Skin Chapter Goals

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Chapter 16: Skin

 Find this out on page 650 in your book:

 What the name for the system that includes skin?  How much does our skin weigh?  How much surface area does it cover?

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Chapter Goals

 Name the layers of the skin and the accessory structures associated with the skin.

 Build medical words using the combining forms that are related to the specialty of dermatology.

 Identify lesions, signs, and symptoms, and pathologic conditions that relate to the skin.

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Chapter Goals

 Describe laboratory tests and clinical procedures that pertain to the skin and recognize relevant abbreviations.

 Apply your new knowledge to understanding medical terms in their proper contexts, such as medical reports and records.

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Introduction

the skin and its accessory structures (hair, nails and glands) make up the integumentary system of

the body
● weighs 8-10 lb ● covers 22 square feet

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Functions of Skin

 provides protective membrane - guards the deeper tissues against excessive loss of water, salts and heat - protects against pathogens

 glands lubricate and cool the skin

receptor for sensations (pain, temp, pressure and touch)

 helps maintain body temperature

(thermoregulation)

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Anatomy of the Skin

Epidermis: outermost, thin cellular membrane - contains keratin

Dermis: dense, fibrous, connective tissue layer - contains collagen

Subcutaneous tissue (hypodermis): thick, fat-

containing tissue

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Acessory Organs of the Skin

HAIR: cells filled with the hard protein; keratin

Hair follicles: shafts that hold the hair

 Five million hairs on body; 100,000 on head  Melanocytes at the root form the color  Grow .5 inch (1.3 cm) per month  Cutting does not affect growth

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Accessory Organs of the Skin
(cont’d)

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Accessory Organs of Skin
(cont’d)

NAILS: hard keratin

plates covering toes and fingers

 lunula  cuticle  paronychium

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Accessory Organs of Skin
(cont’d)

GLANDS: sebaceous and sweat

 Sebaceous glands secrete oily sebum into hair follicle to lubricate.

 Sweat glands secrete into pores to moisten and cool.

 Both are subject to bacterial growth.

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Accessory Organs of Skin
(cont’d)

 Sebaceous gland:

 Oil secreting gland in the dermis that is associated with hair follicles

 Eccrine sweat gland:

 Most numerous sweat producing exocrine gland

 Apocrine sweat gland.

 Sweat gland located in the axilla (armpit) and genital areas

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Colors – combining forms

● memorize this table

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Skin Pathology

CUTANEOUS LESIONS

● a lesion is an area of abnormal tissue anywhere on the body - it may be caused by trauma or disease

crust - collection of dried serum and cellular debris (scab, eczema, impetigo, seborrhea)

cyst - thick-walled, closed sac / pouch containing fluid or semisolid material

erosion - wearing away of the epidermis (dermoepidermal junction) - occur due to inflammation

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or injury

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Skin Pathology

CUTANEOUS LESIONS

fissure - grove or crack-like sore macule - flat lesion < 1cm in diameter (freckles, tattoo marks, flat moles)

nodule - solid, round or oval elevated lesion > 1cm in diameter (enlarge lymph node or solid growths)

papule - small (< 1cm), solid elevation of the skin (pimples - if confluent called plaques)

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Skin Pathology

CUTANEOUS LESIONS

polyp - growth extending from the surface of a mucous membrane (type of papule commonly found in nose / sinuses, colon, bladder and uterus)

pustule - papule containing pus (small abscess) ulcer - open sore on the skin or mucous membranes (deeper than an erosion)

vesicle - small collection (papule) of clear fluid (serum); blister (vesicles form in burns, allergies, dermatitis)

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Skin Pathology

CUTANEOUS LESIONS

wheal - smooth, edematous (swollen) papule or plaque that is redder or paler than the surrounding skin (often accompanied by itching and are seen in hives, anaphylaxis and insect bites)

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Cutaneous Lesions (p 662)

1. Crust 2. Cyst 3. Erosion 4. Fissure 5. Macule 6. Nodule 7. Papule 8. Polyp 9. Pustule 10.Ulcer 11.Vesicle 12.Wheal

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Signs and Symptoms

alopecia: absence of hair where it normally grows

 alopecia or baldness may be hereditary (male pattern baldness) or it may be caused by disease, injury or treatment (chemotherapy)
 alopecia areata - autoimmune disease - hair falls out in patches without scarring or inflammation

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Signs and Symptoms

ecchymosis: blue-black marks (bruise) on the skin

 caused by hemorrhages into the skin from injury or spontaneous leaking of blood from vessels

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Signs and Symptoms

petechia: small pinpoint hemorrhage

 smaller versions of ecchymoses - both ecchymoses and petechiae are forms of purpura (bleeding into the skin)

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Signs and Symptoms

pruritus - itching

 symptom associated with most forms of dermatitis  arises from stimulation of the nerves in the skin

urticaria: acute allergic reaction with red, round wheals on skin

 commonly due to food allergies (shelfish and strawberries)  localized edema occurs as well

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ABNORMAL CONDITIONS

acne: papular and pustular eruption of skin with increased production of sebum

 acne vulgaris (ordinary) is a buildup of sebum and keratin in the pores of the skin

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ABNORMAL CONDITIONS

burns: injury to tissue due to heat, chemical, electric shock, lightning or radiation.

first-degree burn - superficial epidermal lesions,

erythema, hyperesthesia and no blisters

second-degree burn (partial thickness) - epidermal and

dermal lesions, erythema, blisters and hyperesthesia

second degree burn

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ABNORMAL CONDITIONS

burns: injury to tissue due to heat, chemical, electric shock, lightning or radiation

third-degree burns (full thickness) - epidermis and dermis are destroyed (necrosis) and subcutaneous layer damaged, leaving charred, white tissue

third degree burn

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ABNORMAL CONDITIONS

cellulitis: diffuse acute infection of skin marked by local heat, redness, pain and swelling

 abscess formation and tissue destruction can occur without appropriate antibiotic therapy

eczema: inflammation of skin with erythematous, papulovesicular lesions caused by allergy

 chronic or acute atopic dermatitis is accompanied by pruritus
 treatment usually corticosteriods

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ABNORMAL CONDITIONS

exanthematous viral diseases: rash (exanthem) of

the skin due to virus

 examples: rubella (German measles), rubeola (measles) and varicella (chicken pox)

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ABNORMAL CONDITIONS

gangrene: death of tissue associated with loss of blood supply

 ischemia from injury, inflammation, frostbite, diabetes or arteriosclerosis can lead to necrosis followed by bacterial infection and putrefaction

impetigo: bacterial inflammatory skin disease characterized by vesicles, pustules and crusted-over lesions

 contagious pyoderma caused by Staphylococci or
Streptococci
 treatment with systemic antibiotics and cleaning lesions

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ABNORMAL CONDITIONS

psoriasis: chronic recurrent dermatosis marked by itchy, scaly, red plaques covered by silvery gray scales

 not infectious or contagious but autoimmune - caused by in increased rate of growth of the basal layer of epidermis

scabies: contagious, parasitic infection (mites) of the skin with intense pruritus

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ABNORMAL CONDITIONS

scleroderma: chronic, progressive disease of skin and internal organs with hardening and shrinking of connective tissue (autoimmune)

 fibrous, scar-like tissue forms in the skin, heart, lungs, kidneys and esophagus

 palliative treatment - immunosuppressives / antiinflammatory agents, physical therapy
 immunosuppressives

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ABNORMAL CONDITIONS

systemic lupus erythematosus (SLE): chronic

autoimmune disease of collagen in the skin, joints and internal organs

 “butterfly” pattern of redness over cheeks and nose  primarily affects females  treatment includes corticosteroids and

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ABNORMAL CONDITIONS

tinea - infection of the skin caused by a fungus

 tinea corporis (ringworm) - infection is in a ring-like pattern
- highly contagious with severe pruritis

 tinea pedis (athletes foot), tinea capitis (scalp),tinea barbae
(under the beard), tinea unguiun (nails)

 treatment with antifungal agents

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ABNORMAL CONDITIONS

vitiligo: loss of pigment (depigmentation) in areas of skin (milk-white patches)

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SKIN NEOPLASMS - BENIGN

callus - increased growth of cells in the keratin layer of the epidermis caused by pressure or friction

keloid - hypertrophied, thickened scar developing after trauma or surgical incision

 excessive collagen formation in the skin during connective tissue repair

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SKIN NEOPLASMS - BENIGN

keratosis: thickened and rough lesion of the epidermis - associated with aging or skin dammage

leukoplakia: white thickened patches of the mucous membrane tissue of the tongue or cheek

nevus: pigmented lesion of the skin (moles)

 dysplastic nevi - moles with atypical cells that may progress to skin cancer

verruca: epidermal growth (wart)

caused by a virus

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SKIN NEOPLASMS - MALIGNANT

basal cell carcinoma - malignant tumor of the basal

cell layer of the epidermis

 most frequent type of skin cancer  slow growing tumor - chronically sun-exposed skin  almost never metastasizes  treatment - surgical removal

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SKIN NEOPLASMS - MALIGNANT

squamous cell carcinoma - malignant tumor of the

squamous epithelial cells in the epidermis

● tumors may grow anywhere there is squamous epithelium
(mouth, larynx, bladder, esophagus, lungs)
● treatment - surgical removal, cryotherapy, electrodesiccation or radiotherapy

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SKIN NEOPLASMS - MALIGNANT

malignant melanoma - cancerous growth composed

of melanocytes

● genetic predisposition combined with exposure to ultraviolet light

● usually begins as a mottled, light brown to black macule with irregular borders - lesion may turn shades of red, blue, white and may crust and bleed
● often arise from preexisting moles (dysplastic nevi) and frequently appear on upper back, lower legs, arms and neck

● biopsy required to confirm diagnosis ● melanomas can metastasize to lung, liver, bone and brain ● treatment - excision, regional lymphadenectomy, chemotherapy / immunotherapy or radiotherapy

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SkinNeoplasms — Cancerous (cont’d)

the ABCDs of malignant melanoma.

A. asymmetry
B. border irregular

or circumscribed

C. color

varies from one area to another

D. Diameter

usually larger than 6mm

shades of brown, black (white, red, blue)

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SKIN NEOPLASMS - MALIGNANT

Kaposi sarcoma - malignant, vascular, neoplastic growth characterized by cutaneous nodules

● frequently arises on lower extremities ● nodules range in color from deep pink to dark blue or purple

● one form associated with AIDS

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  • Term Topic Content Hair Hair Is One of the Characteristic Features Of

    Term Topic Content Hair Hair Is One of the Characteristic Features Of

    Term Topic content Hair Hair is one of the characteristic features of mammals and has various functions such as protection against external factors; producing sebum, apocrine sweat and pheromones; impact on social and sexual interactions; thermoregulation and being a resource for stem cells. Hair is a derivative of the epidermis and consists of two distinct parts: the follicle and the hair shaft. The follicle is the essential unit for the generation of hair. The hair shaft consists of a cortex and cuticle cells, and a medulla for some types of hairs. Hair follicle has a continuous growth and rest sequence named hair cycle. The duration of growth and rest cycles is coordinated by many endocrine, vascular and neural stimuli and depends not only on localization of the hair but also on various factors, like age and nutritional habits. Distinctive anatomy and physiology of hair follicle are presented in this chapter. Extensive knowledge on anatomical and physiological aspects of hair can contribute to understand and heal different hair disorders. The hair follicle is one of the characteristic features of mammals serves as a unique miniorgan. In humans, hair has various functions such as protection against external factors, sebum, apocrine sweat and pheromones production and thermoregulation. The hair also plays important roles for the individual’s social and sexual interaction. The hair follicle serves as a reservoir for epithelial and melanocyte stem cells and it is capable of being one of the few immune privileged sites of human body. Hair follicle development is related to the interactions between epithelial and mesenchymal cells.
  • EFSUMB Course Book, 2Nd Edition

    EFSUMB Course Book, 2Nd Edition

    EFSUMB ECB2nd Edition Dermatology... 19.07.2019 12:46 1 EFSUMB Course Book, 2nd Edition Editor: Christoph F. Dietrich Dermatologic Ultrasound Fernando Alfageme1, Ximena Wortsman2, Gastón Roustan1, Maria Crisan3, Radu Badea3 1Dermatology Service. Hospital Universitario Puerta de Hierro Majadahonda. Madrid. Spain 2IDIBAPS. Dermatology and Radiology Department Clinica Seervet. Universidad Católica y Santiago de Chile. Chile 3Radiology and Dermatology UMPh Iuliu Hatieganu, Cluj-Napoca. Romanaia Corresponding author: Prof. Dr. Fernando Alfageme Dermatology Service Hospital Universitario Puerta de Hierro Majadahonda (Madrid) Associate Professor Dermatology Universidad Autónoma de Madrid, Spain EFSUMB ECB2nd Edition Dermatology …. 19.07.2019 12:46 2 Ultrasonography of normal skin and appendages (hair and nails) The skin covers all our human body, but its function goes further than being just a physical barrier. It is necessary to know exactly the dermatologic structures and its ultrasound features. The skin is composed by three anatomically distinct layers: epidermis, dermis and hypodermis or subcutaneous tissue. There are anatomical regional variations of these strata depending on the location (face, trunk, palm or sole). Besides the skin there are the skin appendages, especially the nail and the hair for ultrasound purposes. And finally there are other structures (glands, vessels, nerves) that we will have to take into account in our ultrasound examinations. Maybe the best way to classify skin disease is according to the skin structure affected: epidermis, dermis, subcutaneous fat, hair or nails. We will need a high frequency linear transducer (> 12 MHz) and Doppler for a suitable skin ultrasound study. Epidermis It is the external layer of the skin and it is composed mainly of keratinocytes.
  • Effect of Subdermal Pressure on the Skin and Its Appendages in the Sheep

    Effect of Subdermal Pressure on the Skin and Its Appendages in the Sheep

    EFFECT OF SUBDERMAL PRESSURE ON THE SKIN AND ITS APPENDAGES IN THE SHEEP By M. JOLLY* and A. G. LYNEt [Manuscript received October 21, 1968] Summary A method was devised by means of which pressure in an outward direction could be exerted on the undersurface of the skin. In each of two sheep (one black, one white) a Perspex disk was inserted subdermally and connected by means of a pin projecting through the skin to a spring supported on a light tower on the animal's back. The device was well tolerated and a pedicle of skin was formed during a period of some months. Macroscopically, there was no change in the skin or wool which showed normal growth, colour, and crimping. No obvious shedding of the fibres occurred. Microscopically, there was a change in fibre criIp.p, particularly in the time taken to form each crimp. There was a decrease of approximately 50 % in the density of the follicle population over the disks but no change in the ratio of secondary to primary follicles. There was no change in length growth rate of fibres over the disks but there was a small increase in the fibre diameters. The epidermis over the disks increased in thickness and a distinct and continuous granular layer formed. Pigmentation of the epidermis was unchanged except near the pin in the black animal, where both melanocytes and melanin were increased. Within the dermis of the black animal, there was an obvious increase in the concentration of melanocytes and melanin adjacent to the pin, both of which were probably derived from degeneration of follicles.
  • Corneodesmosin Gene Ablation Induces Lethal Skin- Barrier Disruption and Hair-Follicle Degeneration Related to Desmosome Dysfunction

    Corneodesmosin Gene Ablation Induces Lethal Skin- Barrier Disruption and Hair-Follicle Degeneration Related to Desmosome Dysfunction

    Research Article 2699 Corneodesmosin gene ablation induces lethal skin- barrier disruption and hair-follicle degeneration related to desmosome dysfunction Emilie A. Leclerc1, Anne Huchenq1, Nicolas R. Mattiuzzo1, Daniel Metzger2, Pierre Chambon2, Norbert B. Ghyselinck2, Guy Serre1,*, Nathalie Jonca1,‡ and Marina Guerrin1,‡ 1UMR 5165 ‘Différenciation Epidermique et Autoimmunité Rhumatoïde’ (UDEAR), CNRS – Université Toulouse III, IFR150, INSERM, CHU PURPAN, Place du Dr Baylac, TSA 40031, F-31059 Toulouse, Cedex 9, France 2IGBMC (Institut de Génétique et de Biologie Moléculaire et Cellulaire), Inserm U596 – CNRS UMR 7104 – Université Louis Pasteur – Collège de France, Illkirch, F-67400 France *Author for correspondence (e-mail: [email protected]) ‡These authors contributed equally to this work Accepted 1 May 2009 Journal of Cell Science 122, 2699-2709 Published by The Company of Biologists 2009 doi:10.1242/jcs.050302 Summary Corneodesmosin (CDSN) is specific to desmosomes of epithelia layer, then, both the epidermis and the hair follicles degenerated. undergoing cornification, mainly the epidermis and the inner In adults, Cdsn deletion resulted in similar histological root sheath of the hair follicles. CDSN nonsense mutations are abnormalities and in a lethal barrier defect. We demonstrate associated with hypotrichosis simplex of the scalp, a rare that Cdsn is not essential for skin-barrier formation in utero, disease that leads to complete baldness in young adults. CDSN but is vital throughout life to preserve this barrier by displays adhesive properties, mostly attributable to its N- maintaining desmosome integrity. The strong adhesive function terminal glycine-rich domain, and is sequentially proteolyzed that the protein confers on corneodesmosomes also seems as corneocytes migrate towards the skin surface.