Skin Pathophysiology (Maize) Flashcards
A common, self-limiting disease of the pilosebaceous units of the skin, typically located on the face, upper back, and chest
Acne vulgaris
Types of non-inflammatory acne (2)
- closed comedone (whitehead)
- open comedone (blackhead)
Types of Inflammatory acne (4)
- Pimple
- Papule
- Pustule
- Nodule
(Type of Inflammatory acne)
- Small, prominent, inflamed elevation of the skin
pimple
(Type of Inflammatory acne)
- inflammatory comedo that resembles a small (<5 mm), red bump on the skin.
papule
(Type of Inflammatory acne)
- An inflammatory comedo that bursts and has pus in it.
- Area around lesion is red
pustule
(Type of Inflammatory acne)
- Solid, dome-shaped or irregularly-shaped lesion that is larger than a papule (>5 mm).
- May be very painful
- Scarring is likely
nodule or cyst
Pathophysiology of acne:
- Increased _____ production in ____ ____
- androgen,
both sexes
Pathophysiology of acne:
- Increased androgen production leads to three factors that correspond to acne development:
- Follicular hyperkeratinization
- Increased sebum production
- Proliferation of propionibacterium acnes (p. acnes)
Pathophysiology of acne:
__________ - cause skin cells to stick together
Follicular hyperkeratinization
Pathophysiology of acne:
- An increase in ________ _______ size/number increases sebum production and also increases with an _________ ______ at puberty.
sebaceous gland; androgen surge
Formation of acne
- Skin cells ____ ________ and are not ____
- Channel is _______ by a combination of ____ ____ and _____
- Normal flow of ____ is _______
- stick together, shed
- plugged, skin cells, sebum
- sebum, blocked
Propionibacterium acnes (P. acnes)
- Produces ____ which breaks down _______ from sebum into ____ ____ ____
- Free ____ ____ irritate the _______ walls
- Have an ________ effect
- lipase, glyceride, free fatty acids
- fatty acids, follicular
- antigenic
What is this?
pustule
ACNE EXACERBATING FACTOR:
_____________ - anything that occludes the skin or irritates it
Acne mechanica
EXACERBATING FACTOR
_____________ - mild form of acne to comediogenic oils in cosmetics
Acne cosmetica
Acne Exacerbating Factors (5)
- Environmental and Physical factors
- Severe and prolonged periods of stress or emotions
- Hormones
- Acne medica mentosa
- Genetics
Drug-induced acne
Acne medica mentosa
Unsubstantiated causes of acne (3)
- diet (chocolate, fried foods, sugar)
- poor personal hygiene (dirt)
- sex
Chronic disease characterized by recurrent exacerbations and remissions of thickened, erythematous and scaling plaques
Psoriasis
What is this?
Psoriasis
- Epidemiologic evidence suggests that psoriasis has a _____ basis that requires _________ triggers to activate the disease.
- Initial diagnosis occurs between 20-60 years of age but typically in the __s with a second peak at __-__.
- All racial groups but most common in _____
- Symptomatic throughout life, deteriorates with ___ or go through cycles of __________ and ____________
- genetic, environmental
- 20s, 55-60
- whites
- age, remissions and exacerbations
Sebum consists of glycerides, wax esters and cholesterol, it retards ____ ____ from the skin and is on the face, scalp, back and neck
water loss
3 Hypotheses on the cause of psoriasis:
- Defects in the epidermal cell cycle
- Genetic disposition
- Immunologic disorder
In a psoriatic epidermis, keratinocytes take __ days to divide and _ days to mature and shed (increase of _-____)
__-cells contribute this hyperproliferation of skin, resulting in ____ epidermis maturation.
1.5, 4, 7-fold
T-, altered
In a normal epidermis, ___________ take __ days to divide and __ days to mature, migrate to the stratum corneum and shed
keratinocytes, 13, 26
__/__ of patients with psoriasis have a family history and is __ times more common in monozygotic than in dizygotic twins.
1/3; 3
Psoriasis immunologic disorder:
- keratinocytes encounter an ____ or undergo trauma
- ____ triggers result in _-_________ recruitment to the site
- Histocompatibility complex triggers release of T-cell ____, resulting in ____, new capillary formation (____) and further inflammation
- ____ acid levels become elevated
- antigen
- inflammatory; T-lymphocyte
- cytokines; vasodilation; angiogenesis
- arachidonic
Psoriasis contributing factors (5):
- climate (cold exacerbates)
- stress
- infections
- trauma
- medications (lithium & beta blockers)
Type of psoriasis:
- Sharply demarcated erythemateous papules covered with thick silvery scales
- Salmon-pink lesion underneath with pinpoint bleeding (Ausptiz sign)
Distribution: Lesions most common on elbows, knees, sacrum, limbs, hands and scalp. However lesions can occur anywhere
Psoriasis vulgaris (plaque)
Type of psoriasis:
Sudden eruption of pin-point (0.5-1.5 cm lesions) dark-red scaling lesions
Distribution: trunk and limbs
Guttate psoriasis (eruptive)
Type of psoriasis:
smooth patches of red, inflamed skin
Distribution: armpits, groin, under the breasts, around the genitals, in skin folds
Inverse psoriasis
Type of psoriasis:
Generalized eruption of painful erythematous plaques with rows or clusters of yellow 2-3 cm pustules
Distribution: may be generalized or localized to the palms and soles of the feet
pustular psoriasis (Von Zumbusch)
Type of psoriasis:
Generalized erythema with little or no scaling that can lead to a generalized desquamation
Distribution: Affects all body sites, covering 75% of body surface area
erythrodermic psoriasis
Psoriasis vulgaris characteristics:
- ______ _______ form of psoriasis – 80%
- ________ may occur in 20% of patients
- Mildly _____, but can be highly ______
- Most common
- Pruritus
- painful, itchy
Guttate psoriasis characteristics:
- Frequently found in ______ _______
- Frequently preceded by a ______ _________
- young adults
- strep infection
Inverse psoriasis characteristics:
- more common in __________ people
- is worsened by ________ and _____________
- overweight
- friction and sweating
Pustular psoriasis characteristics:
- Accompanied with _____ and _______
- May be _________ to treatment but must treat ______________
- fever and malaise
- resistant; aggressively
Erythrodermic psoriasis:
- Most _______ form which may lead to _______
- May occur __________ to injury or __________ may progress to this form
- severe, death
- secondary; pustular
Misc type of psoriasis:
Pitting, ridging discoloration, and onycholysis (loss of nails)
Nail psoriasis
Misc type of psoriasis:
Asymmetric involvement in hands, feet, and knee joints
Skin lesions usually precede joint involvement
Lacks elevation of rheumatoid factors and autoantibodies seen in rheumatoid arthritis
Psoriasis arthritis
Psoriasis arthritis
- ___________ involvement in hands, feet, and knee joints
- ____ _______ usually precede joint involvement
- Lacks elevation of _________ _______ and _________________ seen in rheumatoid arthritis
- Asymmetric
- Skin lesions
- rheumatoid factors, autoantibodies
A dermatological condition that presents as a rash, dry skin and itching
Dermatitis
Causes of dermatitis (3)
- Allergies (Atopic dermatitis, eczema, or contact dermatitis)
- genetics
- stress
Exaggerated skin and mucosal reactivity to environmental stimuli
Atopic dermatitis
Atopic dermatitis epidemiology:
- Atopic triad is:
- Three peak occurrences:
- More common in ____, _____, higher socioeconomic class and urban areas
- Strong ______ link – 60% if father and 80% if both parents
- 30-80% will also have ____ or ____ _____
- asthma, allergic rhinitis, and atopic dermatitis
- 3 peak occurences:
- infant (5% by age 6 months)
- children (5-10% under 14 yrs)
- adult (2-5%)
- males, whites
- genetic
- asthma, allergic rhinitis
Atopic Dermatitis Signs and Symptoms:
- ___ to ______-____ colored patches that look like chapping
- ________ which may be severe especially at night
- Small, raised ______ which may leak ____ and _____ over when scratched
- Thickened, _______ or _____ skin
- Raw, sensitive skin from scratching
- Secondary ________ infections are common
- Red to brownish-gray
- Pruritus
- vesicles; fluid and crust
- cracked or scaly
- Raw, sensitive skin from scratching
- bacterial
Location of Atopic Dermatitis:
- ____ and ____ are the most common sites in adults
- ____ and _____ are most common in children
- Inside ______, behind the ____, ankles, _____, neck and upper _______
- Skin around ____ including ______
- Hands and feet
- face and scalp
- elbows, knees, wrists, chest.
- eyes; eyelids.
Exacerbating factors of Atopic Dermatitis (8)
- Exposure to allergens – foods, soaps, detergents, fragrances and chemicals
- Long, hot baths or showers
- Dry skin
- Stress
- Sweating
- Rapid changes in temperature or low humidity
- Solvents, cleaners, soaps or detergents
- Wool or man-made fabrics or clothing
Plant Dermatitis:
- Allergic constituents
- __________ is the active irritant (in poison ivy/oak/sumac)
- Etiology (2 Phases)
- Urushiol
- Sensitization phase
- Elicitation phase
Plant dermatitis phase:
At initial exposure, the urushiol binds to epidermal proteins to form an antigen
Sensitization phase
Plant dermatitis phase:
Upon subsequent exposures, hypersensitivity reaction occurs
Elicitation phase
Symptoms of plant dermatitis
- A rash and _____ first appear and then fluid filled ____ form
- The vesicles can be _____ or highly _____
- erythema; vesicles
- painful; itchy
plant dermatitis caused by:
poison ivy
plant dermatitis caused by:
poison oak
plant dermatitis caused by:
poison sumac
________ ___/______ is an acute, transient inflammatory skin condition in the diaper area caused by either moisture, occlusion, chafing, continued contact with urine or feces or both, or mechanical or chemical irritation
Diaper rash/dermatitis
Diaper dermatitis epidemiology
- __% of children get diaper rash but only _% get it severe
- The incidence peaks at _ to __ months
- 65%, 5%
- 9 to 12
Diaper Dermatitis Symptoms:
- Mild:
- Moderate:
- Severe:
- Mild: mild erythema
- Moderate: erythema with maceration and chafing
- Severe: papules, vesicles, oozing, ulceration, and secondary infection
Causes of Diaper Dermatitis symptoms (3):
*The combination of _____, _________, and ______ seems to be the cause of the symptoms
- urine and feces
- retention of fluid
- mechanical and chemical irritants
*urine, ammonia, and feces
Retention of fluids:
- Soiled diapers will hydrate the _______ ____ and ____
- The keratin will ______ the _____ _______
- ________ formation and _________ will occur
- stratum corneum and swell
- block; sweat glands
- Vesicle; irritation
Diaper dermatitis Mechanical and Chemical Irritants:
- Tight fitting diapers and plastic pants increase __________ and __________ of the diaper region
- ________ rubbing ______ skin, makes it susceptible to __________ infection
- Chemical irritants can include ______, ______, _______ and ___________
- moisture and temperature
- Constant; erodes; secondary
- detergents, bleaches, soaps and antiseptics
Diaper Dermatitis Complications
- ________ and ___________ infections are the most common complications
- ___________ infections are secondary to untreated/improperly treated diaper rash
- Fungal (Candida albicans) and bacterial (Staphylococcus aureus)
- Cutaneous
Organism implicated in diaper dermatitis fungal infection
Candida albicans
Organism implicated in diaper dermatitis bacterial infection
Staph aureus
