Skin of children Flashcards
(62 cards)
1
Q
What functions does the skin perform?
A
- regulates temperature
- primary defence mechanism
- melanin production
- protects against UV rays
- absorption
- secretory (skin is home to synthesis of many vitamins, -minerals, enzymes etc.)
- excretory function (ie. sweat)
2
Q
List 7 differences between skin of child from adult
A
- baby can’t sweat due to absence of sweat glands
- more absorptive skin (topical medicine application is better)
- thin epidermis (ca. 2-3 x less for each layer)
- not enough melanin production on basal layer of epidermis
- lack of keratohyalin, causes transparency
- horny layer is thin and easily damaged
- dermis has lack of connective tissue
3
Q
At what age does the skin of a child become similar to that of an adult histologically?
A
6 years
4
Q
Where is lanugo found and what does it indicate?
A
- Lanugo is found in the interscapular area
- it indicates the prematurity of the newborn/neonate
5
Q
Where is lanugo found and what does it indicate?
A
- Lanugo is found in the interscapular area
- it indicates the prematurity of the newborn/neonate
6
Q
What is vernix caseosa?
A
Thick, creamy, cheese-like layer often found on newborns after birth. It may wash off during birth or come off after one week of life.
7
Q
What is physiological newborn catarrhalis/physiological erythema?
A
When the newborn becomes more red in colour after being cyanotic/acocyanotic a few hours after birth.
8
Q
Why is hyperbilirubinemia observed in newborns?
A
- destruction of RBCs - build up of bilrubin in blood
- baby’s liver is not fully develoepd yet to conjugate bilirubin and remove it hence it builds up unconjugated in blood = yellow skin
9
Q
When does icterus neonatorum disappear?
A
7-10 days of life
> month = conjugative jaundice
10
Q
What is not found on the palms and soles of newborns?
A
- sebaceous glands
11
Q
What are the different forms of cyanosis?
A
- peripheral cyanosis (indicates cardio and respiratory problems)
- periorbital cyanosis (around eyes)
- acrocyanosis - blueness of tips
- perioral cyanosis (lips)
12
Q
Name this pathological process that causes this.
A
- localised arterial hyperemia due to increased RBC count
- pathological response during fever
13
Q
What is this. Explain the pathogenesis.
A
Mottled skin
- caused by spasms(s), obliteration of skin vessels =
occlusion by thrombus or embolus
14
Q
How can we classify rashes?
A
Primary and secondary
15
Q
What features are we looking for when inspecting rash?
A
- location
- size
- quantity
- colour
- clear edges?
- form
- consistency
- morbidity during palpation
16
Q
What is this? Can this be classifed into groups?
A
Macule
- flat coloured lesion with no change in thickness
-(light) pink macules can be further classified into groups based on size:
- roseola (ca. 5 mm)
- micromacular (5-10 mm)
- macromacular (10-20 mm)
- erythema (> 20 mm)
17
Q
Name diseases where macules are not of inflammatory region.
A
- vitiligo
- addison’s disease
- cafe au lait
18
Q
What is this?
A
Papule
- raised area of tissues < 1 cm around (circular in shape)
if caused by infection: - found in epidermis + top layers of dermis
if cause is non-infections:
- caused by metabolic products ie. xanthoma
- papilloma
- warts, verucas (epidermal growths)
19
Q
How can we classify this? Name the classifications.
A
Papules can be classified by size:
- miliary (1-2 mm)
- lentil (5 mm)
- nunmular (1-2 cm)
- patches, plaques (papules joint together demarcated from clear skin)
20
Q
What forms can a papule take? What colours can a papule take?
A
forms:
- round
- dome-like
- oval
- peaked
colours:
- natural
- brown
- violet
- pink
21
Q
What surface can papules take?
A
- Smooth
- Rough
22
Q
Do papules always lead to cicatrix?
A
No
23
Q
What is this?
A
Blister
- rash without cavity
- edema on papillary dermis layer
- appears during inflammation
- raised above skin surface
24
Q
What is this?
A
Tubercle
- no cavity formed
- formed typically in the reticular dermis layer
- formed during non-acute inflammation ie. TB, syphilis
25
How can one differentiate between a papule and tubercle?
- characterised by necrosis
| - followed by scarring (cicatrix) or atrophy
26
What is this?
Nodule
- no cavity present
- dense cellular infiltrate rises from subcutaneous layer to above epidermis
- non-inflammatory
- results in scarring
- if nodule is painful and blue-red in colour (cyanotic) = erythema nodosum
- furuncle and carbuncle are types of nodules
27
What is this?
vesicle
- raised rash above skin between dermis and epidermis
- forms a cavity
- filled with transparent serous or opaque serous-bloody liquid
- rasised above skin surface
dried up vesicle = crust
- can lead to hyperpigmentation
= purulent vesicle = pustule ie. herpes
28
What is this?
Bulla
- large blister
- raised, fluid-filled
- localised in top epidermis layers
- fluid is serous or seroanguinous
- large ca. 1-5 cm
29
What is this?
Pustule
- forms cavity with purulent exudate
- happens due to epithelial cell necrosis during inflammation
- mainly WBC, albumin and globulin present
Can be caused by streptococcus or staphylococcus
streptococcal:
- flaccid, flat, superficial - phlyctena
- deep - close to hypodermic layer = ecthyma, this leads to scarring
staphylococcal
= found around hair follicles (folliculitis); superficial and deep
30
What are the 8 primary rash skin elements?
- nodule
- tubercle
- macule
- papule
- vesicle
- bulla
- pustule
- blister
31
What are the 10 secondary skin rash elements?
- cicatrix (scarring)
- scales
- crusts
- erosions
- ulcers
- excoriation
- fissure
- lichenification
- pigmentation
- vegetation
32
What is this?
Scale
- build up of horny-laminae of epidermis
= pathological scaling can be fine (branny) or lamellar
- scales are differentiated b/w consistency, thickness, presence of pain
- yellow scales indicate seborrheae or silver-white psoriasis
33
What is this?
- formed from drying of primary skin rash elements (w/ cavity)
- show different colour(s) and can be serous, sanguinous, purulent etc.
34
What is this?
Erosion
- superficial defect on epidermis + oral mucous membrane
- arises due to flare up of primary element with cavities
- does not leave scar
35
What is this?
Excoriation
- superficial lesion due to mechanical injury
- depigmentation, hyperpigmentation, scarring depends on how deep excoriation is
36
What is this?
Fissure
- may be deep and superficial
- due to long-term diseases in skin-folds
- serous or sanguinous fluid leaks from it, forming crust
Deep fissure penetrates dermis ??carring
= superficial fissure penetrates only epidermis = no scarring
37
What is this?
Ulcer
- deeper than epidermis (unlike erosion) and can reach organs
- primary elements of ulcer are tubercle, deep pustule
- ulcer leads to scarring
- cause of ulcer can be determined by looking at ulcer shape (bottom, edges)
38
What is this?
Cicatrix (scarring)
- connective tissue deposits after deep defects
39
What is this?
Pigmentation
- arises after primary elements ie. tubercles, nodules, bulla, papules, vesickes, pustules)
= can be formed after secondary elements ie. ulcers, erosions
- hemosiderin
40
What is this?
Lichenification
- dense, dry, thickened skin (looks like thick scales)
- due to mechanical injury ie intense itching
41
What is vegetation?
- skin growth of villi and papilla after inflammation
- varies in colour:
- grey, dry, dense = horny layer covering
- pink/red = serous/blood liquid released
- hyperemic = painful
42
What is special about subcutaneous layer in children skin?
Thicker than that of adults
43
What is the purpose of brown fatty tissue in newborns?
Non-contractile thermogenesis
44
How is adipose tissue distributed in a newborn?
- unevenly
| - present in all parts of trunk at 0-2 months of life, but disappears from stomach ca. 6 months
45
What % of body weight does brown adipose make up of a newborn?
1-3 %
46
When does adipose tissue disappear from chest and abdominal cavities, retroperitoneal space?
5-7 years of life
47
How is humidity/dryness of child's skin determined?
- Stroke newborn skin with back of fingers
- pay close attention to palms and soles
- normal skin should be moist, velvety and warm
48
What is skin dryness/hyperhydrosis indicative of?
- dehydration
- lack of vitamin B
- hypothyroidism
- hypottrophy
49
How is skin elasticity measured?
- pinch the dorsal surface fo the hand using thumb and index finger and observe how quickly it springs back.
50
What causes reduced elasticy of skin?
- dehyrdation
| - hypotrophy
51
Where is the thickness of subcutaneous fat layer measured? Why do we measure in different areas?
- under angles of scapulas
- middle third of forearm
- under lower edge of pectoralis major
- abdomen
- thigh
We measure in different areas because in some pathologies, fat distribution is uneven.
52
What causes increased wetness of skin?
- hyperthermia
- vegetative dysfunction
- hyperthyroidism
- collapse
- Hg salt intoxication
53
What condition is this?
Ehler's danlos syndrome
| - increased skin elasticity
54
How many layers of epidermis does a newborn have? What are they?
5 layers
- stratum basale
- spinosum
- granulosum
- lucidum
- corneum
55
What does the baldness of babies at the nape indicate in babies?
Rickets
56
What is sclerema?
Solidification/induration of the subcutaneous layer in the abdomen, butt, hips and calves.
Sclerema + edema = sclerema
57
What are the functions of the skeleton?
- supports the body
- protects internal organs
- storage unit for inorganic ions like Ca2+, Mg2+ and P
-site of hematopoeisis (bone marrow)
58
What equation can be used to calculate the number of adult teeth in growing children / teens?
4n - 20
59
When does curvature of the spine begin in newborns?
At the breastfeeding age
- forward curvature = lordosis
- backward curvature = kyphosis
60
What are the criteria to take into consideration during palpation of the skull?
- size of fontannels
- are the fontannels open or closed? what is their condition?
- what is the bone density?
61
What are the criteria to take into consideration during palpation of the skull?
- size of fontannels
- are the fontannels open or closed? what is their condition?
- what is the bone density?
62
What hormone is scereted by bone cells?
Osteocalcin
