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Senoir 21-2 > Derm (Dz Of The Skin) > Flashcards

Derm (Dz Of The Skin) Flashcards

1
Q

What are the 5 layers of the epidermis

A

Corneum – consists of dead cells, primary barrier function

Lucidum – appear lucent, very thin, only in thickest skin areas

Granulosum – keratinocytes lose nuclei & continue to flatten, appear granular

Spinosum – keratinocytes connected by desmosomes, Langerhans cells located here

Basal – constantly dividing keratinocytes, melanocytes located here

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2
Q

What is a macule

A

Primary lesion that is circumscribed, flat discoloration

1mm

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3
Q

Define a patch

A

A patch is a primary lesion macule that is greater than 1 cm

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4
Q

Define papule

A

Primary lesion that is elevated solid lesion less than 0.5 cm with variable color

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5
Q

Define a plaque

A

A primary lesion that is circumscribed, elevated, superficial, and solid that is greater than o.5 cm

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6
Q

Define a Nodule

A

A primary lesion

Circumscribed, elevated, solid nodule that is greater than 0.5 cm in diameter

When its larger is called a tumor

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7
Q

Define pustule

A

Primary lesion

A circumscribed collection of leukocytes and free fluid (‘pus’) that varies in size

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8
Q

Define vesicle

A

Primary lesion

A circumscribed collection of free fluid ≤ 0.5 cm in diameter

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9
Q

What is a bulla

A

Primary lesion

A circumscribed collection of free fluid > 0.5 cm in diameter

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10
Q

Define a Wheal (Hive)

A

Primary lesion

A firm edematous plaque resulting from infiltration of the dermis with fluid

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11
Q

Define scales

A

Secondary lesion

Excess dead epidermal cells that are produced by abnormal keratinization and shedding

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12
Q

Define crust

A

Secondary lesion

A collection of dried serum and cellular debris
“a scab”

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13
Q

Define erosion

A

Secondary lesion

A focal loss of epidermis
erosions do not penetrate below the dermoepidermal junction and therefore heal without scarring

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14
Q

Define Ulcer

A

2* lesion

A focal loss of epidermis and dermis;
ulcers heal with scarring

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15
Q

Define a fissure

A

2* lesion

A linear loss of epidermis and dermis with sharply defined, nearly vertical walls

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16
Q

Define excoriation

A

Special lesion

An erosion caused by scratching
often linear

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17
Q

Define Comedone

A

Special lesion \ A plug of sebaceous and keratinous material lodged in the opening of a hair follicle

the follicular orifice may be dilated (blackhead) or narrowed (whitehead)

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18
Q

Define milia

A

Special lesion

A small, superficial keratin cyst with no visible opening

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19
Q

Define cyst

A

Special Lesion

A circumscribed lesion with a wall and a lumen;
the lumen may contain fluid or solid matter

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20
Q

Define a burrow

A

Special lesion

A narrow, elevated, tortuous channel produced by a parasite

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21
Q

Define lichenification

A

Special lesion

An area of thickened epidermis induced by scratching

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22
Q

DEfine telangiectasia

A

Special lesion

Dilated superficial blood vessels

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23
Q

Define petechia

A

A circumscribed deposit of blood ≤ 0.5 cm in diameter

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24
Q

Define purpura

A

A circumscribed deposit of blood > 0.5 cm in diameter

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25
If its dry..
Wet it
26
If its wet..
Dry it
27
Xerosis Cutis
Aka DRY SKIN! Skin is rough, covered w/fine white scales, progresses to thicker tan or brown scales Severe: Crisscrossed & fissured Worse in dry winter months MC affects hands and lower legs —Itching (severe) or burning sensation Treatment: Emollients, 12% lactate lotion (Lac-Hydrin, AmLactin)
28
When are creams and lotions most effective for application
Most effective when applied to damp skin After shower or bath, pat dry & immediately apply moisturizer Apply as frequently as necessary to keep skin soft
29
How are wet Dz managed
Managed with Wet Compresses Suppresses inflammation -Debrides crust and serum Repeated cycles of wetting and drying eventually dry the lesion Excessive use OVERDRIES causing severe drying and chapping
30
What are the benefits of using a wet dressing
Inflammation suppression Wound debridement Drying effect Antibacterial action
31
What are the three effects of topical steroids
Anti-inflammation Vasoconstriction Anti-mitotic -Decreased proliferation of cells
32
What vehicle of steroids is best for cosmetics and intertriginous areas
Creams
33
What vehicle of steroid is most occlusive
Ointments Do not use on acute (exudative) eczematous inflammation or intertriginous areas
34
If using a solution or lotion in an intertriginous area What is the ADE
Stinging and drying may result when applied to intertriginous areas
35
How long should foams be used
NLT 2 weeks Suppression of Hypothalamic-Pituitary-Adrenal Axis Do not use if age < 12 yrs
36
What is the effect of applying a steroid after bathing
Steroid application after bathing increases absorption
37
If you think a pt has an allergy What should you send them for/
Patch testing
38
Should you use topical steroids in children under 2
No
39
Should you use steroids in Cushings pts
No
40
Should you use topical steroids in pts with glaucoma
No
41
What are the 5 most common mistakes of topical steroid therapy
Steroid too weak for condition and area involved Not enough medication given -Tube size Failure to follow up on treatment Too strong – kids Too strong – face
42
How much is a finger tip unit And how much is the rule of hand
Finger tip units (FTU) - 5mm diameter nozzle 1 FTU = 0.5gm Rule of Hand: 0.5 FTU = one hand area or 0.25gm of ointment 1 hand area = 1% TBSA So…4 hand areas = 1g of medication
43
Learn FTU for adults and kids | Lecture 2, slide 44, 45
44
What is the limit of using a Group I steroidal agent
No more than 45-60 grams per week
45
What is the most common inflammatory Dz of the skin
Eczema aka dermatitis
46
What are the 4 characteristics of eczema
Erythema, Scale, and Vesicles | Pruritus
47
A pt presents with vesicles, bullae, and intense erythema and itching What phase of eczema? What tx approach?
Acute phase Tx: Cold wet compress, topical or oral steroids, antihistamines, and antibiotics if secondarily infected**
48
A pt presents with erythema, scaling, fissuring, and parched appearance, with moderate pain and itching What phase of eczema/? What is the tx?
Subacute Topical steroids (occlusion if indicated), emollients, antihistamines, antibiotics in indicated
49
A pt presents with thickened skin (lichenification) and accentuated skin lines, excoriations, fissuring, and a moderate to intense itch What phase of eczema What Tx?
Chronic Tx: Top steroids w/occlusion** for best results, antihistamines, emollients, and antibiotics in indicated
50
What is the age range most common with dyshydrotic eczema | Pompholyx
Teens (to middle age)
51
Eczema that presents as symmetric vesicular hand and foot dermatitis Common in teens With itching that presents before visible formation Think ?
Dyshidrotic Eczema (Pompholyx)
52
What kind of lesions are seen in Dyshidrotic Eczema (Pompholyx)
Tapioca lesions | Multiple tiny deep seated vesicles with surrounding erythema
53
What is the suspected to be the primary cause of Dyshidrotic Eczema (Pompholyx)
Irritants
54
What is the tx approach to Dyshidrotic Eczema (Pompholyx)
Potent steroid ( consider occlusion) Avoid water/ irritants ABX prn Antihistamines for itching Cool wet compress PUVA ( psoralen + UV rads) If all else fails methotrexate
55
What is the LAST line tx for Dyshidrotic eczema
Low dose methotrexate
56
What is “winter itch”
Asteatotic Eczema(eczema craquelé)
57
An older pt comes in complaining of a rash that itches more than it rashes CC that the lower legs have become dry and scaly with skin lines Skin resembles cracked porcelain and minimal redness What type of eczema>? What tx?
Asteatotic Eczema(eczema craquelé) Tx: Apply emollients IMMEDIATELY after bathing Stop taking hot showers Steroids: Short term group III-IV ointments, then moisturizing emollients If severe with oozing, crusts, infection: Wet compresses and antibiotics
58
An elderly pt presents with cc of a yearly returning (winter) eczema with coin shaped plaques What type of eczema?? What is the Tx?
Nummular Eczema Tx: Group I-III steroids for 4-6 weeks —Consider occlusion Correct dryness of skin and environment Emollients and humidifiers Antipruritic medications as needed
59
What is the cause of lichen simplex chronicus
Eczematous eruption created by habitual scratching
60
What is the treatment lichen simplex chronicus | (habitual scratching)
Group I ointment 1st gen antihistamine Emollients to dry the skin Behavior mod -to break habitual May require intralesional steroids -Kenalog
61
What is the onset of atopic dermatitis
Childhood Typically always improves with age
62
“The itch that rashses”
Atopic dermatitis
63
What are the common anatomical locations for atopic dermatitis
Flexural surfaces
64
What are 3 major triggers of atopic dermatitis
Temp change and sweating Aeroallergens And emotional stress
65
What are the steroids to treat inflammation in atopic dermatitis
Adults: Mid to high potency -Triamcinolone and Fluocinonide Children: low potency -desonide and hydrocortisone
66
What is the Rx that is used after steroid failure for atopic dermatitis
Crisaborole Or Dupliumab in pts 12 y/o older
67
What are the finding of keratosis Pilaris
Spiny keratotic papules predominantly involving the extensor aspects of proximal arms and thighs Typically asymptomatic Treat with urea or lactic acid
68
How do you apply Group I steroids
Apply Group I agents QD-BID Pulse therapy (2 wks on, then 1 week off) Helps avoid tachyphylaxis
69
How do you apply group II-VI agents
BID x 2-6 weeks
70
How does atopic dermatitis present in pts under 2 years old
Dry, Scaling, red areas that are confined to the cheeks
71
What are the FDA recommendations for using Topical Calcineurin Inhibitors Pimecrolimus (Elidel) & Tacrolimus (ProTopic)
2005 - FDA issued warnings about a possible link between the topical calcineurin inhibitors and cancer 2006 - placed a ‘black box’ warning on the prescribing information Use these agents only as second-line!! therapy in patients unresponsive to or intolerant of other treatments. Avoid the use of these agents in children younger than two years of age (2YEARS!!) Use these agents only for short periods of time and use the minimum amount necessary to control symptoms; avoid continuous use. Avoid the use of these agents in patients with compromised immune systems. (No immunocomp or pregnant, DM)
72
What are 2 medications that can be used for steroid treatment failure in the Tx of Atopic dermatitis
Crisaborole (mild to moderate AD) May cause burning or stinging Dupliumab (Interlukin 4 inhibitor) Only in pts older than 12
73
How is dry skin managed in chronic eczema
Skin emollients BID and within 3 min of exiting bath
74
How do you treat Hot spots of atopic dermatitis
Intermittent use of mid potency topical steroid 2days/week | And/or topical calineurin inhibitors 3-5 days/ week

Senoir 21-2 (77 decks)

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