Podcast
Questions and Answers
What is a distinguishing feature of parakeratosis?
What is a distinguishing feature of parakeratosis?
Which of the following skin infections is associated with polymicrobial etiology?
Which of the following skin infections is associated with polymicrobial etiology?
What skin condition is characterized by 'footprints in snow'?
What skin condition is characterized by 'footprints in snow'?
In psoriasis, which subtype is characterized by pustular lesions?
In psoriasis, which subtype is characterized by pustular lesions?
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Where are the changes associated with an epidermal melanin unit primarily observed?
Where are the changes associated with an epidermal melanin unit primarily observed?
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Which of the following is NOT a typical characteristic of a leprosy lesion?
Which of the following is NOT a typical characteristic of a leprosy lesion?
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What is the diagnostic significance of a Skin Smear (SSS) test in leprosy?
What is the diagnostic significance of a Skin Smear (SSS) test in leprosy?
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Which of the following conditions is associated with golden yellow coloration under Wood's lamp?
Which of the following conditions is associated with golden yellow coloration under Wood's lamp?
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What type of psoriasis is characterized by the presence of Munro’s microabscess?
What type of psoriasis is characterized by the presence of Munro’s microabscess?
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Which characteristic is associated with the epidermal turnover time?
Which characteristic is associated with the epidermal turnover time?
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In which condition would you typically observe Civatte bodies?
In which condition would you typically observe Civatte bodies?
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Which type of leprosy is characterized by a high number of lesions with ill-defined margins?
Which type of leprosy is characterized by a high number of lesions with ill-defined margins?
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What is indicated by the presence of 'exclamatory mark sign' in alopecia?
What is indicated by the presence of 'exclamatory mark sign' in alopecia?
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Which condition is not characterized by arithmetically arranged papules?
Which condition is not characterized by arithmetically arranged papules?
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What distinguishes the Wood's lamp examination at UV-A 365nm?
What distinguishes the Wood's lamp examination at UV-A 365nm?
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Which statement is true about Acanthocytes?
Which statement is true about Acanthocytes?
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Study Notes
Basics of Skin
- Parakeratosis: Retention of nuclei in the stratum corneum (outermost layer of skin), seen in palms and soles.
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Hyperkeratosis: Thickening of the stratum corneum.
- Orthokeratosis: Normal keratinization with no nuclei in the stratum corneum.
- Eleidin: Refractile granules in the stratum granulosum (layer beneath the stratum corneum), seen in palms and soles.
- Odland bodies/Fillagrin: Keratinocyte granules that contribute to skin barrier function.
- Munro's microabscess: Collection of neutrophils within the stratum corneum, seen in psoriasis.
- Pautrier's microabscess: Collection of lymphocytes in the stratum corneum, seen in mycosis fungoides.
- Civatte bodies: Degenerating keratinocytes in the epidermis, seen in lichen planus.
- Acanthocytes: Spiky red blood cells, seen in autoimmune disorders.
- Desmoglein (DSG): Cell adhesion molecule that can be targeted by autoimmune antibodies in certain skin conditions.
- Langerhans cells: Antigen-presenting cells found in the epidermis.
- Melanocytes: Produce melanin, a pigment responsible for skin color.
- Merkel cells: Mechanosensory cells in the epidermis, involved in touch sensation.
- Epidermal melanin unit: Composed of one melanocyte and associated keratinocytes.
- Epidermal turnover time: The time it takes for the epidermis to regenerate, typically 28 days.
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Psoriasis: A chronic inflammatory skin condition characterized by scaly, red plaques.
- Psoriatic arthritis: Psoriasis affecting the joints.
- Erythrodermic psoriasis: Widespread, severe psoriasis.
- Guttate psoriasis: Small, drop-like psoriasis lesions.
- Pustular psoriasis: Psoriasis characterized by pustules.
- Impetigo herpetiformis/Pregnancy: Pustular psoriasis occurring during pregnancy.
Annular Lesions-Pattern
- Annular lesions: Ring-shaped skin lesions.
- Sarcoidosis: A granulomatous inflammatory disease that can cause annular lesions.
- Inflammatory bowel disease (IBD): Can present with annular skin lesions.
- Acute rheumatic fever: Can present with annular skin lesions.
- Herpes simplex virus (HSV), mycoplasma, and Lyme disease: Can cause annular lesions.
- Chloroquine: A medication that can cause annular skin lesions.
- Behcet’s syndrome: A rare, inflammatory disease that can cause annular lesions.
Papulo-Squamous Disorders
- Papulo-squamous disorders: Skin conditions characterized by papules (small, solid bumps) and scales.
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Psoriasis: A common papulo-squamous disorder affecting about 10% of the population.
- Pustular psoriasis: Psoriasis characterized by pustules.
- Impetigo herpetiformis/Pregnancy: Pustular psoriasis occurring during pregnancy.
Infections
- Staphylococcus aureus (S. aureus): A common bacterial skin pathogen.
- SSSS/Ritter disease: Toxic epidermal necrolysis caused by S. aureus toxins.
- Reiter disease: A type of reactive arthritis sometimes associated with S. aureus infections.
Sebaceous Glands
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Modified apocrine glands: Modified sweat glands.
- Montgomery tubercles: Modified apocrine glands on the areola of the breast.
- Mebomian glands: Modified apocrine glands in the eyelids, which produce tears.
- Tyson's glands: Modified apocrine glands on the prepuce (foreskin).
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Ectopic sebaceous gland: Sebaceous gland located in an unusual location.
- Fordyce spots: Small, white papules caused by ectopic sebaceous glands.
- Zeiss glands: Modified apocrine glands in the eyelashes.
- Water glands: Modified apocrine glands in the ear canal.
- Pitted keratolysis: A skin condition characterized by pitted lesions due to Micrococcus infections.
Alopecia
- Alopecia: Hair loss.
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Scarring alopecia: Hair loss that causes permanent scarring.
- Pseudopalade of Brocq: Scarring alopecia that can resemble the footprints in snow.
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Non-scarring alopecia: Hair loss that does not cause permanent scarring.
- Stress/pregnancy (3 months): Telogen effluvium, a temporary hair loss that occurs due to stress or pregnancy.
- Chemotherapy: Hair loss caused by chemotherapy treatment.
- Accessible areas: Pattern of hair loss that commonly affects accessible areas of the body.
- Exclamatory mark sign: Pattern of hair loss with an exclamation mark shape.
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Nail:
- Going white overnight: Possible sign of a serious condition like nail bed infection or trauma.
Hair Perforation Test
- Hair Perforation Test: A lab test used to distinguish between different types of hair loss.
Pigmentation Disorders
- Leukotrichia: White hair.
- Lip-tip: A type of leukotrichia specifically affecting the lip.
- Poor prognosis: Long-standing pigmentation disorders with bony prominence lesions.
- Hyperandrogenism: Elevated levels of androgens, can cause acne.
Leprosy
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Leprosy: A chronic infectious disease caused by Mycobacterium leprae.
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TT (Tuberculoid leprosy): Less severe form of leprosy.
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BT (Borderline Tuberculoid leprosy): Intermediate form of leprosy.
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BB (Borderline lepromatous leprosy): Intermediate form of leprosy.
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BL (Borderline Lepromatous leprosy): Intermediate form of leprosy.
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LL (Lepromatous leprosy): More severe form of leprosy.
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Clinical findings:
- Number of lesions: Increased number of lesions in LL compared to TT.
- Well-defined margins: Lesions in TT are well-defined, while those in LL are ill-defined.
- Nerve involvement: Single thickened nerve in TT, multiple nerves bilaterally in LL.
- Skin smear (SSS): Negative in TT, positive in LL.
- Sensation: Absent sensation in TT lesions, present in LL lesions.
Basics of Skin
- Only found in palms and soles: Refractile granules of Eleidin
- Orthokeratosis: No granular layer, no refractile granules
- Parakeratosis: Retained nuclei in stratum corneum
- Hyperkeratosis: Thickened stratum corneum
- Munro’s microabscess: Psoriasis, found in stratum corneum
- Pautrier’s microabscess: Mycosis fungoides, found in the epidermis
- Civatte bodies: Lichen planus, found in the epidermis
- Acanthocytes: Spiked keratinocytes, found in pemphigus vulgaris
- Langerhans cells: Antigen presenting cells, found in the epidermis
- Melanocyte: Produces melanin, found in the basal layer of the epidermis
- Merkel cell: Sensory receptor, found in the basal layer of the epidermis
- Epidermal melanin unit: Melanocyte and surrounding keratinocytes containing melanin
- Epidermal turnover time: 28 days
- Psoriasis: Increased epidermal turnover time, leads to scales and plaques
Annular Lesions-Pattern
- Sarcoidosis: Annular lesions with central clearing
- IBD: Annular lesions with central clearing
- Acute rheumatic fever: Annular lesions with central clearing
- HSV, mycoplasma: Annular lesions with central clearing
- Lyme disease: Annular lesions with central clearing
- Behcets: Annular lesions with central clearing
- Chloroquine: Annular lesions with central clearing
Papulo-Squamous Disorders
- Psoriasis: Common, scaly skin lesions
- Psoriatic arthritis: Associated with psoriasis, affecting joints
- Erythrodermic psoriasis: Severe form with widespread redness and scaling
- Guttate psoriasis: Small, drop-like lesions
- Pustular psoriasis: Pus-filled lesions
- Impetigo herpetiformis/Pregnancy: Pustular psoriasis in pregnancy
Infections
- Hortaea werneckii: Black piedra, a fungal infection causing dark nodules on hair
- Golden yellow-Wood’s lamp: Used to diagnose pityriasis versicolor
- Branny scales: Characterizes pityriasis versicolor
- Wood’s lamp: Ultraviolet light used to diagnose skin conditions
- SSSS/ Ritter disease: Staphylococcal scalded skin syndrome, affects infants, characterized by large, flaccid blisters
- Oral mucosa involvement: Present in SSSS, not in Reiter disease
Skin Infections
- Polymicrobial infection: Multiple bacteria involved
- Ectopic sebaceous glands: Present in Fordyce spots, Montgomery tubercles, and mebomian glands
- Fordyce spots: Small white bumps on lips and inside cheeks
- Montgomery tubercles: Elevated sebaceous glands around the areolae
- Mebomian glands: Sebaceous glands within the eyelids:
- Modified apocrine sweat glands: Involved in body odor, found in axillae, groin, and perianal areas
- Tyson’s glands: Sweat glands located on the prepuce
- Pitted keratolysis: Bacterial infection causing small pits on the soles
- Zeiss glands: Sebaceous glands in the eyelid, also present in the nose
Alopecia
- Scarring Alopecia: Permanent hair loss with scaring
- Non-scarring Alopecia: Reversible hair loss without scaring
- Stress/Pregnancy (3mon): Temporary hairloss
- Chemotherapy: Hair loss due to chemotherapy
- Accessible areas: Commonly affected in alopecia areata
- Pseudopalade of Brocq: Sign of alopecia areata
- Footprints in the snow: Indentation of the hair shaft in alopecia areata
- Exclamatory mark sign: Common in alopecia areata
- **Nail: ** Affected in alopecia areata
- Going white overnight: Sudden hair graying, could be a sign of vitiligo
Hair Perforation Test
- Hair perforation test: Diagnoses hair breakage, associated with traction alopecia
Pigmentation Disorders
- Poor prognosis: Long-standing vitiligo, involving bony prominences, lips
- Leukotrichia: Loss of melanin in hair, resulting in white hair
- Lip-tip: Commonly involved in vitiligo
- Rule out hyperandrogenism in resistant acne: Common cause of acne, can worsen pigmentation disorders
Leprosy
- TT - Tuberculoid leprosy: Few lesions, well-defined, elevated margins, single thickened nerve, negative skin smear, sensations present
- BT - Borderline tuberculoid: More lesion, ill-defined margins, single thickened nerve, negative skin smear, sensations present
- BB - Borderline borderline: Lesions present with some characteristics of both tuberculoid and lepromatous leprosy
- BL - Borderline lepromatous: Diffuse lesions, more nerves bilaterally, positive skin smear, sensations slightly affected
- LL - Lepromatous: Widespread lesions, multiple nerves bilaterally, positive skin smear, loss of sensations
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Description
This quiz explores the fundamental aspects of skin anatomy, including various conditions and their characteristics. Topics include parakeratosis, hyperkeratosis, and key cellular components affecting skin health. Test your knowledge on the structures and functions of the skin!
