A cutaneous condition is any medical condition that affects the integumentary system — the organ system that comprises the entire surface of the body and includes skin, hair, nails, and related muscle and glands.[1] The major function of this system is as a barrier against the external environment.[2]
Conditions of the human integumentary system constitute a broad spectrum of diseases, also known as dermatoses, as well as many nonpathologic states (like, in certain circumstances, melanonychia and racquet nails).[3][4] While only a small number of skin diseases account for most visits to the physician, thousands of skin conditions have been described.[5] Classification of these conditions often presents many nosological challenges, since underlying etiologies and pathogenetics are often not known.[6][7] Therefore, most current textbooks present a classification based on location (for example, conditions of the mucous membrane), morphology (chronic blistering conditions), etiology (skin conditions resulting from physical factors), and so on.[8][9]
Clinically, the diagnosis of any particular skin condition is made by gathering pertinent information regarding the presenting skin lesion(s), including the location (such as arms, head, legs), symptoms (pruritus, pain), duration (acute or chronic), arrangement (solitary, generalized, annular, linear), morphology (macules, papules, vesicles), and color (red, blue, brown, black, white, yellow).[10] The diagnosis of many conditions often also requires a skin biopsy which yields histologic information[11][12] that can be correlated with the clinical presentation and any laboratory data.[13][14]
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Where cutaneous conditions occur [link]
The skin weighs an average of four kilograms, covers an area of two square meters, and is made of three distinct layers: the epidermis, dermis, and subcutaneous tissue.[1] There are two main types of human skin: glabrous skin, the nonhairy skin on the palms and soles (also referred to as the "palmoplantar" surfaces), and hair-bearing skin.[15] Within the latter type, there are hairs in structures called pilosebaceous units, each with hair follicle, sebaceous gland, and associated arrector pili muscle.[16] In the embryo, the epidermis, hair, and glands form from the ectoderm, which is chemically influenced by the underlying mesoderm that forms the dermis and subcutaneous tissues.[17][18][19]
Epidermis [link]
The epidermis is the most superficial layer of skin, a squamous epithelium with several strata: the stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, and stratum basale.[20] Nourishment is provided to these layers via diffusion from the dermis, since the epidermis is without direct blood supply. The epidermis contains four cell types: keratinocytes, melanocytes, Langerhans cells, and Merkel cells. Of these, keratinocytes are the major component, constituting roughly 95 percent of the epidermis.[15] This stratified squamous epithelium is maintained by cell division within the stratum basale, in which differentiating cells slowly displace outwards through the stratum spinosum to the stratum corneum, where cells are continually shed from the surface.[15] In normal skin, the rate of production equals the rate of loss; it takes about two weeks for a cell to migrate from the basal cell layer to the top of the granular cell layer, and an additional two weeks to cross the stratum corneum.[21]
Dermis [link]
The dermis is the layer of skin between the epidermis and subcutaneous tissue, and comprises two sections, the papillary dermis and the reticular dermis.[22] The superficial papillary dermis interdigitates with the overlying rete ridges of the epidermis, between which the two layers interact through the basement membrane zone.[22] Structural components of the dermis are collagen, elastic fibers, and extrafibrillar matrix (previously called ground substance).[22] Within these components are the pilosebaceous units, arrector pili muscles, and the eccrine and apocrine glands.[20] The dermis contains two vascular networks that run parallel to the skin surface—one superficial and one deep plexus—which are connected by vertical communicating vessels.[20][23] The function of blood vessels within the dermis is fourfold: to supply nutrition, to regulate temperature, to modulate inflammation, and to participate in wound healing.[24][25]
Subcutaneous tissue [link]
The subcutaneous tissue is a layer of fat between the dermis and underlying fascia.[5] This tissue may be further divided into two components, the actual fatty layer, or panniculus adiposus, and a deeper vestigial layer of muscle, the panniculus carnosus.[15] The main cellular component of this tissue is the adipocyte, or fat cell.[5] The structure of this tissue is composed of septal (i.e. linear strands) and lobular compartments, which differ in microscopic appearance.[20] Functionally, the subcutaneous fat insulates the body, absorbs trauma, and serves as a reserve energy source.[5]
Diseases of the skin [link]
Diseases of the skin include skin infections and skin neoplasms (including skin cancer).
History [link]
In 1572, Geronimo Mercuriali of Forlì, Italy, completed De morbis cutaneis (translated "On the diseases of the skin"). It is considered the first scientific work dedicated to dermatology.
Approach to diagnoses [link]
The physical examination of the skin and its appendages, as well as the mucous membranes, forms the cornerstone of an accurate diagnosis of cutaneous conditions.[26] Most of these conditions present with cutaneous surface changes termed "lesions," which have more or less distinct characteristics.[27] Often proper examination will lead the physician to obtain appropriate historical information and/or laboratory tests that are able to confirm the diagnosis.[26] Upon examination, the important clinical observations are the (1) morphology, (2) configuration, and (3) distribution of the lesion(s).[26] With regard to morphology, the initial lesion that characterizes a condition is known as the "primary lesion," and identification of such a lesions is the most important aspect of the cutaneous examination.[27] Over time, these primary lesions may continue to develop or be modified by regression or trauma, producing "secondary lesions."[1] However, with that being stated, the lack of standardization of basic dermatologic terminology has been one of the principal barriers to successful communication among physicians in describing cutaneous findings.[20] Nevertheless, there are some commonly accepted terms used to describe the macroscopic morphology, configuration, and distribution of skin lesions, which are listed below.[27]
Morphology [link]
Primary lesions [link]
- Macule – A macule is a change in surface color, without elevation or depression and, therefore, nonpalpable, well or ill-defined,[28] variously sized, but generally considered less than either 5[28] or 10 mm in diameter at the widest point.[27]
- Patch – A patch is a large macule equal to or greater than either 5 or 10 mm,[27] across depending on one's definition of a macule.[1] Patches may have some subtle surface change, such as a fine scale or wrinkling, but although the consistency of the surface is changed, the lesion itself is not palpable.[26]
- Papule – A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to less than either 5[28] or 10 mm in diameter at the widest point.[27]
- Plaque – A plaque has been described as a broad papule, or confluence of papules equal to or greater than 1 cm,[27] or alternatively as an elevated, plateau-like lesion that is greater in its diameter than in its depth.[26]
- Nodule – A nodule is morphologically similar to a papule, but is greater than either 5[26] or 10 mm in both width and depth, and most frequently centered in the dermis or subcutaneous fat.[27] The depth of involvement is what differentiates a nodule from a papule.[28]
- Vesicle – A vesicle is a circumscribed, fluid-containing, epidermal elevation generally considered less than either 5[28] or 10 mm in diameter at the widest point.[27]
- Bulla – A bulla is a large vesicle described as a rounded or irregularly shaped blister containing serous or seropurulent fluid, equal to or greater than either 5[28] or 10 mm,[27] depending on one's definition of a vesicle.[1]
- Pustule – A pustule is a small elevation of the skin containing cloudy[26] or purulent material usually consisting of necrotic inflammatory cells.[27] These can be either white or red.
- Cyst – A cyst is an epithelial-lined cavity containing liquid, semi-solid, or solid material.[28]
- Erosion – An erosion is a discontinuity of the skin exhibiting incomplete loss of the epidermis,[29] a lesion that is moist, circumscribed, and usually depressed.[20]
- Ulcer – An ulcer is a discontinuity of the skin exhibiting complete loss of the epidermis and often portions of the dermis and even subcutaneous fat.[29]
- Fissure – A fissure is a crack in the skin that is usually narrow but deep.[26]
- Wheal – A wheal is a rounded or flat-topped, pale red papule or plaque that is characteristically evanescent, disappearing within 24 to 48 hours.[28]
- Telangiectasia – A telangiectasia represents an enlargement of superficial blood vessels to the point of being visible.[26]
- Burrow – A burrow appears as a slightly elevated, grayish, tortuous line in the skin, and is caused by burrowing organisms.[26][27]
Secondary lesions [link]
- Scale – dry or greasy laminated masses of keratin[27] that represent thickened stratum corneum.[26]
- Crust – dried serum, pus, or blood usually mixed with epithelial and sometimes bacterial debris.[28]
- Lichenification – epidermal thickening characterized by visible and palpable thickening of the skin with accentuated skin markings.[1]
- Excoriation – a punctate or linear abrasion produced by mechanical means (often scratching), usually involving only the epidermis but not uncommonly reaching the papillary dermis.[27]
- Induration – dermal thickening causing the cutaneous surface to feel thicker and firmer.[26]
- Atrophy – refers to a loss of tissue, and can be epidermal, dermal, or subcutaneous.[27] With epidermal atrophy, the skin appears thin, translucent, and wrinkled.[26] Dermal or subcutaneous atrophy is represented by depression of the skin.[26]
- Maceration – softening and turning white of the skin due to being consistently wet.
Configuration [link]
"Configuration" refers to how lesions are locally grouped ("organized"), which contrasts with how they are distributed (see next section).
- Agminate
- Annular
- Arciform or arcuate
- Circinate
- Digitate
- Discoid
- Figurate
- Guttate
- Herpetiform
- Linear
- Nummular
- Mamillated
- Reticular or reticulated
- Serpiginous or gyrate
- Stellate
- Targetoid
- Verrucous
Distribution [link]
"Distribution" refers to how lesions are localized. They may be confined to a single area (a patch) or may exist in several places. Several distributions correlate an anatomical reference. Some correlate with the means by which a given area becomes effected. For example, contact dermatitis correlates with locations where allergen has elicited an allergic immune response. Varicella Zoster Virus is known to recur (after its initial presentation as Chicken Pox) as Shingles. Chicken Pox appears nearly everywhere on the body but Shingles tends to follow one or two dermatomes. (For example, the eruptions may appear along the bra line, on either or both sides of the patient.)
- Generalized
- Symmetric (one side mirrors the other)
- Flexural (Front of the fingers)
- Extensor (back of the fingers)
- Intertriginous
- Morbilliform
- Palmoplantar (palm of the hand, bottom of the foot)
- Periorificial
- Periungual (under a finger or toe nail)
- Alopecia (hair loss)
- Blaschkoid
- Photodistributed (places where sunlight reaches)
- Zosteriform or dermatomal (associated with a particular nerve)
Other related terms:
- Collarette
- Comedo
- Confluent
- Eczema (a type of dermatitis)
- Granuloma
- Livedo
- Purpura
- Erythema (redness)
- Horn (a cell type)
- Poikiloderma
Combined (conjoint) terms (maculopapular, papuloerosive, papulopustular, papulovesicular, papulosquamous, tuberoulcerative, vesiculobullous, vesiculopustular) are used to describe eruptions that evolve from one type of lesion to the next so often appear as having traits of both, when transitioning[citation needed].
Histopathology [link]
- Hyperkeratosis
- Parakeratosis
- Hypergranulosis
- Acanthosis
- Papillomatosis
- Dyskeratosis
- Acantholysis
- Spongiosis
- Hydropic swelling
- Exocytosis
- Vacuolization
- Erosion
- Ulceration
- Lentiginous
See also [link]
References [link]
- ^ a b c d e f Miller, Jeffrey H.; Marks, James G. (2006). Lookingbill and Marks' Principles of Dermatology. Saunders. ISBN 1-4160-3185-5.
- ^ Lippens S, Hoste E, Vandenabeele P, Agostinis P, Declercq W (April 2009). "Cell death in the skin". Apoptosis 14 (4): 549–69. DOI:10.1007/s10495-009-0324-z. PMID 19221876.
- ^ King, L.S. (1954). "What Is Disease?". Philosophy of Science 21 (3): 193–203. DOI:10.1086/287343.
- ^ Bluefarb, Samuel M. (1984). Dermatology. Upjohn Co. ISBN 0-89501-004-6.
- ^ a b c d Lynch, Peter J. (1994). Dermatology. Williams & Wilkins. ISBN 0-683-05252-7.
- ^ Tilles G, Wallach D (1989). "[The history of nosology in dermatology]" (in French). Ann Dermatol Venereol 116 (1): 9–26. PMID 2653160.
- ^ Lambert WC, Everett MA (October 1981). "The nosology of parapsoriasis". J. Am. Acad. Dermatol. 5 (4): 373–95. DOI:10.1016/S0190-9622(81)70100-2. PMID 7026622.
- ^ Jackson R (1977). "Historical outline of attempts to classify skin diseases". Can Med Assoc J 116 (10): 1165–8. PMC 1879511. PMID 324589. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1879511.
- ^ Copeman PW (February 1995). "The creation of global dermatology". J R Soc Med 88 (2): 78–84. PMC 1295100. PMID 7769599. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1295100.
- ^ Fitzpatrick, Thomas B.; Klauss Wolff; Wolff, Klaus Dieter; Johnson, Richard R.; Suurmond, Dick; Richard Suurmond (2005). Fitzpatrick's color atlas and synopsis of clinical dermatology. McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4.
- ^ Werner B (August 2009). "[Skin biopsy and its histopathologic analysis: Why? What for? How? Part I]" (in Portuguese). An Bras Dermatol 84 (4): 391–5. PMID 19851671.
- ^ Werner B (October 2009). "[Skin biopsy with histopathologic analysis: why? what for? how? part II]" (in Portuguese). An Bras Dermatol 84 (5): 507–13. DOI:10.1590/S0365-05962009000500010. PMID 20098854.
- ^ Xiaowei Xu; Elder, David A.; Rosalie Elenitsas; Johnson, Bernett L.; Murphy, George E. (2008). Lever's Histopathology of the Skin. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7363-6.
- ^ Weedon's Skin Pathology, 2-Volume Set: Expert Consult - Online and Print. Edinburgh: Churchill Livingstone. 2009. ISBN 0-7020-3941-1.
- ^ a b c d Burns, Tony; et al. (2006) Rook's Textbook of Dermatology CD-ROM. Wiley-Blackwell. ISBN 1-4051-3130-6.
- ^ Paus R, Cotsarelis G (1999). "The biology of hair follicles". N Engl J Med 341 (7): 491–7. DOI:10.1056/NEJM199908123410706. PMID 10441606.
- ^ Goldsmith, Lowell A. (1983). Biochemistry and physiology of the skin. Oxford University Press. ISBN 0-19-261253-0.
- ^ Fuchs E (February 2007). "Scratching the surface of skin development". Nature 445 (7130): 834–42. DOI:10.1038/nature05659. PMC 2405926. PMID 17314969. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2405926.
- ^ Fuchs E, Horsley V (April 2008). "More than one way to skin .". Genes Dev. 22 (8): 976–85. DOI:10.1101/gad.1645908. PMC 2732395. PMID 18413712. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2732395.
- ^ a b c d e f Wolff, Klaus Dieter; et al. (2008). Fitzpatrick's Dermatology in General Medicine. McGraw-Hill Medical. ISBN 0-07-146690-8.
- ^ Bolognia, Jean L.; et al. (2007). Dermatology. St. Louis: Mosby. ISBN 1-4160-2999-0.
- ^ a b c Rapini, Ronald P. (2005). Practical dermatopathology. Elsevier Mosby. ISBN 0-323-01198-5.
- ^ Grant-Kels JM (2007). Color Atlas of Dermatopathology (Dermatology: Clinical & Basic Science). Informa Healthcare. pp. 163. ISBN 0-8493-3794-1.
- ^ Ryan, T (1991). "Cutaneous Circulation". In Goldsmith, Lowell A. Physiology, biochemistry, and molecular biology of the skin (2nd ed.). New York: Oxford University Press. p. 1019. ISBN 0-19-505612-4.
- ^ Swerlick RA, Lawley TJ (January 1993). "Role of microvascular endothelial cells in inflammation". J. Invest. Dermatol. 100 (1): 111S–115S. DOI:10.1038/jid.1993.33. PMID 8423379.
- ^ a b c d e f g h i j k l m n Callen, Jeffrey (2000). Color atlas of dermatology. Philadelphia: W.B. Saunders. ISBN 0-7216-8256-1.
- ^ a b c d e f g h i j k l m n o James, William D.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
- ^ a b c d e f g h i Fitzpatrick, Thomas B.; Klauss Wolff; Wolff, Klaus Dieter; Johnson, Richard R.; Suurmond, Dick; Richard Suurmond (2005). Fitzpatrick's color atlas and synopsis of clinical dermatology. New York: McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4.
- ^ a b Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. ISBN 0-7216-0187-1.
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Erosion (morphology)
Erosion is one of two fundamental operations (the other being dilation) in morphological image processing from which all other morphological operations are based. It was originally defined for binary images, later being extended to grayscale images, and subsequently to complete lattices.
Binary erosion
In binary morphology, an image is viewed as a subset of a Euclidean space 
or the integer grid 
, for some dimension d.
The basic idea in binary morphology is to probe an image with a simple, pre-defined shape, drawing conclusions on how this shape fits or misses the shapes in the image. This simple "probe" is called structuring element, and is itself a binary image (i.e., a subset of the space or grid).
Let E be a Euclidean space or an integer grid, and A a binary image in E. The erosion of the binary image A by the structuring element B is defined by:
where Bz is the translation of B by the vector z, i.e., 
, 
.
When the structuring element B has a center (e.g., a disk or a square), and this center is located on the origin of E, then the erosion of A by B can be understood as the locus of points reached by the center of B when B moves inside A. For example, the erosion of a square of side 10, centered at the origin, by a disc of radius 2, also centered at the origin, is a square of side 6 centered at the origin.
Acid erosion
Acid erosion, also known as dental erosion, is a type of tooth wear. It is defined as the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin. Dental erosion is the most common chronic disease of children ages 5–17, although it is only relatively recently that it has been recognised as a dental health problem. There is generally widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to fruit juices, because they tend to be seen as healthy. Erosion is found initially in the enamel and, if unchecked, may proceed to the underlying dentin.
The most common cause of erosion is by acidic foods and drinks. In general, foods and drinks with a pH below 5.0–5.7 have been known to trigger dental erosion effects. Numerous clinical and laboratory reports link erosion to excessive consumption of drinks. Those thought to pose a risk are soft drinks, some alcohol and fruit drinks, fruit juices such as orange juice (which contain citric acid) and carbonated drinks such as colas (in which the carbonic acid is not the cause of erosion, but citric and phosphoric acid). Additionally, wine has been shown to erode teeth, with the pH of wine as low as 3.0–3.8. Other possible sources of erosive acids are from exposure to chlorinated swimming pool water, and regurgitation of gastric acids.
Madhouse
Madhouse may refer to:
Films
Music
(The original group MADHOUSE, is a band from Baltimore, Maryland that consisted of several members that went on to be a part of Bootsy's Rubber Band. They recorded their first album as kids in 1972 titled "Serve Em", which was released on a label called, Today. Prince project Madhouse, would follow years later using the same name.
DNA (Little Mix album)
DNA is the debut studio album by British girl group Little Mix. It was released on 19 December 2012 in the United Kingdom via Syco Music. The group began work recording the album in December 2011 and concluded in September 2012. Throughout the recording process, Little Mix worked with several producers, including TMS, Future Cut, Steve Mac, Jarrad Rogers, Richard "Biff" Stannard, Ash Howes, Jon Levine, Xenomania, Fred Ball and Pegasus. The album was co-written by Little Mix and they stated that they were involved in the development of the album as much as possible. Sonically, the album is primarily a mixture of pop and R&B records, with influences from dance-pop, pop rock and hip hop found on specific songs as well. The album's lyrical content explores empowerment, relationships and heartbreak. Songs on the album were also co-written by members of other girl groups, including Nicola Roberts of Girls Aloud, Shaznay Lewis of All Saints and T-Boz of TLC.
DNA received mixed reviews from music critics. The album's lead single, "Wings", was released on 26 August 2012, reaching number one in UK and Ireland as well as charting in Australia, New Zealand, Slovakia, Czech Republic, Hungary, Belgium, Canada and the US. The second single, "DNA", was released on 11 November 2012, peaking at number three in the UK. Two post-album singles were released: "Change Your Life" on 3 February 2013, and a remix of "How Ya Doin'?" featuring American rapper Missy Elliott was released on 17 April 2013; both songs reached the top 20 in the UK.
Madhouse (song)
"Madhouse" is a song by the American thrash metal band Anthrax. It was released in 1985 on Megaforce/Island Records.
Background
Madhouse was released as the only single and third track from the group's second album, Spreading the Disease. The song is written in an up-tempo time signature, with heavy distorted guitar riffs.
It has become a staple of live concerts, and has also appeared on Anthrax's "best of" album, Anthrology: No Hit Wonders (1985-1991). In 2009, the track was named the 46th best hard rock song of all time by VH1.
Music video
A music video was produced, which features the band performing in an insane asylum with several mental patients moving along to the tune. However, the video did not receive much airplay because it was banned from MTV, who believed the content to be degrading to the mentally ill.
