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122 Cards in this Set
- Front
- Back
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What are the 3 main functions of skin?
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1. Protection
2. Perception 3. Heat and Fluid Regulation |
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What does the skin protect us from?
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Mechanical, chemical, radiation, thermal
PATHOGENS |
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What are the 3 layers of the skin?
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1. Epidermis
2. Dermis 3. Subcutaneous (Hypodermis) |
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What type of cell accounts for 90% of epidermal cells?
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Keratinocytes
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What do keratinocytes do?
How long does this take? |
Move outward from basal cell layer to form keratin protein.
About 28 days |
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What is the function of the keratinocytes?
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Barrier at the skin from water and pathogens.
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Where are melanocytes found?
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In the basal layer
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What do melanocytes do?
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Produce melanin which pigments the skin and protects the skin from UV
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What are the 2 categories of Dermal Cells?
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1. Fibroblasts
2. Leukocytes |
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What 3 things do fibroblasts produce and what do they confer?
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1. Collagen - structural support
2. Elastin - elasticity 3. Reticulin - tensile strength |
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What are 3 types of leukocytes found in the dermis?
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1. Mast cells
2. Macrophages 3. Lymphocytes |
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What are the 2 general categories of sweat glands in the skin?
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1. Eccrine
2. Apocrine |
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Which type of sweat gland is the main type?
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Eccrine
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What is the function of eccrine glands?
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Temperature regulation
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Where are eccrine glands found?
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palms of hands
soles of feet forehead throughout skin |
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What do apocrine glands secrete?
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Fatty part of cells
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Where are apocrine glands found?
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Axilla
Genital Scalp |
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Which type of sweat glands cause odor?
What is the odor from? |
Apocrine
Bacterial breakdown |
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What does the pilosebaceous unit consist of?
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1. Hair
2. Hair follicle 3. Sebaceous gland |
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What does a sebaceous gland secrete?
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sebum
- a fatty material - lubricates hair and skin |
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What are the 8 types of skin lesions?
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Macule
Patch Papule Nodule Plaque Vesicle Pustule Bullae |
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How is a macule described?
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Flat lesion
Less than 1 cm pigmented, hyperpigmented, or hypopigmented |
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How is a patch described?
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Flat lesion
Greater than 1 cm |
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How is a papule described?
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Raised lesion
Less than 0.5 cm in diameter |
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How is a nodule described?
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A large papule
A papule that is larger than 0.5 cm in diameter. |
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How is a plaque described?
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Slightly raised lesion
Greater than 1 cm |
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How is a vesicle described?
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Raised lesion
Less than 0.5 cm Filled with clear fluid |
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How is a pustule described?
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Raised lesion
Less than 0.5 cm Filled with pus |
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How is Bullae described?
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Large vesicle
Greater than 0.5 cm Blister |
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What is miliaria an obstruction of?
What does it cause? What lesions characterize it? |
Sweat glands
Extravasation of sweat into tissue Papules, macules |
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What are the 5 types of acne were mentioned in class?
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Acne Vulgaris:
1. Noninflammatory 2. Inflammatory 3. Nodulocystic 4. Infantile Acne 5. Acne medicamentosa |
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Who is acne most common with?
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Teenagers
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What type of lesions are seen in acne?
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Blackheads
Whiteheads Inflammation Nodules Cysts |
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Where is acne most commonly seen?
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Face, Forehead, chest, Back
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What causes acne (3 steps)?
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1. Overproduction of keratin and
sebum (due to androgens) 2. Blockage of pilosebaceous unit 3. Inflammation and/or infection (propionibacterium) |
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Who has more acne, men or women? Why?
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Men
More testosterone |
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Does diet affect acne?
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Not much if at all
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How can you Tx Acne?
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Topical agents
Oral Isotetinoin |
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What should you not use for acne?
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Steroids
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What type of Topical agents can be used for acne?
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Cleansing agents
Benzoyl peroxide Retinoic acid antibiotics |
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What types of oral meds can be used for acne?
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Antibiotics
Ortho-tri-cyclin Accutane |
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What is the generic name for accutane?
Which type of acne is it best to use it for? |
Isotretinoin
Nodulocystic acne |
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What age range is most affected by rosacea?
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30-50
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Where is it usually seen?
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Face: cheeks, nose, forehead, chin, eyes
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What do you have to DDx?
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Acne
Lupus |
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What causes Rosacea?
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Unknown
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What is known about the etiology of Rosacea?
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It is a chronic inflammatory eruption
Also, it may have an infectious component. |
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What are the signs of rosacea?
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Flushing episodes
Erythema Telangiectasia Ocular Inflammation Papules and Pustules Rhinophyma - overgrowth of sebaceous glands and CT |
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How common are eye problems with rosacea?
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greater than 50% experience
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What is the most common eye problem with rosacea?
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Inflammatory conjunctivitis with or without blepharitis
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What 5 things should rosacea patients avoid?
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1. Heat
2. Hot liquids 3. Sun 4. Steroids 5. ALCOHOL |
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Tx for Rosacea?
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1. Antibiotics
2. Azelaic acid - Finacea |
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What antibiotics are used for Rosacea?
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Oral and/or topical
Metronidazole Doxycycline (FOR OCULAR) Erythromycin |
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What does Azelaic acid do?
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Anti-bacterial
Anti-keratinizing Anti-inflammatory |
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What is another name for Eczema?
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Dermatitis
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What are 2 categories of Eczema?
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Endogenous and Exogenous
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What are 4 types of Eczema/Dermatitis?
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1. Atopic
2. Contact 3. Drug Induced 4. Photosensitive |
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What is another name for Atopic Dermatitis?
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Endogenous eczema
Allergic Dermatitis |
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What type of reaction can atopic dermatitis be?
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Systemic and localized
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What kind of cells are involved in atopic dermatitis?
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Mast cells (and basophils)
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What happens during the first exposure to the antigen with atopic dermatitis?
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The person becomes sensitized to the antigen
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What happens during the second exposure to the antigen with atopic dermatitis?
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The body releases vasoactive substances (histamines) - IgE mediated
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What are the clinical signs of atopic dermatitis?
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Rash
Pruritis and excoriations Xerosis (dry skin) Other allergy symptoms |
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How to Tx atopic dermatitis?
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Avoid the allergen
Topical lubricants Antihistamines: topical and oral Steroids: topical and oral |
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What 2 other specific drugs can be used for atopic dermatitis?
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tacrolimus
pimecrolimus |
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Antihistamines used for atopic dermatitis?
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Chlorpheniramine
Diphenhydramine (Benadryl) Hydroxyzine (Vistaril) Loratadine (Claritin) Cetrizine (Zyrtec) Desloratadine (Clarinex) Fexofenadine (Allegra) |
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Which antihistamines are by Rx only?
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Hydroxyzine (Vistaril)
Desloratadine (Clarinex) Fexofenadine (Allegra) |
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Which antihistamines are sedating?
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Chlorpheniramine
Diphenhydramine (Benadryl) Hydroxyzine (Vistaril) |
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What are the side effects of antihistamines?
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Dry mouth, skin, and eyes
Urinary retention constipation sedation |
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What are the uses of topical steroids?
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Anti-inflammatory effect
Decrease edema, itching, rash, drainage |
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The more potent a topical steroid is what happens to the side effects?
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increase
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What are the side effects of topical steroids?
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CAUSE dermatitis
Infection (depressed immune system) Adrenal suppression Dermal atrophy (Face with less than 2.5% hydrocortisone) GLAUCOMA |
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What is the commercial name for topical tacrolimus?
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Protopic
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What is the mechanism of topical tacrolimus?
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Inflammatory cytokine inhibitor
Inhibits T lymphocyte activation |
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What are a couple benefits of topical tacrolimus?
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No atrophy
Okay to use around face and eyelids |
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What should you avoid when using topical tacrolimus?
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Vaccinations
Sun |
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What are the 2 types of contact dermatitis?
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1. Allergic
2. Irritant |
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What types of things cause Allergic Contact Dermatitis?
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Plant: poison ivy, poison oak
Metals: NICKEL Chemicals: LATEX, rubber |
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What is usually the irritant in Irritiant Contact Dermatitis?
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Various chemicals
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Are there systemic signs and symptoms with contact dermatitis?
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No
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Where are signs and symptoms of contact dermatitis found?
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The area of contact
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What are the localized clinical signs of contact dermatitis?
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erythema
edem blisters pruritis oozing plaques |
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How do you Tx Contact dermatitis?
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Avoid allergen/irritant
Topical lubricants/moisturizer Antihistamine Steroids |
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What is seborrhea?
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Redness and scaling
Macules, papules, plaques, crusts |
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Where is seborrhea found?
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Areas of the body where sebaceous glands are most active.
Scalp, nose, eyebrows, eyelashes, ears |
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What causes seborrhea?
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Sebum gland dysfunction + infection
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What type of infection is associated with seborrhea?
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Fungal
Malassezia furfur - yeast |
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How do you Tx Seborrhea?
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Antifungals
-ketoconazole shampoo/cream -selenium sulfide (Selsun Blue) Steroids Tacrolimus |
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What is the most characteristic sign of psoriasis?
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Silvery patches, plaques (thick and scaly)
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Where is psoriasis most often seen on the body?
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extensor surfaces - knees and elbows
sometimes scalp NOT face usually |
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What kind of changes are seen in 50% of psoriasis patients?
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nail changes
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What causes psoriasis?
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Inflammation of keratocytes
Immune mediated by T-lymphocytes |
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What is the most common type of psoriasis?
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plaque psoriasis
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What gene is associated with pustular psoriasis?
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HLA-B27+
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What joint problem is associated with psoriasis?
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Psoriatic arthritis
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How do you Tx psoriasis?
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Topical and/or oral STEROIDS
Photochemotherapy TNF inhibitors |
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What is involved with photochemotherapy?
What is a side effect? |
Psoralen (oral or topical) +UVA light
Increased risk for cataracts |
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What are the 3 TNF inhibitors mentioned in class?
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Etanercept (Enbrel)
Infliximab (Remicade) Adalimumab (Humira) |
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What do T-cell Activation Inhibitors do?
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Inhibit T-cell activation and reduces the number of memory T-lymphocytes
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What are the names of 2 T-cell activation inhibitors?
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Alefacept (Amevive)
Efalizumab (Raptiva) |
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What is a possible side effect of T-cell activation inhibitors?
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Lymphopenia which can cause increased infection and malignancy risk.
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What are the 3 main categories of Immune/Autoimmune Disorders discussed?
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1. Bullous Disease
2. Erythema Nodosum 3. Erythema Multiforme |
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What are the 3 types of Bullous disease discussed in class?
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1. Bullous pemphigoid
2. Pemphigus vulgaris 3. Dermatitis herpetiformis |
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What are the 2 categories of Erythema Multiforme?
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1. Minor
2. Major (Stevens-Johnson, Toxic Epidermal Necrolysis) |
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What are the 4 types of immune mediated injuries?
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1. Anaphylactic
2. Cytotoxic 3. Immune complex 4. Cell-mediated |
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What diseases are AW anaphylactic reactions?
What causes it? |
Atopic/Allergic/Contact dermatitis
IgE and release of vasoactive amines (histamine) |
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What diseases are AW cytotoxic injury?
What causes it? |
pemphigoid, pemphigus
IgG, IgM, phagocytosis |
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What diseases are AW Immune Complex injury?
What causes it? |
Erythema multiforme?
IgG, IgM, phagocytosis, antigen-antibody complexes |
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What disease are AW Cell-mediated injury?
What causes it? |
Erythema nodosum?
Sensitized T-lymphocytes |
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What Type of autoimmune disorder is bullous pemphigoid?
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Type II
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What characterizes Bullous Pemphigoid?
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Bullae - skin and MUCOUS membranes.
Very pruritic |
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How common are mucosal lesions in bullous pemphigoid?
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33%
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What is the most common age range for bullous pemphigoid?
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60-80
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How do you Tx bullous pemphigoid?
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Steroids
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Is there usually significant scarring after healing?
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No, 90% heal without scarring
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What causes the bullae to form in bullous pemphigoid?
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Separation of the epidermis from the basement membrane
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What causes the epidermis to separate from the BM?
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The collagen component of hemidesmosomes are attacked by autoantibodies.
Hemidesmosomes attack keratinocytes to the BM. |
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What type of autoimmune reaction is pemphigus vugaris?
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Type II
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What characterizes pemphigus vulgaris?
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Bullae - skin and mucus membranes
Pain and itching |
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What is the common age range for pemphigus vulgaris?
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30-60 years old
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How commonly is pemphigus vulgaris fatal?
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10%
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How can you Tx pemphigus vulgaris?
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Steroids
Immunosuppressants |
