DERMATOLOGY
Lecture IV - COMMON SKIN PROCEDURES
COMMON SKIN PROCEDURES
Biopsy
Sometimes, a small piece of tissue is excised through a surgical process for some microscopic examination. This excision is called biopsy and such an act is performed with the help of a needle or syringe. The general purpose of getting a biopsy is to arrive at a diagnosis. The different kinds of biopsies performed are aspiration or needle biopsy, punch biopsy, shave biopsy, endoscopic biopsy, and chorionic villus biopsy. In aspiration or needle biopsy, the specimen is aspirated through a needle or trocar that penetrates the skin, the outer surface of the organ, or the underlying tissue to be examined. In punch biopsy, the specimen removed is in the form of a cylinder. Shave biopsy is a technique performed with surgical or razor blades, chiefly for the lesions of the dermis or epidermis.
Cryosurgery
Cryosurgery is a kind of operation performed using freezing temperature. This temperature is achieved by employing liquid nitrogen or carbon dioxide. This freezing temperature is used either as an agent or in an instrument to destroy tissues.
Dermabrasion
Dermabrasion is a technique to wipe out the acne scars (cicatrix) or the pits (small depressions in the skin). The physicians use sandpaper, rotating wire brushes, or other abrasive materials to efface these scars.
Electrocauterization
Scarring, burning, or cutting the skin by means of heat, cold, electric current, ultrasound, or caustic chemicals is called cauterization. During electrocauterization, a high-voltage current is passed through the tissues or the metal device that has been electrically heated.
Electrodesiccation
Lesions of the skin, sometimes of the mucous membranes, are destroyed and blood vessels sealed off by the monopolar high-frequency electric current. This process is known as electrodesiccation.
Frozen section
In this process, a thin slice of tissue is excised from a frozen specimen and sent for microscopic examination. This procedure is used for rapid diagnosis of malignancy, while the patient awaits surgery. This generally helps in determining the approach towards the surgery, i.e. conservative or radical.
Incision and drainage
Incision and drainage is a simple procedure to drain the fluids from a wound or cavity, An incision is made to allow the free flow or withdrawal of fluids from the wound or cavity.
Patch test
A small, circumscribed, flat area, not more than 1 cm in diameter, differing in color or structure from the surrounding surface, is called a patch. Patch test is done to ensure the sensitivity of the skin. A small piece of paper or tape is soaked with a non-irritating diluted test fluid and applied on the skin of upper back or upper outer arm and covered. After 48 hours, the covered area is compared with the uncovered area. The presence of erythema and vesicles indicate the allergy towards that substance.
Scratch test
Scratch test is one of the various skin tests performed to diagnose a pathology of the skin. In scratch test, an antigen is applied through a scratch in the skin.
Tzanck smear
Arnault Tzanck was a Russian dermatologist (1886- I 954). Tzanck smear is the examination of fluid from the bullous lesions of the altered epithelial cells, rounded and devoid of intercellular attachments, also known as Tzanck cells. These cells are basophilic in nature, with spherical nucleus and enlarged prominent nucleoli. They are characteristic of lesions due to varicella, herpes, and pemphigus vulgaris.
Now, lets take a look at the pharmacopoeia of skin.
Chapter IV - PHARMACOLOGY AND VOCABULARY
Acne vulgaris drugs
These drugs control the inflammatory eruptions composed of cysts, papules, and comedos, predominantly on the face, upper back, and chest. The condition occurs in a majority of people during puberty and adolescence. Examples: benzoyl peroxide, tretinoin, topical erythromycin, and meclocycline
Antipsoriatic
Psoriasis refers to the circumscribed discrete, silvery-scaled, confluent reddish lesions that primarily occur on knees, scalp, elbow, and trunk. There are many drugs for treatment of psoriasis like Calcipotriene, coal tar, and etretinate.
Antiseborrheics
These drugs are effective for treatment of seborrheic dermatitis manifested by erythematous and scaly lesions. Examples: selenium sulfide, chloroxine, coal tar, and sulfur and sulfacetamide.
Emollients and keratolytics
Emollients are agents used to soothe and hydrate the skin. After application to the skin, emollients prevent evaporation of water by forming a thin greasy layer on the skin surface. Emollients improve the dryness of skin but are not to be used on exudative lesions (oils like coconut, groundnut, etc.). Keratolytics are agents applied to soften the epidermic cells and desquamate them, for example, salicylic acid, benzoic acid, propylene glycol, zinc oxide, and dimethicone.
Topical anti-infectives
Topical anti-infectives are used for treatment of bacterial infections of skin, impetigo, eczema, folliculitis, and leg ulcers. They are also used for abrasions, cuts, and as preoperative antiseptics. Example: mupirocin, tetracycline, aminoglycoside, sulfonamides, nitrofurazone, and acyclovir. The antiseptics used are chloroxylenol, cetrimide, and povidone-iodine.
Topical Antifungals
These agents kill the fungus selectively. These antifungals include scabicides, which kill scabiei that invade the epidermis. Example: Malathion, lindane, benzyl benzoate. Someother antifungal are miconazole, which has a broad spectrum of antifungal activity and is used for fungal and eczematous infections of tinea, candidiasis of skin and nails and also for eczema with bacterial infection; clotrimazole which is used for Tinea infections, fungal nappy rash, candida vulvitis, candida balanitis, paronychia, and athlete foot; and vulvovaginal candidiasis; and ketoconazole for fungal infections of the skin.
Topical steroids
Topical steroids are used to treat various dermatological disorders like contact dermatitis, psoriasis, keloid scars, seborrheic dermatitis, eczema, and vulval pruritus. Example: beclomethasone dipropionate, triamcinolone acetate, hydrocortisone, methyl prednisolone acetate, and dexamethasone sodium phosphate.
VOCABULARY
1. Abrasion: scraping away or excoriation of the superficial layer of the skin or mucous membrane
2. Abscess: a pus-filled cavity caused by tissue destruction and associated with swelling
3. Acne: papular follicular eruptions characterized by pus and inflammation
4. Adenopathy: disease of the glands (lymph nodes)
5. Adipose: of or related to fat
6. Allograft: a graft between the individuals of the same species
7. Alopecia: falling hair, loss of hair
8. Anesthetics: agents which suppress the ability to feel pain or other sensations
9. Antibacterial: agents acting against the growth of bacteria
10. Antifungal: agents acting against fungus (syn antimycotic)
11. Anti-inflammatory: agents to reduce inflammation
12. Antiseptics: agents that prevent growth of infective agents (syn. Disinfectives)
13. Areola: any small area (also used for the areola of nipple)
14. Atopic: related to hypersensitivity to environmental allergens
15. Benign: mild, non-malignant
16. Biopsy: process of taking out a specimen of tissue for diagnostic purposes
17. Blemish: unaesthetic circumscribed alteration of the skin
18. Bulla: a large bubble-like blister
19. Carbuncle: skin infections of the subcutaneous tissue, accompanied by fever
20. Cellulitis: inflammation of the cellular tissues
21. Chloasma: skin infections characterized by irregular brown patches
22. Cicatrix: scar
23. Comedo: dilated hair follicle filled with bacteria and sebum
24. Contusion: injury in which skin does not break
25. Corium: dermis
26. Crust: a hard outer layer or covering (sometimes referred to the one formed by pus or blood)
27. Cyst: a bladder or sac containing some sort of fluid
28. Debridement: the process of taking out the dead tissues from a wound site
29. Dermabrasion: operation performed to remove the acne scars
30. Dermatitis: skin inflammation
31. Dermatologist: specialist in the study of skin and its diseases
32. Dermatology: specialty, dealing with skin
33. Dermatomycosis: fungus infection of the skin
34. Dermatophytosis: skin abnormality in which vesicles, papules, and/or fissures are caused by dermatophytes
35. Dermatoplasty: surgical repair of the skin
36. Dermatosis: abnormalities of the skin
37. Dermatotherapy: treatment of skin pathology
38. Dermis: corium, skin
39. Desquamation: shedding or peeling of the outer layer or surface
40. Ecchymosis: a purple spot or patch caused by passing of the blood into the skin
41. Eczema: inflammatory condition of the skin characterized by erythematous edematous papular vesicles of the skin
42. Electrodesiccation: destroying the lesions or pathological skin tissues by applying a high frequency electric current
43. Epidermis: outer layer of the skin
44. Eruption: breaking out of the lesions
45. Erythema: redness of the skin
46. Eschar: a crust or scar formed after the burn or cauterization of the skin tissues
47. Exanthem: skin eruptions, mostly as a result of viral disease
48. Excoriation: scraping or peeling of the pathological tissues from the skin
49. Extravasation: passing out of blood or lymph, into the tissues
50. Fissure: a narrow opening, cleft, or break in the body parts or between the tissues
51. Flaking: eruption of small, thin, flattened pieces of layer
52. Frostbite: a condition caused by extreme cold or frost in which tissues are killed
53. Fulguration: the act or process of destroying tissues or lesions by applying electric current. Syn. Electrodesiccation
54. Glandular: relating to a gland
55. Graft: tissues used for transplantation
56. Hair follicle: the cavity from which the hair shaft develops
57. Hair root: part of the hair embedded in the hair follicle
58. Hair shaft: non-growing portion of hair protruding
59. Hidradenoma: tumor or neoplasm caused by sweat glands
60. Hirsutism: excessive hair on the body especially in women
61. Hives: itching wheals, urticari2,
62. Hyperhidrosis: abnormal condition of excessive sweating
63. Hypodermis: the second layer of skin below the dermis
64. Ichthyosis: abnormal condition characterized by hardening, drying, and scaling of the skin
65. Impetigo: skin pathology characterized by vesicles which rupture and form thick yellowish crust
66. In situ: confined in the original place
67. Integument: skin and related structures
68. Irritation: inflammation with roughness or soreness
69. Itching: uncomfortable skin condition inducing rubbing or scraping of the affected part
70. Keloid: a firm movable nodule
71. Keratin: a kind of protein found in hairs or nails
72. Keratolytics: agents acting against the excessive shedding of the epidermis
73. Keratosis: lesions on the epidermis characterized by the horny layer
74. Laceration: a cut
75. Lactic: relating to milk
76. Lactiferous: giving milk
77. Lentigo: freckle-like brown macule
78. Lesion: a wound, cut, or in jury
79. Lipocyte: fat cell
80. Lipoid: resembling fat
81. Lumpectomy: removal of a lump (mass) from the breast
82. Lunula: a semilunar pale arched area at the beginning of the nail place
83. Macule: a small discolored spot
84. Malignant: spreading and difficult to control (neoplasm)
85. Mammogram: the radiographic record of breast examination
86. Mammography: x-ray, ultrasound, mri or any other radiologic examination of the breast
87. Mammoplasty: plastic surgery of the breast, syn. Mastoplasty
88. Mastectomy: excision of the breast, syn. Mammectomy
89. Mastoplasty: surgical repair of the breast, syn. Mammoplasty
90. Melanocytes: pigment-producing cell. Syn. Melanodendrocyte
91. Melanoma: malignant neoplasm of the skin
92. Menarche: beginning of tile menstruation cycle
93. Metastasize: spread (of the disease) to other areas from the point of origin
94. Microscope: an instrument used to view extremely small objects
95. Mole: birthmark, nevus
96. Neoplasms: abnormal pathological growth of cells
97. Nevus: birthmark, mole
98. Nipple: a projection at the apex of the breast where lactiferous ducts open
99. Nodule: a small circumscribed swelling
100. Nulliparous: a lady who has not experienced childbirth
101. Onychocryptosis: ingrown nail producing a pus-filled granuloma
102. Onychomalacia: softening of the nails
103. Pallor: paleness, yellowish coloration of the skin
104. Papilla: small nipple-like orifice
105. Papule: small elevation on the skin
106. Parasiticides: agents that destroy parasites
107. Pediculosis: lousiness, presence of lice
108. Pemphigus: a pathological condition of skin blisters
109. Petechia: small hemorrhagic spots
110. Pilonidal: relating to the presence of hair in a sinus opening of the skin.
111. Pores: hole, opening
112. Pruritus: itching
113. Psoriasis: circumscribed discrete lesions of macule or papule size which are confluent and silvery-scaled
114. Purpura: lesions characterizing the hemorrhage into the skin
115. Pustule: small circumscribed pus-filled elevation
116. Rash: skin eruptions
117. Ringworm: dermatophytosis, fungus infection of the skin, hair or nails
118. Scabies: vesicular eruptions and intense pruritus due to mites
119. Scale: a small thin plate of hardened epithelium
120. Scleroderma: hardening of the skin
121. Sclerosis: abnormal condition of becoming too firm or hard
122. Sebaceous: relating to sebum or fat
123. Sebum: secretion of the sebaceous glands
124. Site: place, location
125. Squamous: scaly, relating to scales
126. Stage: extent or severity of the disease
127. Stasis: stagnation, the condition of not changing
128. Steatoma: tumor or neoplasm related to fat
129. Stratum: layer
130. Stratified squamous epithelium: epithelium containing scaly keratin cells
131. Stratum corneum: outer layer of the epidermis
132. Stratum germinativum: the deepest layer of the epidermis
133. Subcutaneous: referring to the laver below the dermis
134. Sudoriferous: of or related to sweats
135. Suppuration: pyogenesis, pus formation
136. Thelitis: nipple or nipple-like structure
137. Tinea: a fungus infection of hair, skin or nails
138. Trichopathy: diseases associated with hairs
139. Tumor: neoplasm, swelling
140. Ulcer: an inflammatory lesion on the skin surface or surface of the mucous membrane
141. Ungual: relating to nail
142. Urticaria: itching condition of the skin characterized by wheals
143. Verruca: circumscribed growth of the papillae
144. Vesicle: small circumscribed fluid filled elevation of skin
145. Vitiligo: skin condition characterized by white patches of varied sizes
146. Wart: flesh-colored growth, verruca
147. Welt: lesions occurring because of urticaria, wheal, hives
148. Xenograft: graft from an individual of one species to that of another species