Layer Consistence Function

- Young cells divide by mitosis &

form all the structures of the
The basal cell layer (stratum - One layer of basophilic cells and epidermis
germinativum ) chromatin filled elliptical nucleus - Melanocytes produce Melanin
- Melanocytes which protects the skin from
UVR

- Usually five to ten layers thick,

and they become flattened
Stratum spinosum (prickle cell
towards the surface - Protective cells
layer)
- Langerhans cells

Stratum granulosum ( granular cell - Elongated cells - Beginning of keratinization BUT

layer) - KHG Mitosis is still present
- Eleidin - Protective function: Doesn’t
Stratum Lucidum (lucid cell layer)
- Glycogen, lipids and FA allow substances in or out
- Keratinization = protection from
- Dead anucleated keratinized
Stratum corneum (Horny cell layer) penetration of microorganism
cells filled with keratin
and harmful substances.
Non-bullous Impetigo Bullous Impetigo
- usually no significant symptoms, - blisters tends to be painful and
although there may be some symptoms such as weakness, fever,
itching. and diarrhoea are more common.
- Honey colored crusts or corn - Bullous impetigo does not form a
flakes appearance honey-colored crust.
- Lesions most commonly form in
- May occur in the buccal the intertriginous regions and on
membrane the trunk
Impetigo vs. ecthyma
• Impetigo is an itchy and slightly painful. The itching often leads to
extensive scratching, particularly in children, which serves to spread the
infection.
• Ecthyma is a form of impetigo. It is characterized by small, shallow ulcers
that have a punched-out appearance and sometimes contain pus.
• The crust that covers the ulcers is thicker than the crust caused by
impetigo. It is brown-black in color. The area around the ulcers is typically
purplish red and swollen.

• N.B Ecthyma is a primary skin infection characterized by ulcerating

pustules or vesicles on an erythematous base
 What key clinical finding differentiates
erysipelas from cellulitis?
• In cellulitis, the reddened skin is less clearly defined than it is in
erysipelas, and it is often dark-red or slightly purplish.
• Unlike erysipelas, the infection caused by cellulitis reaches the lower
layers of skin and the tissue beneath it.
• The infection can spread along tendons and muscles, and pus may
form

• Erysipelas is a superficial infection, affecting the upper layers of the

skin, while cellulitis affects the deeper tissues.
• Affects face and legs
• Due to hemolytic streptococci
 How is cellulitis different from erysipelas
demarcation?
• Bright red erythema, elevation of the affected skin, and well-
demarcated borders can help to diagnose erysipelas and distinguish it
from cellulitis, which tends to be more mildly erythematous (pink)
and flat with less distinct boundaries.
• Erysipelas may also have streaking when superficial lymphatics are
involved
 Paronychia

Acute Chronic

- Usually caused by mechanical or chemical factors

- Lasting less than six weeks,
and sometimes infectious etiology like a fungal
-Painful and purulent condition
infection, especially Candida species.
- Most frequently caused by a bacterial infection,
- Streptococci and Pseudomonas are more common
especially staphylococci.
in chronic infections

- The majority of acute paronychias are due to

trauma, nail-biting, aggressive manicuring, artificial
nails, and may involve a retained foreign body.
- Children are prone to acute infection due to
habitual nail-biting and finger sucking
 Bacterial cell Viral cell
- single-celled prokaryotes - non-cellular infectious particles
• A cytoplasm that lacks membrane-bound
organelles
• No nucleus, instead having a single •Structurally they have
circular bacterial chromosome that is free in the • A nucleic acid core
cytoplasm and is not associated with proteins • Their genomes are either DNA or RNA,
• Ribosomes and can be single or double-stranded
• A protein coat called a ‘capsid’ made of
repeating units known as capsomeres
• A cell wall that contains the Some viruses have an outer layer called
glycoprotein murein (peptidoglycan) an envelope formed from the membrane-
phospholipids
• Capsules
• It helps to protect bacteria from drying
out and from attack by cells of the
immune system of the host organism
• Flagella (singular flagellum)
• Long, tail-like structures that rotate,
enabling the prokaryote to move
 The differential diagnosis of orolabial HSV-1
infection

Aphthous stomatitis

HSV Aphthous ulcer

1ary lesion Vesicles Ulcer
Ulcers with erythematous
Appearance Shallow, punctate, multiple
base
Buccal mucosa, floor of
Gingiva, hard palate,
Location mouth, oropharynx,
vermilion border
vestibule, tongue
Number Few to several One to few
Unclear: immunological
Cause Viral
mediated
Common wart Verruca plana Planter wart Filiform wart

• These occur chiefly • They are the only painful type. • They have long,
in children as • Skin colored or narrow projections
elevated rounded pigmented, flat-topped • They are deeply embedded in that extend about
swellings with rough the soles of the feet particularly 1 to 2 millimeters
horny surface. papules with a smooth the pressure points. from the skin.
• Common sites are surface. • They can be
the hands, fingers, • They are sharply defined,
yellow, brown,
palms and • The face, dorsum of
rounded lesions, with a rough
pink, or skin-
periungual area and keratotic surface surrounded by toned, and don’t
the lesions range in hands and shins are the a collar of thickened horn, small generally form in
size from pinpoint to satellite warts may develop clusters.
more than 1 cm. sites of predilections. around a large one.
Differentiation between condyloma accuminata
and codyloma lata.

Condyloma acuminata Condyloma lata

Cause Human papilloma virus Treponema pallidum

Morphology Cauliflower & Flat & sessile
pedunculated
Surface Rough Smooth
Color Pink Grayish white
Base Not indurated Indurated
Bleeding Easy Not easy
Lymph nodes No lymphadenopathy Generalized
lymphadenopathy
Dark ground -ve +ve
Serological -ve +ve
 What is the difference between molluscum
and folliculitis?

• Molluscum contagiosum is a rash of bumps on the skin that can

become inflamed and spreads quickly.
• Folliculitis is an inflammation of the hair follicles, resulting in red
bumps on the skin, which can be caused by an ingrown hair, or a
bacterial or fungal infection
 Scaly Ringworm Black dot Ringworm
Tonsurans, violaceum,
Canis, audouninii

Single or multiple, rounded itchy balded Usually multiple scattered angular small
patch areas

Covered with small grayish white scales

Scales may ocuur

Hair breaks off into short stumps Hair breaks off at the surface of the
scalp leading to the black dot
appearance

No scar

DD: Ps
AD
SD
 Tuberculoid Leprosy Lepromatous Leprosy
Fairly good CMI Poor CMI
Single, unilateral Bilateral
Asymmetrical if multiple Symmetrical
Early loss of sensation Intact
Lepromin test +ve Lepromin -ve
Smear: No bacilli Smear: many bacilli
Pathology: Linear granuloma Pathology: Diffuse infiltrate (foam
following nerve macrophage)
 Little or No
High resistance Unstable resistance
TT BT BB BL LL

Few or many Numerous &

No. of lesions 1-3 Few Many
asymptomatic symmetrical

Bacillary load 0 1+ 2+ 3+ 4+

Lepromin test
3+ 2+ = + 0
reactivity

Linear granulomas following

Histology Grenz Zone ( normal collagen)
nerve
Paucibacaillary (6ms)
Multibacillary (1-2 years)
Treatment Dapson: bacteriostatic
Rifampicin: bacteriocidal
 Tuberculoid Lepromatous
Immunity good Low

C/P Only affect nerves +skin -early :skin & mm.

-Late: nerves & internal organs
Lesion No :Single or few (1-10) Multiple (hundreds)
Skin lesion: (patch or plaque) Macules,papules,plaques, nodules,ill defined edge
Hairless, anhidrotic,well defined shiny surface
anethesia Early & marked late
Nerve enlargment. Marked in few nerves Slight, wide spread
Internal Organ . -ve +ve
m.m. -ve +ve ( URT ,Attacks of epistaxis)

Slit skin smear -ve +ve

Lepromin test +ve -ve

Histopathology Tuberculoid granuloma Diffuse granuloma mainly bacillus laden

histiocytes,(Foam or lepra cells)
Treatment Rifampicin +Dapsone Rifampicin +Dapsone +Clofazimine
6-12 months 2 years
 Contact Dermatitis
Contact Dermatitis is precipitated by an exogenous agent, often a chemical :

Irritant contact dermatitis (ICD) Allergic contact dermatitis (ACD)

• Non- allergic reaction which occur to • Delayed cell- mediated
all individuals when exposed to
irritant substances hypersensitivity reaction (type IV)
• The nature and extent of the rash • Occur on exposure of sensitized
depend on how much of the irritant
was present, and the duration of person to sensitizers
exposure.
• NO Dermatitis on 1st exposure, usually
• E.g. strong acids or alkalis
after repeated exposures
• More common than allergic
 Irritant contact dermatitis Allergic contact dermatitis
Often acute in onset Acute, subacute, or chronic in onset
Appears after first exposure Sensitization necessary before the
reaction occurs
Decrescendo phenomenon - reaches a Crescendo phenomenon - keeps
rapid peak and starts to resolve worsening and resolves more slowly
Red swollen skin, sometimes ulcerated, Vesicles are common, but ulceration or
in acute form skin necrosis is rare in acute cases
Thickening, erosion, fissuring, or shiny Vesicles may not be found in chronic
skin following chronic irritation cases
Sharply delimited rash in area of contact More ill-defined boundaries but lesions
usually found in areas of contact
Burning or stinging of the area, which is Intensely pruritic lesions
intensely tender
 Eccrine sweat glands Apocrine sweat glands

Distribution Over the whole skin surface, except Axilla, perianal and areola
earcanal, clitoris and labia minora

Functions • Body cooling by evaporation in hot Responsible for body odor (bacteria
environment cause decomposition of their oily
• Moisten the skin on the palms and odourless fluid)
soles to improve their grip

Control • Cholinergic sympathetic • Adrenergic sympathetic

• Androgen dependent (poorly dependent in
childhood and begins to enlarge with the
approach of puberty)
 FUNCTIONS Apocrine sweat
Eccrine sweat glands
glands
Serves as a thermoregulatory function Apocrine sweat glands start
internal temp. of the body , sweat to function at puberty under
glands release water to the skin the stimulation of sex
surface. There, it quickly evaporates,
subsequently cooling the skin and hormones.
blood beneath. They are associated with hair
This is the most effective means of follicles in the groin and
thermoregulation in humans. axillary region.
Eccrine sweat glands also participate The viscous, protein-rich
in ion and nitrogenous waste excretion. product is initially odorless
In response to emotional or thermal
stimuli, sweat glands can produce at but may develop an odor
least 500 mL to 750 mL in a day after exposure to bacteria.