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Unit 3 D&D > DD 03-03-14 08-09am Clinical Dermatology-Terminology and Functions - Dunnick > Flashcards

DD 03-03-14 08-09am Clinical Dermatology-Terminology and Functions - Dunnick Flashcards

(93 cards)

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1
Q

Skin - key factos

A

Skin is the largest organ
– Weight 4 kg
– Covers 2 square meters of surface area
Skin diseases are common!
– 8.5% diagnoses in Family Practice Clinics
– 30% Pediatric Conditions
Significant economic burden in treating skin disease & skin disease causing loss of days worked.

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2
Q

Function of the skin

A
  1. Decoration/Beauty
  2. Barrier– Physical, LIght, Immunologic
  3. Vitamin D synthesis
  4. Water Homeostasis
  5. Thermoregulation
  6. Insulation/Calorie Reservoir
  7. Touch/Sensation
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3
Q

Structure/Cells Involved in Skin’s Function as a Physical Barrier

A

Epidermis, Keratinocytes

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4
Q

Structure/Cells Involved in Skin’s Function as a Light Barrier

A

Epidermis: Melanocyte

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5
Q

Structure/Cells Involved in Skin’s Function as a Immunologic Barrier

A

Epidermis: Langerhans cells

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6
Q

Structure/Cells Involved in Skin’s Function in Vitamin D synthesis

A

Epidermis: Keratinocytes

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7
Q

Structure/Cells Involved in Skin’s Function in Water homeostasis

A

Epidermis: Keratinocytes
Adnexa: Eccrine glands

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8
Q

Structure/Cells Involved in Skin’s Function in Grasp

A

Adnexa: Nails

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9
Q

Structure/Cells Involved in Skin’s Function in Lubrication of the Skin

A

Adnexa: Sebaceous glands

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10
Q

Structure/Cells Involved in Skin’s Function in Phermones/ Body Odor

A

Adnexa: Apocrine glands

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11
Q

Structure/Cells Involved in Skin’s Function in Thermoregulation

A

Adnexa: Eccrine glands
Dermis: Blood vessels

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12
Q

Structure/Cells Involved in Skin’s Function in Strength & Elasticity

A

Dermis: Fibroblast (Produces collagen and elastin)

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13
Q

Structure/Cells Involved in Skin’s Function in Sensation

A

Dermis: Nerves

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14
Q

Structure/Cells Involved in Skin’s Function in Insulation

A

Subcutaneous Fat

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15
Q

Structure/Cells Involved in Skin’s Function as a Calorie Reserve

A

Subcutaneous Fat

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16
Q

Fitzpatrick Skin Type I

A 
Hair - Red/Blond
Eyes - Blue/Green 
Skin - White
Freckles - +++
Sunburn - Always
Tan - 0
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17
Q

Fitzpatrick Skin Type II

A 
Hair - Blond/Brown
Eyes - Light to Medium
Skin - Fair
Freckles - ++ 
Sunburn - Easily
Tan - Minimally
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18
Q

Fitzpatrick Skin Type III

A 
Hair - Brown
Eyes - Medium to Dark
Skin - Light Brown
Freckles - +
Sunburn - Initially
Tan - Gradually
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19
Q

Fitzpatrick Skin Type IV

A 
Hair - Medium to Dark
Eyes - Dark
Skin - Moderate Brown
Freckles - 0
Sunburn - Minimally
Tan - Tans Well
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20
Q

Fitzpatrick Skin Type V

A 
Hair - Dark
Eyes - Dark
Skin - Dark Brown
Freckles - 0
Sunburn - Rarely
Tan - Dark Tan
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21
Q

Fitzpatrick Skin Type VI

A 
Hair - Dark
Eyes - Dark
Skin - Black
Freckles - 0
Sunburn - Never
Tan - Always Tan
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22
Q

Components of the skin

A

Epidermis
Dermis
Adnexal structures
Subcutaneous Fat

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23
Q

Epidermis

A

a stratified squamous epithelial layer

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24
Q

Dermis

A

An underlying CT layer, which includes:

  • papillary layer (loose CT) immediately under epidermis
  • deeper reticular layer (dense CT)
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25
Adnexal structures
- Apocrine glands - Eccrine glands - Hair - Nails - Sebaceous glands
26
Subcutaneous Fat
Composed of adipocytes
27
Regional variation of skin
Thick skin is hairless & found on the palms / soles
28
Vitamin D Synthesis
1. 7-dehydrocholesterol converted to cholecalciferol (Vitamin D3) in skin by UVB 2. Cholicalciferol (Vitamin D3) & Ergocalciferol (Vitamin D2) can both be ingested & absorbed through intestines. 3. Vit D2 & D3 then converted to calcidiol (25-hydroxy Vitamin D) by liver. 4. 1,25-dihydroxy-Vitamin D (calcitriol) is active form & is synthesized by kidneys.
29
Cells of the Epidermis
Keratinocytes Melanocytes Langerhans cells
30
Keratinocytes
- Form barrier layer - Synthesize keratin (major intracellular fibrous protein of skin) - Involved in defined cycle of proliferation, differentiation, & apoptosis
31
Melanocytes - defition / source / location
- Pigment producing cells arising from neural crest - Located primarily in basal layer of epidermis, in hair follicles - Reside in basal layer of epidermis in 1:10 ratio (melanocyte:keratinocyte)
32
Melanocytes - action
- Synthesize melanin (tyrosin-derived pigment) - Melanin is packaged in granules (melanosomes) - These granules are transferred from melanocytes to keratinocytes via dendritic processes - Ea/ melanocyte supplies melanin to ~30 nearby keratinocytes - Melanin in basal keratinocytes protects DNA from UV damage
33
Langerhans cells
= Dendritic cells in epidermis derived from bone marrow stem cell - Found in small numbers in all epidermal layers - Participate in cell-mediated immune reactions by processing & presenting antigens (circulate back and forth between skin & lymph nodes)
34
Skin color variation
NOT due to the number of melanocytes in the skin DUE TO: - The type of melanin produced: - The distribution melanosomes
35
Types of melanin produce
Eumelanin: black to brown pigment Pheomelanin: yellow to red-brown pigment
36
Distribution of melanosomes in skin
Light Skin: - melanosomes distributed in clusters above nucleus Dark Skin: - melanosomes distributed individually throughout cytoplasm
37
Life cycle of Keratinocytes
- Epidermis is continually renewed by mitosis of keratinocytes in the basal layer & by shedding of dead keratinocytes from the surface - Process typically takes 28 days - The layered nature of the epidermis (5 layers) is an expression of this developmental sequence
38
Layers of the Epidermis
1. Stratum basalis (germinativum) = Basal cell Layer 2. Stratum spinosum 3. Stratum granulosum 4. Stratum lucidum 5. Stratum corneum
39
Stratum basalis (germinativum) = Basal cell Layer
- deepest layer of epidermis - Consists of a single layer of columnar or cuboidal cells (keratinocytes) - Basal keratinocytes are the stem cells of the epidermis (source of new keratinocytes & thus a site of intense proliferation)
40
Cell attachments in Basal Cell Layer of Epidermis
Hemidesmosomes: - attach basal cells are firmly to basal lamina of dermal epidermal junction Desmosomes: - attach keratinocytes to each other Tonofilaments: - protein structures (keratin filaments) that insert into dense plaques of desmosomes on cytoplasmic side of plasma membrane
41
Stratum spinosum ;ayer of Epidermis
- Has a “prickly” or spiny appearance due to desmosome attachments between cells - Intercellular adhesion depends upon tonofilament-desmosome interaction in the distribution of stress - Synthesis of involucrin & membrane coating granules begins in this layer
42
Stratum granulosum layer of Epidermis
- Cells of this layer contain different types of granules - Keratohyalin granules contain Profilaggrin (filaggrin precursor). - -> Filaggrin cross-links keratin tonofilaments & is important in barrier function of skin * Filaggrin is mutated in dry skin conditions including ichthyosis & atopic dermatitis
43
Stratum lucidum layer of Epidermis
- Under light microscope, a thin, light staining band seen only in thick skin - Cells of this layer no longer have nuclei or organelles
44
Stratum corneum layer of Epidermis
- Outermost layers of epidermis - Keratinocytes have lost their nuclei & organelles and entire cell is filled with keratin - Desmosomes still connect tightly packed adjacent cells
45
Layers of the Dermis
Papillary Layer | Reticular Layer
46
Papillary Layer
- site of attachment to epidermis & necessary to its development / differentiation - contains capillary network (blood supply for epidermis) - pathway for defense cells - contains Meissner's corpuscles which sense touch
47
Reticular Layer
- contains extensive collagen & elastic fibers that provide strength & flexibility - houses (along w/hypodermis) epidermal derivatives such as glands & hairs, and plays major role in their development & functioning - pathway for major blood vessels arranged specifically to facilitate thermoregulation - site of nerve tracts & major sensory receptors - Pacinian corpuscles sense vibration, pressure & touch
48
Encapsulated touch receptors
In dermis Include: - Meissner’s corpuscles - Pacinian corpuscles
49
Meissner’s corpuscles
- detect delicate touch - most commonly found in dermal papillae of thick skin - consist of Schwann cells & sensory nerve terminals wrapped by fibroblasts & collagen
50
Pacinian corpuscles
= rapidly adapting receptors that detect changes in deep pressure (vibrations) - found in dermis of both thin & thick skin = large structures resembling an onion - concentric layers are composed of flattened CT-like cells interspersed w/ intercellular fluid & collagen - single sensory nerve fibers terminates w/in this structure
51
Adnexal Structures of the Skin
``` Apocrine sweat glands Eccrine sweat glands Hair Nails Sebaceous glands ```
52
Apocrine sweat glands
- Specialized sweat glands located in axillary, pubic & perianal regions - -> produce milky, viscid, carb-rich secretion that is initially odorless - -> subsequent bacterial action leads to a characteristic axillary body odor - begin to function in puberty - have ducts which empty into hair follicles just above sebaceous glands
53
Eccrine sweat glands
- Traditional sweat glands distributed over most of the body * Not found in lips, under nails or on glans penis, glans clitoris, or labia minora - -> Watery, enzyme-rich secretion - initially isotonic - becomes hypotonic as Na+ reabsorbed by ducts - Important for thermoregulation
54
Hair
- Develop in utero w/ downgrowth of epidermis forming a pilosebaceous unit - Hair itself consists of central medulla of soft keratin + cortex & cuticle of hard keratin - Hair growth is intermittent (growth period of 2-3 years followed by rest period of several months) - Pigment comes from melanocytes at base of hair - W/contraction of arrector pili muscle (smooth muscle), hairs stand on end (“goose bumps”)
55
Sebaceous glands
- Oil glands which secrete sebum (complex mixture of lipids) - develop along w/ hair follicles & empty their secretion into upper 1/3 of hair follicles - development accelerated at puberty
56
Types of Primary Skin Lesions
``` Macule < Patch Papule < Nodule < Tumor Plaque Scale Wheal Vesicle < Bulla Pustule Atrophy < Erosion < Ulceration ```
57
Macule
- Circumscribed change in skin color that is flush w/ surrounding skin - Lesion is <1.0 cm in diameter (smaller than patch) Examples: Solar lentigo Traumatic purpura
58
Patch
- Circumscribed change in skin color that is flush w/ surrounding skin - Lesion is ≥1.0 cm in diameter (bigger than macule) Examples: Café au lait spot Vitiligo
59
Papule
= A solid or cystic elevation - <1.0 cm in diameter (smaller than nodule & tumor) Examples: Acne Eruptive xanthoma
60
Nodule
= A solid or cystic elevation - >1.0 cm but <2.0 cm in diameter (larger than papule, smaller than tumor) - Example: Dermato-fibroma
61
Tumor
- A solid or cystic elevation - >2.0 cm in diameter (larger than papule/nodule) - Example: Follicular cyst
62
Plaque
- An elevated lesion that is >1.0 cm in diameter | - Example: Psoriasis
63
Scale
= Desiccated, thin plates of cornified epidermal cells that form flakes on the skin surface - Example: Ichthyosis
64
Wheal
= Circumscribed, flat-topped, firm elevation of skin with a well-demarcated and palpable margin - Example: Urticaria
65
Vesicle
= Circumscribed, elevated lesion containing clear serous or hemorrhagic fluid = <1 cm in diameter (smaller than bulla) Examples: - Contact dermatitis - Herpes simplex
66
Bulla
= Circumscribed, elevated lesion containing clear serous or hemorrhagic fluid = >2 cm in diameter (larger than vesicle) - Example: Bullous pemphigoid
67
Pustule
= A vesicle containing purulent exudate | - Example: Folliculitis
68
Atrophy
= A depression from the surface of the skin with underlying loss of epidermal or dermal substance (less severe loss than erosions & ulcerations) - Example: Lichen sclerosis et atrophicus
69
Erosion
= A depression from the surface of the skin with a loss of all or part of the epidermis (more severe loss than atrophy, less severe than ulcerations) - Example: Burn = Can be a secondary lesion - Example: Ruptured bulla
70
Ulceration
- A depression from the surface of the skin with a loss of the entire epidermis and at least some of the dermis (more severe loss than atrophy & erosion) - Example: Ecthyma
71
Secondary Lesions result from...
- external forces such as scratching, picking, infection or healing of primary lesions
72
Types of Secondary Lesions
Lichenification Scar Fissure Crust
73
Lichenification
= Dry, leathery thickening of the skin with exaggerated skin markings - EX: Chronic eczema
74
Scar
= An elevated or depressed area of fibrosis of the dermis or subcutaneous tissue resulting from an antecedent destructive process - EX: Healing wound
75
Fissure
= A deep linear split in the skin extending through the epidermis - EX: Traumatized eczema
76
Crust
= Dried exudates of serum, blood, sebum, or purulent material on the surface of the skin - EX: Acute and/or secondarily infected eczema
77
Disease caused by Skin chronically exposed to sunlight (face, neck, hands, arms)
Actinic keratosis Basal cell carcinoma Squamous cell carcinoma
78
Skin disease in central chest, shoulders, & earlobes
Keloids
79
Skin disease in extensor arms and legs, intragluteal cleft, umbilicus
Psoriasis
80
Skin disease in antecubital fossa, popliteal fossa
Atopic dermatitis
81
Skin disease in anterior surface of lower legs
Palpable purpura Pretibial myxedema Necrobiosis lipoidica diabeticorum Erythema nodosum
82
Skin disease in axilla & inguinal areas
Hidradenitis suppurativa
83
Skin disease in posterior neck & back
Folliculitis
84
Skin disease in web spaces of toes & sides of feet
Tinea pedis
85
Skin disease in web spaces of fingers & wrists
Scabies
86
Skin disease in palms & soles
Secondary syphilis | Erythema multiforme
87
Skin disease with Clustered arrangement
Herpes simplex
88
Skin disease with Grouped arrangement
Lichen planus | Granuloma annulare
89
Skin disease with Linear arrangement
Allergic contact dermatitis
90
Skin disease with Zosteriform arrangement
Herpes zoster
91
Skin disease with Annular arrangement w/out scale
``` Urticaria Hansen disease (leprosy) ```
92
Skin diseases with Annular arrangement with scale
Dermatophytosis | Pityriasis rosea
93
Skin diseases with Coalescing arrangment
Psoriasis Drug hypersensitivity eruption Viral exanthema Urticaria

Unit 3 D&D (18 decks)

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