Intro to dermatology and epidermis Flashcards

1
Q

The epidermis:

What are its layers?

A

The epidermis is the outer (epi in Greek meaning “over” or “upon”) of the two layers that make up the skin (or cutis), the inner layer being the dermis.

It provides a barrier to infection from environmental pathogens and regulates the amount of water released from the body into the atmosphere through transepidermal water loss (TEWL). The outermost part of the epidermis is composed of stratified layers of flattened cells, that overlies a basal layer (stratum basale) composed of columnar cells arranged perpendicularly.

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2
Q

Difference between keratinocyes and melanocytes?

A

Mammalian keratinocytes compose the bulk of the epithelium, undergo keratinization, and form the dead superficial layer of the skin. These superficial keratinized cells are continuously replaced by cells derived from mitotic cells in the lowest layer of the epidermis (i.e., the basal layer). Melanocytes locate in the basal layer and do not keratinize; however, they can produce melanin pigments. Melanin is accumulated in small granules called melanosomes. The melanosomes are transported to dendrites from which the melanosomes are transferred to keratinocytes.

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3
Q

What are the functions of the skin?

A light barrier is provided by the ____1____.

A physical barries and vitamin D synthesis is provides by the ____2____.

Strenght and elasticity is provided by the ____3_____.

Pheromones and body odor is due to ____4_____.

A

1- Melanocytes

2- Keratinocytes

3- Fibroblasts

4- Apocrine glands

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4
Q

Describe the Fitzpatrick skin types:

Type I: Skin is ________, Freckles______, Sunburn_______, Tan_______.

Type II: Skin is ________, Freckles______, Sunburn_______, Tan_______.

Type III: Skin is ________, Freckles______, Sunburn_______, Tan_______.

Type IV: Skin is ________, Freckles______, Sunburn_______, Tan_______.

Type V: Skin is ________, Freckles______, Sunburn_______, Tan_______.

A

Type I- white, a lot, always, never

Type II- fair, some, easily, minimally (with difficulty)

Type III: light brown, few, sometimes (initially), average

Type IV- moderate brown, ZERO, minimally, EASILY

Type V- dark brown, ZERO, rarely, dark tan (very easily)

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5
Q

Melanocytes:

What do they produce?

Eumelanin refers to _______ pigment.

Pheomelanin refers to_______ pigment.

A

–Pigment cells which produce melanin packaged in granules called melanosomes to protect from UV light

Eumelanin: black to brown pigment

Pheomelanin: yellow to red-brown pigment (less effective UV blocker).

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6
Q

Melanogenesis

Defect in tyrosine gene involved in melanin production results in_________

A

Albinism

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7
Q

Skin pigmentation

How are melanocytes distributed in dark skin?

How are melanocytes distributed in light skin?

A
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8
Q

What is vitiligo?

Characterized by _______.

A

It is an autoimmune disorder against the melanocyte.

  • Acquired depigmentation
  • Microscopic finding is a complete absence of melanocytes
  • Commonly seen in periorificial (near body orifices-mouth) and acral (toward peripehery: fingers, hands) locations.
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9
Q

Vitamin D

Deficiency causes______.

It is essential for _______.

In the kidney the active form of vitamin D is __________.

A
  • The sunshine vitamin
  • Produced in response exposing the skin to sunlight.
  • Also acquired from foods: fish, fish liver oils, egg yolks, and fortified dairy and grain products.
  • Vitamin D is essential in bone mineralization
  • Deficiency of Vitamin causes rickets (weakened bones causing skeletal abnormalities).

Vitamin D synthesis:

Our skin naturally contains a precursor to vitamin D (7-dehydrocholesterol). When the sun’s ultraviolet rays touch the skin, they convert the precursor to a molecule called vitamin D3 (cholecalciferol), which then follows a metabolic pathway through the liver and finally to the kidneys, where it’s converted into a molecule called calcitriol. That’s the good stuff—the active form. (Vitamin D obtained from food or supplements must also follow that metabolic pathway to become active.)

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10
Q

Basal Cell Layer (Stratum basalis/stratus germinativum)

A
  • Innermost layer of the epidermis
  • Contains small round cells called basal cells
  • Location of Stem Cells
  • Basal cells continually divide, and new cells constantly push older ones up toward the surface of the skin, where they are eventually shed.
  • Maturation occurs continuously and renewal of the epidermis takes 28 days
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11
Q

What are hemidesmosomes?

A

–Attachment point of basal cells to the basal lamina of the dermal- epidermal junction

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12
Q

Antibodies to proteins (230 or 180) in the hemidesmosomes may cause autoimmune blistering diseases such as ____________.

What kind of blisters are they?

What are bulla?

A

Bullous pemphigoid

  • Primary skin lesions are tense bulla
  • Pathogenesis: Autoantibodies to BP180 (type XVII collagen) or BP230
  • Pathology: *Subepidermal blisters

***Bulla are circumscribed, elevated lesion containing clear serous or hemorraghic fluid that is > 1 cm in diameter.

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13
Q

Epidermolysis bullosa

What are they?

Characterized by ______ formation and response to _________ trauma.

A

Epidermolysis bullosa (EB) is a group of inherited bullous disorders characterized by blister formation in response to mechanical trauma.

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14
Q

Types of Epidermolysis bullosa and the level at which they occur in the hemidesmosome:

EB simplex occurs due to defect in ___1____.

EB junctional is due to defects in____2_____.

EB Dystrophic is due to defects in ________.

A

1- Keratin 5 or 14

2- collagen XVII or laminin 5

3- collagen VII

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15
Q

Junctional EB

Due to genetic defects in ________.

Clinically presents as ______ that improves with age.

A

Due genetic defects in laminin 5.

Clinical: generalized onset of blisters, improves with age**

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16
Q

Recessive Dystrophic EB
Genetic defects in __________

Extensive dystrophic scarring can produce________ of the hand and feet.

Patients have an increased risk for __________.

A

Collagen VII

Extensive dystrophic scarring can produce pseudosyndactyly (mitten-hand deformity) of the hands and feet.

-Flexion contractures

Increased risk of ***squamous cell carcinoma

Other complications include infections.

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17
Q

Epidermolysis bullosa simplex
Genetic defects in _________

When do generalized blister occurs at?

What are the most common sites?

A

Keratin 5 and 14

Clinical: generalized onset of blisters occurs at or shortly after birth.

Hands, feet, and extremities are the most common sites of involvement

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18
Q

Stratum Spinosum

Just above the ______ layer.

A
  • Appears spiny due to the fact that the cells are held together with spiny projections (desmosome attachments).
  • The thickest layer of the epidermis, just above the basal layer
  • Keratinocytes produce keratin, a tough protective protein that makes up the majority of the structure of skin, hair and nails.
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19
Q

What are desmosomes?

A
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20
Q

Pemphigus Vulgaris

Characterized by ______ bulla.

They blister are __________.

A

Acquired antibodies to desmoglein 1 and desmoglein 3

  • Primary skin lesions are *flaccid bulla
  • Pathogenesis: Autoantibodies to desmoglein 1 and 3
  • Pathology: **Intraepidermal blisters
21
Q

Keratinocytes

22
Q

Stratus Granulosum

Characterized by the presnece of ______ granules that contain profilagrin (a filaggrin precursor).

Mutation of filagrin leads to DRY SKIN conditions including _____ and ________.

At this layer, what do cells loose?

A

**Keratohyalin granules contain Profilaggrin (filaggrin precursor). Filaggrin cross-links keratin tonofilaments and is important in the barrier function of the skin.

**Filaggrin is mutated in dry skin conditions including ichthyosis and atopic dermatitis.

  • Cells in this layer start to loose their nuclei
  • Lamellar bodies excrete lipids (ceramides).
23
Q

Stratum Corneum
Corneocyte Layer

A
  • Made up of dead and desquamating keratinocytes
  • Breakdown of filaggrin forms Natural moisturizing factor (NMF) which binds H2O to keep skin moist

•NMF levels in the skin decline with age

24
Q

Icthyosis Vulgaris and Atopic Dermatitis

Due to mutation in ______, which causes significant reduced levels of ____ in the stratum corneum and increase transepidermal water loss.

A

Due to mutated filaggrins

  • Defective skin barrier function due loss-of-function filaggrin mutations
  • Patients with filaggrin mutations have significantly reduced levels of the NMF in the stratum corneum and exhibit increased transepidermal water loss.
25
Other notorious cells of the epidermis:
**_Langerhans cells_** –Participate in _cell-mediated immunity_ as antigen presenting cells **Merkel cells** –Small cells associated with **nerve endings** in epidermis. Their function has long been uncertain, but they seem to be involved in neural development and _tactile sensation._ Recent evidence supports a role for Merkel cells in **_light touch._**
26
Stratum Lucidum
27
**Regional Variation of skin** **Scalp** What gland types are easy to find?
The scalp is relatively easy to identify a biopsy from the scalp; many *_terminal hairs_* are found deeply anchored in the **subcutaneous tissue.** However, biopsies from bald areas can mimic the skin of the face. **\*\*Sebaceous glands** are also numerous in a normal scalp, whereas _apocrine glands_ are few, small, and nonfunctional. On the contrary, \***eccrine glands** are easy to find.
28
Face ## Footnote Rich is ______ glands.
In general, the skin of the face is rich in \*\***pilosebaceous units** and poor in _apocrine glands_, which appear small and nonfunctional. As individuals age, _solar elastosis_ is a common and prominent finding in the dermis. _Vellus hairs_ are seen in the female face and in the nonbearded facial areas of men. Terminal hair follicles are found in the male bearded areas. When a sufficiently deep biopsy is taken from the periauricular area, the parotid gland parenchyma can be identified.
29
The Back
The dermis of the back is the **thickest reticular dermis** in all of the body (measuring more than 4 mm), and it is made up of **broad bundles of collagen**. Although a few eccrine glands can be seen, no apocrine glands are present. Pilosebaceous units are numerous in the midline.
30
The palms
The skin in these areas is thick to protect against constant friction and pressure. Both areas show a remarkably thick horny layer (compact type) with an accompanying prominent granular layer. The rete ridges are also prominent. These areas are devoid of pilosebaceous units, but they have a high number of \*\***eccrine glands (sweating)**. Numerous nerve endings are also a characteristic. This hairless, thick skin is also called **Glaborus skin**.
31
**Flat lesions** are: Macule and patch
**Macule**--\> Circumscribed change in skin color tha is flush with the sorrounding skin \<1 cm in diameter. Example: * -Solar lentigo* * -Traumatic purpura* **Patch--\>** Circumscribed change in skin color tha is flush with the sorrounding skin \>1 cm in diameter. * - Cafe aut lait spot* * -Vitiligo*
32
**Raised and Smooth:** Papule Plaque Cyst Nodule
**Papule**--\> A solid or cystic elevation \<1 cm in diameter (*Acne, Eruptive Xanthoma*). **Plaque--\>** An elevated lesion that is \>1 cm in diameter (*Psoriasis*) **Cyst** **Nodule--\>** A solid or cystic elevation \>1 cm but \<2 cm in diameter (Dermato-fibroma)
33
**Raised Scaly** \*papule with scale/plaque with scale
**Scale**--\> Dessicated, thin plates of cornified epidermal cells that form flakes on their skin surface.
34
**Fluid Filled** **vesicle/bulla/pustule**
**Vesicle**--\> Circumscribed, elevated lesion containing clear serous or hemorrhagic fluid that is \< 1cm (*Contact dermatitis, herpex simples*). **Pustule**--\> A vesicle containing purulent exudate (folliculitis).
35
Redness
36
Macule
Patch
37
Papules ## Footnote Figure A: Smooth papules associated with **tuberous sclerosis**. Figure B: **_Erythematous papules_** in an _arthropod reaction_.
Plaques ## Footnote Figure A: Fixed, _urticarial_ plaques with _halos_. Figure B: Confluent deep red erythematous plaques of _psoriasis._
38
Nodules ## Footnote Figure A: Dome-shaped _dermatofibroma._ Figure B: _Subcutaneous rheumatoid nodule_
Surface change
39
Scale ## Footnote Figure A: Multiple scaly papules and plaques in _guttate psoriasis_. Figure B: Fine scale in _tinea corporis._
Crust Figure A: Green crust in a patient with _non-bullous impetigo._ Figure B: Honey-colored crust associated with _tinea faciale_. Figure C: Hemorrhagic crusting in a patient with _stevens-johnson syndrome_
40
Vesicle ## Footnote Figure A: Grouped, umbilicated vesicles in a patient with _zoster_. Figure B: Tense vesicles in dyshidrotic dermatitis.
Bulla
41
Pustule ## Footnote Figure A: Multiple pustules on an erythematous base in a patient with **pustular psoriasis**. Figure B: Extensive severe pustules in child with pustular psoriasis
Erythema
42
Erythroderma
Telangiectasias ## Footnote Figure A: Severe rosacea with large telangectasias of nose in an adult male. Figure B: Telangiectasia macularis eruptiva perstans in an adult male
43
Ecchymoses
Petechiae
44
Palpable purpura
Atrophy
45
Erosion
Ulcer
46
Fissure ## Footnote Figure A: Deep fissures in a patient with _dermatitis_. Figure B: Fine fissures of the lower extremity in _xerotic dermatitis_.
Eschar
47
Limited distribution
limited distribution Figure A: Numerous umbilicated vesicles in a dermatomal distribution in a patient with **zoster**.
48
**Limited distribution**
**Extensive distribution**
49
Extensive distribution:
Extensive Distribution: