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67 Cards in this Set
- Front
- Back
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dermatologic problems associated with the sun
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actinic keratosis
basal cell carcinoma squamous cell carcinoma malignant melanoma |
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chemical sunscreens
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light creams or lotions designed to absorb or filter UV light, resulting in diminshed UV light penetration into the epidermis
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physical sunscreen
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thick, opaque, heavy creams that reflect UV radiation
They block all UVA and UVB radation as well as visible light |
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sun protection factor (SPF)
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pts should be taught to look for "broad spectrum" on packaging that indicates a wide range of absorbance, esp UVB wavelengths
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UBV Ray blockers
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Para-aminobenzoic acid (PABA) and PABA esters
cinnamates salicylates methyl anthranilate |
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PABA
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has been removed from many sunscreen products because it stains clothing and can cause allergic reations, including contact dermititis
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Parsol (avobenzone)
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blocks UVA rays and has been added to most sunscreens.
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Benzophenones
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block both UVA and UVB rays
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About sunscreens
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apply 20-30 min before going outdoors
even on cloudy days reapply after swimming |
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drug induced photosensitivity
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similar to those of exaggerated sunburn
swelling, erythema, vesicles, papular, plaque-like lesions |
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irritant contact dermatitis
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produced by direct chemical injury to the skin
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allergic contact dermatitis
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an antigen-specific type IV delayed hypersensitivity response
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radiation
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indiscriminant use can cause erythema, dry and moist desquamation,, edema and hypo- or hyperpigmentation
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exercise and skin
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increases circulation and dilates the blood vessels
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Hygiene and skin
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normal acidity of the skin has antibacterial properties
most soaps are alkaline and neutralize skin surface, with loss of protection use mild soaps, avoid hot water and vigorous scrubbing - will decrease local irritation and inflammation |
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Vitamin A
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for normal cell structure
esp epithelial cells necessary for normal wound healing absence causes dryness of conjunctiva and poor wound healing |
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Vitamin B complex
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for complex metabolic functions
deficiencies of niacin and pyridoxine (B6) manifest as erythema, bullae, and sborrhea-like lesions |
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Vitamin C
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for connective tissue formation and normal wound healing
Absence of vitamin c causes scurvy, including petechiae, bleeding gums and purpura |
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Protein
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necessary in amounts adequate for cell growth and maintenance
necessary for wound healing |
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Unsaturated fatty acids
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necessary to maintain the function and integrity of cellular and subcellular membranes in tissue metabolism, esp linoleic and arachidonic acids
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Skin Cancer
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the most common malignant condition and accounts for 40% of all new cancer diagnoses
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ABCD rule
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Asymmetry
Border irregularity Color change/variation Diamter of 6mm or more |
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Risk Factors for Skin Cancer
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Fair skin
history of chronic sun exposure family history of skin cancer exposure to tar and systemic arsenicals living near the equator outdoor occupations frequent outdoor recreation professional indoor and outdoor tanning smoking |
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Darker skin and cancer
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less susceptible because of increased melanin
but melanomas can occur on palsm, soles, mucous membranes |
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nonmelanoma skin cancers
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actinic keratosis
basal cell carcinoma squamous cell carcinoma |
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actinic keratosis
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aka solar keratosis
premalignant form of squamous cell carcinoma |
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basal cell carcinoma (BCC)
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most common type of skin cancer and also the least deadly
treatment modalities include: electrodessication and currettage exision cryosurgery radiation therapy Mohs' surgery topical chemotherapy intralesional alpha interferon |
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squamous cell carcinoma (SCC)
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malignant
less common that BCC can be very aggressive Pipe, cigar and cigarettes can contribute to SCC on mouth and lips sun exposure is another risk factor |
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malignant melanoma
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tumor arising in melanocytes
superficial spreading (SSM) lentigo malignant (LMM) acrallentiginous (ALM) nodular (NM) |
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superficial spreading melanoma (SSM)
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the most common type
the most curable occurs most on chronically sun-exposed areas such as legs and upper back frequently arises from a preexisting mole |
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Lentigo Malignant Melanoma (LMM)
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commonly located on the face and is often found in elderly patients
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Clinical manifestations of melanoma
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about one third of melanomas occur in existing nevi or moles
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Pigmented lesions suspected of being melanoma...
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should never be shave-biopsied, shave-excised, or electrocauterized
all suspicious lesions should be biopsied using an excisional biopsy technique |
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dysplastic nevi (DN)
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atypical moles
nevi tthat are larger than usual (>5mm across) with irregular borders and various shades of color |
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Bacterial infections
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S. aureus and groups A beta-hemolytic streptococci are the major types responsible for primary and secondary infections
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Impetigo
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groups A beta-hemolytic streptococci, staphy, or combo of both.
assoc with poor hygiene and low socioeconomic status contagious |
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Folliculitis
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usually staphylococci
in areas of friction, moisture, rubbing, or oil increased in pts with DM |
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diseases with dermatologic manifestations
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providers should always consider that a particular dermatosis is a clue to an internal, less obvious problem
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psoriasis
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chronic dermatitis that involves excessively rapid turnover of epidermal cells
family predisposition |
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phototherapy
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UV wavelengths cause erythema, desquamation, and pigmentation and may cause a temporary supression of basal cell mitosis followed by a rebound increase in cell turnover
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psoralen
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plus UVA light (PUVA) is a form of phototherapy
conditions that are responsive include atopic dermatitis, cutaneeous T cell lymphoma, pruritus, psoriasis, vitiligo, pruritus |
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Laser therapy
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can cut, coagulate and vaporize tissue to some degree
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Drug therapy
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antibiotics
corticosteroids antihistamines topic fluorouracil |
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high potency corcticsteroids
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may produce side effects when their use is prolonged, including atrophy of the skin resulting from impaired cell mitosis, capillary fragility and susceptibility to bruising
atrophy doesn't occur until used for 2-3 weeks if discontinued promptly, recovery usually occurs in several weeks |
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Oral antihistamines
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used to treat conditions that exhibit urticaria, angioedema, pruritus
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Sedating antihistamines
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hydroxyzine (Atarax)
diphenhydramine (Benadryl) preferred for pruritic condition because the tranquilizing and sedative effects offer symptomatic relief |
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Non sedating antihistamines
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loratidine (Claratin)
fexofenadine (Allergra) cetirizine (Zyrtec) not generally effective for pruritus |
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antihistamines and elderly
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Caution when using because of anticholinergic effects
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fluorouracil (5-FU)
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a topical cytotoxic agent with selective toxicity or sun-damaged cells and used for treatment of premalignant (esp actinic keratosis) and some milignant skin diseases
causes photosensitivity healing may take up to 4 weeks |
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immunomolulators
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pimicromilus (Elidel)
tacrolimus (Protopic) new nonsteroidal meds used to treat atopic dermatitis work my suppressing an overreactive immune system ADEs: transient burning or feeling of heat at application site increased risk of cancer with these drugs |
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imiquidmod (aldara)
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stimulates the production of alpha-interferon and other cytokines to enhance cell-mediated immunity
boosts immune rsponse only where applied, and is safe for transplant patiesnts ADEs: redness, swelling, sore, blister, peeling, itching and burning |
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Telangiectasias
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dilation of groups of superficial capillaries and venules
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electrodessication
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usually involves more superficial destruction, and a monopolar electrod is used
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electrocoagulation
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has deeper effect with better hemostasis an increased possiblitty of scarring
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electrical energy
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results in tissue being destroyed by burning
for coagulation of bleeding vessels to obtain hemostasis and desctruction of small telangiectasias |
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curettage
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removal and scooping away of tissue using an instrument with a circular cutting edge attached to a handle
useful for removal of small, soft skin tumors, superficial lesions, warts, actinic keratoses, and small basal and squamous cell carcinomas area anesthesized first |
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cryosurgery
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for common benign (not for malignant), percancerous conditions including common and genital warts, cutaneous tags, thin seborrheic keratosis, lentigines, and actinic keratosis
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excision
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should be considered if the lesion involves the dermis
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wet dressings
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commonly used when there is oozing from the skin, which indicates infection and/or inflammation
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Baths
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for large body areas
sedative and antipruritic effects |
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topical meds
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thin layer of ointment, cream or lotion, applied to clean, dry skin and spead evenly in downward motion
thickly applied waste meds and leave skin greasy |
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Control of pruritus
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itch/scratch cycle must be broken to prevent excoriation and lichenification, also difficult to diagnose lesion that is inflammed and excoriated
cool environment may cuse vasoconstriction topically applied menthol, camphor, phenol, can numb |
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lichenification
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thickening of skin as a result of the proliferation of keratinocytes with accentuation of the normal markings of the skin
caused by chronic scratching or rubbing of the skin and assoc with atopic dermatoses and pruritic conditions |
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postop managment of skin
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warm, pink skin that blanches on pressure indicates that adequate circulation is present in the surgical area
supportive compressive dressings and ice packs may be necessary early in postop period |
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autograft
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from patient's own body
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isograft
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from an identical twin
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reconstructive microsurgery
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with use of operating microscope, circulation is emmediately established in the free flap by anastomosis of the blood vessels from the skin flap to the vessels in the recipient site
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