Basic Dermatology Flashcards
What are the 3 duties of the PT?
- Document presentation of skin disorder
- Make an assessment
- Refer to another provider, if warranted
What are the 5 primary functions of the skin?
- Protection
- Sensation
- Metabolism
- Thermoregulation
- Communication
Why are 2 reasons why skin changes with age?
- time
- cumulative effects of sun exposure
What are 11 skin changes that occur with increased age?
- Decreased dermal ground substance, elastin, collagen
- Decreased epidermal turnover and vitamin D production
- Flattened rete pegs/dermal papillae
- Decreased dermal and subcutaneous thickness
- Decreased vascularity and immune response
- Decreased sweat glands and skin elasticity
- Decreased barrier function
- Decreased sensory perception and immune function
- Decreased moisture content
- Thickened nails
- Decreased thermoregulation
What are the 2 most common skin problems with patients in nursing homes?
- Xerosis: dry skin
- Pruritus: severe itching of the skin
What are rashes?
Temporary eruptions of the skin such as those associated with heat, childhood diseases, diapers, and drug-induced reactions
What is a lesion?
A pathological or traumatic loss of normal tissue continuity, structure, or function
Lesions that are first to appear are called _____ lesions, and their identification is the most important aspect of the dermatological physical examination
primary
List a few examples of primary lesions
- Macules
- Patches
- Papules
- Plaques
- Nodules
- Tumors
- Wheals
- Vesicles
- Bullae
- Pustules
Primary lesions may continue to develop or they may become modified by trauma, regression, or other extraneous factors producing _____ lesions
secondary
Primary lesions are nonpalpable, flat, changes in skin color, they can be classified as either a _____ if they are small and less than 1 cm. Or a _____ if they are larger than 1 cm.
Macule
Patch
If a primary lesion is palpable, elevated, and a solid mass if is classified as one of the following:
Less than or equal to 0.5 cm: _____
Larger than 0.5 cm and can be a coalescence of smaller ones: _____
Anywhere from 0.5-2.0 cm and deeper and firmer than a papule:_______
A nodule greater than 2.0 cm: _______
Localized skin edema, irregular, transient, superficial, and variable in size:_______
papule
plaque
nodule
tumor
wheal
If a primary lesion is characterized by a superficial elevation formed by fluid within a cavity of between tissue layers it is classified as one of the following:
Less than or equal to 0.5 cm and is serous-filled:______
Greater than 0.5 cm: _______
Any size and filled with purulent material: _______
vesicle
bulla
pustule
Describe the general presentation of secondary lesions
They are depressed and manifest below the plane of the skin
List a few examples of secondary lesions
- Scales
- Crusts
- Excoriations/Abrasions
- Fissures
- Erosions
- Ulcers
- Scars
Describe the characteristics of scales
- dry or greasy laminated masses of keratin
- pathologic exfoliation involving the epidermis
- vary in size and color
Describe the characteristics of crusts
- dried blood, serum, or pus mixed with epithelial and bacterial debris
- vary in size, shape, thickness, color, and composition
- commonly referred to as scabs
Describe the characteristics of excoriations/abrasions
Linear or punctate abrasion produced by mechanical trauma often associated with pruritus and scratching
Describe the characteristics of fissures
- Linear crack or cleft through the epidermis and often into the dermis
- vary in shape, size, and moisture content
- commonly occur in thickened and inelastic skin due to dryness and inflammation
Describe the characteristics of erosions
- loss of portions or all of the epidermis only
- heal without scar tissue
- sometimes areas of erosion are referred to as denuded
Describe the characteristics of ulcers
- vary in size, shape, and etiology
- excavation involving complete loss of the epidermis and a portion of the dermis
- usually heal with scar formation
Describe the characteristics of scars
- collagen and connective tissue that replace lost dermis
- size and shape are dependent upon etiology and level of tissue destruction
- hypertrophic and keloid scars are pathological
What mnemonic can be used to assist the clinician in performing a thorough integumentary examination?
DERMATOLOGICAL
Describe the “D” in the mnemonic
DESCRIBE integrity
- Is the skin intact or present with injury
Describe the “E” in the mnemonic
EDEMA
- location
- pitting vs. non-pitting
Describe the “R” in the mnemonic
REVIEW sensory status
- intact or altered
Describe the “M” in the mnemonic
MOISTURE
- dry or moist to touch
Describe the first “A” in the mnemonic
ATROPHIC changes
- shiny, hairless, extremities
Describe the “T” in the mnemonic
TURGOR/TEXTURE
- normal vs. slow
Describe the first “O” in the mnemonic
OBSERVE nail composition and hair quality
- hirsutism vs. alopecia
Describe the “L” in the mnemonic
LOOK and feel for color and temp changes
Describe the second “O” in the mnemonic
OBSERVE skin folds
Describe the “G” in the mnemonic
GERONTODERMATOLOGICAL changes
Describe the “I” in the mnemonic
INQUIRE about allergies and PMH
Describe the “C” in the mnemonic
CALLUS
Describe the second “A” in the mnemonic
ASSESS vascular status
Describe the second “L” in the mnemonic
LESIONS
What can be defined as an inflammatory skin response to any injurious agent?
eczema
Even though eczema and dermatitis are used interchangeably, eczema is more commonly used to denote _______ disease and dermatitis is more commonly used to denote _______ disease
endogenous
exogenous
What are the 5 types of dermatitis?
1) allergic
2) contact
3) hand
4) seborrheic
5) stasis
Describe allergic dermatitis
Erythema commonly found on the eyelids
What are 2 treatment considerations when treating allergic dermatitis?
- determine irritant and avoid exposure
- consider makeup as a possible irritant
Describe contact dermatitis
Localized erythema common on the hands
What is a treatment consideration when treating contact dermatitis?
Determine irritant and avoid exposure
Describe hand dermatitis
persistent erythema with scaling on the digits and palms
What is a treatment consideration when treating hand dermatitis?
topical steroids
Describe seborrheic dermatitis
Erythemous, scaly eruptions on the face, scalp, and body
What is a treatment consideration when treating seborrheic dermatitis?
Topical hydrocortisones and tar-containing shampoos
Describe stasis dermatitis
Erythema, pigment changes, thickening of the skin, and dependent edema
What is a treatment consideration when treating stasis dermatitis?
Leg elevation, support stockings, exercise, topical and/or systemic management
Describe the general acute presentation of a person with eczema
The acute presentation is often denoted by poorly defined red patches, papules, and plaques with or without scales.
The skin also appears edematous with excoriations from frequent scratching.
Describe the general chronic presentation of a person with eczema
Chronic cases present with a thickening of the skin known as lichenification.
Where does chronic eczema tend to occur on the body?
- neck
- flexor surfaces
- eyelids
- forehead and face
- dorsal of hands and feet
What can be defined as pruritic edematous pink or red wheals, more common referred to as hives?
Urticaria
What is the most common mediator of Urticaria?
histamine
What is acute urticaria most commonly associated with?
- foods
- medications
- exposure to allergens
- chemicals
If daily episodes of urticaria persist for longer than _ weeks, then the condition is considered chronic
6
True or False
It is important for PTs to recognize the clinical features of urticaria because a patient may develop a reaction with the use of cold pack or ice massage
True
What does cholinergic urticaria present like?
Small wheals surrounded by bright red flares and intense pruritus
What does cold urticaria present like?
Red or pale, swollen and pruritic
What does dermographism urticaria present like?
Pruritic linear wheals with a bright red flare
What does pressure urticaria present like?
Large, painful, or pruritic swelling at a site of pressure
What does solar urticaria present like?
Pale or red swelling the is pruritic
Psoriasis is a chronic, recurrent inflammatory disease of the skin that affects up to _% of the population in western countries
2
What is the cause of psoriasis?
Unknown, however it tends to be inherited
What is the general presentation of psoriasis?
Round, erythematous, dry, scaling plaques covered by silvery white scales
Where is psoriasis commonly found?
- scalp
- nails
- extensor surfaces of extremities
- elbows
- knees
- umbilical
- sacral regions
The pathogenesis of psoriasis involves the alteration of what cell kinetics?
keratinocytes
What are the 2 classifications of psoriasis?
pustular and nonpustular
Patients with psoriasis may also present with what type of chronic, destructive arthritis?
psoriatic arthritis
What is the focus of treating psoriasis?
Although there is no cure, the disease can be converted from an active state to a latent state.
Interventions include:
- Systemic and topical steroids and immunosuppressives
- UV therapy
- coal tar produc
What mnemonic can clinicians use to help detect melanoma?
ABCDE
A: Asymmetrical - most early melanomas are asymmetrical
B: Border - most melanomas are uneven
C: Color - shades of brown, tan, black can be first sign of melanoma
D: Diameter ≥6 mm or larger than common moles
E: Elevation or evolving - changing in size, shape, color, bleeding, crusting
What are 8 of the most common benign neoplasms and hyperplasias that may present in the clinical environment?
- melanocytic nevi
- Mongolian spots
- capillary hemangiomas and post-wine stains
- cherry angiomas
- seborrheic keratosis
- skin tags
- lipomas
- dermatofibromas
What are nevi most commonly referred to as?
moles
By the 3rd and 4th decade, Caucasian adults present with approximately how many nevi?
30-50
Describe the general presentation of nevi
Light to dark brown, flat or round tumors, with or without hair, 1-2 mm in size
Describe the general presentation of Mongolian spots
Congenital blue-gray macular lesions
Where are Mongolian spots generally found?
lumbosacral area
What ethnicity are Mongolian spots common?
Amerindian and Asian infants
Describe the general presentation of capillary hemangiomas
soft, bright red or deep purple, vascular nodules or plaques
Capillary hemangiomas disappear spontaneously by the ____ year of life
fifth
Describe the general presentation of port-wine stains
Irregularly shaped, red, macular vascular malformations present at birth
Where are port-wine stains most commonly found?
- neck
- forehead
- glabella
- eyelids
Describe the general presentation of cherry angiomas
Asymptomatic, bright red, domed lesions
Where are cherry angiomas
most commonly found?
trunk
What is the most common benign epithelia tumor?
Seborrheic Keratosis
Describe the general presentation of seborrheic keratosis
Initially flat, well-demarcated, small, brown pigmented areas.
Over time become raised, darker, with a soft, crumbly surface.
In what age population is seborrheic keratosis most common?
elderly
Describe skin tags
Soft, round, skin colored or tan or brown benign tumors ranging from 1 mm to 10 mm
In what age population is skin tags most common?
elderly and/or obese patients
Describe lipomas
Fatty tumors that develop slowly, are easily movable beneath skin. Generally painless
Describe Dermatofibromas
Button-like dermal nodules that are commonly found on the extremities.
What is a classic finding of dermatofibromas?
the “dimple sign” where lateral compression with the thumb and index finger produces a dimpling effect with the lesion
Small, pigmented tumors should be considered suspicious when some or all of what 8 criteria are present?
- rapid growth over weeks to months
- diameter ≥ 6 mm
- changes in pigmentation
- inflamed margin
- irregular, ragged borders
- crust formation
- bleeding
- pruritus
What are 4 skin cancer types?
- Basal cell carcinoma
- squamous cell carcinoma
- malignant melanoma
- Kaposi’s sarcoma
What is the most common form of skin cancer?
basal cell carcinoma
Describe the general presentation of basal cell carcinoma
Small, pink or flesh-colored nodules that enlarge over time
__% of basal cell tumors present on the head, neck, and face
80
Why must basal cell tumors be treated aggressively?
they can extend widely and deeply, destroying skin, cartilage, and bone
True or False
Basal cell tumors have a limited ability to metastasize
True
Squamous Cell Carcinoma is a malignant tumor of what part of the skin?
outer epidermis
Describe the general presentation of squamous cell carcinoma
Scaly, elevated lesions with irregular borders and shallow central ulcers
What are the 2 types of squamous cell carcinoma?
Intraepidermal (local) and Invasive (metastatic)
Patients with squamous cell carcinoma have a __% recurrence rate
40
What percentage or squamous cell tumors will metastasize?
2-6%
Malignant melanoma is a rapidly progressing, metastatic form of cancer involving what cell types?
melanocytes
Describe the general presentation of malignant melanoma
Characterized by irregular borders, uneven surfaces, black or brown. The surrounding area tends to be red, inflamed, and tender. They tumors may also bleed or ulcerate.
Kaposi’s sarcoma is the malignancy of what cells?
Those lining the blood vessels
What 2 diseases is Kaposi’s sarcoma linked with?
Herpes virus 8 and HIV
What do Kapsosi’s sarcomas originally present as? Describe how they evolve.
An ecchymotic-like macule, that evolves into papules, plaques, nodules, and tumors of varying colors
Normal skin color is composed of four biochromes, what are they?
- Melanin (brown)
- Carotenoids (yellow)
- Oxyhemoglobin (red)
- Reduced hemoglobin (blue)
Skin color is determined by all 4 biochromes, however which is the main determinant?
melanin
What can be defined as a congenital disorder affecting skin, hair, and eyes in which the patient lacks the enzyme to synthesize melanin. This results in pale or pink skin, yellow or white hair, and light-colored eyes.
Albinism
Vitilligo is the loss of what cell type?
melanocytes
Describe the general presentation of patients with vitilligo
They have distinct white borders typically on their face, neck, axillae, extremities
Vitilligo is inherited and found in people with what types of disorders?
- thyroid disease
- pernicious anemia
- diabetes
What can be defined as an acquired light or brown hyperpigmentation that presents most frequently on the face?
Melasma
What are the 4 most common causes of Melasma?
- Exposure to sunlight
- Pregnancy
- Oral contraceptives
- Idiopathic
What are Ephilides more commonly referred to as?
freckles
What are Lentigines more commonly referred to as?
liver spots
END SYSTEMIC DISORDERS
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