Skin presentation


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Skin presentation

  1. 1. Main three structures . . .Epidermis  Stratum corneum  Stratum lucidum  Stratum granulosum  Stratum spinosum  Stratum germinatum Dermis  Superficial papillary layer  Reticular layer Sub cutaneous tissue Appendages  Hair follicle  Sebaceous glands  Apocrine glands  Sweat glands
  2. 2.  Epidermis  Thickness – 0.4 – 1.4 mm  Cells :  stratified squamous epithelium  Keratinocytes – 80 %  Melanocytes  Langerhans cells  Merkel cells Dermis  polysaccharides + protein (collagen + elastic)  Rich blood supply  Nervous supply – Sympathetic & Sensory nerve ends
  3. 3. Stratum cornium Outer most skin layer Cells flattened without nuclie and cytoplasmic organels. Corneocytes which are joined by desmosomes 20 -25 cells layer
  4. 4. Stratum Lucidum Between granulosum and corneum Thick epidermis of palm and soles has an additional layer i.e. electrolucentStratum Granulosum Presence of intracellular kerato-hyline granules 2-5 cell layers
  5. 5. Stratum germinativum Columnar cells 1-2 cells layer Mitosis at every 18th or 19th day
  6. 6. Stratum spinosum Also prickle cell layer 8-10 cells layer Appear shrunken and spine like Numerous desmosomal connecting plaques which adjacent keratinocytes and provide a network of stability.
  7. 7. Glands Sebaceous Sweat glandOf skin gland Eccerine Apocrinesite Absent in Lowest Sub glabrous skin portion of cutaneous dermis or b/t fat dermis and subcutaneous fatlocation In face, lips, All over body Axilla and nipple, glans except muco- genital penis, labia major, cutaneous region it opens directly into exterior junctions
  8. 8. Sebaceous` Eccerine ApocrineHolocrine secretion –During heat Mammarycell disintegrate to gland…???secrete sebum activeat birth and puberty SweatingContains free fattyacids and triglycerides,steroids, waxes, EvaporationparaffinStimulated by sex Cooling of bodyhormonesEspecially in male,dehydroepiandrosterone which is responsiblefor acne on face
  9. 9. Hair• develops from primary epithelial germ from ecto derm• three parts : •Lower – base of follicle upto insertion of erector pilorum muscle •Middle – erector pilorum to sebaceous duct opening •Upper – sebaceous duct opening to follicular orifice• growth stages • anagen – 80%, at any moment of time • catagen – transitional phase, last for 1 week • telogen – resting phase, 3 months hair sheds off
  10. 10. Color of skin Melanin – keratinocyts in s.germinatum Hb in blood
  11. 11. FUNCTIONS Maintaining the integrity and shape Protective Sensory Storage [fats, water, chloride, sugar] Synthetic function – Vit d3 Regulation of temperature Excretory & Water - electrolytes balance Absorptive – U V lights, external application Secretary Acts as immunological organ
  12. 12. Primary lesions
  13. 13. PRIMARY LESIONS1. MACULES - / erythema ,purpura2. PAPULES3. PATCHES4. PLAQUES5. NODULES - epidermal ,dermal, subcut6. WHEALS7. VESICLES & BULLAE8. PUSTULES
  14. 14. Macules Circumscribed Altered skin color Flat n non palpable Any shape n size No texture change
  15. 15. 1. Hypo pigmented-- melanocytes or amount of pigment they produce {tuberous sclerosis, naevus acromicus, leprosy} TOTAL ABSENCE OF MELANOCYTES:VITILIGO2. Hyper pigmented- melanin in epidermis (freckles, cloasma) no of melanocytes (lentigo) increase melanin in dermis (mongolian spots)3. Erythema – capillary dilatation---- increase blood flow-----pink macules---- blanch on pressure (viral rash)4. Purpura – extravasation of RBC’S in dermis----- no blanching5. Ecchymosis – large purpura (thrombocytopenic purpura)
  16. 16. papules Small elevation of skin – less then 1 cm Cause  Hyperplasia of epidermis, dermis or both Shape  acuminate pointed shape – miliaria rubra  Scaly - guttate psoriasis  Dome shape – molluscum contagiosum  Flat topped – lichen planus Color  Red – psoriasis  Pearly white – molluscum contagiosum  Violaceous – lichen planus  Coppery – secondary syphilis  Yellow – xanthomatosis  Heamo or necrotic – meningococcemia  Blue / Black papules – melonoma  Skin color – adenoma sebaceum, amyloidosis Papules with central umbilication as in molluscum contagiosum Pedenculated papules – neurofibromatosis
  17. 17. plaques Solid Plateau like elevation of skin Coalescence of neighboring papules or by enlargement of existing papules Erythematous + silvery scaling – psoriasis Lichenified + accentuated margins – ch. Eczema Hypo pigmented – tub. leprosy
  18. 18. nodules Palpable Solid Round Hard/soft/firm/fleshy Tender/painless Fix/mobile Surface smooth/ keratotic/ fungating/ ulcerated
  19. 19. Wheal (hives) Transient vascular reaction & vasodilatation in upper dermis As allergic response Evanescent elevated lesion Erythematous Edematous With central pallor Shape - Irregular Flat/dome, oval, geographic, serpiginous or annular Size – 3-4 mm or large DERMOGRAPHISM ANGIO-EDEMA – diffused edematous reaction occurring in areas with loose dermis and subcutaneous tissue i.e. lips, penis, hands etc.
  20. 20. Vesicles Circumscribed Elevated Superficial Size – 0.5 cm diameter Consist clear fluid Pustules – vesicle + pus Bulla – vesicle + more then 0.5 cm, arise by separation of skin within epidermis walls are thin enough to permit visualization of the serous or blood tinged fluid inside. Intraepidermal vesiculation – impetigo contagiosa & pemphigus foliaceous
  22. 22. PSORA  Primary Psora - mind And Skin & Mucus Membranes  …the trouble some effects occur at the level of the limiting protective envelopes, which separate man from his environment, viz. the skin and its appendages – hairs, nails & m.m. and at the level of limitless mind  In skin….eruptions and discharges  The appearance of boils and the reappearance of eruptions and discharges under treatment is reliable index of the good action of an adequately selected remedy.  …sensitization and allergic responces are psoric in origin
  23. 23. SYCOSIS  altered physical expressions  Non suppurative inflammatory reactions  The imbalance of adrenal cortical hormones produces pigmentation of skin and m.m. as in addisonian syndrome  moles, naive, “liver spot”, freckles, malar pigmentation (butterfly type), vaccinations and inoculations  These result in chronic inflammations of skin, m.m. (catarrhs), serous m. and gland with indurations without suppuration
  24. 24. Tubercular  …skin pigmentation, cracks and fissures of the skin  Premature graying of hair and formation of pustules and lupus
  25. 25. SYPHILIS  skin, hair, nails : squamous copper colored eruptions – non itching. Itching eruption < night  Pustular, cracks, fissures, ulceration with indurations and with acrid, bloody, foul discharges; sloughing, gangrene  mucous and serous mem.: acute and chronic catarrhal with typical discharges acrid, bloody, foul, necrotic changes.
  26. 26. Thank youDr. Dharmesh Bhadja MD