Flat Macule Petechiae Ecchymosis Infarct Sclerosis Depressed Atrophy Ulcer Fissure Erosion Elevated Papule Plaque Nodule Wheal Vesicle, bulla Pustule Abcess Lichenification Crust (exudate)

Flat Macule: change in the color of the skin Petechiae: small (1 - 2 mm) red or purple spot Ecchymosis: larger red or purple spot Infarct: small localized area of dead tissue resulting from failure of blood supply Sclerosis: hardening of skin Depressed Atrophy: thinning or depression of skin Ulcer: sore with disintigeration of skin Fissure: crack Erosion: loss of superficial layers Elevated Papule: dome shaped lesion Plaque: solid, flat topped Nodule: solid, more than 1 cm Wheal: circular, red border, pale centers Vesicle, bulla: circular, fluid filled, small Pustule: pus filled Abcess: larger, fluid/pus filled Lichenification: thickening, perhaps from scratching Crust (exudate): layer of dried serum

AKA: Winter Itch Emollients (petrolatum, mineral oil, glycerine, propylene glycol) Keratinolytics (urea, lactic acid) When really bad, breaks down skin to let emollients in Soap-free cleansers (Cetaphil) Steroids Antipruritics (systemic, topical (not)) Benadyrl, Sarna lotion NOT topical because is a sensatizer, can get sensativities Less showers

Dandruff Seborrheic Dermatitis Psoriasis Normal skin turns over in 21 days Psoriasis turns over in 3 days

Better in summer, aggrevated by stress, difusse, pruitis, bald spots will have no dandruff, uncommon in children Wash Cytostatics Pyrithione zinc Selenium Coal tar Kertatolytics Least potent, use if super scaly Salicylic acid Sulfur Ketoconazole Could encourage resistance, don't use randomly

Derm 1 Flashcards by Rachael Gerboth

Type of lesion
Arrangement
Distribution

Vesicular, red, hot and inflamed, on trunk (not cross midline), follow dermatome
Shingles, terrible pain for a while and then get rash, lots of nerve pain
Vesicular, erythramateous, dermatome
Keep cool, moist packs, water, antiviral, pain pill (NO CREAMS/OINTMENT), creams too much for the first day, not rub on it
Capsaicin after lesion gone

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Flat
- Macule
- Petechiae
- Ecchymosis
- Infarct
- Sclerosis
Depressed
- Atrophy
- Ulcer
- Fissure
- Erosion
Elevated
- Papule
- Plaque
- Nodule
- Wheal
- Vesicle, bulla
- Pustule
- Abcess
- Lichenification
- Crust (exudate)

Flat
- Macule: change in the color of the skin
- Petechiae: small (1 - 2 mm) red or purple spot
- Ecchymosis: larger red or purple spot
- Infarct: small localized area of dead tissue resulting from failure of blood supply
- Sclerosis: hardening of skin
Depressed
- Atrophy: thinning or depression of skin
- Ulcer: sore with disintigeration of skin
- Fissure: crack
- Erosion: loss of superficial layers
Elevated
- Papule: dome shaped lesion
- Plaque: solid, flat topped
- Nodule: solid, more than 1 cm
- Wheal: circular, red border, pale centers
- Vesicle, bulla: circular, fluid filled, small
- Pustule: pus filled
- Abcess: larger, fluid/pus filled
- Lichenification: thickening, perhaps from scratching
- Crust (exudate): layer of dried serum

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Which does not describe:
A.Linear
B.Vesicles
C.Ulcer
D.Erythema

How treat?

Water and itch correlation

Not an ulcer
Rhu sensitivity
Not put anything on it when it is weepy like this
Water the first days, creams in the secondary days
Water and itch
- Cooling effect
- Evaporates and vasocontricts, less itching mediators to surface

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Atopic Dermatitis

AKA: Eczema
Erythema
Chapping
Pruritus
Papules
Vesicles
Excoriation
Lichenification
Infection (S. aureus)
Chronic
Redness in acute phase, dryness I
- Excoriating, digging, thickening like elephant, from scratching, cause infection
If not responding, might be infection
Common spot is flexor surfaces

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Eczema: Definition

Pruritic skin condition PLUS (3 or more)
- Onset < 2 years of age
- Skin crease involvement
  - Flexural dermatitis
Generally dry skin
Other atopic disease (personal or family member)

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When to Refer for Derm

Severe
Intense pruritus
Extensive involvement
<2 years of age
Infected

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Atopic Dermatitis: Treatment

Stop “itch-scratch cycle
Hydration
- during chronic phase
Avoid triggers
- Allergies
Prevent infection
Emollients
- grease, petroluem jelly, Vaseline, mineral oil, Always
Antihistamines
Hydrocortisone
Bath oils
- get in water, prune up, then put on bath oil
- Not waterproof yourself and then get in bath
No soap
- Cetaphil, baby soap, not wash away oils

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Xerosis:

Pruritic
Rough
Scaling
loss of flexibility
“Cracked”
ichthyosis

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Xerosis: Marker for Systemic Diseases

Treat underlying cause, but in meantime, need to treat the xerosis
Hypothyroidism
Lymphoma
Kidney disease
Sarcoidosis
Ichthyosis
Atopic eczema
Drug side effects
- Lithium, Vit A, niacin

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Xerosis: Treatment

AKA: Winter Itch
Emollients (petrolatum, mineral oil, glycerine, propylene glycol)
Keratinolytics (urea, lactic acid)
- When really bad, breaks down skin to let emollients in
Soap-free cleansers (Cetaphil)
Steroids
Antipruritics (systemic, topical (not))
- Benadyrl, Sarna lotion
- NOT topical because is a sensatizer, can get sensativities
Less showers

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Scaly Dermatoses

Dandruff
Seborrheic Dermatitis
Psoriasis
- Normal skin turns over in 21 days
- Psoriasis turns over in 3 days

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Dandruff: Treatment

Better in summer, aggrevated by stress, difusse, pruitis, bald spots will have no dandruff, uncommon in children
Wash
Cytostatics
- Pyrithione zinc
- Selenium
- Coal tar
Kertatolytics
- Least potent, use if super scaly
  - Salicylic acid
  - Sulfur
Ketoconazole
- Could encourage resistance, don’t use randomly

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Seborrheic Dermatitis: What it is and Treatment

Yellow/oily lesions on red skin – hair line, nasolabial folds, scalp, axillae, sternam or goin
- occurs where sebacous glands (scalp, face, trunk)
- Red, scaly, itchy, well demarcated
- Worse in winter
- Parkinson’s, zinc deficiency, endocrine states associated with obesity, and HIV
Wash/shampoo
- will run down face
Cytostatics
Keratolytics
Ketoconazole*
- When immunocompromised or obvious overgrowth
Steroids
- because more inflammed
- Kenlog aresol, looks less greasy

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Psoriasis

Non-contagious, chronic inflammatory disease
Causes: environment, infection, steroid withdrawl, stress, endocrine changes
Start as papules and coelece to plaques, well demarcated, silvery scales (mineral mica)
Extensor, back, trunk, scalp
Nails: Onychomycosis
Psoriasis arthritis: assymetric
Treatments:
- Emollients
- Cytostatics
- Steroids
- Calcipotriol
- Retinoids
- PUVA, UVB
- Methotrexate
- Immunomodulatory Agents (alefacept, etanercept, etc.)

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Contact Dermatitis

Inflammatory skin condition characterized by inflammation, redness, itching, burning, stinging and vesicle and pustule formation on dermal areas exposed to irritant or allergenic agents.
ICD (irritant), ACD (allergic)
Poison ivy, posion oak
Inflamed, red, itchy, blisters
Treatment:
- General
  - Cool with water first, then use below
- Topical anesthetics
  - NOOO!
- Steroids
  - back of loggers hands, not work, too thick
- Topical antipruritics
  - Calamine lotion
- Astringents
- Antihistamines
- Bentoquam (Ivy Block)
  - you put on BEFORE

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Diaper Dermatitis

Erythramateous, fussy, hot
Reasons for diaper rash
- Friction and Moisture
- Overgrowth (killed good bacteria and bad overtook)
Change diapers frequently, cool and dry it, get air time (lock him in the kitchen on lineoleum)
- Vasocontrists during air time
Wants protection
- Not ointment, lock in moisture and not want fungi
Use cream: Destin,
Baby powders are okay, cornstarch can cause overgrowth (fungus and yeast love cornstarch)
If in the creases, then yeast
- Clotrimazole cream because ointment be bad because yeast like moisture
Need to do both
- Need antifungal cream, mix in steroid
- 15g clotrimazole, 15 g, 1/2?% or 1%
- Yeast love steroid by itself
- Use ointment as a protectant (bag balm, desatin, etc.)
- For refill, steroid not needed, just use antifungal cream

UV Radiation

UVC (200-290 nm band)
UVB (290-320 nm band)
- Sunburn radiation, skin cancer, aging
- Vit D
UVA (320-400 nm band)
- Photosensitizing, skin cancer, aging

Sunscreens

MED – minimal erythema dose
- 2 MED is red, 4 MED pain, 8 MED blister
SPF – sun protection factor
- MED protected/MED unprotected
- SPF 10 means that it takes 10 times longer to get burned
SPF 15 – 93% of UVB; SPF 30 – 96.7% of UVB; SPF 40 – 97.5% of UVB; SPF 70 – 98.6% of UVB
UVA? (Broad Spectrum)
Waterproof

Sunscreens: Types

Chemical
- Aminobenzoic acid (PABA) – UVB; major sensitizer
- Anthranilates – UVA (weak), combos
- Benzophenones – UVB, UVA
- Cinnamates – UVA, UVB
- Dibenzoylmethane – UVA
Physical – UVR
- Zinc oxide, titanium dioxide

Sunscreen Changes

SPF only
- Helps prevent sunburn
Broad Spectrum SPF <15
- Helps prevent sunburn
Broad Spectrum SPF >15
- Helps prevent sunburn, decreases skin cancer and early aging
Water Resistant

How Would You Evaluate?

A. Shape

B. Irreg. Borders

C. Color(s)/changing

D. > pencil eraser size (6 mm)

ABCD for melanoma

What is the diagnosis?

A. Benign photoaging skin lesion

B. Possible malignant melanoma

C. Actinic keratosis

D. Seborrheic keratosis

Yes, benign photoaging skin lesion
Not melanoma, same color and regular border
Not AK
Yes, seborrheic keratosis

Seborrheic Keratosis

AK vs. SCC

AK: actinic keratosis, was the front picture
- bald areas, wrists and forearms
- rough spot on ear/forehead
- sting/rough when rub
- Cryotherapy and freeze off, can go to SCC
SCC: Squamous cell carcinoma, this picture
- if freeze and comeback, need to biopsy
Bottom Line: Refer

What is this?

Basal cell carcinoma, pearly dome like leison on side of nose

What is this?

* Melanoma * A: Asymmetric shape * B: Border irregular or poorly defined border * C: Color variation or change in color * D: Diameter larger than pencil eraser

Burns

* 1st, 2nd, 3rd degree * Superficial * Superficial, partial thickness * Deep partial thickness * Full thickness * Minor, Moderate, Major * Treat OTC: 2% superficial, superficial partial thickness, not involving eyes, ears, face, genitalia, not chemical/electrical, healthy * Cool water * **NO OINTMENT** until later in treatment * Aleve for pain * Tetanus status?