Dermatology

The Skin
This chapter provides an introduction to dermatology, the medical study of the skin and related structures,
along with related diseases and their treatments. The skin is the largest organ of the body. The average
adult has approximately 22 square feet of skin. The skin and its accessory organs constitute the
integumentary system. The accessory organs include hair, nails, sweat glands, and sebaceous (oil) glands.
A dermatologist is a physician who specializes in the diagnosis and treatment of diseases and conditions
related to the integumentary system.

THE STRUCTURE OF THE SKIN

The skin has a number of purposes including protecting us from infections, injuries, and substances such
as harsh chemical that could harm the more delicate underlying tissues. The skin helps the body maintain
its temperature and protects against dehydration. Many sensory nerve ending are located in the skin.
Depending on their type, these nerve endings sense cold, warmth, sustained pressure, or pain. When
exposed to sunlight, the skin also synthesizes vitamin D. Some textbook state that the skin has only two
strata: the epidermis and the dermis. These textbooks do not consider the subcutaneous tissue to be a
component of the skin. However, in this textbook we will be including the subcutaneous tissue as a layer
of the skin. The epidermis, which is the epithelium of the skin, is the most superficial layer, and it is the
only part we ordinarily see. The epidermis is composed of squamous epithelial cells. The tern
squamous refers to the fact that these cells are scalelike and do not contain any blood vessels, nerve cells,
or connective tissue. The deepest epidermal layer, the stratum germinativum, is where new cells are
made. The stratum germinativum is also known as the basal baseline
cell or basilar layer. As new cells are
produced, they push the older cells towards the most superficial epidermal layer, the stratum corneum.
When the oldest cells reach this top layer, they die and are filled with keratin, a fibrous protein substance
that is relatively waterproof. The number of keratin in this layer varies from one part of the body to the
other.

The soles and palms have relatively large amounts, which makes them tougher than other parts of the
skin. Special cells within the epidermis called melanocytes produce a substance called melanin, which is
the black or dark-brown pigment that colors the skin. The more melanin in the skin, the darker its color.
Dark areas such as moles have concentrations of melanin. Melanin absorbs ultraviolet light, which is why
darker-skinned people are less susceptible to sun damage than lighter-skinned people. When people are
exposed to strong ultraviolet light over a period of time, melanin production is increased, leading to a
suntan. If melanin is not able to absorb all the ultraviolet light, the skin becomes sunburned.

Immediately beneath the epidermis is the dermis, or corium, a dense fibrous layer of connective tissue.
This layer has a large number of blood and lymph vessels and nerve endings. The dermis is highly elastic
and flexible to protect deeper tissues and is composed of two distinct layers. The papillary dermis is
contiguous with the epidermis. The reticular dermis lies between the papillary dermis and the
subcutaneous tissue. The deepest layer of the skin, the subcutaneous tissue, contains connective tissue
and specializes in creating fat of adipose tissue. The lipocytes (fat cells) in this layer are responsible for
manufacturing and storing fat. The subcutaneous layer protects the deeper tissues and helps to regulate
body temperature. It connects the skin to the underlying muscles and organs. The subcutaneous tissue
also contains blood and lymph vessels and nerve.

The Glands of the skin

The skin has two types of glands,sebaceous, or oil, glands produce an oily substance called sebum.
These glands are found near follicles and discharge sebum into the hair follicles. The sebum helps make
hair soft and flexible. Because sebum is acidic, it helps destroy bacteria on the skin’s surface.
Sudoriferous, or sweat glands produce sweat. There are two types of sweat glands. Eccrine glands are
found all over the body and produce relatively watery sweat when the body becomes overly warm. Their
purpose is to regulate body temperature. When a person reaches puberly, a second type of sweat gland
becomes active. These glands are the apocrine glands. They produce a thicker milky sweat, which is
broken down by bacteria, creating a distinctive order. Apocrine sweat glands occur primarly under the
arms and in the groin area. A special types of apocrine gland is responsible for creating earwax, or
cerumen.

Figure 9-1
Hair and Nails

Both hair and nails are made of keratin. Hair occurs over the entire body except the palms and the soles.
It is concentrated in the scalp, which contains about 100,000 hairs. A hair follicle is a group of cells
forming a cavity from which the hair shaft develops. The part of the hair that protrudes from the skin is
referred to as the hair shaft. The part of the hair that follicle is the hair root. Hair growth takes places
in two phases. The first phase is the anagen (growth) phase, and the second is the telogen (resting) phase.

Nails are made of hardest keratin and protect the ends of the fingers and toes from injury. The lunula is
the arch-shaped white area at the base of the nailbed. This is the area where nail growth takes place.
EXAMINATION THE SKIN

The examination begins by inquiring about any history of skin disease or lesions. The physician also asks
whether the patient has experienced any excessive itching, changes in skin pigmentations, or other
abnormalities. A thorough dermatologic examination involves inspection of the entire body, including
hair, nails, and mucous membranes. In additions to inspection, these areas may be palpated (examined
by pressing with the fingers or palm of the hand). A physician examines for color, vascularity, moisture,
temperature, texture, thickness, mobility, and turgor. Mobility refers to the skin’s ability to move, and
turgor is the speed with which the skin returns distribution and color is noted. Any excessive redness or
pallor can best be observed in areas such as the fingernails, lips and mucous membranes. The fingernails
and toenails are inspected for abnormalities such as depression in the nail bed.

DISEASES AND CONDITIONS OF THE SKIN

Many skin disease can be diagnosed by inspection alone. A physician will note abnormalities such as
growth, lesions, or rashes. Any pathological change in tissue is referred to as a lesion. Figure 9-2
contains illustrations of several types of lesions, which are described in Table 9-1. Lesion may be trigged
by a number of causes, some of which are injury (truma); parasitic infestation; toxic or allergic reaction to
substances; or bacterial, fungal, viral, or yeast infection. For example, bacterial skin infection can be
caused by Staphylococcous aureus or Streptococcus pyogenes, both bacteria commonly found in
humans. Cellulitis, folliculitis, furuncles and carbuncles are dermatological infections that may be caused
by Staphylococcus aureus. Cellulitis may be casues by Streptococcus pyogenes. Some skin conditions
are chronic (long term) while others are acute (short term). Many skin conditions are accompanied by
pruritus (itching). Common skin conditions and disease are listed in Table 9-2.

TABLE 9-1 Skin Lesions

Name Description
bulla A large blister containing clear fluid. It is a vesicle that is greater than or equal to 5
mm.
cyst A sealed sac containing fluid or semisolid material. It has a membrane lining.
fissure A deep furrow, slit, or cracklike sore.
macule A discoloured flat lesion such as a freckle or flat mole that is less than 10 mm and
may exhibit a variety of shapes.
nodule A solid elevation of the skin that is more than 10 mm and can be palpated.
papule A small solid elevation of the skin that is less than 10 mm.
polyp A mushroom like growth on a slender stalk that projects outward from the surface.
pustule A small elevation of the skin containing pus.
ulcer A deep open sore on the surface of the skin or mucous membrane. It may lead to
bleeding and scaring.
vesicle A small elevation of the skin containing clear fluid that is less than 5 mm; a blister.
An example is the lesion that develops with chickenpox.
wheal A discolored swollen area of the skin; it is slightly elevate. Also called hives.
Figure 9-2

TABLE 9-2 Dermatologic Diseases and Conditions

Condition on Description
Disease
abrasion Removal or scraping away of the superficial layers of the skin or mucous
membranes. pus

abscess A cavity filled with purulent matter; usually caused by a localized infection.
acne rosacea An inflammatory disorder characterized by papules, pustules, erythema and
(rosacea) the dilation of small blood vessels on the face. Primarily occurs in middle
 age.
acne vulgaris An inflammatory disorder characterized by papules, pustules and
comedones. There is excessive secretion of sebum and irritation caused by
skin bacteria. Typically occurs at puberty and adolescence.
actinic lentigines Small discolored lesions on exposed areas of the skin caused by long-term
exposure to ultraviolet light or rays of the electromagnetic spectrum. Also
called liver spots.
albinism An inherited disorder in which the body is unable to produce melanin,
causing the skin and hair to be white.
alopecia Loss of hair. It can be either total or partial.
angioma A swelling or tumor that is made up of bold vessels.
anhidrosis The inability to tolerate heat due to a lack of sweat glands or malfunctioning
sweat glands.
asteatosis Dry skin accompanied by flaking and itching.
athlete foot A fungal infection of the foot. Also known as tinea pedia or ringworm of the
foot.
atopic dermatitis Inflammation of the skin arising from hypersensitivity to an environment
substance. The condition is acquired genetically.
atrophy A decline in the functioning of tissues that dermatologically manifests as
wrinked, thin skin.
birthmark A persistent colored lesion noted at or near birth that it typically due to a
hemangioma or nevus.
café au lait spot A patch of skin having light-brown pigmentation.
callus A thickening of the skin that develops when pressure or friction is applied to
it over a period of time. Calluses often develop on the palms and soles and
can protect the skin from damage. Callus also refers to tissues that reforms
at the ends of a broken bone and eventually binds them together.
candida A genus of yeast like fungi that can cause rashes and itching. The skin may
peel and bleed easily. Examples include diaper rash and vaginitis (an
inflammation of the vagina).
carbuncle A deep-seated pus-forming staphylococcal infection comprised of several
furuncles. The disorder heals slowly and results in a large scar.
caruncle A small, fleshy growth. Also called a caruncula.
cellulitis Spreading inflammation of cellular or connective tissue, characterized by
skin eruption in the forms of vesicles, papules, macules, crusting and
accompanied by severe itching.
chloasma Irregular shaped brown patches that occur primarily on the face. It often
occurs during pregnancy or as a result of using oral contraceptives. Also
called moth patch or mask of pregnancy.
cicatrix A scar.
comedo, comedos A dilated hair follicle filled with dead cells and oily secretions. It is the
(plural), comedones primary lesion associated with acne vulgaris. Comedos can be closed, in are
(plural) known as blackheads.
contact dermatitis A localized inflammation that is frequently caused by an allergy to poison
ivy, food, soap, skin care products, etc.
contusion A haemorrhage that occurs beneath unbroken skin. Also called a bruise.
crust A scab containing dried blood, lymph, and/or pus that occurs in some
inflammatory diseases.
cyanosis A dark blue or purplish coloration to the skin caused by lack of oxygen.
decubitus ulcer A dark lesion caused by pressure being placed on the skin over an extended
 period of time. Also referred to as a bedsore diaphoresis sweating.
ecchymosis An irregularly shaped area of discolored tissue caused by blood
haemorrhaging into the skin.
eczema An inflammatory skin disease typically with redness of the skin, vesicles and
crushing.
erosion A loss of all or part of the epidermis in an area of the skin.
erythema Reddish skin due to dilation of underlying capillaries.
erythema A mild infectious disease, usually occurring in childhood, that is
infectiosum characterized by a reddish rash. Also called fifth disease.
erythroderma An abnormal and generally widespread reddening of the skin due to dilation
of underlying capillaries. Sunburn is one cause of erythroderma.
excoriation A scratch or scrape mark on the skin, usually covered with a crust.
fifth disease A mild infectious disease, usually occurring in childhood that is
characterized by a reddish rash. Also called erythema infectiosum.
fistula An abnormal channel or tube that connects two hollow organs or leads from
an organ to the skin’s surface.
folliculitis Superficial infection and inflammation of the hair follicles.
freckle A small yellow or brown macule, typically seen on individuals with light
complexions. Primarily seen on areas of the skin exposed to sunlight. Also
called an ephelis (pl.ephelides).
gangrene The death of tissue caused by lack of blood supply.
hemangioma A congenital benign (noncancerous) tumor that consist of a mass of blood
vessels.
hematoma A localized mass of blood outside the blood vessels and under the skin’s
surface.
herpes simples This term is used for a variety of infections caused by herpes viruses. Type 1
(HSV-1) (HSV-2) caused the eruption of vesicles on the borders of the lips or nose. These
lesions are also called cold sores. Types 2 causes gential lesions. Both types
are recurring.
herpes zoster A viral infection characterized by painful vesicles (blister) along the path of
an inflamed nerve. Also called shingles.
hirsutism Excessive facial and body hair, usually in a female.
hyperhidrosis Excessive sweating.
ichthyosis Dryness of the skin with scales and flaking that can become disfiguring.
impetingo A contangious inflammatory skin disease caused by bacteria and
characterized by vesicles and leisons having a thick, yellowish crust.
jaundice A condition in which the skin, whites of the eyes, and associated tissues take
on a yellowish color.
keloid A firm, movable mass of scar tissue that can be caused by trauma, surgery,
burns,etc.
lentigo A brown or block macule with sharp margins ranging from 2 to 4 mm that
does not darken or multiply with skin exposure. A type of mole.
lichen planus An inflammatory eruption of papules and sometimes bullae that together
form scaly pruritic patches.
lichenificarion Thickening and hardening of the skin.
lipoma A benign neoplasm of fat cells.
melitis An inflammation of the cheek.
milium, milia A keratin cyst caused by blockage of a hair follicle or sweat gland. Also
(plural) called a whitehead.
mole A localized growth of hyperpigmented skin.
mycosis Any disease caused by a fungus.
nerves, nevi A congenital discoloration of the skin such as a mole of birthmark.
(plural)
onycholysis A conditions in which the nails are loosened from the nailbed.
paronychia An inflammation of the skin around the nail which may be caused by
bacteris or fungi.
patch A flat discolored area of skib greater than 10 mm. It is a large macule.
pedicuosis Infestation by lice causing serve itching.
pemphigus A group of distinctive disease characterized by successive outbreak of
vesicles, bullae, or blisters.
petechial Minute hemorrhages of the skin that result in tiny purple or red spots.
plaque A slightly elevated lesion greater than 10 mm. It is larger than a papule and
can be a group of papules.
pruritus Itching.
psoriasis A chronic, recurrent, inflammatory skin disease resulting in dry scaly red
patches covered by silver-gray scales. The epithelial cells divide at an
abnormally rapid rate. The cause is unknown, but a family history of the
disease is common. Age of onset is typically 10-40.
purpura An area in which blood vessels have haemorrhaged into the skin.
rhinophyma Enlargement of thr nose characterized by dilated follicles and caused by
overgrowth of sebaceous.
ringworm A fungal infection, tinea.
rubella An infectious viral disease accomplished by fever and a red rash. It can
caused birth defects in pregnant women. Also known as German measles.
scabies A transmissible skin infection caused by a parasite’s (a mite) burrowing into
the skin. It is accompanied by extreme itching.
scale A raised plate of epithelium that is abundantly filled with keratin.
scar An area of fibrous tissue that has replaced normal skin after some form of
destruction of the dermis.
scleroderma A chronic disease in which the connective tissue hardens and shrinks,
causing thickening of the skin. Over time, symptoms become progressively
worse.
seborrhea Overactivity of the oil glands leading to excessive sebum.
systemic lupus A chronic systemic inflammatory disease affecting the connective tissues in
erythematosus the skin, joints and internal organs. Dermal lesions include and erythema in
(SLE) the shape of butterfly wings across the cheekbones of the face.
telangiectasia Dilation of superficial blood vessels.
tinea A fungal infection. There are several types including tinea corposris
(ringworm of the body), tinea capitis (ringworm of the scalp), tinea pedis
(athlete foot), tinea barbae (ringworm of the beard) and onychomycosis
(ringworm of the nails).
tumor A large nodule or swelling generally greater than 20 mm.
urticiria An allergic reaction that result in the eruption of small itchy patches called
wheals. Also called hives.
varicella An infection viral disease most commonly occurring in children. It causes
pustules and itching and is commonly referred to as chickenpox.
vitiligo Irregularly shaped patches of milk-white nonpigmented skin surrounded by
skin with normal pigmentation.
wart A thickening of the epidermis caused by a virus. Warts typically have a
round shape.
xanthoma A yellowish nodule on the skin composed of fat, most commonly found on
the eyelids.
xeroderma Excessive dryness of the skin.

Burns and Frostbite

A burn is any injury caused by heat. As shown in Table 9-3, burns are classified by degree of severity. If
70% or more of the body surface is covered with burns, death usually occurs because of the large amount
of bodily fluid that are lost. The rule of nines is used to calculate the proportion of total burn surface area
in adults. Figure 9-3 shows the percentages assigned to each area of the body. Note that the values in this
figure total 99%. The remaining 1% covers the genitalia. Because infants’ and children’s heads are
proportionally larger than those of adults, these percentages must be modified when applied to them.
Frostbite is a skin condition caused by excessive exposure to cold temperatures. Frostbite damage is
divided into three categories of degree exposure to cold temperature. Frostbite damage is divided into
three categories of degrees, just like burn damage.

Fig:9-3

TABLE 9-3 Classifications of Burns

Classification Description
first degree burn A burn of the epidermis that is red and swollen, but there is no blistering.
second degree burn A burn of both the epidermis and dermis in which blistering and tissue death
usually occur.
third degree burn A burn that affects all layers of the skin including the subcutaneous tissue
and sometimes even muscle and bone. There is typically extensive scaring.
Neoplasms

Any abnormal growth is referred to as a neoplasm. Neoplasms can be either benign or malignant. A
benign growth does not spread to surrounding tissues. Malignant growths can spread to surrounding
tissues. How quickly a malignant growth spreads depends on where it occur on the body and the type of
malignancy. Skin cancer is the most common type of cancer in humans. These growths are termed
carcinomas, which are malignant growths composed of epithelial cells. Four types of skin carcinomas
are discussed here. Basal cell carcinoma is the most common type and is a malignancy of the stratum
germinativum, which is also called the basal cell layer. Basal cell carcinoma may be caused by
overexposure to the sun. This type of the skin cancer tends to grow slowly and generally does not
metastasize (spread to surrounding tissue). A basal cell carcinoma frequently develops a hard crust on its
surface.

A squamous cell carcinoma, which generally occur in sun-exposed areas of the skin, is a cancerous
growth in the squamous epithelial cells. It can be spread to surrounding tisues. Malignant melanoma is
an aggressive form of skin cancer that starts in the melanocytes, the cells that produce melanin. Primarily
caused by overexposure to the sun, melanomas can spread from the skin to internal organs such as the
lungs.

Melanomas frequently are classified using the Clark level, which is defined in Table 9-4, Kaposi sarcoma
is a special types of tumor that is primarily associated with acquired immunodeficiency syndrome
(AIDS). Kaposi sarcoma often spreads to internal organs, making it fatal. Table 9-5 contains an
overview of these four types of skin cancer.

TABLE 9-4 Clark Level Classification of Malignant Melanomas

Level Description
I Tumor is confined to the epidermis.
II Tumor has invaded underlying papillary dermis.
III Tumor has invaded the junction of the papillary and reticular
dermis.
IV Tumor has invaded the reticular dermis.
V Tumor has invaded the subcutaneous fat.

TABLE 9-5 Cancerous Skin Lesions

Types Description
basal cell carcinoma A malignant tumor of the basal cell layer (stratum germinativum) of
the epidermis. It is slow growing and rarely metastasizes.
Kaposi sarcoma A malignant growth characterized by nodules ranging in color from
pink to purple or dark blue. It can invade internal organs and be fatal.
It is primarily associated with acquired immunodeficiency syndrome
(AIDS).
malignant melanoma A malignant growth that is composed of melanocytes, the cells that
produce melanin. It can metastasize to internal organs such as the
lungs and brain.
squamous cell carcinoma A malignant tumor of the squamous epithelial cells. It can occur in
situ (in position) or it can be invasive.

Aging Disorders

A variety of changes occur as the skin ages. The skin gradually loses its elasticity and wrinkles appear,
while the number of blood vessels decreases. The skin becomes thinner and in Caucasians, it appears
paler. On those part of the body exposed to the sun, the skin may become thicker and red or yellow in
color. Liver spots (actinic lentigines) frequently appear on exposed areas, and skin cancers such as
carcinoma and squamous cell carcinoma are more common. A steatosis (dry skin)increases with age,
leading to flaking and itchy skin.

These skin charges tend to be most significant in light-skinned individuals and those who have spent a
great deal of time in the sun. Other parts of the integumentary system also show signs of aging. Nails
becomes thicker and take on a yellow color. As hair loses its pigments, it becomes gray or white. Men’s
hairlines may recede and hair may become thinner in both sexes, although the extent of these changes is
largely controlled by genetic factors.

COMMON DIAGNOSTIC TESTS AND PROCEDURES

Dermatologists frequently perform biopsies on lesions and send the specimens to the laboratory for
analysis. This analysis can determine whether a growth is malignant. For many small tumors, the
diagnosis and the cure occur at the same time if the excision completely removes the tumor. Various
diagnostic tests and procedures used in dermatology, including biopsy, are listed in Table 9-6.

TABLE 9-6 Common Diagnostic and Procedures in Dermatology

Test Description
bacterial culture Samples of purulent tissue are sent to the laboratory and cultured in
substances to promote growth. It may then be determined if bacteria are
present and, if so, the type(s).
biopsy A small amount of tissue is removal and sent to the laboratory for
microscopic examination to establish a diagnosis. Biopsies are
commonly used to diagnosis malignant growths. The three types of
biopsies are excisional (complete removal of the lesions), incisional
(partial removal of the lesions) and punch (partial removal with a
special operating instruments that makes a hole in the skin).
darkfield microscopy Fluid or tissue in obtained from a lesion and placed on a slide. Light is
directed obliquely through the slides as that a typical cells will appear
bright against a dark background.
frozen section A tissue specimen is frozen and then a thin slice is removal for
 microscopic examination. This procedure allows for rapid diagnosis.
Gram stain A specific chemical agent is used to stain a slide. After staining, the
slide may be examined microscopically to visualize and differentiate
types of bacteria.
immunofluorescence Serum or a biopsy specimen is analyzed under the microscope for the
tests presence of specific antibodies.
patch test A small piece of gauze or filter paper saturated with a test substance is
placed on the skin. If the skin reacts, the test is considered positive.
This testing allows a substances to be pinpointed as the cause of contact
of contact dermatitis.
sabouraud culture A tissue specimen is cultured on a medium conducive to growth of
pathogenic fungi.
scrapings and KOH Scrapings from affected parts of the skin are placed in potassium
solution (fungal) hydroxide (KOH) and examined under the microscope to determine the
presence of superficial fungal infections.
scrapings for parasites Skin is scraped and placed on a slide with special alcohol or oil. The
scraping is examined under a microscope for the presence of a parasite,
its eggs, or its excrement.
Tzanck test Fluid is removal from a vesicle. Stained and examined microscopically
for a typical cells to determine if herpes simplex, herpes zoster or
pemphigus vulgaris is present.
viral culture Fluid is obtained from a lesion and placed in a special substances in
order to microscopically observe and viral growth.
Wood light examination The skin is viewed under ultraviolet light filtered through nickel oxide
in a dark room. This allows diagnosis of fungal and bacterial infections
and the ability to differentiate pigmentation of vitiligo lesions.
Depending upon the microbe, the infected skin will appear to display a
characteristic color.

PHARMACOLOGY

Drugs used in dermatology fall into several classifications (see Table 9-7). Antifungal medications work
against common fungal infections such as tinea capitis and tinea pedis. The type of drug used depends on
the types of fungus and may be administered topically or orally. Fungi are closely related to yeasts.
Many antifungal drugs are also antiyeast drugs. Many of the anti-inflammatory drugs used to combat
itching and skin inflammation are classified as corticosteroids. Corticosteroids are chemical substances
produced by the cortex of the adrenal gland. Antibiotics are used to treat bacterial infections and for
prophylaxis (prevention of a disease). Antipsoriatics aid in controlling psoriasis by decreasing the rate at
which epithelial cells. A pediculicide is a types if parasiticide that kills lice and treats pediculosis. A
scabinide is also a type of parasiticide that treat scabies. Topical anesthetics are useful in depending in
desensitizing an area to relieve itching and pain from minor injuries and sunburn. As its name implies,an
antiacne drug is used to treat acne. Table 9-8 contains a listing of various generic dermatologic drugs.

TABLE 9-7 Classification of Dermatologic Drugs

Classification Usage Examples
anesthetic Temporary relief of pain and itching from benzocaine
(local) minor injuries such as burns, sunburns and
insects bites.
antiacne Treatment of acne. azelaic acid, tertinoin
antibacterial Reduction of the growth of bacteria. metronidazole
antibiotic Reduction of the growth of bacteria and clindamyein
microorganisms such as bacteria and mold.
antifungal Treatment of common fungal infections such butenafine, ciclopirox,
as tinea corporis and tinea pedis. cltrimazole, fluconazole,
griseofulvin, micronazole,
nystatin
antihistamine Reduction of the inflammation, itching and calamine, diohenhydramine
swelling caused by allergic reaction.
anti-infective Treatment and prophylaxis of skin infections, bacitracin, clindamycin,
minor words and acne. Some of these drugs phosphate, erythromycin, silver
are also used in the prevention and treatment sulfadizine, tetracycline
of infection in burns.
anti- Treatment and prophylaxis of skin infections, metronidazole
inflammatory minor wounds and acne. Some of these that
accompany acne rosacea. See also
corticosteroid.
antipsoriatic Topical and oral treatment of psoriasis. calcipotriene, methotrexate,
tazarotene
antiviral Topical or oral treatment of herpes simplex acyclovir, famciclovir
and herpes zoster infections.
antiyeast Treatment of Candida and other yeast ciclopirox, clotrimazole,
infections. miconazole, nystatin
corticosteroid Treatment of itching and inflammation. See betamethasome,
also antiboitc. dexamethasone, fluticasone,
hydrocortisone,
methyloprednisolone,
triamcinolone
keratolytic Treatment of psoriasis, dandruff and salicylic acid
seborrhea.
parasiticide Elimination of skin parasites and their eggs. lindane
These drugs are divided into two broad
groups: pediculicides and scabicides.
pediculicide Elimination of lice and their eggs. lindane
scabicide Elimination of scabies mites and their eggs. lindane

THERAPEUTIC PROCUDURES

As shown in Table 9-9. Dermatologists perform a variety of procedures, including using lasers to remove
scars, fine wrinkles and birthmarks, as discussed in Chapter 6. If the patient has lost skin due to burns or
abrasive injury, new skin may be grafted onto the body. This skin may come from the patient (autograft),
another human (allograft), or an animal donor (xenograft). Excision is the surgical removal of a part of
the body. Benign growths may be excised if they are infected or if the physician thinks they may become
malignant, infected, or lead to other problems. These growths also may be removal if they bother the
patient (for example, by rubbing against clothing) or for cosmetic reasons.

The particular procedure used to treat a malignant growth depends upon the anticipated rate of spread, its
location in the body and the type of tumor. Because basal cell carcinomas grow slowly and generally are
self-contained, they are usually removed by excision. No further treatment is typically necessary.
Squamous cells carcinomas can be either in situ (in position) or invasive. They may be treated by
surgical removal, radiotherapy, or a combination of two. Because malignant melanomas can be invasive,
they are always excised. The prognosis depends on how deeply the melanoma has invaded the skin and
whether it has metastasized to other organs. The surgeon may remove not only the melanoma itself, but
also any lymph nodes that have been affected. Chemotheraphy and radiotheraphy may also be used.

TABLE 9-9 Therapeutic Procedures Used in Dermatology

Procedure Description
allografting Transplanting a graft (tissue or organs) obtained from one individual of a
species to another individual of the same species.
autografting Transplanting a graft obtained from one area of the body to another area of
the same individual.
chemotherapy Treating a neoplasm by using drugs in an attempt to eradicate it or reduce its
size.
cryosurgery Using liquid nitrogen or carbon dioxide to achieve freezing temperature that
destroy tissue.
curettage Scraping an area to remove abnormal tissue or new growths.
debridement Excising dead tissue from a wound and/or removing any foreign matter.
dermabrasion Using special sandpaper, wire brushes, or other abrasive materials to remove
fine wrinkles, acne scars, tattoos, etc.
electrodesiccation Using electric current to destroy tissue or close blood vessels in the skin or
mucous membranes.
excision Surgically cutting out all or part of a structure. Tumors are frequently
excised.
fulguration Destroying tissue by using high-frequency electric sparks.
grafting Transplanting tissue to replace tissue that has been damaged or destroyed
due to disease or injury.
incision and Cutting open a lesion and draining its contents.
drainage (I&D)
laser surgery Using high-energy light beams to remove birthmarks, scars, wrinkles, etc.
mobs surgery Microscopically controlled excising in which superficial cancers are
removed following rapid killing of the tissue by chemicals.
radiotherapy Using radiation to treat a disease. In the case of a neoplasm, radiotherapy
may be used in an attempt to eradicate it or reduced its size.
skin grafting Transplanting skin from one area of a patient’s or donor’s body to a denuded
or traumatized area on the patient.
xenografting Transplanting a graft obtained from an animal of one species to an animal of
a different species.
Combining Forms for Terms Used in Dermatology

Form Meaning Example(s)

adip/o fat (see also lip/o) adipose, adipocyte
albin/o white albinism
angi/o blood or lymph vessels angioma, angioedema
cutaneo/o skin ( see also derm/o and dermat/o) subscutaneous
derm/o skin ( see also cutane/o and dermat/o) dermis, hypodermic
dermat/o skin ( see also cutane/o and derm/o) dermatitis, dermatology
hermangi/o blood vessels (see also angi/o) hemangioma, hemangiectasis
hydr/o water; waterly hydrate, dehydration
kerat/o hard; horny tissue keratin, keratosis
lip/o liquid; fat (see also adip/o) lipocyte, liposuction
melan/o black melanin, melanocyte, melanoma
myc/o fungus mycosis, mycodermatitis
onych/o fingernail; toenail onchomycosis, onchoclasis
phor/o carrying; a carrier diaphoresis, diaphoretic
scler/o hardening scleroderma
seb/o sebum (see also sebace/o) sebum, seborrhea
sebace/o sebum ( see also seb/o) sebaceous
squam/o scalelike squamous
sudo/o sweat; perspiration sudoriferous, sudor, sudation
xer/o dry xeroderma

Abbrevations

Abbrevation Meaning
Bx biopsy
derm dermatology
FS frozen section
HSV – 1 herpex simplex virus type 1
HSV – 2 herpex simplex virus type 2
I&D incision and drainage irrigation and debridement
irrigation and drainage
KOH potassium hydroxide
SLE systemic lupus erythematosus
SQ, subcu subcutaneous
ung ointment
UV ultraviolet