DRA. HJ. KUSMIYATI, M.Si DRS. I WAYAN MERTHA, M.

Si SYAMSUL BAHRI

Lec. 1

The largest organ system (Human: 16 % of total body weight and covers 1.5-2m2 of surface area)

1. Epidermis a. Stratified squamous epithelium b. Keratinizing system (keratin) c. Pigmentary system (melanin) 2. Dermis a. Papillary layer b. Reticulary layer 3. Hypodermis Generally contains areolar and adipose tissue

1. Sudoriferous glands a. Types - Eccrine glands - Apocrine glands b. Functions 2. Sebaceous glands a. Sebum (skin oil) b. Functions

1. 2. 3. 4. 5. 6.

Protective barrier Thermoregulation Excretion Cutaneous sensation Immunity Vitamin D formation D2 (ergocalciferol) and vitamin D3 (cholecalciferol).

Most are not life-threatening, but may affect self image and therefore attitude and general health

Epidermal changes a. Thinner (exfoliation vs mitosis) b. Increased permeability c. Decreased melanocytes d. Decreased immune cells

Dermal changes a. Reduce number of fibroblast and fibers b. Cross-linking of elastin c. Atrophy of glands d. Decreased of blood flow e. Decreased number and activity of hair folicles f. Change in sensory receptors

Hypodermal change = loss of fat, leading to: a. Increased wrinkle b. Emaciated appeareance c. Loss of padding (coupled with blood supply bed sores) d. Loss of thermal insulation

A brown pigmented spot on the skin A harmless (benign) hyperplasia of melanocytes which is linear in its spread (Hyperplasia of melanocytes is restricted to the cell layer directly above the basement membrane of the epidermis where melanocytes normally reside) Lentigines differ from freckles (ephelis) on the issue of proliferation of melanocytes. Freckles have a relatively normal number of melanocytes but increased amount of melanin . A Lentigo has an increased number of melanocytes. Freckles will intensify and fade with sunlight exposure whereas lentigines will stay stable in their color regardless of sunlight exposure.

Produces ecchymoses and results from increased vessel fragility due to connective tissue damage to the dermis caused by chronic sun exposure and aging Typically affects elderly patients as their dermal tissues atrophy and blood vessels become more fragile Develop persistent dark purple ecchymoses, which are characteristically confined to the extensor surfaces of the hands and forearms New lesions appear without known trauma and then resolve over several days, leaving a brownish discoloration caused by deposits of hemosiderin; this discoloration may clear over weeks to months or may be permanent The skin and subcutaneous tissue of the involved area often appear thinned and atrophic No treatment hastens (mempercepat) lesion resolution or is needed. Although cosmetically displeasing, the disorder has no health consequences

The most common kind of angioma Cherry red papules on the skin containing an abnormal proliferation of blood vessels The frequency of cherry angiomas increases with age Made up of clusters of tiny capillaries at the surface of the skin, forming a small round dome (papule"), which may be flat topped They range in colour from bright red to purple When they first develop, they may be only a tenth of a millimeter in diameter and almost flat, appearing as small red dots. However, they then usually grow to about one or two millimeters across, and sometimes to a centimeter or more in diameter As they grow larger, they tend to expand in thickness, and may take on the raised and rounded shape of a dome

To have an incidence of 46% in the general population A small benign tumour that forms primarily in areas where the skin forms creases, such as the neck, armpit, and groin They may also occur on the face, usually on the eyelids Acrochorda are harmless and typically painless, and do not grow or change over time The surface of an acrochordon may be smooth or irregular in appearance and is often raised from the surface of the skin on a fleshy (ber-daging) stalk called a peduncle Consists of a fibro-vascular core, sometimes also with fat cells, covered by an unremarkable epidermis They are more common in people who are overweight, have diabetes and in pregnant women Can be associated with the Birt-Hogg-Dube sydrome and polycystic ovary syndrome

A condition in which an itching sensation is present all over the body The causes of its production and continuation lie in the dry skin and aging as well as heredity, climate and personal hygiene. As usual, ageing skin shows some changes which are clinically reflected in the form of thinning, roughening and decrease in vital function which the cutaneous system performs for the body Associated with the aging process characterized by the decline of hormonal levels and sluggish (seret, melempem) circulation because of the arteriosclerotic changes in the vessels Dryness of the skin is also the result of reduced activity of sweat and sebaceous glands together with the lack of hydration of the horny layer Dry skin lacks lipid, has an increased water loss and will easily crack. Affected dry skin looks pale and feels rough. In case the pruritus is provoked by an unhealthy epidermis it becomes worse in cold weather and in winter months when the humidity is low.

A noncancerous benign skin growth that originates in keratinocytes Seen more often as people age Appear in various colors, from light tan to black Round or oval, feel flat or slightly elevated (like the scab (keropeng) from a healing wound), and range in size from very small to more than 2.5 centimetres (1.0 inch) across Can resemble warts (kutil), though they have no viral origins Can also resemble melanoma skin cancer, though they are unrelated to melanoma as well

A premalignant condition of thick, scaly, or crusty (kerak, keras) patches of skin More common in fair-skinned people Associated with those who are frequently exposed to the sun usually accompanied by solar damage Since some of these pre-cancers progress to squamous cell carcinoma they should be treated Untreated lesions have up to 20% risk of progression to squamous cell carcinoma When skin is exposed to the sun constantly, thick, scaly, or crusty bumps appear. The scaly or crusty part of the bump is dry and rough. The growths start out as flat scaly areas, and later grow into a tough, wart-like area. An actinic keratosis site commonly ranges between 2 and 6 millimeters in size, and can be dark or light, tan, pink, red, a combination of all these, or have the same pigment as the surrounding skin. It may appear on any sun-exposed area, such as the face, ears, neck, scalp, chest, backs of hands, forearms, or lips.

Peak incidence between 50 70 years Must have had chickenpox first (Herpes varicella) Virus lies dormant in sensory neurons Once reactivated (often by stress), person itches and aches along affected dermatome(s) Small red papules appear with 3 days, first on the back Vesicular eruptions can be painful

Lesions caused by many factors such as: unrelieved pressure; friction; humidity; shearing forces; temperature; age; continence and medication; to any part of the body, especially portions over bony or cartilaginous areas such as sacrum, elbows, knees, and ankles Cavities of dead tissue Generally seen in immobilized persons Occurs over bony prominences that are in constant contact with a surface Caused by occluded blood supply (anoxic necrosis) Very prone (mudah) to infection and hard to heal

 Types

1. Basal cell carcinoma 2. Squamous cell carcinoma 3. Malignant melanoma

Cancer

Description

Illustration

Basal Cell Carcinoma Note the fleshy color, symmetrical nature, and ulceration which are characteristic. Squamous Cell Carcinoma Commonly presents as a red, crusted, or scaly patch.

Malignant melanoma

The common appearance is an asymmetrical area, with an irregular border, color variation, and greater than 6 mm diameter.

Areas of skin with seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples), nodules (large papules) and possibly scarring. Acne affects mostly skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in noninflammatory forms. The lesions are caused by changes in pilosebaceous units, skin structures consisting of a hair follicles and its associated sebaceous gland, changes that require androgen stimulation.

Develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum(a microcomedo) is the earliest change Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen(DHEAS) production at adrenarche The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (milia) Comedones are the direct result of sebaceous glands becoming clogged with sebum , a naturally occurring oil, and dead skin cells. In these conditions, the naturally occurring largely commensal bacterium Propionibacterium acnes (anaerobic bacterium) can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation

Acne scars are the result of inflammation within the dermis brought on by acne. The scar is created by the wound trying to heal itself resulting in too much collagen in one spot Physical acne scars are often referred to as "Icepick" scars. This is because the scars tend to cause an indentation in the skin's surface. 1. Ice pick scars: Deep pits, that are the most common and a classic sign of acne scarring. 2. Box car scars: Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars. 3. Rolling scars: Scars that give the skin a wave-like appearance. 4. Hypertrophic scars: Thickened, or keloid scars.

Hormonal activity, such as menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in male sex hormones called androgens cause the follicular glands to grow larger and make more sebum. Use of anabolic steroids may have a similar effect. Several hormones have been linked to acne: the androgens testosterone, dihydrotestosteron (DHT) and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I).

Development of acne vulgaris in later years is uncommon, although this is the age group for rosacea, which may have similar appearances. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushings syndrome. Menopause-associated acne occurs as production of the natural anti-acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thinning hair, hot flushes, thin skin, wrinkles, vaginal dryness, and predisposes to osteopenia and osteoporosis as well as triggering acne (known as acne climacterica in this situation).

Many different treatments exist for acne including benzoyl peroxide, antibiotics, retinoids, antiseborrheic medications, salicylic acid, alpha hydroxy acid, azelaic acid, nicotinamide, and keratolytic soaps.They are believed to work in at least 4 different ways including: normalising shedding into the pore to prevent blockage, killing propionibacterium acnes, anti-inflammatory effects, hormonal manipulation.