Skin disease Flashcards
(130 cards)
1
Q
What system is the skin a part of
A
Th integumentary system
2
Q
Name the largest organ in the body
A
skin
3
Q
What are appendages
A
Hair and nails
4
Q
What are the functions of normal skin
A
- Flexible mechanical barrier
- Temperature control
- Immune functions
- Protection versus UV light
- Vitamin D metabolism
- Nerve endings
- Aesthetics
- Absorption
5
Q
What do we mean by the skin acting as a barrier
A
- It prevents entry of infectious agents
- Controls loss of fluid from the body
- Waterproofing
6
Q
How do the skin control temperature
A
- Blood vessels
- Sweet glands
- Hairs
7
Q
How do blood vessels help control temperature
A
Vasodilation and vasoconstriction changes temperature
8
Q
How does har on the skin help control temperature
A
pilirection holds a layer of air next to the skin raising the body temp
9
Q
Name the cell that helps protect us from UV
A
Melanocytes
10
Q
What do melanocytes do
A
They secrete melanin which protects us from UV damage
11
Q
What do nerve endings in the skin detect
A
- Heat
- Cold
- Vibration
- Denture touch
- Deep pressure
- Pain
12
Q
Name the different layers of the skin
A
- Epidermis
2. Dermis
13
Q
What is the epidermis
A
A waterproofing and barrier to infection
14
Q
How many layers make up the epidermis
A
5 Layers
15
Q
What is the dermis
A
It is where the appendages to the skin are found
16
Q
Name the 5 laters of the epidermis starting with the outermost layer
A
- Stratum corneum
- Stratum lucidum
- Stratum granulosum
- Stratum Spinosum
- Stratum basale
17
Q
What is found under the dermis?
A
Hypodermis
18
Q
what is the hypodermis
A
A subcutaneous adipose tissue that acts as an attachment to underlying structures
19
Q
Name the cells found in the skin
A
- Basal Keratinocytes
2. Melanocytes
20
Q
Where are Basal Keratinocytes found
A
In the stratum basale layer
21
Q
What happens in the stratum basale layer
A
It is the main site for the generation of new keratinocytes
22
Q
What are keratinocytes
A
Stem cells
23
Q
What is the function of keratinocytes
A
Keratinocytes needed to replace those lost from the skin surface and for wound healing
24
Q
What are melanocytes derived from
A
Neural crest
25
What does melanin determine
Skin colour
26
What is melanin synthesis promoted by
Oestrogen, pituitary hormones
27
What is found in the Stratum Spinosum layer
Maturing keratinocytes and langerhans cells
28
What is found in the Stratum Granulosum later
Keratinocytes that become increasingly fun of keratins and other proteins as they undergo programmed cell death
29
Describe the Stratum Lucidum later
It is a thin layer of dead skin cells
| Composed of 3-5 layers of dead flattened keratinocytes
30
What is found in the Stratum Corneum later
Dead cells, keratin and waterproofing substances
31
Describe the dermis layer
It is less cellular than the epidermis
32
What does the dermis play an important role in
Important in
1. Support
2. Strength
3. Elasticity
4. Vascular supply
5. Nerves
6. Sweat glands
7. Sebaceous glands
8. Hair
33
Name some normal skin lesions
1. Freckles
| 2. Moles
34
What is another term for freckles
Ephelis
35
Describe freckles
Small flat brown marks arising on the face and other sun exposed sites
36
What is another term for moles
Melanotic macule or menaocytic naevus
37
What are moles
They are benign proliferating melanocytes
38
Describe how a mole may look
Can vary in tone from pink to black
| The number of moles is determined by genetics and degree of sun exposure
39
Name some different types of naevi
1. Junctional Naevi
2. Compound naevus
3. Intradermal naevus
40
Describe where junctional naevi
Early naevus cells form nests on the junction between the epidermis and the dermis
41
How do junctional naevi look
These moles are flat and colourful
42
Describe where compound naevi
Nest of naevus cells formed in the dermis
43
Describe where intradermal naevi
These are contained within the dermis only
44
How do intradermal naevi look
They are thickens and protrude from the skin surface
| They may not be pigmented
45
How do we classify skin types
The Fitzpatrick scale
46
How do we use the Fitzpatrick scale to classify skin types
I- VI
47
Describe skin type I
Always burns
Never tans
Light, pale white
48
Describe skin type II
Usually burns
Sometimes tans
White, fair appearance
49
Describe skin type III
Sometimes mildly burns
Usually tans
Medium, white to love appearance
50
Describe skin type IV
Rarely burns
Always tans
Olive, moderate brown appearance
51
Describe skin type V
Very rarely burns
Tans with ease
Moderate constitutional pigmentation
Brown, dark brown appearance
52
Describe skin type VI
Never burns
Tans very easily
Marked constitutional pigmentation
Very dark brown, black in appearance
53
Give some signs of sun damage
Sun burn
| Tan
54
What is photoaging
UVA radiation damage due to excessive sun exposure
55
Give some sighs of photoaging
1. Winkles
2. Dry rough leathery skin
3. Freckles
4. Discolouration
56
What is solar lentigo
Large flat brown spots on the face and hand arising in middle age as a result of sun damage
57
What Is solar lentigo also known as
Age spots or liver spots
58
What can increase skin caner risk
UVA and UVB radiation from the sun
59
How can UVA and UVB increase risk of skin cancer
UV induces DNA damage
60
List some sun protective practices
1. Avoid sun in tree hottest times of the day
2. Cover up with suitable clothing
3. Consider wearing sun protective clothing
4. Use SPF
5. Avoid tanning beds and lamps
61
What is actinic chelitis
Is a lesion on the external parts of the lip skin
62
In whom is actinic/ solar keratosis common in
Fair skinned older individuals
63
Where is actinic/ solar keratosis seen
Face, scalp if bald and arms or hands
64
What are some symptoms of actinic/ solar keratosis
Asymptomatic
Mild irritation
Awareness of changes to skin appearance and texture
65
What are the signs of actinic/ solar keratosis
Single or raised maculae or papules which vary in colour form pink to yellow-black with rough scaly surface
Around 1-3mm in diameter and up to 4cm wide
66
What medicaments can be used to help manage actinic/ solar keratosis
1. 5 FU (Fluorouracil) cream fro 2-4 weeks
2. 10% trichloroacetic acid for widespread lesions
3. Systemic acitretin or isotretinoin to reduce number of lesion
4. Diclofenac cream
67
Name the different types of skin cancer
1. Primary malignancies
| 2. Secondary malignancies
68
Give examples of primary malignancies
1. Malignant melanoma
| 2. Non melanoma skin cancers
69
What do non melanoma skin cancers include
1. Basal cell carcinomas
2. Squamous cell carcinomas
3. Appendage and epidermal tumours
4. Dermal and subcutaneous tumours
70
What are malignant melanomas
Cancers of the cutaneous melanocytes
71
What is the lifetime risk of a man getting malignant melanoma
1 in 36
72
What is the lifetime risk of a woman getting malignant melanoma
1 in 27
73
What are the risk factors for melanoma
1. UV light exposure
2. Skin types which do not tan but burn easily (scale I-III)
3. Red or blond hair
4. Pale eye colour
74
Name the 5 main types of malignant melanomas
1. Superficial spreading
2. Nodular
3. Lentigo maligna
4. Acral lentigines
5. Amelanotic melanoma
75
Name some high risk patients for malignant melanomas
1. Those with more than 100 normal naevi
2. More than 5 atypical naevi
3. Patients with changing moles
4. Patients with 2 or more cases of melanoma in first degree relative
5. Age over 65
76
Describe superficial spreading malignant melanoma
1. Most common in middle aged patients
2. Mostly >7mm at diameter
3. Slow growth initially - Grow horizontally before invade deep tissues
77
Describe nodular malignant melanomas
1. More rapidly growing and tend to invade from start
2. Sun exposed areas affected eg back and chest
3. Very dark brown or black in colour
4. Common in middle aged patients
78
Descrive lentigo maligna
1. Most common in aged over 60s
2. Most common on the face
3. Develop in a pre-existing pigmented macule
4. Growth is slow and metastasis only after many years
5. Is an aggressive cancer
79
Describe Acral lentigines
1. Rarest type
2. more common in feet than hands
3. Occur in al skin types and ethnicities
4. Most common melanoma in dark skinned peoples
5. Thought to be unrelated to sun exposure
80
What secondary prevention should we implement for high risk melanoma patients
High risk patients should be referred to a dermatologist for surveillance of moles and self examination o help pick up changes in skin early
81
List some concerning factors we should monitor on skin lesions
lesion is:
1. Getting bigger
2. Changing shape
3. Edges becoming irregular
4. Changing colour
5. Itching or in pain
6. Bleeding or crusting
7. Inflammation locally
8. Nail lesions
82
What mnemonic do we use to assess pigmentation of a skin lesion
ABCDE
83
What is the ABCDE of pigmentation assessment
```
Asymmetry
Border
Colour variation
Diameter
Evolutionary change
```
84
What needs an URGANT referral
1. New moles which are growing quickly if patient is over the age of puberty
2. Any mole which has 3+ colours and lost its symmetry
3. Any new moles which is growing and is pigmented or vascular in appearance
4. New pigmentation line under nail
5. Something growing under a nail
85
Describe a lesion that has a favourable prognosis
1. Shallow lesions have a more favourable prognosis
| 2. Superficial lesions with lymph node involvement
86
How do we manage melanomas
1. Excisional biopsy
| 2. Adjunctive therapies eg chemotherapym immunotherapy, radiotherapy
87
What is the survival rate of melanomas
87%
88
What is seborrhoeic keratosis
A very common condition characterised by brown senile warts
| Not related sun exposure
89
What is seborrhoeic keratosis also called
Basal cell papillomas
90
Describe the skin lesions found in seborrhoeic keratosis
Greasy brown stuck on appearance
| They tend to get more wrinkled with time and become darker with age
91
What are basal cell carcinomas
Rodent ulcers neloebed to arise from undifferentiated basal keratinocytes
92
Who is most at risk of basal cell carcinomas
Fair skinned people
| Older people
93
What are the risk factors of basal cell carcinomas
1. UV sun exposure
2. Ionising radiation
3. Arsenic ingestion
4. Hereditary genetic predisposition
94
Where are basal cell carcinoma lesions found
Primarily found on sun exposed body parts
95
What are the different classifications of basal cell carcinoma lesions
1. Nodular
2. Superficial
3. Morpheaform
96
Name the most normal category of basal cell carcinomas
Nodular
97
Describe nodular basal cell carcinomas
1. Head and neck affected
2. Small translucent pearly white lesion
3. Telangiectasia superficially
4. Enlarging causses central ulcerations with rolled border and a crusted top
98
Describe superficial basal cell carcinomas
1. Pink scalp plaque
2. Difficult to discern from other diagnosis
3. Responsive to topical chemotherapy
99
What is Morpheaform basal cell carcinoma also called
sclerosing or infiltrative basal cell carcinoma
100
Describe Morpheaform basal cell carcinoma
1. Slowly expanding, white, scar like plaque with poorly defined edges
2. similar appearance to scleroderma
3. may be more extensive than it initially appears
4. tend to be aggressive with peripheral spread
101
How do we manage basal cell carcinoma
1. Sun protection
2. Local tumour destruction or removal
3. Local ones are easier to treat
102
What is squamous cell carcinomas
It is an uncommon cancer of keratinocytes
103
Describe the growth of squamous cell carcinomas
Locally destructive and can grow rapidly and will metastasise if ignored
104
What are the risk factors of squamous cell carcinomas
1. UV Light
2. Chronic ulcerations and scarring
3. Ionising radiation
4. Arsenic ingestion
5. industrial chemicals
6. Immunosuppression
7. HPV infections
105
What are the clinical features of squamous cell carcinomas
1. Evolving behaviour starting as a small crusted nodule or plaque
2. Becomes more nodular and indurated.
3. Ultimately ulcerated
4. Affects sun exposed skin
106
How do we manage squamous cell carcinomas
1. Sun protection
2. Surgical excision
3. Radiotherapy
4. Topical chemotherapy or immunotherapy
5. Very early lesions can be treated with local destructive methods
107
Name a skin diseases other than cancer
Dermatitis
108
What is another term for dermatitis
Eczema
109
How common is dermatitis
Very common: up to 20% of children affected and 10% adults
110
What are the clinical features of dermatitis
1. Itchy
2. Hot red skin
3. Oedema in acute condition
4. Oozing and weeping of tissue fluid
5. Crusting in the acute phase
6. Fissuring and scaling in the chronic phase
7. Excoriation due to itching
8. Secondary infection
9. Impairment of thermoregulation
111
Name the types of dermatitis
1. Endogenous dermatiti s
| 2. Exogenous dermatitis
112
What is endogenous dermatitis
Dermatitis caused from within mainly manifests in childhood
113
Give examples of endogenous dermatitis
1. Atopic dermatitis
| 2. Seborrhoeic dermatitis
114
What are the features of atopic dermatitis
1. Asthma
2. Allergic conjunctivitis
3. Rhinitis
4. Urticaria
115
What is the pathogenesis of atopic dermatitis
Multifactorial:
1. Genetic predisposition
2. Abnormality of lipid glue in the building blocks of the skin
3. Abnormal response to allergen with chronically high IgE levels
116
What is the prevalence of atopic dermatitis
10-20% in children
| 1=3% in adults
117
What is Seborrhoeic dermatitis also known as
Cradle cap
118
How common Is Seborrhoeic dermatitis
affects 3-5% of the population
119
Which area in the body is affected by Seborrhoeic dermatitis
Areas rich in sebum eg face, scalp and anterior chest
120
What is Seborrhoeic dermatitis caused by
It is usually an inappropriate immune response to skin commensalism
121
What are the clinical features of Seborrhoeic dermatitis
Red scale patches with flaking
122
Give examples of exogenous dermatitis
1. Primary irritant
| 2. Allergic contact
123
What is primary irritant dermatitis
An acute or chronic exposure to an irritant source eg soap detergent, solvents
124
What is allergic contact dermatitis
A type IV hypersensitive reaction to nickel, colophony, many perfumes
125
How can we diagnose type IV hypersensitivity allergic contact dermatitis
Skin patch testing
126
How do we diagnose dermatitis
1. History
2. Examination
3. Skin patch testing
127
What can happen to a person with dermatitis
That area can get infected
128
What can dermatitis areas be infected by
1. S aureus
| 2. HSV1 or 2
129
How do we manage dermatitis
1. Patient education to avoid problematic habits
2. Emollients are key eg lotions, creams, ointments
3. Corticosteroids to reduce inflammation
4. Wet wraps
5. Occlusion therapy
6. Antimicrobials
7. PUVA phototherapy
8. immunomodulatory drugs
130
List some problematic habits bit dermatitis patents
1. Compulsive Handwashing
| 2. Use of irritants
