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1128 > Skin > Flashcards

Skin Flashcards

1
Q

Functions of the Skin

A
  • Protection
  • Regulation
  • Sensation
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2
Q

Protection

A 
Barrier between the external environment
• Mechanical impacts and pressure
• Variations in temperature
• Micro-organisms
• Radiation (UV light)
• Chemicals
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3
Q

Regulation

A 
• Body temperature is regulated via:
=>Sweat glands
 =>Hair
 =>Subcutaneous fat
• Changes in peripheral circulation 
• Fluid balance via sweat
• Vitamin D synthesis
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4
Q

Sensation

A 
• Receptors for:
=> Pressure
=> Touch
=> Temperature
=> Pain
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5
Q

Structure of the Skin - 3 layers

A
  1. Epidermis
  2. Dermis
  3. Subcutaneous layer
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6
Q

Epidermis

A

• Outer protective layer
• Keratinocytes
=> synthesise the protein keratin
• Cells replaced ~ every 35 days

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7
Q

Dermis

A
  • Collagen for strength
  • Elastic fibers to allow stretch
  • Blood and nerve supply
  • Hair follicle
  • Sebaceous and sweat glands
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8
Q

Subcutaneous layer

A
  • Hypodermis

* Layer of adipose tissue

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9
Q

Types of cells in the Epidermis

A

• Keratinocytes – produce Keratin
• Melanocytes – produce melanin pigment
• Langerhans cells – from the bone marrow
=> provide immunity
• Merkel cells – form the touch receptor with the
sensory neuron

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10
Q

Layers of the Epidermis

A
  1. Stratum corneum
  2. Stratum lucidum
  3. Stratum granulosum
  4. Stratum spinosum
  5. Stratum basale
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11
Q

Layers of the Epidermis

1. Stratum Corneum

A
  • Horny layer
  • 10-30 layers of dead keratinocytes
  • Create a barrier to protect
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12
Q

Layers of the Epidermis

2. Stratum Lucidum

A
  • Thin translucent layer

* Clear, flat, dead keratinocytes

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13
Q

Layers of the Epidermis

3. Stratum Granulosum

A 
• 3-5 layers of flattened cells with deteriorating organelles
• Lamellar granules 
=> release lipids
• Keratohyaline granules 
=> help make keratin
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14
Q

Layers of the epidermis

4. Stratum spinosum

A

• Layers of keratinocytes unified by desmosomes

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15
Q

Layers of the epidermis

5. Stratum basale

A
  • Deepest layer of epidermis
  • 1 row of actively mitotic stem cells
  • As cells divide & differentiate they move to the surface
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16
Q

Structure of the Epidermis

Barrier functions

A

• Keratinocytes => produce keratin = mechanical strength
• Langerhans cells => immune protection
• Lipids and enzymes = chemical protection
• Acid pH 4-4.5
• Skin flora - microorganisms on skin surface
=> repel other microorganisms

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17
Q

Dermis layers

A
  • Papillary layer => loose connective tissue

* Reticular layer => dense & irregular connective tissue

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18
Q

Dermis types of tissue

A
  • Collagen => strength
  • Elastin => elasticity
  • Reticular fibers => protein fibers
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19
Q

Dermis glands

A
  • Sweat glands => produce sweat = temperature regulation

* Sebaceous glands => produce sebum = lubricates skin

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20
Q

Dermis hair follicles

A

• => Protection and temperature regulation

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21
Q

The Dermis consists of blood vessels for

A

• Excretion + temperature control

=> Hot = sweating, vasodilation, insensible perspiration

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22
Q

Skin Pathologies

A

• Physical disruption of the skin => cuts, grazes, burns, wounds, pressure sores
• Infection
=> Bacterial – cellulitis, impetigo, boils
=> Fungal – athlete’s foot, ringworm
=> Viral – chickenpox, shingles
• Infestation – head lice, scabies
• Systemic pathology – measles, tumours, neuropathy
• Allergies – eczema
• Auto-immune disease – systemic lupus erythematous
• Adverse Drug Reactions – Stevens-Johnson syndrome

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23
Q

History Taking in Skin Conditions

A
  • Examine the affected area if appropriate
  • WWHAM (Who, What, How, • Action taken, Medical history)
  • When/where did it start?
  • Any other symptoms?
  • Any potential triggers?
  • Is anyone else affected?
  • Occupational history
  • General medical history
  • Ask the patient what they think it might be
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24
Q

Differential Diagnosis

A
  • Appearance => red all over/ defined regions?
  • Distribution => is it all over the body, in certain places, or random distribution.
  • What does it feel like => rough, smooth, lumpy
  • Symmetry => diagnostic of some conditions
  • Broken skin
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25
Q

Red Flags => Referral

A
  • A changing mole
  • Widespread lesions
  • Recurrent infections
  • Systemically unwell
  • Sudden/ severe loss of hair
  • Uncontrollable itching
  • Herpetiform lesions
  • Other symptoms – e.g. joint pain/ night sweats
  • Recently returned from travels
  • Affecting mucus membranes
  • Suspected meningitis
  • Non accidental injury/ bruising
  • Suspected link with medication
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26
Q

At Risk Groups

A
  • Babies and young children
  • Elderly patients
  • Pregnant women
  • Immunocompromised patients
  • Patients taking other medicines
  • Patients with pre-existing skin conditions
  • Patients with neuropathy
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27
Q

Treatment Principles

A
  • Treat the underlying cause
  • Preventative measures – emollients
  • Topical or systemic therapy
  • Consider the formulation
  • Consider allergies/ sensitivities to excipients
  • High concentration of paraffin = fire risk
  • Application of multiple products
  • Steroids dose – Finger tip unit (FTU)
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28
Q

Dry Skin

A
  • Moisture content of the skin is reduced
  • Causes small fine flakes and dry patches
  • Itching is one of the most common symptoms of dry skin
  • Dry skin may be a side effect of some medicines
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29
Q

Dry skin is more common in

A
  • Colder winter months
  • Elderly patients
  • Hypothyroidism
  • Patients with a history of eczema
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30
Q

Dry Skin Cycle

A

=> Itch => Scratch => Damaged Skin =>Release of Inflammatory Chemicals

31
Q

Eczema = Dermatitis ?

A
  • Dermatitis = inflammation of the skin

* Eczema = acute/chronic, allergy/genetic

32
Q

Types of Dermatitis

A
  • Irritant contact dermatitis
  • Allergic contact dermatitis
  • Atopic eczema
33
Q

Types of Dermatitis - Irritant Contact Dermatitis

A

=> direct damage caused by a provoking agent

e.g. handling water, detergents, solvents or harsh chemicals and by friction

34
Q

Types of Dermatitis - Allergic Contact Dermatitis

A

=> hypersensitivity of skin
when in contact with substances that most people don’t react to
e.g. nickel, perfume, rubber, hair dye or preservatives

35
Q

Types of Dermatitis - Atopic Eczema

A

=> chronic itchy skin condition - commonly

prevalent in children

36
Q

Eczema = Dermatitis ? Causes

A 
• Irritants
e.g. detergent, soap, acid and alkalis (cement) and
oils
• Allergens
e.g. nickel, topical corticosteroids, cosmetics,
rubber, late and dyes
• Genetics 
e.g. a family history of dermatitis
37
Q

Dermatitis Signs + Symptoms

A
  • Red, sore, itchy skin
  • Papules and vesicles may appear
  • Blistering
  • Crusting
  • Fissures
  • Weeping
  • Can be acute or chronic
38
Q

Dermatitis Differential Diagnosis

A
  • Psoriasis
  • Fungal skin infections
  • Pompholyx
39
Q

Dermatitis Referral

A
  • Widespread/ severe / broken skin
  • Lesions on the face not responding to emollients
  • OTC treatment failure
  • Children under 10 years who need a steroids
40
Q

Treatment for Dermatitis

A 
Emollients
Steroids
Humectant
Antiseptics
Antipruritic
41
Q

Emollients are

A

• Moisturisers

=> help soothe the skin and provide relief from itching and dryness.

42
Q

Emollients mode of action

A

• Trap moisture in the skin and form a protective oily layer on the outer skin
surface.
=> helps the skin repair and improves skin hydration.

43
Q

Steriods mode of action

A

• Reduce inflammation in the skin

44
Q

Humectant

A

• Penetration skin layers + attract + retain h2o

=> h2o from the Dermis is moved to the Epidermis to hydrate the Stratum Corneum,

45
Q

Antiseptics

A

• Slows or stops the growth of micro-organisms on external surfaces of the body + helps to prevent infections

46
Q

Antiseptics help prevent infections because

A

=> When you itch you damage the skin barrier function + microbes can get into the skin causing an infection

47
Q

Antiprutitic

A

• Relieves itching

48
Q

Dermatitis Treatment

- Emollients Active Ingredient + Pharmaceutical Product

A 
=> Cetraben cream 
• White soft paraffin 
• Liquid paraffin 
=> Diprobase ointment 
• White soft paraffin 
• Liquid paraffin 
=> Balneum bath oil 
• Soya oil
49
Q

Dermatitis Treatment

- Steriods Active Ingredient + Pharmaceutical Product

A

=> Hc45
• Hydrocortisone 1% (mild potency steroid)
=> Eumovate
• Clobetasone 0.5% (moderately potent steroid)

50
Q

Dermatitis Treatment -

Humectant Active Ingredient + Pharmaceutical Product

A

=> Hydromol intensive

• Urea 10%

51
Q

Dermatitis Treatment -

Antiseptics Active Ingredient + Pharmaceutical Product

A 
=> Dermol 500 lotion
•Benzalkonium chloride 
• Chlorhexidine Hydrochloride
• Liquid Paraffin
• Isopropyl Myristate
52
Q

Dermatitis Treatment

- Antipruritic Active Ingredient + Pharmaceutical Product

A

=> Eurax

• Crotamiton

53
Q

Dermatitis Treatment Formulations

A
  • Bath oil
  • Cream
  • Gel
  • Lotion
  • Oil
  • Ointment
  • Pastes
  • Shower gel
54
Q

Dermatitis Treatment Formulation - Ointments

A

• Greasy in nature
• They are usually made of White Soft Paraffin/ Liquid Paraffin
• Ideal for very dry or thickened skin + night-time application
• They do not usually contain preservatives (ingredients that help to protect the product from bacteria + increase its shelf-life)
=> + are therefore less likely to cause skin reactions

55
Q

Dermatitis Treatment Formulation - Creams

A

• Contain a mixture of oil and water
Less greasy
• Easier to spread on the skin than ointments
• Should be used frequently and applied liberally to prevent the skin from drying out
• Creams usually come in a container with a pump dispenser
• Good for day-time application

56
Q

Dermatitis Treatment Formulation - Lotions

A
  • Contain the least oil and most water
  • Least effective in moisturizing the skin
  • They normally contain preservatives so may cause skin irritation
  • Lotions are useful for hairy areas such as scalps
57
Q

Seborrhoeic Dermatitis (Cradle Cap in Infants) Causes - Unknown

A
  • Increased cell turnover - could be linked to immunological, hormonal, nutritional factors
  • Malassezia ovale (which is a yeast) involved
  • May be related to medication e.g. haloperidol, methyldopa, lithium, phenothiazines
58
Q 
Seborrhoeic Dermatitis (Cradle Cap in Infants) 
Signs + Symptoms
A

• Cradle Cap = large yellow greasy scales which crust over
=> Can sometimes affect other areas too (e.g. face, ears and skin folds)
• Adults ranges from dandruff (not inflamed)to more severe inflamed condition
• More common in men than women
• No change in sebum production

59
Q

Seborrhoeic Dermatitis Differential diagnosis

A
  • Atopic Dermatitis

* Psoriasis

60
Q

Seborrhoeic Dermatitis Referral

A
  • OTC treatment failure

* Lesions are weeping, broken skin, widespread

61
Q

Seborrhoeic Dermatitis Treatment

A
  • Cradle cap = Dentinox cradle cap shampoo (Sodium lauryl ether sulphate), Olive oil
  • Adults seborrheic dermatitis = medicated shampoos (can cause local irritation)
62
Q

Seborrhoeic Dermatitis Treatment: Pharmaceutical Product, Active Ingredient , Mode of action

A 
=> Nizoral 
• Ketoconazole 
• Anti-fungal & anti-dandruff 
=> Selsun
• Selenium sulphide
• Anti-fungal & anti-dandruff
=>Polytar or Neutrogena T/Gel
• Coal Tar
• Antiseptic & anti-inflammatory action
=> Capasal Therapeutic Shampoo (coal tar & coconut oil)*
• Salicylic acid
• Keratolytic, reduces itchiness and dandruff
63
Q

Systemic Illnesses Affecting the Skin – Infections

A
  • Meningitis
  • Measles
  • Mumps
  • Rubella
64
Q

Systemic Illnesses Affecting the Skin – Infections

Meningitis

A
  • Stiff neck, headache, fever, drowsy

* Blotchy red rash doesn’t fade when glass rolled over it

65
Q

Systemic Illnesses Affecting the Skin – Infections

Measles

A
  • Cold like symptoms for 7-10 days before rash appears

* Sore, red eyes that may be sensitive to light

66
Q

Systemic Illnesses Affecting the Skin – Infections

Mumps

A

• Painful swelling of the parathyroid glands (hamster face)

67
Q

Systemic Illnesses Affecting the Skin – Infections

Rubella

A

• Swollen glands and fever

68
Q

Systemic Illnesses Affecting the Skin - Erythema Multiform Causes

A
  • Adverse drug reaction (e.g. antibiotics such as tetracyclines, NSAIDs)
  • Triggered by an infection (i.e. viral infection)
69
Q

Systemic Illnesses Affecting the Skin - Erythema Multiform Symptoms

A

Rash – suddenly develops in a few days (starts on the hands and feet and
spreads to limbs, upper body and the face). Starts as small red spots which
can become raised. Patches look like a target (bulls-eye). Fades after 2-4
weeks.
• High temperature, headache, generally feeling unwell, achy joints
• Sores inside the mouth (make it hard to eat and drink)
• Sore eyes, sensitivity to light & blurred vision
• Sores on the genitals (makes urination painful)s

70
Q

Systemic Illnesses Affecting the Skin - Erythema Multiform - Treatment

A
  • Stop the medicine which may be triggering the reaction
  • Antiviral tablets (if caused by a viral infection)
  • Antihistamines (to reduce itching)
  • Emollients (to reduce itching)
  • Steroid cream to reduce redness and swelling (inflammation)
  • Pain relief
  • Anaesthetic mouthwash to ease the discomfort of any mouth sores
  • Antibiotics – if a bacterial infection develops
71
Q

Adverse Drug Reactions Affecting the Skin -

Stevens Johnson Syndrome (SJS)

A
  • Flu like symptoms
  • Red-purple rash that quickly spreads and forms blisters
  • Skin dies and peels off
  • Medical emergency
72
Q

Medicines which cause Stevens-Johnson Syndrome SJS:

A
  • Allopurinol
  • Carbamazepine
  • Fluconazole
  • NSAIDs (e.g. Ibuprofen)
  • Paracetamol Phenobarbital
  • Phenytoin
  • Sertraline
73
Q

Adverse Drug Reactions Affecting the Skin -

Toxic Epidermal Necrolysis (TEN)

A
  • Prodromal symptoms (fever, sore throat, conjunctivitis)
  • Red, burning/ painful rash
  • Spreads across the body
  • Hair and nails may be shed
  • Epidermis layer peels off
74
Q

Medicines which cause Toxic Epidermal Necrolysis (TEN)

A
  • Allopurinol
  • Ampicillin
  • Anti-convulsants (carbamazepine, phenytoin)
  • Corticosteroids
  • NSAIDs

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