CMA: Dermatology

Function of Skin

Function of Skin

• first line of defense against pathogens, physical barrier

• temperature regulation (homeostasis)

• protection against hydration

• environmental sensing of pain, temperature, and pressure

• synthesis of vitamin D from sunlight

• excretion of toxins in perspiration

Epidermis

• outer layer

• thicker in feet and hands than face or torso

• 5 layers

  • stratum basale

  • stratum spinosa

  • stratum granulosum

  • stratum lucidum

  • stratum corneum

• cells push their way up as corneum sheds dead cells every 2 weeks

• cells flatten as they move up

Dermis

• middle layer

• thickness varies on location

• contains 3 tissues

  • collagen

  • elastic tissue

  • reticular fibers

• contains specialized cells and structures

  • hair follicles

  • sebaceous glands

  • sweat glands

  • blood vessels

  • nerves and nerve receptors

Subcutaneous

• base level of skin

• houses larger blood vessels and many nerves

• composed of fat tissue and connective tissue

• regulate body temp by insulation & dilation or constriction of blood vessels

Nail

• protect phalanges with tough keratin

• enhances sensory function of fingertips as counterforce for nerve endings

• provides more sensory input when object is touched

• includes nail bed, nail body, lunula, nail root, and cuticle

Hair

• nonliving keratin tissue

• functions to transmit sensory info to the brain and maintain body temp

• each hair is formed in a hair follicle and extends upwards toward skin

• hair root consists of bulb and papilla (nourished by tiny blood capillaries)

• hair follicle attached to arrector pili muscles that causes to erect when stimulated

• sebaceous gland near shaft to condition hair and skin from drying out

Eccrine Sweat Glands

• located in dermis and subcutaneous tissue

• in most areas but concentrated in head, back, neck, palms of hands, and soles of feet

• begins at tiny bulb in subcutaneous level, lined with sweat-producing cells

• secrete substances when increased temp and physical activity

Apocrine glands

• responds to emotional stimulation, such as stress, anxiety, pain, or sexual stimulation

• secretes substance with odor

• scent glands that function at puberty

• numerous in armpits, groin, and nipples, associated with the hair follicles

Sebaceous Glands

• deposits oily secretion on hairs called sebum

• found in all parts of body except palms and soles

• concentrated on face, scalp, chest, and back

• begins secretion at puberty, setting acne and other skin disorders

Dermatitis

inflammatory condition that occurs on or in laters of skin; can be acute or chronic

Allergic Contact Dermatitis

• results from direct contact with an allergen

  • poison oak, poison ivy, latex, laundry products, drugs, etc.

• can also result from radiation from sun or tanning beds

• symptoms: skin redness, swelling, and burning or itching from oozing small vesicles

• treatment: remove allergen, cleanse skin, and apply steroid cream or take oral steroid medication

Contact Dermatitis

• similar to allergic dermatitis, but not caused by allergen

• in contact with chemical substance (dye, detergent, acid, cleaning product, etc)

• symptoms: skin becomes red, swells, and presents small vesicles that ooze, burn, or itch

• treatment: remove allergen, cleanse skin, and apply steroid cream or take oral steroid medication

Eczema

• inflammation of skin that can be triggered by stress, sudden and severe weather changes, or certain foods

• symptoms: rash on face, neck, elbows, knees, and upper trunks, severe itching, possible rash with small oozing blisters

• in adults, blisters can turn dry and leathery

• treatment: steroid cream, antihistamines, and antibiotics

• pimecrolimus cream is steroid-free inflammatory cream that can be used instead of steroids

seborrheic dermatitis

• chronic inflammatory noncancerous infection caused by increased secretion of sebaceous glands

• in infants, cradle cap

congenital skin disorders

• presented at birth

• chronic, noninfectious, and inflammatory with no known cause or cure

• various sized plaques with thick, flaky, red, dry, or silvery scales concentrated at scalp, knees, elbows, or trunk

• plaques can be itchy, painful, and contain pustules

• treatment of psoriasis with UV light exposure to reduce inflammation; also antihistamines; chemotherapy for serious cases

Herpes Zoster

• shingles

• systemic disorder from infections with herpes varicella virus (chickenpox)

• virus moves to nerve root and become dormant

• triggered by stress or when patient becomes immunocompromised

• patients can suffer from post-herpetic neuralgia for several months after blisters disappear

• only contagious to those who have not had chickenpox

• symptoms: severe pain, fever, headache, malaise, rash, and blisters filled with fluid then dark pus or blood which turns into scabs

• blisters appear on trunk of body and follow dermatomes

• treatment: cool compress, antiviral drugs, corticosteroids, and pain medication

Herpes Simplex

• systemic disorder from previous infection with herpes simplex virus

• virus moves to nerve root and remain dormant until triggered by stress

• symptoms: severe pain on lips and in mouth, fever, headache, malaise, and blisters that scab over

• treatment: cool compress, antiviral drugs, corticosteroids, pain medication, and antiviral cream for the lips

Acne

• begins in puberty where pores become plugged with dead cells and sebum, forming a growth medium for bacteria into pimples and cysts

• main area are face, neck, arms, and upper back

• picking and squeezing pimples could spread bacteria and damage skin, leaving a scar

• physicians may prescribe vitamin A acid cream to reduce bacteria and antibiotic cream to kill bacteria and encourage healing of the skin

• oral antibiotics can also be prescribed

furuncles

• localized infection of abscess that involves the entire hair follicle and surrounding subcutaneous tissue

• patient experiences pain, discharge, and drainage through the skin

• treatment: warm compresses to promote spontaneous drainage, oral and topical antibiotics

carbuncle

• very large furuncle or multiple furuncles connected by several drainage canals

• tissue becomes red and swollen around hair follicle

impetigo

• highly contagious skin infection caused by streptococcus virus

• found around nose, mouth, cheeks, and extremities

• infection becomes a pustule and fluid spreads the infection to surrounding area

• lesions are yellow or red, weeping, crusted, and swollen

• treatment: topical antibiotics to reduce bacteria growth

fungal skin conditions

superficial skin conditions caused by fungi; affects epidermal layer; typically treated with antifungal cream

scalp ringworm

• tinea capitis

• causes lesions that are round, scaly, and itchy

body ringworm

• tinea corporis

• affects hairless body skin

• transmitted by infected animals

• red scaly patches with clear centera area that looks like a ring

• can form vesicles and itch

jock itch

• caused by tinea cruris

• affects groin area

• patches on groin area and inner part of upper thigh

athlete’s foot

• tinea pedis

• affects feet

• common in athletes or those who visit locker rooms and public showers

• cracks and blisters between toes and on soles that burn and itch

yellow nail

• tinea unguium

• affects fingernails and toenails

• nails becomes thick, hard, brittle, and have yellow tinge

head lice

• mainly on scalp and in hair

• caused by pediculus humanus capitis

• commonly seen in school-aged children and contagious

body lice

• body mites and itch mites

• spread by poor hygiene and body contact or sharing of clothing or bedding

• pediculus humanus corporis

public lice

• found in pubic area

• spread through sexual contact

• pediculus humanis pubis

albinism

• genetic disorder

• results in partial or total lack of skin color

• no known cure

• skin is very pale and hair is light or white

• eye color can be very white or red irises

• some visual difficulties (nystagmus, strabismus, astigmatism, and photophobia)

vitiligo

• causes patches of light skin

• affects people of all skin types

• more noticeable with people in darker skin

• not life-threatening or contagious

• treatment improves appearance of affected skin, not cure it

melasma

• brown to gray-brown patches on face

• women more likely than men

• common during pregnancy because hormones trigger melasma

benign neoplasms

• localized growth that does not spread or invade surrounding tissue

• do not metastasize to other body areas

• can affect tissue function and cause physical symptoms

actinic keratosis

• caused by exposure over time to solar or artificial UV rays

• can be precancerous

• physicians recommend a biopsy of the tissue after removing it

• scaly, bumpy, crusty area on the face, ears, and neck

• affected area may be flesh-colored, light or dark tan, pink, red, or combination

• can be itchy and tender

keloids

• benign overgrowths of collagenous scar tissue that is often raised and hard

• result of a surgical procedure or traumatic injury

• some disappear by themselves

• treatment can be cryotherapy or surgical procedure followed by X-ray treatment or steroid injection

moles

• unknown cause

• monitored for changes in color or size, or increase in itching, pain, or bleeding as signs of cancer

• moles can be removed for cosmetic purposes

sebaceous cyst

• arises from epidermal tissue

• caused by blocked sebaceous gland duct

• treatment: perform an incision to drain cyst and prescribe antibiotics as needed

ABCD rule for skin cancers

Asymmetry - shape of one half is different than other half

Border - edges of lesion appear irregular and ill-defined, ragged, and uneven

Color - mix of tan, black, and brown, but can also include blue, red, and white

Diameter - lesions larger than 6mm in diameter

Avoid sun exposure for skin cancer:

• avoid when UV rays are strongest, from 10am to 3pm

• apply sunscreen with UB protection greater than SPF 30 and repeat application often

• wear protective clothing outdoors

• plan outside activities for periods in the day when UV rays are weaker

cellulitis

• inflammation and infection of subcutaneous tissue

• caused by Staphylococcus

• prescribed IV antibiotics and possible pain medication

• address impaired circulation of swollen tissue by elevation of extremity and heat

folliculitis

• inflammation and infection of a hair follicle

• caused by Staphylococcus

• pustules at hair follicles

• treated by daily cleansing with antiseptic cleanser

• may be prescribed oral antibiotics

alopecia

• partial or complete hair loss

• inherited or caused by aging, iron deficiency, thyroid diseases, skin infections of scalp, chemotherapy, and radiation

• if condition is addresses, hair will grow back

hirsutism

• excessive hair growth

• caused by polycystic ovaries or tumors of adrenal glands

• may treat with medications to suppress production of the hormone causing the condition or remove the tissue or organ causing hormonal balance

lyme disease

• transmitted by ticks

• ticks found on deer and other outdoor animals

• symptoms: begin with red ringed area with a white or faded center around the bite, later experience mild flu-like feelings to severe neurologic involvement

• prescribed antibiotics

rosacea

• in middle-aged and elders

• unknown cause

• symptoms: pustules, papules, and rhinophyema

• treated with antibiotics

medical assistant tasks in dermatology office

1. obtain patient medical history

2. measure and record patient vital signs

3. instruct and assist patients in removing clothing

4. drape patients for specific purposes

5. assist patients as necessary and provide emotional support during procedures

6. assist dermatologists as necessary during physical exam and procedure

7. instruct patients about medication orders and pre- or post-procedure instructions

8. schedule and remind patients about appointments