OF THE
SKIN AND MUCOSAE
GENERALITIES
TEGUMENTUM = WHAT COVERS
= is the outer covering of living tissue,
with complexes functions:
sensation
adaptive immune system
heat regulation
storage and synthesis
excretion
= semiological map
GENERALITIES
Thickness = 0,2 - 0,5mm (at the level of the eyelids)
GENERALITIES
3 layers:
The epidermis:
Superficial, no blood vessels
Layers of cells melanocytes produce melanin
The dermis:
Connective tissue (collagenic, elastic and reticular
fibers, fibroblasts, mast cells)
Nerves, blood vessels, lymphatic vessels, muscles,
Sebaceous glands, the channels of sebaceous glands
Role: dermis nutrition, skin analyzer
The hypodermis:
Adipose lobules separated by fibrous tracts,
Nerves, receptors, blood and lymphatic vessels,
Sudoriferous glands, the deeper portion of bulb of hair
Role: tegument support
SKIN GLANDS
Sudoriferous glands:
= merocrine glands produce sweat: water, chloride,
sodium, potassium, lactic acid, urea, fat acids,
mucopolysaccharides, glycoproteins, hydrosoluble
vitamins
Sebaceous glands
= holocrine glands
hair 1:
1 hair shaft
2 sebaceous gland
3 epidermis
4 dermis
5 hair follicle
6 hair bulb
7 papill
CUTANEOUS SYMPTOMS:
PRURITUS
pruritus (latin) = itch
= cutaneous symptom produced by subliminal irritation of
nervous terminations by the mediators (histamine,
acetylcholine) which determines an attenuated pain
In producing pruritus, interfere:
Genetic factors
Psychological factors emotional pruritus
Secondary lesions:
excoriations
lichenification
cutaneous infections
local pigmentations
degraded nails
! Pruritus Prurigo
(Prurigo =
papulous, pruriginous lesions, determining local pruritus)
SECONDARY
PRURITUS
GENERALIZED
PRIMITIVE
(SINE MATERIA)
LOCAL
SYSTEMIC PRURITUS
Appears in:
SYSTEMIC PRURITUS
Appears in:
Parasitic infections
Hyperthyroid, hypothyroid, Cushing syndrome,
acromegaly, menopauses)
Senile (elasticity changes; + capillary fragility)
Drugs allergy
(usually along with urticarian eruption)
Scabies - intensive (specially during the night), +
grattage lesions
Other causes: psychological, gastric hypoacidity,
LOCAL PRURITUS
Has preferential localization in several affections:
Vulvar
Diabetes
Scrotal/Penian
Diabetes mellitus
Prostate carcinoma
urinary tract infections (frequent urethritis)
psychogenic
LOCAL PRURITUS
Has preferential localization in several affections:
hepatitis, cirrhosis
Nasal:
asthma
allergic rhinitis
lambliase (children)
uremia
morphinomania
hyperfoliculinemia
Auricular
diabetes mellitus
LOCAL PRURITUS
Has preferential localization in several affections:
Scalp:
alcohol abuse
pre-/postmenstrual
Anal:
parasitic infections
hemorrhoids
intestinal diseases
nearby infections
bilirubin
metals
Depends on:
skin thickness
light (artifical light distorts colours)
!!! The examination of skin color must be done in
sunlight
PALLOR
CYANOSIS
JAUNDICE
HYPERCAROTENEMIA
PALLOR
= lighter color of the skin and visible mucosae, causes by a
reduced amount of oxyhemoglobin
Main causes:
PALLOR
Different colors associated with pallor could be
correlated with the causes of the anemia
+ flavinic shade hemolytic anemia
+ yellowish shade - pernicious anemia
+ verdinic shade young girls chlorosis (green
sickness) = hypchromic anemia
+ lighter yellow shade gastric neoplasia
+ cafe au lait shade bacterial endocarditis
+ white like paper shade acute hemorrhagic anemia
PALLOR
Pallor is associated with clue signs that could
ascertain the origins of anemia:
spoon nails - anemia due to
iron deficiency (the nails are flattened and
have concavities)
Koilonychia=
Hunter
Inappetence
Cutaneous
hemorrhagic manifestations
(petechia, ecchymoses, hematomas) acute
leukemia, loss of blood
CYANOSIS
= bluish color of the skin and mucosal surfaces due to the
presence in the circulating blood of an increased
quantity of reduced Hb (more than 5g/dl) or a different
type of Hb
- Disappears with digital pressure
CYANOSIS
Due to abnormal hemoglobin
or rare type of hemoglobin
-Kansas Hb
- Methemoglobin
- Sulphuretted Hb
CYANOSIS
Due to an increased
quantity of reduced Hb
Increased quantity of reduced
Hb in the arterial blood
SULPHURETTED HEMOGLOBIN:
CYANOSIS
LOCALIZED
PULMONARY
right-left SHUNT
CYANOSIS
CENTRAL
GENERALIZED
PERIPHERAL
CARDIAC
/STASIS
CENTRAL CYANOSIS
LOCALIZED CYANOSIS
ERYTHROCYANOSIS
Appears in POLYCYTHEMIA VERA
It is also called red cyanosis
Described by Osler in XIX century, as red like
LOCALIZED CYANOSIS
ACUTE
Thrombophlebitis
(Phlegmatia coerulea)
Arterial embolus
LOCALIZED
CYANOSIS
Peripheral chronic
ischemia syndrome
CHRONIC
Acrocyanosis
LOCALIZED CYANOSIS
ACROCYANOSIS
= refers to a persistent blue or cyanotic discoloration of the
digits, most commonly occurring in the hands although also
occurring in the face and feet as well
Appears in: cold exposure, phlebitis, chronic venous
failure, Raynaud syndrome
Causes: functional anomalies in capillary circulation
LIVEDO RETICULARIS
- a lace-like purplish discoloration
- a particular aspect: RACEMOS LIVEDO permanent redviolet arborizations?? in SLE, PAN
- abdomen: acute pancreatitis
FACE CYANOSIS
venous thrombosis, superior cave vein syndrome
ACROCYANOSIS
THROMBOPHLEBITIS
LIVEDO RETICULARIS