Active Listening: Allow the aggressor to express their concerns without escalating the si | Thesis Law

Anatomy and physiology of the skin.

Primary and secondary skin rash elements.

The SKIN the outer covering of the human body. The skin consists of three layers. Upper (outer) layer

the epidermis, the second layer dermis, the third (the lowest) subcutaneous fatty cellular tissue

hypoderma

The EPIDERMIS is composed of 5 layers. At the direction from bottom to top: basal (fetal), thom

(spongious), granular, shining, comeous

The lowest basal layer, is a single layer of prismatic and cylindrical cells. The cells are in a state of

mitosis. These cells contain many DNA and RNA structures, organelles. Mitosis ensures the formation

of overlying layers of the epidermis. Another cells at this layer there are melanocytes, produce

melanin pigment. Melanin gives skin color, protects against ultraviolet radiation.

The second laver thom spongious. It consists of 3-8 rows of cells. The cells are connected with each

other through cytoplasmic outgrowths, called akants. Akanta form a network of channels with

circulating on the intercellular fluid

Granular layer composed of 1-3 rows of cells, on the soles and palms this layer of the 3-4 series.

Compared with the lower layers in the nucleus of cells of the granular layer significantly reduced the

number of DNA and RNA. In the cytoplasm of cells formed inclusion grain of keratogialin, Keratogialin

- the first stages of keratin formation. Keratin the main protein of skin.

Fourth laver shining. The layer is well seen in the palms and soles, but on other sites of body skin this

layer is visible slightly. In the cytoplasm there is a shininig agent-eleidin Eleidin a product of

keratogialim evolution, the second stages of keratin formation

Comea (hom layer) the most thick, consist of many tightly adjoin to each other denuclearized cell

cages-plates. Superficial cells of layer consistently rejected as a result of desquamation, that is

physiological peeling. In keratinocytes completed the formation of skin basic protem keratin. The

thickness of the comea layer is expressed on the palms and soles (physiological hyperkeratosis). This

layer of skim is thin on face, genitals, as well as children's skin. Comea (hom) laver constantly

replenishes due to the continuous mitotic division.

Mitosis occurs in the three lower layers of the epidermis, the maximum expression of mitosis in cells

of basal layer.

The epidermis is separated from the dermis by BASAL MEMBRANE (BM). BM is formed due to root-

like outgrowths of basal layer cells, as well as filaments, fibers and desmosom of dermis. The

contours of the BM rough.

DERMIS connective tissue part of the skin. It consists of two layers.

The top laver niple papilla. The layer is formed papilla, lying between crests thorn layer. Naplle layer

consists of amorphous substance and a soft fibrous connective tissue. Fibers- collagen, arguophyle

elastic. Between the fibers numerous cellular elements (fibroblasts. fibrocstes, histiocytes, bazofilies,

melanophaga), blood vessels, nerve endings settle down

The lower layer reticular. It is more compact and roughly fibrous layer. Stroma laver formed by

bundles of collagen and elastic fibers, Cells are the same as in niple layer, but their number is much

less. Reticular layer provides the strength of the skin

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Anatomy and physiology of the skin. Primary and secondary skin rash elements. The SKIN the outer covering of the human body. The skin consists of three layers. Upper (outer) layer the epidermis, the second layer dermis, the third (the lowest) subcutaneous fatty cellular tissue hypoderma The EPIDERMIS is composed of 5 layers. At the direction from bottom to top: basal (fetal), thom (spongious), granular, shining, comeous The lowest basal layer, is a single layer of prismatic and cylindrical cells. The cells are in a state of mitosis. These cells contain many DNA and RNA structures, organelles. Mitosis ensures the formation of overlying layers of the epidermis. Another cells at this layer there are melanocytes, produce melanin pigment. Melanin gives skin color, protects against ultraviolet radiation. The second laver thom spongious. It consists of 3-8 rows of cells. The cells are connected with each other through cytoplasmic outgrowths, called akants. Akanta form a network of channels with circulating on the intercellular fluid Granular layer composed of 1-3 rows of cells, on the soles and palms this layer of the 3-4 series. Compared with the lower layers in the nucleus of cells of the granular layer significantly reduced the number of DNA and RNA. In the cytoplasm of cells formed inclusion grain of keratogialin, Keratogialin

the first stages of keratin formation. Keratin the main protein of skin. Fourth laver shining. The layer is well seen in the palms and soles, but on other sites of body skin this layer is visible slightly. In the cytoplasm there is a shininig agent-eleidin Eleidin a product of keratogialim evolution, the second stages of keratin formation Comea (hom layer) the most thick, consist of many tightly adjoin to each other denuclearized cell cages-plates. Superficial cells of layer consistently rejected as a result of desquamation, that is physiological peeling. In keratinocytes completed the formation of skin basic protem keratin. The thickness of the comea layer is expressed on the palms and soles (physiological hyperkeratosis). This layer of skim is thin on face, genitals, as well as children's skin. Comea (hom) laver constantly replenishes due to the continuous mitotic division. Mitosis occurs in the three lower layers of the epidermis, the maximum expression of mitosis in cells of basal layer. The epidermis is separated from the dermis by BASAL MEMBRANE (BM). BM is formed due to root- like outgrowths of basal layer cells, as well as filaments, fibers and desmosom of dermis. The contours of the BM rough. DERMIS connective tissue part of the skin. It consists of two layers. The top laver niple papilla. The layer is formed papilla, lying between crests thorn layer. Naplle layer consists of amorphous substance and a soft fibrous connective tissue. Fibers- collagen, arguophyle elastic. Between the fibers numerous cellular elements (fibroblasts. fibrocstes, histiocytes, bazofilies, melanophaga), blood vessels, nerve endings settle down The lower layer reticular. It is more compact and roughly fibrous layer. Stroma laver formed by bundles of collagen and elastic fibers, Cells are the same as in niple layer, but their number is much less. Reticular layer provides the strength of the skin

SUBCUTANEOUS FATTY CELLULAR TISSUE (HYPODERMA) consists of bundles of connective tissue. In the loops of connective tissue are different numbers of spherical fat cells. In hypoderma there are nerve trunks and nerve endings, sweat glands, hair follicles. Hspoderma ends by fascia SKIN APPENDAGES

Hair are subdivided on long (head), bristle (face, genitals, armpits), fluff (other skin). The hair part acting over a skin surface is called as a core, intraepidermal part is called as a root The root is surrounded by a hair follicle Distal part of a root which is in hypoderma is called as a bulb, the bulb provides hair growth. Average growth rate of hair of 0.5 mm a day.
Nails. The nail plate is constructed from tightly adjoin to each other horn plates. Nad plate have the brilliant cover, located on a nail place
Sweat glands. Distinguish 2 types of sweat glands: Simple, merocrine the secret is formed owing to secret activity of cells and with the assistance of osmosis and diffusions processes; -apocrine- the secret is formed with participation of cell substance, therefore the part of cell is in a tearing away condition; glands function from beginning of the period of a sexual maturity to menstrual pause.
Sebaceous glands. The majority of glands is surrounded with the hair follicle, therefore all sites of a hair skin in norm are covered by skin grease greasing THE BASIC PATO HISTOLOGIC PROCESSES IN THE SKIN
Hyperkeratosis-strengthened horn process, the thickening of a horn layer of epidermis, is characterized by occurrence tightly sitting scales. Hyperkeratosis can be as result of delay of tearing away horn scales, Hyperkeratosis can be local (callous) and diffuse (ichthyosia) type. 2. Parakeratosis infringement hom process at which the formation phase of keratogialin and eleidin drops out. Parakeratosis it is characterised by absence granular and thiming layers in epidermis, preservation the nucleus and disappearance the basic protein keratin in hom layer cells. Clinical: the form of expressed peelings (dandruff) Hyperkeratosis and parakeratosis on a mucous membrane are characterised by a thickening of spatelum, occurrence by white-grew films.
Acanthosis a thickening spongious layer
Granuletit expansion of a granular layer of epidermis at the expense of increase in number of cells (3-4 and more numbers of rows).
Papillomothosis-the growth connect-tissuall nipples of dermis. Process is often combined with acanthosis
Acantholysu fusion of intercellular communications (acants) between spongious layer cells of epidermis. Cells are separated and between them arise the cracks filled by exudate. As a result of it there are bubbles. The changed cells decrease m sizes, become roundish, contain large nucleus (there can be 2-3 nucleus), cover a bottom of bubbles. Such cells are called acantholytical, on the author Tank-Pavlov's cage Acantholysis underlies formation of bubbles at pemphigus. In most cases acantholysis result of autoimmune process

a) the temporary enlargement of vessels (disappear with pressure, after the termination of the pressure appeared agam): -Emotional" -Inflammatory small-roseola large- erythema b). the result of strong expansion vessels (stams do not disappear when pressure): teleangiectasis (small superficial blood vessels), varicosity (large vems) c) The result of the integrity of the vessel wall, or increased permeability of vessel walls hemorrhagic Hemorrhage, usually disappear without trace Types hemorrhages: -linear form-vibitaess Minor point hemorrhages - petehu Small round-purpura Large-ekhumor

Dvschremi spots (macula) arise due to congestion or reduce lack of the pigment a). hyperpigmentic congenitalna -acquisition-freckles b) depigmentic congenital-albinism -acquisition-Vitiligo
Stams (macula) resulting from deposits in the skim coloring matter. Tattoo. PAPULA-non cavity, infiltrating element, towering above the surface of the skin. As a rule, do not leave behind any scars or atrophy. Oudime elements round or polygonal Surface flat, cone, half-spherical. The size, consistency and color of papules may be of various kinds Some papules may be connected with the formation of plaques. Mechanisms for education: hyperkeratosis, parakeratosis, acanthosis, granuleais, papillomatosis Types papules: -epidermal changes only in the epidermis (warts) -epidermis-dermal - changes in the epidermal, infiltrate in the dermis (psoriasis) -dermal-infiltrate only in niplle layer of dermis (syphilis) NODE (NODUS) infiltrating elements of different density There is deep in the subcutaneous adipose tissue. At first, feel like packing in the depth of the skin, gradually rismg, increases in size, and rises above the surface of the skin. The size of the node(nodus) may be different the size of a pea to the size of chicken eggs. Nodes (nodus can be formed as a result of inflammation, tumor growth, deposits of calcium or cholesterol in the skin. Changes of infiltration forming node (nodus): loss (nodular vasculitis)

fusion (hydroadenitis) necrosis (gumma) In place of the node formed the ulcer, which later beal scars. TUBERCLE-infiltrating, non cavity, towering above the surface of the skin element. Form element circular or half-spherical, coloring inflammatory. Infiltrate of tubercle is located in the reticular layer of dermis. Typically, central part of tubercle (or entire tubercle) subjected to necrosis, further changes in two ways: formation of ulcers-scar -healing with formation of scar atrophy Tubercle a primary element, with tuberculosis, leprosy, sarcoidosis, leishmaniasis and tertiary syphilis URTICA (blister) an element which occurs as a result of acute edema niple layer of dermis, usually due to allergies, Description: no cavities, soft consistency, slightly above the surface of the skin, clear, subjectively itching, Urtica formed at one point or as a stroke, persist short time, then disappear without trace. The color.elements red pink with a mother-of-pearl and white. BULLA (bubble) cavity element towering above the surface of the skin. In bulla distinguish the cover, the bottom and the liquid in the cavity. The contents may be serous, purulent, or hemorrhagic nature. The size of the bulla as a pea or larger. There are bulla intraepidermalis a thin cover, quickly opened -underepidermalis - formed between layers of basal membrane, or under membrane, a thick cover Mechanism of the bulla-akantolitis The evolution of the bulla:

opening the bulla with the formation of erosion. Erosion later covered crust 2 bulla is not opened, its contents dry in the crust VESICULLA-cavernous, vautriepidermalny element, towering like the dome above the skm. The size of the vesiculla, from pin head to a pea, Unlike the bulla in the vesiculla is smaller and the other tools of education Mechanisms of the vesiculla -akuol degeneration -balloon degeneration -spongiosus PUSTULA cavity, above the surface of the skin element is filled with purulent contents. The size of the element to a pea and more. Pustula formed in the epidermis, as a result of the death of epithelial cells under the influence of infection. In the epidermis-dermal pustula also affected niple layer of dermis, in this case on the ground of pustila formed scar. Purnula can localize around the mouth of

CRUST it is dried exudation. Crust is formed as a result of drying the contents of the bulla (may be with the tires of bulla) or on the surface of erosions and ulcers. The newly formed crusts are soft and easily separated, the long-standing crusts - dense and soldering to the tissue. The color of the crust depends from the nature of exudation: gray-yellow-when serous, honey yellow when serous-purulent, dirty-yellow or green-yellow when purulent, bloody brown when haemorrhagic Rupes it is crusts, which deposited each other and significantly protruding above the surface of the skin, *Scales crusts are formed as a result of soaking the epidermis by serous exudation and sticking together scales. These elements are found when the exudative psoriasis, exfoliative cheilitis Scales crusts unlike the crusts, they are not crumble SCAR (CICATRIN) this is newly established tissue, developed after (or in place) the destruction of dermis or connective-woven layer of mucous membrane. Scar is composed of collagen fibers. Epithelium on the surface of the scar is thm, the number of vessels and nerve endings clear reduced, glands and hair follicles are not available. The surface of the scar is usually flat, without skin pattern. Scars can be pink, pale, pigmented. Usually the scars are located at the level of the skin or slightly sink *Keloid - are dense, thick, hypertrophied, towering above the surface of skin scars. Scar atrophy arise during healing of lesion sites without ulcers formation Skin or mucous membrane on these areas is very thin, sites easily tuck, through the skin vessels translucent. VEGETATION is soft growing (proliferation), resembling to cocks combs or cauliflower. Vegetation is the result of the proliferation of papilla dermis with thickening spongious layer (between-nipple epidermal outgrowths). The surface vegetation may be Jdry, ash-gray; 2erosion, red, a lot of exudation Vegetation are formed on the surface of erosions and papules, especially located in areas of high friction, sweating, prone to trauma. Vegetation may be primary-sharp-point condyloms. LICHENISATION (LICHENIFICATION) change of the skin associated with massive infiltration papilla layer and acanthosis. Skin: congestive hyperemic color, dense, dry, peeling and significantly expressed skim pattem on the surface. Lihenisation may be as result from the connect of papules or the presence of chronic inflammatory infiltration. Typically, there are strong itching in the lihenisation zone.

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