A 20 year old women with an ulcer

Skin
1. Histology
2. lymphatic drainage
3. Role of skin in nonspecific Immunity
  1. barrier to the entry of microorganisms
  2. Sweat and sebaceous secretions contain bacteriostatic substances
  3. pH(3-5)
Itchy erythmatous papules and plaques
1. Papule
  1. small circumscribed superficial solid elevation of the skin less than 5mm
2. Plaques
  1. An elevated dome-shaped or flat-topped lesion ≤ 5mm in diameter
3. Other skin lesions
  2. Infectious
    1. Bacterial
      1. Impetigo
      2. Erysipelas
      3. Cellulitis
      4. Necrotizing fasciitis
      5. Staphylococcal scalded skin syndrome
    2. Viral
      1. Herpes
      2. Molluscum contagiosum
      3. Varicella zoster virus
      4. Hairy leukoplakia
  3. Non-Infectious
    1. Acne
    2. Eczema
    3. Allergic contact dermatitis
    4. Melanocytic nevus
    5. Pseudofolliculitis barbae
    6. Psoriasis
    7. Rosacea
    8. Seborrheic keratosis
    9. Verrucae
    10. Urticaria
4. Causes of itching
  1. Complications
    1. Secondary infections
    2. Scratch marks
    3. Bleeding
    4. Scars
      1. Wound healing
        Skin is Labile tissue
        Stem cells  continuously cycle to regenerate
        It occur via
        Primary intention
        The edges are close to each other ( surgical incision )\Minimal scar formation
        Secondary intention
        Edges are not approximated\ Granulation tissue fills the defect leading to myofibroblasts contract\ Forming scar ( larger than primary intention
5. The lesion has pus and yellow crust
  1. Pus
    1. is an exudate that consists of a thin, protein-rich fluids and dead leukocytes from the body's immune response (mostly neutrophils)
  2. Crust
    1. Dried exudation and pus
6. Then became swollen and started to ulcerate
  1. Cardinal Signs of Inflammation
    1. Rubor
    2. Calor
    3. Tumor
    4. Dolar and loss of function
  2. ulcer
    1. It is a local defect of the surface of an organ or tissue that is produced by necrosis of cells and shedding of necrotic and inflammatory tissue.
    2. Differential diagnosis of skin ulcer
      1. Vascular
        peripheral arteriosclerosis, diabetic ulcers, and varicose ulcers
      2. Infections
        Spirochetes
        syphilis
        Parasites
        leishmaniasis
        Lifecycle
        Vector borne zoonotic disease
        Sandfly
        Phlebotomas
        Lutzomyia
        Obligate intracellular parasite, Invade reticuloendothelial cells
        Amastigote
        circular, about 5 microns in diameter, having a nucleus, kinetoplast and rudimentary flagellum
        LD bodies
        Prognosis
        Cure rates are high with the proper medicine, especially when treatment is started before the immune system is damaged.
        Cutaneous leishmaniasis may lead to disfigurement.
        Death is usually caused by complications (such as other infections), rather than from the disease itself.
        complications
        Cutaneous leishmaniasis
        Bleeding\other infections due to a weakened immune system, which can be life-threatening\ disfigurement
        Visceral leishmaniasis
        often fatal due to the effects it has on both internal organs and your immune system.
        Laboratory Diagnosis of Leishmaniasis
        Clinical Specimens
        Splenic aspirate
        Most sensitive
        Bone marrow aspirate
        Safest
        Lymph node aspirate
        Dermal scrapings
        Epidemiology
        cutaneous Leishmaniasis
        Afghanistan, Algeria, Brazil, Colombia, the Islamic Republic of Iran, Pakistan, Peru, Saudi Arabia
        visceral leishmaniasis
        Bangladesh, Brazil, Ethiopia, India, South Sudan and Sudan.
        12 million people are infected
        Clinical presentation
        Treatment
        Pathogenesis
        cell mediated immunity
        marked leukopenia with relative monocytosis and lymphocytosis, anemia and thrombocytopenia
        IgM and IgG levels are extremely elevated – but they are not protective
        Th2 cells produce IL-4, IL-5, IL-6, IL-10
        Favor induction of antibody response by B cells
        Fungal
        actinomycosis, blastomycosis, sporotrichosis, and cryptococcosis
        Viruses
        herpes simplex
        Bacteria
        tuberculosis, leprosy, cutaneous diphtheria
      3. Neoplasm
        BCC
        SCC
      4. Degenerative
        peripheral neuropathy, syringomyelia, muscle atrophy
      5. Autoimmune
        Stevens-johnson syndrome
      6. Endocrine
        Diabetes
Skin tumors
1. Basal Cell Carcinoma
  1. Presents as an elevated nodule with a central, ulcerated crater surrounded by dilated (telangiectatic) vessels; 'pink, pearl-like papule'
2. Squamous cell carcinoma
  1. Presents as an ulcerated, nodular mass, usually on the face (classically involving the lower lip)
  2. Actinic keratosis is a precursor lesion of squamous cell carcinoma and presents as a hyperkeratotic, scaly plaque, often on the face, back, or neck.
  3. Keratoacanthoma is well-differentiated squamous cell carcinoma that develops rapidly and regresses spontaneously; presents as a cup-shaped tumor filled with keratin debris
3. Malignant melanoma
  1. Presents as a mole-like growth with "ABCD"
Antiprotozoal drugs

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A 20 year old women with an ulcer

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	Creado por hamda ali hace casi 6 años