Derm I Flashcards
How much does skin weigh, and area
4 lbs, 2 m squared
what are the main 3 layers of skin
epidermis, dermis and subcutaneous layer
what is in the dermis layer
appengages, blood vessels and nerve endings
what is in the subcutaneous layer
appendages and fat
what is the key to a good derm diagnosis?
good history and physical exam., negative is as importain as positive
what are the possible causes for a derm reaction
infection, infestation, sun, autimmune, allergy, cancer, environmental, hormonal etc.
how many historys question to ask?
ten10
What are the 10 history questions?
Where, when, location, sensation, changed appearance, worse/better, anyone else, recent travel, exposures, treated?
what are the additional history questions?
history of allergic reaction, exposures to chemicals, sun, general health travel history and medications
what are the general health questions to ask?
systemic diseases, diabetes, IBD, candida etc
ROS
concomitant symptoms and organ involvement
family history
make sure that you ask if family has atopy, autoimmune, malignancy
why ask about sexual history
syphilis, gonorrhea, warts herpes etc.
what lamp is helpful to see skin problems
woods lamp, although adequate light in general is importaint.
what are the categories for describing the lesion?
lesion type, configuration, texture, location/distribution, color, other
macule
flat, non palpable color change
papule
elevated, palpable, smaller <10mm
plaque
elevated, plateau like, larger, > 10mm
Nodule
firm papule, elevated, extends deeper into dermis or sub Q
what is a large nodule >10mm
a tumor
Vesicle
fluid filled blister, smaller <10mm
bullae
fluid filled blister, larger >10mm
Pustule
elevated lesion with pus
Urticaria
elevated lesion, transient, localized edema
Scale
accumulation of epithelium, dry, whitish
Crust
dried pus, blood or serous exudate. Ususally due to broken pustules or vesicles
Erosion
loss of top layer(epidermis)
Excoriation
linear erosion, cause by scratching
Ulcer
deep erosion, involves dermis, bleeding and scarring possible
Petechiae
small non blanchable foci of hemorace - tiny buruise
Purpura
larger area of hemorage, possibly palpable, large areas oare burises
Atrophy
paper thin wrinkled and dry skin, old lady hands
Telangiectasis
dialated superficial blood vesselse (spider veins)
What 6 words can describe lesion configuration?
Linear, annular, nummular, Target, serpiginous, Reticulated
Linear
in a line
Annular
ring with central clearing
nummular
circular, without central clearing
Targetoid
ring with central duckiness
Serpiginous
fungal and parasidic, looks like worm wiggled a path under skin
Rediculated
lacy pattern
What are the 4 words for tecture?
verrucous, lichenification, induration, umbilicated
verrucous means what?
irrecular surface, like cauli flower, or warts
Lichenification means what
epidermal thinkening, skin lines are accentuated from chronic irritation
Induration
dermal thickening, skin is hard and rough
difference between lichenification and induration,
induration is dermal thickening, while lichenification is epidermal thickening
Unbilicated
raised bump with central indentation, like cherrio is under skin.
What are the importain location issues?
single/multipule, what body parts, random or not, symmetric or not, sun exposure or not, does it cross mid line.
What what is the word for red
erythema -
what causes erythema
increased blood flow to skin
What causes orange
hypercarotenemia
what causes yellow
jaundice, heavy metal poisoning, myxedem or uremia
what causes green in fingernails
pseudomonas
what may cause violet
darkening cutaenous hemmorage(bruise) or vasculitis
Grey blue skin
cyanosis, metal deposits
Black
melanocytic lesions, infections, arterial insufficiency
what would turn skin white
tinea, pityriasis alba, vitilago
what is Dermatographism
urticaria after stroking skin, swelling
Diascopy
pressure to indicate blanching
What type of lesions do blanch
inflammatory ones
What type of lesions don’t blanch
hemorrhagic lesions
Dariers sign
if you stroke lesion it suddenly cause erythema and wheal/urticaria
Nikolsky sign
bullae formation that spreads with tracton
Auzpitz sign
pinpoint bleeding after plaques removed
Koebners phenomenon
development of lesions withing areas of trauma
What is puritis
itching
what stimulates itching
chemical and physical syimulation of cutaneous nerve ending, external or internal.
what mediates iching
histamine, kallekrein and some peptidases
for itching what must be included in history
drug and occupational exposures
What type of testing for puritis
biopsy, CBC, liver, kidney, thyroid function, unerlying malignancy evaltuation, immunoglobulins.
what is the most common cause of puritis
dry skin
what may help determine cause of puritis
if there is or there is not a skin eruption
Urticaria
Migratory erythemous puritic plaques, Hives
what determines if urticaria is chronic?
greater than >6 weeks
what basically causes urticaria
release of histamine
Etiology of urticaria can be what 5 things
infection, IgE allergy, medications, autoimmune, malignancy
Is autoimmune urticaria common
nope
What are the importaint history questions for urticaria
duration, triggers, frequency, concomitant, respiratory system, drugs, travel and FH
What is included in urticaria PE
check for infection, or systemic disease
Testing for urticaria
CBC, allergy testing, thyroid studies, and biopsy if unsure
what is acne vulgaris
obstruction of pilosebaceous unit.
what can acne vulgaris present with
open or closed comedones, papules, pustules, inflamed nodules, pus filled cysts and deep purulent sacs
what are some main causes of acne vulgaris
androgen stimulations, sebum, bacteria interaction, drug, diet
major diet triggers for acne vulgaris
sugar, milk, bromine.
who is morelikly to have acne vulgaris
men and people under 35
common distribution for acne vulgaris
face, back chest and upper arms
S/Sx for acne vulgaris 5
comedones, papules, pustules, nodules and cystes
what are the three grades of acne vulgaris severity
mild, moderate and severe
describe mild acne vulgaris
< 30 lesions
moderate acne vulgaris
30-125 lesions
severe acne vulgaris
> 5 cysts or > 125 lesions
what labs for acne vulgaris
Serum testosterone, FSH, LH, DHEA-s, and bacterial/fungal cultures
Roseacea
chronic inflammatory disorder characterized by facial flushing, telangiectasias, erythema, papules, pustules and possibley rhinophyma
