CH 5 Derm Flashcards
in dermatology assessment, assess..
assess the entire patient, not simply the skin problem
when there is a new lesion, ask?
which lesion is the oldest and which lesion is the newest?
primary skin lesion
the result from the disease process
ex: vesicles: fluid filled lesions, <1cm,
secondary skin lesion
lesions altered by outside manipulation, treatment, the natural course of the disease
ex: crust (raised lesion from dried serum and blood remnants from vesicle rupture)
Actinic Keratosis
Can be diagnosed visually
Actinic keratosis
location:
description:
location: sun-exposed skin (forehead, tip of ear/nose, eyebrows)
“loosely glued on skin”
red, brown, or flesh town, scaly, often tender. unchanged, spontaneously resolve, or progress to invasive SCC
Actinic Keratosis (AK) treatment
topical 5 fluorouracil (5-FU)
5% imiquimod cream
topical diclofenac gel
photodynamic therapy (PDT) with topical delta-aminolevulinic acid
Cryosurgery (liquid nitrogen)
medical grade laser or chemical peel
basal cell carcinoma (BCC)
location:
sun exposed areas
arises as NEW LESION
Squamous cell carcinoma (SCC)
location:
sun exposed areas
arises as NEW LESION or from AK
BCC Description:
papule, nodule with or central erosion
pearly or waxy appearance, distinct borders with or w/o telangiectasia
low cancer risk but if no tx, high risk
“an open sore that doesn’t heal”
SCC description:
red, conical hard lesions with or without ulceration
“more angry looking lesion”
cancer risk higher, can be anywhere but mostly on lip, oral cavity, genitalia
BCC
SCC
ABCDEE for malignant melanoma
Asymmetric
Irregular Borders
Color not uniform (shades of brown, black, red, blue, white)
Diameter (>6mm size of a pencil eraser)
Evolving (NEW) or change in longstanding lesion or nevus or pigmented lesion
Elevated (not always)
first line tx for Psoriasis vulgaris:
medium potency topical corticosteroids
first line tx for scabies:
permethrin lotion
first line for verruca vulgaris:
Imiquimod cream: immune modulator, cause body to create immunological action to keep wart in check)
warts caused by HPV (location of wart is a diff type)
first line tx for tinea pedis:
topical ketoconazole
antifungal
first line med for rosacea:
topical metronidazole
eczema
-antecubital fossa, dry scale skin pruritus, crusted or weeping sores x month
-worse during cold, dry weather
facial redness, swelling, pustular lesions over nose and cheeks with small visible blood vessels
-more common in light tone skin
Rosacea
if rosacea goes untreated..
hyperplasia occurs and permanently thickens. blood vessels become more visible
acute onset of pruritus, erythematous papules, and burrows on wrist or hands, between fingers
scabies
solitary salmon-colored scaling patch (herald patch) on the truck or limbs, enlarges over few days with similar lesions on chest, and, back over a few weeks with “Christmas tree” distribution
pityriasis rosea
self limiting
phytodermatitis
poison ivy, poison oak, poison sumac
phytodermatitis
poison ivy, poison oak, poison sumac
Use systemic corticosteroids for phytodermatitis (vs topical) when…
20% or more of total body surface area is affected, severe rash (ie lots of blisters), or have rash on face, genitals, hands and/or impacts job
Use which topical corticosteroids for phytodermatitis such as..
for thinner skin use…
mid or high potency = triamcinolone (0.1% kenalog Aristocort) or clobetasol (0.05% Temovate)
thinner skin (flexural surfaces, eyelids, face, anogenital), use lower potency like desonide ointment (Desowen) or oral therapy
ointment preferred
skin atrophy risk with long (2-3 wks) higher potency use
Which systemic corticosteroid for phytodermatitis (vs topical)?
prednisone 0.5 to 1 mg/kg/day PO x 5-7 days (relief after 1-2 days), then 5-7 additional days with 50% prednisone dose reduced to minimize the risk of recurrence
Total 10-14 days
adjunct therapies for phytodermatitis
cool compresses to relieve sx’s
calamine lotion
colloidal oatmeal baths to help dry and soothe oozing lesions
OTC analgesics to relieve pain
Oral histamines for pruritus
non bullous impetigo (non bullous= no large blisters)
erythematous macule rapidly evolves into vesicle or pustule, ruptures, dries, leaving honey colored exudates
bullous impetigo
-bulla with clear, yellow fluid that turns cloudy, dark yellow
rupture easily in 1-3 days and leaves rim of scale around red, moist base then brown acquired or scalded skin appearance
Most in infants and younger children
press lesion with finger and DOESN’T hurt child *so know it’s not child abuse burn
impetigo treatment (non bullous and bullous)
non bullous: topical antimicrobial (mupirocin/Bactroban)
-don’t give OTC bc not strong enough
bullous: systemic antimicrobial therapy
Erysipelas cellulitis
-subcategory of cellulitis
-superficial celllulitis form, face, legs arm
cellulitis
(infection of dermis & subcutaneous fat, heat, redness, discomfort
Cellulitis most likely organism
strep pyogenes
less common: staph aureus
MSSA (methicillin sus S aureus)
beta lactam producing MRSA
elevate legs
warm packs
tx systemic antimicrobial therapy
Cutaneous Abscess
-skin infection involving hair follicle and surrounding tissue (heat, redness, discomfort in region)
Staph Aureus
Med Treatment of MILD Cellulitis/erysipelas impetigo
if systemic therapy needed:
PO penicillin, cephalexin (preferred), dicloxacillin, or clindamycin (c diff risk)
for topical therapy with non bullous impetigo only: mupiricin
Mild Abscess treatment
abscess with MINIMAL redness around it
I&D and warm compresses
no antibiotics
Moderate abscess treatment
lesion and cellulitis around it
1. I&D and culture and sensitivity
- give empiric PO TMP/SMX or doxycycline (consider MRSA or MSSA)
- once C&S results come back, if need to switch meds:
- if MRSA: stay on PO TMP/SMX or doxy
-if MSSA: switch to PO dicloxacillin or cephalexin
treat for 7 days!
