Untitled Deck Flashcards
- Layer of the epidermis:
- vascular
- mesh
- spinous
- papillary
The epidermis is the outermost layer of the skin, and it consists of five layers (from deepest to surface):
Stratum Basale (Basal Layer) – A single row of basal cells where cell division (mitosis) occurs. It contains melanocytes, which produce melanin.
Stratum Spinosum (Spinous Layer) – Several layers of keratinocytes connected by desmosomes, giving them a spiny appearance under a microscope. This layer provides strength and flexibility.
Stratum Granulosum (Granular Layer) – Contains keratohyalin granules, which help in keratinization and waterproofing the skin.
Stratum Lucidum (only in thick skin) – A clear, thin layer found only in palms and soles for extra protection. Dead keratinocytes that are clear and flattened.
Stratum Corneum (Horny Layer) – The outermost layer made of dead, flattened keratinized cells ((corneocytes) that form a protective barrier and shed regularly. globes
the epidermis is a vascular no blood vessels
mesh refer to reticule layer in dermis
papillary part of dermis layer
Increasing the rows of cells in the granular layer is
1. acanthosis
2. spongiosis
3. parakeratosis
4. granulosis
answer is granulosis
Term What Happens? Example Disease
1) Granulosis - More cells in granular layer example Lichen Planus
2) Acanthosis - Thicker lower layers (basale & spinosum) example Acanthosis Nigricans
3) Spongiosis - Skin cells puff apart with fluid example Eczema
4) Parakeratosis- Dead cells keep their nuclei example Psoriasis
- Skin appendages are:
- mucous membranes
- derma
- epidermis
- hair
the answer is hair
Skin appendages are structures that grow out of the skin. They develop from the epidermis but go deeper into the dermis. The main skin appendages include:
Hair – Protects the skin and helps regulate temperature.
Sebaceous (oil) glands – Produce oil (sebum) to keep skin moist.
Sweat glands – Help control body temperature by producing sweat.
Nails – Protect fingertips and help with grip.
Why the Other Answers Are Incorrect?
Mucous membranes (Wrong ❌) – Mucous membranes line body cavities (like the mouth, nose, and intestines), but they are not considered skin appendages.
Derma (Wrong ❌) – The dermis is a layer of skin (not an appendage). It contains blood vessels, nerves, and glands.
Epidermis (Wrong ❌) – The epidermis is the outer layer of skin, not an appendage. However, appendages (like hair and nails) develop from the epidermis.
- The sebum-secreting holocrine gland is
- Cooper’s gland
- sebaceous gland
- sweat gland
- Bartholin’s gland
Correct Answer: 2. Sebaceous gland ✅
Explanation (Easy Version)
The sebaceous gland is a holocrine gland that produces sebum, an oily substance that keeps the skin and hair moisturized. It is mainly found attached to hair follicles but can also exist independently in some areas like the lips and eyelids.
Holocrine secretion means that entire cells break down and release their contents (sebum). This is different from other types of glands like sweat glands, which use a different method.
Sebaceous glands are more active during puberty, which is why oily skin and acne are common in teenagers.
Why the Other Answers Are Incorrect?
Cooper’s gland (Wrong ❌) – Also called Bulbourethral glands, these are found in males and produce mucus to lubricate the urethra.
Sweat gland (Wrong ❌) – Sweat glands are not holocrine; they use merocrine or apocrine secretion to release sweat, which helps regulate body temperature.
Bartholin’s gland (Wrong ❌) – These glands are found in females and produce mucus for vaginal lubrication, not sebum.
How to Study This Topic?
Understand the Types of Glands in the Skin:
Sebaceous gland → Makes sebum (oily, holocrine secretion).
Sweat gland → Makes sweat (merocrine/apocrine secretion).
- Where are the sebaceous glands in the skin:
- neck
- the scalp
- axillary
- palms
Correct Answer: 2. Scalp ✅
Explanation (Easy Version)
Sebaceous glands are found all over the body, except for the palms and soles. They are most concentrated in areas with hair follicles, such as the:
Scalp (produces oil for hair)
Face (especially forehead and nose)
Neck, upper chest, and back
These glands produce sebum, which moisturizes the skin and hair, preventing dryness.
Why the Other Answers Are Incorrect?
Neck (Partially Correct ❌) – The neck has sebaceous glands, but they are not as numerous as on the scalp.
Axillary (Wrong ❌) – The axilla (armpit) contains apocrine sweat glands, which produce odor but not sebum.
Palms (Wrong ❌) – Sebaceous glands do not exist on the palms or soles. These areas need friction and grip, so having oil would make them too slippery.
- An increase in the rows of cells of the spinous layer is
- acanthosis
- spongiosis
- parakeratosis
- granulosis
Correct Answer: 1. Acanthosis ✅
Explanation (Easy Version)
Acanthosis refers to the thickening of the stratum spinosum (spinous layer) of the epidermis due to an increase in keratinocyte numbers. This happens in conditions like:
Acanthosis nigricans → Dark, thick skin in body folds (often linked to insulin resistance).
Psoriasis → Rapid skin cell growth leading to thick plaques.
Chronic skin irritation → Constant friction can thicken the epidermis.
Acanthosis is different from hyperkeratosis (thickening of the stratum corneum).
Why the Other Answers Are Incorrect?
Spongiosis (Wrong ❌) – Refers to fluid buildup (edema) between skin cells, seen in eczema.
Parakeratosis (Wrong ❌) – Means nuclei are retained in the stratum corneum, seen in psoriasis.
Granulosis (Wrong ❌) – Refers to increased thickness of the granular layer (stratum granulosum), often in lichen planus.
How to Study This Topic?
Remember Epidermal Changes:
Acanthosis → Thickening of spinous layer.
Granulosis → Thickening of granular layer.
Parakeratosis → Nuclei stay in the corneum (abnormal keratinization).
Spongiosis → Fluid between skin cells (edema).
- Secondary morphological element:
- flake
- blister
- bubble
- erythema
the correct answer is flakes
the skin lesion can be classified into two primary 1st occurs in disease and secondary appears later due to develop or changes in the primary element
flakes - scales
thin layer of dead keratinized cell that have been shed in the surface of the skin due to abnormal mutation of shedding of the outer layer of the skin
- it is secondary desquamative morphological element that can be fine tiny or coarse large greasy or dry non infiltrative non cavity
desquamative process of stratum carenum shedding
pathogenesis
inflammation
rapid turnover of cells
abnormal keratinization
clinical examples
psoriasis
slivery dry scales over red inflamed patches
abnormal turnover of cells which lead to rapid accumulation of keratin which then shed as scales
seborrheic dermatitis
greasy yellowish scales can occur in scalp face or upper chest
ichthyosis
group of genetic skin disorder where skin becomes dry thickened and scaly fish scales
describe the following
2. blister
3. bubble
. erythema
vesicle or vesicula
small skin lesion (blister) that is typically less than 5mm
formed within or just beneath the epidermis
-primary exudative cavity non infiltrative palpable morphological element
-contain clear or serous fluid
-can rupture easily often leads to crust
example
chickenpox
herpes simplex
contact dermatitis
bubble or bulla
large fluid filled skin lesion that is typically larger than 5mm
formed in epidermis but can extend to dermis
-primary exudative cavity non infiltrative palpable morphological element
- clear or serous fluid can vary blood or pus
- can be tense if overlying skin is tight or flaccid of roof is loose
example
burns
bullous pemphigoid
pemphigus vulgaris
erythema
skin redness due to increase blood flow to an area
sign to inflammation-sunburn or allergies infection or irritation - heat chemicals
primary non infiltrative non cavity non palpable morphological element
- The infiltrative morphological element is:
- papule
- flake
- vesicle
- blister
the answer is papule
papule
small solid raised skin lesion that is typically either or less than 1 cm without visible fluid
-primary infiltrative non cavity morphological element
- can occur due to epidermal hyperplasia or dermal infiltration
can very in size shape and color
characteristics
size equal or less 1cm
surface smooth or rough or others
color flesh red purple brown or other
raised above the skin surface
solid without fluid
can be rounded pointed or flat topped
examples
psoriasis
raised erythematous papule with silvery white scales
location elbow knees scalp lower back
lichen planus
flat topped purple papules with white lines called Wickham striae
location wrists ankles forearms sometimes inside mouth
insect bite pointed pruritic papule on site of bite
location
- The exudative morphological element is:
- papule
- tubercle
- vesicle
- crack
the answer is vesicle
Tubercle: A small, solid, raised lesion similar to a papule but typically larger and extending into the dermis. It is non-exudative.
Crack (Fissure): A linear break in the skin, often due to dryness, extending into the dermis. While it may ooze blood or serous fluid, it is primarily a secondary lesion resulting from skin breakdown, not an exudative primary lesion.
definition of crack and tubercle ?
- Fissure
Definition: A linear crack in the skin extending into the dermis.
Classification: Secondary lesion; destructive.
Characteristics:
Appearance: Narrow, linear breaks.
Depth: Penetrates epidermis into dermis.
Sensation: Often painful.
Common Locations: Corners of the mouth, hands, feet, between toes.
Common Causes:
Dry Skin: Lack of moisture.
Inflammatory Conditions: Eczema, psoriasis.
Fungal Infections: Athlete’s foot.
Mechanical Factors: Friction, pressure.
Examples:
Angular Cheilitis: Cracks at mouth corners.
Athlete’s Foot: Fungal infection between toes.
Chronic Eczema: Dry, cracked skin.
Management:
Moisturization: Regular use of emollients.
Protective Measures: Barrier creams, protective clothing.
Treat Underlying Conditions: Antifungals, corticosteroids.
Medical Consultation: For persistent or severe cases. - Tubercle
Definition: A solid, rounded lump larger than a papule, extending deeper into the skin.
Classification: Primary lesion; infiltrative, non-cavity.
Characteristics:
Size: Generally >0.5 cm.
Consistency: Firm and solid.
Depth: Involves epidermis and dermis.
Appearance: Skin-colored or discolored; smooth or irregular surface.
Common Causes:
Infectious Diseases: Cutaneous tuberculosis.
Inflammatory Conditions: Granulomas.
Neoplastic Processes: Benign or malignant tumors.
Examples:
Cutaneous Tuberculosis (Lupus Vulgaris): Reddish-brown plaques progressing to tubercles.
Granulomas: Inflammatory nodules.
Benign Skin Tumors: Dermatofibromas.
- Primary morphological element:
- flake
- scar
- erosion
- erythema
the answer is erythema
To help you understand and remember the key aspects of erosions and scars, here’s a concise overview:
Erosion
- Definition: A superficial loss of the epidermis that does not penetrate the dermis.
- Classification: Secondary lesion; destructive morphological element.
-
Characteristics:
- Appearance: Shallow, moist, and often red depressions.
- Healing: Typically heals without scarring.
-
Common Causes:
- Ruptured Blisters: When blisters break, they leave erosions.
- Excoriation: Skin picking or scratching leading to surface damage.
-
Examples:
- Ruptured Vesicles: Blisters from conditions like chickenpox that, when broken, result in erosions.
- Excoriations: Linear erosions caused by scratching, often seen in conditions like eczema.
Scar
- Definition: Fibrous tissue replacing normal skin after an injury or wound has healed.
- Classification: Secondary lesion; reparative morphological element.
-
Characteristics:
- Appearance: Varies; can be flat, raised, or depressed.
-
Types:
- Atrophic Scars: Depressed scars, often from acne or chickenpox.
- Hypertrophic Scars: Raised, red scars that stay within the wound boundary.
- Keloid Scars: Thick, raised scars extending beyond the original wound area.
-
Common Causes:
- Injuries: Cuts, burns, or surgical incisions.
- Inflammatory Skin Conditions: Severe acne or infections.
-
Examples:
- Surgical Scars: Marks left after surgical procedures.
- Acne Scars: Depressed or raised areas following severe acne.
- Burn Scars: Often hypertrophic, resulting from deep burns.
Key Differences:
-
Depth of Damage:
- Erosion: Involves only the epidermis.
- Scar: Involves dermal healing and fibrosis.
-
Healing Process:
- Erosion: Heals without scarring.
- Scar: Results from deeper injuries and involves fibrous tissue formation.
Understanding these distinctions is crucial for identifying and managing various skin conditions effectively.
- Choose one location that is most typical for psoriasis:
- on the palms and soles
- on bending surfaces of limbs
- on the extensor surfaces of limbs
- on genitals
the answer is on the extensor surface of the limbs
The correct answer is 3. on the extensor surfaces of limbs.
Explanation:
- Extensor Surfaces: These are the outer parts of the joints, such as the front of the knees and elbows. Plaque psoriasis, the most common form, typically manifests on these areas. citeturn0search1
Why Other Options Are Less Typical:
-
On the palms and soles:
- Psoriasis can affect these areas, known as palmoplantar psoriasis, but it’s less common than plaque psoriasis on extensor surfaces.
-
On bending surfaces of limbs:
- These are flexor surfaces, like the inner elbows and behind the knees. Inverse psoriasis affects these areas but is less common than plaque psoriasis. citeturn0search5
-
On genitals:
- Genital psoriasis occurs in skin folds and is less common than plaque psoriasis on extensor surfaces. citeturn0search7
Key Points to Remember:
- Plaque Psoriasis: Most common type; appears as raised, inflamed, scaly patches, typically on extensor surfaces like elbows and knees.
- Inverse Psoriasis: Occurs in skin folds (flexor surfaces) such as underarms, groin, and under breasts; lesions are usually red and lack scales. citeturn0search5
- Palmoplantar Psoriasis: Affects palms and soles; characterized by thickened, scaly skin.
- Genital Psoriasis: Involves the genital area; lesions may be red and shiny. citeturn0search7
Understanding these distinctions helps in identifying and managing psoriasis effectively.
- Papules are polygonal, the size from a pinhead to a penny and more, blue-red or purple in color with a smooth shiny surface and an umbilical depression in the center, severe itching is troubling. Positive Wickham symptoms and isomorphic reaction. What disease do the following symptoms indicate?
1.lichen planus - secondary syphilis
3.atopic dermatitis - psoriasis
The clinical features described—polygonal papules ranging in size from a pinhead to larger than a penny, blue-red or purple coloration, smooth shiny surface with central umbilication, severe itching, positive Wickham striae, and isomorphic reaction—are characteristic of lichen planus.
Explanation:
- Lichen Planus: This condition presents with flat-topped, polygonal, violaceous papules that may exhibit fine white lines known as Wickham striae. Patients often experience significant itching. citeturn0search0
- Secondary Syphilis: Typically manifests with a widespread rash that may include reddish-brown spots on the palms and soles, along with mucous membrane lesions, but lacks the polygonal shape and Wickham striae.
- Atopic Dermatitis: Characterized by itchy, inflamed skin, often with a history of allergies, but does not present with polygonal papules or Wickham striae.
- Psoriasis: Features well-demarcated, erythematous plaques with silvery scales, commonly on extensor surfaces, without the polygonal shape or Wickham striae.
Therefore, the correct diagnosis is lichen planus.
- Lichen planus can be treated with:
- azithromycin
2. aciclovir - hydroxychloroquine
4. cytostatics
- azithromycin
The correct answer is 3. hydroxychloroquine.
Explanation:
- Hydroxychloroquine: This antimalarial agent has been utilized in the management of lichen planus, particularly in cases resistant to first-line therapies. Studies have shown its efficacy in treating cutaneous and oral forms of the disease. citeturn0search1
Why the Other Options Are Incorrect:
- Azithromycin: This antibiotic is primarily used to treat bacterial infections and is not indicated for lichen planus, which is an inflammatory condition.
- Aciclovir: An antiviral medication used for herpes virus infections; it is not effective against lichen planus.
- Cytostatics: These are chemotherapeutic agents that suppress cell growth and are generally reserved for severe, refractory cases of lichen planus due to their significant side effect profiles.
Key Points for Study:
- First-Line Treatments: Topical corticosteroids are commonly used to reduce inflammation and control symptoms of lichen planus.
- Systemic Therapies: For cases unresponsive to topical treatments, systemic options like hydroxychloroquine may be considered. citeturn0search1
- Role of Antimicrobials: Antibiotics (e.g., azithromycin) and antivirals (e.g., aciclovir) are not effective in treating lichen planus, as it is not caused by bacterial or viral infections.
- Use of Cytostatics: Due to potential severe side effects, cytostatics are not commonly used and are reserved for severe, refractory cases.
Understanding the appropriate treatment options and their indications is crucial for effectively managing lichen planus.
What do typical case of psoriasis and lichen planus have in common?
1. intolerable itching
2. lesions of mucous membranes
3. localization on the anterior surface of the limbs
4. isomorphic reaction
The correct answer is 4. isomorphic reaction.
Explanation:
- Isomorphic Reaction (Koebner Phenomenon): This refers to the development of new skin lesions at sites of trauma or injury. Both psoriasis and lichen planus can exhibit this phenomenon, where skin trauma leads to the appearance of new lesions. citeturn0search0
Why the Other Options Are Incorrect:
- Intolerable Itching: While both conditions can be itchy, lichen planus is typically more intensely pruritic compared to psoriasis. citeturn0search9
- Lesions of Mucous Membranes: Lichen planus commonly affects mucous membranes, such as the mouth and genital areas, whereas psoriasis rarely involves these areas. citeturn0search2
- Localization on the Anterior Surface of the Limbs: Psoriasis often affects the extensor surfaces of the limbs (e.g., elbows and knees), while lichen planus typically affects the flexor surfaces (e.g., wrists and ankles). citeturn0search9
Key Points for Study:
- Psoriasis: A chronic autoimmune condition characterized by well-demarcated, erythematous plaques with silvery scales, commonly found on the extensor surfaces of the limbs, scalp, and lower back. citeturn0search0
- Lichen Planus: An inflammatory condition presenting with flat-topped, polygonal, violaceous papules, often affecting the flexor surfaces of the limbs, inner wrists, and ankles. It can also involve mucous membranes, such as the mouth and genital areas. citeturn0search2
- Isomorphic Reaction: Both conditions can exhibit the Koebner phenomenon, where new lesions develop at sites of skin trauma. citeturn0search0
Understanding these distinctions is crucial for accurate diagnosis and effective management of these dermatological conditions.
The most typical localization of the rash in lichen planus:
1. scalp
2. palms and soles
3. anterior surface of extremities
4. posterior surface of extremities
The correct answer is 4. posterior surface of extremities.
Explanation:
Lichen planus is a chronic inflammatory skin condition characterized by the development of flat-topped, polygonal, violaceous papules. The most typical locations for these lesions include:
- Flexor Surfaces: The inner surfaces of the wrists and ankles. citeturn0search4
- Lower Back: The lumbar region. citeturn0search10
- Genital Area: The penis, scrotum, and vulva. citeturn0search0
While the posterior surfaces of the extremities (the back of the arms and legs) can be affected, they are less commonly involved compared to the flexor surfaces and lower back.
Why the Other Options Are Incorrect:
- Scalp: Lichen planus can affect the scalp, leading to hair loss and scarring alopecia. citeturn0search11
- Palms and Soles: These areas are less commonly affected by lichen planus.
- Anterior Surface of Extremities: The front surfaces of the arms and legs are less commonly involved compared to the posterior surfaces.
Key Points for Study:
- Clinical Features: Lichen planus presents as shiny, flat-topped, polygonal, violaceous papules, often with fine white lines (Wickham striae) on the surface. citeturn0search0
- Mucosal Involvement: Approximately half of individuals with lichen planus develop oral lesions, presenting as lacy white patches or painful sores. citeturn0search1
- Treatment: Management may include topical corticosteroids, phototherapy, and systemic treatments in severe cases. citeturn0search1
Understanding these aspects is crucial for accurate diagnosis and effective management of lichen planus.
- Psoriasis is characterized by
- superimposed silvery-white scales
- monomorphism
- tendency for elements to grow peripherally and merge
- all of the above are true
The correct answer is 4. all of the above are true.
Explanation:
Psoriasis is a chronic inflammatory skin condition with several hallmark features:
- Superimposed Silvery-White Scales: The most common form, plaque psoriasis, presents as raised, red patches covered with a silvery-white buildup of dead skin cells. citeturn0search9
- Monomorphism: Psoriatic lesions are typically uniform in appearance, maintaining consistent characteristics across affected areas. citeturn0search4
- Peripheral Growth and Merging: Lesions often expand outward and can merge with neighboring plaques, leading to larger affected areas. citeturn0search2
These features collectively define psoriasis, confirming that all the statements are accurate.
Key Points for Study:
- Clinical Features: Well-demarcated, erythematous plaques with overlying silvery-white scales.
- Lesion Behavior: Uniform appearance with a tendency to grow peripherally and coalesce.
- Common Sites: Elbows, knees, scalp, and lower back.
Understanding these characteristics is essential for recognizing and diagnosing psoriasis effectively.
- What are the typical signs of papules with lichen planus:
- polygonal outline
2. waxy sheen - umbilical depression in the center
- all of the above are true
- polygonal outline
The correct answer is 4. all of the above are true.
Explanation:
Lichen planus is a chronic inflammatory condition that affects the skin and mucosal surfaces. The characteristic lesions are papules with the following features:
- Polygonal Outline: The papules are typically flat-topped and have an angular, polygonal shape. citeturn0search0
- Waxy Sheen: The surface of the papules often appears shiny or has a waxy luster, especially when observed under proper lighting. citeturn0search1
- Umbilical Depression in the Center: Some papules may exhibit a central indentation or depression, giving them an umbilicated appearance. citeturn0search0
These features are collectively characteristic of lichen planus papules.
Key Points for Study:
- Wickham Striae: Fine white lines or reticulations on the surface of the papules, best seen under magnification or after application of oil. citeturn0search0
- Koebner Phenomenon: Development of new lesions at sites of trauma or injury. citeturn0search0
- Common Sites: Flexor surfaces of the wrists, forearms, ankles, and lower back. citeturn0search0
- Symptoms: Intense itching (pruritus) is a common symptom associated with lichen planus. citeturn0search0
Understanding these clinical features is essential for the accurate diagnosis and management of lichen planus.
- The primary morphological element for psoriasis is:
- papule
2. spot - blister
4. microvesicle
- papule
The correct answer is 1. papule.
Explanation:
In psoriasis, the primary morphological lesion is the papule, which is an elevated, solid lesion less than 1 cm in diameter. These papules often coalesce to form larger plaques, characterized by well-demarcated, erythematous (red) areas covered with silvery-white scales. The typical distribution includes extensor surfaces such as elbows and knees, as well as the scalp and lower back. citeturn0search2
Key Points for Study:
- Primary Lesion: Papule
- Secondary Lesion: Plaque (formed by the confluence of papules)
- Appearance: Erythematous with silvery-white scales
- Common Locations: Extensor surfaces (elbows, knees), scalp, lower back
Understanding these characteristics is essential for diagnosing and differentiating psoriasis from other dermatological conditions.
- In addition to the skin, it can also be affected with lichen planus:
1.joints
2.mucous membranes
3.hair
4. nails
The correct answer is 2. mucous membranes.
Explanation:
Lichen planus is an inflammatory condition that primarily affects the skin but can also involve other areas:
- Mucous Membranes: Commonly affected sites include the mouth, where it forms lacy white patches, and the genital areas. citeturn0search0
- Hair: The scalp can be involved, leading to a condition known as lichen planopilaris, which may cause hair loss. citeturn0search2
- Nails: Nail involvement can result in ridges, grooves, splitting, and even nail loss. citeturn0search2
However, lichen planus does not affect the joints.
Key Points for Study:
-
Affected Areas:
- Skin: Purplish, itchy, flat-topped bumps.
- Mucous Membranes: Lacy white patches, sometimes with painful sores.
- Hair (Scalp): Potential hair loss due to lichen planopilaris.
- Nails: Ridges, grooves, splitting, and possible nail loss.
-
Unaffected Area:
- Joints: No involvement in lichen planus.
Understanding the typical sites affected by lichen planus aids in accurate diagnosis and management.
- What contribute to the development of psoriatic erythroderma?
- use of antihistamines
- application of corticosteroid ointments
- irrational local treatment (keratolytics in progressive stage)
- administration of cytostatics
