• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/390

Click to flip

390 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Common inflammatory pilosebaceious disease characterized by comedomens, papules, pustules, inflamed nodules, superficial pus-filled cysts?
Acne
What causes acne?
follows sebaceious activity, pluggin of the infundibulum of the folliciles
Retention of sebum
Overgrowth of acne bacillus
Symptoms/signs/exam findings of ACne?
mild soreness Pain and itching
Acne lesions divided into to catergories:
inflammatory and noninflammatory
Noninflammatory lesion consist of what?
comedomes (whiteheads) and closed comedomes (black heads
Inflammatory lesions are characterized by what?
prescence of papules, pustules, nodules (cysts)
Papules are smaller than 5 mm
Pustules have central core of purulent material.
Nodules >5mm.
Differential diagnosis of Acne?
Rosacea
-baterial or yeast folliculiits
Keratosis Pilaris
Independenent operational labs and treatment for Acne?
Baterial/ fungal cultures
Full dugy
May require light duty based on treatment
Class of medications for Acne?
bacteriostatic
topical antibiotics
Exfoliants and irritants
Oral antibiotics
Specific treatment for NICA?
benzoyl peroxide (dry and peeling the skin
Tertinoin (retinal A) very effective for comedonal acne
When appling Tretinoin, how should you apply and what areas should you avoid on the face?
Cautiously, liquid applied with CTA. Nightly or every other night
the eye, nasolabial folds and creased of the mouth
Specific tx of Inflammed Papules and pustule acne?
Topcial clindamycin sol.
Patients with few deep lesions are usualy tx How?
broad spectrum-antibiotics (due to reduction of bacterial organisms)
What is the most effective antibiotic and fewest side effects for tx of Inflammed papules and pustules?
Tetracycline..cont. for 4 wks then decrease to the lowest amount that gives a good response
test
If patients don't respond to Tetracycline for IPPA, you can use what drug instead? TEST
Minocycline
How would you obtain better clinical results when giving oral antibiotics for IPPA?
starting at higher dosages and tapering only after control of acne is achieved
Prolonged used of antibiotic usecan cause what type of infection?
Candidal Vaginitis
What are some specific tx for I.N.C.A?
vigorous mangament reduce scarring
Topical tx unsat for severe, deep lesions
-Oral Predisnone intitial therapy for very severe acne_
_
what drug can only be perscribed by dermatologis and is best treatment for patients in failed tx and/ or with severe deep acne?
Oral Isotretinoin
Pt educ on acne?
Avoid sun..depeding on meds
No Maniupulation
topical exposure to oils, cocca butter and greases
Soaps play role in tx
Don't not open lesion until they have pointed in a pustule
Complications of Acne?
Cyst formation
Pigmentary changes in darkly pigmented changes
Severe scarring
Psychologic problems may result by appearance
Prognosis of Acne?
Physical and emotional stressors...scarring and acne
Supportive counseling for pts may be indicated in severe cases
What is essential to success in mang. of cane, effective when consistent and appropiate?
Combination therapy
What are the hallmark of Acne Vulgaris?
Open and closed comedomes
A superfical or deep baterial infection and or irriations of the hari follicle?
FOlliculitis
When lesion is deep seated, chronic, and recalcitirant on the head and neck?
Sycosis
Usual cause of folliculities?
Staphylococcus aueres and may be more common in diabetics
This may develop during antibiotic treatment of acne and may present as a flare of acne pustules and nodules?
Gram-negative folliculitis
Caused by Psudomonas aeruginosa is characterized by pruritic or tender folliculare or pustular lesions occurring1-4 days after bathing in a hot tube?
Hot tube Folliculitis
What nonbacterial folliculitis substances that irritate the follicle?
occulsion
perspiration
rubbing
Folliculitis on the back that looks like acne but does not respond to acne therapy may be caused by what ?
Yeast Malassezia fufur
S/S and exam findings of folliculitis?
slight buring
tenderness to intense itching
Acute lesion consists of superficaal pustule or inflammatory nodule surrounding the hair
IN Sycosis the surrounding skin becomes involved and resembles what condtion?
eczema
Differnital dx of Folliculties?
Bacterail folliculties vs non bacterial
Acne vulgaries
Pustular miliria
Fungal foliculitis
Impetigo
Independent operational labs/test?
Gram stain
Culture, non rountinely necessary, Staph aureus most commone
Culture
KOH prep and woods lamp
For bacterial folliculitis of a limited area what is the tx?
topical 2% mupirocin is effective TID for 10days protected with dressing
Treatment plan for FOlliculitis of systemic antibiotics?
Skin infection is resistant to local tx
Extensive or server and accompained by a febril reaction
Complicated
Involves the nose or upper lip
Gram negative folliculites pt may be treated with what?
Isotretinon
Irritan folliculites treated how?
remove irritating substance and use of drying agents such benzoyl peroxide
Pt education of folliculitis?
Proper hygiene!!!
minimize heat, friction and occultion
Razors should be changed out freq
What is major complication of Folliculties?
Abcess formation
Most folliculites response well to what type of treatment?
antibiotics and hygeine measures
What is PFB?
papular and pustular, foreign body, inflammatory reaction that can affect any individual who has curly hiar and shaves closesl on regular basis
What causes PFB?
ingrown hais in the beard area, nape and groin and legs
Who is PFB found mostly on?
African-americans 50-75%
SYmptoms of PFB?
tenderness, pain itching
Signs and exam findings of PFB?
papules and pustules are located at the side of and ont infollicles
Scarring and hypopigmentation from healed lesion
Differntial Dx for PFB?
Acen
Folliculities (bacterial or fungal)
Complications and prognosis for PFB?
Abscess formation
Scarring
Prg: Out pt therpay
F/U based on Buperinst 1000.22 tx protocol
This condition is deep-seated infection (abcess) involoving the entire hair follicle and adjacent subcutaneous tissue ?
Furuncle (boil)
What is a carbuncle?
cluster of furuncles, with spread of infection subcuatneously resulting in deep suppuration often extensive local sloughing, slow healing, and a large scar
What is major cause of Carbuncle or furuncles?
Bacterial colonization of skinor nares
Hot, humid climiates
Occulsion or abnormal follicular antaomy
What are some signs and exam findins of Furuncels an Carbuncles?
Rounded or conical and occurs most frequently on the neck, breasts, face and buttocks.
How does carbuncles develop different to furuncels?
more slowly than single furuncles
May have fever and prostration
what are some predisposing factors of boils/
DM
Debilitating dz
Old age
Differentail dx of carbuncle and furuncel/
Cystic acne
Hidradentits supprative
Ruptured pilar (sebaceous) or epidermal cyst
Treatment plan and dispostion of patiet with carbuncles and fruuncles?
Wound should be check during treatment to be certain pain is less and drainage is adequate
DUTY status base on location, severity and contorl of infection
Specific treatment for Carbuncles and furuncles?
I&D loculated suppurations and is the mainstary of therapy
Systemic antibiotsc(dicloxicillin, Cephalexin, Erythromycin for PCN allergic individuals
iF pt has recurrent Furnunclosis what is the effective treatment?
como of Diclox and Rifampin
What measure of treatment is used for reduced occurences of boils?
Topical 2% mupirocin in the nares, axialle, and anogential areas
Localt tx measures for boils?
immoblized
moist heat 15-30 min several times daily to localized
Drainage of fluctuant lesions results inrapid resolution
What is some complications of Carbunciels and Furuncles?
staphylococcal infection such as septicmia
Prognosis of boils/
Recurrence possible for months an years
Deep abcess are iether reabsorbed, or points toward surface and ruptures
Rupture lesion usually heal with scarring
Acute or choronic bacterial or fungal infections of the proximal and lateral nail fold tissues (periungal tissues)
Paroncyhia
What and how causes Paroncychia?
staph auers or strep, less commonly Psuedomonoas
Organisms ener through the break/trauma in the epdiermis or chronic irritation
Chronic paronychia occurs almost alwas in whom/
people whose hands are always wet
Candida often presetn
Signs and symptoms of Paronychia?
Pain tenders swelling
erythema around the affected nail. Pus forms at nail margin, behind cutile
Rarely, the infection penetrates more deeply
Chronic parnonycia has signs of what?
many or all fingers are involved
may cause nail plate to be distorted
Differntial dx of Paronychia?
Psoriasis
Onycholysis
Onychomycosis
Ohychoryptosis
Labs and test for paronychhia?
gram stain KOH
Class of meds for paronychia?
antibiotics
Group V topical steriods
anitifungals
Specific treatment for Paronychia?
hot compresses with acute infeciont
Systemic antibiotics for Paronychia?
diclo
Cephalexin
clindamycin
What is the Specific treatment for Chronic recurrent inflammation of Paronychia?
Group V steriods mainstay of treatment
Complications of Paronychia?
furthur extension of infection and deeper involovement
Nail distortion in chronic infectinos
Infectionof the pulp space of the finder pad?
Felon
Signs and symptoms of Felon?
severe local pain
erythema
Painful swollen, erythematic distal phalanx fat pad
Differntial dx of Felon?
Cellutitis
Dispostion of felon?
LD, with no or limited use of hands until no signs of infection and wound is healed
Medications given for felon?
antibitoics
Speifici treatment for felon?
prompt incision, with division of the fibrous septa, to ensure adequate drainage
Diclox or Keflex
REst
Immobilzation and elevation
What type of dressing will you apply for felon?
Wet normal saline dressings 3-4 x daily when ulcerating
IV antibiotics (PEN G) for compartment syndrome
Complications for Felon
Osteitis is frequent
\Occasionally Osteomyleitis
Ulceration and necrosis
Uncontrolled infection leading to septicemai
What is impetigo?
is a contagious and autoinoculable infection of the skin caused by stap or strep or both
what two forms of Impetigo are there?
NON bullous
Bullous
Signs and symptoms of impetigo?
Pruitius is common. Mild pain an discomfort
Scratching may spread infection, inoculating adjacent and nonadajent skin
What is characterized of non bullous type of impetigo
Vesiculopustualar type of rupture, exsposing red and moist base with thick golden to white-brown crusted lesions
Characteristics of Bullous type of impetigo?
Thin roofed bullae that collapse and present central thein flat honey]collored crust
Differential dx of impetigo?
Allergic contact derm., contact derm, suggestive by history or by linear distribution of lesions
-Perioral dermatits
-Herpes simplex
-Herpes zoster
-Tinea infection
Labs and tests for impetgio?
Gram stain and cluture
KOH
woods lamp
Dispostion of impetigo?
Hospitalize pt who worsen
It is self limiting, but if untreated may spread and may last for wks to months
Class of meds given for impetigo?
antibacteral ointments
Antibiotics
Specific treatment for Impetigo?
Limited localized spread 2% mupirocin ointment (bactroban)
System antibiotics )diclox, Keflex
Recurrence of impetigo, what is specific treatment must be done?
Mupirocin 2% ointment to nares for staph carrier stated
Crustes and weepy (compressess)
Complications of Impetigo?
ulceration an scarring
Frequently on th elegs and otehr covered areas
What is a deeper for of impetigo?
Ecthyma
Complicaitons of Impetigo?
Cellulitis
Resistance of tx
recoccurence
hyper and hypopigmentation withor without scarring
acute nephritis
lymphangitis
furunculosis
What is cellulitis?
diffuse spreading of infeciton of the dermis and subcutaneous tisse
Most common factor to cellulitis?
gram-postivie cocci expecial GABHS and Staph aureus
Where does cellulitis typciall y starte?
surgical wounds and trauma areas (breaks in the skin)
Symptoms of "cellulities?
erhytema
edeam
pain
fever
chills
malaise
sings and exam findings of cellulities?
lower ext are the most commone sites
Cuteanous abnormlaity (skin trauma, ulceration, tinea pedis or dermatitis) ofetn preceded the infection.
What are some major findinds of cellulities?
lcoal erythema
tenderness
frequently with lymphangitis and regional lymphadenopahty
and indistinct boarders.
skin is hot, red, and edematous
the lesion expands over hours so that from onset to presenation is usually ______to _____hrs?
6-36 hrs
Type of cellulitis that has raised margins are sharpley demarcated most often caused by GABHS?
Erysiplea
Differential dx of cellulities?
Thrombophlebitis
DVT
contact Derm
Necrotizing fascitis
Stasis dermatitis
What are some lab test that can be performed for cellulities?
Gram stain and culture
Leukocytosis or at least neutorphillia (left shift)
Dispostion of Cellulities?
Out pt therpay and aggressive f/u based on severity
wound check frequently accessing Tx proper drainage pain level and healing
Some basic specific tx for cellulities?
Empiric tx with antibiots (stapha dn strep)
IV antibiotics 1st 24-72 hrs
Mild cases or folowing intial parenteral therapy, DICLOX or CEPHALEXIN
If severe infections that require hospitalization, what is the drug of choice for treatment?
OXACILLIN or Nafcillin 1gm/IV q 6 h
If pt have PCN allergic or MRSA, what drug is used for cellulites?
Vancomyacin 1gm IV q 12 hr
Treatment plan for the patient after seen in the clinci?
Immoblization (rest)
eleveation of affected area
Wet dressings may relieve local discomfort
Complication of Cellulitis
Septicemia
Necrotizing subcutaneous infection
What are some prognosis for the patient treated for cellulities?
resovels quickly with antibiotc threpay
Cellulites of the face and hand may require hospitalization
Follow pt closely during the first 12-24 hrs
This is a yeast infection that is usually limited to the skin and mucus membranes?
Candidiasis (moniliaisis)
Where can candidiasis be found ?
lives among normal flora of the mouth , vaginal, an d lower GI tract
what is mos susceptable to candidiasis?
intertriginous and mucocutaneious areas (moist, warm)
Factors that predispose to infection and incease susceptablity?
1. systemic antibacterial, corticosteriod and imunosuppresive therpay
2. Skin maceration
3. Pregnacy
4. Obesity
5. DM
6. Blood dyscarsias (blood disorder)
Symptoms, signs an PE findings of Candidiasis?
Itching, erythema, scaling , and burning and stinging
Primary lesion pustule
--Red pint papules
-maceraiton
-ulceration
-fissures-
-scaling-
-well demarcated with varing sizes and shapes
Differntial dx of candidiasis?
HErpes simples
mollucscum contagiousum
INverse Psoriasis
Irritant contact derm
What is effective treatment for many forms of mcuocutaneous candidiasis?
Fluconazole
How are fungal infections treated?
topically except: nailes or those deep inhair follicles on the face or body
Itraconazole
Terbinafine
Griseofluvin
Tinea of the scalp caused by infection of stratum corneum and the hair shaft with fungal hyphae?
Tinea capitis (ringworm of the scalp)
Some symptoms of tinea capitis?
depending on severity
itching
tenderness
There are four different types of clinical infections patterin, what are they/
seborrheeic type
INflammatory tinea capitis
"black dot" pattern
Pustualar type
Most common type of tinea capitis?
Seborrheic type:
How does seborrheic type Tinea present?
resembles seborrheic derm, diffuse pathch , fine , white, adherenet scale on the scalp .ADenopathy often present
What is inflammatory Tinea Capitis (Kerion)?
one or more boggy tender areas of alopecia with pustuels, Scarring may occur Fever, occipial adenopathy and leuocytosis occur
Uncommon, large areas of alopecia and inflammation, mild to moderate scaling Arthrospores, weaken hair an cause break off at surface resulting in black dot appearance?
Black dot pattern
Differential Diagnosis of Tinea capitis/
Scalp psoriaisis
Seborrheic dermatitis
Labs and tests for tinea capitis?
KOH and gram stain
Treatment plan for tinea capitis?
full duty
Meds: Topical and oral antifung
Specific treatment for Tinea capitis?
Selenium 1% or 2.5%shampp used twice weekly to decrease spore shedding
Griseofluvin is safe and effective
Tx for adults: itraconazole..Oral Terbinafine...Fluconazole
Pt ed and f/u procedure for Tinea capitis?
proper hygiene....close living quarters increase risk,,, don't share combs., towels, bedding ect
F/U: as needed .Outpt thearpy
Complications for Tinea capitis?
Secondary bacterial infection
Permanent alopecia
Prognsosi of Tinea Capitis?
extremely presistent, may resolve spontaneously and may recur
Definitive dx and tx of Tinea Cap?
all pts must have tinea id by KOH prior to tx
Montier LFT and renal function for all oral aintifugals
What is Tinea Corporis?
Dematophyte infection of the body, trunk and limbs
What is the most common pathogen of Tinea corporis?
Trichophyton rubrum
Symptoms of Tinea Corporis?
Asymptomatic mild itching for larger lesions
Signs and exam findings of tinea corporuis?
pink to red papulosquamous annular lesions have raised borders, exapnd peripherally and tend clear centrally
Differential dx of Tinea corporis?
Pityrisasi rosea
Drug eruptions
Nummular eczema
tinea versicolor
psoriasis
Secondary syphillies
Independent operational labs for Tinea corporisi?
Hypae seen on KOH
Woods lampt
What is the treatment plan for tinea corporis?
full duty
Meds: antifungals..oral steriods
What specific treatment will be done for tinea corporis?
small to mod lesions:
Clotrimazole
Mconoazole
tolnaftate
BID to 7-10 days afer lesions disappear
Most effetive therpay for extensive or resistent tinea corporis?
Oral Griseofulvin or ketoconazole
2-6wk therapy requried
Pt education and f/u procedure for pt being treated for Tinea corporis?
avoid contact with infected household pets
Close skin contact with individuals at home or berthing
Proper hygien
F/U: as needed for treatment and resistance
What are some complications of Tinea Corporis?
Extension of dz down the hair follicles
Pyoderma
Prognosis of tinea corposis?
Usually responds promptly to conserative topical therpay or to oral agent within 4 weeks
Re-Infection common among close contacts
Definitive dx and tx of Tinea corporis?
Monitor LFT's if systemci antifugals are given
Is mild superficial Malassezia furfur infection of the skin (usually the trunk)?
Tinea vesicolor
Symptoms of the Tinea versicolor?
Lesion ares asymtpomatic, but few pts note itching when overheated
Signs and exam findings of tinea veriscolor?
are velvty, tan, pink, whitish, or brown macules that vary from 4-5mm in diametere to large confluent areas
Scaling may not be apparent unless scraped
Noticed in the summer b/c the lesions vary in pigmentation
Differential diagnosis of tinea versicolor?
Vitilgo usually presents with larger periorifical lesions
Pityriasis Rosea
Independent operational labs/tests for Tinea Versicolor?
KOH..large, blunt hyphae and thick walled budding spores (spaghetti and meatballs)
Wood's lamp
Golden fluorescence or pigment changes
Treatment plan for Tinea veriscolor?
Full duty without restrictions
Meds: antifungals; topicals(creams, shampoos, lotions)
Chronic or reoccurances: Systemic Antifungalls
Specific treatment for Tinea versicolor?
Topical: Selenium sulfide lotion (AAA head/neck left on 5-15 min for 7 days, weekly for month then monthly for maintenance
--Sulfur-salicylic soap or shampoo or zinc pyrithrone-containing shampoos
KETOCONAZOLE 200mg po QID x 1wk or 400mg as single oral dose
What should you tell your patient after perscribing Ketoconazole treatment?
not to shower for 12-18hrs after taking meds, b/c it is delivered in the sweat tot he skin
Take and GO Sweat?
Pt edu and f/u treatment of tinea versicolor?
Self limited, take yrs to resolve with or without tx
Edu on specific directinos using meds
F/U: as needed for med and re-eval.
Complications and Prognosis for tinea versicolor?
Relapses are commone with any complications
Prog: Montior LFT's with systemic antifungals
Relapses are common may resolve over yrs
Definitive diagnosis and treatment for Tinea Versicolor/
Diagnosis easily seeing HYPHAE and thick walled budding spores (spagetti and meatballs) in KOH prep
What is another name for Tinea Unguium?
ONychomycosis
What is may cause of Tinea Unguium?
infection is usually caused by Trichophyton species but not limited to
Signs, symptoms and exam findings of tinea unguium?
Discomfort....pain...functional limitiations, thick nails
--Longstanding tinea pedis
--nails thick, discolored and lusterless. Debris under free edge.
-See nail oncyholysis
-become distorted or be destroyed
Differential Diagnosis of tinea unguium?
Psoriasis
Leukonychia
Eczema
Thick nails
Onycholysis
Independent operational labs/test for tinea unguium?
Griseofluvin (effective high doses, but inferior meds in treatment of onychomycosis)
Oral Terbinafind daily for 12wks recommended for toenails (fingernails 6wks
Toenails 12wks treatment
Follow up, complications and prognosis ofr Tinea unguium?
f/u: for meds and eval of LFT
Comp: secondary baterial infections
Prog: fingernail can virtually always be cured, toenails cured 35-50% of the time clinically about 75% of the time
Definitive dx and tx of tinea unguium?
refer to derm.
Diagnosis thorugh KOH due to long term tx
MOnitor LFT monthly if placed on systemic antifungals
Begins at tinerdigital spaces and later involves the plantar surface of the arch, with maceration, scaling borders and vesicualr lesions. Most times caused by Trichophyton and epidermophyton specites?
Tinea pedis (extremely common)
How will tinea pedis present on the foot?
"moccasin" on sole and heel, occasionally with thickening and cracking of the epidermis
What are the three classic presentations of Tinea Pedis?
Interdigital toe web infection
Chronic scaly infection of plantar surface
Acute vesicular infection
Differential dx of tinea pedis?
Psorisasis
Eczema
Dermititis
Independent operational labs/test of tinea pedis/
KOH-positive for hyphae
Treatment plan for tinea pedis?
Full duty generally
Meds: topical and oral antifungal and antibiotics for secondary baterial infections
IF skin is macerated, what is the specific tx for tinea pedis?
Aluminum subacetate sol soaks
Broad-spectrum antifungal creams and solutions (imidazoles)
Clotrimazole
Lotrimin
Ketaconazole
Miconazole Faile 1wk once daily topical (terbinafine or butenafine) will often result in clearing
Specific tx for dry and scaly stage of tinea pedis?
Use of creams:
clotrimazole
miconazole
Tolnaftate
Pt ed, f/u, and complications of pts with tinea pedis?
Pted: Personal hygiene...sandals especially in showers...dry btw toes, freq change of socks
F/U: meds, eval and recurrences
Comp: Secondary bact infections...Lymhangitis...Lymphadentitis
Prognosis of tinea pedis?
Once diagnsosis is established individual becomes carrier and is more susceptible of recurrences
Definitive dx and tx of tinea pedis/
refer as needed
Monitor LFT with systemic antifungals
Pt with dermatophyte or yeast infection of the crural fold (groind and gluteal fold)?
Tinea cruris..jock itch
Symptoms, signs and exam findings for tinea cruris?
Itching may be severe, rash may be asymptomatic
-Lesions have sharp margins, cleared centers, active, spreading scaly peripheries
Rarely: vesicle formation at the borders or follicular pustules are encountered
Differential diagnosis of tinea cruris?
Contact dermatitis
Psoriasis
Erythrasma
Candidasis
Independent operational labs/test for tinea cruris?
Hyphae can be demostrated in KOH prep
Treatment plan for Tinea cruruis/
Full duty, limited depending on severity
Meds: topical and oral antifungals
General Speific treatment measures for Tinea Cruris/
Eliminate moist evnironment...Drying powder for excessive perspiration or occlustion...Avoid over bathing..underwear loose.
Local measures and specific treatment for tinea cruris?
Antifungal creams activity against Candida and dermatophytes (Micatin, Lotrimin, Miconazole, clotrimazole creams/
Terbinafind cream (curative 80% of cases once-daily use for 7 days.
For severe cases of Tinea Cruris what meds are reseved?
Griseofulvin
one wk of (itraconazole or terbinafine) daily can be effective
Pt edu and f/u instructions should you give to pt about tinea cruris?
Ed: proper hygiene, Flare ups occur more often during the summer...Tight clothing or obesity tends to favor growth of the organisms
F/U: as needed for evaluation and medicaiton
Complications of tinea cruruis?
Lesions mayb be complicated by maceration
miliiaria
Secondary baterial infections
Candidal infection
Reactions to treatment
Prognosis and definitive dx and tx of tinea cruris?
Prog: Recurrence
Defin: Refer as needed
Montior LFTs with systemic antifungals
Are common, contagious benign epidermal lesions associtaed with HPV infection?
Warts (verrucae vulgaris)
How many types are linked to skin lesions?
60
What is the etiology or cause of Verrucae (warts)?
Trauma or maceration facilitate intiial epidermal incoculation. Spread may then occur autoinoculation
Symptoms of Verrucae?
Usually no symptoms
Tenderness on pressure occurs with plantar warts
What is the most evident of the verrucae observed under oblique illumination?
flat warts
What type of verrucae is dry, fissured and hyperkeratotic?
Subungual warts
Differential diagnosis of Verrucae ?
Hypertrophic actinic deratoses or squamous cell carcinomas
Some gential warty lesions may be due to secondary syphilis (condylomata lata)
What is the treatment plan for Verrucae (warts)/
full duty
Meds: Salicylic acid (sca)
Trichloroacetic acid
Tretinoin
Class of medication for Verrucae (warts)
Cryo
Electro
Curettage
Excision
laser
Patient edu and f/u for verrucae (warts)?
Biting, shaving, picking the wart infected skin can spread warts.
F/U: as needed for treatments and recurrence
Sharply demarcated, rough-surfaced, round or irregular, firm, light gray, yellow, brown, grayish-black tumors 2-10mm in diamter (on sites subject to trauma?
common warts (verruae vulgaris)
Tx of common warts?
Depends on location..type..extent, and duration of the lesions, age of pt, pt's immune status and desire to have the lesion treated
Medicine used for common warts/
17% salicylic acid and 17% lactic acid prep applied daily after gentle peeling
May be frozen for 15-30 secons with liquid nitrogen
Common on the palms and soles, are flattened by pressure and surroundd by cornified epithelium, tender?
Plantar and palmer warts
Small long, narrow growths usually on the eyelids, face, neck or lips?
filiform warts
Smooth, flat, yellow-brown lesions, occur more commonly in children and young adults, most often on the face and along scratch marks,,difficult to treat?
Flat warts
Treatment for Flat warts?
Tretinoin (retinoic acid .05% as used in acne or 5% benzoyl peroxide
Appears as soft, moist minute, pink red or velvety swellings that grow rapidly and may become pedunculated on the perineal, perirectal, labial and penial areas?
Venereal warts (condyloma acuminata)
Treatment of Venereal Warts?
Removed by Cryotherpay.
Electrocauterizzation,
laser, surgical excision
Podophyllinor tricholroacetic acid
Complications of Verrucae (warts)
Scarring and recurrance
Some types of HPV have higher risk for carcinoma
Molluscum contagious caused by what?
poxvirus
What would be some signs and exam findings for molluscum contagiosum?
white-to skin colored, smooth, waxy, dome shapped central umbilicated filled with semisolid papules 2-10mm in dameter
Differential Diagnosisi of Molluscum contagisoum?
flat or gential warts
HSV
Independent operational labs/test of molluscum contagisum?
Giemsa-stain, on clinical appearance
Treatent plan ofr molluscum contagisoum?
Individualized...
Successful treatment requries destroying each lesion by freezing or b yremoving the central core of the papule with curettage.
Dispostion of Molluscum Contagiosum?
Full duty generally
LD may be warranted based on occupatio and training and location of infection
Class of medication for Molluscum contagisoum?
Curettage
cyrosug
Laser
Electrocautery
Pt edu and f/u criteria for Molluscum contagiosum?
Edu: skin to skin should be avoided to minmize transmissionof virus
F/U: as needed treatment or recurrence
Recurrent viral infection characterized by the appearance on the skin or mucous membranes of single or multiple clusters of small vescicles, filled with clear fluid on sllightly raised inflammatory bases/
hsv
HSV Usually appears where?
mouth, lips on the conjuctive/cornea and on gentialia
How many types of HSV are there?
HSV1 oral infections
HSV 2 Usually genital
What is the definition and etiology of HSV?
virus remains dormant in the nerve ganglia, and recurrent herpetic eruptions can be precipited by
OVerexposure to sunlight
Febrile illnesses
Phycial or emotional stress
immunosuppression and Certan drugs
symptoms of Primary infections?
commonly asymptomatci tenderness, pain, mild paresthesias or buring
Prodroma symptoms of HSV?
localized pain, tender lymphandeopathy , HA, generalized aching, and fever are charc. lasting 2-24hrs
Signs/ exam findings of HSV?
small tense vesiciles appear on a erythematous base
Single clusters size .5-1.5 mm diameter
--Several groups and may coaleses
Differential dx of HSV?
Hand, foot, and mouth disease
Aphthous stomatits
Erythema multiforme
Impetigo
Herpes Zoster
Tx plan for HSV?
full duty
antiviral (topical acyclovir generally not effective
Acyclovir,,Valacyclovir
Pt edu and f/u for HSV?
avoid contact with others and lesion, do not share razors, glasses avoid kissing while active lesion is present and use condoms
f/u: as needed to recurrence and meds
Complications for HSV?
Pyoderma
Eczema herpeticum
Herpetic whitlow
Ocular keratitis
Meningitis
Hepatitis
Pneumonitis
Prognosis for HSV?
Hospitalization may be warranted who may have severe pain , systemci symptoms, and other complicatons
Pregnant newly dx refere to OB
Serologic test for Syphilis in all pts
Higjhly contagious infection that results when varicella-zoster virus reactivites from its latent state?
Herpes zoster (shingles)
Herpes zoster results from what?
reactivition of varicella virus that was acquired during chicken pox
Symptoms of Herpes zoster (shingles)
Pain may begin before, during or after the onset of lesion
HA, photophobia, malaise precede eruption by several days. Fever and chills may also precede eruption
Signs and exam findings of Herpes zoster?
unilateral dermatomal distribution rarley
Vesicles dry up, crust up, crusts falls off about 2-3wks
Differential dx of herpes zoster?
Poison Oak dermatitis
Herpes simplex
Eczema herpeticum
Smallpox
Folliculitis
Impetigo
Aphthous stomatitis
Independent operational labs/test for herpes zoster?
Tzanck smear
Treatment plan for Herpes zoster?
Gen. Full duty
LD, based onlocation, presentation of pt, symptoms mang ofpain and complications
Hospitalization is not required unless dissemination has occured in an immunocompriosed pt.
Class of medications for herpes zoster?
Primary-symptotic tx and anlgesics
antiviral med
Topcial and oral corticosteriods
Trycyclic antidepressants
Specific treatment for herpes zoster?
Pain control
Wet compreses may be helpful
Oral acyclovir (zovirax) 800mg 5times daily 7-10 days
Patient education and f/u of Herpes zoster?
Edu: avoid manipulating scratching
Avoid contact with others and lesions
F/U: as needed for meds and complications
Most common after involvment of the trigeminal region, and in pts over the age of 55?
Postherpetic neuralgia
What is Neurogenic bladder (herpes zoster)
sacral zoster may be associated with bladder and bowel dysfunction
What type of herpes zoster can result in visual impairment?
Herpes zoster ophthalmicus
Prognoisi and Definitve and tx of Herpes zoster?
Eruption persist 2-3 wks, does not recur by may. Motor involvment in 2-3% of pts may lead to termporary palsy
Defin: refer to dermatology or specialty care
Symptoms, signs and exam findings for tinea cruris?
Itching may be severe, rash may be asymptomatic
-Lesions have sharp margins, cleared centers, active, spreading scaly peripheries
Rarely: vesicle formation at the borders or follicular pustules are encountered
Differential diagnosis of tinea cruris?
Contact dermatitis
Psoriasis
Erythrasma
Candidasis
Independent operational labs/test for tinea cruris?
Hyphae can be demostrated in KOH prep
Treatment plan for Tinea cruruis/
Full duty, limited depending on severity
Meds: topical and oral antifungals
General Speific treatment measures for Tinea Cruris/
Eliminate moist evnironment...Drying powder for excessive perspiration or occlustion...Avoid over bathing..underwear loose.
Local measures and specific treatment for tinea cruris?
Antifungal creams activity against Candida and dermatophytes (Micatin, Lotrimin, Miconazole, clotrimazole creams/
Terbinafind cream (curative 80% of cases once-daily use for 7 days.
For severe cases of Tinea Cruris what meds are reseved?
Griseofulvin
one wk of (itraconazole or terbinafine) daily can be effective
Pt edu and f/u instructions should you give to pt about tinea cruris?
Ed: proper hygiene, Flare ups occur more often during the summer...Tight clothing or obesity tends to favor growth of the organisms
F/U: as needed for evaluation and medicaiton
Complications of tinea cruruis?
Lesions mayb be complicated by maceration
miliiaria
Secondary baterial infections
Candidal infection
Reactions to treatment
Prognosis and definitive dx and tx of tinea cruris?
Prog: Recurrence
Defin: Refer as needed
Montior LFTs with systemic antifungals
What is contact dermatitis?
acute or chronic dermatitis results from direct skin contact with chemicals or allergens
Commonly allergic dermatitis implicated sutbstances?
plants (poison ivy, oak, sumac ragwee
Chemicals used in the manufacture of shoes and clothing
Metal compounds (nickel, chrome, mercury)
Dyes and cosmetics (makeup
Symptoms of contact dermatitis/ for irritant contact dermatitis?
pain, tenderness, buring often predominates over itch
Buring are common
Allergic contact dermitis symptoms would be?
Degree depends on senstivity of pt. Exterme pruritis
Swelling and pruritis are commone
Signs and Exam findings for Contact dermitis?
Continuing exposre to the causative agent or complicatinos (allergy, topical drug, excoriation, infection
What is the biggest determing factor to identify contact derm?
History:
occupation
hobbies
vacations
cosmetics
vacations
topical drugs
wearing apparel
What are some irritant contact derm signs and exm findings?
Hands most affected. Erythema, dryness, cracking, fissuring and scaling. Vesicles may be present but not typeicall
What part of the body is most affeced with irritant contact dermatitis?
dorsal and palmar surface of the hands
What are some commone skin findings for ICD?
Erythema, dryenss, painful cracking or fissuring an scaling.
Vesciles may be present , typically not.
Common tenderness and buring.
JUICY papules,
Persisent chronic irritant dermatitis is characterized by what findings?
lichenification , patches or erythema, fissures, excoriations an scalling.What
What are some laboratory test for ICD?
KOH
What are some Diff diagnosis for ICD?
Allergic contact dermatitis (common vesicles that itch)
Atopic dermatitis
Tinea infection
Treatment for ICD?
Meds : topical or oral corticosterioids.
Remove offending agent
What is the oral corticosteriod treatment for Contact derm?
prednisone 60mg/day 3wk tapering dose fore severe allergic dermatitis , but not relied on repeatdly
What is some pt education for ICD?
Avoidance of or decreased exposure to irritants or allergen is critical
Proper PPE
Furthur education will be based on cause of exposure
Complications for ICD?
anaphylaxis
Secondary infection
Prognosis for ICD?
allergic contact dermatitis is sefl limited, if re-exposure is prevented but often takes 2-3 wks for full resolution.
INcreased snesitivity to industrial chemicals may necessitate a change of occupation
What is the definitive care for contact dermitits?
Refer to derm for resistant cases, complications, biopsy based on findings
Refer to allergic clinic for patch testin
This condition is an eczematous eruption?
Atopic demratitis
What is the cause of Atopic dermaitis?
unknown
What is the main etiology of Atopic dermaitits?
perasonal or family history of realted disorders (hay fever, asthma)
Accurate cause unknown
Food allergy is an uncommon
Differential diagnosis for Atopic dermatitis?
Contact dermatitis
Nummular eczema
Seborrheic dermatits
scabies
tinea infecitons
What are some independent operational labs/tess?
KOH-neg, woods lamps shows no fluroecnce
Gram stain if suspected bacterial infeciton
Class of medications for Atopic dermatitis?
Topical corticosterioids
Antibiotics
Bland emollients
Atopic dermatitis prepations
What is the most effective drug for Atopic dermatitis?
Corticosteriods creams and ointments applied TID
For secondary infection of Atopic dermatitis, what is the drug of choice?
DIcol or keflex (cephalexin)
What is pt education would you give this patient?
Offending agents removed if possible
Bathing be minimized (once day)
Soap on affected area minimum, b/c soap and water is drying.
When should lubricate and steroids be applied?
within 3min after a bath, before skin dry. Pat with towel.
what is the f/u procedure for patient treated with Atopic dermatits/
as needed for medcations and complications
Sch f/u visits even just for support and patient medication complinace
A generalized herpes simples infection mainfiested by monomorphic vesicles crusts, or eroisions superimposed on atopic dermatitis is called?
Eczema Herpticum
What is the Definitive tx and dx of pt with Atopic dermatitis?
derm consult for managment of severe, refractory disease
What causes Urticaria (hives or wheals)?
histamine release by allergens (drugs, pollens, foods)
What is the most common cause of urticaria?
histamine
what is the differnece from acute urticaira and chronic urticaria/
acute (majority) lasting from hours to 1-2wks
chronic: lasting longer than 6 wks
Symptoms of Urticaria?
Varying intensity of the itching
What is the signs and exam findings for urticaria?
erythematous or white nonpitting edematous plaque that changes in size and shape extent during the few hours or days that the individual lesion exists
Sings and exam findings for urticaria?
Round or oval, or incomplete ring
Determine by exam pt actally has urticaria and not bites
Ruleout contact derm
Determine if hives are acute or chronic
What are the Five I's of urticaria?
Ingestants
Inhalants
Infectants
Infections
Interal disease
What are some differntial diagnosis for Urticaria?
chronic: Physical Urticaria
Erythema multiforme
Acute: Drug eruption
Viral exanthem
Bites
Bullous pemphigoid
Hereditary angioedema
Treatment for Urticairia?
Stop trigger
Prescribe Antihistamines (mindful of sedative affects)
what would you give for Urticaria?
antihistamines
Oral corticosteriods (second line of treatment, but use in chroic urticaia is controversial and somtimes detrimental
Sympathomimetic agent: Epinephrine
what is pt educa, f/u and complications for urticaria?
Ed: all suspected triggers should be d/c
f/u: as needed base on symptoms, severity, complications
COmpl: recurrence
Uncommon, pruirtic, inflammatory papulosquamous disorder of skin and mucous membranes of unknown etiology?
Lichen planus
What is some determine factors that could be a cause of lichen planus?
gold, sufla, tetracycline, quinidine, NSIADS and hydochlorthiazide
Severe Lichen planus may degenerate to what condiction and found to be 3% of cases?
Squamous cell carcinoma
What are some symptoms of Lichen planus?
itching is variable, intermittent most often insatible.
Signs and exam findings for Lichen planus/
difficult to diff from leukoplakia. histologically distinctive
Onset may be abrupt or gradual
Primary papules are 2-10 mm in diameter
What are the Five P's of Lichen planus?
Pruritic
Plantar (flat topped
Polygonal
purple
Papules
The surface of the Lichen planus shows what?
lac reticulated pattern of whitish lines (Wichhams striae) on the mucosa
There are several different clinical forms of Lichen planus, what are they/
Papular
Mucosal
Hypertorphic
Follicular
What is the most common lichen planus, located on the flexor surfaces of the wirst, forearms, ankles and lumbar region?
Papular LP
Most common non erosive with white lavy pattern of the buccal mucosa and latera edge of the tongue and sometimes, lip mucosa.
Mucosal LP
Differential dx of Lichen planus?
Psoraisis- during papular stage
Scarring alopecia
Leuoplakia
Independent operational labs and test for lichen planus?
None by IDCs
Histologically distinctive
What is the disposition of Lichen planus?
Full duty, however based on presentation severity and tx of dz
Class of meds given for lichen planus?
Sedating antihistamines
Corticosteriods inject oral or topical
What is the treatment for asymptocmatic lichen planus?
none requred, if a drug or chemical is susptecd its use should be d/c
Hypertrophic lesion of lichen planus can be treated how?
with Triamcinolone Acetonide (Kenalog 5-10mg/ml) injected into the lesion
Predisone for skin or erosive mucosal involvment 4 wk week tapering course may be adequate
Complications of Lichen planus/
self-limiting but may recur after years
Prognosis for lichen planus/
benign dz, may persist for mnths or yrs and may be recurrent
Chronic exacerbation and remissions oare common. 10% of pts have a postive famhx
Definitive dx and trx of Lichen planus/
Erosive oral lesion requrie biopsy and often direct immunofluorescence for dx.
Refer for scarring alopecia, eroxive mucosa, and refactory cases.
Chronic condition characterized by sueedn eruptions of deep seated itch vesicles onthe palms, sides od fingers and soles?
Dyshidrosis
What is Dyshidrosis called?
pompholyx or dyshidrotic eczema
What are some causes of Dyshidrosis?
atopic fbackground of persoanl and family hx of ashtma, hay fever, or atopic eczema
Compete hx needed
Symptoms of Dyshidrosis?
mod to severe itching
What would you find one exam for dyshidorsis?
1-5mm smal clear vesicles deep seated stud the skin at the sides of the fingers and on thepalms or soles. They look like the grains in tapicoa
What are some differntial diagnsis of Dyshidrosis?
Pustualr psoriasis
Id reaction (distinct focus of tinea)
Acute allergic contact deramtitis
bullous pemphigoid
What specific tx for dyshidrosis if you suspect secondary infection/
Diclox or keflex
what pt edu will you give your patient for tx of Dyhidrosis?
Limit aggravating factors
stress and smoking may play in aggravating factors but have been poorly studied
Limit wet chroes
Complications for Dyshidrosis?
Pompholyx can be incapacitating
Secondary infection (bacteria)
What is the prognosis of pt with Dyshidrosis?
inconveniencem
mod to sefere dz, flares controled with scrupulous care
A hearld or mother patich, found most commonly on the trunk , usually precedes gen eruption 5-10 days. On th back, their long axes parallel th elines of cleavage, typically radiatin from the spinal col like "christmas tree patterN
Pityriasis rosea
What are some symptoms of Pityriasis rosea?
asymptomatic may have mild itching.
self limited, mild inflammatory skin dz.
scaly lesions.
What would you find on exam for Pityriasis roscea?
Circinate or oval slightly erythematous, rose or fqwn colored, sclay raide border , resembles a tinea infection
Differntial diagnosis of Pityriasis rosea?
Tinea corporis
Secondary syphilis
Tinea vericolor
Drug eruption
Guattate psorisis
Independent labs and test for Pityriasis roscea?
koh and woods lamp
what class of meds will you give this person with Pityriasis rosea?
Antihistamines
Corticosteriods if needed
NO TREATMENT REQUIRED
What would you give for severe itching of pityraisis roscea/
predisone
What is the most important out of all differential dx, should you be concerned with if patient presents with P. roseca?
syphiles (STS) stronlgy considered
Common, chronic dz characterized by combo of red papules, plaques dry well circumcribed (sharply demarc) silvery, shiny, scaling, papules and plaques of various sizes
Psoriasis
What area does psoriasis mainly affect?
Scalp
extensor surfaces of elbows and knees, the back, and the buttocks
What are some other findings of psoriasis?
1-2 lesions, to widespread dermatosis toraely disabling arthirtis or exfoliation
Nial involvment resemble fungal infecction with pitting (stippling)
fraying separation of the distal margin.
who is mainly targeted by psoriasis?
light skinned affected most
Uncommon, requires immediate medical attention. Total body redness with chills and skin pain occurs, what type of psoriasis is this condtion?
Erythrodermic
Tobacco use has been assocated with this condition and pustules do not rupture but turn dark brown and scaly as they reach the surface?
Pustular psoriasis
What factors exacerbate psoriasis?
Phsycial trauma (sunburns)
Drugs (antimalarial therpay, lithuim, beta blockers and withdrawal
Infections (strep an candida)
WINTER SEASONS
Differential diagnosis for psoriasis?
Seborrheic dematitis (face more often)
Eczema (dyshidrotic hand/foot ; more vesicular than pustular
Tinea captits (conychomycosis should be excluded with KOH)
Candidiasis-perform KOH
Pityriasis Roscea-look for herald patch, collate of scale, christmas tree pattern
Independent operaitonal tests and labs?
KOH rule out fungal or yeast
Gram stain if bacterial infection is suspected
Class of meds given for psoriasis?
Lubrincnats
Topcial cortiocosteriods 1-5
Tomcap tar prep
Phototherpay
Anitpsoratic agen Dovonex a vitamin d3
Deratolytics
Corticsteriod injection
SYSTEMIC CORTICOSTERIODS SHOULD NOT BE USED
How are corticosteriods most affect in threatment for psoriaisi?
used under occlusive polyethylene coverings,
What is a substitute for steriods after about 3 wks use of steriods?
Triamcinoolone acetonide .1% usually effective
Scalp plaques may be difficult to treat, so what is the prescribed way to treat psoriaisis of the scalp?
suspension 10% salicylic acid in mineral oil may be rubbed inat bedtime with a toothbrush and washied off the nxt moring with cosmetically acceptable tar shampoo
What is the prefered tx for pustular psoriasis?
Isotretinoin (accutatne)
What are some complications of psoriasis?
Psoriatic arthritis often resembles rheumatiod arthritis and may be equally crippling
Exfoliative dermatitis
Prognosis of Psoriasis ?
depends on extent and seveity.
Usually earlier in life begins, greater with severity
Acute attacks usually clear up, but complete permanent emmission is rare
no therapy assures patients of cure, but most cases can be well controlled
Gradual symptoms iwth complaints of dandruff dry or greasy scaling and ariable ithcing.
Seborrheic dermatitis
In severe case of Seborrheic derm, with yellow red scaling papules can found where?
hairline, behind ears in the external auditory canal
Eyebrows
Bridge of nose
Nasolabial folds
Over the sternum
Differential dx of Seborrheic dermatitis?
tinea of the face
Cutaneous lupus
Rosacea
Psoriasis may be present with seborrheic derm
What is the lab aand test of choice for specific treatment?
KOH to r/o fungal /yeast
What is the treatment of choice for Seborrheic dermatitis/
Selenium sulfide
Hydrocortisone cream with more potency forms may produce side effects like?
Telangiectasia
Atrophy
Perioral dermatitis
What is the Pt edu, f/u and complicatino of this condition?
Pted: cooperation and understanding
f/u: as needed for meds and unresolved cases
Compl:none
Sudden hari loss in cirucmscribed areas occurs in individual who have no obvious skindisorder or systemic dz. It is immunologic process?
Alpecia areata
What you could see if patient has alopecia areata
patches, perfectly smooth no scarring
tiny 2-3mm "excalmation hair"
Telogen hair easily disloged from teh periophery of active lesions
Involvement may extend to all of the scalp hair?
alopceia totalis
All body hair gone is called?
alopecia universalis
Differential diagnosis for alpecia areata?
Trichotillomania
Tinea capptis
Syphilis
Telogen effluvium
Androgenic alopecia
Class of meds given for Alopecia areata?
corticosteriod injections
Stuck on papules, superficial epitheial lesions thar are usually warty, but may occur as smooth papules or plaques?
Seborrheic keratosis
Differential diagnosis for Sevorrheic keratosis?
pigmented Actinic keratosis
Superficial spreading melanonma
Class of medication for Seborrheic keratosis?
cryotherapy
Curetage
slow growing benign tumor of the skin , mass is firm, globular, movable, and nontender. Has overlying pore or punctum?
Epidermal cyst
Differentail dx of Epidermal cysts?
Abscess
distinguished form lipomas by being mroe superficial and by their overlying punctum.
Circumscribed areas of hyperderatosis is called what?
callues or clavus(corns)
What cause calluses and corns?
intermitent friction, pressure and repeated trauma
Painful concial hyperkeratosis, found principally over a bony prominence (wt bearting, orthopetic efromites, repeated trauma
Symptoms of Clavus and calluses?
corns: may be painful or tender with pressure
Calluses..usually asymptomactic , friction is extreme, may be irritated
Signs and exam findings for corn calluses?
hyperkeratoic well localized overgrowths always occur at pressure points
Corns: pea sized or slightly larger sharply circumscribed keratinous plug
What is different from corns vs calluses?
Paring, a glassy core is found
Signs and exam findings of Calluses?
lack of central plug and associated dermal changes and have a more even appearance
Usually found on th ehands or feet but may occur elsewhere
How does plantar warts differ from corns and calluses?
mutliple capillary bleeding points or black dots when pared
Differential diagnosis for clavus and callusues?
Tinea pedis
Warts
Disposition of clavus (corns) and calluses?
LD may be needed to reduce friction or repeated trauma
Class of medications for clavus and calluses?
Hyperkeratotic prep
What are some specific treatment for corns angd calluses?
Prophylaxis is important
Completely eliminating undue pressure on the affected site.
Shoes properly fitted and orthopeidic deformites corrected
Pads
What type of meds can you give for corns and calluses?
Hyperkeratotic tissue (keratolytic 17% salicyclic acid in collodion or 40% salicylic acid plasters.
Complications of clavus (corns) and calluses?
secondary infecton
debilitation
Prognosis and definitive diagnosis and treatment for clavus (corns) and calluses?
Pts tendency to corns and calluses may need the regular services of a podiatrist
Def care:pts with imparied peripheal circulation, especially if associated with diabetis mellitus, requre special care
Pt presents with small papules .2 to .6 cm , flesh-colored pink, or slighty hyperpigmented that feel like sandpaper and are tender when the finger is drawn over them?
Actinic keratoses
How is Actinic keratoses defined?
Precancerous keratotic lesions
What are some symptoms of Actinic keratoses?
tender to palpation
feel like sandpaper
Differential diagnosis of Actinic keratoses?
Squamous cell carcinom
Actinic chelitis
What is the disposition of the pt with actinic keratoses?
Pt with multiple actinic keratoses requires at least annual follow up
Class of medications are used for Actinic keratoses?
Cryotherapy
Anti-Cancer topical chemotherapy-
Specific treatment for Actinic keratoses?
Liquid nitrogen to solitary superficial lesions
Lesion crust and disappear in 10-14 days
What is the alternative treatment is the use for actinic keratoses?
5% fluorouracil cream
Rub into lesion AM and PM until they become first red and sore and then crusted and eroded.
What are some instruction you would give the patient after treatment for AK>
Decrease sun expsoure
Follow up as needed or based on severity, recurrence and number of lesions
What is the major complications of Actinic keratoses?
Carcinomas