Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
108 Cards in this Set
- Front
- Back
|
Grouped vesicles on an erythematous base
|
Herpes Simplex
|
|
|
Erythematous plaques with overlying silver scale
|
Psoriasis
|
|
|
Brown symmetrical stuck-on papule
|
Seborrheic Keratosis
|
|
|
Color
|
Erythematous, violaceous (purple), flesh-colored, reticulated (webbing, lace like), variegated (various colorsin lesion), hyperpigmented, hypopigmented
|
|
|
Shape
|
Symmetrical, irregular, stuck-on, serpigmous (winding snake like), polygonal, pedunculated (on a stalk), annular, dermatomal distribution, linear, well-circumscribed, lichenified (thick and leathery)
|
|
|
Distribution
|
diffuse, generalized, localized, grouped, photodistributed (sun-exposed area)
|
|
|
Key Word: Stuck-On
Lookds as if you can "flick-off" the lesion |
Seborrheic Karatosis
|
|
|
Polygonal = very geometric, sharp angles
|
Lichen Planus
|
|
|
Pedunculated
|
Skin Tags (acrochordons) and some Nevi
|
|
|
Annular = ring-shaped
|
Granuloma annulare
or Tinea or Eczema |
|
|
Dermatomal
|
Herpes Zoster
|
|
|
Linear
|
Poison Ivy/Plant Dermatitis
|
|
|
Primary Lesions vs Secondary Lesions
|
primary = initial, not altered by trauma or scratching, rubbing, or natural regression with time
(macules, papules, plaques, patches, nodules, wheals, vesicles, bullae, pustules, cysts) Secondary = created, changed or different from primary, induced by scratching rubbing or infection (crusts, ulcers, excoriations, erosions, scales, fissures, scars) |
|
|
Neither primary or secondary
|
telangiectasis (small dilated blood vessels), petechiae, burrows, purpura (purple/red that do not blanch), comedones (blackhead)
|
|
|
Macule
|
FLAT skin discolorations less than 10 mm
Nevi (mole), vitiligo (white discoloration), cafe-au-lait, ephelides (freckles), lintigines (very small mole) Can be caused by Viral Exanthem or drug rashes |
|
|
Patch
|
FLAT skin discoloration greater than 10 mm aka large macule
Vitiligo (depigmented), Nevus flammeus |
|
|
Papule
|
ELEVATED solid lesion less than 10 mm
Acrochordons (skin tags), molluscum (viral), nevi (moles), Basal cell carcinomas, squamous cell carcinomas, some acne lesions |
|
|
Buzz words for Basal Cell carcinoma
|
rolled borders, ulcerations (crusted), waxy/shiny, telangiectasis
|
|
|
Palque
|
ELEVATED solid lesion more than 10mm aka large papule
Does NOT have a deep dermal component Psoriasis, Eczema, Tinea Melanoma, Sebhorrheic Keratosis |
|
|
Nodule
|
ELEVATED solid lesion greater than 10mm but WITH a deep dermal component
Rheumatoid nodules, lipomas, erythema nodosum Acne |
|
|
Cyst
|
Nodule w/ purulent material, central punctum (hole in middle)
Cystic acne lesions, epidermal inclusion cysts, pilar cysts Digital Mucous Cyst, Epidermal Inclusion Cyst |
|
|
Wheal
|
Firm, SWOLLEN, edamtous plaque, preuitic
aka HIVE Uticaria, dermographism, uticaria pgmentosa PUPPP = pruritic utivarial papules, plaques of pregnancy in later stages, self-limited Migrate around body |
|
|
Vesicle
|
Papule that contains clear fluid aka Blister
Herpes Simplex, Herpes Zoster, Dyshidrotic eczema (hands), contact dermatits |
|
|
Pustule
|
Papule that contains purulent material
Folliculitis, impetigo, some acne lesions Pustular psoriasis w/p silver scale (oozes) |
|
|
Bulla
|
Fluid collection; greater than 10 mm
Pemphigus vulgaris, bullous Bullous Pemphigoind = rash over skin can have resolving bulla (already popped) Allergic dermatitis (bulla and vesicles) |
|
|
Crust
|
collection of cellular debris, dried serum, and blood aka scab
from vesicle, bulla, or pustule excoriated acne lesions (picked at by person, can cause scarring) |
|
|
Erosion
|
Partial loss of epidermis, will heal without a scar
not too deep |
|
|
Ulcer
|
full thickness, focal loss of epidermis and dermis
will heal WITH a Erosions and ulcerations = diabetic, basal cell carcinoma surgery, factitial (did to themselves such as cig burns, digging into skin, bugs in skin) |
|
|
Fissure
|
vertical loss of epidermis and dermis - crack in the skin
common in Tinea Pedis (atheletes foot) Angula chelitis eczema |
|
|
Excoriation
|
linear erosion, induced by scratching
|
|
|
Scar
|
dermoepidermal damage - collection of new connective tissue
may by hypertrophic or atrophic (caved in or out) |
|
|
Scale
|
thick stratum corneum
results from hyperproliferation or increased cohesion of keratinocytes common in psoriasis (silver, well-defined), tinea (central clearing, annular) KOH prep |
|
|
Telangiectasis
|
small, dilated superficial blood vessels that blanch with pressure
commonly over noduloulcerative basa cells common with sun-damaged skin or chronic topical steroid use |
|
|
Burrow
|
ELEVATED channel in the epidermis
produced by Scabies Mite common on wrists or interdigital regions |
|
|
Comedone
|
collection of sebum and keratin within a follicle
open = exposed to air, oxidation occurs, turns black = blackhead closed = whiteheads occurs in dermatoheliosis due to sun exposure (open) |
|
|
Petechiae and Purpura
|
result from leaking of RBCs into dermis
NOT blanch with pressure petechiae are less than 10mm purpura are greater than 10 mm |
|
|
Acne
|
affects 90% females and 100% of males at some point in life
causes distress and can lead to scarring |
|
|
Normal skin flora
|
not all bacteria are pathogens (staph epidermis and hominis, micrococcus, corynebacterium, acinetobacter, propionibacteria) and existing skin flora can play a role in disease
|
|
|
Staph Aureus CArriage
|
Anterior Nares, perineum, axillae and toe webs
some people are predisposed because they carry potentially harmful bacteria |
|
|
Gram + bacteria
|
most of the common infections of immunocompetent indv are Staph and Strep
|
|
|
Impetigo Contagiosa
|
BUZZWORD = honey-colored crust
Superficial staph or strep only involving epidermis, primary or secondary to break in skin Common in children and IS contagious Nose and Mouth areas but DOES NOT look sick Non-bullous: honey colored crust, small pustules Bullous: bullae and vesicles with clear to turbid fluid Clinical appearance usually enough to Dx, swabs if resistant Remove crust, cleanse, wet dressings Mild= TOPICAL MUPIROCIN (Bactroban) or FUSIDIC ACID (Fucidin) to lesions and nares! Severe = ABX Beta lactamase-resistant PCN, MACROLIDE, or CEPHALOSPORIN Complications: Post-strep glomerulonephritis with 18-21 day latent period, or risk of scarlet fever NO risk of rheumatic fever or scarring Bullous Impetigo is caused by phase II staph with bullae and vesicles with clear to turbid fluid |
|
|
Staph Scalded Skin Syndrome (SSSS)
|
Caused by staph exotoxin
In infants and CKD patients since kidneys cannot clear the toxin Widespread falccid bullae and erosion of skin with top layer peeling off Primarily conjunctiva or skin Dx with swab (nose, eyes, diaper area) IV or PO systemic ABX |
|
|
Ecthyma
|
Caused by Strep with Staph superinfection
Much deeper form of non-bullous impetigo that can come from deep extension of primary infection of superpinfection of ulcer Less than 10 lesions, shallow punched out ulcers often with eschar (dead tissue) In septic patients, consider ecthyma gangrenosum caused by disseminated P aeruginosa Risk factor: poor hygeine and homelessness Dx clinically or with swab for gram stain and culture TEN DAY COURSE of PO ABX |
|
|
Folliculitis
|
Caused by Staph aureus or Psydomonas in hot tub folliculitis
Superficial infection of hair follicles causing folliculocentric inflammatory papules and pustules found on hairy areas such as beard, legs and back It is aggravated by shaving, plucking, occlusion, humidity In curly hair - consider pseudofolliculitis barbae ANTIBACTERIAL SOAP, TOPICAL MUPIROCIN and TOPICAL CLINDAMYCIN if severe, PO ABX |
|
|
Furuncles/Carbuncles
|
Caused by Staph; Moist areas
Furuncle is a painful follicular abscess (large) that is deep seated and very tender Carbuncle is a collection of furuncles WARM COMPRESSION, PO ABX May need incision and drainage |
|
|
Cellulitis
|
Acute spreading infx of deep dermis and subcutaneous tissue by Staph Aureus and Staph pyogenes often preceding subclinical break in skin
Ill-defined borders, erythema, warmth, swelling which spreads over time and may develop blisters Fever, chills, rarely bacteremia, lymph nodes Check temp, CBC, culture, needle asp rare SYSTEMIC ABX (think MRSA) IF poor rsp to PO ABX, orbital or severe facial cellulitis, or severe systemic sx - ADMIT AND IV Vancomycin, Clindamycin, Bactrim |
|
|
Erysipelas
|
Superficial form of cellulitis; Strep pyogenes
Dermal infection with lymphatic involvement Well defined, sharp and raised borders, nodes Young children, elderly, pts with lymphedema, chronic ulcers CBC, cultures, ASO and anti-DNase B TEN to FOURTEEN DAYS of PCN |
|
|
Necrotizing Fasciitis/Myonecrosis
|
Life threatening, rapidly progressive necrosis of the subQ fat and fascia
Tense painful swollen erythema which become blue-grey as necrosis begins SubQ feels hard and anesthesia develops as nerves destroyed PROMPT recognition, abx, and rapid surgery PAIN OUT OF PROPERTION = 1ST SIGN Group A strep or mixed bacteria |
|
|
Erythrasma
|
BUZZWORD: CORAL RED with WOODS LAMP
Form of intertrigo caused by corynebacterium mintissimum which is normally normal skin flora MOIST spaces Red brown scaly patches ERYTHROMYCIN and ANTIBACTERIAL SOAP |
|
|
Pseudomonal Nails
|
BUZZWORD: GREEN NAILS
Fungal infx usually cause yellowing of nails SOAK IN VINEGAR and use CIPRO OTIC DROPS to fingers |
|
|
Acne
|
Abnormal keratinzation where keratin is overproduced and starts to block infundibulum --> comedone
Sebacceous glands - increased activity of normal puberty or androgens cause sebum P. acne - break down sebum into more inflammatory products and are pro-inflamm Papule --> pustule --> nodule/cyst which leaves scars Comedones: plugged follicles disgtended by keratin - open = blackhead with wide ostium - closed = whitehead with narrow ostium Inflammatory: papules or pustules from a brisk immune response to P. acne and sebum (pimples) Nodular/cystic: if there is rupture of follicular unit --> deep inflammation that heals with scar Evaluate for type, age and sex of pt, topical products or cosmetics, medications, signs of androgen excess, previous tx Steroid acne would be all over trunk - bumps and pustules in same stage RETINOIDS improve keratinization and anti-inflam (3 months) (Vit A derivatives) (counsel on pregnancy) BENZOYL PEROXIDE abx and reduces oil TOPICAL ABX Clindamycin ORAL ABX Doxycycline is antibiotic and anti-inflam REFER if injection steroids or Accutane |
|
|
Psoriasis
|
2.1% of adults
Majority <35 years old 30% will develop arthritis Mostly on elbows, scalp, knees, umbilicus, sacrum, palms, soles, nails Comorbidities: CAD, DM, fatty liver, stroke, depression |
|
|
Types of Psoriasis
|
Chronic Plaque most common, scalp involvement
Erythoderma - generalized inflammation Pustular: sterile pustules in elderly - palmoplantar psoriasis (RETINOIDS) - von zumbush associated with arthritis Gutatte (droplets) in children and young adults - assoc with URI (streptococcal) (trunk) (PCN, TOPICAL STEROIDS) Inverse: armpits, skin folds, groin, buttocks, genitalia - less thick silvery scale, LOW POTENCY steroids, calcipotriene |
|
|
Assessing Severity
|
Body surface area
Mild <3% Mod 3-10% Severe >10% Patients hand = 1% arthitis? scalp? hands and feet? quality of life? failure to topicals? female? liver disease? |
|
|
Physical, Triggering Factors, Tx
|
Round, annular well-demarcated plaques and polycyclic papules
BUZZWORD: SILVERY WHITE SCALES (micaceous) no scale in intertrigenous areas Auspitz sign (bleeds when remove scale) Hands feet nails scalp gluteal umbilicus Koebner phenomenon (form at site of injury) infections, stress, drugs (rapid taper of systemic steroids), obesity, alcohol, smoking TOPICAL STEROIDS, VIT D analogs, CAL TAR, UVB, ACITRETIN, METHOTREXATE, CYCLOSPORINS |
|
|
Psoratic Arthritis
|
Joints affected in 30%
fingers and toes affected Skin disease precedes arthritis by 10 years Symmetric arthritis resembles RA asymmetric affects 1-3 joints, sausage digits DIP predominant is classic type and resembels OA |
|
|
Atopic Dermatitis (Eczema)
|
Increasing Prevalance
Onset at infancy and early childhood Associated with atopic triad = eczema, asthma and allergic rhinitis Intense pruritis with chronic relapse Papules, plaques with oozing/crust Xerosis = dry skin Dennie-morgan lines = prominent folds or lines below lower eyelid (bags under eyes) Allergic Shiners = periorbital darkening = postinflamm rxn follicular promonence = goosebump appearance on trunk Infantile: after 2nd month of life, edematous papules/plaques with ooze, face and neck btwn 2-6 months, extensors and trunk Childhood: less exudative, more lichenified - thick leathery skin (chronic), antecubital and popliteal fossa neck wrists ankles Secondary infx = impetigo, eczema, herpeticum, molluscum AVOID systemic steroids for flares 60% remission by age 12 |
|
|
Manage Psoriasis
|
Emollient moisturizer
Lukewarm daily bath with hypoallergenic soap topical steroids topicall CALCINEURIN inhihibitors for face ANTIHISTAMINES sedating to break itch cycle Wet wraps and bleech baths |
|
|
Pityriasis Rosea
|
Self-limited inflam exanthem
Peaks in spring and fall Affects 10-35 year olds Salmon colored papules, central crinkled or fine scales - collarette of scale Herald patch Christmas tree or fir-tree distribution Lesions run parallel to lines of cleavage = Langer's lines Resembles TV or tinea corporis Drug induced MOST require no tx, asymp and lesions spont disappear in 3-8 weeks Emollients, topical corticosteroids, antihistamines |
|
|
Seborrheic Dermatitis
|
BUZZ = cradle cap in infants
Common superficial inflamm (malassezia furfur and high sebum production) Scalp, eyebrows, eyelids, nasolabial folds, ears, intertriginous areas Yellow greasy scales, dandruff, cradle cap infantile - self-limited 0-3 months - bathing, emollients, ketoconazole cream adult: peak in 40s-60s topical ketoconazle shampoos and creasm with low potency topical CS (selenium sulfide, tar shampoos, topical calcineurin inhibitors) assoc with parkinsons disease HIV associated |
|
|
Allergic Contact Dermatitis
|
Pruitic, eczematous rxn
well-demarcated localized to site of contact 20% contact dermatoses with type IV delayed type hyper rxn poison ivy or nickle remove allergen, patch testing, potent topical steroids, antihistamines, short course systemic steroids |
|
|
Irritant contact Dermatitis
|
local toxic effect (non-ig induced) (soaps, solvents, acids, alkalis)
erythema, vesciles, scaling, fissures stinging and burning common 80% of all contact dermatoisis common form of occupational skin disease bodily fluids can cause irritant diaper dermatitis lip lickers dermatits AVOID causative, use emoillients and topical steroids |
|
|
Types of cutaneous wounds
|
Erosion - superficial epidermis only, generally no scarring
Partial Thickness - epidermis AND part of the dermis - ulcer Full Thickness - all of epidermis AND dermis missing - hair follicles/glands, allows reepitheliazing |
|
|
Phases of Wound Healing
|
Inflammatory Phase - Day 1-5
Hemostasis - platelet aggregation and fibrin clot formation - neutrophils early and mcp later recruited - release of multiple mediators from platelets and mcp which provides stimulus and support for subsequent wound healing stages - mcp debride wound Proliferative Phase - Day 5-14 Re-epithelialization matrix laid down, fibrin and fibronectin, collagen 3 granulation tissue is seen, angiogenesis, mcp secrete GF and chemo, fibroblasts produce collagen fibers Remodeling Phase - Day 14+ ECM and granulation tissue become collagenous scar collagen secreted, after 3 months strength is 70% of normal skin |
|
|
Types of Wound Healing
|
First Intention Healing: fastest way to heal, edges are even, minimal scarring, do not want dead space
Second Intention: heal by itself, leaving wound open to heal, more granulation tissue, wound contraction, more inflammation, scarring, longer healing time, increased risk of infxn Third Intention healing - delayed primary closure, 2 surfaces of granulation tissue brought together to heal by 1st intention - used in contaminated dirty or infected wounds such as trauma infx, poor nutrition, old age, diabetes, mechanical, poor blood supply, steroids, venous htn all impair wound healing faciliate wound healing by moist environ, protect, absorb exudate, immoblize, miminize wound pain |
|
|
Suture
|
Ideal: no such thing but should have minimal tissue traction
higher number suture is thinner and with lower tensile strength Absorbable sutures places in subQ tissue - gut and synthetic sutures - gut made from sheep or beef intestines and absorbed by enzymes - ex) chromic, fast absorbing used in epidermis, surgical for sewing visceral - synthetic degraded by hydrolysis, not enzymatic, takes longer to degrade, lower reactivity - ex) dexon, PDS, monocryl Non-absorbable sutures not broken down by hydrolysis or enzymes so need to be removed - composed of single or multiple filaments of metal, synthetic, organic fibers - silk, steel, nylon, prolene |
|
|
Granulation
|
ingrowing capillary buds and fibroblasts as well as their ECM
initial tissue deposited within the forming scar sign of wound healing, may not see in chronic wounds |
|
|
Dressings
|
immobilize: minimizes hematoma/seroma formation, lessens discomfort, prevents physical disruption of a stured wound
moist: promotes faster healing and re-epi, prevents crust formation, retains fluid rich in GF, less discomfort, better result If wound dry, apply ointments, occlusive dressings if wound wet, look for infxn ointment layer, contact layer, absorptive (dry gauze, do not use on sutured wound, for 2nd intention), cushioning and contouring layer, tape or securing layer |
|
|
Burns
|
1st degree: epidermis with minimal dermal injury, sunburn, red, painful, blanches white, no bullae, heals itself in 3-6 days
2nd degree: superficial partial thickness or deep partial thickness, some dermis but not total, pain, weeping, eryth bullae, 3 weeks heal, deep may give hypertrophic scars 3rd degree: full thick, complete loss of dermis, painless, tough dry, white gray, excise dead tissue, graft |
|
|
Rule of 9's
|
head and neck = 9%
arm 9% leg 18% chest/abdomen front = 18% back adn lower back = 18% |
|
|
Treatment of Burns
|
fluid resuscitation
monitor for infection or malig acute therapies - debride and graft compression, casts, exercise/therapy, postioning and splinting |
|
|
Lotions
|
easy to use for large, hairy areas of body
may dry out skin too much may use in OILY or MACERATED areas to help DEGREASE and dry skin - acne lotion for mildly oily teenager - will cover more SA than cream |
|
|
Creams
|
most cosmetically acceptable but high water content
creams can be occluded to enhance penetration - cover with wraps and gloves |
|
|
Ointments
|
drives medication through thick skin, better absorption
may cause folliculitis secondary to occlusion - use for very thick skin lesions, can also be occluded - do not use on wet oozing lesions and do not use where secondary infection suspected - cover more surface than cream |
|
|
Gels
|
cover large surface areas and cost effective
will dry out skin, high h2o content and may sting - use in areas where must be used soon after tx, not as strong |
|
|
powders
|
hygroscopic - absorbs water from surroundings helps to maintain dry environment
waste sig amount of medication, not well absorbed - use in moist, folds areas to discourage bacterial and dermatophytic colonization - antifungal powders for feet in T. pedis |
|
|
PEARLS for applying CS
|
pat dry and put only on bad spots, then cream over
best applied on moist skin with bare hands be judicious gentle massage in one direction only cover when needed wash hands after application q-tip in small areas here accuracy imp apply with tongue depressor if worried about superinfection start strong then knock down, switch to lower potentcy |
|
|
Dangers of systemic steroids
|
can cause avascular necrosis, bone loss (irreversible), suppression of hypothalamic-pituitary axis which can persist beyond completion of therapy
osteoporosis, metabolic abnorm (HTN, hyperglycemia, hyperlipidemia), immunosupression cushingoid appearance, steroid acne, striae, atrophy TAPER OFF DOSE steroid withdrawal sx = arthralgias, myalgias, fatigue, depression |
|
|
Tenia Versicolor
|
malssezia furfur
lipophilic yeast Rf: high sebum, high humidity, greasy product application young adults, well demarcated scaling patches with variable pigment trunk and shoulders; summer Dx: clinical and KOH KETOCONAZOLE SHAMPOO, FLUCONAZOLE or ITRACONAZOLE PO |
|
|
Candidiasis
|
candida albicans, yeast
RF: DM/occlusion, hyperhidrosis, CS use, abx use, immunosuppression, wet work markedly eryth with sometimes erosive patches, often accomp by satellite pustules - interdigitalis, peleche (mouth), parnychia (nails) dx: clinical, KOH, culture topical NYSTATIN CREAM/POWDER for severe, oral FLUCONAZOLE PO |
|
|
Dermatophytoses
|
synthesize keratinases that digest keratin and sustain existence of fungi in keratinized structure
RF: atopy, topical or systemic steroids, sweating, occlusion, high humidity Tinea Capitis = gray patch on head, block dots on head dx: clinical, KOH, culture, wood's lamp tinea corporis = Trichophyton pathogen annular eryth plaque with central clearing, scales, pustules in active border - SUGGESTIVE tinea cruris (sexual organs) "jock itch" sharply demarcated erythema w/ raised eryth scaly advancing borders; starts in inguinal region and spreads but SCROTUM is SPARED tinea pedis (athlete's foot) moccasin diffuse hyperkeratosis, interdigital, inflammatory, ulcerative tinea mauum (hand) diffuse hyperkeratosis of palms and digits, unilateral and assoc with tenia pedis |
|
|
Onychomycosis
|
distal and lateral subungal - discoloration and subungal debris, white superficial, prioximal subingual
dx; clinical, PAS stain, culture, KOH tx: topical butenafine, systemic for |
|
|
Sporotrichosis
|
dimorphic fungus in soil and plants
papule at site if innoculation --> ulders/nodules along pat of lymphtic draining dx: biopsy/culture tx: potassium iodide, itraconazole, amphotericin B if very severe |
|
|
Histoplasmosis
|
capsulatum
acquired via inhalation of spores containing bird or bat droppings (ohio/mississppi river valleys) dx biopsy and culture amphotercin B, itraconazole |
|
|
Coccidiomycosis
|
most virulet
SW papules, plaques, avscesses, sinus tracts, toxic eryth, ulcers, hyerpsen rxn biopsy and culture amphtercin B nad keto or itraconazole |
|
|
Cryptococcus
|
neoformans, opportunistic
pigeon droppings systemic mycosis acquried secondary cutaneous: papulonodules, ulcers, abscess biopsy and culture amphotericin B |
|
|
Cancer
|
Most common:
basal cell carcinoma squamous cell carcinoma melanoma non-melanoma skin cancer |
|
|
Basal Cell Carcinoma
|
80% of NMSC, most common malig
low risk for metastasis RF = fair skin, easily burnt nodular, suprficial, morpheaform, metatypical - open sore that bleeds, oozes, or crusts and remains open for >3 weeks = a persistent non-healing sore = early BCC - pink growth with slightly elevated rolled pearly border and crusted indentation in center, growth slowly enlarges with tiny blood vessels on surface - shiny papule that is pearly or translucent and is often pink, red, or white (can also be tan, black, or brown in dark skinned ppl) and can be confused with mole - scar like area which is white, yellow or waxy and often has poorly defined borders. skin appears shiny and taut can indicate presence of aggressive tumor Tx: ablative liquid nitrogen cryosurgery or curettage, surgical excision with standard margins, micrographic surgery OR topical/intralesional 5-fluorouracil OR radiotherapy |
|
|
Squamous Cell carcinoma
|
in adults over 85, majority skin cancer deaths due to SCC
Upper limbs, head, neck RF: sun exposure, increasing age, skin type, hx of actinic keratoses (premalig thick crusted scaly) - wart like growth that crusts and occasional bleeds - elevated growth with a central depression that occasionally bleeds, growth may rapidly increase in size - persistent scaly red patch with irregular borders that sometimes crusts or bleeds - open sore that bleeds and crusts and persists for weeks In situ: affects Bowen's disease, affects full thickness of epidermis, treat with aldara or efudex tx: same as BCC |
|
|
Actinic Keratosis
|
pre-cancers benign to malig; upper limbs, head, neck
RF: >80 of fair skinned above age of 70 cumulative sun exposure - scattered thick scaly patches on back of hand - multiple keratoses appearing as red bumps and an crusts on forehead and bald scalp tx: cryosurgery, curettage, topical |
|
|
Melanoma
|
superficial spreading melanoma is the most common type
RF: older white male, fair skin, light hair and eyes, intermittent intense sun exposure or regular use of tanning bed |
|
|
ABCDs of Melanoma
|
Asymmetry
Border irregularity: uneven borders, scalloped or notched edges Color variability: carious shades of brown tan or black are often first sign up melanoma erythematous component to melanoma, nodular melanoma, first step in diagnosis = excisional biopsy staging: T1-T4 based on with out without ulceration and size, N1-N3 based on metastasis, M1-M3 tx - surgical excision, nodal mapping |
|
|
Herpes
|
Almost always HSV1, primary infection unrecognzied (gingivostomatitis) lesions in mouth are broken vesicles that appear as erosions or ulcers covered with a white mebrane
reccurent cold sores, grouped blistered on eruth base, lips freq involved- tx: VALAcyclovir or VALTREX Genital herpes is usually due to HSV2. classic grouped blisters on an eryth base - avg typical outbreak is 7 days scalloped border, bilaterally symmetrical and often extensive tx: Valtrex |
|
|
VZV - Varicella
|
Chicken pox or recurrent = zoster or post-herpetic neuralgia
Varicella - teardrop vesicles on a eryth base, can become pustular and umbilicated, then crusted, lesions appear in crops, lesions of various stages are present at the same time secondary bacterial infection with S. aureus or strep most common complication fo varicella tx of uncomplicated zoster = valtrex and gabapentin |
|
|
Drug Rxns
|
STOP the offending agent
type I = ige dependent, hives, angioedema, anaphylaxis type II = cytotoxic, drug caused, thrombocytopenia or petechiae type III = immune complex, vasculitis, serum sickness, some hives type IV = delayed, exanthematous, dixed, echenoid, JS, TEN nonimmune drug rxns: overdose, side effects, cumulative toxicity, drug-drug interactions, exacerbation |
|
|
Morilliform Drug Eruptions
|
most common drug rash beginning 7-14 days after beginning meds
Eryth maculopapular eruption +\- pruitis with no mucosal involvement; may have low grade fever caused by PCN, sulfa, cephalo, anticonvulsants |
|
|
Urticaria and angioedema
|
hives; transient eryth adn edematous papules and plaques, pruitic, last less than 24 hours - migrate, re-exposure to causative agent
caused by PCN, cephalo, sulfa, tetra, NSAIDs angioedema: transient edema of dermis and subq tissue caused by ACEI, NSAIDs, PCN, cephalo, contrast dyes photosensitivity (light + drug = eruption), seen on sunexposed areas, erythema caused by tetra, NSAIDs, fluroquinolones, sulda, doxy |
|
|
Vasculitis
|
palpable bruise, inflammation of endotelial structure, purpuric palpules that do not blanch, lower extrem (leukocyticlastic vasculitis)
LCV caused by infx, RA, or drugs caused bu NSAIDs, PCN, sulfa, cephalo |
|
|
Acute generlaized exanthematous pustulosis (AGEP)
|
small pustules on edematours eryth skin, burning or pruitic starting 2 days after drug use
systemic: high fever, eosinphilia, renal dysfunction,normal LFTs caused by betalactam antiobiotics and macrolide |
|
|
DRESS
|
drug reaction with eosinphilia and systemic sx
treat with prednisone |
|
|
SJS/TEN
|
sjs and ten both due to cell apoptosis, flaccid bullae, and full thickness epi
palms and soles often involved systemic signs of fever, URi sx and mucosal lesions prone to fluid imbalance and sepsis caused by NSAIDs, sulfa, alloppurinol, anticonvulsants, PCN If <30% of skin = SJS If >30% of skin = TEN |
|
|
Lichenoid drug erutions
|
clinically resembles lichen planus - flat topped polygonal purple papules
occurs xmonths after tkes weeks to months to resolve after stopping drug ACEI, beta blockers, thiazide diuretics, antimalarias, gold |
|
|
Erythema nodosum and others
|
painful eryth nodules on anterior shins, subQ, tender, bilateral
acually a panniculitis estrogen, ocps, sulfas, iodides, bromides "shins really hurt" erythema annulare: annular, arcuate, polycyclic eryth patches (trailing scale on inside) - migration with central clearing erythema gyratum repens (rare): migrating parallel bands of eryth resembeles wood grain and is a sensitive sign of internal cancer exfoliative erythroderma aka exfoliative dermatitis - widespread eryth and edema, AND thickening/scaling of skin due to contact derm or drug rxn to sulfa, PCN, barbituates, phenytoin eryth multiforme = HSV, target lesions and mucosal erosions |
|
|
Treatment for lice
|
Permethrin
Ivermectin |
|
|
Nails
|
splinter hemorrhages, onycholysis (separation from nail bed), clubbing, kellonychia (spooning of nails), Lindsay's nails (half white), Terry's nails (white nails), muehrcke's nails (paired white bands), onychorrhexis = dry brittle nails, leukonychia = white lines, melanonychia = pigmentation
mee's lines = arsenic poisoning |
|
|
Pyoderma gangrenosum
|
reactive state with rapid onset, painful and deep ulceration
1/2 of cases = ulcerative colitis |
|
|
signs of internal neoplasia
|
acnathosis nigricans: velvety pigmentation of neck axilla groin, pseudo due to obesity, GI/GU adenocarcinoma and most common site = abdomen
Hypertrichosis Lanuginosa: excess growth of fine downy hair, face most affected, occult malig Acquired ichthyosis (scaly dry skin) - rhomboid scales on upper extrem, acute onset assoc with lymphoreticular malig paget's disease = eryth eczematous patches with no rsp to topical steroid, breast cancer indicative |
|
|
DM
|
Granuloma Annulare
Necrobiosis Lipoidica - atrophic yellow plaques, surface telangiectasia, may ulcerate Xanthomas - hyperlipoproteinemia. local acccum of lipid |
