Derm I Flashcards by jennifer davidson

How much does skin weigh, and area

4 lbs, 2 m squared

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what are the main 3 layers of skin

epidermis, dermis and subcutaneous layer

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what is in the dermis layer

appengages, blood vessels and nerve endings

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what is in the subcutaneous layer

appendages and fat

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what is the key to a good derm diagnosis?

good history and physical exam., negative is as importain as positive

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what are the possible causes for a derm reaction

infection, infestation, sun, autimmune, allergy, cancer, environmental, hormonal etc.

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how many historys question to ask?

ten10

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What are the 10 history questions?

Where, when, location, sensation, changed appearance, worse/better, anyone else, recent travel, exposures, treated?

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what are the additional history questions?

history of allergic reaction, exposures to chemicals, sun, general health travel history and medications

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what are the general health questions to ask?

systemic diseases, diabetes, IBD, candida etc

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ROS

concomitant symptoms and organ involvement

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family history

make sure that you ask if family has atopy, autoimmune, malignancy

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why ask about sexual history

syphilis, gonorrhea, warts herpes etc.

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what lamp is helpful to see skin problems

woods lamp, although adequate light in general is importaint.

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what are the categories for describing the lesion?

lesion type, configuration, texture, location/distribution, color, other

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macule

flat, non palpable color change

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papule

elevated, palpable, smaller <10mm

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plaque

elevated, plateau like, larger, > 10mm

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Nodule

firm papule, elevated, extends deeper into dermis or sub Q

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what is a large nodule >10mm

a tumor

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Vesicle

fluid filled blister, smaller <10mm

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bullae

fluid filled blister, larger >10mm

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Pustule

elevated lesion with pus

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Urticaria

elevated lesion, transient, localized edema

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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