Lector: Shkilna M.

1. Anatomy, histology, physiology of the skin. Methods of examination of patients with skin diseases.Morphology of primary and secondary skin lesions. Lector: Shkilna M.

2. Content Anatomy of skin: • Epidermis • Dermis • Subcutis • Skin appendages . Functions of the skin. Methods of examination of patients with skin diseases: • Patient’s passport. • Patient’s complaints. • History of present illness. • Life history (past history). • Objective investigation (morphology of primary and secondary skin lesions). Investigations.

3. SKIN… the heaviest single organ of the body! Skin is the largest organ of the body, it constitutes about 16% of body weight.

4. Anatomy of skin • Epidermis • Dermis • Hypodermis or subcutaneous tissue • Appendages (hair, nails, sebaceous and sweat glands).

6. Pic: Epidermal Layers

8. Dermis is organized into two distinct areas: Papillary dermis(the superficial zone). Reticular dermis (the deeper zone - it composes the bulk of the dermis).

9. Components of the dermis: • collagen (70-80%) – for resiliency; • elastin (1-3%) – for elasticity; • proteoglycans – to maintain water within the dermis.

10. Subcutis or subcutaneous fat : is arranged into distinct fat lobules which are divided by fibrous septae blood vessels, nerves, and lymphatics are also found in the fibrous septae.

11. Superficial net (in granular cell layer). Deep plexus (in subcutaneous fat). Skin vessels: Skin nerves:

12. Appendages • Eccrine sweat glands (open directly onto surface of skin and regulate body temp) • Apocrine glands (axillae, nipples, areolae, anogenital area, eyelids and external ears) respond to emotional stimuli, bacteria causes body odor. • Sebaceous glands (secrete sebum, keep skin/hair from drying out) stimulated by hormones • Hair(Vellus and Terminal) • Nails (protect distal ends of fingers/toes)

13. Functions of the skin: • Barrier. • Metabolic. • Temperature regulation. • Secretion. • Immune surveillance. • Coetaneous sensation.

14. Methods of examination of patients with skin diseases 1. Patient’s passport. 2. Patient’s complaints: a) skin rashes b) subjective sensation, which are connected with skin rashes: • itch of the skin; • burning; • pain; • skin weeping; • dryness of the skin; • feeling of a tense skin; • weakness, weight loss, fever etc.

15. History of present illness: • Possible etiology of the disease ( according patient’s mind). • Duration of the disease: Acute ( < 2 month) Chronic ( > 2 month). • Course of a disease. • Previous treatment and effect from it. • Family history: • contagious diseases; • hereditary diseases.

16. Life history (past history): • Past medical history. • Associated inner diseases. • Occupational hazards. • Allergic history. • Harmful habit.

17. Objective investigation • General state of the patient ( satisfactory or not, fever etc. ). • Systems revive. • Assessment of nails, hair, and mucosal surfaces, even if these are recorded as unaffected.

18. Objective investigation (continued) Palpation ( to diagnose): • Skin elastic. • Skin moistness. • Subcutaneous fat. • Lymphatic nodes: ( size, consistency, movable or immovable etc.).

19. Dermatological status: • Inspection. • Palpation. • Scraping. • Dermoscopy. • Laboratory end special methods.

20. Inspection: • Skin texture • Lesions: • type: primary and secondary; • color: red, brawn, white; • shape: round, oval, annular; • arrangement: grouped (herpetiform, zoster form), disseminated (erythrodermic psoriasis).

21. Examination of Lesions Configuration Annular (rings) Grouped Linear Diffuse

22. DISTRIBUTION

23. CONFIGURATION

24. Morphology of primary and secondary skin lesions Primary skin lesions is the initial lesion that has not been altered by trauma, manipulation (scratching, scrubbing), or natural regression over time. Types: • primary lesions without cavity; • primary lesions with cavity.

25. Primary lesions without cavity: • Macula's • Urtica • Papule • Nodule

26. Macula and Patch Description Circumscribed Flat Discoloration Smaller than 0.5 cm-macula Larger that 0.5 cm- patch May be brown, blue, red.

27. MACULE • Description • Circumscribed • Flat • Discoloration • Smaller than 0.5 cm-macule • Larger that 0.5 cm- patch • May be brown, blue, red or hypo pigmented • Inflammatory • Noninflammatory TINEA VERSICOLOR

28. BROWN MACULE Becker's nevus. A typical lesion with macular pigmentation and hair. Becker's nevus. This lesion contains no pigmentation.

29. PAPULE • Description • an elevated solid lesionup to 0.5 cm in diameter • Color varies: flesh, yellow , white, brown, red, blue or violet • May become confluent • May form plaques

30. PLAQUE • Description • A circumscribed, elevated, superficial, solid lesion more than 0.5cm in diameter • often formed by the confluence of papules

31. Plaque SECONDARY SYPHYLIS PSORIASIS PLAQUE • Examples of Plaques • Eczema • Pityriasis roseas • Tinea corporis • Psoriasis • Syphilis

32. Nodule • Description • Circumscribed • Often round • Solid lesion • More that 0.5 cm in diameter • Larger nodule is a tumor Metastatic carcinoma of the breast.

33. LIPOMA BENIGN TUMOR

34. WHEAL (HIVE) • Description • Starts as red erythematous macules. • Soon paleoedematous wheals develop • Irregular, asymmetrical • Velvety to touch • Erythematic well defined, fades on pressure • Subside within few hours without leaving any trace • Dermographism positive • Wheals develop along line of scratching or pressure.

35. Physical urticaria • Cold urticaria: Reaction to cold, such as ice, cold air or water - worse with sudden change in temperature

36. Primary lesions with cavity: • Vesicles • Bulla • Pustules • Cyst

37. Vesicle • Description • Circumscribed collection of free fluid • Up to 0.5 cm in diameter Herpeszoster

38. Bulla formed dueto fluid in the skin and fluid collection occurs at sites where the cohesion on the skin is weak: • Subcorneal • Intra – epidermal, due to individual keratinocytes • Dermo –epidermal junction A circumscribed collection of free fluid more than 0,5 sm in diameter

39. PUSTULE • Description • Circumscribed collection of leukocytes • Free fluid • Varies in size Staphylococcal folliculitis

40. CYST • A circumscribed lesion with a wall and a lumen, it may contain fluid or solid matter

41. Secondary skin lesions Types: Scale. Crusts. Erosions.

42. EROSION • Description • A focal loss of epidermis; • erosions do not penetrate below the dermoepidermal junction; • and therefore heal without scarring Toxic epidermal necrolysis

43. CRUST Impetigo. A thick, honey-yellow adherent crust covers the entire eroded surface. • Description Is a collection of dried serum and cellular debris- a scab • Examples • Acute eczematous inflammation, Atopic on the face, Impetigo- golden or honey colored, Tinea capitis.

44. Ulcer • A focal loss of epidermis and dermis, and heal with scarring • Examples • Decubitus • Ischemic • Stasis ulcers • Neoplasm's

45. FISSURE • Description A linear loss of epidermis and dermis with sharply defined nearly vertical walls Examples • Chapping – hands and feet • Eczema on the finger tip Asteatotic eczema. Excessive washing produced this advanced case with cracking and fissures.

46. ATROPHY • Description A depression in the skin resulting from thinning of the epidermis or dermis Lichen sclerosus et atrophicus. The epidermis is thin and atrophic and gives the appearance of wrinkled tissue paper when compressed.

47. Scar • Description An abnormal formation of connective tissue, implying dermal damage, after injury Are initially thick and pink, but become white and atrophic • Examples • Post surg. • Burns • Keloid • Post any herpes Keloids on the chest and extremities are raised with a flat surface. The base is wider than the top.

48. EXCORIATION • An erosion caused by scratching; • excoriations are often linear.

49. LICHENIFICATION • Description • An area of thickened epidermis induced by scratching • Skin lines are accentuated so it looks like a washboard • Examples • Atopic dermatitis, chronic eczematous dermatitis

50. LICHENIFICATION