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4 Clinical Physiology > L9 Skin > Flashcards

L9 Skin Flashcards

1
Q

Skin functions

A

Protection
Sensation
Thermoregulation
Immune System
Endocrine System/Metabolism

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2
Q

Somatosensory receptors

A

Merkel’s disk
Meissner’s Corpsule
Ruffini Ending
Pacinian Corpuscle

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3
Q

Skin layers

A

Epidermis
Dermis
Subcutaneous Tissue

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4
Q

Epidermis

A

outermost layer that provides 1st barrier of protection

avascular
Keratinocytes and Nonkeratinocytes

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5
Q

Keratinocytes

A

primary cells of epidermis, synthesize keratine

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6
Q

Non-kertinocytes

A

Melanocytes
Langerhans’ cells
Mechanoreceptors

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7
Q

Melanocytes

A

synthesize melanin and pigment responsible for skin color
protects against UV

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8
Q

Langerhans’ cells

A

involved in immune response as antigen-presenting cells

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9
Q

Mechanoreceptors

A

Merkel, Meissner, Ruffini

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10
Q

Layers of Epidermis

A

Stratum…
Corneum
Lucidum
Granulosum
Spinosum
(Langerhan’s, Melanocytes, Merkel)
Basale

(Come, let’s get sun-burnt)

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11
Q

Dermis

A

provides thermoregulation and supports vascular network to supply nutrients to avascular epidermis

2 regions: papillary, reticular

contains many cells, vascular, nerve

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12
Q

Papillary layer of Dermis

A

thin, loose connective tissue just under epidermis
free nerve endings

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13
Q

Reticular Layer

A

thicker, irregular tissue beneath papillary layer, provides strength and elasticity

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14
Q

What does the dermis contain?

A

fibroblasts, macrophages, mast cells, lymphatic vessels, blood vessels, nerves, eccrine/apocrine units

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15
Q

Epidermal appendages

A

sweat glands
hair follicles
nails
sebaceous glands

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16
Q

Eccrine glands

A

directly to surface of skin, thermoregulation

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17
Q

Apocrine

A

joins at hair follicle
does not produce sweat continuously, but at times of stress

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18
Q

Hypodermis role

A
  1. largest store of energy
  2. provides insulation from thermal stress of cold environment
  3. largest endocrine organ in body
  4. significant effects on immune system
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19
Q

Effects of aging on epidermis

A

becomes thinner
decreased number of melanocytes
fewer langerhan’s cells
decreased vitamin d synthesis

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20
Q

Epidermis becomes thinner

A

more hyper-reactive to skin irritants
increased risk of skin tearing

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21
Q

Decreased # of melanocytes in epidermis

A

loss of photoprotection
increased risk of cancer

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22
Q

Fewer Langerhans’ cells in epidermis

A

decreased immune response
increased risk of skin cancer

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23
Q

Decreased Vitamin D Synthesis in epidermis

A

increased risk of osteoporosis

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24
Q

Dermis and Aging

A
  1. Decreased dermal thickness and degeneration of elastin fibers
  2. Changes in epidermal appendages
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25
Q

Decreased dermal thickness and degeneration of elastin fibers in dermis

A
  1. slower wound healing
  2. increased susceptibility to shear force trauma
  3. Altered thermoregulation
  4. Less scar tissue
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26
Q

Changes in epidermal appendages in dermis

A
  1. decreased number of altered structure of sweat glands
  2. Impaired sensation, increased pain threshold
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27
Q

Skin disorders that are contagious

A

impetigo
chickenpox
superficial fungal skin infections (tinea)
warts
scabies
lice

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28
Q

Macule

A

circumscribed flat discoloration
may be brown, blue, red or hypopigmented

freckle
cafe au lait spots (birthmarks)

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29
Q

Pustule

A

circumscribed collection of leukocytes and free fluid that varies in size

acne
folliculitis

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30
Q

Vesicle

A

circumscribed collection of free fluid
less than .5 cm in diameter

example is a herpetic lesions from chickenpox

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31
Q

Bulla

A

circumscribed collection of free fluid that is greater than .5 cm in diameter

lupus erythematosus

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32
Q

Wheal

A

firm edematous plaque resulting from infiltrations of dermis with fluid. Transient, may last only a few hours

hives
insect bites

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33
Q

Papule

A

elevated solid lesion, color varies, papules may become confluent (grown together) and form plaques

melanoma, warts, moles, skin tags

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34
Q

Scale

A

excess dead epidermal cells produced by abnormal keratinization and shedding

eczema, psoriasis, lupus

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35
Q

Crust

A

collection of dried serum and cellular debris

scab, impetigo, tinea capitis

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36
Q

When should a PT document skin lesions?

A

any time you note a lesion during eval or tx
any time a pt or client reports S/S of skin lesions
possibly medical referral would be needed

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37
Q

How should a PT document a skin lesion?

A

Location
Characteristics
Exudate

38
Q

Location of skin lesion

A

generalized or localized
region of body
unilateral/bilateral
pattern

39
Q

Characteristics documentation

A

Size and shape
color and temp
tenderness, pain, pruritic
texture
mobility
elevated or depressed

40
Q

Exudate documentation

A

color
odor
amount
consistency

41
Q

Atopic dermatitis

A

chronic inflammatory skin disease
Begins in infancy, red, oozing rash
skin becomes dry, thickened
common on face and flexor surfaces
S/S: xerosis and pruritus

not contagious

42
Q

Xerosis

A

abnormal dryness

43
Q

Pruritus

A

intense itching

44
Q

Treatment of atopic dermatitis

A

no cure, often resolves spontaneously
therapy is aimed to break inflammatory cycle–> personal hygiene and topical medications

45
Q

Eczema

A

flexing folds
has acute, subacute, chronic stages

common in older people
may be caused by venous insufficiency, allergens

46
Q

Reminders for Eczema/dermatitis

A
  1. Provide education
  2. Avoid using topical agents containing alcohol
  3. Provide resources
47
Q

Rosacea

A

inflammatory skin condition that causes redness of face

often cyclic, with flare-ups lasting weeks-months

Usually impacts those with lighter skin, women, adults

48
Q

Clinical Presentation of Rosacea

A
  1. red areas on face
  2. small red bumps or pustules on nose, cheeks, forehead, chin
  3. Visible blood vessels on nose and cheeks
  4. Tendency to flush or blush easily
  5. Burning or gritty sensation in eyes
49
Q

Rhinophyma

A

rare form of rosacea, severe cases
hypertrophy of sebaceous glands in nose

more common in men

50
Q

Pathogenesis of Rosacea

A

unknown cause
likely genetic and environmental factors

alcohol consumption does NOT cause rosacea, can worsen it

worsened by any condition that increases blood flow to skin surface

51
Q

Treatment of Rosacea

A

Rarely clears up on its own, tends to worsen over time if left untreated

dermatologist can be helpful, PTs can be helpful in referring

self-care (minimize sun, alcohol) can be beneficial

52
Q

Psoriasis

A

Chronic, hereditary inflammatory disorder that affects skin and nails

marked by itchy patches of thick red skin covered with silvery scales

cycles, most cases, the disease eventually returns

53
Q

Psoriasis epidemiology

A

More common in females, onset is 29 years
most common in white people

54
Q

Pathogenesis of psoriasis

A

develops when ordinary life cycle of skin cells accelerates

skin cells usually in 26-28 days, with psoriasis in 3-4 days

NOT contagious, lots of different triggers that can possibly cause it

55
Q

Psoriasis Treatment

A

no cure, treatment is meant to slow cell turnover with fewest possible adverse effects

Topical creams
Phototherapy

56
Q

PT role in Psoriasis

A

Meditation and stress reduction techniques can reduce healing time

proper application education of topical creams –> rub down, only lesions, gloves to reduce infection

57
Q

Benign skin tumors

A

seborrheic keratosis
nevi/moles
lipomas

58
Q

Premalignant skin lesions

A

actinic keratosis
bowen’s disease

59
Q

Malignant Skin lesions

A

basal cell and squamous cell cancer
melanoma

60
Q

Seborrheic keratosis

A

waxy yellow, light to dark brown or black papules

usually appear as though they are stuck on

very common, increasingly common in older age groups

medically insignificant

61
Q

Moles/Nevi

A

clusters of pigmented cells

normal: uniform in color with distinct borders

dysplastic: ABCDEs/irregular

62
Q

Lipomas

A

fatty tumors
within dermal subcutaneous layers
soft/fairly mobile, feel doughy

they are benign. Will be removed if cosmetically upsetting, symptomatic, size > 5 cm

63
Q

Actinic Keratosis

A

most common on sun-exposed surfaces of fair-skinned people

brown or dark-pink rough scaly plaques with well-defined margins

Tx: surgical excision, topical meds

can result in carcinoma

64
Q

Bowen’s disease

A

persistent, brown to reddish brown scaly plaque with well-defined margins

can occur anywhere on skin on mucous membranes

Tx: surgical excision and topical meds

65
Q

Skin cancer

A

abnormal growth of skin cells

Basal cell, squamous cell, melanoma

most common in women <40 yrs of age

develops primarily on areas of sun-exposed skin

66
Q

Basal cell carcinoma

A

90% of all cases of skin cancer

Usually appears as either pearly or waxy bump with rolled edges, small blood vessels on surface, slowly increase in size

Lesions commonly bleed, rarely metastasize, but 10% recur

67
Q

Treatment options of Basal Cell Carcinoma

A

depends on size, location, depth of lesion

Cyrosurgery
Curettage
Chemotherapy
Surgical Excision
Moh’s surgery

68
Q

Squamous cell carcinoma

A

less distinctive in apperance

occurs 60 year of age, men more than women

usually in sun damaged skin, hard horny crust

69
Q

Risk of metastatic spread with SCC

A

Lesion on unexposed skin
Lesion >1-2 cm in diameter
Lesion on nose, lip, ear

70
Q

Treatment of SCC

A

biopsy and histologic exam

Tx: depends on size, location, depth

Prognosis: tx has excellent cure rates

71
Q

Melanoma

A

malignant neoplasm orginating from melanocytes

comprises smallest % of all skin cancers, greatest # of deaths

occurs most commonly on upper back and legs

most common cancer in women 25-29

72
Q

Pathogenesis of Melanoma

A

Exact cause is unclear

thought to be caused by intensity rather than duration of sun exposure

73
Q

UVA

A

longer wavelength, damage melanocytes can impact subcutaneous

responsible for DNA damage and premature AGING of skin

74
Q

UVB

A

partially into dermis, can increase cancer growth

causes DNA damage to cells, responsible for SUNBURN

75
Q

UVC

A

never actively hits humans, absorbed by environment

76
Q

UV radiation

A

wavelength of sunlight in range too short for human eye to see

commercial tanning lamps and tanning beds produce high doses of UV radiation

77
Q

Skin Cancer Risk factors

A
  1. fair skin
  2. sunburn history
  3. sunny, high-altitude or equatorial climates
  4. mole
78
Q

Fair skin

A

less melanin = less protection from damaging UV radiation

79
Q

Sunburn History

A

> 3 blistering sunburns 20 year of age

> 3 year of outdoor summer work hx

80
Q

Sunny, high altitude or equatorial climates

A

more common in AZ than in MN

Altitude: 8-10% increase in UVB radiation for every 1000 ft of gain

81
Q

Mole risk factors

A

having 1 dysplastic mole doubles risk of melanoma

having > 50 ordinary moles increases risk

82
Q

Other skin cancer risk factors

A
  1. family or personal hx of cancer
  2. precancerous skin lesions
  3. increased age
  4. weakened immune system
  5. hazard exposure
  6. fragile skin
83
Q

ABCDEs

A

helpful in diagnosis of melanoma

Asymmetry
Border
Color
Diameter
Evolving

84
Q

Ugly Ducking sign

A

a mole that is obviously different than others in a given individual

85
Q

Diagnosis of Melanoma

A

first sign may be a change in an existing mole

scaliness, itching, change in texture, oozing, bleeding

can only be dx with a biopsy

86
Q

Treatment of melanoma

A

w/out evidence of spread: surgical excision

regional spread: surgery and radiation

87
Q

Prognosis of melanoma

A

99% curable, if detected early

determines on thickness/depth

ones that are deeper are at higher risk

Distant metastases have a lower survival rate

88
Q

Melanoma screening

A

monthly self-exams

skin screening exam every 3 years for those with not a ton of RF

89
Q

Sid the seagull ◡̈

A

Slip
Slop
Slap
Seek
Slide

90
Q

Skin cancer prevention

A
  1. Avoid peak sunlight hours
  2. Wear broad spectrum sunscreen year round
  3. Sunscreen should be 15 SPF, on all exposed skin
  4. Apply 30 min before sun exposure, 30 min after you are in the sun
  5. Wear protective clothing
  6. Avoid tanning beds
  7. Be aware of sun-sensitizing meds
91
Q

Photoprotective clothing

A

Lightweight fabrics either treated with a UV inhibitor or woven to eliminate penetration of UV rays

92
Q

SPF vs UPF

A

SPF = measures the time it takes UV rays to cause the skin to redden

UPF = measures amount of UV radiation that penetrates a fabric and reaches the skin

4 Clinical Physiology (9 decks)

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