Abundez Hernandez Diana_FLASHCARDS DERMA .pdf

Flashcrt derma

1. HIPODERMIS EPIDERMIS
keratinocytes
perpetually regenerating
tissue.
Merkel cells type1
mechanoreceptors high tactile
sensitivity:
digits, lips, oral cavity, hair
follicle.
Langerhans cells T cell
response-bone marrow
derivative 2-8% total
population.
Squamos and granular layer:
oral cavity, vagina, esophagus
colágeno tipo 1 lipocytes
DERMIS
INTERTEGUMENTARY
SYSTEM
INTERTEGUMENTARY
SYSTEM
SECTION 1 SECTION 1

2. HAIR FOLLICLE
DEVELOPMENT
keratinocytes (K)
Langerhans cells (L) in the
Malpighian layer and
melanocytes
melanocytes (M) in the basal
layer
Apocrine sweat glands:
scent release. Axillae and
perineum, opens into a
pilosebaceous follicle
Eccrine sweat glands:
thermal regulation
Apocrine sweat glands:
axillae secretory rate
Anlagen: active growth
stage, 3-5 years on the
scalp 0.33 mm per day,
decrease with age
1.
2. Catagen: 2 weeks period of
involution
3. Telogen: 3 to 5 months on
the scalp
SKIN APPENDAGES
ECTODERMO
epidermis:queratinocitos 80%
queratinización 28 días
MESODERMO
dermis (mastocitos-histamina,
heparina,
serina proteasas, sitios receptores
para IgE.
Dermis y submucosa tipo 1, tracto
respiratorio e intestino tipo 2.
Alergia, enfermedades
parasitarias, artritis reumatoide,
malignidad, asma, fibrosis pulmonar
THE THREE BASIC
CELL TYPES IN
EPIDERMIS

3. Blood supply: subpapillar or
superficial and lower plexus
Arterial and venous circulation
Nerve regulation: Meissner
corpuscle papillary dermis,
touch hands and feet,
fingertips. Vater-paccini
dermis, sense pressure nipple-
anogenital region
Length and weight 15-16%
total body weight, eyelid
0.5mm, palms and soles 1.5mm
Thin and Thick skin
HUMAN BARRIER including
protection agains external
chemical, physical and biological
assailants
1.
PROTECTIVE SHELL the skin is
continuous lining with mucous
membranes
2.
REGENERATIVE PROCESS3.
VITAMIN D SYNTHESIS4.
THERMOREGULATION
DERIVATIVES pilosebaceous
apparatuses, nails and sweet
glands
5.
HUMAN SKIN
PHYSIOLOGY
CLINICAL ASPECTS

4. TAKE A THOROUGH
HISTORY
PERFORM A
PHYSICAL
ASSESSMENT
POPULATION
Skin diseases affect
20-30% of the
population
interfering with
activities in 10%
Take a thorough history1.
Perform a physical
assessment
2.
Personal or family history of
atopy
3.
about skin changes such as xerosis (dry
skin), itching, wounds, rashes, or changes in
skin pigmentation or color
if the appearance of the skin changes with
the seasons about any changes in nail
thickness, splitting, discoloration, breakage,
and separation of the nail bed.
A change in the patient's nails may be a sign
of a systemic condition.
about allergies, including those caused by
medications, topical skin and wound
products, and foods.
skin color1.
humidity2.
temperature3.
texture4.
mobility and turgor5.
skin lesions6.
Occupational exposures (contact
dermatitis)
1.
Prolonged exposure to sunlight or
other forms of radiation (benign
and malignant skin tumors)
2.
Systemic disease (diabetes and
Candida or ringworm, hepatitis C,
and cryoglobulinemia)
3.
Sexual history (syphilis and
gonorrhea)
4.
Medication use (Stevens-Johnson
syndrome, toxic epidermal
necrolysis)
5.
Travel history (Lyme disease, skin
infections)
6.
COMPONENTS OF A
GOOD SKIN
ASSESSMENT.
PERSONAL OR FAMILY
HISTORY OF ATOPY
SKIN
LESIONS
TOPOGRAPHY
SKIN
LESIONS
TOPOGRAPHY
SECTION 2SECTION 2
Inspect and palpate the fingernails and
toenails, noting their color and shape and
whether any lesions are present.

5. SECONDARYPRIMARY
Birthmarks: These are the most
common primary skin lesions. They
include moles, port-wine stains,
nevi, etc.
Blisters: Less than half a
centimeter in diameter and filled
with clear fluid. Blisters may be
caused by burns (including
sunburns), viral infections
(herpes zoster), friction due to
shoes or clothes, insect bites,
drug reactions, etc.
Macules: Freckles and flat moles
are examples of macules. A
macular rash is commonly seen in
measles.
Crust: Or a scab is a type of skin lesion that
forms over a scratched, injured or irritated
primary skin lesion. It is formed from the
dried secretions over the skin.
Ulcer: Break in the continuity of the skin or
mucosa. Skin ulcers are caused by an
infection or trauma. Poor blood circulation,
diabetes, smoking and/or bedridden status
increase the risk of ulcers.
Scales: Are patches of skin cells that build
up and flake off the skin. Patches are often
seen in psoriasis and cause bleeding when
they are removed.
Scar: Injuries, such as scratches, cuts and
scrapes, can leave scars. These may cause
itching or oozing and appear reddish or
brownish. These are called keloids.
Skin atrophy: Skin-> thin and wrinkled. This
could occur due to the frequent use of
steroid creams, radiation therapy or poor
blood circulation.
PART OF THE BODY ROUTE OF THE
LESIONS
CAUSES OF PRURITUS
TYPES OF SKIN
LESIONS
Primary
Present at birth or acquired
later
Secondary
Result of irritated or
manipulated primary skin
lessions
PRIMARY
Nodules: The nodules are seen in
certain diseases such as
neurofibromatosis and leprosy.
Papule: Plaques are commonly
seen in psoriasis. Papules may be
seen in viral infections, such as
measles, or may occur due to
mosquito bites.
Pustule: Boils and abscesses are
examples of pustules.
Wheals: They are mostly caused
by an allergic reaction. For
example, hives (also called
urticaria), insect bites, etc.
MORPHOLOGY

6. Rare medical condition, presence of abnormal
proteins cryoglobulins in the blood, which
precipitate or clump together at low
temperatures
deposit in small- to medium-sized blood vessels
throughout the body, causing endothelial injury
and end-organ damage.
CRYOGLOBULINEMIA
joint pain
skin rashes
kidney problems
due to blood vessel blockage and triggering of
inflammatory reactions.
Precipitate at temperatures <37oC
Skin ulcers
arthralgia
glomerulonephritis
neuropathy
purpura
hepatitis C
autoimmune disorders or certain cancers
Pharmacotherapy, plasmapheresis, and
management of associated diseases
Measuring cryoglobulin levels along with low
complement C4 levels
Usually treated with steroids and rituximab
CRYOGLOBULINEMIA
SYMPTOMS
Tx -> Typically
steroids and
rituximab

7. LYME DISEASE
Transmited though a bite (Garrapata macho)
 Animals tah most carry these insects: white-
footed field mice, deer, raccoons, opossums,
skunks, weasels, foxes, shrews, moles,
chipmunks, squirrels and horses.
 Where? -> NY, Connecticut, NJ, Minnesota and
Wisconsin
 Lesiosn in early stages of lyme-> largue,
expanding skin rash
 Stiff neck, chills, fever, swollen lymph nodes,
headaches, fatigue, M, aches and joint pain/
largue, expanding skin rash
 Irregular heart beat, nerve problems (Facial
paralysis), arthritis (Knees)
 Tx-> Doxycycline, amoxicillin, cefutoxime 14-
21d

8. SYSTEMIC SCLEROSIS
Or systemic scleroderma or
scleroderma
Immune-mediated connective
tissue disease, progressive skin
fibrosis and other clinically
heterogenous features
Vasculophaty and immune system
dysregulation -> Leading to
fibrosis
Autoantibody profiles are
predictive or skin and internal
organ involment and disease
course
Many of the clinical manifestations
that present early signs of
disease progression and activity
are cutaneous

9. VASCULITITS

10. CHRONIC LIVER
DISEASE
Multiple spider nevi
Palmar erythema + ichthyos or
macular purpura
Coagulophaty
Cholestasis -> A.C. with jaundice
and generalized pruritus, wich can
result in secondary changessuch
as exocriatiosns and prurigo
nodules
Hepatitis-C infction has been
associated with a range of
cutaneous manifestations

11. WOOD LIGHT
SKIN BIOPSY
Punch: Tubular punch is
inserted into deep dermal or
subcutaneous tissue -> specimen
Shave: (Scapel or razor blade)
Superfitial lesions. Bñeeding is
controlled with aluminium
chloride solution or
electrodesication
Wedge excision: (Scapel) Large
o deeper biopsies-> closed by
sutures
It can help distinguish
hypopigmentation from
depigmentation
(depigmentation of
vitiligo fluoresces ivory-
white and
hypopigmented lesions
do not).
DIASCOPY
DX TESTS FOR
SKIN DISORDERS
When is not obvious from history
and physical examinationalone:
Patch testing
Biopsy
Scrapings
Examination by Wood light
Tzanck testing
Diascopy
SKIN
SCRAPINGS
Fungal infection: Taked from the
border of the lesion and placed
on a microscope slide-> Add. 20%
Potasioum hydroxide-> Hypnae,
Budding yeast, tinea or
canididiasis
Scabies: taken from suspected
borrows-> Placed in a coverslip
with mineral oil-> Mites, feces,
eggs
TZANCK TESTING
Dx viral disease-> Herpes
simplex or herpes zoster
(No distinguish between
herpes simplex and zoster)
Blister roof is removed
with a sharp blade -> Bse of
the unroofed vesicle is
scraped-> Transfer to a
slide and taining with
Wright stain or Giemsa
stain
Determinate any erythema
in a lesion is due to within
superfitial vessels
(Inflamatory or vascular)
(Blanch) or is due to
hemorrhage (No blanch)

12. •PARASITIC: LARVA MIGRANS,
ONCHOCERCOSIS, FILARIASIS, CHAGAS
DISEASE, LEISHMANIASIS, SCABIES,
BEDBUGS, LICE
•VIRUSES: WARTS, SMALLPOXS, CHIKENPOX,
RUBELLA, HERPES (TYPES I-VIII),
MOLLUSCUM CONTAGIOSUM
CLASSIFICATION
FUNGAL: CANDIDIASIS,
MICETOMA,
CRIPTOCOCOSIS,
HISTOPLASMOSIS,
PITYRIASIS, ORAL TRUSH,
RINGWORM
1.
SKIN AND
INFECTIVE
DISEASES
SKIN AND
INFECTIVE
DISEASES
SECTION 3 SECTION 3
BACTERIAL: INFECTIVE
ENDOCARDITIS, TUBERCULOSIS,
LYME DISEASE, ROCKY MOUNTAIN
FEVER, SOFT TISSUE INFECTIONS,
CAT SCRATCH DISEASE, SYPHILIS,
LEPTOSPIROSIS, HANSEN DISEASE
1.
CLASSIFICATION
CLASSIFICATION

13. INFECTIVE
ENDOCARDITIS
Acute IE: fever, chills, fast heart rate,
fatigue, night sweats, aching joints and
muscles, persistent cough or swelling in the
feet, legs or abdomen.
Chronic IE: fatigue, mild fever, a
moderately fast heart rate, weight loss,
sweating and a low red blood cell count
(anemia)
Rheumatic heart disease, mitral valve most
commonly involved site
streptococci, staphylococci, and
enterococci infection (80% to 90% of all
cases)
Staphylococcus aureus 30% of cases in the
developed world

14. RISK FACTORS FOR
DEVELOPING IE
INCLUDE:
Heart valve disease
Previous heart valve surgery
Congenital heart disease
Intravenous drug use
Previous history of IE
Bacteremia can occur after daily activities
such as:
• tooth brushing and flossing.
• use of wooden toothpicks.
• use of water flossers (Waterpik).
• chewing food.

15. THE DUKE CRITERIA FOR THE CLINICAL
DIAGNOSIS OF INFECTIOUS ENDOCARDITIS
Major criteria
Two separate blood cultures positive for
microorganism consistent with infectious
endocarditis
Recovery of a microorganism consistent
with infectious endocarditis from blood
cultures drawn more than 12 hours apart
Evidence of endocardial involvement
Positive echocardiography
Single positive blood culture for Coxiella
burnetii or phase 1 immunoglobulin G
Minor criteria
Fever of at least 38.0°C
Immunologic phenomena:
glomerulonephritis, Osler nodes, Roth
spots, rheumatoid factor
Predisposing heart condition or history of
injection drug use
TREATMENT REGIMENS FOR INFECTIOUS
ENDOCARDITIS
Penicillin-susceptible viridans Streptococcus or
Streptococcus bovis
Penicillin G or ceftriaxone (Rocephin) for
four weeks
Penicillin G plus gentamicin for two weeks
Ceftriaxone plus gentamicin for two weeks
Relatively penicilin-resistant viridans
Streptococcus of 5. bovis
Vancomycin for four weeks
Penicillin G or ceftriaxone for four weeks,
plus gentamicin for two weeks
Vancomyon for four weeks
Penicillin-resistant viridans Streptococcus or 5.
Bows
Ampicilin plus gentamicin for four to six
weeks
Penicilin G plus gentamicin for four to six
weeks
Vancomycin for six weeks

16. CUTANEOUS
TUBERCULOSIS
Mycobacterium tuberculosis the same
bacterium that causes tuberculosis of the
lungs (pulmonary TB)
Close contact with a patient with active
TB, living in or visiting a country or
community where TB is common, living in a
crowded community, including institutions
such as aged care residences, long-stay
hospitals, and prisons, working in hospitals
and healthcare environments
Direct inoculation of tubercle bacilli into the
skin, spread to the skin via bloodstream,
extension into the skin from an underlying
infective focus
Lupus vulgaris is the most common
presentation of reinfection cutaneous
tuberculosis.
Squamous cell carcinoma, or other skin cancer in the scar
25-30 years later (10% patients)

17. CUTANEOUS TUBERCULOSIS
FEATURES
Direct inoculation of the skin or mucous
membranes with tubercle bacilli from an outside
source results in a tuberculous chancre.
Children are predominantly affected. Infection
may follow piercings, tattooing, or other
penetrating skin injury. The face, hands, and legs
are the commonest sites involved.
The tuberculous chancre appears 1-4 weeks
after inoculation, presenting initially as a firm red
papule which becomes a painless shallow ulcer
with a granular base and undermined edge.
Tuberculosis verrucosa cutis (warty tuberculosis)
occurs after direct inoculation of tubercle bacilli into
the skin of someone who has been previously infected
and developed good immunity. It was called
'prosector's wart' when it followed accidental injury
in the autopsy room.

18. CUTANEOUS TUBERCULOSIS
FEATURES
Miliary tuberculosis follows generalised spread
of tubercle bacilli via the bloodstream from an
active internal focus of tuberculosis.
Mainly in children and immunocompromised
patients. Skin involvement is called disseminated
cutaneous tuberculosis or acute cutaneous
miliary tuberculosis.
Metastatic tuberculous abscess (tuberculous
gumma) is also due to haematogenous spread to
the skin in children and immunocompromised
adults, but presents as a subcutaneous nodule or
cold abscess on an extremity.
Extension into the skin from an underlying
infective focus.
Scrofuloderma follows the direct invasion of the
skin from tuberculosis in an underlying lymph node
or bone, often in association with pulmonary TB.

19. BAZIN DISEASE
is categorized as a tuberculid skin
eruption, which is a group of skin
conditions associated with an underlying
or silent focus of tuberculosis (TB).
They are sequelae of immunologic
reactions to hematogenously dispersed
antigenic components of Mycobacterium
tuberculosis
Other members of the tuberculid group
include papulonecrotic tuberculid, lichen
scrofulosorum, and vascular reactions
caused by tuberculosis, namely, nodular
tuberculid and nodular granulomatous
phlebitis, all of which are distinct from
erythema induratum..

20. HOW IS CUTANEOUS TUBERCULOSIS
DIAGNOSED?
Skin biopsy. Tuberculin skin test (Mantoux
or PPD test).
Interferon- gamma release assay (IGRA)
blood test such as QuantiFERON-TB gold.
Sputum culture (it may take a month or
longer for results to be reported).
Chest X-ray and other radiological tests
for extrapulmonary infection. GeneXpert.
Ziehl-Neelsen stain.
Polymerase chain reaction (PCR)
WHEN SHOULD TUBERCULOSIS SCREENING
BE PERFORMED?
in people at risk of contracting tuberculosis
and in people at risk of converting
undetected latent tuberculosis to active
tuberculosis.
Treatment with corticosteroids, biologics,
especially tumor necrosis factor alpha
(TNF-α) inhibitors, and immunosuppressive
agents such as azathioprine, cyclosporine,
mycophenolate, or chemotherapy.
Diseases, particularly human
immunodeficiency virus (HIV) infection,
leukemia, lymphoma, diabetes, alcoholism,
and kidney failure.
railty (older age, very young age, and
chronic or heavy smokers).

21. WHAT IS THE TREATMENT FOR CUTANEOUS
TUBERCULOSIS?
This is usually a combination of:
isoniazid
rifampicin
pyrazinamide
ethambutol
given for a period of six months as standard
treatmen.
Patients with latent tuberculosis infection
but no active disease may also be treated
with antituberculosis drugs to prevent the
development of active disease. (See
Screening for tuberculosis.)
Single-drug therapy is not recommended.
Surgical removal of localized cutaneous
tuberculosis, such as lupus vulgaris or
scrofuloderma, is sometimes recommended.

22. TICK-BORNE DISEASES
Include Lyme disease, Rocky Mountain spotted
fever (RMSF), ehrlichiosis, anaplasmosis,
babesiosis, tularemia, Colorado tick fever, and
tickborne relapsing fever.
Tickborne diseases are increasing in incidence
and should be suspected in patients presenting
with flulike symptoms during the spring and
summer Months.
Lyme disease presents with an erythema
migrans rash in 70% to 80% of patients, and
treatment may be initiated based on this
finding alone
RMSF has a higher rate of mortality than other
tickborne diseases; therefore, empiric
treatment with doxycycline is recommended
for all patients, including pregnant women and
children, when high clinical suspicion is present

23. TICK-BORNE DISEASES
ETIOLOGIC AGENT
Borrelia burgdorferi transmitted by hind-
legged ticks I. Scapulars or Ixodes
pacificus. The tick must be attached for
36 to 48 hours to transmit the diseas.
Signs and symptoms of Lyme disease can
be delineated into early localized, early
disseminated, and late disseminated
manifestations
La Marquesa, Nevado de Toluca, Distrito
Federal, Quintana Roo, Tabasco, places
where borreliosis could be transmitted in
Mexico

24. TICK-BORNE DISEASES
SIGNS AND SYMPTOMS
include fever
chills, fatigue
headache
myalgias.
An erythema migrans (EM) rash occurs in 70% to 80% of
patients. The rash begins at the site of the tick bite after
three to 30 days.
EM is characterized by an expanding erythematous patch
that initially appears homogeneous and may present partial
central clearing within a few days. It usually resolves within
three to four weeks
After the initial rash appears and include neurological,
musculoskeletal, and cardiovascular symptoms, and possibly
multiple MS lesions. Late disseminated symptoms include
encephalomyelitis, polyarthritis, and persistent
atrioventricular block (Lyme carditis)
Diagnosis can be made clinically in patients with MS rash and
tick exposure in endemic areas
TREATMENT: DOXYCYCLINE