Derm

Front 1

Skin Anatomy
The skin is an organ that forms a protective barrier against germs (and other organisms) and keeps the inside of your body inside your body, and keeps what's outside of your body outside.
Skin also helps maintain a _______________.
Human skin is only about __________ thick.
On average, an adult has from 18-20 square feet (about 2 square meters) of skin, which weighs about 6 pounds (2.7 kg).

Back 1

constant body temperature

0.07 inches (2 mm)

Front 2

The outer layer is called the ___________; it is a tough protective layer that contains __________(which protects against the rays of the sun and gives the skin its color).

Back 2

epidermis

melanin

Front 3

The second layer (located under the epidermis) is called the ________; it contains nerve endings, sweat glands, oil glands, and hair follicles.

Back 3

dermis

Front 4

Under these two skin layers is a fatty layer of subcutaneous tissue (the word subcutaneous means "under the skin"). This is also known as the ____________

Back 4

Hypodermis

Front 5

________- a tube-shaped sheath that surrounds the part of the hair that is under the skin. It is located in the epidermis and the dermis. The hair is nourished by the follicle at its base (this is also where the hair grows).
________- The part of the hair that is above the skin.
_____________- a muscle is connected to each hair follicle and the skin - it contracts (in response to cold, fear, etc.), resulting in an erect hair and a "goosebump" on the skin.

Back 5

hair follicle

hair shaft

hair erector muscle

Front 6

_____________- a cell in the epidermis that produces melanin (a dark-colored pigment that protects the skin from sunlight).
_____________- nerve receptors that respond to pressure and vibration; they are oval capsules of sensory nerve fibers located in the subcutaneous fatty tissue
_____________- a small, sack-shaped gland that releases oily (fatty) liquids onto the hair follicle (the oil lubricated and softens the skin). These glands are located in the dermis, usually next to hair follicles.
____________- (also called sudoriferous gland) a tube-shaped gland that produces perspiration (sweat). The gland is located in the epidermis; it releases sweat onto the skin.

Back 6

melanocyte

Pacinian corpuscle

sebaceous gland

sweat gland

Front 7

Skin Function

Sensation (largest sensory organ in the body)
Protection
Prevents dehydration
Prevents infection
Physical barrier to injury
Protects against ultraviolet light injury (__________)
______________
Insulation (hair and adipose tissue)
Heat dissipation
Sweat evaporation
Increased blood flow
Metabolic
Energy storage of )______________in adipose tissue
____________ synthesis

Back 7

Melanin

Thermoregulation

Triglycerides

Vitamin D

Front 8

Epidermis
Epidermis is the outermost layer of the skin. It forms the waterproof, protective wrap over the body's surface and is made up of stratified squamous ___________with an underlying _____________.
It contains no ____________, and is nourished by _____________from the ________. The main type of cells which make up the epidermis are keratinocytes, melanocytes, __________ cells and _______________cells.

Back 8

epithelium

basal lamina

blood vessels

diffusion

dermis

Langerhans and Merkels

Front 9

Epidermal Layers
Epidermis is divided into several layers where cells are formed through _________at the innermost layers.
They move up the strata changing shape and composition as they differentiate and become filled with ____________.
They eventually reach the top layer called stratum corneum and become sloughed off, or desquamated.
This process is called ___________and takes place within weeks. The outermost layer of Epidermis consists of 25 to 30 layers of dead cells.

Back 9

mitosis

keratin

keratinization

Front 10

Epidermis is divided into the following 5 sublayers or strata:

Mneumonic: "Before sex, get latex condoms" (from deep to superficial)

Back 10

Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum or mucosum
Stratum germinativum (also called "stratum basale")

Front 11

Stratum corneum (“horny layer”)
It is composed mainly of dead cells that lack ________. As these dead cells slough off, they are continuously replaced by new cells from the _______________

Back 11

nuclei

stratum germinativum

Front 12

Cells of the stratum corneum contain _________, a protein that helps keep the skin hydrated by preventing ___________ and absorbing water, further aiding in hydration and explaining why humans and other animals experience _________of the skin on the fingers and toes when immersed in water for prolonged periods.

Back 12

keratin

water evaporation

wrinkling

Front 13

The thickness of the stratum corneum varies according to the amount of protection and/or grip required by a region of the body. In general, the stratum corneum contains _________layers of dead cells.

Back 13

15 to 20

Front 14

Stratum lucidum
a thin, clear layer of dead skin cells in the epidermis.
It is found beneath the stratum corneum of thick skin
The keratinocytes of the stratum lucidum do not feature distinct boundaries and are filled with _______, an intermediate form of _________.
It is the waterproof layer of skin and is also called the _________of the skin

Back 14

eleidin

keratin

BARRIER LAYER

Front 15

_________________
This layer typically contains 1 to 3 rows of flattend cells with many small _________granules in their cytoplasm.
These keratohyalin granules are a step in the synthesis of the waterproofing protein ________, and contain large amounts of filaggrin.
Filaggrins are filament-associated _________which bind to keratin fibers
This is the highest layer in the epidermis where living cells are found

Back 15

stratum granulosum

basophilic

keratin

proteins

Front 16

______________
multi-layered arrangement of cuboidal cells that sits beneath the stratum granulosum.
Adjacent cells are joined by ___________giving them the spiny appearance from which their name is derived.
Their ________are often darkened (a condition called pyknosis), which is an early sign of cell death. Their fate is sealed because the nutrients and oxygen in interstitial fluid have become exhausted before the fluid is able to reach them by diffusion.
Cells of the stratum spinosum actively synthesize intermediate filaments called _________which are composed of keratin.
These intermediate filaments are anchored to the desmosomes joining adjacent cells to provide structural support, helping the skin resist abrasion.

Back 16

Stratum spinosum

desmosomes

nuclei

Front 17

Cells of the stratum spinosum actively synthesize ____________called cytokeratins which are composed of __________.
These intermediate filaments are anchored to the desmosomes joining adjacent cells to provide structural support, helping the skin resist abrasion.

Back 17

intermediate filaments

keratin

Front 18

_____________
Stratum germinativum (also stratum basale or basal cell layer) is the layer of keratinocytes that lies at the base of the _________immediately above the dermis.
It consists of a single layer of tall, simple columnar epithelial cells lying on a _____________

Back 18

Stratum basale

epidermis

basement membrane.

Front 19

stratum basale
These cells undergo rapid cell division, ____________ to replenish the regular loss of skin by shedding from the surface. About 25% of the cells are ___________, which produce melanin which provides pigmentation for skin and hair
________________is a relatively benign form of skin cancer which arises from this layer of cells.

Back 19

mitosis

melanocytes

Basal cell carcinoma

Front 20

_______________
the major cell type of the epidermis, making up about 90% of epidermal cells.
Keratinocytes originate in the basal layer. They are pushed up through the layers of the epidermis, undergoing gradual ___________until they reach the stratum corneum where they form a layer of dead, flattened, highly keratinized cells called ______________.

Back 20

Keratinocyte

differentiation

squamous cells

Front 21

Keratinocytes
This layer forms an effective barrier to the entry of foreign matter and infectious agents into the body and minimises ____________
Keratinocytes are shed and replaced continuously from the stratum corneum. The time of transit from basal layer to shedding is approximately one month although this can be accelerated in conditions of keratinocyte hyperproliferation such as __________

Back 21

moisture loss.

psoriasis

Front 22

___________are located as the bottom layer of the epidermis.
They produce melanin, a pigment in the ____________. There are both basal and activated levels of melanogenesis; lighter-skinned people generally have low basal levels , and exposure to UV radiation generally causes an inc.
The difference in skin color between fair people and dark people is due not to the number of melanocytes in their skin, but to the melanocytes' level of activity.

Back 22

Melanocytes

skin, eyes, and hair

Front 23

___________are immature immune cells (dendritic cells). On infection of an area of skin, the local Langerhans' cells will take up and process __________ before travelling to the draining __________and maturing to become fully-functional ____________.
Generally, Langerhans' cells are active in the capture, uptake and processing of antigens. Once they arrive in secondary lymphoid tissue however, they lose these properties while gaining the capacity to interact with naive ________.

Back 23

Langerhans' cells

microbial antigens

lymph node

antigen-presenting cells

T-cells

Front 24

Langerhans' cells are derived from the __________ of monocytes stimulation by ______________.
The inner surface of the foreskin, especially the downpart, contains Langerhans' cells with _____ receptors; these cells are likely to be the primary point of viral entry.

Back 24

cellular differentiation

colony stimulating factor-1

HIV

Front 25

__________ are large oval cells found in the skin of vertebrates. They are associated with the sense of touch, and are responsible for the highly malignant skin tumor known as _____________
Most often they are associated with sensory nerve endings, when they are known as ____________
F.S. Merkel referred to them as Tastzellen or "_________", although their function has been disputed ever since.

Back 25

Merkel cells

Merkel cell carcinoma.

Merkel nerve endings.

touch cells

Front 26

___________
the layer of skin beneath the epidermis that consists of -____________and cushions the body from stress and strain.
The dermis is tightly connected to the epidermis by a ____________. It also harbors many nerve endings that provide the sense of touch and heat.
It contains the hair follicles, ___________(3)glands and blood vessels.
The blood vessels in the dermis provide nourishment and waste removal to its own cells as well as the Stratum basale of the epidermis.

Back 26

Dermis

connective tissue

basement membrane

sweat glands, sebaceous glands, apocrine

Front 27

2 regions of the dermis
1. _____________
is composed of loose _______________. It is named for its fingerlike projections called ________, that extend toward the epidermis. The papillae provide the dermis with a "bumpy" surface that interdigitates with the epidermis, strengthening the connection between the two layers of skin.
In the palms, fingers, soles, and toes, the influence of the papillae projecting into the epidermis forms contours in the skin's surface. These are called ________, because they help the hand or foot to grasp by increasing friction. Friction ridges occur in patterns (_________) that are genetically determined and are therefore unique to the individual, making it possible to use fingerprints or footprints as a means of identification.

Back 27

Papillary region
areolar connective tissue
papillae
friction ridges
fingerprint

Front 28

2. ______________
lies deep in the papillary region and is usually much thicker. It is composed of dense irregular connective tissue, and receives its name from the dense concentration of ________,_________, and reticular fibers that weave throughout it. These ________fibers give the dermis its properties of strength, extensibility, and elasticity.
Located within the reticular region are also the _________, ________glands, receptors, nails, and blood vessels.
Tattoo ink is injected into the dermis. Stretch marks from pregnancy are also located in the dermis.

Back 28

Reticular region
collagenous, elastic
protein
roots of the hair, sebaceous glands

Front 29

__________ also called the hypoderm, subcutaneous tissue, or superficial fascia.
It is the lowermost layer of the _____________.
Types of cells that are found in the hypodermis are Fibroblasts, Adipose Cells, and Macrophages.
The hypodermis is used mainly for ____storage. Its physiological function includes insulation and storage of nutrients.
Continuous bundles of elastic fibers connect the subcutaneous tissue with the dermis. The blood vessels that supply the skin and help _________run through the subcutaneous layer. This layer also contains nerves and nerve endings.

Back 29

Hypodermis
integumentary system
fat
regulate body temperature

Front 30

Physical Exam
Dermatology has the obvious benefit of having easy access to tissue for diagnosis. _________ is generally done under bright light and preferably involves the whole body.
A morphological classification of __________is important in the diagnosis of dermatological disorders. Dermatologic diagnosis is often dependent upon pattern recognition of lesions and symptoms.

Back 30

Physical examination
dermatological lesions

Front 31

Primary lesions
________: a circumscribed change in skin color without elevation or depression.
________: a solid elevated lesion usually 0.5 cm or less in diameter.
________: a raised lesion that has a greater area as compared to its elevation above the skin surface.
_________ : a rounded or flat-topped elevated lesion formed by local dermal edema.

Back 31

Macule
Papule
Plaque
Wheal (hive)

Front 32

________: a palpable solid lesion of varying size, greater than 0.5 cm and less than 2 cm in diameter, which may be present in the epidermis, dermis or subcutis.
__________: a circumscribed elevated lesion which contains free fluid.;0.5 cm or less in diameter
___________: (abscess) a circumscribed elevated lesion which contains pus. An abscess is usually in the dermis or subcutis.
________: a non-blanching erythema or violaceous color due to extravasation of blood into the tissue.
_________: a sac containing liquid or semisolid material usually in the dermis.

Back 32

Nodule

Vesicle

Pustule

Purpura

Cyst

Front 33

Macule
A ________is a change in the color of the skin. It is flat, if you were to close your eyes and run your fingers over the surface of a purely macular lesion, you could not detect it.;greater than 1 cm. may be referred to as a _________.

Back 33

macule

patch

Front 34

_________is a solid raised lesion that has distinct borders and is less than 1 cm in diameter. May have a variety of shapes in profile (domed, flat-topped, umbilicated) and may be associated with secondary features such as ________

Back 34

Papule

crusts or scales.

Front 35

________is a solid, raised, flat-topped lesion greater than 1 cm. in diameter. It is analogous to the geological formation, the plateau

__________is an area of edema in the upper epidermis.

Back 35

plaque

wheal
Aka Hives

Front 36

_________is a raised solid lesion more than 1 cm. and may be in the epidermis, dermis, or subcutaneous tissue.

________are raised lesions less than 1 cm. in diameter that are filled with clear fluid.

Back 36

Nodule

Vesicles

Front 37

_________are circumscribed elevated lesions that contain pus. They are most commonly infected (as in folliculitis) but may be sterile (as in pustular psoriasis).


A ______is a harmless sac-like growth in the deeper layers of the skin, which is filled with a soft, whitish brown material that sometimes oozes onto the skin surface

Back 37

Pustules

cyst

Front 38

________is the appearance of red or purple discolorations on the skin, caused by _________underneath the skin. Small spots are called ___________, while large spots are called __________.

Back 38

Purpura
bleeding
petechiae
ecchymoses

Front 39

Secondary lesions
________: a heaping up of stratum corneum or keratin.
________: a loss of epidermis above the basal layer leaving denuded surface.
________: an accumulation of serum, blood, or purulent exudate.
_________: linear crusts and erosions due to scratching.
_________: a loss of epidermis and part or all of dermis leaving depressed moist lesion.
________: a thinning of epidermis or dermis.
________: a hardening or induration of skin.

Back 39

scale

Erosion

Crust

Excoriations

Ulcer

atrophy

sclerosis

Front 40

_______: fibrous tissue replacing normal skin in areas of healing.
_________: (1) an accentuation of skin markings commonly associated with thickening of epidermis usually caused by scratching or rubbing. (2) marked by the presence of fine papules.
____________: a combination of atrophy, hyper and hypopigmentation and telangiectasis.
___________: dilated superficial blood vessels, especially of the upper reticular dermal plexus.

Back 40

scar

lichenification

poikiloderma

telangiectasia

Front 41

Skin Biopsy
If the diagnosis is uncertain or a cutaneous _________is suspected, the dermatologic surgeon may perform a small _________(using a local anesthetic) for examination under the microscope by the dermatologist who is a trained dermatopathologist.

Back 41

malignancy
punch biopsy

Front 42

The KOH potassium hydroxide test is the microscopic examination of a skin, nail, or hair sample for the presence of a ________that infects these structures

diagnosis of infections produced by dermatophytes and _________from other skin disorders.

Back 42

fungus

Candida albicans

Front 43

___________are a type of fungus that invade the top layer of the skin, hair, or nails, and produce an infection commonly known as ringworm, technically known as tinea. It can appear as "jock itch" in the groin or inner thighs (tinea _______); on the feet (tinea pedis); on the scalp and hair (tinea capitis); and on the nails (tinea ________). Tinea _________appears anywhere on the skin and produces characteristic unpigmented patches. Tinea unguium affects the nails.

Back 43

Dermatophytes
cruris
unguium
versicolor

Front 44

Tzank prep
The Tzanck test is a method of testing for the ________ (which causes cold sores, __________, or genital sores), or varicella-zoster virus (which causes chickenpox and "_________").
The test may help diagnose or confirm an infection with 1 of these 2 viruses. This test can not distinguish between these two viruses
The sore is scraped and the scraping is put on a slide, stained, then examined under a microscope.

Back 44

herpes simplex virus
fever blister
shingles

Front 45

_________
Indications
Distinguish _________from erythema (Diascopy)
Technique
Place glass slide over lesion border
Apply direct pressure on lesion
Interpretation
Lesion remains red suggests Purpura
Lesion blanches (loses red color) suggests erythema

Back 45

Diascopy
Purpura

Front 46

_________is a diagnostic tool used in dermatology by which ultraviolet light is shone onto the skin of the patient
a technician then observes any subsequent ________. For example, _________— associated with some skin diseases — will fluoresce pink.
Useful in diagnosing conditions such as ________ and erythrasma, both in distinguishing them from other conditions and in locating the precise boundaries of the condition.
It is also helpful in diagnosing __________(Microsporum audouini), ________(Corynebacteriium minutissimum, pseudomonas), and pigmentary disorders

Back 46

Wood’s Light
fluorescence
porphyrins
tuberous sclerosis
fungal infections
bacterial infections

Front 47

Patch test
Indications
__________(Type 4 Hypersensitivity)

Back 47

Allergy test

Front 48

Interpretation of skin test
Erythema: __
Edema or Vesicles involve <50% of patch area: ____
Edema or Vesicles involve >50% of patch area: ____

Back 48

1+
2+
3+

Front 49

An _________is a benign growth that consists of small blood vessels. These tumors can be located anywhere on the body
TX: usually none (but treated with ___________, liquid nitrogen or laser)

Back 49

angioma

electrodessication

Front 50

__________consists of small, harmless growths caused by a skin virus. They resemble pimples with a waxy, pinkish look and a small central pit.
TX: (_________or TCA acid) or liquid nitrogen

Back 50

Molluscum contagiosum

cantharone

Front 51

Rash that develops in the spring and the fall, and seems to favor adolescents and young adults

a single, isolated oval scaly patch (the "_________") appears on the body, particularly on the trunk, upper arms, neck, or thighs.

Back 51

pityriasis rosea

herald patch

Front 52

_____________ is a common condition of the beard area occurring in up to 60% African American men and other people with curly hair.

Back 52

Pseudofolliculitis barbae (razor bumps)

Front 53

It shows up as flaking skin, or reddish patches. Difficult to tell apart from psoriasis
TX: using shampoos containing _______ (Head and shoulders, ZNP bar), ________(Selsun blue and prescription strength Selsun) or _________(Nizoral AD and prescription strength Nizoral

Back 53

Seborrheic Dermatitis

zinc pyrithione
selenium sulfide
ketoconazole

Front 54

_____________, is a common problem. Your skin needs moisture to stay smooth and supple, and retaining moisture is especially difficult in winter

Back 54

Dry skin, also called xerosis

Front 55

____________is a chronic disease of the apocrine glands (a form of sweat gland found on certain parts of the body; common in people who have had _______
tx: abx, antiinflammatory pills, birth control, injections

Back 55

Hidradenitis

acne

Front 56

__________is a relatively common skin disease that comes in episodes lasting months to years. The onset may be gradual or quick;
appears as shiny, flat-topped bumps that often have an angular shape

Back 56

Lichen planus

Front 57

___________is the specific name given to lichen planus on the scalp that causes permanent scarring alopecia with inflammation around affected hair follicles

Back 57

Lichen Planopilaris

Front 58

___________ are benign lesions that occur on the sun-exposed areas of the body. The backs of hands and face are common areas

Back 58

Lentigines, or liver spots

Front 59

___________is a form of 'panniculitis' or inflammation of subcutaneous fat tissue. It is quite painful, especially if pressed upon. It looks like painful bruises on both of the shins; caused by meds (____) and infx (_________)

Back 59

Erythema nodosum
sulfa drugs
strept throat AND TB

Front 60

___________ is an acute, self-limiting, inflammatory skin eruption. The rash is made of spots that are red welts, sometimes with purple or blistered areas in the center. It often also affects the mouth, eyes and other moist surfaces

Back 60

Erythema multiforme (EM)