Skin & Appendages
Skin and its Appendages
Skin is the largest organ of the body, covering and protecting the entire surface of the body. The total surface area of skin is around 3000 sq inches or roughly around 19,355 sq cm depending on age, height, and body size. The skin, along with its derivatives, nails, hair, sweat glands, and sebaceous glands forms the integumentary system. Besides providing protection to the body the skin has a host of other functions to be performed like regulating body temperature, immune protection, sensations of touch, heat, cold, and pain through the sensory nerve endings, communicating with external openings of numerous other body systems like digestive system, urogenital system, and respiratory system via mucous membranes and also one of the most important function of acting as a storage house of energy by collection of adipose tissue, which is the principal fat depot in the body. It is the first line of defense of our body against any organism. So, lets now study the physiology and anatomy of skin in detail.
IMPORTANT THINGS TO KNOW
1. The study of skin and its appendages (hairs and nails) is called dermatology.
2. A dermatologist is a person who specializes in the skin diseases and disorders and their treatments.
3. The skin is the largest organ of the body, with a total surface area of 19,355 sq cm or 3000 sq inches.
4. The color of the skin varies, depending upon the amount of pigment melanin produced by melanocytes within the epidermis.
5. About 80 per cent of the body's hair follicles are in the scalp.
6. Besides forming a covering of the body, the skin has a host lot of functions.
ANATOMY AND PHYSIOLOGY
The skin is primarily composed of three layers. The skin, which appears to be so thin, is still itself divided into epidermis, dermis, and subcutaneous layer or hypodermis. Please refer to the figure below to understand all the three layers. Each layer has it own function and own importance in maintaining the integrity of skin and thereby the whole body structure. So lets, study each part in detail.
1. Epidermis: Epidermis is the topmost layer or rather the visible part of the skin that is composed of stratified squamous epithelial cells. This layer is composed of five layers of cel1s, which are arranged in two zones; the superficial horny layer and a germinal layer beneath it. The horny layer is again made up of three layers of cells. These are stratum corneum, which is the superficial layer. It has thin, flat, dead cells filled with keratin, which are constantly being cast off. Keratin is a very important constituent as it is a type of insoluble fibrous protein that helps to protect the body. This layer helps in protection against heat, chemicals, light, and microorganisms. Below this layer is stratum lucidum. This layer contains flat cells with no distinct outline and no nuclei. These cells contain eleidin, which is a retractile and weakly staining keratin present in the cells of the stratum lucidum of the palmar and plantar epidermis, which is a prekeratinous substance. Below this layer is stratum granulosum. It is a layer of well-defined flat cells, which have their own nucleus and also granules and contains a substance called keratohyalin, which later becomes keratin. The next layer of the epidermis is stratum spinosum, which is the first and largest layer of the germinal zone of epidermis. It is made up of prickle cells having prickle-like appearance. The deepest layer of epidermis is stratum basale also known as stratum germinativum. It is a single layer of cuboidal and columnar cells from which new epidermal cells are constantly being produced, which later become cells of more superficial layers. These cells divide continuously by mitosis and either push older cells closer to the surface or replace them.
2. Dermis: The next layer below the epidermis of the skin is called the dermis, which is primarily made up of elastic and fibrous connective tissue. This layer is arranged in small papillae, which contain loops of capillary blood vessels. This layer also contains nerve endings of sensory nerves, coiled tubes of sweat glands in deep parts of dermis and sebaceous glands, which produce an oily secretion called as sebum. Ducts from sweat glands pass through dermis and epidermis as spiral canals and open on the skin as minute depressions, which are called pores.
The sweat glands found on the skin are of two types; eccrine and apocrine. Eccrine sweat glands, which are found everywhere in the body, secrete a watery fluid to regulate the body temperature. Apocrine sweat glands are present in certain parts of the body and secrete a milky sweat caused by breakdown of cells by bacteria. Both types of glands perform an important function of excretion for the body.
3. Subcutaneous tissue (hypodermis): The third layer below the dermis is the subcutaneous layer. This layer contains adipose tissue, which is the storage depot for fats. Also called hypodermis, this layer helps in regulation of body temperature and provides cushioning to the skin. All the underlying muscles and structures are below the hypodermis.
APPENDAGES OF THE SKIN
Appendages of the skin:
Appendages of the skin are nails, hair, sebaceous glands and sweat glands.
Hairs and nails are modified epidermal cells composed of keratin. Hairs grow from a cavity called hair follicle, which is located in the dermis as seen in the figure. Hair follicle is lined with epidermal cells.
At the base of the hair follicle is an enlarged hair bulb. At the bottom of it is the papilla, which contains connective tissues and blood vessels to provide nourishment to the hair. It is from these cells in this region that the hair grows. The hair projects above the body surface as hair shaft. The portion that penetrates in the dermis (in the hair follicle) is called the root. Associated with the hair follicles are minute specialized smooth involuntary muscles called arrector pilus, which contract during stress and raise the hair and pull it in an upright position. Also sebaceous glands are connected to the hair follicles, which secrete a fatty or oily substance called sebum. It keeps the skin soft, smooth and gives a glossy feeling to the hair. Hairs grow in two phases; anagen or growing phase and telogen or resting phase.
Nails are also composed of keratin. They are present on the distal ends of fingers and toes. The nail lies on the nailbed in which dermis is arranged in longitudinal ridges. The nailbed is supplied with nerve endings and blood vessels. Nail grows from root of the nail, which lies in the groove of the skin called the nail grooves. Nail is thinnest in this region. The body of a nail is the uncovered part, which is firmly attached to the nailbed. Its distal end is free and called free border.
Sweat secretes from the sweat glands. It is essentially a saline solution comprising about one-third of the concentration of plasma. Its secretion is under the control of the sympathetic nervous system. Body temperature can be lowered by means of sweat glands. Sweating varies from 0 to 2000 ml per day, depending upon requirements of body temperature regulation.
During physical assessment of a patient, it is imperative for the examining physician to take note of the skin condition. The physician has to look for skin texture, moistness or dryness, tenderness, skin turgor, and most importantly temperature. The physician also evaluates the skin color for any abnormality like cyanosis, erythema, jaundice, etc., and sees the pigmentation pattern of the skin. The examiner also inspects the skin for any hemorrhagic lesions like petechiae, purpura, and ecchymosis, or structural changes on the skin like macule, vesicles, bullae, wheals, pustules, papules, plaque, nodules, scales, excoriations, fissures, scars, ulcers, or lichenifications. A variety of skin conditions and diseases can be properly diagnosed by a proper assessment of skin condition. Not only that, even systemic condition can be reflected many times to the skin surface, like jaundice and cystic fibrosis, in which skin is the primary indicator of the underlying disease.
COMMON SKIN CONDITIONS AND PATHOLOGY
COMMON SKIN CONDITIONS AND PATHOLOGY
Albinism is a genetic and/or hereditary pigment disorder in which melanocytes, cells that produce chemical called melanin and that are responsible for giving color to the skin, are present but they do not produce melanin. Characteristics of people with this disorder are white hair, pale, very light skin and pink eyes. Because of improper melanin formation, such individuals are very susceptible to skin cancers as skin and melanic act as an ultraviolet light filter for the body. Though medical science has advanced, but for albinism there is no medical treatment available still.
Basal cell and squamous cell carcinoma:
Basal cell carcinoma is the most prevalent type of skin malignancy. It arises from the malignancy of the basal cell layer of the lowest part of epidermis. Excessive exposure to sun's ultraviolet rays is the most common cause of basal cell carcinoma. It may appear as a skin sore or firm lump that does not heal. Basal cell carcinoma progress slowly and hence, is readily curable if detected early. Squamous cell carcinoma originates in the cells that form the skin's outer surface. It may appear as a scaly or crusty patch that may develop most often on the rim of the ear, mouth, or scalp. Squamous cell carcinoma can sometimes also invade nearby organs.
Decubitus ulcers (bed sores, pressure sores)
People who are bedridden, confined to the wheelchair, lacking sensation because of paralysis, and who cannot or do not change their positions every few hours, their blood flow is reduced consequent to prolonged pressure. This results in cell death, skin thickening, consequently leading to blisters and open sores and, finally to skin ulceration called bedsores or pressure sores. These ulcers occur mostly at places where the bone is close to the skin, such as heels, ankle, hip, shoulder, elbow, and base of the spine. Advance bedsores may require debridement to remove dead tissue, whereas in early stages, they can be treated with special gels or antibiotics.
Eczema is an inflammatory skin disease with lesions that may be erythematous, scaly, blistering, thickened, crusty, oozing, or itchy. These symptoms may exist in combination or singly. Anti-inflammatories are often prescribed in their treatment. Topical medications may include coal tar and a cortisone cream, hydrocortisone. If bacterial infection has set in as a result of scratching, then antibiotics may be prescribed.
Impetigo is a contagious skin infection caused by either staphylococcal or streptococcal bacteria, characterized by many small, isolated, itchy blisters, some of which may contain pus. When these blisters break, a characteristic yellow crust forms. Diagnosis can be made by inspecting the lesions and confirmed by scraping off a sample of cells from the sores for laboratory exam. Impetigo is most common among in infants and children. This infection in early stages affects only a small area and hence, can be treated with topical antibiotic ointments, such as mupirocin (Bactroban). In certain cases, oral antibiotics like penicillin and cephalosporinsmay be prescribed.
Kaposi’s sarcoma is a cancer in which malignant cells appear as red and purple patches under the skin or mucous membranes. The lesions of Kaposi’s sarcoma originate mostly on the leg and then may spread to lungs, liver, intestinal tract, or lymph nodes. The skin lesions themselves are painful. They can be accompanied by swelling, edema, and low-grade fever.
Melanoma is most lethal form of cancerous growth. It develops when the melanocytes (pigment cells) undergo malignant changes. Melanoma can frequently metastasize to other organs such as liver, brain, lungs, and other internal organs. Sunlight exposure is considered to be a leading contributing factor of this disease. Surgery is the most effective treatment for this disease. Chemotherapy and radiation therapy are used in addition to surgery to treat melanoma.
Miliaria, also known as heat rash or prickly heat, is a skin condition characterized by clusters of tiny blisters filled with perspiration, mostly on the armpits and groin, sometimes also on chest, waist, and back. These blisters are formed when pores become blocked and sweat cannot be released from them. The heat rash is itchy. Remedies that alleviate itching and cool the skin work well for miliaria.
Pruritus is an itching sensation in the skin. It can be caused by a number of local factors ranging from insect bites, allergic reaction, dry skin, eczema to infectious diseases, or systemic problems.
Psoriasis is a chronic skin disorder in which patches of skin become red and covered with dry silvery scales. The skin makes new cells so fast with psoriasis that they form silvery scales. The psoriatic patches form initially on the scalp, behind the ears, on the back of neck, on the elbows and knees, and near the nails of fingers and toes. The cause of psoriasis is unknown. In some cases, psoriasis is characterized by blisters usually on palms, and soles and is called pustular psoriasis.
Any vascular bleeding disorder characterized by hemorrhage in the tissue, particularly beneath skin tissue and showing up as bruises, ranging from tiny reddish or purplish spots called petechia to large hemorrhagic patches called ecchymosis is called purpura. Most types of vascular bleedings or purpuras are due to temporary change in the blood composition of platelets or rupturing of blood vessel walls because of deterioration of tissue making the vessel wall. Several types of purpura are purpura simplex (mostly hereditary), senile purpura (due to aging), allergic purpura (due to allergy), and idiopathic cytopenic purpura. Acute idiopathic cytopenic purpura affects children and follows a viral infection that has a reduced number of platelets, which are instrumental in blood clotting. Chronic idiopathic thrombocytic purpura affects mostly women in the age group 20-40 and is an autoimmune disorder in which platelets are destroyed.
Scabies is a contagious, intensely itchy and highly infectious parasitic skin disease caused by itch mite, Sarcoptes scabiei. The mite is most often transferred by direct skin contact, especially during sexual activity, and less often by indirect contact like sharing clothing or a towel. The female mite looks for places in skin, which are thickest, especially at the palms and soles to reproduce. It burrows a tunnel under the skin in which she deposits her eggs. Larvae hatch within 2 to 4 days. The characteristic itchy rash is caused perhaps due to hypersensitivity to eggs, or waste products or mites and larvae. Potent parasite-killer medications like gamma benzene hexachloride and lindane are used to destroy mites and their eggs. However, nowadays, milder but equally effective drugs such as permethrin are used.
Lesions are the pathological conditions resulting from a wound or injury. Primarily, the skin lesions can be classified into the following
· Macule: A circumscribed lesion of any size, which is flat and discolored and which is nonpalpable.
· Papule: A small, solid, raised skin lesion less than 1 cm in size.
· Nodule: Palpable raised skin lesion, 1-2 cm in diameter that is larger than papule
· Vesicle: Elevated skin lesion that contains fluid, less than 0.5 cm.
· Bulla: Elevated lesion containing fluid greater than 0.5 cm; blisters containing clear fluid. Pustule: Elevated skin lesion containing pus; abscess.
· Tumor: Elevated skin lesion greater than 2 cm in diameter.
· Scale: Excessive dry exfoliation from the upper layer of skin.
· Wheal: A raised, red lesion, usually accompanied by itching.
· Fissure: Small break in epidermis, arack-like sore exposing the dermis.
· Ulcer: Lesion caused on the surface of the skin or mucosa caused by superficial loss of tissues accompanied by inflammation.
Tinea (Ringworm Infection)
Tinea is any fungal skin infection, caused by dermatophytes. The name of the fungus indicates the body part it affects. The fungi can infect the scalp (Tinea calpitis), the beard (Tinea barbae), the skin (Tinea corporis), the groin area (Tinea cruris), the feet (Tinea pedis a.k.a. athlete foot), or fingernails or toenails (Tinea unguium). Tinea infections can be identified by the distinctive appearance of their lesions. As they most often produce round lesions, hence, the name ringworm. Most Tinea infections can be treated with antifungal drugs like clotrimazole, nystatin, and miconazole.
Urticaria is an allergic skin disorder, characterized raised pink or pale red lesions with a flat top. Hives are warm and itchy to touch and normally range in size from one-fourth of inch to 1-1/2 inch. Hives are most often caused by food allergies. They can also develop in response to certain drugs, such as penicillin, aspirin, etc; or in response to contact with insect bites, cats, exposure to detergents or dry cleaning chemicals on clothes. Skin tests performed by an allergist can help in identifying the substance responsible for hives. Hives usually disappear on their own within one to seven days. To alleviate the symptoms, itching, antihistamines, such as diphenhydramine, hydroxyzine, and cyproheptadineare prescribed. In severe cases, corticosteroids, such as prednisonemay be prescribed.
Vitiligo is a pigment disorder characterized by area of hypopigmentation, which develop when melanocytes are damaged. Hypopigmentation may range from small patches to large sections that cover most of the body. Combination of drug and light therapy is used, in which a drug is administered and followed by exposure to the ultraviolet light. This drug is activated by light and stimulates re-pigmentation by increasing the availability of melanocytes at skin surface. If vitiligo consists of only small, scattered patches, drugs to stimulate pigmentation may be applied directly to the affected skin and areas then exposed to the sunlight. In those with vitiligo covering more than half the body, depigmentation is done by bleaching the rest of the skin.
Warts are epidermal growths caused by strains of HPV (human papilloma virus), which infect the epithelial cells of skin and then prompt them to multiply. The virus can spread abnormally and very fast from one person to another by direct contact. Veruccae vulgaris, the most prevalent form, develops on fingers, elbows, face and knees. Other types of warts are filiform, flat, pedunculated, periungual, plantar, venereal, and laryngeal. Majority of the warts are benign. Warts can be quickly removed by burning them with electrocautery, laser surgery, cryosurgery, but about one-third may recur.
COMMON SKIN PROCEDURES
COMMON SKIN PROCEDURES
Sometimes, a small piece of tissue is excised through a surgical process for some microscopic examination. This excision is called biopsy and such an act is performed with the help of a needle or syringe. The general purpose of getting a biopsy is to arrive at a diagnosis. The different kinds of biopsies performed are aspiration or needle biopsy, punch biopsy, shave biopsy, endoscopic biopsy, and chorionic villus biopsy. In aspiration or needle biopsy, the specimen is aspirated through a needle or trocar that penetrates the skin, the outer surface of the organ, or the underlying tissue to be examined. In punch biopsy, the specimen removed is in the form of a cylinder. Shave biopsy is a technique performed with surgical or razor blades, chiefly for the lesions of the dermis or epidermis.
Cryosurgery is a kind of operation performed using freezing temperature. This temperature is achieved by employing liquid nitrogen or carbon dioxide. This freezing temperature is used either as an agent or in an instrument to destroy tissues.
Dermabrasion is a technique to wipe out the acne scars (cicatrix) or the pits (small depressions in the skin). The physicians use sandpaper, rotating wire brushes, or other abrasive materials to efface these scars.
Scarring, burning, or cutting the skin by means of heat, cold, electric current, ultrasound, or caustic chemicals is called cauterization. During electrocauterization, a high-voltage current is passed through the tissues or the metal device that has been electrically heated.
Lesions of the skin, sometimes of the mucous membranes, are destroyed and blood vessels sealed off by the monopolar high-frequency electric current. This process is known as electrodesiccation.
In this process, a thin slice of tissue is excised from a frozen specimen and sent for microscopic examination. This procedure is used for rapid diagnosis of malignancy, while the patient awaits surgery. This generally helps in determining the approach towards the surgery, i.e. conservative or radical.
Incision and drainage
Incision and drainage is a simple procedure to drain the fluids from a wound or cavity, An incision is made to allow the free flow or withdrawal of fluids from the wound or cavity.
A small, circumscribed, flat area, not more than 1 cm in diameter, differing in color or structure from the surrounding surface, is called a patch. Patch test is done to ensure the sensitivity of the skin. A small piece of paper or tape is soaked with a non-irritating diluted test fluid and applied on the skin of upper back or upper outer arm and covered. After 48 hours, the covered area is compared with the uncovered area. The presence of erythema and vesicles indicate the allergy towards that substance.
Scratch test is one of the various skin tests performed to diagnose a pathology of the skin. In scratch test, an antigen is applied through a scratch in the skin.
Arnault Tzanck was a Russian dermatologist (1886- I 954). Tzanck smear is the examination of fluid from the bullous lesions of the altered epithelial cells, rounded and devoid of intercellular attachments, also known as Tzanck cells. These cells are basophilic in nature, with spherical nucleus and enlarged prominent nucleoli. They are characteristic of lesions due to varicella, herpes, and pemphigus vulgaris.
Now, lets take a look at the pharmacopoeia of skin.
PHARMACOLOGY AND VOCABULARY
Acne vulgaris drugs
These drugs control the inflammatory eruptions composed of cysts, papules, and comedos, predominantly on the face, upper back, and chest. The condition occurs in a majority of people during puberty and adolescence. Examples: benzoyl peroxide, tretinoin, topical erythromycin, and meclocycline
Psoriasis refers to the circumscribed discrete, silvery-scaled, confluent reddish lesions that primarily occur on knees, scalp, elbow, and trunk. There are many drugs for treatment of psoriasis like Calcipotriene, coal tar, and etretinate.
These drugs are effective for treatment of seborrheic dermatitis manifested by erythematous and scaly lesions. Examples: selenium sulfide, chloroxine, coal tar, and sulfur and sulfacetamide.
Emollients and keratolytics
Emollients are agents used to soothe and hydrate the skin. After application to the skin, emollients prevent evaporation of water by forming a thin greasy layer on the skin surface. Emollients improve the dryness of skin but are not to be used on exudative lesions (oils like coconut, groundnut, etc.). Keratolytics are agents applied to soften the epidermic cells and desquamate them, for example, salicylic acid, benzoic acid, propylene glycol, zinc oxide, and dimethicone.
Topical anti-infectives are used for treatment of bacterial infections of skin, impetigo, eczema, folliculitis, and leg ulcers. They are also used for abrasions, cuts, and as preoperative antiseptics. Example: mupirocin, tetracycline, aminoglycoside, sulfonamides, nitrofurazone, and acyclovir. The antiseptics used are chloroxylenol, cetrimide, and povidone-iodine.
These agents kill the fungus selectively. These antifungals include scabicides, which kill scabiei that invade the epidermis. Example: Malathion, lindane, benzyl benzoate. Some other antifungal are miconazole, which has a broad spectrum of antifungal activity and is used for fungal and eczematous infections of tinea, candidiasis of skin and nails and also for eczema with bacterial infection; clotrimazole which is used for Tinea infections, fungal nappy rash, candida vulvitis, candida balanitis, paronychia, and athlete foot; and vulvovaginal candidiasis; and ketoconazole for fungal infections of the skin.
Topical steroids are used to treat various dermatological disorders like contact dermatitis, psoriasis, keloid scars, seborrheic dermatitis, eczema, and vulval pruritus. Example: beclomethasone dipropionate, triamcinolone acetate, hydrocortisone, methyl prednisolone acetate, and dexamethasone sodium phosphate.
1. Abrasion: scraping away or excoriation of the superficial layer of the skin or mucous membrane
2. Abscess: a pus-filled cavity caused by tissue destruction and associated with swelling
3. Acne: papular follicular eruptions characterized by pus and inflammation
4. Adenopathy: disease of the glands (lymph nodes)
5. Adipose: of or related to fat
6. Allograft: a graft between the individuals of the same species
7. Alopecia: falling hair, loss of hair
8. Anesthetics: agents which suppress the ability to feel pain or other sensations
9. Antibacterial: agents acting against the growth of bacteria
10. Antifungal: agents acting against fungus (syn antimycotic)
11. Anti-inflammatory: agents to reduce inflammation
12. Antiseptics: agents that prevent growth of infective agents (syn. Disinfectives)
13. Areola: any small area (also used for the areola of nipple)
14. Atopic: related to hypersensitivity to environmental allergens
15. Benign: mild, non-malignant
16. Biopsy: process of taking out a specimen of tissue for diagnostic purposes
17. Blemish: unaesthetic circumscribed alteration of the skin
18. Bulla: a large bubble-like blister
19. Carbuncle: skin infections of the subcutaneous tissue, accompanied by fever
20. Cellulitis: inflammation of the cellular tissues
21. Chloasma: skin infections characterized by irregular brown patches
22. Cicatrix: scar
23. Comedo: dilated hair follicle filled with bacteria and sebum
24. Contusion: injury in which skin does not break
25. Corium: dermis
26. Crust: a hard outer layer or covering (sometimes referred to the one formed by pus or blood)
27. Cyst: a bladder or sac containing some sort of fluid
28. Debridement: the process of taking out the dead tissues from a wound site
29. Dermabrasion: operation performed to remove the acne scars
30. Dermatitis: skin inflammation
31. Dermatologist: specialist in the study of skin and its diseases
32. Dermatology: specialty, dealing with skin
33. Dermatomycosis: fungus infection of the skin
34. Dermatophytosis: skin abnormality in which vesicles, papules, and/or fissures are caused by dermatophytes
35. Dermatoplasty: surgical repair of the skin
36. Dermatosis: abnormalities of the skin
37. Dermatotherapy: treatment of skin pathology
38. Dermis: corium, skin
39. Desquamation: shedding or peeling of the outer layer or surface
40. Ecchymosis: a purple spot or patch caused by passing of the blood into the skin
41. Eczema: inflammatory condition of the skin characterized by erythematous edematous papular vesicles of the skin
42. Electrodesiccation: destroying the lesions or pathological skin tissues by applying a high frequency electric current
43. Epidermis: outer layer of the skin
44. Eruption: breaking out of the lesions
45. Erythema: redness of the skin
46. Eschar: a crust or scar formed after the burn or cauterization of the skin tissues
47. Exanthem: skin eruptions, mostly as a result of viral disease
48. Excoriation: scraping or peeling of the pathological tissues from the skin
49. Extravasation: passing out of blood or lymph, into the tissues
50. Fissure: a narrow opening, cleft, or break in the body parts or between the tissues
51. Flaking: eruption of small, thin, flattened pieces of layer
52. Frostbite: a condition caused by extreme cold or frost in which tissues are killed
53. Fulguration: the act or process of destroying tissues or lesions by applying electric current. Syn. Electrodesiccation
54. Glandular: relating to a gland
55. Graft: tissues used for transplantation
56. Hair follicle: the cavity from which the hair shaft develops
57. Hair root: part of the hair embedded in the hair follicle
58. Hair shaft: non-growing portion of hair protruding
59. Hidradenoma: tumor or neoplasm caused by sweat glands
60. Hirsutism: excessive hair on the body especially in women
61. Hives: itching wheals, urticari2,
62. Hyperhidrosis: abnormal condition of excessive sweating
63. Hypodermis: the second layer of skin below the dermis
64. Ichthyosis: abnormal condition characterized by hardening, drying, and scaling of the skin
65. Impetigo: skin pathology characterized by vesicles which rupture and form thick yellowish crust
66. In situ: confined in the original place
67. Integument: skin and related structures
68. Irritation: inflammation with roughness or soreness
69. Itching: uncomfortable skin condition inducing rubbing or scraping of the affected part
70. Keloid: a firm movable nodule
71. Keratin: a kind of protein found in hairs or nails
72. Keratolytics: agents acting against the excessive shedding of the epidermis
73. Keratosis: lesions on the epidermis characterized by the horny layer
74. Laceration: a cut
75. Lactic: relating to milk
76. Lactiferous: giving milk
77. Lentigo: freckle-like brown macule
78. Lesion: a wound, cut, or in jury
79. Lipocyte: fat cell
80. Lipoid: resembling fat
81. Lumpectomy: removal of a lump (mass) from the breast
82. Lunula: a semilunar pale arched area at the beginning of the nail place
83. Macule: a small discolored spot
84. Malignant: spreading and difficult to control (neoplasm)
85. Mammogram: the radiographic record of breast examination
86. Mammography: x-ray, ultrasound, mri or any other radiologic examination of the breast
87. Mammoplasty: plastic surgery of the breast, syn. Mastoplasty
88. Mastectomy: excision of the breast, syn. Mammectomy
89. Mastoplasty: surgical repair of the breast, syn. Mammoplasty
90. Melanocytes: pigment-producing cell. Syn. Melanodendrocyte
91. Melanoma: malignant neoplasm of the skin
92. Menarche: beginning of tile menstruation cycle
93. Metastasize: spread (of the disease) to other areas from the point of origin
94. Microscope: an instrument used to view extremely small objects
95. Mole: birthmark, nevus
96. Neoplasms: abnormal pathological growth of cells
97. Nevus: birthmark, mole
98. Nipple: a projection at the apex of the breast where lactiferous ducts open
99. Nodule: a small circumscribed swelling
100. Nulliparous: a lady who has not experienced childbirth
101. Onychocryptosis: ingrown nail producing a pus-filled granuloma
102. Onychomalacia: softening of the nails
103. Pallor: paleness, yellowish coloration of the skin
104. Papilla: small nipple-like orifice
105. Papule: small elevation on the skin
106. Parasiticides: agents that destroy parasites
107. Pediculosis: lousiness, presence of lice
108. Pemphigus: a pathological condition of skin blisters
109. Petechia: small hemorrhagic spots
110. Pilonidal: relating to the presence of hair in a sinus opening of the skin.
111. Pores: hole, opening
112. Pruritus: itching
113. Psoriasis: circumscribed discrete lesions of macule or papule size which are confluent and silvery-scaled
114. Purpura: lesions characterizing the hemorrhage into the skin
115. Pustule: small circumscribed pus-filled elevation
116. Rash: skin eruptions
117. Ringworm: dermatophytosis, fungus infection of the skin, hair or nails
118. Scabies: vesicular eruptions and intense pruritus due to mites
119. Scale: a small thin plate of hardened epithelium
120. Scleroderma: hardening of the skin
121. Sclerosis: abnormal condition of becoming too firm or hard
122. Sebaceous: relating to sebum or fat
123. Sebum: secretion of the sebaceous glands
124. Site: place, location
125. Squamous: scaly, relating to scales
126. Stage: extent or severity of the disease
127. Stasis: stagnation, the condition of not changing
128. Steatoma: tumor or neoplasm related to fat
129. Stratum: layer
130. Stratified squamous epithelium: epithelium containing scaly keratin cells
131. Stratum corneum: outer layer of the epidermis
132. Stratum germinativum: the deepest layer of the epidermis
133. Subcutaneous: referring to the laver below the dermis
134. Sudoriferous: of or related to sweats
135. Suppuration: pyogenesis, pus formation
136. Thelitis: nipple or nipple-like structure
137. Tinea: a fungus infection of hair, skin or nails
138. Trichopathy: diseases associated with hairs
139. Tumor: neoplasm, swelling
140. Ulcer: an inflammatory lesion on the skin surface or surface of the mucous membrane
141. Ungual: relating to nail
142. Urticaria: itching condition of the skin characterized by wheals
143. Verruca: circumscribed growth of the papillae
144. Vesicle: small circumscribed fluid filled elevation of skin
145. Vitiligo: skin condition characterized by white patches of varied sizes
146. Wart: flesh-colored growth, verruca
147. Welt: lesions occurring because of urticaria, wheal, hives
148. Xenograft: graft from an individual of one species to that of another species
149. Xeroderma: dry scaly skin
150. Xeromammography: xeroradiographic breast examination
151. Xeroradiography: radiography using the dry powder in stead of liquid chemicals
1. Bx: biopsy
2. C&S: culture and sensitivity
3. derm: dermatology
4. FS: frozen section
5. HSV: herpes simplex virus
6. I&D: incision and drainage
7. KOH: potassium hydroxide
8. ung.: ointment
9. UV: ultraviolet
10. decub.: decubitus
11. ID : intradermal
12. IM: intramuscularly
13. IV: intravenously
14. subcu: subcutaneous
15. Dx: diagnosis
16. FH: family history
17. PE: physical examination
18. SC: subcutaneous
19. WBC: white blood cell
1. adeno: glands
2. adip/o: fat
3. lip/a: fat
4. steat/o: fat
5. crypt/a: hidden
6. cutane/o: skin I.
7. dermat/o: skin
8. derm/o: skin
9. hidr/o: sweat
10. ichthy/o: dry, scaly
11. kerat/o: hardening
12. lact/o: milk
13. mammo/o: breast
14. mast/o: breast
15. myc/o: fungus
16. onych/o: nail
17. ungu/o: nail
18. pillo: hair
19. scler/o: hardening
20. squam/o: scaly
21. thel/o: nipple
22. trich/o: hair
23. xerlo: dry
1. -cyte: cell
2. -derma: skin
3. -gram: record
4. -graphy: process of recording
5. -logist: specialist in the study of
6. -logy: study of
7. -therapy: treatment
1. epi-: above
2. hyper-: excessive
3. hypo: below normal, less
4. sub: below
Bx, biop., Biopsy.
Discoid lupus erythematosus.
Purified protein derivative (of tuberculin).
Systemic lupus erythematosus.
(Sub cutis) subcutaneous.
Skin & Appendages