Derm (Dz Of The Skin) Flashcards
What are the 5 layers of the epidermis
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
What is a macule
Primary lesion that is circumscribed, flat discoloration
1mm
Define a patch
A patch is a primary lesion macule that is greater than 1 cm
Define papule
Primary lesion that is elevated solid lesion less than 0.5 cm with variable color
Define a plaque
A primary lesion that is circumscribed, elevated, superficial, and solid that is greater than o.5 cm
Define a Nodule
A primary lesion
Circumscribed, elevated, solid nodule that is greater than 0.5 cm in diameter
When its larger is called a tumor
Define pustule
Primary lesion
A circumscribed collection of leukocytes and free fluid (‘pus’) that varies in size
Define vesicle
Primary lesion
A circumscribed collection of free fluid ≤ 0.5 cm in diameter
What is a bulla
Primary lesion
A circumscribed collection of free fluid > 0.5 cm in diameter
Define a Wheal (Hive)
Primary lesion
A firm edematous plaque resulting from infiltration of the dermis with fluid
Define scales
Secondary lesion
Excess dead epidermal cells that are produced by abnormal keratinization and shedding
Define crust
Secondary lesion
A collection of dried serum and cellular debris
“a scab”
Define erosion
Secondary lesion
A focal loss of epidermis
erosions do not penetrate below the dermoepidermal junction and therefore heal without scarring
Define Ulcer
2* lesion
A focal loss of epidermis and dermis;
ulcers heal with scarring
Define a fissure
2* lesion
A linear loss of epidermis and dermis with sharply defined, nearly vertical walls
Define excoriation
Special lesion
An erosion caused by scratching
often linear
Define Comedone
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)
Define milia
Special lesion
A small, superficial keratin cyst with no visible opening
Define cyst
Special Lesion
A circumscribed lesion with a wall and a lumen;
the lumen may contain fluid or solid matter
Define a burrow
Special lesion
A narrow, elevated, tortuous channel produced by a parasite
Define lichenification
Special lesion
An area of thickened epidermis induced by scratching
DEfine telangiectasia
Special lesion
Dilated superficial blood vessels
Define petechia
A circumscribed deposit of blood ≤ 0.5 cm in diameter
Define purpura
A circumscribed deposit of blood > 0.5 cm in diameter
If its dry..
Wet it
If its wet..
Dry it
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)
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
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
What are the benefits of using a wet dressing
Inflammation suppression
Wound debridement
Drying effect
Antibacterial action
What are the three effects of topical steroids
Anti-inflammation
Vasoconstriction
Anti-mitotic
-Decreased proliferation of
cells
What vehicle of steroids is best for cosmetics and intertriginous areas
Creams
What vehicle of steroid is most occlusive
Ointments
Do not use on acute (exudative) eczematous inflammation or intertriginous areas
If using a solution or lotion in an intertriginous area
What is the ADE
Stinging and drying may result when applied to intertriginous areas
How long should foams be used
NLT 2 weeks
Suppression of Hypothalamic-Pituitary-Adrenal Axis
Do not use if age < 12 yrs
What is the effect of applying a steroid after bathing
Steroid application after bathing increases absorption
If you think a pt has an allergy
What should you send them for/
Patch testing
Should you use topical steroids in children under 2
No
Should you use steroids in Cushings pts
No
Should you use topical steroids in pts with glaucoma
No
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
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
Learn FTU for adults and kids
Lecture 2, slide 44, 45
What is the limit of using a Group I steroidal agent
No more than 45-60 grams per week
What is the most common inflammatory Dz of the skin
Eczema
aka dermatitis
What are the 4 characteristics of eczema
Erythema, Scale, and Vesicles
Pruritus
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**
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
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
What is the age range most common with dyshydrotic eczema
Pompholyx
Teens (to middle age)
Eczema that presents as symmetric vesicular hand and foot dermatitis
Common in teens
With itching that presents before visible formation
Think ?
Dyshidrotic Eczema (Pompholyx)
What kind of lesions are seen in Dyshidrotic Eczema (Pompholyx)
Tapioca lesions
Multiple tiny deep seated vesicles with surrounding erythema
What is the suspected to be the primary cause of Dyshidrotic Eczema (Pompholyx)
Irritants
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
What is the LAST line tx for Dyshidrotic eczema
Low dose methotrexate
What is “winter itch”
Asteatotic Eczema(eczema craquelé)
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
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
What is the cause of lichen simplex chronicus
Eczematous eruption created by habitual scratching
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
What is the onset of atopic dermatitis
Childhood
Typically always improves with age
“The itch that rashses”
Atopic dermatitis
What are the common anatomical locations for atopic dermatitis
Flexural surfaces
What are 3 major triggers of atopic dermatitis
Temp change and sweating
Aeroallergens
And emotional stress
What are the steroids to treat inflammation in atopic dermatitis
Adults: Mid to high potency
-Triamcinolone and Fluocinonide
Children: low potency
-desonide and hydrocortisone
What is the Rx that is used after steroid failure for atopic dermatitis
Crisaborole
Or Dupliumab in pts 12 y/o older
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
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
How do you apply group II-VI agents
BID x 2-6 weeks
How does atopic dermatitis present in pts under 2 years old
Dry, Scaling, red areas that are confined to the cheeks
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)
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
How is dry skin managed in chronic eczema
Skin emollients BID and within 3 min of exiting bath
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
