L2 - Intro to Derm Flashcards by Emily Walter

Layers of the Skin

Epidermis
- Barrier from environment
- Waterproof
Dermis
- Blood vessels, hair follicles, sebaceous glands, sweat glands, nails, apocrine glands
Subcutaneous (Hypodermis)
- Subcutaneous fat and connective tissue

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Epidermis: Layers

What are the layers of the epidermis?

Stratum corneum
- Superficial layer with shedding dead skin
Stratum lucidum
- Layer found on palmar and plantar surfaces
Stratum granulosum
- Keratinization
Stratum spinosum
- Spiny-shaped cells (strength and flexibility)
Stratum basale
- Cells germinate: keratinocytes

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Epidermis: Cell types

What types of cells are found in the epidermis?

Keratinocytes
Melanocytes
Merkel cells
Langerhans cells

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Dermis

What is the function of the dermis?

What are the layers of the dermis?

Function
- Support structure that contains blood and lymphatic vessels, nerves, hair follicles, glands and fibrous tissue
- Provides flexibility, strength and contains sensation
Layers
- Papillary dermis (superficial dermis)
  - Comprised of a loose network of fine collagen bundles
- Reticular dermis (deep dermis)
  - Comprised of densely packed and thick collagen bundles
- Ground substance

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Hypodermis (subcutis)

What makes up the hypodermis?

Fibroblasts, adipose and macrophages
Subcutaneous fat
- Deepest layer
- Network of collagen and fat cells
- Conserves heat
Contains larger vessels and nerves

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Anatomy of the skin

What are the appendages of skin?

Hair
Nails
Sebceous glands
Sweat glands
- Eccrine
- Apocrine

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Eccrine Glands

Where are they located?

What do they do?

Covers most of the body
Abundant on the palms, soles and forehead
Releases salt and water to keep the body cool
Does not cause odor
Duct opens in pore at skin’s surface

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Apocrine Glands

Where are they located?

What do they secrete?

Triggers?

Concentrated in axillary and genital regions
Secretes into the sac of hair follicles
Releases thick clear odorless fluid
- Bacteria that live on the skin break down apocrine secretions, which leads to body odor
Triggered by nervous system
- Stress, exercise, hormones, emotions

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Hair Follicles

Vellus hairs: What are they? Where are they located?

Terminal hairs: What are they? Where are they located?

Bulb: What is it?

Vellus hairs
- Short and fine (forehead)
Terminal hairs
- Long and thick (scalp/axillae)
Bulb
- Enlargement at the base of follicle
- Matrix cells at inferior aspect of bulb
- Melanocytes within matrix contribute to pigment

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Physiology of the Skin

What is the function of the skin?

Protect from trauma and infection
Prevent fluid loss
Regulate body temperature
Provide sensory information
Produce vitamin D

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Morphology of Skin Lesions

What is morphology?

Morphology refers to how dermatologists describe forms and structure of skin lesions
- Key for diagnosis
- This is important when presenting to your preceptor
To arrive at the right description, you will need to perform:
- Visual inspection
- Tactile inspection

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Morphologic Characteristics of Skin Lesions

What are the morphologic characteristics?

Distribution
Shape / arrangement
Border / margin
Pigmentation / color
Palpation

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Morphological Characteristics of Skin Lesions

Distribution

What are the different distributions?

What is an example of each?

Localized

Lesions appear in one small area
Ex: Herpes Simplex Virus (HSV)

Regional

Lesions appear in a specific region of the body
Ex: Atopic dermatitis on flexor surfaces
Ex: Psoriasis on extensor surfaces

Generalized/disseminated

Lesions appear widely distributed or in multiple areas simultaneously
Ex: Chickenpox (Varicella-Zoster Virus)

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Morphologic Characteristics of Skin Lesions

Shape/Arrangement

What are the different shapes/arrangements?

What is an example of each?

Round/discoid
- Coin shaped
- No central clearing
- Seen with eczema
- Umbilicated lesions
Oval
- Ovoid
- Ex: Pityriasis rosea
Annular
- Round
- Active margins with central clearing
- Ex: Seen in tinea infections
Dermatomal
- Following a nerve segment
- Ex: Herpes or Varicella Zoster
Target
- Pink macles with purple central papules
- Ex: Erythema Multioforme
Linear
- Phytophotodermatitis
Serpiginous
- Cutaneous larva migrans
Morbilliform
- Measles-like
- Erythematous maculopapular lesions that become confluent on the face and body

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Morphological Characteristics of Skin Lesions

Borders/Margins

What are the types of borders/margins?

What is an example of each?

Distinct
- Well-demarcated or defined
- Able to draw a line around the area with confidence
Indistinct
- Poorly defined
- Borders merge with normal skin
Irregular
- Ex: Malignant melanoma
Raised
- Center of lesion is depressed compared to the edge
- Ex: basal cell carcinoma

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Morphological Characteristics of Skin Lesions

Color/Pigmentation

What are the types of colors/pigmentations observed?

What is an example of each?

Flesh colored
- Same color as surrounding skin
Erythematous
- Variable shades of red: pink, salmon, coppery, reddish-blue
Violaceous
- Light violet
Tan-brown
Black or blue-black
- Blue nevus
Hyperpigmented / Hypopigmented

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Morphological Characteristics of Skin Lesions

Palpation of Lesions

Whata are you feeling for?

Consistency
Mobility
Blanchable
- An erythematous lesion that loses all redness when pressed
- Diascopy (test for blanchability)
Tenderness
Depth of lesion
Deviation in temperature
Fluctuant

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ABCDs of Melanoma

A – asymmetry
- If cut in half, sides should mirror each other (doesn’t in melanoma)
B – borders
- Irregular
C – color
- Variegated
D – diameter
- >6mm
E – evolution or elevation
- Most important to assess with patient
- Has it changed in shape/size color

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Primary vs. Secondary Lesions

What do they arise from?

What are secondry lesions caused by?

Primary Lesions
- Arise from previously normal skin
- Key to diagnosis
Secondary Lesions
- Arise from changes in primary lesions
- Usually due to exogenous factors / changes
- i.e.: scratching, infection, rubbing, crusting, etc.

Primary Lesions:

Circumscribed, flat, nonpalpable

Macule vs. Patch

Primary lesions

Superficial elevations by free fluid

Vesicle

Bulla

Pustule

Primary lesions:

Palpable, elevated, solid masses

Papule

Plaque

Nodule

Tumor

Wheal

Furuncle vs. Carbuncle

what are they?

Cause?

Furuncle (aka: boil)
- Infection of single hair follicle
- S. aureus
Carbuncle
- Infection of multiple hair follicles
- S. aureus
- Can form an abscess

Secondary Lesions:

Material on the skin surface

Crust

Scale

**Secondary Lesions:** **Loss of skin surface** Fissure Erosion Ulcer

**Secondary Lesions:** **Miscellaneous lesions** Excoriation Atrophy Lichenification

**Vascular lesions:** **Petechiae vs. Purpura** Distribution Shape/ Arrangement Border Color Palpation Size

**Vascular Lesions:** **Ecchymosis vs. Spider Angiomas** Distribution Shape/ Arrangement Border Color Palpation Size

**Vascular Lesions:** **Cherry angiomas vs. Telangiectasias vs. Hemangioma** Distribution Shape/ Arrangement Border Color Palpation Size

**Categories of Skin Disease** What are the categories of skin disease?

Papulosquamous Nodular Vesiculobullous Maculopapular

**Categories of Skin Disease** Papulosquamous Lesions

**Categories of Skin Diseases: Lichen Planus** What type of skin disease? What are the 5 P's?

* Papulosquamous * The 5 P’s * Pruritic * Polygonal * Purpl * Planar * Papules

C**ategories of Skin Disease: nodular lesions** What are they? Cause? Examples?

* Nodular Lesions - Benign and malignant epidermal and dermal nodes * Benign * Nevi, cherry angiomas, epidermiid cyst * * Malignant * Squamous Cell carinoma (SCC) * Basal Cell Carcinoma (me * Benign and malignant epidermal and dermal nodes

**Categories of skin lesions: Vesiculobullous Lesions**

**Categories of Skin Lesions: Vesiculobullous Lesions**

* Examples: * Impetigo * Herpes * Pemphigus

**Categories of Skin Lesions: Vesiculobullous Lesions**

* Macules and papules * Examples: * Viral exanthems * Generalized, erythematous, * maculopapular rash * Drug eruptions

*Nail Disorders* **Clubbing**

* Rounded, bulbous nail base * Feels spongy * How to Diagnose * Flex the fingers of both hands * Bring index fingers together until distal phalanxes are touching * Diamond space between nails indicates no clubbing