Dermatology

Module 1
Skin

The skin is an ever-changing organ that contains many specialized cells and structures. The skin functions as a
protective barrier that interfaces with a sometime-hostile environment. It is also very involved in maintaining the
proper temperature for the body to function well. It gathers sensory information from the environment, play an
active role in immune system protecting us from disease. Understanding how skin can function in these many ways
starts with understanding the strcture of 3 layers of skin – the epidermis, derma, and subcutaneous tissue.

Epidermis
The epidermis is the outer layer of sin. The thickness of epidermis varies in different types of skin. It is the thinnest
on the eyelid at 0.5mm and thickest on palms and soles at 1.5mm.the epidermis contains 5 layers. From bottom to
top the layers are named:

• Stratum basale
• Stratum spinosum
• Stratum granulosum
• Stratum licidum
• Stratum corneum

The bottom layer, the Stratum basale, has cells that are shaped like columns, in this layer the cells divide and push
already formed cells into higher layers. As the cells move into the higher layers, they flatten and eventually die.

The top layer of epidermis, the stratum corneum, is made of dead, flat skin cells that shed about every 2 weeks.

Specialized epidermal cells

There are three types of specialized cells in the epidermis.

• The melanocytes produces pigment (melanin)

• The langerhans’ cell is frontline defense of the immune system in the skin
• The merkel’s cell function is not clearly known

Dermis

The dermis also varies in thickness depending on the location of the skin. It is 0.3mm on the eyelid and 3.0mm on
the back. The dermis is composed of three types of tissue that are present throughout-not in layers. The types of
tissue are:

• Collagen
• Elastic tissue
• Articular fibers

Layers of dermis

• The two layers of dermis are papillary and reticular layers.

• The lower reticular layer is thicker and made of thick collagen fibers that arranged parallel to the surface of
the skin.

Specialized dermal cells

• The dermis contains many specialized cells and structures

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Module 1

• The hair follicles are situated here with erector pili muscle that attaches to each follicle.
• Sebaceous (oil) glands and apocrine (scent) are associated with the follicle.
• This layer also contains acrine (sweat) glands but they are not associated with the hair follicles.
• The blood vessels and nerves course this layer, the nerves transmit sensation of pain itch and temperature.
• There are specialized nerve cells called Meissner’s and Vater-pacini corpuscles that transmits the light
sensation of touch and pressure, the sensation of heat is called ruffini, cold sensation is called krause’s end
bulbs corpuscles.

Sub-cutaneous tissue

• It is a layer of fat and connective tissue which houses a larger blood vessels and nerves.
• This layer is important because it regulates temperature of the skin and the body.
• The size of the layer varies throughout the body and from person to person.

The skin is a complicated structure with many functions. If any of the structures in the skin are not working
properly, a rash and abnormal sensation is the result. The whole specialty of the dermatology is devoted to
understanding of the skin, what can go wrong, and what to do if something does go wrong.

Structure of the skin

• Skin is covering the human body.

• It started to develop in first week of the prenatal life from ectoderma and mesoderma.
• It consist from epiderma, derma and hypoderma .
• The skin is an organ that forms a protective barrier against germs (and other organism) and keeps the inside
of your body inside, and keeps what outside of your body outside.
• Skin also helps to maintain a constant body temperature.
• Human skin is only about 0.07 inches (2mm) thick.
• Skin is made up of 2 layers that cover a third fatty layer.
• The outer layer is called the epidermis, it is a tough protective layer that contains melanin (which protects
against the rays of the sun and gives the skin its color).
• The second layer (locate under the epidermis) is called the dermis, it contains the nerve endings sweat
glands, oil glands and hair follicles. Under this 2 skin layers is a fatty layer of sub cutaneous tissue (the
word sub cutaneous means “under the skin”).
• On average, an adult has from 18-20 sq. ft. (about 2 sq. m.) of skin, which way about 6 pounds (2.7 kg).

Epidermis

• The epidermis is the most superficial layer of the skin and provides the first barrier of protection from the
invasion of foreign substances into the body. The principal cell of the epidermis is called keratinocyte. The
epidermis is subdivided into five layers or strata, the stratum, germinativum(SG), the stratum
spinosum(SS), the stratum granulosum(SGR), the stratum lucidum ( not seen in this photomicrograph) and
the stratum corneum (SC) in which a keratinocyte gradually migrates to the surface and is sloughed off in a
process called desquamation.

Derma

• The derma (D) assumes the important functioning of the thermoregulation and supports the vascular
network to supply the avascular epidermis with nutrients. The dermis is typically subdivided into two
zones, a papillary dermis and a reticular layer. The dermis contains mostly fibroblasts which are
responsible for secreting collagen, elastin, and ground substance that give the support and elasticity of the

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Module 1
skin. Also present are immune cells that are involved in the defense against foreign invaders passing
through the epidermis.

Skin Appendages

The skin contains a variety of appendages, mainly hair follicles (HF), sweat glands and sebaceous glands (SG),
which are all embryonically epidermal in origin.

Function of the skin

• Protecting role_ mechanical, immune (T- Lymphocytes), barrier

• Secretin(Keratinum, Fat, Sweat)
• Respiratory(reabsorption)
• Heat regulatory
• Receptor-tactile, pain, temperature sense
• Exchange (Depot of iodine, fat, minerals and vitamins producing A, E, and D).

Reason of skin diseases

External reasons: contacts, mechanical, physical, thermal, chemical, and infections

Internal reasons: internal diseases, disturbance of metabolism, psychosomatic reasons, problems with nervous
system, stress and others.

Hereditary factors: Allergy

Primary elements of rash:

Proliferative: macula, hemorrhagic, papule, tuberculum, nodus, and urtica. Exudative: Bulla, Vesicles, and Pustule.

1. Spot (macula) - most simple primary element, clinically it’s only a change of the skin color.
2. Papula- is the element without cavity, emanating above skin level. Pathology is in epidermis or the upper
parts of derma.
3. Tubercle (Tuberclum) –infiltration without cavity, above skin level, hemisphere form or plane, round,
inflammation color, different consistency and size.
4. Nodus – sphere form or looks like egg or knob with the size of Greek nut or bigger, in the basis has cellular
infiltration, could be very massive.
5. Bladder (Bulla) –big cavitum development, which stay different levels of the skin, cover of this could be
tense and not, usually formed on the level of epiderma.
6. Vesicular – small cavital element, consist from serosity fluid the size of the usually from 1 to 5mm, the
yare place on inflammation basis, after recovery there are no signs on the skin.
7. Blister (urtica) –element without cavity, acute inflammation morphology, developing because of acute
edema of derma.
8. Pustule – cone shaped, a rounded with inflammation, with size from 5 to 10mm, consist from pus

Second elements of rash

1. Sand buckles (sqaumae) – loosened seizing of horn stratum, which locate above the primary elements of
rash.
2. Scab (crusta) – exudation of different type, which has under erosion, ulcer.
3. Fissure – line breach of the skin, upon to loose elastic and infiltration.

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4. Excoriation- defect of the skin because of mechanical reason – comber and others
5. Ulcers (ulcus) – deep skin defect covering epidermis, derma and hypo-derma.
6. Scar (cicatrix) – fibrous tissues, replacing deep defect of the skin.
7. Vegetation –uneven papaillomatosis accretion of the epidermis and papilla part of the derma on the place of
primary element of the rash.
8. Lichenifications – changes of the skin, characterize with compression, reinforcements of pattern,
hyperpigmentation, similar to shagren skin.

General principle of the treatment

a) Concept diagnosis establishment of cause and eliminate or correct cause

b) Reassuracnce to patient and realtives so also alley their anxiety about infection, severity and scaring and
recovery chances.
c) Specific and paleative treatment
• General measures – diet, rest, environment.
• Long term - systemic drugs
• Local – topical measure
• Physical treatment – surgery

General measure:

a) Mind: physic sponsor (emotional conflict- polychartist)

b) Diet: spices, non- vegetarian food, tea, coffee, alcohol not if allergic
c) Rest
d) External environment - home
1. General treatment
2. External treatment
3. Internal treatment

General treatment

• Psycho-pharmacology treatment nerve system treatment with medicines

• Psychotherapy – by words and behavior
• Electro sleep
• Acupuncture
• Vitamin therapy
• Hormonal treatment
• Antibiotics
• Chemistry therapy
• Immune therapy

External treatment

• Lotions – to reduce wet, itch

• Compress – for better recovery
• Liniments, ointments
• Powdering - reduce acute inflammation
• Dredges- to dry the wet parts
• Paste – powder with liniments

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• Oils – for clean elements of rash

Internal Treatment

Treatment of internal disease of:

Liver, kidney, digestive system – intestine, metabolism, endocrine system, and allergy

Systemic Scar:

Corticosteroids and adreno-corticoscpic – hormones.

Pulse therapy – Ig alone succinate in 150 ml of 5 % dextrose daily for 3-5 days.

Hydrocortisone -20-240mg Predinosolne- 5-60mg

Frucorisone

Antibiotics – bacterically agents erythromycin topical gel or solution 2-4/ day

Clindamycin 1/day, cephalosporin

Antifungal: Gerseofluvin, Ketoconazole, Fluconazole, Acyclovir

Antihistamine- Amititidine

Sex hormones: Estrogen, androgen,

Vitamins.

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