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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.
Some other 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)
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Atopic: related to hypersensitivity to environmental allergens
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Benign: mild, non-malignant
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Biopsy: process of taking out a specimen of tissue for diagnostic purposes
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Blemish: unaesthetic circumscribed alteration of the skin
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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
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Comedo: dilated hair follicle filled with bacteria and sebum
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Contusion: injury in which skin does not break
Corium: dermis
Crust: a hard outer layer or covering (sometimes referred to the one formed by
pus or blood)
Cyst: a bladder or sac containing some sort of fluid
Debridement: the process of taking out the dead tissues from a wound site
Dermabrasion: operation performed to remove the acne scars
Dermatitis: skin inflammation
Dermatologist: specialist in the study of skin and its diseases
Dermatology: specialty, dealing with skin
Dermatomycosis: fungus infection of the skin
Dermatophytosis: skin abnormality in which vesicles, papules, and/or fissures are
caused by dermatophytes
Dermatoplasty: surgical repair of the skin
Dermatosis: abnormalities of the skin
Dermatotherapy: treatment of skin pathology
Dermis: corium, skin
Desquamation: shedding or peeling of the outer layer or surface
Ecchymosis: a purple spot or patch caused by passing of the blood into the skin
Eczema: inflammatory condition of the skin characterized by erythematous
edematous papular vesicles of the skin
Electrodesiccation: destroying the lesions or pathological skin tissues by applying
a high frequency electric current
Epidermis: outer layer of the skin
Eruption: breaking out of the lesions
Erythema: redness of the skin
Eschar: a crust or scar formed after the burn or cauterization of the skin tissues
Exanthem: skin eruptions, mostly as a result of viral disease
Excoriation: scraping or peeling of the pathological tissues from the skin
Extravasation: passing out of blood or lymph, into the tissues
Fissure: a narrow opening, cleft, or break in the body parts or between the tissues
Flaking: eruption of small, thin, flattened pieces of layer
Frostbite: a condition caused by extreme cold or frost in which tissues are killed
Fulguration: the act or process of destroying tissues or lesions by applying electric
current. Syn. Electrodesiccation
Glandular: relating to a gland
Graft: tissues used for transplantation
Hair follicle: the cavity from which the hair shaft develops
Hair root: part of the hair embedded in the hair follicle
Hair shaft: non-growing portion of hair protruding
Hidradenoma: tumor or neoplasm caused by sweat glands
Hirsutism: excessive hair on the body especially in women
Hives: itching wheals, urticari2,
Hyperhidrosis: abnormal condition of excessive sweating
Hypodermis: the second layer of skin below the dermis
Ichthyosis: abnormal condition characterized by hardening, drying, and scaling of
the skin
Impetigo: skin pathology characterized by vesicles which rupture and form thick
yellowish crust
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In situ: confined in the original place
Integument: skin and related structures
Irritation: inflammation with roughness or soreness
Itching: uncomfortable skin condition inducing rubbing or scraping of the affected part
Keloid: a firm movable nodule
Keratin: a kind of protein found in hairs or nails
Keratolytics: agents acting against the excessive shedding of the epidermis
Keratosis: lesions on the epidermis characterized by the horny layer
Laceration: a cut
Lactic: relating to milk
Lactiferous: giving milk
Lentigo: freckle-like brown macule
Lesion: a wound, cut, or in jury
Lipocyte: fat cell
Lipoid: resembling fat
Lumpectomy: removal of a lump (mass) from the breast
Lunula: a semilunar pale arched area at the beginning of the nail place
Macule: a small discolored spot
Malignant: spreading and difficult to control (neoplasm)
Mammogram: the radiographic record of breast examination
Mammography: x-ray, ultrasound, mri or any other radiologic examination of the
breast
Mammoplasty: plastic surgery of the breast, syn. Mastoplasty
Mastectomy: excision of the breast, syn. Mammectomy
Mastoplasty: surgical repair of the breast, syn. Mammoplasty
Melanocytes: pigment-producing cell. Syn. Melanodendrocyte
Melanoma: malignant neoplasm of the skin
Menarche: beginning of tile menstruation cycle
Metastasize: spread (of the disease) to other areas from the point of origin
Microscope: an instrument used to view extremely small objects
Mole: birthmark, nevus
Neoplasms: abnormal pathological growth of cells
Nevus: birthmark, mole
Nipple: a projection at the apex of the breast where lactiferous ducts open
Nodule: a small circumscribed swelling
Nulliparous: a lady who has not experienced childbirth
Onychocryptosis: ingrown nail producing a pus-filled granuloma
Onychomalacia: softening of the nails
Pallor: paleness, yellowish coloration of the skin
Papilla: small nipple-like orifice
Papule: small elevation on the skin
Parasiticides: agents that destroy parasites
Pediculosis: lousiness, presence of lice
Pemphigus: a pathological condition of skin blisters
Petechia: small hemorrhagic spots
Pilonidal: relating to the presence of hair in a sinus opening of the skin.
Pores: hole, opening
Pruritus: itching
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Psoriasis: circumscribed discrete lesions of macule or papule size which are
confluent and silvery-scaled
Purpura: lesions characterizing the hemorrhage into the skin
Pustule: small circumscribed pus-filled elevation
Rash: skin eruptions
Ringworm: dermatophytosis, fungus infection of the skin, hair or nails
Scabies: vesicular eruptions and intense pruritus due to mites
Scale: a small thin plate of hardened epithelium
Scleroderma: hardening of the skin
Sclerosis: abnormal condition of becoming too firm or hard
Sebaceous: relating to sebum or fat
Sebum: secretion of the sebaceous glands
Site: place, location
Squamous: scaly, relating to scales
Stage: extent or severity of the disease
Stasis: stagnation, the condition of not changing
Steatoma: tumor or neoplasm related to fat
Stratum: layer
Stratified squamous epithelium: epithelium containing scaly keratin cells
Stratum corneum: outer layer of the epidermis
Stratum germinativum: the deepest layer of the epidermis
Subcutaneous: referring to the laver below the dermis
Sudoriferous: of or related to sweats
Suppuration: pyogenesis, pus formation
Thelitis: nipple or nipple-like structure
Tinea: a fungus infection of hair, skin or nails
Trichopathy: diseases associated with hairs
Tumor: neoplasm, swelling
Ulcer: an inflammatory lesion on the skin surface or surface of the mucous
membrane
Ungual: relating to nail
Urticaria: itching condition of the skin characterized by wheals
Verruca: circumscribed growth of the papillae
Vesicle: small circumscribed fluid filled elevation of skin
Vitiligo: skin condition characterized by white patches of varied sizes
Wart: flesh-colored growth, verruca
Welt: lesions occurring because of urticaria, wheal, hives
Xenograft: graft from an individual of one species to that of another species
Xeroderma: dry scaly skin
Xeromammography: xeroradiographic breast examination
Xeroradiography: radiography using the dry powder in stead of liquid chemicals
ABBREVIATIONS
1. Bx: biopsy
2. C&S: culture and sensitivity
3. derm: dermatology
4. FS: frozen section
5. HSV: herpes simplex virus
6. I&D: incision and drainage
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KOH: potassium hydroxide
ung.: ointment
UV: ultraviolet
decub.: decubitus
ID : intradermal
IM: intramuscularly
IV: intravenously
subcu: subcutaneous
Dx: diagnosis
FH: family history
PE: physical examination
SC: subcutaneous
WBC: white blood cell
COMBINING FORMS
1. adeno: glands
2. adip/o: fat
3. lip/a: fat
4. steat/o: fat
5. crypt/a: hidden
6. cutane/o: skin I.
7. dermat/o: skin
8. derm/o: skin
9. hidr/o: sweat
10. ichthy/o: dry, scaly
11. kerat/o: hardening
12. lact/o: milk
13. mammo/o: breast
14. mast/o: breast
15. myc/o: fungus
16. onych/o: nail
17. ungu/o: nail
18. pillo: hair
19. scler/o: hardening
20. squam/o: scaly
21. thel/o: nipple
22. trich/o: hair
23. xerlo: dry
SUFFIX
1. -cyte: cell
2. -derma: skin
3. -gram: record
4. -graphy: process of recording
5. -logist: specialist in the study of
6. -logy: study of
7. -therapy: treatment
PREFIX
1. epi-: above
2. hyper-: excessive
3. hypo: below normal, less
4. sub: below
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