Skin Anatomy and Conditions Quiz

Skin Cross Section

• The skin is comprised of epidermis, dermis, and hypodermis layers
• The epidermis is the outermost layer and contains multiple sublayers
• Structures like hair follicles, nerve fibers, and glands (sweat/sebaceous) are present in the dermis and hypodermal layers

Dry Skin (Xerosis)

• Affects 75% of older adults
• Environmental factors like temperature extremes contribute to dry skin
• Common symptoms include: roughness, scaling, cracking, fissuring, redness and itching
• Treatment focuses on modifying environment and bathing habits with warm water and moisturizers immediately after bathing for optimal absorption.

Dry Skin (Xerosis)

• Barrier dysfunction leads to water-holding capacity issues
• Lipids (ceramides, free fatty acids, cholesterol) are decreased
• Epidermal water loss is increased
• Advanced age causes thinner epithelium and reduced lipids
• Associated with dehydration, hypothyroidism, and renal failure

Skin Hydration

• Bath oils can create a slippery surface
• Colloidal oatmeal provides relief from itching

Moisturizers

• Ingredients like emollients, humectants, ceramides are crucial for hydration
• Moisturizers are applied liberally 3-4 times per day
• Patient preference plays a significant role in moisturizer choice.

Lotions and Creams

• Oil-in-water emulsions (less greasy and easy to spread, for hairy areas)
• High patient preference (warm weather)
• Ointments (water-in-oil, occlusive), greasy texture - not used in oozing/infected areas or intertriginous areas (not recommended for oozing lesions, or hot weather)
• Gels feel good on skin but dry
• Butters (like shea butter) are stiffer formulations

Eczema

• Group of conditions causing itchy and inflamed skin.
• Skin tone influences appearance of redness (lighter tones).
• Genetics, environmental factors are triggers
• Affects ~31 million Americans

Atopic Dermatitis

• Most prevalent eczema type
• Affects 15-20% of children and 1-3% of adults
• Chronic, beginning in childhood, with episodes and remissions.
• Associated with elevated IgE, alterations in the epidermal barrier, and immune system disturbances, also often accompanied by asthma and allergic rhinitis (up to 80% of patients).
• Can be triggered by dry skin, harsh substances (soaps/detergents), seasonal changes, heat, sweating, infections, stress, and food allergies.

Clinical presentation

• Itchy rashes and dry/discolored skin
• Repeated itching can cause thickened, rough skin (lichenification)
• Flakes, secondary infections, and/or crusty skin are possible
• Acute eczema is marked by intense itching, papules, or vesicles
• In subacute cases, dry scaly and papules and plaques are present
• Chronic stage is characterized by lichenification, secondary bacterial or viral infections.

Self-Care Exclusions

• Moderate-severe eczema with intense itching
• Extensive skin involvement, <1 year of age
• Appearance of infection with pustules/vesicles/crusting, or involvement in sensitive areas (facial/intertriginous)
• No improvement or worsening within 2-3 days of treatment

Treatment

• Stop itching and scratching behavior
• Maintain adequate skin hydration
• Avoid known triggers
• Prevent infections.

Non-Pharmacological Treatment

• Avoid triggers (chemicals/detergents)
• Limited water exposure with lukewarm water
• Use moisturizers immediately post-bath
• Avoid identified allergens
• Maintain adequate hydration.
• Keep fingernails short

OTC Pharmacologic Therapy

• Moisturizers are the standard of care
• Topical corticosteroids suppress cytokines for inflammation and itching (Rx/OTC)
• Hydrocortisone (1%) is a common OTC steroid
• Oral antihistamines may aid sleep (not routine treatment)
• Wet wraps are helpful for steroids and/ or emollients for skin care

Contact Dermatitis

• Includes irritant and allergic forms
• Irritant contact dermatitis (ICD) is inflammation, redness, vesicles/pustules development
• Common in individuals with dry, cracked/inflamed skin accompanied by itching, burning, and stinging.
• Allergic contact dermatitis (ACD) manifests similar but is associated with a delayed hypersensitivity reaction.

ICD Treatment

• Remove offending agent
• Wash exposed area with mild soap
• Burow's solution (Domeboro) provides cooling, anti-bacterial and anti-inflammatory effects
• Use emollients (petrolatum, Aquaphor), barrier creams
• Preventive measures include applying barrier creams before exposure

Allergic Contact Dermatitis

• Allergic Contact Dermatitis (ACD) involves 3000 documented chemicals, as well as reaction to poison ivy/oak/sumac (urushiol).
• A delayed hypersensitivity reaction involves T cells and inflammatory mediators.
• Urushiol is the active component in these plants. This leads to intense itching, erythema, vesicles and bullae.

Poison Ivy Treatment

• Immediate washing with water and removal of contaminated clothing
• Avoid direct contact with the allergen
• Topical corticosteroids can help reduce itching and inflammation
• Other treatments include using Burow's solution and wet compresses for weeping lesions
• Oatmeal baths or calamine lotion may be supportive.

Neurodermatitis

• Usually confined to 1-2 patches
• Can occur anywhere on the skin (often on areas prone to scratching)
• Common in people aged 30-50 years of age.
• Triggered by stress/anxiety.

Dyshidrotic Eczema

• Small, itchy fluid-filled blisters localized to palms, soles, and edges of fingers/toes
• Women > men
• Triggers such as metals (especially nickel) are common

Nummular Eczema

• Scattered, circular, itchy patches (coin-shaped lesions)
• Typically present on arms and legs
• Stress is also a frequent trigger

Dandruff

• Scaling of the scalp with minimal inflammation
• Malassezia yeast is often involved
• Treatment options include shampoos containing selenium sulfide, pyrithione zinc, or ketoconazole.

Seborrheic Dermatitis

• Scalp and other oily areas with sebaceous glands (face, nose, eyebrows, ears, chest; cradle cap in infants)
• Flaky, red skin
• Treatment for adults includes medicated shampoos (used daily initially). Infants are treated with baby oil and shampoo.

Stasis Dermatitis

• Venous insufficiency leads to ankle swelling, orange-brown discolored/hot spots, and scaling, itchiness in the legs (lower extremities)

Test your knowledge on the structure of skin, its layers, and conditions like dry skin (xerosis). Explore various factors affecting skin hydration and examine treatment options for maintaining skin health. Perfect for students learning about dermatology or human biology.