integumentary part 2

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Vesiculobullous Disorders : 

Vesiculobullous Disorders Pemphigus Rare, chronic, blister-forming disease of the skin and oral mucous membranes Blisters form in the deep or superficial epidermis Autoimmune disease caused by circulating IgG autoantibodies The antibodies are against the cell surface adhesion molecule, desmoglein in the suprabasal layer of the epidermis 1

Vesiculobullous Disorders : 

Vesiculobullous Disorders Pemphigus Tissue biopsies demonstrate autoantibody presence Types Pemphigus vulgaris (severe) Pemphigus foliaceus Pemphigus erythematosus 2

Vesiculobullous Disorders : 

Vesiculobullous Disorders Bullous pemphigoid More benign disease than pemphigus vulgaris Bound IgG and blistering of the subepidermal skin layer Subepidermal blistering and eosinophils distinguish pemphigoid from pemphigus 3

Bullous Pemphigoid : 

Bullous Pemphigoid 4

Vesiculobullous Disorders : 

Vesiculobullous Disorders Erythema multiforme Acute, recurring disorder of the skin and mucous membranes Associated with allergic or toxic reactions to drugs or microorganisms Caused by immune complexes formed and deposited around dermal blood vessels, basement membranes, and keratinocytes “Bull’s-eye” or target lesion Erythematous regions surrounded by rings of alternating edema and inflammation 5

Vesiculobullous Disorders : 

Vesiculobullous Disorders Erythema multiforme Bullous lesions form erosions and crusts when they rupture Affects the mouth, air passages, esophagus, urethra, and conjunctiva Severe forms Stevens-Johnson syndrome (bullous form) Toxic epidermal necrolysis 6

Erythema Multiforme : 

Erythema Multiforme 7

Infections : 

Infections Bacterial infections Folliculitis Furuncles Carbuncles Cellulitis Erysipelas Impetigo 8

Infections : 

Infections Viral infections Herpes simplex virus Herpes zoster and varicella 9

Herpes Simplex Virus : 

Herpes Simplex Virus 10

Warts : 

Warts Benign lesions caused by the human papillomavirus (HPV) Diagnosed by visualization Condylomata acuminata Venereal warts 11

Fungal Infections : 

Fungal Infections Fungi causing superficial skin lesions are called dermatophytes Fungal disorders are called mycoses; mycoses caused by dermatophytes are termed tinea Tinea capitis (scalp) Tinea pedis (athlete’s foot) Tinea corporis (ringworm) Tinea cruris (groin, jock itch) Tinea unguium (nails) or onychomycosis 12

Tinea Pedis : 

Tinea Pedis 13

Fungal Infections : 

Fungal Infections Candidiasis Caused by Candida albicans Normally found on the skin, in the GI tract, and in the vagina C. albicans can change from a commensal organism to a pathogen Local environment of moisture and warmth, systemic administration of antibiotics, pregnancy, diabetes mellitus, Cushing disease, debilitated states, age younger than 6 months, immunosuppression, and neoplastic diseases 14

Vascular Disorders : 

Vascular Disorders Cutaneous vasculitis Results from immune complexes in the small blood vessels Develops from drugs, bacterial infections, viral infections, or allergens Lesions Palpable purpura progressing to hemorrhagic bullae with necrosis and ulceration 15

Cutaneous Vasculitis : 

Cutaneous Vasculitis 16

Vascular Disorders : 

Vascular Disorders Urticaria Due to type I hypersensitivity reactions to allergens Histamine release causes endothelial cells of the skin to contract Causes leakage of fluid from the vessels Treatment Antihistamines and steroids 17

Urticaria : 

Urticaria 18

Vascular Disorders : 

Vascular Disorders Scleroderma Sclerosis of the skin that can progress to the internal organs The disease is associated with several antibodies Lesions exhibit massive deposits of collagen with inflammation, vascular changes, and capillary dilation Skin is hard, hypopigmented, taut, and tightly connected to underlying tissue 19

Vascular Disorders : 

Vascular Disorders Scleroderma Facial skin becomes very tight Fingers become tapered and flexed; nails and fingertips can be lost from atrophy Mouth may not open completely 50% of patients die within 5 years 20

Scleroderma : 

Scleroderma 21

Benign Tumors : 

Benign Tumors Seborrheic keratosis Keratoacanthoma Actinic keratosis Nevi (moles) 22

Cancer : 

Cancer Basal cell carcinoma Squamous cell carcinoma Malignant melanoma Kaposi sarcoma 23

Frostbite : 

Frostbite Skin injury caused by exposure to extreme cold Usually affects fingers, toes, ears, nose, and cheeks The “burning reaction” is caused by alternating cycles of vasoconstriction and vasodilation Inflammation and reperfusion are both part of the pathophysiology 24

Disorders of the Hair : 

Disorders of the Hair Male-pattern alopecia Genetically predisposed response to androgens Androgen-sensitive and androgen-insensitive follicles Female-pattern alopecia Associated with elevated levels of the serum adrenal androgen dehydroepiandrosterone sulfate No loss of hair along the frontal hairline 25

Disorders of the Hair : 

Disorders of the Hair Alopecia areata Autoimmune T cell–mediated inflammatory disease against hair follicles that results in baldness Hirsutism Androgen-sensitive areas Abnormal growth and distribution of hair on the face, body, and pubic area in a male pattern that occurs in women 26

Disorders of the Nail : 

Disorders of the Nail Paronychia Acute or chronic infection of the cuticle Onychomycosis Fungal or dermatophyte infection of the nail plate 27

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