1. The Language Of Medicine
Dr. Michael P. Gillespie

2. Chapter 16 Skin

3. Chapter Goals
Name the layers of the skin and the accessory structures associated with the skin.
Build medical words using the combining forms that are related to the specialty of dermatology.
Identify lesions, signs, and symptoms, and pathologic conditions that relate to the skin.

4. Chapter Goals
Describe laboratory tests and clinical procedures that pertain to the skin and recognize relevant abbreviations.
Apply your new knowledge to understanding medical terms in their proper contexts, such as medical reports and records.

5. Introduction Skin: integumentary system weighs 8 to10 lbs.
covers 22 sq. ft. in average adult
What tissues can you predict will be integrated into this organ system?
What are the unique qualities of epithelium that make it a suitable tissue for covering the body?
How is the epithelium on the “outside” (part of the skin) similar to that on the inside of the body?

6. Functions of Skin Provides protective membrane
Skin glands lubricate and cool the skin
Receptor for sensations
Helps maintain body temperature
Have students define desiccation. Ask them to list three ways that skin guards against desiccation.
How does skin guard against acidic secretions?

7. Functions of Skin
Produces sweat: sweat glands produce watery secretion that evaporates and cools Produces sebum: sebaceous glands produce oily secretion that lubricates skin and hair Receives sensation: pain, temperature, pressure, and touch Thermoregulates: interprets message from heat center in the brain
Ask the students to define the word thermoregulate. How does the skin thermoregulate?
There are multiple mechanisms for thermal control. Describe at least three or four.

8. Structure of the Skin
Epidermis: outermost, thin cellular membrane Dermis: next layer; dense fibrous, connective tissue Subcutaneous tissue (hypodermis): thick, fat-containing tissue
What does the epidermis lack? Ask the students to describe what it is dependent upon.
What is the dermis composed of? Ask the students to describe what supports this layer.
Ask the students what lipocytes are and where they are found.

9. Structure of the Skin
In the inset of this picture (B) you can see what are called dermal papillae. They look like wavy folds. What is the advantage of this kind of tissue architecture?
The dermis appears to be pushing up folds into the epidermis. Why?
Is the epithelium vascular? Why is that an advantage or disadvantage?

10. Structure of the Skin
In the inset of this picture (B) you can see what are called dermal papillae. They look like wavy folds. What is the advantage of this kind of tissue architecture?
The dermis appears to be pushing up folds into the epidermis. Why?
Is the epithelium vascular? Why is that an advantage or disadvantage?

11. Acessory Organs of the Skin
HAIR: cells filled with the hard protein;
keratin
Hair follicles: shafts that hold the hair
Five million hairs on body; 100,000 on head
Melanocytes at the root form the color
Grow .5 inch (1.3 cm) per month
Cutting does not affect growth
Ask the students to describe melanocytes and where they can be found.
What functions does hair have? (sensory, thermoregulation)

12. Accessory Organs of the Skin

13. Accessory Organs of Skin
NAILS: hard keratin plates covering toes and fingers
lunula
cuticle
paronychium
How are hair, nails, and epidermis alike?
How do these structures grow and slough off cells?

14. Accessory Organs of Skin
GLANDS: sebaceous and sweat
Sebaceous glands secrete oily sebum into hair follicle to lubricate.
Sweat glands secrete into pores to moisten and cool.
Both are subject to bacterial growth.
Why do people have so many sweat glands?
Could people live without sweat glands?
Do sebaceous glands make hair feel oily?

15. Accessory Organs of Skin
Sebaceous gland, eccrine sweat gland, and apocrine sweat gland.
Why do people have so many sweat glands?
Could people live without sweat glands?
Do sebaceous glands make hair feel oily?

16. Combining Forms adip/o fat albin/o white caus/o burn, burning
cauter/o heat, burn
cutane/o skin
derm/o/ skin
Combining Form Meaning

17. diaphor/o profuse sweating erythem/o redness erythemat/o redness
Combining Forms
COMBINING FORMS
dermat/o skin
diaphor/o profuse sweating
erythem/o redness
erythemat/o redness
hidr/o sweat
ichthy/o scaly, dry
Combining Form Meaning

18. kerat/o hard, horny tissue leuk/o white lip/o fat melan/o black
Combining Forms
COMBINING FORMS
kerat/o hard, horny tissue
leuk/o white
lip/o fat
melan/o black
myc/o fungus
onych/o nail
Combining Form Meaning

19. pil/o hair, hair follicle py/o pus rhythid/o wrinkle seb/o sebum
Combining Forms
COMBINING FORMS
phyt/o plant
pil/o hair, hair follicle
py/o pus
rhythid/o wrinkle
seb/o sebum
squam/o scalelike
Combining Form Meaning

20. Combining Forms steat/o fat trich/o hair ungu/o nail xanth/o yellow
xer/o dry
Combining Form Meaning

21. QUICK QUIZ: Which combining form refers to white? chlor/o jaund/o
melan/o
albin/o
Correct answer is D: albin/o means white as in albinism

22. QUICK QUIZ: Which combining form refers to the same color as jaund/o?
xanth/o
chlor/o
erythr/o
cyan/o
Correct answer is A: xanth/o means yellow as in xanthoma

23. Colors

24. Cutaneous Lesions Label the lesions
What is the definition of a lesion?
Which of these lesions are similar but are differentiated by size?
Which lesions involve the dermis layer?

25. Cutaneous Lesions Review the lesions
What is the definition of a lesion?
Which of these lesions are similar but are differentiated by size?
Which lesions involve the dermis layer?

26. Signs and Symptoms Alopecia: absence of hair where it normally grows
What are some causes of alopecia?
Are there any treatments for baldness? Are they successful?
Another form of alopecia is a result of trichotillomania, or obsessive hair-pulling.

27. Signs and Symptoms Ecchymosis: blue-black marks on the skin
What can cause ecchymosis?
What is the treatment?

28. Signs and Symptoms Petechia: small pinpoint hemorrhage
Use the pictures as examples. Ask students whether they have ever been diagnosed with any of the skin conditions mentioned.
What diseases are associated with these symptoms?
What is pruritus?
What is purpura?

29. Signs and Symptoms
Urticaria: acute allergic reaction with red, round wheals on skin
What is the common term for urticaria?
Have students discuss their experiences (or that of someone they know) with hives.
What causes hives? How long do they last?

30. Abnormal Conditions
Acne: papular and pustular eruption of skin with increased production of sebum
What is the medical term for a blackhead?
Why are adolescents so prone to acne? Myths and reality.
Are over-the-counter treatments effective?

31. Abnormal Conditions
Burns: injury to tissue due to heat, chemical, electric shock, lightning or radiation. Image shows (A) Second degree burn and (B) Third degree burn.
Go over the different degrees of burns and use a chart with the layers of the skin to demonstrate how deep the burns go.
What percentage of body burn results in death? Why?

32. Abnormal Conditions Cellulitis: diffuse acute infection of skin
Eczema: inflammation of skin with erythematous and papulovesicular lesions caused by allergy
Exanthematous viral diseases: rash due to virus (for example, rubella)
Gangrene: death of tissue with loss of blood supply
Which of these diseases is/are common in children? Why?
What are other diseases that are similar to eczema? Are they all treated in the same way?

33. Abnormal Conditions
Impetigo: contagious pyoderma caused by staph or strep
Psoriasis: chronic recurrent dermatosis with silver gray scales that itch
Scabies: parasitic (tiny mites) and infectious pruritus
Scleroderma: chronic and progressive disease of skin with hardening of connective tissue
Which of these diseases are NOT contagious?
Which disease may worsen if the patient experiences anxiety?

34. Abnormal Conditions
Systemic lupus erythematosus (SLE): inflammatory disease of collagen in skin, joints, and internal organs
What are the current thoughts about the origin of SLE? How is it treated?
Where have we discussed it before because of other organ systems it affects?

35. Abnormal Conditions Tinea: infection of the skin caused by fungus
Tinea corporis
Tinea unguium
What is tinea? (fungal infection of skin or nails, that is, ringworm, athlete’s foot)

36. Abnormal Conditions Vitiligo: Loss of pigment in areas of skin
What is vitiligo? (loss of pigment in areas of skin causing milk-white patches)

37. Skin Neoplasms — Benign
Callus
Keloid
What is a callus? (increased growth of cells in keratin layer of epidermis due to friction against skin)
What is a keloid? (hypertrophied, thickened scar after trauma or surgery)
Ask for student examples of places that commonly develop calluses. Why?
Some people who are prone to keloids are discouraged from having their ears pierced.

38. Skin Neoplasms — Benign
Keratosis: thickened area of epidermis
Leukoplakia: white thickened patches on tongue or cheek
Nevus: pigmented lesion
Verruca: warts caused by virus
Have students find images for abnormalities not shown in the text. Images are very useful for remembering these conditions.

39. Skin Neoplasms — Cancerous
Basal cell carcinoma
Malignant tumor of the basal cell layer of the epidermis
Refer back to the chapter that included AIDS.
Why are AIDS patients susceptible to this condition?
Why does it rarely occur in the rest of the population?

40. Skin Neoplasms — Cancerous
Squamous cell carcinoma
Malignant tumor of the squamous epithelial cells of the epidermis.
Refer back to the chapter that included AIDS.
Why are AIDS patients susceptible to this condition?
Why does it rarely occur in the rest of the population?

41. Skin Neoplasms — Cancerous
The ABCDs of malignant melanoma.
A. Asymmetry
B. Border, irregular or circumscribed
These skin tumors often metastasize to the lung, liver, bone, and brain. What is the current treatment for this type of cancer?
Squamous cells can grow wherever there is squamous epithelium (internal or external). Common places include the mouth, larynx, bladder, esophagus, and lungs. Some are cigarette-related.
Why are healthy organs lined with squamous cells in the first place? What about this tissue makes it appropriate for those particular organ systems?
D. Diameter, usually larger than 6mm
C. Color variation

42. Skin Neoplasms — Cancerous
Kaposi sarcoma
Malignant, vascular, neoplastic growth characterized by cutaneous nodules.
Refer back to the chapter that included AIDS.
Why are AIDS patients susceptible to this condition?
Why does it rarely occur in the rest of the population?

43. Laboratory Tests
Bacterial analyses: pus or fluid samples examined to detect microorganisms Fungal tests: scrapings for culture and microscopic examination after treatment with KOH

44. Clinical Procedures
Cryosurgery: destroy tissue with subzero temperatures using liquid nitrogen Curettage: scrape lesion with sharp curet Electrodesiccation: destroy tissue by burning with electric spark
For what conditions is electrodesiccation recommended?

45. Clinical Procedures
Mohs surgery: remove thin layers of growth to examine under microscope (basal and squamous cell) Skin biopsy: punch and shave to remove for examination in path lab Skin test: test reaction of body to allergen with skin test (scratch or patch tests)
Discuss how some of the surgeries are for both diagnosis and treatment. Removal is done whether or not the physician knows that the lesion is cancerous.
All suspicious-looking tissues removed from the body are sent to the pathology lab for analysis. Why?

46. Abbreviations
ABCDE asymmetry, border, color, diameter, evolution (or change) —characteristics associated with melanoma
bx biopsy
Derm. dermatology
DLE discoid lupus erythematosus
PPD purified protein derivative
PUVA psoralen-ultravoilet A light therapy
SLE systemic lupus erythematosus
SC subcutaneous
Ask students to provide the full terms for these abbreviations.

47. Review Sheet adip/o ___________ albin/o ___________ caus/o ___________
COMBINING FORMS
adip/o ___________
albin/o ___________
caus/o ___________
cauter/o ___________
cutane/o ___________
derm/o ___________
Combining Form Meaning

48. Review Sheet adip/o fat albin/o white caus/o burn, burning
COMBINING FORMS
adip/o fat
albin/o white
caus/o burn, burning
cauter/o heat, burn
cutane/o skin
derm/o skin
Combining Form Meaning

49. Review Sheet dermat/o ___________ diaphor/o ___________
COMBINING FORMS
dermat/o ___________
diaphor/o ___________
erythem/o ___________
erythemat/o ___________
hidr/o ___________
ichthy/o ___________
Combining Form Meaning

50. Review Sheet dermat/o skin diaphor/o profuse sweating
COMBINING FORMS
dermat/o skin
diaphor/o profuse sweating
erythem/o redness
erythemat/o redness
hidr/o sweat
ichthy/o scaly, dry
Combining Form Meaning

51. Review Sheet kerat/o ___________ leuk/o ___________ lip/o ___________
COMBINING FORMS
kerat/o ___________
leuk/o ___________
lip/o ___________
melan/o ___________
myc/o ___________
onych/o ___________
Combining Form Meaning

52. Review Sheet kerat/o hard, horny tissue leuk/o white lip/o fat
COMBINING FORMS
kerat/o hard, horny tissue
leuk/o white
lip/o fat
melan/o black
myc/o fungus
onych/o nail
Combining Form Meaning

53. Review Sheet phyt/o ___________ pil/o ___________ py/o ___________
COMBINING FORMS
phyt/o ___________
pil/o ___________
py/o ___________
rhythid/o ___________
seb/o ___________
sabace/o ___________
squam/o ___________
Combining Form Meaning

54. Review Sheet phyt/o plant pil/o hair, hair follicle py/o pus
COMBINING FORMS
phyt/o plant
pil/o hair, hair follicle
py/o pus
rhythid/o wrinkle
seb/o sebum
squam/o scale-like
Combining Form Meaning

55. Review Sheet steat/o ___________ trich/o ___________
COMBINING FORMS
steat/o ___________
trich/o ___________
ungu/o ___________
xanth/o ___________
xer/o ___________
Combining Form Meaning

56. Review Sheet steat/o fat trich/o hair ungu/o nail xanth/o yellow
COMBINING FORMS
steat/o fat
trich/o hair
ungu/o nail
xanth/o yellow
xer/o dry
Combining Form Meaning

57. Review Sheet -algia ___________ -derma ___________ -esis ___________
SUFFIXES
-algia ___________
-derma ___________
-esis ___________
-lysis ___________
-ose ___________
Suffix Meaning

58. Review Sheet -algia pain -derma skin -esis condition
SUFFIXES
-algia pain
-derma skin
-esis condition
-lysis breakdown; separation; destruction; loosening
-ose full of; pertaining to; sugar
Suffix Meaning

59. Review Sheet -osis ___________ -ous ___________ -plakia ___________
SUFFIXES
-osis ___________
-ous ___________
-plakia ___________
-plasty ___________
-rrhea ___________
Suffix Meaning

60. Review Sheet -osis condition, usually abnormal -ous pertaining to
SUFFIXES
-osis condition, usually abnormal
-ous pertaining to
-plakia plaque
-plasty surgical repair
-rrhea flow; discharge
Suffix Meaning