Q: WHAT TEGUMENT IS ?

A:
Simply:
scientific definition

Q: WHAT TEGUMENT IS ?

A:
Simply:

= WHAT COVERS the body

scientific definition

Q: WHAT TEGUMENT IS ?

A:
Simply:

= WHAT COVERS the body

scientific definition
= is the outer covering of living
tissue

WHAT ARE TEGUMENTUM FUNCTION ?

A

WHAT ARE TEGUMENTUM FUNCTION ?

A
1. Sensation (feeling)
2. heat regulation
3. excretion

4. Contribute to immune system

5. storage and synthesis

 ? Thickness

? Surface =
? Appearance:

 ? Thickness

Between: 0,2 - 0,5 mm 4 - 8mm

? Surface =
? Appearance:

 ? Thickness

Between: 0,2 - 0,5 mm 4 - 8mm

? Surface = 1,5 - 2 m2
? Appearance:

 ? Thickness

Between: 0,2 - 0,5 mm 4 - 8mm

? Surface = 1,5 - 2 m2
? Appearance:

folds: coarsely, discreet, fine, etc

pores (infundibular depressions) the
openings of sudoriferous or sebaceous glands

Q: How many layers tegument have ?

A:

Q: How many layers tegument have ?

A:

3 layers

1. The epidermis:
Role: Layers of cells

2. The dermis:
Role: nutrition, skin analyzer

3. The hypodermis:
Role: tegument support

What are the SKIN GLANDS ?

What are the SKIN GLANDS ?

Sudoriferous glands:

= merocrine glands
produce sweat

Sebaceous glands
= holocrine glands
-

produce sebum

What are the visible annexa of skin ?

What are the visible annexa of skin ?

1. NAILS
2. HAIR

What pruritus (itch) is ?

Produced by :

Cause:

What pruritus (itch) is ?

= cutaneous symptom

Experienced as An attenuated pain

Produced by :
Cause:

What pruritus (itch) is ?

= cutaneous symptom

Experienced as An attenuated pain

Produced by : irritation of skin nerves

Cause:
Genetic factors
Emotion ( Psychological factor)

Which are the

Secondary lesions in pruritus:

Which are the

Secondary lesions in pruritus:
1. excoriations
2. lichenification
3. cutaneous infections
4. local pigmentations

5. degraded nails

PRURITUS CLASIFICATION:

PRURITUS CLASIFICATION:

1. SECONDARY
(Determined by cutaneous affections)
2. PRIMITIVE (SINE MATERIA)

a) GENERALIZED
b) LOCAL

Q.
Common causes of systemic pruritus

Q.
Common causes of systemic pruritus
1.

Jaundice

2.

Cancers ( called paraneoplasic pruritus)

3.

Diabetes mellitus

4.

Uremia

5.

Parasitic infections, Scabies

6.

Old age (Senile pruritus)

7.

Drugs allergy (associated with skin eruption)

8.

Psychological

Q. Common site and cause of local pruritus

Woman: Vulvar

Diabetes mellitus
menopause
cancer
psychogenic

Men: Scrotal/Penian

Diabetes mellitus
Cancer
Urinary tract infections
psychogenic

Nasal:
asthma, allergic
rhinitis
lambliase (children)
morphinomania
Scalp:
alcohol abuse

Auricular
diabetes mellitus

Anal:
parasitic infections
hemorrhoids

skin colour changes are due to ?

skin colour changes are due to ?

A:
pigments ( 4 natural pathologic ones)
melanin (brown)

oxyhemoglobin (bright red)

deoxyhemoglobin (more bluish)

carotene (yellow)

Special conditions/pathologic ones:

hemosiderin

bilirubin

metals

REMEMBER !!!
The examination of skin color must be

done in sunlight

What are skin colour changes ?

What are skin colour changes ?

1.

PALLOR

2.

CYANOSIS

3.

JAUNDICE

4.

HYPERCAROTENEMIA

5.

CHANGES OF SKIN PIGMENTATION

6.

HYPEREMIA

What mean pallor ?

Causes by: ???
Sites where the Pallor is best appreciated ?

What mean pallor ?

= lighter color of the skin and visible mucosae

Causes by: ???

Sites where the Pallor is best appreciated ?

What mean pallor ?

= lighter color of the skin and visible mucosae

Causes by: ???

a reduced amount of oxyhemoglobin
Sites where the Pallor is best appreciated ?

What mean pallor ?

= lighter color of the skin and visible mucosae

Causes by: ???

a reduced amount of oxyhemoglobin
Sites where the Pallor is best appreciated ?
At thinnest epidermis !!! :
1. palpebral conjunctiva
2. palmar skin
3. fingernails
4. lips
5. Tongue

? Definition of CYANOSIS
? Cause of cianosis
Characteristic

? Definition of CYANOSIS
= bluish color of the skin and mucosal surfaces
? Cause of cianosis
Characteristic

? Definition of CYANOSIS
= bluish color of the skin and mucosal surfaces
? Cause of cianosis

= presence of reduced Hb in the blood ( 5g/dl)

Characteristic

? Definition of CYANOSIS
= bluish color of the skin and mucosal surfaces
? Cause of cianosis

= presence of reduced Hb in the blood ( 5g/dl)

Characteristic
Disappears with digital pressure
REMEMBER
False cyanosis doesnt disappear with digital pressure

?? Cause of central cyanosis

Mechanism
Characteristics of CENTRAL CYANOSIS :

?? Cause of central cyanosis

PULMONARY (respiratory insufficiency)
Mechanism
Characteristics of CENTRAL CYANOSIS :

?? Cause of central cyanosis

PULMONARY (respiratory insufficiency)
Mechanism
low arterial oxygen saturation in the lungs
Characteristics of CENTRAL CYANOSIS :

?? Cause of central cyanosis

PULMONARY (respiratory insufficiency)
Mechanism
low arterial oxygen saturation in the lungs
Characteristics of CENTRAL CYANOSIS :
Generalized
Warm
Negative

Lewis test
(cyanosis not disappear with ear lobe rubbing)
Oxygen administered by masc correct cyanosis

?? Other Cause of central cyanosis

It is influenced by oxygen administration ?

?? Other Cause of central cyanosis

heart disease (HD)

Congenital HD with right-to-left shunt

It is also called the blue syndrome

It is influenced by oxygen administration ?

?? Other Cause of central cyanosis

heart disease (HD)

Congenital HD with right-to-left shunt

It is also called the blue syndrome

It is influenced by oxygen administration ?

NO

JAUNDICE
(also called icterus)
Definition: the yellow color of skin and mucosae
caused by a high level of seric bilirubin

does not disappear with digital pressure

Bilirubin colors the elastic tissue

digital pressure emphasizes the jaundice

!!! Icterus must be examined in sunlight,

because artificial lights distorts colours,
being visible only the verdinicterus/
melasicterus

JAUNDICE
Better seen on:
1. The bulbar conjunctives
(visible at the level of inferior fornix of
conjunctivae)

2. Under the tongue

3. Hard palate
4. The lips (after digital pressure)
plasma bilirubin value : 0,5 1 mg%
If bilirubin exceeds 7 mg %,
the jaundice becomes more obvious both
for the patient and entourage

JAUNDICE

In natural hyperpigmentated patients,

icterus is put in evidence by:

Plasma aspect
Urine color changes
Seminal fluid color changes
Serosae color changes

JAUNDICE

!
XANTHOPSIA
= a visual disturbance in which
objects appear yellow due to
problem of the eye (dyeing of
ocular media)

JAUNDICE
Differential diagnostic of jaundice

is done with:
Hypercarotenima
Chronic renal failure

JAUNDICE
classification
Depending on shade

Orange hepatocellular icterus

Flavin hemolytic jaundice, hepatocellular icterus associated

Rubin leptospiroses (icterus + fever)

Verdin - mechanical icterus, critical hepatocellular icterus

- due to the convertion of bilirubin into biliverdin;
- associated with pruritus

Melas

pancreatic head cancer

(there is a large amount of biliar salts and biliverdin
at the level of tegumentum)

RUBINIC JAUNDICE

ORANGE JAUNDICE

VERDINIC JAUNDICE

HYPERCAROTENEMIA

carotenoids = are lipid soluble compounds

which give the yellow to yellow-orange

discoloration of the skin (adipose tissue)

the color change is most prominent in

regions of increased
sweating (face) and

thickness of the stratum corneum (palms

and soles)

HYPERCAROTENEMIA
classification
Primary hypercarotenemia

(CAROTENODERMA)
due to increased dietary foods intake or
nutritional supplements (children yellow
parsnips)

Conditions associated with hypercarotenemia:

Simmonds disease
(secondary panhypopituitarism)
Myxedema
Diabetes
Chronic renal failure
Eunuches

HYPERCAROTENEMIA

! Carotenoderma is CLINICALLY

differentiated from jaundice

by the characteristic
sparing of the
Conjunctiva
urine and
Feces
! Existence of carotenoderma invalidates the

malabsorption syndrome

HYPERCAROTENEMIA

DISORDERS OF PIGMENTATION

MELANIN
= The main cutaneous pigment
produced by melanocytes

The number of melanocytes is the same for all

races (inclusively for albinos), but

the number of melanin granules varies

DISORDERS OF PIGMENTATION
Melanocytes
predominates in:
axillas
genital regions
Areolas
elbows,
knees
Rare location: mucosae, palms and soles

Melanogenesis

= is hormonally controlled
by MSH ( stimulated in ACROMEGALY, ADDISON dis.)
by catecholamine, corticosteroids, estrogens

DISORDERS OF PIGMENTATION

Melanin melanoid excoriation

corneous layer

YELLOISH - SOIL color

DISORDERS OF PIGMENTATION
classification
GENERALIZED
HYPOPIGMENTATION
LOCAL

Disorders
of
pigmentation

DISCOLORATIONS

GENERALIZED
HYPERPIGMENTATION
LOCAL

GENERALIZED HYPOPIGMENTATION
Albinism = genetic disease

Total- with amelanosis

Partial - only the eyes lack pigment

Total oculocutaneous albinism

The most obvious example of hypopigmentation

Genetic disease (autosomal recessive) with:

white tegument,

northern white hair,

decolorized iris through which the eye fundus is seen

Decreased visual acuiity, nistagmus, photophobia

skin cancers on the regions exposed to sunlight ( !

frequent )

LOCAL HYPOPIGMENTATION

Phenylketonuria

an inherited metabolic disorder

caused by an enzyme deficiency

resulting in accumulation in the blood of

phenylalanine and its metabolites

severe mental retardation,

decolorized hair and iris
(comparing with the rest of family)

urine smelling like mouse

LOCAL HYPOPIGMENTATION

OTHERS:

Biermer disease
burns, scars
melanocytes deficiency in protein deficiencies
shadows around the nevi
Simmonds disease

DISCOLORATION

Vitiligo (leukoderma)
is a chronic skin disease
causes loss of pigment resulting in
irregular pale patches of skin
Due to Migration of melanocytes to the
border of affected area

Areas of hypopigmentation with

surround hyperpigmentation

DISCOLORATION

Vitiligo (leukoderma)

primary disease dominant autosomal

transmission

secondary disease:
autoimmune disease
Hyperthyroid conditions- meche blanche
Biermer anemia
Addison disease
Reclinghausen neurofibromatosis
Intoxications with hydroquinone, phenol

VITILIGO

VITILIGO

GENERALIZED HYPERPIGMENTATION

(MELANODERMA)
Conditions in which there is the

darkening of an area of skin

caused by increased deposits of
Melanin
Hemosiderin
metals (pseudocyanosis)

Melanoderma
= abnormally intense pigmentation of the skin
Pathologic hyperpigmentations:
generalized (melanoderma)
local
circumscribed

GENERALIZED HYPERPIGMENTATION

(MELANODERMA)

Addison disease

The most typical melanoderma

determined by ACTH, MSH

Early diagnosis-initial affected

areas:

nipples,
axillas,
folds,
palmary crests,
genitalia,
white linea,
mucosae,
areas submitted to frictions or pressure, scars

GENERALIZED HYPERPIGMENTATION

(MELANODERMA)

Addisonian melanoderma

Covers all the tegument, excepting the palms and

soles
Sometimes associated with vitiligo
Accompanied by:
asthenia,

weight loss emaciation,

hTA (TAs<90 mmHg),
inappetence, nausea, vomiting,

associated abnormal lab values

GENERALIZED HYPERPIGMENTATION

(MELANODERMA)

HEMOCHROMATOSIS

a hereditary disease characterized by

excessive absorption of dietary iron
resulting in

a pathological increase in total body iron

( 50 - 100 x at the level of liver,
pancreas bronzed diabetes,
pigmentary cirrhosis)

GENERALIZED HYPERPIGMENTATION

(MELANODERMA)

HEMOCHROMATOSIS

Hyperpigmentation of tegument with metal shade

(Iron deposits (hemosiderin))
Distribution areas:
face
belly
nipples
genitalia
the extension faces of forearms
scars

Atrophic tegument, with loss of hair

Differential diagnosis
with hemosiderosis (post transfusional hemochromatosis)
in which pigmentation is progressive

OTHER GENERALIZED HYPERPIMENTATION

Causes:
physical:

Exposure to sunlight and UV

pruritus, + vitamin/proteins deficiencies -the tramps (melanoderma) pelerine

neck and scapular-humeral region

nutritional:

pellagra associated with photosensibility

vitamin A deficiency

OTHER GENERALIZED HYPERPIMENTATION

Causes:
metabolic
hepatolenticullary cirrhosis
tardive cutaneous porphyria

hormonal:
pregnancy
puberty
ACTH secreting pulmonary tumors

deposits of metal (silver, gold, mercury, chrome, arsenic)

drugs: chlorpromazine (brown), amiodarone (blue-grey),
tetracycline

LOCAL HYPERPIGMENTATION

PREGNANCY MASK = irregular symmetric patches like a

mask- pregnant women after the 5th month
FACE - thalassemia, malabsorption syndrome,

contraceptives
PERIOCULAR PIGMENTATION hepatic diseases,
ovarian tumors, Graves-Basedow disease
RIEHL DISEASE

Pigmentary patches at the level of face and thorax

Carencies syndromes, malabsorption, emotions

REGIONAL HYPERPIGMENTATIONS

SHANKS- chronic venous insufficiency

NIPPLES AND MAMMARY AREOLAS
- pregnant women, patients with prostate cancer treated
with estrogens

AXXILAS - acantosis nigricans

- associated with hyperkeratosis in plaques --- carbon
powder appearance
- gigantism, acromegaly, diabetes mellitus, abdominal
cancer
UNCLOTHED PARTS OF THE BODY
- porphyria, pellagra, Felty syndrome
DIFFERENT ZONES
- due to the itching lesions or to the application of
heated objects

ACANTOSIS
NIGRICANS

CHRONIC VENOUS INSUFFICIENCY

PORPHYRIA
PELLAGRA

CIRCUMSCRIBED HYPERPIGMENTATION

FRECKLES

LENTIGO (moles) = AGE SPOTS

CAF AU LAIT PACTHES Recklinghausen neurofibromatosis

PEUTZ-JEGHERS SYNDROME

= periorificial lenticulosis + colic poliposis

LEOPARD SYNDROME (L= lentigo, Ecg =conduction problems,

O= ocular hypertelorism, P= pulmonary pulmonary stenosis,

A = genetic anomalies, R= retard, D= deaf)

FIX DRUG ERUPTION

- erythemaous- pigmentary plaques

URTICARIA - mastocytosis

MALIGN MELANOMA tumor developed around a nevus

Recklinghausen neurofibromatosis

PEUTZ-JEGHERS SYNDROME

URTICARIA - mastocytosis

MALIGN MELANOMA

FIX DRUG ERUPTION

Ocular hypertelorism

LENTIGO

FRECKLES

ERYTHEMA
= redness of the skin which
Is due to tegument vasodilatation (hyperemia )
disappears with digital pressure

Classification :
A. LOCALIZED
PHYSIOLOGICAL: pudic, emotional
PATHOLOGICAL:

PALMO-PLANTAR: liver cirrhosis

E. of ZONES EXPOSED TO SUNLIGTH:
pellagra, photosensibilisating diseases

ERYTHEMA
B. GENERALIZED
PHYSIOLOGICAL: solar
PATHOLOGICAL
ERUPTIVE DISEASES
RASH = diffuse erythema, transient, precedes the eruption
MORBILIFORM E. in MEASLES
SCARLATINIFORM E.

DRUG ALLERGIES
ROSEOLA (secondary syphilis)
CARCINOID
FLASH = sensation of heat followed by redness

FIGURATE/ANULLAR ERYTHEMA
FEVER children, teenagers

EXFOLIANT ERYTHEMA: leukemias

RHEUMATHIC

FIGURATE/ANULLAR ERYTHEMA