What is?

 Dermatology?
Functions of the Skin

 Sensation-
 Immune function-
 Thermoregulation-
 Cutaneous absorption
Functions of the Skin

 Excretion
 Vitamin D synthesis-
 UV light for 10-15 minutes.
Skin Anatomy
Layers
 Epidermis- outermost, no blood vessels or blood
supply.

 Dermis- vascular layer/sensation. Strength and

elasticity to skin.

 Hypodermis or subcutaneous layer.

 Skin Anatomy
Epidermis-5 Layers
 Stratum corneum-

 Stratum lucidum-
 palms and soles of feet only.
 Skin Anatomy
Epidermis-5 Layers
 Stratum granulosum-
 Most differentiated layer.
 Skin Anatomy
Epidermis-5 Layers
 Stratum spinosum-
 Has desmosomes (spiny
projections and so spinosum).
 Skin Anatomy
Epidermis-5 Layers
 Stratum basale-
 deepest layer of the epidermis.
 Consists of a single layer of
keratinocytes.
Skin Anatomy
Epidermis-Cell Types
 Melanocytes-
 Produce melanin. Not many melanocytes in soles
or palms.
 Albinos lack tyrosinase
 Cancer of a melanocyte known as melanoma
Skin Anatomy
Epidermis-Cell Types
 Keratinocytes
 Produce keratin
 Immunology role-
 Merkel’s cells- Free nerve endings attached to
epidermal cells.
Skin Anatomy
Epidermis-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.
Skin Anatomy
Epidermis-Cell Types
 Parakeratosis-Retention
of nuclei in stratum
corneum.
 Spongiosis-Intercellular
edema of the epidermis.
 Skin Anatomy
Basement membrane(Basal
lamina)
 Selectively filters molecules
moving between two layers.
 Immunoglobulin and
complement deposition in
skin disease.
 Skin Anatomy
Dermis
 Thickest skin
layer/connective tissue layer.
 Composed of collagen, blood
vessels, nerves, hair follicles,
and sweat glands
Skin Anatomy
Subcutaneous Tissue
 Eccrine glands and
deep hair follicles
extend to this layer
 Insulator/shock
absorber/stores energy
as calories
 Skin Anatomy
Appendages-Hair
 Hair follicle associated with
sebaceous gland to form
pilosebaceous unit.
 Growth is cyclic
 Anagen phase-
 Catagen-
 Telogen phase-
Skin Anatomy
Appendages-Nails
 Hardened keratinized plates
 Skin Anatomy
Appendages-Glands
 Sebaceous- Entire
skin surface except
palms, soles, sides of
feet. Secrete sebum
 Skin Anatomy
Appendages-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.
Common Skin Lesions
Equal to plane of the Skin
Common Skin Lesions
Equal to plane of the Skin

Telangiectasia-
 Common Skin Lesions
Equal to plane of the Skin
Petechiae-
 Common Skin Lesions
Equal to plane of the Skin

Purpura or ecchymosis:
Common Skin Lesions
Equal to plane of the Skin
Sclerosis:
Common Skin Lesions
Equal to plane of the Skin

Lichenification:
Common Skin Lesions
Equal to plane of the Skin

Acanthosis
 Common Skin Lesions
Above the plane of the Skin

Actinic Keratosis Hyperkeratosis

Common Skin Lesions
Above the plane of the Skin.

Callus Corn
Common Skin Lesions
Above the plane of the Skin

papule Nodule
Common Skin Lesions
Above the plane of the Skin

Wheal

Plaque
Common Skin Lesions
Above the plane of the Skin

Vesicle-
Blister-
Bulla-
 Common Skin Lesions
Above the plane of the Skin

Pustule-

Cyst-
 Common Skin Lesions
Above the plane of the Skin

Tumor:
 Common Skin Lesions
Above the plane of the Skin

Verruca:
 Common Skin Lesions
Above the plane of the Skin

Scale/crust

Desquamation
Common Skin Lesions
Above the plane of the Skin

Exudate
Common Skin Lesions
Above the plane of the Skin

Comedone
Common Skin Lesions
Below the plane of the Skin

Excoriation
Common Skin Lesions
Below the plane of the Skin

Ulcer
Common Skin Lesions
Below the plane of the Skin

Fissure
Common Skin Lesions
Below the plane of the Skin

Excoriation
Common Skin Lesions
Below the plane of the Skin

Eschar
Disorders of Pigmentation and
Melanocytes Blanched

Vitiligo
Disorders of Pigmentation and
Melanocytes

Albinism
Disorders of Pigmentation and
Melanocytes

Melasma
 Disorders of Pigmentation and
Melanocytes
 Lentigo-
 Due to melanocyte proliferation.
 Can be due to hypermelanosis,
Addison’s disease,
Hemochromatosis, Acanthosis
nigricans
 Hydroquinone may temporarily
bleach the spots Inhibit synthesis
of pigment
Common Skin Lesions
Based on Color- Erythema

Erythema
Common Skin Lesions
Based on Color- Blue
Cyanosis
Common Skin Lesions
Based on Color- yellow

Jaundice
Approach to patient

 Distinguish normal vs. abnormal

 Appropriate differential diagnosis
 Pros and Cons of dermatology
Approach to the Patient
History-Lesions
 Acute vs. chronic illness
 Onset
 Subjective symptoms
 Location, distribution, spread or change in
lesions
Approach to Patient
Physical Exam
 Observe four points:
 Palpate
 Systemic examination including
lymphadenopathy, organomegaly, arthralgia,
and neurological changes
 Approach to Patient
Physical Exam
 Rash-

 Lesion-
Physical Exam
Shape of the Lesion
 Round
 Oval
 Polygonal
 Annular
 Serpiginous
 Umbilicated
Physical Exam
Arrangement of lesions
 Grouped: herpetiform, arciform, annulra,
reticulated, linear,
Physical Exam
Arrangement of lesions

Disseminated-
Physical Exam
Arrangement of lesions

Demarcated
Discrete
Physical Exam
Arrangement of lesions

Diffuse-
Physical Exam
Distribution of lesions
 Extent:
 Pattern:
 Any characteristic patterns such as seen in acne, chicken
pox.