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Dermatologist

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are medical specialists in diseases of the skin

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Dermatopathologists

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are medical specialists in dermatology and surgical pathology and who focus on the study of cutaneous diseases a microscopic level.

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cosmetic surgeons

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are board certified by the american board of cosmetic surgery to enhance appearance through elective surgical and medical procedures

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plastic surgeons

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are board certified by the american board of plastic surgery to reconstruct facial and body defects due to birth disorders, trauma, burns and disease

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nurse practitioners and physician assistants

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who with extensive training and experience in dermatology work under the supervision of dermatologists.

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estheticians

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also called skin care therapists, who perform various cosmetic procedures for the treatment of the skin. They do not diagnose, prescribe medications, or suggest treatments.

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keynotes

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the skin is the largest and the most vulnerable organ in the body

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biopsy

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removing tissue from a living person for laboratory examination

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biopsy removal

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used for small tumors when complete removal provides tissue for a biopsy and cures the lesion

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excision

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surgical removal of part or all of a structure

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carcinoma

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a malignant and invasive epithelial tumor

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cosmetic

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a concern for appearance

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cryosurgery

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use of liquid nitrogen or argon gas in a probe to freeze and kill abnormal tissue

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cutaneous

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pertaining to the skin

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dermis

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connective tissue layer of the skin beneath the epidermis

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dermatologist

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medical specialist in diseases of the skin

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epidermis

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top layer of the skin

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epithelium

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tissue that covers surfaces or lines cavities

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epithelial

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relating to or consisting of epithelium

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esthetics

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concerned with beauty

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esthetician

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a therapist who enhances the beauty of the skin

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integument

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organ system that covers the body, the skin being the main organ within the system

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integumentary

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pertaining to the covering of the body

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lesion

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pathological change or injury in a tissue

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microscope

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instrument for viewing something small that cannot be seen in detail by the naked eye

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micriscopic

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visible only with the aid of a microscope

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pathology

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medical specialty dealing with the structure and functional changes of a disease process or the cause, development, and structural changes in disease

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Pathologic

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pertaining to the changes in the body induced by disease

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prognosis

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forecasting of the probable course of a disease

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squamous cell

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flat, scalelike epithelial cell

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keynote

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the skin provides protection, contains sensory organs, and helps control body temperature

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protection

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the skin is a physical barrier against injury, chemicals, ultraviolet rays, microbes, and toxins.

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water resistance

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you don't swell up every time you take a bath because your skin is water resistant. It also prevents water from leaking out of the body tissues.

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temperature regulation

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A network of capillaries in the skin opens up or dilates (vasodilation) when your body is too hot so that the blood flow increases and the heat from the blood dissipates through the skin, When your body is cold, the capillary network narrows (vasonstriction), blood flow decreases, and heat is retained in your body.

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Vitamin D synthesis

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As little as 15 to 30 minutes of sunlight daily allows your skin cells to initiate the metabolism of vitamin D, which is essential for bone growth and maintenance.

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sensation

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Nerve endings that detect touch, pressure, heat, cold, pain, vibration, and tissue injury are particularly numerous on your face, palms, soles, nipples, and genitals

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Excretion and secretion

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water and small amounts of waste products from cell metabolism are lost through the skin by excretion (the process of removal of waste products from the body) and by secretion (the process of producing and releasing a substance by a tissue or organ of the body) from your sweat glands.

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social functions

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the skin reflects your emotions, blushing when you are self-conscious, going pale when you are frightened, wrinkling when you dislike something.

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excrete

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to pass out of the body waste products of metabolism

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excretion

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removal of waste products of metabolism out of the body

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function

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the ability of an organ or tissue to perform its special work

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protect

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to shield from attack or invasion

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regulation

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control of the way in which a process progresses

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regulate

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to control the way in which a process progresses

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resistance

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ability of an organism to withstand the effects of an antagonistic agent

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secrete

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to produce a chemical substance in a cell and release it from the cell

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Sensation

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the conscious feeling of the effects of a stimulation

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synthesis

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the process of building a compound from different elements.

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the outer layer of the epidermis, the stratum coreum is a layer of compact, dead cells packed with keratin. these dead cells have no nuclei and are continually shed

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the bottom layer of the epidermis, the stratum basale, is a single layer of cells that form the keratinocytes. This layer contains melanocytes. which produce the dark pigment melanin, and tactile (touch) cells attached to sensory nerve fibers.

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malignant melanoma

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is the least common skin cancer but is the most deadly. it arises from the melanocytes in the stratum basale. it metastasizes quickly and is fatal if neglected.

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keratin

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protein found in the dead outer layer of skin and in nails and hair

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keratinocyte

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cell producing a tough, horny protein (keratin) in the process of differentiating into the dead cells of the stratum corenum

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macule

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small, flat spot or patch on the skin

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malignancy

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tumor that invades surrounding tissues and metastasizes to distant organs

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malignant

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having the properties of being locally invasive and metastasizing.

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melanin

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black pigment found in skin, hair, retina

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melanocyte

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cell that synthesizes (produces) melanin

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metastasis

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spread of a disease from one part of the body to another.

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metastasize

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to spread to distant parts

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metastatic

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pertaining to the character of cells that can metastasize

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sebaceous glands

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glands in the dermis that open into hair follicles and secrete an oily fluid called sebum

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sebum

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waxy secretion of the sebaceous glands

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stratum basale

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deepest layer of the epidermis, from which the other cells originate and migrate

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tactile

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relating to touch

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Abbreviations

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IM-intramuscular SC= subcutaneous TB- tuberculosis

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Structure of the skin:Dermis

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Dermis is a much thicker connective tissue layer than the epidermis. It consists mostly of Collagen, with fibers and fibroblasts. It is well supplied with blood vessels and nerves and contains the other skin organs: sweat glands, sebaceous glands, hair follicles, and nail roots. The boundary between the dermis and the epidermis is distinct and irregular.

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Structure of the skin: Hypodermis

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The hypodermis, the layer beneath the dermis, is the site of subcutaneous fat (adipose tissue). It is also called the subcutaneous tissue layer.

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Clinical Applications

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Another important reason you should be able to identify the layers of the skin is to understand the different sites for giving injections. The three types of injection are

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Intradermal

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A short, thin needle is introduced into the dermis between the stratum corneum and the stratum basale. Injected into this site, the medication raises a small wheal. This site is used for allergy testing or a tuberculosis.

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Subcutaneous

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a longer needle pierces the epidermis and dermis to reach the hypodermis, or subcutaneous layer. This site is used for insulin injections.

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Intramuscular (IM)

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a long needle pierces the epidermis, dermis, and subcutaneous layer into the muscles underneath. Some antibiotics can be given by this route.

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Transdermal Applicatons

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Some medicatons can be administered through the skin by an adhesive transdermal patch that is applied to the skin. In the patch, a small reservoir contains medication that leaves the reservoir at a known rate through a semipermeable membrane. The medication diffuses across the epidermis and enters the blood vessels in the dermis. Medications for motion sickness and cardiac problems, testosterone, birth control hormones, and the chemical nicotine are administered by trans-dermal patches.

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adipose

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containing fat

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collagen

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major protein of connective tissue, cartilage, and bone

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follicle

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spherical mass of cells containing a cavity or a small cul-de-sac, such as a hair follicle

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hypodermis

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tissue layer below the dermis

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hypodermic

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beneath the skin

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intradermal

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within the dermis

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intramuscular

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within the muscle

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papilla

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any small projection

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papillae

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benign projection of epithelial cells

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semipermeable membrane

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a membrane that allows only certain substances to pass through it

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subcutaneous- hypodermic

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below the skin

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transdermal

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going across or through the skin

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wheal hives (syn)

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small, itchy swelling of the skin. Wheals raised by an injection do not itch

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Disorders of the skin

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when a patient lies in one position for a long period, the pressure between the bed and bony body projections, like the lower spine or heel, cuts off the blood supply to the skin and decubitus (pressure) ulcers can appear. The protective function of the skin is broken, and germs can enter the body other major factors in the breakdown of Rose's skin were that it was thing and dry because of aging. Also, her poor nutritional status had depleted the fatty protective layer in the hypo-dermis under the skin.

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Dermatitis

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direct exposure to an irritating agent.

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Eczema

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is a general term used for inflamed, itchy skin conditions. When the itchy skin is scratched, it becomes excoriated and produces the dry, red, scaly patches characteristic of eczema.

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Sunlight

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cal also be an irritant to the skin, not only by burning it but by leading to cancer when there is excessive exposure, as it did for Mr. Andrews Any congenital lesion of the skin, including various types of birthmarks and all moles, is referred to as a nevus.

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allergen

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substance producing a hypersensitivity (allergic) reaction

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allery

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hypersensitivity to an allergen

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decubitus ulcer

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sore caused by lying down for long periods of time

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Dermatitis

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inflammation of the skin

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eczema:

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inflammatory skin disease often with a serious discharge

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excoriate

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to scratch

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excoriation

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scratch mark

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latex

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manufactured from the milky liquid in rubber plants; used for gloves in patient care

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mole

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benign localized area of melanin-producing cells

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nevus

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congenital or acquired lesion of the skin

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pruritus

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itching

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pruritic

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itchy

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serous

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thicker and less transparent than water

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vesicle

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small sac containing liquid, for example, a blister

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Infections of the skin:

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the skin is also susceptible to the many different types of infections. the following examples:

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Warts( verrucas)

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are caused by the human papillomavirus invading the epidermis and causing the outer epidermal cells to produce a roughened projection from the skin surface. Human Papillomavirus is discussed extensively in chapter 8.

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Caricella-zoster

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virus causes chickenpox in unvaccinated people, forming macules, ppules, and vesicles. The virus can then remain dormant in the peripheral nerves for decades before erupting as the painful vesicles of herpes zoster (shingles)

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Tinea

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is a general term for a group of related skin infections caused by different species of fungi. The fungi live on, and are strictly confined to the nonliving stratum corneum and its derivatives, hair and nails, where keratin provides their food. The different types of tinea take their name from the location of the infection.

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Tinea Pedis

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Athlete's foot, causes itching, redness, and peeling of the foot, particularly between the toes.

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Tinea capitis

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describes infection of the scalp (ringworm)

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Tinea corporis

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is the name for infections of the body

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Tinea cruris

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(jock itch) is the name for infections of the groin. The fungus spreads from animals, from the soil, and by direct contact with infected individuals.

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Tinea versicolor

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is characterized by brown and white patches on the trunk

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candida (a yeastlike fungus)

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can produce recurrent infections of the skin, nails, and mucous membranes. The first sign can be a recurrent diaper rash or thrush in infants. Older children can show recurrent or persistent lesions on the scalp. In adults, chronic candidiasis can affect the mouth(thrush) and vagina, as well as the skin. It can also be associated with diseases of the immune system.

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Parasite

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is an organism that lives in contact with and feeds off another organism (host). this process is called an infestation. It is different from an infection

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lice

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are small, wingless, blood-sucking parasites that produce the disease pediculosis by attaching their eggs (nits) to hair and clothing.

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scabies (itch mites)

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produce an intense, itching rash, often in the genital area, waist, break, and armpits. The mites live and lay eggs under the skin the skin normally sheds its cell. These tiny specks form some of the dust on our furniture, floors, and carpets. The house dust mite thrives on the keratin of these cells and lives well on carpets, upholstery, pillows, and mattresses. Many people are allergice to the inhaled feces of these parasites.

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staphylococcus aureus (commonly called staph)

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is the most common bacterium to invade the skin and is the cause of pimples, boils, carbuncles, and impetigo. It can infect hair follicles and the surrounding tissues to produce furuncles and carbuncles. staph can cause a cellulitis of the epidermis and dermis.

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necrotizing fasciitis

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is caused when some strains of staph and strep produce enzymes that are very toxic and digest the connective tissues and spread into muscle layers.

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louse

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hair of the scalp

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phthirus pubis

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pubic hair

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pediculus humanus

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clothing, body hair

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candidiasis

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infection with the yeastlike fungus candida

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thrush

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infection with candida albicans

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caruncle

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infection composed of many furuncles in a small area, often on the back of the neck.

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cellulitis

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infection of subcutaneous connective tissue

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furuncle

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an infected hair follicle that spreads into the tissues around the follicle.

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hepes zoster shingles

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painful eruption of vesicles that follows a dermatome or nerve root on one side of the body.

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impetigo

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infection of the skin that produces thick, yellow crusts

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infection

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invasion of the body by disease-producing microorganisms

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infestation

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act of being invaded on the skin by a troublesome other species, such as a parasite

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louse (lice)

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parasitic insect

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necrotizing fasciitis

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inflammation of fascia, producing death of the tissue

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parasite

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an organism that attaches itself to, lives on or in, and derives its nutrition from another species

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pediculosis

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an infestation with lice

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scabies

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skin disease produced by mites

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tinea

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general term for a group of related skin infections caused by different species of fungi.

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Collgen

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a fibrous protein, accounts for 30% of total body protein. Therefore, collagen diseases can have a dramatic effect all over the body. Collagen diseases, autoimmune or otherwise, attack collagen or other components of connective tissue.

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systemic lupus erythematosus (SLE)

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an autoimmune disease, occurs most commonly in women and produces characteristic skin lesions. A butterfly-shaped red rash on both cheeks joined across the bridge of the nose is commonly see. is is associated with fever, fatigue, joint pains, and multiple internal organ involvement.

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rosacea

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produces a facial rash similar to that of SLE, and the underlying capillaries become enlarged and show through the skin. It is thought to be worsened by alcohol and spicy food. Its etiology is unknown. It has no systemic complications.

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scieroderma

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is a chronic, persistent autoimmune disease, occurring more often in women and characterized by hardening and shrinking of the skin that makes it feel leathery. joints show swelling, pain, and stiffness. Internal organs such as the heart, lungs, kidneys, and digestive tract can be involved in a similar process. The etiology is unknown, and there is no effective treatment

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psoriasis

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is marked by itch, flaky, red patches of skin of various sizes covered with white or silvery scales. It appears most commonly on the scalp, elbows, and knees. Its cause is unknown

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vitiligo

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produces pale, irregular patches of skin. It is thought to have an auto-immune etiology.

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skin manifestations of internal disease:

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signs of the presence of cancer inside the body are often shown by skin lesions, even before the cancer has produced symptoms or been diagnosed.

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dermstolmyositis

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is often associated with ovarian cancer, which can appear within 4 to five years after the skin disease is diagnosed.

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pharmacology

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no matter what the cause of skin lesions, a wide range of topical pharmacologic agents of different types can be used in their treatment, either to relieve symptoms or to cure the disease.

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antipururitics

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topical lotions, ointments, creams, or sprays that relieve itching. Corticosteroids such as hydrocortisone are most frequently used

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antibacterials

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topical agents that eliminate the bacteria that cause epidermal infections. The antibiotic neomycin is frequently used in ointments for this purpose.

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antifungals

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topical agents that eliminate or inhibit the growth of fungi. lamisil is used as a cream, gel, or spray

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parasiticides

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topcal agents that kill parasites living on the skin. Lindane 1% is in a lotion or shampoo used to kill lice

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keratolytics

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topical agents that peel the stratum corneum away from the other epidermal layers. salicylic acid is usded for this purpose.

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anesthetics

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topical agents that relieve pain or itching on the skin's surface Benzocaine is used for this purpose.

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retinoids

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derivatives of retinoic acid that are used in the treatment of acne.

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anesthetic

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substance that takes away feeling and pain

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anesthesia

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complete loss of sensation

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antipruritic

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medication against itching

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pruritus

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itching

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pruritic

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itchy

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corticosteroid

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a hormone produced by the adrenal cortex

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dermatomyositis

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inflammation of the skin and muscle

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pharmacology

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science of the preparation, used, and effects of drugs

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pharmacist

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person licensed by the state to prepare and dispense drugs

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pharmacy

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facility licensed to prepare and dispense drugs

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psoriasis

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rash characterized by reddish, silver-scaled patches

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retinoid

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a class of keratolytic agents

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rosacea

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persistent erythematous rash of the central face

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scleroderma

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thickening and hardening of the skin due to new collagen formation

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sign

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physical evidence of a diseases process

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symptom

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departure from normal health experienced by the patient

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symptomatic

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pertaining to the symptoms of a disease

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systemic lupus

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inflammatory connective tissue disease affecting the whole body

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topical

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medicaton applied to the skin to obtain a local effect

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vitiligo

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nonpigmented white patches on otherwise normal skin.

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hair follicles and sebaceous glands

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each hair follicle has a sebaceous gland opening into it. The gland secretes into the follicle a mixure of oil, acidic sebum and broken- down cells from the base of the gland

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androgens

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are thought to trigger excessive production of sebum from the glands, which then brings excessive numbers of broken-down cells toward the skin surface

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comedo

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whitehead or blackhead

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acne

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inflammatory disease of sebaceous glands and hair follicles

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androgen

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hormone that promotes masculine characteristics

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comedo, comedones

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a whitehead or blackhead caused by too much sebum and too many keratin cells blocking the hair follicle

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cyst

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an abnormal, fluid-containing sac

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cystic

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relating to a cyst

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dandruff

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seborrheic scales from the scalp

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papule

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small, circumscribed elevation on the skin

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rupture

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break or tear of any organ or body part

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seborrhea

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excessive amount of sebum

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seborrheic

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pertaining to seborrhea

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Hair

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Each hair, no matter where it is on your body or scalp, originates from epidermal cells at the base (matrix) of a hair follicle. As these cells divide and grow, they push old cells upward away from the source of nutrition in the hair papilla. The cells become keratinized and die. They rest for a while; and when a new hair is formed, the old, dead hair is pushed out and drops off. Straight hair is round in cross-section. Curly hair is oval. Two pigments derived from melanin (eumelanin and pheomelanin) give hair its natural color. Black and dark brown hair has a lot of a dark form of the pigment eumelanin in the cells of the cortex. Blonde hair has a little of this dark pigment but a moderate amount of the lighter form of pheomelanin. Red hair has a lot of the lighter pigment. White or gray hair has little pigment

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Keynote

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*Genes, hormones, and pigment determine hair characteristics. *body hair has no specific function.

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albinism

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genetic disorder with lack of melanin

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albino

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person with albinism

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alopecia

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partial or complete loss of hair, naturally or from medication

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axilla

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medical name for the armpit

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axillary

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pertaining to the axilla

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cortex

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outer portion of an organ, such as bone

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cortical

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gray covering of cerebral hemispheres

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cuticle

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nonliving epidermis at the base of the fingernails and 4 toenails, and the outer layer of hair.

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medulla

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central portion of a structure surrounded by cortex

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melanin

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black pigment found in skin, hair, retina

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eumelanin

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the dark form of the pigment melanin

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pheomelanin

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the lighter form of melanin

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Sweat glands

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you have 3 million to 4 million eccrine (merocrine) sweat glands scattered all over your skin, with higher concentrations on your palms, soles, and forehead. Their main function is to produce the watery perspiration (sweat) that cools your body. Your sweat is 99% water; the rest is made up of electrolytes such as sodium chloride, which gives the sweat its salty taste. Some waste products of cell metabolism are also secreted. In the dermis the sweat gland is a coiled tune lined with epithelial cells that secrete the sweat. Around the tube, muscle cells contract to squeeze the sweat up the tube directly to the surface of the skin - In your armpits (axillae), around your nipples, in your groin, and around your anus, apocrine sweat glands produce a thick, cloudy secretion that interacts with normal skin backteria to produce a thick, cloudy secretion that interacts with normal skin bacteria to produce a distinct, noticeable smell. The ducts of these glands lead directly into hair follicles. They respond to sexual stimulation and stress and secrete chemicals called pheromones, which have an effect on the sexual behavior of other people. Chemicals called pheromones, which have an effect on the sexual behavior of other people.

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ceruminous glands

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are found in the external ear canal, where their secretions combine with sebum and dead epidermal cells to form earwax. This wax waterproofs the external ear canal and kills bacteria. sweat gland functions are severely affected in a group of diseases termed ectodermal dysplasia, manifested in the reduction or absence of sweat. They can be involved in the infections that engulf the nearby hair follicles and sebaceous glands.

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mammary glands

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a type of modified sweat gland, serve a distinct purpose in reproduction and are therefore discussed in chapter 8 under the female reproductive system.

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nails

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nails are formed from the stratum corneum of the epidermis. they consist of closely packed, thin, dead cells that are filled with parallel fibers of hard keratin. fingernails grow about 1 mm per week. New cells are added by cell division in the nail matrix, which is protected by the nail fold of skin and the cuticle at the base of the nail. The nail rests on the nail bed, which consists of the living layers of the epidermis, the strata basale, spinosum, and granulosum

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apocrine

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apocrine sweat glands open into the hair follicle

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cerumen

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waxy secretion of the ceruminous glands of the external ear

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eccrine

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coiled sweat gland that occurs in skin all over the body

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hypoxia

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decrease below normal levels of oxygen in tissues, gases, or blood.

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malnutrition

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inadequate nutrition from poor diet or inadequate absorption of nutrients

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matrices

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substance that surrounds cells, is manufactured by the cells, and holds them together

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merocrine

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another name for eccrine

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onychomycosis

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condition of a fungus infection in a nail

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paronychia

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infection alongside the nail

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pheromone

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substance that carries and generates a physical attraction for other people

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Burns:

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burns are the leading cause of accidental death. the immediate threats to life are from fluid loss, infection, and the systemic effects of burned dead tissue.

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first-degree (superficial) burns

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involve only the epidermis and produce inflammation with redness, pain, and slight (edema). Healing occurs in 3 to 5 days without scarring

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second- degree (partial-thickness) burns

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involve the epidermis and dermis but leave some of the dermis intact. They produce redness, blisters, and more severe pain. Healing occurs in 2 to 3 weeks with minimal scarring

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Third-degree (full-thickness) burns

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involve the epidermis, dermis, and subcutaneous tissues, which are often completely destroyed. Healing takes a long time and involves using skin grafts

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Fourth-degree (full- thickness) burns

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destroy all layers of the skin and involve tendons, muscles, and sometimes bones

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In full thickness burns there is no dermal tissue left for regeneration, and skin grafts are needed. The ideal graft is an (autograft) taken from another location on the patient. It is not rejected by the immune system.

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If the patient's burns are too extensive, (allografts) from another person are needed. These are provided by skin banks and are taken from deceased people (cadavers). A (homograft) is another name for an allograft. A xenograft, or heterograft, is a graft from another species, for example, pigs.

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allograft

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skin graft from another person or cadaver

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autograft

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a graft using tissue taken from the individual who is receiving the graft

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debridement

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the removal of injured or necrotic tissue

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edema

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excessive collection of fluid in cells and tissues

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edematous

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marked by edema

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eschar

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the burned, dead tissue lying on top of third-degree burns

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regenerate

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to reconstitute a lost part

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regeneration

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reconstitution of a lost part

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shock

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sudden physical or mental collapse or circulatory collapse

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xenograft

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a graft from another species

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WOUNDS AND TISSUE REPAIR

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*If you cut yourself with paper and produce a shallow (laceration) primarily in the epidermis, the epithelial cells along its edges will divide rapidly and fill in the gap. An adhesive bandage helps the process by pulling the edges together

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*If you cut yourself more deeply, extending the (wound) into the dermis or hypodermis, or if a surgeon makes an (incision), then blood vessels in the dermis break and blood escapes into the wound.

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*This escaped blood forms a (clot) in the wound. The clot consists of the protein (fibrin) together with (platelets), blood cells, and dried tissue fluids trapped in the fibers. (macrophages) come into the wound with the escaped blood. They digest and clean up the tissue Debris.

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*The suface of the clot dries and hardens in the air to form a (scab). the scab seals and protects the wound from beceoming infected.

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The clot begins to be invaded by new capillaries from the surround dermis. 3 or 4 days after the injury, fibroblasts migrate into the wound and form new collagen fibers that pull the wound together. This soft tissue in the wound is called (grandulation tissue) and in unsutured wounds take a couple of weeks to completely form.

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As healing continues, surface epithelial cells from the edges of the wound migrate into the area underneath the scab. As this new epithelium thickens, the scab loosens and falls off. Inside the wound, new collagen fibers formed by the fibroblasts form a (scar) to replace the granulation tissue. In unsutured wounds, this takes up to a month to complete.

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In some people, there is excessive fibrosis and scar tissue formation, producing raised, irregular, lumpy, shiny scars calls (keloids). They can extend beyond the edges of the original wound and often return if they are surgically removed. They are most common on the upper body and earlobes.

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abrasion

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area of skin or mucous membrane that has been scraped off

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clot

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the mass of fibrin and cells that is produced in a wound

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fibrin

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stringy protein fiber that is a component of a blood clot

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fibrous

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tissue containing fibroblasts and fibers

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granulation

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new fibrous tissue formed during wound healing

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incision

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a cut or surgical wound

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keloid

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raised, irregular, lumpy, shiny scar due to excess collagen fiber production during healing of a wound

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laceration

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a tear of the skin

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laser

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intense, narrow beam of monochromatic ligh

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macrophage

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large white blood cell that removes bacteria, foreign particles and dead cells

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platelet (also called thrombocyte)

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cell fragment involved in clotting process

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scab

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crust that forms over a wound or sore during healing

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scar

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fibrotic seam that forms when a wound heals

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suture

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stitch to hold the edges of a wound together

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wound

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any injury that interrupts the continuity of skin or a mucous membrane

Lesson 3 Chapter 15 Integumentary System The Language of Dermatology – Flashcards

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