SKIN: Effect of environment on skin Flashcards

1
Q

What is an integument and insult?

A

An integument (a tough outer protective layer) is an interface between the body and environment. Thus is subject to a wide range of insults (stresses). An insult is the cause of some kind of physical or mental injury.

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2
Q

What is the importance of keratin in integument, and how is it formed?

(SS flashcards)

A

Keratin is important in protection and adaptation.

There is a cell flow in the epidermis upwards. The basal layer, sitting on top of the dermis, contains dividing stem cells. The daughter cells move distally through the epidermis, while differentiating into mature keratinocytes, making lots of the tough and waterproof protein, keratin.

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3
Q

What is the significance of keratin in the stratum corneum?

Not in lecture - from previous years lecture

A

The top of the epidermis, the stratum corneum, is made up of cornified keratinocytes that lose their nuclei and continue to move distally.

The stratum corneum is referred to as being keratinised; it is full of keratin and not much else.

At the stratum corneum, cells flake off and are constantly being replaced.

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4
Q

What happens when the skin is damaged (at its worst)?

A

The skin is a vital organ. Due to this, on extensive epidermal (or both epidermal and dermal) damage, such as severe burns or a rare drug reaction, death may occur.

This could be due to one or more of:

  • dehydration and shock
  • infection
  • heat loss and hypothermia (or sometimes hyperthermia due to impaired thermoregulation)
  • others (for eg. protein loss, electrolyte imbalance, high-output cardiac failure or renal failure)
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5
Q

What is toxic epidermal necrolysis?

A

It is an example of severe epidermal damage; it is a rare adverse drug reaction.

It is where there is a detachment of the epidermis, which is often fatal.

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6
Q

Why is the skin so vital and what are some environmental insults against it?

A

The skin protects us from a wide range of environmental insults (stresses).

This includes:

  • irradiation and UV light
  • physical trauma (burns, friction, pressure, etc.)
  • irritants (chemicals)
  • allergens (triggering allergic reaction of the immune system)
  • microbes (cause infections)
  • ectoparasites (parasite that lives on the outside)
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7
Q

List some features of the skin protecting against various stresses.

A
  • DRYING: waterproof epidermis, oil from sebaceous glands
  • FRICTION/IMPACT: thick, regenerating epidermis; nails; basement membrane anchoring epidermis to dermis, wavy border against shear forces; collagen fibres in dermis (strong, running in all directions)
  • HEAT: sweating, vasodilation
  • COLD: subcutaneous fat, adaptable blood supply, hair (head)
  • BURNS/INJURY: thick, regenerating epidermis
  • RADIATION/SUNLIGHT: thick epidermis; melanin
  • INFECTIONS: impervious epidermis; resident cells of the immune system
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8
Q

List some adaptations (fast and slow) of the skin to adapting in different environments.

A
  • Sweating and Vasodilation in heat or Vasoconstriction in the cold. - Fast response (minutes).
  • Hyperkeratosis (callus); this is the thickening of the stratum corneum with rubbing or pressure (seen in feet or guitarists fingers, or also slightly after UV exposure). - slow response (weeks)
  • Tanning: this a long-term adaptation. It is a melanocyte response, after UV exposure. - slow (days).
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9
Q

Describe thermoregulation by blood supply.

A

Arteriovenous (AV) shunts are anastomoses between arterioles and venules. They are numerous in the dermis.
They respond to thermoreceptors in the skin - to hot and cold.

They open and close to increase or decrease blood flow to the superficial vascular plexus in the papillary dermis (just below the epidermis). Hence, the skin gets redder (more heat loss) or bluer.

In the face, they can also respond to emotion/the sympathetic nervous system - blushing.

If they shut off for too long, there is a danger of damage (via frostbite).

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10
Q

What is the function of melanin?

A

The colour of human skin is mainly due to melanin (dark skin) and haemoglobin (light skin). There is much normal genetic variation in the amount of melanin (over 12 genes are known).

Melanin protects against DNA damage, and thus skin cancer, especially in dark (black and Asiatic skin). The incidence of skin cancer is only 8-10% to that of white people.

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11
Q

How does tanning play a role in protection?

A

Melanocytes increase their activity, making and transmitting more melanin when tanning.
This gives them some protection from UV rays.

There is also additional protection by the skin thickening in response to UV exposure.

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12
Q

How does the skin adapt and function to protect against UV radiation? - the basis of sun tanning.

A

MSH - Melanocyte Stimulating Hormone
MC1R - Melanocortin1receptor

UV radiation –> DNA damage (in the basal keratinocyte) –> (triggers signalling) causing the synthesis (in chromocytes) and secretion of MSH from the basal keratinocyte –> MSH binds to MC1R on the melanocyte –> (signal events) cAMP –> transcription in the nucleus of enzymes (tyrosinase) that will go onto synthesise melanin –> enzymes produce melanin –> thus increasing melanin synthesis and transfer, and increases cell division –> more melanin sent to the basal keratinocyte.

Tyrosinase hydroxylates the amino acid tyrosine to L-DOPA which is hydroxylated to DOPAquinone.

In the skin: DOPAquinone produces Eumelanins (brown to black). Tyrosine-related proteins help with the conversion.

In the hair:
DOPAquinone produces Pheomelanins (yellow to red).Tyrosine-related proteins help with the conversion.

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13
Q

Describe how Langerhans cells and the immune system protect against microorganisms.

A

Langerhans cells are small, dendritic cells in the non-basal layers of skin.

They function as antigen-presenting cells. They form a network in the epidermis, and are part of the immune system.

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14
Q

What is lichenification?

A

It is a more extreme form of hyperkeratosis
It is a reaction to the excessive rubbing or scratching/skin conditions.

Can give a leather tree bark appearance

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15
Q

Describe sunburn as a result of UV exposure.

A

UVA has the longest UV wavelength. The ozone layer filters out the most harmful UVC (has the shortest wave length). However, most of the UVA and UVB are able to penetrate the ozone layer so we are exposed to them in the sun. UVB is implicated the most in regards to skin cancer.

Prolonged exposure to UV radiation leads to sun burn.

Sunburn is a radiation burn.

It causes blisters, inflammation and cell death (due to severe DNA damage).

“Ever-sunburnt” are associates with an increased risk of skin cancer. Also, using a sunbed before the age of 35 can increase the risk of skin cancer by 75%.

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16
Q

What is polymorphic light eruption?

A

Polymorphic light eruption is a fairly common skin rash triggered by exposure to sunlight or artificial ultraviolet (UV) light. The rash usually appears as red, tiny bumps or slightly raised patches of skin.

17
Q

What is solar elastosis?

A

Overexposure to UV light can cause a lack of elasticity. This can cause sever wrinkles.

18
Q

What are naevi?

A

Naevi are moles. They are the benign proliferation of melanocytes.

Having many or large naevi is a risk factor for melanoma skin cancer.

This is also due to UV radiation.

19
Q

What are ephelides?

A

Ephelides are freckles.
They involve a genetic component. It is also linked to red/fair hair. It’s often due to MC1R variants. (not fully understood)

They can be found mostly on sun-exposed areas of the body (eg. face, shoulders, etc.).

20
Q

What are solar lentigos?

A

They are liver spots, or age spots.

They are age-related.

21
Q

What are solar keratoses?

A

They are the dysplastic growth of keratinocytes. This results from exposure to UV radiation.

22
Q

What are the different kinds of skin cancers?

A

Skin cancer can be split into two types:

  • Melanoma (melanocytes) - most dangerous
  • Non-melanoma (mostly keratinocytes) - common

Melanomas can be thin but still very dangerous and can spread rapidly. UVA as well as UVB can cause melanoma, in pigmented mice.
Relevant to sunscreen design and tanning salons.

The non-melanoma cancers can be split into two kinds:

  • squamous cell carcinoma
  • basal cell carcinoma (commonest) –> also called ‘rodent ulcer’ because it can eat into the skin. It is often curable surgery, especially if reported early.
23
Q

What is the good side (ie. beneficial effects) of UV exposure?

A

UV is needed to Vitamin D3 production in the skin. 15 minutes of summer sun on the face and arms is enough for white skin; it would be longer for dark skin. Alternatively, you can take tablets.

Ultraviolet radiotherapy is also used for skin conditions (eg. vitiligo, psoriasis).

24
Q

What are the three types of burns?

A

1st DEGREE:
- a superficial burn, where only the epidermis is destroyed

2nd DEGREE:

  • where the epidermis and a bit of the dermis is destroyed, just before the sebaceous glands
  • it may not scar

3rd DEGREE:

  • a deep burn, where all the dermis and epidermis is destroyed
  • it will scar, and you will get a loss of pinprick sensation when the patient presents acutely.
25
Q

What is irritant contact dermatitis?

A

It occurs when a patient gets too much exposure to a substance. They can still use it, but they have to reduce the amount of exposure.

People vary in sensitivity. Symptoms can be any of:

  • redness
  • itching
  • swelling
  • blistering/scaling
26
Q

What are some examples of irritants?

A
  • washing powder
  • cleaning spirits
  • baking soda
  • bleach
  • soap
27
Q

What is allergic contact dermatitis?

A

It is the allergy to something that contacts the skin - the immune system is involved. A tiny amount can be sufficient to trigger a reaction.

The effects vary greatly between people. It may develop after long or short-term exposure.

The symptoms can be any of:

  • redness
  • itching
  • swelling
  • blistering
  • weeping (small blisters with clear fluid inside form, so the skin can ‘weep’)

You have to avoid the allergen in the future.

28
Q

What are some examples of allergens?

A
  • some metals (eg. nickel)
  • nylon/latex
  • leather
  • bleach
29
Q

How common are irritant and allergen contact dermatitis?

A

Irritant contact dermatitis is common.

Allergen contact dermatitis is relatively uncommon (eg. nickel)

  • we get sensitisation first: Langerhans cells produce an antigen and ‘present’ it to lymphocytes
  • delayed hypersensitivity occurs at the next exposure (due to memory T-cells)
30
Q

Microbes can also affect the skin.

List the three main types of microbes.

A
  • fungi
  • bacteria
  • viruses
31
Q

Give examples of fungal skin infections.

A
  • paronychia (nail disease) [can be fungal or bacterial]

- Tinea capitis (scalp ringworm)

32
Q

Give examples of bacterial skin infections.

A
  • Impetigo (infection on surface of skin)

- Cellulitis (streptococcus infection, for eg.)

33
Q

Give an example of a viral skin infection.

A
  • Human papilloma virus (HPV) [ie. warts]
34
Q

How can the body be exposed to infection?

A

Portal of entry: microbes can enter breach in epidermis (e.g. Streptococcus in cellulitis) usually due to damage/injury to skin.

Impaired immunity predisposes to infection,
e.g. HIV and viral warts;
eczema herpeticum, which is herpes (cold sore) virus infecting eczema

35
Q

Glossary

A

Thermoregulation – regulation of body temperature

Waveband – a band of wavelengths (of radiation)

Ultraviolet (UV) A, B and C – the three wavebands of UV light. Band UVA comprises the longest and UVC the shortest wavelengths. All shorter than visible light.

Solar elastosis – loss of skin elasticity (wrinkles)
Naevus (pl. naevi) – a skin mole

Melanoma – cancer of melanocytes

Non-melanoma skin cancer – as it sounds, but nearly always from keratinocytes

Dermatitis – skin inflammation

Allergen – something that can cause allergy

Papilloma – a wart