Derm Flashcards
Epidermis
Superficial layer
Barrier from environment, waterproof
Dermis
Blood vessels, hair follicles, sebaceous glands, sweat glands, nails, apocrine glands
-Provides flexibility, strength, and sensation
Subcutaneous hypodermis
Deepest layer, Subq fat (conserves heat) and connective tissue, fibroblasts, macrophages
Layers of Epidermis (5)
- Corneum: superficial, shedding skin
- Lucidum: on palms and plantar
- Granulosum: keratinization
- Spinosum: spiny cells, strength and flexibility
- Basale: keratinocytes
Types of cells in Epidermis (4)
-Keratinocytes, melanocytes, merkels, langerhans
Papillary Dermis
superficial dermis, loose collagen bundles
Reticular dermis
Deep dermis, densely packed and thick collagen bundles
Eccrine glands
- palms, soles, forehead
- No odor
- releases salt and water to cool body
- covers most of body, opens to skin surface
Apocrine Glands
- axillary/genital regions
- thick colorless fluid
- bacteria react with fluid to cause odor
- Triggered by nervous system: stress, exercise, hormones
- Secretes into the sac of hair follices
Vellus hairs
short and fine (forehead)
Terminal hairs
Long/thick (scalp)
Bulb of hair
- base of follicle
- matrix cells at inferior aspect
- melanocytes within matrix- pigmentation
Functions of skin (5)
-Protection, fluid loss, vitamin D, sensory info, body temperature regulation
Equipment needed for derm exam
Light source (daylight is best), tape measure
During history taking, consider these aspects…
-Recent travel, hx sun exposure, occupation, pregnancy, duration of condition, new medications, new hygiene products, food allergies, comorbid conditions
Make sure to check between..
Toes, axillae, thighs, between legs, fingers, buttocks, genitals
Dermoscopy
- Trans illuminating light with magnification
- Requires additional training to be proficient
General skin inspection
- Symmetry
- Color: pigmentation, cyanosis, jaundice
- Hair: distribution, quantity
- Nails: capillary refil, color, lesions
Skin palpation
Moisture, temperature, texture, turgor
Turgor
checks for dehydration, skin should rebound after pinching
Checking temperature hand positioning
Dorsal side touching patient
Checking texture hand positioning
Palmar side touching patient
Morphology of skin lesion is assessed by?
Visual inspection, tactile inspection
Characteristics of Skin lesions (5)
- Distribution
- Shape/arrangement
- Border
- Pigmentation
- Palpation
Distribution (3)
- Localized: one small area
- Generalized: widely distributed on multiple areas at same time (back, face, UE, flexor/extensor regions) one place
- Regional: specific region of body
Round/discoid
Coin shaped, no central clearing, umbilicated
-seen with eczema
Oval
ovoid
seen in pityriasis rosea
Annular
Round, central clearing, active/jagged margins
-tinea infections
Dermatomal
Follows nerve pattern
-varicella zoster
Target lesion
- Pink macules with target in center
- Erythema multiforme
Linear
Erythematous streaks
-phytophotodermatitis
Serpiginous
Cutaneous larva migrans
Morbilliform
Measles-like
_erythematous maculopapular
Distinct Borders
Well-demarcated, can draw line around area
Indistinct
diffuse, poorly defined, rough edges
Irregular
Seen with malignant melanoma
-jagged edges, no sort of pattern
Raised
Center of lesion is depressed compared to surrounding edge
Flesh colored
surrounding skin color
Erythematous
variable shades of pink, red, coppery, salmon
Violaceous
light violet
Other coloration
Tan, brown, black, blue, hyperpigmented, hypopigmented
Blanchable
erythematous lesion that loses redness when pressed upon
Palpation of lesions look for (7)
- Consistency
- Mobility
- Blanchability
- Tenderness
- Depth
- Temperature
- Fluctuant
ABCDEs of melanoma
- Asymmetry
- Borders
- Color variation
- Diameter
- Evolution/elevation
Primary lesions
Arise from previously normal skin
Secondary lesions
Arise from changes in primary lesions usually due to infection, rubbing, crusting, scratching, malignancy
Macule
flat, non-palpable circumscribed color change
- <1cm diameter
- freckles
Patch
- flat, non-palpable, irregular shape at times
- > 1 cm in diameter
- Hypo/hyper pigemented
-cafe au lait
Papule
- Palpable, firm, circumscribed, flesh colored, red or brown
- <1cm
-seborrheic keratosis
Plaque
- Elevated, firm, palpable, skin colored/pinkish/red, may be scale
- > 1 cm
- psoriasis
Nodule
- elevated, circumscribed, deeper and firmer than papule
- > 1.5 cm
-epidermal inclusion cyst
Tumor/Lipoma
- large nodule deep in dermis
- > 2cm
-lipoma
Wheal
- irregular, raised, comes and goes, superficial edema
- hives, insect bites
Vesicles
- elevated, well circumscribed
- <1 cm
- fluid containing, usually clear
-chickenpox, herpes virus
Bullae
- elevated, well circumscribed
- > 1 cm
- Serous fluid
-bullous pemphigoid
Pustule
-elevated, superficial, well circumscribed
–pus filled
-folliculitis
Furuncle
- Boil
- usually staph aureus
-one hair follicle infected
Carbuncle
- multiple hair follicles infected with staph aureus
- may progress to abscess
Primary Lesions (10)
- Macule,papule
- Vesicle, bulla, pustule
- Papule, plaque, nodule, tumor, wheal
Secondary Lesions (8)
- Crust, scale
- Fissure, erosion, ulcer
- Excoriation, atrophy, lichenification
Crust
- dried serums, pus, blood
- adherent
- bacterial
-impetigo
Scale
- hyperkeratosis
- accumulation of corneum
- increased proliferation or delayed desquamation
-psoriasis
Fissures
- linear cleft, painful
- drying, skin thickening, loss of elasticity
-irritant dermatitis
Erosion
- partial or complete loss of epidermis
- moist, oozing, crusted lesion
-SJS, pemphigus foliaceus
Ulceration
deeper defect with loss of entire epidermis plus superficial dermis
- loss or entire dermis
- venous stasis ulcer
Excoriation
- scratch marks
- liner or rounded
- exogenous injury
-neurotic excoriations
Epidermal atrophy
thinning of epidermis, shiny appearance, wrinkling
Dermal atrophy
loss of collagen, leads to depression
Lichenification
thickening of epidermis
increased visibility of skin markings
lichen simplex chronicus
Petichiae
Purpura
> 0.5 cm
non-blanchable
round, irregular, deep red
Ecchymosis
purple lesions of variable size
fades to green yellow
bruising
blood outside vessels due to trauma or bleeding disorder
Spider angiomas
fiery red lesions
up to 2cm
blanch with pressure
seen with liver disease, sometimes pregnancy
Cherry angiomas
1-6 mm in size, non blanchable
Telangiectasias
blanchable, fine, irregular, rosacea, sun damaged skin, BCC
Hemangioma
benign vascular neoplasm that represents the most common tumor of infancy
red, irregular lesion secondary to dilation of dermal capillaries
Papulosquamous lesions
papules, plaques, and scales
psoriasis
Lichen PLanus
5 Ps
Pruritic, polygonal, purple, planar, papules
Nodular Lesions
Nevi
Cherry angiomas
Epidermoid cysts
Malignant Lesions
SCC- isolated keratotic and eroded papule or nodule
sun exposed areas
BCC: central ulcerations and telangietasias, pearly
Vesiculobullous lesions
Vesicles and bullae
Impetigo, herpes, pemphigus
Maculopapular lesions
Macules and papules
drug eruptions
viral exanthems
Clubbing
rounded, bulbous nail base
feels spongy
- Schamroths sign-diamond space between nails indicates no clubbing
- Lines grow out with the nails
- transverese depressions
Beaus line
inflammation of proximal and lateral nail folds
acute <6 weeks
chronic >6 weeks
Paronychia
nail grows into dermis
can become infected
Onychocryptosis
most white with a distal band of redish brown
no lunula
Terry Nails
areas of discoloration caused by trauma
Leukonychia
spoon shaped concave nail, iron deficiency
Koilonychia Spoon
painless separation of the nail plate from the nail bed
Onycholysis
fungal infection, plate of matrix
Onychomycosis
small punctate depressions
caused by nail matrix inflammation
