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121 Cards in this Set

  • Front
  • Back
What are the three skin layers?
Epidermis
Dermis
Subcutaneous
What is contained in the Dermis layer of the skin?
Blood Vessels
hair follicles
sebaceous
glands, sweat glands
What are the four appendages of skin?
hair
Nails
sebaceous glands
sweat glands
What are the two types of hair?
Vellus- fine body hair
Terminal- thicker head hair
What are the two types of sweat glands?
Eccrine-
Apocrine- pits and groin- BO
What are the five purposes of the skin listed in lecture?
Protect from trauma and infection.
 Prevent fluid loss
 Regulate body temperature
 Provide sensory information
 Produce vitamin D
What are the 6 HISTORY Factors when evaluating a patient's skin condition?
Duration
Relationship of lesion to external factors
History of sun exposure
Associated symptoms
Constitutional Symptoms
Review of Systems
name a few of the External factors to be considered when evaluting the relationship of skin lesions to external factors
• Topical irritants / allergens
• season
• travel
• temperature
• previous treatment
• occupation
• hobbies
• pregnancy
name a few of the Associated symptoms to be considered when evaluting the relationship of skin lesions to associated symptoms
pruritis, dryness, rashes/sores, color
changes, changes in hair or nails
What are the constitutional symptoms evaluated in an individual with a skin disorder?
URI
Wt loss
Mailaise
Fatigue
* All have to be evaluated to be chronic or acute
During the physical examination what is tengential lighting good for?
Tangential lighting is good for contours
 Ophthalmoscope “trick” for illuminated
magnification
Along with Adequate lighting, adequate ___ is also important?
Adequate exposure is important
• Be sure to check axillae, buttocks, back of
thighs, between fingers & toes
What are the 8 aspects of Inspection for skin disorders?
Symmetry
Color
Hair
Nails
Moisture
Temperature
Texture
Mobility and Turgor
What should be evaluated when inspecting the color of a skin lesion?
Color
• Increased v. decreased pigmentation
• Pallor v. cyanosis
 Central v. peripheral cyanosis
• Central cyanosis consistent with pulmonary or
cardiac disease; peripheral cyanosis seen with
cooler temps or anxiety
• Jaundice - also check conjunctivae
What should be evaluated when inspecting the Hair around a skin lesion?
Hair – distribution, quantity
What should be evaluated when inspecting the nails proximal to a skin lesion?
Nails color lesions 12
 – color, lesions, capillary refill
How do we examine Mobility and Turgor?
Mobility & turgor – pinch section
of skin on the forearm…should
return to place immediately
• Avoid back of hand…too loose
• Pinch skin on the thigh in the elderly
What are the three skin lesion Distribution terms?
Localized
Regional
Generalized/disseminated
What is a localized skin lesion?
Lesion appears in one small area
What is a regional skin lesion?
Lesions appear in specific region of the body
What is a generalized/disseminated skin lesion?
Lesions appear widely distributed or in
multiple areas simultaneously
Describe Round/discoid shaped lesions
and associated conditions
Round / discoid
• Coin shaped
• No central clearing
• Seen with eczema;
• Umbilicated lesions
seen with Molluscum
contagiosum (photo)
Describe Oval shaped lesions and associated conditions
Oval
• Ovoid
• Seen with Pityriasis rosea
Describe annular shaped lesions and associated conditions
 Round; active
margins with central
clearing
 Seen with tinea
(fungal) infections
• Example –
Tinea corporis
Describe zosteriform shaped lesions and associated conditions
 Zosteriform
(dermatomal) –
following a nerve
segment
 Example:
• Herpes Zoster
Describe Iris / Target shaped lesions and associated conditions
 Pink macules with purple central papules
-Erythema multiforme
What are the three Arrangements of lesions listed in the lecture
Linear- Contact dermatitis
Serpiginous- Cutaneous larva migrans
Morbilliform- measles.
Describe Morbilliform shape/arrangement of lesions
Measles-like
• Erythematous
maculopapular lesions
that become confluent
on the face and body
What are the five terms used to describe borders of skin lesions?
Distinct
Indistinct
Active
Irregular
Raised Borders
Define Distinct Borders of a skin lesion
Well-demarcated or
defined; able to draw a
line around the area
with confidence
Describe indistinct boders of a skin lesion
Poorly defined;
borders merge with
normal skin
Describe active boders of a skin lesion and example
Active – margin of lesion shows greater
activity than the center
 Example – tinea infections
Describe irregular boders of a skin lesion and example
Irregular – notched margins; not smooth
 Example – malignant melanoma
Describe Raised boders of a skin lesion and example
Raised borders – center of lesion is
depressed compared to the edge
 Example – basal cell 27
carcinoma
What are the six color terms when defining a skin lesion?
 Flesh – same tone as surrounding skin
 Erythematous – variable shades of red
• Pink, salmon, coppery, reddish-blue
 Violaceous – light violet
 Tan-brown
 Black or blue-black
 White
What are the six things being observed when palpating a skin lesion?
 Consistency
 Mobility
 Blanchable
 Tenderness
 Depth of lesion
 Deviation in temperature
What are the ABCDs of Malignant Melanoma
A – asymmetry
 B – borders (irregular)
 C – color (variegated)
 D – diameter > 6mm
 E – elevation
What is a primary skin lesion?
• Arise from previously normal skin
• Key to accurate diagnosis
What is a secondary skin lesion?
• Arise from changes in primary lesions
• Usually due to scratching and/or infection
What are the three types of primary lesions (basic)
Circumscribed, flat, non-palpable
Superficial elevations by free fluid
Palpable, elevated solid masses
What are two types of Circumscribed, flat, nonpalpable primary skin lesions?
Macule
Patch
What are three types of Superficial elevations by free fluid in primary skin lesions?
Vessicle
Bulla
Pustule
What are five types of Palpable elevated solid masses in primary skin lesions?
Papule
Plaque
Nodule
Tumor
Wheal
Macule Definition and example
 Definition:
• Flat, non-palpable
• Circumscribed color
change
• <1 cm in diameter
• Variable color
 Examples:
• Measles
• Freckles
• Petechiae
Patch Definition and example
 Definition:
• Flat, non palpable
• Irregular shape
• > 1 cm in diameter
 Examples:
• Mongolian spots
• Café au lait spots
• Port wine stain
• Vitiligo
Papule Definition and example
Definition:
• Up to 1 cm
• Palpable, firm
• Circumscribed
• Colors - Flesh colored,
red, brown
• May be confluent and
form plaques
 Examples:
• Molluscum
contagiosum
• Warts
• Nevi
Plaque Definition and example
 Definition:
• Elevated, firm, rough
• > 1 cm
• Well-circumscribed
 Examples:
• Psoriasis (photo)
• Eczema
Nodule Definition and Example
 Definition:
• > 0.5 cm
• Deeper and firmer than
a papule
• Usually round
 Example:
• Lipomas
• Skin cancers
 Malignant melanoma,
basal cell or squamous
cell carcinomas
Tumor Definition and Example
 Definition:
• A large nodule
• Deeper in the dermis
• >2 cm
 Examples:
• Hemangioma
• Benign tumor
Wheal Definition and example
Definition:
• Irregular, transient,
superficial edema
 Examples:
• Mosquito bites
• Hives (Urticaria)
 See photo 
• Allergic reaction
Vessicle Definition and example
 Definition:
• Well-circumscribed
• Up to 1.0 cm
• Filled with serous fluid
 Example:
• Herpes simplex
 “Dew drops on
rose petals
Bulla Definition and example
 Definition:
• Well-circumscribed
• Greater than 1.0 cm
• Filled with serous fluid
 Examples:
• 2nd degree burns
• Blisters
Pustule Definition and example
 Definition:
• Elevated, superficial;
well-circumscribed
• Epidermal
• Filled with pus
 Examples:
• Acne
• Impetigo
• Fire ant bites (photo)
What are the three types of secondary skin lesions (basic)
Loss of skin surface
Material on the skin surface
Misc.
What are the types of secondary lesions from loss of skin surface?
Erosion, Ulcer, Fissure
What are the types of secondary lesions considered "miscellaneous"
Lichenification
Excoriation
Atropy
Scar
Burrow
What are the types of secondary lesions considered Material on the skin surface
Crust
Scale
Skin erosion definition and example.
 Definition:
• Loss of a superficial
epidermis
• Surface is moist, but
doesn’t bleed
• Heal without scarring
 Examples:
• Ruptured varicella
vesicles (pock marks)
• Eczema
Skin ulcer definition and example.
Definition:
• Deeper loss of
epidermis and dermis
• Heals with scarring
 Examples:
• Stasis ulcer (photo)
• Decubitus
Skin fissure definition and example.
 Definition:
• Linear crack, or break,
from the epidermis to
the dermis
 Examples:
• Eczema (photo)
• Tinea pedis
• Angular cheilitis
Skin Excoriation definition and example
 Definition:
• Abrasion or scratch mark
• May be linear or rounded
• Usually due to scratching
 Examples:
• Scabies
• Atopic dermatitis
• Dry skin
Skin Crust definition and example
 Definition:
• Dried residue of
serum, pus, or blood
 Examples:
• Impetigo (photo)
• Tinea capitis
• Kerion
 Raised boggy
secondarily infected
fungal lesion of hair
Skin Scale Definition and example
 Definition:
• A thin flake of
exfoliated epidermis
 Example:
• Dandruff
• Psoriasis (photo)
• Seborrheic dermatitis
Skin Lichenification definition and example
 Definition:
• Thickening and
roughening of the skin
• Increased visibility of
skin markings
 Examples:
• Atopic dermatitis
• Chronic dermatitis
Skin Atrophy Definition and example
 Definition:
• Thinning of skin with loss
of normal skin markings
• Skin looks shinier and
more translucent
 Examples:
• Stretch marks / striae
(photo)
• Topical steroid use
what are the four categories of Skin diseases?
Papulosquamous
Nodular
Vesiculobullous
Maculopapular
What are the papulosquamous lesions, what are examples?
Papules, plaques and scales
 Examples:
• Psoriasis
• Lichen planus
Pityriasis rosea
What are the 5 P's of this certain skin disease?
Lichen planus
The Five P’s
Pruritic
Polygonal
Purple
Planar
Papules
What are the nodular lesions?
 Benign and malignant epidermal and dermal
nodules
What are examples of benign and malignmant nodular lesions?
 Examples of benign lesions:
• Nevi (photo)
• Cherry angiomas
• Epidermoid cysts
 Malignant:
Squamous cell
carcinoma
• Isolated keratotic,
eroded papule or
nodule
• Located in a sun
exposed area
 Basal cell carcinoma
• “Pearly” nodules in sun
exposed areas
• Associated with central
ulcerations and
telangiectases
What are vesiculobullous lesions?
 Vesicles and bullae
 Examples:
• Impetigo
• Herpes
• Pemphigus
What is Pemphigus
Autoimmune disease
affecting the skin and
mucous membranes
Associated with vesicles
and bullae that can
rupture and weep
Can be fatal
What are maculopapular lesions, what are examples?
 Macules and papules
 Examples:
• Viral exanthems
 Generalized,
erythematous
maculopapular rash
• Drug eruptions
What is the definition and cause of clubbed nails?
 Definition:
• Rounded, bulbous
nail base. Feels
spongy.
 Causes:
• Chronic hypoxia
• Congenital heart
disease
• Lung cancer
What are Beau's lines?
 Definition:
• Transverse
depressions
secondary to
trauma or acute or
severe illness
 Lines grow out
with the nail
What are the lines in the nails secondary to trama that grow out with the nail?
Beau's lines
Define Paronychia, what is a cause?
 Definition:
• Acute or chronic
inflammation of the
proximal & lateral
nail folds
• Nail folds swollen,
reddened, & tender
 Cause:
• Frequent immersion in water
What is onychocryptosis, what is a cause?
 Definition:
• INGROWN TOENAIL
• Usually involving the
large toe. Nail grows
into the dermis.
 Cause:
• Improperly cutting nails
• Tight shoes
Define Terry's nails. What is a cause?
 Definition:
• Mostly white with a
distal band of
reddish brown
 Cause:
• Aging
• Chronic disease
such as diabetes
cirrhosis, heart
failure
Define Leukonychia, what is a cause?
 Definition:
• Trauma to nails
causing areas of
white discoloration
 Cause:
• Trauma
• Repeated
manicuring
Define Koilonychia
"spoon nail"
Define Onycholysis- what is a cause?
 Definition:
• Painless separation
of the nail plate
from the nail bed
 Causes:
• Most common
cause: trauma to
long finger nails
• Other causes:
psoriasis, contact dermatitis
What is Onychomycosis? What can be a cause?
 Definition:
• Fungal infection of
nail bed, plate or
matrix
 Cause:
• Occlusive footwear,
dissemination of
fungal infections,
and locker room
exposure
What can be some causes of Nail pitting?
 e.g., psoriasis, arthritis, SLE,
alopecia areata
Define Petechiae
 Deep red/purple-red
lesions < 0.5 cm
 Round, irregular
 Non-blanchable
 Variable distribution
 Represent blood
outside of vessel
• Seen with infections
and bleeding
57
disorders
Define Purpura
 Deep red/purple-red
lesions > 0.5 cm
 Same descriptors as
petechiae, just larger.
Define Ecchymosis
 Purple lesions of
variable size
• Fade to green, yellow,
brown
 Round/oval, irregular
borders
 Represent blood
outside of vessels
due to trauma or
bleeding disorder
Define Spider Angioma and causes
Fiery red lesions
• Small in size…up to 2 cm
 Central body with
surrounding erythema and
radiating legs
 Blanch with pressure
 Seen on face, neck, arms
& upper trunk
 Seen with liver disease,
pregnancy; may be normal
Define Cherry Angiomas
Bright –red papules,
1-3 mm size, red, flat
or raised, nonpulsatile,
seen on the
trunk; don’t blanch
associated with aging
Define Telangectasias and causes
 Fine, irregular red
lines secondary to
dilation of capillaries
 Blanch
 Seen with basal cell
carcinomas, sundamaged
skin,
rosacea
Define Hemangioma
 Red, irregular lesion
secondary to dilation
of dermal capillaries
 Starts as macular
patch, can progress
to plaque or nodule
 Example: “Strawberry
hemangioma”
Annular Tinea Corporis
Atrophy
Beau's lines
Bulla
Cherry Angioma
Crust
Ecchymosis
Excoriation
Fissure
Hemangioma
Hemorrhagic Bullae
Iris-Target lesions, Pink Macules with purple central papules Erythema Multiforme
Koilonychia
Lichenification
Linear Arrangement Contact Dermatitis
Macule
Morbilliform Arrangment of Erythematous maculopapular lesions from Measles
Nodular lesion- Basal Cell carcinoma
Nodule
Onycholysis
Onychomycosis
paronychea
patch lesion Vitiligo
Pemphigus
Plaque
Purpura
Pustule
Round-Discoid umbilicated Molluscum Contagiosum
Scale
Vesiculobullous lesion- Herpes Zoster