burns & chronic skin disorders Flashcards
1
Q
causes/types of burns
A
thermal Scolding (most common) corrosive (chemical) electrical (extensive damage but not visable) classification of burn: depth/extent/complications
2
Q
superficial burn
A
reddend skin
painful
3
Q
superficial partial thickness burn
A
burned epidermis/papillary dermis
blistering
dermis is red/moist
painful
4
Q
deep partial thickness burns
A
damage to epidermis/papillary dermis
reticular layer of dermis
injury to hair follicles
blistering
5
Q
full thickness burns
A
damage to epidermis/dermis/subQ (maybe even muscle/bone)
skin is scarred/pale
painless
leathery skin
6
Q
greater than 20% surface bone
A
produces major systemic effect (inflamm, coagulation, firbrinolysis)
life-threatening hypovolemia
7
Q
thermal injuries
A
extent of injury relative to body surface area (BSA) trunk 36% arm 9% leg 18% total rule of nines does not apply for electrical burns
8
Q
complications of large burns
A
vascular prermeability and edema (hypopreteinemia caused by increased capillary permeability)
altered hemodynamics (fluid shifts, decreased CO)
hypermetabolism (catecholamine, glucagon, glucocorticoids release, increased gluconeogenesis, muscle catbolism)
decreased renal blood flow
immunosuppression
9
Q
complications of smoke inhalation
A
carbon monoxide poisoning
cynaide poisoning
airway obstruction or chemical injury to lungs
10
Q
carbon monoxide poisoning s/s
A
HA weakness N/V confusion decreased LOC "cherry-red" skin loss of short-term memory seizures DX: ABG/serum CO
11
Q
carbon monoxide poisoning TX
A
100% FiO2 (half-life is 75-80 min)
hyperbaric oxygen therapy
12
Q
carbon monoxide poisoning complications
A
acidosis (r/t cellular respiration)
loss of consciousness
death
CO has a higher affinity to bind to RBC than CO2
13
Q
ABC TX
A
asses airway = early intubation
watch for burns that prevent chest movement
TX hypovolemia (aggressive fluid replacement)
assess for distal pulses (some burns are like tourniquet)
urine output should be .5ml/kg/hour or greater
14
Q
eschartomy
A
incision in eschar down to subQ fat layer
allows for expansion w/ swelling
5Ps of compartment syndrome (pain, paresthesia, pallor, pulselessness, paralysis)
15
Q
burn TX
A
depends on classification pain management fluid resuscitation infection prevention (PPE/clean/sterile sheets/ABX) wound care (w/ mild soap/water) continuous enteral feeding surgical debridement
16
Q
chemical burns
A
direct contact
inhalation
ingestion
17
Q
chemical burn s/s
A
pain erythema burning sensation numbness blisters necrotic tissue visual impairment/blindness coughing/dyspnea hypotension HA dizziness
18
Q
chemical burns TX
A
depends decontamination irrigation ABCDE fluid resuscitation sterile dressings analgesics debridement
19
Q
electrical injuries
A
electricity/lightening lowvoltage <1000 volts high voltage >1000 can have low evidence of external damage risk for compartment syndrome extravasation of fluids
20
Q
electrical injuries heart/neuro injury s/s
A
shortness of breath
chest pain
palpitation
loss of consciousness
21
Q
electrical injuries tx
A
electrical: LR, cardiac monitor, wound care
lightning: burn center, CPR, exit wound care
22
Q
Herpes simplex virus 1
A
labialis (lips/cold sores) keratitis (eye) whitlow (hands/fingers) gladiatorum (torso of wrestlers) sycosis (beard follicles) usually contracted during childhood
23
Q
herpes simplex virus 2
A
most sexually-transmitted anogenital herpes
lesions on genitals/perineum/anus
may cause cold sores
likely to be contracted during sexual contact (typically younger)
5th most common STI
24
Q
HSV 1/2
A
herpesvirus family
covered by glycopreotein coat
helps virus attach to host sell
25
vesicular rash
dermatome eruption
localized skin region
innervated by single sensory spinal nerve
pattern may lead to misdiagnosis
26
HSV 1/2 s/s
may be asymptomatic or mild fever
prodrome (early): fever/flu-like symptoms (primary) pain, itching, tingling, burning, paresthesia (recurrent)
red/swollen area of skin/mucous membrane
painful vesicles
regional lymph nodes swell
vesicles open (painful ulcer then crusts)
primary genital herpes: dysuria/urinary retention, especially in women)
27
HSV 1/2 DX
```
viral culture (PCR)
serologic testing
```
28
HSV 1/2 TX
antiviral meds (acyclovir, valacyclovir, famciclovir)
not curative, control s/s and shorten outbreak, supress recurrent episodes
anagesiccs (acetominopehn, ibuprofen)
cool compress
sitz bath (for genital herpes/dysuria, dilute urine, decreases burning)
29
acyclovir, valacyclovir, famciclovir
antivirals
selectively inhibit replication of viruses
short-half life (admin PO up to 5x a day)
SE: few, nephro/neuro toxic if IV, resistance can develop
interx: concurrent use w/ nephrotoxic agents
C
30
herpes zoster
shingles
chronic viral skin condition
caused by reactivation of varicella-zoster virus
first VZV infection causes chickenpox then viral particles travel to other structures and become dormant
cell-mediated immunity prevents virus reactivation but that decreases with age
zostavax vaccine recommended 60+
31
herpes zoster pathogenesis
latent varicella-zoster virus reactivated
spreads
panful rash develops
usually preceded by a prodrome
onset: malaise, fever, chills, myalgia, HA, nausea
32
herpes zoster s/s
typically affects one dermatone (tingling, itching, burning, numbness, pain, increased sensitivity to touch)
initial: macuales and papules on red base, vesicles spread over the dermatome, vesicles open and crusts form, painful skin lesions persist, rash 10 days - month
33
herpes zoster opthalmicus
involves opthalmic division of trigeminal nerve
may cause visual impairment
retinal necrosis
requires emergent treatment by opthalmologist
complication of shingles
34
ramsay-hunt syndrome/herpes zoster oticus
involves facial nerve CN7
risk of hearing loss or permanent facial weakness
emergent treatment required
complication of shingles
35
posterherpetic neuralgia PHN
most common complication of shingles
| burning, itching pain w/ periods of lancinating pain
36
other herpes zoster complications
encephalitis/aseptic meningitis
bacterial superinfection of lesions
cranial or peripheral nerve palsies
pneumonitis hepatitis
37
herpes zoster TX
antiviral meds
if initiated w/in 72hrs of first lesions: shortens duration/severity
antivirals started later may benefit those (50+, complications)
glucocorticoids (may decrease pain/hasten healing in patients over 50 w/ no other contras)
38
post-herpatic neuralgia TX
gabapentin (analog of GABA, binds and modulates influx of calcium = decreased neurotransmitter release)
TCA ex amitriptyline/doxepin/imipramine (inhibit reuptake of serotonin/norepinephrine)
39
human papillomavirus (HPV)
warts in skin
occur anywhere on skin or mucous membranes
most lesions = benign
some HPV (genital) linked to dysplasia/cancer
specific to humans
40
HPV patho
enters skin via small openings, infects epidermal basal layer
viral replication in cell nuclei
causes structural abnormalities
triggers epidermal cell changes = wart
41
HPVs/s
lesion presentation varies due to selectivity of HPV
specific serotypes affect specific areas
ex: flat, papular, pedunculated
42
HPV (warts) TX
treats cutaneous warts
doens't eradicate HPV or prevent HPV transmission
HPV does not respond to antiviral meds
50% resolve w/out TX w/in 1 year
43
HPV TX
```
salicylic acid (topical kertolytic agent, chemically destroys wart)
antiproliferative topical agents (podophyllin) chemodestructive agents (trichloroacetic acid)
second line: cryotherapy
surgical intervention (electrosurgery, excision)
```
44
atopic dermatitis
eczema
genetic component of FLG gene
chronic recurring itchy inflammatory disorder
associated w/ increased IgE
affected individuals often have other atopic disorders (asthma, allergic rhinitis)
most often in children may persist into adulthood
environmental factors (extreme heat/cold, low humidity)
45
atopic dermatitis & immune system
increased IgE (increased IgE sensitization)
imbalance of T-cell subsets
predominance of T-helper 2 cells (produce inflamm cytokines)
increased eosinophils/mast cells
reduction in antimicrobial peptides
less movement of neutrophils to skin
toll-like receptor defects
high-risk for bacterial/viral/fungal infections
46
atopic dermatitis s/s
exacerbation and remission of dry itchy red skin
begins in infancy
constant pruritus (prevailing symptom, preceds eczematous rash)
skin excoriations adn lichenification
xerosis and crusting lesions
negative impact on overall quality of life
47
atopic dermatits DX
based on s/s
| pruritius distribution chronic w/ recurring flare-ups
48
atopic dermatitis TX
topical agents (moisturizers, oatmeal, corticosteroids, topical calcineurin inhibitors)
lukewarm water baths (for removal of scales, crusts, allergens, follow w/ moisturizer while wet)
cool-mist humidifiers (year-round)
wet-wrap therapy wet-to-dry (significant flare-ups, apply topical corticosteroid, wrap saline-soaked bandages/gauze, dry outside layer bandage/gauze)
49
cyclosporine
calcineurin inhibitors
immunosuppresant (binds to calcineurin & disrupt T cells)
less toxic to BM
SE: reduction in urine output, half will experience HTN/tremor, HA, gingival hyperplasia, elevated hepatic enzymres
BBW: only admin by those experienced in immunosuppressive therapy
interx: phenytoin phenobarbital carbamazepine rifampin (decrease elvels) antifungal drugs, ACE inhibitors, NSAIDS macrolids (^ levels) grapefruit juice can drastically raise cyclosporine levels
C
50
cyclosporine WBC/platelet levels
can't be <4000 WBC
or
<75000 platelets
51
psoriasis
```
immune-mediated disease
noninfectious
hyperproliferation of keratinocytes
decreased epidermal cell turnover rate
inflamm
thickening of dermis & epidermis (shed repidly 4-7 days)
```
52
psoriasis s/s
```
plaques (round/oval well-demarcated)
auspitz sign (removal of scale results in pinpoint bleeding)
```
53
psoriasis TX
corticosteorids (betamethasone/hydrocortisone acetate
vitamin D analogs
topical retinoids calcieurin inhibitors
phototherapy biologic agents
54
hidradenitis suppurativa
genetic/immunologic/hormone/environment
occlusion of hair follicle > hyperplasia of follicular epithelium > collection of cellular wastes > cyst formation in sweat gland adjacent to follicle > abscess & tract formation > keloid-like scarring
lesions develop in skinfolds
55
hidradenitis suppurativa TX
```
lifestyle changes (tobacco cessation)
diet (avoid diary & eat low-glycemic diet)
stage III: extensive surgery is only permanent cure
```
56
benign neoplasms
noncancerous types of tissue proliferation
may be mistaken for cancer
can be premalignant
57
photodermatitis
photosensitivity (sun poisoning)
| immune response to UV rays
58
solar urticaria
skin cells may function as photoallergens
| photodermatitis
59
photoallergy
type IV cell-mediated response to sun
60
phototoxicity
UV light generates free radicals & inflamm mediators
61
photodermatitis s/s
urticaria in sun-exposed skin
acute: wheezing, dizziness, fainting, erythema, pruritis, papules, vsicles, eczema, skin pain, chills, HA, fever, N
chronic: skin thickening, scarring
62
actinic keratosis
non inflamm skin disease
skin damage from sun/tanning-device
chronic UV exposure causes keratinocyte changes
63
actinic keratosis s/s
```
thick rough crusting or scaly areas
bald head
face
ears
lips
back of hands
forearms
shoulders
neck
```
64
actinic keratosis TX
```
cryotherapy
chemical peal
curettage
laser
5-fluorouracil cream
diclofenac sodium gel
imiquimod cream
```
65
hemangioma
strawberry mark
congenital (10-12% of infants)
collection of blood vessels in or beneath skin
66
hemangioma s/s
bright red, slightly raised lesions
if beneath skin will appear bluish
50% on head/neck
67
hemangioma TX
usually disappear w/out intervention
laser: if impairs vision or breathing
corticosteroids: shrink lesion prior to laser
68
nevi (moles)
congenital or occur later in life
usually benign
may become cancerous
sun exposure can promote malignant changes
proliferation of altered melanocytes grow in clusters
69
moles s/s
macules
papules
small plaques varying in color/size/shape
typical: symmetric/regular borders
atypical: multicolord, asymmetric, irregular shape, may evolve to melanoma
70
moles TX
typical: none
atypical: surgical removal
71
acrochordons (skin tags)
develop where skin rubs on skin (neck, axillae, groin)
r/t insulin resistance, dyslipidemia, HTN, elevated c-reactive protein
friction leads to soft papules ons talk
72
skin tags s/s
pedunculated papules
flesh colored/dark pigmentation
usually painless
73
skin tag TX
cryotherapy
| excision
74
lipomas
family tendency
arise from mesoerm
made up of mature adipose cells in fibrous sheath
grow under skin in subQ tissue
75
lipomas s/s
may be single or multiple
| smooth, soft, doughy, rubbery, painless
76
lipomas TX
only needed if complications or changes
liposuction
surgical excision
77
skin cancer
```
most common cancer in US
1 in 5
increased incidence past 30 years
most common: basal cell carcinoma / squamous cell carcinoma
most dangerous: melanoma
```
78
basal cell carcinoma
UV rays damage DNA in cell nucleus
| arises from bottom layer (base) cells of epidermis, hair follicles, sweat glands
79
basal cell carcinoma causes/RF
repeated/prolonged UV exposure
| chronic sun exposure, fair complexion, immunosuppression
80
basal cell carcinoma s/s
most often in sun-exposed areas
81
basal cell carcinoma TX
```
requires biopsy then removal of lesion
immune modulator (imiquimod)
```
82
squamous cell carcinoma
arises from damaged, unrepared DNA in nucleus of squamous cells of epidermis
UV radiation triggers cancerous keratinocyte transformation
risk if sun exposure/fiar complexion
83
squamous cell carcinoma s/s
firm, smooth, hyperkeratotic papules or plque w/ ulcer in center
non-healing sore that bleeds easily
sun-exposed areas
84
squamous cell carcinoma TX
requires biopsy/removal of lesion
topical chemo
radiation or systemic chemo if metastasis present
85
melanoma
not fully understood
linked to genetic mutations
least common, most dangerous
melanocytes mulitply rpaidly & form cancerous tumors
86
melanoma s/s
```
most often brown/black color
asymmetrical irregular
large diameter
enlarging macule papule or nodule
appears as sores, lumps, new moles after 30, color changes in skin, changes in existing mole
```
87
melanoma TX
```
biopsy and complete excision
lymphadenectomy if metastasis
surgery
immunotherapy
chemo
radiation
```
88
melanoma warning signs ABCDE
asymmetry (two halves differ in shape)
borders (irregular, uneven, notched, scalloped)
diameter (more than 1/4 inch)
evolving (new mole if 30 +, changing mole or mole differs from others)
89
vitiligo
exact cause unknown
| loss of functional melanocytes in skin/hair/mucous membranes
90
vitiligo s/s
milky-white or chalk white hypopigmented
| hands arms feet trunk & face most common
91
vitiligo TX
```
will never restore all skin color
phototherapy, laser therapy, steroid therapy, topical tacrolimus ointment
depigmentation therapy
use higher SPF
cosmetic coverups
```
92
cafe au lait spots
increased melanin spots on skin
neurofibromatosis type 1 commonly associated
usually benign
93
cafe au lait spots s/s
```
flat, light/dark brown lesions
irregular or smooth borders
vary in size
present at birth
darken with age
no TX required
```
94
solar lentigo
cauesd by UV light exposure
| UV light induces epidemral hyperplasia > increased pigmentation
95
solar lentigo s/s
```
tan, brown, black macules
well demarcated and surrounded by normal skin
variable in size
irregular in shape
sun-exposed areas
```
96
solar lentigo TX
usually benign
biopsy may be needed to r/o precancerous or melanoma
aimed at reducing appearance
97
alopecia
various causes
hair growth cycle shortens
affected hair follicles stop replacing lost hair
98
androgen alopecia
androgen receptors cause excess of androgen in hair follicles
99
alopecias/s
androgen alopecia; starts around temples & progresses to top of scalp
100
alopecia TX
males: minoxidil/finasteride
females: oral contraceptives/spironolactone (finasteride not used in women r/t teratogenic)
101
alopecia areta
autoimmune, strong genetic connection
inflammatory cells attack hair follicles
hair shaft weakens and breaks at or near skin surface
102
alopecia areata s/s
well-demarcated patches of hair loss
asymmetric
may progress to alopecia totalis (scalp) or alopecia universalis (entire body)
103
alopecia areata TX
may spontaneously recover
topical steroids (minoxidil intralesional)
corticosteroid injections
topical immunotherapy
