Anatomic and Physiologic Overview

Largest organ system in the body Skin forms a barrier between the internal organs and the external evironments and participates in many vital functions. Functions: 1.Protection -provides protection againts abrassion and ultraviolet light. -Prevents the entry of microorganisms and dehydration by reducing water loss from the body. 2.Sensation -has sensory receptors that can detect heat, cold, touch, pressure, and pain. 3. Vitamin D production -When exposed to ultraviolet light, the skin produces a molecule that can be transformed into vitamin D. 4. Temperature regulation -Body temperature is regulated by controlling blood flow through the skin and the activity of sweat glands. 5. Excretion -Small amounts of waste products are lost through the skin and in glands secretion.

Anatomy of the Skin, Hair, Nails, and Glands of the Skin

Epidermis -contiguous with the mucous membranes and the lining of ear canals -consists of live, continously dividing cells covered on the surface by dead cells that were originally deeper in the dernis but were pushed upward by the newly developin cells underneath. -dead cells contains large amounts of keratin, an insoluble fibrous protien that forms the outer barrier of the skin and has the capacity to repel pathogens and prevent excessive fluid loss from the body. -Melanocytes are the special cells of the epidermis that are primarily involved in producing the pigment melanin, which colors the skin and hair. Dermis -makes up the largest portion of the skin, providing strenght and structure. Subcutaneous Tissue -subcutaneous tissue or hypodermis, is the innermost layer of the skin. -it is primarily adipose tissue, which provides cushion between the skin layers, muscles, and bones. -It promotes skin mobility, molds body contours, and insulates the body. Hair -out growth of the skin -present over the entire body except for the palms and soles. -consist of a root formed in the dermis and a hair shaft that projects beyond the skin. -grows in a cavity called a hair follicle. Nails -located on the dorsal surface of the fingers and toes -a hard transparent plate of keratin that overlies the skin -grows from its roots, which lies under a thin fold of skin called cuticle. -protects the fingers and toes by preserving their highly developed sensory functions.

Que, Honey Sharlotte L. BSN III-G

Glands of the skin

-2 types of glands: Sebaceous glands- associated with hair follicles Sweat glans- found in the skin over most of the body surface. -subclassified into two categories: Eccrine- found in all areas of the skin. -ducts are open directly onto the skin surface. Apocrine- larger than eccrine sweat glands. -located in axillae, anal region, scrotum, and labia majora. -their ducts generally open onto hair follicles. Disorders of the Integumentary System Seborrhoeic dermatitis also known as "seborrheic eczema" is an inflammatory skin disorder affecting the scalp, face, and trunk. Typically, seborrheic dermatitis presents with scaly, flaky, itchy, red skin. It particularly affects the sebumgland rich areas of skin. Pathophysiology There is increasing acceptance that the lipophilic yeast Pityrosporum ovale, a commensal skin organism, is a contributing factor. Increased sebaceous gland activity likely favors the growth of P. ovale. The use of topical antifungal agents such as ketoconazole significantly decreases the number of Pityrosporumyeast in seborrheic dermatitis patients with subsequent clinical improvement. The local host immune response to P. ovaletoxins or enzymes also plays a probable role in the development of seborrheic dermatitis. Androgen-mediated stimulation of sebaceous gland activity is likely important, given that seborrheic dermatitis presents in infancy and puberty. Diagnosis: clinical evaluation with characteristic manifestations detailed history to locate possible source of contact rash patch test may isolate allergens Treatments Dandruff is usually treated with a shampoo that contains salicylic acid, selenium sulfide or zinc pyrithione. These shampoos can be used 2 times a week. Shampoos that contain coal tar may be used 3 times a week. Contact dermatitis is a term for a skin reaction resulting from exposure to allergens or irritants Phototoxic dermatitis occurs when the allergen or irritant is activated by sunlight. Symptoms localized rash or irritation of the skin takes days to fade away results in large, burning, and itchy rashes Pathophysiology Contact dermatitis is caused by irritants or allergens. Irritant contact dermatitis is a nonspecific inflammatory reaction to substances contacting the skin; the immune system is not activated. Numerous substances are involved, including: Chemicals (eg, acids, alkalis, solvents, metal salts)

 Soaps (eg, abrasives, detergents) Plants (eg, poinsettias, peppers) Body fluids (eg, urine, saliva) Phototoxic dermatitis is a variant in which topical (eg, perfumes, coal tar) or ingested (eg, psoralens) agents generate damaging free radicals and inflammatory mediators only after absorption of ultraviolet light. Allergic contact dermatitis -type IV cell-mediated hypersensitivity reaction that has 2 phases: Sensitization to an antigen -allergens are captured by Langerhans' cells (dendritic epidermal cells), which migrate to regional lymph nodes where they process and present the antigen to T cells. The process may be brief (6 to 10 days for strong sensitizers such as poison ivy) or prolonged (years for weak sensitizers such as sunscreens, fragrances, and glucocorticoids). Sensitized T cells then migrate back to the epidermis and activate on any reexposure to the allergen, releasing cytokines, recruiting inflammatory cells, and leading to the characteristic symptoms and signs of ACD. Allergic response after reexposure -In autoeczematization, epidermal T cells activated by an allergen migrate locally or through the circulation to cause dermatitis at sites remote from the initial trigger. However, contact with fluid from vesicles or blisters cannot trigger a reaction elsewhere on the patient or on another person. Diagnosis Clinical evaluation Sometimes patch testing treatment Avoidance of offending agents Supportive care (eg, cool compresses, dressings, antihistamines) Corticosteroids (most often topical but sometimes oral) Eczema Eczema is a general term for many types of skin inflammation (dermatitis). is a group of skin conditions that cause skin to become red, irritated, itchy, and sometimes develop small, fluid-filled bumps that become moist and ooze. Pathophysiology Doctors do not know the exact cause of eczema, but a defect of the skin that impairs its function as a barrier, possibly combined with an abnormal function of the immune system, are believed to be important factors. Some forms of eczema can be triggered by substances that come in contact with the skin, such as soaps, cosmetics, clothing, detergents, jewelry, or sweat. Environmental allergens (substances that cause allergic reactions) may also cause outbreaks of eczema. Changes in temperature or humidity, or even psychological stress, can lead to outbreaks of eczema in some people. Diagnosis Eczema is usually diagnosed through a physical examination. Further tests may include skin biopsy, in which a small sample of the inflamed skin is removed for testing, or patch tests, in which little patches of different substances are stuck to your skin for a few days to see if you react to any of them. Treatment lifestyle changes and the use of medications.

Que, Honey Sharlotte L. BSN III-G

 Keeping skin well hydrated through the application of creams or ointments as well as avoiding overbathing. Corticosteroid creams are sometimes prescribed to decrease the inflammatory reaction in the skin. To control itching, the sedative type antihistamine drugs like diphenhydramine [Benadryl], hydroxyzine [Atarax, Vistaril], and cyproheptadine. short course of oral corticosteroids such as prednisone. two topical (cream) medications such astacrolimus (Protopic) and pimecrolimus (Elidel). Acne is a common human skin disease, characterized by areas of skin with seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples), nodules (large papules) and possibly scarring. affects mostly skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Acne occurs most commonly during adolescence, and often continues into adulthood. Signs and symptoms seborrhea (scaly red skin) comedones (blackheads and whiteheads) papules (pinheads) pustules (pimples) nodules (large papules) possibly scarring Pathophysiology During chilhood, the sebaceous gland are small and virtually nonfunctioning. These glands are under endocrine control, especially by the androgens. During puberty, androgens stimulate the sebaceous glands, causing them to enlarge and secrete a natural oil, sebum, which rises to the top of the hair follicle and flows out onto the skin surface. Diagnosis Your doctor can diagnose acne based on the appearance of the skin. Testing is usually not required. Treatment Clean your skin gently with a mild, non-drying soap. Remove all dirt or make-up. Wash once or twice a day.However, avoid excessive or repeated skin washing. Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this, it can lead to skin infections and scarring. Avoid touching your face with your hands or fingers. Avoid greasy cosmetics or creams. Prescription medicines include: Oral antibiotics such as minocycline, doxycycline, tetracycline, erythromycin, and amoxicillin Topical antibiotics such as clindamycin, erythromycinm or dapsone Retinoic acid cream or gel (Retin-A) and isotretinoin pills (Accutane) Prescription formulas of benzoyl peroxide, sulfur, resorcinol, salicylic acid spironolactone may help women with hormonally controlled acne. A laser procedure called photodynamic therapy may also be helpful. Birth control pills can sometimes help clear up acne. chemical skin peeling, removal of scars by dermabrasion, or removal, drainage, or injection of cysts.

 A small amount of sun exposure may improve acne. Psoriasis is a chronic autoimmune disease that appears on the skin. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious. The most common form, plaque psoriasis, is commonly seen as red and white hues of scaly patches appearing on the top first layer of the epidermis (skin). Some patients, though, have no dermatological symptoms. Diagnosis A diagnosis of psoriasis is usually based on the appearance of the skin. There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy, or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will show clubbed Rete pegs if positive for psoriasis. Another sign of psoriasis is that when the plaques are scraped, one can see pinpoint bleeding from the skin below (Auspitz's sign). Treatment Topical agents Bath solutions and moisturizers, mineral oil, and petroleum jelly. Ointment and creams containing coal tar, dithranol (anthralin), corticosteroids like desoximetasone (Topicort), fluocinonide, vitamin D3 analogues (for example, calcipotriol), and retinoids. Phototherapy Phototherapy in the form of sunlight. Wavelengths of 311313 nm are most effective and special lamps have been developed for this application. Systemic agents Psoriasis that is resistant to topical treatment and phototherapy is treated by medications taken internally by pill or injection (systemic). The three main traditional systemic treatments are methotrexate, cyclosporine and retinoids. Herpes Simplex is a viral disease caused by both herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Oral herpes -coldsores or fever blisters -most common form of herpes Genital herpes, known simply as herpes, is the second most common form of herpes. Common infection of the skin or mucosa may affect the face and mouth (orofacial herpes), genitalia (genital herpes), or hands (herpes whitlow). More serious disorders occur when the virus infects and damages the eye (herpes keratitis), or invades the central nervous system, damaging the brain (herpes encephalitis). Patients with immature or suppressed immune systems, such as newborns, transplant recipients, or AIDS patients are prone to severe complications from HSV infections. Pathophysiology Herpes is contracted through direct contact with an active lesion or body fluid of an infected person.

Que, Honey Sharlotte L. BSN III-G

Herpes transmission occurs between discordant partners; a person with a history of infection (HSV seropositive) can pass the virus to an HSV seronegative person. The only way to contract Herpes simplex virus 2 is through direct skin-to-skin contact with an infected individual. To infect a new individual, HSV travels through tiny breaks in the skin or mucous membranes in the mouth or genital areas. Diagnostics Specimen Collection Cell Culture ELVIS (Enzyme Linked Viral Induced System) Treatment Antiviral aciclovir (acyclovir), valaciclovir (valacyclovir), famciclovir, and penciclovir Topical acyclovir, penciclovir, and docosanol. Alternative medicine dietary supplements and alternative remedies echinacea, eleuthero, L-lysine, zinc, bee products and aloe vera.