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Introduction to Dermatology

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Introduction to Dermatology By Stacey Singer-Leshinsky R-PAC What is? Dermatology? Dermatologist? Functions of the Skin Sensation- Immune function ... – PowerPoint PPT presentation

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Title: Introduction to Dermatology


1
Introduction to Dermatology
  • By
  • Stacey Singer-Leshinsky R-PAC

2
What is?
  • Dermatology?
  • Dermatologist?

3
Functions of the Skin
  • Sensation-
  • Immune function-
  • Thermoregulation-
  • Cutaneous absorption

4
Functions of the Skin
  • Excretion
  • Vitamin D synthesis-
  • UV light for 10-15 minutes.

5
Skin AnatomyLayers
  • Epidermis- outermost, no blood vessels or blood
    supply.
  • Dermis- vascular layer/sensation. Strength and
    elasticity to skin.
  • Hypodermis or subcutaneous layer.

6
Skin AnatomyEpidermis-5 Layers
  • Stratum corneum-
  • Stratum lucidum-
  • palms and soles of feet only.

7
Skin AnatomyEpidermis-5 Layers
  • Stratum granulosum-
  • Most differentiated layer.

8
Skin AnatomyEpidermis-5 Layers
  • Stratum spinosum-
  • Has desmosomes (spiny projections and so
    spinosum).

9
Skin AnatomyEpidermis-5 Layers californians like
girls in string bikinis)
  • Stratum basale-
  • deepest layer of the epidermis.
  • Consists of a single layer of keratinocytes.

10
Skin AnatomyEpidermis-Cell Types
  • Melanocytes-
  • Produce melanin. Not many melanocytes in soles
    or palms.
  • Albinos lack tyrosinase
  • Cancer of a melanocyte known as melanoma

11
Skin AnatomyEpidermis-Cell Types
  • Keratinocytes
  • Produce keratin
  • Immunology role-
  • Protection and water proofing
  • Merkels cells- Free nerve endings attached to
    epidermal cells.

12
Skin AnatomyEpidermis-Cell Types
  • Langerhans cells
  • Found in epidermal layers with keratinocytes
  • Involved in cell-mediated hypersensitivity,
    antigen processing and recognition, stimulation
    of immune competent cells and graft rejection.

13
Skin AnatomyEpidermis-Cell Types
  • Parakeratosis-Retention of nuclei in stratum
    corneum.
  • Spongiosis-Intercellular edema of the epidermis.

14
Skin AnatomyBasement membrane(Basal lamina)
  • Selectively filters molecules moving between two
    layers.
  • Immunoglobulin and complement deposition in skin
    disease.

15
Skin AnatomyDermis
  • Thickest skin layer/connective tissue layer.
  • Composed of collagen, blood vessels, nerves, hair
    follicles, and sweat glands

16
Skin AnatomySubcutaneous Tissue
  • Eccrine glands and deep hair follicles extend to
    this layer
  • Insulator/shock absorber/stores energy as
    calories

17
Skin AnatomyAppendages-Hair
  • Hair follicle associated with sebaceous gland to
    form pilosebaceous unit.
  • Growth is cyclic
  • Anagen phase-
  • Catagen-
  • Telogen phase-

18
Skin AnatomyAppendages-Hair
  • Hair loss due to

19
Skin AnatomyAppendages-Nails
  • Hardened keratinized plates

20
Skin AnatomyAppendages-Glands
  • Sebaceous- Entire skin surface except palms,
    soles, sides of feet. Secrete sebum

21
Skin AnatomyAppendages-Glands
  • Sweat glands-
  • Eccrine-Originate in dermis and open on skin
    surface.
  • Apocrine- Large, deep in dermal layer. Open
    through a hair follicle. Mostly in axillae and
    groin.

22
Common Skin LesionsEqual to plane of the Skin

23
Common Skin LesionsEqual to plane of the Skin
Telangiectasia-
24
Common Skin LesionsEqual to plane of the Skin
Petechiae-
25
Common Skin LesionsEqual to plane of the Skin
Purpura or ecchymosis
26
Common Skin LesionsEqual to plane of the Skin
Sclerosis
27
Common Skin LesionsEqual to plane of the Skin
Lichenification
28
Common Skin LesionsEqual to plane of the Skin
Acanthosis
29
Common Skin LesionsAbove the plane of the Skin
Actinic Keratosis
Hyperkeratosis
30
Common Skin LesionsAbove the plane of the Skin.
Corn
Callus
31
Common Skin LesionsAbove the plane of the Skin

papule
Nodule
32
Common Skin LesionsAbove the plane of the Skin
Wheal
Plaque
33
Common Skin LesionsAbove the plane of the Skin
  • Vesicle-
  • Blister-
  • Bulla-

34
Common Skin LesionsAbove the plane of the Skin
Pustule- Cyst-
35
Common Skin LesionsAbove the plane of the Skin
Tumor
36
Common Skin LesionsAbove the plane of the Skin
Verruca
37
Common Skin LesionsAbove the plane of the Skin

Scale/crust Desquamation
38
Common Skin LesionsAbove the plane of the Skin

Exudate
39
Common Skin LesionsAbove the plane of the Skin

Comedone
40
Common Skin LesionsBelow the plane of the Skin

Excoriation
41
Common Skin LesionsBelow the plane of the Skin
Ulcer
42
Common Skin LesionsBelow the plane of the Skin
Fissure
43
Common Skin LesionsBelow the plane of the Skin
Excoriation
44
Common Skin LesionsBelow the plane of the Skin
Eschar
45
Disorders of Pigmentation and Melanocytes
Blanched
  • Vitiligo

46
Disorders of Pigmentation and Melanocytes
  • Albinism

47
Disorders of Pigmentation and Melanocytes
  • Melasma

48
Disorders of Pigmentation and Melanocytes
  • Lentigo-
  • Due to melanocyte proliferation.
  • Can be due to hypermelanosis, Addisons disease,
    Hemochromatosis, Acanthosis nigricans
  • Hydroquinone may temporarily bleach the spots
    Inhibit synthesis of pigment

49
Common Skin LesionsBased on Color- Erythema
Erythema
50
Common Skin LesionsBased on Color- Blue
  • Cyanosis

51
Common Skin LesionsBased on Color- yellow
  • Jaundice

52
Approach to patient
  • Distinguish normal vs. abnormal
  • Appropriate differential diagnosis
  • Pros and Cons of dermatology
  •  

53
Approach to the PatientHistory-Lesions
  • Acute vs. chronic illness
  • Onset
  • Subjective symptoms
  • Location, distribution, spread or change in
    lesions


54
Approach to PatientPhysical Exam
  • Observe four points
  • Palpate
  • Systemic examination including lymphadenopathy,
    organomegaly, arthralgia, and neurological changes

55
Approach to PatientPhysical Exam
  • Rash-
  • Lesion-

56
Physical ExamShape of the Lesion
  • Round
  • Oval
  • Polygonal
  • Annular
  • Serpiginous
  • Umbilicated

57
Physical ExamArrangement of lesions
  • Grouped herpetiform, arciform, annulra,
    reticulated, linear,

58
Physical ExamArrangement of lesions
Disseminated-
59
Physical ExamArrangement of lesions
Demarcated Discrete
60
Physical ExamArrangement of lesions
Diffuse-
61
Physical ExamDistribution of lesions
  • Extent
  • Pattern
  • Any characteristic patterns such as seen in acne,
    chicken pox.

62
Special Signs and tests Darier sign

63
Special Signs and tests Auspitz Sign

64
Special Signs and tests Nikolsky sign

65
Special Signs and tests Diascopy
  • Diascopy-
  • Blanching indicates intact capillaries known as
    erythema.
  • If no blanching capillaries are not intact, known
    as purpura.

66
Special Signs and tests Koebner phenomenon

67
Diagnostic TechniquesWood Light Exam
Hair green fluorescence in tinea capitis Skin
erythrasma coral red fluorescence Hypomelanosis
decrease in intensity
68
Diagnostic TechniquesAcetowhitening
Acetowhitening-
69
Diagnostic Techniques Patch test

70
Diagnostic TechniquesMicroscopic Examination
  • KOH preparation
  • For bacteria gram stain
  • For virus Tzanck smear
  • For spirochetes
  • Cultures bacterial, viral, parasitic, mycologic

71
Diagnostic techniquesBiopsy

72
Review 1
  • Name the five layers of the epidermis
  • What enzyme is lacking in albinos? What does this
    enzyme produce?
  • Which cells are known as touch receptors?
  • What is the function of the basement membrane?
  • Which layer is composed of fat, connective tissue
    and blood vessels?

73
Review 2
  • List two types of sweat glands and state their
    difference.
  • Describe a macule
  • What is Telangiectasia?
  • Describe lichenification
  • Describe a papule
  • Describe a nodule

74
Review 3Describe this
75
Review 4What is this?
76
Review 5What is this?
77
Review 6What is this due to?
78
Review 7What is this?
79
Review 8What is this?
80
Review 9
  • How would you describe this lesion?
  • What is the diagnosis?

81
Review 10
  • Describe this lesion
  • What is your diagnosis?

82
Review 11
  • What is this?

83
Review 12
  • How would you describe these lesions?

84
Review 13
  • How would you describe this lesion?

85
Review 14
  • What is this sign? What does it mean?

86
Review 15
  • Filled with pus this is known as
  • Filled with fluid this is known as
  • If this is embedded in the skin and filled with
    fluid it is known as
  • If it is solid it is known as

87
Review 16
  • what sign is positive?

88
Review 17
  • What sign is positive?

89
Review 18
  • How would you define these markings?
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