What is the Fitzpatrick skin type system and why is it used?
It classifies skin type according to the amount of pigment in your skin and your skin’s reaction to sun exposure. This information can help predict your overall risk of sun damage and skin cancer.
Describe Types 1-6 of the ‘Fitzpatrick skin types’ classification individually.
Type I : Pale white skin (blonde/red) - Always burns, does not tan
Type II : Fair skin - Burns easily, tans poorly
Type III : Darker white skin - Tans after initial burn
Type IV : Light brown skin - Burns minimally, tans easily
Type V : Brown skin - Rarely burns, tans darkly easily
Type VI : Dark brown or black skin - Never burns, always tans
Describing (skin examination) - What does SCAM stand for?
S - Site + distribution (rash) / Size + shape (lesion)
C - Colour (+configuration)
A - Associated changes (surface features)
M - Morphology
What should you look for in pigmented lesions?
Asymmetry
Border (irregular/blurred)
Colour
Diameter
What words are used to describe Site + Distribution of a skin issue?
- Generalised
- Flexural (eg. inside elbow)
- Extensor (eg. elbow, knees)
- Photosensitive
What words are used to describe the configuration of a skin issue?
- Discrete (few lesions, small)
- Confluent (small lesions, together)
- Linear
- Target (blister in the middle sometimes)
What words are used to describe the colour of a skin issue?
- Erythematous (red + blanching)
- Purpuric (red/purple + non-blanching)
- Brown/Black (pigmented/hyper-pigmented)
- Hypo-pigmented (depigmented/total loss of colour)
What words are used to describe the surface features of a skin issue?
- Scale (built-up keratin)
- Crust (dried exudate)
- Excoriation (Erosion from scratching=pruritis)
- Erosion/Ulceration (partial or full thickness loss)
What words are used to describe the morphology of a skin lesion?
Type
- Patch
- Plaque
- Nodule
- Vesicle
- Pustule
- Bulla
Shape
- Annular (ring-shaped)
- Wheal (eg. urticaria)
- Discoid/nummular
- Comedone (open/closed)
List some functions of the skin.
- Protective barrier against environmental insults
- Temperature regulation
- Sensation
- Vitamin D synthesis
- Immunosurveillance
- Cosmesis
What is Erythroderma?
The term used to describe an inflammatory skin disease affecting >90% of the body’s skin surface area. It may be acute or chronic. It often precedes or is associated with exfoliation (exfoliative dermatitis).
What cause Erythroderma?
- ADRs
- Psoriasis
- Eczema
- Cutaneous T cell lymphoma
What are the symptoms of Erythroderma?
- Pruritis
- Fatigue
- Anorexia
- Feeling cold
- Hair loss
What are the clinical signs of Erythroderma?
- Erythematous
- Inflamed (Oedema)
- Thickened
- Scaly
What are some complications of Erythroderma?
- Hypothermia (loss of thermoregulation)
- Infection (loss of protective barrier)
- Renal failure (insensible losses)
- High output cardiac failure (dilated skin vessels)
- Protein malnutrition (high turnover fo skin)
How is Erythroderma managed?
- May need to be hospitalised to restore fluid an electrolyte imbalance, circulatory status + body temperature
- Discontinue all unnecessary medications
- Apply emollients and mild topical steroids
- Wet dressing
- Oral/IV antibiotics
- Sedative antihistamines
What are the 3 basic layers of the skin?
Epidermis
Dermis
Hypodermis
What layers make up the epidermis? (superficial to deep)
Stratum corneum [Stratum lucidum found in areas of thicker skin such as palms and soles] Stratum granulosum Stratum spinosum Stratum basale
What does each layer represent?
A different stage of maturation of a keratinocyte
What are the 4 major cell types of the Epidermis?
Keratinocytes
Langerhan cells
Melanocytes
Merkel Cells
What is the function of Keratinocyte?
Protective barrier
What is the function of Langerhan cells?
They are antigen presenting cells
What is the function of Melanocytes?
They produce melanin which provides pigment to the skin and protects cell nuclei from UV DNA damage
What is the function of Merkel cells?
They contain specialised nerve endings for sensation
