Skin part 2 Flashcards
what is made of hard keratin?
Hair and nails
where is the coloring for hair created and by what cell?
from melanocytes at he base of the follicle
what causes hair to stand up or “goose bump”?
Arrector pili muscle
what is the main factor with hair growth?
nutritional status
excessive growth of hair on a woman is called?
Hirsutism
patches of hair that the cause is to thought to be autoimmune
Areata allopecia
totally hair loss from head to toe and thought to be autoimmune
universalis allopecia
hairball in the stomach from the action of pulling out one’s hair and eating it, causing GI distress
Tricotillimania or bezoar
fungal infection of the head
tinea capitis
a pt is genetically predisposed response to androgens, with androgen-sensitive and androgen-insensitive follicles. what sex are they and what do they have?
Male and Male-pattern alopecia
a pt has elevated levels of the serum adrenal androgen dehydroepiandrosterone sulfate with
no loss of hair along the frontal hairline, what sex are they and what do they have?
Female and Female-pattern alopecia
Autoimmune T-cell–mediated inflammatory disease against hair follicles that results in baldness
Alopecia areata
Androgen-sensitive areas. Abnormal growth and distribution of hair on the face, body, and pubic area in a male pattern that occurs in women
Hirsutism
Produce oily/waxy matter, Meibomian glands, Lubricant for skin, Kills bacteria, Glands are activated at puberty
Sebaceous Glands
chalazion is a…?
Blocked Meibomian gland
a stye is a….?
A small infection forms at the base of an eyelash
Different types prevent overheating of the body; also secrete cerumen and milk
Sweat Glands
abundant on palms, soles of the feet, and forehead – more numerous – ducts empty onto surface of skin
Eccrine sweat glands
found in axillary and anogenital areas – ducts empty into hair follicles, little role in thermoregulation
Apocrine sweat glands
modified apocrine glands in external ear canal that secrete cerumen
Ceruminous glands
specialized sweat glands that secrete milk
Mammary glands
Mostly water, Some metabolic waste, Fatty acids and proteins (apocrine only)
Sweat composition
Helps dissipate excess heat, Excretes waste products, Acidic nature inhibits bacteria growth
Sweat Functions
Odor is created from where?
Bacteria sources
Mechanical damage, Chemical damage, Bacterial damage, Thermal damage, Ultraviolet radiation, Desiccation
Skin functions that protects deeper tissues
Aids in heat regulation/ blood reservoir, Aids in excretion of ammonia, urea and uric acid (sweat), Synthesizes vitamin D
Skin functions
these arent vitamins, only steroid hormones
Vitamin D
Ergocalciferol
D2
Cholecaleiferol
D3
what plays a major role in calcium and phosphorous absorption?
Vitamin D
children in england have a vitamin D deficiency which has a sequela of?
Rickettes
what organs are involved in the vitamin D pathway which control the serum phosphate and calcium levels?
Skin, liver, kidney, bones and small intestines
Tendency to affect certain areas in certain patterns and Response to treatment is often a clue to what it is?
Skin Disease
Most ___________ are slow growing and treatable except for ________________
skin cancers. and malignant melanoma
Name the Lesion Patterns and Shapes
Linear Clustered Geographic (highly irregular - resembling continents/islands) Serpiginous – snake-like, wavy margin Annular/Arciform – circular/disc-like
Two factors affect significance of damage?
Depth of burn
Size of burned area
Only epidermis is damaged Skin is red and swollen Pain subsides in 2–3 days No scarring Complete healing complete in about one week
First Degree Burns
Epidermis and upper dermis are damaged
Skin is red with blisters
Blistering continues to extend after initial burn
Blisters heal in 10–14 days if no complications
Deeper second degree burns heal in 1–3½ months
Scarring common with second degree burns
Second Degree Burns AKA Partial Thickness
Destroys entire skin layer
Burn is gray-white or black
Ranges in color from black, brown, tan, red or white
Victim feels no pain (pain receptors are destroyed)
Sudoriforous and sebaceous glands, hair follicles, and blood vessels also destroyed
Third-Degree Burns AKA Full Thickness
The most severe of all burns
Penetrate the bone and cause bone damag
4th degree burns
Elevated, rounded, and firm
Claw-like margins that extend beyond the original site of injury
Excessive collagen formation during dermal connective tissue repair
Common in darkly pigmented skin types and burn scars
Keloids
What causes pressure ulcers
Pressure ulcers result from any unrelieved pressure on the skin, causing underlying tissue damage (ischemic necrosis). Pressure, Shearing forces, Friction, and Moisture
Pressure ulcers risk factors are?
Older adults in hospitals and nursing homes, Neurologic disorders that result in loss of mobility and/or sensation (spinal cord injuries, dementia, or cerebrovascular disease), Immobilization Incontinence, and Debilitation
Clinical Manifestations of pressure ulcers risk factors are?
Lying in bed without changing position or relieving pressure over an extended period, Lying for hours on hard imaging and operating tables, Chronic diseases accompanied by anemia, edema, renal failure, malnutrition, sepsis, and urinary or fecal incontinence, and Coarse bed sheets used for turning by dragging, which produces a shearing force
Describe the first stage of a pressure ulcer.
Nonblanchable erythema of intact skin
Describe the second stage of a pressure ulcer.
Partial-thickness skin loss involving epidermis or dermis (shallow ulcer)
Describe the third stage of a pressure ulcer.
Full-thickness skin loss involving damage or loss of subcutaneous tissue (Deep Ulcer)
Describe the fourth stage of a pressure ulcer.
Full-thickness skin loss with damage to muscle, bone, or supporting structures
Describe the ustageable stage of a pressure ulcer.
Unstageable if wound bed covered with eschar
List the Inflammatory Disorders of the skin
Dermatitis = Eczema Allergic Contact dermatitis Atopic Dermatitis Irritant Contact Dermatitis Stasis Dermatitis Seborrheic Dermatitis
Caused by a hypersensitivity type IV reaction
Allergen comes into contact with skin, binds to carrier protein to form sensitizing antigen; Langerhans cells process antigen, carry it to T cells, which become sensitized to antigen
Manifestations: Erythema, swelling, pruritus, vesicular lesions
Allergic contact dermatitis
Type I hypersensitivity—activation of mast cells, eosinophils, T lymphocytes, other inflammatory cells
Causes red, weeping crusts and chronic inflammation, lichenification
Atopic dermatitis
Nonimmunologic inflammation of the skin
Chemical irritation from acids or prolonged exposure to irritating substances
Symptoms similar to allergic contact dermatitis
Treatment—remove stimulus
Irritant contact dermatitis
Occurs in the legs as a result of venous stasis, edema, and vascular trauma
Sequence of events: erythema, pruritus, scaling, petechiae, ulcerations
Stasis dermatitis
Inflammation of the skin involving the scalp, eyebrows, eyelids, nasolabial folds, and ear canals
Scaly, white, or yellowish plaques
Seborrheic dermatitis
Chronic, relapsing, proliferative skin disorder
T-cell immune-mediated skin disease
Scaly, thick, silvery, elevated lesions, usually on scalp, elbows, or knees caused by a high rate of mitosis in the basal layer
Shows evidence of dermal and epidermal thickening
Epidermal turnover goes from 26-30 days to 3-4 days
Cells do not have time to mature or keratinize
Psoriasis
Various Kinds of Psoriasis are?
Plaque psoriasis – most common, patches or plaques
Inverse psoriasis – skin folds
Guttate psoriasis – (drops) small, distinct lesions
Pustular psoriasis
Erythrodermic psoriasis - inflammatory
Benign, self-limiting inflammatory disorder
Usually occurs during winter months
Herald patch: Circular, demarcated, salmon-pink, 3- to 4-cm lesion
Pityriasis rosea
Benign, inflammatory disorder of the skin and mucous membranes
Unknown origin, but T cells, adhesion molecules, inflammatory cytokines, and antigen presenting cells are involved
Nonscaling violet-colored, 2- to 4-mm lesions
Wrists, ankles, lower legs, genitalia
Lichen planus
Inflammatory disease of the pilosebaceous follicle
Acne vulgaris
Inflammation of the skin that develops in adulthood
Lesions: Erythematotelangiectatic, papulopustular and phymatous
Also: Associated with chronic, inappropriate vasodilation resulting in flushing and sensitivity to the sun
Acne rosacea
Excessive hormonally influenced sebum production
Abnormal keratinization of portions of the follicular epithelium
Response to anerobic bacterium P. acnes
Follicular rupture and inflammation
Acne Vulgaris
Inflammatory, autoimmune disease with cutaneous manifestations
Thought to be an altered immune response to an unknown antigen or response to UV wavelengths with the development of self-reactive T and B cells, decreased number of regulatory T cells, and increased proinflammatory cytokines
Autoantibodies and immune complexes cause tissue damage
Lupus erythematosus
Restricted to the skin
Photosensitivity
Butterfly pattern over the nose and cheeks
Subtype of systemic lupus erythematosus (SLE)
Leads to SLE in approximately 5% of cases
Discoid lupus erythematosus
Diseases that have different causes and clinical courses but share the common characteristic of vesicle, or blister, formation
Vesiculobullous Disorders
List the two Vesiculobullous Disorders?
Pemphigus & Erythema multiforme
Rare, chronic, blister-forming disease of the skin and oral mucous membranes
Blisters form in deep or superficial epidermis
Autoimmune disease caused by circulating IgG autoantibodies: The antibodies are against the cell surface adhesion molecule, desmoglein in the suprabasal layer of the epidermis
Pemphigus
Three types of Pemphigus
Pemphigus vulgaris (severe)
Pemphigus foliaceus
Pemphigus erythematosus
how do you diagnosis Pemphigus?
Tissue biopsies demonstrate autoantibody presence
More benign disease than pemphigus vulgaris
Bound IgG and blistering of the subepidermal skin layer
Subepidermal blistering and eosinophils distinguish pemphigoid from pemphigus
Bullous pemphigoid
Acute recurring disorder of skin and mucous membranes
Associated with allergic or toxic reactions to drugs or microorganisms
Caused by immune complexes formed and deposited around dermal blood vessels, basement membranes, and keratinocytes
“Bull’s-eye” or target lesion: Erythematous regions surrounded by rings of alternating edema and inflammation
Erythema multiforme
Bullous lesions form erosions and crusts when they rupture
Affects the mouth, air passages, esophagus, urethra, and conjunctivae
Severe forms:
Stevens-Johnson syndrome (bullous form)
Toxic epidermal necrolysis
Erythema multiforme
What are inflammatory skin disorders?
stasis and seborrheic
Whats the events of stasis?
erythema, pruritus, scaling, petechiae, ulcerations
anerobic bacterium P. acnes causes what?
Acne vulgaris
Whats the diffenece btwn acne vulgaris and acne rosacea?
Vulgaris has comedones while rosacea is seen in adults with no comedones.
What are autoimmune diseases caused by circulating IgG?
pemphigus
What disease is associated with bound IgG and blisters?
Bullous pemphigus
what is desmoglein associated with?
where is desmoglein found?
what are the types of pemphigus?
Pemphigus vulgaris (severe)
Pemphigus foliaceus
Pemphigus erythematosus
what is associated with extensive confluent erosions and crust
with a few large flaccid bullae?
what distinguish pemphigoid from pemphigus?
Subepidermal blistering and eosinophils
what Vesiculobullous Disorders is associated with TEN and steven-johnson syndrome?
erythema multiforme
whats the serve form of erythema multiforme with bullus?
steven-johnson syndrome
what is the infection of the hair folicles?
folliculitis caused by s. aureus
what is a furuncle?
boils/inflammation of hair follicle caused by s.aureus
how do you know a pt has a gram + infection?
skin is hot and tender to touch
scald skin syndrome from staph aureus is what type of infection?
gram + superfical in skin
what is a carbuncle?
collection of infected hair follicles, may develop in abscesses.
how do you know cellulitis is getting worse?
its ascending
what is impetigo?
alpha hemolytic stept or staph
a superfical lesion on skin
kids
what is Erysipelas?
group a strept
acute superficial infection of the upper dermis
what is a superficial form of cellulitis?
erysipelas
what is cellulitis?
infection of dermis and sub Q
caused by strept B and staph
could be localized or ascending
where does varicella virus live for a prolonged period?
nerve root
when herpes zoster shows symptoms where does it appear?
one sided nerve dermatome
what are characteristics of Condylomata acuminata?
genital warts
Highly contagious, sexually transmitted
Cauliflower-like lesions occur in moist areas, along the glans of the penis, vulva, and anus
Oncogenic HPV a primary cause of cervical
what is it called when Fungi cause superficial skin lesions?
dermatophyte
what is mycoses?
fungal disorders
mycoses caused by dermatophytes are termed
tinea
name the 5 tinea
Tinea capitis (scalp) Tinea pedis (athlete’s foot) Tinea corporis (ringworm) Tinea cruris (groin, jock itch) Tinea unguium (nails) or onychomycosis
how are fungal infections diagnosed?
KOH prep
what causes Tinea versicolor?
the organism Pityrosporum ovale
where is Candida albicans normally found?
on skin, in GI tract, and in vagina
what is unique about oral thrush?
it could be scrapped off
what looks like thrush thats precancerous and cant be scrapped off?
oral luekoplaquea
what are predisposing conditions for candidiasis?
systemic administration of antibiotics, pregnancy, diabetes mellitus, Cushing disease, debilitated states, age younger than 6 months, immunosuppression, and neoplastic diseases
Pediculus humanus capitis
Lice that infest the head
Pediculus humanus corporis
Lice that infest the body
Phthirus pubis
Pubic lice (crabs)
Sarcoptes scabiei
Itch mites
which parasite is sexually transmitted and borrows into the skin?
scabies - itch mites
what are nits?
lice eggs
what are characteristics or vascular disorder?
what is the MOA of uticaria?
Histamine release causes endothelial cells of the skin to contract
which Causes leakage of fluid from the vessels
what immune response is uticaria?
type 1
how does uticaria appear?
geographic type patterns that are raised
what vascular disorder is characterized by taut skin, massive deposits of collage, inflammation, autoimmune w association of several antibodies and hypopigmentation?
scleroderma
what are symptoms of scleroderma?
Facial skin becomes very tight
Fingers become tapered and flexed; nails and fingertips can be lost from atrophy
Mouth may not open completely
50% of patients die within 5 years
what are types of insect bites?
Ticks, Mosquitoes, Flies and Spider
Lyme disease, Rocky Mountain spotted fever
Ticks
Malaria, yellow fever, dengue fever, filariasis, St. Louis encephalitis
Mosquitoes
Painful bites
Urticaria, mild bleeding
Flies
why is a spider bite the worst?
localized allergic reaction
What disease is Autoimmune, rare, chronic, blister-forming disease of skin and oral mucous membranes and caused by IgG autoantibodies?
Pemphigus
skin injury from exposure to extreme cold results in?
frostbite
what causes the burning reaction in frostbite?
alternating cycles of vasoconstriction and vasodilation
what causes the alternating vasoconstriction and vasodilation during frostbite?
Prostaglandins, thromboxanes, bradykinin and histamine (similar to burn inflammation)
during frost bite ice crystals form where?
extracelluar and intracellular
Name two nail disorders
Paronychia
Onychomycosis
What nail infection is associated with the nail plate?
onychomycosis
name the 4 types of benign skin tumors? MASK
Seborrheic Keratosis Benign proliferation of basal cells Actinic Keratosis Premalignant (in elderly) Keratoacanthoma Tumor arising from hair follicles Nevi (Moles)
what bengin skin tumor has Benign proliferation of basal cells?
Seborrheic Keratosis (germ layer)
how does seborrheic keratosis appear?
multiple brown warty papules on nodules having stuck on appearance
whats another name for actinic keratosis?
solar keratosis
what is solar keratosis?
macules and papules with coarse adhearing scaling on forehead from sun damage
what is a keratocanthoma?
Dome shaped tumor with a central plug
what does a keratocanthoma with a central plug resemble?
Squamous cell carcinoma
Skin cancer is categorized into cancerous what are they?
malignant and benign
What is the difference between benign and malignant skin cancer?
malignant - metastasizes, (melanoma)
benign - does not spread, encapsulated (carcinoma)
name the 4 types of skin cancer
Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma
Kaposi sarcoma
which skin carcinoma can metastasize and to where?
lymph node - squamous cell carcinoma
which are some characteristics of Basal cell carcinoma?
affects p53 gene
curly rolled borders
associated with UV exposure
whats the most deadly skin cancer, with genetic predisposition? why?
malignant melanoma - Metastasizes rapidly to lymph and blood vessels
what are the 4 types of Kaposi sarcoma?
Drug-induced immunosuppresion
Associated with AIDS
Endemic – equatorial Africa
Classic form – elderly (purple lesions)
what virus is kaposi sarcoma associated with?
Kaposi-Associated Herpesvirus 8
kaposi sarcoma affects what cell?
progenitus cell = Endothelial Cells
What is ABCD rule used for?
used to check for malignant melanoma
ABCD
A = Asymmetry Two sides of pigmented mole do not match B = Border irregularity Borders of mole are not smooth C = Color Different colors in pigmented area D = Diameter Spot is larger then 6 mm in diameter
what characteristic would you see with kaposi?
Kaposi Sarcoma – dark purple macules, nodular plaques
a Pt has white thick plaque of firm consistency and irregular margins on the inner side of the cheek and the pt was a heavy pipe smoker
oral leukoplakia
3 types of vascular skin lesions
Strawberry Hemangioma
Cavernous Hemangioma
Port Wine Stain
Port Wine Stain
sharply marginated port wine red macula occur in a distribution of the maxillary in kids
Cavernous Hemangioma
large soft semispheric blue tinged swelling of dermis and sub Q
Strawberry Hemangioma
a purple dermal nodular lesion near elbow of a newborn may go away
how does Integumentary system reflects changes from genetic and environmental factors
skin - becomes thinner, drier, wrinkled, and demonstrates changes in pigmentation
capillary loops - Shortening and decrease in number
melanocytes and Langerhans cells # decreases
Atrophy - sebaceous, eccrine, and apocrine glands
hair - color changes, Fewer hair follicles, and growth of thinner hair