Skin Diseases & Disorders

Introduction to Human Diseases Chapter 16

Skin Anatomy

Stratum corneum Stratum germinativum Keratin Melanin Sebaceous glands Sudoriferous glands Hair follicles

Skin Lesions
Flat: macules Elevated: Solid: papules, nodules, wheals, tumors Liquid-filled: vesicles, bullae, pustules, cysts

Psoriasis

Chronic, noninfectious inflammatory disease of unknown etiology Affects millions, females more than males Dominant trait (variable penetrance) Usually begins in childhood Environmental influences may affect presentation

Psoriasis

Characteristic silvery scales on lesion Usually elbows, knees, scalp, gluteal cleft, finger and toenails Treatment: UV light, anthralin past or tar with UV, methotrexate

Urticaria (Hives)

Also called wheals Episodic inflammatory, allergic reaction in a localized area of skin Majority of cases are acute, not chronic Migratory lesions Itchy, raised, erythematous, warm lesions that blanch when pressed

Urticaria

Localized capillary dilation & fluid transudation Histamine is most important chemical mediator Up to 20% population has had at least one episode in lifetime Treatment: antihistamines, epinephrine, steroids, avoidance of allergens

Acne Vulgaris

Inflammatory disease of sebaceous glands and hair follicles Characterized by comedos, papules, pustules Typically appears during puberty More severe forms in males More persistent in females May involve scarring

Acne Vulgaris

Sebaceous gland plugged by cornified cells Sebaceous secretions continue, increasing size of lesion Treatment: Vit A, benzoyl peroxide, tetracycline, erythromycin, estrogen, Accutane (related to Vit A), drying or pealing agents, topical antibiotics

Alopecia

Absence or loss of hair, most notable on the head Etiologies: numerous

Systemic diseases or treatments

Scarring: fibrosis & loss of follicles Non-scarring: no follicle loss, reversible

Types

Alopecia
Types: Generalized Localized Male pattern baldness frontotemporal loss, then midfrontal recession and near vertex Female pattern baldness central scalp

Alopecia

Treatment

Minoxidil Treatment of androgen levels Autografting, etc

Furuncles

Furuncle:

Boil Infection of a hair follicle Self-limited usually Increases during and after puberty Usually staphylococcal infection

Carbuncles

Several or a group of infected follicles Infection deeper in dermis and subcutaneous tissues Broad, erythematous, slowing evolving mass Drains through multiple openings Common sites: back of neck, back of trunk, & lateral thighs

Pediculosis

Lice infestation = insect infestation Most commonly on body, scalp, and pubic area (pediculosis corporis, capitis, pubis or crabs) Lice feed on blood, lay eggs (nits) in hair or clothing, hatch in 2-3 weeks Acquired via close contact with infected people

Pediculosis

Dx: visualizing lice or nits S/S: itching, excoriations, Rx: Lindane or pyrethrin lotions & shampoo, laundering clothes, bedding, etc.

Decubitus Ulcers

Necrotic skin & subcutaneous tissues Most commonly in ischemic sites

Lack of blood supply often due to prolonged periods of immobility and pressure on that body part Also called pressure sores Most common in incapacitated, immobilized, paralyzed patients

Decubitus Ulcers

Sequence of skin changes

Bony prominence & increased pressure Shiny, erythematous skin Shallow ulcer forms, becomes deeper Forms blisters, necrosis, drainage

Treatment: relieve pressure, topical antibiotics, surgical debridement, etc.

Corns & Calluses

Corns:

Hardened thickenings of stratum corneum Central keratinous core

Calluses:

Localized hyperplasia of same layer Has a definite border

Most common on feet & other areas of repeated trauma

Especially 5th toe

Corns & Calluses

Result from repeated trauma due to pressure, friction

Orthopedic deformities, abnormal weight-bearing

More common in diabetics, peripheral vascular disease Treatment:

Keratolytic ointments, orthopedic devices, debridement, local steroid injections, metatarsal & corn pads

Dermatophytoses

Chronic superficial fungal infection Usually categorized by region it infects

Tinea capitis (scalp), children mostly Corporis (ringworm) Unguim (toes), pedis (athletes foot) Cruris (groin, jock itch) Only in stratum corneum, hair, nails

Fungi infect dead cells (keratin)

Dermatophytoses

Diagnosis: via KOH prep Treatment: various skin and scalp infections treated by topical fungicides

Nail infections treated by weeks-several months of oral fungicides

Scabies

Infection by skin mites Caused by contact with scabies-infested patients S/S: nocturnal itchiness

Small, discrete lesions Usually in finger webs, sides of hands & feet, waist, ankles, extensors of elbow and knee

Scabies

Dx: visualization of mites on scrapings under microscope Rx: permethrin, lindane, crotamiton topically

Impetigo

Contagious, superficial skin infection Often self-limiting but may last for weeks if untreated Usual cause is staph or strep bacteria Common in children in close contact Treatment: antibiotics

Impetigo

Two types

Bullous type

staphylococcus a. Streptococcal Honey-colored crusting lesions

Vesicular type

Warts

Also called verrucae Benign skin lesions that are epidermal hypertrophy Infection by papilloma viruses

Various viruses affect different parts of the body

Caused by direct contact or autoinnoculation

Warts

Most common in children & young adults Types

Common, filiform, flat, genital, plantar, periungual Keratolytics, liquid N2, laser, salicyte acid plasters, etc.

Treatment:

Scleroderma

Multisystem disease of unknown etiology that causes progressive fibrosis of the skin and internal organs 2 forms:

1. Skin only 2. Skin & visceral involvement

Autoimmune etiology suspected Females predominantly Age 30-50 YOA

Scleroderma

Almost all have Raynauds phenomenon

Vasoconstriction, white to blue to red Acrosclerosis (skin hardening first in hands then face) CREST syndrome (includes skin, finger & esophageal involvement) Diffuse systemic sclerosis (most severe) Morphea (localized linear skin changes)

Four syndromes:

Scleroderma

Treatment

Chemotherapy with immunosuppressives Steroids, colchicine Antihypertensive & vasodilator drugs Plaquenil, hydroxychloroquine

Dermatitis

A range of inflammatory diseases of the skin Typically have erythema, pruritis, and a variety of skin lesions May be acute, subacute, or chronic Some types

Seborrheic, contact, atopic

Seborrheic Dermatitis

Chronic sebaceous gland disease Increase in amount of secretions and change in quality of secretions In infancy:

cradle cap resolves by 8-12 months without treatment

Seborrheic Dermatitis

Often occurs with nervous system disease or other disease Treatment: shampoos (selenium, zinc), topical steroids Skin lesions

Moist, dry, or greasy Brown-yellow or red Scalp, eyelids, beard, chest, axillae, groin, trunk dandruff

Contact Dermatitis

Caused by direct contact of irritative substance or contact with substance to which patient is allergic or sensitive

Drugs, plants, additives, latex, wool, etc.

S/S: erythema, warmth, edema, vesicles Dx: via patch test, allergy testing Rx: usually self-limiting, avoidance

Latex Allergy

Range of hypersensitivity reactions to latex, a product derived from rubber May be contact dermatitis, urticaria, GI symptoms, facial symptoms, anaphylactic shock Higher risk: frequent contact with latex products, asthma hx, banana, avocado, or topical fruit allergy

Latex Allergy

Dx: serum test for IgE for latex and via clinical signs Treatment: avoidance, epinephrine if needed

Atopic Dermatitis

Skin inflammation of unpredictable course Highest incidence in children

3-5% population by 5 YOA

70% have family history of asthma, allergic rhinitis, atopic dermatitis

Eczema

More generic term than used in this textbook Most common inflammatory skin disease May be acute, subacute, chronic Components:

Erythema, scales, vesicles

Herpes-related skin lesions

Etiology is HSV-1 Characteristic lesion are clusters of vesicles Cold sores/fever blisters: perioral Herpes zoster (shingles): dermatomal distribution anywhere on body

HSV-related skin lesions

Paresthesias (tingling, burning, etc) or pain along dermatome precede vesicular rash eruption Treatment: acyclovir and other antiviral medicines

Basal Cell Carcinoma

Originate in basal cell layer of epidermis Locally invasive Slow growing Metastases are rare Most common in fair-skinned males over 40 YOA

Squamous Cell Carcinoma

Originate in epidermis Produce keratin Greater risk of metastasis More common in fair-skinned males over 60 YOA Sun exposure is a risk factor

Malignant Melanoma

Abnormal growth of melanocytes in the epidermis and dermis Most common type is superficial spreading type Increasing incidence Greater risk in fair-skinned, excessive sun exposure in first 10-18 years of life

Malignant Melanoma

Metastases common Treatment: surgical excision, regional lymph node excision, chemotherapy, and/or radiation Poorer prognosis if vertical growth rather than horizontal growth predominates in primary lesion