What are the layers of the skin?
Epidermis, dermis, and subcutaneous layer
What type of epithelial cells is the epidermis?
Stratified squamous epithelium
How thick is the epithelium?
0.05mm to 1.5mm
What are the functions of the skin and nails?
-Physical barrier: prevents fluid loss and entry to toxic chemicals, organisms and trauma -temperature regulation -protection against UV radiation -Synthesis of Vit. D -Sensation
"Peach fuzz" body hair on children and adults, not effected by hormones
Characteristics of both vellus and terminal hair
Growth phase; duration average of 3 years
Degenerative stage; duration few weeks
Resting phase; length varies by body site
Fine hair that covers fetus that is discarded after birth
Hair shaft shedding 25-100 per day
How thick is the dermis?
0.3mm to 3.0mm
What are the functions of hair?
-Protection -Regulation of temperature -Evaporation of perspiration -Sensation
What is it important to do what evaluating the patient's skin?
MAKE SURE TO UNDRESS THE PATIENT
Scalp, beard, axilla, pubic-area: growth influenced by hormones
inflammation of the skin
Sx of acute phase of dermatitis
- vesicle formatio
- oozing crusting
Sx of subacute phase of dermatitis
- parches or scalded appearance
Sx of chronic phase of dermatitis
- lichenification due to scratching/itching
Results from contact by irritating substance. direct toxic effect on skin
What are common agents for contact dermatitis?
- cleaning agents
- caustic agents
What are the acute and chronic rashes seen in contact dermatitis?
T-cell mediated response that occurs in individuals that have become sensitized
Allergic contact dermatitis
Causes of allergic contact dermatitis?
- Topical medications
- plants (most commonly poison ivy)
What acute and chronic rash is seen with allergic contact dermatitis?
What type of testing is done for allergic contact dermatitis?
Patch testing after the dermatitis resolves
What is the most common fo all mucocutaneous infections?
Superficial fungal infections
What causes most superficial fungal infections?
overgrowth of mucocutaneous microbiome, invading skin & mucosal sites
- Candida species
- Malassezia species
Superficial infection that may involve any cutaenous or mucous surface of the body
What is the most common cause of Candidiasis?
Risk factors for mucocutaneous candidias?
- Systemic antibiotics
- Oral corticosteroids
- OCP & IUD
- Warm/humid climate
- Moist/occluded sites
What lab exams should be carried out for dx of mucocutaneous candidiasis?
- Direct microscopy with KOH prep
- Pseudohypae & budding yeast
- Culture to identify Candida albicans/rule out secondary infection
- Pseudohypae & budding yeast
Patches & pustules on erythematous base "beefy red" become eroded & confluent, sharply demarcated, "satellite lesions"
pruritis, tenderness, pain
What is the distribution of Candidal intertrigo?
Axillae, groin (perineal, intergluteal cleft)
What will be on the diff dx with candidal intertrigo?
- Pityriasis versicolor
- Tinea cruris
Management of candidal intertrigo?
- Topical antifungal (eg Nystatin cream), oral antifungals
Prevention of candidal intertrigo?
keep area dry, use imidazole powder
Irritability, discomfort with urination/defecation, changing diapers; erythema ("beefy red"), edema with papular & pustular lesions
Distribution of diaper dermatitis?
Genital & perianal skin, inner aspects of thighs/buttocks
Diff dx with diaper dermatitis?
- irritant dermatitis
Prevention of diaper rash?
Management of diaper rash?
Topical antifungals (eg Nystatin cream)
White-curd like plaques on mucosal surface that when removed with dry gauze leaves erythematous mucosal surface
Oropharyngeal candidiasis (“thrush”)
Distribution of Oropharyngeal candidiasis (“thrush”)?
Dorsum of tongue, buccal mucosa, hard/soft palate
Diff dx with Oropharyngeal candidiasis (“thrush”)?
- condyloma acuminatum
- geographic tongue
- lichen planus
- hairy tongue
Management of Oropharyngeal candidiasis (“thrush”)?
- Correct precipitating cause (eg d/c inhaled corticosteroids)
- topical antifungals (eg Nystatin suspension)
What % of women experience at least 1 episode of Vulvovaginitis candidiasis?
>20% of women have vaginal colonization by...
Abrupt onset, vaginal discharge/soreness, pruritis, burning, dyspareunia, that may occur before menses
Vulvar/vaginal erythema and edema, curd-like white plaques
Diff dx with Vilvovaginitis candidiasis?
- bacterial vaginosis
- lichen planus
- lichen sclerosis
Management of Vilvovaginitis candidiasis?
Oral antifungal (eg fluconazole) or intravaginal prep (many OTC)
Etiology of Balanitis?
Papules, pustules, erosions; white plaques under foreskin
Diff dx with Balanitis?
- Lichen planus
Which infection should you consider treating sexual partner if reinfection ooccurs?
Management of Balanitis?
Topical nystatin ointment and warm soaks BID to relieve pruritis/burning
Superficial overgrowth of Malassezia furfur (lipophiic yeast that normall resides in the keratin of skin & hair follicles) under favorable
Risk factors of Pityriasis versicolor?