DISEASES OF THE SKIN, HAIR, AND NAILS, INCLUDING DISEASES DUE TO THE

AUTOIMMUNE SYSTEM

Diseases of the Hair, Skin, and Nails

CUTANEOUS MELANOMA

Melanoma occurs when something goes wrong in the melanin-producing cells (melanocytes) that give color to your skin. Normally, skin cells develop in a controlled and orderly way — healthy new cells push older cells toward your skin's surface, where they die and eventually are sloughed off. But when some cells develop DNA damage, new cells may begin to grow out of control and can eventually form a mass of cancerous cells.

What is it?

Just what damages DNA in skin cells and how this leads to melanoma isn't clear. It's likely that a combination of factors, including environmental and genetic factors, causes melanoma. Still, doctors believe exposure to ultraviolet (UV) radiation from the sun and from tanning lamps and beds is the leading cause of melanoma. UV light doesn't cause all melanomas, especially those that occur in places on your body that don't receive exposure to sunlight. This indicates that other factors may contribute to your risk of melanoma.

RISK FACTORS

SUN EXPOSURE: UV B AND TO SOME EXTENT UV A/ VISIBLE

CONTROVERSY OVER CUMULATIVE EXPOSURE AND EARLY EXPOSURE

PRE-EXISTING LESION: 1/3 ARISE IN CONGENITAL NEVI; 1/3 IN NEVI > 5 YEARS;

1/3 IN NEVI < 5 YEARS

BLUE/GREEN EYES; BLOND/RED HAIR; FAIR CMPLEXION; INABILITY TO TAN

CUTANEOUS MELANOMA STATISTICS

IN 2001, 47,700 NEW CASES WILL BE DIAGNOSED

INCIDENCE IS INCREASING AT 5% PER YEAR

BY THE YEAR 2000 1 IN 75 PEOPLE WILL DEVELOP MELONAMA

THIS INCREASE IS GREATER THAN ANY OTHER CANCER IN MEN AND SECOND ONLY

TO LUNG CANCER IN WOMEN

15-30% OF MELANOMA OCCUR IN THE HEAD AND NECK

10 YEAR SURVIVAL FOR STAGE 1 MELANOMA OF THE HEAD AND NECK IS 69% COMPARED

TO 89% WITH MELANOMA OF THE EXTREMITY

50% RECCURRENCE RATE AFTER 5 YEARS FOR HEAD AND NECK COMPARED TO 50% IN

10 YEARS FOR EXTREMITY

CUTANEOUS MELANOMA STATISTICS

IS THIS SPOT A MELANOMA? USE THE ABCD METHOD:

ASSYMETRY- UNEVEN GROWTH RATE

BORDER- IRREGULAR (THE STRONGEST PREDICTOR OF MALIGNANCY)

COLOR- VARIETIONS AND SHADING

DIAMETER- INCREASES IN SIZE OR A DIAMETER >6MM

Skin Cancer and Sunshine Each year, more new cases of skin cancer are diagnosed in the U.S. than new cases of breast, prostate, lung, and colon cancer combined. One in five Americans will develop skin cancer in their lifetime. One American dies from skin cancer every hour. Unprotected exposure to UV radiation is the most preventable risk factor for skin cancer.

Skin Cancer and Sunshine Ultraviolet B rays are burning rays (blocked by window glass) that are the primary cause of sunburns and skin cancer. Ultraviolet A rays (penetrate through window glass) are able to penetrate deeper into the dermis or the base layer of the skin. UV A rays also contribute to skin burning and cancer. Both UV A and B rays can suppress the immune system, which helps protect against the development and spread of skin cancer.

Consequences of Skin Cancer Skin cancer, once discovered, must be removed. This involves excising (cutting out) the entire cancer.

Consequences of Skin Cancer Sometimes the removal of the cancer may involve radical surgery.

Consequences of Skin Cancer Once the cancer is removed, the wound must be closed. This may involve plastice surgery using adjacent skin flaps.

Consequences of Skin Cancer The surgery may be relatively successful. In the best-case scenarios, reconstructive surgery can leave the patient with an acceptable appearance.

Skin Infections

• The skin always has some amount of bacteria, fungus, and viruses living on it

• Skin infections occur when there are breaks in the skin and the organisms have uncontrolled growth

Skin Infections - Highlights

• Bacteria (can be cured) – Staphlococcus including MRSA & Impetigo

– Streptococcus

• Fungal (can be cured) – Ringworm

• Viral (can’t be cured but can be treated) – Herpes

– Warts

– Molluscum contagiosum

Folliculitis

• Inflammation of hair follicle

• Frequently caused by infection

• Physical injury can cause problem

• Painless or tender pustule

Furuncles (Boils) are very common. They are generally caused by the bacteria Staphylococcus aureus, but they may be caused by other bacteria or fungi found on the skin's surface. Damage to the hair follicle allows these bacteria to enter deeper into the tissues of the follicle and the tissue underneath. Boils may occur in the hair follicles anywhere on the body. They are most common on the face, neck, armpit, buttocks, and thighs. There can be one or many boils.

A carbuncle is a skin infection that often involves a group of hair follicles. The infected material forms a lump, which occurs deep in the skin.

Most carbuncles are caused by the bacteria staphylococcus aureus. The infection is contagious and may spread to other areas of the body or other people. A carbuncle is made up of several skin boils (furuncles). The infected mass is filled with fluid, pus, and dead tissue. Fluid may drain out of the carbuncle, but sometimes the mass is so deep that it cannot drain on its own. Carbuncles may develop anywhere, but they are most common on the back and the nape of the neck. Men get carbuncles more often than women. Because the condition is contagious, several family members may develop carbuncles at the same time. Often, the cause of a carbuncle cannot be determined.

STAPH

• “Staph” and “Strep” bacteria often cause skin infections.

• MRSA is a type of staph that is resistant to many of the traditional “Staph” antibiotics

The first bacteria that form a biofilm on

cleaned tooth surfaces are Streptococci

species (Gram positive cocci)

PERIODONTAL DISEASE

PERIODONTAL DISEASE

Within two days

Gram negative

bacteria also

appear in the

subgingival

biofilm and

gingival

inflammation

begins

PERIODONTAL DISEASE Early Gingivitis.

There is bleeding from

the gingival grooves

with probing, brushing

or mastication.

OTHER STREP INFECTIONS

Rheumatic fever Rheumatic fever is an inflammatory disease that may develop after an infection with Streptococcus bacteria (such as strep throat or scarlet fever). The disease can affect the heart, joints, skin, and brain.

OTHER STREP INFECTIONS

Causes, incidence, and risk factors Rheumatic fever is common worldwide and is responsible for many cases of damaged heart valves. It is not common in the United States, and usually occurs in isolated outbreaks. Rheumatic fever mainly affects children ages 6 -15, and occurs approximately 20 days after strep throat or scarlet fever.

OTHER STREP INFECTIONS Symptoms Abdominal pain Fever Heart (cardiac) problems, which may not have symptoms, or may result in shortness of breath and chest pain Joint pain, arthritis (mainly in the knees, elbows, ankles, and wrists) Joint swelling; redness or warmth Nosebleeds Skin nodules Skin rash (erythema marginatum)

Skin eruption on the trunk and upper part of the arms or legs Eruptions that look ring-shaped or snake-like

Sydenham chorea (emotional instability, muscle weakness and quick, uncoordinated jerky movements that mainly affect the face, feet, and hands)

Impetigo • A bacterial infection that can develop on any

exposed skin surface after skin-to-skin contact.

Ringworm (fungus) • Also known as Tinea corporis (fungus) • A contagious condition; a person can prevent scalp

ringworm by avoiding contact with infected people or objects such as brushes, combs, or hats.

Herpes Infections

• Herpes infections are associated with nerve endings and are never completely killed in the body

• Herpes skin infections are the same as sexually transmitted herpes infections – same organism and they recur during times of stress and illness

Molluscum contagiosum

• Virus infection of skin

• Discrete, flesh-colored, dome-shaped papules

Hives

• A.k.a. Urticaria • Formation of “wheals” • Usually raised, red welts appear • Multiple causes:

– Irritants – Allergens – Foods – Medications – Stress – Pet dander – Pollen – Environments

Atopic Dermatitis

• Poison Ivy • Poison Oak • Various chemicals • Clothing • Cosmetics • Laundry detergents • Food • Jewelry

Atopic Dermatitis From a Temporary Tatoo

Atopic Dermatitis From Shampoo

Psoriasis • A chronic skin condition, not infectious

The exact cause of psoriasis remains unknown. There may be a combination of factors, including genetic predisposition and environmental factors. It is common for psoriasis to be found in members of the same family. The immune system is thought to play a major role. Despite research over the past 30 years looking at many triggers, the "master switch" that turns on psoriasis is still a mystery.

Verruca Vulgaris

• “common wart”

• Benign, hypertrophied areas of the skin

• Papilloma

viruses

• Types – common warts

– plantar warts

• Contagious

Warts Gone Wild

How the Hair, Skin, and Nails Can Tell You That Your

Body is Sick

Epidermolysis bullosa (EB) is an inherited connective tissue disease causing blisters in the skin and mucosal membranes, with an incidence of 1/50,000. Its severity ranges from mild to lethal. It is caused by a mutation in the keratin or collagen gene.

Epidermolysis Bullosa

As a result, the skin is extremely fragile. Minor mechanical friction or trauma will separate the layers of the skin and form blisters. People with this condition have an increased risk of cancers of the skin, and many will eventually be diagnosed with it as a complication of the chronic damage done to the skin.

DISEASES OF THE SKIN, HAIR, AND NAILS DUE TO THE BODY’S

AUTOIMMUNE SYSTEM

Immune System

Major Structures

• white blood cells, lymph nodes and vessels, skin

Functions

• defends against pathogens and diseases

Interesting Facts…

• The immune system is constantly on guard to keep germs, bugs, and poisons out the body.

• The skin is the immune system’s first line of defense.

• There are germ-killing chemicals in saliva, tears, ear wax, and mucus.

• White blood cells destroy germs that enter through cuts.

• Sticky yellow pus is made of bodies of white blood cells that die in the battle against germs.

• An allergy is the immune system making a mistake.

• Some white blood cells make antibodies which can protect against bacteria, viruses, and poisons.

Eczema • The exact cause of

eczema is unknown, but it's thought to be linked to an overactive response by the body's immune system to an irritant. It is this response that causes the symptoms of eczema.

• In addition, eczema is commonly found in families with a history of other allergies or asthma.

Eczema of Head and Hand

I. Vasculitis

• Definition: Inflammation of a blood vessel wall due to an immune system reaction

• In AUTOIMMUNE VASCULITIS white blood cells attack one’s own blood vessel walls causing swelling of the vessels.

Large/Medium Vessel Vasculitis

Vasculitis

• Autoimmune system attack may also cause the following symptoms…

– fever, malaise, myalgia,

– arthralgia, lower ext. edema

Small Vessel Vasculitis:

Appearance

Small Vessel Vasculitis: Signs/Symptoms

• Renal-mild to severe

• Pain in extremeties

• Abdominal pain, diarrhea

• Cough, coughing blood

• Joint pain

• Heart arrhythmia

Systemic lupus erythematosus (SLE) Also called Lupus

• chronic inflammatory disease of unknown cause. Causes skin, joint, kidney, lung, nervous system, serous membrane and/or other organ inflammation.

Diagnosis of SLE

• 50% Will show skin rash

• 85% Will have some skin iregularity at some point

Discoid LE • distribution:

sun-exposed

• face and scalp

• papules, plaques

• erythema, pigmentary alteration, scarring, follicular plugging

SLE

• malar rash

• erythematous macules/patches/plaques

• butterfly distribution

• photo induced

• 90% arthritis

Other Symptoms of SLE

• Seborrhea (dandruff)

• paranasal scaling

• look for scalp/eyebrow involvement

• Contact dermatitis

– pruritic, well-demarcated

– look for other sites

Other Symptoms of SLE (cont.)

Dermatomyositis

• Periungual erythema

• Painful roughening and cracking fingers termed "mechanic's hands”

Dermatomyositis is a muscle disease characterized by inflammation and a skin rash. It is a type of inflammatory myopathy (muscle disease) The cause of dermatomyositis is unknown. Experts think it may be due to a viral infection of the muscles or a problem with the body's immune system. It can also sometimes occur in patients who have cancer of the abdomen, lung or other body area.

Scleroderma • variable sclerosis

• hands and face Scleroderma is a connective tissue disease that involves changes in the skin, blood vessels, muscles, and internal organs. It is a type of autoimmune disorder, a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue.

Scleroderma

Sarcoidosis

Sarcoidosis is a disease in

which abnormal collections of chronic inflammatory cells form in multiple organs. The cause of sarcoidosis is unknown. Inflammatory cells most often appear in the lungs or the lymph nodes, but virtually any organ can be affected. Normally the onset is gradual. It commonly improves or clears up spontaneously, but about 10% develop serious disability. Lung scarring or infection may lead to respiratory failure and death. Chronic patients may deal with waxing and waning symptoms over many years.

Sarcoidosis-Lupus pernio

• fibrotic disease • nose, lips, cheeks, ears • respiratory tract involvement • Uveitis (eye lining inflammation) • bone cysts • Arthritis • fever

Erythema Nodosum Erythema nodosum is an inflammatory disorder that involves tender, red bumps under the skin. Causes, incidence, and risk factors In about half of cases, the exact cause is unknown. Some cases may occur with Infections. Some of the more common ones are:

Streptococcus (most common) Cat scratch disease Chlamydia Hepatitis B Mononucleosis Syphilis Tuberculosis

Erythema Nodosum- Features

• Preceding uri

• Low grade fever

• Malaise

• Arthralgias 50%

Pyoderma Gangrenosum

• Defn: Ulcerating skin disease

• Population: Adults

• Distribution: Lower legs, but anywhere

• Morphology: – Tender red papules and pustules

dusky red/indurated nodules necrotic ulcer

– with undermined purple margin

– Cribiform scarring

Pyoderma Gangrenosum- Caused By:

• Inflammatory Bowel Disease

• Malignancy

• Rheumatoid arthritis

• 40-50% unknown

Shingles • After you get

chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves years later.

• The reason the virus suddenly become active again is not clear. Often only one attack occurs.

• You are more likely to develop the condition if your immune system is weakened by medications or disease

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