DERMATOLOGY NOTES

An e-learning initiative of Keltron

DERMATOLOGY NOTES

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 1

DERMATOLOGY NOTES

INTRODUCTION
The skin and its accessory organs (hair, nails and glands) are known as
integumentary system of the body. Integument means covering and the skin is
the outer covering of the body. It weighs about 8 to 10 pounds over an area of
22 square feet in an average adult. It is, however, more than a simple body
covering. The skin, as a complex system of specialized tissues, contains glands
that secrete several types of fluids, nerves that carry impulses, and blood vessels
that aid in the regulation of the body temperature. The skin has many important
functions. First, as a protective membrane over the entire body, the skin guards
the deeper tissues of the body against excessive loss of water, salts, and heat
and against invasion of pathogens and their toxins. Secretions from the skin are
slightly acid in nature and this contributes to the skin's ability to prevent bacterial
invasions. Second, the skin contains two types of glands that produce important
secretions. These glands under the skin are the sebaceous and sweat glands.
The sebaceous glands produce an oily secretion called sebum, and the sweat
glands produce a watery secretion called sweat. Sebum and sweat are carried
to the outer edges of the skin by ducts and excreted from the skin through
openings or pores. Sebum helps to lubricate the surface of the skin and sweat
helps to cool the body as it evaporates from the skin surface. Third, nerve fibers
located under the skin act as receptors for sensations such as pain, temperature,
pressure and touch. Thus, the adjustment of an individual to her or his
environment is dependent on the sensory messages relayed to the brain and
spinal cord by the sensitive nerve endings in the skin. Fourth, several different
tissues in the skin aid in maintaining the body temperature (thermoregulation).
Nerve fibers coordinate thermoregulation by carrying messages to the skin from
heat centers in the brain that are sensitive to increases and decreases in body
temperature. Impulses from these fibers cause blood vessels to dilate to bring
blood to the surface and cause sweat glands to produce the watery secretion that
carries heat away.

STRUCTURE OF THE SKIN

There are three layers in the skin. These layers from the outer surface to inward
surface are:
1. Epidermis - a thin cellular membrane layer.
2. Corium or dermis - dense, fibrous connective tissue layer.
3. Subcutaneous tissue - thick, fat-containing tissue.

Epidermis: This is the outermost, totally cellular layer of the skin. It is

composed of squamous epithelium. Epithelium is the covering of both the
internal and the external surfaces of the body. Squamous epithelial cells are flat
and scale-like. In the outer layer of the skin, these cells are arranged in several
layers (strata) and are therefore called stratified squamous epithelium.

2 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS

DERMATOLOGY NOTES

The epidermis lacks blood vessels, lymphatic vessels and connective tissue
(elastic fibers, cartilage, fat) and is therefore dependent on the deeper corium
layer and its rich network of capillaries for nourishment. In fact, oxygen and
nutrients seep out of the capillaries in the corium, pass through tissue fluid and
supply nourishment to the deeper layers of the epidermis.

The deepest layer of the epidermis is called the basal layer. The cells in the
basal layer are constantly growing and multiplying and give rise to all the other
cells in the epidermis. As the basal layer cells divide, they are pushed upward
and away from the blood supply of the dermal layer by a steady stream of
younger cells. In their movement toward the most superficial layer of the
epidermis, called the stratum corneum, the cells flatten, shrink, lose their nuclei,
and die, becoming filled with a protein called keratin. The cells are then called
horny cells, reflecting their composition of keratin, which is a hard protein
material. Finally, within 3 to 4 weeks after beginning as a basal cell in the
deepest part of the epidermis, the horny, keratinized cell is sloughed off from the
surface of the skin. The epidermis is thus constantly renewing itself, cells dying
at the same rate at which they are replaced.

The basal layer of the epidermis contains special cells called melanocytes.
Melanocytes form and contain a black pigment called melanin that is transferred
to other epidermal cells and gives color to the skin. Melanin can absorb
ultraviolet light, which reacts with the chemicals within the skin to convert them
into vitamin D, a necessary nutrient which is absorbed through the skin. The
number of melanocytes in all races is the same but the amount of melanin
accounts for the color differences among the races. Individuals with darker skin
possess more melanin within the melanocytes, not a greater number of
melanocytes. The presence of melanin in the epidermis is vital for protection
against the harmful effects of ultraviolet radiation, which can manifest themselves
as skin cancer. Individuals who, through a flaw in their chemical makeup, are
incapable of forming melanin at all are called albino (meaning white). Skin and
hair are white. Their eyes are red because in the absence of pigment, the tiny
blood vessels are visible in the iris (normally pigmented portion) of the eye.

Melanin production increases with exposure to strong ultraviolet light and this
creates a suntan, which is a protective response. When the melanin cannot
absorb all the ultraviolet rays, the skin becomes sunburned and inflamed
(redness, swelling and pain). Over a period of years, excessive exposure to sun
can tend to cause wrinkles and cancer of the skin. Since dark-skinned people
have more melanin, they have fewer wrinkles and they are less likely to develop
skin cancer.

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 3

DERMATOLOGY NOTES

Corium (Dermis): The corium layer, directly below the epidermis is called the
dermis. It is composed of blood and lymph vessels and nerve fibers as well as
the accessory organs of the skin, which are the hair follicles, sweat glands, and
sebaceous glands. To support the elaborate system of nerves, vessels and
glands, the corium contains connective tissue cells and fibers that account for the
extensibility and elasticity of the skin.

The corium is composed of interwoven elastic and collagen fibers. Collagen is a

fibrous protein material found in bone, cartilage, tendons and ligaments as well
as in the skin. It is tough and resistant but also flexible. In the infant, collagen is
loose and delicate and it becomes harder as the body ages. During pregnancy,
overstretching of a woman's skin may break the elastic collagen fibers and
stretch the collagen resulting in linear markings called striae or stretch marks.
Collagen fibers support and protect the blood and nerve networks that pass
through the corium. Collagen diseases affect connective tissues of the body.
Examples of these connective tissue collagen disorders are systemic lupus
erythematosus and scleroderma.

Subcutaneous layer: The subcutaneous layer of the skin is another connective

tissue layer. It specializes in the formation of fat. Lipocytes (fat cells) are
predominant and the subcutaneous layer is composed of adipose tissue or fat
tissue. They manufacture and store large quantities of fat. Obviously, areas of
the body and individuals vary as far as fat deposition is concerned. Functionally,
this layer of the skin is important in protection of the deeper tissues of the body
and as a heat insulator.

4 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS

DERMATOLOGY NOTES

ACCESSORY ORGANS OF THE SKIN

Hair
A hair fiber is composed of a tightly fused meshwork of horny cells filled with the
hard protein called keratin. Hair growth is similar to the growth of the epidermal
layer of the skin. Deep-lying cells in the hair root produce horny cells that move
upward through the hair follicles (shafts or sacs that hold the hair fibers).
Melanocytes are located at the root of the hair follicle and they support the
melanin pigment for the horny cells of the hair fiber. Hair turns gray when the
melanocytes stop producing melanin. Of the 5 million hairs on the body, about
100,000 are on the head. They grow about ½ inch (1.3 cm) a month and cutting
the hair has no effect on its rate of growth. Hair grows in two phases, a growing
phase (anagen) and a resting phase (telogen).

Nails
Nails are hard, keratin plates covering the dorsal surface of the last bone of each
toe and finger. They are composed of horny cells that are cemented together
tightly and can extend indefinitely unless cut or broken. A nail grows in thickness
and length as a result of division of cells in the region of the nail root, which is at
the base (proximal portion) of the nail plate. Most nails grow about 1 mm a
week, which means that fingernails may regrow in 3 to 5 months. Toenails grow
more slowly than fingernails. It takes 12 to 18 months for toenails to be replaced
completely. The lunula is a semilunar (half moon), white region at the base of
the nail plate and it is generally found in the thumbnail of most people and in
varying degrees in other fingers. Air mixed in with keratin and cells rich in nuclei
give the lunula its whitish color. The cuticle (eponychium), a narrow band of
epidermis (layer of the keratin), is at the base and sides of the nail plate. The
perionychium is the skin that overlies the nail plate on its sides. It is also known
as the paronychial edge. The hyponychium is the area between the nail plate
and the fingertip. It is the junction between the free edge of the nail and the skin
of the fingertip, also providing a waterproof barrier. Nail growth and appearance
are frequently altered during systemic disease. For example, grooves in nails
may occur with high fevers and serious illness and spoon nails (flattening of the
nail plate) occurs in iron deficiency anemia. Nails appear pink because of
underlying capillaries.

Glands

Sebaceous glands
Sebaceous glands are located in the corium layer of the skin over the entire
body, with the exception of the palms of hands and soles of feet. They secrete
an oily substance called sebum. Sebum, containing lipids, lubricates the skin
and minimizes water loss. Sebaceous glands are closely associated with hair
follicles and their ducts open into the hair follicle through which the sebum is
released. The sebaceous glands are influenced by sex hormones, which cause
them to hypertrophy at puberty and atrophy in old age. Overproduction of sebum

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 5

DERMATOLOGY NOTES

during puberty contributes to blackhead (comedo) formation and acne in some

individuals.

Sweat glands
Sweat glands are tiny coiled glands found on almost all body surfaces (about 2
million in the body). There are two types of sweat glands: eccrine and apocrine.
They are most numerous in the palm of the hand (3000 glands per square inch)
and on the sole of the foot. The coiled sweat gland originates deep in the corium
and straightens out to extend up through the epidermis. The tiny opening on the
surface is called a pore with a duct that extends up through the skin and opens
onto the surface to regulate body temperature. The eccrine sweat glands are
distributed all over our body and are under thermal control. However, eccrine
glands are most dense on our axillae (arm pits), palms, soles, and forehead.
Similar to the eccrine sweat gland, apocrine sweat gland originates from the
epidermis. On the other hand, apocrine sweat glands differ as they open into
hair follicles and are larger glands. They densely populate the axillae, perineum,
and areolae; a special variety of sweat gland, active only from puberty onward
and larger than the ordinary kind, is concentrated in a few areas of the body near
the reproductive organs and in the armpits. These glands secrete an odorless
sweat, but it contains certain substances that are easily broken down by bacteria
on the skin. The breakdown products are responsible for the characteristic
human body odor. The milk-producing mammary gland is another type of
modified sweat gland; it secretes milk only after the birth of a child.

Sweat or perspiration is almost pure water with dissolved materials such as salt
making up less than 1 per cent of the total composition. It is colorless and
odorless. The odor produced when sweat accumulates on the skin is due to the
action of the bacteria on the sweat. Sweat cools the body as it evaporates into
the air. Perspiration is controlled by the sympathetic nervous system, whose
nerve fibers are activated by the heart regulatory center in the hypothalamic
region of the brain, which stimulates sweating.

Skin in stress
The skin is the outermost part of the body, providing protection from cuts,
scratches, poisons, bacteria and other insults and it also reflects the inner
turmoil. It flushes, pales, sweats and bristles with the emotions. It scales, cracks
and swells with allergies.

Pale skin might indicate anemia, yellowish skin may signal liver malfunction and
blue skin may indicate circulatory or respiratory disorder.

6 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS

DERMATOLOGY NOTES

INFLAMMATION AND REPAIR OF WOUNDS

Any bodily injury caused by physical means that disrupts the normal continuity of
structures can be called a wound. When the skin (or any other tissue) is injured,
it reacts homeostatically by attempting to protect itself against harmful agents
and by repairing the wound.

Mechanisms are activated to destroy bacteria that may have entered, dilute
harmful chemicals, dispose of dead or injured cells and even wall of the injured
area. These reactions collectively are referred to as inflammation, which is
characterized by redness, swelling, heat, and pain. Chemicals such as
histamines are released by cells in the injured area, causing the blood vessels to
dilate and become more permeable. As a result, large amounts of fluid may
leave the blood and enter the injured area caused edema (swelling). The excess
fluid exerts pressure on the nerves and other tissues resulting in pain. Pus is a
creamy fluid containing dead white blood cells and bacteria. If the wound
damages the blood vessels, blood leaks out and a clot forms. Soon after it
forms, the blood clot contracts and begins to dehydrate, forming a scab, a
temporary covering t hat seals the defect in the skin. Finally, scar tissue forms.
It contains dense collagen. It may lack hair, sweat glands, and sensory receptors.
Formation of scar tissue is a process of collagen synthesis and collagen
breakdown that continues for many months and even years after a wound
appears to have healed. During this time, the scar tissue is remodeled, that is,
the collagen fibers are rearranged so as to impart strength to the tissue.

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 7

DERMATOLOGY NOTES

VOCABULARY
Abscess: Sharply localized bacterial infection usually due staphylococci.

Acne: Papular and pustular eruption of the skin. Acne vulgaris is caused by
the buildup of sebum and keratin in the pores of the skin. A blackhead or
comedo is a sebum plug partially blocking the pore. If the pore becomes
completely blocked, a whitehead forms. Bacteria in the skin breakdown the
sebum, producing inflammation in the surrounding tissue. Papules, pustules and
cysts can thus form.

Normal skin-cross section Skin with acne

Albino: A person with skin deficient in pigment.

Basal layer: The deepest region of the epidermis; it gives rise to all the
epidermal cells.

Boils: Pus-filled infected lumps on the skin.

Bulla: A blister, a thin-walled sac exceeding 1 cm in diameter and containing

clear fluid.

8 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS

DERMATOLOGY NOTES

Burns: Injury to tissues caused by heat contact. Examples are dry heat (fire),
moist heat (steam or liquid), chemicals, lightning, electricity or radiation. They
are classified into three types.
First-degree burns: Superficial epidermal lesions, erythema,
hyperesthesia and no blisters. Sunburn is an example.

Second-degree burns: Epidermal and dermal lesions, erythema, blisters

and hyperesthesia.

Third-degree burns: Epidermis and dermis are destroyed (necrosis of

skin) and subcutaneous layer is damaged leaving charred white tissue.

Candidiasis: Infection of skin and mucous membranes with the yeast like
fungus Candida albicans).

Carbuncle: Spreading lesion made up of furuncles communicating by

subcutaneous passages.

Cellulitis: Type of infection occurring in soft tissues including the skin with
swelling, redness, pain, and fever caused by streptococci.

Chilblains: Small, itchy, painful, red swellings on the skin. They typically affect
toes but other extremities such as fingers, nose and earlobes may be affected.

Cicatrix: A zone of fibrous tissue occurring at the site of a healed injury or

inflammatory or destructive lesion extending into the dermis.

Collagen: Structural protein found in the skin and connective tissue.

Corium: The middle layer of the skin; dermis.

Crust: A hard, friable irregular layer of dried blood, serum, pus, tissue debris or
any combination of these adherent to the surface of injured or inflamed skin.

Cuticle: Band of epidermis at the base and side of the nail plate.

Dermis: The corium.

Diaper rash: A common condition in babies in which the skin in the diaper area
becomes irritated and red, usually because of exposure to urine, feces, or heat

Eczema: Inflammatory skin disease with erythematous papulovesicular lesions.

This chronic or acute dermatitis is often accompanied by pruritus and may occur
without any obvious cause. It is a common allergic reaction in children and also
occurs in adults. Allergy may be due to food, dust or pollens.

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 9

DERMATOLOGY NOTES

Epidermis: The outermost layer of the skin.

Epithelium: The layer of skin cells forming the outer and inner surfaces of the
body.

Erosion: A surface defect in the epidermis produced by rubbing or scratching.

Erysipelas: Severe form of cellulitis with a sharply circumscribed border, bulla

formation and often septicemia.

Eschar: The crust that forms on the burn.

Exanthematous viral diseases: Rash (exanthem) of the skin due to a viral

infection. Examples are rubella (German measles) and varicella (chickenpox).

Excoriation: Abrasion of the epidermal surface by scratching.

Furuncle: Deep solitary abscess.

Gangrene: Death of tissue associated with loss of blood supply. In this

condition, ischemia resulting from injury, inflammation, frostbite, diseases such
as diabetes or arteriosclerosis can lead to necrosis of tissue followed by bacterial
invasion and putrefaction (proteins are decomposed by bacteria).

Hair follicle: The sac or tube within which each hair grows.

Head lice and nits: Head lice are very small insects, which live on the scalp of
human beings. The lice feed by sucking blood from the scalp. They lay eggs,
called nits.

Horny cell: A keratin-filled cell in the epidermis.

Impetigo: Bacterial inflammatory skin disease characterized by vesicles,

pustules and crusted-over lesions. This is a contagious pyoderma and is usually
caused by staphylococci or streptococci.

Induration: Dermal thickening produced by excessive dermal collagen, or by

dermal infiltrative processes.

Integumentary system: The skin and its accessory structures such as hair and
nails.

Keratin: A hard protein material found in the epidermis, hair and nails. Keratin
means horn and is commonly found in the horns of the animals.

10 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS

DERMATOLOGY NOTES

Lichenification: Thickening, coarsening and pigment change of skin due to

chronic irritation usually scratching.

Lipocyte: A fat cell.

Lunula: The half-moon shaped white area at the base of the nail.

Melanin: A black pigment formed by melanocytes in the epidermis.

Paronychia: Inflammation of the nail fold surrounding the nail plate; may be due
to bacteria or fungi, most commonly staphylococci and streptococci.

Pit: A small depression in the skin resulting from local atrophy or scarring after
trauma or inflammation.

Prickly heat: A rash caused by trapped sweat under the skin.

Psoriasis: Chronic recurrent dermatosis marked by itchy, scaly, red patches

covered by silvery gray scales. This commonly forms in the forearms, knees,
legs and scalp. It is neither infectious nor contagious, but it is caused by an
increased rate of growth of the basal layer of the epidermis. Etiology is unknown,
but the condition runs in families and may be brought on by anxiety.

Scabies: A contagious, parasitic infection of the skin with intense pruritus. This
is often spread through sexual contact and commonly affected areas are the
penis, groin, nipple and skin between the fingers.

Scale: A flake of epidermis shed from the skin surface.

Scleroderma: A chronic progressive disease of the skin with hardening and

shrinking connective tissue.

Sebaceous gland: An oil-secreting gland in the corium that is associated with

hair follicles.

Sebum: An oily substance secreted by sebaceous glands.

Squamous epithelium: Flat, scale-like cells composing the epidermis.

Stratified: Arranged in layers.

Stratum: A layer of cells.

Stratum corneum: The outermost layer of the epidermis, which consists of

flattened keratinized (horny) cells.

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 11

DERMATOLOGY NOTES

Subcutaneous tissue: Innermost layer of the skin, containing fat tissue,

Systemic lupus erythematosus: Chronic inflammatory disease of collagen in

the skin, of joints and of internal organs. Lupus produces a characteristic
butterfly pattern of redness over the cheeks and nose. This is primarily a disease
of the females and is an autoimmune condition. SLE should be differentiated
from chronic discoid lupus erythematosus (DLE), which is a milder, scaling,
plaque-like, superficial eruption of the skin confined to the face, scalp, ears,
chest, arms and back.

Tinea: Infection of the skin caused by fungus. Tinea or ringworm is highly

contagious and causes severe pruritus. Examples are tinea pedis (athlete’s
foot), which affects the skin between the toes, tinea capitis (ringworm of the
scalp) and tinea barbae (ringworm of the skin under the beard).

UNDERSTANDING MEDICAL TERMS

COMBINING FORM MEANING TERMINOLOGY

Adip/o Fat Adipose
Albin/o White Albinism
Anthrac/o Black Anthracosis
Caus/o Burn Causalgia
Cutane/o Skin Subcutaneous
Derm/o Skin Epidermis
Dermat/o Skin Dermatitis
Diaphor/o Profuse sweating Diaphoresis
Erythem/o Redness Erythema
Hidr/o Sweat Anhidrosis
Ichthy/o Scaly, dry Ichthyosis
Kerat/o Hard horny tissue Keratosis
Leuk/o White Leukoplakia, leukoderma
Lip/o Fat Lipoma
Melan/o Black Melanocyte
Myc/o Fungus Dermatomycosis
Onych/o Nail Onycholysis
Phyt/o Plant Dermatophytosis
Pil/o Hair Pilosebaceous
Py/o Pus Pyoderma
Seb/o Sebum Seborrhea
Squam/o Scale like Squamous epithelium
Steat/o Fat Steatoma
Trich/o Hair Trichomycosis
Ungu/o Nail Subungual
Xanth/o Yellow Xanthoma
Xer/o Dry Xeroderma

12 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS

DERMATOLOGY NOTES

SUFFIXES

SUFFIX MEANING TERMINOLOGY

-derma Skin Pyoderma

SYMPTOMS
Alopecia: Absence of hair from areas where it normally grows. Alopecia or
baldness may be hereditary or it may be due to disease, injury or treatment
(chemotherapy) or occur in old age. Alopecia areata is an idiopathic condition in
which hair falls out in patches.

Ecchymosis: Bluish-black mark (macule) on the skin. These are caused by

hemorrhages into the skin from injury or spontaneous leaking of blood from
vessels.

Petechia: Small pinpoint hemorrhage. These are smaller version of

ecchymoses.

Pruritus: Itching. Pruritus is associated with most forms of dermatitis and with
other conditions as well. It arises as a result of stimulation of nerves in the skin
by enzymes released in allergic reactions or by irritation caused by substances
from the blood or from foreign bodies.

Purpura: Merging ecchymoses and petechiae over any part of the body.

Urticaria (hives): An acute allergic reaction in which red round wheals develop
on the skin. Pruritus may be intense and etiology is commonly allergy to foods.
Localized edema occurs as well.

Vitiligo: Loss of pigment in areas of the skin (milk-white patches). This is also
called leukoderma. There is an increased association of vitiligo with certain
autoimmune conditions such as thyroiditis, hyperthyroidism and diabetes
mellitus.

PATHOLOGICAL CONDITIONS
Seborrheic dermatitis: A scaly dermatitis of parts of the skin richly supplied
with oil glands.

Atopic dermatitis: A chronic pruritic condition of the skin.

Contact dermatitis: Dermatitis resulting from contact with an irritant or an

allergen.

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 13

DERMATOLOGY NOTES

Generalized exfoliative dermatitis: Severe inflammation that affects the entire

skin surface and leads to extreme redness and scaling.

Folliculitis: Bacterial infection in hair follicles.

Pityriasis rosea: Mild disease that causes scaly, rose-colored inflamed skin.

Lichen planus: Recurring itchy disease, starts as a rash of small discrete

bumps that then combine and become rough, scaly plaques (raised patches).

Lesions

Cutaneous lesions
A lesion is an area of damaged tissue caused by disease or trauma. The
following terms describe common skin lesions.

Cyst: A thick-walled, closed sac or pouch containing fluid or semisolid

material. Examples of cysts are pilonidal cyst, which is found over the
sacral area of the back in the midline and contains hair and sebaceous
cyst, which is a collection of yellowish, cheesy sebum commonly found on
the scalp, vulva, and scrotum.

Removal of a sebaceous cyst

14 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS

DERMATOLOGY NOTES

Fissure: A groove or crack-like sore. An anal fissure is a break in the

skin lining and anal canal.

Macule: A discolored (often reddened) flat lesion. Freckles, tattoo marks

and flat moles are examples.

Papule: A small (less than 1 cm in diameter) solid elevation of the skin.

Pimples are examples of papules. A larger solid elevation is called a
nodule.

Polyp: A mushroom-like growth extending on a stalk from the surface of

mucous membrane. Polyps are commonly found in the nose and sinuses,
urinary bladder and uterus.

Pustule: A small elevation of the skin containing pus. A pustule is a

small abscess on the skin.

Ulcer: An open sore or erosion of the skin or mucous membrane.

Decubitus ulcers (bedsores) are due to pressure from lying in one
position. Ulcers usually involve loss of tissue substance and pus
formation.

Vesicle: A small collection of clear fluid (serum); blister. These are found
in burns, allergies and dermatitis.

Wheal: A smooth, slightly elevated edematous area that is redder or

paler than the surrounding skin; hives.

Skin neoplasms
Callus: Increased growth of cells in the horny layer of the epidermis due
to pressure or friction. The feet and hands are the common sites. A corn
is a type of callus that develops a hard core (a whitish, corn-like central
kernel).

Keloid: Hypertrophied, thickened scar after trauma or surgical incision.

Keloids occur from excessive collagen formation in the corium during
connective tissue repair.

Keratosis: Thickened area of the epidermis. Some keratoses are red

and are due to excessive exposure to light (actinic keratosis).
Seborrheic keratoses are yellow or brown and are also called senile
warts. Both types occur in middle age and old age.

Leukoplakia: White, thickened patches on mucous membrane tissue of

the tongue or cheek. This is a precancerous lesion. It is common in
smokers and may be caused by chronic inflammation.

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 15

DERMATOLOGY NOTES

Nevus: Pigmented lesion of the skin. Nevi include dilated blood vessels
(telangiectasis) radiating out from a point (vascular spiders),
hemangiomas, and moles. Dysplastic nevi are moles that do not form
properly and may progress to form a type of skin cancer called
melanoma.

Wart (verruca): Epidermal growth caused by a virus. Plantar warts

occur on the soles of the feet, juvenile warts occur on hands and face of
children, and venereal warts occur on the genitals and around the anus.
Warts may be removed by use of acids, electrocautery or freezing with
liquid nitrogen (cryosurgery).

Cancerous lesions

Basal cell carcinoma: Malignant tumor of the basal cell layer of the
epidermis. This is the most frequent type of skin cancer. It is a slow-
growing tumor that usually occurs on the upper half of the face, near the
nose.

Kaposi’s sarcoma: Malignant, vascular, neoplastic growth characterized

by cutaneous nodules usually on the lower extremities. Nodules range in
color from deep pink to dark blue and purple. The condition is associated
with acquired immunodeficiency syndrome.

Malignant melanoma: Cancerous growth composed of melanocytes.

This malignancy is attributed to the intense exposure to sunlight that many
people experience. Melanoma usually begins as a mottled, light brown to
black, flat macule with irregular borders. The lesions may turn shades of
red, blue and white and may crust on the surface and bleed. Melanomas
often arise in preexisting moles and frequently appear on the upper back,
lower legs, head and neck. Melanomas often metastasize to the lung,
liver and brain.

Squamous cell carcinoma: Malignant tumor of the squamous epithelial

cells of the epidermis. This tumor may grow in places other than the skin,
wherever squamous epithelium is found (mouth, larynx, bladder,
esophagus, and so forth). It may arise from actinic keratosis and
metastasize to lymph nodes.

16 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS

DERMATOLOGY NOTES

DIAGNOSTIC INVESTIGATIONS/LABORATORY TESTS AND CLINICAL

PROCEDURES

Laboratory tests

Bacterial analysis: Samples of purulent (pus filled) material or exudate

(fluid that accumulates in a space or passes out of tissues) are sent to the
laboratory for examination to determine what type of bacteria are present.

Fungal tests: Scrapings from skin lesions are placed on a growth

medium for several weeks and then examined microscopically for
evidence of fungal growth.

Clinical procedures

Cryosurgery: Tissue is destroyed by the application of intensely cold

liquid nitrogen.

Moh’s surgery: Thin layers of a malignant growth are removed and each
is examined under the microscope; also called microscopically controlled
surgery.

Skin biopsy: Skin lesions such as pigmented nevi, chronic dermatoses

or any lesion in which there is the possibility of present or future malignant
change are removed and sent to the pathology lab for examination. A
punch biopsy (used to obtain tissue in cases in which complete excision
is not feasible) involves use of a surgical instrument that removes a core
of tissue by rotation of its sharp circular edge. In a shave biopsy, tissue
is excised using a cut parallel to the surface of the surrounding skin.

Skin testing for allergy or disease: The patch test is performed by

applying to the skin a small piece of gauze or filter paper on which has
been placed a suspected allergy-causing substance. If the area becomes
reddened or swollen, the result is considered positive. The scratch test
involves making several scratches in the skin and inserting a very minute
amount of test material in the scratches. The test is considered negative if
no reaction occurs. Intradermal tests are performed by injection of a
reactive substance between layers of the skin and observation of the skin
for a subsequent reaction. This test is used for the detection of sensitivity
to infectious agents such as tuberculosis (Mantoux tests, PPD test) or
diphtheria (Schick test). Strong reactions indicate ongoing infection.

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 17

DERMATOLOGY NOTES

ABBREVIATIONS

Bx: Biopsy

Derm.: Dermatology

DLE: Discoid lupus erythematosus

PPD: Purified protein derivative.

PUVA: Psoralen-ultraviolet A light therapy

SLE: Systemic lupus erythematosus

Subq: Subcutaneous

DRUGS TO TREAT SKIN DISORDERS

Drugs used to treat acne

 Acetoxyl (benzoyl peroxide)
 Avita (tretinoin)
 Benzagel Wash (benzoyl peroxide)
 Clearplex (benzoyl peroxide)
 Triaz (benzoyl peroxide)

Drugs used to treat psoriasis

 Soriatane (acitretin)
 Aclovate (alclometasone)
 Cordran (flurandrenolide)
 Delcort (hydrocortisone)
 Dermacort (hydrocortisone)
 DesOwen (desonide)
 Dovonex (calcipotriene)
 Florone (diflorasone)
 Hytone (hydrocortisone)
 Nasonex (mometasone furoate)
 Oxsoralen (methoxsalen)

Topical corticosteroids
 Aclovate (alclometasone)
 Cyclocort (amcinonide)
 Valisone (betamethasone)
 Temovate (clobetasol)

18 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS

DERMATOLOGY NOTES

 Cloderm (clocortolone)
 Tridesilon (desonide)
 Topicort (desoximetasone)
 Maxiflor (diflorasone)
 Lidex (fluocinolone)
 Cordran (fluticasone)
 Hytone (hydrocortisone)

The endings –sone, -onlone, and –onside are common to generic corticosteroids.

Topical antifungal drugs and antiyeast drugs

 Vioform hydrocortisone (clioquinol and hydrocortisone)
 Desenex (undecylenic acid and derivatives)
 Micatin (miconazole)
 Tinactin (tolnaftate)
 Mentax (butenafine)
 Loprox (ciclopirox)
 Spectazole (econazole)
 Nizoral (ketoconazole)
 Nilstat (nystatin)
 Oxistat (oxiconazole)
 Lamisil (sulconazole
 Fungoid (triacetin)

The ending –azole is common to generic antifungal drugs.

When topical fungal infections are severe, become severely embedded in nails or
become systemic, the following antifungal drugs may be given orally or
intravenously.

 Fungizone (amphotericin B)
 Diflucan (fluconazole)
 Nizoral (ketoconazole)

Drugs used to treat itching

Antihistamines
 Benadryl (diphenhydramine)
 Zonalon (doxepin)
 Caladryl (pramoxine)
 Periactin (cyproheptadine)
 Atarax (hydroxyzine)
 Vistaril (hydroxyzine)

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 19

DERMATOLOGY NOTES

Drugs used to treat scabies and lice

 Acticin (permethrin)
 Eurax (crotamiton)
 Hexit (lindane)
 Nix (permethrin)
 Tisit (pyrethrins)
 Elimite cream (permethrin)

Combination dermatologic drugs

 Lotrisone (betamethasone, clotrimazole)
 Mycitracin (bacitracin, neomycin, polymyxin B)
 Mycolog II (triamcinolone, nystatin)
 Neosporin (neomycin, polymyxin B)
 Polysporin (bacitracin, polymyxin B)

Miscellaneous dermatologic drugs

A and D: An ointment containing vitamins A and D to promote healing.

Aveeno: An oatmeal and lanolin solution used as a lotion or in bath water to

treat the itching and weeping lesions of poison ivy and chickenpox.

Betadine: A brown antibiotic solution used as a hand scrub prior to surgical

procedures.

Calamine: A lotion used for poison ivy, insect bites, and sunburn. It decreases
itching and soothes.

Debrisan: Applied topically to absorb exudate from burns and wounds.

Desitin: An ointment for diaper rash.

Gentian violet: An antibacterial and antifungal agent.

Sulfamylon: An agent that inhibits bacterial growth. It is applied to second and

third degree burns to prevent infection.

Actinex: Applied topically to treat keratoses and superficial basal cell

carcinomas.

Bactroban: An antibiotic used topically to treat impetigo.

20 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS

DERMATOLOGY NOTES

EXERCISES

Complete the following terms from their meanings given below

1. The outermost layer of the skin ____________________________________

2. Profuse sweating _______________________________________________

3. Excessive secretion from sebaceous glands __________________________

4. Burning sensation in skin _________________________________________

5. Surgical repair of the skin ________________________________________

6. Pertaining to under the skin _______________________________________

7. Under the nail _________________________________________________

8. Abnormal condition of lack of sweat ________________________________

9. Larger than 1 cm solid elevation of the skin __________________________

10. Baldness ____________________________________________________

Describe the following

1. Second-degree burn ____________________________________________

_______________________________________________________________

2. Blackheads ___________________________________________________

_______________________________________________________________

3. Keloid _______________________________________________________

_______________________________________________________________

4. Warts ________________________________________________________

________________________________________________________________

5. Purpura _______________________________________________________

________________________________________________________________

HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS 21

DERMATOLOGY NOTES

6. Gangrene _____________________________________________________

________________________________________________________________

7. Hives _________________________________________________________

________________________________________________________________

8. Tinea pedis ____________________________________________________

________________________________________________________________

22 HANDBOOK OF MEDICAL INFORMATION FOR MEDICAL TRANSCRIPTIONISTS