Derm I (Babcock) Flashcards
epidermis
-scaly rashes
outermost layer
-stratum corneum
Dermis
- blood vessels
- nerves
- connective fibers
- accessory organs - hair follicles, sebaceous glands, sweat glands, nails
Subcutaneous fat lesion example
-ex. lipoma
Macule
- Circumscribed area of change in skin color
- <1cm
- Flat
Patch
macule >1cm
Papules
- circumscribed
- solid superficial elevations <1cm
Nodules
papule > 1 cm
- Palpable
- Dermis or subcutaneous tissue
Plaques
- well defined
- Elevated
- Confluence of papules > 1 cm
Vesicles
- Circumscribed epidermal elevation
- <0.5cm
- contain serous fluid*
Bulla
- Large vesicle
- >0.5cm containing serous fluid
Pustules
small circumscribed with purulent exudate
Wheals
Plateau-like edematous elevations
ex. hives
Secondary changes
- Scales: dry or greasy flakes of stratum corneum
- Crusts (scabs): dried serum, blood, or pus with debris on skin surface
- Excoriation: stractch marks
- Erosions: (ex. ulcer) loss of all or portions of epidermis from physical abrasions
Atopic Dermatitis
- Disruption of the skin surface (xerosis= dry skin)
- ATOPIC TRIAD***
- Itch comes before rash**
- “the itch that rashes”
- Worse in winter
Atopic Dermatitis: Classic distributions
Infants/toddlers: cheeks, forehead, scalp, extensor surfaces
Older kids/adolescents: flexural surfaces; neck, elbows, wrists, ankles, behind knees
Adults: hands, wrists, ankles, feet, face, lichenification
Seborrheic Dermatitis “dandruff”: definition
chronic inflammatory dermatitis accompanied by -overproduction of sebum*
associated with yeast (ex. malessezia furfur)*
Seborrheic Dermatitis: clinical findings
erythema with yellow-orange greasy scales of scalp, face (eyelids, eyebrows, nasolabial folds*), ears, perineum
Seborrheic Dermatitis: treatment
- Selenium sulfide shampoo
- 2% ketoconazole shampoo
- Topical steroid (low potency)
Dyshidrotic Eczema: clinical findings
- confluent
- symmetric tapioca-like vesicles**on fingers, finger webs, palms, soles
- Secondary change: crusts, scaling, fissures, lichenification
- VERY ITCHY
Dyshidrotic Eczema: treatment
- Topical steroids
- Emollient care
- Oral antibiotics for secondary infections
Stasis Dermatitis: definition
chronic dermatitis from venous insufficiency
- hyperpigmentated plaques on lower legs and ankles
- +/- painful ulceration on the medial ankles
Statis dermatitis: risk factors
- Older age
- Female
- Pregnancy
- Varicose veins
Stasis dermatitis: treatment
- Topical steroid
- Antibiotics (for secondary infections
- Reduce edema - compression wraps, treat veins
Lichen Simplex Chronicus: definition
localized, lichenification from repetitive scratching
- Women
- > 20
- Atopic patients*
Lichen Simplex Chronicus: clinical findings
Well-defined plaques made by confluent papules, thickened skin, dull red can progress to brown or black
Lichen Simplex Chronicus: Treatment
- Stop itching and scratching!
- Topical corticosteroids +/- occlusion at night
What is the most common drug eruption?
Exanthematous drug eruption
Exanthematous drug eruptions: description
- Symmetric
- Erythematous macules and papules on trunk, then spreading to extremities
- Morbilliform = measles-like
What drugs commonly cause exanthematous drug eruptions?
- Sulfonamides
- Beta-lactam
- NSAIDs
- Barbituates
- Nitrofurantin
- Isoniazid
- Gold salts
Drug eruptions: treatment
- stop the offending drug
- antihistamines
- topical steroids
Lichen Planus: 4 P’s
Pruritic
Purple (violaceous)
Polygonal
Papules/plaques
Lichen Planus: body locations
- Volar wrists
- Shins
- Ankles
- Mucous membranes*
- Genitalia
- Scalp
- Nails
What phenomenon is common with Lichen planus?
Koebner Phenomenon - shows up after local trauma of the skin
Pityriasis Rosea: definition
Herald patch
exanthematous eruption characterized by a primary plaque (herald patch) usually on the trunk that develops into a secondary generalized scaling eruption 1-2 weeks later
Pityariasis Rosea: herald patch
- oval
- slightly raised plaque 2-5 cm
- Salmon red
- Marginal collarette scale
- Christmas tree distribution: Fine scaled, pink, oval papules and plaques distributed in the lines of cleavage
What is the name of condition and the lab that need to be ruled out and ordered for Pityriasis Rosea?
RPR to rule out syphillis!
Psoriasis vulgaris: clinical presentation
- Localized or generalized
- Pustular
- Erythrodermic
Well-demarcated erythematous plaques with silvery scale typically on extensor surfaces, scalp, sacrum
- Auspitz’s sign - removal of scale result in blood droplets
- Koebner’s phenomenon - rubbing/scratching (physical trauma) stimulates proliferative process
Psoriasis vulgaris: triggers
physical trauma, infections, drugs (b-blockers, lithium), stress, smoking, alcohol, streptococcal- guttate)
Psoriasis vulgaris: treatments
Mild to moderate: topical steroids, emollients, vitamin D analogues, coal tar, UV therapy, retinoids
Moderate to severe (>10% TBSA): Methotrexate, cyclosporine, oral retinoids (acitretin), Biologics (etanercept, infliximab, adalimumab)
Erythema Multiforme: overview
- reactive, inflammatory skin lesions
- symmetric distribution, predominantly on extremities caused by drugs (sulfa, phenytoin, PCN), viral syndromes (HSV)
What is wickham’s striae in the mouth associated?
whitish lines in the mucosa of the mouth
What infection is associated with Lichen Planus?
Hep C
Erythema multiforme: clinical findings
-Target or iris lesions***
dull red macules and papules. May have vesicles/bullae develop in the center of the lesion
-Severe Erythema multiforme: constitutional symptoms such as fever, weakness, malaise
Erythema multiforme: treatment
Symptomatic - oral antihistamines, topical steroids
Recurrent - oral antiviral (acyclovir, valcyclovir) in suppressive doses
Stevens-Johnson Syndrome: overview
severe mucocutaneous reaction often triggered by a medication by can be idiopathic
- Extensive necrosis and sloughing of epidermis (<10%)
- Prodrome - fever, flu-like symptoms, conjunctival itching
Common causes of Stevens-Johnson Syndrome
- NSAIDs
- Sulfonamides
- Anticonvulsants
Which mucosa are involved most often in SJS?
Eyes (MC**)
Oral (hemorrhagic crusts on lips)
Describe the clinical course of SJS?
generalized lesions initially with target-like appearance -> confluent bright red -> rapid progression into painful bullae and erosions
Toxic Epidermal Necrolysis (TEN)
-Severe form of Stevens-Johnson syndrome
> 30% epidermal loss
Only 30% survive (septicemia (acute renal failure)
-Nikolsky’s sign**
Bullous pemphigoid: overview
Chronic, autoimmune bullous disorder
- > 60 years old
- Subepithelial blisters and immunoglobulin deposits
Bullous pemphigoid: how is this diagnosed?
punch biopsy with immunofluorescence
1st degree burn [sunburn]
red, dry, painful, often sloughs the next day
1st degree burn [sunburn] treatment
symptom control: acetaminophen, cool compresses, emollient
What virus is implicated in Erythema multiforme?
Herpes Simplex
so, one treatment is oral antiviral
Second Degree burn when to admit to burn center
- > 10% TBSA younger than 10, or older than 50
- > 20% TBSA in 10-50
- Burn on the face, genitalia, perineum, hands, feet, major joints
- Chemical burns, inhalation injury, electrical burns, pre-existing medical conditions
Second Degree burn treatment
Silvadene, mupirocin with dressings and pain control
Third Degree burn
loss of tissue, full thickness of skin, some of the SQ tissue, scarring
Third degree burn: treatment
skin graft
Rosacea: overview
- centrofacial area
- telangiectasias
- flushing
- erythematous papules and pustules
- Fair skinned adults
- Rhinophyma**- enlarged bulbous nose in men
Rosacea: triggers
stress, alcohol, heat (vasodilators)
Rosacea: treatment
- sun protection
- Metronidazole gel
- Doxycycline/tetracycline
- intense pulsed light/broad band light
- Laser surgery for telangiectasias
Hidradenitis suppurativa: overview
chronic inflammatory disease of the apocrine glands characterized by recurrent abscess formation, rupture, suppuration.
-Can lead to sinus tract formation and scarring
Hidradenitis suppurativa: clinical findings
- recurrent abscess formation
- double comedones
- very tender, erythematous inflammatory nodule/abcess
Hidradenitis suppurativa: differences in distribution of men and women
women: axillae, breasts
Men: anogenital, groin
Hidradenitis suppurativa: treatments
- antibiotic (tetracycline, minocycline, erythromycin)
- Intralesional steroids
- Isotretinoin
- Surgery
