Skin and integument Flashcards
what do desmosomes do
Provide mechanical strength and contribute towards the water barrier
Different layers of the skin from outermost to innermost
stratum corneum stratum lucidum stratum granulosum stratum spinous (prickle cell layer) stratum basale (basement membrane)
(come lets grow some bananas)
What glands are in the skin
sudoriferous (sweat), sebaceous, ceruminous, mammary
What are Langer’s lines
skin tension lines (also called cleavage lines)
parallel to natural collagen fibres in the skin
What are Blashcko lines
lines of normal cell development in the skin
invisible under normal conditions
Anatomy layers of scalp (five)
Skin Collagen fibres Aponeurosis loose areolar periosteum
Why does skin elasticity change
Skin loses ability to stretch and bounce back with ageing
things that accelerate: sun exposure, smoking
Typical skin distribution of psoriasis
Extensor surfaces
Typical skin distribution of eczema
flexor surfaces
Four uses of skin
Physical barrier
chemical barrier
immune barrier
microbiome barrier
Describe microbiome barrier of the skin
commensal bacterial in and on skin compete with potential pathogens
Things that affect the microbiome nature of the skin
host physiology environment immune system hosts genotype lifestyle pathobiology
what is meant by host physiology
age
sex
site
what is meant by environment (microbiome)
climate
geographical location
what is meant by immune system (in microbiome skin)
previous exposure
inflammation
what is meant by hosts genotype (microbiome)
susceptibility genes such as flaggarin
what is meant by lifestyle (microbiome)
occupation
hygiene
what is meant by pathobiology (microbiome)
underlying conditions such as diabetes
describe immune barrier nature of the skin (epidermis)
keratinocytes and resident immune cells protect against potential pathogens langerhans cells (antigen presenting cells that activate T cells that provide an immune response)
Name cells present in immune barrier nature of the skin (dermis)
mast cells macrophages dendritic cells B&T cells NK cells plasma cells
Describe chemical barrier nature of the skin
skin has an acidic pH (maintained by sweat conversion of triglycerides to fatty acids)
alters to this pH (i.e. more acidic) alters the microbiome function
lipids that require trans-epidermal water loss are produced by enzymes that require an acidic pH
Name a couple of effects that vitamin D synthesis has on the skin
differentiation and proliferation anti-microbial effects sebaceous gland regulation photo-protection adaptive immunity wound healing hair follicle cycling deficiency linked to (hair loss, cancer, atopic dermatitis..)
What receptors are located superficially in the skin
Meissner’s corpuscles and Merkel’s discs
What are Meissner’s corpuscles
cutaneous nerve ending responsible for transmitting fine, discriminative touch and vibration
What are Merkel’s discs
widely distributed (in fingertips and lips)
slow adapting and unencapsulated
respond to light touch (discriminative)
What receptors are located deeply in the skin
Pacinian corpuscles and Ruffini endings
What are pacinian corpuscles
detect pressure and vibration from being compressed which stimulates their internal dendrites
What do Ruffini endings detect
detect stretch
deformation within joints
warmth
What are the rapidly adapting receptors
pacinian corpuscles, Meissner’s corpuscles and hair follicle afferents
(all sense vibration)
Do superficial receptors have large or small receptive fields
small - sense fine details and textures
what is glabrous skin
skin without hair (palms, soles of feet)
Paraesthesia
burning or prickling sensation, often accompanied by numbness, usually felt in hands or feet
Transient (short-lived; passing; not permanent) factors of paraesthesia
pressure-induced, hyperventilation, viral infection, hyperthermia
Chronic factors of paraesthesia
vascular disorders, metabolic disorders (diabetes), malnutrition, neuropathy, arthritis, autoimmune (MS)
What is tactile hyperesthesia
increased tactile (touch) sensitivity due to peripheral neurological disorders (peripheral neuropathy)
What is tactile hypoesthesia
(numbness) Decreased tactile sensitivity due to damage of afferent nerves (ischaemia due to vascular disorders, decompression sickness, thiamine deficiency)
Three types of cutaneous pain sensation receptors
polymodal nociceptors
mechano-cold receptors
mechanically insensitive nociceptors
what do polymodal nociceptors detect
mechanical, thermal and chemical stimuli
What do mechano-cold receptors detect
mechanical and cold stimuli
what do mechanically insensitive nociceptors detect
chemical and possible thermal stimuli
What fibres does fast pain run along
what do this fibres produce
A𝛅 fibres produce initial and well localised pain (sharp/.pricking)
what fibres does slow pain run along
and what pain do they give
C fibres more prolonged aching pain
What fibres do pressure blocks block
myelinated A𝛅 fibres
What fibres does a local anaesthetic block
unmyelinated C fibres
What is hyperalgesia
excessive response to noxious (painful) stimuli
over-reaction to painful stimuli
what is allodynia
production of pain by non-noxious stimuli (not painful)
being stroked by a feather causes a pain response
Describe primary hyperalgesia include sensitising agents
Primary hyperalgesia is characterized by increased responsiveness to both heat and mechanical stimulation in the area of injury.
sensitising agent: An agent which, when added to a biological system, increases the amount of damage done by a subsequent dose of radiation.
chemically mediated sensitisation of nociceptors results in increased firing rate
sensitising agents including bradykinin, prostaglandins, and cytokines
Describe secondary hyperalgesia
occurs without an increase in the firing rate of nociceptors - increased responsiveness of central pain circuit
secondary hyperalgesia is generally associated with increased responses to mechanical but not heat stimuli.
What reflex does pain cause
flexion withdrawal reflex
what reflex does itching cause
scratching behaviour
What causes an acute itch
insect bite/allergen
what causes a chronic itch
inflammatory dermatoses (psoriasis, eczema)
systemic disorders (renal failure)
neuropathic (MS)
psychological (OCD)
What does nociceptor activity cause release of and what does this do
substance P from axon collaterals which increases blood flow and inflammatory agents (histamine causing redness heating and swelling of efferent nerve)
Layers of the scalp
pneumonic SCALP Skin (& dense connective tissue) Connective tissue Aponeurosis loose areolar connective tissue periosteum
What does Zosteriform mean
stays in one dermatome and doesn’t cross the midline
What are lines of Blaschko thought to represent
lines of normal cell development in the skin. These lines are invisible under normal conditions. They become apparent when some diseases of the skin or mucosa manifest themselves according to these patterns.
thought to represent pathways of epidermal cell migration and proliferation through development of foetus
What is a vesicle
fluid-filled raised sac/lesion, 5mm or less in diameter
what is a bulla
fluid-filled raised sac/lesion, greater than 5mm in diameter
what is a blister
common term used interchangeably with vesicle and bulla
what is a pustule
pus-filled raised sac/lesion
5 types of psoriasis
vulgar psoriasis psoriatic erythroderma guttate psoriasis inverse psoriasis pustular psoriasis
Why don’t you treat psoriasis with potent steroids
can turn into pustular psoriasis -which is resistant to a lot of treatment
What are the associated comorbidities of psoriasis
DVT/PE and cardiovascular disease
Signs of rosacea
facial redness
bumps and pimples
skin thickening (rhinophyma - of the nose)
eye irritation (bloodshot, burning and/or stinging)
ABCDE model for melanoma
asymmetrical border (irregular border) Colour (several colours) Diameter (>6mm) Evolution (how it has changed over time)
Difference between neuropathic, vascular and arterial leg ulcers
neuropathic - diabetes, usually over pressure point
arterial - painful, usually over medial malleolus
vascular - spread out, superficial, background venous changes on the legs (varicose veins, darkened patches)
5 different dermatology investigations
skin swab fungal scrapes/nail clippings punch biopsy superficial sample excision
Define homeotherms
(mammals) that have physiological mechanisms that can regulate temperature
Define poikilotherms
(fish) temperature varies with that of external environment
define the meaning of core in terms of temperature
The core houses vital organs (temperature only varies a little here)
Define the meaning of shell in terms of temperature
temperature can vary more as a result of regulatory responses to preserve core temperature
what is the optimal core temperature
37 degrees celsius
Describe the receptors near the central thermoreceptors near the midbrain, medulla and spinal cord)
More warm receptors than cold receptors
describe the peripheral receptors temperature
more cold receptors than warm receptors
how is sodium and calcium involved in body’s set temperature
if sodium increases then the set temperature increases
if calcium increases then set temperature decreases
What are the five ways you can clinically measure temperature?
rectal (representative of core temp.)
sublingual (representative of core temp. but can deviate if you have eaten or drunk anything)
axillary (useful for children - can come up cold)
Forehead (cooler than core temp.)
external auditory meatus (ear)
what does cholinergic mean
nerve cells where acetylcholine acts as a neurotransmitter
what is acetylcholine? what does it do?
main neurotransmitter of parasympathetic nervous system
contracts smooth muscle, dilates blood vessels, increases bodily secretions, and slows heart rate
Three causes of hyperthermia
heat exhaustion
heat stroke
malignant hyperthermia
Run down of heat exhaustion (caused by? Symptoms?treatment?)
caused by: strenuous activity, dehydration, alcohol use, overdressing
symptoms: dizziness, fatigue, faintness, increased HR, decreased BP, cramps, nausea, headache
treatment: stop activity and rest, move to cooler place, rehydrate
Run down of heat stroke (what is it? Symptoms? treatment?)
failure to regulate core temperature
symptoms (heat stroke ++): racing HR, hot skin, confusion, agitation, loss consciousness, coma
Treatment: ice packs, cooling blankets, IV fluids, support injured organ system
Run down of malignant hyperthermia (what is it? Treatment?)
aberrant (not normal) response to volatile general anaesthetics (halothane and suxamethonium)
aberrant cellular ca handling leads to increased metabolic rate (& therefore increase in temperature)
treatment: dantrolene sodium immediately
what is hyperhidrosis?
excessive sweating
axillary and palmoplantar (sometimes face)
occurs in 2-3% population
onset after adolescense
primary hyperhidrosis cause
idiopathic (arises spontaneously and unknown cause)
secondary hyperhidrosis cause
hyperthyroidism, some medications, diabetes, and obesity
Treatment options for hyperhidrosis
aluminium based antiperspirants (block sweat glands)
anticholinergics (decreases sweat production)
botox
surgery (remove sweat glands)
define pyrexia
fever
how does a fever occur
occurs as result of an infection
this produces toxins
which increases WBCs that release pyrogens (fever causing substance)
pyrogens act on neurons which set temperature in the hypothalamus (they then increase the set point)
how does body temperature change with a menstrual cycle
Your body temperature naturally changes a tiny bit throughout your menstrual cycle. It’s lower in the first part of your cycle, and then rises when you ovulate. For most people, 96°– 98° Fahrenheit is their typical temperature before ovulation.
6 ways in which skin can be damaged
trauma surgery burns tattoos skin disorder disease
4 steps of coagulation
1) Constriction of the blood vessel. 2) Formation of a temporary “platelet plug.” 3) Activation of the coagulation cascade. 4) Formation of “fibrin plug” or the final clot.
what is a keloid scar
thick raised scar
difference between arterial and venous ulcers
Arterial ulcers develop as the result of damage to the arteries due to lack of blood flow to tissue. Venous ulcers develop from damage to the veins caused by an insufficient return of blood back to the heart.
Arterial ulcers have a distinct “punched out” appearance and are typically circular with a red, yellow, or black coloration. They are usually extremely painful. Venous ulcers are often painless unless they are infected.1
define haemostasis
process to prevent and stop bleeding, involving coagulation
define wound exudate
fluid leaking from a wound
What happens with high wound exudate
healing can be delayed, surrounding skin may be macerated and excoriated
What is normal exudate compared to not
thin and watery is normal
thick and sticky can indicate infection
define autolysis
breakdown of all or part of a cell or tissue by self-produced enzymes
define granulation tissue
vascularised tissue that forms as chronic inflammation involves
(new capillaries make the tissue appear pink)
3 phases of wound healing
inflammatory phase
proliferation phase
maturation phase
what happens in the inflammatory phase of wound healing
what signs can you see? what cells at work?
blood vessels contract and blood clot is formed
when haemostasis is achieved blood vessels then dilate for essential cells (antibodies, WBC, growth factor, enzymes and nutrients to reach wounded area)
can see signs of erythema, heat, oedema, and functional disturbance
predominant cells at work are phagocytic cells (neutrophils, macrophages)
what happens in the proliferation phase of wound healing
wound is rebuilt with new granulation tissue
(comprised of collagen and extracellular matrix)
(angiogenesis occurs here)
epithelial cells then resurface the wound (called epithelisation)
what is healthy granulation tissue dependent on?
fibroblasts receiving sufficient levels of oxygen and nutrients supplied by the blood
should be uneven in texture, does not bleed easily and is pink in colour
what is dark granulation tissue an indicator of
an indicator of poor profusion, ischaemia, and/or infection
what happens during the maturation phase of wound healing
final phase
occurs once the wound has closed
involved remodelling of collagen from type III to type I
Cellular activity reduces and the number of blood vessels in the wounded area regresses and decreases
how many types of skin in the Fitzpatrick skin type scale
6
Define bulla
raised, fluid-filled lesion larger than a vesicle
define fissure
crack or break in the skin
define macule
flat, coloured spot
define nodule
solid, raised lesion larger than a papule, usually indicative of systemic disease
define papule
small, circular, raised lesion at the surface of the skin
define plaque
a small, abnormal patch of tissue on a body part or an organ.
define pustule
raised lesion containing pus, often in a hair follicle or sweat pore
define ulcer
lesion resulting from destruction of the skin and perhaps subcutaneous tissue
define vesicle
small, fluid filled, raised lesion; blister or bleb
define wheal
smooth, rounded, slightly raised area often associated with itching; seen in urticaria such as resulting from an allergy
what is sebbhoreic keratosis
highly variable appearance
flat or raised papule or plaque
1mm to several cm in diameter
can be skin coloured, yellow, grey, light brown, dark brown, black or mixed colour
smooth, waxy or warty surface
appear to stick on skin surface like barnacles
describe basal cell carcinoma (BCC)
slow growing lesion
classically a nodule with a central crust and telangiectasia
high risk area of the T-zone (should be referred to secondary care within two weeks)
define telangiectasia
spidery in appearance blood vessels, sharp and demarcated to the tip of the lesion
describe keratin horn
prevents you from identifying an underlying lesion
50% have a benign base
should be referred as risk of malignancy
describe squamous cell carcinoma (SCC)
keratinocyte tumour more common in elderly male increased risk of other skin cancers larger lesions carry worse prognosis quick onset usually painful
what is a BCC a tumour of
the basoloid epithelium
what is a keratoacanthoma
rapidly growing volcanic like lesion can form on sites of trauma tend to resolve spontaneously not malignant difficult to differentiate between SCC
what is a actinic keratosis
very common (usually on protruding bits and mens scalps)
pre-cancerous
(rare to progress to SCC but can increase with the more you have)
prevention better than cure
a rough, scaly patch on the skin that develops from years of sun exposure.
treatment options for actinic keratosis
nothing emollient topical chemotherapy agents cryotherapy surgical removal
what are sebaceous cysts and how are they treated
benign lesions
surgical removal required when not inflamed
have to make sure entire sack is removed otherwise it will be recurring
on skin its called an epidermal cyst, on scalp its a pilar cyst
What is Hutchinson sign a sign of and what does it look like
a malignant lesion (subungal melanoma)
looks like longitudinal brown-black pigmentation on nails
What is Fitzpatrick sign a sign of and what does it look like
a benign lesion (dermatofibroma)
looks like:dimple sign, sign in which lateral pressure on the skin produces a depression.
what is a lipoma
benign fatty lumps
they are mobile under the skin
can be painful if traumatised/or on bony prominence
what is a dermatofibroma and how does it look
benign fibrous nodule
probable reactive process
skin looks shiny and stretched
hard to touch
describe keloid scar
firm smooth growth secondary to trauma
the worst site - necklace to navel
more common in people of colour
what is a cherry angioma
noncancerous (benign) skin growth made up of blood vessels
(increase in number over the age of 40)
(can be linked to pregnancy and rarely malignant)
what is a Moe’s surgery
they take the lesion out and a histologist sits with you and you remove layer by layer
what is erythema multiforme
symmetrical, red, raised skin areas that can appear all over the body.
usually noticeable on hands and feet
most common cause: Herpes simplex virus
spontaneously resolves within 4 weeks
what does periorbital mean
around the eyes
what is cellulitis
deep inflammation of subcutaneous and dermis
presents as unilateral - hot, tender leg
(occasionally has blisters)|
risk factors for cellulitis
defective barrier diabetes/immunosuppresion chronic lymphedema peripheral vascular disease previous cellulitis
what is lipodermatosclerosis
what does it typically look like
what is it linked to
how do you treat it
results from chronic inflammation and fibrosis of the dermis and subcutaneous tissue of the lower legs
in acute phase may be painful and red
(no systemic upset)
linked to obesity
Inverted champagne flute (tight around ankle then flares out towards calves)
compression for treatment
what is paronchyia
acute treatment?
acute infection around nail (usually bacterial)
usually vey painful
treatment: warm soaks, topical antiseptic if localised, antibiotics if not localised
what is erytheroderma and its causes
severe and potentially life-threatening inflammation of most of the body’s skin surface
causes: dermatitis, psoriasis, drugs, leukaemia, idiopathic
what to look for in erythroderma
Pustules (infection or pustular psoriasis) Superficial blisters (acute dermatitis) Keratoderma Nail changes Lymphadenopathy
treatment for erythroderma
stop all non-essential drugs
emollients
treat underlying infection
fluid balance and control
what is pyoderma gangrenosum
rare condition that causes large, painful sores (ulcers) to develop on your skin, most often on your legs.
• Neutrophilic dermatosis (lots of neutrophils causing inflammation)
what is necrotising fasciitis
bacterial infection of soft tissue and fascia
Pain out of proportion to how it looks (agony)
Most common site is lower leg
Severe pain and systemically unwell
Needs surgical debridement
what is SJS
Steven - johnson syndrome
what is TEN
toxic epidermal necrolysis (Toxic epidermal necrolysis is a life-threatening skin disorder characterized by a blistering and peeling of the skin. This disorder can be caused by a drug reaction—often antibiotics or anticonvulsives.)
what is Eczema herpeticum
small punched out ulcers
common in children with atopic eczema
what is generalised pustular psoriasis
rare
sterile pustules on an erythemous background
can occur in response to stopping steroids, pregnancy, drugs
how is skin colour determined
melanocytes in the stratum basale
(all skin types have the same number of melanocytes)
melanosomes produce melanin
(melanin is carried by the keratinocytes up the epidermis layer)
where do you look for jaundice
in the eyes
where do you look for cyanosis
nail beds
less obvious around the mouth
under the tongue
how to look for urticaria in skin of colour
feel the skin (should be raised)
won’t see the erythema as clearly
what is Mongolian blue spot (skin of colour)
flat bluish- to bluish-gray skin markings commonly appearing at birth or shortly thereafter
lumbosacral dermal melanocytosis
Caused by entrapment of melanocytes in dermis of developing embryo
usually resolves by four years of age but can last forever
what is ochranosis
the bluish black discoloration of certain tissues
from hydroquinone deposition in the skin (people of colour use it to lighten their skin)
usually on face when related to hyroquinone
what can secondary hypopigmentation be due to
corticosteroid injection
• More common if injections are instilled subcutaneously or intradermally
what is vitiligo
acquired depigmentation syndrome
(loss of melanocytes)
its an autoimmune condition
more cosmetically significant in people of colour
what is Dermatosis papulosa nigra
benign
• Multiple smooth black/brown papules on the face and neck
most common in black females
(histology same as sebbhoreic keratosis)
what is melanonychia
is brown or black discolouration of a nail
benign
common in darker skin types
look for multiple lines to confirm diagnosis (check toes too)
what is an aural melanoma
type of melanoma arising on the palms or soles.
(in darker skins this is the most common)
not related to sun exposure
malignant
what is a subungal melanoma
presents as brown-black discolorations of the nail bed. It can present as either a streak of pigment or irregular pigmentation. The discoloration can progress to thickening, splitting, or destruction of the nail with pain and inflammation.
what is traction alopecia
caused by repeated trauma to hair follicles or from pulling your hair back into tight hairstyles
encourage less traction on hair
apparent in darker skin type hairstyles
what is Acanthosis nigricans
when does it usually appear
It causes thicker and darker patches or streaks, usually in skin creases and folds, such as the sides and back of the neck, armpits, elbow pits, and groin. But it can show up anywhere on the body.
can appear in people with ovarian cysts, underactive thyroids or problems with the adrenal glands.
what is a regional flap in plastic surgery
conducted when tissue is transferred from a part of the body in or near the head and neck region and rotated into the surgical defect.
what is a local flap in plastic surgery
when your surgeon takes tissue from 1 part of your body (called the donor site) and moves it to the surgical site that needs to be covered (called the recipient site). Local flaps can be used for reconstructing different areas of the body.
what is a free flap in plastic surgery
involves the transfer of a patient’s own tissue from a donor site to a recipient site, which is typically the site of a defect. The donor site usually has a distant location with respect to the recipient site.
what are two skin substitutes (plastic surgery)
integra (synthetic skin replacement used to reconstruct wounds after elective planned surgery)
matriderm (acellular dermal substitute with porous membrane three-dimensional structure composed of collagen and elastin from bovine ligament and dermis, applicable for full-thickness skin defects.)
how should you go about describing a rash
• Site, distribution, colour, shape, border
true/false: IgE levels are raised in cases of eczema
true
6 different types of emollients
lotions - thin
creams - thicker but can be greasy
ointments - thick and greasy
sprays - for sensitive and hard to reach places
bath additives (little to no area to support evidence)\
bleach baths
discoid/ nummular eczema discussion
defined by scattered, well-defined, coin-shaped and coin-sized plaques of eczema
resistant to treatment
important differential - fungal infection (eczema has all over scale whereas fungal is usually just the outside with central sparing)
varicose eczema discussion
really common
eczema on lower legs
linked to varicose veins
Haemosiderin - brown appearance, blood has leaked out and is sat in the skin
can be called stasis or gravitational eczema
Dyshidrotic/pompholyx eczema discussion
is a skin condition where you get itchy blisters on your hands and feet. intensely itchy skin looks bubbly at surface responds well to topical steroids associated with stress
Asteatotic eczema discussion
a type of eczema that is more common in older people. It usually affects the shins but sometimes affects other areas such as the thighs, arms, tummy and back.
use loads of emollients
common in hospitals because peoples legs get dry
what is intertrigo
inflammation caused by skin-to-skin friction, most often in warm, moist areas of the body, such as the groin, between folds of skin on the abdomen, under the breasts, under the arms or between the toes
what is tinea pedis
fungal skin infection that usually begins between the toes. It commonly occurs in people whose feet have become very sweaty while confined within tight-fitting shoes. Signs and symptoms of athlete’s foot include an itchy, scaly rash.
what is tinea versicolour
common fungal infection of the skin. The fungus interferes with the normal pigmentation of the skin, resulting in small, discolored patches. These patches may be lighter or darker in color than the surrounding skin and most commonly affect the trunk and shoulders.
what is tinea cruris
fungal infection that causes a red and itchy rash in warm and moist areas of the body. The rash often affects the groin and inner thighs and may be shaped like a ring. Jock itch gets its name because it’s common in athletes
what is alopecia areata
Smooth patches of hair loss with exclamation mark hairs(short broken hairs) around edge
strong link to autoimmune condition
what is scabies
treat with?
very itchy skin condition caused by tiny mites burrowing into your skin.
• Looks on wrists and between finger web spaces for signs of burrows
• Treat with dermal lyclear cream twice 7 days apart (for eggs that havent hatched)
• Treat everyone who has been in contact
• Itch may persist for weeks after treatment (eczema from burrows)
what is molluscum contagiosum
usually a harmless infection that causes small dimpled spots to appear on the skin.
small, firm spots that have a dimple in the middle. They can be itchy.
goes over a matter of months
widespread in an adult - think HIV
what is rosacea
what do you treat the symptoms with?
common skin condition that causes blushing or flushing and visible blood vessels in your face.
can occur with papules and pustules
can cause rhinopehyma - change in nose shape due to papules and pustules
• Treat flushing with vasoconstrictors
• Treat papules and pustules with metronidazole gel
• Treat rhinophyma with surgery or laser
what is hypodermis
subcutaneous tissue
non-epithelial cells in epidermal layer
melanocytes
langerhan’s (dendritic) cells - type of macrophage
Merkel cells - sensory receptors to touch
where do melanocytes sit in epidermis
basement membrane
how thick is the stratum basal (basal layer) in epidermis
one cell thick
how do sebaceous glands develop
as an outgrowth of the hair external root sheath
describe eccrine glands
all over body simple secretory coil in epidermis with pore opening on surface via duct secrete watery hypotonic solution thermoregulation pH 4-6 reduces fungal growth lubrication
describe apocrine glands
straight narrow ducts running parallel to hair follicles
secretory portion is located in the dermis and/or hypodermic
ductal portion similar to eccrine ducts
thick secretion into adjacent hair follicle
involved in pheromone secretion
under hormonal control
what is parakeratosis
presence of nucleated keratinocytes in the stratum corneum
○ Thought to be due to accelerated keratinocytic turnover
○ Scaly appearance
○ Can occur in benign and malignant skin conditions
what is JACCOL
jaundice anaemia clubbing cyanosis oedema lymphadenopathy
what to do in a skin examination
- Inspect
- Describe
- Palpate
- Systemic check
what does it mean if lesions are discrete
individual lesions are separate and distinct
what does it mean if lesions are grouped
they are clustered together
what does it mean if lesions are confluent
they merge so discrete lesions are not visible or palapable
what does it mean if lesions are linear
they form a line
what does it mean if lesions are annular
they are arranged in a single ring or circle
what does it mean if lesions are polycyclic
they are arranged in concentric circles
what does it mean if lesions are arciform
they form arcs or curves
what does it mean if lesions are reticular
they form a mesh like network
