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166 Cards in this Set

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dematology
study of the integument:
skin
hair
nails
mucous membrances
Functions of the skin
-protect against microbial and foreign invasion and minor physical trauma
-provide mechanial barrier against body fluid loss
-regulates body temperature
-provides sensory perception via free nerve endings and specialized receptors
-produces vitamin D from precursors in skin
-contributes to BP regulation through constriction of skin and vessels
-excretion of metabolites
-express emotions (blushing)
Layers of epidermis
1. stratum corneum
2. cellular stratum
stratum corneum
-1st layer of epidermis
-dead layer
-cornified cells, "horny layer"
-tightly packed dead squamous cells
-contains keratin (the waterproofing protein)
-keeps skin hyrated
layers of cellular stratum (of epidermis)
1. stratum granulosum
2. stratum spinosum
3. stratum basale
Stratum granulosum
granular cells
-contains 3- rows of granular cells (flattened cells whose cytoplasm contains small granules)
-granules are proteins that are in the process of transforming into the waterproofing protein keratin
-contains glycolipids and a thickening of the membrane.
Stratum spinosum
-prickle or spinous cells
-multi-layered arrangement of cuboidal cells
-adjacent cells are joined by desmosomes giving them a spiny appearance
-cells actively synthesize intermediate filaments composed of keratin
-intermediate filaments are anchored to the desmosomes joining adjacent cells to provide structural support, helping the skin resist abrasion
Stratum basale
-germinativum
-contains keratinocytes and melanocytes
-lies just above dermis
-single layer of tall, simple columnar epithelial cells lying on a basement membrane
-cells undergo rapid cell division to replenish the regular loss of skin by shedding from the surface
Basement membrane
connnects epidermis to the dermis
Dermis
-provides nutrition for the epidermis by means of penetrating papillae
-contains:
-connective tissue (elastin, collagen, reticulin fibers)
-sebaceous glands
-blood vessels
-sensory nerve fibers
-autonomic motor fibers
Hypodermis
-subcutaneous layer
-loose connective tissue filled with fatty cells
-sweat glands
-some hair follicles
Eccrine sweat glands
-distibuted over most of body
-open directly to surface of skin
-regulated body temp through water secretion
-produce sweat composed chiefly of water
miliaria
pathology of eccrine glands
apocrine sweat glands
-inactive until puberty
-larger and deeper than eccrine
-found in axilla, anogenital region, areola, nipple, eyelids, external ear
-secretion stimulated by emotional stress
-produce sweat that contains fatty materials
-reponsible for body odor
What causes body odor
bacterial decomposition of apocrine sweat (bacteria breaks down organic compounds in the sweat)
hidranetitis suppurativa
pathology of apocrine glands
sebaceous glands
-stimulated by sex hormones
-secrete lipid rich sebum to keep skin and hair lubricated
-sebum moves to skin through hair follicles
-NONE on palms or soles
Acne
pathology of sebaceous glands
hair follicles consist of...
-root, shaft, follicle
nutrients for hair follicles provided by the...
papilla
Determination of skin pigments
-melanin (brown)
-carotene (golden yellow-orange)
-oxyhemoglobin (bright red)
-deoxyhemoglobin (dark blue)
Skin type I
-always burns, never tans
-severe sun damage can appear as permanent freckling, especially on shoulders, face, arms
-red hair and green eyes are associated with this skin type
Skin type II
-frequently burns, sometimes tans
-fair hair and blue eyes
Skin type III
-frequently tans, sometimes burns
-darker hair and eyes
-sun protection is required to avoid sunburn and prevent premature aging of the skin
Skin type IV
-always tans, never burns
-tolerant skin when exposed to sunshine
-dark brown hair and eyes
- non-melanoma skin CA may develop after yrs of sun exposure
Skin type V & VI
-asian and black skin
-non-melanoma skin CA may also develop following yrs of sun exposure
What light rays are useful for skin inspection?
-natural sunlight is best
-combination of incandescent and fluorescent is next best
Abnormal skin colors
-pallor (pale)
-cyanosis (blue)
-erythema (red)
-jaundice/sclera icterus (yellow)
-ashen/dusky (gray)
Acrocyanosis
cyanosis in palms and soles of feet
peripheral cyanosis
cyanosis in arms and legs
central cyanosis
cyanosis in mouth and tongue
Vellus hair
short
fine
soft
inconscpicious
nonpigmented
Terminal hair
conspicious
thicker
coarse
usually pigmented
Life cycle of hair
1. anagen (growth)
2. catagen (atrophy)
3. telogen (rest)
4. shed (loss)
Nail composition
epidermal cells converted to hard plates of karatin
Nail growth
0.1 mm/day = 1 cm/100 days

-finger nails - 3 months to grow out
-toe nails - 6 months to grow out
Parts of the Nail
-nail bed
-lunula
-eponychium (cuticle)
-paronychium (lateral sides)
Changes in androgen stimulate...
-increases terminal hairs on face
-appearance of axillary hair
-increased truncal and body hair (M>F)
Changes in apocrine glands with adolescence
-enlarge
-become active causing axillary sweating and body odor
Changes in sebaceous glands with adolescence
-increase sebum production (response to hormones, mainly androgen) causing oily skin and acne
Changes in Eldery
-dec skin turgor
-dec vascularity of dermis
-skin thins and becomes more fragile
-furrowing and thickening of skin
-nails lose luster and yellow
-hair loses pigmentation and begins to thin
Derm Hx questions
-how long have you had it?
-does it itch/burn/hurt?
-how and where did it start?
-has it changed? how?
-any meds?
-exposed to new substances/irritating agents at home or work? (soaps, detergents, fabric softeners, pets, cleaners, foods, clothing)
-tried anything for it?
-allergies?
-ongoing systemic illness?
-Previous hx of this? diagnoisis? tx?
-friends/family with this?
Glass slide
equipment used for blanching
Woods lamp
equipment used to illuminate fungus (like a blacklight)
Diagnostics for derm
-fungal scraping with KOH prep (kills everything but the fungus)
-fungal culture
-Tzanck smear (Herpes)
-scabies prep (Scabies)
-Alergy skin testing (patch tetsting and prick testing)
Primary lesion
lesions that occur as the INITIAL spontaneous manifestation of an underlying pathologic process
Secondary lesion
lesions that result from later evolution of or trauma to a primary lesion
Examples of primary skin lesions
-macule
-patch
-papule
-plaque
-wheal
-nodule
-tumor
-pustule
-cyst
-vescicle
-bulla
Macule
-flat, nonpalpable
-circumscribed
-less than 1 cm in diameter
-brown, red, purple, white, tan
Examples of macules
-freckles
-flat moles
-solar lentigines
-tinea versicolor
Patch
-flat, nonpalpable
-irregular in shape
-greater than 1 cm in diameter
Examples of patches
-vertiligo
-congential melanocyte nevus
-port wine stains
Papule
-elevated, palpable
-firm, circumscribed
-less than 1 cm in diameter
-brown, red, pink, tan, or bluish red
Examples of papules
-warts
-malignant melanoma
-lichen planus
-pigmented nevi
Plaque
-elevated, palpable
-firm, rough
-greater than 1 cm in diameter
Plaque examples
-psoriasis
-seborrheic and actinic keratoses
Wheal
-elevated, palpable
-irregular shaped area of cutaneous edema
-solid
-transient, changing
-variable diameter
-pale pink with lighter center
Wheal examples
-uticaria
-insect bites
Nodule
-elevated, palpable
-firm, circumscribed
-deeper in dermis than papule
-1-2 cm in diameter
Nodule examples
-erythema nodosum
-keratoacanthoma
-lipomas
-cystic basal cell carninoma
-kaposi's sarcoma
Tumor
-elevated, palpable
-solid
-may or may not be clearly demarcated
-greater than 2 cm in diameter
-may or may not vary from skin color
Tumor examples
-neoplasm
-turban tumor
Vesicle
-elevate, palpable
-circumscribed
-superficial
-filled with serous fluid (clear fluid)
-less than 1 cm in diameter
Vesicle examples
-blisters
-varicella
-eczema
-herpeticum
-herpes zoster
Bulla
-elevated, palpable
-vesicle greater than 1 cm in diameter
Bulla examples
-blisters (giant blisters)
-pemphigus vulgaris
Pustule
-elevated, palpable
-superficial
-similar to vesicle but filled with purulent fluid (white fluid)
Pustule Examples
-impetigo
-acne
-folliculitis
Cyst
-elevated, palpable
-circumscribed, encapsulated
-filled with liquid or semi-solid material
Cyst examples
-epidermoid cyst
Examples of Secondary lesions
-scale
-crust
-lichenification
-scar
-keloid
-excoriation
-fissure
-erosion
-ulcer
Scale
-heaped up keratonized cells
-flaky exfoliation
-irregular
-thick or thin
-dry or oily
-varies in size
-silver, white, or tan color
Scale examples
-psoriasis (white/silver)
-exfolaitive dermatitis
Crust
-dried serum
-blood or purulent exudate
-slightly elevated
-size varies
-brown, red, black, tan, or straw color
Crust Examples
-scab on abrasion
-impetigo
-eczema
Lichenification
-rough, thickened epidermis
-accentuated skin markings caused by rubbing or iiritation
-often involves flexor aspect of extremity
-often d/t scratching
Lichenification example
-chronic dermatitis
Scar
-thin the thick fibrous tissue replacing injured dermis
-irregular
-pink, red, or white
-may be atrophic or hypertorphic
Keloid
-progressively enlarging scar
-irregularly shaped
-elevated, growing beyond boundaries of the wound
-caused by excessive collagen formation during healing
Excoriation
-loss of epidermis
-linear or hollowed out crusted area
-dermis exposed
Excoriation examples
-abrasion, scratch
Fissure
-linear crack or break from epidermis to dermis
-small, deep
-white, pink, and red
Fissure examples
-athletes foot
-cheilosis
Erosion
-loss of all or part of epidermis
-depressed
-moist, glisterning
-follows rupture of vesicle or bulla
-larger than a fissure
Erosion example
-pemphigus vulgaris
Ulcer
-loss of epidermis and dermis
-concave
-varies in size
-exudate
-red or reddish blue
-deeper than an erosion
Ulcer examples
-decubiti
-stasis ulcers
-radiation ulcers
Atrophy
-thinning of skin surface
-loss of skin markings
-skin translucent and paper-like
Atrophy examples
-striae
-aged skin
-stretch marks
Vascular Skin Lesion
-difference in whether they blanch or not
-examples: ecchymosis, petechiae, purpura, capillary hamingioma, telangiectasia, venous star, spider angioma
Ecchymoses
-red-purple nonblanchable discoloration
-variable size

-caused by vascular wall destruction, trauma, vasculitis
Causes of ecchymoses
-vascular wall destruction
-trauma
-vasculitis
Petechiae
-red-purple nonblanchable discoloration
-less than 0.5 cm in diameter (pinpoint size)
-usually linked to blood disorder
Cause of petechiae
-intravascular defects
-infection
-meningococcemia
Purpura
-red-purple nonblanchable discoloration
-usually spot-like, round
-greater than 0.5 cm in diameter
Cause of purpura
-intravascualr defect
-infection
Capillary hemangioma (Nevus flammeus)
-red, irregular macular patches
-"cherry hamangioma"
-caused by dilation of dermal capillaries
Cause of capillary hemangioma
-dilation of dermal capillaries
Telangiectasia
-fine, irregular lines
-caused by dilation of capillaries
Causes of telangiectasia
-dilation of capillaries
-seen in autoimmune dz (lupus)
Venous Star
-bluish spider
-linear or irregular shaped
-does NOT blanch
-caused by increase pressure in superficial veins
Causes of venous star
-increased pressure in superficial veins
Spider Angioma
-red, central body with radiating spider-like legs
-blanched with pressure to central body
Causes of spider angioma
-liver dz (often in alcoholics)
-vitamin B deficiency
-idiopathic
Primary union
-mechanically close wound
-healing by first intention
-used for clean, incised wounds where edges are in close opposition
Secondary union
-let the wound close itself
Used when:
-unable to achieve opposition of wound edges
-foreign material is present
-extensive necrosis is present
-infection is present
Characteristics used to categorize skin lesions
-distribution
-pigmentation
-shape and pattern
-consistency
-symmetry
-margins/borders
Distribution
-localized (extensor surfaces, sunexposed areas, unexposed areas, intertriginal areas)
-regional
-generalized (often viral or drug rxn)
Pigmentation
-hetergneous vs homogenous
-color
Shape
-linear
-round or discoid
-oval
-annula (round with clear center)
-polycyclic (multi-ringed)
-arciform (incomplete ring)
-grouped
-iris or target lesions
-reticulate (net/mesh pattern)
-dermatomal
-descrete vs confluent (blend together)
pattern
-smooth
-rough
-flat topped
-pointed
-dome shaped and umbilicated (central depression)
consistency
-soft (more epidermis)
-firm (deeper, into dermis)
-hard (often dead tissue)
Symmetry
-symmetrical
-asymmetrical
margins
-demarcated (circumscribed if dealing with round border)
-irregular
Therapeutic rules for dermatology
1.If it is wet, make it dry
2.if it is dry, make it wet
3. If you don't know what it is..consider a steroid cream
4. start with low potency agent first and work your way up
5. remove allergens from environment when possible (pets, soaps, perfumes)
6. know when to refer
7. DO NO HARM
Corticosteroids
-fluorinated vs unfluorinated
-potency
-ointment vs cream
-system corticosteroids are sometimes required (prednisone, depromedrol)
fluorinated vs unfluorinated
fluorinated are higher potency
Ointment vs Cream
Ointments are usually stronger than creams
Potency
low, medium, high, and superhigh potency groups
Emollients for Dry Skin
-best applied after bath or shower
Examples of emmollients
-petrolatum (vaseline)
-mineral oil
-creams (sucerin)
-lotions (lubriderm)
-lac-hydrin (lactate) - in cream or lotion
Soaps should be limited to...
axillae, groin, and feet in pt with dry skin!!
Drying agents for weepy dermatitis
-water
-aluminum salts
-colloidal oatmeal (aveeno)
-shake lotions (starch or calamine)
-powders
Antipruritics
-lotions (0.5% camphor and menthal)
-pramoxine HCl cream/lotion
-corticsteroids
-antihistamines
-tricyclic antidepressants
-psychotrophic meds
What works best as an antipruritic?
sedating antihistamine
Examples of sedating antihistamine
-benadryl (diphenhydramine)
-atarax (hydroxizine)
Examples of non-sedating antihistamines
-claritin
-allegra
Examples of mildly sedating antihistamines
-zyrtec
Examples tricyclic antidepressants
-doxepin (sinequan)
UVB vs UVA
UVB:
-effects more superficial layers
-causes sunburn
-causes majority of skin CA (primarily basal and squamous cell CA)

UVA
-penetrates deeper
-responsible for aging process
-helps with mutation for melanoma
-most tanning beds

BOTH
-cause retinal damage
-contribute to aging
SPF
-sun protection factor
-15 or above (15 is basically max effect)
PABA vs PABA free
Para-aminobenzoic acid

PABA - absorbs UV light, helps prevent sun damage BUT frequent cause of allergic rxn and stains clothing
Topical antifungals
-imidazoles
-clotrimazole
Sunscreen should be applied...
-1 hour before exposure and q4 hrs thereafter
Topical antibiotics
-bacitracin
-neomycin (most sensitizing so many pt are allergic!!)
-polymycin
-sulfa preps
-bactroban
Vehicles
-powders
-liquids
-gels
-creams
-ointments
Liquids
-lotions
-tinctures (more concentrated)
-sprays
-aerosoles
Ointments (types)
-soluble in water
-emulsify with water
-insoluble with water
-pastes
Topical anesthetics
-viscous lidocaine
Topical Scabicides
(antiparasitics - used to kill scabies)
-permethrin
-lindane (kwell)
Powders
-promote drying by inc surface area
-reduce moisture, maceration, and friction
-useful in intertriginous areas)
ointments
-contain little water, if any
-feel greasy
-used to lubricate
-preferred for lesions c thick crusts, lichenification, heaped up scales
-often more potent than creams
creams
-semisolid emulsions of oils and water
lotions
-most are water based emulsions
-cools and DRY acute inflammatory and exudative lesions
Types of Dressings
-open wet (wet to dry)
-closed wet
-occulsive
occulsive therapy
-covering with nonporous dressing
-increases absorption and effectiveness
Complications of derm therapy
-allergic rxn
-irritation
-hypopigmentation
Allergic rxn d/t derm therapy
-neomycin
-corticosteroids
-bandage/tape rashed
irritation d/t derm therapy
-lindane (kwell)
-soaps (especially antispetic and fragrant soaps)
-podophyllum resin
Hypopigmentation d/t derm therapy
-d/t use of corticosteroids
-greater in genital area
-greater with long term use
-irreversible
-more common in skin type IV and V
Greatest absoption in which areas
-face
-genital area
-mucous membranes
-broken skin
-under occlusive dressing
When to use lower potency
-larger surface area
-prolonged use
Absorption in children vs adults
Children absorb 3x more than adults
Lindane contraindicated in...
-children
-pregnancy woman
Inquire about pregnancy when using
-podophyllum
-accutane
Therapeutic techniques
-skin biopsy
-curettage
-electrosurgery
-cryosurgery (liquid nitrogen)
types of Skin biopsy
-shave biopsy (partial thickness)
-punch biopsy (full thickness)
-elliptical excisonal biopsy
Shave biopsy shoud not be used with...
melanomas
What is the difference between a fluorinated and unfluorinated corticosteroid?
-fluorination (chemical modification) generally enhance both anti-inflammatory activity and increase the likelihood of adverse effects
Basic effects of corticosteroids?
-anti-inflammatory
-anti-pruritic
-vasocontriction
Science behind corticosteroid effects?
-corticosteroids are thought to induce phospholipase A2 inhibitor proteins, preventing arachidonic acid release & biosynthesis of potent mediators of inflammation
Why is nonfluoronated corticosteroids preferred for facial dermatosses?
nonfluorinated, does not usually induce facial telangiectasia, perioral dermatitis, atrophy, or striae
emollients
skin softeners
Gels vs Creams
-more drying than creams
-less potent than creams
astringents
-drying agents that precipitate protein
-skrink and contract skin
relative potency between lotions, ointments, and creams
-ointments (most potent)
-cream
-lotion (least potent)