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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
Q

If its dry..

A

Wet it

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26
Q

If its wet..

A

Dry it

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27
Q

Xerosis Cutis

A

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)

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28
Q

When are creams and lotions most effective for application

A

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

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29
Q

How are wet Dz managed

A

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

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30
Q

What are the benefits of using a wet dressing

A

Inflammation suppression

Wound debridement

Drying effect

Antibacterial action

31
Q

What are the three effects of topical steroids

A

Anti-inflammation

Vasoconstriction

Anti-mitotic
-Decreased proliferation of
cells

32
Q

What vehicle of steroids is best for cosmetics and intertriginous areas

A

Creams

33
Q

What vehicle of steroid is most occlusive

A

Ointments

Do not use on acute (exudative) eczematous inflammation or intertriginous areas

34
Q

If using a solution or lotion in an intertriginous area

What is the ADE

A

Stinging and drying may result when applied to intertriginous areas

35
Q

How long should foams be used

A

NLT 2 weeks

Suppression of Hypothalamic-Pituitary-Adrenal Axis
Do not use if age < 12 yrs

36
Q

What is the effect of applying a steroid after bathing

A

Steroid application after bathing increases absorption

37
Q

If you think a pt has an allergy

What should you send them for/

A

Patch testing

38
Q

Should you use topical steroids in children under 2

A

No

39
Q

Should you use steroids in Cushings pts

A

No

40
Q

Should you use topical steroids in pts with glaucoma

A

No

41
Q

What are the 5 most common mistakes of topical steroid therapy

A

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
Q

How much is a finger tip unit

And how much is the rule of hand

A

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
Q

Learn FTU for adults and kids

Lecture 2, slide 44, 45

A
44
Q

What is the limit of using a Group I steroidal agent

A

No more than 45-60 grams per week

45
Q

What is the most common inflammatory Dz of the skin

A

Eczema

aka dermatitis

46
Q

What are the 4 characteristics of eczema

A

Erythema, Scale, and Vesicles

Pruritus

47
Q

A pt presents with vesicles, bullae, and intense erythema and itching

What phase of eczema?

What tx approach?

A

Acute phase

Tx: Cold wet compress, topical or oral steroids, antihistamines, and antibiotics if secondarily infected**

48
Q

A pt presents with erythema, scaling, fissuring, and parched appearance, with moderate pain and itching

What phase of eczema/?

What is the tx?

A

Subacute

Topical steroids
(occlusion if indicated), emollients, antihistamines, antibiotics in indicated

49
Q

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?

A

Chronic

Tx: Top steroids w/occlusion** for best results, antihistamines, emollients, and antibiotics in indicated

50
Q

What is the age range most common with dyshydrotic eczema

Pompholyx

A

Teens (to middle age)

51
Q

Eczema that presents as symmetric vesicular hand and foot dermatitis
Common in teens

With itching that presents before visible formation

Think ?

A

Dyshidrotic Eczema (Pompholyx)

52
Q

What kind of lesions are seen in Dyshidrotic Eczema (Pompholyx)

A

Tapioca lesions

Multiple tiny deep seated vesicles with surrounding erythema

53
Q

What is the suspected to be the primary cause of Dyshidrotic Eczema (Pompholyx)

A

Irritants

54
Q

What is the tx approach to Dyshidrotic Eczema (Pompholyx)

A

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
Q

What is the LAST line tx for Dyshidrotic eczema

A

Low dose methotrexate

56
Q

What is “winter itch”

A

Asteatotic Eczema(eczema craquelé)

57
Q

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?

A

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
Q

An elderly pt presents with cc of a yearly returning (winter) eczema with coin shaped plaques

What type of eczema??

What is the Tx?

A

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
Q

What is the cause of lichen simplex chronicus

A

Eczematous eruption created by habitual scratching

60
Q

What is the treatment lichen simplex chronicus

(habitual scratching)

A

Group I ointment

1st gen antihistamine

Emollients to dry the skin

Behavior mod -to break habitual

May require intralesional steroids
-Kenalog

61
Q

What is the onset of atopic dermatitis

A

Childhood

Typically always improves with age

62
Q

“The itch that rashses”

A

Atopic dermatitis

63
Q

What are the common anatomical locations for atopic dermatitis

A

Flexural surfaces

64
Q

What are 3 major triggers of atopic dermatitis

A

Temp change and sweating

Aeroallergens

And emotional stress

65
Q

What are the steroids to treat inflammation in atopic dermatitis

A

Adults: Mid to high potency
-Triamcinolone and Fluocinonide

Children: low potency
-desonide and hydrocortisone

66
Q

What is the Rx that is used after steroid failure for atopic dermatitis

A

Crisaborole

Or Dupliumab in pts 12 y/o older

67
Q

What are the finding of keratosis Pilaris

A

Spiny keratotic papules predominantly involving the extensor aspects of proximal arms and thighs

Typically asymptomatic

Treat with urea or lactic acid

68
Q

How do you apply Group I steroids

A

Apply Group I agents QD-BID
Pulse therapy
(2 wks on, then 1 week off)
Helps avoid tachyphylaxis

69
Q

How do you apply group II-VI agents

A

BID x 2-6 weeks

70
Q

How does atopic dermatitis present in pts under 2 years old

A

Dry, Scaling, red areas that are confined to the cheeks

71
Q

What are the FDA recommendations for using Topical Calcineurin Inhibitors

Pimecrolimus (Elidel) & Tacrolimus (ProTopic)

A

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
Q

What are 2 medications that can be used for steroid treatment failure in the Tx of Atopic dermatitis

A

Crisaborole (mild to moderate AD)
May cause burning or stinging

Dupliumab
(Interlukin 4 inhibitor)
Only in pts older than 12

73
Q

How is dry skin managed in chronic eczema

A

Skin emollients BID and within 3 min of exiting bath

74
Q

How do you treat Hot spots of atopic dermatitis

A

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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