Week 2: Examination Of The Skin Flashcards
What is in the layers of the epidermis
Basement membrane
Dermis
Hypodermis
Epidermis
▫ Stratified squamous epithelium
▫ Keratinocytes
▫ Protective function
▫ Melanocytes
• Basement membrane
▫ Attachment
▫ Allows nutrient movement
• Dermis
▫ Vascular, nerves, adnexal structures
▫ Sweat glands
• Hypodermis
▫ Predominantly fat
What is the skin good for?
- First barrier against microorganisms
- Protects body from radiation and corrosive substances
- Regulates body temperature
- Preserve body fluids
- Synthesised Vitamin D
- 20% body weight
- Covers about 2 sqm
When examining the skin what are the basics? Ie What do they wear? What kind of light Kind of questions you ask What to check for?
Wear gown
S Use natural light
S Start with open-ended questions
S Look for any changes in skin colour
S Look for any lesions
Look at the images of a macule, patch, papule, and plaque on slide 8
Look at images of vesicle, nodule, bulla and pustule on slide 9
And shingles on slide 11
H
Tell me about the presentation of eczema and the types of eczema, common complications an treatment
• Common complications:
▫ Excoriation( 1. To tear or wear off the skin of) ➡ Bleeding ➡ Infection
• Treatment
▫ Topical ointments: corticosteroids
▫ Oral antihistamines if severe pruritis
▫ Short doses of oral corticosteroids in severe cases
▫ Phototherapy (UV)
▫ Antibiotics if infection as complication
Presentation:
▫ Pruritic rash, erythematous
▫ May become confluent to form a wide area of rash, Urticaria
▫ Predominantly flexor surfaces
Types of Eczema:
◦ Most common:
Contact dermatitis
Atopic eczema
Seasonal Foods Drugs
Psoriasis
Definition
Aetiology
Presentation
• Definition:
▫ Chronic, non-contagious autoimmune disease which affects the skin and joints
• Aetiology: ▫ Not fully understood
▫ Main hypotheses :
Primarily a disorder of excessive growth and reproduction of skin cells. The problem is simply seen as a fault of the epidermis and its keratinocytes
An immune-mediated disorder in which the excessive reproduction of skin cells is secondary to factors produced by the immune system
• Presentation:
▫ Causes red, scaly patches to appear on the skin
▫ The scaly patches, called psoriatic plaques, are areas of inflammation and excessive skin production
▫ Skin rapidly accumulates at these sites and takes on a silvery-white appearance
▫ Plaques frequently occur on the skin of the elbows and knees (extensor surfaces), but can affect any area including the scalp and genitals
• Presentation:
▫ Joints (when involved) can be painful and appear swollen, hot, and red.
▫ When swelling in the hands is severe, entire digits become swollen, and are often called “sausage digits”
Slide 18
Name the most common skin tumours
- Basal cell carcinoma
- Squamous cell carcinoma
- Malignant melanoma
- Basal cell carcinoma
Describe
Slide 22 for picture
S Basal cell carcinoma is the most common malignancy in caucasians
S Exposure to ultraviolet radiation is the main causative factor in the pathogenesis of basal cell carcinoma
S However, the precise relation between risk of basal cell carcinoma and the amount, timing, and pattern of exposure to ultraviolet radiation remains unclear.
S Approximately 80% occur on the head and neck (sun-exposed regions), with the rest mainly on the trunk and lower limbs, particularly in women
S The classic form is the “rodent ulcer”, which has an indurated edge and ulcerated centre
S This malignant tumour is slow-growing but, if neglected, can spread locally to cause great destruction, especially around the eye, nose, or ear
S Rarely metastasizes
- Squamous cell carcinoma
Describe, causes
Presentation
View- image on slide 25
More than 90% of tumours in the head and neck are squamous cell carcinomas (SCC) • More common in males, usually age >45 • Most common causes: • Smoking • Sun exposure • Immunosupression
Presentation
▫ Head & neck SCC’s may present with the following associated symptoms:
▫ hoarseness
▫ difficulty in swallowing
▫ enlargement of cervical lymph node(s)
▫ Early detection should be a priority, given the excellent prognosis of early stage disease compared with the poor results in advanced stages (rapid metastasis)
- Malignant melanoma
What are the signs and symptoms of a melanoma
Slide 28 for images
Malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye
• Common and very serious type of skin cancer
• Malignant melanoma accounts for 75 percent of all deaths associated with skin cancer
• Exposure to ultraviolet radiation (UVA and UVB) is one of the major contributors to the development of melanoma
S A popular method for remembering the signs and symptoms of melanoma, as well as documenting it, is the mnemonic “ABCD”:
S Asymmetrical skin lesion
S Border of the lesion is irregular
S Color: melanomas usually have multiple colors
S Diameter: moles greater than 6 mm are more likely to be melanomas than smaller mole
Examination of a lump:
Examination of the lump itself
And
Examination of the patient:
Examination of the lump itself:
SSize
SShape
SMobility
STenderness
Examination of the patient:
SExamine regional lymph nodes
SExamine local tissues
SAlways remember to examine the whole patient
Further research
Henoch-schonlein purpura
Henoch-Schonlein purpura (HSP) is a short-term inflammation of certain blood vessels.
. Symptoms include a purple spotted skin rash, abdominal pain and diarrhoea. The cause is unknown, but HSP tends to develop after an upper respiratory tract infection or a bout of hay fever. Children and adults usually make a full recovery, but in extreme cases, the kidneys can be damaged.
Shingles
Aetiology
Cause and key clinical presenting features
Shingles is a skin rash, caused by the same virus that is responsible for chickenpox. It causes painful blistering around or across the body. Shingles occurs because of a reactivation of the chickenpox virus after an attack of chickenpox. Presentation: -burning or shooting pain -tingling or itching -rashes or blisters
Causes: Hirsutism
Polycystic ovary syndrome. This common condition is caused by an imbalance of sex hormones that may result in irregular periods, obesity, infertility and sometimes multiple cysts on your ovaries. Polycystic ovary syndrome is the most common identifiable cause of hirsutism.
Cushing’s syndrome. Cushing’s syndrome is a condition that occurs when your body is exposed to high levels of the hormone cortisol, a steroid hormone involved in your body’s response to stress. It can develop when your adrenal glands — small hormone-secreting glands located just above your kidneys — make too much cortisol, or it can occur from taking cortisol-like medications over a long period. Increased cortisol levels disrupt the balance of sex hormones in your body, which can result in hirsutism.
Congenital adrenal hyperplasia. This inherited condition is characterized by abnormal production of steroid hormones, including cortisol and androgen, by your adrenal glands.
Tumors. Rarely, an androgen-secreting tumor in the ovaries or adrenal glands may cause hirsutism.
.
-excessive facial hair growth
Causes: high level of male hormones
-polycystic ovarian syndrome
-cushings syndrome
-congenital adrenal hyperplasia
Eczema
- pruritic rash, erythematous
- mostly flexor surface
- contact dermatitis
- atopic eczema (seasonal, foods, drugs)
- complication: excoriation ➡ bleeding ➡ infection
- treatment- corticosteroids, oral antihistamines, UV therapy, antibiotics (infection)
