Dermatology Slides

Introduction to clinical dermatology Hiba Jarra7

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2 layers: Epidermis and Dermis Epidermis: All Cells (keratinocytes 85%, MC,MC,LC):
4-Cell layers (Keratinocytes): 1. Basal layer: 2. Prickle(spinous,squamous) layer: 3. Granular layer 4. Horney layer:

Cells travel from basal layer towards surface (Turnover) The trip takes around 60 days then cells are shed from surface. Shed cells are replaced from basal cells (mitosis).

Melanocytes: Dendretic Derived from neural crest Within Basal layer Produce melanin which is then transferred to KC
Langerhans cells: Dendretic Skin tissue macrophages APC of both epidermis and dermis Present throughout epidermis

Merkel cells: non-Dendretic

Transducers for fine touch At Basal layer


1. 2. 3. 4. 5.

Dermis several components: Fibers: collagen and elastic fibers Ground substance (GAGs) Cells: Fibroblasts, Lymphocytes, Macro, Mast cells.. Appendages: Glands ( sebaceous, Apocrine and Eccrine), Hair follicles and Nails Supportive structures: Nerves, lymphatics, vasculature, smooth muscles

The main function of skin to prevent entry of foreign things into internal environment

Horney layer is the main structure

responsible for this Problems and diseases affecting Horney layer will impair this function leading to infections, allergies

Always start by introducing yourself

Ask patient permission before examining them

Always respect patient wishes Always keep patient privacy

Chief complaint + Duration:

Rash: multiple red things with/out scale Lesion: one or few things Others: as appropriate ( e.g hair loss, blisters, color change)

Analysis of the complaint :

Onset and progression: site where it started and how, increasing/decreasing/same , and which sites

Modifying factors?
Symptoms: itch, pain

Recent illness: viral/fevers.. (esp for rashes)

Atopy: asthma+eczema+hay fever (personal or 1st degree relative) Drugs used ?

R.O.S: Related Past Hx: as per others Family hx

T. SAD:
Type: primary vs secondary (modified..scratched, traumatized) lesion
Macule/patch: pigmentary disorder or resolving papulosq Scaly papules/plaques: papulosquamous condition Non scaly papules/plaques: reactive erythema Bullae/vesicles: bullous dis.

 Shape: details of the primary lesion

Color:
red: more RBC.s(Hb) eithre intravascular(dilated vessels) or extravascular (hemorrhage) Brown/black: melanin Yellow: carotene (Horney layer and sc fat) Exogenous.

Surface:
Scaly: papulosqumaous Non scaly.

Margins: well defined vs ill-defined (esp important for scaly rashes)

Arrangement:
Grouped: grouped vesicles (Herpes), Linear ( plane warts, Kobner)

Distribution: where?
Unilateral: infection, contact Bilateral: inflammatory Hands/face: sun exposed (photodermatoses/photoaggravated dermatoses).

 Approach

??

Red is BLOOD This is either

Intra vascular: dilated vessel due to usually release of inflammatory mediators (histamine) DIASCOPY.BLANCHABLE Extra vascular: Hemorrhage
- Vessel wall injury: vasculitis - Bleeding tendency or due to trauma - DIASCOPY.NON-BLANCHABLE

Red NONScaly rash DIASCOPY

NONBlanchable

Blanchable Reactive Erythema (Urticaria/E M/EN)

Vasculitis

Bleeding tendency

Red non scaly (ask about Duration Of individual lesion)

Urticaria Time limit for Individual wheals Of 24 hrs

Erythema multiforme Lesions for 1-2 wks Acrofacial dist Target lesions

Erythema nodosum Lesions last 4-6 wks Shins Painful hot tender Nodules. Bruise like upon resolution

Scale is flake (piece) from horney layer. Usually indicates hyper-proliferation of epidermis The group includes many conditions but commonest are:
- Eczema - Psoriasis

- Lichen Planus - Fungal infections -Pityriasis Rosea

Look at margins: Next: look at distribution:

Look for special features
Unilateral: Fungal infection

Scaly rash

Well-defined margins

Ill-defined margins

Bilateral: -psoriasis -P.Rosea - Lichen Planus Eczema

Scaly,well defined, Bilateral

Psoriasis Commonest Salmon pink Large silvery scales Extensor dist

Lichen planus Violaceous color Wickhams striae Flexors

Pityriasis Rosea Time limit 2-10 wks Mother plaque Trunk dist (christmas Tree/ribs)

Solid, elevated without depth Bilateral 6 months duration

5 months duration, elevated, no depth, fine scales.

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Woods light KOH Diascopy Tzanck smear IF (Direct: tissue and Indirect: plasma) Patch Test

The End!!!!