Derm Flashcards
Epidermis
Superficial layer-contains & maintains & carotene
Dermis
Contains connective tissue, sebaceous glands, sweat glands, hair follicles and provides blood supply & nutrition to epidermis
Adipose tissues
fat layer, surrounds
Actinic purpura
-purple patches or macules may appear where blood has leaked from capillaries into the dermis
Normal findings of aging
-check for signs of sun exposures
-letigines (liver spots)
-actinic keratoses (superficial flattened papules covered by dry scales)
Medications that cause photosensitivity
Medications that cause photosensitivity or secondary skin cancers. Cipro, Doxy, Levaquin, Bactrim, Voriconazole,
Macules
-flat, colored lesions < 2cm
Patch
-large, flat lesion > 2cm (size is only difference from macule)
Papule
small, solid lesion <0.5 cm raised above the skin
Nodule
Larger, solid lesion 0.5-5.0 cm (differs from papule only in size)
Plaque
Large > 1 cm flat topped raised lesion
Vesicle
Small fluid filled, transclucent lesion <0.5 cm raised above skin
Pustule
a vesicle filled with leukocytes
Bulla
fluid filled, raised often translucent lesion >0.5 cm
Wheal
raised erythematous, edematous papule or plaque usually representing rapid vasodilation or vasopermeability
Telangiectasia
dilated, superficial blood vessel
Contact Dermatitis: skin rash
-Hypersensitivity reaction
-T lymphocyte mediated
-Irritant versus Allergy
Treatment:
-Identify the offending agent & remove it
-Severe reactions: Systemic steroids may be needed
—Prednisone 1 mg/kg, usually < 60 mg day
—Taper over 2-3 weeks
—May need allergy testing
High Potency steroid for contact dermatitis: Generally limit high-potency TCS to <2 weeks duration
-Betamethasone diproprionate
-Clobestasol proprionate
-Halobetasol propionate
-Desoximetasone
-Fluocinonide
Medium potency steroid for contact dermatitis
-Betamethasone valerate
-Triamcinolone acetate
-Flurandrenolide
-Fluticasone propionate
-Fluticasone propionate
Low potency steroid for contact dermatitis
-desonide
-hydrocortisone
Eczema
-Chronic disease w/ flares
-3 phases from childhood to adulthood (early puberty)
-Commonly on Flexor surfaces (hands/eyelids)
-Pruritic, dry, scaly skin, inflammation
-Develop erosions / excursions & hyperpigmented plaques
Triggering factors of eczema
Temperature changes, excessive hand washing, contact with irritants, food, emotional stress
Treatment of Eczema
-Topical steroids
-May need antibiotic if associated Staph infection
-Antihistamines
-May need oral steroids in severe cases
-Light Therapy
-If severe-may warrant wet wraps or phototherapy
Psoriasis
-Many types
-Most common is plaque psoriasis
-Commonly a trigger such a stressful event, strep throat, medications (lithium, antimalarials, beta blockers), cold/dry weather, cut/scratch or bad sunburn
Psoriasis: etiology
-Chronic inflammatory skin condition
-T cell mediated disorder
-Genetic component
-erythmatous, sharply demarcated papules & rounded plaques
-silvery scales
-extensor surfaces like elbows, knees, gluteal cleft and scalp
Psoriasis Treatment
-Keep skin well hydrated
-Mid-potency topical glucocorticoids
-NO ORAL STEROIDS (risk of developing life-threatening pustular psoriasis)
-May use methotrexate in severe cases
-Topical Vitamin D analogues
-UV light
Carbuncle
-Abscess filled with pus / dead tissue
—-Pea sized to golf ball sized
—Sometimes so deep they cannot drain itself
-Caused by bacterial infection, usually Staph Aureus
-Contagious
Treatment:
Excision and drainage
Antibiotics
Dermatophytosis
-Fungal infections of the hair, skin or nails
-Tinned Capitis – Ringworm on the head
-Tinea Corporis – Ringworm on body
-Tinea Cruris – Jock itch
-Tinea/Pityriasis Versicolor – Short sleeve shirt distribution
-Tinea Pedis – Athlete’s foot
-TineaUnguium/Onychomycosis – Nails
-Tinea/Pityriasis Versicolor – Short sleeve shirt: Treatment
-Daily application (no more than 10 minutes) of lotions or Shampoos that contain sulfur, salicylic acid or selenium sulfide; continue for 1-2 weeks after rash resolves
-PO agents are not approved for this (no lasting results)
Tinea Pedis-Athlete’s Foot
-Most common dermatophylte infection
-Often chronic
-Variable edema, scaling and puritis
-May be widespread or localized usually to web space of 4th and 5th toes
Treatment of Tinea Pedia-Athletes Foot
-Often need a combination of topical or oral antifungal agents
-Requires longer treatment courses due to frequent relapses
Herpes Zoster (Shingles)
-Reactivation of varicella-zoster virus
-Usually presents in older adults > 50
Predisposing factors:
Aging
Impaired immune system
Radiation
Local trauma
Surgical stress
Spinal cord tumors
Lymphoma
Fatigue
Herpes Zoster findings
-Prodromal symptoms of pain
-Malaise, fever, headaches
-Increased sensitivity to mild stimuli
-Characterized by unilateral pain; presenting prior to the rash
Herpes Zoster Physical Exam
-Grouped vesicles on an erythematous, tender base
-Usually unilateral rash along a dermatome
-May involve 2 or more dermatomes
-May occasionally cross midline with few lesions on opposite side
-Papules appear in 24 hours, progress to vesicles and bullae in 48 hours, then to pustules with cloudy fluid in 96 hours
-Crusts form in 7-10 days and heal in 2-3 weeks
Herpes Zoster Tx
-Antiviral therapy (Acyclovir 800 mg PO five times daily for 7-10 days)
Other PO tx:
-Famciclovir 500mg TID
-Valacyclovir 1000mg TID
-Foscarnet (IV option)
-Antipiuretic agents
-moist dressings QID or bath soaks w/ baking soda
-Zoster vaccination
-pain control
-isolation
Antivirals: Acyclovir/Valacyclovir
-Bottom of pyramid
-HSV
-VZV
Antivirals: Glanciclovir/Valganciclovir
-Medium of pyramid
-HSV
-VZV
-CMV
-HHV-6
Antivirals: Foscarnet
-Second to top of pyramid
-HSV
-VZV
-CMV
-HHV-6
-HHV-7
Antivirals: Cidofovir
-Top of pryamid
-HSV
-VZV
-CMV
-HHV6/7
-BK virus
-Adenovirus
Cabdidiasis
-Fungal/Yeast infection of mucous membranes or skin
-Bacterial overgrowth in GI tract in the setting of broad spectrum antibiotic use
Skin cancers
-Basal Cell Carcinoma (BCC)
-Squamous Cell Carcinoma (SCC)
-Melanoma
Actinic Keratosis
-Precancerous lesions caused by UV light damage
-Derm to follow
BCC
-Most common form of skin cancer
-caused by exposure to UV light
-DX by skin biopsy
-*Usually, the only sign of BCC is a growth on the skin
-Usually found on sun exposed skin areas-head, neck, back, hands, arms
-Dome-shaped skin growth; visible blood vessels; pink or skin colored. Or brown, back or with flecks.
BCC Tx
-Excision or surgical procedure to remove growth
—-Mohs procedure (extract border or healthy tissue)
-Cryosurgery
-Radiation
-Photo dynamic therapy
-Good prognosis if diagnosed early & removed
Squamous Cell Carcinoma
-Due to increased sun exposure
-Can occur anywhere on the body
-flat, reddish, scaly patch that grows slowly (Bowen’s disease)
-bump or lump grows, it may become dome-shaped or crusty and can bleed
-Biopsy for Dx
Melanoma Staging
-Stage 0 (in situ): confined to epidermis
-Stage 1-confined to skin but has grown thicker. Can be as thick as 1.0mm
-Stage 2-Grown thicker. Thickness ranges from 1.0->4.0mm. Skin covering melanoma may have broken skin. Cancer hasn’t spread
-Stage 3-melanoma has spread to nearby lymph node or nearby skin
-Stage 4-spread to internal organ
MRSA skin infection
-Methicillin-resistant Staphylococcus aureus (MRSA)- potentially dangerous type of staph bacteria, resistant to antibiotics commonly used to treat staph infections
-May cause skin and other infections
-Community acquired (healthy people) or health-care associated
-Spread by skin to skin contact
MRSA characteristics
-Present as small red bumps that resemble pimples, boils or spider bites
-Can quickly turn into deep, painful abscesses that require surgical draining.
-May involve only the skin, but can also burrow deep into the body, causing potentially life-threatening infections
Redman Syndrome
-Associated w/ vanco
-Hypersensitivity mast cell reaction; can cause anaphylactic reaction
-occurs in first 4-10 min or soon after infusion
Redman Syndrome Symptoms
-Pruritus, an erythematous rash that involves the face, neck, and upper trunk
-Hypotension and angioedema can occur
-Diffuse burning, itching and generalized discomfort
-Dizziness, agitation, headache, chills fever, and paresthesias around the mouth.
-Chest pain and dyspnea in severe cases
Redman Syndrome Tx
-Tx w/ antihistamines (diphenhydramine 50 mg IV)
-Abx such as cipro, ampho B, rifampin can cause this
-May pretreat to first dose to prevent reaction (diphenhydramine & H2 blocker)
-Once rash and itching resolve may resume at lower rate
Steven Johnson’s Syndrome (SJS) Erythema Multiforme
-Hypersensitivity reaction that develops in response to medications, infection or illness
-Common medications: Barbiturates, Penicillins, Phenytoin, Sulfonamides
Infections include: Herpes simplex, Mycoplasma
-Can be minor or severe (SJS)
-Exact cause unknown; occurs usually in children or young adults
-Symptoms: fever, malaise, arthralgias, pruritis, skin lesions (begins as flu like symptoms)-skin begins to blister and peel
SJS Toxic Epidermal Necrolysis
Lesions
-Rapid onset
-Circular, symmetrical nodule, papule or macule surrounded by pale red rings, also called a “target”, “iris”, or “bulls-eye” lesion
-May look like hives
-May have vesicles of various sizes (bullae)
-Located on the upper body, legs, arms, palms, hands, or feet
-May inv`olve the face or lips
SJS Treatment
-Antihistamines to control itching
-Moist compresses applied to the skin
-Oral antiviral medication if it is caused by herpes simplex
-Pain medication
-Topical anesthetics (especially for mouth lesions) to ease discomfort that interferes with eating and drinking
-Antibiotics to control any skin infections
-Corticosteroids to control inflammation
-ICU or burn care unit for severe cases (SJS)
-Intravenous immunoglobulins (IVIG) to stop the disease process
Urticaria (Hives)
-Chronic-hives lasting more than 6 weeks. More common in women. Usually related to autoimmune disease
-Angioedema-massive swelling in deeper tissues w/out wheals
MOA of Hives
1-IgE mediated histamine reaction causes plasma to leak from blood vessels into the tissues causing swelling
2-Complement mediated reaction typically with administration of whole blood, plasma, immunoglobulins, drugs & insect stings
3-Nonimmunologic release of histamines usually with drug reactions such as acetylcholine, opiates, polymyxin B or strawberries
Treatment of HIVES
-Antihistamines-H1 antagonists and H2 antagonists
-Corticosteroids (Prednisone, Methylprednisolone)
-Epinephrine (0.3mL/dose SQ/IM for severe hives/angioedema
H1 antagonists for Hives
First Generation (Sedating)
-Diphenhydramine (Benadryl), -Hydroxyzine (Atarax)
Second Generation (Non-sedating)
-Fexofenadine (Allegra),
-Loratidine (Claritin) or
-Cetirizine (Zyrtec)
H2 antagonists for hives
Ranitidine (Zantac), Famotidine (Pepcid)
