Dermatology
The Skin
• Largest organ in the body
• Performs many functions to protect the body
– Regulates body temperature
– Maintains water and electrolyte
balance
– Focal point of the body’s sense of
touch, temperature, and pain
– Defends the body against infection
– Shields the body from the sun’s harmful
effects
– Protects the body’s deeper tissues from
injury
Anatomy of the Skin
• Skin collectively is referred to as integument
• Integumentary system consists of:
– Skin
– Its accessory structures (hair, sweat
glands)
– Underlying tissue
• Cutaneous describes something relating to the
skin
Three layers: Epidermis, dermis, and subcutaneous
• Epidermis
– The outermost layer of skin made up of
stratified, or layered, tissue
– The thinnest layer of skin and the first
barrier of protection against foreign
substances entering the body
– Keratinocytes – the principal cells of
the epidermis
– Skin cells are produced by mitosis, the
basic process of cell division and
producing new cells
– Desquamation is the process of
replacing dead skin cells with new cells
from deeper layers below
• Five sub-layers of the epidermis:
– Bottom layer—stratum germinativum
(basal layer)
• Made up of basal cells and
melanocytes that produce
melanin, the pigment that
makes up skin color
– Stratum spinosum (spiny layer)
– Stratum granulosum (grainy layer)
– Stratum lucidum (clear layer)
– Stratum corneum (uppermost, horny
layer)
• Contains mostly dead skin cells
• Dermis HAIR

—Second Layer, often called “true skin” – Composed of dead epithelial cells

Contains: – Contains varying amounts of melanin

for color
- Collagen and fibrillin that gives elasticity,
tone, and strength to skin – The root ends in a bulb, which is lodged
- Nerve endings, hair follicles, and blood in a pit in the skin called a follicle
vessels
– Each follicle gives rise to a single hair –
- Immune cells that defend the body against
foreign invaders the skin of the average adult contains about
5 million hairs
- Papillary layer, where epidermis and dermis
meet

• Subcutaneous Layer NAILS

—Third Layer – Develop from the epidermis and

protect the tips of the fingers and toes
– Subcutaneous means “beneath the
skin” – Lunula: the white half-moon shape
located on top of the nail at the proximal
– Also called the “fat layer”
end of the nail bed
– Fastens the skin to the underlying body
surface

– Stores most body fat

 – Paronychia: a bacterial infection caused
by biting or tearing the skin at the side or
base of a fingernail

– Onychomycosis: a fungal infection of

the nail

GLANDS: 2 Types

• Exocrine glands, which drain

secretions through ducts, or tubes

• Two types of exocrine glands: Common Dermatologic Disorders and Treatments

• Rash: Also called rubor, is an inflammation in
• Sebaceous glands open into hair the skin that affects its appearance or texture
follicles and secrete sebum, which – Symptoms of rash:
softens and lubricates the skin • Erythema (redness)
• Pruritus (itching)
• Sebaceous cyst: a sebaceous
• Edema (swelling)
gland that becomes blocked
• Hives (urticaria)
with sebum
• Dermatitis: an inflammation of the upper layers
• Sweat glands secrete a watery fluid of the skin that results in a rash
(sweat) in response to heat or – Types of dermatitis:
sometimes to emotions such as fear • Seborrheic dermatitis – causes
(“cold sweat”) scaly, flaky, itchy patches over
sebum-rich areas of the skin of
• Mammary Glands Found only in the scalp, face, and occasionally
mammals. Are structurally related to the trunk of the body (e.g.,
the skin in that they are a modified type dandruff, “cradle cap” in
of sweat gland but functionally related infants)
to the reproductive system because • Unknown cause but
they produce milk to nourish offspring. thought to be caused
by a fungal infection
• Endocrine glands, which
• Condition can become
release secretions directly into the bloodstream or
chronic in individuals
tissue spaces to be circulated throughout the body
with decreased
Nerve Endings immunity
• Atopic dermatitis (eczema) –
- Also called “receptors,” the skin contains chronic rash and dry, thickened
millions of them all over the body skin
- Located in the dermis Treatments for atopic dermatitis:
- The sensitivity of an area of skin is related to • Oral drugs to control symptoms
the number of receptors present, making some and spread (antihistamines and antibiotics)
areas more sensitive than others • Phototherapy: Exposure to
- Send nerve impulses to the brain when they ultraviolet (UV) light, which can kill certain
detect changes (pain, heat, cold, etc.) cells involved in skin disease
 – Sometimes combined
with psoralen, a drug taken orally before
treatment to lessen effects of UV therapy
– PUVA (POO-va)
therapy: An acronym for the oral
administration of psoralen and UV light
• Topical immunomodulators
(TIMs): Drugs that inhibit inflammatory skin
reactions (Protopic, Elidel)
• Rosacea: a chronic skin
condition causing redness and flushing around the
center of the face and eyes
- Cause unknown, but thought to be hereditary
• Treatments for rosacea
• Topical antibiotics
(metronidazole and clindamycin) to improve
health and appearance of the skin
• Oral antibiotics (tetracycline,
doxycycline, erythromycin)
• Electrosurgery and laser
surgery to reduce the visibility of blood vessels
in the face and improve facial appearance
• Psoriasis: A chronic disease characterized by
red, raised patches with silvery scales (plaques) due
to an abnormally high rate of skin cells. Cause is
unknown.
• Treatments for psoriasis:
• Treatment to reduce the growth of skin
cells (Dovonex ointment)
• Phototherapy and PUVA therapy
• Exposure to natural sunlight
Skin Infections
• Skin infections occur when skin barrier is broken
and bacteria, viruses, fungi, and parasites enter
the body
• Three most common types:
– Bacterial
– Fungal
– Viral
Bacterial Skin Infections
– Cellulitis: an acute bacterial infection of
the skin and underlying tissues
• Most common bacterial cause:
Streptococcus species
• Invades skin to deep dermis and
spreads quickly, resulting in redness, swelling,
and tenderness
• Peau d’orange: Term used to
describe tense skin resembling the peel of an
orange
• Diagnosis made by skin
appearance as well as blood cultures and/or
skin biopsies.
• Complications of cellulitis
• Strep cells can invade the body
and result in:
• Cardiac impairment (bacterial
endocarditis), an infection of the heart
muscle
• Infections of the lymph nodes
throughout the body
• Gangrene (tissue death) and
flesh-eating bacteria
• Treatments:
• Antibiotic treatments
(penicillin)
• Cool, wet dressings to infected
skin
• Impetigo
– A contagious skin infection leading to
fluid-filled, honey-colored clusters called bullae on
the body
– Commonly affects children and is
spread by fluid that oozes from the blisters
– Caused primarily by Streptococcus or
Staphylococcus aureus, or a combination of both
– Treatments
– Antibiotic ointments (Bactroban)
– Oral antibiotics for more severe cases
(dicloxacillin, erythromycin, or
cephalexin) to clear the lesions.
• Folliculitis
– a bacterial infection of hair follicles that develops
when bacteria (most commonly Staphylococcus aureus)
invades the skin
– Boil: A warm, painful, pus-filled pocket
of infection below the skin’s surface
– Carbuncle: A cluster of abscesses
connected to each other under the skin
– Treatments
 – Topical antibiotic creams (neomycin,
bacitracin)
– Oral antibiotics to kill staphylococci
Fungal Skin Infections
• Caused by dermatophytes (microscopic
organisms) that live on keratin in skin
• Warmth, moisture, or irritation to the skin can
cause them to grow uncontrollably, resulting in
a skin infection
• Mycosis: Another name for “fungal infection of
the skin”
• Mycologist: A person who identifies and
classifies fungal infections
• Tinea
- another name for ringworm, because of the circular
shape of the rash
• Tinea capitis—scalp or neck
• Tinea barbae—beard area
• Tinea corporis—nonhair parts of the
body (arms, shoulders, and face)
• Tinea cruris—groin, also called jock itch
• Tinea pedis—feet, also called athlete’s
foot
• Treatment for ringworm:
• The use of special shampoo to eliminate
fungus on the scalp
• Oral antifungal medication or steroids
to help destroy the fungus and reduce
inflammation of the skin
• Candidiasis
- commonly called a fungal infection, yeast infection,
or thrush
- Caused by the Candida species of fungi
- Candida: small, thin-walled yeasts that reproduce
by budding
- Candida albicans: probably the most common form
of skin disease in humans
- Cutaneous candidiasis: infection of the skin with
Candida, the most common form of candidiasis
(intertrigo and diaper rash are common
manifestations)
• Treatments for candidiasis
• Antifungal creams (nystatin or
clotrimazole creams) applied to the affected
area
• Oral antifungal drugs (fluconazole) to be
taken internally
Viral Skin Infections
• Caused by a virus entering the skin and causing
skin conditions requiring treatment by a
physician
• Warts
- also called verrucae, are small skin growths caused
by the Papillomavirus
• Plantar warts—bottom of the foot
• Filiform warts—face, neck, or lips
• Genital warts—around the genitals;
also called condyloma acuminata
• Verrucae vulgaris—on the hands, arms,
and legs; also called common warts
• Treatments:
• Often go away on their own
• Over-the-counter corrosive agents
• Surgically removed with cryotherapy
(freezing), electrocautery (burning), or
laser surgery
• Shingles
- also called herpes zoster
• A viral infection of the nerves caused by
reactivation of the varicella-zoster virus that
causes chickenpox
• “Chickenpox” initial manifestation of
the virus, which re-emerges after laying
dormant in the spinal or cranial nerves for
several years, causing pain and a painful
rash on the skin
• Chronic pain that remains in the area
after rash is called postherpetic neuralgia
• Treatments
• Topical creams (sulfadiazine)
• Oral antivirals (acyclovir, famciclovir,
valacyclovir)
Damage from Heat and Cold
• Burn
– an injury caused by heat, electricity, chemicals, or
radiation
– Destroys layers of skin
– May require long-term medical care,
multiple surgeries, and psychological treatment
• First degree
– Outer layer (epidermal) of skin
– No blisters
– Heal quickly
• Second degree
– Affects both epidermal and
dermal layers
– Burns heal but leave a change
in skin color
• Third degree
– Destroys all the epidermal and dermal
skin layers
– Damage extends to deep subcutaneous
tissue
– The skin becomes charred and leathery
• Fourth degree
– Deep enough to involve muscle, bone,
tendon, and/or ligaments
– Life-threatening
• Burn Treatments
– Topical antibiotic cream for minor burns
– Debridement: dead tissue and debris
are removed from wound to expose
and cleanse the area
• Dressings: materials used to
cover and protect the wound
• Dressing changes: the process
of removing old bandages and
replacing them with new ones
• Skin Grafting
- where a layer of healthy skin is taken from another
area of the body and transferred to the area of skin
defect
– Autologous graft (autograft): graft
taken from the patient’s own skin
– Cadaver graft (allograft): graft taken
from the skin of a dead person
– The graft is applied and takes up blood
supply from the wound, helping it to survive
• Types of Grafts:
– Split-thickness skin graft: a graft that
includes the epidermal layer and part of
the dermal skin layers
– Full-thickness skin graft: consists of
both the epidermal and complete
dermal skin layers
– Artificial skin grafts: skin substitutes
created in the laboratory that contain
components of donated skin tissue that
is more useful because it will not be
rejected by the body
• Frostbite
- an injury to skin and underlying tissues resulting
from exposure to very cold temperatures
– Ice crystals begin to form in the tissues
– Ice crystals cause the skin to rupture,
killing skin cells
• First degree
– Temporary tenderness and numb
– White patches of skin that peel after
warming
– No permanent skin damage
• Second degree
– Formation of blisters
– Underlying tissue is unharmed
• Third degree
– Extremity feels cold, numb, and hard
– Underlying tissue damage that feels
hard and cold
– Eventually requires skin grafts or
amputation of the affected limb
Skin Cancers
• The most common form of cancer in the U.S.
• Ultraviolet radiation is the main cause of skin
cancer
• Develop when DNA in skin tissues becomes
damaged and the body cannot repair the
damage. Damaged cells multiply and divide
uncontrollably, forming a mass, called a lesion
or tumor, on the skin.
• Most skin cancers detectable and treatable at
an early stage
• Three main types, named after the type of cell
in which it originates: basal cell, squamous cell,
and melanoma
• Basal cell carcinoma
 – Most common skin cancer – Punch biopsy: removal of a cylinder of
– Begin in the basal cells located in the skin with a sharp, punchlike instrument
lowest layer of the epidermis – Excisional biopsy: removal of the entire
– Generally do not spread to other parts lesion for analysis
of the body • KOH test (pronounced K-O-H)
• Squamous cell carcinoma – A microscopic examination of skin, hair,
• Begins in the squamous cells located in or nails for the presence of fungus
the upper levels of the epidermis – Named after potassium hydroxide
• Can spread to other parts of the body (KOH), which is used to help identify
• Melanoma fungi in the sample
• Arises from the melanocytes in the • Tzanck Test
epidermis – Also called “herpes skin test” or
• Most harmful; prognosis poor if not “chickenpox skin test”
caught early – Tests for herpes simplex virus, which
• ABCD method for evaluating suspicious causes cold sores, fever blisters, or
skin lesions: genital sores
• A: Asymmetry – uneven or – Also tests for presence of varicella
irregular shape zoster virus (for chickenpox and
• B: Border irregularity – smooth shingles)
or jagged or notched
• C: Color variation – various
colors may indicate skin cancer
• D: Diameter of 6 mm or more
– cancerous lesions grow larger than regular
moles
• Treatments
– Curettage and desiccation
• Curettage: removing the lesion with a
scooplike instrument called a curette
• Desiccation: application of electric
current to the area to control bleeding
and kill remaining cancer cells
– Surgical excision
– Radiation therapy: high-energy x-rays kill or
shrink cancer cells
– Cryosurgery: freeze and kill abnormal cells
– Mohs surgery: process of removing tumor layer
by layer
- Chemotherapy for malignant melanoma

Diagnostic Studies and Procedures

• Skin Biopsy: removing a sample of skin and
examining it under a microscope
– Shave biopsy: removes only superficial
levels of skin