Derm 1 Flashcards
1
Q
- Type of lesion
- Arrangement
- Distribution
A
- 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
2
Q
- Flat
- Macule
- Petechiae
- Ecchymosis
- Infarct
- Sclerosis
- Depressed
- Atrophy
- Ulcer
- Fissure
- Erosion
- Elevated
- Papule
- Plaque
- Nodule
- Wheal
- Vesicle, bulla
- Pustule
- Abcess
- Lichenification
- Crust (exudate)
A
- 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
3
Q
Which does not describe:
A.Linear
B.Vesicles
C.Ulcer
D.Erythema
How treat?
Water and itch correlation
A
- 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
4
Q
Atopic Dermatitis
A
- 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
5
Q
Eczema: Definition
A
- 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)
6
Q
When to Refer for Derm
A
- Severe
- Intense pruritus
- Extensive involvement
- <2 years of age
- Infected
7
Q
Atopic Dermatitis: Treatment
A
- 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
8
Q
Xerosis:
A
- Pruritic
- Rough
- Scaling
- loss of flexibility
- “Cracked”
- ichthyosis
9
Q
Xerosis: Marker for Systemic Diseases
A
- 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
10
Q
Xerosis: Treatment
A
- 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
11
Q
Scaly Dermatoses
A
- Dandruff
- Seborrheic Dermatitis
- Psoriasis
- Normal skin turns over in 21 days
- Psoriasis turns over in 3 days
12
Q
Dandruff: Treatment
A
- 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
- Least potent, use if super scaly
- Ketoconazole
- Could encourage resistance, don’t use randomly
13
Q
Seborrheic Dermatitis: What it is and Treatment
A
- 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
14
Q
Psoriasis
A
- 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.)
15
Q
Contact Dermatitis
A
- 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
- General
16
Q
Diaper Dermatitis
A
- 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
21
Q
How Would You Evaluate?
A
A. Shape
B. Irreg. Borders
C. Color(s)/changing
D. > pencil eraser size (6 mm)
ABCD for melanoma
22
Q
What is the diagnosis?
A. Benign photoaging skin lesion
B. Possible malignant melanoma
C. Actinic keratosis
D. Seborrheic keratosis
A
- Yes, benign photoaging skin lesion
- Not melanoma, same color and regular border
- Not AK
- Yes, seborrheic keratosis
23
Q
Seborrheic Keratosis
A
24
Q
AK vs. SCC
A
- 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
25
Q
What is this?
A
Basal cell carcinoma, pearly dome like leison on side of nose
26
Q
What is this?
A
- Melanoma
- A: Asymmetric shape
- B: Border irregular or poorly defined border
- C: Color variation or change in color
- D: Diameter larger than pencil eraser
