OHCEPS - Skin, Hair, and Nails Flashcards
What is also important to keep in mind about the skin?
Has an important psychosocial function - When we look at another person we are in fact looking at their skin.
What is almost 90% of epithelial cells of epidermis?
Keratinocytes.
What is the time taken from forming in the basal layer to shedding?
Usually 3 months.
What determines the skin tone?
The size and the number of melanin granules and NOT by the number of melanocytes.
What do we find inside the dermis?
- Skin appendages
- Muscles
- Nerves
- Blood vessels
What is the hypodermis?
Also known as the subcutaneous layer or the superficial fascia, this consists of adipose tissue and serves BOTH as a lipid store + provides insulation.
Also contributes to the body contours and shape.
After infancy, when do sebaceous glands become active again?
At puberty + secrete sebum - A mixture of fatty acids and salts, directly onto the skin or into the necks of hair follicles.
In which sites are the sebaceous glands particularly numerous?
- Upper chest
- Back
- Face
- Scalp
What do sweat glands secrete?
A mixture of:
- Water
- Electrolytes
- Urea
- Urate
- Ammonia
- Mild acids
Where do we find ECCRINE glands?
All over the body surface, besides the mucosa.
Where do we find APOCRINE sweat glands?
- Axillae
- Pubic regions
- Secrete a more viscous sweat and are under clear autonomic control.
- These do not function until puberty.
Human are covered with hair, apart from which sites?
- Palms
- Soles
- Inner surface of the labia minora
- Prepuce
- Glans penis
Most is fine, unpigmented, vellous hair –> NOT EASILY SEEN.
Growth is cyclical with each follicle shedding its hair and then regrowing. How much does a cycle last?
4 years for scalp hair.
What are basically the nails?
Sheets of keratin which are continuously produced by the matrix at the proximal end of the nail plate.
How fast do nails grow?
0.1mm/day –> toenails growing slower than fingernails.
What is important to keep in mind about the dermatological history?
Don’t waste time listening to the patient describe what the rash looks like –> You’re about to examine it yourself.
During dermatological history, what factors which either trigger or relieve the problem should specifically asked?
- UV light
- Foods
- Temperature
- Contact with any other substances
What should be asked during PMH?
- Previous skin problems?
- Diabetes, connective tissue disease, IBD, asthma?
- What does the patient use on their skin? - soaps, creams, cleansers.
What should be asked during the family history?
- Atopy
- Eczema
- Psoriasis
- Skin cancers
How should we treat alopecia?
In much the same way as any other symptom:
1. Mode of onset (sudden/gradual)
2. Associated symptoms
3. Pain
4. Rash
5. Family history of hair loss
Note ALSO –> Regions of hair loss - recognizable pattern?
If the patient reports abnormal hair growth, treat as any other symptom, BUT what must also be asked?
- FHx of similar problem.
- Menstrual cycle - when was the last one, regular or erratic?
- Symptoms of virilization –> voice change, clitoromegaly.
- DHx
What happens in male pattern baldness and when does it start?
- Commonly occurs from the 2nd decade.
2. Hair is lost first from the temporal regions, frontal and crown.
What is the alopecia areata?
- Associated with autoimmune disorders and occurs in the 2nd or 3rd decade.
- Sharply defined, non-inflammatory patches on the scalp.
- May be “exclamation mark” hairs which are thinner at the base.
- Also affects eyebrows and beard.
- Nails may be slow-growing and show pitting.
What is alopecia totalis?
Loss of hair from all of the scalp.
What is alopecia universalis?
Loss of all body hair.
What is telogen effluvium?
- Normally, hairs are growing and shedding at different times and at different rates.
- A severe illness, high fever, or childbirth may synchronize all the hair follicles causing them to shed at the same time –> about 3 months later.
- This gives a brief total hair loss which grows back.
What is scarring alopecia?
Inflammatory lesions causing hair loss include:
- Lichen planus
- Burns
- Infection
Mention altogether the important hair disorders/signs?
- Male-pattern baldness
- Alopecia areata
- Alopecia totalis
- Alopecia universalis
- Telogen effluvium
- Scarring alopecia
In which persons may splinter hemorrhages be a NORMAL finding?
In manual workers, caused by trauma.
With what conditions is pitting of the nails associated with?
- Psoriasis
- Eczema
- Lichen planus
- Alopecia
What is the pitting of the nails?
Tiny indentations in the surface of the nail.
What is onycholysis?
Premature lifting of the nail.
What is leukonychia?
White discoloration of the nail.
What does leukonychia indicate?
A sign of low albumin or chronic ill-health.
What are the Beau’s lines?
Transverse depressions in the nail.
What is paronychia?
Infection of the skin adjacent to the nail –> causing pain, swelling, redness, and tenderness
What is koilonychia?
Spooning (concave indentation) of the nail.
With what is koilonychia associated with?
With severe iron-deficiency.