dermatology slides - introduction to clinical dermatology
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Dermatology Slides
Introduction to clinical
dermatology
Hiba Jarra7
25
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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:
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Cells travel frombasal layer towardssurface (Turnover)
The trip takesaround 60 daysthen cells are shedfrom surface.
Shed cells arereplaced from basalcells (mitosis).
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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
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Dermis several components:1. Fibers: collagen and elastic fibers
2. Ground substance (GAGs)
3. Cells: Fibroblasts, Lymphocytes, Macro,
Mast cells..
4. Appendages: Glands ( sebaceous, Apocrineand Eccrine), Hair follicles and Nails
5. Supportive structures: Nerves, lymphatics,vasculature, smooth muscles
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The main function of skin to prevent entry offoreign things into internal environment
Horney layeris the main structure
responsible for this
Problems and diseases affecting Horney layerwill impair this function leading to infections,allergies
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Always start by introducing yourself
Ask patient permission before examining
them
Always respect patient wishes
Always keep patient privacy
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Chief complaint + Duration: Rash: multiple red things with/out scale
Lesion: one or few things
Others: as appropriate ( e.g hair loss, blisters, colorchange)
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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 1stdegree relative)
Drugs used ?
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R.O.S: Related Past Hx: as per others
Family hx
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T. SAD: Type: primary vs secondary (modified..scratched,
traumatized) lesion
Macule/patch: pigmentary disorder or resolvingpapulosq
Scaly papules/plaques: papulosquamous condition
Non scaly papules/plaques: reactive erythema
Bullae/vesicles: bullous dis.
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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 forscaly rashes)
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Arrangement: Grouped: grouped vesicles (Herpes), Linear ( plane
warts, Kobner)
Distribution: where? Unilateral: infection, contact Bilateral: inflammatory
Hands/face: sun exposed(photodermatoses/photoaggravated dermatoses).
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Approach ??
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Red is BLOOD
This is eitherIntra vascular: dilated vessel due to usually release
of inflammatory mediators (histamine)
DIASCOPY.BLANCHABLEExtra vascular: Hemorrhage
- Vessel wall injury: vasculitis
- Bleeding tendency or due to trauma
- DIASCOPY.NON-BLANCHABLE
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Red NON-
Scaly rash
DIASCOPY
NON-
Blanchable
VasculitisBleeding
tendency
Blanchable
Reactive
Erythema
(Urticaria/E
M/EN)
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Red non scaly
(ask about Duration
Of individual lesion)
UrticariaTime limit for
Individual wheals
Of 24 hrs
Erythema multiformeLesions for 1-2 wks
Acrofacial dist
Target lesions
Erythema nodosum
Lesions last 4-6 wks
Shins
Painful hot tender
Nodules.
Bruise like upon
resolution
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Scale is flake (piece) from horney layer.
Usually indicates hyper-proliferation ofepidermis
The group includes many conditions butcommonest are:- Eczema - Lichen Planus- Psoriasis - Fungal infections
-Pityriasis Rosea
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Look forspecial
features
Next: look at
distribution:
Look at
margins:Scaly rash
Well-defined
margins
Unilateral:Fungal infection
Bilateral:-psoriasis
-P.Rosea
- Lichen Planus
Ill-defined
margins
Eczema
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Scaly,well defined,
Bilateral
Psoriasis
CommonestSalmon pink
Large silvery scales
Extensor dist
Lichen planusViolaceous color
Wickhams striae
Flexors
Pityriasis Rosea
Time limit 2-10 wksMother plaque
Trunk dist (christmas
Tree/ribs)
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Solid,elevatedwithoutdepth
Bilateral
6 monthsduration
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5 monthsduration,elevated, no
depth, finescales.
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1. Woods light2. KOH
3. Diascopy
4.
Tzanck smear5. IF (Direct: tissue and Indirect: plasma)
6. Patch Test
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The End!!!!