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Skin Flashcards

1
Q

What is Dermatology

A

Specialty of medicine that deal with the skin and skin diseases

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2
Q

What is a dermatologist

A

Dermatologists – medical doctors who have specialised in diagnosis and management skin disease

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3
Q

Describe the current issue with dermatologists in the UK

A

Proportionate to the population, the UK has a small number of dermatologists- thus many skin diseases are treated by GPs or pharmacists.

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4
Q

What is the rule for skin cancers

A

Must be seen by a dermatologist within 2 weeks

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5
Q

What is a dermatoscope

A

Torch with magnifying glass- can look into lesion

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6
Q

Describe the characteristics of a typical lesion of malignant melanoma

A

Asymmetric
Streaks
Grey spots
Atypical melanocytes in an abnormal architecture

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7
Q

How are lesions moved

A

Depending on depth- wide excision (1-2cm deep) in fat layer will remove the lesion. Need to also assess its spread and treat accordingly.

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8
Q

Describe Toxic Epidermonecrolysis

A

Reaction to drug in an immune-modulated way- keratinocytes in the epidermis apoptose- it dies and sloughs off- often all over the body- mucous surface in eye and genital area also effected.

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9
Q

Describe the treatment for Toxic Epidermonecrolysis

A

Intensive care unit- supportive care- treated as burns patient- stop taking the drug.

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10
Q

Describe Psoriasis

A

Inflammatory dermatosis- not an infection- over proliferation of keratinocytes - inflamed plaques formed- salmon pink colour- elbows- knees and scalp affected- but can be anywhere- sore or itchy- disfiguring for patients

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11
Q

What are the implications of Psoriasis for patients

A

Has a low quality of life equivalent to T2DM, predisposition to T2DM, CVD and psoriatic arthritis.

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12
Q

Describe the treatment for psoriasis

A

Topical steroids, methotextrate- biological agents

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13
Q

What is meant by a topical steroid

A

Odourless, tasteless, colourless- excellent for psoriasis and eczema

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14
Q

Describe Herpes Zoster

A

Reactivation of chicken pox- due to stress and low immunity- chicken pox appear along a nerve dermatome- area initially has a stinging sensation before the onset of a rash- 2-3 weeks to heal.

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15
Q

Which area does Herpes Zoster usually affect

A

Ophthalmic division of the trigemminal nerve- supplies the eyes and eyelid.

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16
Q

How can we treat Herpes Zoster

A

Acyclovir- some have chronic pain and eyelid problems.
Vaccine also available (not routine)- to stop chicken pox. Also a vaccine for those older than 70- but not widely encouraged.

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17
Q

Describe the history of dermatology

A

1572 – first printed book on dermatology

Pre 18th Century
Skin disease treated by physicians and surgeons

18th – 19th Century
Specialty emerges
Classification and naming of diseases
Eg mycosis fungoides

19th Century –
Many diseases named after German and French Dermatologists

Many skin hospitals eg St. Johns Hospital for diseases of the skin, Lisle Street

1878 – Sir Erasmus Wilson bring Cleopatra’s Needle to London

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18
Q

Describe the key developments in the 20th century

A

1903 – Nobel prize for treatment of Lupus Vulgaris with UVB
1920 – X-rays used to treat skin fungal infections and cancer
1928 – Penicillin discovered by Sir Alexander Fleming
1930s – Sulphonamide antibiotics for cellulitis and bacterial skin infections
1940s – UVB + tar treatments for psoriasis
1940s - Venereology and Dermatology become separate specialties in UK
1940s – Penicillin introduced into clinical practice widely
1950s- Topical steroids
1960 - Griseofulvin for fungal infections
1970s – PUVA for psoriasis
1980s – Isotretinoin for acne
2000s- Biologics for psoriasis

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19
Q

Why should we learn about the skin

A

20% consultations in GP

Under represented in curriculum

Overlaps with many specialties

Largest organ (16% body mass, 1.8m2 surface area)

Clinical skills paramount in diagnosis

Over 2000 diseases affect the skin

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20
Q

Describe some common skin conditions

A

Common skin diseases include skin cancers, inflammatory conditions such as acne, eczema and psoriasis and many systemic diseases will have a skin manifestation. Infections of the skin or that involve the skin are common and create a burden especially in resource poor communities

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21
Q

How are many skin diseases recognised

A

Many skin diseases are able to be diagnosed without specialised investigations, but rather depend on the clinical skills of the doctor in recognising the condition by the clinical features manifested in the patient.

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22
Q

What is the issue with some of the classifications of skin diseases

A

Don’t match what they are

e.g mycosis fungoides- are a lymphoma

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23
Q

What is Lupus Vulgans

A

TB infecting the skin

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24
Q

What is PUVA

A 
Psorylin UVA
Tablet photosensitises the skin
Phototoxic rays
reaction between keratinocytes and light
immunosuppresses the inflamed skin
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25
Describe the skin as a single organ
The skin is a single organ and has complex inter relationships with other organ systems. This includes through endocrine, immune, vascular and neural mechanisms
26
List the functions of the skin
``` Protection against injury Protection against pathogenic organisms Waterproofing and fluid conservation Thermoregulation Protection against radiation, absorption of ultra violet radiation and vitamin D production Surface for grip Sensory organ Cosmetic ```
27
What are the layers of the skin
Skin includes epidermis, dermis and subcutis.
28
What separates the dermis and epidermis
A basement membrane
29
What are the Apendigeal structures of the skin
Apendigeal structures include: the pilo-sebaceous unit (follicle, hair shaft, sebaceous gland and pilo erecti muscle), sweat glands (apocrine and eccrine).
30
What does the sebaceous gland produce
Sebum
31
What is Meissner's corpuscle
A specialised nerve ending involved in sensation
32
Describe the histology of the skin
Stratum cornea- weaved structure Epidermis- lots of nuclei Papillary dermis- pink- uniform- not many cells Reticular dermis- lots of collagen fibres (pink streaks) Hypodermis- lots of fat- white
33
Describe the appearance of glands in the skin
White- due to the high lipid content.
34
Which cells are responsible for the nuclei seen
Fibroblasts and inflammatory cells.
35
Describe the epidermis
The epidermis consists of keratinocytes arranged in 4 layers (stratum basale, spinosum, granulosum and corneum). Other cell types in the epidermis include the melanocyte (involved in the production of melanin), Langerhans cell (antigen presenting cell) and Merkel cell (involved in sensation).
36
What gives rise to the different layers of the epidermis
keratinocytes form in the basal layer and proliferate and move upwards- differentiating as they do so- then drop off as dead cells at the top. Change in morphology e.g spinosum- form processes, granulosum- have granules.
37
Where do the melanocytes, Merkel cells and Langerhans cells reside
Basement membrane- they can all become cancerous.
38
Describe the differentiation of the keratinocytes from top to bottom
Basal cell Prickle cell Granular cell keratin
39
What is the key function of the epidermis
Barrier function to the skin- keratin forms the barrier- keratin is found in the stratum corneum.
40
Describe the structure of the Stratum Corneum
Corneocytes- making keratin- surrounded by a cement of lipids and proteins (filaggrin) forming a epidermal seal.
41
What are the consequences of defects in the epidermal seal
Can let in irritants/allergens and cause allergies Very important for barrier function of the skin Defects lead to eczema Filagrin gene mutation common in eczema patients
42
What is a sign of a fliagrin gene mutation
Palmar hyperlinearity
43
What is Ichthyosis
Dry, fish-like skin- mutated filaggrin gene
44
What is a consequence of eczema
More prone to infections
45
How can we identify the melanocytes
Vacuole inside | Special stains are required to identify Merkel cells and Langerhans cells
46
Describe melanocytes and pigmentation
Melanocytes are dendritic cells located within the basal layer of the epidermis. They produce the pigment melanin in organelles known as melanosomes. These are packaged into granules which move down the dendritic processes and transferred by phagocytosis to adjacent keratinocytes. The melanin granules form a protective cap around the keratinocyte nuclei and protect the DNA within the nucleus from UV induced damage and lead to skin pigmentation. UV radiation mainly within the 290-320 nm spectrum stimulates the melanocytes to produce more melanin. Variation in racial pigmentation is not from differences in melanocyte numbers, but from the number and size of melanosomes produced.
47
Describe the production of melanin
``` Sun Keratinocytes MSH Melanocytes Melanin Travel to keratinocytes via spinous processes ```
48
Describe Rickets
Deficiency of vitamin D- affects children
49
What are the clinical features of rickets
``` Dental hypoplasia Bowing of tibia Swelling in wrist and ankles Craniotabes Rachitic rosary wide sutures frontal bossing pectus carinatum Harrison's sulcus delayed closure of fontanelles ```
50
What is the key consequence of a vitamin D deficiency
Predisposition to cancer
51
How many keratinocytes are there for each melanocyte
5
52
Describe the basement-membrane zone
The basement membrane zone is a specialised region where the epidermis is attached to the dermis via hemi-desmosomes, anchoring plaques and a multitude of proteins. The area is clinically important as a genetic abnormality resulting in an abnormality of a protein in this region can give rise to a blistering condition eg epidermolysis bullosa. Detailed knowledge of each protein is not required for the course.
53
What are the consequences of a defective basement membrane zone
epidermis can split off- splitting and blister formation- due to trauma or autoimmune disease.
54
Describe epidermolysis bullosa
Genetic- easy blistering- splitting of epidermis from dermis with minor trauma- repairs itself and leaves a scar- inflammation can cause skin cancer. Less severe forms exist.
55
Describe Bullous Pemphigoid
Autoantibody against proteins in basement membrane- blister formation. Treat with steroids- suppress the immune system.
56
Describe the dermal layer
The dermis is supportive connective tissue consisting of collagen, elastin and glycosaminoglycans. The thickness varies between 0.1mm (eyelids) and 3 mm (back). The dermis contains fibroblasts that synthesize collagen, elastin and glycosaminoglycans. Dermal dendritic cells are found along with other immunocompetent cells.
57
What are the GAGs
Gel-like substance for everything to sit in.
58
How do we stain to see collagen and elastin
Collagen- Haemotoxalyin and eosin stain | Elastin- Elastic van Gieson stain
59
Describe how blood flow can lead to thermoregulation
Skin temp responsive to blood flow 1 – 100ml / min per 100g skin Sympathetic control Effects of vasoconstriction/dilation Heat lost by convection or radiation.
60
Describe the role of sweat in thermoregulation
Sweat cools skin through evaporation Minimum 0.5L per day Max 10L per day Produced by eccrine and apocrine sweat glands
61
Describe the difference between apocrine and eccrine glands
Eccrine- watery- all over the body Apocrine- axillary and groin- viscous sweat- subject to bacterial metabolism- producing odour. Eccrine- directly to epidermis Apocrine- infundibulum of hair follicle near surface.
62
Describe the embryology of skin
Epidermis – ectoderm Dermis – mesoderm Melanocytes – neural crest

Tissues (12 decks)

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