Derm terms and approach to the patient Flashcards by Cierra Pennal

______ – When the condition was first noted and dates of any recurrences
or remissions

Duration

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______ – Constant, waxing and waning, worst at night, worst in winter

Periodicity

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______ – Sun exposure, heat, cold,
wind, trauma, and exposure to chemicals, topical products, plants,
perfumes or metals, relation to menses or pregnancy

Ameliorating and Exacerbating Factors

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Tools for skin assessment

● A magnifying tool such as a loupe, magnifying glass, and/or dermatoscope
● A bright focused light such as a flashlight or penlight to sidelight lesions
● Glass slides or a hand magnifier for
diascopy
● Alcohol pads to remove scale or
surface oil
● Gauze pads or tissues with water for
removing makeup
● Gloves
● A ruler for measuring lesions
● Scalpel blades (number 15 and number 11) for scraping
and incising lesions, respectively
● A camera for photographic documentation
● A Wood’s lamp (365 nm) for highlighting subtle
pigmentary changes

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Characteristics of skin inspection

● Color
● Moisture
● Temp
● Texture
● Mobility and turgor
● Lesions

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Cafe Au-Lait spot

Hyperpigmentation
● A slightly, but uniformly, pigmented
macule or patch with a somewhat
irregular border
● Benign
● 6+ that are >1.5 cm suggest
neurofibromatosis

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Depigmented macules appear on face, hands,
feet, extensor surfaces

Vitiligo

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Common superficial fungal infection
that causes hypo or
hyperpigmented, slightly scaly
macules on the trunk, neck, arms

Tinea Versicolor

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Paleness or loss of color; results from
decreased redness (anemia) or blood flow
(fainting, arterial occlusion)

Pallor

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Somewhat bluish color of the skin and/or mucous membranes; most apparent in the lips, nail bed, and malar eminences (upper cheek)

Cyanosis

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Yellow-tinged skin; caused by increased beta-carotene levels, often from a diet high in carrots or other yellow vegetables or fruits

Carotenemia

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Violaceous patches over the eyelids

Heliotrope

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Develop as a direct result of
the disease process

Primary Lesions

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Primary Lesions

● Macules
● Patch
● Plaque
● Papule
● Nodule
● Cyst
● Wheal
● Vesicle
● Bulla
● Pustule
● Burrow
● Comedones
● Purpura
● Telangiectasia

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Flat lesion with a
change in color, less than 1 cm
Example: Lentigo

Macule

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Flat lesion with a color change
in color, but it is larger than 1 cm
Examples: Vitiligo, T-cell lymphoma

Patch

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Raised, solid or cystic lesion less than 1 cm

Papule
Common shapes and surfaces – sessile, pedunculated,
dome-shaped, flat-topped, rough, smooth, filiform,
mammillated, acuminate, umbilicated
Example: Lichen planus (flat tops and glistening
surfaces)

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Example of papules

Lichen planus

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Raised, solid plateau-like elevation that has a diameter of 1 cm or larger
Example: Psoriasis

Plaque

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Example of pathology that has plaques

Psoriasis

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Example of pathology that has macules

Lentigo

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Solid or cystic, round or
ellipsoidal, palpable lesions, larger than
1 cm; may be superficial or deep

Nodule

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Five main types of Nodules

(1) epidermal, (2) epidermal–dermal,
(3) dermal, (4) dermal–subdermal, and
(5) subcutaneous

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Encapsulated cavity or sac lined with
true epithelium; contains expressible
material, fluid or semisolid

Cyst

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Example of a pathology that includes a cyst

Cystic hidradenoma

Serous fluid-filled cavity or elevation smaller than 1 cm Example: Blistering aspect of impetigo, shingles

Vesicle

Serous fluid-filled cavity larger than 1 cm Spherical due to equal pressure. They arise from cleavage at various levels of the epidermis or the dermal-epidermal interface (subepidermal)

Bulla (blister)

Raised cavity in the epidermis or infundibulum containing pus which may be sterile or contain bacteria. May vary in size. May be white, yellow, greenish-yellow. May coalesce to form “lakes” of pus

Pustule

Example of a pathology with pustules

Superficial pyoderma

Larger pustules =

Furuncles

Multiple furuncles =

Carbuncle

Larger area of purulent discharge =

Abscess

A dilated hair follicle that is plugged by keratin and lipids

Comedo

The pilosebaceous unit is open to the skin surface with a visible keratinaceous plug; black due to the oxidized sebaceous content

Open comedones “Blackheads”

The infundibulum of the follicle is closed resulting in ”accumulation of whitish keratin

Closed comedones “whiteheads”

Superficial, localized, transient swelling of the skin resulting from edema; usually erythematous or pink, and itchy

Wheal (Hives, Urticaria)

A wavy, threadlike tunnel through the outer portion of the epidermis excavated by a parasite

Burrow

Evolve from primary lesions or develop as a consequence of the patient’s activities (scratching, picking, infection, or healing)

Secondary Lesions

● Scale ● Crust ● Lichenification ● Scar ● Keloid ● Erosion ● Excoriation ● Fissure ● Ulcer

A flat plate or flake from the outermost layer of the stratum corneum

Scale

The epidermis is replaced every ____ days

Hardened deposits that result when serum (yellow-brown), blood (reddish-black), or purulent (yellowish-green) exudate dries on the skin surface

Crust (encrusted exudates)

Example of a pathology with crusts

Impetigo

Reactive thickening of the epidermis due to repeated rubbing or itching. The dermal collagen of the skin is affected and changes

Lichenification

Proliferation of fibrous tissue that replaces normal collagen after a wound or ulcer disrupts the dermis. Often the epidermis is thinned and the surface appears wrinkled

Scar

firm papules or nodules

Hypertrophic scars

elevated, extends beyond the initial borders

Keloid scars

A moist, circumscribed, depressed lesion that results from a loss of part or all of the epidermal or mucosal epithelium. May result in pinpoint bleeding

Erosion

A pathology example with erosion

Toxic Epidermal Necrolysis (TEN)

Surface excavations of epidermis that result from scratching

Excoriation

a linear loss of continuity of the skin’s surface, results from excessive tension or decreased elasticity; cracks

Fissure

A defect where the epidermis and upper dermis have been destroyed which impedes reepithelialization. The defect heals with scarring

Ulcer

bedsores are an example pathology of ____

Ulcers

Asymptomatic pink papule due to a central dilated arteriole and very fine branches

Spider Angioma (Spider Nevi/Nevus Araneus)

Smooth, dome-shaped to polypoid papules. Early smaller lesions are cherry-red, and deeper larger lesions are maroon

Cherry Angioma

Extravasation of blood from cutaneous vessels into skin or mucous membranes resulting in reddish-purple lesions. Non Blanching redness

Pupura

Leukocytoclastic vasculitis is an example pathology that has ____

purpura

Small, pinpoint purpuric macules

Petechiae

Larger, bruise-like purpuric patches

Ecchymoses

Persistent dilatations of small capillaries in the superficial dermis. May appear as fine, bright, nonpulsatile red lines or net-like patterns on the skin

Telangiectasia (Spider veins)

Unilateral and lying in the distribution of a single spinal afferent nerve root; the classic example is herpes zoster

Dermatomal/zosteriform

Following lines of skin cell migration during embryogenesis; generally longitudinal on the limbs and circumferential on the trunk, but not perfectly linear; implies a mosaic disorder Describing Skin Findings

Blaschkoid

Lying along the distribution of a lymph vessel; “red streak along a limb” implies an infectious agent that is spreading centrally, usually due to a staphylococcal or streptococcal cellulitis

Lymphangitic

Occurring in distal locations, such as on the hands, feet, wrists, and ankles

Acral

Occurs where two skin surfaces are in contact

Intertriginous

Mycosis fungoides is an example of pathology that has this appearance

geographic

Maculopapular eruptions with red macules and papules which become confluent in a symmetric, generalized distribution

Morbilliform

Smaller lesions join into larger groups

Confluent/coalescing

Scabies burrow or poison ivy dermatitis (single lesions), or lichen planus (multiple lesions) have this appearance

Linear

Cutaneous larva migrans is an example of pathology that has this appearance

Serpiginous – Serpentine or snake-like

Ring-shaped; implies that the edge of the lesion differs from the center, either by being raised, scaly, or differing in color

Annular

Example of pathology with an annular presentation

tinea corporis

Coin-shaped; usually a round to oval lesion with uniform morphology from the edges to the center

Nummular (round, discoid)

plaque-type psoriasis is an example of pathology with this appearance

Nummular

Flat lesions and their sizes

You cannot palpate the lesion with your eyes closed ○ Macule – Lesion is flat and <1 cm ○ Patch – Lesion is flat and >1 cm

Raised lesions and their sizes

○ Papule – Lesion is raised, <1 cm, and not fluid filled ○ Plaque – Lesion is raised, >1 cm, but not fluid filled ○ Vesicle – Lesion is raised, <1 cm, and fluid filled ○ Bulla – Lesion is raised, >1 cm, and fluid filled