO BE CONFUSED WITH SYSTEMIC LUPUS ERETHEMATOSIS (SLE)
PLAQUES
What is Sarcoidosis? What is its appearance and cause?
Sarcoidosis is a disease characterized by the growth of tiny collections of inflammatory cells (granulomas) in any part of your body. Most commonly affects the lungs and lymph nodes. But it can also affect the eyes, skin, heart and other organs. It is thought to be an autoimmune disease
PLAQUES
What is Erythema nodosum? What is its appearance and cause?
Erythema nodosum is inflammation of the fat plaques under the skin due to hypersensitivity. Erythema nodosum results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. Can be triggered by strep throat (group A streptococcus) or other infections such as sarcoidosis.
PLAQUES
What is SLE? What is its appearance and cause?
SLE - Systemic lupus erethematosis an autoimmune disease in which the immune system attacks its own tissues. It is the most common type of lupus. It appears like a butterfly shape rash over the cheek and crosses the nasal bridge
TUMOURS
What is an Angioma?
An angioma is a benign tumor of the blood vessels. An angioma is due to proliferating endothelial cells; these are the cells that line the inside of a blood vessel. They are seen on a pale skin person more easily. DDx should include pyogenic granuloma
TUMOURS
What is a Xanthoma?
A Xanthoma is a benign, cholesterol plaque that often present if someone has a underlying lipid (cholesterol/triglyceride) abnormality -diabetes or high cholesterol. Uncontrolled excess fat in blood (hyperlipidemia) should be of concern to a practitioner (risk factor for upper cervical manipulation)
A Xanthoma around the eye is called a Xanthelasma
TUMOURS
What is a Wart?
It is a benign growth in the skin. Can be caused by human papillovirus. Common in children
TUMOURS
What is a dermatofibroma?
A dermatofibroma is a common benign fibrous nodule usually found on the skin of the lower legs. Dermatofibromas are caused by an overgrowth of a mixture of different cell types in the dermis layer of the skin. Has a star shaped center that look opaque and often forms after trauma - bite, puncture, splinter
TUMOURS
What is a Lipoma?
A lipoma is a benign fat tumor that forms in the adipose tissue
TUMOURS
What is a Malignant melanoma?
A Malignant melanoma occurs when the pigment-producing cells that give colour to the skin become cancerous.
What are the differences between a mole and tumour?
The following would indicate a tumour rather than a mole:
- Rapid growth
- Variegated instead of homogeneous pigment (speckles of different colour)
- Diffusion of pigment from papule into surrounding skin. Resembles spread of ink on blotting paper
- Inflammation of surround skin
- Bleeding, oozing and crusting of surface
What can cause stretch marks?
- Rapid stretching of the skin
- Obesity
- Cushing’s
- Pregnancy
- Ehlers-Danlos
- Puberty
What is hyperhidrosis?
Abnormally excessive sweating involving the extremities, underarms and face, usually unrelated to body temperature or exercise
What is Miliaria?
(Heat rash) - A skin condition caused by blocked sweat ducts and trapped sweat beneath the skin
INFLAMMATION
Name the types of skin conditions related to inflammation:
- Dermatitis eg allergic, atopic, contact, varicose
- Drug eruptions
- Eczema
- Erythema multiforme
- Erythema nodosum
- Lichen planus
INFECTIONS
Name the types of skin conditions related to skin infections:
Boils, Carbuncles, Creeping eruption, Tinea, Erysipelas, Erythrasma, Folliculitis barbae, Impetigo, Paronychia, Pediculosis, Pityriasis rosea, Pityriasis versicolour, Scabies, Scalded skin syndrome, Warts
SKIN PIGMENTATION
- Name two melanin disorders that cause systemic hypopigmentation
- Name a melanin disorder that cause hyperpigmentation
Albinism and Vitiligo - hypopigmentation
Melasma - hyperpigmentation
DISORDERS OF THE HAIR FOLLICLES AND SEBACEOUS GLANDS
Name the disorders that interrupt the normal function of the hair follicles and sebaceous glands:
- Acne rosacea
- Acne vulgaris
- Alopecia
- Hypertrichosis
- Milia
- Sebaceous cysts
Inflammatory bowel disease is linked to what skin manifestations?
Pyoderma gangrenosum and Erythema nodosum
Celiac disease is associated with what skin manifestations?
Dermatitis, herpetiformis, alopecia, vitiligo and oral mucosal lesions
Psoriasis is more commonly found in patients with what disease?
Crohn’s disease
Sweets syndrome (distinctive eruption of tiny bumps that enlarge and are often tender to the touch) common on the neck is associated with what other type of lesion?
Oral - affecting the lips, buccal mucosa, and/or tongue
NEOPLASIA AND ALTERATIONS IN CELL DIFFERENTIATION
List the common disorders that fall under the neoplasia/alterations in cell differentiation category:
- Angiomas
- Melanocytic naevi
- Basal cell carcinoma
- Squamous cell carcinoma
- Melanoma
- Lipomas
- Seborrheic keratoses
- Skin tags
