A 20 year old women with an ulcer

A 20 year old women with an ulcer

1. Skin

   • Histology
   • lymphatic drainage
   • Role of skin in nonspecific Immunity
     • barrier to the entry of microorganisms
     • Sweat and sebaceous secretions contain bacteriostatic substances
     • pH(3-5)

2. Itchy erythmatous papules and plaques

   • Papule
     • small circumscribed superficial solid elevation of the skin less than 5mm
   • Plaques
     • An elevated dome-shaped or flat-topped lesion ≤ 5mm in diameter
   • Other skin lesions
     • Infectious
       • Bacterial
         • Impetigo
         • Erysipelas
         • Cellulitis
         • Necrotizing fasciitis
         • Staphylococcal scalded skin syndrome
       • Viral
         • Herpes
         • Molluscum contagiosum
         • Varicella zoster virus
         • Hairy leukoplakia
     • Non-Infectious
       • Acne
       • Eczema
       • Allergic contact dermatitis
       • Melanocytic nevus
       • Pseudofolliculitis barbae
       • Psoriasis
       • Rosacea
       • Seborrheic keratosis
       • Verrucae
       • Urticaria
   • Causes of itching
     • Complications
       • Secondary infections
       • Scratch marks
       • Bleeding
       • Scars
         • 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
   • The lesion has pus and yellow crust
     • Pus
       • is an exudate that consists of a thin, protein-rich fluids and dead leukocytes from the body's immune response (mostly neutrophils)
     • Crust
       • Dried exudation and pus
   • Then became swollen and started to ulcerate
     • Cardinal Signs of Inflammation
       • Rubor
       • Calor
       • Tumor
       • Dolar and loss of function
     • ulcer
       • 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.
       • Differential diagnosis of skin ulcer
         • Vascular
           • peripheral arteriosclerosis, diabetic ulcers, and varicose ulcers
         • 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
         • Neoplasm
           • BCC
           • SCC
         • Degenerative
           • peripheral neuropathy, syringomyelia, muscle atrophy
         • Autoimmune
           • Stevens-johnson syndrome
         • Endocrine
           • Diabetes

3. Skin tumors

   • Basal Cell Carcinoma
     • Presents as an elevated nodule with a central, ulcerated crater surrounded by dilated (telangiectatic) vessels; 'pink, pearl-like papule'
   • Squamous cell carcinoma
     • Presents as an ulcerated, nodular mass, usually on the face (classically involving the lower lip)
     • Actinic keratosis is a precursor lesion of squamous cell carcinoma and presents as a hyperkeratotic, scaly plaque, often on the face, back, or neck.
     • Keratoacanthoma is well-differentiated squamous cell carcinoma that develops rapidly and regresses spontaneously; presents as a cup-shaped tumor filled with keratin debris
   • Malignant melanoma
     • Presents as a mole-like growth with "ABCD"

4. Antiprotozoal drugs

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