SKIN 6131 Flashcards
protects the body against external insults in order to maintain
internal homeostasis
skin
Skin is _______ of our body mass
10%
Skin is the most accessible organ in the body (t or f)
T
It participates directly in ________, _________, ________, ________, and _________
thermal, electrolyte, hormonal,
metabolic, and immune regulation
- Thick stratum
corneum—good physical
barrier - Common site of contact with
chemicals - Occlusion with protective
clothing
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Palm/soles
- Moist, occluded areas
- Chemical trapping
- Enhanced percutaneous
absorption
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Intertriginous areas
example of Intertriginous areas
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
axillae, groin, neck, finger webs, umbilicus, genitalia
- Exposed frequently
- Surface lipid interacts with
hydrophobic substances - Chemicals frequently
transferred rom hands
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Face
- Poor barrier function—thin
epidermis - Sensitive to irritants
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Eyelids
- Chemical trapping
- Occlusion
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Postauricular region
- Chemical trapping
- Hair follicles susceptible to
metabolic damage
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Scalp
- Increased sensitivity to
irritants - Impaired barrier function
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Atopic dermatitis
- Impaired barrier function
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Psoriasis
- Predisposition to skin
disorders - Variation in sensitivity to
irritants - Susceptibility to contact
sensitization
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Genetic Factors
- Vasodilation—improved
percutaneous absorption - Increased
sweating—trapping
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Temperature
- Increased
sweating—trapping
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Humidity
- Variation in relative humidity
- Chapping and wind-related
skin changes
(FACTORS INFLUENCING CUTANEOUS RESPONSES)
Season
Two major components of the skin that are separated by a basement membrane
epidermis and underlying dermis
Thickness of dermis
approximately 90% of the skin (has largely a supportive function)
span the epidermis and are embedded in the dermis
epidermal appendages
examples of epidermal appendages
- Hair follicles
- Sebaceous glands
- Eccrine glands
Layer that separates the dermis from underlying tissues
adipocytes
Accumulation of fat has a cushioning action
adipocytes
Somehow regulates our body temperature
adipocytes
Supply the bulbs of the hair follicles and the secretory cells of the eccrine (sweat) glands.
Capillaries
The ducts from these glands carry a dilute salt solution (that is sweat) to the surface of the skin, where its evaporation provides cooling sensation.
capillaries
Stratified squamous epithelium consisting primarily of keratinocytes
Interfollicular epidermis
Interfollicular epidermis is a stratified squamous epithelium consisting primarily of __________
keratinocytes
stimulated by ultraviolet light in the epidermis to produce melanin granules which are extruded and taken up by the surrounding keratinocytes and become pigmented
melanocytes
Widely distributed in the dermis, with occasional concentrations beneath the basal lamina and in the
papillae of hair follicles
Melanocytes
Dendritic, antigen-presenting cells usually involved in the immune response of skin to foreign agents,
particularly to xenobiotics
Langerhans cells (LCs)
Keratinocytes of the ___________ make up the germinative compartment
basal layer
- Cells become flattened and increase in volume nearly 40-fold.
- Lipid granules fuse with the plasma membrane, replacing the aqueous environment in the intercellular space with their contents.
Granular Layer
- Plasma membranes of these cells become permeable and cell organelles are degraded, while a
protein envelope is synthesized immediately beneath the plasma membrane.
Granular layer
Begins as keratinocytes leaving the basal layer, producing the outermost layer of the skin, the stratum corneum.
Terminal Differentiation
- Mature cells
- No longer viable
- ~80% keratin in content
- They are gradually shed from the surface and replaced from beneath
Corneocytes
process typically takes 2 weeks or basal cells to reach the stratum corneum and another 2 weeks to
be shed from the surface
Terminal Differentiation
When a basal cell divides, one of the progeny detaches from the basal lamina and migrates outward. Usually moves towards the skin surface
Terminal differentiation
The primary barrier to percutaneous absorption
Stratum corneum
the stratum corneum is formed during the process of ___________
terminal differentiation
the stratum corneum has _________ properties which prevents water loss from underlying tissues by evaporation
Hydrophobic
The SC is ordinarily hydrated which contains around ____ water or the moisture residing in corneocyte protein
20%
The lipids, a major component being ________, have a high content of long-chain ceramides removal of which seriously compromises barrier function as measured by TEWL
sphingolipids
Two intrinsic factors which contributes to the absorption rate of a given compound
- Hydrophobicity
- Rate of Diffusion through this barrier
- Affects its ability to partition into
epidermal lipid, and its rate of diffusion through this barrier - Usually computed using the
octanol/water partitioning ratio
Hydrophobicity
↑ Kow = ____________
hydrophobic
Partitioning of an agent into the skin is greatly affected by its solubility in or adhesion to the medium in which it is applied (including soil) (t or f)
T
hydrophobic compounds, once in the SC, may diffuse rapidly into less hydrophobic regions below (t or f)
F; very slowly
Hydrophobic substances with low MW permeate the skin better than those with high MW or those that are hydrophilic. (t or f)
T
A list in order of decreasing permeability under steady-state
conditions gives the following hierarchy
foot sole > palm > scrotum > forehead > abdomen
Absorption through the epidermal appendages is generally
neglected because the combined appendageal surface area is
a small fraction of the total available area for the absorption (t or f)
T
Advantages of transdermal drug delivery
- Provides a steady infusion or extended periods (typically 1 to 7 days) thereby avoiding large variations in plasma concentration
- Preventing exposure to the acidic pH of the stomach
- Avoid biotransformation in the
gastrointestinal tract or from first-pass removal by the liver
For risk assessment and pharmaceutical design, the
most useful subject or experimentation is ___________
(Measurement of Penetration)
human skin
human skin is always used for clinical trials (t or f)
(Measurement of Penetration)
T
Human skin can also be used for pre-clinical trials (t or f)
(Measurement of Penetration)
F
For in vitro work, _______________ can be employed in special diffusion chambers, though care is needed to preserve the viability of the living layer of epidermis.
(Measurement of Penetration)
excised split-thickness skin
A simpler setup commonly employed uses ____________ skin with the lower dermis removed.
(Measurement of Penetration)
cadaver
No life. Lacks biotransformation
capability but retains the barrier function of the SC
(Measurement of Penetration)
Cadaver skin
To simplify determination of penetration kinetics, __________ may be employed and the _____________ monitored to measure penetration.
Pig skin may be used
(Measurement of Penetration)
skin flaps; capillary blood
flow
The major sites of biotransformation or metabolism of the skin
is the _________ and __________ of the skin.
epidermis; pilosebaceous units
Enzymes participating in the biotransformation that are expressed in the skin
- CYP450
- epoxied hydrolase
- UDP glucuronosyltransferase
- Quinone reductase
- Glutathione transferase
Other metabolic enzyme activities detected in human epidermal cells include:
- Sulfatases
- β-glucuronidase
- N-acetyltransferases
- Esterases
- Reductases
The intercellular region of the stratum corneum has catabolic
activities…..
- proteases
- lipases
- glycosidases
- phosphatase
- Common skin disorder
- Accounts or over 90% of reported causes (of all occupational skin
disease) - involve in inflammatory processes and can have indistinguishable clinical characteristics of erythema
(redness), induration (thickening and firmness), scaling (flaking), and vesiculation (blistering) on areas directly contacting the chemical agent.
Contact dermatitis
two types of contact dermatitis
- irritant
- allergic
both may co-exist
- Arises from the direct contact of agents on the skin at a higher concentration or longer exposure
- Certain chemicals at sufficient concentration produce an acute irritation, sometimes called a second-degree chemical burn.
Irritant dermatitis
- It can be produced by strong acids, alkalis, and powerful oxidizing or reducing agents can substantially disrupt the cornified layer, producing cytotoxicity directly
Irritant dermatitis
Contact with a variety of plants can also have irritant effects resulting in the production of proinflammatory cytokines like
IL1a, IL1B, and TNFa from keratinocytes
the back is more sensitive than the forearm (t or f)
T
____________ are the most sensitive to irritants and exhibit a propensity to produce specific IgE antibodies to allergens and typically suffer from hay fever
Atopic individuals
- Extremely corrosive and reactive chemicals may produce immediate coagulative necrosis that results in substantial tissue damage
Chemical burns
Manifestations of chemical burns
Ulceration and Sloughing
Chemical burns are sometimes referred to as ___________
Third degree burns
____________ can act as a chemical reservoir resulting in either continued cutaneous damage or percutaneous
absorption and systemic injury after exposure
Necrotic tissue
- Potent skin corrosive
- Contact with compressed
gas can cause frostbite
(SELECTED CHEMICALS CAUSING SKIN BURN)
Ammonia
- Severe chemical burns
- Extremely exothermic
reaction—dissolving in water
can cause heat burns
(SELECTED CHEMICALS CAUSING SKIN BURN)
Calcium Oxide (CaO)
- Liquid and concentrated
vapors cause cell death and
ulceration
(SELECTED CHEMICALS CAUSING SKIN BURN)
Chlorine
- Solutions and vapors may
burn - Compressed gas can cause
frostbite
(SELECTED CHEMICALS CAUSING SKIN BURN)
Ethylene oxide
Severe burning with scar
formation
(SELECTED CHEMICALS CAUSING SKIN BURN)
Hydrogen chloride (HCl)
- Severe, painful, slowly healing
burns from high concentration - Lower concentration causes
delayed cutaneous injury - Systemic absorption can
lead to electrolyte
abnormalities and death - Calcium-containing topical
medications and quaternary
ammonium compounds are
used to limit damage
(SELECTED CHEMICALS CAUSING SKIN BURN)
Hydrogen flouride (HF)
High concentration causes
severe burns and blistering
(SELECTED CHEMICALS CAUSING SKIN BURN)
Hydrogen peroxide
Liquid exposure produces
blistering, deep burns
(SELECTED CHEMICALS CAUSING SKIN BURN)
Methyl bromide
Moist skin facilitates the
formation of nitric acid
causing severe yellow-colored burns
(SELECTED CHEMICALS CAUSING SKIN BURN)
Nitrogen oxides
White phosphorus continues
to burn on skin in the presence of air
(SELECTED CHEMICALS CAUSING SKIN BURN)
Phosphorus
- Extremely corrosive even in
low concentrations - Systemic absorption through
burn sites may result in
> Cardiac arrhythmias, Renal
disease, and Death
(SELECTED CHEMICALS CAUSING SKIN BURN)
Phenol
High concentration causes
deep burns, readily denatures
keratin
(SELECTED CHEMICALS CAUSING SKIN BURN)
Sodium hydroxide
- Severe burns with contact
- Skin contact rarely may result
in respiratory sensitization
(SELECTED CHEMICALS CAUSING SKIN BURN)
Toluene diisocyanate
is a delayed (T-cell mediated) hypersensitive reaction
(SELECTED CHEMICALS CAUSING SKIN BURN)
Allergic contact dermatitis
Unlike contact irritants where the response is generally
proportional to applied dose and time, contact allergens can
elicit action even at small doses (t or f)
T
To induce sensitization, ______________ must penetrate the skin and become attached to carrier proteins
(ALLERGIC CONTACT DERMATITIS)
chemical haptens
complete antigens are processed by ____________ and presented to ___________ in regional lymph nodes
Langerhans cells; type 1 -helper cells
Subsequent exposure to the same antigen results in an amplified immune response characterized by ____________ and ____________
dermal infiltration; spongiosis
Topical medications/hygiene
products
(COMMON CONTACT ALLERGENS)
- Antibiotics
- Therapeutics
- Preservatives
- Others
- Bacitracin
- Neomycin
- Polymyxin
- Aminoglycosides
- Sulfonamides
(COMMON CONTACT ALLERGENS)
Under antibiotics
- Benzocaine
- Idoxuridine
- α-Tocopherol (vitamin E)
- Corticosteroids
(COMMON CONTACT ALLERGENS)
Under therapeutics
- Benzalkonium
chloride - Formaldehyde
- Formaldehyde releasers
- Quaternium-15
- Imidazolidinyl urea
- Diazolidinyl urea
- DMDM hydantoin
- Methylchloroisothiaolinone
(COMMON CONTACT ALLERGENS)
Under Preservatives/personal care products
- Cinnamic aldehyde
- Ethylenediamine
- Lanolin
- p-Phenylenediamine
- Propylene glycol
- Benzophenones
- Fragrances
- Thioglycolates
(COMMON CONTACT ALLERGENS)
Under Other topical medications and hygiene products
- Abietic acid
- Balsam of Peru
- Rosin (colophony)
- Pentadecylcatechols
- Sesquiterpene lactone
- Tuliposide A
(COMMON CONTACT ALLERGENS)
Under Plants and trees
- Chloramine
- Chlorhexidine
- Chloroxylenol
- Dichlorophene
- Dodecylaminoethyl glycine HCl
- Glutaraldehyde
- Hexachlorophene
- Thimerosal (Merthiolate)
- Mercurials
- Triphenylmethane dyes
(COMMON CONTACT ALLERGENS)
Under Antiseptics
- Diphenylguanidine
- Hydroquinone
- Mercaptobenzothiazole
- p-Phenylenediamine
- Resorcinol monobenzoate
- Benzothiazole sulfenamides
- Dithiocarbamates
- Thiurams
(COMMON CONTACT ALLERGENS)
Under Rubber products
- Formaldehyde
- Glutaraldehyde
- Potassium dichromate
(COMMON CONTACT ALLERGENS)
Under Leather
- Abietic acid
- Formaldehyde
- Nigrosine
- Rosin (colophony)
- Triphenyl phosphate
- Dyes
(COMMON CONTACT ALLERGENS)
Under Paper products
- Bisphenol A
- Epichlorohydrin
- Formaldehyde
- Acrylic monomers
- Cyanoacrylates
- Epoxy resins
- p-(t-Butyl)
formaldehyde resin - Toluene sulfonamide resins
- Urea-formaldehyde resins
(COMMON CONTACT ALLERGENS)
Under Glues and bonding agents
- Chromium
- Cobalt
- Mercury
- Nickel
(COMMON CONTACT ALLERGENS)
Under Metals
Chemical: Abietic acid
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Pine resin (colophony)
Chemical: Balsam of Peru
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Pine resin, cinnamates,
benzoates
Chemical: Bisphenol A
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Diethylstilbestrol, hydroquinone monobenzyl ether
Chemical: Canaga oil
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Benzyl salicylate
Chemical: Chlorocresol
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Chloroxylenol
Chemical: Diazolidinyl urea
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Imidazolidinyl urea, ormaldehyde
Chemical: Ethylenediamine di-HCl
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Aminophylline, piperazine
Chemical: Formaldehyde
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Arylsulfonamide resin,
chloroallylhexaminium chloride
Chemical: Hydroquinone
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Resorcinol
Chemical: Methyl hydroxybenzoate
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Parabens, hydroquinone monobenzyl ether
Chemical: p-Aminobenzoic acid
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: p-Aminosalicylic acid, sulfonamide
Chemical: Phenylenediamine
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Parabens, p aminobenzoic acid
Chemical: Propyl hydroxybenzoate
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Hydroquinone monobenzyl ether
Chemical: Phenol
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Resorcinol, cresols, hydroquinone
Chemical: Tetramethylthiuram disulfide
(COMMON CROSS-REACTING CHEMICALS)
Cross-reactor: Tetraethylthiuram mono- and disulfide
is one in which invading substances that cannot be readily removed are consequently isolated.
Granulomatous reactions
- Silica
- Talc (Seen in powders)
- Paraffin or mineral oil
- Beryllium
- Gadolinium
- Metallic mercury and zirconium compounds
- tattoo dyes (containing cobalt, chromium, mercury, lead, iron, cadmium, and manganese compounds)
substances that may produce granuloma
UV and visible spectra of solar radiation reaching the earth
extend from
290 to 700 nm
wavelength of UV-C
< 290 nm
wavelength of UVB
290-320 nm
The protective skin pigment melanin, synthesized in melanocytes, absorbs a broad range of radiation from
UV-B
Other chromophores in the skin include amino acids, primarily
_________ and to a lesser extent ________, and their breakdown products (e.g., urocanic acid), which absorb light in the UV-B range.
tryptophan; tyrosine
Biologically, the most significant chromophore in the skin is
________ since damage from radiation can have lasting effects on
the genetic information in target cells.
DNA
Most evident acute feature of UV radiation exposure is ___________.
erythema (redness or sunburn)
Pigmentary changes
- Freckling and hypomelanotic areas
- Wrinkling
- Telangiectasias (fine superficial blood vessels)
- Actinic keratoses (precancerous lesions)
- Malignant skin lesions such as basal and squamous cell carcinomas and malignant melanomas
Chronic exposure to radiation
- From exogenous chemicals may be
produced by systemic or topical administration or exposure.
Phototoxicity
Phototoxic reactions may be produced either by systemic or topical exposures (t or f)
T
the skin may appear red and blister within minutes to hours after ultraviolet light exposure, particularly
UV-A (320 to 400 nm)
(PHOTOTOXICITY)
Acute exposure
responses may result in hyperpigmentation and thickening of the affected areas
(PHOTOTOXICITY)
Chronic reactions
is the most commonly responsible for phototoxicity (wavelength)
UV-A (320 to 400 nm)
may occasionally be involved (wavelength)
UV-B (290 to 320 nm)
- 8-Methoxypsoralen
- 5-Methoxypsoralen
- Trimethoxypsoralen
(SELECTED PHOTOTOXIC CHEMICALS)
Furocoumarins
- Anthracene
- Fluoranthene
- Acridine
- Phenanthrene
(SELECTED PHOTOTOXIC CHEMICALS)
Polycyclic aromatic hydrocarbons
- Tetracyclines
- Sulfonamides
- Sulfonylureas
- Nalidixic acid
- Thiazides
- Phenothiazines
- Nonsteroidal anti-inflammatory drugs
(SELECTED PHOTOTOXIC CHEMICALS)
Drugs
- Disperse blue 35
- Eosin
- Acridine orange
(SELECTED PHOTOTOXIC CHEMICALS)
Dyes
- Hematoporphyrin
(SELECTED PHOTOTOXIC CHEMICALS)
Porphyrin derivatives
is a type IV delayed hypersensitivity reaction, leading typically to eczema
Photoallergy
Photoallergy requires prior sensitization to the chemical. (t or f)
T
________ is necessary to convert a potential photosensitizing
chemical into a hapten that elicits an allergic response
UV light
Pleomorphic disease with a multifactorial etiology
Acne
- The influence of sebum, hormones, bacteria, genetics, and
environmental factors is well known. - Additionally papules, pustules, cysts, and scars may complicate the process.
Acne
- One of the most disfiguring forms of acne in humans
- Caused by exposure to polyhalogenated aromatic
hydrocarbons
Chloracne
Chloracne is a common disease; however, its recalcitrant nature and
preventability make it an important occupational and environmental illness. (t or f)
F; Relatively rare
Pigmentary disturbances can be classified into….
hyperpigmentation or hypopigmentation
- results from increased melanin production or deposition of endogenous or exogenous pigment in the upper dermis.
- can arise from deposition of
metals and drugs in dermal tissue
Hyperpigmentation
is a loss of pigmentation from melanin loss, melanocyte damage, or vascular abnormalities.
Hypopigmentation
Denote complete loss of melanin from the skin, imparting a porcelain-white appearance
Leukoderma (vitiligo) and depigmentation
May develop for those allergens to which IgE antibodies have been elicited by previous or ongoing exposure, subsequent contact can lead to development of __________ (hives), typically in minutes, through an immediate type I hypersensitivity
reaction
urticaria
are raised wheals that usually itch or sting and may appear reddish.
uticaria
are major causes of acute urticaria
food allergies and pharmaceuticals
- Rare, life-threatening disease
- Represents one of the most life-threatening dermatologic diseases that is caused by drugs and chemicals.
- Involves detachment of ≥ 30% of the epidermal surface from the dermis, commonly accompanied by severe erosions of mucous membranes
Toxic Epidermal Necrosis (Ten)
TEN commonly resembles an upper respiratory tract infection in the in the second month (fever, cough, sore throat, and malaise) (t or f)
F; first several days
Mucous membrane involvement can result in ……
(TOXIC EPIDERMAL NECROSIS (TEN))
gastrointestinal hemorrhage, respiratory failure, ocular abnormalities, and genitourinary complications
Nearly 200 drugs have been reported to cause this syndrome
with major contributors being:
- anticonvulsants,
- nonsteroidal anti-inflammatories
- antibacterial
- sulfonamides,
- allopurinol,
- nevirapine.
Radiation from ________ wavelengths to _________ wavelengths has been shown to cause skin cancer
ionizing; ultraviolet
Shortly after the discovery of radioactive elements at the turn
of the twentieth century, it was observed that X-rays could
cause:
- severe burns
- squamous cell carcinoma
- basal cell carcinomas
X-ray-induced nonmelanoma skin cancers (NMSC) continued
to be observed throughout the twentieth century, as X-rays
were used therapeutically until the mid-twentieth century or a
variety of skin diseases such as
acne, atopic dermatitis, psoriasis,
and tinea
Although NMSC from X-rays are now uncommon, __________ or ________ still is seen as sequelae of radiodermatitis, which sometimes develops after X-ray treatment of internal malignancies.
dermal atrophy or sclerosis
Most skin cancers in the US are now ___________
UV-induced
Most common UV-induced skin cancers are:
NMSC and cutaneous malignant melanoma
The _____ tumor suppressor gene has been targeted in nearly all squamous cell carcinomas
p53
Substances rich in polycyclic aromatic hydrocarbons _______________ are skin carcinogens in humans and
animals.
coal tar, creosote, pitch, and soot
Oxidative biotransformation of polycyclic aromatic compounds produces ___________ that can form DNA adducts
electrophilic epoxides
_______ produced by rearrangement of the epoxides, can be oxidized further to ________, yielding active oxygen species, and they are also toxic electrophiles.
Phenols; quinones
has been developed as an important target for carcinogenicity testing.
Mouse skin
Advantage of the mouse skin carcinogenesis model
Ability to separate the neoplastic process into stages of initiation, promotion, and progression
depending on experimental design.
Abundant element in the earth’s crust that is encountered
routinely in small doses in the air, water, and food.
arsenic
High exposures from smelting operations and from well water
derived from rock strata with a high arsenic content are associated with:
- arsenical keratoses (premalignant lesions),
- black-foot disease (a circulatory disorder reflecting endothelial cell damage),
- squamous cell carcinoma of the
skin and several other organs (bladder, lung, and liver)
(+ 3 oxidation state) avidly binds vicinal thiols and is
thought to inhibit DNA repair
Arsenite
(+ 5 oxidation state) can replace phosphate in macromolecules such as DNA, but the resulting esters are
unstable.
Arsenate
________ also alters DNA methylation, suppresses keratinocyte
differentiation markers, and enhances growth factor secretion
in the epidermis.
Arsenic
_____________ has been considered the most likely detoxification
method, because the observed mono- and dimethyl arsenate
isolated in urine from exposed humans and animals are indeed
much less toxic.
Methylation